A friend recently confided about a patient who, a few years after completing orthodontic treatment, sought the help of a periodontist for receding gingivae. The periodontist told the patient that all of her problems were due to the orthodontic treatment. A cursory glance at the orthodontic records, however, would have shown that early gingival recession was apparent at the beginning of treatment, and that it had not progressed during the course of orthodontic therapy. Had the patient allowed herself to be misled, my friend could have been in for some difficult legal problems.
Would that such breaches of professional ethics were rare. Unfortunately, they are not. I have now been in this profession for more than 40 years, and I have never seen legal action taken against a dentist without the active and, usually, eager participation of another dentist. It has always seemed strange to me that health professionals would ever expect any of their problems to be resolved by our current system of jurisprudence. And I am astonished that dentists and physicians do not try to stay as far away as possible from the arbitrary and questionable decisions of present-day jurists.
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I often wonder what practitioners gain from accusing others of negligence or malpractice. They may feel that such claims make them appear to be unusually astute to prospective patients. In fact, their accusations only call into question the patients' choice of doctors, and people don't take kindly to having their judgment criticized by new acquaintances. This kind of conduct causes patients to lose confidence in all of dentistry--not to mention stirring up a great deal of resentment among colleagues. Ultimately, the entire profession suffers.
Animosity between dentists usually involves little more than a difference of opinion or philosophy. For example, one orthodontist may believe in the extraction of bicuspids, while an antagonist sees this as a cardinal sin. One orthodontist may choose to extract second molars, while another insists that this is tantamount to malpractice. When I review the old debates between Angle and Case, it strikes me that orthodontists haven't learned anything at all over the past century. Many still argue the extraction-nonextraction question with all the warmth and intellect of a hot rock. It isn't so much that Angle was wrong 100 years ago about not extracting teeth or not trying to move the maxillary molars distally, but that people nearing the 21st century hang on to these archaic and indefensible beliefs with a passion that would shame the most fanatic religious zealot.
I have a friend who used to extract bicuspids frequently--too frequently, I thought--but he was comfortable with that regimen and handled it well, and his patients benefited from his therapy. It was certainly nothing to lose a friendship over. A few months ago, my friend surprised me with a confession of his recent professional epiphany, which now obliges him to treat 95% of his patients nonextraction. I wanted to ask (but prudently did not) if he still took diagnostic records. When 95% of an orthodontist's therapies have been decided beforehand, records become almost superfluous. But such a rational thought would seldom occur to a true believer.
Perhaps our passion for belonging to a group with like beliefs and behaviors is a pack or herd instinct, left over from our mammalian and reptilian forebears and now buried deep within the human genetic makeup. Whatever it is, it short-circuits rational discussion and keeps us from reaching reasonable solutions to our common therapeutic problems. Humans do have a neocortex, and even though it is relatively new (about 500,000 years old, give or take a few millennia), to insist that people engage it when trying to discover a scientific truth is, to paraphrase Lysle Johnston, not unreasonable, impolite, or uncollegial.
The power of ideology, in my opinion, is rooted in a human lack of curiosity about facts. It is not that ideas do not interest us. But the ideas that interest us most are familiar ones. Our need for intellectual certainty and mental tranquility seems considerably stronger than our need to know or explore the truth. For science to progress, it has always had to struggle against this primordial human apathy.
Maybe nature will eventually make something a little more sensible out of this. Until that good day arrives, orthodontists and other professionals will simply have to rely on lowering their voices and claiming the freedom to make mistakes and admit them. There is no shame in this; indeed, it is the core of scientific progress and the signature of a true scientist.
LWW