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32. Can't vs Won't - published 07.11.2013

This blog was first published on the 7th November 2013. 

Often, in the English language, the subtlety of words hides a crushing difference.

For me, this is perhaps best demonstrated with "eat as much as you can vs eat as much as you want"

When I was a student we used to play great games in the 'all you can eat' restaurants around the "eat as much as you can" philosophy.

This can be extrapolated into my dental career with the 'can't vs won't' argument. There are situations where I encounter something in my practice that I just can't do. Those procedures in dentistry have grown and grown over the past few years as I stopped providing restorative dentistry for patients and would now shudder at the prospect of doing a decent composite filling (if I ever managed to do one in the past)

It's therefore very easy, when a patient comes into me looking for composite fillings, for me to say "i'm sorry but I can't" and refer that patient onto a colleague within the practice.

The issue of won't is different entirely. To say to a patient "I won't do that because I don't believe it will work or I don't think it's right" is very difficult.

I have talked a lot about the commercialism of dentistry and how difficult it is to balance running a business with being and ethical practitioner and the 'can't vs won't' argument is crucial in this.

There are cases I can recall in my career where I shouldn't have treated but I was encouraged  by the patient to do so because their needs were great and their circumstances were dire. I look back on cases such as those and shudder and I know that all my colleagues have been in similar situations. The trick going forward is to avoid these type of cases and to explain to the patients that we won't provide the treatments because it is not in their best interests.

Heroically, trying to save something which is un-saveable or providing treatment which is unsustainable in the long term will cause a greater problem in the future for all of us in dentistry and the times to see these coming back are becoming close.

Some of the best clinicians I have ever seen are the ones who will easily refuse a patient treatment because they are sure it is in the best interests not to treat or to treat with the simplest possible plan at the time.

There are many things in dentistry at the present time which are encouraging complexity instead of simplicity. Complexity rarely wins out when simplicity is a viable option.

Blog post number: 1532