Methods and Madness

Orthodontics is as much an art as it is a science.

Many times a day I consult with parents and patients regarding the possible treatment plans to correct their teeth and frequently there is more than one solution to the problem.
Headgear or no headgear? Extractions or no extractions? Invisalign or clear braces?
These are the issues we bump into over and over again.

It gets even more confusing for the patient if they have gone for multiple orthodontic consultations and they've been told a different story at each.
In fact, I recently met with a family that had gone for three other consultations and had three different treatment plans! Needless to say they were more confused than when they had started the process.
What I explained to them was that there was merit to each and every treatment plan that they had been presented with and that in their particular case it was possible that they could get a good result with any of them. I discussed my own preferences and then proceeded to articulate the reasons for why I chose my particular route. They were grateful for the explanation and left feeling like they had a better handle on the situation and where they wanted to go with their son's treatment. As they walked out the door the mother asked me: "Why didn't the last three orthodontists explain their reasons like you did?"
To that I had no answer. But I suspect it has something to do with the time allotted for consultations, something to do with a slightly paternalistic approach to patient management and something to do with communication in general.

In medicine we seek "informed consent" before treatment. That means a patient needs to be presented with all the advantages and disadvantages of any particular treatment so that they can make an informed decision to consent to it. Without it the doctor is vulnerable to a malpractice lawsuit. Briefly, it's in everybody's best interest if the patient can't say "if I had know that beforehand I wouldn't have agreed to it." A full disclosure of all the risks and benefits is the only way to avoid this and even then it needs to be documented thoroughly.
Sometimes it can get a little scary when you have to disclose a severe possibility (like death from a rare drug reaction) but informed consent is a double edged sword. We gain nothing from lying to our patients. The way I see it the purpose of an informed consent is to open a dialog about the patient's treatment so we can get it all out in the open before anything irreversible happens. I want my patients to have all their questions answered and to be 100% clear on the "why" and the "how".

So the moral of the story is that it is up to you as a patient to discuss a potential medical treatment with your doctor thoroughly before engaging in any sort of treatment. This applies to everything from orthodontics to brain surgery. If your doctor isn't able to sufficiently articulate his/her reasons for their treatment plan; the "method behind the madness" so to speak, then promptly go somewhere else and get a second opinion.

In my office I follow what I call "the golden rule of diagnosis". What that means is that I ask myself: knowing what I know about orthodontics, if I was in my patient's situation what particular treatment plan would I choose for myself? I don't think you can go wrong with this method of patient care. My father used to tell me "the only thing we owe others is our honesty". I think this is wise advice.

For more information about our office or on orthodontics in general please click through to www.WildSmiles.org. You'll learn something and help us boost our Google ratings all at the same time!