New Patients / Patients of Record

Often a dentist or team member can believe: A new patient or patient of record wants to be efficiently informed on two or three things:

• What do you want me to know about my dental health?
• What and how do you want me to do “it”?
• What is this going to cost? Or isn’t dental insurance going to pay for this?

A Story of Dr. R. A. Green from the Past to the Present:

A retired physician of seventy-five years of age was enjoying teaching at The University of Chicago Medical School. At the time of this conversation, I was attending Northwestern University Dental School and working part-time as a Doorman at The Hotel Pearson. The Hotel Pearson was a residence hotel; the physician was a resident of the hotel. The hotel was located where the Ritz Carleton presently stands on Pearson Street, one block East of Michigan Avenue; the time frame was the early 1960’s. That evening, as the retired physician walked out for some fresh air, he engaged me in a conversation, which he had done on previous occasions. I remember asking him about, what he was teaching?

His reply has stuck with me all these years. He said, “I am trying to encourage the young Interns and Residents to slow down and listen.” Slow down and listen, I replied with a question lingering in my voice. He said, “Yes, if I can help them begin to create opportunities for a patient to experience “deep listening” and then stay “present” with and for a patient, the Intern/Resident will notice, in time, a patient will diagnose their own ailment (at least offer enough important information to be able to develop a very accurate differential diagnosis); a wonderful place to start, a beginning!”

He went on to say, “If I can encourage the Intern/Resident to continue to listen deeply, a patient can reveal how they want to be treated. And, if the Intern/Resident can listen just a little longer, a patient can initiate a conversation about how they want to pay for the services to be rendered. Deep Listening accomplishes a greater understanding of the patient, which leads to a better diagnosis, and can lead to a more successful practice model than running from room to room, thinking you only have three – five minutes to do all of the above, while not accomplishing any of the above. I am really trying to encourage them to slow down and listen!”

Now, almost sixty years later, I am sitting and reflecting on my lifetime in dentistry and work with patients, team, and dentists; I too have been involved with teaching and coaching, myself and others, for over sixty years. While I strive to have conversations concerning many different aspects of dentistry, which surface while being present, with and for others, the bottom-line in a relationship-based life and practice are very similar to that of the retired physicians’ message, nearly sixty years ago.

My response is also altered and influenced, due to an early encounter’s with Dr. L. D. Pankey, soon after I had met him in 1968. In a conversation, he had asked me to tell him about my office and the flow of a day in my office. His response to my description of my usual day was, “Why don’t you Slow Down and become more Affective, you are Efficient Enough!” A similar message, and it had a heightened impact upon further reflection: “I have heard this before and it sounds very familiar!”

What is it you do intentionally, on a regular basis, to slow down and become more Affective (Affective Domain), for you too are Efficient Enough?

Hmmm… Isn’t that interesting!

According to a recent survey released by the John Templeton Foundation, people are less likely to feel or express gratitude at work than any other place. And their feeling of appreciation toward their current jobs, ranked dead last on their list of things they are most grateful for.

Oddly, this outcome isn’t because people don’t crave receiving gratitude at work. Ninety-three percent of those surveyed agreed that their bosses are more likely to succeed if they expressed gratitude more often, and only 18 percent thought that expressing gratitude made their bosses “weak,” or hurt the organization. Additionally, the majority surveyed reported that hearing “thank you” from others at work made them feel better about themselves and more motivated.

So, What Gives?

Why is something which is so obviously appreciated and helpful so frequently withheld? Why do Americans actively suppress gratitude at work, even to the point of robbing themselves of happiness and all its benefits?

The answer lies within the nature of our “reptilian” brain which lies buried underneath or logical neocortex. Our brainstem, midbrain, and limbic system are constantly surveying the environment to determine if we are safe as well as where we are within our tribe social status-wise, as well as how our tribe ranks relative to other tribes.

As a result, we are slow to give support and appreciation to others because it might change the organization of our social structure in such a way that we might personally lose out. Another way of saying this is that we are all built on a neurobiological level to be inherently selfish.

Overcoming Our Silence

The role of gratitude in dental practice should be a positive, intentional one that makes every single care team member feel values. When they feel good about themselves and their contributions, performance will rise. To this end, we must consciously work at overcoming our tendency to remain silent and ignore other people’s contributions and exceptional performances. And how can we do this?

1. Make gratitude part of your practice culture from the top down. One of the biggest takeaways from research on workplace gratitude is that your care team needs to hear “thank you” from the doctor regularly. This is because it’s up to the people with the most social, political, and financial power to clearly, consistently, and authentically thank, in both public and private settings, those who have helped their status. In other words, we need to lift everyone else around us. Rising tides should lift all boats.
2. Gratitude should also be built into your performance reviews and staff meetings, where time can be allocated for each person to say “thanks” to others on the team for being thoughtful and pitching-in at critical moments.
3. Thank those who seem to never get thanked. Thanking those who do important, but easy-to-take-for-granted work is key. Your office cleaning crew, your UPS delivery person, the mailman, your accountant… You get the picture. These simple gestures improve morale and increase trust, and therefore increase performance.
4. Aim for quality thankfulness, not quantity. Forcing your team to be grateful to one another won’t work if they’re harboring resentment and other unresolved issues which remain untouched. Hence, forcing gratefulness as a strategy is not “cultural,” its superficial and doesn’t work. Instead, it can feed upon the power imbalances which undermine gratitude in the first place, and therefore make expressions of gratitude feel inauthentic.

The key is to create times and spaces that foster the voluntary, spontaneous expression of gratitude such as morning huddles and regular team development meetings.

Many of you are already doing these things, but are you doing them frequently enough and with the right intentions?

What would you like to build your relationships upon in your practice? With all the attention that is paid to dental insurance, it sometimes seems as though that becomes the foundation of our relationships with patients. When this is the basis of our relationship, the moment the plan changes, the patient may be looking for another dental office. Do we want to have our relationship based on such a fragile platform?

When I think about what we could have at the foundation and how we could make this happen, several things come to mind.

Compassion as the Basis

Basing a relationship on compassion can begin with the very first phone call. When a new patient calls, compassion can be expressed by something as simple as, “What prompted you to call us today? I hope you are not experiencing any discomfort.” Right out the gate, you are putting out there that you care about their comfort.

For a new or an existing patient, you might to say something like, “I’d like to make sure we schedule enough time to do this very thoroughly…very gently, and that we provide you with the best possible service so you are as comfortable as you can be.”

When you talk with patients about conditions you are seeing in their mouths, you can express concern as simply as saying, “I see a crack in this tooth, and I am concerned that, as it gets larger, you may experience some pain. Have you experienced any pain there?”

Mutual Trust as the Basis

On the very first call, you can begin to base your relationship on mutual trust and respect. You might do this by saying something like, “I’d like to schedule enough time for you to get to know us and for us to get to know you. When we learn what is important to you, we can help you make choices that are in your best interest. We’ll want to know what your previous experiences have been in dentistry because we want to provide you with the best possible experience in this practice.”

During Hygiene appointments, you might say something like this, “As I look in your mouth, it appears to me that over the years, you’ve gone to the dentist regularly and done everything you could to take care of yourself. You’ve chosen to have treatment when it was recommended. I believe that if you have the right information and you have some support in working through the process, we can help you make good choices for yourself in the future.”

If the patient is not in pain, you might say something like, “You’re in a really good position right now. We’ve got time to study the information we’ve gathered and to learn about your preferences. The doctor will want to go over all the information we’ve gathered today and spend time thinking about your oral health circumstances and options. If you decide later to have treatment, you will be fully informed about your options so you can make the decision that is right for you.”

Shared Values as the Basis

When we discover shared values in conversation, there is a powerful connection between us and the patient. If a patient mentions a filling has lasted for decades, you might say something like, “It seems to me that you like to have your dentistry last as long as possible?” And if the patient says yes, you might say, “Excellent, we’ll take that into consideration when we think about options for you.” Give them opportunities for discovering together with you what is most important to them.

The foundation you intentionally build on compassion, mutual trust, and shared values will enable you to expand conversations you have with patients about insurance and the cost of care. You will be able to assure them you will do whatever you can to make the dentistry they value affordable for them.

In 1999, I participated in the writing of a 500-word bio of Dr. Lindsey Dewey Pankey, Sr. for his posthumous induction in the Pierre Fauchard Academy International Hall of Fame. Although he was born over a century ago, his legacy has impacted many thousands of dentists and millions of patients.

Sharing this abridged bio with you 20 years later means that the asterisked number of dental professionals instructed by The Pankey Institute has greatly grown. Nevertheless, I offer this to you in its original words to make his abridged biography more widely known.

From the Pierre Fauchard Academy International Hall of Fame of Dentistry, 1999

Dr. L.D. Pankey, Sr. Was born on July 31, 1901. He received his Doctorate in Dental Surgery degree from the College of Dentistry at the University of Louisville, practiced in New Castle, Kentucky for one year, then relocated to Coral Gables, Florida, where he practiced dentistry until 1969. In 1932, he became a member of the Florida State Board of Dental Examiners and served 12 years, including his term as secretary and chairman. Concurrently, he was a member of the American Association of Dental Examiners, serving as Vice President in 1942 and President in 1943.

Throughout his professional career, Dr. Pankey was an essayist, lecturer, and student.

Having made presentations before countless local, state, national and international dental groups, he was best known for his seminars on “A Philosophy of the Practice of Dentistry.” In 1956, his Philosophy lectures were organized into three-day seminars. Subsequently, a curriculum was developed whereby practicing dentists would attend a series of once-a-year classes over a three-year period. In these classes, Dr. Pankey helped dentists find fulfillment through building relationships with patients about the benefits of optimal dental care. He helped his colleagues seek a balanced life. And he inspired them to do their personal best for every patient.

Dr. Pankey also developed a procedure for occlusal rehabilitation. In collaboration with Drs. Arvin W. Mann of Ft. Lauderdale, Florida, and Clyde H. Schuyler of New York city, he developed a teaching manual. In 1959, they began giving seminars, attracting dentists from throughout the United States and many other nations. Their occlusal rehabilitation procedures became known as the Pankey-Mann-Schuyler Technique (PMS). He was acknowledged by the dental profession for this work by being elected President of the American Prosthodontic Society.

Over 7,000 dentists attended the occlusal rehabilitation and philosophy classes taught by Dr. Pankey. The dentists who attended these classes formed the nucleus of support for establishing The L. D. Pankey Foundation, Inc., and creating “The L. D. Pankey Institute.” The Pankey Institute was the first advanced dental education organization of its kind in the world. It opened the doors to its first class in Miami, Florida in 1972. The curriculum was organized into what has become known as “The Continuum,” a series of one-week classes taken at a pace that is convenient and pertinent to the growth of the participant.

Well beyond simply honoring its namesake and continuing his teaching, The L. D. Pankey Dental Foundation, established a higher mission for dentistry “to bridge the gap between what is known and what is practiced.” Since 1972, The Pankey Institute has instructed over 17,000* dental professionals from many nations of the world, affecting the dental outcomes and well-being of millions of patients. Dr. L.D. Pankey, Sr. was deeply committed to the Institute’s success, participated in its development, and lectured at the Institute up until the time of his death in March of 1989.

Dentistry, our beloved profession, is better because of the man we recommend for induction. The Academy is privileged and honored to induct Dr. Lindsey Dewey Pankey, Sr., into the PFA International Hall of Fame of Dentistry.

Few people have worked as tirelessly to advance the thinking of L.D. Pankey and Bob Barkley as Rich Green DDS, MBA. Recently, I ran across some of Rich’s quotes that truly capture the nature of his experience in dentistry.

A behaviorist’s definition of learning is changed behavior demonstrated. As my personal growth allowed, I relaxed and thought more about creating an experience in which my patients had the opportunity to learn something, which would challenge them to change behaviors that had negative impact on their life and health. The more I looked at those “learning moments,” the more they appeared. The learning occurred as I helped patients clarify what was most important to them and what they wanted to learn. As I facilitated a learning process with my patients, they were able to discover for themselves those two things, and then they were able to take their own steps in personal growth…People tend to support what they help to create.

Below Rich is speaking of his long-term work with Don Clifton and The Gallop Organization.

As we studied the uniqueness of individual private practices, one finding was the tendency of a dentist and team to unwittingly create barriers to the patient’s progress when what they really wanted was to create pathways to greater health. The barriers were typically caused by an impatient or judgmental attitude and the “teach and tell” method of attempting to change behavior.

In this last passage, Rich speaks to the central theme Bob Barkley taught across the country following the publication of his book, Successful Preventive Dental Practices. In the mid 1960’s, Bob worked closely with Nate Kohn Jr, PhD to dramatically reorganize how he interacted with his patients. In so doing, he largely abandoned what Rich refers to here as “teach and tell,” in lieu of what Bob called “CoDiscovery.” Because Nate Kohn, Jr. had his PhD in Educational Psychology, he exposed Bob to the latest thinking in learning science – and much of it had been influenced by the work of Carl Rogers, PhD.

It fascinates me that we can now go back and understand how all of this evolved, as well as why Bob chose to do things in a very specific way. Perhaps most important is how it all evolved through the hearts and missions of both Bob and Rich. And this last point is key, because if the motivation behind a person’s use of CoDiscovery doesn’t emanate from their heart, from a deeply sincere desire to help others grow and realize greater health through that growth, it won’t work. Instead, it will be perceived as being manipulative and thwart the desired outcome.

The “unwittingly created barriers” will block the passage of the relationship to the next interpersonal level — the level necessary to establish enough trust to proceed to the needed care. CoDisovery is an intentional practice, born out of a personal philosophy toward life and practice. This heartfelt way of interacting with others sometimes feels slow, but it is the fastest way I know to truly help others.

If you watch one episode of Gordon Ramsay’s Kitchen Nightmares, you will see a repeating theme. Previously great restaurants have come close to shutting their door, because the owners’ passion for maintaining high standards has waned. Diners have dropped them from their A list, their B list, maybe even their C list. Without a dramatic makeover and grand opening, diners are not going to come through the door.

Bring this forward to 2020 and the pandemic. Patrons… clients… customers… have legitimate concerns about moving forward with their lives. Dental teams are doubling down on conversations with patients, along with adopting and adapting to many changes in how they practice. And, then, there is another problem I am seeing in all businesses, not just dental practices. The government gave money to employees to “not work.” Now when they are needed (especially in dental practices and labs), employees want to stay out not only for more “free lunch” but also out of health concerns of their own. They don’t want to take coronavirus back to their family members at risk.

Some of this comes down to the history of the business and how they practiced before and the culture they created…that went way beyond “money.” I’m not saying this is true of all dental practices and less so in the relationship-based practices, The Pankey Institute and other thought leaders promote. But, practicing every day consistently at the quality level of the past takes tremendous commitment. The moral compass of the practice leader—the dentist, must continue to show courage, trust, respect, authenticity, integrity, communication, education and growth, excellence, resilience, purpose, and alignment. Whew! That’s a tall order when you are feeling stressed and exhausted.

It’s no wonder if some of your pre-pandemic passion for spending time with individual patients has waned. When I came out of dental school in 1973, Paul Simon had not yet written his monumental song Slip Slidin’ Away, but within my first decade of practice, I knew the song well and already sensed that life was not on the trajectory I wanted. My passion for dentistry had waned.

We work our jobs
Collect our pay
Believe we’re gliding down the highway
When in fact we’re slip slidin’ away

With inspiration at Pankey and Dawson, wide-wide reading, and encouraging colleagues, I found my way… my passion… my balance… my joie de vivre in dentistry. I discovered how to not only conserve my personal energy but also generate more energy through personal contemplation time and daily exercise. The greatest discovery I made was that my practice of dentistry actually centered around one specific system: the comprehensive patient examination and the meaningful conversations I had with patients during the exam.

The One Thing to look out for is the quality of your comprehensive patient exam. Is it at the highest level?

The comprehensive examination is the “one procedure” or process that gives the dentist the opportunity to express and display his or her leadership “virtues.” Don’t let it slip slide away.

Conversation is where the human side of health care takes place. Continue to spend extra minutes in conversation. The meaningful moments you share with your patients will energize you and help you get through current stressful days. Just remember that having a meaningful conversation, in many cases, requires us to let our guards down and become vulnerable. It means sharing our philosophy and showing our human side… maybe even how challenging dentistry is right now… and yet still so rewarding.

L.D. Pankey famously said, “People change but not very much,” and hearing this for the very first time represented an “aha moment,” as it put into proper context an important realization I had previously ignored.

As dentists, we know a lot, and we have worked very hard to acquire that knowledge. As a consequence, we naturally want to use it to help others. But there’s a problem. Often times others act like they don’t want to be helped. Often times others act like they don’t want to be better. Often times others act like they don’t want to map a course toward a higher level of health. So, we struggle to make sense of it and even judge others as a result of it.

Developmental psychologist Jean Piaget, PhD told us that the motivation to change comes from within the individual, from their perception that they’re in a state of “disequilibria,” wherein what they’ve been doing in the past (including what they believed to be true) isn’t producing the outcome they want. And as a consequence, the person is confronted with an uncomfortable truth. They can’t keep on doing what they have been doing and expect a different outcome. They’re going to have to suffer through some personal change if they sincerely desire to experience something different in their life. And executing the change is going to cost them something namely time, energy, and money. In other words, significant change can’t be done for them or to them. It’s an “inside-out” process that they will have to do for themselves.

Some people will look at their need to change and ignore it. They will say to themselves the cost is too high for them to pay, or they will simply rationalize away their need to change in an elaborate form of denial. Others will immediately confront the challenge, learn what they need to know, figure out a way to pay the price, and move on. So, what’s the difference between these people?

Perception… values… readiness.

What Can We Influence? 

In our world as dentists, we can build up a person’s understanding of their situation through CoDiscovery, and therefore we can facilitate how they frame, prioritize and think about what they have learned. But we can’t make them change. We can’t cause them to act. We can only honor where they are with it all and stand ready to assist them when they are ready to move forward.

Significant change often requires a change in a person’s value structures and the hierarchy of those structures. Piaget called changes of this type “accommodations. Piaget said that they are made at the person’s own pace after the person senses that he or she is in a state of disequilibria. And so, Dr. Pankey was right. Those who change do so not because we are highly skilled at “case presentations.” They do so because they want to, and it may occur only a little bit at a time.

In previous parts of this series, we looked at leadership, the commitment it requires, and the first three of four universal promises of leadership. The first promise was the promise to set a clear direction and create meaningful work for the organization you lead. The second was the promise to engage all stakeholders and hold them accountable for performance. The third was the promise to ensure your strategies, systems and processes facilitate focus and execution.

Now we will look at promise four.

The Fourth Universal Promise

You will lead effectively by maintaining relationships of trust to achieve and sustain results.

Why would someone want to follow you? The answer is trust. In order to keep the first three promises of leadership, you must value the priceless currency of relationships built upon trust.

Trust is one of the most difficult concepts for sociologists to describe and define. Two exceptional thought leaders on trust in our culture said this:

Steven M. R. Covey: “Trust lives at the intersection of character and competence.”

Rachel Botsman: “Trust is a confident relationship with the unknown.”

Becoming Trustworthy

Because trust builds confidence and frees up hearts and minds to commit, it forms the basis for a thriving practice culture and draws out the inherent potential of your team (their individual talents, energy and passion). Traditionally, I focused my energy on building trust.

Rachel Botsman proposed that in creating a culture built on trust, we would be served better by focusing on becoming more trustworthy. Rachel’s idea hit me hard. It was spot on. Trust demands the best that we have to offer. Perhaps, it demands all that we have to offer. It is the secret sauce of why people decide to surrender themselves to the great vision you offer.

If you take one thing away from this, take away a renewed devotion to becoming a more trustworthy person. You will likely find that your aspirational identity shows up with more clarity, courage, conviction and compassion.

And So, Back to Clarity

People follow leaders they trust by surrendering to a compelling vision that engages their hearts and minds. Others will trust your vision if you are clear, courageous, have conviction, and are compassionate. These are the building blocks of a shared (collective) style of operation and leadership in which each individual in the organization contributes, benefits and leads. This is relevant to your patients (clients) as well as the team you lead.

As I end this series, I leave you with my belief that developing and elevating your leadership competencies is the best investment you can make. Effective leaders who deliver on the four universal promises of leadership create strong cultures that outperform average cultures by multiples, not percentages, in every measurable dimension over time.

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

The Third Universal Promise

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

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

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

Focus Versus Distractions

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

Leaders sometimes break the third universal promise of leadership by:

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

Here are two examples:

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

Keep Hope Alive

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

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

Until next week and Part 5

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

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

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

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

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

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