Universal patient acceptance: ethics pipe dream or key to improved access in dentistry?

The authors discuss ways that dentistry engages silently and sometimes unknowingly in practice patterns that adversely affect public access to dental care. The concept of acceptance is explained and contrasted with treatment and with access to care. The concept of Universal Patient Acceptance (UPA) is introduced, with a focus on how it underlies and precedes access, creating a pathway so that truer universal access to dental care can be realized. The authors argue that a commitment to Universal Patient Acceptance shows promise as an important starting point in the dental profession's concern to address society's unmet oral health needs.

Quality improvement and substance abuse: rethinking impaired provider policies.

Substance abuse is known to be our nation's number one public health problem. Physicians and other health providers can develop chemical dependency problems that create significant quality assurance and risk management dilemmas. Not all of society understands drug dependence to be a treatable medical disease and behavioral problem. Sometimes impaired providers are ignored or punished rather than treated and rehabilitated. This results in an enormous waste of human and monetary resources. In the last 10 years, impaired physician programs have developed focus and credibility. But certain difficulties exist in these programs: namely, that such programs are affected by tensions between medical societies and state licensing boards; that substance-dependent providers escape detection by moving to other states; that existing impaired provider programs have limited practical application within the federal health care system; and that liability risks are incurred if institutions rely on impaired provider policies that do not include all members of the medical staff. Hence, we argue that existing impaired provider policies might be worth rethinking. To promote that dialogue, we offer a sample policy for consideration and review. It includes specific actions and procedures for the identification, referral, and reentry of impaired providers and allows for National Practitioner Data Bank reporting in that process. The Data Bank has been in place for only a few years and offers society and the health community a new opportunity to better control chemically dependent, licensed medical staff without dismantling existing impaired provider programs. The policies for managing chemically dependent health professionals are changing from a focus on stigma and prosecution to one of early identification, rehabilitation, and reentry. We hope to advance that process.

Color blindness and Rorschach color responsivity.

Color vision deficits occur in 10% of the American white male population. Thus, color blindness may invalidate diagnostic hypotheses generated from Rorschach data. The Rorschach protocols of 43 white, college male color-blind subjects were compared to the protocols of normally sighted controls. The color-blind group manifested fewer pure "C" responses. No significant between group differences emerged for any of the other primary Rorschach color variables. Pure "C" responses rarely figure prominently in Rorschach evaluations, and the apparent lowered frequency of these responses by the color-blind is insufficient to warrant modification of current Rorschach practice. The data suggest that color blindness is unlikely to confound Rorschach assessment.