On Becoming a Humanistic Dentist - Part I
Robert F Barkley, DDS
Robert F. Barkley, DDS, wrote this article just prior to his death on August 13, 1977 as part of a manuscript that was to become a book titled Humanistic Dentistry. This article shows Barkley's soul searching about how he unwittingly reinforced dentist's obsession "with looking for answers in the wrong places" in his "disease control" lectures. This soul searching led to his discovery of the work of many people in the humanistic - participative management field - Carl Rogers, Alvin Toffler, Peter Drucker, Naomi Remen, and Douglas McGregor. Barkley defined humanistic as: To me, it denotes a person whose relationships with others are highly inter-dependent, a person whose purpose is to help others to get into touch with their own strengths and develop their own capacities in order to become more effective human beings. It draws upon the spiritual (not merely the mortal) resources which are available to all of us. He was an excellent student. With On Becoming a Humanistic Dentist, Barkley went far beyond his work on disease control and painted a bright possible future for dentistry "I anticipate that dentistry's next evolutionary development will be directed toward the refinement of humanistic management skills. Therefore, we must take enough time to obtain badly needed remedial training as human beings". Sadly his death in a plane wreck postponed the achievment of his vision. Most people in dentistry are still "seeking answers in the wrong places". Fortunately, many dentists who were influenced by Bob Barkley have achieved his vision. I think Bob would be pleased to see how these dentists have applied his work and vision. Reprinted with the permission of his widow Willa Barkley Jefferson and his step son Doug Reese. Doug Reese is in the final stages of republishing Barkley's ground breaking book Successful Preventive Dental Practices. It should be out by early next year. This is a long article, printing it will make it 25% faster to read.
On Becoming a Humanistic Dentist - Part I
Robert F Barkley, DDS Many obstacles to effective change in dentistry (me included) are now identified. Our present knowledge could launch a new and sustained growth in the aspiration and skills of the dentist and staff. I want to share some of my thoughts about our progress, the problems which confront us and possible modes of resolution. The decade from 1965 to 1975 witnessed the greatest wave of hopefulness ever to sweep through the dental profession. Prevention of dental disease was conceptually "born again" with a fervor unequaled in dental history. Weary of their image as highly paid technicians, many in dentistry welcomed the philosophies of the new evangelists. Newly developed disease control programs promised to end some of the too-frequent technical failures that have always harassed dentists, staffs and patients. We began to perceive ourselves as health care professionals instead of providing a repair service. Yet the fervor of the early 1970's has been retained by only a few in the profession.
 We have come to recognize that changing one's style takes considerably more than lectures and books. The pioneering professionals who have succeeded know that work, sacrifice, risk and repeated failure are the price of achievement. 
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We have come to recognize that changing one's style takes considerably more than lectures and books. The pioneering professionals who have succeeded know that work, sacrifice, risk and repeated failure are the price of achievement. Most of all, it takes a change in self image -- how one sees one's role in the lives of others. Now, during the ebb tide, most of the profession faces the difficult (but essential) task of role clarification. Many individuals and groups have already made great progress. But a substantial number have fallen far short. Their dreams have not yet been realized because they approached a philosophical conversion of themselves in a mechanical way. They simply added new techniques and tactics without adequately redefining their roles or examining their values and beliefs about dentistry and its relationships with people. The profession is reacting to these frustrations. Some of us keep trying to grow, undaunted by our problems. For others, disillusionment has set in. More than a few have cynically labeled the evangelists as "purveyors of false hope" because "experts" presented what the disenchanted now see as an impossible dream. Sadly, others have become impotent to positive change by seeing themselves as personally inadequate. These men and women like others who feel hopelessly trapped by the poverty of their environment, have withdrawn; they no longer can make effort to change. To better cope with the pain of their failure, they often criticize and belittle their colleagues who still seek improvement of motivational and interpersonal skills. I believe the future is still bright for most people who have been less successful than they had hoped. They tend to seek answers for their problems in wrong places. As with a treasure hunt, the clues are obscure. But I hope this paper may illuminate portions of the solution which is open to them.
A major part of the answer is in studies of humanistic (participative) management and in humanistic methods of parenting, teaching and doctoring.
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A major part of the answer is in studies of humanistic (participative) management and in humanistic methods of parenting, teaching and doctoring. This involves identifying a number of non-humanistic, ingrained beliefs about lecturing, teaching, motivation, doctor-patient relationships and doctor-employer relationships. What does "humanistic" mean? To me, it denotes a person whose relationships with others are highly inter-dependent, a person whose purpose is to help others to get into touch with their own strengths and develop their own capacities in order to become more effective human beings. It draws upon the spiritual (not merely the mortal) resources which are available to all of us. Let's look at some recent humanistic management developments in the business world. The stumbling blocks to factory managers' humanistic growth, described in Douglas McGregor's book The Professional Manager, are identical to those blocks that have impeded dentists during this past decade of disease prevention. McGregor maintains that by previous conditioning, most managers seek answers in the wrong places. They express a near-compulsive need for new and better tactics which might help them have better results with their subordinates. Often the new tactics do not mature before they are abandoned in favor of other newer strategies that appear even more promising, To make matters worse, most dental management consultants and lecturers spend considerable time promoting tactics that are unique and seem to work. Thus, success by few, failure by many is assured. McGregor explains that the reasons for failure are simple, but the solutions are complex.
Most people who are trying to learn better tactics have underlying beliefs and perceptions about their roles that actually impede their own growth and development.
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Most people who are trying to learn better tactics have underlying beliefs and perceptions about their roles that actually impede their own growth and development. Until these factors are identified, analyzed and modified, success will be limited, regardless of the tactics tried.Constructive responsible change is possible when the manager's underlying beliefs, values and role perception can be identified and analyzed; and the manager can work toward eliminating the inhibiting factors that dilute success. Since each person on the dental team is a manager in varying degrees, role identification can be satisfactorily accomplished as a team effort It will not be a quick process, but it may be the only effective one. Of course, individuals can grow and develop alone. But the accumulative impact of continuous small group discussion on personal growth is highly significant. I anticipate that dentistry's next evolutionary development will be directed toward the refinement of humanistic management skills. Therefore, we must take enough time to obtain badly needed remedial training as human beings. As Drucker stated so eloquently in The Age of Discontinuity, We will have to demand of the scientifically trained person that he… become a humanist; otherwise, he will lack the knowledge and perceptions needed to make his science effective, indeed to make it truly scientific. I believe that the quality of our upbringing, schooling and religious training have made most of us practicing authoritarians. We must learn to become humanists and realize the extent of our humanistic potential. I have only begun. What I have accomplished has drastically changed my self-image. If I truly wish to help, I must become more effective in my aid to my colleagues so they can get in touch with their own strengths, values and beliefs. I must change my lectures to drastically reduce the promotion of new tactics; try to convince my colleagues to stop frantically searching for quick answers in the wrong places.
I believe that the quality of our upbringing, schooling and religious training have made most of us practicing authoritarians.
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Prior to reading McGregor's work, it never occurred to me that those people who were able to reproduce my results with their patients were those whose fundamental beliefs, values, perception of themselves and life experiences closely resembled mine. From McGregor's viewpoint, their underlying "managerial style" was close enough to mine for the duplicated tactics to yield substantially the same results in their office. Conversely, those people whose beliefs, values and perceptions of themselves as dentists were not similar to mine had less tendency to accept my tactics -- at least not without major modification. Many people agreed with me in principle, but not in practice habits. The wider the gap between our self-images, the greater was the modification to my tactics with progressively less chance of duplicate results. The same situation holds with people listening to the lectures given by other "role models" in the disease prevention movement. Thus, the lecture process (in which evangelists promote tactics to dental teams who are searching for new tactics) actually limits the potential for change in the profession. A relatively small percentage of dentists successfully alter their practices. Others have partial success. Disillusionment settles upon many. But even those who fail are better off than the large percentage of traditional professionals who merely yawn at new concepts of dentistry. Those who have once tried to change still have the greatest potential for change. Help lies in the behavioral sciences. McGregor notes that managers are usually impatient when they seek help from behavioral scientists because their aid seems vague and inconclusive. Managers insist on being told "how to do it". Their interest is in the technique. The program. The gadget. The hardware.
The implementation. Behavioral scientists, on the other hand, tend to be convinced that hardware is secondary. The real problem, as they see it, rests with a change in basic beliefs about motivation, rewards and punishment in subordinates and clients. From their point of view, if these relevant factors are changed, invention of hardware becomes a simple process of developing new tactics or selecting from an array of already available alternatives. An exciting and relevant perception comes from Toffler's comment that unless people have specific preferred plans for their future, they tend to remain victims of fate and luck. They dissipate their resources in reacting to assorted problems. With the establishment of preferred futures, these same people become innovative and their behavior changes. For example, the last time you rode in an automobile, did you plan specifically to not be thrown for the car in the event of an accident? Did you fasten your seat belt? Or did you depend on fate or luck? Do you plan to not have a heart attack to the extent that you are actively seeking to avoid one through regular cardiovascular exercise, proper diet, weight control and no smoking? Or are you depending upon fate and luck? Most people lack specific preferred futures for their general health and dental health; they simply react to immediate problems. Education does not seem to help. Such people need assistance in developing preferred futures and interdependent relationships so that they can conceptualize their desire long-term objectives. Innovation follows a recognized need, but the time lag for sustained action may be several years. (I waited nearly four years after visiting Cooper Clinic in Dallas before beginning to jog and reducing my weight by 31 pounds.) It takes time for people to decide to become more responsible for themselves, and dentists are not accustomed to allowing patients to wait this long. In Toffler's book, Learning for Tomorrow, Benjamin Singer describes the future-focused role image. I have mentioned earlier the manager's role image in how he views his present role. His future role is what he aspire to grow into. Singer says that the more sharply one can bring into focus a future role image, the easier and quicker it is to learn. This is vitally important for dental teams who wish to grow together toward humanistic dental practice.
This is vitally important for dental teams who wish to grow together toward humanistic dental practice.
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Simon and Kirschenbaum also have a chapter in Toffler's book which is pertinent to this discussion. They differentiate between three methods of education: moralizing, modeling and valuing. They contend that moralizing is a dominant method of education today. Moralizing by parents, churches, schools, peer groups and disease prevention evangelists instructs learners in what to value and what to believe. If learning has taken place at all, the learner merely parrots what he has learned. But he often sees hypocrisy because moralizers tend to not live consistently with what they preach. The general and dental health of dentists is one example, The expectations which dentist place on staff and patients is another.Valuing, on the other hand, is a process of teaching that encourages a learner to identify and develop their own values and beliefs with a reasonable trust that the learner will wisely choose sound concepts. Those persons who learn the process of valuing should be able to grow independently throughout their lifetimes and to live more nearly the kind of lives which they desire. The disease prevention movement has been one of dental evangelists moralizing and modeling, often to people who not only do not have clear focus upon their future role image, but who are hazy about their present role. Such an education mode creates great enthusiasm, but it is weak and limiting. The future of dentistry is with those people who gain the ability to clarify their own values, focus upon their preferred futures and develop humanistic management capacities.
Humanistic professional growth requires the abandonment of some obsolete beliefs that contributed to the subversion of the so-called preventive movement.
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Humanistic professional growth requires the abandonment of some obsolete beliefs that contributed to the subversion of the so-called preventive movement. The worst of these is blind acceptance of the principle that all persons should have regular oral hygiene instruction. Dentists and hygienists have both been trained to indiscriminately show and tell all patients how to clean their mouths. This effort is not sound -- dentally or behaviorally. Our patients have tolerated us and our methods for decades because teaching hasn't taken too long, and we haven't charged a fee for it. There is however, no evidence that their behavior is changed by our efforts. In 1965, I stumbled onto a way of helping people de-plaque diseased mouths under direct supervision for a series of five consecutive days. I called this a "disease control program" because its use was limited to those people who had serious disease. This group comprised about one-third of the patients who entered my practice. During the next decade, I unwittingly promoted a disease control program to audiences whose unconscious mindset was that all patients indiscriminately need oral hygiene instruction. Thus, "disease control" was interpreted by many as "plaque control", a preventive procedure to be used promiscuously on virtually all people. The ultimate result was that people who had previously tolerated free, quick oral hygiene instruction now rebelled at a more sophisticated approach that cost money. People without significant problems simply refused a plaque control program. I don't blame them, for under those conditions, I would have refused it, too. On the other hand, many patients who truly needed disease control also refused (or did not achieve long-term benefit for) the program. The traditionally passive role of patients during examination, joined with failure to clearly define a preferred dental future, continues to leave people confused and unable to understand or accept their needs. An excessively dependent office-patient relationship during history taking, examination and diagnosis negates the development of personal responsibility by the patient. The altered nature of relationships needed in a humanistic practice can be best described by two books from the Institute for the Study of Humanistic Medicine in San Francisco. Dimensions of Humanistic Medicine and The Masculine Principle, The Feminine Principle and Humanistic Medicine. The reader is strongly encouraged to purchase these incredible paperbacks. Three perceptions particularly need to be mentioned: differentiation between disease and illness; between curing and healing; and between active caring and receptive caring. The Institute describes an active caring doctor as a person who diagnoses and treats "disease" and a receptive caring doctor as one who deals with "illness". Disease is described as a pathological process. On the other hand, illness indicates one's personal experience with a disease and takes into consideration the entire person, including his attitudes, feelings thoughts and values which surround, reflect and, indeed, often define his disease For example, the active caring doctor would diagnose and treat all diabetics substantially alike, Conversely, the receptive caring doctor would see each person as a different identity whose individual illness is unique to him. The distinction is apparent too, in dentistry, where periodontally involved patients are handled very differently by active caring professionals and receptively caring professionals. The receptive dental team modulate their activities and response to the personality and needs of the patient. The active doctor cures; the receptive doctor heals. In curing, the doctor does it all. In healing, responsibility is shared by the patient, who actively participates in the restoration of his own integrity. The role images of the two are thus, remarkably different. An interesting manifestation of these distinctions can be found in the peododontic recall program.
On Becoming a Humanistic Dentist - Part II
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Most Helpful Customer Comment or Reviews
It is our job as a dentist to make sure our patient's teeth are cleanable and it is their job to keep them clean. If we can encourage our patients to have excellent daily home care, they will have their teeth for a lifetime. The best age to do this is at a young age. It is more important to encourage excellent daily home care at hygiene appointments then it is to get every piece of tarter removed. Having a philosophy like Bob's book explains is paramount to long term dental health. Without the patient's comittment to daily home care, any dentistry we do will fail sooner than later. This is such a simple concept but yet we tend to get caught up in how nice of a dental restoration we camn do. The very best thing we can do for our patients is to teach them how to stay healthy with nutrition, and home care. >Our fancy restorations mean nothing if they last a short time. Teach your patients how to wash and wax their new car before they buy.
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