The Dental Performer’s Paradox

You’ve just completed an exam on a new patient. As you seat the patient up and remove your mask, your thoughts race. How you should present your findings and recommend treatment? This particular patient is new to the practice only because she moved to a new state and had to leave her beloved dental office.  She has expressed her admiration and fondness for her previous dentist and explained that over the years, he became a trusted friend. Her new neighbor recommended your office. 

Although the patient has been maintaining 6 month recalls and has meticulous home care, your exam reveals multiple areas of recurrent decay, overhangs and some early periodontal disease. She seems unaware of her oral health issues since she explained she has not had any problems or pain. However, you know there are problems that need addressing. She will need multiple visits and her treatment will go beyond her insurance coverage. 

You are now stuck between wanting to give her full disclosure on all that you see and not wanting to overwhelm a new patient. Michael Port, author of Steal the Show, identifies this situation as the ‘Performer’s Paradox’. He states that we all play different roles in our lives. In our roles as dental professionals, we have ambitions of delivering comprehensive care. Our objective is to address all of the areas of disease, returning our patients to a state of optimal oral health. The paradox is that the ambition itself is adding to anxiety and fear, increasing your resistance to achieving your goal. 

In this situation it is easy to imagine the anxiety of wanting the approval of the new patient. We have all heard stories from patients and friends about the ‘dentist who wanted to sell me things I didn’t need’. It is difficult to explain that action needs to be taken when there is no pain. No dental clinician wants a patient to report back to the person who referred them, that they had a bad experience because they were surprised by a large treatment plan. Michael Port would state that in this situation you have to choose between achieving your goal and results, or having the patients approval. I disagree.

Some clinicians would consider only explaining one issue at a time with the patient. This creates a situation where the patient is being told at each recall that there is another problem that needs treatment. This approach may create doubt. The question becomes ‘why is there always something new to fix at each of my appointments?’ The entire treatment plan should be presented, to allow for transparency of your diagnosis and recommended treatment. 

The key to success is how the plan is presented. Schedule adequate time in the doctor’s schedule, don’t present during a quick hygiene exam. Ask the patient what their primary dental concerns are; keeping all of their teeth, for example. Use their concern as a way to explain your ultimate goal to them. Use all the visual aids possible; films, models, videos and mirrors. Create a treatment plan that lists the most important action first. Finally, never speak negatively about the prior dentist while assuring the patient that you will take the very best care of her. 

It can be challenging to play the dentist or hygienist role, especially to a new audience. Know what your ultimate goals are for your patients and allow for enough time to connect with them. When you present treatment to your patients with an authentic voice, you will gain their trust quickly and avoid the ‘Performer’s Paradox’.