It’s not about winning. It’s not about what’s fair.

1. Taking care of patients as we would take care of our own family – doing to them only what we would do to our own spouse or kids.
2. Doing what is best for our business and (ultimately our team) in terms of integrity, reputation, sustainability and profitability.
3. When in doubt, err on the side of the patient.
4. Whenever possible (and it’s almost always possible) err on the side of making colleagues/competitors look good.

1. Transfer patients – Accepting and being very reasonable with transfer patients is the moral and ethical thing to do. Rules 1, 2, 3 & 4 apply here. Plus you’ll likely transfer a couple patients out in your career! Be nice to them. Cut them a deal. Forget what’s fair. Focus on the fact that they have family and friends and coworkers who will come to you for treatment. Not to mention that in most cases getting part of something is better than all of nothing if you’re not at capacity.
2. Early treatment – I still see a great many cases where orthodontists start treatment early. Very early. And there is an accepted justification for “starting the case before someone else does”. Rule 1 applies here for sure but so do rules 2 and 3. Don’t do it guys. I’m all about early treatment if there is a clear problem that can be best addressed early. I’m all about addressing a social issue early. Just be sure that finances are not the driving factor for starting early.
3. Financial wires – What do you do when a patient is done with treatment but not finished paying you? Keep the braces on?? That’s unethical even though it’s widely accepted among our colleagues. Rule 1 and 2 and 3 should guide here. Clearly separate financing from treatment in the new patient visit and put everyone on autodraft if you’re worried about it. And don’t let the few outliers who don’t pay color your opinion of everyone else!
4. Disputes with reasonable patients – I’m not as good as I should be about this but I’m trying to be more like Neal Kravitz and Anil Idilculla (in this and other ways). I and other orthodontists tend to get defensive and stubborn when there is an upset when it’s actually easier and better to just do what it takes to make the patient happy. These upsets are rarities though we allow these the outliers to consume us. Rules 1, 2 and 3 apply in these situations.
5. The patient is happy but you’re not finished – I know many of you refuse to take braces off before you’re done and I know you think doing so is a violation of rule 1 but I think you’re mistaken in both cases. We are hired help – like hair stylists – and we should act accordingly. The patient is in charge. They call the shots. Sure you can tell them there is more to be done but they are in charge. I know you think you’d force your family member to “do it properly” but perhaps you’re thinking of the wrong family members? Sure you can make your kids do what you want but how about a spouse or parent or uncle or cousin? I think you’d take the braces or attachments off when they said stop… rules 1, 2 & 3 apply here.
6. Insurance overpayment/credits on patient accounts – I’m sure none of you ever consider letting those lie and are quick to inform patients that they have a credit and give them the money right? I’m sure you send insurance overpayment back to the insurance company as soon as you find it? I’m sure you actively audit your practice for credits right? It’s the right thing to do and aligns with the first three rules though from what I’ve seen we aren’t as good about this as we should be.
7. Talking about colleagues/competitors – I hear a lot of talk among orthodontists given what I do. Heck, I’m the subject of a great deal of the most negative talk out there so I know what I’m saying when I state that orthodontists in general are the most hateful, nasty mean bunch when it comes to talking about peers, how they practice and why we are better than them. To do so strongly conflicts with rule 4 but also with rules 1, 2 and 3. Think about it. How does putting a patient, any patient, in the middle of a pissing match between orthodontists help the patient or you or your business? It doesn’t and it’s time we changed our attitudes when it comes to our peers. I will say that I’m very pleased to witness the tide turning in this arena on the Facebook groups that are doing so much to improve the orthodontic speciality. I am certainly not perfect in this area and have to work hard to improve like everyone else! But I’m working on it and I hope you will too.

So now do you see what I’m getting at? Do you understand why we orthodontists need some guiding principles that have nothing to do with Angle Classification, ABO score or appliance type? I hope so. Because from where I sit the biggest threat to orthodontics are orthodontists! It doesn’t have to be that way! We can all make a difference by changing ourselves and if enough of us change for the better the speciality as a whole will follow suit.