The Eastleigh by-election has been in the news these past few weeks and the result announced as I sit down to write. Not only is Eastleigh close to where I live and work in Winchester, but inevitably, a mid-term by-election in a key seat (especially given the tense relationships in the Coalition right now) was always going to attract a huge amount of media interest.
Clearly one of the headlines of the day is that UKIP came so close to ousting the Lib Dems from one of their strongholds, and additionally pushed the Conservatives into third place, albeit by gaining votes from both of the governing parties.
A commentator voiced the opinion that UKIP’s ‘protest vote’ was not so much on policy grounds, as a general reaction by the electorate against ‘elitism’. Such a feeling, he said was not directed just against politicians but against other sectors of society, such as bankers and the professionals involved in the ‘Mid Staffs’ report.
As professionals in dentistry, I guess we have, perhaps unconsciously, always regarded ourselves as something of an elite, even though our earnings don’t put us in the same league as, say, professional footballers or hedge-fund managers.
Elites are, according to the dictionary: “a group of people considered to be superior in a society”. The derivation, although obviously French, comes from the same Latin root as the word ‘elected’, so while that applies certainly to politicians, it is hardly applicable in healthcare professions. Not even, these days to our own elite – the members of the GDC who are now appointed.
If we are an elite, does that mean that we are tarred by the same brush as MPs and bankers? Do we therefore deserve to be considered in the same terms? The famous ‘vox pop’ quote has the man or woman being interviewed in the street and saying: “I hate dentists... but my dentist is great”, which suggests that fear might not be the biggest characteristic associated with dentistry. It suggests more to me that the relationship of trust with an individual dentist is far more important to a patient than the characteristics of ‘all dentists’ considered as a whole.
That underlines to me that the ‘care’ in health care is just as important as the ‘health’ part. We
train to provide effective, evidence-based and keenly efficient health outcomes for our patients, but if we forget to ‘care’ for them as individuals then we are indeed in danger of becoming just another ‘elite’.
Just as politicians, and it seems, investment bankers appear to have lost the ability to put themselves in the shoes of the ordinary person, struggling with the pressures and tensions of life today, we have to constantly put ourselves in the shoes of our patients and perceive the treatment we provide from their viewpoint.
I constantly argue with colleagues that it’s not the cost of dentistry, but the worth or value of dentistry to each patient that is the deciding factor between treatment plan acceptance or refusal.
Milton Erickson, the famous psychotherapist used to shock his patients by congratulating them, at the outset, on their problems. He was far more interested in why they became obese, continued to smoke, or had other failings. He explored the reasons behind their unhealthy or dysfunctional issues and then looked to find alternative solutions. Once a solution, a ‘re-framing’ was found, he never mentioned the ‘problem’ as such again.
That’s an extreme example, but it bears thinking about. Why does a caries prone patient snack between meals? How can we replace that problem with a solution? The same goes for home care, interproximal cleaning, whatever. One thing we do know for sure, and that is that ‘telling’ patients they have a problem and that ‘this’ is what they should do about it simply doesn’t work in the real world.
I don’t think you can ‘motivate’ a patient either, all you can do is to help them see themselves in a different way. Help and care are pretty much identical concepts to my way of thinking.
For the same reason, dental health education campaigns raise awareness (maybe) but they don’t achieve much more than that in my view. Each patient has their own mindset and unconscious rationale for unhealthy or aberrant behaviour. And blaming a patient for their disease is probably the last thing you’ll ever say to them.
If we are indeed an elite we need to avoid becoming classed with the others that I have mentioned here. We need to become truly ‘elected’ by our patients to a position of trust and to understand their priorities and their motivation.