Repositioning Ankylosed Maxillary Canines by Segmental Osteotomy
Perception Is Reality
My orthodontic partner and I recently had a philosophical discussion regarding patient care and management. I had determined that a retainer wasn't needed in a particular case, given the clinical situation. She said it didn't matter whether I was correct; what mattered was that the patient believed that if the teeth moved after active treatment, it would be because of the lack of retainers. The fact that a tooth might move anyway was irrelevant. My opinion was that a retainer would not enhance the stability of the finished result and, therefore, using a risk-benefit analysis, I could not justify giving the patient a retainer even if the risks were negligible. My partner countered, "Larry, as far as the patient is concerned, perception is reality."
I started to contemplate the ramifications of this idea. The World Book Encyclopedia Dictionary defines to perceive as "to take in or understand with the mind". It defines reality as "the true state of affairs or actual fact". If perception is reality, then a perception can easily be taken as fact by a patient, unless that patient is made aware of the dichotomy.
For example: A new patient calls for an appointment. She is given one, and a letter is sent to welcome her to the practice. Enclosed is a slick and expensively produced office brochure extolling the virtues of orthodontics, the background of the doctor, and the services provided by the office. The brochure also describes office policies regarding fees, appointments, and so on. Other enclosures are a two-or-three-page health questionnaire, an informed-consent brochure, and an initial patient contact sheet asking for, among other things, a complete financial history of the person responsible for payment.
What are the patient's perceptions? That this office spends a lot of money for things unrelated to the actual delivery of orthodontic care, and that therefore she will be charged a higher fee? That orthodontics is dangerous because of the negative sequellae mentioned in the informed-consent brochure (particularly if her dentist recommended an orthodontic consultation even though she was happy with how her teeth looked and had no idea a problem existed)? That the practice is prying into her personal affairs by asking where she works, what position she holds, how long she has been employed, her Social Security number? These perceptions are real to the patient, even if they were unintended.
The orthodontist, on the other hand, knows the "reality" of this scenario. The office brochure was developed to save valuable chairtime by enlightening prospective patients in advance about the benefits of orthodontics and the doctor's philosophy of practice and educational qualifications. The informed-consent brochure was designed to help the patient understand the extensive benefits resulting from orthodontics, given the slight risks associated with treatment (and to provide medicolegal protection for the practice, of course). The health-history form was sent in advance so it could be completed ahead of time in a relaxed atmosphere, and nothing would be omitted. The financial information was necessary for appropriate fiscal management of a small business--nothing more, nothing less. Perception vs. reality.
What happens when the new patient arrives in the office? What do the office decor and the equipment in the operatory tell her? Does she perceive that the doctor cares about her comfort and keeps abreast of the latest techniques and technology? If she sees an old-fashioned waiting room with outdated magazines, does she believe that the practice may be old-fashioned in its therapeutic approach? If the office is unkempt and the staff's clinical garb is stained, does she perceive the office and staff to be unclean? There may be explanations for all these things, but what is the reality for the patient?
When the patient goes to the operatory, does she see the doctor and staff wash their hands and change gloves between patients? Are sterilization procedures being performed? Does the orthodontist take the time to explain what is going to be done at the appointment and what to expect, or is that task relegated to an assistant so the doctor can hurry on to the next patient? Does the patient perceive that the orthodontist and staff really care about her as a person, or does she get the impression that she is just another payment collected that day?
Of course, all orthodontists have their own perceptions, often based on the reality of running a busy practice. What is important is not the actual fact, but the difference between the beliefs of the patient and the beliefs of the practitioner.
I'm not sure there is any one solution to this dilemma, considering that the situation varies from one office to another. What is important is to step back and look at your practice from the patients' perspective. Their accumulated perceptions do indeed become reality for them. After you've done that, ask yourself if the "facts" as you know them aren't merely your own perceptions, playing the age-old game of fooling oneself through rationalization. Perception or reality?
