People-centered Versus Procedure-centered Dentistry — A Story.

Just had an interesting conversation with a fellow dentist and good friend in his office. He expressed interest in my thinking about people-centered dentistry. One thing led to another and he shared a story I think you will find interesting. It involves his fairly recent interactions with a younger dentist. He told this to me because he believes it underscores my point that a people-centered, rather than procedure-centered focus, makes a real difference whether or not we enjoy and are successful in dentistry.

Less than a year ago he brought in an associate. This young man came with highest recommendations having just completed a general dental residency program in a nearby hospital. My friend did not send him procedures to perform on existing patients, but instead permitted him to see all new patients as they came in until he had enough to do. Unfortunately he didn’t stay with this very talented and highly respected dentist but a few months. His reason for leaving was because there just wasn’t enough work to do.

So after the young dentist left, naturally my friend took over the care for all of his patients. It turns out, based on patient interviews with him, that many of this young dentist’s treatment plans were simply not accepted. Patients did not understand why any of the work he proposed was necessary. The care that he had planned to do involved a great deal of cosmetic modification to anterior teeth, yet people were not stating that they had any problems with how their smiles looked.

My friend took a different approach. He just listened to what patients wanted and also told them in honest terms without a lot of dental jargon what he was seeing. He talked about crown margins that were open, porcelain and tooth wear associated with occlusal problems, as well as findings associated with periodontal disease, all described in ways they could understand, yet without talking down to them. He didn’t push. Not everything was urgent. And where something could be watched for the time being, he permitted the patients to decide if and when something should be done. What happened was people began to relax —  and they began to accept treatment. This resulted in thousands of dollars of legitimate and necessary dentistry being delivered in just a few months time.

The difference between the two providers really came down to listening skills followed by communication skills that explained comprehensive dentistry in logical understandable ways. This simply enabled patients to choose appropriate care over choosing supervised neglect.

There is not, and will not be in our lifetimes, a reduction in the serious need for comprehensive dentistry. Neglect some problems too long and they simply become bigger and more expensive. In fact, in spite of technology breakthroughs coming out of dentistry all the time, we still can project a million new complete denture cases this year and for the foreseeable future in the United States. We are not winning the dental caries and periodontal disease battles, and yet dentists as a group are not as busy this year as last year. Blame it on the economy, but I think it has more to do with the inability to connect to patients as people and providing them long-term solutions for their dental problems.

Too many dentists are either deciding or being “managed”  in order to streamline office processes by shortening initial patient/dentist interactions. Ironically this fails to build the trust necessary to get patients to accept larger, more expensive procedures. Many dental offices are passively permitting patients to think that the insurance-level care is adequate to maintain health when it is often not true.

On the one hand, dental insurance opens access to care for some, but because it interferes with the doctor/patient relationship it diverts both patients and dentists away from comprehensive care. The result is a level of neglect that results in growing problems over time. But I don’t fault insurance. It’s presence in care is a reality. I fault all of us who know better for not being clearer with patients about the risks, benefits and alternatives to insurance-driven dentistry.

Perhaps we need informed consent forms for those who elect limited insurance-driven care.

BTW: My presentation: A Tooth Has Four Parts actually accomplishes this informed consent level of an explanation for patients with periodontal disease, so keep reading my series on How To Succeed in Periodontal Therapy.

3 Comments

  1. Ben, Again you have hit a home run. It’s all about listening, describing without being arrogant and building trust. With this approach, patients get comfortable and accept treatment. You go Ben!!

    Reply
  2. Dr. Ben Young raises a good point but still seems to have a conflict in his mind that implicitly blames insurance companies. His comment that streamlining office processes somehow results in poor patient care shows his lack of understanding of business operation flow.
    There is no conflict between patient centered and business centered care. They are both necessary conditions for success of our practices. All private businesses including dentistry must deliver value to patients in order to succeed. Dental practices, solo or network of multi-specialty practices that provide high value compared to other competitors succeed tremendously-even in bad economy.
    As dentists, we all are familiar with epidemiology of dental diseases. Our goal as a profession is to prevent dental diseases and at the same time quickly bring the patients back into state of oral health. There are patients with different values strongly influenced by their different socio-economic backgrounds. Successful dental practices must take patient values into account while designing their dental care delivery systems. Within this framework different treatment plans could be made and patients made to flow as quickly as possible. Let us take an example: If we develop a practice in low socio-economic neighborhood, the dental disease is most prevalent in these neighborhoods. Dr.Young has it right here that patient values must be taken into account. Let us assume a lot of patients need caries control and periodontal disease management. Patients best interest can be taken into account and several teeth could be removed and partial dentures made rather than expensive endodontic, periodontics and implant therapy. The remaining teeth could be saved and the patient encouraged, motivated for preventive care.
    The confusion comes when dental practices are not trained in how to capture patient values and how to change patient attitudes, behaviors towards preventive care. The constraint in achieving successful dental practices is not that we don’t have patients who could pay for our services. It is in our heads. We need education in epidemiology, business processes and system designs to deliver high value to patients from different socio-economic backgrounds.

    Reply
    • Dr. Benjamin Young

      Thank you for your very thoughtful reply.
      1. I do not implicitly or explicitly blame insurance companies. The most responsible individual when it comes to delivering dental care is the dentist. There is nothing wrong with working with dental insurance.
      2. No conflict between patient centered and business centered care? This is like saying all dental care is good because it’s caring and involves dentists who are good people.
      3. Do patients in different socioeconomic situations have different values or different constraints?
      4. I don’t treat patients based on epidemiology and I have taken a number of courses in this area along with statistics. As you know, next to the case report, epidemiology is the weakest level of research conducted and its purpose is to see if there are reasons to go deeper into more expensive experiments in a particular area. Yes we need business processes, and system designs is fine as well, but what we really need to learn as practicing dentists is diagnosis and treatment planning to a more sophisticated level than what we have time to learn as dental students.

      Reply

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