Are changes in dentistry compromising ethics?-part II

March 1, 1996
Editorial Board members discuss the pros and cons of a national image-building campaign for dentistry.

Editorial Board members discuss the pros and cons of a national image-building campaign for dentistry.

Penny Elliott Anderson, Senior Editor

Could a national marketing campaign really create increased awareness of the value of good oral health, motivating some of those who never go to a dentist to seek out dental services and persuading those who do go to place a higher priority on quality dental care? With increased busyness, would dentistry see less participation in restrictive managed-care programs and, as a result, a return to higher ethical standards for the profession as a whole?

Here, in this second and final part of the round- table discussion on ethics in dentistry, are our Editorial Board members` thoughts on the pros and cons of a national image-building campaign for dentistry:

Dr. Erich Heidenreich: I feel managed care leaves the good dentist hungry, and a hungry dentist is going to do whatever he can to feed his family. Even if a dentist were unethical, he could busy himself with ethical work . . . if there were enough of it to go around. But there isn`t. The demand for dentistry does not equal the number of dentists that are out there.

Dr. Andrew Schwenk: It seems like we have been skirting the issue of who is the primary receiver of care because of all the euphemisms that have begun to burden the way we think. Unfortunately, a dentist who is hungry enough to need to pay his/her bills will be more tempted to join programs that purport to offer tremendous patient-base growth and income-generation. Once these programs have "captured" the doctor and his office to become a part of their "network of care," it is very difficult to leave. In fact, it may be impossible. We need to educate ourselves first into the areas of managed care before we consider how much benefit may be derived."

Dr. Erich Heidenreich: My solution to the problem is to increase demand for our services through a national marketing campaign. What I`m talking about is something similar to those ads we`ve all seen encouraging the public to drink more milk by showing photos of well-known celebrities with milk mustaches on them. What I`m talking about is a first-class, image-building campaign that really will focus the public on the value of maintaining their teeth for a lifetime and the importance of forming a relationship with a dentist who will help them achieve this goal.

Dr. Charlie Vogel: I think it was in 1985 that the ADA came to us with a really nice campaign that featured a professional actor, but the ADA House of Delegates voted it down, even though the ADA already had borne a lot of the cost as far as making the commercial.

My point is, if we`re going to do this, we`re going to have to accept a program that is not going to appeal to all of us individually. We might decide on a "Take Your Children To See the Dentist" campaign, even though I personally don`t see children and don`t feel it will help my practice. I might support that advertising campaign just to get the ADA to stick its foot in the water and try something. Based on past experience, you are not going to get a consensus on any one campaign. We need to give and take to develop a good overall marketing plan that will benefit all dentists.

Dr. Andrew Schwenk: One thing we seem to fail to understand as a profession is that we are in control in a way that physicians were not. Let`s face it: the AMA caved in to managed care! After all, dentistry, unlike its medical counterpart, involves noncatastrophic care. Worst-case scenario: you lose all your teeth! That`s not good, but you won`t die from it. Medicine has a catastrophic potential-permanent disability, which could mean loss of employment and the ability to provide for your family, and even death itself.

If the ADA stands firm, which it has not done up to this point, we easily can overcome this predicament. However, capitulating Washington bureaucrats will lead to our downfall without question.

At this point, I see most of the ADA "big-wigs" smiling too much and too often with those who will legislate our future. Additionally, one huge advantage we have that physicians do not have is that most of us are not affiliated with hospitals, which are the essential "sponges of absorption" for those HMOs, PPOs, DRGs, etc. It is these hospitals who say to these physicians, "become a part of this managed-care program or lose privileges with our facility." For a physician, that could be devastating to his/her practice. We do not have to deal with these threats from hospitals or large-care facilities on a grand scale.

Dr. Erich Heidenreich: The one point that everybody who has talked about this seems to agree on is that our main competition isn`t with each other; our main competition is the other things patients are electing to spend their money on. Unlike a lot of medical care, dentistry is elective. As Andrew said earlier, people don`t die from tooth loss. The problem is they put a greater priority on things like the latest exercise machine or fastest computer than they do on their dental health. It`s a question of perceived value. If people really understood the importance to their quality of life of maintaining good dental heath, they might reorder their priorities and the demand for dental services would increase. If we can increase demand on a national level by even a few percentage points, there would be more work for all of us in the profession, based on improving the standard of care, not on joining plans that encourage patient neglect.

Dr. Larry Cook: If I understand you correctly, you feel we can influence the perceptive value systems of the consuming public through an effective marketing mechanism. But how are we going to do that? How are we going to change life-long value systems?

Dr. Erich Heidenreich: Every person`s lifestyle has been impacted by the media, with television having the biggest impact. An example is the cars we choose to drive. Most of us find something we like and then stay with it because it has the features we value. But why did we choose that particular model in the first place? Who told us it had the kind of features that were important to us? If we really think about it, we probably responded to something that clicked in an ad.

Dr. Larry Cook: The problem I have with the mass thing is the "glitz" that goes along with it, and I don`t say that derogatorily. You have to do a certain amount of that to get the public to respond to the ad. But, by the same token, once the patient is in your door, then everything from that point on depends on the ability of the dentist and his team to relationally react with that patient to raise that individual`s level of appreciation of dentistry. It can`t be done with one ad. A dentist must build a relationship of trust with his patients to raise their level of knowledge and appreciation for the benefits of fine dental care.

Dr. Erich Heidenreich: That`s a good point. I agree.

Dr. Charlie Vogel: I agree with Erich that dentistry doesn`t have anything that makes you pick up a magazine and say, "Gee, I wish my teeth looked like that." You`ve got ads from the toothpaste companies and other dental products that we know people are responding to, because my patients frequently will ask me what I think about a toothpaste or an electric toothbrush they`ve seen in an ad. But we don`t have anything that says to the public, "You, too, can have beautiful teeth that last for a lifetime if you see a dentist regularly."

I think such a campaign would be great, but I don`t think you would get enough dentists to underwrite the cost. The problem is too many practitioners would worry that it would generate business for other dentists and not for them.

Dr. Andrew Schwenk: So we are in competition with each other?

Dr. Charlie Vogel: We are because we believe we are. Where you really see this is on the local level. You get something like this down to a vote of the local dental society and you`re going to find it won`t pass, because too many dentists will say to themselves, "I`m not going to have anything to do with that marketing program because it might help that guy across the street and he`s kind of an outlaw."

Dr. Bette Robin: But I think where we do have control is at the local society level. The California Dental Association`s program got shot down, but now my local society, which is the largest one in California, is doing something. I`m on the advertising committee and we are doing 30-second promotions on local television and developing 30-second cable spots. We can do it at this level and it can grow.

Dr. Charlie Vogel: But we can`t saturate the market like it has to be that way.

Dr. Erich Heidenreich: Are you going to have the ADA do it? Is the AGD going to do it? They are too busy doing other things to do it. They`ve been doing the kind of marketing they believe in, which is informational advertising-such as telling people they should floss every day. They don`t believe in persuasive advertising, which is what I believe we need. I think it`s going to have to be done outside of organized dentistry, in a separate organization.

We need a national dental promotion board . . . a National Quality Dentistry Promotion Board, similar to the National Fluid Milk Processors Pro-motion Board that sponsors the milk-mustache ads. We need to get a few influential dentists together and create an organization to be responsible for this national advertising campaign. I believe there are plenty of dentists out there who are just crying out for something like this and that they would be willing to contribute the money to get the job done. I also think corporations, like dental manufacturers, who know the value of advertising, would be willing to contribute, because they know the more dentistry we do, the more products they are going to sell. The more business we do, the more business our suppliers do. These leaders would set up an organizational meeting to develop a strategic plan, focused on designing a campaign to raise the value of dentistry in the eyes of the consumer. When we accomplish that, we will be able to achieve higher ethical standards within the profession.

Dr. Charlie Vogel: I think if we would label it an educational campaign and not marketing, we`d get more dentists willing to lend their financial support.

Dr. Erich Heidenreich: But what I`m talking about doesn`t educate anybody! The milk-mustache campaign doesn`t educate anyone either; it just says all these celebrities drink milk, so it must be good for you and something I should do.

Dr. Andrew Schwenk: I agree with Charlie. The ADA`s budget is $50,000,000 plus this year. What if we allocated just 5 percent of this toward a national "dental awareness" program related to, for example, seal-ants. I have parents cheering my office on when they are educated on what something as simple and painless as a sealant is and how cost-effective it can be. Yet, less than 10 percent of children under 16 have all posterior teeth sealed! We have so much to offer so many and yet we seem to keep most of it hidden. This is what has many of us questioning why we have to work so hard just to get the public educated about such simple ideas.

Dr. Larry Cook: How many of you have ever seen a fully-edentulous individual who`s extremely overweight? You see them all the time . . . and many of these people still have a healthy self-esteem. They are overweight, have no teeth and still they smile. So, there are people who don`t have to have teeth for self-esteem, who don`t have to have teeth for survival. My point is that we are in a profession in which the purchasing of our services is totally discretional. What makes it not discretional for some of us? Because of our value systems; because we say this is what we want for me.

Dr. Charlie Vogel: And we want to change the value system of that portion of the public that doesn`t put a high value on their dental health.

Dr. Larry Cook: Now I`m going to tell you in one word why it`s not going to happen-and that word is leadership. There isn`t anybody willing enough to stick his or her neck out and say, "I believe this! I believe it`s the salvation of the profession! I believe it`s the salvation of your life! Listen up, little Mr. Dentist who isn`t earning as much as his hygienist. We`re going to change the perceptions of that 50 percent of the public that doesn`t see a dentist. Not all of them, but a percentage of them."

Now here`s my campaign. I believe in saying to those people, "Do you want to live out your life with two teeth?" The campaign would show the end result of no teeth and beautiful teeth, and it would sell the future benefits of keeping your teeth in good health. Some-thing that would say, "This is what you can expect if you take good care of your teeth for a lifetime."

But until we as a profession are willing to get behind some opinionated leadership who is forceful and assertive and who is willing to do what needs to be done, it`s not going to happen. I don`t think that kind of leadership is going to come from the ADA. The ADA president is a figurehead. The kind of leadership the ADA needs won`t come until the executive director`s position is filled by a highly assertive, opinionated leader with a vision.

Dr. Andrew Schwenk: I agree that the ADA needs somebody who is decisive and opinionated and represents the views of those of us who say, "Look, it`s been this way for 150 years. Things need to change."

Dr. Bette Robin: But everyone`s saying somebody else should do it!

Dr. Andrew Schwenk: That`s right. We need someone to stand up and say, "Look. What would be wrong with neutral ads that say something like, `Have you seen your dentist lately? Look what he or she can do!` It doesn`t have to say, `We treat cowards.` "

Dr. Larry Cook: I`ll even take it a step further. I don`t think it should say anything about dentists except at the end. I think we want to talk about "them," the patients, in this campaign, and the future benefits they are going to gain by taking good care of their natural teeth. Then, somewhere at the end, it should say something about seeing your dentist.

Dr. Charlie Vogel: We`ve got a lot of advertising being done for us now just because a pretty model has pretty teeth.

Dr. Erich Heidenreich: But that advertisement isn`t being done for dentists! It`s being done for over-the-counter tooth-whitening products or for cosmetics.

Most dentists are not unethical at heart. Managed care and a lack of demand for quality, ethical dentistry forces some into unethical behavior to earn a basic living. Effective national marketing can change this by improving the profession`s image and increasing the perceived value of healthy teeth and the demand for quality dental care.

Dr. Chris Kleber: This ethical debate doesn`t end. It continues on in the head and heart of every dentist, every day. Every dental society Board of Directors, the American Dental Association and other dental professional societies will continue to debate this issue and the third-party providers can only guess at what we are debating.

It is my belief that we must act or react. If we do not take a proactive position and take ACTion to educate and motivate patients to accept and demand the benefits of good, oral health care, then they will have to REACT to third-party mandates and accept their imposed limitations on care.

If every dentist went out to breakfast with three physicians and talked about the way managed care has taken control of their profession, the answer would be very clear-preserve your ethics and the enforcement of high, ethical standards in the profession. Act with unity now more than ever before and retain the trusted dentist-patient relationship!

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