The concept of unit-based dentistry is based upon the sickness-centered medical model and a by-product of the industrialization of health care delivery. As such, it begs a question: Are people simply the sum total of their body parts? And if so, when someone is missing a few of their body parts, are they therefore less of a person as a result?
Obviously, we are much more than a sophisticated aggregation of symbiotically functioning parts. Why then are we seduced into treating our patients as if this were not the case?
Another question: Would an artist ever consider charging per color when creating a painting? If the medical model of reimbursement were true, universal, and appropriate, why wouldn’t the value of a painting simply be based upon the sum total of the cost of the paint and the time it takes to apply it?
Is a masterful painter more or less of an artist than a masterful dentist designing and creating sophisticated solutions which take into consideration -at extremely high levels – biology, physiology, biomechanics, neurology, form, function, esthetics, and dare I say…feelings?
My point here is that unit-based thinking is mechanistic , reductionistic, and puts us at great risk of completely separating our thinking and treatment strategies apart from our patient’s complex and fascinating humanness.
Unit – based thinking is an immediate solution-centered concept fostered by historical insurance reimbursement patterns. It completely disregards the complexity of our work -on and with humans – and the fact that we are much more than an accumulation of teeth, bone, and gingiva attached to jaw joints.
The challenge remains for many dentists to figure out how to treat their patients more holistically when they are only being reimbursed by third parties for parts repair, servicing, and replacement.
Dentists who aspire to treat their patients as “whole people” with feelings, goals, and uniquely challenging physical circumstances must separate themselves from the needs and the demands of the insurance industry as much as possible if they are to be successful.
Dentistry is an art and a science. It is also extensively about care, skill and judgment. In that context, a crown is not just a crown applied universally like a 3/4 inch stainless steel bolt, an exam is not an exam when goals differ, and a treatment plan is not the same for every patient with the same code-worthy disability.
Clearly getting paid by the unit simply fails to acknowledge this fundamental truth.
Paul A. Henny, DDS