In today's digital age, it is not uncommon for patients to leave reviews online about their experiences at medical and dental clinics. While feedback is invaluable, it becomes problematic when negative reviews arise from misunderstandings, particularly after initial consultations and not after treatment. This means you get rated on the experience and service and not your actual medical expertise.
In many cases these reviews are a fair analysis of the overall experience and usually are written at the end of the treatment as a thank you from the patient to the medical team and staff. It’s a valued reward system for many small businesses like my own that rely greatly on feedback and word-of-mouth marketing. I still believe word-of-mouth to be the best form of reputation building. Non-withstanding in an ever-growing online world, online reviews matter. The problem for me lies in the few bad reviews that are truly unfair, untrue and do not reflect the truth.
Obviously, no two clinics are the same, and I would argue that all clinics and hospitals are dynamic entities that rely heavily on staff, and not just medical staff, to manage day-to-day operations, which include not just clinical work but all the other little, but important, things behind the scenes. The larger the clinic, the more complex the operation is to run. Just like any business.
Running a clinic is not easy. I remember in 1998 when I graduated, most clinics were single-chair operations with a dentist and one assistant who answered the phone, made bookings, did billing, and helped the dentist perform daily tasks. Much has changed, and now clinics need to offer great service and customer care beyond good dentistry. One pitfall of this is that many times a clinic with poor quality or inexperienced dentists can hide behind great service, excellent customer care, and pricing. But what, at the end of the day, is the real objective? Great dentistry! That’s the mission. It’s very hard for some patients to focus on what matters most, and that’s good quality medical care. If the doctor is a little late, or your appointment needs rescheduling, or the work needs to be improved and will take a little longer, all these things are normal in a dynamic and modern dental setting, but for extremely demanding patients these little things become problems. How do we get to a place where instead of a service industry mindset, we have a collaborative relationship between the patients and the medical team instead? It’s much more beneficial for all involved, because partners tend to work together in finding solutions rather than getting upset about details that would ruin a single transactional relationship like buying a coffee and bagel at a coffee shop and getting the wrong order after a long wait, that would upset anyone.
Patients must understand that most dentists sell and provide oral health based on medical science and not products like food or beverages. To judge a clinic based on service alone is not reasonable. A big challenge here is that most people don’t know how to critique a good or bad dentist. Being nice, fast, painless, and affordable are most definitely not top criteria for excellence in dentistry. They’re added value. It’s nice when possible, but what you should want and expect is a safe, hygienic, well-equipped practice that uses state-of-the-art materials and technology and the latest science and methods to restore your total health with ethics and a minimally invasive approach.
However, we still lack the right tools to allow patients to understand what is good work and what is bad. A great dentist might have terrible service, always be late, have poor communication skills, and a terrible dentist might be a smooth, funny, and charming person that makes the patient feel great and is extremely punctual. Which do you believe is best to get the important job of fixing your teeth done?
At the White Clinic in Lisbon, founded in late 1999, we rarely encounter issues, as we have carefully created a unique onboarding workflow for new patients to make sure we have as much data as possible. We also practice Slow Dentistry and as such have a strict policy on the volume of patients per dentist, and since day one we never book more than one patient per hour per treatment room. In some cases for more complex work we book one patient for the whole morning as not to rush. This is extremely costly to the operation but enables everyone to work at the ideal pace. As we are a fully private practice, we can dictate the way we like to work. We also have never been part of insurance networks because we need operational freedom in the way we do things and always have worked with the best materials on the market with an interdisciplinary approach. I know this is not the standard around the world, but quite frankly, should be.
I founded the Slow Dentistry Global Network over a decade ago to inspire dentists to see fewer patients a day, dedicating more quality time to each one. This approach ensures that patients receive the thorough care they deserve without feeling rushed. It has been laughed off by some as being impractical and costly, but costly to who? I always advocate that you can’t rush proper treatment room disinfection and preparation, and doctors need time to prepare, think and explain treatment to the patients so that there is a deep understanding of what therapy entails and the risks and rewards as well as associated costs.
This fosters a stronger relationship and builds empathy and trust for all involved.
Even with all our safeguards, sometimes online complaints happen after an initial consultation and even after a preliminary phone call where people feel that our onboarding process is too complicated or the consult is too expensive. When they do, I like to study the reasons why. It’s essential to shed light on the complexities involved in these initial consultations and the shared responsibilities between patients and healthcare providers. I can only talk about the way we do it, and I believe it’s the gold standard and sets the bar for what should be the ideal process to safely manage new patients so everybody, and most importantly the patient, gets the best diagnostic and treatment plan possible to restore their entire smile back to perfect health. The trifecta: no infection/inflammation, a great bite and a beautiful smile.
I understand that in the dental world not all businesses can afford this mindset and that’s fine. There has to be different clinics for different budgets and needs. We see this in the hotel and aviation industry all the time, where you pay more for better service, comfort and quality. There is room for all players, but consumers need to understand the huge difference between dental clinics. Not all dentists are equal, and not all clinics are equal no matter what is publicised on their website. What I don’t understand is why some patients get so offended about having to pay for an initial consultation in some European countries.
The Significance of the First Consultation
The first consultation at any clinic is a critical step. For us at the White Clinic, it is not just a casual meet-and-greet but a thorough evaluation where we diagnose complex issues, plan extensive treatments, and set realistic expectations regarding time and cost. This process is vital because many of our patients come from all over the world, often with severe dental problems that require a detailed and structured approach. To be clear, we have many new patients that have no real dental or health issues and we love that as well. These patients go immediately into a maintenance program to ensure prophylaxis and correct oral hygiene are maintained over their lifespan.
During this initial meeting, we must gather extensive medical history, understand the patient’s previous treatments, and assess their current condition using advanced diagnostic tools. This preparation is not only time-consuming but also necessitates significant behind-the-scenes work, often taking twice as much time as the face-to-face appointment. This comprehensive evaluation forms the foundation for a successful treatment plan. Many times patients bring a huge array of emotions to the discussion and also have well established expectations regarding time and costs before they understand the complexity of their case. This makes for a challenging start to any relationship.
Our first consultation is probably one of the most comprehensive in the world, incorporating as a standard, 3-D CBCT analysis, intra-oral x-rays, a full check of the mouth, oral cancer screening, an intricate analysis of the oral microbiome via saliva test, a vitamin D test, and we also check the bite and TMJ for any functional pathology. We include the study of sleep apnea and the need for orthodontics and obviously we discuss esthetics if and when this is important to the patient. It’s quite a unique approach and requires, in some cases, four team members including two dentists and may take up to two hours. We pride ourselves on the detailed, in-depth analysis we provide.
The way we see it, this meeting is to see if the team believes they can (and also wants to) help the patient just as much as the patient seeing if they like the team and believe in what they’re saying and can afford the associated costs. Both sides are interested in a positive outcome but also studying risk and possible complications. It’s a two-way street.
It’s highly unlikely that 100% of the times it’s a perfect match and that’s fine. This is what second opinions are for and the free market in dental healthcare. Patients shouldn’t be so upset if it’s not a fit and should continue to find a team or doctor that they feel confident is the right one for their oral health and budget.
Ensuring Safety and Filtering Patients
As Clinical Director, my team’s safety is of paramount importance. As such, we also need a proper filter system to identify individuals who are not safe to treat due to mental illness, drug or alcohol abuse, aggressive, narcissistic or abusive behaviour, or serious illness that could pose life threatening risks to the patient. The onboarding process is designed to filter out such individuals and ensure we only proceed with those who have the right mindset for therapy and appropriate care and in cases of severe medical issues we engage with their medical team to ensure we have a safe case to proceed. If not it’s best for all, we do not proceed with treatment.
I always say, the first consultation is a lesson and a conversation, not a sales pitch.
Dentists are typically very welcoming and open to new patients as they represent new business opportunities. However, this openness can sometimes lead to overlooking potential red flags indicating a toxic relationship in the making. It’s a challenging scenario because, on one side, we want to help but might be inviting into our lives a real problem we are not prepared to handle because once we start a job, we are usually committed to finishing it.
One thing I was thinking about, is that unlike patients, doctors and dentists do not have a formal platform to voice concerns or complaints about problematic patients. Where can we go to complain against such patients or even see negative reviews on bad characters? You would be surprised how many times these types of toxic people start an initial conversation by bad mouthing previous dentists. This is a red flag for my team and I. It would be amazing to have this option as most clinics have an open-door policy and are extremely welcoming to all new patients.
Perhaps one day there will be an online platform where clinicians and medical facilities can blacklist aggressive or rude patients and also those that don’t pay for their treatments. This could help our community also protect themselves the same way reviews about a business do to help consumers.
Moreover, when a patient complains on Google reviews and we want to answer back with more information, are we breaking our confidentiality protocols? Sometimes it’s so unfair. I would argue that once a patient opens up online, it’s fair game to repost all the information. But personal and medical ethical concerns would make that difficult.
There are many dentists around the world lecturing on this topic and how our profession is facing a mental health crisis due to the pressures of the job. I believe it’s not the dentistry alone that is challenging, but also the complexities of navigating these toxic conversations with difficult people that have different levels of trauma and PTDS associated to previous experiences, and many times not related to healthcare. Though I agree all people should be helped and deserve equal care, it’s also important that patients understand that dentists are free agents and do not have to put up with poor attitude and bad behaviour and many do so just because they don’t own the clinic, don’t believe they can stand up to this behaviour or simply because they need to make their living.
This gap between patient rights and doctors’ rights underscores the necessity of a robust onboarding process to filter out individuals who might manipulate or mistreat the medical team. During initial consultations, it’s not uncommon for individuals with certain mental health issues to attempt to manipulate the medical team or staff. These behaviours can be subtle and may go unnoticed without a structured filtering process.
Patients that complain about pricing, challenge your diagnosis or method, and start to negotiate with you and say things like, “I hate dentists,” the second they meet you, or “if you don’t do what I want I’ll write a negative review,” or “I’ll go to your competition down the road.” It’s super stressful and I usually invite them to leave the clinic immediately. No point in taking on people like this.
This has happened many times over the years, but only late in my career did I gain the confidence to have a stricter stance against this behaviour. In the first decade, I usually would yield out of fear. The dental and medical community needs more support against these kinds of patients that are truly toxic.
Thankfully, it’s only a small minority of people that are like this and most people are kind and respectful and work to create good energy and understand that as humans we must foster good relationships, and for this we are grateful.
As such, the onboarding process at the White Clinic is meticulously designed to identify and discreetly exclude individuals who display such toxic tendencies. This ensures that we maintain a safe and professional environment for both our team and all our patients.
Unfortunately, those filtered out often feel aggrieved and may turn to online platforms to express their dissatisfaction. They may claim they were unfairly treated, not because of any fault in the care provided, but because they did not receive the control or validation they sought. It’s crucial for us to maintain the integrity of our practice by ensuring that only those who are genuinely committed to their dental health and who can engage constructively with our team proceed with treatment.
Private healthcare is not a right. It’s a partnership between patient and doctor and will never yield the desired results if one side doesn’t help the other.
Most dentists are very grateful to the community of patients that trust us with their most valued asset, their smiles, and even more so to those that take the time to leave kind reviews. It’s also a fact that not all patients leave reviews and actually only a fraction do so, so I guess this should all be taken with the proverbial “pinch of salt”.
Setting the Record Straight
In a modern interdisciplinary dental clinic, many times new patients have no idea of the dramatic difference in how things are done because they base their expectations on previous experiences. They have never seen anything like it, so sometimes, frustrated people think it’s exaggerated or overkill to have lengthy consultations like the one we do, or just a way to make more money, because they have no understanding of the complexities behind interdisciplinary diagnostics and treatment planning. Again, this is a small minority, but it really is a huge challenge to me personally when I engage with these types of people in the first meeting. I honestly feel disrespected and hurt that a complete stranger would come into my clinic, that is kind of a home to me, and feel entitled to challenge me and my doctors on our diagnosis and treatment strategies based on their previous experiences with no understanding of how much investment was made to be where we are today as a team or how much we truly love what we do and the ethical way we plan and study everything to the last detail, always considering costs and time.
Also, an alarming number of our new patients lack the understanding to connect their dental issues to broader systemic health issues because their previous dentists lacked the training or mindset to know this. To be fair, the “Mouth-Body Connection” is only now gaining traction around the world, and luckily for our patients we have been involved in this for a long time.
As a result, they might come in for a simple bleaching or cleaning, oblivious to the devastating health issues that poor quality dental work has created. They often do not want to hear about the intricate complexities and financial burdens of fixing these issues. Instead, they focus on what they think is important, which is aesthetics. It is incredibly challenging to meet a stubborn person who doesn’t want to be educated because, first and foremost,
a doctor has to be a teacher and not a salesperson.
This is a very important principle in our practice.
This underscores the importance of keeping an open mind and a positive attitude and leaving all “emotional baggage” at the door.
Learning from Other Industries
Leading medical centres and other industries face similar challenges. For example, in the aviation industry, safety and protocol adherence take precedence over passenger comfort during critical phases of flight. Similarly, in the service industry, hotels may enforce strict policies to ensure the safety and comfort of all guests, even if it occasionally inconveniences some. Medical centres globally have adopted various strategies to manage patient expectations and improve satisfaction. For instance, the Mayo Clinic emphasises clear communication and patient education to ensure that patients understand the scope and limitations of initial consultations.
A Call for Understanding
Private clinics are under no obligation to take on all patients. Our decision-making process is governed by clinical judgment, the patient’s ability to follow through with treatment, and mutual respect. We welcome patients from all walks of life, provided they meet these criteria. Patients must also recognise their role in this partnership. Presenting their problems clearly, understanding the complexity of their conditions, and respecting the professional boundaries set by the clinic are essential.
Negative reviews often stem from unmet expectations rather than the quality of care provided.
Thus, it is crucial for patients to approach their first consultation with an open mind and realistic expectations. The beauty of dentistry lies in its objectivity: it doesn’t matter what you did in the past or who treated you. What matters is where you are now and how we can help you achieve optimal health moving forward.
This perspective allows us to focus on solutions rather than past grievances.
Conclusion
At our dental clinic in Lisbon, Portugal, as with most good clinics around the world, our primary mission is to provide top-tier dental care, leveraging advanced technology and clinical expertise. While we strive to always offer a compassionate environment, our priority remains: diagnosing and treating simple to complex dental issues with precision and care. We encourage all patients to view the first consultation as a collaborative step towards optimal dental health, rather than a simple service transaction and to always bring a positive mindset to each appointment moving forward.
By fostering mutual understanding and clear communication, we can better serve our patients and maintain the high standards each patient deserves.
*Originally published here.
