While I make it routine to review the editorials and letters in JADA, I was struck by the singular vehemence with which Dr. Robert Kreashko (Letters, November) assailed the August editorial.
I was compelled to go back and reread the editorial to find out what could have been so abominable in your graduation address to the University of Colorado School of Dentistry and how I could have skipped past it on the first pass.
Graduation time is a time of celebration and a time for looking forward. It is a passage to a greater level of expertise and, some would say, responsibility. I found your message to be accurate, balanced and optimistic. To me it reflected a concept of the profession that gets lost too often in the day-to-day clamor of business and politics.
In attempting to justify the two strikingly different postures presented by you and Dr. Kreashko, I came to the conclusion that it is fundamentally the difference between a professional who conducts business as part of being a member of a learned and skilled profession and a businessperson who uses professional training and skills in the conduct of business. The two postures present much more than a simple philosophical difference.
Dentistry continually decries the way that it is depicted in the popular media, such as movies, cartoons and magazines (the Reader’s Digest, for example), as well as how it is treated so often in regulation, health policy and insurance matters. We are quick to point out that "dentists are doctors, too!" when references are made to "doctors and dentists." Yet too often we are our own worst enemies.
In his own words, Dr. Kreashko opens up himself, all other dentists and the profession to criticism for being uncaring, self-centered and callous. He states: "I am an honest orthodontist because it is in my self interest." This could easily be interpreted by the public, an ethicist, a religious leader, a regulator or a dental student as: "I am not honest because it is the right thing to do, or because I have an ethical duty to my patient, but because it will provide me the surest financial reward in the future."
Similarly, he characterizes studying to become a dentist as "an investment of my time, money and effort" much as any other business proposition, where return-on-investment ($) is the driving principle. Does he realize that the cost of educating him went well beyond what he paid in tuition and fees? Does he understand that those additional costs were paid by state and/or federal taxpayers and alumni through contributions?
It is a fact that dentists enjoy and benefit from a functional monopoly. Government ensures that only dentists can provide the full range of oral health services to the public. Additionally, government allows dentists to avoid paying taxes on a wide variety of expenses associated with practice such as depreciation, licensure fees, continuing education and retirement accounts. Thus there are a number of interests that, in one way or another, support the delivery of oral health care to the public, and our patients are drawn from the public.
Two images come to mind. One is the painting of the caring physician at the bedside of a suffering patient. The other is of children in my son’s preschool class playing doctor (not dentist!), giving each other pretend injections while assuring each other that it will be all right. Where are these images for dentistry? Dentistry’s image suffers not just from what others do to us, but from what we do to ourselves.
Would [Dr. Kreashko] be comfortable if his letter were published in the newspaper or posted outside his office for the public to see? Would career guidance counselors be willing to share such views with young people in discussing career options? I doubt it.
I do not remember exactly what was said by the speaker at my graduation. I can only hope that it was as credible as that presented by Dr. Meskin to the graduating class at Colorado. There is more than enough time for cynicism later. The ideals of becoming a professional should at least have an opportunity to take root.
