Doctor L.D. Pankey would often say to me, “Communicate with others by making your examples relevant to the other person’s experience or frame of reference.”

Years ago, I had been asked by a young dentist to come to his office and help him with the implementation of his new learning with occlusion applied to bite splints and equilibration. I suggested he line up a few patients for us to work on together during my visit. When we arrived at his office early in the morning to talk about the patients we were going to see together over the next two days, I asked him to bring me up to speed on where he was in treatment with the patients and the conversations he had had with them. We also looked at full mouth models, models of bite splints, and radiographs. I asked him what he wanted me to do with the first patient who was coming in that morning.

He said, “I want to watch you sell him a bite splint!” A little surprised, I asked him to tell me about the patient. He said he was a new acquaintance. They played golf together and occasionally gambled as they played to keep their interest up in the game. They also gave each other a hard time about handicap ratings. He mentioned he felt a bit embarrassed because he thought he knew what was best for his new friend and had kind of hustled his friend on the golf course to be a patient. Now he was feeling a bit guilty about having his new friend come in as a patient, and he could not bring himself to a have conversation concerning the benefits of a bite splint.

Charlie (the friend) appeared, and the dentist introduced me. Charlie and I stood about the same height. We looked each other in the eye, and we smiled at each other – a good beginning. In my mind, I was repeating slowly to myself, “Find a relevant connection.”

I said, “Thanks for taking the time to come in and meet me on such a beautiful Spring day, as I pointed to a comfortable chair for him to sit in.”

He offered something about how golf could be a bit boring if you played it too much. Still looking for a relevant connection, since my “stated task” was to sell him a bite splint, I asked him about his work, and he said he was retired from directing filmed commercials. I asked him what he did with his new found time aside from golf. He smiled a big smile and said he ran about five to seven miles a day. I smiled as I remembered the years when I ran three to five miles a day during the week and seven to ten miles on weekends. A light bulb went on, in my head, and I knew a question I could ask to engage him and tweak his curiosity.

I asked, “How often do you buy new running shoes?” And without hesitation, he said, “Every four hundred miles.” I then asked, “How did you discover that interval?”

He reached down with his right hand and rubbed the lateral surface of his right leg from the mid-thigh, across the lateral surface of his knee, to the lateral surface of his calf, while telling me of the discomfort he would experience in his muscles when the bottoms of his running shoes became worn.

I made the statement, “You must run with the traffic!” Surprised, he asked, “How do you know that?”

I told him I experienced the same thing when I ran on a road with the traffic, especially when the road had a bit of a “crown” on its surface. I thought I had found a relevant connection, and I let it sink in a bit. Then, I told him his dentist friend wanted to offer him a new pair of shoes for the top of his teeth in the form of a removable bite splint. It would be like getting a new pair of running shoes. It would be professionally custom fitted to the tops of his teeth, which would please your chewing muscles and create greater comfort, just like a new pair of running shoes pleased his leg muscles and knee joint.

Charlie looked at his dentist friend and then at me before standing up. With a big smile he said, “I will make an appointment with the receptionist.” Hmmm… Isn’t that Interesting!

The art of helping our patients develop ownership of their present condition and their desires for their dental health is built on the foundation of listening. But much of the time, we do all the talking and provide all the information.

Several years ago, my friend and I were coaching a young hygienist when her patient asked how she could get her teenage son to spend more effort caring for his teeth. I was ready to dazzle them with all the tips I had learned over my 20+ years in Hygiene but my friend Linda cautioned us to “stay in the question.” She was curious to know what the mother in the chair was really asking. That was the first time I became aware of the concept of staying in the question.

The model I learned in my clinical training—the model of teach and tell, really isn’t enough to help patients make choices about their dental care. And over the years, I learned that when I assumed I knew what a patient meant by a question and gave information I thought they wanted… I was wrong. My assumptions got in the way of my ability to really help my patients.

Are our patients asking for help or for information?

When I learned to combine the ability to stay in the question with my knowledge about dental health and dental care, all my conversations became a bit easier. I have come to realize that that mother with a teenage son, like so many of our patients, was asking for HELP but not information.

Today I can think of several questions I might have asked that mom before I jumped in to giving her information. I might have asked, “Well, what have you tried so far?” Or I might have asked, “What motivates your son in other areas of his life?” I might have asked, “What is he doing to care for his teeth?” I might have asked all those questions but asking even one of those questions, might have enabled me to better help.

Sometimes asking just one question before offering information is enough to open the door to real learning.

Staying in the question is both a skill and an attitude.

We need to skillfully ask authentic questions that are not designed to manipulate people into doing what we want them to do. If the questions help us understand our patients better, they are authentic questions. If the questions help them talk through and move through any barriers they perceive, they are authentic questions. If the questions open their minds to possibilities, they are authentic questions.

But staying in the question is not just about asking questions. It’s about an attitude of curiosity, of coming to the conversation with a desire to know more. It’s about releasing the attitude that we know everything we need to know to help the patient move forward.

Staying the question requires a genuine belief that our patients have information that we need to help them better.

Both periodontal disease and TMD are inflammatory disorders.

We have lots of dental patients who are suffering from the effects of inflammation, and one of the things we can do is help them look at inflammation not from just a local perspective but also from a systemic perspective. Our goal is to help them reduce inflammation where it occurs in the mouth and, also, throughout their bodies in general.

In addition to the first line dental treatments, we can work with our patients at higher risk to manage their general inflammatory response by advocating and discussing dietary changes. I have had great success with some patients by giving them nutritional guidelines.

I know some of you are “rolling your eyes” when you read this because you have had little impact on dietary changes. But we can throw it out there, and some of our patients will latch on to that information and try hard between their dental appointments to make a visible difference when we next see them. These are patients who want to be proactive, and this is something over which they can take control, much like the percentage of patients who accept fluoride varnish and implement the Sonicare devices we recommend.

We don’t need to hold ourselves out there as nutrition experts. We can explain that periodontal disease and TMD are inflammatory processes and one of the things we are learning today is that the foods we eat can increase or decrease inflammation in general. We can suggest this is something they could become curious about, do some internet research, and use the anti-inflammatory foods information they find to affect positive changes in their total health and the oral health issues we are observing.

I tell patients there are great books on anti-inflammatory diet guides and anti-inflammatory cookbooks on Amazon. Dr. Joel Fuhrman and the Forks Over Knives publications are two I mention. If you delve into reading on this topic yourself, you will find you can easily converse about the impact this reading has had on your own diet and the health of other patients.

Be as general in the information you provide or as specific as you are comfortable, but by starting this conversation with patients, you are doing your best to help them.

Over the past few months, I’ve had a series of coaching sessions with frustrated dentists due to many of their exchanges with team members not being as effective as they had hoped. The dentists were confident they had been clear about their expectations, and yet there was still lagging or even absent implementation of the anticipated behavioral and system changes.

“Maybe this is not the right team member! How can they not just do what I ask them to do?”

Of course, I appreciate how disconcerting this can be, AND I want to challenge the notion that a single conversation can lead to effective change.

I imagine we can agree that most of your patients are in the midst of their own developmental process, as dental offices have quality systems in place to support this idea. A patient comes in for a hygiene appointment and they are routinely scheduled to return in 3 or 6 months to follow up, monitor for changes, and (hopefully) celebrate new levels of health. We are used to the idea of having a return date, better known as a “recall appointment.” More often than not this system works. Over time, as the recall appointments continue, trust levels increase along with deepening relationships and even case acceptance.

The question I pose is this: How can you as a leader apply this same principle to coaching your team members? I like to call this system a Conversational Recall.

What if at the end of a coaching conversation, even a short one, you create an opportunity to revisit with the team member to assess progress, problem solve any obstacles, and set a time for yet another Conversational Recall? My own experience tells me that sustained change typically occurs by implementing small changes over time. Staying connected with a team member by offering ongoing feedback and support may very well be the difference between you being frustrated by unmet expectations and your ability to celebrate high performance and heightened levels of engagement.

One aspect of leadership is setting each team member up for success. You can do this by investing time and energy, walking alongside them, and committing to following up as a pathway to letting each person know that you care. One of the greatest ways to inspire change is to demonstrate to your team members that you both value what they have to bring and that you believe in them…sometimes even more than they believe in themselves.

Another aspect of quality leadership may just lie in your ability to be congruent in all areas of your practice; do for your team what you do for your patients—if not more. Care for your team like you care for your patients—if not more. The rewards for everyone involved could be incredible!

When I think of the small things my practice does on an everyday basis that have a big impact on patient relationships, patient satisfaction, and case acceptance, the first thing that comes to mind is what we call check-in and debrief.

Early in my practice years, way back when I was practicing corporate dentistry, when I walked into the operatory, the patient already had topical in place and my job was to get them numb. There wasn’t much of an opportunity to have a conversation. Over time, I learned the concept of check-in and debrief, which is really about how you can use the time at the beginning and end of the appointment to influence the relationship you have with the patient.

These are ideal times to build value for what the patient has agreed to do at that appointment and to tie the goals of the patient to the value of the treatment the patient is receiving, or you hope the patient will accept.

Usually, the check-in and debrief each take about two minutes. My assistants participate in this process with me, so they have increased understanding as well.

Previous Conversations Inform Me

I can be mindful and successful with my conversations if previous conversations with the patient were documented. My assistants take notes for me during my conversations with patients. I need to know:

• What is important to them,
• What they are hoping for, and
• What could get in the way of accomplishing what they believe is best for themselves?

My Check-in Conversation

During the check-in, I aim to converse about what we have planned to do and how this fits the overall goals of the patient. Usually, I enter the room and there is a little chit-chat. Then I ask, “What is your understanding of what we are going to do today?” The response helps me gauge the patient’s awareness. Following this conversation, I may ask, “What is your understanding of how this is part of your long-term health plan?” Or, if the patient has a stated a good understanding of what we are going to do, I say, “Yes, and this is how it fits into your long-term goals for your teeth.” They should now have a good sense of why the appointment time is of benefit to them.

My Debrief Conversation

During the end-of-the-appointment conversation, I aim to thank the patient for being cooperative, talk about what they can expect as a result of today’s appointment, and what they can expect as we move towards their preferred future. No matter what happened during the appointment, I want my patients to hear how much we appreciate them being our patients and being there today. When we talk about what to expect from today’s appointment, we can go over any post-op instructions, which are also presented in written form. Lastly, I want to give them hope that we are accomplishing steps on the road to their preferred future and that we can get there with their continued cooperation. I want to see the rays of hope register on their faces.

I believe all of this is of high value to the patient personally and in building value for the practice. It is well worth the time, and for me, it is a standard part of every patient visit.

For years now, I have followed this simple reflective process. I hope it proves to be helpful for you in your personal and professional growth. My reflection BAG contains Blessings, Accomplishments, and Goals. 

Blessings  

List all the blessings you are grateful for; family, friends, satisfying work, freedom to worship, health, warm home, living in America, etc. Give thanks for the blessings of life. Gratitude is essential to the journey, and too frequently in our “push” to “get ahead”, we forget our core blessings. Compared to these Blessings, getting ahead isn’t the most important thing. INVOLVE YOUR FAMILY THIS YEAR…even your two-year-old will feel the gratitude. 

Accomplishments 

Summarize all things you accomplished throughout the year. This is such an important step to write down because it never ceases to amaze me, when I reflect, just how much I have accomplished. I always need my calendar for this one because I find I forget all the little things I did do throughout the year. The journey can be so (apparently) slow and frustrating, that seeing how far you progress each year is very important. 

Goals 

Now that you are grateful for the mess you have gotten yourself into, write down your goals for the coming year. Come up with 20-30-50 ideas. Many times, the “best” ones are the last few that pop into your head. Remember the Pankey Cross and plan in all areas, Work, Love, Play, and Worship. Know Yourself, Know Your Patient, Know Your Work, and Apply Your Knowledge (this is a part of that). Spend as much (or more) time and money on the behavioral - communication aspects of care as you do the technical aspects of dental care. Plan to integrate Joy, Wonder and Relationships into your work. 

Set Aside Quiet Time to Reflect

Please set aside quiet time to do this. The first time it may take several struggling hours. I reflect several times a year and still set aside a few hours, but it has become almost like meditation for me and is one of the most important things I do for myself. I do this to continually refocus my efforts and to enhance gratitude. This has become part of my personal Peace process.

Thinking Beats Regurgitation

Throughout our education process we dentists are taught to memorize and regurgitate…not to reflect nor to think (I believe, at times, thinking is beaten out of us). We look to others to provide us the “answers” we might be missing that will guarantee our passing the tests (success). Sometimes we glance at someone else’s success and, thus, we let others define success for us — and we all are obsessive enough to bust our butts for an “A” to please someone else. If we just miss being perfect, we feel like such a failure. And for those of you paralyzed by needing to be perfect…Perfection is a disease. The goal is excellence, not perfection. John Wooden said it best:

“Success is the self-satisfaction in knowing you did your best.”

When we have experienced a deeply traumatic event, such as an emotionally laden death, or the near-death of a family member, what is often left behind is emotional debris with the potential to follow us around indefinitely. Subsequently, we can become haunted by memories of what happened, or what we should have done to make things better. These kinds of recurring thought patterns can easily bleed over into our daily lives and negatively influence our behavior—and our future.

On a neurobiological level, this occurs as our brain is designed to keep self-preservation as its highest priority. Thus, possessing the ability to quickly recall traumatic events protects us from similar things happening in the future. But commonly, this constant re-remembering can lead us into a state of psychological paralysis, depression and/or chronic anxiety, and poor decision-making.

At the present time, many patients live in fear of going to the dentist, because they believe there is too high of an infection risk. Concurrently, they consider the process of addressing their dental needs as being a lower life risk. These shadows of fear can remain strong in their mind, particularly when they have a family member who is in a high-risk category. Simultaneously, some dental team members have made the decision to leave dentistry for similar reasons. However, both challenges are happening at significantly lower rates within relationship-based / health-centered dental practices, as these practices have already built strong, enduring bridges of communication within their patient pools.

The Shadow

A contagious virus is a concept most people understand. The level of anxiety this virus has generated world-wide is something many cannot successfully manage alone. We have all had patients whose past dental experiences were so negative and their thinking about it so distorted they cannot recall why certain situations trigger their dental PTSD. Carl Jung referred to the source of these recurring thoughts as “the shadow.” Buried memories and their emotional associations can be so strong that they take complete control over a person’s behavior.

Letting Go

The brain does not stop maintaining its focus on traumatic memories until it has come up with a rational explanation for why they happened and a plan for how to avoid them in the future. On this, Jung stated, “Until you make the unconscious conscious, it will direct your life and you will call it fate.”

CoDiscovery was designed to address the influence of the shadow’s influence on current behavior patterns, in much the same way as psychotherapy facilitates the exploration of the past and associates new meanings with those memories. It is intended to help patients associate new meanings with what they are learning about their dental past.

The “Rogerian” therapy model of unconditional positive regard, congruence, and non-judgementalism is an ideal format for patients to safely explore their fears, beliefs, values, and priorities. And that’s why Bob Barkley and Nate Kohn, Jr., Ph.D., leaned so heavily on Carl Rogers’ work. Bob Barkley put this re-experiencing process under an umbrella he called, “Three Phase Adult Education,” and the rest became history.

The Future

As optimistic as the future appears to be regarding the successful management and treatment of COVID-19, this pandemic experience has reshaped our thinking—our “shadows,” forever. How we manage these memories, conscious and subconscious, will have a lot of influence on our success going forward. If we demonstrate we are on the same side as our patients in preventing COVID-19’s negative impact, we create yet another strategic advantage we can leverage against our transaction-oriented competition. On the other hand, if we allow our patients’ fear-driven “shadows” to drive their decision-making, we will rue the day we allowed this proverbial cart to be placed in front of their psychological horse.

Bob and Nate had it right. CoDiscovery is the pathway to deeper understanding, hence better decision-making. And better decision-making is exactly what our profession needs right now.

In previous parts of this series, we looked at a definition of leadership, the commitment it requires, and the first two of four universal promises of leadership. The first promise was the promise to set a clear direction and create meaningful work for the organization you lead. The second was the promise to engage all stakeholders and hold them accountable for performance. Now we will look at promise three.

The Third Universal Promise

You will ensure your strategies, systems and processes facilitate focus and execution.

Selecting the strategies, systems and processes that serve your vision best is a leadership function. Execution of the systems is a management function involving the entire team, including you, the dentist.

Strategies are designed to fit your destination. Strategies, systems and processes efficiently channel actions into results. The ongoing results create feedback for refining your focus, systems and processes. This promise of leadership is about keeping the team (and yourself) focused on execution and minimizing distractions.

Focus Versus Distractions

Practice owners are flooded with messages that distract them. The entire dental industry targets them with promotions for things, services, and behaviors. They are told many versions of what they should buy and should do in order to succeed. Other distractions come in the form of emotions and self-doubt that become barriers to living out their dreams. Those “should” messages, emotions and self-doubt serve as continuous distractions from everything that is important.

Leaders sometimes break the third universal promise of leadership by:

• Not providing or managing their critical resources.
• Allowing distractions that diminish their focus or lead to inaction.
• Ineffective or inadequate processes.
• Becoming addicted to the process rather than results.

Here are two examples:

• One of those distracting messages leads you to buy the latest and greatest technology. It uses up your capital resources, and you then hesitate to purchase the fundamental instruments, equipment and materials that your organization needs to perform at its best. If you were to live this all over again, you would have made a different decision. If you are clear that your strategies and budget are designed to get you to your destination, you can discipline yourself to refrain from such impulse purchases in the future.
• You read an article or talk to a colleague who is trying the latest hottest strategy for practice building. It is in conflict with everything that you have said that you believe in and hope for. You wonder if you are doing the right thing. Your doubt leads to team confusion and disillusion. This is getting you nowhere. Now you find you have to go back and clarify your vision, mission and values to reset your strategies, systems and processes as aligned steppingstones to your destination. With determination and hope, you can and will refocus and get back on track!

Keep Hope Alive

Breaking promises is exhausting and energy stealing. It builds resentment and degrades hope.

Our organizational brand and our effectiveness as a leader are about the promises that we make and keeping them. I firmly believe the first and last task of a leader is to keep hope alive…the hope that we are finding our way to a better place. That place is the destination we call our vision!

Until next week and Part 5

Life is a lot like a game, it’s a series of physical, emotional, and financial interactions with our environment and others. Sometimes we “win,” and sometimes we “lose.” And sometimes all we can do is just learn, so that the next time a similar situation comes around, the outcome will be more favorable for us. In this context, we can also view life as a series of negotiations… negotiations with ourselves, negotiations with others, and negotiations with our environment.

On this, psychologist Jordan Peterson, Ph.D. states: “You can’t negotiate from a position of weakness. You need to understand that if you want to advance your career and yourself you must negotiate with others. And this is because, even if you are competent at what you do, but you remain silent, you will be ignored. So, in the grand scheme of things, what you can do will not even be considered. You will just be a part of the background which is keeping everything functioning for everyone else.”

To develop ourselves, and to become successful, we must, therefore, be both competent AND strategic. We must be able to say to ourselves and to others (directly and indirectly), “This is who I am. This is what I believe. This is what I can do to make your life better, easier, or more fulfilling.” But that kind of posture, that kind of clarity, and that kind of purposefulness, is only useful within the context of a helping relationship, where the meaning of “better,” “easier,” and “more fulfilling,” can be discussed and negotiated.

In the posture of a helping relationship, we are in a position to make a better offer than doing nothing. Truly helping relationships with our patients require personal power, and personal power is both principle-centered and reciprocal, as the power actually comes from the other person and their belief in us.

In situations where we have no personal power, because we have not or cannot establish a truly helping relationship, we rely on other means to advance our agenda, such as leveraging convenience, emotions, pride, deception, loyalty to a third party, fear, and so forth.When we do this, our principles are lost, as is the greatest potential for the other person to believe in us.

Remember, you have the personal power to continually reassess relationships with patients and choose whether or not proceeding with a relationship in its current form is helpful. Helping the other person have personal power… creating experiences that earn trust… choosing to manage relationships with our patients first… then, offering true help and discussing why it is better… this is the path that positively influences everything else downstream.