Dentists Must Understand the Power of Refusal

dr aqib mudassar

                    “Learn to say no to the wrong treatments, and you will always win in the long run”

          By Dr. Aqib Mudassar

We as human beings are vulnerable to the fear of loss; we take all such actions which lead us to safe comfort zones only. We are frightened of taking any decision which might end up in any sort of loss. However, zooming out and taking a look at the bigger picture helps one acknowledge the importance of having the courage to refuse. We should be bold enough to say no to things; even if that no leads us to a temporary loss. These losses are always a bigger win in the long run. Such is the power of refusal!

An incident from Hazrat Ali (R.A)’s life very well emphasizes on the same idea.

“Once Hazrat Ali R.A. was travelling through a desert. He stopped at a masjid to pray and asked a passing-by Bedouin to take care of his horse. While he was doing wudhu he realized that the stranger is doing him a favor so after he is done praying, he will reward him with 2 dirhams. However, that Bedouin left the horse, stole the saddle and took off. When Hazrat Ali RA came out after praying he found his horse but saw that the saddle was missing. So he went to a near-by market to buy another one. There he saw the man who stole his saddle was trying to sell it. Hazrat Ali RA hid his identity by covering his own face and offered to buy the saddle. The thief sold it to him in 2 dirhams”

Moral? What has been destined for us cannot miss us. It’s our own very choice to let it come to us morally or immorally, ethically or unethically. Only when we truly believe in this, will we develop the courage and the power to refuse.


We develop habits of quick fixes without worrying about long term consequences. We think we are saving, but in the longer run it just proves to be more expensive as quick fixes do not last long and need to be repaired from time to time.

For example, everyone likes to jump to extractions. A lot of patients say they do not have time for root canal and crowns and jump to a conclusion that they want an extraction. This brightens up the dentist’s day too because an extraction is easier than a root canal at any point of time.  The dentists never bother telling the patient about the disadvantages and that the tooth replacement collectively might actually end up costing more money.

Don’t Let Patients Blindly Dictate Your Work

We let our patients dictate what treatment should be done. Yes, the patient has every right to accept, deny and choose his treatment, but he needs to be well informed in order to make this decision. Many dentists just want to please their patients by compromising on the standards of care and codes of ethics. They do whatever the patients ask them to do. We think if we tried to discourage patient from extraction patient the will leave. Loss of patient is loss of revenue.

However, if we start caring a little more and try to reason with the patient that loss of tooth rids you of the pain but it has various disadvantages like spacing, overeruption, bite shifting, etcetera they might actually reconsider their choice. Tell them that when you get a cut on your finger, you do not chop off your finger; you try to heal the wound. Make the patient see that loss of tooth compromises function and general wellbeing. They will have more faith in you. If they decide to go somewhere else later in life, they can always compare your patient management to theirs and will know who is more ethical.


There are many times we all have been impulsive in our decisions and the patients can have those days too; but we should never capitalize on such moments. Social media and web education is reshaping our nation and lot of awareness in being created. However, when we do the right thing we never have to worry.

In our office we had many patients who wanted to do the necessary restorative treatment but didn’t want to go through our hygiene protocols. Unluckily for them, we don’t do any restorative work without establishing gingival health. Quite few of the patients with need of major restorative work were refused services as they didn’t want to schedule for hygiene therapies. They can always get their work done somewhere else, which we are okay with, but we have to do the best we can in order to stick to the right treatment. We don’t want to do crowns or veneers on bleeding gums! Absolutely not! We have refused many such patients.

Fortunately, they always come back. The refusal makes them question their choice. They also do some research and come back to agree with us. They realize that we are not willing to compromise on our integrity and quality.

One thing we need to understand is that every patient who walks into our door is not an ideal patient and our long term success depends on keeping only those who value us and value our recommendations. Those who know us for not compromising on integrity will value it and help us grow substantially.

Don’t go for the numbers, go for the quality

I have set down personally with roughly five hundred patients in last one year and only about 200 have scheduled work with us. From day one, I knew that it is the type of first 500 patients which will determine quality of the type of dentistry I will do. I know we are doing the right thing and that will help us become a brand who will be known to do what’s best for patient and is not willing to make any compromises.

I also believe at least half of the patients who did not schedule will be back in next two years after going about and trying new dentists. It is only because of the value we are creating for our patients. I am confident that the experience they have at Ideal Smile is unparalleled.


Some personal examples from my practice

We had a 62-year-old come in for a consult. She was a patient of a very big name in town and really liked her dentist. She wanted to try us out as we were closer to her house. She was diagnosed with periodontal disease and was recommended 4 visit subgingival curettage. My associate dentist spent ample time explaining to her about gum disease and what the consequences of no treatment are. When my financial coordinator told her that cost was PKR 28,000, the patient argued that she wants to get work done in PKR 20,000/. She kept asking for additional discount which was against our policy, and we had to refuse her treatment. She said she’s going back to her old dentist.  So the patient left, but I told my team that she will be back. I was certain because I knew she had an experience which she would never forget and also she was empowered by knowing what was best for her. My financial coordinator came to me very next day in all the excitement as she told me that the very same patient was on her way to drop off the full amount of treatment and wanted to get started. This is power of creating value and educating our patients.

I have another patient who has become a close friend of mine. He is a big shot in real estate and has brought in quite a few of his elite class friends. He asked me for special discount and I told him politely that it was not possible because I treat all my patients equally. He actually appreciated my straightforwardness and didn’t get offended. To this day he brings referrals.

One of the richest names in the country is our patient. He is worth 400 billion. When he came in he wanted to get done quickly with the treatment. He was in a rush with everything. He interfered with my treatment options. He wanted to skip basic essential treatment and wanted to start with a smile makeover. I told him I will not compromise on the standard of care and if he was not ok with my treatment plan then I would not like to do it. The moment I said that he relaxed, reclined back and asked me to do my best. He was probably not used to having being told what to do, however, I did not wish to compromise on my integrity.

“We gain power in our refusal to accept less than what we deserve.”


As a dental community, once we decide to run dentistry based on the principal of power of refusal; we will ultimately end up doing right things for the right reasons. We will not try to gain short-term benefits which ultimately haunt us. This also ruins our peace of mind and results in loss of integrity to ourselves and others. But when we take courage to say no to any unethical decisions or even to the unjustifiable requests of the patients; we actually earn credibility and integrity. Consequently, patients trust us enough with whatever we tell them & agree to the treatment plans.

December 11, 2017

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