in diagnosis

Delivering bad news

Most dentists have gotten really good at the delivery of bad news. Most of us are pretty good at explaining our findings in a dispassionate way. We’re supposed to explain what we’re seeing, recommend different treatment options, explain the pros and cons of each option and then let the patient ask questions and make a choice. The trick is that you can’t own the patient’s problem. It’s really important that you don’t care more than the patient does.

Straightforward stuff, really. I mean, it’s not like we’re oncologists or something. The great majority of dental problems are not life and death.

I’m here to tell you…I still struggle. I’m not as good at delivering the bad news. I sometimes struggle because I do care more about the problem than the patient does. I think that’s because I understand the problem better.

Tooth decay doesn’t hurt until the tooth is in real trouble. Gum disease is painless right up until the teeth get wiggly. I see what’s going on in their mouth in HD. I use high powered loupes or even a microscope to see what’s going on and sometimes it’s hard for the patient to get as concerned about it as I do.

Some days I get really discouraged about it. I’ve got to let people know what I’m seeing. Modern dentistry can do some amazing things, but getting people to choose that is the difficult part, in my opinion. Some days I get burned out. Sometimes I have patients with multiple and serious problems that have no clue. That is so hard for me. It’s times like those where I don’t even know where to start.

But I’m a doctor. I owe my patients the truth. I don’t have to be mean about it, but I have to be truthful to the best of my ability. Patients need to understand that I don’t enjoy giving bad news any more than they enjoy hearing it. But we’re in this together. They always have the choice to do nothing, but my duty as a doctor is to let them know what’s going on and give them ideas on ways to treat it. We’ll get through this together.

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  1. It’s difficult especially when the patient is told by us that the care of their teeth is important and, like with flossing, needs to be done everyday. Then on their next visit, they are still struggling with the recommendations. Great reading your blogs!

  2. I really enjoyed reading your thoughts, Dr. Mead. I own my own practice and understand the delicacy of breaking bad news to patients, especially when they don’t expect it. You’re right, gum/periodontal disease often progresses silently and patients don’t know until they come and see me. It’s still hard, but at the end of the day, we are there to take care of our patients and their dental health. I know that there are many people I’ve helped – including saving their natural teeth, or restoring their smile and giving them back something that had been missing. Dentistry is more than a regular visit, it truly can change people’s lives. Keep posting, your insights are wonderful – I think not only for those of us in the profession, but for patients as well!

  3. You’re absolutely right. All the findings and recommendations should be expressed to the patient in a straightforward manner rather than finding ways to work around them. It is more important to understand the pain of the patient and cure it rather than trying to sympathize and feel it. Both the patient and the doctor should be in it together, but the doctor should focus on providing a solution than sharing the pain.

  4. Alan, I can understand your feeling but we can’t control everything but being a dentist I can suggest all the dentist no to mislead patients. Treat patient only when you’re capable to deliver results.