Julian Perez, J.D., Chief Legal Officer, dentalcorp
A new patient walks into your practice. They’re in their early twenties, and generally healthy. After reporting their medical history, which reveals struggles with mental health, they tell you, “I’m not happy with my smile. I want white crowns on my teeth. My grandfather recently died and left me $40,000.” Your clinical evaluation notes healthy intact dentition with slight staining, no periodontal issues, and sound occlusion other than minor aesthetic orthodontic concerns. The patient says they’re “ready to write a check for the full amount” of 32 crowns and “pay upfront.” Before you decide how you would respond, let’s explore a concept known as “radical (compassionate) candor”.
Radical Candor: Be a Kick-Ass Boss Without Losing Your Humanity, is an influential business leadership book by Kim Scott, that earned instant renown when published in 2017. A former Apple and Google executive, Scott worked in some of the world’s best-managed companies, and her time in those organizations lead her to powerful realizations about the nature of high-functioning relationships. She shares those insights with readers in Radical Candor.
Radical compassion—Scott later acknowledged this term more accurately describes the ideas explored in her book—combines two keys to communicating and providing feedback. Imagine an X-Y axis. The X-axis represents compassion (“caring personally” about the person you are communicating with). The Y-axis stands for frank honesty (providing constructive feedback and “challenging directly”.)
In Scott’s paradigm, a boss who doesn’t care about their team and fails to challenge them directly, practices “manipulative insincerity”. They gossip behind others’ backs but play nice when it's in their own self-interest. A boss who cares personally, in contrast, but still fails to communicate frankly and honestly suffers from “ruinous empathy”. Such martyrs will shelter others from their own mistakes but, fearing conflict, leave the underlying issue unaddressed. “Obnoxious aggression”, sometimes known as “front stabbing”, results when a leader challenges someone directly, without truly caring about them. Obnoxious aggression can take the form of brutal honesty, pouring cold water on people’s ideas and dishing out harsh criticism regardless of how it will be received.
Compassionate candor, the upper right quadrant, and relationship sweet spot means “caring personally” about the person receiving the feedback, while frankly challenging their ideas or actions.
As bosses, dentists should consider the lessons of Radical Candor. But the notion of “compassionate candor” applies to the practice of healthcare itself. It embodies the relationship aspect of person-centred care and what patients want. A study on the top ten demands of dental patients reports that people seeking dental care want: (a) to be called by their name and asked about their family members, (b) clear explanations about their treatment, and time to ask questions and receive answers, (c) personalized recognition and (d) a clinician who “truly cares about them and their needs.” In other words, patients want compassionately candid healthcare providers.
Now that you’re familiar with compassionate candor, return to the case study at the top of this article. How might you demonstrate to the patient that you care while being honest and direct about the risks, benefits, and alternatives to their proposed treatment plan?
Originally published in Oral Health journal.
About the Author
Julian Perez is Chief Legal Officer at dentalcorp, where he oversees legal, regulatory compliance, corporate governance, and enterprise risk functions to support practices in the delivery of optimal patient care. He earned his bachelor’s degree from Yale University and a JD from Columbia University’s School of Law.
