The perfect patient


There is  a common canvas in the patients presented by the dental speaker , up there in the podium .

The patients are always well educated , able to understand all the possible alternatives beautifully exposed from the doctor , they have always high esthetic requests , they have ( or they develop during the first plan of the treatment )   a good oral hygiene and they have no financial constraints.They also , it seems , understand the high value of the dental treatment they have to go trough..

Simply the perfect patients we all would like to have in our offices .

This description was someway ubiquitous in most of dental courses and conferences .

You go to an endodontic course and you see patients willing to stay 3 hours with their mouth wide open in order to save  a tooth with broken instruments , ledges , apical lucency . …cause they understand the value of  a tooth .

You go  to an implant course and you see patients going under the third  graft from the palate in order to rebuild the lost thickness of soft tissues and improve their esthetics .

The list of perfect patients in each specialty is endless.

The problem arises when you go back in your office and your patients are anything but not perfect .

You discuss with your patient about saving a tooth because of  a deep decay ;the treatment , a normal root canal treatment , is highly predictable yet the patient decides for a simple extraction .

You talk each day with your patients and your feeling is exactly the opposite : your patients are not good ,definitely  .

The good ones are those going to the famous ’s speaker , yours are the worst ever .

And because your patients are not “good”  enough is almost impossible to perform a good every day dentistry .

The quality of your patients become one of your strongest reasons to justify your dentistry .

How many times I ve heard the sentence : I wish I could do that , but in my office I simply can’t”.

The problem is at the foundation of our education . We develop protocols and techniques for ideal scenarios . But everything falling apart this ideal scenario is not covered . This is something peculiar to dentistry .

If you go in other fields like , let’s say , engineering , the techniques , materials and protocols are tested in the worst environment before being applied in the real world .

For example aircraft’s wings are tested with a 50% increase according to expected maximum load during their life cycle .

If you study about skyscrapers and the effects of wind on their safety you will learn incredible tests and this was the incredible  ability of the skyscraper Taipei101 to withstand a wind of 233 km /h  in 2014 during a typhoon .

Back to dentistry …quite the opposite . We develop protocols for ideal situations and when conditions are just less than ideals we are alone .

And real dentistry is anything but not ideal , especially nowadays .

We have financial limitations both from our patients and the competition we have to deal with everyday from our competitors .

We have time constraints , we have to deal with multiple health problems and assumption of drugs .

I get crazy when I read the nth article on implant dentistry with a 95% success where they selected young people , without parafunctions, non smokers , good health , no periodontal problems , good oral hygiene ….cause the simple problem is that most of the patient where I place implants are people with some periodontal problems , often with  a less than optimal oral hygiene and , maybe, also smokers.

I think we can do  a “quality “ dentistry everyday in our office , but to do so we have to redesign our mindset . we have to stop , as speakers , to show just our best and share our daily struggle .

We have to redesign our goals treating our patients, They are the ones paying for our bills and our employees .

Too many times we have different values in deciding goal of treatment .

The perfect patient is  a chimera .

Looking for the perfect patient in order to do great dentistry is  useless.

We have to rebuild a “perfect “ dentistry around imperfect dentists and imperfect patients.

But the first step is to stop self deceiving ourselves : perfection is not a goal , it’s a chimera.

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