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My View: Spectacles

May 07, 2012

By Kerry K. Carney, D.D.S.

I got my first pair of prescription glasses at the age of 13. The drive home was a trip through a different world. Trees were no longer cartoon-like green lollypops. They had depth and fascinating, scintillating leaves.

Every visual event contained more information. I had always thought the actors in a stage play were supposed to be iconic, like the traditional masked actors of ancient theater. It was a surprise that in a theatrical production, the audience is supposed to be able to see the facial expressions of the actors on stage. Corrective lenses brought me a new intimacy with reality.

Eyeglass lenses were so common by the beginning of the 14th century that their manufacturing strictures were incorporated into guild regulations. Only the wealthy could afford them initially, but imagine the impact of corrective lenses in those times. It must have seemed miraculous, magic. To be able to see clearly: what a revelation.

The study of optics facilitated Galileo’s observations of the moon and Jupiter in the first part of the 17th century. His careful documentation of what he observed through the telescope became the fulcrum of change for cosmological thought. Being able to see clearly is a tremendous aid to understanding.

However, seeing something clearly does not always mean we agree on what we are looking at.

The other night I had dinner with four friends. Four of us had been in the same class in dental school; three of us are in private practice and two work solely in public health (clinical and consulting). During the course of conversation, the subject of the Alaskan DHATs (dental health aide therapists) came up.

At one point, our friends in public health were agreeing with each other that if they were in private practice they would be eager to hire someone like a DHAT so that they could focus their efforts on producing veneers. I was stunned. That was what they thought private practice was about.

I spent some time thinking about that conversation. The three of us in private practice have very similar professional styles. We have small offices. We operate in one or two chairs. Only one of us employs a hygienist. We can count the number of veneers we produce per year on one or two hands. We spend a lot of time trying to educate our patients in oral health. We help our patients get the most for every dollar that they spend on their oral health care. Our reward is greatest when we see a patient turn around and begin to value his/her oral health, and partner with us to take steps to ensure its continued improvement.

It made me sad to think that my friend and colleague had bought into the view of private practice as solely production and cosmetic-focused.

Now shift the scene to a lunch meeting of dental school representatives. The subject of PGY1 (required postgraduate year residencies) comes up. There is discussion about the potential need for more residency locations and the possibility of locating more residencies in community clinics should one-year postgraduate residencies ever become mandatory.

The thought is expressed by one of the dental school representatives that those residencies in community clinics might be viewed as a lower level of training due to the limited resources for extensive prosthetic experience. Again, I was stunned. Some of the highest quality dentistry I have seen has been in community clinics where skill and creativity had to be combined to mitigate the disconnect between oral health need and available resources. I reflect that my own conservative, prevention- and caries management-oriented practice, and my reluctance to embrace high-cost technology would probably be viewed with the same implied disdain.

I suppose we are all looking at the same elephant but focusing on different parts. There are many aspects to the delivery of care. The private practice model is flexible and has survived economic downturns over a long period of time. However, there has always been a significant portion of the population that has not been able to access that model.

There is no problem communicating when we interact with those who see the elephant just the way we do. The dissonance arises when we interact with people who see the elephant through a different lens, focusing on a different part.

The commentaries in public health publications tend to depict private practice dentists as salesmen, our heads down, providing care, unable to see the big picture. Commentaries in proprietary dental publications tend to depict public health professionals as policy wonks who cannot make it in a real world combining business success and patient welfare.

Reading public health research and proprietary dental magazines is like reading about life in alternate universes: existing in close proximity but unable to communicate or "see" one another. How we see the world plays a large role in how we interact with it.

Examining barriers to oral health care and thinking about various potential ways to address those barriers is like putting on someone else’s spectacles. It can cause headaches but it does give you a glimpse of the world you live in with a different focus.

Dr. Carney is the editor of the Journal of the California Dental Association. Her comments, reprinted here with permission, originally appeared in the March issue of that publication.