Although Oscar Wilde used this phrase long before the notion of consumerism entered the mainstream of human life, he nonetheless, gave expression to the less-than-palatable motto of a consumer driven society. We have indeed come to the point where it can be said that we know the price of everything and the value of nothing. Many commentators, although lamenting this modern trend, have advised us that it is a fact of life and that we had better simply get used to it. It certainly does seem like an unstoppable engine driving more and more aspects of our lives. Medicine and dentistry, once in the realm of the healing arts must now bow to the all-powerful god of Commerce.
And what can we expect to receive in return for our allegiance to the Holy Consumer? What wonderful blessings are bestowed upon us? Well, we have more business. We have more customers and that must mean we will have more profits. So now, we are all happy doctors and dentists, financially secure, enjoying a happy fulfilling career.
The Proof of the Pudding is in the Eating
Does that description fit with our experience of daily practice? How many dentists and doctors wake up in the morning with a sense of delight and joy in the new day? How many drive happily to work anticipating a fulfilling interaction with people? How many relish the next treatment challenge?
As the laughter dies down from the crazy images of the last paragraph, maybe we notice our features hardening to a frown. Is that not a feeling of sadness I detect as the truth of our daily routine brings a bitter taste to our own oral cavities? The waking up is more like a long trudge in soft mud, possible only with ?caffeine-assisted? hyper drive. The drive to work is more likely a zoned out absence of feeling, with odd thoughts of possible problems of the day or driving-related incidents intruding harshly on our more comfortable mental anaesthesia. Maybe some of us would like the first 2mls of xylocaine hydrochloride delivered to the anterior frontal lobe of our brains as we begin the first of the daily list!
What have we done to deserve this? What on earth has gone wrong that our dreams of a fulfilling career in a caring profession, dedicated to the elimination of disease, should end up as such an empty struggle? It seems that where we expected a blessing we found only a curse. An enemy called stress has appeared out of nowhere and surrounded us, threatening every aspect of our lives. As if we hadn?t enough to do already, we are now told that we must take steps to reduce stress in our lives. Is it any wonder that we sometimes feel so bewildered!
Arse About Face
Forgive the bluntness of my language but this is the answer to all the questions posed. Arse about face, upside-down, back to front, cart before the horse, disease before health, treatment before prevention, - these are the things that have gone wrong. We are literally travelling in the wrong direction. No wonder then that the landscape looks so bleak.
Let me explain. We, as medical and dental practitioners, are paid for treating disease. Therefore our income depends on the presence of disease. What incentive is there in this model for taking prevention in any way seriously? Because no fee is paid for a condition prevented while a fee is earned for a condition treated, those practitioners seriously and successfully engaged in prevention will most likely starve. Prevention of disease, can therefore seriously damages a practitioner?s health.
It seems very obvious that in a society where prevention of disease is neither honoured nor valued, disease inevitably increases. As the incidence of disease increases, the resources for the treatment of disease become increasingly stretched. This means that we must try to treat more people in less time. We must also try to have more people treated for less in terms of cost. Often the quality of the treatment begins to suffer at this point and morale plummets. When resources for the treatment of disease can no longer keep pace with increasing need for treatment, the waiting list is born. As the need for treatment of disease further increases, crisis develops. Our attempts at solution are based on the same false premises and so they fail. As each ?new? solution is tried and fails, crisis deepens and despair is born.
Rather than a health care system, as we like to call it, we have actually created a disease management system. The people working such a system are under far too much pressure for any comfort or safety, never mind any possibility of happiness or fulfilment. Likely, poor morale will dominate the stressed-out people in the stressed-out working environment. This type of environment can lead to all manner of problems, including poor communication, misunderstanding, conflict and error. All of these ingredients are the ingredients of litigation and as the amount of litigation inevitably increases, the threat of litigation begins to weigh heavily indeed, adding further burden, adding insult to injury.
Does this description resonate with anyone? Is not this a reasonably accurate representation of our current system and worse still, of our current and ongoing trends.
The Need for a Change in Direction
The signposts on the road we are travelling could not be clearer. The most radical change is needed. The god of Commerce has indeed cursed us onto the road to what surely feels like hell. The time has come to stop, turn right around and begin in the very opposite direction. We need to honour and value the prevention of disease. We need to value prevention as highly as any treatment regimen. We need ?Education as Medication?. We need to begin in earnest the broadest education in the knowledge and skills of behavioural and preventive medicine.
People need to know the limitations of modern medicine as well as its wonders, that they not have unreasonable expectations which will inevitably bring disappointment, disillusionment and/or litigation. People and practitioners need training in the various techniques for immune system enhancement that they may contribute fully as partners in the maintenance of health as well as in the management of their conditions and diseases. They (and we) need to be educated in the various psychological strategies that have proven to be of benefit in coping with serious and/or chronic illnesses. They (and we) need to be educated in non-pharmacological pain management that we may reduce the unwanted effects of medication. They (and we) need to be fully respected as whole people, - mind, emotion, body and spirit. They (and we) need to care for, nurture and enhance the health we have, rather than make a mad scramble for a ?cure? when illness strikes. They need and we need to care for ourselves and our health on a daily basis.
The comprehensive preventive educational package needed could easily be funded by the reduction in the amount of litigation which such a patient-centred system would surely bring about in a very short time. Myself and others (doctors, nurses and teachers so far) are passionate about this message which we feel has the capacity to restore the dream of so many dedicated and caring people to have a happy, successful and fulfilling career in a healing profession, which has had the honesty and courage to heal itself before deigning to offer healing to others.
My name is Philip Christie. I qualified as a Dental Surgeon at Trinity College, Dublin (Ireland) in 1980 and completed a Master?s Programme in Dental Science, again at Trinity College Dublin, by research in 1995. I have been working full time in dental care either in general practice or specialist practice since qualification. My main interest is and always has been prevention.
My real qualification is 23 years experience in dealing with real people and their problems face to face, as a clinical practitioner.
I am the author of ?Something To Chew On: A Mouth Map To Health?. It is a Health Manual with a difference. Different because it is designed for the future and for success. It is different because it gives the power back where it belongs, to the person?s own self. Different because it prevents problems at source and saves on treatment and cost!
Philip.christie3@ntlworld.ie
http://www.peopleaspartnersinmedicine.com