We orthodontists have a big problem and almost all of us suffer from the same disease. Perfectionism. It’s ironic to me that in a profession where we are dealing with asymmetric people and too many variables to count, much less model, we still think that perfection is the goal or even possible. Worse still, we will grind patients into dust in the pursuit of perfection even though it’s unattainable. Don’t believe me? Before you get your back up too much, stop reading this article, go to your practice management software and run a report called “patients beyond treatment time”. Look at that list. LOOK at it. While you are thinking to yourself, “These people are all the non-compliant, bad growers who never show up for appointments” and convincing yourself that none of this is your fault, take a minute to think about what you are doing. First of all, it’s ALL YOUR FALUT. It’s your practice and your job to get the teeth straight so if you can’t get people to comply that’s on you. Secondly, even IF what you are saying is true then why the hell do you keep those patients in treatment?? If they won’t comply then you should stop treatment!

Either way, you’re wrong!

Not to mention, I’ll bet you quite a bit that most of the patients on that list would be delighted if you would remove their appliances… So why don’t you? Why won’t you? Why can’t you? Why do we do this to ourselves? What’s the rationale for belaboring the point months/years beyond estimated treatment time, long after a patient has proven they are non-compliant or in spite of requests/pleas from the patient to remove the appliances because they are happy?

It’s all about our EGO!

I would suggest that our ego and pride are the main drivers in our orthodontic practices – not patient well-being, not smart business, not even great results. Our egos are even more in control when things are not going well in a given case or in our practice. We are a proud lot and we care more about what other orthodontists or dentists might think of our work than we do about patient satisfaction, patient well-being and patient happiness! Deny this all you want but if you think about what I’m suggesting and keep this notion in mind the next time you’re working on a problem case and then tell me I’m off base.

So how do we stop this behavior loop? It’s not easy I can tell you for sure but I think the key to me escaping this repetitive behavior had a lot to do with really listening to the patient – at the new patient visit, during treatment and at the end of treatment. Ironically the end of treatment comes much sooner in the vast majority of cases if you do this AND patient satisfaction levels are much higher but you have to LISTEN. To achieve this nirvana, you must first stop putting what you want and what you think on your patient and LISTEN. Ask questions like, “How does your bite feel to you?”, “Your teeth look a lot better than they did when you started, don’t they?” and “What do you think about your teeth?” to get honest feedback from patients about what they want in terms of treatment and results. You might even say that you must look for reasons to end treatment instead of looking for reasons to continue it – even though this goes against our nature. I know you think this is crazy and that saying this means that I’m not a good orthodontist. That’s certainly your prerogative and most orthodontists will probably agree with you but remember that I’ve taken over dozens of practices and dealt with all those overtime patients that accumulate over the years in the average practice. The most recent practice I took over drove this point home for me especially well. It contained scores of patients in tears, thanking me because I asked them what they thought. Patients who told me they begged the previous doctor to remove their braces but were told, in no uncertain terms, “NO!” and that the experience left them afraid to ask again. Patients who were months and even years over treatment time and desperate to get their appliances off – they were well satisfied with their teeth and incredibly tired of orthodontic treatment and the practice was suffering massively because of their unhappiness. And then I got to look at the results in that practice – the previous doctor’s results were not bad at all but I certainly didn’t see a marked improvement in the cases that were in treatment 36+ months over the ones who escaped at 24 months…

What’s my point? Simple. Be pragmatic. Be realistic. Be understanding. LISTEN. Realize that we are much more like hairdressers than we are like MDs and make peace with that. We are hired by patients/clients to get an elective/esthetic result and we are told the parameters we will have to abide by. That’s just how it is even though you don’t like it. And it will only get “worse”.

Why are traditional orthodontists getting crushed by PCDs doing ortho? Why are patients flocking to upstarts like SmileDirectClub? Simple. These orthodontic channels are giving patients what THEY want on their terms instead of forcing them to an antiquated standard for which there is no proof of superiority. Argue all you want but the proof is in the pudding. Next time we will talk about how to offer services at lower price points and still be profitable…