The Process of Caring
The three most important principles of a successful professional practice are availability, affability, and ability--in that order. Like most principles of life, they are easier to know than to practice. In the words of Seneca, "I persist in praising not the life that I lead, but that which I ought to lead. I follow it at a great distance--crawling."
Many orthodontists seem to be like Seneca when it comes to availability. They won't pass up their Wednesday golf games, for instance--even to see new patients who might not be able to come in any other time. Twenty-five years ago, perhaps, practitioners might have been able to get away with being exclusive and inaccessible, but that day is long gone and probably will never return. This is true not only in orthodontics, but in all the professions, because the general population continues to grow at a much slower pace than the professional community.
The importance of availability has apparently begun to dawn upon increasing numbers of orthodontists, as we see satellite offices in communities that even five years ago were thought too small to support an orthodontist. One of my satellites is in a small city that has three general dentists, and there are now three satellite orthodontic offices there. I know this is not just a local phenomenon, because I hear similar stories from all over the country.
My father, who was a barber, put it this way: "The secret is to be there when they want to be there". If someone wanted a haircut at 6 a.m., he would be there to give it. If a "client" of the local mortician needed a Sunday haircut before a Monday funeral, my father would cut the hair in the casket. There weren't many things he would allow to interfere with the provision of his services. And he did well in a line of work that isn't ordinarily associated with economic success.
The second principle--affability--is the courtesy or genuine friendliness we extend to those who entrust their oral health to us. The old axiom, "People don't care how much you know until they know how much you care", is no less true for being a cliche. People do want to feel that, above all else, their doctor cares about them personally--and this is not an unreasonable expectation.
There are hundreds of ways you can display respect and courtesy for patients and most of them don't cost a cent. For starters, you can take patients' telephone calls or, when that is impossible, call back right away. You can establish an office policy of having parents come to the chairside so you can show them how treatment is progressing. Our patients and their families have a right to know what is happening to their oral health, and we have the professional responsibility to tell them. You can also remember patients' birthdays, notice their achievements, and give them recognition. Dr. Haim Ginott, author of Between Parent and Child, probably summed it up best: "If you want children to be better, let them hear the nice things you have to say about them".
Orthodontic patients are likely to be anxious and nervous at first because of the importance they attach to their dental appearance and their uncertainty about how it is to be improved. They need to be confident they are in good hands and not just lost in the patient shuffle. The orthodontist who is able to reassure patients will do well in the marketplace.
Another aspect of affability is the respect we have for the comfort of our patients. It is absolutely impossible to be kind and deferential if we ignore the technical advances that make orthodontics, if not comfortable, at least bearable. I'll never forget visiting an extremely able orthodontist who, rather than bonding, still preferred to hammer bands in place with a mallet and chisel. The teenage patient's tears indicated it would be hard to convince him that his orthodontist was an obliging, affable fellow.
The third principle of professional practice is the ability to perform the service for which our patients pay us. It is hard to imagine in this day of orthodontic enlightenment that any orthodontist would not know his or her job. In fact, I don't know any orthodontist who has graduated from an accredited program and who can't successfully treat a typodont. But occasionally we get evidence that our own ability or that of others is not up to the task before us. Many times there are extenuating circumstances, such as poor patient cooperation or totally unexpected growth, that all but make our professional obligations impossible to discharge.
In my own experience, though, the point where most mistakes are made and my ability is most severely compromised is in the diagnosis. The diagnostic regimens of the past have been successful from the standpoint of geometric simplicity, but they have been woefully inadequate in accurately forecasting the quantity and quality of growth we might expect from a patient. And absolutely none has made allowance for the psychosocial features that seem so important to our clinical success. We must habitually reevaluate every case to see if our original diagnostic and treatment planning decisions were valid. If we find that our expectations are frequently exceeding our results, then we need to approach some better-informed colleague who can help us.
Availability, affability, and ability--three principles every orthodontist ought to follow, and not at a great distance.