You are beginning to think that quality care is becoming equated with rapid treatment completion. The speaker of the seminar you are attending proudly presents an array of cases that were completed in 14 to 18 months of treatment time. He lauds the modern methods of accelerating tooth movement, including advances in appliances, accelerating devices, and various forms of surgical adjunct. As he projects his slides depicting final treatment results, you can’t help thinking that the finishing and detailing that you’ve consistently tried to provide were lacking. In many of his cases, buccal segment interdigitation is insufficient, anterior alignment is inconsistent, and the second molars are not controlled. The lecturer recognizes these shortcomings but seems to minimize them, emphasizing that his treatment time combined with the results shows total success in therapy. Each time he concludes a case display in his lecture, he comments that “The patient and the parents were delighted with the outcome.” By the end of the morning, you ask yourself whether maybe merely “good enough” is “good enough.”
Orthodontic practice affords both patients and doctors with many remunerations. The patient benefits from a physical change that leads to emotional enhancement from the esthetic and often functional improvement. The orthodontist enjoys the opportunity to earn a comfortable living but also works in an environment where most patients arrive happy—and leave even happier. But shouldn’t there be something more?
Quality can be subjective, but doesn’t have to be and shouldn’t always be. Lack of quality might even have lasting consequences. Consider an unfortunate incident involving lack quality that led to fatal consequences—just 1 example of many. On October 23, 2003, a 10-story parking garage collapsed, killing 4 workers and injuring 21. The subsequent report ascribed the tragedy to a “lack of clarity in structural design” (aka, treatment planning, in our arena), lack of execution, such as the failure to place sufficient structural reinforcement (inadequate case management), and “flawed inspection of site engineers” (overdelegated, loosely supervised therapy without professional oversight). Although our work does not involve the potential for life-threatening consequences, lack of quality might have negative repercussions that can undermine the trust of our patients.
Naysayers might object, claiming that uneven marginal ridges, inadequate alignment, and lack of buccal segment interdigitation are inconsequential if the patient is content with the result. Yet your vulnerable patient trusts your expertise to deliver the best care you can—that’s why he and his parents have engaged your services. The patient expects that you will allow him to choose between the ideal and the compromised. That’s autonomy. If the compromise is based on the orthodontist’s financial motivation or the absence of the patient’s knowledge, or transcends the consideration of special circumstances that may surround the case, a breach of autonomy might become an issue. And your patient needs to know that although some aspects of a finished result might improve, teeth or bones do not always move favorably. Reliable and consistent settling to a more functional occlusion is not guaranteed.
Quality care involves 2 major components, both pertinent to what we do: skillful delivery and the “appropriateness” of the treatment. “High technical quality is doing the right thing right.”
Certainly, the orthodontist’s highest priority in delivering quality treatment is the inner satisfaction we get from doing our best and knowing it. There is no greater remuneration that the internal satisfaction we receive from knowing that we deliver the quality we have been educated to deliver. Good enough should not be good enough. Not for our patients—and not for authentic professionals.