Every one of you knows from your own experience with care providers that you want to have complete trust in them before accepting their recommended treatment. Your dental patients are no different, and that trust is affected by their entire experience with everyone on your care team. The dental experience in relationship–based practices increases this desire, because listening well to others is one of your priorities. Patients become at ease confiding their concerns with you and celebrating high points in their life with you. In your dental practice, listening well and acts of kindness generate positive emotions and positive memories of their dental experience.  

The Golden Rule 

Under daily situational stress, personal psychological stress, and oftentimes lingering physiological stress from the day before, preoccupation with internal concerns gets in the way of being truly present for the patient. The benefits of discussing this occasionally within team meetings foster a continuing positive culture of everyone striving to intentionally apply the Golden Rule with patients.  

When that aspiration is sustained and everyone on the team “takes care of” patients by “treating others as you would want to be treated,” the emotions experienced by patients are positive and support treatment acceptance. And, the genuine care you give others has a way of stepping down your own stress with the release of oxytocin.  

I’m speaking to all team members from the front to back when I say, “Practicing being truly present for patients until it becomes a natural habit is one of the greatest things you can do for them, yourself, your fellow team members, and the business.” 

A Few Extra Minutes  

If appointment times are increased by five to ten minutes, the clinical care team has more opportunity to converse with patients without stress developing, and in just a few more minutes a lot can happen. Conversations between care team members and patients help establish trust. These conversations also disclose patient feelings, concerns and unanswered questions. The sharing of this information with other team members can be used to create an optimal patient experience in this and future appointments.  

It takes just a minute more to share this information appropriately in handoffs to tee up the doctor-patient conversation about treatment and to support scheduling the next visit before the patient leaves. By the latter, I mean the business team at the front and the patient always need to be prepared for the end of the appointment when the follow-up treatment fee is presented and scheduled. This preparation includes communicating the why behind the treatment and true concern for the patient’s welfare.  

Same Page, Same Language 

Patient confidence grows when every team member is on the same page, is aware of the patient’s expressed goals and concerns, supports the treatment plan with why it is recommended and enthuses about the expertise of the practice. Using the same language helps too.  

In a relationship-based practice that focusses on these details, this is possible, and more treatment is accepted. If team members stop occasionally to ask themselves, “How was that handoff,” you will discover ways to improve how everyone “takes care of” patients through shared knowledge, empathy, and language. And knowing the Pankey community as I do, I see in my mind’s eye care teams around the world coming together at the end of the day to say, “Nailed it!” 

Dentistry can be emotionally taxing, and Stoicism helped me to get through some tough times. I am not referring to being a small “s” stoic. In truth, being a stoic can be harmful to a dentist’s emotional health because that implies suppressing feelings. I’m referring to capital “S” Stoicism…a practical philosophy which has as its goals freedom, happiness, and tranquility. And that is how I became fascinated with it. 

The first person I ever heard speak about “philosophy” in dentistry was L.D. Pankey. He used language I hardly understood. It was foreign to me. I studied his philosophy and the philosophy of Aristotle. The application was difficult. Mounted models in centric relation is one thing…but “virtues?” What was Pankey trying to get across?  

It was years later that I learned about the Stoics who were not theoreticians or academics, but rather real down-to-earth working people who considered Stoicism a new school of Greek philosophy that was practical. They lived it rather than studied it, and they were mostly happy emotionally resilient people.  

Their virtues included justice, fairness, and kindness to others. Applying these virtues takes work. It takes self-awareness to avoid making value judgments and creating narratives about situations and people that lead to stress. 

Hearing L.D. Pankey speak of “virtues” sounded old fashioned to me, but I knew there was more to him than mounting models. The essence of his message was how to achieve happiness, tranquility, and virtue…something I was sorely missing when I first went to Key Biscayne. By practicing the Stoic virtues of justice, fairness and kindness to others, I have found happiness. I have found that a virtuous life of inner coherence and outer harmony relieves confusion about life and practice.  

On January 10th, 2020, The Wall Street Journal published an article on the changing patterns of retirement. It is worth a look. After 43 years in the world of dentistry, I have now survived three years as a “retiree” and have a few comments about preparing for and transitioning into this significant life event.  

Preparation Tips 

1. Before you “pull the plug” on work, start to figure out what you would like to do when you have more time. My unhappy retired friends generally failed to do this. I suggest you build on the things you like to do. Include personal time and together time with your spouse. Look forward to a new challenge such as learning a new language or trying your hand at gardening. If you are not now in a service club or a similar group, you will have the time to try that.  
2. With your spouse, discuss how you will manage money. Long before retirement, create your retirement budget and financial growth plan. The Pankey Institute curriculum will help you with this.  
3. Be genuinely interested in others. The happy retirees I have met talk much more about the new friends they have made than about themselves. They are outward-focused and active listeners.   

Transition Tips 

1. Create a schedule and stick to it. If you used to get up at 5:30 am and liked doing so, don’t change. Just get up and do something you did not have time to do in the past.  
2. Be committed to your plan. Intentionally stick to your financial and time management budgets.
3. Stay involved in dentistry if you love it. Keep your membership in organized dentistry and your study club. Be a mentor and continue to learn. If I am fortunate, I will help a few young dentists be more successful and avoid some of the errors I made. 
4. Meditate on L.D. Pankey’s Cross of Life. Be committed to spending social time with your family and friends, even volunteer for their causes. And don’t forget your spiritual life. I’ve been amazed at the nice folks we’ve met at church who are interested in us as people and not as what we did in our careers

Final Thoughts 

If you are 30 and have not started to think about retirement, it is time to start. The successful economics of retirement takes time and commitment. If you are nearing the years when you will retire from practice, start thinking about your future lifestyle now. Keep in mind that a life well lived is a happy one. Continue intentionally “giving back” after retirement, and you will continue to make memorable, good things happen for yourself and others. 

When the art and science of dentistry are reduced down to primarily being about production and code mining, its spiritual dimension is easily lost. Spend a few minutes on some dental social media sites, and you will quickly see this truth in black and white. 

Dr. L.D. Pankey warned us about this problem.

The key to becoming a truly successful professional isn’t just about mastering the technical skills and endlessly chasing after the siren songs of our materialistic culture. Such narrow pursuits are ultimately hollow and do not represent enough to carry us through life as a fully developed person. And they do not represent enough to carry us through life’s inevitable tragedies and periods of significant suffering.  

Creating a habit of connecting with our patients in deeply meaningful ways, helps us to form the emotional antibodies we will need to carry us through the inevitable not-so-good times, the times when all the money and material possessions in the world can’t solve our problem. These are the times when only love, support, and reciprocated empathy can start the process of healing our wounds. 

Never forget this central truth.

Chasing after the next new and shiny object may not be the best solution for our challenging situation today. The best solution may very well be sitting right in front of us in the form of a deeply caring patient.
 

Being efficient with your time increases profitability. 

Life is busy and everyone is trying to find a better balance between work and time off. If you could produce the same amount of dentistry in three days as you did in four, how would your team react?

Efficiency is a mindset and can become part of your practice culture. Producing more in less time does not mean running around like chickens or being hasty with patients. We can learn the art of using time better for our patients. Focusing on the conversation rather then multi-tasking is one example. Being prepared is the Boy Scout motto and fits perfectly here. Most patients would prefer fewer visits to your office.

Being prepared for any possibility allows your team to feel confident.

Having enough tray set-ups for any opportunity that presents itself is a start towards efficiency. Having a team completely cross-trained allows the team members to shine by being prepared and results in greater efficiency.

More time is created when the practice culture is to offer a complete exam on patients. When there is a comprehensive plan, this moves a practice beyond patching and emergency care. There is a reason why patients come to you, and most want to know you have a plan for them. Along with this, at the end of every appointment, team members need to ask the doctor, “Is there anything else we can do at the next appointment?” It is a signal to the doctor to maximize every appointment. 

Combining treatments can be a measure of efficiency.

Always combine crown prep and endo, or any other treatment. If there are fillings and a crown, do the fillings first as you will complete the crown prep in the allotted time. This works well with CAD/CAM as there is downtime available during milling and baking time.

In Hygiene, collect the fee at the time of service. “Yikes,” say the hygienists, “We’ve never done that before.” Patients love it, and once the hygienists do it, they like the connection, too. This eliminates the line at the front desk and allows more concentration on phone conversations.

Follow Nordstrom and Apple examples. Clinically, encourage hygienists to do full mouth debridement at one appointment.  It saves the patient time, and the result is a healthier mouth.

Become completely paperless.

Operating two systems is a waste of time.  New patient forms are on your websites, and all patient records are digital. To be paperless, just start one day at a time, and don’t waste time putting people in digital who have not been in yet.

Efficiency starts over the phone by asking questions to eliminate the 30-minute “look-see” emergency appointment. With the patient records on your computer, ask, “Is this broken tooth one the doctor had already recommended for a crown?” From the records, ask if there are any other previously diagnosed teeth in the same quadrant needing treatment. Ask, “Would you like to have all three of these taken care of at the same time? I can make arrangements for that.”

The team is accountable for an efficient schedule.

Phone training is a big part of making days efficient and profitable. You can save a lot of time for the doctor and patient, practicing phone scripts for different scenarios that occur in your office on a regular basis.

Timing your procedures is a great way to evaluate your efficiency. We can learn great lessons from efficient assistants. We call this “Ruth’s Rule” as a tribute to one of those fine assistants: Use one bur or instrument, do what you need to do, and then move on. That bur does not appear again for that patient.

Efficient scheduling in blocks has a profound effect on efficiency and profit. 

For example, booking alike procedures at the same time eliminates the team having to shift gears both mentally and physically. Blocks of two hours with a production goal forces the team to focus on better scheduling.

For example, if your goal for each two-hour block is $3k, don’t schedule “look-see” appointments during this time. When you produce $6k in the morning, you are on track to efficiency and more time away from the office to rejuvenate.

Drs. Blatchford are America’s leading dental business coaches. Their book, Bringing Your ‘A’ Game 2.0 is now available at Blatchford.com (888) 977-4600. Blatchford Coaching results in less patient contact days, greater net, more focus on what is important to you.  

L.D. Pankey, when talking about the assimilation of knowledge would say, “First you get it in your hands, then your head, and finally in your heart,” meaning objective understanding and competence was only a step in becoming a complete dentist. 
 
This, of course, was a hard message to hear as a young clinician, because after rapidly proceeding through Pete Dawson’s curriculum, purchasing three Denar articulators, and then going on to The Pankey Institute, I felt that I was ready to start practicing as a “comprehensive dentist.” 
 
But unfortunately, most of my patients and the citizens of my berg didn’t get the memo. Most of them just looked at me suspiciously, while others left. Fortunately, a few of them allowed me to perform my “complete exam,” collect study models and take 35mm slide photography. And then, I’d spend hours waxing up cases, and preparing a thorough written report containing all of my findings and recommendations. Finally, I’d make  a “case presentation” appointment and unveil the brilliance of my understanding of complete dentistry–about which I was sure the patient would be impressed and then have no alternative but to say “yes” to my plan for them.

From there, it was easy for me to visualize a completely organized schedule full of people who had said “yes,” and a projected level of income of my choice based upon how hard I wanted to work, and the number of hours I was willing to commit to being at the office. It all sounded so perfectly logical, and it all fits quite well with my left brain driven in the world view of dentistry.

But things didn’t work out that way very often. And since that time, I’ve have spoken and consulted with literally hundreds of dentists who’ve experienced similar frustrations. Many of them told me that they eventually gave up on their effort to try and practice comprehensive dentistry. Others took their practice to near bankruptcy via their determination.

You see, most of us missed Dr. Pankey’s message the first time we heard it, or even after the next two or three times.

We failed to recognize that the concept of complete care also hinged on how each patient felt, what they wanted for themselves, and what the solution would mean to them on an emotional level.

It was only after this difficult realization that things began to improve for me and my practice. The work of Carl Rogers, Bob Barkley, Lynn Carlisle, Avrom King, Sandy Roth, Mary Osborne, and many others, helped me to make some critical adjustments regarding how I was communicating with my patients–and perhaps even more critically– when.

Patient-centered dentistry is just that, patient-centered, not treatment centered.

This means we must first come to appreciate each person without imposing our beliefs and expectations upon them. This is a process that involves feelings first (their feelings not ours) before cognition–and before the discussion of any solutions. We must first be able to grasp the contextual meaning of the dentistry in each person’s life, and by so doing, better appreciate their perspective.

When we become better at doing this, we’ll feel that our knowledge has finally reached our hearts and the hearts of our patients as well. And it’s only at that moment that things will start to become easier and our patient’s behavior more predictable. It’s only at that moment that the “yes” to comprehensive dentistry will happen on a regular basis.