Why Patient Relationships Matter in Dentistry

Do you know that more doctors lose patients not because they’re not competent, but because they don’t have a good relationship with them? What does that mean? They don’t connect with the patient. They don’t connect because they’re talking from one perspective, and the patient is on another level.

The doctor becomes the authority figure. Of course, we are authority figures—we have a lot of knowledge that patients don’t have—but we shouldn’t have more authority than they do. It’s their bodies, after all, and we’re here to serve them.

The Importance of Communication with Patients

When I talk to a patient, I’m coming from an informative perspective. Let me back up a little bit. In Atul Gawande’s book Being Mortal, he talks about three different types of patients. You might know Atul Gawande from The Checklist Manifesto, which is sort of a bible in our office. We’ve talked about that in previous videos, but in Being Mortal, Atul discusses an experience he had with his father.

Atul is a Harvard-trained surgeon, and his father was also a doctor—an ENT. His father ended up having cancer. Here, we have a doctor with cancer, and his son, who’s also a doctor, is managing his care. However, the son wasn’t his doctor.

Personal Experiences with Medical Decision-Making

When a family member has a medical problem, often times, we as healthcare professionals are marginalized. I know this from my own experience with my mother. My mom died of cancer 30 years ago, and she was given chemotherapy when she only had four months to live. Unfortunately, due to her reaction to the chemotherapy, she passed away two weeks after starting it. Those last two weeks of her life were far from pleasant—she lost her hair, she was sick, and she died of an embolism.

Was she told she might lose her hair, get sick, or potentially die of an embolism? No. Nor was my dad, who was her caregiver at the time. I knew those risks might exist because of my medical background, but my family didn’t.

Because of my younger age at the time, I didn’t have the power to tell my dad what to do. He wanted to do everything possible to keep her alive. The last two weeks were terrible, and they weren’t pleasant at all.

The Three Types of Doctor-Patient Relationships

Atul Gawande talks about three types of doctor-patient relationships. The first one is paternalistic, where the doctor is the authority, and the patient is like a child. This approach isn’t really common anymore, especially not with today’s educated patients.

The second relationship is informative. This is a more retail-like exchange, where the doctor gives information, and the patient takes it in at their level. But let’s face it: patients don’t have the same level of medical knowledge we do. They haven’t gone through medical school, completed residency, or practiced for 30 or 40 years. Unless, of course, they’re another periodontist who comes in, which I hope doesn’t happen too often.

Patients usually come in with little to no knowledge. We provide them with information that they may or may not understand, and unfortunately, they only hear about 3 to 4% of what we say. They make decisions based on how they feel, which might not be the right decision for them.

The Consequences of Misinformation

For example, a patient might come in for treatment that costs $20,000. Even though it’s the right treatment, they might only hear "$20,000" and immediately decide it’s too expensive. Or, they might want the treatment to be completed in a shorter time frame because they heard about a faster method on TV. Or they might opt for non-surgical options when surgery is actually what’s required, ultimately leading to worse outcomes.

Unfortunately, these types of situations happen all the time in both medicine and dentistry. The patient ends up making the wrong decision due to a lack of understanding and a failure to connect with the doctor.

The Solution: Shared Decision-Making

So, what’s the solution? This was determined years ago by the Greeks, during the time of philosophy. Socrates, Aristotle, and Plato all talked about shared decision-making. But perhaps the most famous dentist most people don’t know is Bob Barkley, who emphasized this idea.

In Atul Gawande’s Being Mortal, he talks about interpretive decision-making. In this approach, the doctor and patient share the decision, but the doctor helps guide the patient through the process. This is where we bridge the gap from one perspective to the other, allowing the patient to understand the treatment options fully.

We educate the patient by sharing the costs, risks, and benefits of treatment. We lay everything out: this is what we can do, how much it will cost, the time it will take, the surgery involved, the aesthetic outcomes, and the short-term and long-term prognosis. Then, we offer alternatives: should we extract the tooth and do a bridge, or save the tooth with a crown and endo? Should we take out the tooth and do an implant, or is a sinus graft needed?

The Role of the Dentist in Education

The key is to share this information without any bias. I really don’t care what the patient chooses. That might sound a little odd, but it’s true. My goal isn’t to push the patient toward a decision but to ensure they fully understand the costs, risks, and benefits of each option. It’s my responsibility as a doctor to educate my patients because the more informed they are, the better decision they can make.

A Focus on Patient Education

When you go back to your practice tomorrow, think about what kind of doctor you are. Are you the doctor who’s the authority figure and tells the patient what to do? And if they don’t agree, they leave? Or are you the doctor who says, “It’s up to you, whatever you decide,” without the patient truly understanding the information? This is where things get tricky.

If you manipulate the patient by scaring them or lowering your fee to what you think they will accept, it’s not a good approach. Your business should be ensuring that the patient has the right information to make an informed decision—not making the decision for them.

The Results of Proper Patient Education

When I educate my patients well, 90% of them say yes to the right treatment, regardless of the time, cost, pain, or suffering involved. They choose the treatment that’s best for them, and in the long run, that’s what matters.

When my patients return for regular check-ups and cleanings, I want them to stay healthy. I don’t want to treat them again unless necessary. My goal is to treat them once, get them into the hygiene room, and maintain their health. That’s the type of doctor I strive to be.

Conclusion

This is the approach I try to follow, the same one that Bob Barkley and Atul Gawande advocate. It’s all about providing your patients with the education they need so they can make the best decisions for their own health and well-being. In doing so, you build trust, enhance your relationships with your patients, and ultimately provide better care.

Have a great day, everybody!