Viktor Frankl wrote his famous memoir, Man’s Search for Meaning, over a period of nine days in 1946, and it has become an indispensable meditation on the wisdom Frankl gleaned from his gruesome experience at Auschwitz. The horrific circumstances he faced – circumstances which caused many others to surrender their very will to live, caused Frankl to focus his energy on a pursuit of meaning. He sought to find a deep sense of personal relevance in the face of incomprehensible evil, helplessness, and hopelessness. This, in turn, led him to discover personal relevance could be found through the cultivation of:

· Purposeful work

· Developing a clarified, values-driven Vision and Goals

· The intentional loving of others

· Courage when confronted by extreme challenges

· Choosing not pursue material success, and instead, focus on allowing it to ensue

As we advance toward and through our purposeful work, as well as through loving others, we will inevitably be confronted by circumstances which require tremendous courage and perseverance. Frankl felt these situations – these periods of courageous suffering were key to our ability to progressively discover the deeper meanings to life and to positively change as a result of new realizations and perspectives. On this, Frankl commented, “Without suffering and death, human life cannot be complete.”

What Does Life Expect of Us?

During his time in Auschwitz, Frankl fundamentally changed his perspective toward living, as he observed that what he wanted from life didn’t matter in the grand scheme of things. Rather, what truly mattered was: What did life expect of him, and could he live up to it all, in spite of the horrible circumstances which surrounded him each and every day?

Purposeful Work

Trying to apply Viktor Frankl’s other-centric philosophy today requires us to turn the current egocentric culture on its head, as implementation begs even more potentially life-changing questions such as:

· Why am I here?

· What have I been called to do?

· How can I make sure I will be able to achieve it?

By sincerely answering these questions, it’s my hope you will discover, like Frankl, that your work in dentistry isn’t just about what you want from life; rather it’s about much more. It’s about a “calling” driven by your desire to significantly help others.

The Ancient Greek aphorism “Know Thyself” is one of the Delphic Maxims inscribed on the ancient Temple of Apollo. Dr. Pankey referenced this aphorism because self-awareness is key to our ability to stand apart from our patients and form healthy and effective interpersonal boundaries. This ability to “stand apart” greatly influences how we see our patients and the world that surrounds THEM. It not only affects our attitudes. It also affects our behaviors.

Lack of Self-Awareness Leads to Misinterpretation of Patient Behavior

Until we take into account how we see ourselves, we will be unable to understand how our patients see and feel about themselves and what the dental issues they are experiencing mean to them. This is because a lack of self-awareness causes us to function more on assumption than reality, and this in turn causes us to project our prospective onto our patient’s behavior and then fool ourselves into thinking that we are being objective. These assumption-laden relationships significantly limit our potential to positively influence and relate effectively with our patients. And this limited ability to relate to our patients on a deeper level easily leads to misunderstandings, the devaluing of recommendations, deferral to insurance companies, and even to open conflict.

Knowing Yourself Leads to Knowing Your Patient

Bob Barkley’s co-discovery method is the pathway to “knowing our patients” as well as allowing our patients, over time, to know us on a philosophical level. And it is the practice philosophy which moves people toward health or keeps them stalemated in dependency. Knowing yourself leads to knowing your patient which allows you to optimally apply your knowledge. And isn’t that your mission?

Three-quarters of human brain growth takes place in the first three years of life.

And that represents almost everything except the prefrontal cortex, which does not fully mature until around the age of twenty-five. This means that our ability to cognitively process…our ability to understand and respond appropriately to lower brain functioning, and particularly our emotional system, is quite limited early-on. Yet that is exactly when most of our beliefs about the world and how it works are formed and rarely challenged. So, when a person comes into the office claiming that “When I was a kid, the dentist put both feet on my chest to extract the tooth. It was horrible. I hate going to the dentist,” we are actually dealing with a belief and not a fact.

Responding to “When I was a kid…”

It is counterproductive to begin a new relationship with a person by telling them that they are wrong and don’t know what they are talking about. So, we have to begin someplace else, with the goal of facilitating a change in belief over time, and not with a goal of convincing others how much we know and that they should surrender to our intellectual prowess. Start with the understanding that we humans don’t like to be challenged as wrong. Also understand that we’d often rather be wrong than right, simply because it feels better to our ego.

It turns out that the only way beliefs change is through an inside-out process of self-reflection, re-assessment, new realizations, and new assumptions repeatedly confirmed by new experience. Before there is a commitment to action, your patient with negative beliefs about dentistry must go through this. And, I’ll bet you weren’t thinking all of that was going on in your patients’ brains, but it is…every single day. That is why relationship-based dentistry holds so much power and potential.

Truly helping relationships are the only vehicle through which significant personal change occurs in dentistry. L.D. Pankey said, “Know your patient,” not because you can use the knowledge strategically to defeat them on an intellectual level, but rather to help pave the way toward significant change and therefore better decision-making.

We can’t manipulate our patients toward becoming healthier.

In fact, the more we try to manipulate people, the more their lower brain recognizes something is wrong. It doesn’t know what, but at least it’s smart enough to stop listening, and focus on self-preservation—like staying away from people who will likely put “both feet on their chest.”

It seems that “empathy” has become one of the most popular buzzwords in dentistry, and in spite of the popularity of its use, few people understand what it is and why it is so important.
Confusion may be rooted in dictionary definitions such as “the ability to understand and share the feelings of another.”

Can we really understand and share the feelings of another?

Avrom King used to say, “There is no such thing as a second-hand feeling.” It’s impossible for us to fully understand the feelings of another person. In truth, the best we can do is contemplate intellectually what a person MIGHT be feeling and then project our feelings upon our thinking.

Our feelings, and our patients’ feelings are unique to us and them. They cannot be fully explained or understood by others. Yet, they are valid because what we feel is our reality.
Our brains function based on mental models or “thought constructions.” These thought constructions may be fairly accurate, total fabrication, or something in-between. But in all cases, they are still our reality. And the only way for us to square the inaccuracy of our thought constructions with reality is to test them against what we perceive to be reality.

Perceptions are open to review. They change.

And, there is another problem. Our perception of reality is a thought construction as well. In other words, our brains function by testing our thought constructions against our thought constructions, and then we call the most successful ones “beliefs.”

Because a belief is still a thought construction, it is always up for review with regard to accuracy, unless of course, we don’t want to do that. And in that case, we choose to become dogmatic instead of continuously being open to refining our version of reality.

So, why is understanding this important?  Because beliefs, dogma, and empathy all fully infuse the relationship we have with ourselves as well as our patients.

What we think they think influences how we think.

Let me say that again. What we think they think influences how we think. So, if we come into a new relationship with beliefs about ourselves and other people which are rigid and dogmatic, then it is very unlikely that we will find the whole truth, and most certainly, we will never even come close to understanding our patient’s perspective. Yet, our patient’s perspective is the complete source of their motivation to act or change their perspective.

Empathy is an attempt to understand another’s thoughts and feelings.

Giving others quality attention signals we are interested in understanding what they think and feel. It signals that their thoughts and feelings are important to us. Empathizing is an act of caring about another person. When we give others this kind and quality of attention, it allows them to feel safe and accepted. And in that space, they are more likely to re-assess their beliefs about dentistry, dentists, and what dentistry might be able to do for them. Consequently empathy, non-judgmental acceptance, and behaving in a transparent authentic fashion is the pathway towards facilitating change in others. This is what Carl Rogers called “congruence.”

When patients feel supported and risk committing to change, we call it trust.

Change in attitudes, beliefs, and perspectives is what causes patients to commit to significant change, which at the end of the day is a risk…a risk taken because they feel like the people around them will support and care for them along their journey toward new understandings, perspectives, and experiences. And when that happens, we call it “trust,” which is at the foundation of every enduring and meaningful relationship.

One of the hardest things in dentistry is to know when to keep pressing onward or deeply reconsider a situation and move on in a new direction.

Everyone knows that perseverance and “grit” are key to success. Anyone who has worked their way to the top can tell you about their moments of doubt, horror stories and wounds acquired along the way. But never re-assessing, never changing course is problematic as well, as it is analogous to sailing with a fixed rudder. It is only a matter of time before you run your boat aground.

Do you have both a plan and a strategic planning process?

Successful management of the direction and functionality of a practice requires the use of both approaches, and that is why every practice needs to not only have a plan but also a strategic planning process. A strategic planning process is an iterative process of self-reflection. It is constant and not just an event. Because it is a “process” of constant reassessment, you can discover when to reimagine and change course. Dwight D. Eisenhower spoke to this truth when he said, “Planning is essential, but plans are useless.”

Where are things breaking down?

An objective way to arrive at an answer is to begin to analyze where things are breaking down. The work of Simon Sinek is helpful in making this analysis. He says we can have breakdowns in the areas of HOW, WHAT and WHY.

Breakdowns in specific areas of a practice are often breakdowns in HOW. This is when people are not executing well-designed and well thought through processes and procedures. This may be driven by a lack of knowledge, understanding, ability and/or desire. And these represent objectively correctable problems. For example, if the margins of our crowns are consistently substandard, we need to go back and figure out where our processes and thinking are breaking down. If a team member is failing to execute their responsibilities in an appropriate fashion, the same approach holds true.

Are you climbing fast in the wrong direction?

Failures can also occur at what I would call a “strategy level.” This is a more global level above execution, because it involves more of why we are attempting to do what we are attempting to do. Simply put, poor strategies will lead practices in the wrong direction. Steven Covey’s metaphor of having our life ladder up against the wrong wall applies here. We can be climbing fast, while simultaneously climbing in the wrong direction.

Does your work feed your soul?

Failures can and do originate on a WHY level. An example of this would be a person working hard and making bank, while hating being a dentist. This represents a failure on the visionary or philosophical level. Failures on this level represent spiritual depravation. In this case, we are going through the motions, yet very little of what we are doing feeds our soul. As a consequence, people often attempt to fill this void in a dysfunctional way, perhaps, with alcohol, drugs, sports, extreme exercise regimens—or something else that easily becomes an addiction.

If we have HOW and WHAT breakdowns in a practice and still have our WHY worked out, staying focused and working through issues and problems is appropriate. However, if the reason things are not being executed well and the reason our strategies aren’t effective is really because our heart isn’t in it, then we have a spiritual crisis on our hands.

Without first addressing our inner nature and our inner truths, we will never be successful at addressing more downstream challenges such as HOW and WHAT. L.D. Pankey was speaking to the essential nature of this truth when he said, “Know yourself.”

When asked about The Pankey Philosophy, L.D. Pankey famously responded, “What do you mean when you ask me about The Pankey Philosophy? I am not familiar with the document, although I do recall writing an essay entitled A Philosophy of Dentistry by L.D. Pankey.”

Most dentists are comfortable acknowledging that L.D. Pankey was a great philosopher and that he was the first well-known philosopher in dentistry, but most dentists don’t think of themselves in a similar fashion; rather they like to think of themselves as being prototypes of practicality. This is why most dentists never even think about the value of writing a Philosophy Statement.

Just what is a philosophy statement?

A philosophy statement is a statement of core beliefs, and a validated philosophy is a philosophy statement which has been affirmed through its frequent use, reference, and revision. It is, therefore, a living creed around which a person or group of people live their lives.

A great example of a validated philosophy statement was how Wilson Southam and the Group at Cox operated a number of years ago. Cox was a progressive dental equipment designer and manufacturer located in Stony Creek, Ontario. Wilson Southam was an investor, a co-owner, as well as the philosophical leader of the company. Cox had developed a philosophy around which all of its equipment would be designed – a concept is called, “the computerized dental cockpit,” fashioned similarly to how a fighter pilot might operate. And Cox preferred to sell its equipment to only those who understood its philosophy…only to those who understood the “why” behind the “how” and the “what.” Cox believed in this so strongly that it held workshops centered around its philosophy at Stony Creek.

A philosophy statement can also be called a “core beliefs statement.” A good example of a philosophy statement is the Nicene Creed, co-authored after the center of the Roman Catholic Empire was moved from Rome to Constantinople. At that time, Christianity was in a fractured state, with many different sects, and with many different belief systems. The Nicene Creed was co-created by the Roman Catholic leadership with the intention of having it function as a unifying document around which everyone could agree, so that the church could again move forward.  It states, “We believe…. We believe.”

It’s a well thought out basis for behavior.

So, a philosophy statement represents a statement of beliefs, which is so basic and so fundamental that it provides a rational and comfortable basis for you and your care team to determine what it is that each member of a care team should do, as well as what they should choose not to do.

William James was a physician who lectured at Harvard in the late 1800s on Philosophy and Psychology. He is considered to be America’s first psychologist and was thought of as a “pragmatic philosopher.”  In this regard, James said, “There is nothing more practical than having a personal philosophy.” In the case of dentistry, an applied philosophy (validated philosophy) is practical as well, as it naturally leads to an organically-driven team, deep in mission, and high levels of personal autonomy and interpersonal trust.

A philosophically-aligned team is essential for the creation of a philosophically-driven community.

Barkley a year or so before his untimely death in 1977, said during an interview with Avrom King said: “If I had one wish that could be granted, it would be that every dentist would take the time to create a written philosophy statement.” Let’s talk about why Bob would make such a statement.

The creation of a relationship-based/health-centered practice is a perfect example of the creation of a philosophically-driven community, with the word community being used as a reference not only to the creation of a care team, but also to the patients of a practice, its associated suppliers, mentors, and facilitators. All of the members of this community are philosophically aligned through either careful selection, development, or both.

A community of this type begins with the creation of a care team which has co-authored a written statement of philosophy. This is because you cannot have a true health-centered dental practice without a philosophically-aligned care team which listens well, are true helpers, and who facilitate healing in each other, as well in those with whom they come in contact. One or two people acting alone, simply cannot apply a practice philosophy as others, who are in contact with patients, will create too much confusion and mixed messages in the minds of the patients.

A personal philosophy statement starts the ball rolling.

The dentist might begin the process of thinking through a personal philosophy statement by answering these questions:

1. Who am I? (What are my values and core beliefs?)
2. Who do I want to become? (How do I want to see my life unfold?)
3. Why do I feel this way? (What is my personal purpose in this life?)

To develop your philosophy-driven community (care team, patients, suppliers, mentors and facilitators) the dentist next shares his or her personal philosophy with care team members and leads them in co-authoring a practice philosophy statement.

Remember: A philosophy statement is a statement of core beliefs, and a validated philosophy is a philosophy statement which has been affirmed through its frequent use, reference, and revision. It is, therefore, a living creed around which a person or group of people live their lives.

A co-authored and applied practice philosophy statement produces multiple benefits.

Here are four concrete benefits of co-creating a written group philosophy statement with your care team:

1. It will establish a standard of behavior for everyone to live up to and aspire towards.
2. It will allow for that standard of behavior to be used in a situationally appropriate fashion, and therefore not be used dogmatically, as everyone recognizes that every person and every situation is unique.
3. It will function as a centripetal force…as a kind of principle-centered psycho-social glue which will hold the care team together during times of change and challenge.
4. It will function as the foundational document out of which a practice vision (where are we going long-term) and a mission statement (how we will get it done) can evolve.

Like many aspiring students on a track toward dental school, I studied Latin with the hope that someday my understanding of Latin root word forms would translate into a greater value to me as a dentist.

That day never really came as an obvious epiphany, but rather as thousands of subtle moments later while reading, listening, or learning.

Not Your Standard Definition…

And it also came the day when that I started to attend The Pankey Institute and saw the tag line was “quid pro quo,” and it confused me. It confused me because all standard definitions of quid pro quo sound transactional – something is given or taken in return for something else, so it did not line up with the Institute’s preferred definition: “Give before receiving,” which has a much different tone…a much different intention.

Even today, due to my Latin training when I see “quid pro quo,” I have to stop myself and insert the Pankey definition when thinking about my profession. And I would argue that it is deeply important that we all do so, because viewing dentistry primarily as a transactional business is to devalue it down to a highly skilled trade. And this totally neglects the spiritual and more holistic aspects of our work which are the true source of joy, fulfillment, and meaning over long careers – a lesson Dr. Pankey routinely taught.

The Pankey Institute’s definition of quid pro quo is more aligned with words like Scott Peck’s “love” (selflessly giving to another with the sole agenda of helping them to grow and to become healthier and more fully functioning). The Institute’s definition is more aligned with trust and investing…investing in the sense that we believe that if we selflessly facilitate in others’ greater self-knowledge, self-understanding, and personal empowerment, they will reciprocate by gifting us an opportunity to help them achieve their goals.

What is the quid? What is the quo?

In other words, we offer our true and sincere caring as the “quid,” and if done in the right way, at the right time, with the right person we get the “quo” in return, as a reward experienced as a new trusting and deeply helpful relationship which yields respect, admiration, and appreciation in an ongoing fashion.

We get emotional confirmation in return. As dentists serving patients in our professional capacity, we get proper financial compensation in return as a SYMBOL of how much the person values the relationship and what it has brought into their life.

“Because I care.”

In a recent sermon, our minister said: “The summons for us as people of God…those who are called to be full of compassion, mercy, and love, is to live in such a way that people ask ‘Why’? Why do you feed me? Why do you clothe me? Why do you visit me when I am sick? Why do you do these things for me? And our response will be, simply, because I care…because I love you.”

Quid pro quo…THAT is what it means to me.

Lin-Manuel Miranda concludes his iconic musical Hamilton with a piece titled, “Who Lives, Who Dies, Who Tells Your Story.” The song causes the audience to reflect on why certain people in history are remembered, while others are forgotten. It draws them in and includes them in the drama to discover personal meaning through the experience.

L.D. Pankey knew and told his story. Others told it too.

One of my favorite quotes from Peter Drucker is, “The aim of marketing is to know and understand the customer so well the product or service fits him and sells itself… The aim of marketing is to make selling superfluous.” When I first read Drucker, is was a true “a-ha” moment for me; it completely shifted my paradigm about marketing while simultaneously connecting it to L.D. Pankey.

The light came on. L.D. Pankey was one of the greatest marketers in the history of dentistry. And he achieved it by first knowing who he was, and then clearly and consistently communicating it to the world. In other words, he was very good at telling his story, and it was through that narrative that others learned, grew, and our entire profession benefited.

Clarify your story to tell it well.

If we are to thrive in this rapidly-changing marketplace, our own compelling story must be known. Our story must be told by ourselves, by our care team, by our patients, and others. It’s ultimately up to us who will tell our story and what they will say. So, how do we go about telling our story? First, we must clarify our philosophy and vision to the point that they are “in our tissues” … to the point that we can’t NOT talk about them. Put your story out there with enthusiasm. The rest will follow.