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A Rose Is a Rose Is a Rose

A Rose Is a Rose Is a Rose

When Gertrude Stein penned "A rose is a rose is a rose", she was undoubtedly alluding to Shakespeare's famous line: "A rose by any other name would smell as sweet". Her inference was that it may smell as sweet, but we still call it a rose.

A minor, but significant, part of the facelift being administered to the health care professions is the substitution of the word "client" for the word "patient". It was as though the word "patient" was offensive to the tenets of holism, or of behaviorism, or of business, or of economics, or of government bureaucracy. Apart from being idiomatic to some or all of these fields, the substitute term "client" has occasionally been rationalized as being more appropriate to modern health care by describing a less dependent relationship than the word "patient". That idea is not borne out in a visit to Webster's Unabridged Dictionary:

client/n -s [ME, fr MF & L; MF client, fr L client- cliens client, dependent, lit., one who has someone to lean on; akin to ON hlita to be satisfied with, L. clinare to lean--more at LEAN] 1: a person under the protection of another: VASSAL, DEPENDENT; esp. a dependent (as a freed slave or one of the plebs) in ancient Rome who was obliged to perform certain services in return for the protection he received from his patrician patron 2a: a person who engages the professional advice or services of another; specif. a person who consults or engages the services of a legal advisor b: PATRON, CUSTOMER c: a person served by or utilizing the services of a social agency or a public institution.

To depict a patient as in a more passive role than a client is to put one's own feelings and attitudes into the definition. Patients have been called patients for hundreds of years. That's our jargon. If outside influences want to impress their jargon on us and at the same time impress us with the inevitability of change, that's transmogrification, brother.

A similar situation exists with the recent introduction of the term "marketing". Here is what Webster says about marketing: marketing /n -s 1 a: the act of selling or purchasing in a market b: the bringing or sending of goods to market 2 a: produce for the market b: things purchased at a market 3: an aggregate of functions involved in transferring title and in moving goods from producer to consumer including among others buying, selling, storing, transporting, standardizing, financing, risk bearing, and supplying market information.

In the end, usage dictates definitions, and if enough of us use the term, one might expect a future edition of Webster to speak of "goods and services". However, those who do use the term are acting out a kind of charade. It is as though we have come upon a whole body of knowledge that will lead the professions to some new promised land. Highly respected consultants can say, "You cannot expect to solve today's problems with yesterday's solutions". Yet, with the exception of advertising and other overt forms of promotion, there is no discernible difference between "marketing" and what we have always called "practice building". Indeed, most consultants are so far treading lightly around the issue of advertising and are presenting all of yesterday's practice building ideas as requirements of today's marketing. If this gentle deception alerts dentists and orthodontists to a need for renewed efforts at practice building, that is all to the good. However, given the power of words, changing the most ordinary word conventions in the profession can make the inevitability of change a self-fulfilling prophecy. The substitution of the word " marketing" widens the ring to admit advertising to the generally accepted concept of practice building. So far, though, there is very little advertising by orthodontists, and there is no evidence that it is increasing.

Still, orthodontics is a part of dentistry and, more or less, is being caught up in the surge of innovation in general dentistry for which the basic justification is that a majority of the people do not receive regular dental care. Even though previous studies revealed that cost came out about fourth on the list of reasons people do not seek dental care, various individuals and agencies are convinced that cost is the barrier, that encouraging competition will reduce cost, and that advertising is the way to increase competition. While there is yet no evidence to support these contentions, the changes that have followed from the reintroduction of advertising in dentistry, and the growth of franchising, closed panels, and other "innovative" delivery forms, will make their mark on general dentistry for many years to come.

Whether orthodontics can divorce itself from the marketing of dentistry will probably be determined by whether orthodontists can continue to enjoy a relatively high standard of living and whether entry into orthodontic practice will be financially feasible without seeking employment within an "innovative" general dentistry form. It should be one additional obligation of the orthodontic departments training future orthodontists to establish a program that will increase the likelihood of their graduates' being able to find a place in the specialty practice rather than in other forms. There is no apparent reason, other than economic necessity, for orthodontists to become involved in programs that could lower the status of the specialty and its members, the income potential of orthodontists, the quality of care, and the impetus to innovate and grow professionally.

One thing is for sure. Language was meant to communicate. If we mean "patient", we should say "patient", not "client"; if we mean "practice building", we should say "practice building", not "marketing".



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