By David R. Rice, DDS 

I’m guessing your practice is a whole lot like mine. People can be challenging. Patients are people. Ergo, yes, patients often bring us challenges. With that and 29 years into dentistry, there are a few challenges I’m willing to admit and, like you, work to overcome.  

Our great patients get great dentistry.
Our challenging patients get our best effort.
Our job is to understand who each is, what each wants,
and how we do our best to deliver it. 

As you and I learn the best techniques and technology, we have to understand that many of our patients see the world differently. They see it differently than each other, and they see it differently than we do. At first glance, yes, this is an obstacle. But for those of us willing to spend time focusing on their views, this is a massive opportunity.  

About 20 years ago, the treatment planning and presentation mantra our team developed was: Pizza by the slice or the whole pie? 

 A talented and curious team with character, plus a well-defined process,
always equals complete care and profitable production. 

 Here are the four keys: 

1. Understanding who of our patients wants complete care—the whole pie right now. 

1. Knowing who of our patients isn’t ready for the whole pie today and needs us to serve that complete care one prioritized slice at a time. 

1. Recognizing that some patients love pepperoni, some love veggies, some are all NY and thin crust, some love that Chicago deep dish, and so on. 

1. Delivering each individual patient’s pizza the way they want it without yielding on our quality. 

All our patients come with a story. Some are ready for a whole pie. They want complete care and they want it now. Other patients are overwhelmed by the whole pie. Right or wrong, some past experience makes their yes to the complete care we know they need challenging. We can push them, or we can appreciate where they are and work with them one slice at a time. 

I’m not proposing we compromise our care. I’m offering us all an opportunity to elevate it. Whether you’re scanning and milling, 3D printing, injection molding, direct bonding, or prepping and temping long-term, the materials and technology we have at our fingertips today afford us an incredible ability to segment care. 

Complete-care case acceptance at 90%+ is a reality when we add great communication skills to the clinical skills we’ve worked so diligently to achieve. Today, I challenge you to assess, calibrate, and elevate your ability to deliver pizza by the slice…or the whole pie. 

By Pina Johnson, Professional Certified Coach, and Edwin (Mac) McDonald, DDS 

B.F. Skinner, a noted 20th century behavioral psychologist, conducted an intriguing and provocative experiment using laboratory mice. Using behavioral conditioning he was able to condition one group of mice to believe that through their actions they were able to determine their fate. Using the same methodology, he also succeeded in conditioning another group of mice to believe that there was nothing they could do to alter their fate. 

He then placed the first group of mice, the ones that believed their actions mattered, into a large tub filled with water. As anticipated, this group of mice, when placed in a life-threatening situation, acted instinctively and began to swim to the side of the large water-filled tub. Upon reaching the edge of the tub the mice were able to crawl out to safety. 

The second group of mice, the ones that believed that their actions were meaningless, when placed in the tub of water, simply sank to the bottom and drowned. Appropriately, the lack of responsiveness displayed by the second group of mice was termed “learned helplessness.” 

Culture Lifts or Sinks Ambition 

Belief that our actions and choices matter is essential to “making things happen.” 

According to Edgar Schein, an icon of modern leadership thought, the primary function of leadership is to create an organizational culture. The culture that we choose to create will influence every aspect of our organization and ultimately determine our dental practice’s success or failure. 

Value-based leaders understand the power to alter the course of the organization does not reside with a few; it is shared by many. Organizations with cultures based on shared beliefs and purpose are higher performing. Leaders of the highest performing organizations foster cultures rich in collaborative decision making and a profound belief that everyone has influence. 

Counter Learned Helplessness by Empowering Self-Confidence 

We have come to recognize that good-old “self-confidence” is a learned competency, and effective leaders create organizational cultures that promote and teach self-confidence to each individual team member. This is accomplished by empowering teams through collaborative decision making and ensuring each team member has been given the knowledge, skill, support, resources, and appropriate authority to accomplish each task required to meet the shared goal. 

Unleash Teamwork and Creativity 

In organizations with shared leadership cultures, human self-confidence is unleashed beyond saving oneself to act in the best interest of the organization. Knowing that our individual actions will have some effect on our organization’s future (and thus on our own future and the future of others we value) compels us to want to take actions that have positive benefit for everyone. This is “meaningful” for the individuals within the organization. This raises their engagement in the work and simultaneously generates a sense of wellbeing.  

In our dental practices, “We are serving others with empathy and care to ultimately improve their wellbeing.” This is a form of love. It begets appreciation and reciprocity. When the slings and arrows of daily life initiate negative thoughts of being out of control of a situation, remembering our purpose and prior successes enables us to see disappointments and frustrations as opportunities to create a new type of approach and carry on. 

The goal for effective leaders is to allow all of this to happen in a psychologically safe environment in which our staff need not fear repercussions for their well-intended actions even if the outcome of these actions is less than ideal. By creating organizational cultures that are psychologically safe, we draw out our organizational creativity which is often stifled by the psychological repression found in command-and-control cultures. 

Creative thinking is considered to be one our highest-level cognitive functions and has been found to be a distinguishing characteristic of exceptional organizations. The wise leader understands that their organization is best served through shared power, collaboration, and utilization of their organization’s collective creativity. 

By Laura S. Harkin, DMD  

My dad and I were enjoying our favorite lunch spot years ago when he turned to me and said, “Laura, isn’t it amazing? There’s an incredible sense of trust that our patients have in us. Sometimes, we give our best recommendation for treatment, and it is declined as if it weren’t important or a priority. I’ve recognized that, more often than not, our patients eventually choose to move forward, proving that it was more a matter of timing and circumstance than lack of value.” 

Trust is the cornerstone of our practice. It was transferred from patients to Grandpa to Dad and to me. I do believe that every morsel is earned through guidance, thoughtfulness, and skill. Trust is an entity that requires constant nurturing. In private practice, one should recognize that a doctor’s trust in their patient is equally as important as a patient’s trust in their provider. With synergy there’s the opportunity for optimal health. Even as a child, I had a very clear understanding of the care my dad had for his patients. This feeling is innate and deeply imbedded in me. I imagine that he felt the same.  

I don’t consider myself “a writer,” but I’ve always enjoyed the art of letter writing. I grew up writing frequently to my grandparents and friends and always loved picking out stationary that reflected my personality. Recently, I reread the letters that my grandfather typed on his old typewriter and my oldest brother scribbled on his Grateful Dead CD inserts – crafted just for me. It seems fitting then that I enjoy writing personalized letters to my patients. In fact, I’m pretty sure I salvaged my mental health during COVID by writing “updates” to my patients during months of closure. I digress. 

The letters that I write to my patients are most often in reference to comprehensive treatment. They provide a bird’s eye glimpse of our most recent findings, diagnoses, and treatment recommendations. My older patients, especially, appreciate my thoroughness, organization, and systematic approach to recommended treatment. These letters certainly aren’t handwritten, but the hard copy renders a sense of care that’s transferred from my hands to theirs. We must remember that individuals comprehend and retain information differently. The one-on-one, verbal, treatment consultation can become lost in the shuffle of everyday. Add dental language and complicated procedures to the mix, and that’s simply a recipe for confusion.  

Whenever I present complex treatment to a patient, I write a letter in everyday language to support our conversation. It’s stored in their digital chart as part of their dental record. In my first paragraph, I state my patient’s chief complaint. A summary of clinical findings followed by bullet point. Next, I provide my best treatment recommendation, an appointment sequence, and the financial investment. Photographs are also a helpful insert to aid in explanation for family members who were unable to attend the consultation. I think there’s value in a tangible letter taken home to revisit.  

Treatment letters are also an irreplaceable resource for my team. When a patient calls to schedule treatment previously presented, my stored letter immediately becomes a reference for scheduling appointments, including time allotments and space in-between subsequent visits. In my office, we offer a courtesy for treatment paid in full. This amount is figured in the financial investment portion of my letter so that conversations regarding immediate payment or a payment plan can easily flow. Should a case not be accepted prior to a routine recare visit, this letter serves as an excellent reminder during team huddle. It’s inefficient to page through multiple chart notes and software-driven plans with no explanation of the diagnoses which caused a need for restoration in the first place.  

In my first few years of practice, it was hard for me to accept that I needed to view this document as fluid with a potential need for multiple modifications to suit my patient’s desires and limitations. For example, financial concerns often lead to the need for phased treatment or a compromise from the ideal. I’m committed to openly discussing what may occur if no treatment is rendered or if a compromised approach is chosen. Likewise, I believe in the importance of presenting the financial component of extensive treatment myself. As the dentist and business owner, I must “own” the fee that I’ve carefully determined to reflect indirect and direct time, the skill level and support to be provided by my team, the technical excellence of my laboratory technicians, and my own knowledge. The fee that I present is steadfast, barring an unanticipated need such as root canal therapy. Should there be a need for additional chair-time or visits, it’s included in the quoted fee.  

Finally, my letters include my expectations for post-treatment maintenance. For example, if we are to complete a hybrid case in conjunction with a surgeon, I’m careful to share the importance of periodontal health and frequent maintenance visits to prevent peri-implantitis. In patients who have pre-existing medical conditions that when uncontrolled can be contradictory, I stress the importance of regular monitoring. Ultimately, I strive to empower my patients to choose and achieve oral health, Undoubtedly, oral health positively impacts overall health. My personal letters are a distinguishing trait of my practice that convey the level of care to be carried from presentation through treatment and in maintenance. Consider the value in this extra step! 

By Pina Johnson Professional Certified Coach 

 What motivates teams is a question that has been asked for as long as someone has been seeking solutions for organizational performance. The day of top-down (or command-and-control) leadership is gone.  

Daniel Pink, in his 2009 book Drive: The Surprising Truth About What Motivates Us, takes a deep dive into the decades long effort to understand the research around human motivation in the modern workplace. Consistently, employers believe they are doing a great job of recognizing, rewarding, and motivating their employees. The people that work for them report the opposite. The tension between the two groups is observable and measurable. In this book, Pink discusses the key patterns that are consistent in what motivates people., takes a deep dive into the decades long effort to understand the research around human motivation in the modern workplace. To his credit, he uncovers the key patterns that are consistent in what motivates people. 

What doesn’t work—external rewards and punishments 

Although there are times and places to administer rewards (carrots) and consequences for behaviors that violate the organization’s values (sticks), “carrot and stick” strategies do not work and have not been working for quite some time. In fact, according to a great deal of research, these strategies reduce performance over time after a brief initial improvement when they are introduced.  

What does work—internal motivations 

Research has clearly demonstrated that there are three primary internal motivations that drive team member engagement: 

1. Autonomy 

1. Mastery 

1. Purpose 

Autonomy over your work appears to be the strongest driving force among those three. There are many aspects to autonomy that you can explore in Daniel Pink’s book. My takeaways are that people want: 

• Control over how they do their work 
• Ability to creatively enhance the methodology of their work 
• A strong voice in the direction and future of their work 

This begs the questions:  

• Have you met individually with each team member and talked about this?  
• Are you giving them the freedom to do their jobs well?  
• Are you developing them with training opportunities and direct challenges?  

Responsibility without authority creates frustration. Responsibility demands autonomy. 

Mastery is defined as the desire to get better and better at something that matters. You can feel the natural connection to Autonomy as the desire to improve is based in each person’s unique gifts, talents, skills, and desire to use these for something important.  

Control seeks compliance. Autonomy seeks engagement. When a person becomes fully engaged in an activity, and is challenged enough to be stimulated, they can lose themself in that activity be it work or play. That optimal state of peak performance is described as flow. Mastery happens in and through those experiences of flow. Mastery is a mindset that requires a great deal of grit and becomes the infinite game that we never complete. 

Purpose answers the question for each person: “What are you supposed to do with your one short life?” When the organization has a clear purpose, the individual understands their role in that purpose. When they connect the organization’s purpose to their own life’s purpose, then you have a powerful force at work. Is the purpose of your organization clear? Have you asked the key people in your organization what their purpose is? Have you helped them to connect those two purposes?  

Our responsibility 

As practice owners and leaders, we are people developers. Everyone possesses a unique set of gifts, talents, hopes, dreams, and ultimately a life purpose. Unlocking that unique set of internal motivators for everyone on your team is the key to building an abundant future. That future is defined by a transformational mindset rather than a transactional mindset in which power is limited by time, redundancy, compliance, and efficiency.  

Each person motivates themself. Our role as a leader is to help our team members, one at a time, to discover, connect with, and unleash their powerful internal motivators. Then together, as a team, we can channel all of that discretionary energy into a shared mental model with a laser-like focus on the organization’s clearly defined and stated purpose.  

Pina Johnson PCC is a Certified Professional Coach with the International Coach Federation, and as a former practice administrator, she has over 20 years of experience in the dental field. Her coaching strategy and emphasis lie in developing leadership skills and practice cultures that produce peak-performing teams along with increased productivity and profitability. In her private practice, Pina specializes in group coaching. Partnering with Drs. Joel Small and Edwin (Mac) McDonald at Line of Sight Coaching, she coaches many dental teams with great success, resulting in increased employee engagement, reduced stress, improved performance, and enhanced communication. Pina received her professional coaching certification from the University of California, Davis. Upon completing her training, she was invited back to serve in multiple capacities as a UC Davis coaching program faculty member. Pina has been a featured speaker covering topics including, The Neuroscience of Trust, Management Behaviors that Foster Employee Engagement, and How to Talk So Your Staff Will Listen, and Listen So Your Staff Will Talk. 

Pina is a Member of the American Association of Dental Office Managers, Dental Speaking Consulting Network, Dental Entrepreneur Women, International Coach Federation, and the ICF Sacramento Chapter. 

Paul Henny DDS

I wrote about this topic last October in The Never-Ending Interview and wanted to revisit it to connect the timeless teachings with my most recent thoughts. Bear with me as I recount some of the history from that previous article. 

Dr. F. Harold Wirth had a very successful restorative practice in downtown New Orleans but he always felt that something was missing until he met Dr. L.D. Pankey and was influenced by his teachings. Dr. Wirth became a missionary for Dr. Pankey’s philosophy of dentistry and life, and he gave Dr. Pankey most of the credit for developing a deeper understanding of people, both physically and emotionally.  

One of Dr. Wirth’s key messages from the podium was that dentists are always presenting the case, even from the beginning of their first encounter with the patient. Another key message was that the patient’s feelings matter in accepting care and the patient interview should be forever ongoing. 

He said, “Every time the patient comes in, you’re doing a presentation. As a matter of fact, I think the interview is forever ongoing. It might only be one word, but every time the patient comes into your office, you should be interviewing them.” 

He said, “Ask questions that have to do with how the person feels. A case history is exploring what happened. An interview is about how they feel! You need to understand the difference!” 

We might ask, “Since I last saw you, have you noticed any changes in your oral health? How do you feel about these changes?” We might ask, “How do you feel about the appearance of your teeth?” or “How do you feel about the restorations we did?” We might ask, “At your last visit, you talked about the possibility of doing ortho; how do you feel about that now?” We might ask, “You mentioned last visit that you weren’t looking forward to Thanksgiving because it was difficult to eat all your favorite foods. Would you feel good about revisiting the possibility of replacing your denture with something more stable?”  

Do you feel better after a long conversation with someone who knows you well on the emotional level? I know I do. Over time, those kinds of conversations cause us to feel more positive and hopeful. They occur when a person gifts us their full attention while making no attempt to judge. And because we experience no judgment, we share more feelings, which leads us into an even deeper level of self-understanding. 

Doctor-patient conversations that tap into how a patient is feeling on an emotional level enable patients to grow in trust and to become more open to the possibilities we offer.  

In her recent blog series, Mary Osborne has encouraged us to journey toward health with our patients as fellow travelers because we all have health issues we hope to resolve. We can make connections over shared feelings and hopes. These connections bond us so we can pursue a mutual, positive goal with our patient.  

What I love and sticks with me from Mary’s blog is that the medical health review during each preclinical interview is an ideal time to check-in about feelings regarding health in general. So, if you and your team are not doing that now, you might want to add a question about the patient’s feelings about their current health. It’s ideal if the doctor or hygienist  asks the question. It may be as simple as “How do you feel about your overall health?” Wait for the patient to think and speak.  

One of my favorite quotes is this: 

Any kind of gesture that pulls another living soul out of despair is indistinguishable from magic. – Michael Xavier, Author 

The medical history review is a prime opportunity to demonstrate we care. Expanding our preclinical interview to routinely ask one or more questions that surface feelings related to health will give us opportunities to touch hearts on a deeper level. This will engender greater trust so patients more readily accept us as partners in their health.  

By Mary Osborne, RDH  

The late Dr. Bob Barkley said your dental degree gives you the right to practice dentistry, but you have to earn the right to influence your patients. How do we earn the right to influence? How do we get that invitation we need to be invited into influence? 

There is a powerful tool you already have in your practice that can enhance your relationships from the initial visit through continuing care: a Health History. The Medical History forms most offices use are designed to efficiently gather information from patients about existing and previous conditions and diseases. Patients quickly check boxes. But it can do so much more. If you use health histories as opportunities to begin a dialogue with your patients you can also connect with them in the context of a mutually interesting topic — their health! 

I might begin a conversation with a new patient by saying “In this practice we believe that the health of your teeth is related to your overall health. I know you filled out this health history form and we can talk about the specifics of that, but I wonder if we could begin by taking a few minutes for you to tell me a little bit about your health in general.” Beginning with a conversation in that way it takes us out of focus on disease and opens the door to talking about health; what they know about their health, how they feel about it, and what they do to maintain health. Similarly, when a patient comes in for a hygiene visit instead of asking if there are any changes in their medical history, I might ask, “How has your health been since I saw you last?”  If we listen carefully to their stories about health, we will gather important clinical data, and we will also begin to understand their values. We will begin to co-discover what is important to them. 

The concept of co-discovery is frequently seen as having to do with helping the patient see current clinical conditions that we see. In that way, it’s a very useful tool. But I’d like you to begin to also think about co-discovery as a way of being in relationship with your patients. When you take a few minutes to have a dialogue about health you learn about your patients, as they learn about themselves. It is an opportunity for you to learn about their experiences, concerns, and perceived barriers to health—and it’s also an opportunity for patients to learn about themselves. 

In her book, “Kitchen Table Wisdom,” Dr. Rachel Naomi Remen says, “When you listen generously to people they can hear truth in themselves, often for the first time.” If you’ve had a conversation like this you know the magic that occurs as a patient realizes things about themselves they’ve never thought of before. As they speak out loud they hear themselves for the first time. I have found that if I show up as an understanding fellow traveler with a desire to learn, it opens the door for them to begin to see me as a trusted advisor. 

Paul A. Henny, DDS 

Oftentimes, perspective is everything. Our thoughts influence our emotions, and then our emotions influence our behavior. How we view our situation as challenging but surmountable, impossible and insurmountable, or somewhere in-between, influences the outcome itself. 

When challenged with a difficult situation, for example, chronic intra-staff turmoil, how we view the problem makes all the difference in the world. A conclusion of “That’s just the way people are and I can’t change it,” yields a very different outcome than “I’ve got to do something about this right now, because it is holding my practice back.” 

In 1960, Bennet Cerf made a $50 bet with Theo Geisel. Bennet, the founder of Random House Publishing, bet Geisel, already a well-known author, that he couldn’t author a successful book that only had fifty different words. 

Bennet lost the bet because Geisel saw the imposed limitation as a creative opportunity. The outcome was a book that would sell over 200 million copies. He titled it “Green Eggs and Ham.” 

It’s old news that dentistry is rapidly changing—and in some ways not for the better. But if we focus on the negatives, we automatically shut down the creative solution-oriented side of our brain. 

When we are locked into a glass-half-empty mindset, we think the glass will surely be even more empty soon. Einstein, Jobs, Edison, and Tesla avoided such thinking. That’s why they just kept on creating and overcoming seemingly impossible odds along the way.  

Thomas Edison said, “Opportunity is missed by most people because it is dressed in overalls and looks like work.”  

Putting on our overall and going to work is precisely how we should approach our challenges. We need to stop ruminating over what we think can’t be accomplished, because chances are quite good that they can be. Failing to do so will cause another day to be lost spinning our wheels instead of moving forward. 

Looking for inspiration and examples of creative opportunities in dentistry? My CoDiscovery book—available on Amazon and in the Pankey Institute’s online store, is full of them. 

By Bill Davis, DDS 

When Dr. L. D. Pankey was developing his Philosophy, he studied with many early American business authors and teachers. One such person was Napoleon Hill (1883 -1970). Hill was considered one of the earliest producers of the modern genre of personal success literature.  

Hill’s Early Life 

He was born in a one-room cabin near the town of Pound in the Appalachian area of Southwest Virginia. Unfortunately, his mother died when he was 9 years old. At the age of 13 he began his writing career as a “mountain reporter” for his father’s local newspaper. Later, he moved to Pittsburgh to work for a big city newspaper as a reporter. 

A Career-Making Assignment 

In 1908, the editor of the newspaper assigned Napoleon, who was the papers newest and youngest reporter, the job of interviewing the industrialist and philanthropist Andrew Carnegie. At the time Mr. Carnegie, known for his steel business, was among the most powerful men in the world. Napoleon was warned that Mr. Carnegie did not do interviews. Undaunted, Hill went to Andrew Carnegie’s office and told the receptionist he was a reporter and asked to speak to Mr. Carnegie. When he was turned down for the interview and told again that Mr. Carnegie did not like to do interviews, Napoleon didn’t give up. He came back daily and sat in the reception area. 

Persistence Paid Off 

During the second week of going in and out of his office, Andrew Carnegie asked, “Who is that young man waiting in the reception room.” Carnegie was told it was a newspaper reporter waiting to see him. That evening, at the end of the day, Mr. Carnegie went out to the reception room to see if the young newspaper reporter, who had been waiting quietly for over a week to see him, was still there. 

After they introduced themselves, Napoleon told Carnegie he had been sent by his editor to get a story. Napoleon told Mr. Carnegie he hoped to interview him and other wealthy people to discover a simple formula for success. Carnegie was so impressed that he took Napoleon to dinner to continue their conversation. 

This was the beginning of a great friendship, and over the next year they met regularly to develop the formula, as Carnegie also wanted to know the formula. Carnegie presented Napoleon with a letter of introduction to Henry Ford. Ford, after his series of interviews, introduced Hill to Alexander Graham Bell, Elmer R. Gates, Thomas Edison, John D. Rockefeller, and others. 

Hill’s Bestselling Book 

In 1937, Napoleon Hill published a bestselling book, THINK AND GROW RICH, which emphasized a positive attitude and having good communication skills. After reading the book, Dr. L. D. Pankey was very impressed by Hill’s statement: “Whatever the mind of man can conceive and believe, it can achieve.” Conceiving and believing are just the first steps to achieving your goals. According to Hill, you must take serious action. 

Every innovation, every invention, and every work of art begins with an idea. Long before the Wright brothers ever flew, Leonardo Da Vinci had sketched and designed an aircraft. Da Vinci conceived of mechanized flight, but the Wright brothers believed it was possible, they acted on that belief, and thus achieved flight.  

Hill’s Lasting Impact on Dentistry 

In 1929, L. D. Pankey had the idea that teeth could and should be saved, although at first, he didn’t know how. His belief was strong enough to motivate him to do some research, study what was known at that time, and do the necessary experimentation to make his idea a reality. One of the people he was most inspired by was Napoleon Hill. His model of ambition and teachings about how others achieved innovations spurred L. D. on. Belief in himself and his idea helped L. D. persist despite some uncertainty, blind alleys, and many other frustrations. 

The ambition and growing ability to save teeth was arguably the biggest change ever to occur in dentistry. From this concept, innumerable innovations have been born and are accelerating today. 

Where Would You Like to Go? 

There is an old Chinese saying, “If you do not know where you are going, you are likely to end up somewhere.”  

Too many people end up “somewhere” because they have not clearly defined where they want to go. The first step in moving toward greater satisfaction is to set specific goals. Vague goals such as, “I’d like to be a better dentist,” “I’d like to be happier,” or “I’d like to make more money,” are common.  

Napolean Hill would say that more specificity will take you somewhere purposeful. Perhaps, “I would like to learn about implant placement,” “I want to have more fun with my children,” or “I want to earn 15% more this a year.” Then, be evermore specific and set definite time frames so you can measure your progress. For example:  

• “I would like to begin training in implant placement this coming September and be placing implants successfully in June. Tomorrow, I will begin by investigating continuing education programs in the science of implants.” 
• “I would like to have more fun with my children. At dinner tonight, I will ask my children about ideas they think would be fun activities, and we will start by doing one of the activities each week.”  
• “I would like to increase my income by 15% this year. I will meet with my accountant and a dental practice coach this month to look at ways to increase my profitability. I will also do some more reading in practice management.” 

Believe in Your Goals and Your Ability to Achieve Them 

Once you have conceived your ideas, you must believe it is possible to achieve them. Without the power of belief, you will not take your ideas seriously; nor are you likely to weather the many setbacks and frustrations that will probably come along with you on your journey. 

By Mary Osborne, RDH 

There was a time when I thought “partnering in health” was just about getting people to take better care of their teeth. 

Many years ago, I had a patient who was excellent with her home care, but she showed up periodically with an acute periodontal infection. We asked about stress and her overall health, but she was not aware of any issues. We would treat the infection and she would be fine for a sometime. We knew she worked for National Public Radio, and one day we made the connection that her infections showed up concurrent with NPR’s fund-raising drives. That shared realization allowed us to help her see that her stress was affecting her dental health and her overall health. She was open to conversations about lifestyle changes that would help her be healthier. My relationship with her influenced my thinking and my ability to connect with my patients from a perspective of Whole-health Dentistry. I came to understand that I had been missing opportunities to influence the way people think and feel about health. I knew that I wanted my patients to see me as “a partner in health.” 

Unfortunately, most of our patients come to us with the perspective that we are fixers of teeth, not partners in health. 

In the culture today people are bombarded with information about what is healthy. From friends and families, social and news media, and a wide variety of health care practitioners, everybody expresses opinions on how they are supposed to take care of themselves. Why, then, are we surprised when our patients don’t know whom to trust? Why are we surprised when they shrug their shoulders or appear confused? It’s not always a case of conflicting facts but a case of various perspectives that people don’t know how to navigate. 

Think about where you place your trust. How do you decide whom to trust about decisions—whether it’s about your health, or about your finances, or about how you raise your children? When I ask myself that question, two criteria surface. They need to know their subject and to know me. I want that person to know what it is they’re talking about. I want them to be well informed. I also want someone who knows me, who understands my values. I want that person to have a sense of who I am and what is important to me. 

As we get to know our patients over the years, most of them come to see us as trusted advisors when it comes to their dental health—but fewer see us as trusted advisors when it comes to their general health. If we jump too quickly to making recommendations about their overall health, we are more likely to meet resistance. If we want to cross the bridge into influencing our patients’ overall health and wellbeing, I believe we need an invitation to cross that bridge.   

The Missing Piece in our quest to influence the overall health of our patients is the failure to invite patients to share their perspectives on health. Beginning a conversation with a new patient with the question, “What can you tell me about your health in general?” is an invitation for them to talk about their experience of their health, not just details. Instead of “reviewing” health histories, what if we “explore” health histories? As we connect and get to know each other we can learn to listen beyond information to hear attitudes, beliefs, fears, biases, concerns, barriers, etc. As you understand their perspectives on health issues that come up in conversation, it’s easy to ask if they would like your perspective on that issue. These conversations often lead to more questions and answers that invite more and more invitations from our patients to be their partner in health. 

Kelley Brummett, DMD 

Recently, I completed growth conferences with everyone on my team. The beauty of a growth conference is that it’s all about growth. It’s all about effort. It’s all about meeting each other and becoming more aligned with the mission of the practice. If I have something I want to share with a team member that’s a concern or something new I would like them to achieve such as mastery of a new skill, I think about how I’m going to communicate it. And as I do growth conferences with the individuals on my dental team, I am cognizant that they are likely to want to receive feedback differently as individuals.  

I’ve discovered that if I ask my employee upfront how they like to receive feedback, they pause to think before responding. I wait patiently for their response because I know the response will save both of us time and energy. For example, there are some team members who want the short and skinny of it—“Give it to me straight now.” They don’t want you to hold back. There are some team members who need to be gently warmed up before they can hear the message and require thorough explanations of why. 

I’ve discovered it helps to frequently ask the “how do you like feedback” question of my team to get their buy-in of my feedback. The beauty of “feedback” is that even criticism can be framed in a positive way as the next identified step in working towards a goal.  

Those of us in dentistry know that sometimes we move fast, but there are times that we need to sit back, think through what somebody gave us information about, and then come back and have a conversation. Mary Osborne has guided us to have conversations with patients that allow us to slow down and learn more about them so they can think, hear themselves speak, and learn about themselves. I’ve decided the feedback question is also a good question to ask patients. “How do you like to receive information? Would you like to know all the details or for me to summarize?” 

I’ve learned from Mary and experiences with patients that “staying in questions” helps them grow. Staying in questions also helps team members grow. Staying in questions helps us providers grow. So, feedback—how do you give it? How do you like to receive it? How do you handle it? I encourage you to think about this.