As of two days ago, I have been practicing dentistry for forty years. It hardly seems possible that it could be that long because I really do not have any sense of the passage of such a long period of time. I look forward to going to work more than I ever have, but what has passed has sort of disappeared into the void, almost as if it never happened. I guess if I had it to do over I would do some things differently, but on the other hand, I don't think I would have the same level of satisfaction with my career if I had not had the experiences that I have had. I don't think I would be as grateful for the good things I have in my professional life if I had not had the not-so-good things as a source of comparison.
There was an article in the May 27 issue of the New York Times called "Let's Be Less Productive." It addressed the world's relentless pursuit of greater productivity and efficiency and brings up the question of what happens to the number of jobs available as we get more efficient and the cost to the environment as we pursue ever greater levels of productivity. The author, Tim Jackson, points out that there are sectors of the economy where chasing growth does not make any sense - such as medicine, social work and education - what he calls the "caring professions." He says, "Time spent by these professions directly improves the quality of our lives. Making them more and more efficient is not, after a certain point, actually desirable. . . The care and concern of one human being for another is a peculiar 'commodity.' It can't be stockpiled. It becomes degraded through trade. . . Its quality rests on the attention paid by one person to another. Even to speak of reducing the time involved is to misunderstand its value."
Looking back on my forty years of practice, there is no other single factor that has contributed to my sense of satisfaction and fulfillment as much as my decision several years ago to stop pursuing efficiency and allow enough time to meet the relationship needs of my patients. (And, it turns out, my own relationship needs.) This is not to say that taking more time drags out the sometimes physically unpleasant experience of dentistry for my patients. Allowing more time does not mean that the actual dentistry is done slower. It does mean that I am not rushing from one procedure - or one patient - to the next. Allowing more time does not necessarily improve the technical quality of the dentistry but it definitely does improve the quality of the emotional experience in my office. This is true for the patient, for me, and for my staff.
Medicine and to a lesser extent dentistry are at a turning point regarding delivery of care. There is no question that, as a nation, we can no longer afford the medical delivery system we have. In the painful and politically charged debate about what is to come next, I have heard a lot about reducing cost and almost nothing about improving the quality of the patient's and the clinician's experience. There is a lot of talk about improving patient outcomes. Unfortunately, I think the measurements for determining outcomes mostly have to do with statistical measures of results and tend to leave out the quality of the patient's experience. It is one thing to determine which treatment will be successful for a given disease. There are statistics that can document that. In my experience however, the skill, care and judgment involved in determining the appropriate treatment for an individual human being is far more complex and requires a great deal more time than simply determining the treatment for a given disease. It's more than a matter of doing the right treatment. It is a matter of doing the right treatment for each individual patient. What is appropriate for one patient may be absolutely wrong for another even though the disease process is the same. To make the determination of what is right for an individual it is necessary to get to know and build trust with that individual. Given enough experience and skill it is possible to do it, but I don't know any way to do it that doesn't involve uninterrupted time, attention and the ability to get your own agenda out of the way so you can listen - really listen - to the patient. Forty years of experience have enabled me to do that and, more than anything else, accounts for the pleasure and satisfaction I find in my work.
So after all those years of dentistry, the main thing that I feel is gratitude. I am grateful to be able to say that I enjoy going to work every day. I am grateful to work with the people I do. I am grateful that my health permits me to do what I do with a high degree of skill and awareness. I'm grateful for the satisfying relationships I have with so many of my patients. I'm grateful that so many of them have been a part of my life for much of my forty years. I am grateful that I have been successful enough that I can now work because I want to, not because I have to. I am grateful that I truly enjoy the people that I work with and that it is not an exaggeration to say that we love each other. And I am especially grateful that forty years of working with people and working on myself have given me the wisdom to be able to get out of my own way, at least most of the time.
