ArcaNuova · Being and appearance

What remains when appearance falls away

What I took from my former profession about craft, vanity and real help.

A thought chapter about the difference between lived responsibility and professional self-display. Not as a reckoning with persons, but as a reminder of an attitude: the person in front of you is more important than your own shining image in the white coat.

Being and appearance in the white coat

A profession leaves more than memories. It leaves ways of thinking. Some of them one lays aside like an old coat. Others remain because they do not belong to the profession, but to the way one looks at the world.

From my former work as a dentist I did not take the title with me. Not the vanity of the white coat. Not the feeling of being greater than the person who seeks help.

I took something simpler with me: look closely, think practically, work cleanly and help the person sitting in front of you.

There are practical dentists. And there are those who bathe in their own divine light until they can hardly see what lies before them. The practical dentist does not work in order to admire himself. He asks: what is necessary here? What is safe? What is gentle? What is responsible?

The other type likes to confuse professional competence with self-staging. He makes things more complicated than they need to be, hides insecurity behind grand words and sometimes chooses a tool not because he has understood it, but because it was recommended in the last course by a respected professor.

He adopts the authority, but not the understanding.

That is dangerous. Not because further training is bad. It is necessary. But repeating is not thinking. An instrument is not right because a famous name showed it. It is right when one understands why it is suitable in exactly this situation: because of its form, stability, guidance, effect on tooth and bone and above all because of safety for the patient.

The right forceps were in sterilisation

Already at university I received an early lesson that practical help for the patient and formal rule-belief are not always the same thing.

It was many years ago, during a football World Cup. For us students it was a special time. Not because of football alone, but because we did night duty in the clinic and hoped to obtain the number of tooth extractions required for the exam.

Such opportunities were not easy to get. One examined patients, assigned them, prepared everything and hoped that in the end one would actually be allowed to carry out the extraction.

Before every extraction a newly qualified assistant had to agree. That was understandable; after all, we were students and not finished dentists. In practice, however, it often happened that when the case had been prepared, the assistant quickly extracted the tooth himself.

For the patient this was usually irrelevant. For us students it meant: another night spent there, another preparation, another hope, and again no recognised extraction on the list. Bureaucracy can be very industrious when it lets people wait for nothing. There it suddenly shows stamina one would never otherwise credit it with.

One of those nights I had a patient for whom a tooth extraction was necessary. The situation was clear, the patient was there, the treatment was prepared. Only the prescribed forceps were not available. They were in sterilisation.

One could have waited. One could have left the patient lying there until exactly that instrument became available again. One could have turned the situation into a small ritual, as institutions sometimes love: formally correct, practically not very helpful.

I decided differently.

I was a student, so certainly no experienced practitioner. But I had understood enough of the basics to assess the situation. There was another suitable pair of forceps. It was available, sterile and fitted the task. So I used it.

The extraction went smoothly. The tooth was removed, the patient was cared for, there was no drama, no complication, no damage. From the patient’s point of view the decisive thing had happened: he had been helped.

It still did not count.

Not because the extraction was bad. Not because the patient had been endangered. Not because I had acted arrogantly. But because I had not used the prescribed forceps.

The right forceps were in sterilisation.

The right decision lay on the table. It was not recognised.

That was an early experience with a way of thinking I would meet again and again: the decisive thing is not necessarily whether something was understood, whether it worked or whether the patient was helped. Sometimes the decisive thing is only whether the form was observed.

A tool is not catalogue faith

Of course medicine needs rules. Without rules, treatment becomes arbitrariness. But rules must not replace thought.

This applies to tools as well. A tool is not good because it appears official. It is good when it can be used under controlled conditions safely, sterilely, stably and gently for the patient.

Later in practice there were situations in which a perfectly sterilised tool-steel lever was superior to a dental instrument. Not as an amateur recipe. Not as an invitation to improvise. But as experience that understanding of material, leverage, stability and responsibility can sometimes be more important than the pretty name in the specialist catalogue.

The practical dentist does not first ask whether an instrument looks especially noble. He asks where the force acts, how the material behaves, where the risk lies and whether the patient can be treated more gently as a result.

The impractical dentist often asks only what was shown most recently in the course. Then understanding is no longer central, but borrowed authority. Thinking becomes repetition. Craft becomes theatre. Help becomes self-display.

Not gods. Helpers.

Good dentistry does not arise from self-praise, academic showing off or complicated self-display. It arises from understood practice, clean hands, clear responsibility, calm assessment and the will to help the patient.

The patient does not need a god in a white coat. He needs someone who can help.

Perhaps that is the actual sentence I took from my former profession. It applies not only to dentistry. It applies to technology, water, electricity, websites, houses, gardens and the whole strange human project of bringing order into a world that regularly makes an effort to become disorderly again.

Being and appearance part company where no one applauds anymore. Then only the work remains. And the question whether it truly helped a person.

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