Guest Editorial: Health Care and Behavioral Change

Guest Editorial: Health Care and Behavioral Change

David H. Lipschultz, D.D.S.**:


A first impression upon reading the following editorial might be “Amen. But … you’re preaching to the converted.” A second look will show that we are reprinting this article, which first  appeared in the Minneapolis StarTribune. Why? To demonstrate that every member of the dental profession can add his or her voice to the continuing, necessary discussion of the public  health and the public good. Many dentists already have, many more will; Dr. Lipschultz is in good company historically. 
 
Dentistry is one of the learned professions. In support of that responsibility, we subscribe to the following quote from author Chaim Potok: 
“If a person has a contribution to make, he must make it in public. If learning is not made public, it is a waste.”
                                                                                           The Editors



All of the buzzwords and phrases bandied about regarding health care and education puzzle me. We are hearing them all the time. “Quality of care” and “outcomes” are two of the most  prominent.
 
The discussion goes something like this: Educators should be evaluated and paid based upon the student’s performance on standardized testing. Health care providers should be paid based  upon whether the patient’s disease state is either eradicated or markedly better by the end of treatment. Nowhere are the terms “individual responsibility” or “behavior” factored into these equations.
 
I have spent 38 years treating children’s dental disease. We spend many hours every day educating parents about dental hygiene and dietary issues, which are the basics of prevention. 
 
“Don’t put infants to bed with a bottle of milk or juice!” we say to the parent of a one-year-old. They often return months later with early childhood decay, and the child requires general anesthesia at age two for severe dental decay. 
 
Then the next child is born, several years go by, and we are faced with the same dilemma.  Bad outcome? My fault? No, because I have spent time trying to educate. The change has to  come from behavior modification of the parent and/or the patient. 
 
If a desired outcome were so easy to accomplish, there wouldn’t be any tooth decay or overweight people. These things are preventable, but only with behavioral changes by the patient —  just as in education, where lack of parental controls regarding time spent reading and studying, or help with homework and reading to children, are not within the purview of a teacher to  change. 
 
Check out all the advertisements for dietary plans you see daily. If education were enough, the plans would theoretically be putting themselves out of business. Not happening! It shows what  all professionals have known for years: Changing behaviors is one of the most difficult things we attempt, and one of the least predictable and successful. 
 
So while we’re reforming the health care and educational systems, let’s put the emphasis on the partnership required for the desired outcomes and recognize that these cannot be “done to  someone or for someone” but instead must be “done with someone” to have the desired results. ■
 
 
*Reprinted with permission, Minneapolis StarTribune, August 25, 2012.
 
**Dr. Lipschultz is a pediatric dentist in Edina. Email is dadlippy@comcast.net