The Relationship of the Profession to Society

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The Relationship of the Profession to Society

• What Model or Metaphor Can We Use to Best
  Understand the Relationship of Dentistry to
  Society?What are the Tensions that Exist
  Between Understanding Dentistry as a Profession
  and Dentistry as a Business?

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In What Ways Is Dentistry Like A Business?

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• ...

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In What Ways Is Dentistry Not Like A Business?

• ...
• ...

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Are These Ways In Which Dentistry Not Like A
Business Consistent With the Characteristics of a
Profession?
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Is The Nature of These Transactions
Substantively Different?

• Buying gas at Super America
• Buying a suit at Dillards
• Buying a Mercedes at James Motors
• Minister performing my wedding
• Lawyer preparing my will
• Dermatologist Freezing my actinic lesion
• ENT M.D. prescribing drug for my tonsillitis
• Pharmacist filling my prescription
• Internist doing my annual physical
• Preventive medicine doctor discussing with me
  precautions for travel to China

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Dentistry as a Business Conference Money,
Management, Marketing, and Technology

• Sponsored by the ADAs Council on Dental
  Practice
• ADA News, August 23, 1999

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Culture

• Understanding culture is our way of
  understanding people. Acknowledging the existence
  of different cultures is affirming that different
  people have different understandings about life
  and the world. We hold different ways of
  measuring and evaluating our existence.

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Culture Defined

• Culture is the collective, mutually shaping
  patterns of norms, values, assumptions, beliefs,
  standards, and attitudes that guide the behavior
  of individuals and groups, whether those groups
  be families, colleagues, religions, races,
  geographic regions, nations, or professions..

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• Culture provides a construct for understanding
  behavior.
• Culture serves as an interpretive framework to
  determine what is valued and what is not.
• Culture establishes the moral imperatives that
  bind us together, order our behavior and
  determine rewards and punishments.
• Culture provides contextual clues to interpret
  words and actions.
• Culture gives actions and events meaning.
• Culture enhances stability in that it permits
  predictability and enhances our sense of
  certainty.
• Culture permits introductions to and
  socialization of individuals who would become
  members of a cultural community.

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• Norms-what the culture understands as normal
  that which should occur naturally the cultures
  guiding rules or principles.
• Values-what the culture desires desires create
  purpose- purpose provides meaning.
• Assumptions-what the culture takes for granted
  what it presupposes, takes for granted.
• Beliefs-that in which the culture places its
  trust and confidence.
• Standards-the uniform referents of the culture
  the touchstones used in measuring and evaluating.
• Attitudes-the emotional intentions of the
  culture what it feels and wills.

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Culture and Ethics

• To describe differences between cultures is not
  necessarily to draw moral conclusions only to
  characterize differences.
• Of course, one can prefer the characteristics of
  one culture over another. Preferences are not
  morality.
• Kentucky/California French/ChineseAfrican/Europ
  eanArabs/Jews

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• The Culture of Profession

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• Professions are organs contrived for the
  achievement of social ends rather than as bodies
  formed to stand together for the assertion of
  rights or the protection of interests and
  privileges of their members.
• The organizational component of the
  profession is explicitly meant to emphasize the
  advancement of common social interests through
  the professional association.
• Abraham Flexner

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• The core criterion of a full fledged
  profession is that it must have means of ensuring
  that its competencies are put to socially
  responsible uses professionals are not
  capitalists, and they are certainly not
  independent proprietors or members of proprietary
  groups.
• Talcott Parsons, professor
• Harvard University
• Dean of American Sociology

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• Is Social Work A Profession?
• Abraham FlexnerSchool and Society1915

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Characteristics Of A Profession(al)

• Work is primarily intellectual
• Work is based in science and learning
• Work is practical
• Work can be taught and learned
• Organized in democratic collegial units
• Exist to achieve societally defined goals rather
  than self-interest of its members.

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• Characteristically professionals profess
  (promise, avow) a technical competency based on a
  tradition of advanced learning/education for
  which they will be morally accountable in placing
  this expertise at the service of society. The
  concept of profession is deeply rooted in the
  notion if making a promise toanother.

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Knowledge Is Power Baruch
Spinoza
Dutch philosopher

• Law Power over Property
• Medicine Power over Person
• Clergy Power over Providence
  (Ultimate Destiny)

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• The extraordinary ethical responsibilities of
  the professional flow from the power
  differential existent between the professional
  and the person they serve.

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Professional Relationship is Fiduciary

• To be a fiduciary means to stand is a special
  relationship of trust, confidence or
  responsibility to another.
• Professionals are in a fiduciary relationship due
  to the power they hold over others power based
  in knowledge. They know when others do not.
• Therefore, others must trust them to use the
  knowledge they have in their best interest.

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• The patient-physician (dentist) relationship
  is the center of medicine(dentistry). As
  described in the patient-physician (dentist)
  covenant, it should be a moral enterprise
  grounded in the covenant of trust. This trust
  is threatened by the lack of empathy and
  compassion that often accompany an uncritical
  reliance on technology and by present economic
  considerations. The integrity of medicine
  (dentistry) demands that physicians (dentists),
  individually and collectively, recognize the
  centrality of the patient-physician (dentist)
  relationship and resist any compromises of the
  trust this relationship requires.
• Richard M. GlassJournal of American Medical
  Association, January 10, 1996

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The Culture of Dentistry As A Profession

• Norm - Oral health is a primary good an end in
  itself.
• Value - Care and concern for all people and their
  oral health.
• Assumption - Societal good
• Belief - Cooperation and reciprocity with society
  can result good for all.
• Standard - Justice/Fairness
• Attitude - Egalitarianism

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The Culture of Dentistry As A Business

• Norm - Oral health as a means
• Value - Entrepreneurial building a successful
  enterprise profits
• Assumption - Private good to be maximized
• Belief - Dentistry as a part of the free
  enterprise system
• Standard - Marketplace
• Attitude - Social Darwinism

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• A new language has infected the culture of
  American health care. It is the language of the
  marketplace, of the tradesman, and of the cost
  accountant. It is a language that depersonalizes
  both patients and health professionals and treats
  health care as just another commodity. It is a
  language that is dangerous.
• Rashi Fein, professor
• Health Economics
• Harvard University

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Do Any Groups Exist Today in Contemporary America
That Are Professions In the Traditional Sense?
Is the Concept of Profession Viable
Today?
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Has The Business Community Usurped the Concept of
Profession By Its Commitment to Product Quality
and Customer Satisfaction?
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Enlightened Self-Interest

• 18th Century thinking bought new social and
  political understandings, among them the
  appreciation and valuing of self-interest.
• Realization that our private good is ultimately
  grounded in the larger public good.
• Or, that our success as dentists depends on how
  we treat our patients.

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Short Term versus Longer Term

• Another way of expressing it is we must
  distinguish between what appears to be in our
  best interest at the moment from what is in our
  longer term self-interest.
• Sacrificing of quantity of care issues today with
  monetary implications for quality concerns, in
  exchange for longer term value of reputation for
  quality care.

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Short Term versus Longer Term

• Interestingly, this is what American business has
  decided is good business.
• Our business will ultimately make more money, if
  we provide quality products at fair prices and
  gain customer loyalty, than if we sell a less
  than quality product one time at a large profit
  margin.

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What Factors Are Erasing the Distinctions Between
The Concepts Of Profession and the Proprietary?

• Power differential going away.(Education of the
  populace, Internet)
• Increasingly traditional professionals are
  working in corporate/business settings.
• Business has adopted traditional professional
  standards of putting the client/customer good
  first. The former warning of the marketplace,
  caveat emptor (let the buyer beware) is no
  longer applicable, due to customer guarantees.

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A Lingering Question

• Is a visit to the dentist or cardiologist for
  care in no way substantively different than a
  visit to the Toyota dealership to buy a new car,
  or to Lazarus department store to purchase a new
  suit?