By Paul A. Henny, DDS 

The word “prescriptive” recently got stuck in my head. It made me think about the important distinction between a relationship that’s primarily focused around “giving directions or injunctions” versus mutually goal-oriented and collaborative. It’s all too easy in the middle of a busy day to reduce our patients’ complex problems down to prescriptive responses so we can move on to the next problem or obligation on our schedule.  

The reality of dentistry was brilliantly stated long ago by Bob Barkley, “Our goal is to design dentistry that will fail at the slowest possible rate.” This humble statement should always sit at the center of our practice philosophy: We aren’t gods; hence we aren’t perfect, and we can’t control the future. The best we can do is learn, practice, and do our best with the best of intentions. The rest will be up to the patient and fate.  

If our patients choose to not assertively take charge of their oral microbiome through appropriate oral hygiene and diet management, then all of our skills and good intentions will be undercut, and the failures sometimes blame-shifted onto us. That thought brings me around to the central reason behind why I’m writing today: We can’t be successful unless we are also good teachers and leaders. We have to want our patients to be successful on a very deep level. 

Last year my daughter Allison graduated at the top of her high school class, and it was easy to think “Wow! Look at what she did!” Yet it wasn’t just her efforts that made it happen, so the thought should be “Wow! Look at what WE did!” as the effort was communal and very philosophically-driven. It’s clear that Allison’s Principal and teachers LOVED her enough to invest a significant part of themselves in her development. You could feel it, see it, and hear it in their words. 

Are we similarly invested in our patients success? Are we doing a whole lot more than just being prescriptive? Are we investing a significant part of ourselves in our patients’ lives because we want to see them succeed? Can they feel it, see it, and hear it?  

By Paul A. Henny, DDS 

Effective leadership in dentistry requires open-mindedness and empathy, while at the same time, assertiveness, consistency, adaptableness, and resilience.  

That’s a tall order! 

Many of us struggle to be assertive and empathetic at the same time, particularly when we are under pressure. All too often, we lean into our positional power and superior knowledge and don’t stop to ask ourselves: 

• How does the patient feel about my message? 

• Does the patient understand the long-term implications of the information I have presented? 

It’s important to remind ourselves that decision-making is a two-step process: 

Step 1: The recognition of accurate, relevant, timely, and important new information 

Step 2: Reasoning to make choices that align with values and goals 

Few people fully understand the nature of their problems, needs, and the complex processes necessary to realize their goals when they first come into our dental offices. Patients often behave dogmatically or too emotionally, which leads them to choices that result in more failure and frustration. 

Our ability to facilitate learning in others and lead them to decisions with predictably better outcomes can be developed. This is good news! With understanding, practice, and reinforcement through successful experiences, we can all learn how to become more effective leaders and develop a more successful practice. 

The 6 Key Steps to Effectively Guiding Our Patients 

1. Slow down and manage your time more strategically to spend more time with each patient.
2. Demonstrate empathy. Stay in conversation and ask questions to understand what they know and how they feel about the information you are giving them. 
3. Create a safe and effective environment for learning. This entails slowing down your delivery of information into the bite sizes that are appropriate for the patient and pausing often for their minds to catch up and for them to experience self-discoveries.  
4. Show deference for the fact that each person is the best expert regarding themselves, their feelings, values, and goals. Let them know you will support them in their process and invite them to learn more and weigh their new knowledge against their values, priorities, and long-term goals.
5. Give each person enough time to make complex decisions as well as work through the logistics necessary to make their decisions fit into their life.
6. 6. Remain clear and assertive about what is in the patient’s best health interests and consistent with your values. Only proceed with treatment decisions that are mutually agreed upon as appropriate.

By Mary Osborne, RDH 

Developing a partnership begins with an attitude of curiosity. It stems from a belief in the possibility that by working together we can achieve more than either of us can accomplish alone. With an attitude of curiosity we can develop the skill of listening and asking questions before going too quickly to teaching and telling. 

How do we help our patients see the part they can play in improving their health?  

We can begin by inviting the patient to share with us what they know about their health. They come to us with attitudes, beliefs, biases, and concerns about their health, as well as specific knowledge of their history. The more we know about where they have been the better able we will be to help them plan their future. We will have information to share about what we find and recommendations for how to proceed, but if we listen first we honor their perspective. We can also begin to hear their aspirations for their health in general and their dental health in particular. 

When dentists discover plaque or bleeding in an initial exam, they can tell the patient that the hygienist will help them with home care. But if we ask the patient if they would like help with home care and they say yes, we now have an invitation to give them information. The difference is subtle, but important.  

You can also ask the patient if a solution they have thought of or a recommendation you have made is something they would like to try. A yes is a commitment on some level to share in the oral hygiene process with you. Inviting and asking means moving the locus of control from you to the patient. I recognize that that is not our default mechanism, so doing this takes intention.  

How can we help patients to see us as a trusted advisor and seek our guidance? 

One of the things that I have learned over the years is that, when I remember who is really in control of the patients’ health, I am better able to partner with them. This process may take a little longer initially, but I would like to suggest we have all the time we need. We have the lifetime of our relationships with our patients.  

Once you agree that you have the mutual goal of moving toward improved health, you can invite them to deeper levels of conversation and understanding around health. You can avoid assuming what is best for them and help the physician inside each patient go to work. As they share their thoughts, they often become clearer about what they hope for.  

When you are genuinely interested in your patient, you earn a level of trust that opens the patient to hear more about their existing conditions and your concerns for them. By making connections with them over what is possible to achieve and what they want to achieve, you create a bond that opens the patient to your expert perspectives. When you ask for and respect their input on solutions, they are more likely to commit to a solution. 

When a new patient needs urgent treatment, how can we meet those treatment needs and still commence a lifetime journey toward health with the patient? 

Of course, we want to help our patients with immediate treatment when disease conditions are acute, but we want to do so in a way that inspires the patient to see the bigger, more comprehensive health picture. We want to help them see health as a journey and see us as empathetic fellow travelers who understand their suffering. As we facilitate dialogue about the health outcomes of treatment, we uncover their broader health aspirations. 

We intentionally deliver the message that we are here for them. We are interested in them and care about them as a person, and we let them know they can count on us to help them become healthier and maintain achieved levels of health. We do not allow the fact that the patient needed immediate relief to get in the way of a long-term commitment to their overall health.  

How do we engage our patients in being curious about their total health? 

At every visit, we can invite them into conversation about their health. The questions you ask will shape the conversation. Instead of “Any changes in your health history?” you might begin with, “How has your health been since the last time we were together?” Pause and listen to learn about your patient’s experiences, opinions, and feelings.  

In my experience, this process respects the physician that lives within each patient and leads to continuous co-discovery and collaboration toward health. Every conversation can empower the patient a little bit more to become clearer about their knowledge, attitudes, beliefs, biases, and barriers. The insights developed over the lifetime of your relationship enable you to become a trusted advisor to your patients.  

By exposing your interest about a range of health issues (diabetes, heart disease, obstructive sleep apnea, weight loss, smoking cessation, stress reduction, etc.), they will see you as a professional with broad knowledge and a worthwhile perspective. They will see you as a valuable resource. They will see you as someone who knows about health and ¾ more important ¾ someone who knows them.  

By Mary Osborne, RDH 

One way to involve patients in making choices about their health is to ask for an invitation to give information. Everyone on the team can look for ways to get permission before taking action. For example, if the dentist observes bleeding or plaque while doing an initial exam, the dentists often say, “The hygienist will help you with that.” That’s okay but getting an invitation for the hygienist is even more helpful. Instead of telling the patient what the hygienist will do, the dentist could ask for an invitation. “Would you like the hygienist to help you with that when you see her?” Patients typically say yes, and that sets the hygienist up for a different conversation when she sees that patient.  

When the hygienist sees a note that the patient wants some help removing deposits in a certain area, she has been invited to give information. The hygienist can say, “So, I understand from the doctor that you’d like to have some help with being more effective at removing the deposits that are around this tooth on the lower right.” 

In this circumstance, I might ask the patient, “What have you tried in cleaning that area?” I pause and allow the patient to think and speak. Perhaps they would demonstrate how they brush or floss in that area. If I do make a recommendation to a patient, I like to follow it with, “Is that something you’d like to try?” 

The dentist and hygienist are a team, and the patient is the third team member in partnering for health. In ideal practice, all clinical and front office team members are part of the collaboration and share their understanding of the patient with each other. Many times, especially with elderly patients, I find there is a family member who is a health partner, and we can invite them to participate in consultations. In dentistry, when we become trusted health advisors to our patients, we can also influence their choices in other areas of their health.  

When we listen well, we can filter our information through the lens of improving overall health. We can make connections between their perspective and our own. When we understand the patient as an individual with special circumstances, opinions, and emotions, we can help them get in touch with their own aspirations for health and help them move toward those goals.  

By Bill Davis, DDS  

A Culinary Surprise 

After about 18 months of working on the Pankey book, Pam and I were headed to a Club Med Vacation on the Eleuthera Island in the Bahamas with our three sons. This Club Med (now closed) had a circus theme. The boys would be able learn how to dress up like clowns and train to be a performer on  flying trapezes. 

Pam suggested on the way to Club Med that we stop in Miami and take Dr. Pankey and Betty out to dinner. I had been wanting to do something for him to show my gratitude for his willingness to help me fulfill my dream of becoming a full professor by writing his life story and the Philosophy. 

Part of the information gathering process for the book was for me to visit Dr. Pankey one full day a month. On several occasions we talked about Miami as a vacation destination with it’s restaurants and resorts. He said, of all the places in the area, he and Betty liked the Ritz Carlton Hotel and Joe’s Stone Crab in Miami Beach the best. 

Before we left Toledo on our way to Club Med, I went to my bank and drew out $800 in cash so we could go anywhere L.D. and Betty wanted to go in the Miami area. The boys and Pam were all excited to go out to dinner with L.D. and Betty because they had heard so much about them. 

I rented a large rental car to accommodate all of us, and I drove to the Pankey home to pick them up. I told L.D. that Pam and I wanted to take them anywhere in Miami for dinner to thank him for collaborating with me on the book project. L.D. said, “Betty and I are not used to eating big dinners. We spend a lot of our time trying to eat only enough to keep us going because we both have a hard time keeping our healthy weight. Many times, we will even split a meal when we go out.” 

Betty was standing next to L.D., and she said, “We do have a place we love to go on a regular basis, and they even serve burgers for the boys. Maybe we can go there. They have the best, all-you-can-eat salad bar in Coral Gables.” 

I said, “Wow, that sounds great.” I asked, “What is it called?” 

Betty said, “Wendy’s,” so, we all loaded into the rental car and went to Wendy’s. The bill was under $800.00 dollars. 

By John C. Cranham, DDS  

Sometimes you can see clearly where you want to go with your dental practice. I can vividly remember driving my car to St. Petersburg for my first class taught by Pete Dawson. It was 1989. When the class was over, I drove my little car all the way back to my 800-square-foot office in Portsmouth, Virginia, and arrived at four o’clock in the morning. I had just bought the office from a doctor who did mostly silver fillings—maybe only four crowns in the entire year. I remember I could visualize what I wanted to do with “my” practice but deciding the first steps was overwhelming.  

A dental office can be the loneliest place in the world. I had to figure out the attainable steppingstones. We didn’t have the internet back then. Finding mentors and connecting with supportive, sharing colleagues was more difficult. In dentistry today, it’s easier to find those steppingstones. One of the most rewarding things I do today is helping dentists develop. 

I caution dentists to not assume they will achieve their big goals fast. There is a temptation to give up when progress is slow. You’ve got to stay on the path to get to where you want to go. Think about your goals and steppingstones every day but be kind to yourself if it takes more time than you visualized.  

Remember that everyone is different. All your buddies are going to be in different cities, different socioeconomic areas, and different practices. They’re going to have different opportunities. Social media can be your enemy when it comes to self-confidence and determination. There will be certain people that develop faster.  

I can remember being very frustrated the first year or two in my little town of Portsmouth. There were dentists going through the same classes I was and were already doing the kinds of cases that I wanted to do but wasn’t doing yet. During the first two years in practice, I sometimes wondered if I would ever do the kind of dentistry I wanted. But I kept in conversation with my patients, eventually they began accepting treatments, and the floodgates finally opened.  

One of the greatest things about this profession is we can always strive to be great. I don’t think I’m there yet. It’s the striving part—the working at it and seeing things improve that makes it so fun and rewarding. I love it.  

People ask me, why are you setting BHAGs at this stage in your life? You’ve already accomplished so much. Why are you totally reinventing your practice systems? Why are you going fully digital after practicing on analog articulators for 35 years? 

What I’ve been able to do in dentistry is constantly reinvent myself, and I feel like I am growing in what I can do. So, I say it’s because reinvention is awesome. It’s fun. And my staff knows that if I get something working well, I’m going to find a way to make it even better tomorrow. 

By Paul A. Henny, DDS 

How are you doing in your quest for a “positive” life? 

Martin Seligman PhD spent most of his career at the University of Pennsylvania advancing the concept known today as “Positive Psychology.” He states that Positive Psychology is “the scientific study of what makes life most worth living.” Along the way, Martin identified five core elements highly associated with psychological well-being and happiness. He believes understanding these five elements helps us to create more fulfillment, happiness, and meaning in our life. 

In Part 2 of this two-part series, we’ll pick up where I left off with the third core element in Seligman’s model. 

R – Relationships 

Relationships and social connections are essential for the creation of meaningful lives. Human beings have been social animals since the earliest of times, hence we are hard-wired to bond and depend on each other. That worked particularly well when we functioned in small social units or “tribes.” The tribal unit allowed us to easily ascertain who was friend or foe. It also allowed us to know who to pay attention to, ignore, and with whom we should invest our time and energy. 

In our modern-day world, the historical notion of tribes has largely been broken and replaced by sub-sects of people who are clustered together around common interests, agendas, and values, brought together in new and different ways. Social media now connects people from around the world in ways we never could have imagined 20 years ago. So, this has created a situation where we don’t know our neighbors, but we do know intimate details about our friends in Australia, Tampa, and Kansas City. 

Since we are less tribal in the historical sense, we have lost our ability to easily trust those who are around us, as we can no longer assume they share our values and priorities. That is WHY the relationship-based practice model is so valuable today.  

The relationship-based practice model is a vehicle of connection that can be used to co-discover our similarities as well as areas of disagreement. Alignment of values, goals, perspectives, and efforts are key to successfully advancing health. Strong interpersonal relationships are the key to the door which opens up all of those possibilities. 

M – Meaning 

Some people work to live, while others live to work, with the latter meaning that a person has been successful at merging their life purpose with their daily work. And when work becomes meaningful on a deeply personal level, it evolves into becoming much more than just a “job.” 

With the ever-expanding discovery of connections between oral health and whole health, dentistry now stands at the forefront of a huge new opportunity – the opportunity to help others to grow, develop, and maintain whole health over their entire life  

A – Accomplishments 

Living a values-driven, purposeful life, integrated with how we practice, aligns ourselves with the achievement of deeply meaningful accomplishments on a daily basis. Helping others in deeply meaningful ways, and then being rewarded with appreciation and appropriate compensation, establishes a self-sustaining cycle, and a successful model for living.  

That’s why you will commonly see relationship-based dentists practicing into their 70’s. Their sense of purpose as they continue to accomplish meaningful work is what motivates them to return to the office and continue striving to help patients, coach younger dentists, and create an-ever-happier positive environment. 

An Easy Acronym to Remember: PERMA 

A great to start your day might be to remember what each letter of PERMA stands for: 

• Positive Emotion 

• Engagement 

• Relationships 

• Meaning 

• Accomplishments 

How will these five elements of Seligman’s model fit into your quest for a sense of wellness and happiness today? How will these fit into your quest to serve and help others? 

By John C. Cranham, DDS 

Even today, after decades into family life, dental practice, and continuing dental education, I sit down every January to outline my BHAGs (Big Hairy Audacious Goals) for the year. I block out the first Monday after Christmas to do this, but for the previous month, I’ve been thinking about what new goals will excite me most. I commonly do this type of thinking while I am exercising and driving.  

It’s during these alone times that I can intentionally mull over the things I could do next. I pay close attention to which possibilities excite me most. Oftentimes, these are goals that I feel will benefit others. 

Successful people have the ability to create daily behaviors that direct themselves towards their goals and take them forward on steppingstones. One of the simplest, yet powerful things I witnessed Dr. Pete Dawson do is how he started each day. He would go to his desk and spend 15 to 20 minutes writing six things on a 3×5 card. These weren’t a To Do list. These were six things that would direct him toward his next BHAG. He would place the card in his breast pocket. He did this day in and day out. 

Two weeks before he passed, Pete came to my lake house on oxygen. When he arrived, I had to help him out of the car and into the house on his walker. I looked at his shirt pocket, and there it was, the 3×5 card.  

We don’t have to use 3×5 cards to make notes for ourselves. We can use our phones. But it is powerful to reflect daily on steps that will take us in the direction we want to go and record those steps to lock them in our memory.  

In dentistry, we need to carve out habitual time to think about our goals and steppingstones. We need to carve out time to take the identified steps. The point is to have a system in place where you are thinking about it every day, because there is so much coming at us all day long that we are at risk of drowning in the noise.  

When we get caught up in the mundane, life is less interesting and less fulfilling. At least that has been my experience. When you sense you are becoming bored, you might just need to identify the next big goal that excites you. The challenge of getting there will bring you back to full life. 

By Paul A. Henny, DDS 

Martin Seligman PhD spent most of his career at the University of Pennsylvania advancing the concept known today as “Positive Psychology.” He states that Positive Psychology is “the scientific study of what makes life most worth living.” Along the way, Martin identified five core elements highly associated with psychological well-being and happiness. He believes understanding these five elements helps us to create more fulfillment, happiness, and meaning in our life. 

One of our Pankey colleagues, Barry F. Polansky, DDS, spent a lot of time and energy studying Seligman’s work. In his last decade in practice, Polansky turned his attention to writing books to help new dentists find wellness and happiness in dentistry. Polansky’s 2017 book The Complete Dentist: Positive Leadership and Communication Skills for Success is an excellent guide to starting and running an effective and meaningful dental practice. 

In this two-part series, we’ll take a look at Seligman’s positive psychology model in relation to how we feel about our work in dentistry. 

Seligman’s Five Core Elements: 

P – Positive Emotion 

This represents a “glass-is-half-full” perspective toward life, commonly called an “abundance” perspective. This positive world view is critical because it has a heavy influence on how the brain functions. Our brain is a memory-driven cybernetic solution-seeking organ, with a primary purpose of creating and supporting a successful life. When our mind is in a positive orientation towards our environment, we are typically in a very observant and creative mode of living. In this mode, we constantly scan our environment for relevant bits of information and experiences that are potentially useful in the advancement of our desires.  

When our desires are positive and life-affirming, we are co-creating our experience: We see and experience to a large degree what we expect to see and feel. That is why having a clarified positive vision and purpose for our life and practice is essential for well-being. 

E – Engagement 

L.D. Pankey famously said, “Know Yourself.” What interests us most? What worries us most? In what circumstances are we most comfortable? Under what conditions are we most productive? What are our personal strengths? What are our habits? What are our triggers? What do we aspire to do? What about ourselves would we like to change? 

We all direct most our attention toward the things that interest us or we fear. And it is what we pay the most attention to, whether at work or elsewhere, that we develop the most while engagement with things of lesser importance wither away. It’s healthy to go into ever deeper relationship with the things we value. Clarifying what we believe we are good at and what we will enjoy is a key first step to successful practice development. 

Defining our values is essential so we know when to keep “first things first,” as Stephen Covey likes to say. 

Mac McDonald is a Visiting Faculty member at Pankey, his 2017 book Unchanging Points of Light: Finding Your Way in the Dark is an example of the positive power of values clarification. 

My discussion of Seligman’s five core elements will be continued in Part 2. 

By Bill Davis, DDS 

During the first two years of the book project, the institute was still at the DuPont Plaza Hotel in Miami. My schedule was simple. I would fly down on the red eye from Detroit Monday night after my practice time and stay at one of the apartments used by the visiting faculty next to the hotel. Dr. Pankey and I would meet for breakfast at 8 a.m. Then, we would go over to a room in the Institute to talk and I would record everything. 

At our very first meeting, I realized why everyone was taken with Dr. Pankey and his philosophy. We sat down for breakfast and started with the usual small talk. Then L.D. looked me directly in the eyes and asked, “Bill, may I ask you a couple of questions?”  

I looked back at him, and I said, “Yes, of course”.  

He then asked, “Do you tell your wife you love her every day?”. 

I was a little taken aback by the question and said, “I think I do”. 

L.D. then said, “You should.”  

From that day forward, I made it a point to tell Pam I loved her every day. If I was out of town, I would always call long distance and now I text her. That question made me realize how important Dr. Pankey felt it was for us to stay closely connected to our loved ones. I am sure that gesture has helped me during my 57 years of marriage to my best friend Pamela.

L. D.’s second question was, “Do you save regularly for your retirement?”

I told him, “Yes, I do. At the end of the year, when all my bills and taxes are paid, I send most of the remaining money to my Merrill Lynch investment account”.  

Dr. Pankey told me that was okay, but not a good way to save real money. He recommended that when I got my paychecks, one from the university and one from my private practice, I immediately sit down and write a separate check for 10% of my total net income for the week and put it in the investment account.  

Then he said, “Live on the budgeted remaining 90%.”  

I realized he was following his philosophy and wanted me to be sure I could take care of my family. Over the years, his advice has been spot-on. These first two questions were my introduction to his philosophy. 

To be continued…