Dental failure and being ‘perfect’ in patient care is a key stressor for dentists. In her first blog on this topic, Dr. Brummett talked about deciding to work toward perfection rather than feeling frustrated about not achieving it. Read on for the rest of her story:

Stop Trying to Be the Right Kind of Perfect

The next morning after my revelation about perfection, I woke up, had coffee, and realized the patient who had been the focus of my upset (over a mistake I made) had texted me. She wrote, “Good morning Dr. Brummett! I just wanted to let you know that I am doing well and have not had any pain.”

What? My patient was doing well, texting me to tell me how well, and she was thanking me?

A quest to provide myself with a new perspective and a reminder acronym began. This perspective would hopefully take shape so that I could share it with my team, my children, and anyone suffering from the punching match of perfection.

Perfection can be the root of depression and upset, which is why becoming perfect will be my focus and acceptance of the process my goal. Perfect will stand for seven perfect words:

P is for position, as it’s good to remain humble about one’s status.

E is for effort, not the result.

R is for resilience, as I will fall, get back up, and grow from the failures.           

F is for facing the fear, embracing the challenge, and striving in the face of fear.

E is for empathy, treating myself and others with compassion.

C is for courage, as though I might not have a cape, I can still use my whole heart.

T is for trust, because with perseverance I can trust that everything will work out.

Later that day, my patient contacted me again and wanted me to know one last thing. She said, “I forgot to thank you for your gentle touch.”

This acknowledgment really drove home the point to me. I will attempt to stop looking through my rearview mirror and look forward through the front window of my life. I will allow myself, and encourage others, to become.

I am thankful for Dr. Pankey’s courage to share his failures and for our patients that believe in us and show us gratitude and appreciation. Now, isn’t that perfect? 

Failure is a hard thing to accept in dentistry. This is especially true because what constitutes ‘failure’ can mean different things to different patients and different dentists.

Keep reading for an anecdote that puts failure in the dental practice into perspective:

Changing Your Perspective on Dental Failure

On my way home from work one day, I turned the radio off, looked through the rearview mirror, and thought, what a day! I had just left my dental office dealing with a “dental failure.” I felt disappointed that this sort of difficult situation had occurred.

Then, this question came to the forefront of my mind: Why do I think I can or should be perfect? With that question, a wonderful reminder appeared out of the blue.

Bill Davis had conversations with LD Pankey about his philosophy and wrote an amazing book that I refer to often. The story I remembered was about Dr. Pankey sharing his own failures. He had worked five cases out on the Monson articulator and said that he basically obliterated the patients’ occlusion.

He shared how all five of the cases failed. He then stated that four of the five patients stuck it out with him because they felt he was conscientious enough to see them through. That’s when it hit me! I realized I had been thinking about this perfection thing all wrong. And, in the voice of Richard Green in my head, I could change my perspective. 

What if I didn’t focus on being perfect, but on becoming perfect?

In my own personal religious growth, I am learning how to develop my physical, mental, and spiritual health. I can learn the principles and values inherent to my faith and develop my character, but I can never truly be perfect. What if I approach my dental life in the same way? On becoming.

To be continued…

Consistent case acceptance is a skill it can take years to develop. Part of the reason it can seem so challenging is that a patient’s true motivations may not be clear from the outset. We have to hone that sixth sense that can tell us what information or guidance would truly speak to a patient.

Two aspects of case acceptance in particular often go ignored because they either seem too obvious or are just not as fun to dive into: offering individualized options and making sure patients understand insurance.

Individualized Options for Case Acceptance

You may think the concept of individualized options is a no brainer, but that isn’t necessarily the case from a patient’s perspective. If you’re willing to provide this extra level of specificity, you can put many ‘maybe’ patients right into the ‘yes’ category.

We accept that car and other big purchases are often paid in installments, so why not do the same with a large investment like dentistry? Offering financing or other piecemeal payment options to patients is a game changer. It also makes comprehensive dental care accessible to a broader demographic. That in and of itself is valuable.

When dealing with patients, break the payment options down into easily understandable terms. Tell them the total fee, but decrease the stress by making it clear that there are different ways they can arrange to pay, including pre-pay, pay as you go, and Care Credit. Using a term like Care Credit is helpful because everyone is familiar with the idea of credit. When they ask for more information, you can lay out the details of payment plans.

Understanding Insurance for Case Acceptance

The real role of insurance is a mystery to most patients. Some may deliberately avoid understanding it because of how convoluted and frustrating it can be. They may have an entitlement mindset complete with the belief that the only healthcare they can indulge in is the kind covered by insurance.

Before you ever even look in a patient’s mouth, my advice is to have the insurance talk in low-stress language. Explain the actual definition of insurance and describe how dental insurance functions more as a maintenance plan. Use analogies to clarify the fact that just like with car insurance, its more of a backup fund than a way to pay for necessary yearly interventions such as a new tire or oil changes.

During an occlusion-focused hygiene exam, there are certain things the hygienist should pinpoint. This will help them develop a deeper relationship with the patient as well.

A Hygiene + Occlusion Exam

What the hygienist should look for:

1. “Can you eat/drink cold things comfortably?”
2. Subtle wear facets – those shiny spots on the edges of teeth.
3. Chipping of the edges of teeth. Can you get the patient to line up an incisal “chip” with a sharp edge of a lower front tooth?
4. Fremitis – that subtle shimmying of an upper front tooth when you gently place your fingernail on the facial of a maxillary incisor and ask the patient to grind side-to-side and front-to-back.
5. NCCL – could that be from clenching or orthodontic expansion? Both/and?
6. Persistent marginal inflammation that could be a sign of clenching (or an imbalanced bite).

The hygienist’s role is to raise patient awareness –  to “discover” changes that can be brought to the doctor’s attention for long-term protection of the patient’s teeth.

The doctor’s arrival for an exam is the time that real skill and teamwork begins. The hygienist takes the lead and informs the doctor what they (hygienist and patient together) have been discovering/discussing.

Many times, the most significant questions come when I am behind and feeling rushed. Our goal, practiced for years, is for me to get in and out of the hygiene room in under 5 minutes. Therefore, our total goal together is to encourage the patient to schedule another appointment for a more thorough evaluation of any changes/discoveries.

The hygienist then supports and reassures the patient about the need for a more thorough understanding to protect their teeth and eating for a lifetime. They confirm the uniqueness of a full understanding of teeth, harmonizing bite forces, and oral-systemic health and well-being.

“This is what sets our office apart. Together we strive for the best in your total oral health prevention.”

A well-thought-out and choreographed hygiene appointment can truly establish you in the relationship-based sector of dental care.

As a maximizer, I’m always tweaking processes to try to make things a little better. A few years back on the advice of a wise mentor, I made a small change to the last question I ask of patients in my Pre-Clinical Conversation. This change required a dramatic difference in how I view my “job” for patients.  

A Powerful Pre-Clinical Conversation Question

For years, I thought I was so unique to finish my time in the consult room with the question: “Is there anything else I should know about you to take good care of you?” Patients genuinely seemed to appreciate that question. I felt great about the responses I got, almost always along the lines of, “Nobody has ever asked me these types of questions!”  

A few years back, I was diving deeper on Locus of Control of Oral Health with my small growth group, The Sinking Stones. I was hoping to help my patients increase ownership of their condition and shift the “locus of control” from the doctor/expert (tell me what to do, when, and how) toward a true partnership (I can be the expert of the technical pieces, but you are the expert of you).  

The elegance of this transfer relies on our ability to do so without the patient feeling abandoned and unguided. I was gently reminded by Dr. Rich Green that a small change to that question could help frame the relationship differently right off the bat.

My new question is: “Is there anything I should know about you to work well with you?” Rather than facilitating a dependent/top-down/expert doctor relationship, I now have a much better chance of a patient understanding how important it is for me to be in partnership with them.

I can look them in the eye and tell them my healthiest patients are those that view me as their partner. This is better than looking for “experts” to tell them when it is appropriate to take on a particular procedure or make a decision for them without knowing their temperament, circumstances, and objectives.  

Though I love taking care of people, a change in those four words has allowed me to do so in a partnership according to the context of the patient’s life.

Dentistry is rapidly segmenting into two distinct professions.

One will be what most patients think of as traditional dentistry. The tooth fixer and cleaner. The technician. These dental offices will focus on bits and pieces of treatment to get full insurance dollars from each patient each year. The staff will likely also be fragmented by tasks.

The other profession will be the doctor of the oral-health system. The valued family advisor on health and wellness. As Pankey-trained dental offices, we are well positioned to become the relationship-based advocates for our patients’ health.

Training Your Team to Advocate for Patient Health

How about your team? Have you put in the time to train and behaviorally change your most valued support?

A most important person in that team approach is the hygienist. Are they having conversations about total health? Social conversations don’t lead to behavior change that improves the health awareness of our valued patients.

Again, as Pankey-trained dentists, our hygienists can have a huge impact on our patients’ perception of our unique thoroughness. Occlusal awareness should be part of hygiene discovery about their health.

Bringing Up Occlusion in the Hygiene Appointment

This can involve simple questions: What have you been noticing about your bite? Chewing? Jaw? Headaches? “What have you been noticing about [fill in the blank]…?” can begin a discussion.

Depending on the conversation, one can follow with: “We are noticing that, as people live longer (keep their teeth longer), we see things slowly develop that can lead to big concerns. In our office, our purpose is unique – we want you to be able to enjoy eating all the foods you love the remainder of your life. I will look at potentially traumatic bite forces for you.”

How do you introduce occlusion in your hygiene exams? Let us know in the comments! 

Exceptional service is more than just a set of benchmarks we strive to reach in the dental practice daily. It’s a philosophy that steers the ship, drives everyone on the team to seek greatness. As such, it can’t be a mandate handed down to your team. It has to go deeper than that.

There are three things you can do that will enable your team to embrace and embody exceptional service. Remember, it must be natural to them, instead of forced, if the impression they give is to come across as genuine.

3 Steps to Truly Exceptional Service

1. Be a Good Role Model

This may seem too simple to work, but it’s like magic. Model exceptional service and your team will inevitably follow suit. Set an example that also sets the tone for your dental practice as a whole. Go out of your way to surprise patients with how good your service can be.

It’s easy to expect greatness from others while not putting the same pressure on yourself. Walk the talk. Live an unbridled excitement for patient care that’s completely clear of resentment toward their demands or needs.
Choose quality and excellence in every way you can, whether that be in your stationary, your lab, or even the drinks you have in the waiting room.

2. Hire People Who Go the Extra Mile

During your hiring process, make an effort to find team members who inherently want to go above and beyond. They should have a personality intent on always taking success to the next level. It’s not as difficult to sense this in an interview as you might think.

Ask the interviewee what they consider an exceptional doctor’s office experience. Go even further and ask them to talk about their own experience providing care beyond expectations. Then, ask why they did this. Use your own intuition to decide what their story means about them.

3. Reward Exceptional Actions

No dentist is an island, which is why you’re always hearing about the importance of your team. It’s a lesson we all need to be reminded of throughout the years as we grow complacent, things change, or new challenges arise that reveal cracks in our team’s capabilities.

Your Team is Key to Exceptional Service

Because exceeding expectations is an intangible thing, you can’t easily make it an actual practice policy. It’s not a rule, it’s a goal. If you want to make delivering exceptional service part of your practice brand, it needs to be an aim shared by all of the people on your team. They must genuinely enjoy delivering exceptional care. It must be the attitude that drives them.

But like anything, your intention to mandate exceptional service can backfire. This will leave you frustrated and your patients confused. A great analogy of this is an experience my husband and I had purchasing a car. The salesman insisted on taking us to a repair place nearby, despite the fact that we knew where it was. He told us he couldn’t get a ’10’ on the sale otherwise. As it turned out, this task was necessary to fit the quality control expectations of his superiors.

Exceptional Service Can’t Be a Mandate

This transparency wasn’t a good thing. It made it sound like our salesman was more worried about his performance review than our needs. The exact same problem can happen in the dental office. It’s why you don’t want to make exceptional service a strict rule. It has to be genuinely wanted by your team.

So how do you develop a practice culture that makes this happen? It all comes down to three key factors that will encourage your team to embody a true passion for patient care …

Check out Part 2 of this series soon!