In my last post I said that the introduction of dental insurance has led to a mindset in many patients – the “Anything That's Covered” (ATC) mindset – that has become a barrier to ideal care. But that patient mindset has, in many cases, also led to a clinician mindset – one that feeds off of and plays into this kind of thinking.

It's a natural human reaction. You hear the “no” repeatedly from “ATC” patients, so you begin to anticipate it. And because you don't want to keep hearing it (nobody enjoys rejection, after all) you begin to alter your presentations to accommodate what you think patients want to hear. You start self-censoring based on the perceptions you have of what they think their needs are, and what you think they will accept. And when you do that, you're both playing a self-defeating game.

Even when you do present the absolute best treatment plan for them, you still often end up playing the game. “There's no way I can do all of that, doctor,” the patient says. “What should I do first?” What they're really asking is: “Which part of this treatment plan is not really necessary?” They want to divide it into the “needs” and the “wants” and the “wants” usually end up losing to other more exciting priorities. And they want you to help them prioritize; they want you to tell them which part of their treatment it's ok to say “no” to.

If you want proof that allowing yourself to be pre-programmed by the “no” is self-defeating, you don't have to look any further than the surprises. There are the patients who you know very well can afford it but who unexpectedly refuse even basic treatment. But there are also the good surprises – the ones you thought could never afford it but ended up saying yes. That's not to mention the ones who ask you for treatment you didn't even present.

These patients are living evidence that it does not pay to make assumptions. This is why you need to fight the impulse to play into the limiting mindset. You have to immunize yourself against the “no” reflex and make the commitment to “go in fresh” every time. A “no” today just means you fulfilled your obligation to present to the fullness of your ability. It's just another opportunity to build the relationship further tomorrow. Stay committed to that purity of purpose and, over time, there will be more pleasant surprises in store.

Great dentistry is what it is, and being a great dentist means standing by that commitment to always say what you see, to educate, and to take patients on a journey towards valuing quality care.


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Commenter's Profile Image Bron
February 6th, 2012
As a patient, I have a few comments. I am Dr. Spear's patient from Inside Dentistry, May 2006, Volume 2, Issue 4. I didn't get there by accident. I got there by mutiple career professionals who were sick of hearing "no" and self-censored. I had a skeletal aberration, concomitant or caused by a traumatic injury involving a baseball bat and a tetherball. (it's a good story, but not one I remember much aside from seeing "ECNALUBMA" reflecting off the third-grade art window) I also accumulated dentists who self-censored. By the time I was 18, three dentists had suggested dentures. By the time I made that last desperate call to Dr. Spear, six had recommended dentures. Not because I needed them or wanted them. But, because there were two things at play 1) She's going to say no 2) How do you cope with all these problems at once? I went through a dozen highly recommended dentists. During that time, I went from 1 to 20 provisional crowns. No dentist stood up and said "you won't like this, but..." Every dentist assumed I'd say no. For every dentist I visited, my oral hygeine went down, why bother? After hearing from me that I didn't want to accept dentures, they either referred me out or re-recommended dentures. They self-censored. Dr. Spear did not. He created a PLAN. He asked me what I *wanted*. He put aside his own experience and *listened*. So, I have the satisfaction in reporting that over the last 10 years (Inside Dentistry article came out about 5 years late), my low point was a single cavity on the buccal of 31, on the crown margin. I'm pretty unhappy that I had one at all. I sat in the chair, listening to the sound of the drill, and hating that I had a failure. Dr. Kinzer reminded me that it had been 3 years since they noticed the spot, but I'd like it to be 30. Or maybe 300. That's a problem I'll take up with my sonicare and my floss. But those don't require any self-censoring from my paid, professional, career dentist. Check out my before and after pics. Those alone will remind you why you do this. It's not because some people say "no", it's because some say "yes." And you can't tell which ones are which.
Commenter's Profile Image John Sweeney
February 15th, 2012
Thanks Imtiaz for your thoughts on this. You discuss commitment to your values and commitment to always say what you see and educate, etc. For me, it's taken almost 7 years of practice to really embrace what you are talking about in this blog. Self censoring was probably my biggest obstacle in the first few years of practice. Thankfully, I don't do that anymore. For me, it comes down to defining your core ideals as a dentist and then letting those guide everything you do from treatment planning to the management of your practice. If one of your core values is to provide the best dental care possible and you truly embrace this, then that in itself, should keep you from self censoring. However, It seems to me that a good number of dentists are more "reactionary". The way they do things kind of changes with the wind. From treatment planning to marketing, their decisions are made based on the current state of the practice rather than a guiding vision grounded in a set of core values that never change... A set of values that maintains consistency and excellence.