Do Dentists Have a Self-Esteem Problem?

Article published in Dental Economics, May 2023

Even the most confident, self-assured dentist may develop a self-esteem problem based on their patient interactions. Let’s experiment if you’re vulnerable.

Give yourself one point if:

• You’ve ever had a patient directly say to you, “I hate coming to the dentist.”
• Your front desk team spends countless hours texting, emailing and calling patients to remind them of their appointments only for those patients to no-show anyway and then express indignation that they’re charged a missed appointment fee.
• You’ve spent 20 minutes with a patient sharing their x rays, pictures and models only for the patient to say they’ll “think about it” because (A) they want to spend the money on Disneyland or (B) insurance might not fully cover it or (C) they’re just too busy.
• Patients tell you they have self-diagnosed their issue and also done some DYI dental work based on a TikTok video.

Who wouldn’t have a self esteem issue after all that?

But – and here is a direct and harsh question –  have dentists inadvertently contributed to the devaluing of their own profession?  Before you howl in protest, let’s examine this honestly. While I’m not a big fan of Dr. Phil, he has said one thing I find impactful:

We teach people how to treat us

Is it possible that dentists inadvertently teach patients to diminish the worth of their dental care and to behave with a level of disrespect? After 20+ years as a practice management consultant, I’ve observed how dentists and their teams sometimes enable patients to behave badly.  

Let’s take another quiz.  Give yourself one demerit if you or your team ever:

• Minimize treatment with terms like “just” or “little” or “patch” or “cleaning” so that patients aren’t too alarmed.
• Apologize if the patient has any out-of-pocket cost because the insurance company has more credibility than you.
• Beg, plead and cajole patients to remember to show up to their own appointment, as if the patient is doing you a favor.
• Inconsistently threaten to fine chronic no-show patients, but reappoint them anyway.
• Engage full-time employees to navigate patients’ insurance plan because patients don’t want to do this for themselves.
• Hesitate to charge fees that are commensurate with your services because patients will groan if there is even a small increase.
• Open early or stay late to see a patient who believes you should accommodate their work schedule as if their health is less important than their job or your time.
• Ask patients if they want to pay today and if they don’t, cheerfully assume all the costs for their treatment until they get around to writing you a check.

When Customer Service Becomes Co-Dependence

Mental Health America defines co-dependency as an “emotional and behavioral condition that affects an individual’s ability to have a healthy, mutually satisfying relationship.”  Note the term “mutually satisfying” implies that both parties get their goals and needs met. But what I’ve observed is that under the guise of customer service, dentists have somehow become the underdog in their patient relationships.

I’ve wondered why these behaviors are so common in dental offices.  I don’t imagine many cardiologists have these issues. (Do their patients  routinely miss appointments or arrive late? Do their patients demand that the receptionist should research their insurance benefits? Do their patients declare they’ll do one valve this year and one next year?) Why do dental patients balk at paying $150 for their hygiene appointment but will plunk down $500 or more to clean their dog’s teeth?  Is there something unique about dental patients or is there something amiss with dentists?

Adjusting Your Mindset

Let’s go crazy and imagine a different scenario.  In this scenario, let’s pretend that dentists have a different (less co-dependent) mindset.  Because behavior correlates to attitudes, let’s look at how new beliefs would lead to different actions.

New Mindset	New Behaviors
I attract an abundant supply of patients who genuinely appreciate my dental care.	Because I don’t have to “settle” for patients who don’t fit my philosophy,  I spend quality time with patients, deliver more preventive treatment and invest in leading edge technology.
I provide life-changing and even life-saving treatment at reasonable prices.	I confidently share my fees during the treatment dialogue which increases case acceptance and reduces the burden on my front desk team.
My responsibility is to provide health care, not manage a patient’s byzantine insurance plan.	I don’t apologize if treatment isn’t “covered.” We file the paperwork, but patients need to advocate for themselves with their own plan when there is a problem. As a result, I cut down on my admin costs and staffing.
Patients are responsible adults who can be expected to keep their appointments without constant reminders.	We describe and ask for a commitment to  our cancellation process. If a patient violates our agreement, it’s the patient’s responsibility to reappoint and assure us they will commit to the next appointment. As a result, we have fewer unfilled appointments and a more responsible patient base.
Patients pay for their treatment at the time of service, just like they pay for everything else in their lives.	We stop billing and sending out statements and increase our over-the-counter collections.  Our collection % increases while our admin costs go down.
It’s fair to ask patients to adjust their work schedules in order to receive treatment so that my team and I have a healthy work/life balance.	We have predictable work days and time for lunch and meetings which don’t get cancelled to accommodate patients. We are able to rest, meet and plan during the workday which decreases my overtime costs and everyone’s stress.

How Would You Change?

These behavior and systems changes are possible if you make shift in your beliefs. It begins with knowing in your bones that you will always be able to attract and retain patients who fit your philosophy. You would still provide compassionate customer service, but you would have healthier, more responsive patient relationships. I imagine that would restore your self-esteem.