I came across an interesting chapter in one of the five books I am trying to read at the moment, which talked about the frustration people experience when, ahem, faced with a large number of possibilities to choose from. This particular chapter was dedicated to how we choose health care providers and how in today’s world a lot of the decision making in health care is being left to the patient (as a consumer). The patient/client is faced with mind-numbing quantities and permutations of possible choices of health insurance cover, conventional and alternative treatments, medication side effects, etc. They are supposed to make informed decisions about their treatment, become an “overnight expert” in their ailment and then, using information given by the doctor, the media and the Internet, they are to tell the doctor which treatment modality to proceed with. The author goes on to say that most people actually feel apprehensive about making these decisions and would rather trust an expert to decide, with their best interest at heart!

Wow! I have to admit, this one chapter got me thinking about a lot of things I used to consider as commonplace in modern healthcare. I started questioning what I was taught in my “community dentistry” subject at University!

Firstly, my generation are among the first to be completely at ease with dentistry as a service industry, dedicated to serving consumers, who in return have rights guaranteed to them by various consumer acts. Dentistry had moved on, much like medicine, from authoritative attitudes of practitioners who treated their patients like simple-minded children and into an era of informed consent, patient-centered practice and lastly, consumerism! Back in the dying years of the 20th century, in my very early 20s, I felt this was a reasonable model for a modern health system. It gives the power back to the patients, it expects accountability from practitioners and it forces doctors to spend at least a little time educating their patients.
A decade later, having had to face the realities of private practice in the CBDs of two major cities in Australia, I am beginning to question whether we took consumerism in dentistry a touch too far! You don’t have to look very hard to spot an example of how consumerism is affecting dentistry today: dentists themselves are progressively becoming more at ease with mass marketing tools previously reserved for “non-professionals”, however, more interesting still is the sleek marketing presence of manufacturers of dental implements (like non-fixed orthodontic appliances manufactured in Central America and Asia) in front of the general public. Then there is the clever the use of “no wait periods on extras benefits” in most health insurers’ campaigns to drive their insurance sales. Heck, the insurers have even gone a step further and now want to offer you not just a choice of covers and rebates but also a choice of dentists you can see, how many visits per year you can have and the list goes on, all in disguise of offering “more choice” or “better service” to their ‘members’. They like us to think that paying our premiums somehow gives us a coveted title of ‘member’, making us feel like we ‘belong’ to a large, happy family of healthy, smiling, satisfied people who get amazing service and huge benefits from their fund! It makes you want to do splits in the air and yell out how much better you feel for knowing how lucky you are, doesn’t it?* 
Is this emphasis on choices shifting our patients’ focus from the imperative of their health to a prerogative to exercise their consumer rights, the basic one being the right to choose, to “vote with their feet”? I was asked by one of my patients a while ago:”How is it that whenever I change dentists, I end up needing to have some treatment on my teeth?” I really liked his question, not only because he had observed a pattern which is well known to scientists who do research in dentistry (and that is lack of consistency not only between operators but also with same operator over a period of time), but also because he pointed to a very important part of the patient-dentist relationship and that is: HISTORY…personal, medical, dental! 
A long term patient-dentist relationship allows the dentist to get to know their patient on many different levels and establish their “baseline status” or what is “normal” for that patient. Only then can the dentist pick up on changes, or the “abnormal”. Knowing the patient really well also helps the dentist avoid the awkward situation of presenting them with treatment options and fees which may be completely overwhelming to them. When faced with a decision which may involve more complex treatment, the patient would feel less anxious about making the decision, because they would feel a great deal of trust in their dentist. Trust is something which develops in a lasting relationship, not something patients or dentists are supposed to immediately feel for each other. I am a big fan of choices, but most choices we are bombarded with daily are just different packaging for the same thing, so we seem to fall back on cost as the determining factor of our choice. However, are all dental services the same? 
I believe that in the age of modern materials and modern preventative care it is unforgivable to lose teeth, develop jaw and muscle dysfunction from missing teeth or allow poor oral health to affect the way our patients present to the world. As a professional, I take pride in enabling my patients to function and look like nature intended. I believe good oral health is achievable through education and through a deeper involvement in our patients’ lives. I believe what my patients are buying from me is not just my technical skill in producing their restorations or improving their appearance, what they are buying from me is a promise, a guarantee that one day, with our help, they will be better. They are asking of me to be a part of their recovery, not just a part of their problem. 
Dentistry is being challenged by the modern consumer while the consumers themselves are being challenged by the overwhelming complexity of what they are trying to understand and choose from. It does not have to be this complicated! 
No matter what you are faced with as a client or a dentist, ask yourself these three questions first: 

1: How well do you understand your current condition? 

2: Do your trust your dentist’s ethical, professional and personal judgement to deliver the best service or product in your best interest? 

 And: 3: Do you want to be Captain Hook or The Bionic Man, in other words, would you prefer to live your life limited by ancient technology or do you want to live your life to the fullest, having a peace of mind that your health is benefiting from all that modern science has to offer? After all, isn’t that the purpose of scientific advancement, to see it in everyday use, making our lives better and richer? 

Ask, listen, question and challenge, but most importantly, find a dentist whom you can and want to trust and let them look after you, not just for 6 or 12 months, but for a lifetime! The real price of health is the price you are willing to pay to achieve it and keep it. It may be monetary, it may be a physical change (change in diet) or a psychological one (giving up smoking), but it depends solely on how far you “fall” before you decide to get back up again! 

*I should probably say here with my utmost honesty that I don’t know many people who are happy with many (if any) parts of the service their health fund has to offer. The whole health fund realm is a huge topic for a blog in itself, so I had to restrain myself, although I did rattle on a bit… It is an issue I have strong feelings about, so if you are interested to know how I feel, check in again in a few weeks and I promise to attack that topic, too.