Elephant in the room

I am a student. I fall into the third category (36 percent) described by Dr. L.D. Pankey in his famous “Ladder of Competency.” Sometimes I think of myself as being in the second grouping, the 8 percent of us who are very adept at what we do, but mostly I am satisfied with being a lifelong student. I have been in practice for 33 years and have become very dependent on continuing education. I am grateful that I don’t fall into Pankey’s fourth (and largest) grouping, the 54 percent of the profession who are indifferent, and I think that saved my career and my life. Pankey said there are about 36 percent of us who are students that have become quite dependent on the 2 percent who are truly the masters of dentistry (his first category). It is to the masters that the adept and the students owe a debt of gratitude.

Throughout the history of dentistry, it has been easy to spot the masters. They usually were associated with the very best learning institutions. They were published in the very best refereed dental journals. They wrote the books and they gave the courses. I can remember asking the great dentists how they accomplished beautiful and functional dentistry so consistently, and they answered as if they had been there when it all began. Their appreciation for the art and science of dentistry was unsurpassed, and they continue to be something we should all aspire to be like.

The work of masters

There is a Zen story I tell that describes the work of masters. A lady goes to a master calligrapher to purchase some artwork for her home. The master tells her to come back in six months. She is surprised at the length of time, but obeys the master. In six months, he tells her he needs more time … another year. Annoyed, she now leaves, wondering what could take so long. Eighteen months after she initially contracted with the calligrapher, she returns only to find out the master needs still another six months ... but he assures her it’s getting close. Finally, two years after she first began her quest, the master reveals the most beautiful calligraphy she has ever seen.

But why, she asks, did it take so long to produce this one piece of art? The master walks her over to a cabinet. When he opens it, out falls thousands of renditions of what she had asked for.

Masters are rare people who take their work to another level.

At least that’s the way things used to be. No one can deny that we have had a cultural shift in this country. That cultural shift has affected every industry, including dentistry. These days, for whatever reasons (mostly the pursuit of profit over perfection), we cannot tell the masters from the imposters. It has become too easy to make things appear as if they are perfect, when in reality they are not. You do not have to go very far to see what I mean. Open any dental magazine and you’ll find an advertisement that shows perfectly natural teeth and implies that some product or technique is responsible for the result.

Real ... or illusion?

Popular magazines and television shows use computer aids and makeup to give the illusion that things are possible when in truth they are not. Advertising and desktop publishing have made paper masters out of very average dentists. Take a look at some magazines and Web sites in your local area. How many touch-ups can you find?

I know you’re saying, “What’s the big deal? Everyone does it.” Well, that’s what I asked myself - as a student and dental practitioner - what is the big deal?

I am reminded of the famous Hans Christian Andersen tale about the emperor’s new clothes. The captivating story survives to this day because of the commentary it makes about our society. The crowd praises the beauty of the clothing when, in fact, the emperor is naked. A child then becomes the whistleblower by yelling out loud, “Either I am blind or you are naked.”

Andersen makes the whistleblower a child for good reason. It is hard to blame a child for exposing the truth that we all see. In today’s world, too many of us stand by and watch as obvious frauds pass our very eyes. These frauds are a big deal to the children ... and to the students. The students are tomorrow’s professionals. To let things get by, we bring down the entire profession. We have seen gross, dramatic effects of this “elephant in the room” scenario throughout our culture.

Acknowledging the elephant

In his book, “The Elephant in the Room,” author Evitar Zerubavel tells us “the verbs ‘to notice’ and ‘to remark’ are denoted in French by a single word, remarquer, which reminds us how closely related noticing something and publicly acknowledging having noticed it actually are.” In France, the whistleblower is regarded as a hero.

Robert Cialdini, author of the book, “Influence,” recounts such a story that occurred during the ’60s in a New York City neighborhood. A woman was brutally raped and murdered on the street while 12 onlookers stood by and watched. Cialdini explains this behavior with a concept known as the social mirror, in which we look to one another for the correct behavior rather than acting according to what our eyes tell us.

This story of Kitty Genovese reminds me of the conspiracy of silence - the biggest difference is that someone died … and most cases aren’t as dramatic. But does that take away the consequences of ignoring what happened?

Every week, dental professionals, young and old, come together for the sake of learning to be the very best they can become. There are many great dentists in this country who have so much to offer. The masters still live amongst us, but how am I, as a student, supposed to know what is real and what I can believe? If what I see is so magnificent that it defies human ability, then am I to be encouraged to do something I cannot do or be discouraged about never being able to accomplish mastery? Is what I am seeing real dentistry or is it illusion?

And what about the patients?

I stopped doing computer imaging many years ago. I take full advantage of diagnostic wax-ups, but I stay away from things I may not be able to reproduce. Patients come to us with pages ripped from magazines and ask us to duplicate what they see. Sometimes it is possible. Sometimes it is not possible. Michelangelo once said, “Trifles make perfection, and perfection is no trifle.” It is important that the domain of education remains with the masters. Students of today sit in wonder viewing the elephant in the room, then ask, “Is what I am seeing real? Is the speaker being subsidized? Can the material do what it promises?”

Patients expect perfection.

Dr. Pankey’s Ladder of Competency revealed that 54 percent of dentists are apathetic or indifferent. If we continue to ignore the elephant in the room, then the masters, the adept, and the students will become part of the problem rather than the solution.

Barry F. Polansky, DMD, practices in Cherry Hill, N.J. Author of the book, The Art of the Examination, and publisher of “Dental Life,” he is on the visiting faculty of The Pankey Institute. E-mail him at [email protected].