Unrealistic Expectations -- Dentistry’s Demon!

The perceived level of success that the association has had in dealing with major outside entities that seek to modify dentistry also influences formation of these negative conclusions. If the association is successful in its pursuit of issues of professional concern, the critics (aka "experts") are quiet; and the satisfaction level with organized dentistry is positive. If a decision or compromise reached on an external issue of importance to dentistry does not meet the "expectations" of the critics, their opinions on the shortcomings of their organized profession, whether justified or not, enter into the discussions that occur at dental society meetings, study clubs, and other professional gatherings. Instead of questioning the fitness of the organization itself, the question all critics should really ask is, "Were our expectations for a preferred or desired decision in dealing with external ‘intrusions’ REALISTIC?"

Too often, in a rapidly changing world, we have felt that the expectations held by many of our colleagues for organized dentistry to negotiate an outcome that either favors the status quo, or is more favorable to the profession than to the public, are UNREALISTIC. In fact, some issues with public importance may leave no room for any negotiation.

Our concern goes well beyond whether a dentist’s position on an issue is reasonable. We believe that two characteristics of members of our profession prevent many colleagues from accepting or supporting any decision that compromises what they desire.

The first is that most of us do not respond well to change. We become entrenched with our business, continuing to do the things we were taught or learned early in our careers because they have enabled us to achieve various goals along the way. While some in our profession do constantly look for new methods and materials, many of us are content to continue using the methods, principles, and techniques that have brought satisfaction and success. Most important, we are reluctant, or even unhappy, if an outside entity seeks to change, or is successful in changing, policies or procedures that force us to modify our work patterns in practice. This is not a criticism but rather a trait that has traditionally characterized the dental practitioner. Dentists are not alone, as this characteristic is probably typical of many small-business owners. OSHA requirements, the Dental Materials Fact Sheet, HIPAA, the Denti-Cal fee schedule, and the Proposition 65 negotiations and settlement are some of the major dissatisfiers that have faced dentists in recent years.

The second characteristic many dentists share is that, either by nature or as a result of the philosophy under which we were trained, we seek perfection. Many achieve that reputation from patients and other colleagues. This being the case, it should not be a surprise that an individual expecting perfection and success within his or her own enterprise would find a lack of success by their representatives in achieving the result they personally want to be below their expected standard.

To bring this discussion full circle, a group that seeks perfection and dislikes change expects these principles to be upheld by those representing their interests in the public sector. This is why dentistry’s representatives are frequently in a "no-win" situation in the regulatory-happy business environment today, because they will automatically receive some blame from within the membership for failure to achieve a "perfect" resolution or maintain the status quo. Those expectations however, are UNREALISTIC. Such unrealistic expectations end up being divisive if they are used improperly to sway some members and nonmembers into believing that membership in organized dentistry does not provide desired value.

The unrealistic expectations that many dentists have for their membership organization explains why some fail to join or to remain as members. Through education, it is our hope that more colleagues will understand the negative impact that Dentistry’s Demon of unrealistic expectations has upon our collective strength as a profession.

Brief Anatomy of a Negotiation

By now, all CDA members should have had the opportunity to review the settlement package of the Proposition 65 case. In a world of perfectionists, the requirements this settlement brings are not popular. We are printing here a letter written by Linda Seifert, general counsel of the California Dental Association, that we believe does an excellent job of describing some of the issues and obstacles of the Proposition 65 negotiations and settlement that lasted almost two years.

This letter was originally addressed to some CDA members who had raised concerns and questions about the Proposition 65 settlement and the new requirements it will impose on dental offices. Those reading this letter should realize that an expectation for a better final outcome would have been unrealistic. Association efforts not only supported those CDA members out of the group of 80 who had been served with Notices of Violation, but also supported every dentist who could have ultimately been served with a notice in the future, had CDA not stepped in.

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Dear Member,

Your letter concerning the Proposition 65 settlement has been forwarded to my attention for response. As you know, settlement of any litigation requires negotiation and compromise. In a perfect world, CDA would have preferred that dentists not be required to issue warnings under Proposition 65 and that the chemicals that are used in the dental office not be included among those for which the state of California requires a warning. Unfortunately, those positions were not available to us, and I continue to believe that CDA’s leaders made the best of a most difficult situation.

Before my tenure with CDA, CDA was a party to litigation in which we argued that FDA rules pre-empted the state law and that, under federal law, dentists could not be required to comply with Proposition 65. After many years of litigation, the court in that case mandated that dentists comply with the warning requirements. Since before the final rulings in that case, CDA has advised its members to post warnings and has disseminated warning signs that focused on amalgam.

When 80 dentists in California were served with official Notices of Violation in early 2001, the attorney serving the notices warned us that his plan was to shortly serve more and more dentists throughout the state. At that time, CDA made a calculated decision to seek resolution of this matter on behalf of the entire profession. We then re-evaluated whether there were legal challenges that could be made, consulted with other industries and associations that had challenged the law, met with several lawyers expert in this field, and concluded that further legal challenges would not achieve a favorable result. As you are likely aware, the plaintiff group that brought these actions was most interested in forcing a warning about mercury, one of the chemicals on the state’s list. In evaluating our position, we concluded early that we would not be able to eliminate a warning for this chemical for numerous reasons. In the absence of litigation as a viable alternative, our goal became to achieve a resolution that would achieve compliance for members and reasonably ensure that no further Proposition 65 violations could be assessed against our members so long as they posted the approved sign.

The negotiations leading to the signage that was included in the recent article that was sent to you as part of the court-ordered settlement package occurred over approximately two years. When the agreed-upon signage was submitted for the court’s approval in late December 2002, the judge refused to approve the proposed language and eventually (with comment and recommendations from both sides) drafted language of his own that he maintains will provide consumers with the information required by the law. While the signage is not completely to our liking, we were satisfied with it as it informs patients that the U.S. Food and Drug Administration has approved all dental materials for use. All in all, we were "pleased" with the result.

As to what you should advise your patients when they inquire about the "Notice," we have developed a "Frequently Asked Questions" document for both patients and dentists that is included on the CDA Web site (www.cda.org).

Linda Seifert
General Counsel
California Dental Association