Equivocation. What a horribly sickening word, particularly when it comes at the expense of patient care.

Dr. Rethman’s statement of the work that he and others of the AAP have done sheds light to me on what organized dentistry via the AAP has done for us.  Our leaders created principles.  Our leadership fought hard for these principles and we owe them a debt of gratitude for the dedication and service that they have given to us. Yet, if those principles became subject to equivocation as a result of attacks from and then a conference with a special interest group, we can learn from that.  That equivocation serves as an example for all of us of the damage that occurs when the principle of “best patient care” becomes the step-sister to the needs of a self-interest group. It’s dangerous not only to the health of the profession.  More importantly, equivocation is dangerous to the health of the patient.

Here we are just nine years later. As Dr. Rethman states, “All AAP leaders had been repeatedly briefed on how to respond to criticisms from a “patient first” perspective.  But over the next year or two the Guidelines were undermined from within the AAP (by a few leaders who had other agendas) and they fell into disuse.”  I do not for a moment think that this conference resulted in the plight that we suffer right now.  But if this “conference” set the example of equivocation, perhaps in some small way, we are suffering today.

We, as a profession and as individuals are not strangers to equivocation. I have heard from several of you. And the message is the same. We understand what you are saying, and we agree with you.  But we don’t want to tick off our referral sources. So let’s table the referral sources question and see other ways of how the insidiousness of equivocation may be entering our practice lives.

How about the examples that we set for our staffs?  Do we have core principles for staff performance in our office?  Do we, as individual practice owners, write down our core principles so that our individual staffs know what we stand for?  Do we write down “Rules for the Office” that ensure these core principles as well as setting guidelines for staff behavior?  Do we ask each staff member to sign off on each of these guidelines?  If we do announce our core principles, what then?  What happens when a staff member violates the core principles?  Do we look the other way?  Or do we correct the staff member?  Good staff members do respond to a very light gradient of correction. Good staff members corrected then go on to be great staff members and set the example for the others.

But if we equivocate in management of our own staffs, what then is the result? Standards drop, staff performance drops, staff morale drops, and consequently, the morale of our patients drop.  Once we allow equivocation, it spreads. How do we see it?  We see it as gossip, office drama, tardiness, absence, frequent upsets, a 9 to 5 attitude, patients not scheduling, and patients not accepting treatment.

Yes, this is personal.  Yes, this is each of us setting the standards for ourselves, our staffs, and our patients. This is what grassroots is all about.  This is how we recreate our practices. And once we see the benefits of really setting down principles, enforcing principles, we end up with a very happy practice.  A very happy practice makes more money because we have set free the scourge of equivocation. Making more money is not the goal, but in my experience, it is the benefit.

We are in the process of recreating the periodontal practice.  We are deciding that our training and our vision of dental health needs to be sung from the rooftops.  We are deciding that the best in patient care is in our best interests. We are deciding that we can stem the tide of failed dentistry and the poor treatment planning that accompanies it. We are deciding that we, the periodontists, are the most likely specialty of dentistry to lead this effort. We are the Doctors of Complex Dentistry. It is a movement. It is a movement fueled by truth.  Truth has a mighty hand. But that mighty hand is weakened by equivocation.

We can rebuild our profession practice by practice. We can use the AAP’s Bill of Patient Rights as our guide as Dr. Rethman so aptly suggests.  We can add a Bill of Staff Rights. And just as importantly, we need to write our own Bill of Staff Responsibility for each of our individual practices. Then, when we see the benefits that accrue, we will feel more comfortable with that next step, our responsibility to our patients, because patients are already seeking us first.  We’re now finding the ways to let more of them know that we exist.

We can then write our own bills of responsibility to our patients.  We can write our own codes of non-equivocation.  If we do that, then patients will understand that we are there in their best interests.  And as such, we will not only raise the bar. We will secure it.