A “Place for Everything,” and “Everything in its Place!”
The last Editorial “Up in the Air,” focused on the technological infusions in orthodontics. We discussed the today and a possible tomorrow of our specialty. I share most of my editorials with a very well-respected orthodontist and an important leader of our profession (someone I have grown to admire deeply over the years) from across the globe. His e-mail response to the editorial read –
“I see all this technology at every program I visit, yet – I do not see that orthodontics for the patient is improving. Indeed, the service rendered to the public is much worse than it used to be. Ultimately, service to the public is what we are about – but does all this stuff improve the service? I doubt it.
I am afraid the person into all this technology wants the technology to do their thinking for them and it will do nothing but denigrate the service to the patient. There you have it – an old man’s opinion of what is happening to us. Our patients are getting tooth alignment orthodontics – nothing else.”
Profound and extremely thought-provoking words indeed! The big question facing the millennial orthodontist is - “It is a great time to be an orthodontist, but is it also a great time to be an orthodontic patient?” Is patient-centered care really being delivered despite all the technological gizmos at our disposal to ensure it happens? Are there any pitfalls to this technology overdose to life in general and orthodontics in particular?
We are consumed by laptops, TV, cell phones, etc. Our lives are so dependent on technology that we fail to live. Some “wake up moments” to pinpoint how technology can pose serious questions to our interaction abilities are discussed in this editorial.
My grandmother despite limited education can rattle off more than fifty telephone numbers by rote, easily. I struggle with my own office numbers at times! Is this ability really important, especially when the Internet teaches us to look online, when we require answers to a problem? This requires little thought or effort; we do not have to really remember stuff now. The Internet is an “external hard drive” which allows us to access things and store information instead of holding it.
I remember chatting with a gentleman on a flight, who was speaking about his orthopedic surgeon (who incidentally was a patient of mine!). The gentleman went on to explain why he thought that this orthopedic surgeon was the best doctor he had ever been to - “He remembered my wife and daughter’s name, even though I met him 6 years after I was treated by him, and he asked about their well-being.” Was he serious? He could have recollected the bedside manners, efficient care, and so many other things about the doctor or his treatment experience. He chose to remember the “connect.” A simple humane connect that needs no super cables or information highways!
Technology makes us multitask, really efficiently at one level. But, can our brains function at optimal levels when we multitask? Do we really justify our focus and yields from all the tasks that are undertaken in this zone? I rarely buy a real paper book anymore. I almost always buy books on Kindle. I do not read from a Kindle, but from the Kindle app on my iPad. So, when I sit down to read a book, I have Facebook, ESPN, and Angry Birds, all screaming for my attention. A half hour goes by before I even open up the Kindle app to begin reading. Can an orthodontist who possesses all the devices/applications by his/her chair side connect with the patient and the device at the same time, engaging both in a memorable way?
Technology has made the world a 24 × 7 entity that does not rest, is impatient, replaces real things and worships creations. The “selfie-ing” culture of the millennial generation sees incisal angulations being discussed at bedtime with the doctor through Messenger chat applications, with selfie images being shared that have themselves been clicked at interesting angles. While technology breaks down walls, it also breaks down walls of inhibition. Be it DIY Braces, chat rooms or clinical discussions by professionals on social media that promise to change the world and introduce path-breaking paradigms(but rarely do !), are all reflective of this culture! A “No screen Sunday” is probably a balance that will be sought in the near future to allow the human user of technology, the recoup time to be able to keep pace with the blitz!
Am I implying that we are treading on technological quicksand? Absolutely not! Utopian treatment plans and progressive appliances are a reality today. The domain elements of orthodontic care have expanded their envelope, and we can deliver so much more to our patients. However, what is it that patients really seek beyond the therapeutics of orthodontic care? Care itself!
ORTHODONTIC CARE IN THE TIMES OF TECHNOLOGY
We published a study 2 months ago, where patients who had completed orthodontic treatment at least 5 years before the date of the interview were asked about memories of orthodontic treatment that they recalled. The recall factor of the so-called orthodontic variables (type of appliance, choice of extraction, and kind of finish) was minimal compared to the experience variables (courtesy, staff grooming, personal attention, office décor, etc.) when assessed by the Q sort methodology. In fact, 75% recall was for experience elements and only 25% for the domain orthodontic elements. While this research is a case in point for humanizing orthodontics in times of technology, there is another important issue that needs deliberation.
If we were to focus on just the domain aspects of orthodontics, it is important to assess from time to time, how many of the technological CAD/CAM appliance systems, many of which are governed by “Wall Street-esque” protocols dictated by corporate entities, have proven themselves on the clinical evidence terrain? How many of these magic appliances (some of whom have been around for more than 15–20 years now) have published peer-reviewed data on clinical outcomes and stability, or treated a “Board-certified case?” If a system claims to have treated more than a few million cases globally – and not a single one of them is board certified anywhere in the world – it is time to pose either a - “question” or a “challenge”! Whichever of the two is answered, orthodontics will be the winner.
Seeking these answers is critical as technology and commercial interests have a close relationship. Technological infusions in orthodontics have and will be dependent on investments made by venture capitalists, whose goals of-course would be profits! Dr.’s James Ackerman and William Proffit in a Guest Editorial in the AJODO have articulated the pitfalls of this phenomenon excellently-
“What a dilemma! On the one hand, there is such a great promise that modern technology can accomplish the dream that orthodontists have had for nearly a century. On the other hand, becoming closely linked with a commercial enterprise whose only goal is profit is a dangerous precedent. The boundary between ours and the oldest profession of them all could become obscured.”
Professionals have an additional responsibility in these times. And that is to determine the most appropriate appliances for correcting malocclusion based on the current evidence, accepted standards of care, with a “hawk-eye” on advertising claims and standardized “one size fits all philosophies” that are enticing science with unsubstantiated claims! Dr. Dave Turpin is spot on when he says; “Outcome measures have been available for decades-perhaps now they should be used to actually improve patient care. Those who seek to deliver orthodontic treatment must meet the requirements of evidence-based practice, providing only the best care available.”
As an ambitious child who was impatient to take on more than what my age would allow, my father often asked me to take it easy, relax, and said - “there is a time and place for everything.” My mother, on the contrary, was a disciplinarian and wanted us to be go-getters, regimented in our upbringing, where academics and co-curricular activities took precedence over “chilling out.” She made sure we had a timetable to adhere to where “everything was in its place.” As an orthodontist in this era, I think I need a bit of learning from both mom and dad as I embrace technology. Of course, technology is a fantastic adjunct to our specialty, if we do not succumb to becoming adjuncts to it! Or simply put - “There is a place for everything in this world, but it is more important for things to be in their place!”
Nikhilesh R. Vaid
Visiting Professor, Department of Orthodontics, European University Dental College, DHCC, Dubai, UAE
Address for Correspondence: Prof. Nikhilesh R. Vaid, Only Orthodontics, New Blue Gardenia Housing Society, Peddar Road, Opp Jindal Mansion, Mumbai - 400 026, Maharashtra, India. E-mail: email@example.com