Trust and Dental Treatment

DF2 Uncategorized

The Perio Perspective
Spring 2019
Trust but verify.
(Old Russian proverb. Reagan doctrine.)

Our world is built on trust. All of it.

Consider the dollar bill. It is a green piece of paper. But because we all trust that it has value, we can have a world economy. Credit cards, which are just pieces of plastic, are no different. And the internet, where most of us keep our savings and conduct transactions, is even more evanescent. We trust our lives to the cloud, and none of us even knows what that is. We trust other drivers when we are driving or when we cross a street. We trust because we have no choice, and because it usually works, and because our species has evolved to be trustworthy.

We have all had our trust violated. There are few acts that trigger a more violent reaction – usually a mixture of shock, anger, and sadness. Words like “devastated” or “furious” come to mind. Our relationship with the transgressor is either degraded or lost. Betrayal of trust is the only nonviolent crime that carries the death penalty. Ask Benedict Arnold.

Trust is the single greatest asset in our patient relationships, and it is essential to be aware of how we gain or lose it. What affects trust?
  • Pain. This is at the top of the list of how our patients evaluate us. There are many examples.
    • Local anesthesia administration and effectiveness. If our patient says “ow” while we are injecting, we have lost their trust. If we expect them to “hang in there” when they are not numb enough, we have lost trust.
    • Pain management during treatment, including rest breaks and respect for the TMJ.
    • Post-treatment pain management. We recommend preoperative and postoperative NSAIDs. Adding acetaminophen (“2 Advil and 1 Tylenol”) augments analgesia.
  • Money. If a patient expects to pay $200 and ends up paying $600, we have lost their trust. If they expect to pay $900 and end up paying $600, we gain trust.
  • Complications. We are not omniscient, but patients assume that we are. When everything goes to hell, they will be on our side if we warned them ahead of time. If we did not, then we lose their trust.
  • Esthetics. Our patients expect our treatment to make them look better. It is tempting to over-promise, but wiser to set realistic expectations. Black triangles and shade compromises are only acceptable to patients who expected them.
  • Time. Studies show that patients tolerate seven minutes of waiting before becoming annoyed. Anyone who sits in our waiting room for twenty minutes loses trust. And why shouldn’t they? We told them 9:00 and they’re still waiting at 9:20. We lied.
  • Responsiveness. We all want to know that our caregivers truly care about us. When patents have a problem, they expect prompt attention. If we put them off, or don’t follow up with them, we lose their trust. It is easy to view the phone as an intrusion. Actually, it is our lifeline.
  • Responsibility. The best response if you sense a whiff of mistrust is to take ownership and apologize. You won’t get sued. Admitting that we are human and doing everything we can to make things right is the best way to regain trust.  
  • Proxies. In the absence of reliable data, new patients evaluate us using indirect measures. For example: website, online reviews, phone interactions (not being routed through voicemail, not being put on hold, not needing to answer a dozen questions to make an appointment), office cleanliness. Everything we do should create an image of trustworthiness.
  • Smiling, eye contact, and taking time. Research on the placebo effect has shown that patients who see their caregivers as warm, patient and caring experience less post-treatment pain and perceive better results (Howe, L. et al, Health Psych 36:1074, 2017). People trust happy people.
In this newsletter, we are talking to ourselves as well as you. We have committed every sin on this list at least once. So have our own doctors when we were the patients. We have been blindsided by pain, cost, infections, disfigurement, and non-responsiveness at the hands of some of our doctors. Our mission is to never have a single patient remember us this way. It is an endless but worthwhile challenge.

As one of our mentors, Dr. Michael Sonick, says, “Do the right thing. And how will you know that it is the right thing? Because it is the right thing.”

Trust is the right thing.