Keeping the Humanity in Dental Practice
Patient-centered care creates an exceptional experience
William T. Brown, DDS
Could the dental profession become corporatized? The medical profession is rapidly becoming corporatized. Dr. John Levinson, a cardiologist at Massachusetts General Hospital and Harvard Medical School, says that the deterioration of the patient-doctor relationship is the most pernicious problem facing medicine. The private medical practice is largely a thing of the past because most physicians are becoming employees of hospitals and medical groups. Some physicians might feel the humanity draining out of the profession—a profession they were drawn to because of a desire to interact with human beings.1
More hospitals used to be operated by religious entities, and more physicians were private practitioners. Today, it is generally business people without clinical degrees who manage hospitals, and the physicians have become employees of the organizations.
In the past, “drug stores” were operated by pharmacists who were healthcare professionals as well as small business owners. Now, most pharmacists are employees of large corporations.
The future of dentistry is unknown, but could evolve into a variety of different models, including:
• a government regulated (socialized) model with highly restrictive fees that are subsidized by taxpayers;
• a composite or modified corporate model that is regulated by contracted or limited fee arrangements;
• a private care, fee-for-service, patient-centric, high service model; or
• a “hybrid concierge model,” merging traditional and fee-for-service, in which patients pay a flat fee per year.
The government regulated and corporate models are highly restrictive and regulated by fees, contracts, and/or bureaucratic fiat; however, any of the models can be profitable if everyone works hard and is all in.
One way to characterize the payment relationship is that either the fee fits the service or the service fits the fee. For example, if a crown is $500 it will have a $500 value. The price conscious person may accept that level of care. The person who understands value may want more. The practice that follows the patient-centered model will have to provide exceptional service in order to differentiate itself. Whether any one of these models is perceived as good or bad is in the eyes of the beholder. However, if the dental profession can balance technology with humanistic values and devotion to human welfare, it could combine the best of both worlds. Treating patients as total beings instead of objects of treatment instills abiding trust. Establishing long-lasting relationships with patients who trust your philosophy is superior to the never-ending recruitment of new patients required to replace those who leave in a less patient-centric model.
Some dentists may correlate exceptional service with offering the latest technology. The problem with that mindset is that technology increases your overhead, and if you try to compete with new technology, someone else will always have even newer technology. If you try to compete with a lower price, someone else’s will always be lower.
Unfortunately, in the realm of truly uplifting patient-centered service, there seem to be few competitors. Many dentists have expressed feelings of frustration because their patients won’t accept the level of care they recommend. One possible reason for this is failure on the part of the dentist to establish a trusting patient-doctor relationship.
The cause of dental disease is known, as are realistic methods of prevention. The methods of prevention may change through further research and development (eg, recent changes based on the oral/systemic connection), but based on thorough understanding of periodontal disease and its sequelae, the cause is known and the cure is clear. Changes such as these have altered the dentist’s basic relationship with patients. First, personal responsibility for oral healthcare has transferred to the patient. Second, extensive research gives the dentist confidence that his or her treatment is the best possible one for the patient, reducing the old fears of failure due to oral disease, particularly periodontal disease. Third, the dentist has been placed in the role of educator/motivator, encouraging the patient to practice daily oral hygiene and receive routine professional care.
Becoming More Patient-Centered
Making the transition from the sick-care, find-and-fix model to the humanistic, preventive healthcare oriented practice doesn’t require much change to the daily routine, but the transformation isn’t simple. Unlike adding a new dental technique, the changeover to a patient-centric practice is in the domain of human interaction. It may take a year or two for conversion; however, the payoffs are enormous. You can enjoy the respect, the creativity, and the joy of simply being occupied in your own special work. Instead of being motivated primarily by financial gain, focusing on patients allows dentists to be motivated by the work itself and by the self-esteem that comes from the admiration of their patients and coworkers. And empowering patients with the knowledge and skill to control oral disease is an enormous reward in itself.
Concepts For Change
The following concepts can help in establishing a patient-centered practice:
Know your patients by knowing yourself. Because the dentist is the center of the practice, self-understanding can have a direct impact on the quality and quantity of service that he or she can make available to patients.
Try to capture and consolidate your attitudes and philosophy in writing. Share your written philosophy with a colleague, spouse, or coworker and seek their reaction. This will help to clarify issues and broaden your point of view. Your philosophy of practice comes from your self-concept and is influenced by your technical abilities. This self-appraisal can help the dentist define his or her practice.
Build an infrastructure around the patient. Develop a team based on a scientific, systematic, and thorough selection process with training that will result in better return and less strain for the dentist and an enhanced image for the practice.
Create an exceptional new patient experience. The interaction should be uplifting and educational for the patient as well as the dentist. It is at this point in the process that the patient-doctor relationship is established with an agreement on the goals of the practice. A comprehensive “co-discovery” examination can be administered to selected patients, family members, or colleagues to solicit their feedback and make necessary adjustments.
The very existence of a successful practice depends on effective communication. Successful transactions between people depend on how well they understand each other. Primarily, the dental office should be a place of education. The very foundations of dental practice should be to understand the dental disease process, learn the skills necessary to control dental disease, and establish a system that provides the patient with capacity to monitor their oral health status.
You Are What the Patient Experiences
How the patient sees the dentist is how the patient sees dentistry. How does the patient see the dentist? How do you want the patient to see dentistry? Consider how the initial contact between the patient and you and your staff will influence the role that the patient assigns to you as well as his or her view of oral health.
Achieving patient-centeredness requires hard work and study. For example, I started the process by defining my practice. You need to complete an appraisal to become keenly aware of what you have created. My staff and I determined that the important enterprise of analyzing our professional activity shouldn’t be delegated to an outside consultant. That is because the process is as important as the analysis. By understanding each of our personal identities through profiling and intercommunication, we had developed the accord and rapport necessary to work together on the practice analysis.
One of the most important aspects of dental education is diagnostic accuracy. This is apparent to anyone who has been misdiagnosed and lost teeth or had treatment that was unnecessary or only peripherally necessary. The diagnosis is based upon a comprehensive oral examination, which should include treating the patient as a total being, the establishment of the patient-doctor relationship, agreement on the goals of the practice, a co-discovery examination to find all potential issues, and a plan to preserve the natural teeth and reduce the need for repair.
When it comes to patient-centeredness, the value of your achievement is proportional to the magnitude of the effort you put forth.
1. Gardner C, Levinson J. Turn off the computer and listen to the patient. The Wall Street Journal. September 21, 2016.
About the Author
William T. Brown, DDS, has retired from practicing dentistry, but continues to be actively involved in lecturing, mentoring, writing, and doing extensive research on the latest technological advances and patient communication skills.