I’m replying to this thread, although I could certainly apply this to the other running thread as well.  I choose this thread because Danny addressed this to the young periodontist.  And frankly, it is a number of us who are in the tail ends of our careers who are contributing not to accumulate riches or recognition, but because we want the profession that we love and served us and our patients so well to continue.


When I was a young periodontist, my purpose was to serve my patients and the doctors who referred those patients as well as I could. I didn’t have a much of a viewpoint to operate from. I thought that I did, but I really didn’t. After all, a viewpoint is the product of one’s learning and one’s experiences. At the age of 30, I certainly had some viewpoints, but those viewpoints could not be developed as a product of experiences, because I just didn’t have time for all of those experiences, at least not yet. So I depended upon the elders of our profession as well as the literature and yes, even some vendors, to provide those experiences that I did not yet have.   Some of those viewpoints worked well for me and some did not.  For those that did not, I’m sure that their viewpoints worked for them, but they just didn’t work for me.  That in itself gave me more experience and developed my viewpoint even further.  One thing that I can tell you though, my viewpoint today is not the same as my viewpoint in 1980.  One other thing that I can tell you is that the things that periodontists debated in 1980 are totally different from what we are debating today.  In 2046, the subjects will be totally different as well, because thought develops as a result of newly created thoughts, and ultimately of tested truths.


Here’s what we don’t debate, serving the patient well, serving the patient as well as you would serve your family.  And I’ll give you one other viewpoint that I hope that you find incontestable.  When you make a decision for a patient and that decision that you’ve made fails, back up your work.  There are countless times that those my age have seen patients for second opinions simply because the first practitioner blamed the patient for failure.


Have I made mistakes?  Absolutely.  And when I blamed the patient, it always backfired.  You can take that to the bank.  When it does backfire, what happens next? The patient leaves your office, tells others, and finds another periodontist or dentist to work with. And what happens to your public relations? What happens to your reputation?


When we see patients, the decisions that we make, the treatment plan that we create, has to be the product of our observations of the patient as well as the particular skill sets that we bring to the table.  If we make a decision, we should back up that decision.  If we are not sure what the outcome will be before we do the treatment, we need to tell the patient the risk and see whether patient is willing to accept the risk. And if it is a risk, we need to let the patient know in advance what the costs of that risk might be, monetarily and otherwise.  If we don’t foresee a problem that ultimately occurs under our watch, and it may happen to you as it has to me, we need to back up our decision truthfully, compassionately, and monetarily.


The most unsatisfied patient that you will see will be the patient who was told that a treatment would cost $X and then after the procedure, it costs more.  The most unsatisfied patient that you will see will be the patient that you treated for a particular problem, it fails, and then you charge again for the retreatment.  And while there was no way of knowing that the treatment would fail, the patient has paid you for an outcome, not a treatment  (Outcome-based treatment is in our future and is poised to replace fee for service anyway.)
Every decision that you make, every patient interaction that you have, helps to create your reputation and the future of your practice.  The price that you pay in taking the time to treatment plan now, to assess the risks now, and to back up your inevitable, but very few, failures will be very small in comparison to the goodwill that you will create for your future.


–Lee Sheldon