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The Sounds of Institutional Silence
[By Darrell K. Pruitt DDS]
Hey you, American Dental Association.
What do you have against talking with us members?
Do you fear the questions we might ask, or something?
Who I Am
I am one of a growing number of dentists who believes that our profession, as well as all US health care, urgently needs transparency through communications – hair and all – bottom to top. That means accountability from leadership.
Government Similarity
President-elect Barack Obama has the same idea about government. Over a year ago, candidate Obama promised that all his Cabinet Secretaries would maintain weblogs to promote two way communication with all citizens. Even before he takes office, his website has been busy for weeks with interactive conversations with average citizens … yet I cannot get an official from my own professional association to respond to me online at all. I pay dues to the non-profit organization. How good is that?
The Naked Conversations
Over two years ago, I read about weblogs in “Naked Conversations,” written by Robert Scoble and Shel Israel. I quickly became a fan of networks. A few months later, I offered to help start an ADA weblog – in a conversation with ADA Senior Vice President Dr. John R. Luther. I suggested that if ADA members could interact online with ADA officials or their representatives in real time, the transparency would empower the organization like never before in history. He was not interested.
An ADA Weblog
Dr. Luther dismissed my idea outright and refused to discuss it further. He specifically told me that when the ADA was ready for a weblog, “the ADA leadership would let me know.” If you don’t recognize it, his was a variation of a typical conversation-ending response often used by leaders of traditional top-to-bottom, command-and-control business models like the ADA’s. Other door-closers are “Just because,” and “Anyway, it’s mandated so we have no choice.” In my opinion, the ADA and in turn, the dental profession, are hobbled by an archaic model that no longer works and is recently vulnerable to trouble-makers like me who not only don’t play by their self-serving rules – but have a hell of a good time flaunting them.
So-Called Authoritarian Dismissals
By the summer of ’06, I was already accustomed to authoritarian dismissals from Dr. Luther. On a separate issue I had raised earlier concerning the NPI number, he used a nuclear door-closer when he suggested that I write a letter to the editor if his committee-approved non-answer didn’t satisfy me … which he knew didn’t come close. If I had gone through my ADA publications with my question, the turnaround – if it were even considered for publication – would have been at least six weeks.
Chain of Command
That is how the leaders of the ADA used to conveniently handle those who didn’t respect proper chain-of-command representation, which normally shelves tricky questions on local dental society levels long before they reach Headquarters in Chicago. Very soon, officials in the ADA will be demanded to explain what’s wrong with responding to members immediately, or their silence will look more and more suspicious. It is not a good time in history to be a dinosaur. Barack Obama’s team finds the time to talk to underlings. What makes the leaders of the American Dental Association so special?
Internal Rules
Oh yea! Here is another internal ADA rule. “Let’s not wash our laundry in public.” That means laundry never gets washed. Now, Dr. Luther isn’t the only ADA official who won’t venture onto the Internet. I have tried to attract past Presidents, current Presidents and future Presidents as well.
For example, when one Google searches “Dr. Ron Tankersley,” who will be our next President of the ADA, my article on the PennWell forum titled “An invitation to Dr. Ron Tankersley, President-elect of the ADA” – appears on his first page.
http://community.pennwelldentalgroup.com/forum/topics/an-invitation-to-dr-ron
Here is the invitation that has been ignored for two months
Dear Dr. Tankersley,
I too am a member of the ADA. Congratulations on your election to the highest post in our professional organization. It is an esteemed compliment when so many colleagues put so much faith in a fellow professional, especially in these challenging times for dentistry.
As a dentist, I am excited about the miracles of discovery that will become possible when we begin applying Evidence-Based Dentistry to a vast network of interoperable computers in dentists’ offices across the nation – creating real-time research.
-
How soon do you foresee this happening?
-
Can we expect to see the beginning of it during your reign?
Your response is appreciated by dentists and patients alike.
Assessment
Does anyone else found institutional silence odd these days? Or, am I unprofessional to demand information that I consider is owed me?
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February Dental Meeting
I attended the monthly Fort Worth District Dental Society meeting last night. Dr. Hilton Israelson, the Texas Dental Association President, was the guest speaker. You may recall that Dr. Israelson and I have a hidden history around the issue of the NPI number that began in June of 2008 – shortly following his inauguration.
Here is where he and I differ in our opinions: I think I deserve answers about the NPI from the TDA, and he doesn’t.
Last night was my once-a-year chance to pin a TDA President, but for the third year in a row, I declined to engage. Following his presentation, Dr. Israelson generously invited questions about the issues before the state organization. I could have easily lobbed an innocent nuclear-tipped question like, “Do dentists still have to have NPI numbers to take part in CHIP (state-supported dental care)?” Only those in the room who are members of my social network, including Dr. Israelson, would have immediately recognized the ominous change in the atmosphere. As you will see, Israelson simply has no answer that would not have led him into a mine field.
My follow-up question to his answer would have surely caused the sedate, professional meeting to take a 90 degree turn towards memorable. I’ve done this sort of ambush before, in front of hundreds of dentists. But never so close to home.
I didn’t seriously consider going after Israelson last night, especially following his warm welcome. Dr. Israelson has a very gentle, soothing demeanor. It is easy to see why TDA members like him, and why he has the talent to develop consensus among many dental societies in the state. It’s hard to say if he fights effectively for the rights of dental patients. I doubt it.
After meeting three TDA Presidents in the last three years, I see a pattern. It seems that charisma is as important as reticence if one wants to climb the political ladder in dentistry. The national ADA sets the standard by tolerating the loose ethics of business partners it chooses on behalf of membership. “Image is everything” – ADA/Intelligent Dental Marketing slogan found on the IDM website. Image is not everything. Image is superficial and sometimes deceptive. I think that is why it is not mentioned in the Hippocratic Oath.
Considering that the others in the room last night are local colleagues, and that many are personal friends as well, I think my hesitation to stir up animosity is understandable. Courage is an admirable quality, but I have to live in this town. Personally, I find it much easier to go nose-to-nose with good ol’ boys in far-away places like Chicago – my kind of town.
If you are a TDA member, or a member of a similar slow-moving organization, remember this tale about the TDA presidents the next time your leaders brag about their transparency and/or responsiveness. Take a whiff. Bureaucratic evasion instantly smells rotten. From there, it ages like milk.
I posted the following on the TDA forum this fall. Not only has Israelson still failed to respond to my concerns outlined in the comment, but not a single TDA official has bothered to offer answers – even when I hold it under their noses on the TDA forum. Just how much are Texas dentists expected to pretend not to see, just to protect our image?
One more thing about the meeting last night: Two members, who minutes apart issued their reports about state government concerns, both proclaimed that “Dentists in Texas practice at the pleasure of the state.”
No. Dentists in the former Soviet Union practiced at the pleasure of the state. I practice at the pleasure of the patients I satisfy. Austin is also not mentioned in the Hippocratic Oath.
If it doesn’t please Texas that I practice dentistry on the east side of Fort Worth where my patients love me, then the state can just buy me out. Expect it to be costly. I like it here.
Darrell
http://www.tda.org/forumviewmessage.cfm?forumnbr=4825&topicnbr=8486&discussionnbr=431469
TDAFF
03 Sep 2008 12:47 PM
“Ask the President”
It was in the June 2008 TDA Today that I read newly elected Texas Dental Association President Dr. Hilton Israelson’s inaugural edition of his monthly column, “Ask the President.” It replaces past TDA President David May’s column, titled “Let’s Talk.” I was optimistic that Dr. Israelson was more sincere about engaging members in discussion than Dr. May proved to be.
Dr. Israelson wrote, “It is my hope that this monthly column in our TDA Today will serve as a forum for members to ask questions and dialogue about key issues facing the TDA.”
Even Dr. Israelson’s closing remarks sounded promising. “Please send your questions and comments to me via email to Terry Cornwell at terry@tda.org. I look forward to hearing from you!”
Within an hour of reading the invitation, I sent my topic for discussion to Terry, which I copied below. I was so fast in responding that I felt certain that if mine was not the first one in line, it just had to be the second – which would have put it in the August edition of the TDA Today.
Here are the two questions that somehow beat mine to Terry Cornwell’s email inbox. The first question to reach Terry was presented in Dr. Israelson’s July column. It was, “How does the Texas Dental Association prepare ‘To be the Voice of Dentistry’ for the next 5 years?” It occurred to me that this might have been a question that Dr. Israelson was hoping someone would ask. It was not noted who posed the question.
The second anonymous question that beat mine to Terry’s inbox on June 25th appeared in the August edition. Its title, “Has the state Health and Human Services Commission (HHSC) implemented any dental programs using funds set aside for strategic initiatives related to the (Medicaid) agreement?”
Wow. It would have taken me only a couple of hours to put together that question, but it would have taken me days to think of it.
I find it incredible that two TDA members beat me to the draw with two safe, committee-approved, safe questions. I would like to know who these dentists are who think so slowly, yet respond so quickly.
I assume my question about the NPI number is certain to come out in Dr. Israelson’s September column – just in time for the National ADA Convention in San Antonio. Sweet.
Darrell
From: pruittdarrell [mailto:pruittdarrell@sbcglobal.net]
Sent: Wednesday, June 25, 2008 10:07 AM
To: ‘Terry@tda.org’
Subject: Welcome
Dear Dr. Israelson:
Congratulations on becoming the President of the TDA. It is a fine compliment when so many colleagues put their trust in you.
Here is a topic for your new “Ask the President” forum.
CHIP – Charity to a Fault
I think it is noble of dentists to help the state with their obligations by volunteering for CHIP. I have always respected dentists who work for near-charity fees plus the bureaucracy – just like I respect those who work in charity dental clinics for no pay and without bureaucracy. They are equally generous.
Personally, I would consider helping with CHIP, but the NPI number really scares me. I have watched how the NPI number has delayed physicians’ pay for months because of crosswalk foul-ups. Recently, the IRS has added their requirements to the NPPES as well. If a provider’s name does not match up with the IRS records it will also delay payment. I have even heard that some of those who need NPI numbers may have to reapply all over again because of the IRS’s late intrusion into the mess.
But that is not the worse part. By volunteering for an NPI number, a dentist permits insurance companies to rank their quality by data-mining CHIP dental claims that they have been collecting for years. CMS intends to allow payers to post grades of CHIP dentists according to how long the restorations in kids’ mouths last, and compare the results to kids’ whose parents have dental insurance. As a general rule, children who are treated by the state do not keep their teeth as clean as others. Why should I risk so much for charity?
It just does not seem fair to be treated with such disrespect by our own state when we are trying to help them out of their mess that we did not cause.
Darrell K. Pruitt; DDS
Fort Worth, Texas
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Jill Kring Carter, a long time contributor to PennWell, posted this comment following my latest addition to my thread, “Is the ADA responsive to membership?”
“Didn’t we establish. many months ago, that indeed, the ADA is not responsive to its’ members, let alone PAYING members?”
http://community.pennwelldentalgroup.com/forum/topics/is-the-ada-responsive-to-1?page=1&commentId=2013420%3AComment%3A33398&x=1#2013420Comment33398
Here is my response. I let the crap fly this time. I thought, why not? Nothing else is getting the attention of ADA leaders. What will happen if I get in their face and call them lying cowards? Probably nothing, because they are after all, cowards.
Members have no voice
Yes, Jill. As one can see from the hundreds of times I have fruitlessly sought answers from the leaders of the ADA, they simply fear members and have crammed their pudgy fingers deep into their ears – loudly singing, “LA-LA-LA-LA…” It once bothered me to do this, but I can now unabashedly tell you that ADA leaders at the top of our national organization are cowards who don’t even have the self-respect to defend their own honor. Watch this: I can publicly call Dr. John S. Findley, who claims to be a Texan, a spineless politician, and he hasn’t the balls to so much as mildly complain about it to me. I can do it again and again as many times as I want. He apparently doesn’t care. For Dr. John S. Findley, the charismatic goofball who was elected on the campaign promise “Findley for our future,” image is everything.
“Image is everything.” As a matter of fact, that slogan happens to be the proud motto of the defunct ADA/IDM. What an embarrassment for ADA members that ADA Business Enterprise Inc. project turned out to be. I also warned our leaders about the inadequacies of ADA/IDM long ago, but ADABEI head Dr. Robert Faiella holds himself above pandering to members’ concerns. He’s a real take-charge and hide sort of good ol’ boy himself. Here is another warning I’ll offer that Faiella is too good to heed: The ADA-approved CareCredit/GE is destined to be the next expensive embarrassment for ADA members because CareCredit Vice President Cindy Hearn refuses to properly inform dentists about CareCredit and the Red Flags Rule. For Hearn, profits continue to be more important than truth. How utterly stupid can an executive be? Don’t worry. Hearn won’t risk defending herself any more than Findley, Faiella, or our next irrelevant ADA President, Dr. Ron Tankersley.
Some may think our leaders cause no harm with their self-serving lies. Remember Dr. Robert Ahlstrom? He is the ADA’s point man on electronic dental records and has invested so much of his career in technology that he’ll tell Congress whatever he has to in order to promote his own authority.
Just look at Dr. Robert Ahlstrom’s lame testimony in front of NCVHS two years ago. (See “Dr. Robert H. Ahlstrom’s controversial HIPAA testimony.”)
http://community.pennwelldentalgroup.com/forum/topics/dr-robert-h-ahlstroms
Each of his rationalizations for HIPAA is weaker than the next, yet he hasn’t the guts to publicly defend the testimony he gave before those who make the laws that directly affect the welfare of our patients. Dr. Ahlstrom will harm American’s for his own interests and will not allow himself to be held accountable. I’ve met the man, and I don’t like Robert Ahlstrom one bit. He is just one more lying coward. Is that too strong? Think someone might tell him that I am waiting for him to get pissed enough to defend his honor? He’d be the first ADA leader to do so.
Beware: Dr. Ron Tankersley, our next lame president, is just one more unaccountable good ol’ boy looking for nothing more than a plaque for his wall. He’s been ignoring me for a year.
I intend to rip the weakling apart his entire term unless he acknowledges my complaints about the ADA – which he hasn’t the guts to try. I have paid dues to my professional organization for 27 years. I intend to get my money’s worth in hide if I have to, Ronnie.
Here is something ADA weaklings as well as readers might find informative. In over three years, nobody has stood tall to defend the honor of a single ADA leader I have attacked – not even privately. That must be disheartening for them, as well as embarrassing. The closest anyone came was when Dr. Findley’s campaign chairman (Michael something from Dallas), told me not to pester the man with my questions about stolen computers with patients’ identities because the practicing periodontist is just too busy. I wish I could remember Michael’s last name. He’s a real piece of work and probably in line for some leadership position where he can also be irrelevant and collect a plaque. I am starting to see how the system works.
Wow! That was a nasty one. Thanks, Jill. You always get me going.
D. Kellus Pruitt; DDS
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Investigative Dental Reporter
I’d like to share with this group a badge of vindication I received for my time spent on this computer. I’m a freelance investigative reporter on healthcare topics, focusing primarily on dentistry, with the emphasis on “free” (as in gratis). It’s a hobby I find exciting because I’ve known from the start that dental patients’ representation in front of lawmakers is so lousy that I can make a difference just by illuminating parasites – inside as well as outside the ADA. I piss a lot of people off, but that doesn’t bother me much.
Every now and then I get attaboys that feel really, really good. A couple of days ago, Mark Hartley, the well-respected editor of RDH (Registered Dental Hygienist) Magazine mentioned me in one of his blogs “In addition, I think my recent views are being shaped by Dr. Darrell Pruitt’s blogs at the PennWell Dental Group, as well as my own experience dealing with the health care provided to my father-in-law dating back to last February.”
http://community.pennwelldentalgroup.com/profiles/blog/list
I’m progressively gaining momentum, and it’s all very, very fun.
D. Kellus Pruitt; DDS
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Courage at last
If you’re in favor of transparency in the non-profit American Dental Association, I’ve got some terrific news for you. If on the other hand, you don’t want more transparency for some reason … sorry.
For the first time in almost 4 years, an ADA representative responded to my persistent pleas for discussion of important issues. Chicago Dental Society Communications Director Keri Kramer commented on an article I posted on Pruitt’s Platform titled “Was it something I said?” I think we have discussion.
It’s reassuring to find one person in the whole ADA who has courage, and loves her job enough to defend it. Dr. Ron Tankersley, President of the ADA, could learn accountability from Keri Kramer.
http://community.pennwelldentalgroup.com/forum/topics/was-it-something-i-said
D. Kellus Pruitt; DDS
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It’s time to lay down, TDA
My response to TDA Council on Ethics and Judicial Affairs: Read ‘em and weep.
The TDA is folding because of unbridled pride among a handful of renegades who somehow took control of our non-profit organization from membership. I intend to enforce a cutback in wasteful spending on that corporate luxury. Just sit back and watch. Since I represent only my patients’ interests, I scare water from lightweight stakeholders. It is my hope that you find this entertaining, sports fans.
Today, I received my second letter by certified mail from the TDA concerning my alleged unprofessionalism. Not unexpectedly, I typed out the letter for everyone to read (below). If you’ve been following the slow-moving judicial bluff that TDA officials are doggedly pursuing, you are aware that I publicly called into question my colleagues’ motivation to judge my professionalism even before I recently experienced the wrath of a vindictive, out-of-control TDA Delegate from San Antonio. (See The American Way of Dentistry Facebook, July 10 and 11: “Preliminary conversations with a TDA Delegate.” and “TDA ethics slides out to sea.”)
I contend that it is my timely but politically incorrect questions about dentistry which continue to elicit petty charges of unprofessional conduct from skip-thinkers. Because of the TDA’s long history of bureaucratic success against troublemakers using intimidation, those who backed the low-value complaints were betting against them becoming vested charges that can no longer be pulled back.
Dentalcare stakeholders entrenched in the TDA can no longer resist the loss of control to principals – dentists and our patients. A handful of our leaders abuse the power entrusted to them. They choose to squander unearned, traditional trust on childish games using certified mail.
——————
Texas Dental Association
July 13, 2010
Dr. Darrell Pruitt
6737 Brentwood Stair Rd., Ste. 220
Fort Worth, TX. 76112
RE: Judicial Case No. 12-2010-3
Dear Dr. Pruitt:
The Texas Dental Association (TDA) Council on Ethics and Judicial Affairs (the Council) has received a copy of the case file from the Judicial Committee of the Fort Worth District Dental Society in connection with the above-referenced case. It has been alleged that you may have engaged in unprofessional conduct regarding your communications to and about the TDA and/or the TDA staff.
The Council is currently conducting an investigation of the allegations at issue. As part of its investigation and in an attempt to resolve the matters at issue, one or more of the Council members may contact you for more information. In addition, the Council may wish to have an informal conference with you. The Council will keep you apprised of any developments.
Thank you for your participation and cooperation with the process.
Sincerely,
Roy N. Burk, D.D.S.
Chair, TDA Council on Ethics and Judicial Affairs
———————-
“Professionalism” is a malleable buzzword suitable for manipulation by healthcare leaders with ulterior motives. I know what I am capable of saying. I promise that when we all read for the first time the evidence Dr. Roy Burk is betting on against my otherwise stellar public reputation as a caring dentist, fans and foe alike will agree that the machinations of the TDA are childish – especially considering the importance of my questions which preceded the avalanche of secret complaints about my professionalism that had never before been called into question by anyone..
It is my intention to post not only all correspondence from this adventure, but I also look forward to sharing the stakeholders’ names with everyone interested. Who will be the first not-anonymous TDA official to possibly take a hit to enable immediate improvement in representation of dental patients’ interests in Texas? One or more of ya’ll risk some skin for once. I do.
Once I’m allowed to read (and copy) the complaints against me – some of them reported to be THREE YEARS OLD – I intend to compare my objectionable statements with those of the TDA Delegate from San Antonio. Then readers will be able to judge for themselves whether either one of us should be recognized as an example for new dentists to emulate.
We’re ready for this game to be over, Dr. Roy Burk. We can’t waste any more time on this hand because there are others that also desperately need to be played out. You show me what you’ve got, I’ll show you what I’ve got, and then I’ll share the outcome with everyone and we’ll move on to other things. There will be no private conferences and do not attempt a phone call. I will not accept it. Those are my non-negotiable rules.
Expect your investigation to be transparent, not only to TDA members, but to anyone in the nation who takes an interest in the real-time failure of a professional bluff that used to work every time.
I’m waiting.
D. Kellus Pruitt DDS
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Is the AMA a Dinosaur?
American Medical Association President Cecil B. Wilson MD puts aside the notion that his group is no longer relevant.
http://www.physicianspractice.com/blog/content/article/1462168/1723136?GUID=E5D1C438-A423-4146-A0D3-9E314F5871B2&rememberme=1
But, if you have to ask – or defend the AMA – it already is not relevant!
Now, what about the ADA, AOA, ANA and/or APMA, etc?
Joseph
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Wonder what ADA leadership thinks of Trump?
For three years, the American Dental Association has assured dues-paying members that “EHRs provide long-term savings and convenience.” No byline, ADA News, December 6, 2013. Since then, the costs of EHRs over paper have only increased.
http://www.ada.org/en/publications/ada-news/2013-archive/december/ehrs-provide-long-term-savings-convenience.
When Melissa Flygare, Sales Account Executive Team Lead, Henry Schein Practice Solutions – maker of Dentrix – was asked which is cheaper, she responded, “To answer your question – is software cheaper than paper? No – paper is rather cheap.” (See: Dental EHRs and the pop of a balloon… Wait for it. Wait for it…” Linkedin Pulse, January 23, 2016).
https://www.linkedin.com/pulse/dental-ehrs-pop-balloon-wait-darrell-pruitt?trk=hp-feed-article-title-comment&trk=hp-feed-article-title-share
The anonymous ADA article (ad) promotes “The Dental Record, the only ADA Business Resources-endorsed EHR provider.” Even though there is no disclaimer, The Dental Record, like Care-Credit and PBHS – a dental website and marketing firm which is mentioned in the same ad – is a source of non-dues revenue for the Chicago-based not-for-profit corporation. The sales arrangement is similar to AARP’s non-dues revenue acquired from dues-paying members: A premeditated conflict of interest in situ.
Both the ADA and the AARP fund Washington lobbyists, whose influence is based on numbers of dues-paying members. For these two not-for-profits, political influence depends on affordable dues. I wonder if AARP’s dues have been as stable as the ADA’s over the last decade.
Perhaps other, smaller, hidden swamps need to be drained as well.
D. Kellus Pruitt DDS
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