Så fint och lyckosamt: hjulet är redan uppfunnet!
Det finns redan en färdig lösning på hur vi ska klara tandvårdsbehovet trots tandläkarbrist och ökat vårdbehov hos våra invandrare.
Kollegan Robert (Bob) Barkley DDS hade svaret på gång redan 1963 och förfinade det fram till sin död i en flygolycka 1977.
År 1977 hölls FDI i Toronto med en efterutbildningsvecka i Loma Linda, Kalifornien. Förebyggande tandvård var på modet och jag hade under flera år hört talas om namnet på allas läppar: Bob Barkley, kollegan som omsatt teori till praktisk handling i sin privatklinik.
Dr Barkley hade engagerats av Praktikertjänst som en av föreläsarna vid efterutbildningsveckan och jag brann för möjligheten att få lyssna till honom. Tyvärr fick jag aldrig träffa honom. Han omkom redan innan kursen till följd av motorbortfall på sitt tvåmotoriga privatplan och kraschade mot en bergstopp. Som ersättare hade man kallat in ”en profylaxinriktad privatpraktiker” från Phoenix, Arizona vid namn Dr Omer Reed DDS. Dr Reed var en av Dr Barkleys efterföljare och de hade arbetat tillsammans.
Dr Reed föreläste och jag var alldeles fascinerad. I sitt arbete gjorde Dr Reed det som alla talade om och som jag drömde om att göra, men ingen hade satt i system, åtminstone inte hemma i Sverige så vitt jag kände till.
Omer blev min mentor och har så förblivit i 39 år. Vi har träffats otaliga gånger, nu senast för tre veckor sedan. Vi talade då om hur tandvården utvecklats under de trettionio åren och vi var helt eniga om att den tekniska utvecklingen varit svindlande. Vi var även överens om att budskapen från Barkley, L. D. Pankey, Avrom King med flera mer eller mindre fallit i glömska.
Vad hjälper det om vi gör en aldrig så fin krona, digitalt framtagen, eller en aldrig så perfekt kompositfyllning om vi inte lyckas höja patientens dentala IQ och förändra dennes beteende? Efter en tid får vi ändå se vårt excellenta arbete i spillror.
Det finns inga borrmaskiner som arbetar så snabbt att vi kan hålla jämna steg med sjukdomsutvecklingen hos många av våra invandare. Vi klarar inte vårdbehovet med ”Drill, Fill and Bill”. Vi måste åter börja arbeta med att motverka orsaken till sjukdomarna!
Jag vill minnas att det var Bob Barkley, men jag är lite osäker, som tog hand om illegala mexikanska emigranter till USA i slutet av sextiotalet. De hade en förödande kariesaktivitet och inga pengar till lagning. Extraktioner var alternativet. Barkley lärde dem att klippa till borstståna på en tandborste så att de kom åt att borsta i kariesangreppet. Angreppet övergick då från att vara ljusgult och mjukt till att bli svart och hårt. Karies hade avstannat! Substansförlusten fanns kvar men risken för värk var borta och i bästa fall kunde extraktion undvikas.
Profylaxkliniker
Den stora frågan idag är hur vi ska klara att erbjuda tandvård till alla nyanlända utan att förlänga köerna för de ordinarie patienterna? Det viktigaste är att sätta stopp för sjukdomsutvecklingen. Kanske är detta något för organisatörer i tandvården att ta till sig?
Hur vore det att utbilda profylaxpersonal (ej överutbildade) som har lämpliga språkkunskaper och kulturell bakgrund och i ett första steg starta kliniker som bemannas med sådan personal? Personal som förstår patienterna och kan tala till deras känslor. För övrigt är det kanske säkert inte fel att låta alla patienter på sikt gå igenom en sådan utbildning!?
Människan gör sina val baserat på känslor och inte på logik. Patienter ”köper” ett budskap för att de känner sig förstådda, inte för att de behöver det utan för att de vill ha det! Detta är en del av Dr Barkleys budskap.
Googla gärna Bob Barkley! Läs också artikeln nedan om hans fantastiska karriär: ”A Legendary Figure: Robert F. Barkley, DDS”.
Just hemkommen efter en föreläsningsserie för Folktandvården fick jag bekräftat att trycket på vårdgivarna med akutfall, företrädesvis från nysvenskar, förrycker den planerade arbetsdagen vilket leder till sämre arbetsmiljö. Många känner att de inte räcker till. Resultat: sjukskrivningar och personalomsättning samt bristande ekonomi, vilket i sin tur leder till ökat tryck på resten av de anställda. Nu är kliniken inne i en snabbt nedåtgående spiral.
Lycka till med nya tankar på ett femtio år gammalt nytänkande!
Er tillgivne
Gordon M
Tel 070 21 31 201
E-post gordon.meland@gmail.com
A Legendary Figure: Robert F. Barkley, DDS
By Paul A. Henny, DDS
August 13, 2013 marks the thirtyfifth year anniversary of the passing of one of the greatest innovators, leaders, and teachers in the history of dentistry, Robert F. Barkley, DDS. This article is presented to honor his life and work as well as share some of his contributions with the current generation of dentists – many of whom are unfamiliar with the impact he had on our profession.
Robert F. Barkley was born August 23, 1930 and grew up in the small farming community of Ipava, Illinois – population 600. Bob later entered and graduated from Northwestern University Dental School in downtown Chicago. After some deliberation, he decided to practice in Macomb, Illinois a larger community that Bob described as being “the largest town between Ipava and the Mississippi River”. Bob established his practice in the style of the time – a family practice – and like most newly minted graduates; he thought he was practicing a superior brand of dentistry.
Within a fairly short period of time however, Bob noticed that much of his dentistry was failing. He concluded that his techniques and materials were the cause, so he set about to learn more about cast gold restorations. As a result, he included more of this approach in his treatment plans and was fairly sure that this new strategy would work. “I assured myself that better quality repairs were the answer”, he said.
While this change helped increase Bob’s income, it came with an unanticipated side effect. Many patients were turned off because they believed that Bob’s dental solutions were too elaborate and too expensive. Many left the practice as a result. Persistent in his new strategy, Bob soon developed a reputation as a “gold” man. While this would not be a negative description in dental circles, the citizenry in tiny Macomb developed a decidedly negative tone when they described Bob in these terms. Bob, in their eyes, had gone “big time” and left their needs behind.
About that time, Bob attended a lecture by Dr. Clyde Schuyler, a close friend and colleague of Dr. L.D. Pankey. Dr. Schuyler told Bob that he needed to learn more about a broader range of clinical dentistry and that he already knew “how to sell more things than he knew how to do”. Dr. Schuyler’s words struck home and set Bob on a path of learning even more about clinical options. From that point on, the more Bob learned, the more he saw in each patient’s mouth – but this time he knew what to offer and how to more strategically approach their care. This new-found confidence and knowledge lead Bob to develop even more elaborate treatment plans, resulting in even higher case fees. It was easy to see that this should lead to a more successful practice, but it didn’t turn out that way at all.
While Bob’s recommendations were sound, his patients could not understand the value behind what he was suggesting. Was there really that much wrong? Was there that much to do? Obviously, there was a flaw in this new strategy as well. Here was Bob, an accomplished dentist with skills and treatments that would clearly benefit his patients, yet few seemed interested. It was back to the drawing board.
It was at this point that Bob identified the tug between how he felt dentistry should be practiced and the way the people of his community seemed to want him to practice. He summed it up by commenting “…it seemed that a decision had to be made whether to work for the classes or the masses. Reluctantly, I chose the former. I would offer what I knew was best for the patient and let the chips fall where they might.”
And fall they did. Some patients left disgruntled, and others just left. Even some childhood friends refused to associate with him. During this time of turmoil, a high school classmate (one of his favorite cheerleaders at that time) came to his office seeking help for her debilitated mouth. Four children had been birthed since high school and she was convinced that between her family heritage of “soft teeth” and the well known “drawing out of calcium” from the teeth during pregnancy, her dental future was dim. Bob was cautious. He was fully aware of his failure to sell proper dentistry to many others. Taking this into consideration, Bob recommended that she improve her hygiene habits as well as address some basic needs in the most affordable way. Certainly, surrendering to this more pragmatic approach would win the day. After all, he did not want to compromise his long-standing relationship. The appointment was set, but on the scheduled appointment came and went. She did not show up. What had happened?
Bob recalled that he nearly cried when he saw her next – this time in public and not in his practice. She had, in his words, “committed dental suicide” in another office and was now wearing full dentures. This event was catalytic and changed Bob’s practice life forever. It set the stage for changes that that he would make and ultimately share with thousands of dentists to whom he would eventually speak.
It was at this point that he committed himself to “make prevention pay off”. He wanted to be certain that – especially for those who could not afford extensive care – a preventative strategy would be both more successful and less expensive than extracting teeth and inserting dentures.
Bob committed to becoming a student of an even wider range of concepts. From Dr. Sumter Arnim he learned how to successfully treat and manage dental caries and periodontal disease. From Dr. L. D. Pankey he learned about creating a principle-centered philosophy of practice as well as the inter-relationship between behavioral and clinical dentistry. And through Dr. Nathan Kohn, a PhD Psychologist, Bob deepened his understanding of interpersonal communication, the requirements for behavior change, and on how people learn.
Bob Barkley’s most recognized legacy is based on his advancing of what is commonly known today as “Preventive Dentistry” – a concept that rarely existed outside of academia. He developed a program and toured the country teaching a five-day learning and skill development program that dentists used with their patients. This approach was often augmented with phase-contrast microscopes and bacterial samples taken from the patient’s mouth.
His most overlooked legacy is related to his development of what is known today as co-diagnosis or co-discovery. These were concepts that Bob pioneered and taught extensively as well. (Anyone who has had a chance to see videos of Bob working with patients can testify to his masterful ability to engage people and lead them though a facilitated learning process). This co-diagnostic process became the linchpin of his practice success as it allowed people the opportunity to value proper dentistry and consistently request it.
As you can see, Bob’s influence on dentistry was both broad and deep considering his premature passing at the age of 46. His death in a private airplane accident brought a tragic end to a highly influential career. Fortunately, Bob’s influence lives on through the work of many others who continue to be amazed at the progressive nature of his thinking (he even wrote about his suspicion that heart disease and periodontal disease were likely associated in the 1970’s). Those who routinely give direct credit to him for influencing their practice as well as the way they view dentistry, life, and relationships are too numerous to count. The short list would most certainly include Avrom King, Bob Frazer, Omer Reed, Lynn Carlisle, Rich Green, Doug Young, Sandy Roth, Doug Roth, Mary Osborne, Mike Schuster, Paul Henny, Charley Varipapa, M. Johnson Hagood, among others.
Doug Reese, Bob Barkley’s stepson, has recently announced plans to republish Bob’s book Successful Preventive Dental Practices, which was used as a primary resource for this article. It is exciting to know that on this the 30th anniversary of his untimely death, even more people will have access to Bob’s wisdom and insights. And it is my hope that many will discover or re-discover its value for years to come.
Steven M Silberg said:
Greetings! In 1970 as a sophomore dental student I organized the 12:07 study club. We met once a week to review the works of that weeks learning block. Having studied so much during my first two years I found myself doing my own studies in the library. That is where I learned about the late and GREAT ROBERT BARKLEY! The short version of the story was to contact him and invite him to my dental school for a full day conference. With the full support of my dean he agreed to present. I could conclude even as a sophomore student that this man was a master in the art of living… What an amazing experience then and now.
Dear Dr. Henny,
I enjoyed your article about Bob Barkley in DENTISTRY TODAY very much. I was in the first class at the Medical College of Georgia, School of Dentistry and our class was so small that the local dental society allowed us to attend Dr. Barkley’s two day lecture in the spring of 1971 when he was in Augusta, Georgia. Since I was a Sophomore in dental school, much of my time had been spent waxing teeth and doing some of the more technical aspects of dentistry. We had had a lecture from the Chairman of the Department of Oral Surgery and I found the material he presented to be very exciting. I had already decided to go into oral surgery and I was well on my way to achieving that goal when Dr. Barkley came to town. At the end of the two day program, I told my wife I was going to be a general dentist and I was not going to be going into oral surgery. She was shocked since I had been so committed to specializing in oral surgery. Dr. Barkley taught me, as he taught many dentists, that dentistry is more than the technical aspect that we were learning in dental school. Later in my career I became interested in dental implants and I have actually enjoyed a career where I have been able to be involved with implant dentistry as well as restorative dentistry and I have been able to lecture quite a bit on the topic of dental implants. When I wrote a book about implant prosthetics in the 90’s, I made sure that the first reference in my book was Dr. Barkley’s book. I seem to have misplaced my copy of Dr. Barkley’s book so if you would let me know how I could purchase a copy of the book that his step-son will be republishing, I would certainly appreciate it.
Again, thank you for writing this article as it was very uplifting for me. As a sidebar to this, my son will be joining me in my practice next summer as he has been practicing in the Atlanta area for the past three years or so after finishing dental school. I have made arrangements for him to go to the Pankey Institute in January. I attended the Pankey Institute starting in 1974 and before I started the continuum, I actually went through P1, P2, and P3. These “philosophy” series were actually Dr. Pankey himself lecturing for three straight days. Dr. Pankey never used a slide the entire nine days that I heard him and it was certainly an inspiration to get to hear Dr. Pankey early in my career. There are probably very few dentists still practicing that had the opportunity to hear Dr. Pankey and Dr. Bob Barkley early in their careers so I feel very blessed to have heard them both during the early years of my dental experience.
Again, thank you very much.
Sincerely,
Douglas P. Clepper, DMD
Paul, thank you so much for the great article and memory of Dr. Barkley. I first heard of him in the early 80s while studying at the Pankey Institute. I stayed late one night to go to the library and view his video. It was amazing. I purchased it later on and consider it one of the classics.
Gary B Solomon, DDS, MAGD
July 02, 2013 at 02:24 PM
Detta är en krönika och åsikterna som uttrycks är personliga.
