Some time ago, I was listening to a person speak about love and replacing the word “love” with “forgiveness.” His argument was that if you truly expressed forgiveness, then you are a loving person. As I thought about it, I decided “acceptance” was a better word for me. I felt that if I could accept a person for who they are, then it would be easier for me to forgive, and thus love. This started me thinking about the present and past relationships in my life and how I could apply acceptance.

After intentional self-work in this area, I have found that life is more understandable and pleasant when I practice the art of acceptance.

Consider Relationships

We all have had concerns about relationships. We all wonder why others act a certain way towards us. We benefit emotionally, physiologically, and strategically by understanding where they are coming from and how their past experiences have molded them. Stephen Covey would use the phrase “seek to understand, before trying to be understood.” In other words, accept the person for where they are, before you feel you should be influencing them to be what you perceive is correct. In a bad situation, understanding the other person would be a big step towards forgiveness.

Consider Situations

Acceptance of situations has emotional, physiological and strategic benefits as well. It comes down to understanding what is happening instead of trying to control everything. I find this so true in my practice life when my patients have some sort of moderate to severe dental issue. Until they accept what is wrong and “take ownership” of the situation, there is very little that I can do to help them. Often, the worst thing you could do is to try to fix a bad situation without the patient having ownership of the problem, because if things go astray, it becomes your fault.

For Both Ourselves and Our Patients

The art of waiting for when the patient is ready to accept treatment—and the art of understanding, accepting, and positively influencing the patient during the waiting—have both become easier for me over time. Sometimes we need to have difficult conversations with patients to help them accept the truth. But oftentimes we simply need to better understand what they are thinking and why. And, the gentle way to get at this is to inquire why they are reluctant to move forward without a tone of judgment—instead, with genuine care.

One of the great discoveries of working with the public and patients so closely is that most of what we apply to them we can also apply to ourselves. Therefore, we can benefit from accepting who we are, our personal situation, and how those around us are trying to help us. These can be important keys to moving forward in our own lives. Remember, we all travel the same journey.

When it comes to diabetes, let your patients know about the impact oral inflammation can have on their health. Explain what you can do to help them and what they can do to help themselves. Clarify what they can do to take control so that they can live happier, longer lives.

Give your patients optimal assistance.

Include questions in your health interview about whether the patient has been diagnosed with diabetes, has been counseled about being at risk (prediabetic), and/or has a family history of diabetes. If your patient affirmatively answers to any of these questions, inquire about what they know about the link between gum inflammation and systemic diseases, such as diabetes.

Gently, explain why you are concerned.

Even if it is slight, gum inflammation is harmful when chronic. Let them know that among other health problems, persistent inflammation exacerbates diabetes and development of diabetes. It would help to tell them a story about an anonymous dental patient whose blood sugar decreased over a matter of six months and improved again within a year due to the elimination of gum inflammation.

Invite your patients to begin a new oral health regimen.

Let them know that you will partner with them to track their compliance, evaluation, and improvement. Inspire them with a story about another anonymous patient whose oral health and diabetes was improved by starting a healthier regimen.  They too can experience the healing power of making healthy choices and developing healthy habits throughout their life.

Your patients will start to report to their physicians, family, and friends about the conversations you have had with them. They will all be able to see the efforts you are making to control inflammation in their mouths, and the evidence of improved health. You might begin to see referrals from these patients and their doctors start to follow.

When I was a young dental student, the voice of “right from wrong” came from my instructors. Their voices annoyed me, and I didn’t think that the dental school approach could ever work in the real world. When I got out of residency I began to learn “real world” dentistry from employers and insurance companies. They became my voice of right from wrong. I concluded that cutting corners was the way most dentists practiced—no face bows, no articulators, models or comprehensive examinations.

I found that I had a knack for selling dentistry. I was blessed with patients who allowed me to perform some rather complex dentistry…without articulators, face bows or comprehensive examinations. I became a master at making excuses for my dentistry:

• “You’ll get used to your bite…”
• “The temporaries really can’t approximate what the final will look like….”
• “Your jaw pain is stress. You need to relax…”

I was lucky! Most of my dentistry worked, but it was never predictable. Dentistry became stressful and honestly downright scary sometimes. So, I studied at the Pankey Institute. I heard voices of honorable people. What was right and good and decent for my patients…and me…and my family! I thought that I can’t do this type of Dentistry; it’s like dental school! No one practices like this.

Then, a Voice Appeared

One day I was fabricating a provisional and left an open margin. “So what?” I thought. I became aware, however, of a very faint voice that said, “Do the right thing; close the margin.” Hmm, close the margin. “Why should I?” I thought. “The new crown will be here in two weeks. What’s the big deal?” Again, I heard a whisper, “Close the margin.”

Annoyed, I explained to the patient that I wanted to work more on the temporary in order to make it fit better. The voice stopped whispering. The patient said, “Thank you for caring and being so thorough.”

The voice, once a sheepish whisper, began to speak in clear tones:

• “Carve the restoration the best that you can.”
• “Let specialist perform the procedures that they do best.”
• “Restore that patient only when you really know that person both clinically and behaviorally.”
• “Treating a patient is not about you; it’s about them, always.”

I was really starting to feel that I was going insane until one morning a poem came to me. I titled it “The Voice.”

THE VOICE

Who was this voice that I couldn’t see? It pushed and prodded and bothered me.

The voice was strong and judgement free, and I began to like its philosophy.

As time went on its words rang true, and I began to see the good I could do.

The voice which spoke of doing things right, began to be my guiding light.

I began to live with genuine care, with genuine love, a genuine air.

Who is this voice that I can’t see, that stirs my soul and bothers me?

This voice lives in me deep and strong.

It guides my path. It sings my songs.

It is so much a part of me

Who is this stranger I can’t see?

One day the voice said loud and clear:

“I’m always with you. I’m always near.”

I asked the voice to give its name,

to show its face, to stop playing games.

The voice just laughed. It said with glee.

It’s always been you, yourself, you see!

To the many participants who come to The Pankey Institute to study, I hope that you all let your best inner voice become your guiding light throughout your journey. That voice, that wonderful voice will never let you down!

I’d like to tell you about my neighbor up here on Bent Mountain. His name is Mike Stockton. He personally designed the house we live in. He drew every line of it and then supervised, as well as participated in its construction. Mike had no formal training in architecture or construction. He just loved it and then studied it long enough to master it. His history is that of an artist.

We are all born with certain gifts and talents.

The key is to discover them, develop them, find ways to connect them with others in a fashion that they will be valued, and then to share them. Of course, applies to dentistry as well. We will only be willing to invest the time, energy, and attention necessary to master something if it brings us joy and satisfaction. That’s the pay-off—the ability to step back and say to ourselves, “That was pretty good, but next time I think I’ll try this instead and see if I can make it even better!”

But that’s not enough to be successful. To be a masterful and successful dentist, you also must be able to connect and inspire others to become better versions of themselves. And that, of course, includes team members and patients alike.

What else do you need?

You need to be able to promote yourself. You must be willing and able to share what you know and can do with others in a way that they feel it will be helpful. And there’s a word for that. It’s called “marketing.” Marketing is not a dirty word if it’s done from your heart and you deliver on your promises. No, let me correct that. You over-deliver on your promises.

When you go into that private coffee shop and they take a moment to create a heart in the froth of your latte, that’s marketing too. That’s caring enough about what you do to take the extra steps that demonstrate you sincerely care about what you are doing and how other’s feel about it.

So, now we have five key things:

1. Gifts and Talents

2. Mastery

3. Inspiration

4. Communicating What You Can Do to Help Others

5. Extra Steps that Show You Care

How others perceive how well you do these five things, will determine your financial future, because people will give you their money in exchange for your gifts, talents, skills, and caring when they perceive that you do the above five things exceptionally well and they benefit significantly as a result.

Passionately practice these things, and you will have a bright future ahead!

It’s early in the morning and the first sip of coffee full of that fresh aroma just went down with a sigh, a sagging of the shoulders and a feeling of here we go for another day. My mind is starting to run the list of what is on the day’s agenda…work deadlines and meetings…the kids’ schedules…what is my spouse doing today? Did I pay that electric bill or not? Then it hits. Oh, that’s right! I have a dental appointment today!

The morning life puzzle pieces all start to come together as they always do.

Everyone and everything are in their place. And off I go to the dentist with that fearful thought, “I hope they don’t hurt me today.” Parking in a rush and taking a breath before entering the dental office door, I worry, “Am I just in time?” A gentle face looks up, smiles and greets me by name. With that kind hello, I begin to relax and mentally whisper to myself, “I’m safe here. They know me. They want to take care of me. They’re happy to see me. I’ll be okay.”

The reality is this kind of personalized attention and care is slowly going away.

In medicine and dentistry, consolidation of practices into corporate entities has forced doctors to “run” on a patient-number schedule and production list. Statistics and numbers are slowly pulling their want and desire to give personalized care away from them. And I, the Patient, don’t want to be treated this way.

I’m glad my dentist takes time to know me and my concerns, spends time diagnosing and planning treatment that is individualized and best for me, and doesn’t let insurance companies limit my choices and the quality and quantity of care I receive. What’s important to me is I trust this type of dental care, I think I deserve this type of care—and the comfort I feel during my dental visits is priceless.

While communicating, we can learn to become more mindful of the emotions which are rising up in our body and the sensations we are feeling on an intuitive level. We can begin to notice what has happened that has triggered our initial response, as well as feeling the sensations it has created in our body.

This requires us to remain in a state of curiosity and observation rather than in assessment and judgment. And when we treat these thoughts and sensations with equanimity, we are less likely to react inappropriately during stressful situations.

When I mention staying curious, I mean to approach the experience with the curiosity of a child.

When we remain curious, we are inspecting our experience like a child who has seen a flower for the very first time. This helps take the power away from the strong emotions we might be feeling in that moment. To paraphrase Mary Osborne from this past weekend at The Pankey Institute Annual Meeting, “You are standing on the balcony, and not on the floor.”

This whole mindfulness practice is extremely important as it gives us a chance to hit the pause button.

And when we pause, we’re able to respond rather than simply react. Reactions are often what our limbic brain wants us to thoughtlessly do. And if we have developed an insensitive pattern of reacting over the years, it can lead to regret and suffering. Hence, by developing an ability to pause our limbic brain’s instant impulses, we become more capable of responding in a much wiser fashion.

Mindfulness is at the epicenter of a truly relationship-driven practice.

And it’s a skill which can be developed and enhanced over our lifetime. Hence, it’s at the epicenter of “knowing ourselves” as well.

Janet Hagerman’s book, Selling Dentistry – Ethically, Elegantly, Effectively, presents a provocative and compelling analysis of how sales opportunities are missed by the entire dental team. Filled with practical solutions for how to feel good about your treatment recommendations and build your practice at the same time, Janet’s book focuses not only on how to be effective in your sales communications but also how to be elegant in your approach.

Selling Dentistry – Ethically, Elegantly, Effectively was born from a need, a cry for help from dental teams says the author and dental practice coach Janet Hagerman. Dental teams kept asking her how to stop dentistry from walking out of their doors and how to reverse the trend, so more patients would say yes to dental treatment.

In her book, Hagerman uses real-life examples and stories that come from her years of experience helping dental teams succeed.

According to Hagerman, dentists want to know how to sell dentistry. Their teams want to know how to sell dentistry. They want to move beyond an aversion to the “S” word to embracing the “E’s” of selling. Selling does not need to be controversial, says Hagerman, it’s about better serving patients and building trustful relationships, so patients accept the care they really need.

It comes down to surpassing external marketing and focusing on internal conversations with patients.

Viktor Frankl believed the key to the successful creation of a happy and successful life was to aim toward a deeply significant and meaningful life purpose. On this, he commonly referenced Friedrich Nietzsche’s quote, “He who has a Why to live for can tolerate with almost any How.” Suffering is no fun, but suffering for a deeply significant purpose becomes much more tolerable when you know that the end will justify the means.

Loving Others

On love, Frankl said, “Love is the only way to grasp another human being in the innermost core of their personality. No one can become fully aware of every essence of another person unless they truly love them, because by love we are enabled to see the essential traits and features in the other person; and even more importantly, see that which is potential in them—that which is not yet actualized, but ought to be actualized.” So, this begs yet another challenging question: Do we love our patients enough to suffer with them, as well as help them to become more of what they are capable of becoming through our collaborative work in dentistry?

Finding Courage in the Face of Adversity

The practice of true relationship-based / health-centered dentistry represents a counter-cultural decision with regard to mainstream thinking and behavior, as corporate dentistry is rapidly moving the profession in the exact opposite direction. Consequently, dedicating oneself to a truly patient-centered philosophy requires courage, commitment, and perseverance. Additionally, one is likely to experience tepid local support for it, as most peers will be following a very different philosophy – a philosophy focused on what they want or need to get out of dentistry, and not what life expects of them. Regardless, the striving for a cause greater than oneself, allows us to experience more meaning in a month than most corporate dentists find over their entire career.

Regarding Success

Regarding the achievement of material success, Frankl wrote, “Don’t aim for it, because the more you aim at it and make it a target, the more you are going to miss it. For success, like happiness, cannot be pursued; it must ensue, and it only does so as the unintended side-effect of one’s dedication to a cause greater than oneself, or as a by-product of one’s surrender to a person other than oneself.”

Personal Meaning

As you can see, meaning and personal relevance can’t be bought, copied, or transferred. Rather, it’s an inside-out process which must be discovered within ourselves and then refined over time. If this is the kind of challenging, growth-oriented journey which motivates and inspires you, then The Pankey Institute represents the very best place to both begin it, as well as nurture it all along the way.

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.