Transcript The Relationship of the Profession to Society

The Relationship of the
Profession to Society
“What Model or Metaphor Can We
Use to Best Understand the
Relationship of Dentistry to
Society?”
What are the Tensions that Exist
Between Understanding Dentistry as
a Profession and Dentistry as a
Business?”
In What Ways Is
Dentistry Like A
Business?
•
•
•
•
•
•
•
•
•
...
…
…
…
…
…
…
…
...
In What Ways Is
Dentistry Not Like A
Business?
•
•
•
•
•
•
•
•
•
…
...
…
…
…
…
…
…
...
Are These Ways In
Which Dentistry Not
Like A Business
Consistent With the
Characteristics of a
Profession?
Is The Nature of
These Transactions
Substantively Different?
•
•
•
•
•
•
•
•
•
•
Buying gas at Super America
Buying a suit at Dillards
Buying a Mercedes at James Motors
Minister performing my wedding
Lawyer preparing my will
Dermatologist “Freezing” my actinic
lesion
ENT M.D. prescribing drug for my
tonsillitis
Pharmacist filling my prescription
Internist doing my annual physical
Preventive medicine doctor
discussing with me precautions for
travel to China
Dentistry as a Business
Conference: Money,
Management,
Marketing, and
Technology
Sponsored by the ADA’s
Council on Dental Practice
“ADA News,” August 23,
1999
Culture
Understanding culture is our
way of understanding people.
Acknowledging the existence of
different cultures is affirming
that different people have
different understandings about
life and the world. We hold
different ways of measuring and
evaluating our existence.
Culture Defined
“Culture is the collective,
mutually shaping patterns of
norms, values, assumptions,
beliefs, standards, and attitudes
that guide the behavior of
individuals and groups, whether
those groups be families,
colleagues, religions, races,
geographic regions, nations, or
professions..”
• Culture provides a construct for
understanding behavior.
• Culture serves as an interpretive
framework to determine what is valued
and what is not.
• Culture establishes the moral
imperatives that bind us together, order
our behavior and determine rewards
and punishments.
• Culture provides contextual clues to
interpret words and actions.
• Culture gives actions and events
meaning.
• Culture enhances stability in that it
permits predictability and enhances our
sense of certainty.
• Culture permits introductions to and
socialization of individuals who would
become members of a cultural
community.
• Norms-what the culture understands
as normal; that which should occur
naturally; the cultures guiding rules
or principles.
• Values-what the culture desires;
desires create purpose- purpose
provides meaning.
• Assumptions-what the culture takes
for granted; what it presupposes,
takes for granted.
• Beliefs-that in which the culture
places its trust and confidence.
• Standards-the uniform referents of
the culture; the touchstones used in
measuring and evaluating.
• Attitudes-the emotional intentions of
the culture; what it feels and wills.
Culture and Ethics
• To describe differences between
cultures is not necessarily to
draw moral conclusions; only
to characterize differences.
• Of course, one can prefer the
characteristics of one culture
over another. Preferences are
not morality.
• Kentucky/California;
French/Chinese;
African/European;
Arabs/Jews
The Culture of
Profession
“Professions are organs
contrived for the achievement of
social ends rather than as
bodies formed to stand together
for the assertion of rights or the
protection of interests and
privileges of their members.”
“The organizational component
of the profession is explicitly
meant to emphasize the
advancement of common social
interests through the
professional association.”
Abraham Flexner
“The core criterion of a full
fledged profession is that it must
have means of ensuring that its
competencies are put to socially
responsible uses …
professionals are not capitalists,
and they are certainly not
independent proprietors or
members of proprietary
groups.”
Talcott Parsons, professor
Harvard University
“Dean” of American Sociology
“Is Social Work A
Profession?”
Abraham Flexner
School and Society
1915
Characteristics Of A
Profession(al)
• Work is primarily intellectual
• Work is based in science and
learning
• Work is practical
• Work can be taught and learned
• Organized in democratic
collegial units
• Exist to achieve societally
defined goals rather than selfinterest of its members.
Characteristically professionals
‘profess’ (promise, avow) a
technical competency based on
a tradition of advanced
learning/education for which
they will be morally
accountable in placing this
expertise at the service of
society. The concept of
profession is deeply rooted in
the notion if “making a
promise” to‘another.
“Knowledge Is Power”
Baruch Spinoza
Dutch philosopher
• Law: Power over Property
• Medicine: Power over Person
• Clergy: Power over Providence
(Ultimate Destiny)
The extraordinary ethical
responsibilities of the
professional flow from the
“power differential” existent
between the professional and
the person they serve.
Professional
Relationship is
Fiduciary
• To be a fiduciary means to stand
is a special relationship of trust,
confidence or responsibility to
another.
• Professionals are in a fiduciary
relationship due to the power
they hold over others; power
based in knowledge. They
“know” when others do not.
• Therefore, others must trust
them to use the knowledge they
have in their best interest.
“The patient-physician (dentist)
relationship is the center of
medicine(dentistry). As described in the
patient-physician (dentist) covenant, it
should be a ‘moral enterprise grounded in
the covenant of trust.’ This trust is
threatened by the lack of empathy and
compassion that often accompany an
uncritical reliance on technology and by
present economic considerations. The
integrity of medicine (dentistry) demands
that physicians (dentists), individually
and collectively, recognize the centrality
of the patient-physician (dentist)
relationship and resist any compromises
of the trust this relationship requires.”
Richard M. Glass
Journal of American Medical
Association, January 10, 1996
The Culture of
Dentistry As A
Profession
• Norm - Oral health is a primary
good; an end in itself.
• Value - Care and concern for all
people and their oral health.
• Assumption - Societal good
• Belief - Cooperation and reciprocity
with society can result good for all.
• Standard - Justice/Fairness
• Attitude - Egalitarianism
The Culture of
Dentistry As A Business
• Norm - Oral health as a means
• Value - Entrepreneurial;
building a successful enterprise;
profits
• Assumption - Private good to be
maximized
• Belief - Dentistry as a part of
the free enterprise system
• Standard - Marketplace
• Attitude - Social Darwinism
Profession
Norms
Business
(Proprietary)
Oral Health a
Building a Successful
Primary Good … an
Enterprise … Oral
End
Health as Means
Values
Care and Concern
for Patient
Selling Therapies
Assumptions
Social Good
Individual Good
Beliefs
Cooperation Leads
to Good for All
Free Enterprise,
Competitively
Providing Dentistry
as Commodity
Standards
Social Justice
Market Place
Attitudes
Egalitarianism
Social Darwinism Fittest Economically
Gain Good of Oral
Health
“A new language has infected
the culture of American health
care. It is the language of the
marketplace, of the tradesman,
and of the cost accountant. It is
a language that depersonalizes
both patients and health
professionals and treats health
care as just another commodity.
It is a language that is
dangerous.”
Rashi Fein, professor
Health Economics
Harvard University
Do Any Groups Exist
Today in Contemporary
America That Are
Professions In the
Traditional Sense?
*****
Is the Concept of
Profession Viable
Today?
Has The Business
Community Usurped
the Concept of
Profession By Its
Commitment to Product
Quality and Customer
Satisfaction?
Enlightened SelfInterest
• 18th Century thinking bought
new social and political
understandings, among them the
appreciation and valuing of selfinterest.
• Realization that our private
good is ultimately grounded in
the larger public good.
• Or, that our success as dentists
depends on how we treat our
patients.
Short Term versus
Longer Term
• Another way of expressing it is
we must distinguish between
what appears to be in our best
interest at the moment from
what is in our longer term selfinterest.
• Sacrificing of quantity of care
issues today with monetary
implications for quality
concerns, in exchange for
longer term value of reputation
for quality care.
Short Term versus
Longer Term
• Interestingly, this is what
American business has decided
is good business.
• Our business will ultimately
make more money, if we
provide quality products at fair
prices and gain customer
loyalty, than if we sell a less
than quality product one time at
a large profit margin.
What Factors Are Erasing
the Distinctions Between
The Concepts Of Profession
and the Proprietary?
• Power differential going away.
(Education of the populace, Internet)
• Increasingly traditional professionals
are working in corporate/business
settings.
• Business has adopted traditional
professional standards of putting the
client/customer good first. The
former warning of the marketplace,
“caveat emptor” (“let the buyer
beware”) is no longer applicable,
due to customer guarantees.
A Lingering Question
Is a visit to the dentist or
cardiologist for care in no way
substantively different than a
visit to the Toyota dealership to
buy a new car, or to Lazarus
department store to purchase a
new suit?