Why I Don't Care About My Patients

Your patient has no money. How do you deal with an expensive treatment plan?

My patient Janet was a single mother of 3. She worked night shift as a nurse in the local hospital. She had lost her 3 molars on the lower right and here upper molars were over-erupting. Ideally she needs at least 2 implants. 

But I’m torn. 

How hard do I try to steer Janet towards ideal treatment? If I succeed, will her kids go hungry? If we are too good at communicating, we could cause the patient financial stress. 

Every day, Dentists are caught between these three morality pressures: 

1. The commitment to provide ideal care and 

2. the need to stay solvent…so that they can continue to provide that care.

3. The need to factor in the patient’s ability to pay. 

We get stuck in a daily morality struggle. This can wear you down. You might think that all you need to do is to not care. But that’s not going to work unless you can morph yourself into a heartless sociopath.  

Over the years I’ve come to my own conclusion as to how to navigate this question, and it might help you. I have developed a system where I never make any recommendations and at the same time, I use a system that results in much  better treatment decisions.

Here’s the overall strategy.

As soon as we can determine what is the patient’s most impactful clinical condition, we help them discover what is the worst case scenario, if their condition is left untreated.

This needs to be done in a sensitive truthful manner. 

Then the conversation moves to the sub-optimal treatment options. Using a specific sequence, the patient is exposed to these options and will usually reject them because they generally don’t solve their main problems adequately. The only choice left is the ideal treatment as the default choice. If they choose this treatment, or don’t, they are fully informed.

This means, I can speak with any patient, present all the very best treatment in a way that makes me 100% rejection proof; and if they choose the very best treatment, I wont feel guilty…because it was all their decision, fully informed and if they didn’t choose the best, then I’m never rejected. The patient feels zero pressure from me and I’m never stressed by the treatment chosen, no matter what is chosen.

For years I cared more for the patient than they cared about themselves. I censored the case presentations so that I only presented what I was sure they could afford. That’s fundamentally flawed. I can’t play god. I don’t know anyone’s real circumstances.

I still care of course, but in a sense, I don’t care what choice they make. I can’t be responsible for their financial choices or capabilities. I’m a dispassionate carer. 

I’m only upset if I did a poor job communicating….not by the outcome.



Dr. Michael Sernik