The Doctor/Patient Relationship
Until now, the so-called learned professions have had a somewhat different definition of a professional from that of others who call themselves professionals. There are professional ballplayers, professional wrestlers, and professional gamblers; and, of course, there is the oldest profession. The non-learned professionals ascribe their professionalism to expertness at what they do or to the fact that they are paid for performing tasks that are also pursued by amateurs.
The learned professions ascribe their professionalism to advanced education and to service in the public interest. Until now, of all the features that have been used to describe the uniqueness of a health care professional, one of the most distinctive has been the doctor/patient relationship. If we relinquish the doctor/patient relationship and seek an office/patient relationship, we will also be relinquishing a special place that we have had in our society and will become a subhead in the business world.
Whether such a turn of events will be good or bad for the public's health and welfare is debatable. However, the present cadre of health care professionals is not well suited--by personality, philosophy, and training--to compete in the business world by running a business or by being an employee. Orthodontists in general have little or no business training and often little or no interest in or instinct for business skills.
If the premise is true, then it is predictable that the great majority of orthodontists will try to stay in the practice mode that they are presently in. It also follows that this will be more difficult or even impossible if the distinguishing ingredient of the doctor/patient relationship is allowed to disappear in those practices.
In most practices today, there is not enough time for one person to be a part of all the one-on-one relationships involved in the doctor/patient relationship. This means that priorities must be set. Certainly there is a close doctor/patient relationship at the chair--the closest. However, if a doctor spends all day at the chair--or even a great majority of it--there is little or no time left for other important functions that are also an important part of the doctor/patient relationship and should not be delegated. They might be described as professional communication, and they include examination, diagnosis, treatment planning, case presentation, progress evaluation and reporting, and post-treatment evaluation and conference.
The orthodontist in an average practice might spend an hour and a half to two hours a day on these treatment evaluation functions. Additional non-patient time must be spent on management, communications, practice building, planning, quality control, and staff training and retraining. This leaves half of the day or less for treatment of patients by the doctor. While an orthodontist should try to see every patient at every visit, many of the actual technical procedures in treatment can be assigned to competent assistants. We are fortunate that technical tasks in the operatory can be delegated. Otherwise, the important non-patient treatment functions would not get done--or the number of patients would be reduced by half.
Some orthodontists do not like to spend their time at patient relations and therefore delegate case presentation, progress reporting, and post-treatment conferences. They are encouraged to believe that this is a good idea because it works. Assuming that it can work, it should be evaluated on a cost/benefit basis. The cost is the abandonment of the contribution that those functions make to the doctor/patient relationship. The benefit is that the doctor has 45 minutes to an hour a day for other things. Whatever those other things are, it is not a good trade-off. In fact, that time could be made up by performing diagnosis, treatment planning, and post-treatment evaluation outside of office hours. Even more time can be found by removing some of the doctor's non-patient administrative functions from patient days and performing them outside of office hours. Doing this increases the doctor's time commitment to the practice, but entrepreneurs work longer than employees.
Some also believe that doctors are very bad at patient relations and that assistants are very good at them. While that may occasionally be true, it is far from a universal truth and makes a very unsubstantial rule. Also, patients do not seek out an orthodontic office because it has terrific assistants, regardless of the importance to an orthodontic practice of an excellent staff. All assistants play a role in patient communications, but the doctor is the constant in a practice. If the day arrives that orthodontic practices lose their identification with the doctor, and if the doctor ignores the seminal importance of the doctor/patient relationship, and if the doctor misreads what the ingredients of the doctor/patient relationship are, there will no longer be a professional indicia to orthodontic practice as a learned profession. We will join the category of professionals who have merely lost their amateur standing.