There is a fairly common misunderstanding among dentists, that a “patient -centered” practice is a structureless, even pandering way of working with people, where the patient’s happiness is the only thing that matters.
But that is not true.
In fact, I would argue that a reductionistic, insurance-centric practice is much more pandering than a truly patient-centered practice ever could be.
Because an insurance-centered, high-volume, procedure-oriented practice is about harvesting that which is immediately available – the low hanging fruit “covered” by insurance. And how does one harvest the proverbial “fruit” as a fast as possible? By playing nice. By being friendly. By memorizing the latest way to subtly manipulate people through heuristics.
A truly patient-centered practice is much different. So much so in fact, that many who practice in this way prefer to not even think of the people they help as “patients,” because the word “patient” implies a sense of dependency and involuntary-ness to the relationship.
Yes, there are people with whom we work who are both dependent upon us as well as are with us because they have to be -and not because they want to be. But the philosophy behind a patient/client-centered practice is to move away from dependency as quickly as possible and then to move towards collaboration.
Successful collaboration is only possible when we share values and a vision for what it is that we are trying to achieve together. But values are funny things, because they are often unrefined mindless beliefs which are floating around in the background of our unconscious. They are what psychologists call “introjected,” meaning, they may be significant to the person, but there can also be a wide and unrecognized discrepancy between the evidence available for holding tightly to the values and the justification for doing so.
In short, values are about beliefs, beliefs which we tend to build our lives around – for the good and bad…”If I smoke this cigarette, I will be able to settle down and refocus on the task at hand…If I eat this brownie, I will feel better about what just happened to me…If I meet this goal, I will feel better about myself.”
Because interjected values are generally untested, the internal contradictions remain unresolved. And nowhere is this truth is more apparent than in dentistry.
Most people come to us clueless about their current status, or even about how things got to be that way. Often, they are half the way to edentulous, and in their mind, they have just been following the advice and direction of their previous dentists.
Significant change in our patients is only possible when beliefs and values are re-examined. This means that some will have to be discarded, some updated, and some re-prioritized.
And THAT is what patient/client-centered practice is really all about – helping people to help themselves through values clarification and therefore better decision-making. Even thought this approach may lead to more patient/client happiness , happiness is not the primary purpose , realization of greater health is the primary purpose.
Paul A. Henny, DDS
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