The Paradox of Clinical Confidence: When Certainty Undermines Trust

By Dr. Gilberto Salas | Orthodontics, Philosophy & Digital Practice

In the first consultation with a patient, clinical confidence is often seen as a cornerstone of trust. Patients expect professionals to convey clarity, knowledge, and decisiveness. However, what happens when the very certainty that should build trust ends up eroding it?

This paradox occurs more frequently than we realize. A dentist who speaks with unwavering certainty may inadvertently cause the patient to doubt their own experience — or even begin to distrust the clinician. Let’s explore the psychological, relational, and clinical dynamics behind this phenomenon.

1. Confidence vs. Imposition: A Fine Line

Expressing clinical decisions with confidence is necessary. It communicates experience and reduces anxiety. However, when confidence becomes rigid assertion, the patient may feel disempowered. Especially in orthodontics, where long-term treatments and aesthetic expectations are involved, patients need to feel part of the decision-making process.

A statement like “This is clearly the best option” may sound efficient, but it can silence the patient’s unspoken doubts or prior beliefs. If those concerns later resurface, they often return in the form of dissatisfaction or treatment rejection.

2. The Epistemic Impact: When Patients Doubt Their Own Perceptions

From a psychological standpoint, humans tend to recalibrate their internal judgments in response to confident external statements — a phenomenon known as epistemic displacement.When a professional expresses something with great certainty, it can override the patient’s initial intuition, even if that intuition was valid.

Example: A patient feels slight discomfort but hears “This shouldn’t hurt at all”. The result? The patient begins to question their own sensation, which in time may lead to anxiety, distrust, or even avoidance of future treatment.

3. The Risk of Late Opposition

In many cases, the effects of overconfidence are not immediate. Patients may nod in agreement during the consultation, appearing compliant. Yet days later, they seek second opinions or cancel follow-ups. This often stems from the fact that they never felt safe enough to express their concerns, and the professional was not perceived as open to dialogue.

4. A Communication Strategy: Assertive but Open

To avoid this rupture, professionals should cultivate a communication style that is:

• Clinically assertive, based on evidence and experience.

• Interpersonally open, showing willingness to hear doubts, feelings, and previous experiences.

  
  

A useful phrase:

“In my clinical experience, this approach tends to be very effective, but I’d like to hear your thoughts and any concerns you might have.”

This sentence does not dilute expertise. Instead, it validates the patient’s voice and positions the clinician as a trustworthy partner.

5. The Power of Empathic Authority

True authority in clinical settings is not about speaking louder or sounding more certain — it’s about being right and being relational. A dentist or orthodontist who listens, who adapts their discourse to the patient’s emotional and cognitive landscape, earns long-term trust. Patients do not remember every word, but they remember how they felt: heard, respected, included.

Final Reflection: Clinical Ego vs. Clinical Ethos

In the age of digital orthodontics, AI-assisted diagnostics, and highly personalized treatments, technical skill is essential — but relational intelligence is what differentiates an excellent practitioner.The ego says, “I know what’s best”.The ethos says, “Let’s discover together what works best for you.” And that, ultimately, is what builds not only trust, but loyalty.