Every Patient a Finals Patient

You remember finals don’t you? Of course you do. Your examiners carefully selected a patient(s) for you to examine, diagnose and present your treatment plan. The final’s patients were unlucky enough to have more than one dental problem and you were marked on finding all of them and your ability to create a set of solutions for the patient.

Then most of us headed off into practice and a series of “finals patients” paraded in front of us. These patients willingly pay us now to make our professional judgements, offer them our best solutions and suggest a fee for doing the dentistry!

However, that’s not always what happens, is it?

 There’s something that happens in General Dental Practice (be it NHS, Mixed or Private practice) that is rarely spoken about in Dental Magazines or in on-line forums or even at the bar at dental conferences. And it’s this. That many dentists consult-with, examine, diagnose and treatment plan their patients, not in the way that they did for their finals patient, but by applying some sort of filter, a filter that the patients are completely unconscious of. Such filters have several elements and in 25 years of being a dentist and then 10 years coaching dentists, I think I’ve probably heard or seen them all, (I’ve certainly seen the effects they create).

The filter may have some or all of these components:

1.    Will the patient like me if I tell them about all of this

2.    Will the patient come back if I tell them about all of this

3.    Will the patient think I am over prescribing

4.    (For returning patients) If I tell them about all this now, will they wonder why on earth I haven’t mentioned it before?

5.    Will the patient be willing to pay for all this?

6.    If I persuade the patient to have the big treatment plan, what happens if it goes wrong?

7.    As long as I make a note on the records, I am keeping myself within the GDC/Legal rules.


The enemy within here is fear, and not the patient’s but the clinician’s! And so the filter gets applied and the patient is offered the treatment plan that the clinician believes is absolutely “necessary” or the one they feel the patient “needs”. Presumably, they leave the rest until it becomes (as they deem it), “necessary” or “needed”. An additional filter (of course) is the one that pushes the dentist towards offering treatments that are well paid or earn the most number of UDA’s.

So, before anyone rushes off to the moral high ground and starts sending me emails beginning, how very dare you… let me run this analogy past you.

Imagine putting your 3 year old. £25,000 car in for a 30,000 mile service. During the course of this the technician discovers that as well as the regular service items needed, your car also has these faults:

  • 2 sets of worn brake pads
  • Front brake discs are warped
  • Rear dampers are leaking
  • 2 tyres are nearly at their worn out marks


As a customer, which of these phone calls would you like them to make?

1.    The call that lists the faults, your options and the costs for having everything put right?

2.    The call that tells you about the faults they think you will want to hear?

3.    The call that tells you about the faults that you will be able to see?

4.    The call that tells you about the faults they think you will be willing to have fixed?

5.    The call that tells you about the faults that makes them the biggest margin when they repair them?


And what will they do about the faults they don’t tell you about? Perhaps, put a ‘watch” on their records and consider telling you at the next service?


Duty of Care.

I know that some of you will be wincing already at my comparison between a clinician and a mechanic but wait, there’s more “mileage” in this analogy still to come!

After paying for just the service, you drive off from the garage with the faults left unreported. A child runs out in front of your car and you fail to stop in time because of the worn tyres/brake pads/discs/dampers. In the investigation that follows, these things come to light and sparks a witch hunt.

A good garage owner dare not risk this and the inevitable damage to their reputation. A good garage must tell you exactly what it finds wrong with your car/ A good garage takes their duty of care seriously.

So what’s really going wrong when a patient leaves a dental surgery with half a treatment plan? In my opinion, this happens because we’ve lost the simple, straightforward, trusting relationship between patient and clinician that we had as a final year student.  External circumstances such as: The NHS, the economy, the practice finances and probably most importantly, our lack of confidence and self esteem have filtered our behaviours so that we agree to compromise our professional skill set and integrity in order to be liked, keep the patient or stay within our comfort zone.

So, how does that sound? Not so great from where I’m sitting and let’s not tell the national newspapers! When I left the NHS in 1992, I decided to get rid of all the filters I had acquired and simply show and tell my patients what I could do for them as if they were one of my family and money and time wasn’t an issue.

I’ve used the exactly the same approach in my coaching practice. I was lucky enough to be mentored by some great coaches on the idea that you often do your best coaching just before you get fired (for telling it like it is).  And that’s what I do for our clients.

In my view, you have to decide what sort of dentist you want to be. An anxious single unit one tooth at a time type dentist, forever destined to gross a thousand pounds a day whilst complaining that patients don’t want my treatment.

Or a dentist who communicates clearly and straightforwardly with their patients about what they can see in their mouths and the best way to fix it. Thereby giving the patients back their responsibility for their health and leaving the decision about whether to proceed with them.

As Steve Jobs said in 2005,

 Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do. If you haven’t found it yet, keep looking. Don’t settle. As with all matters of the heart, you’ll know when you find it. And, like any great relationship, it just gets better and better as the years roll on. So keep looking until you find it. Don’t settle.”




If you would like some help with effective patient communication or improving your self confidence…

Contact me directly at simon@nowbreathe.co.uk

Or contact The Breathe Business Team on 0845 299 7209


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