Mediocrity is the New Standard of Care

I was raised in Crown and Bridge with strict standards, where no steps are skipped and where I was proud to put my name on every case that I completed.  My Dad once admonished me, “If you think you can do better, why don’t you?”

My Dad was the ultimate role model—I saw him remake dentistry that almost everyone I know would accept. No one will ever match the sheer volume and quality of cases that he did in his 50-year career; and  I have 100,000+ slides to prove it.  My father always maintained that one of the hardest tasks in Dentistry was “to be your own worst critic.”  No one is looking over your shoulder and watching what you are doing.  Patients have to rely on their doctor to right by them because they have no way of judging what is being done for them.  It is a breach of trust when the Doctor looks the other way when something is not right.

All too often I hear dental practitioners give up and proclaim “That’s the best I can do.”   What a cop out!   Do they really think they will get away with that broken margin that no one can see?  Not likely!  Bacteria are microns and the open margin might as well be the Grand Canyon.  The poor patient will be the one to suffer the consequences.

Unfortunately, all too often steps are being skipped in lectures and article presentations.  It certainly is more profitable to slap some dentistry in the patient’s mouth in two visits and not worry about how it will last.  I voiced objections at a recent meeting, and do you know what was said to me?

“No one can practice like you;  Insurance company reimbursements won’t allow me to do the kind of dentistry that you do.”  These statements are simply justifications for accepting mediocrity.  So many dentists kid themselves with this belief that I have to conclude that “Mediocrity is the New Standard of Care.”

Most worrisome is how attitudes have slid into mediocrity over the course of my career.  When I started my career, my new dentist colleagues in my residency program wanted to learn as much as possible.  Whenever we residents were offered free continuing education—we were there!  Evening or weekend didn’t matter, we were there!

Not so with the residents I have seen of late.  I have heard numerous complaints from Attending Dentists about the attitudes of their residents.   I gave a presentation at a residency program in Brooklyn a few years ago.  I called the Director and remarked that one hour was not enough to teach very much.  I wanted to give the residents a full day of continuing education on a Saturday; and I was willing to come for no fee.

Do you know what I was told?  The residents would never come on their days off—only on workdays would they come.  Worse, I had the displeasure of overhearing some residents bitterly complain about their salaries—that they were worth so much more than what they were being paid.  Really???!!!  New graduates have rudimentary knowledge and skills because education really begins the day of graduation.  The residency compensation is NOT a salary; it is a token payment so doctors can live while they continue their education.

One factor that may be contributing to such attitudes is the fact that students graduate Dental Schools with unbelievable debts—and in fairness, it is much worse than when I graduated dental school.  At a time when they SHOULD be concentrating on building their knowledge and skills, they are forced to concentrate on how they will pay back their enormous debts.  Many accept employment in corporate “mills,” and they are pushed into a production mindset instead of a mindset of learning and quality.  Once they start down this path, they are done for.  They will never become great practitioners and they are likely to hate Dentistry and never give anything back to the profession.

We should all  be angry that a rich country like America can’t find funds to subsidize education so students don’t have to start their careers this way.  Isn’t it ironic that money is available to build that bridge to nowhere or to fund studies on the sex lives of slugs, but there is no money to support dental students?  We should be outraged and demand change.

However, blame for such attitudes cannot be pinned solely on government or financial circumstances.  There are many individuals who have excelled in spite of disadvantageous life circumstances.  It IS possible to overcome hardship, but only with a positive attitude and an intense desire to excel.

One very important ingredient for success is to find the right mentor.  I was lucky enough to have the perfect mentor–my famous father.  He was a tough taskmaster, so being his protégé was no walk in the park.  I spent a great deal of time working with him and observing everything he did. I sat in on all his courses; and I assisted him with the demonstration courses he gave at the office to practicing dentists on Wednesday mornings.  I asked a lot of questions.  I did all the patient emergencies after hours and on weekends.

I did not win patient acceptance and trust overnight.  No patient really wants the “young guy” when they are used to being treated by a master.  But as I improved, the patients began to realize that I was an excellent practitioner they could trust.  They liked that I had an easygoing personality.  The patients recognized that my father and I complimented each other perfectly.  We made such a great team!  I had such admiration and respect for him, even though he was difficult.

When I first came to Arizona I visited Talliesin West, the Frank Lloyd Wright house where he once trained student architects.  Frank Lloyd Wright was a tough taskmaster, but he was a genius innovator who changed the course of Architecture.  Students endured harsh treatment in order to learn from him because he was the best.  My father was very much like Frank Lloyd Wright—a genius innovator who was difficult, uncompromising and, at times, downright mean.  I often think that today’s young practitioners would never put up with such treatment to learn from a master.  They  haven’t had enough life experience to overlook the gruff exterior and see what really mattered.   What’s in someone’s heart?  Now that’s what matters.  My father was really a pussy cat wearing a lion suit, (I’m sure he did not want anyone to know that.)  He would go to hell for his patients and his friends.  But those who can only see the superficial gruff exterior would  view every inappropriate comment as an insult and leave in a huff.    By placating their fragile egos, they would lose out on something truly wonderful.

My father lined up full mouth cases in my first year of practice (no one usually does cases like this until they are in practice for TEN years).  The patients were only going to pay the laboratory fees.  My father was going to check every step—and believe me–he RARELY gave compliments.  Mistakes came with unimaginable tirades that were very unpleasant.  On my very first patient in practice I had to prepare 32 teeth for fixed bridgework on the upper and lower arches! That case turned out great and lasted for many years.  But the outcome did not result by luck or by saying “That’s the best I can do.” It came through hard work, through a willingness to do things over, and by not skipping steps to save a visit.

Quality Dentistry must promote health and longevity, not just esthetics.  Rarely do the courses and magazine articles show outcomes of health and longevity.  All that is shown is the esthetic result on the day of insertion.  The profession should demand that practitioners show finished X-Rays and followup X-Rays 5, 10, 15, 20 years later.  The ONWARD program’s case examples almost always include these X-Rays.

Can you imagine how hard it is for me—having been brought up in Dentistry with intense attention to detail and quality– to see the blind acceptance of mediocrity all around me? I simply want to SCREAM!!!    I KNOW where full coverage restorative dentistry came from, and I KNOW it is going in the wrong direction.  Will someone please listen!

I believe strongly that anything new that comes down the pike MUST be compared to the standard of what came before.  This is NOT being done. Many young dentists feel that because they are skilled in “high tech” that they are offering the highest quality dental care.  Nothing could be further from the truth.  Technology is a tool; not an end in itself. If the high standard cannot be obtained with high tech, it is of no value.  Let’s compare outcomes. Let’s see which basic principles were violated with high tech in the name of expediency and profit.  Then we’ll talk.

But in order to have a real conversation, come to the table with the right attitude–an honest striving for excellence.  Be your own worst critic.  Take great pains to ensure that no error is overlooked.  Come to the table with these aspirations—or go home.

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