Well begun, half done.

The phone call comes one evening as you are reviewing an interesting article in the latest issue of the Journal. It's your neighbor, who tells you that his wife Susan is now in braces. You swallow once, wondering why Susan didn't seek your opinion. Evidently, Susan had responded to a mailed advertisement from an orthodontist who practices in a nearby dental group. After a brief examination, Susan left the orthodontist's office that same day with full brackets on both arches and an archwire in place. You ask whether x-rays and images or casts of the teeth were produced at that appointment. Your neighbor responds that only a few photographs and a radiograph of the teeth were made, but the brackets went on even before the radiograph was brought to the operatory for the doctor's review. A treatment coordinator told Susan that she “needed full braces as soon as possible.” The financial contract was signed, and the brackets were placed. The entire appointment lasted less than an hour. Susan said that the staff assured her that she was doing the right thing, so she decided to proceed with immediate treatment to minimize lost work time. As your neighbor recounts the story, you recall that Susan had lost a few teeth several years ago because of periodontal involvement. Your neighbor is concerned that no collaboration with her periodontist occurred. Susan said that the informed consent discussion was too brief to be understood, and her idea of her overall treatment plan was sketchy at best. Your neighbor asks whether this is the new standard of orthodontic care. There appear to be several concerns associated with this style of orthodontic care delivery. The patient is not only denied a thorough diagnosis and thoughtful treatment planning, but also deprived of dental or medical collaboration when needed. The time spent with the doctor is minimized given the priority of accomplishing multiple procedures in a short time, limiting the opportunity to establish trust and confidence in the doctor.