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Ethical Dilemma: The In Criminal by Jen Butler, MEd, CPC, BCC

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Crime: murder, theft, assault. We know the sins that go against society and the painful consequences that are attached. But what about the other crimes? The ones masked within our own walls that we commit and hide from ourselves and others? Incompetence and indifference are two such crimes committed in offices where dentists are the criminals and rarely does their punishment go noticed. Their punishment is personal and takes place in the form of detachment, loss of patients, apathy and burnout.

These types of crimes don’t go on any rap sheet or public document. They do come with a social stigma that can be just as damaging and create a public reputation that is not easily erased. There are signs to knowing if you or someone is experiencing incompetence or indifference. Learn these and help stop the IN criminal.

Incompetence

No one sets out planning on doing a bad job. Dentists don’t maliciously intend on doing bad dentistry. But what safeguards do dentists put into place to ensure they are doing great dentistry? How does a dentist know they aren’t incompetent? Here are some things to look out for, questions to ask yourself and tasks to complete to give you insight

What to Look Out For

Independence: Going it alone is a sure fire way of slipping into incompetence. When there is no one to look at your work and question your skills, you don’t need to challenge yourself. Being independent allows you to go on believing, acting and doing the same level of work and conducting the same level of business you always have. Avoiding collaboration with colleagues, team members, coaches, consultants, CPAs and other professional partners keeps you thinking small, so it keeps your practice small. Dentists by nature are independent, which is what has gotten you through 20 plus years of education, exam after exam and boards after boards. Yet the business of dentistry is way too big to think you can do it all on your own and do it competently.

Buying into Self-deception: Self-deception is when you deny or rationalize away opposing evidence that doesn’t fit within the constr uct of who you think you are. Selfdeception is all about the lies we tell ourselves that make us feel better about how we act, what we’ve done, our talents and achievements. For example, when a patient comes in with a cracked crown you just completed you say, “They are a terrible grinder,” or, “They have a strong bite,” or even, “They wanted the cheaper crown. It’s the material. They got what they paid for.” You become immune to how often you buy into your own self-deception. When you do rationalize away situations, you fail to take the opportunity to interrogate your own reality. It’s only when we logically analyze situations and search for facts that we can determine if it truly is an external issue or if the problem is your level of incompetence.

Constant Satisfaction: Being constantly satisfied with what you do and how you do it can quickly put someone at the ‘incompetence level’ of dentistry. When you become satisfied with something you stop being curious. Curiosity is what propels people to seek change. When people are curious they ask different questions and seek out the answers (“Is there a way for me to do this faster?”; “How efficient is this procedure?”; “What can I do about team communication?”; “Am I retaining patients?”). Constant satisfaction continues to feed the ego, often times at a very high price.

Mary-Poppins Effect: “Practically perfect in every way” mentality solidifies incompetence in dentistr y. There is a level of egocentric thinking doctors must possess in order to do what they do – fix another human being. Too often this way of thinking is massaged and nurtured by the dentist himself and reinforced by others, that a healthy dose of confidence turns into full-blown narcissism. This thinking then becomes the filter used when choosing CE courses and workshops, procedures completed in office and who you deem acceptable in providing you feedback. The more you separate yourselves from others, the less you will question and truly understand about your own abilities.

What to Ask and Answer

The first step in facing the realities of incompetence is to ask yourself questions that challenge your current level of thinking, and then answer them. Often when a question puts us too far outside our own box and contradicts what we already think of ourselves, we dance around or completely pass over providing an answer. The more difficult a question is to answer, often times the more right the question is to be asked.

Start with these:
“How high is my failure rate?”
“What do I rationalize away?”
“What excuses (others call these reasons) do I tell myself and others that gives me permission to not accept responsibility?”
“What do I tell others I’m a master at but when facing reality I really don’t know very much about?”

“If I were to take a course on just one thing, what would make the biggest difference in my practice?” (Hint: It’s not always clinical!)

What to Do

Now that you’ve answered the right questions, it’s time to gather supporting evidence.

Run reports: Your office software is full of answers for you. Take the time to pull reports and actually see what story the numbers tell you.

Post cases on Dentaltown.com: Making your work public for comment takes courage. It also is one of the most effective ways for you to learn about your strengths and areas of opportunities.

Join a group: Study clubs, mastermind calls and online chat groups are incredible ways for you to gain the perspective of other professionals. The more you surround yourself with people of varying viewpoints, the more your perspective opens up.

Clinical Audits: There are always choices in dentistry and one isn’t necessarily better than the other. Having a clinical mentor review your work allows for one-on-one discussion of your specific cases, gives you someone you trust to challenge your thought process and pushes you to think outside the box.

CE Courses (see sidebar): To avoid becoming incompetent, take a variety of CE courses, especially on those things you find to be “out of the box.” Taking similar courses from similar presenters gives you a similar perspective. Branch out and start looking at things from a 180-degree view. Dentaltown.com has an incredible list of courses that give dentists a wide range of opinions. Take advantage of your resources.

Indifference

There is a distinction between depression and indifference. Dentists with depression still care. They are depressed because of the emotional gap between what they think they have and what they desire. There are still emotions with depression. Finding a way to get to where you want to be is what poses the challenge.

Indifference is one step away from complete burnout and a threat to a dental office. With a total lack of care, complete apathy, lethargy and feeling numb, dentists who are indifferent lower their standard of patient care because they don’t have energy to do what’s necessary. They hang out in their office or don’t bother coming to work at all, letting the team survive where they can. Indifferent dentists don’t notice what’s failing and falling behind. Allowing yourself to get to indifference is just plain criminal.

What to Look Out For

Disorganization: Disorganization can be a sign of a disorganized person. It can also be one of the key symptoms of indifference. Disorganized dentists have always been one to pile their mail, stash old material in drawers and keep stacks of bills waiting to the last minute to pay. When a dentist experiences indifference it’s a process that occurs over time and highly observable by others. They slowly accrue more items, miss details normally never overlooked and forget to submit payments. When asked about the change in behaviors, their response lacks urgency, concern and attentiveness.

Autopilot: Successful dental offices are well-oiled machines. They rely on processes and systems to ensure details don’t fall through the cracks. What makes the routine and mundane worth it are the moments in between where the team laughs together, shares and supports one another. It’s those times when patients are so appreciative for the work the team did it’s obvious a life has been changed. Autopilot looks very similar to following along in the process except for one key element: The moments are missed. The dentist takes every opportunity to fade into his or her office, or any woodwork, avoiding the laughter and support. They lose the connection with patients because they don’t have any emotions to offer. Indifferent dentists go on autopilot when they feel they have nothing more to offer.

White Flag Approach: In dentistry, decisions need to be made, issues need to be addressed and problems need to be solved. That’s just within the first 10 minutes of each morning. When a dentist is indifferent, they wave the white flag and defer decisions to the team, patients or an outside partner. They don’t trust their decision-making skills and would rather postpone anything final than risk failure and making the situation worse. Giving in is right before giving up.

Lack of Conflict: Whether you find it uncomfortable or not, conflict is a natural part of communication. It’s during times of conflict that people build trust, share opinions and show vulnerability. Conflict is a very important component to any relationship. Being indifferent, a dentist doesn’t have capacity to care enough to participate in anything difficult. And it’s more than taking the passive approach. Being passive still requires caring about outcomes. Showing a lack of conflict without any regard for results and consequences is the telltale sign that indifference is the driving force.

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What to Ask and Answer

The questions to ask yourself to determine a level of indifference focus on internal thoughts and feelings, as opposed to incompetence, which focuses on external facts. People have a tendency to avoid looking internally because they either don’t like what they see or don’t value the experience. When looking at indifference, there’s no getting around taking a long, hard look on the inside.

“What is it that I do care about?”

“If I were to point the finger at the one thing that is behind my indifference, what would that one thing be?” “What thoughts do I have that are giving me permission to continue to be indifferent?”

“If I were to tell myself I am not indifferent, what other emotion would I use?”

“What tools and resources do I have at my disposal that would get me from indifference to anger?” (That’s right, I said “anger.” People who are angry, care. People who are angry get in motion. People who are angry do something to change their situation. )

“Who is the one person I can talk to?”

To avoid sliding deeper into depression and experiencing complete burnout, it’s imperative to find those things in life you do care deeply about. Those are the things that will get you through difficult times.

What to Do

With your answers, follow these steps in order for an easy way out of indifference.

Accept Your Current Situation: You can’t change what you don’t acknowledge. Accepting your current emotional state as is will become the reality you need to start doing whatever it takes to make changes for your future.

Seek Medical Attention: Your medical physician is the perfect first resource for you to search out. They will provide you with the concrete direction and medical interventions necessary for you to take next steps in turning things around.

Work with a Coach: What gets dentists to the level of indifference is their stubbornness to go it alone, their inability to convey their emotions and their level of confidence in communication. A coach will be that one supporter who doesn’t give you all the answers but provides you space, questions and the possibility for you to determine your own direction. You got yourself into this mess and you have the strength to get yourself out.

  Author's Bio
Jen Butler, M.Ed., CPC, BCC has been working in the area of stress management and resiliency coaching for over 20 years. She is available as a coach, consultant, speaker and trainer. To learn more about her services and sign up for her monthly StressLESS newsletter go to www.jenbutlercoaching.com. Take the Dental Stress Self-Assessment at www.jenbutlercoaching.com/quiz/ to find out your stress levels. Her partnership with The Business Backer removes any financial barriers so you get the support you deserve. Go to www.thebusinessbacker.com/JenButler and contact Jen Butler directly at 623-776-6715.
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September 2025
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