By Michael (Mike) Rogers, DDS

Close to my office there is a small strip center that includes a realty group and a small church. At one end, there is no sign to show what it is, but it has a drive-through window. Every day there is a significant line of cars going up to that window. Cars line up waiting their turn, and the line is so long the cars snake through the parking lot, out into the street, with hazard lights flashing. 

I have a friend who loves to create stories about what is going on in strangers’ lives. Why is someone driving so fast? What meal are they going to create with food in a shopping cart? Why are two people arguing?  

Fantasized from some level of observation, my friend has captured what this drive-through is all about. He believes that because the drive-through is adjacent to a church, you can pull up to the window and are given a donut along with a prayer. It’s a small ministry for people to have a better day. That’s not a bad narrative but no real basis for the story. I say that as the line of cars grows longer, the prayers gain power. I get a warm feeling of their impact on others. 

I find we make up stories in my office as well. We make them up about why someone didn’t show up for an appointment, why someone didn’t move forward in care that has been advised, or why someone won’t pay a balance. Our tales are based on some level of observation, but they are tales none the less. 

I try to remember to look at these moments in three ways. 

• What do I know? 
• What do I think I know? 
• What do I want to know? 

We practice this in our office. I encourage my team to not live in “what I think I know.” This state of mind too often leads to creating stories that reflect a judgement. If I hear a team member begin to create a narrative based on a circumstance with the phrase “I think…,” I try to politely make them aware of what they are doing. They most certainly recognize when I do it and politely let me know. I just grin to hide my disappointment in myself. Maybe someday, I’ll say, “thank you.” 

In relationship-based practices, we have such marvelous opportunities to help people be healthier. Asking questions about what we’d like to know and sometimes creating self-discovery for the patient as well. We often get repeated moments to connect and learn with each other. The need to make up stories is dissolved when we get to hear their story. Sometimes that story is fun, other times hard. We get to walk along that story with them. What a gift to live a life in that connection! 

Recently, a member of the realty group on one end of the strip center came in to see me. I couldn’t resist asking what the line of cars is about. It turns out it is an Ignition Interlock site for people that have had a recent DUI. You go up to the window for your installation time of the small handheld breathalyzer to prevent your car from starting after drinking alcohol. 

I haven’t shared that with my friend. I like his story better. 

Gary M. DeWood, DDS, MS 

Many dentists believe that provisional restorations don’t really matter. After all, they are not really a stand-in for the final restoration. I would respectfully disagree. I am a proponent of creating functional, durable, and highly esthetic provisional restorations, every time. They have the potential to impact your dental practice a lot more than you might think. Whether you print them, form them, or free-hand them, a GREAT temporary is a great billboard for your practice. 

1. Make the provisional as Esthetic as the final restoration.

I contend that the more your provisionals look like what you are hoping for when you seat the final restorations, the more people will talk about them, AND you. 

I was able to build a referral restorative practice by creating provisionals that made patients want to come to my practice and specialists want to send people. For much of our career, almost the entire team of the oral surgery office we worked with, and many of the team members from the other specialty practices we worked with, were our patients in Pemberville, Ohio. 

Front teeth or back teeth, when you make them look like teeth, people will like it and they will show and tell other people. “This is just the temporary?!” was not an uncommon question or exclamation from our patients.  

2. A GREAT guide makes a GREAT provisional restoration.

Your wax-up** cast/model serves as your vision, as your preparation guide fabrication device, and as your provisional former. When the preparation is appropriately reduced for the material selected, the temporary can mimic the restoration. 

** The wax-up might be created with wax then duplicated with impression material and stone to create a cast, or it might be scanned to be duplicated with resin and printed or milled to create a model. 

3. 3. Use that provisional to highlight the talents of your team members.

You might LOVE to make those provisionals, but if your assistant is equally excited when it comes to recreating nature for the patient to appreciate, then it could be an opportunity for patients to see that your assistant does much more than set-up, clean up, and hand you an instrument. My dental partner, Cheryl, (who is also my wife) and I actively sought out things that could help our patients experience our team as much more than our helpers. 

As we all know, dental assistants are an integral and vital part of what the practice is and are a powerful force in how and why patients ask for dentistry. Assistants who fabricate provisionals have an opportunity to be seen differently, and we were always looking for ways to create partnership with them in our treatment. 

4. 4. Take pictures of them.

Photographs of the temporary will make it easier for the lab to design the outcome. They will be able to see what you are thinking, able to visualize what you want, AND maybe even more importantly, see what you do not want. With anterior provisionals, I have frequently noted to my ceramist, “Please put the incisal edge in exactly this position vertically and horizontally in the face, then use your artistry to create the tooth that belongs in the face you see in the photographs of the patient before, prepared, and temporized.” 

There were many times when the technician was able to see and create effects that I might have not recognized as being “just the thing that would make these teeth extraordinary.” And don’t forget to show the patient the photograph. 

5. 5. Love the material you make the temporary with.

The better the provisional material is at holding tooth position and functional contact, the less adjustment we’re going to have, so using a high-quality material is important. There are a lot of them out there. I like bis-acryl materials that polymerize with a hard surface, have little or no oxygen inhibited layer, and can be polished easily. The polish is more about feeling smooth than about the shine. Ask you patients how their provisional tooth “feels” when you are done, so they sing your praises. 

6. 6. Use high-quality core material.

When you use a good core material the prep will be smoother, making it easier to fabricate nice provisionals. Ideal prep form goes a long way toward better provisionals. 

7. ASK your patient to tell people.

As noted above, when you can elicit an emotional response about the awesomeness of your provisional, ask the patient to tell other people, “….and this is just the TEMPORARY!” 

Clayton Davis, DMD 

Hint: It wasn’t because I was cold. 

A First Impression I Will Not Forget 

One of the activities my family enjoyed on our vacation to Ireland 25 years ago was visiting the famous McGee tweed factory in Donegal. They had a loom set up so visitors could pick out threads, weave with the shuttlecock, and make a pattern. My children were at an age when that was very entertaining. 

On our last day in Ireland, we walked the main street of Sligo and stopped in the Mullaney Brothers haberdashery. While my wife looked for a few things, I waited with no intention of buying. An elderly gentleman walked up behind me, and with a charming Irish brogue asked, “I say, sir, are those your children over there?” I said, “Yes.” And he said, “Oh, they’re fine looking  children. They are a credit to you, well behaved.”  

As the conversation proceeded, he introduced himself as Mr. Johnny Mullaney. He inquired about where I lived and what we had done while in Ireland. He mentioned how he enjoyed watching the Olympics in my hometown of Atlanta. He knew a lot about Markree Castle, our accommodation for the week, and Rosses Point, a golf course I played at. He enthusiastically shared his opinion of its famous 18th hole. He was immensely proud of the golf course. Then he mentioned the pride they had in their tweed jackets made from tweed from the McGee tweed factory.  

He pointed to the jackets and asked which of the tweeds I liked best. I pointed to one and he said I appeared to be size 41L (exactly right), and before I knew it, he had slipped the jacket over my shoulders. As he brushed his hands over my shoulders and down the sleeves and tugged at the cuffs and bottom of the jacket, it felt tailor-made for me. I told him I liked the way it fit, but our luggage would be tightly packed for our trip home. I expressed my concern the jacket would end up badly wrinkled. He said, “Oh, it’s tweed, sir. We can fold it very nicely and have it ready for you to pack and it will unfold without wrinkles when you get home.” 

I liked the look of the jacket, yes, and I appreciated the quality of McGee tweed. But ultimately, what I appreciated most, what made me want the jacket, was Johnny Mullaney, himself; the consummate haberdasher, a master at his craft, who won me over by becoming my friend in a mere five minutes.  

I thought, “I don’t have a memento of this trip. This jacket will always remind me of our wonderful trip, our day at McGee factory, and this endearing Irish businessman.” I said, “Mr. Mullaney, I will take the jacket.” 

What I Learned from that Lasting Impression 

There are four elements from meeting Johnny Mullaney that I apply to meeting every new patient in a preclinical interview: 

1. Make a friend. (How can you trust each other if you don’t become friends?) 

1. Make an invitation. (Accepting an offer to be examined makes co-discovery exams flow.) 

1. Make it easy. (Find out their concerns, and address them.) 

1. Connect the feeling to the choice. (People do business with people they like.) 

You see, we always make choices based on our feelings. The preclinical conversation allows the new patient to feel good about my desire to genuinely help them and understand their feelings and needs. This is how we can move forward toward optimal care.  

A Series of Invitations Lead to the Treatment “Yes” 

When dentists ask me how they can do more cosmetic and restorative cases, they are usually surprised when I tell them it begins with doing pre-clinical conversations at the first visit.  

• You can’t do comprehensive cosmetic and restorative treatment until you’ve presented a treatment plan.  

• You can’t produce a treatment plan until you’ve done a good diagnosis.  
• You can’t produce a diagnosis until you’ve done a thorough exam. 
• And that thorough exam is incomplete when it doesn’t start as a good preclinical conversation with the new patient. 

The preclinical conversation sets the tone for trust and healthy open communication. It is the essential first step in creating a lasting good impression that leads to the first “yes” in a series of invitations on the way to treatment.  

Gary M. DeWood, DDS, MS 

As an associate dentist, you may be fortunate to learn from the instruction and observation of a senior dentist, but over your career, you will gain innumerable benefits from outside consultants, coaches, and mentors. 

One of my mentors, Dr. Richard A. Green, told me that one of the keys to my success would be to surround myself with a Board of Directors. He was correct. My board is composed of people who are willing and able to see my vision and hold me accountable for going to it. Some are consultants, some are coaches, and some are mentors. Sometimes they are all three in one person but no one person has all the answers. 

Consultants, coaches, and mentors help us in different ways. 

In dental practice, I often hear the words mentor, coach, and consultant used interchangeably to describe the activities of someone assisting the doctor with the management of his or her practice. I believe that these functions, while not mutually exclusive of the same individual, are different in their roles with regard to all three of you. 

What do I mean by that? “You #1” is the entrepreneur and leader of the business you have established. “You #2” is the manager of that business. “You #3” is the dentist working in the business. Each you possesses a different level of training, understanding, and ability. Each you benefits differently from consulting, coaching, and mentoring. 

Early in practice my partner and I hired consultants to see what escaped us and to give us solutions.  

Consulting is all about being an outsider looking in. The adage that consultants are individuals who are paid a lot of money to tell you what you already knew but couldn’t see, does not diminish their effectiveness or necessity, particularly in offering solutions.  

I met Jim Pride while I was still in dental school. In the early years of our relationship, following the acquisition of our practice, Laura, our Pride consultant, consulted us by telling us what to do. I was directed to employ systems that were developed by Jim Pride and his team while working with many Pride Institute clients. I did as we were “consulted” because I had no reference for individualizing the systems, something that changed as we found the parts and pieces that delivered and left behind parts that did not resonate for us.  

As my partner (who happened to be my wife) and I changed, our expectations changed, and our needs changed, we continued to need that outsider looking in to see for us that which we could not see. We did not, however, need or want to be offered solutions. The best consultants understand that their ultimate goal is to empower and develop their clients’ skills and abilities so that they can eventually operate independently. 

When we no longer needed a consultant, we needed a coach. 

Unlike consulting, where solutions with precise instructions are offered, coaching offered us a process out of which our vision for our practice developed. Dental practice coaches ask questions rather than give answers. They are observers. They take us inside ourselves and assist in our development as leaders. They draw out what is already within and empower us to act on it. 

What, then, is a mentor? 

For me, mentors are individuals who have traveled the path we seek to follow. They may fill the role as a consultant and/or a coach depending on our needs and their comfort with the things that are challenging us at any given time, but frequently their primary role is that of an example. The Pankey Institute community abounds in them. 

I have observed that dentists who develop a relationship with a mentor are able to move more quickly and clearly toward their preferred future. It is precisely for this reason that one of the goals of participation in a study club is to build groups with a broad range of experience and experiences. It is the third YOU, the practicing dentist, who gets the most from being mentored.  

Dentistry is a tough job. It’s demanding and stressful to perform highly technical, intricate procedures continuously on a daily basis. Our mentors show us that we can do it because they did. Often there is peer-to-peer collaboration in “surfacing up” the mindset, approaches, and solutions that will work best for us. Always there is encouragement. 

Sometimes mentors listen. Sometimes they challenge. Always they support. Their map is not always the map we choose to follow, but their example–as individuals who continue to see their vision and map their future accordingly–inspires us to do the same. 

Paul H. Henny, DDS 

Trust is commonly thought of as a firm belief in the reliability, truthfulness, and capability of another. But trust is about vulnerability . 

The more a person trusts, the more they are willing to allow themselves to be potentially hurt. They make a risks-benefit analysis, and when they feel they are ready, they decide to throw the dice.  

Conversely, when a person isn’t willing to trust, they have strategically chosen to minimize their vulnerability.  

Think about the times when you were personally unwilling to let someone into your life—when you were feeling too vulnerable. 

It’s easy for us to project our values without sensitivity to others’ often hidden concerns. When a patient says no to x-rays, to allowing us to proceed with a proper restoration, or other appropriate procedures, they don’t trust us enough right now. And when that occurs, it’s easy for us to instinctively respond by projecting our values onto the situation.  

A better strategy is to empathetically explore why a person responded to the situation the way they did—try to understand the situation from their perspective, and then focus on finding common ground in shared goals and values. Hopefully, with the right questions and empathy, we can build a bridge of trust and help our patients cross over to a place of more information on which to make the appropriate decisions for themselves. 

“No” often means “not yet,” as in “You haven’t convinced me yet that I should allow myself to be that vulnerable around you.” 

Co-Discovery requires a leap of faith on our part—a belief that most people will eventually do the right things for themselves. If we are unable to trust our patients on that level, then we’re going to struggle emotionally, demonstrate frustration, and to some extent inadvertently manipulate patients into doing what we want them to, a behavior that drives emotionally sensitive patients away. 

We need to trust our patients will make the leap as well. We need to willingly take the time and energy to continue in and trust the Co-Discovery process during which the patient starts to believe that we are the best resource to help resolve their problems and achieve their goals. When we allow our patients the time to make decisions based on what they think is in their best interest, they usually make healthy choices and appreciate the services we provide. This is how we succeed in helping them (and us) have a healthier, happier life. 

For an in-depth look at Co-Discovery and multiple essays on patient-centered dentistry, you are invited to read my recently published book: CoDiscovery: Exploring the Legacy of Robert F. Barkley, DDS, available at The Pankey Institute and on Amazon. 

Gary M. DeWood, DDS, MS 

Challenging what you think you know will pique your curiosity and lead to pursuing more information and interactions from which you learn. Challenging what you think you know leads to learning with the benefits of brain development, longer life, emotional wellbeing, and inspiration to share yourself in new ways with others. Simply said, challenging what you know prompts intentional learning to BE more expansive, to grow. 

My hope is that after reading this blog series, you will take time to reflect on the following statements from three of the many people who have influenced me over the years. 

Quotes from Daniel J. Boorstin, historian and Pulitzer Prize winning author of The Americans: 

Education is learning what you didn’t even know you didn’t know. 

The single largest obstacle to discovery is NOT ignorance; it is the illusion of knowledge. 

Quote from Herbert E. Blumenthal, DDS: 

Don’t believe everything you think. 

Quotes from William J. Davis, DDS, co-author with L. D. Pankey of A Philosophy of the Practice of Dentistry: 

Learning best takes place when we “live” a philosophy, meaning living in a state of inquiry based on our values, knowledge, and goals. 

When the late Dr. L.D. Pankey decided to devote his life to saving teeth, he was forced to ask himself, “How can I help people keep all of their teeth all of their lives?” In 1925 L.D. didn’t know the answer or even if there was an answer. When he decided to never extract another good tooth, he was taking an enormous professional and economic risk. He was able to uncover and develop many principles that have proven instrumental in our understanding of restorative dentistry and patient communication.  

Philosophy, in its most valuable form, is more concerned with the right questions than the right answers. 

Now that I am back actively within the Pankey community of learning and inspiration, I have four wishes for you: 

• May you come face-to-face daily with something that you don’t even know you don’t know.  
• May you not be blinded by what you think you do know when it shows up and fail to see it because you believe everything you think.  
• May you ask questions and intentionally seek answers. 
• May intentional leisure learning be not just what you do but how you live. 

Gary M. DeWood, DDS, MS 

We might define leisure learning as “Anything that is taught in an organized formal or informal plan of education to assist an adult in learning something about his or her occupation, occupational opportunities, personal happiness, or social enhancement and into which that adult engages him or herself for the purpose of learning about it.”  

I’d like to rename it “Intentional Learning” for the purpose of our discussion. My best guess is that your intent in coming to The Pankey Institute is to learn something about dentistry that will help you do what you do better. The incentive for that goal, being better, is why you come. You are choosing to use leisure time to learn dental stuff with intention. 

Any information you perceive as other than about being “better at clinical dentistry” you might be less interested in retaining and consequently likely to forget quickly. You will not really learn the stuff for which you have limited curiosity. Interestingly, that stuff that is not about the “dentistry” is the most important part of what The Pankey Institute sends you home with. At least I and countless others have found this to be true. 

Intentional learning is essential if you want to live a longer life. 

In the absence of Intentional Learning, defined as “actively seeking out new information that you WANT to integrate into your experience and understanding of the world,” certain parts of your brain will shrink. Your capacity for learning and your critical thinking/problem-solving skills will diminish. A reduction in neurons and neurotransmitters will affect your memory, your concentration, your mood, and your physical movement. Blood flow to parts of the brain can even be reduced–use it or lose it is a common thread in nature.  

So, Intentional Learning is GOOD for your brain and necessary if you wish to thrive. Synapses continue to form and re-form if you are acquiring new information, experiences, and knowledge with intent. Intentional Learning reduces stress levels. Stress reduction not only helps us perform better in our professional life, but our personal lives as well. 

Intentional learning opens social possibilities. 

Homo Sapiens are social creatures, we crave interaction, in fact we require it. Intentional learning encourages us to take risks, adjust, and adapt as we go. It sparks social engagement which leads to happiness in so many aspects of our lives. It enhances motivation, creativity, and innovation. It provides an opportunity to open our minds, challenge ourselves, and appreciate new opportunities. 

Intentional Learning fuels even more learning
as it stimulates curiosity, renews our purpose,
and moves us toward problem solving actions.
It has the potential to keep us young. 

My mother’s desire for Intentional Leisure Learning, never left her; she was and is a voracious reader, and to this day at the age of 90, she loves nothing more than sharing something she has read recently and is busy integrating into her view of the world and how it works. Her beliefs are open to what she experiences in her life, to what she learns.  

The day will come, sooner than I wish, when “dental” learning will not be as applicable to my daily life as it is today. I will still want to be part of a dental study club, still challenge what I think I know, and offer whatever wisdom I’ve been able to store to the conversation.  

Once found, intentional lifelong learning is something one does not easily lose the desire for. 

I will never forget Dr. Parker Mahan’s words, “I know I too can never live long enough.” Some might hear those words as limiting. I hear them as liberating. The well of knowledge will never be dry. It is and will remain an infinite source of things that I can still learn. 

I am so grateful to be back home at The Pankey Institute after spending my intentional learning (and teaching) time for the past fifteen years in a place that has made a choice to focus on “dental” learning. The behavioral aspects of dentistry and developing understanding of oneself and others have always had equal focus at Pankey. And since that “other stuff” is not something that can ever be checked off as “learned” no matter how many years I have left to be here, my intentional learning can and will always be young and new. It’s why The Pankey Institute is not a place you DO, it’s a place you learn to BE. 

The Institute is a place where learning never stops because, when you learn to BE, you have learned to act. Being is an ongoing and continuous process. It’s something that is lived. It is community. It is home. It is still The One Place.  

Gary M. DeWood, DDS, MS 

Adults have a wealth of experience to draw on and they like to do so as part of their learning. Adults are not used to taking direction in education; they choose what they want to learn. When my friend (in Part 1 of this series) lost his active interest in seeking out dental education, he had made a choice to learn other things he hoped to know.  

One of my heroes, Doctor Parker Mahan, told me once that one of the harshest lessons of mortality for him was the realization that he could never live long enough to learn everything he wanted to know. 

Adults need to create specific opportunities to self-reflect and internalize what they are learning in order to integrate it with what they already know. Adults have preconceived notions about education, learning style, and subject matter that interfere with their learning. Adults are often afraid to fail so they frequently guard their learning process by telling themselves why what they are hearing is wrong. 

Where children are sponges when it comes to learning, as adults our brains adapt to experiences and interactions that occur “on purpose.” We acknowledge a reason to remember that experience…to have that new knowledge. 

Here’s an example. 

Our eldest child, Patricia, entered a world in which those charged with her immediate care had barely learned to care for themselves–a world to which she adapted very quickly. In no time she had taken control of the lives of two sentient beings who proudly professed their independence and right to make decisions about their own lives but nonetheless jumped through the hoops of her creation as soon as they were offered. 

After the grandmothers had departed and Cheryl and I were now totally responsible for this baby FOR REAL, her training of us began in earnest. Turns out Cheryl and I CAN be taught, proven by our immediate response to Patricia’s guidance in managing her universe. A visit by Uncle Toby and Aunt Patsy presented us with an opportunity to learn from another source. 

Following a hearty meal, a very sleepy baby was laid in her crib for some sleep. Almost immediately upon our return to the living room Patricia realized she was no longer being held, and realized she was no longer where the “party” was happening. Being WITH the party is very high on Patricia’s list. When she “called out” in response to that situation, two very well-trained parents immediately stood to head for the emergency that was happening for the helpless baby. Uncle Toby looked at us as we simultaneously rose and said, “What are you thinking?” 

That might sound like a question, but it was really a statement that meant “stop.” So, when Uncle Toby asked his “question,” Cheryl and I stopped as we were instructed. Uncle Toby then asked, “What are you teaching that baby if you go in there and pick her up every time she cries?” 

As brand-new, first-time parents, this thought was alien to us. Being so well trained, we thought our only mission in life was to keep the baby from crying. With some angst in our stomachs that tightened each time Patricia’s wailing reached a new crescendo, we sat in the living room and pretended to ignore what we were hearing.  

Suffice it to say that when our second child Dale came along, he learned, and reasonably quickly, that we were not necessarily coming every time he rang the bell.  

Every day, we hear and see a lot of information that never makes the transition to “learning” because it does not produce change.
Change can only occur for adults when we enter into an agreement with ourselves that there is something we want to learn in what is being said or shown to us. We ACT on it. 

The truth is EVERY interaction we have with any other person or situation is a potential learning experience if we reflect upon it and internalize its meaning for us and act on it. It’s impossible not to learn. We do it all the time. Lifelong learning is thus a forgone conclusion.  

One of the greatest joys in dental practice is creating learning moments for patients by providing intentional opportunities for them to experience their oral health and interact with us in a way that provokes their curiosity, internal reflection, and acknowledgement of needs. Just as we are lifelong learners, we can trust that they are lifelong learners, too. 

Gary M. DeWood, DDS, MS 

Learning begins from our first moment of awareness as our eyes open and we have a response to something external to us that is brand new. That experience and all the ones that follow until the moment awareness leaves us to shape our reactions to and our actions in the world. 

Experiential Learning 

The brain is a dynamic and ever-changing organ, constantly adapting to new experiences and knowledge. 

When our youngest daughter Katie was a child, I was cooking dinner one night–my turn–and Katie was sitting at the island where the stove was. I turned around to get something from the cupboard and heard a loud inhale followed by a whimper. Upon turning quickly, I saw her move her hand rapidly behind her back. No more sounds came forth, but I saw a tear and I asked her what was wrong. She said in a wavering voice, “Nothing,” and then looking at the stove burners, “Mom told me those were HOT and never to touch them.”  

I gently took her hand from behind her and saw the blisters rapidly forming on her fingers. She started crying and said to me, “Please don’t tell mom.” I’m certain she never felt the need to verify the information her mother had given her again. THAT is learning. 

All of us have experiences like that every day. Some are memorable and become part of us, embedded in a manner as yet not fully understood inside our brains for almost instant access. Some “learning” seems to fade quickly or never even get recorded. I “touched” a lot of biochemistry information over the years without burning much of anything into my brain. Maybe I should have been touching the stove at the same time. Learning is not simply having an experience of something and then being able to view the recording later.  

The Definition of Learning 

In nearly all of the definitions I have located in my research I see that CHANGE and PROCESS are prominent parts of learning. For example: 

• A change in disposition or capability that persists over time and is not simply ascribable to processes of natural growth. 
• Relatively permanent change in a person’s knowledge or behavior due to experience. 
• A transformative process of taking in information that, when internalized and mixed with what we’ve experienced previously, changes what we know and what we do. 

Choice & Focus 

My personal experiences have shown me that a big part of lifelong learning is what you believe about it and how you embrace it. It’s driven by some measure of choice and focus. 

Cheryl and I have sought out new ideas in dentistry wherever they took us. One of my friends in dental school, a wonderful man whom Cheryl and I still hold close, took a different path. Sometime around the 10th anniversary of our graduation we were visiting, and he told us that he had been able to get all the continuing education he needed without traveling.  

I discovered that his feelings around need and learning as it pertained to dentistry meant satisfying the requirements to stay current with licensure. He is NOT a bad dentist, but like many of the dentists I have come to know in the last 48 years, a hunger for dental learning changed once school was finished.  

A Drive for Learning 

I am reminded of one of the most original and influential thinkers on the creativity process, Robert Fritz, who believed you can create your life in the same way an artist develops a work of art. He said, “If you limit yourself only to what seems possible or reasonable, you disconnect yourself from what you truly want and all that is left is a compromise.” 

As a philosopher and scientist-physician, Dr. L. D. Pankey intentionally observed processes and their results (change) with the goal of becoming better at helping others. The embodiment of compassion, he was highly curious and actively sought ways to alleviate the sufferings and misfortunes of patients and colleagues. He traveled long distances to learn from others’ experiences. He inspired others to know themselves, their patients, and their work on a continuous road of mastery. As a lifelong “leisure” learner, he was interested in a wide range of subjects outside of dentistry as well. Through reflection, he often discovered he could apply this outside learning to his work. 

The Pre-Clinical Interview – Part 1 

Laura Harkin, DMD, MAGD 

I am a third-generation, restorative dentist in New Holland, Pennsylvania, which may be best known for its blue, New Holland tractors. I own my grandfather’s and father’s dental practice where I am the sole provider for approximately 1,000 patients. My dental team consists of two hygienists, two assistants, and two front office administrators. 

I graduated from dental school in 2008 after short careers both in the actuarial sciences and as a stay-at-home mom. In 2010, I purchased my practice and signed up for my first course at The Pankey Institute. Note, my father also studied at the Institute when it first opened its doors in the early 70’s. One of my greatest challenges, early in my career, was learning how to diagnose oral conditions, develop and present treatment plans, and execute that treatment via phases. I found it quite overwhelming to simultaneously manage multiple, complex cases. Now, I love sharing my experience and the approach I’ve found works best for me. 

Above all, I’ve learned that in the midst of daily pressures in dentistry, we need to maintain our own health and strength to properly treat our patients and lead our teams. Surrounding ourselves with knowledgeable, positive, and compassionate colleagues helps! 

Knowing ourselves is as important as knowing our patient. 

Dr. L. D. Pankey’s Cross of Dentistry supports the belief that knowing oneself is of equal importance to knowing a patient whom we choose to treat. This challenge forever evolves because no person remains unchanged with time. I frequently evaluate my strengths and weaknesses as a provider, team leader, and mentor. At the same time, I ask myself what aspects of patient care and business management I excel at and most love to do. I can then choose my specialist team accordingly and empower my office team to best support me. 

Together we ultimately provide a better product and higher level of care. 

To prepare specifically for the treatment planning process, my team helps me gather key information and clinical records from a patient for a comprehensive evaluation. After a thorough analysis, I carefully craft written documentation which will help educate my patient, my team, and the specialist team I’ve chosen. An added benefit is its ability to serve as legal documentation.  

I always ask a team member to join me during treatment plan presentations. They bring another set of ears and eyes so that we may better understand a patient’s motivating factors as well as the challenges they may face in receiving treatment. We encourage open and honest conversations and understand that treatment plans evolve to fit the needs of individuals. 

How do we get to know our patients? 

In addition to gathering a thorough health history and dental history, we are seeking to learn more about our patient’s chief complaint, perception of their current state of oral health, desires for treatment, and barriers to care. 

We listen intently for clues to identify a patient’s communication style. I’ve always heard that we have two ears and one mouth for a reason. I practiced with my father for two years and once, after observing me, he said, “Laura, you do far too much talking. You need to really listen to what your patients are sharing.”  

I’ve had to develop the skill of active listening. To stay in the question and become comfortable with silence takes practice. Some observations that I try to make in order to effectively communicate and build a relationship with a patient are as follows: 

• Do they seem to enjoy conversing or are they responding with short answers in order to get through the interview quickly? 
• Do they readily ask questions and express thoughts, or are they quiet and need to be invited and prompted to share? 
• Are they amiable? 
• Are they distrustful or fearful due to past dental experiences? 

We need to intentionally verbalize our empathy when we’re in conversation with a patient to help them recognize that they’re being both heard and understood. 

It is beneficial to understand a patient’s background. For example, what have they done in life? What do they love to do? Who is important in their life? Sharing in these conversations will help build a rapport, lead to improved doctor/patient communication, and can help to begin a trusting relationship. 

Does the patient have limitations such as the ability to drive to appointments, afford dentistry, or find time for treatment? Do they need to discuss their oral health condition and treatment options with a trusted family member before making a decision? 

Understanding these answers helps us to not only provide respectful and resourceful solutions but also limit inaccurate assumptions. This knowledge is especially helpful in my third-generation practice, where I have many elderly patients who are dealing with health issues, multiple medical appointments, and scheduled drivers. Their desire is to simply make a careful decision for an oral rehabilitation which fits their objectives and abilities. 

Do we hear the desire for treatment? When speaking with an existing patient, I can often recognize signs of interest to move forward with previously recommended treatment. At that point in time, I often ask, “Why now?” The answer helps me clarify their chief concern(s) so that we can move forward fittingly. 

In Part 2 of this series, we will explore additional techniques to clarify our patient’s desire for oral health and long-term, oral stability.