Ethics in orthodontics

I read the Ethics article in the August issue with much interest (Greco PM. What values most? Am J Orthod Dentofacial Orthop 2014;146:139). I recall being a first-year resident, interviewing prospects for the next year’s orthodontic class. One applicant, in particular, struck me as being grounded, and possessing humility and professionalism—a hopeful “gem” of an addition to the orthodontic specialty, I thought.

Upon getting to know this person (who was successfully admitted the next year to our program), I came to realize that my impressions were either blind or wishful, or the applicant was a master of disguise. A more self-centered, opportunistic true self began to emerge over the first several months of residency. The connections with classmates slowly became less team oriented and more “what’s in it for me.” Of course, patterns of behavior in residency are not necessarily indicators of future relationships with patients, but I mostly believe that there generally is significant predictability of one domain being a reflection of others.

If we can successfully substitute subjectivity with objectivity in the ABO clinical examination, maybe there is hope for differentiating our applicants’ superficial personality traits from their deeper traits. If our desire, for example, is to reduce the odds of inviting people with entitlement mindsets into our specialty, perhaps a task force could devise a method for better understanding and measuring this personality trait. Even if there was only moderate correlation with a method, it might be better than the simple hunch we often rely upon. I believe that half of being a skilled orthodontist touches on the dimensions of compassion, humility, and psychological balance, not a “me” way of practicing our specialty and seeing life.

A classmate and I once lamented, jokingly, in our residency that we might be better choices as orthodontists because we were not “number 1” in our class. There was undoubtedly some jealousy going on here. But we both felt that there is sometimes an irony to overachievers who are number 1 in their class. Sometimes it seems that the narcissism required to become number 1 backfires on what lends to a compassionate, caring, and grounded practitioner. Obviously, we should never penalize a person for being bright and number 1 in the class. But, it is not the most important quality, to me, of a skilled, caring clinician and health provider. I think it would be exciting and worthwhile to just get a foot in the door of understanding integrity and humility, objectively, for the purpose of making better decisions on applicants.

It would be a challenge to research and develop something of a system that presents “what if” scenarios to applicants being interviewed to get more of a glimpse of what they are about below the surface. Obviously, the method would have to be repeatable and sophisticated enough to allow applicants not to “outsmart” the process. If a system could be found, it should be based on a well-established psychological index with validity and extensive research. The Meyers-Briggs test is an example that has much credibility on personalities, although it might not measure what our specialty is looking for: a means to reduce the likelihood of making erroneous decisions on an applicant’s character. In any case, an index score on personality traits would only augment the mix of many other factors in evaluating our applicants.

At a recent Angle Society meeting, I was at a lunch table discussing the prospects of new residents, hearing of their trending attitudes as well. The consensus of program chiefs and many faculty of 2 orthodontic programs was that there seems to be a new expectation by residents that they should accept no associate jobs paying less than $250,000 to $300,000 per year, starting out. It is true that education is expensive for residents with pressures of student loans and so on, but those pressures have always been there throughout our specialty’s history and for our predecessors. I was just amazed at what “professionalism” has become in orthodontics: a sort of rookie National Bastketball Association view of the orthodontic landscape. I’m not sure that this view by residents advances the specialty as well as it could.

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Apr 6, 2017 | Posted by in Orthodontics | Comments Off on Ethics in orthodontics
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