EDITORIAL

Orthodontic issues as seen by constituent society presidents Part II

We really have no ri.ghts; nothing but responsibilities-chiefly, a basic duty of sewirk to the public and educational qualifications at a high level of competence maintained by continuing self-education.

-Wilbwr D. Johnston, President’s Address.

espite its shock value, there is a certain element of truth in the statement that President Johnston read before the Northeastern Society. We have, of course, all the rights of every American citizen, but we also have a professional responsibility that goes far beyond that required in most human endeavors. The reason is simple: Our patients are not able to judge professional services; they can only rely on our intellectual and ethical honesty. We must not betray that trust. There can be only one standard of health care, and the public is entitled to the best. Our responsibilities, indeed, are greater than our rights.

These sentiments were echoed when President William C. Jackson told the Rocky Mountain Society that it “might be possible, through continued educa- t.ion and effort, to mount a response to the demands placed upon us. We have an obligation to strive for this goal and, indeed, the public has a right to expect no less.” In a commentary on the current social unrest, President Jackson also advised us “to pay more than casual attention to the younger generation’s call for greater concern and participation with the civic, social, and environ- mental problems of our communities. With our extensive education and train- ing, we are more qualified than most to make contributions of talent, time, and effort. We must not extract more from the community than we put back in. It may well be that our own self-interest, as well as the interest of the com- munity, would best be served by assuming these responsibilities, along with those for which we have been especially trained. ” To which Midwestern Presi- dent Karl von der Heydt added: “We must be willing to accept these re- sponsibilities, for history teaches us that such changes will be enforced by ex- ternal authority if we relinquish the helm. ”

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At the Middle Atlantic meeting, Presid(~nt~ Rol)t~rt 13. I It~lg:cs cic~s~ribc~rl tho newly developed depa.rtmcnts of c~ornmunit,y dentist I*,V in the clt:nt,:tl srlrt~~ls. The principal purpose of these depart.mc~nts, hc said, is 10 “:lCT~ilijil~t tllc clC’lltill student with the needs of the public, ,\\-ith 1 hc I~D t111(7 in which ~1rntislr.y i7ltl best serve the great& number of p~oplc, ilIlt 04th clc:ntistr~~‘s IY~liLt,ioU t0 Ilicl total health problem. It is a departmcint that ~O~CVIXS itself with evcryt hing fmn epidemiology t,o community care. It may btt wcbll Bliat we in c~rtl~ocJonti(*ti should think in the same frame of thought. . . . (C’ertainly, some phases of corn- munity orthodontics should be a part of every orthodontic I raining program SO that the new practitioner will he aware of his l,csponsibilities to t’hc corn- munity. ”

Public health care and the associated prepaid h~~alth programs were of concern to every constituent societ,y president. At the Southern meeting7 I’resi- dent Charles R. Crook warned that “prepaid dental programs arc not som+ thing of the future. They arc here IJOW, and thtly arc here to stay. They will proliferate as the public demands, ant1 be assured that the public will tlema~~cl as it becomes informed. ” President. Johnston concurred when hc said : “It is difficult to forecast what the immediate fut,urc will bring or what course our professional practices will take, but I can a.ssure y-on major changes in the delivery of all health services to t,he public will be made and made soon.”

President Robert R. McGonagle told the Great, Ilakes Society that “as dental prepaid programs expand and include orthodontic trca tmctnt as ;I fringe bonc- fit, it is essential that our position bc a.clequately rcpresonted while bargaining with the third party groups that est,ablish these programs. This fast-growing development makes it essential that \vfk have stron g fwnlponent sockt.ics wpw- senting us with state dental scrvicc corporations, private insurance c’ompanics, and the third party programmers, Every program must hale one basic tctnctt--- the welfare of the patient. ”

In his references to public hea1t.h care, P&dent 1,loyd 11. (‘ot~tingham reported that the Pacific Coast “officers wished t (1 mainta.in our* standards and our individual customs of practice, yet they knew that we ha.d to provide a means whereby a third party could pay the bill. The officers ditl not want, the patients neglected, and they did not want the bill payer telling us how to set our standards. They had many fears and experienced many squabbles. Thcsc fears had not been unfounded; nor have the squabbles been unfruit i’ul. I am happy to rcpolt that orthodontic care has not succuuibctl to tli(> wrath of tht! fund masters; nor are we under the foot of a czaristic director. We appear to be able to live with thr cha.ngcs that hare been brought, into our prac+cac>s.”

President Cottingham then urged t.hat, orthodontists become I~IOI’R \~.a1 with their state and national dental organizations, for that is where 111(x tl+ cisions will be made on these complex problems. Similar recornn~cndatit,ns on increased orthodontic participation in ADA affairs were matlc by PresidentZ Crook and by President Johnston. In referring t,o this obligation, President Willis H. Murphey told the Southwestern Society :

The position of the or(thodontist of the 1970’s and his relationship with dentistry should be of major concern to each member of the American Association of Orthodontists.

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[We must] be aware of the tremendous impact of the American Dental Association’s 1970 Task Force on National Heal,th Problems. The concerns of this task force include dental manpower, delivery of services, quality review, methods of payment, priorities of service, a review of national health programs, and consumer concerns.

We are proud that an orthodontist, Edward A. Cheney, ADA Ninth District Trustee, will head ‘the committee on priorities of service and review of national health programs. These committees will report to the fourteen-member task force which, in turn, will make its report to the House of Delegates through the Board of Trustees of the American Dental Association.

In meeting its manpower goals, the constituent society presidents reported increased activity in the potential functions of auxiliary personnel. In a series of comments, President von der Heydt offered this as a possible solution for meet.ing the public ‘s need for additional dental service :

There is a shortage of brain power for all of the tasks in modern society. We probably cannot afford to allocate a substantially higher percentage of capable students to dentistry. Instead, a way must be found to relieve the dentist of the necessity for doing technical procedures which largely require manual skills and artistry, rather than broad knowledge and professional judgment. It is not reasonable to have the highly trained dentist in- volved in work which does not call for the use of his extensive background. The goals of the seventies must be toward the “training” of auxiliaries and the “education” of dentists and orthodontists. In the past, too many of us have been “trained” and too few have been “educated.”

If the dentist of the future is to reach a level of professionalism which truly reflects the caliber of his education and the high degree of his responsibility, a more liberal interpretation of the duties of auxiliary personnel needs to be made. Dentists should be responsible for the professional services of their employees, provided that the latter have had educations appropriate for their duties. The role of auxiliaries in dentistry is currently a matter of heated and serious discussion. The debaters should remain objective and un- selfish, keeping in mind that the responsibility of the profession is to provide better dental care for more people--obviously, not an easy task. This will require all the ingenuiby we can muster.

President von der Heydt was not alone in his concern about our responsi- bilities in maintaining high standards in orthodontic treatment. In his ad- dress, President McGonagle had this to say :

We also hear the complaint that we don’t handle enough patients, but there comes a point of diminishing returns relative to our criteria of results if we increase our patient load. Certainly, the use of all possible aids in enabling us to increase our output without sacrificing quality is desirable. However, the main stimulation must come in the utilization of ancillary personnel, but the role of these people must be clarified.

The responsibility allotted these individuals varies from office to office. l think we can all agree that there are many phases of our work that can be competently handled by our aids. However, state laws, which, unfortunately, vary from area to area, set certain rigid standards, and most of us live by these limitations. Many of us do not, however, and utilize our help far beyond the set legal limits. I think it is time that the hypocrisy be taken out of this phase of our work, so that we can all feel comfortable about the assignments in our ofices.

Continuing education in orthodontics for general dentists again received

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extensive attention from the constit,rlcnt society IjrWidents. ;\ t, tjic~ 31 itl(ll6b Atlantic meeting, President Hedges first spoke of’ the co-rc?spoHsi~)ilit~ that must he shared by the universities and the specialt,ies. 1 fc then iold oi’ a qws-

tionnaire that had been submit,tecl by the I’ermsylvania Dental Soci(Tt,,v I o general dentists on specialt,y rrsponsibility. Dr. Hedges’ remarks follow:

It is interesting to note some of the comments which came from the general practi- tioners. They maintained that they really are not interested in providing maior ortho- dontic treatment, but they would like to know what is going on as far as their patients are concerned. No#tes on the condition found clinically upon the first visit seemed to be most appreciated by the general practitioner, and some of them would like to have progress reports. Most of them realize that the care will be proper, but they would like to be advised of it. Perhaps we have been too busy to let our fellow practitioners know what we anticipate doing for their patients. Again, it would seem that this problem of communication is pretty great.

As far as continuing education is concerned, they all want to take courses in the materialistic aspects of orthodontics to find out what is going on and to know what minor procedures they can safely attempt. The general attitude seems to be, “If you want to give courses in diagnosis, forget it, for we are not interested!” It appears that this matter of diagnosis for the purpose of recogniztion of malocclusion is something which should be emphasized at the dental school level.

President van der Heydt expressed similar thoughts when hc suggested that “it is all but impossible for the cloistered general practitioner to keep pace with the ‘knowledge boom’; the half-life of scientific information has been placed at about 5 years. It might be better to teach a dental student how to use an orthodontist rather than to teach him how to be an orthodontist. This should also be related to the use of oral surgeons, hospitals, laboratories, and all the other allied health services. ”

President McGonagle concentrated on the challenges of continuing etluca- tion that face the professions as well as t.he specialties. His statement read :

Continuing education is one of many demands being made on dentistry and ortho- dontics. In response, we face two choices. First, we can lead our profession toward its future. We can listen to the demands, discuss the applicability of our specialty, and make the changes believed to be in the best interest of the profession and the public. Second, we can ignore the demands, refuse to make changes, and be led probably into the role of public employees, like many of our colleagues abroad. My hope is that we will continue to guide the changes in dentistry.

I mentioned before the idea of continuing education programs for our members at our annual meetings. We are being hounded by national watchdogs of the Ralph Nader variety who are quick to seize on the fact that, once our formal education is completed, many men seem to get into a rut and make little effort to further their professional educa- tion by taking additional courses. There are a few large city orthodontic societies that have both the membership and the money to afford one or two clinical courses a year, but this hardly helps the man who is some distance from the megalopolis.

Would it be possible for our meeting clinicians to present concentrated courses prior to or immediately following our annual meeting. 3 This would enable our members to avail themselves of additional education in clinical or related fields and yet enjoy the scientific and social endeavors of our regularly planned meeting. If inconvenience is part

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of the reason men do not take courses, then the above suggestion might be helpful. To those who are not interested, then I can only say that we as a group are going to be open to critcism in the years ahead, and perhaps with some justification.

In another sensitive area, President Johnston suggests that WC may al- ready be open to criticism. His fears center around “an increasing trend toward the surgical-orthodontic approach to the treatment of dentofacial de- formities. In some instances, this is done to save time for a patient, particularly in the adult group. When the costs of orthodontic treatment are compared with the costs of hospitalization, I have doubts that surgical procedures should bc used if orthodontic procedures alone will suffice. I urge the use of experiencrtl orthodontists and the exercise of good judgment in treatment planning for such patients.” In this analysis, Dr. Johnston speaks with a certain amount of authority, since he holds an M.D. degree as well as the D.D.S. degree.

Issues considered by the constituent society presidents during their fall meetings often serve as a prelude to more comprehensive study and action by the American Association of Orthodontists during its spring sessions. !l’he various problems were analyzed in a competent manner, and many of them will receive the attention of the AA0 House of Delegates in New Orleans. Interested member are encouraged to participate in the Reference Committee hearings and to observe the House in action during the Association’s seventy- first sessions in May.

B. P. II.