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Recognizing Abuse
VIEWS
any action on your part will dissuade the patient from leaving the practice. For m any of your patients, however, their decision will be “elastic.” They’ll stick with your practice if they can see some good reason for doing so. Here is where you and your office staff can really have an impact on the future of your practice. The critical factor is quality. Not technical quality, for few dental consumers are capable of assessing the quality of dental service. Rather, it is the patient’s perception of quality th a t will influence choice. At issue is the quality of service offered by you and your dental team. The message is clear and unequivocal—enhance your commitment to service. Practitioners who expect to survive today’s marketplace revolution with their profes sional dignity intact will provide service th a t exceeds the professional norm. Their practices will demand th a t all staff members personalize every interaction with patients. They will provide services th a t assign the highest priority to minimiz ing logistic barriers, such as patient waiting time for appoint ments; service th at defines a personalized after-hours com munication system for patients in need; service th at offers meaningful acknowledgments to loyal patients who refer friends and acquaintances; service th at is innovative—such as providing transportation to the elderly or others who might have difficulty accessing the practice. The realm of creative quality services is boundless, limited only by the creative energies and imagination of your dental team. 658
JADA, Vol. 125, June 1994
Do patients really respond to high-quality, personalized service? Check the cover story by Dr. B arbara Gerbert and others in the March 1994 JADA. Patients gave highest scores to dentists’ caring attributes and professional competence. Interestingly, the patients’ beliefs about their dentist were more positive than the dentists’ view of themselves. Major differences in scoring were noted between patients and dentists on the importance of the dentist “explaining dental procedures, offering reassurance, and being friendly and cheerful.” Dentists rated these items 10 to 20 percent lower th an patients. Dentists take heed: there is a not so hidden message in those responses. W hat can the dental team do to reinforce its commitment to patient service? As an initial step, consider assessing the present quality of those services. Try a questionnaire to determine w hat patients do and don’t like about your practice. You may even w ant to hold a series of focus groups bringing together a small group of patients over lunch or dinner and inviting them to be open and frank about their experiences in your office. A useful initiative for the dental office might be to institute a Total Quality Management System. U.S. business and industry have successfully used this system to enhance their business operations and productivity. Some have characterized this system as the ultimate marketing tool. It is concerned with changing the organization by involving all members of the
work force in a concerted effort to do things right the first rather than reactive manner. In 1972, Studs Terkel published “Working,” his description of the American worker. Included was a characterization of the dentist who was quoted as saying, “I’ve had some patients who did not stay with me. There are some people who are used to deference. This is not my way. ... Damn it, when they’re in my office, I’m boss.” If Mr. Terkel’s dentist intends to survive into the 21st century, someone m ust convince him or her th a t professional competence alone is not enough. To compete effectively in the dental marketplace of today and tomorrow, dental professionals m ust have an unwavering commitment to individualized patient service. ■
ADA welcomes letters from readers on topics of current interest in dentistry. JADA reserves the right to edit all communications and requires th a t all letters be typed, double spaced and signed. The views expressed are those of the letter w riter and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated. RECOGNIZING ABUSE
In his January 1994 editorial, Dr. Meskin suggests th at dentists take courses to familiarize them in recognizing abuse of spouses, children and the elderly. You w ant to assign
LEITERS
us yet another task, Dr. Meskin? You close your editorial by asking the question, “If not us, then who?” That is, if dentists don’t address this problem then we are remiss. I reply with an adolescent slang phrase, “W hat a guilt trip.” It is equally dismaying to note th a t the ADA House of Delegates made a similar statem ent in 1993. Who, you may ask, is in favor of the abuse of people? No one. But the question begs the issue. N either am I in favor of auto theft, illegal immigration or divorced parents who do not financially support their children. But I am not willing to join the enforcement body of individuals who combat these problems. It is a topic th a t m ight place people in the position of being thought of as callous and uncaring if they oppose the idea, but I disagree with th a t conclusion. In tru th there are many unfortunate, brutal acts th a t are perpetrated on hum an beings by other hum an beings. And an occasion may arise when you or I have an opportunity to be helpful. I hope we will do so, but I hope we will do it respons ibly. A false accusation or even insinuation of abusive behavior can cause a great deal of hurt. As surely as you institute required completion of a continuing education course for dentists about the recognition and referral of abuse, the num ber of complaints will increase—some justifiably and some unjustifiably. Instead of shifting the partial solution of the abuse problem to us, how about recognizing the responsibility incum bent on the injured 660
JADA, Vol. 125, June 1994
party, or the spouse, the nonoffending parent of the child, a relative or neighbor of the elderly person. It makes a dram atic state ment, but is it true? I do not peruse JADA seeking dram a and appeals for social pro grams. Let’s stick to dentistry! D onald M. Sm ith, D.D.S. O klahom a C ity ASSOCIATES HI PS
I agree with most of the observations from Dr. Howard F arran ’s article (“Associateships: A Business Wedding,” February JADA). But I think Dr. F arran has stated fiction as fact. He says, “Hiring an associate is a convenient way to attract more patients.” I take serious issue with this statem ent. Except for vague, anecdotal comments (such as Dr. F arran ’s), there is not a shred of evidence anywhere th a t proves this statem ent. In fact, in my experience, the practitioners who make this assumption are the very ones who find th a t “associateships” don’t work! I believe a key element in one’s decision to hire an associate is to have a patient base so large th a t the solo person cannot service it. Then—and only then—is there room for, money for and a reason for an associate. The one exception to this is the owner who wishes to reduce this time and work load, and thus, and importantly, his compensation! R obert J. M allin, D.D.S. M etuchen, N.J. A u th o r’s respon se: Dr. Mallin takes issue with my position th a t hiring an associate is a convenient way to
attract more patients. His position is th a t an associate is w arranted only when you have “a patient base so large th a t the solo person cannot service it.” T hat’s like McDonald’s saying, “We won’t add a second cook until th ere’s a long line at the counter.” By the time the additional cook comes aboard, everyone’s down the street at Jack-in-the-Box. The point is th a t if you, the dentist, are truly consumeroriented, then you will plan in advance to meet patient needs, rath er than w ait until the demand for products and services forces you to expand, by which time your potential new patients have gone off to find a dentist who is ready to meet their needs. Being consumer-conscious means being open when it’s convenient for patients (we’re open 7 a.m. to 7 p.m., seven days a week). Being open those extra hours necessitates two associate doctors. As word of these new hours and th a t addition of skill and care got out, the public responded to the extent th a t we’re already thinking of adding still more associates. And th a t’s the point: expand first; then welcome new patients. Howard E. Farran, D.D.S. Phoenix, Ariz. ASSOCIATE POSITIONS
Dr. F arran’s article in February was published three years too late! After graduating from dental school in 1991,1 was eager to find an associate position with a practice that had a senior dentist equally eager to pass on his expertise and working knowledge of dentistry. I settled for a position
any action on your part will dissuade the patient from leaving the practice. For m any of your patients, however, their decision will be “elastic.” They’ll stick with your practice if they can see some good reason for doing so. Here is where you and your office staff can really have an impact on the future of your practice. The critical factor is quality. Not technical quality, for few dental consumers are capable of assessing the quality of dental service. Rather, it is the patient’s perception of quality th a t will influence choice. At issue is the quality of service offered by you and your dental team. The message is clear and unequivocal—enhance your commitment to service. Practitioners who expect to survive today’s marketplace revolution with their profes sional dignity intact will provide service th a t exceeds the professional norm. Their practices will demand th a t all staff members personalize every interaction with patients. They will provide services th a t assign the highest priority to minimiz ing logistic barriers, such as patient waiting time for appoint ments; service th at defines a personalized after-hours com munication system for patients in need; service th at offers meaningful acknowledgments to loyal patients who refer friends and acquaintances; service th at is innovative—such as providing transportation to the elderly or others who might have difficulty accessing the practice. The realm of creative quality services is boundless, limited only by the creative energies and imagination of your dental team. 658
JADA, Vol. 125, June 1994
Do patients really respond to high-quality, personalized service? Check the cover story by Dr. B arbara Gerbert and others in the March 1994 JADA. Patients gave highest scores to dentists’ caring attributes and professional competence. Interestingly, the patients’ beliefs about their dentist were more positive than the dentists’ view of themselves. Major differences in scoring were noted between patients and dentists on the importance of the dentist “explaining dental procedures, offering reassurance, and being friendly and cheerful.” Dentists rated these items 10 to 20 percent lower th an patients. Dentists take heed: there is a not so hidden message in those responses. W hat can the dental team do to reinforce its commitment to patient service? As an initial step, consider assessing the present quality of those services. Try a questionnaire to determine w hat patients do and don’t like about your practice. You may even w ant to hold a series of focus groups bringing together a small group of patients over lunch or dinner and inviting them to be open and frank about their experiences in your office. A useful initiative for the dental office might be to institute a Total Quality Management System. U.S. business and industry have successfully used this system to enhance their business operations and productivity. Some have characterized this system as the ultimate marketing tool. It is concerned with changing the organization by involving all members of the
work force in a concerted effort to do things right the first rather than reactive manner. In 1972, Studs Terkel published “Working,” his description of the American worker. Included was a characterization of the dentist who was quoted as saying, “I’ve had some patients who did not stay with me. There are some people who are used to deference. This is not my way. ... Damn it, when they’re in my office, I’m boss.” If Mr. Terkel’s dentist intends to survive into the 21st century, someone m ust convince him or her th a t professional competence alone is not enough. To compete effectively in the dental marketplace of today and tomorrow, dental professionals m ust have an unwavering commitment to individualized patient service. ■
ADA welcomes letters from readers on topics of current interest in dentistry. JADA reserves the right to edit all communications and requires th a t all letters be typed, double spaced and signed. The views expressed are those of the letter w riter and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated. RECOGNIZING ABUSE
In his January 1994 editorial, Dr. Meskin suggests th at dentists take courses to familiarize them in recognizing abuse of spouses, children and the elderly. You w ant to assign
LEITERS
us yet another task, Dr. Meskin? You close your editorial by asking the question, “If not us, then who?” That is, if dentists don’t address this problem then we are remiss. I reply with an adolescent slang phrase, “W hat a guilt trip.” It is equally dismaying to note th a t the ADA House of Delegates made a similar statem ent in 1993. Who, you may ask, is in favor of the abuse of people? No one. But the question begs the issue. N either am I in favor of auto theft, illegal immigration or divorced parents who do not financially support their children. But I am not willing to join the enforcement body of individuals who combat these problems. It is a topic th a t m ight place people in the position of being thought of as callous and uncaring if they oppose the idea, but I disagree with th a t conclusion. In tru th there are many unfortunate, brutal acts th a t are perpetrated on hum an beings by other hum an beings. And an occasion may arise when you or I have an opportunity to be helpful. I hope we will do so, but I hope we will do it respons ibly. A false accusation or even insinuation of abusive behavior can cause a great deal of hurt. As surely as you institute required completion of a continuing education course for dentists about the recognition and referral of abuse, the num ber of complaints will increase—some justifiably and some unjustifiably. Instead of shifting the partial solution of the abuse problem to us, how about recognizing the responsibility incum bent on the injured 660
JADA, Vol. 125, June 1994
party, or the spouse, the nonoffending parent of the child, a relative or neighbor of the elderly person. It makes a dram atic state ment, but is it true? I do not peruse JADA seeking dram a and appeals for social pro grams. Let’s stick to dentistry! D onald M. Sm ith, D.D.S. O klahom a C ity ASSOCIATES HI PS
I agree with most of the observations from Dr. Howard F arran ’s article (“Associateships: A Business Wedding,” February JADA). But I think Dr. F arran has stated fiction as fact. He says, “Hiring an associate is a convenient way to attract more patients.” I take serious issue with this statem ent. Except for vague, anecdotal comments (such as Dr. F arran ’s), there is not a shred of evidence anywhere th a t proves this statem ent. In fact, in my experience, the practitioners who make this assumption are the very ones who find th a t “associateships” don’t work! I believe a key element in one’s decision to hire an associate is to have a patient base so large th a t the solo person cannot service it. Then—and only then—is there room for, money for and a reason for an associate. The one exception to this is the owner who wishes to reduce this time and work load, and thus, and importantly, his compensation! R obert J. M allin, D.D.S. M etuchen, N.J. A u th o r’s respon se: Dr. Mallin takes issue with my position th a t hiring an associate is a convenient way to
attract more patients. His position is th a t an associate is w arranted only when you have “a patient base so large th a t the solo person cannot service it.” T hat’s like McDonald’s saying, “We won’t add a second cook until th ere’s a long line at the counter.” By the time the additional cook comes aboard, everyone’s down the street at Jack-in-the-Box. The point is th a t if you, the dentist, are truly consumeroriented, then you will plan in advance to meet patient needs, rath er than w ait until the demand for products and services forces you to expand, by which time your potential new patients have gone off to find a dentist who is ready to meet their needs. Being consumer-conscious means being open when it’s convenient for patients (we’re open 7 a.m. to 7 p.m., seven days a week). Being open those extra hours necessitates two associate doctors. As word of these new hours and th a t addition of skill and care got out, the public responded to the extent th a t we’re already thinking of adding still more associates. And th a t’s the point: expand first; then welcome new patients. Howard E. Farran, D.D.S. Phoenix, Ariz. ASSOCIATE POSITIONS
Dr. F arran’s article in February was published three years too late! After graduating from dental school in 1991,1 was eager to find an associate position with a practice that had a senior dentist equally eager to pass on his expertise and working knowledge of dentistry. I settled for a position