Stop Performing.
Why congruence—not perfection—is at the foundation of person-centered dentistry
There is a question that if we honestly answer it, will change the way we practice, lead, and live: How much of how we behave is actually us, and how much of it is a performance —a subtle, series of adjustments designed to gain approval, avoid rejection, and maintain control?
Our extensive training in dentistry didn’t discuss or reward authenticity, instead we learned to perform. In dental school—and often in practice—we are rewarded for saying the “right” thing, looking confident when we’re uncertain, following scripts rather than listening, and managing perception instead of sharing the truth.
Over time, this creates a professional identity that’s highly competent, but often disconnected from ourselves, our patients, and our teams.
And there is a hidden cost for doing so: The more we perform, the less we’re able to see and fully sense the person in front of us, because part of our cognitive bandwidth isn’t available —instead, our mind is consumed by impression management.
When we’re performing, we stop seeing the other person clearly, because we are too focused on fear of what the other person might be thinking about us. In my opinion, this represents a central problem in our profession, because true person-centered care depends on one thing above all else —our ability to fully “be with” another human being.
Why So Many Patients Don’t Fully Trust Us
Most patients walk into a dental office with some degree of anxiety that ranges from mild to complex and deeply personal. And what do they encounter? A dentist who is polished, controlled, technically skilled, and subtly performing. Patients may not consciously recognize the latter, but their nervous system does, because we humans are exquisitely sensitive to incongruence—the subtle mismatch between what’s being said and what’s felt. And when a mismatch is present, our guard stays up, the information we share is filtered, and our willingness to collaborate is delayed because our trust is only partial.
This is why “case presentations” often fail—even when our findings, diagnosis, and recommendations are correct and appropriate. The patient declines, not because they don’t need the dentistry, but because their relationship with us doesn’t feel completely safe.
Congruence: The Missing Link
Dentists who build loyalty in their patient pool aren’t the smoothest talkers, they are the most congruent. Congruence means that there is full and transparent alignment between what is thought, spoken, and acted upon.
I recently spent a weekend with Steve Rasner, an amazingly successful dentist in one of the poorest counties in southern New Jersey. There is no question that a substantial part of Steve’s success is related to the skill set he developed by studying under Spear, Kois, Pikos, Strupp, Misch, and many others, but that’s only half the story. Steve is extremely successful because he is congruent—he is authentic in every thought, word, and deed, and when he combines that with confidence and humility, his capacity for influence is almost infinite. There is no “gap.” There is no performance layer, there are no hidden scripts running underneath Steve’s communication. And when that happens, something remarkable occurs —his patients’ nervous system settles down and organically follows his lead. Why? Because on a subconscious level his patients believe, “This guy knows what he’s talking about, and he really cares about me.”
Steves communication style opens the door for open, honest conversations, and values-based decision-making, which lies at the center of person-centered dentistry.
Congruence Is NOT Radical Transparency
Many of us misunderstand the concept of congruence. It doesn’t mean saying everything we think, oversharing, emotional dumping, or acting in an “unfiltered” fashion. That’s called low emotional intelligence.
Congruence involves stopping ourselves from saying things we don’t think (meaning our non-modulated emotional midbrain driven instincts). That distinction is everything, because professionalism matters, discernment matters, and timing matters.
When we’re congruent, we stop engaging in micro-performances such as agreeing when we really don’t want to, pretending that we are certain when we know we are looking at complexity, responding to silence with pointless conversation filler to avoid discomfort, and saying “I’m fine” when something meaningful needs to be addressed.
And each time we eliminate one of those small character distortions we deposit trust in our patient’s emotional bank account. Saying, “I’m not sure, but we’re going to figure it out,” is a lot more powerful than saying “All of our patients love this —don’t worry about it.”
The Role of Silence
One of the most powerful—and underutilized—tools in communication is leveraging silence. Most of us are uncomfortable with silence, because it feels like a loss of control and that we’re at risk of disapproval, so we fill silence with more explanations.
Allowing silence to do its work creates space for reflection, emotional processing, and problem ownership —all right hemisphere cerebral cortex functions, and all key to a person eventually saying “yes,” as silence allows them to become part of the conversation.
Leadership: From Performance to Presence
These truths also apply to our role as dentist-leaders as well. Many of us unconsciously “perform” by using our positional authority instead of developing clarity and alignment within our team, we use a false front of positivity instead of non-judgmentally confronting the truth so problems can be resolved. (This is yet another strength of Steve Rasner, as he is extremely good at delivering the unvarnished truth without allowing his team members to feel diminished).
So, our care team—just like our patients—feel it when we aren’t fully forthcoming, and acting more out of self-interest than leaning into our practice philosophy. And when they do, they hold back, they filter communication, they disengage emotionally and subsequently fail to bring to the table their full creative problem-solving abilities.
Congruent leaders say what they believe, freely admit what they don’t know, hold standards without pretending they are perfect, and listen without rehearsing a response. And in doing so, they create a practice culture wherein pretending and performing isn’t allowed.
The Hidden Cost of Being “Well-Liked”
If people only admire the version of us that we’ve constructed, then they don’t really admire us—they like our performance. This applies to patients who “like” us but don’t commit to proper care, and care teams that “respect” us but don’t entirely trust our leadership. That’s because performing creates approval, compliance, and surface-level success. But unfortunately, that’s not enough in true person-centered dentistry, because it cannot create loyalty —which only emerges when people feel “I’m interacting with someone real and who cares about me.”
So, congruence isn’t about becoming a different person, it’s about removing the behavioral parts of us that don’t represent who we truly are. My recommendation: Just once this coming week—catch yourself when you think you’re performing, instead of “being.” Maybe it’s when you agree but really don’t, explain when allowing silence would have been more effective, or when you act certain when you’re thinking, “I don’t know yet.”
And instead- pause. Say the real thing —or say nothing at all. Let the moment breathe. It will feel uncomfortable, because you’ll be interrupting a pattern used to relieve anxiety. That’s key, because on the other side of that moment your patients will experience —something rare these days—feeling known.
In a world where dentistry is becoming more and more transactional, scripted, production-driven, and increasingly artificial, the greatest competitive advantage isn’t better marketing, it’s becoming a person who no longer needs to perform.
Just ask Steve.
