JACD 71-4 - American College of Dentists

Leadership
64
There are new economic
schemes that treat dentists
as salable commodities.
Such practices inevitably
erode professionalism.
Tooth whitening doesn’t count as
part of the profession. It is probably an
aberration that the Baby Boomers have
enough money and ego to define
appearance as part of their essential
identity. For purely demographic reasons,
dentistry should not lean too far in that
direction. For professional reasons,
health must always be the foundation
of the profession, and dentists take a
great risk if they make the ultimate
judge of their professional contributions
to be what the patient sees in the mirror.
The literature on professionalism
accepts as commonplace that quacks are
those who trust their reputations to
their patients.
Professionals treat individuals. They
do not develop products or services
whose value can be increased by wide
distribution. This means that technology
functions differently in the professions
than in other segments of commercial or
public life. Innovation in dentistry will
be continuous and small. There is no
capital formation in the profession that
allows for the development of expensive
and mass technology or for its deployment
in large systems.
There have been attempts to bend
this rule of professions as custom work.
In all cases, moving away from treating
one patient at a time has raised concerns.
Large clinics compromise diagnosis and
follow through, which are low-paying
but essential aspects of professional care.
Industry has attempted to create an
impression that quality of patient care is
directly proportional to selecting and
purchasing the right technology.
Commercialism accepted on this article
of faith will weaken the profession.
Arguably, practitioners who have the
best-dressed 1040s are those whose
clients are other dentists. This is a blurring
of the lines delineating what it
means to be a professional.
Professionals are outside the supply
and demand economy. They function as
agents, acting, for an agreed amount of
compensation, on the best interests of
their clients as they, the professional,
and the client agree to define it. Patients
do not purchase results or even services
that they are well qualified to evaluate.
The usual laws of economics are out of
the question in the professions, because
the demand for what they do always
substantially exceeds supply.
Dental practices have inescapable
commercial aspects, some of which are
appropriate and some of which are
demeaning. It is offensive, for example,
that veterinarians sell dog food and flea
powders in their offices. Any move in
the direction of making oral health a
commodity, either in the relationship
between the provider and the patient or
among providers, is a move away from
professionalism.
The final element is trust. But this is
the most essential and most delicate of
the characteristics of professionalism.
Informed consent is essential, but it can
never be complete. The professions have
asked for and society has largely granted
the privilege of the professions deciding
who can hold themselves out to the public
as a professional, whether the work
done by professionals is appropriate, and
even what services clients need. This is
an incredible relationship that does not
exist in the insurance industry, our
schools, or the home appliance market.
The work of professionals is complex
and can never be fully explained to the
public. It is also inherently based on
professional judgment. This follows from
the individual, custom nature of the
work that professionals do. The project
of reducing the work of professionals to
a set of written standards that the public
could understand is both impossible
and unwise.
At the same time, vice d’estime—an
attitude that those that don’t understand
should be excluded from consideration
or that the professional alone is the
judge of the value of what professionals
do—is a dangerous attitude. The Internet
and the media have put a spotlight on
professionals. The public is generally
aware that the professions “go light” on
their own stinkers, and the growing
helplessness of consumers generally in
the face of complex transactions makes
confidence harder to win. I used to feel
good about getting an oil change. Now
I have to fight my way through the
cross-selling of air filters, fan belts, and
even some things that I don’t understand
but that the service technician implies
are necessary to prevent me from being
derelict as a responsible car owner. The
greatest challenge professionals have
today may well be to maintain a distinction
between this kind of treatment and
professional care that is meaningful to
the patient.
Professionalism is not a code, nor is
it a contract between the public and
some individuals. It certainly cannot be
conferred through education or licensure.
It is a moment. It is the point in time
when an individual patient trusts a
professional to provide customized
healing skills to the best of his or her
ability with no one else watching or
saying what it right or wrong. Professions
endure to the extent that this moment is
continuously repeated. ■
2005 Volume 71, Number 4