Private dentistry and the CMA inquiry – it’s all a matter of trust

Nigel Jones judges how much trust the public has in the dental profession – patients might have faith in their own dentist, but how do they feel about the entire sector?

The media coverage of both the launch of the CMA inquiry into private dentistry and NHS money being handed back has prompted concern about potential reputational damage for the profession. The threat of a reappearance of headlines featuring the label ‘greedy dentists’ looms large for some.

In this context, I think it is important to acknowledge that the BDA and Eddie Crouch in particular have done some excellent work in recent years at ensuring the public receive a more balanced view of the dental profession. This is not always easy when the media have an agenda that might be supported by telling the truth but not necessarily the whole truth.

Why does trust matter?

Without doubt, building and maintaining the general public’s trust in the profession is vital when it comes to negotiations with the various governments and contractual frameworks and funding. A public that is suspicious of the motives of those in the business of dentistry could embolden the powers that be who wish to tighten rather than loosen the purse strings.

However, it should also be remembered that the trust patients place in their own dentist nearly always seems to outweigh any misgivings they may have about the profession. In some ways, the start of my career was based on that premise. 

In 1990, when I first began working in dentistry, the papers were still carrying stories of over treatment as a legacy of the Australian trenches of the 1970s and the 1986 Schanschieff Review (formerly the Committee of Enquiry into Unnecessary Dental Treatment). At the same time, NHS dentistry was widely available to anyone that wanted it, accounting for over 85% of dental provision. The public were being given reasons to be suspicious and had plenty of choice of clinicians if they became unsure of the motives of ‘their’ dentist. 

The Trust Equation

However, despite these factors, trailblazing dentists and practices still managed to go private very successfully and were rewarded for their bravery with massive improvements to their professional and, often, personal lives. More than enough patients were prepared to pay more to continue receiving care from a dentist in whom they had built up significant trust rather than change to an unknown quantity and pay less.

It’s helpful to unpack that by referring to the Trust Equation which first appeared in 2000 in the book The Trusted Advisor by Maister, Greene and Galford. The Trust Equation is a framework to help explain how trustworthiness is built through a combination of credibility (trusting what someone says), reliability (trusting what someone does) and intimacy (entrusting someone with something) and can be diluted by self-orientation (is your focus primarily on yourself rather than others).

When it comes to credibility, a dental qualification is enough for most patients and only in certain circumstances does this become a differentiator. However, perceptions of reliability generally build with time. Connecting at an emotional human level rarely happens immediately, especially in the stressful environment of a new dental surgery. An assessment of self-orientation is potentially made more quickly but for many, backing out of an arrangement once you have crossed the threshold is an uncomfortable thought. 

It’s no wonder therefore, that the majority of patients who are in a financial position to do so, choose to stay with a tried and tested dentist going private rather than change to an unknown quantity. It also helps explain why, when it comes to general dentistry, successful practices grow by referral. If someone you already trust feels a dentist offers them enough credibility, reliability and intimacy to be deserving of their trust, it improves the odds.

Cosmetic dentistry: a different matter

What about cosmetic dentistry? I have to admit to being as perplexed as many dentists at the number of incidents where a regularly attending patient reappears for their routine recall having gone to an unknown quantity for cosmetic treatment. Indeed, the extreme example of ‘Turkey teeth’ seemingly challenges the whole basis of the Trust Equation.

The only way I can rationalise it is to think there is something about the psychology of elective care that seems to turn patients into consumers. It may be that patients feel more empowered due to their ability to self-diagnose and visualise the outcome they want. 

Whatever lies behind it, that consumer-like behaviour potentially makes them more open to sophisticated marketing that almost certainly taps into the elements of the Trust Equation when they are making their choices. That and the poor internal marketing skills of their existing trusted general dentist!

Regardless of that exception, the point is that it will take a lot more than a fleeting headline and a CMA inquiry to undo the good work of the BDA or damage the relationship patients have with their own dentist. Applying the Trust Equation to the profession’s relationship with government though, is an entirely different matter.

This article is sponsored by Practice Plan.