COMMENTARIES

provides an opportunity to connect

LETTERS with the patient, offer superior cus-
tomer service, and build value for

J
ADA welcomes letters from readers on articles that have appeared in The
Journal. The Journal reserves the right to edit all communications and continuing (or beginning) a relation-
requires that all letters be signed. Letters must be no more than 550 words ship with the practice. But scripting
and must cite no more than five references. No illustrations will be accepted. only works, as he mentions, when
A letter concerning a recent JADA article will have the best chance of team members practice through
acceptance if it is received within two months of the article’s publication. For role-playing.
instance, a letter about an article that appeared in April JADA usually will be Running through the script repeat-
considered for acceptance only until the end of June. You may submit your edly allows staff members to grasp its
letter via e-mail to jadaletters@ada.org; by fax to 1-312-440-3538; or by mail to underlying concepts and gradually
211 E. Chicago Ave., Chicago, IL 60611-2678. By sending a letter to the editor, learn how to make the necessary points
the author acknowledges and agrees that the letter and all rights of the author using their own words, as well as the
in the letter sent become the property of The Journal. Letter writers are asked to appropriate body language. In the
disclose any personal or professional affiliations or conflicts of interest that process, they gain confidence and the
readers may wish to take into consideration in assessing their stated opinions. ability to stay on message.
The views expressed are those of the letter writer and do not necessarily reflect Again, I appreciate Dr. Goldstein’s
the opinion or official policy of the Association. Brevity is appreciated. letter expanding the discussion on
the importance of communication,
which cannot be overemphasized.
SHOW, DON’T TELL squeaky tones are a sure-fire way of
As a dentist and a coach, I think diluting the message; ergo, poor Roger P. Levin, DDS
the answer to the question that Dr. practice metrics are sure to follow. Founder and Chief Executive Officer
Levin Group
Roger Levin received in his March Alan Goldstein, DMD Owings Mills, MD
JADA column, “How Clear Commu- New York, NY
nication Can Improve Practice Per- http://dx.doi.org/10.1016/j.adaj.2015.06.013
formance” (JADA. 2015;146[3]:211-212), http://dx.doi.org/10.1016/j.adaj.2015.06.012
Copyright ª 2015 American Dental
was embodied in the question itself. Copyright ª 2015 American Dental Association. All rights reserved.
The question was this: “I tell my staff Association. All rights reserved.
what I want them to do, but the DENTISTRY IN THE MODERN ERA
message does not seem to be getting Author’s response: I thank I am writing regarding Dr. Marko
through. What am I doing wrong?” Dr. Goldstein for his thoughtful Vujicic’s March JADA article, “Of
Perhaps because the focus was on comments on my article. I could Lawyers, Lattes, and Dentists” (JADA.
improving performance metrics, as not agree more that effective com- 2015;146[3]:208-210). Although his
it often is with practice management munication between the dentist article does touch on some key points
experts, the issue of linguistics and and the team requires both telling and sheds light on some data that
the form of communication often and showing. Dentists should not need to be recognized and understood
gets lost. only clearly convey their expecta- by dentists, I find that there are a few
I am reminded of the Pogo car- tions to each staff member but things that were not addressed that
toon where he says, “We have met also demonstrate the professional ought to be in order to put the
the enemy and he is us.” My point demeanor that the team should downturn in dental spending into
is that the dentist should not tell emulate. context.
staff members what to do; rather, By exhibiting the following be- First, from an historical perspec-
the dentist has to show them what haviors, for example, practice leaders tive, dental spending has had less
to do. The dentist has to demon- guide their team by setting the tone than a century of growth from levels
strate proper communication skills for the practice: that were, at one time, much lower
(both verbal language and body - remain calm when confronted than they have been in past decades.
language) and—what is important with unexpected challenges; One hundred years ago, most people
and mostly overlooked—has to take - treat patients and team members did not even brush their teeth.
into consideration the issue of tone. with respect and consideration. Excellent quality dentistry was
The way we say something either As Dr. Goldstein mentions, how available, and there was affluence to
demonstrates weakness or power, and we say things requires careful atten- support it, but people chose not
the dentist has to teach that. I suggest tion as well. That is why I have long to have it. The public interest in
that role-playing in staff meetings recommended that all practice– spending on dentistry in the 20 or so
may be one effective way of doing this patient interactions be scripted for years leading up to the 2007-2009
sort of coaching. High-pitched and effectiveness. Every conversation recession was more of an historical

JADA 146(8) http://jada.ada.org August 2015 567

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anomaly than anything else, fueled
by an economy boosted largely by
borrowing.
Second, many of us who are
practicing in real-world dental pra-
ctices have come to see a strange
dichotomy of themes in our profes-
sion. On one hand, we go to meet-
ings and are told that we need to
have hundreds of thousands of
dollars of esoteric equipment and
digital imaging technology and to
do the sort of dentistry that will pay
for all those costs on each and every
patient who walks into our waiting
room. On the other hand, we also
are being lectured by academicians
and public sector dentists about
the lack of access to health care
for anyone who is not wealthy, and
that we must address that issue by
lowering fees.
When you add the cost of a dental
education to this, can you expect
a young person to deal with the
cognitive dissonance this situation
presents? Is it any wonder that we
are now seeing the rise of corporate
dentistry and a rising level of over-
treatment? Drs. Cummings and
Vergo, in the benchmark article
“Traditional Dentistry Versus Retail
Dentistry: A Sociological Pilot Study
of the Dental Profession,”1 published
in 1985 before the high growth
occurred in the dental economy
during most of the years from the
mid-1980s through 2007, showed
conclusively that this is not the model
patients want for their dental care.
Finally, the health care industry
needs to recognize that although we
care a great deal about health care,
the American public does not. The
reason there is support for govern-
ment intervention in medicine is not
because the public thinks that health
care is important; it is because they
do not, and they take it for granted.
In a free society, people can spend
their money on what they want.
Dentists need to make peace with
that notion.
To the extent that dentistry can
do something about this, we need
to have a more coherent vision of
568 JADA 146(8) http://jada.ada.org
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COMMENTARIES
what dentistry is as a profession. Are
we a boutique industry composed
only of those who can afford an
overpriced education and treat only
those who want cutting-edge treat-
ment? Are we to be largely welfare
providers who put out lowest com-
mon denominator restorative treat-
ment? Or can we cobble together
something like what we were before
the big buildup and bust—practi-
tioners who could address the needs
of many in the same office with high-
quality, predictable care for the bulk
of our patients, regardless of what
their specific priorities are about
dentistry?
That is our challenge.
Robert K. Thompson Jr., DMD
Cohasset, MA
http://dx.doi.org/10.1016/j.adaj.2015.06.014
Copyright ª 2015 American Dental
Association. All rights reserved.
1. Cummings J, Vergo TJ Jr. Traditional
dentistry versus retail dentistry: a sociological
pilot study of the dental profession. Quintes-
sence Int. 1985;16(9):651-655.
ETHICAL DECISION MAKING
In Dr. Don J. Ilkka’s May JADA
Ethical Moment, “Keeping Skills
Current” (JADA. 2015;146:[5]:352-353),
the question posed concerned a
pediatric dentist who, after a few
years of administering conscious
sedation, hired an anesthesiologist
to perform the task. Then, 20 years
later, he decided to resume sedating.
Because sedation is allowed with
proper permits, is it ethical for this
dentist to administer sedation
without an anesthesiologist being
present?
Although this is hardly a signifi-
cant ethical dilemma and so long as
the pediatric dentist is capable most
would reflexively answer “yes” to
this question, the article goes on to
cite the principle of Nonmaleficence
as embodied in the American Dental
Association (ADA) Principles of
Ethics and Code of Professional Con-
duct, carefully explaining the word
means “do no harm”1 to indicate that
the practitioner should not injure.2
August 2015
Not satisfied, the reply goes on to
cite the principle of Beneficence,
affirming that this means “do good,”
clarifying an ethical demand that
patients are entitled to competent
care.
This well-meaning article clearly
demonstrates the misapplication of
ethical decision making and inherent
weaknesses in the ADA’s Code of
Conduct. Usually, it is only when
recognized principles are in conflict
that ethicists are called on for their
expertise and thereby play an im-
portant role in decision making.
For example, Beneficence means
doing good for the patient. Veracity
asks that we tell the truth. An insured
patient is desperately in need of pro-
sthetic replacement of his maxillary
anterior teeth but cannot afford the
copayment. It would be a beneficent
act to forgive the copayment. How-
ever, truth would be compromised by
dishonest reporting to the insurer.
Which is the appropriate ethical
choice?
Autonomy respects the participa-
tion of the patient in treatment plan-
ning decisions. A patient presents with
an obvious need for significant dental
care. A full series of radiographs is
proposed to the patient and refused.
Without the series of radiographs,
proper care cannot be rendered. Al-
though it is possible to take care of the
readily apparent problems, major dif-
ficulties will remain. Do you help the
patient wherever you can, or do you
dismiss the patient?
Another patient says he “hates his
teeth” and asks that they all be taken
out. An inspection reveals no indi-
cation for removal. Beneficence and
Nonmaleficence conflict with the
principle of patient Autonomy. Do
you extract?
Major religious philosophies—
Judeo-Christianity, Buddhism,
Confucianism, Islam, Hinduism,
and even Wicca—have a central
thesis of, “Do unto others as you
would have them do unto you.” Also
called the Golden Rule, it embodies
respect for others, being good and
not bad, fairness, and truth telling.