THE EDITOR'S CORNER

Fifty years ago, a dentist named Oscar Farkasch taught dentists new concepts of treating the whole mouth in the whole person and approaches to diagnosis, treatment planning, and case presentation aimed at strongly educating the patient to understand his oral health problems, to appreciate the service that dentistry could render, to accept the recommended treatment program, and to become missionaries for the dental office with this approach, and for dentistry. At that time, he recognized that a primary need was to educate the dentist to the objective of obtaining and maintaining optimum oral health for his patients.

Basic to understanding and attaining optimum oral health was a complete and thorough diagnosis, including general health history, dental history, full set of x-rays, study models, and a detailed clinical examination. Dr. Farkasch used to emphasize that it was in the patient's interest that the dentist be thorough and honest and in the dentist's interest that the patient recognize that the dentist was thorough and honest. In the routine of many orthodontists, a perfunctory, preliminary diagnosis is made first, and a thorough diagnosis follows case presentation, fee presentation, and case acceptance. The thorough diagnosis is merely confirmatory of preliminary clinical findings, at best. This approach may work a large percentage of the time. Its problem is that it violates one of Dr. Farkasch's principles. It places the needs of the orthodontist first. He believed in placing the patient's welfare first and that everything, including the dentist's prosperity, would flow from that. He also believed in "the one best diagnosis", and the inability to arrive at the best diagnosis without doing the best and most thorough diagnostic procedures. In orthodontics, we are frequently faced with close decisions on borderline cases. Would you blame a patient who accepted a case presentation which includes a decision to extract based on a thorough diagnosis, over a case presentation which indicated that there was a possibility that extraction would be necessary, but we will find that out later?

Furthermore, by naming a fee before you have done a thorough diagnostic workup, you have categorized orthodontics as a generic product and you have made fee the primary factor in the transaction. If that approach is not turning some patients away now, you can bet that it will in the future.

Far from trying to eliminate as many preliminaries as possible, I think that orthodontists should establish a pretreatment routine that follows the accompanying chart.

This chart should be explained to the patient and parent (or consultant) at the first meeting. Then some explanation of orthodontics should be given. Then a clinical examination to determine if diagnostic records should be taken at this time. If not, there should be an explanation of what the clinical findings are, what they mean, why it is important not to treat at this time, when the next visit should be to have another clinical evaluation.

When diagnostic records should be taken, it should first be explained to the patient what is involved in obtaining them, why it is important to have them, what they are intended to show, what important information will be available from them that is not available without them, and what they will cost. The diagnostic records should be taken at that time if it is convenient for the patient and the office. If not, a separate appointment should be made within a week. Time should be taken to continue the education process, perhaps showing some diagnostic materials from other cases which might be similar, and especially the good results of treatment.

The case presentation visit should begin with another clinical examination, studying the details of the diagnostic records as related to the clinical exam. How often have you sat with diagnostic records and wished that you had the patient there to help with the diagnosis and treatment plan? Then the case is presented in detail and, only after that, the fee.

From the case presentation, the patient can go either to treatment or to observation and recall for another clinical examination at a stated interval to see if the patient will then be ready for a new diagnostic examination. In any case, they ought to know exactly what their financial obligation will be and, at that point, the doctor turns the patient over to the financial secretary to make the financial arrangements.