“But The Patient Was Happy!”

I recently came upon a 15-year-old comment while browsing through my social media accounts. Curious, I went back to the post and the contentious conversation that had taken place with a senior dentist at the time. A 20-year-old woman who was dissatisfied with her ugly smile was the subject of the debate. In addition to alignment and bite issues, she had a lingually positioned maxillary lateral incisor in crossbite. The treatment plan was the starting point of the debate. To enhance occlusion and appearance, the lingually erupted lateral incisor was removed and replaced with an implant. I objected as an orthodontist. This was a simple orthodontic case that could be easily treated with clear aligners or a fixed appliance. The patient had refused orthodontics and desired a “quick fix,” the dentist insisted. She opted for extraction and implant insertion despite being made aware of the compromises. His ultimate defense, following numerous back-and-forth exchanges, was a well-known Expression: “But the patient was happy.”!! Recently, something similar happened. A young lady sought my advice regarding an unsightly smile caused by a lost lower incisor and a midline diastema. I booked her for diagnostic records and gave her an explanation of the orthodontic strategy. When she returned 2 months later with her cousin, I was taken aback to see that detachable partial dentures, which resembled “iatrogenic mesiodens,” which were affixed to her dentition using acrylic!. She clarified that there was an additional “option” that was presented to her and she chose that. Later, at a CDE conference. I got to know the treating dentist. He concurred that the replacement she was given was unsuitable and that orthodontics would have been the best course of action. The defense reappeared once more: “But the patient was happy”!! When I was a consulting orthodontist in a tier-3 city years ago, a family presented a girl who had a significant overjet and severe maxillary incisor proclination. I recommended a 24-month orthodontic treatment plan including the extraction of the first premolars. But in 3 months, she was going to get married. Her family begged for a speedier resolution, which I was unable to deliver in an ethical manner. After a month, I found out that her maxillary incisors had been extracted and replaced with a fixed prosthesis, which was once more supported by the same refrain: “.but the patient was happy.” The Deeper Question: Is Happiness Enough? These repeated experiences made me reflect: Should treatment outcomes be dictated by patient demands or by scientific standards? These problems are prevalent in all dental speciality. Quality care cannot be determined solely by a patient’s level of satisfaction. If the patient is happy with the outcome, does the quality of the treatment provided matter? We are trusted by vulnerable patients to make clinically sound recommendations. The patient anticipates that you will let him select between the compromise and the ideal. Autonomy entails providing options, but those options must be morally righteous, supported by science, and well-informed.[1] If the compromise is based on the absence of the patient’s knowledge or the dental surgeon’s financial motivation, or transcends the consideration of special circumstances that may surround the case, a breach of autonomy might become an issue.[1] What Defines Quality Care? Quality care has two integral components: Technical excellence and skillful delivery Appropriateness of treatment. As has been said, “High technical quality is doing the right thing right.”[2] The Latin word doctus, which means “teacher,” is where our title, doctor, originates. The Latin word docere, which means “to teach,” is the root of the term doctus.[3] Therefore, educating our patients is our top priority. Practitioners will always have different therapeutic beliefs, but these differences need to be politely and honestly communicated to patients and colleagues. Disagreements in the workplace are normal. The patient’s welfare, which is based on accepted dental concepts, is what matters. Collegiality is important, but our first responsibility is words to our patients, telling them the truth about both the obvious and the subtle parts of their disease. When there is a disagreement, it should be expressed honestly yet politely. Our preferred treatment philosophies should be based on accepted dental concepts, both as individuals and as professionals. The patient’s well-being and interests must always be the common denominator in collaborative treatment.[4] Patient Satisfaction versus Scientific Validity We need to consider if patient pleasure is always a sign of quality care. If our sole objective is to fulfill the patient’s wish, we run the risk of coming perilously near to causing them discontent or even injury.[5] Patients may not be aware of the long-term effects of treatment regimens that are compromised. Although patient happiness is crucial, the treatment plan must take into account aspects that the patient might not be aware of but would greatly benefit from. Unfortunately, practitioners occasionally continue this concerning trend whose actions align more with their own goals than with the patient’s best interest.[5] “Patient satisfaction” should not be used as an excuse to make clinically incorrect choices. The integrity of the specialty is compromised, and the intricate and nuanced nature of specialized patient care is trivialized when patient satisfaction is used as a general defense for inadequate care or treatment regimens.[5] A Call to the Profession As dentistry evolves, we must be like the lighthouse guiding patients through waves of misinformation and pseudoscience. Innovations should be embraced only after they withstand scientific scrutiny. Our responsibility is not only to provide what patients want but also to offer what is ethical, safe, and scientifically justified.[5] Principles of successful clinical practice: Productivity – Deliver scientifically grounded, high-quality clinical work. Profit – Earn ethically through evidence-based practice. Rational and ethical clinical work. Patient satisfaction – Educate patients about the benefits of scientifically sound treatment over perceived shortcuts. Word-of-mouth reputation – Patients value ethical conduct as much as clinical outcomes. Branding – A practitioner’s reputation grows from skill, ethics, and lifelong learning. An “Error of judgment” may be forgiven, but “Error of negligence” is unacceptable. A simple test can guide every clinical decision: “Would I do this for my own family member?” If yes, proceed. If no, then Please STOP!