The other day I posted this pano and the following question on The Pragmatic Orthodontist: Clinical Discussions:
Patient doesn’t want extraction of H or #11. Patient doesn’t want exposure and ligation of #11. Patient wants Invisalign to align mild crowding and wants to leave tooth H and #11 in place. What say ye?
The discussion that followed was fascinating! I will readily admit that I expected a lot less orthodontists to say they would treat the case as requested than the many who did. About half of the 1600+ orthodontists and residents in Derek Bock’s group who shared an opinion said they would treat the case as the patient wanted as long as there was clear informed consent. The other half seemed divided into those who wanted more information and wouldn’t commit and those who were staunchly against treating this patient in what they considered a “less than ideal” manner. The latter generally went on to say that to treat this case in this manner was iatrogenic dentistry and shameful. Honestly I expected a lot more of that kind of thing.
The world has changed. The paternal model of healthcare delivery is dead. Patients are “educated” and via the internet they have access to all kinds of information about their orthodontic options. Patients will not simply do what orthodontist tell them to do unquestioningly and I, for one, think this is a good thing! Patients are not dentaforms or a set of teeth floating in space. Patients are people with lives and desires and fears and beliefs that we cannot begin to comprehend. Patients are the ones paying us to do our job and we are much more like other service providers than real doctors when you get right down to it.
“But we ARE real doctors and we have an obligation to do no harm” I can hear you saying. And that is absolutely true. But I believe that we orthodontists have warped the definition and we now believe that “do no harm” means “do nothing that we don’t like or consider ideal”. These are two wholly different things and as I’ve stated many times before, Ideal is Dumb. We are nothing more than waiters in a nice restaurant. We know what we want and we know what we like and we have varying degrees of experience to back up these preferences but we are not the ones paying the tab! The patient is in charge. If the patient wants to put ketchup on their well-done filet mignon then that is their choice. If the patient wants to sip their wine through a straw and demand one of those little paper umbrellas in their glass while they do, then they can have it! Why shouldn’t we give them what they want if it truly will do no harm? Obviously we take the time to explain our point of view but it is THEIR body and those are THEIR teeth. Angle Classification is dead and profile change is overrated. People want straight teeth. I’m all for getting the best possible result for each patient. Personally, I like minimal overjet and overbite, coincident midlines, proper torque, proper lip support, etc. (whatever proper means… I’m sure in your mind it’s what you do just like I believe it’s what I do) but patients are in charge and we have to learn that we work for them.
So, back to this case… What would you do? No, I won’t show you the photos as they are simply a distraction from the central question. I will tell you that the patient is a teen with minimal OJ and OB and slight crowding. I will also tell you that this is one of my SmileDirectClub cases! What do you think about that?
The world is changing. People are individuals and not life support systems for the teeth and jaws. You’re going to have to start letting your patients have a say in what you do to them at some point so why not start now so long as they are fully informed and your treatment truly does no harm?
Pride is expensive…