November 23, 2016
by René Brewer
A Crisis of Trust
In a Gallup poll taken in November 2012, Americans were asked to rate service providers, including dentists, on ethical standards and honesty. Among health professionals, nurses came out on top with 85 percent of respondents rating them “high” or “very high”, followed by pharmacists at 75 percent, medical doctors at 70 percent and dentists at 62 percent. Chiropractors and psychiatrists trailed badly, with only about 40 percent of respondents giving them high marks for ethics.
In Canada, the perception of dentists may be even more negative than in the U.S. A comprehensive Ipsos Reid survey commissioned by the Canadian Dental Association and the provincial dental associations in 2009 found that 59 percent of those polled had an unequivocally positive view of dentists. This might not appear ominous, but for the fact that only nine percent “completely agreed” that they trust dentists and a more recent Ipsos Reid survey pegged Canadians’ trust in their own dentists at just 50 percent.
Contributing, no doubt, to cynicism about the dental profession is the prominence of financial issues in the patient-dentist relationship. In the same 2009 Ipsos Reid study, more respondents agreed with the statement, “Dentists are business people” than, “Dentists are doctors”, and most viewed dentistry as a “hybrid commercial/health service”. To be fair, most Canadian dentists have no choice but to be entrepreneurial in order to make a living, but the consequence is that their motives for recommending particular treatment are more likely to be questioned than those of their counterparts in the publicly-funded health care system.
An Uncertain Future
There are good reasons to pay attention to the polls. Competition for patients is only going to grow as global labour mobility and enhanced allied professional roles broaden the pool of health care providers. But there are also other, potentially more cataclysmic forces that could dramatically affect how dental professionals practise their craft in the not-too-distant future.
According to Richard and Daniel Susskind, authors of The Future of the Professions, the democratization and commoditization of information through technology will eventually cause the dismantling of professions that owe their existence to an era in which it made sense for “experts” to be the gatekeepers of specialized knowledge and skills, including the health professions. Such monopolies may no longer be necessary or appropriate, they say, in a world where everything we need to know is available with the click of a mouse and the exercise of judgment is no longer within the sole purview of sentient beings.
This is not science fiction. The impact of technology on our lives is undeniable and the pace of change is dizzying. It would be naïve for any market segment to assume it is insulated from the tsunami of disruption that the next decades are likely to bring. Among the professions, the “knowledge” experts are already feeling the pinch: do-it-yourself wills, contracts and dispute-resolution are widely available, encroaching on what was once considered to be the exclusive territory of lawyers.
But even the “hands on” professions are not immune to the effects of the information revolution. Patients self-diagnose and seek guidance online not just from health practitioners but also from other patients. Surgery is performed using computer-guided lasers and robots. It is not far-fetched to imagine a time when patients obtain their diagnoses and treatment options from sophisticated computer algorithms and self-refer to live or mechanical technicians to carry out the chosen plan.
It is not all doom and gloom, of course. Any such changes will not happen overnight, and with turmoil comes opportunity. If the profession of dentistry is not to become a relic of a bygone era, dentists need to understand and deliver what patients in the Internet age want from health care providers. A good starting point may be to ask what a profession is and why dentists deserve to be called professionals in the first place.
A Return to Core Values
Modern western health professions are largely creatures of the 19th century that came about as result of practitioners themselves clamouring for minimal standards of education and conduct. And while part of the impetus for this movement may have been occupational overcrowding, there was also genuine concern for public safety. Indeed, alarmed by the bad dentistry inflicted on unsuspecting patients by those with little or no training, Ontario dentists sought to organize and pursue regulation. On March 4, 1868, the Act Respecting Dentistry, the first of its kind in the world, received Royal Assent from the Ontario Legislature, giving Ontario dentists the right to govern themselves.
Naturally, that right came with responsibilities. In exchange for autonomy and exclusivity, dentists were expected to, among other things, be honest, act in good faith and put their patients’ interests ahead of their own. This “social contract” is what is at the heart of the professions. Many health professionals are seen as continuing to embody these values, and there may be an ongoing role for them even in what the Susskinds call “post-professional” societies, since no one can be an expert in everything and access to information doesn’t automatically translate into practical expertise. More importantly, some patients will always want help coping with illness by having someone distil and interpret data for them, and it is unlikely the virtual will ever completely replace the physical when it comes to the healing arts.
But the survey results suggest many Canadians think dentists are not holding up their end of the bargain. If this perception doesn’t change or becomes more pervasive, there will be little public support for retaining a system that protects the privileges dentists now enjoy once alternatives are available. Any hope of securing that support depends on regaining patients’ trust, and that may mean getting back to basics. While it is important to embrace technology in order to improve patient care, it may be a return to core values and old-fashioned notions of service that saves dentistry as we know it from extinction. Dentists who are clearly healers first and businesspeople second, who are authentic and caring, who know their patients and are engaged in their communities, may not only survive, but thrive. Dental offices that offer a positive experience from first contact to treatment to follow up may win out over service providers lacking the personal touch.
Of course, individuals cannot restore the reputation of a profession. It will take a concerted effort by a critical mass of dentists to sway public opinion, and it will take time. Even if the Susskinds’ predictions seem fantastical or the developments they describe a long way off, waiting to take action until someone or something better, faster, cheaper enters the market is dangerous. Just ask a taxi driver. OH
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