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Stop Running Scared from Patients Scott Cairns, DDS

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I graduated from dental school 15 years ago. As I reflect back on those times, I think I was a fairly typical new dental graduate: anxious, eager, excited, scared. The four years following graduation were typical. I went through all the routine stages of a newly minted dentist. I made many of the typical mistakes — clinical, strategic and financial — as well as many of the typical successes. About eight years ago, fortune turned me down the atypical path. This path has been exciting and rewarding, but certainly not free of dangers and fear. In many ways, this path, though rich with promise, has been much more arduous than any I have taken thus far. Unfortunately, today's dental climate has made the path I tread — the path of most resistance— a path that many of the readers have similarly traveled.

The long journey
In my first years as a dentist, I was like a teenager. I knew it all, especially when it came to all the accumulated knowledge of practice management. After all, I had been reading dental magazines since I was a freshman in dental school. I had even read six years' worth of back issues to catch up!

When I finally bought my own practice, I began to try to implement all of the sage advice I had read. I knew that insurance was bad, so I tried to avoid participation. I knew hygiene was a profit center, so I added hygienists. I knew nightguards and bleaching were high production at little expense, and so many patients received these services. I was absolutely sure that bigger was better, so I built a large physical office. I knew I could borrow money today to satisfy my desire for immediate gratification, so that is what I did.

All the while, as I was busily implementing all my knowledge, I began to get hints that my knowledge was incomplete, if not fatally flawed. Something was missing. I realize today that I was becoming more and more of a provider of commodity services, and less and less of a doctor, educator, healer and friend to my patients. At that time though, I couldn't clearly put my finger on what was happening, so I began a search for something. I didn't know what I was searching for, just that something important was missing.

That was when my wife (also a dentist) and I began our journey toward change. Fortuitously, we discovered a philosophy of care that was bigger and more enduring than our personal egos. We discovered that our purpose was service to people, not to teeth. We have spent the last few years developing our skills and our practice so as to better serve the best interests of our patients. However, we struggle with this seemingly simple objective. It sometimes feels as if all of dentistry is conspiring to make patient-centered an impossible emphasis for a modern dental office.

I remember when we first began our journey, spending time with a group of dentists struggling and trudging along the path just like ourselves. As I looked at the group, I noticed the fear and frustration lurking in the shadows. As I looked even closer, I noticed everyone had these personal demons haunting him or her. For some, these fears and frustrations were more brazen and bold. Others had them very well in check and controlled. But no one had banished them completely. Perhaps this is just the natural progression of developing a practice based on care rather than production. Perhaps it is impossible to exorcise these demons, I don't know. What I do know is the path to freedom is much more difficult than it intuitively should be. I don't want to blame anyone or anything for the difficulty, but I think it is empowering to acknowledge those things that make it so difficult.

Anyone, after careful reflection, could come up with his or her own personal list of obstacles. As I shared earlier, my list included arrogance, a desire for immediate gratification, pride and ignorance. But, as I looked at a group of 23 intelligent, motivated dentists, I noticed the greatest and most innocuous demon of all was fear.



What are we so afraid of?
As a group, we are afraid of a myriad of things. We are afraid that we cannot provide the service, we are afraid of insolvency, and we are afraid of what our peers will think. But the most common fear, and perhaps the most curious fear, is a fear of our patients.

I think it is safe to say that among this group of gifted and blessed dentists, that fear of the patient was universal — even among the bold drivers of the group, although I suspect they don't think of themselves as afraid. I know I didn't until I reflected on those things that were holding me back.

This fear can present in many ways: a fear that the patient will think we are over-treating, have wasted their time, that we are self-serving, or a fear that the patients will not accept the healthiest long-term method of treatment.

Running the race with confidence
Where does this fear of our patients come from? I'm not entirely sure, but I have given this question considerable thought. I think this fear comes from our lack of a relationship with our patients. For those fortunate patients — those who we get to know best — we are never afraid to tell them the truth as we see it. We are never afraid of what they will think of us. We are certain that they trust us and are fully aware that we have their best interests in mind. The unfortunate thing is many dentists do not always have this confidence among patients.

I marvel at how long it has taken me to reach this realization — after all, I had read years worth of dental articles. If knowledge were the key, it would be easy. The key isn't knowing that you should know your patient — everyone familiar with L.D. Pankey is aware of this. The key is actually knowing your patient. Until we have the courage to set up systems in our offices that, without exception, allow us to spend the time necessary to get to know our patients, we will always be in fear of our patients. Our individual visions will never become a concrete reality. Not until then, can we stop running scared.
Dr. Scott Cairns is a graduate of Creighton University School of Dentistry and has been practicing dentistry since 1999. He is a multiple-office owner dentist supported by Pacific Dental Services with three offices in Southern Colorado. Dr. Cairns is driven to help new dentists along their journey toward improving their dentistry and quality of life. He oversees multiple dental study club groups aimed at helping dentists become the practitioner they envisioned when they began their careers. He is a member of American Academy of Cosmetic Dentistry, L. D. Pankey Alumni Association, American Academy of Orofacial Pain and Spear Faculty Club. He, his wife and three daughters live in Colorado.
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April 2024
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