Cogito, ergo sum is a philosophical proposition developed by René Descartes translated as “I think, therefore I am.” The proposition went on to become a fundamental element of a developing secular Western philosophy. Descartes asserted that the very act of doubting our own existence served as proof that we exist. 

But that’s pretty thin gruel.  

I believe Descartes got it backwards. I contend that he should have said, “I am, therefore I think.” Each of us has been given an amazing gift. In fact, we’ve been given many gifts such as life itself, but I am referring to the gift of thought and contemplation. And it’s a gift which can either “make us” or paralyze us into a state of inaction and failure. 

Success in practice today comes down to one thing and one thing only. Those of us who master the ability to think and solve problems quickly and efficiently with foresight will ultimately win the game, set, and match. The rest will be marginalized, consumed, controlled, oppressed, and limited by third parties. 

Our brains work like an executive committee of three members, each with its own primary purpose, which either work in harmony to achieve great things or which work at counter-purposes on a level that is counter-productive or even self-destructive. 

Our executive committee is made up of: 

1. A primal “reptilian” brain which is focused on very basic functions and maintenance.  
2. A rapid pre-cognitive information gathering, analysis, and response system designed for the purpose of self-preservation, known as the limbic system. 
3. A super-computer information processing system that can take new and stored information, reorganize it and then CREATE things like the Declaration of Independence or the Toccata and Fugue in D minor. It’s called our “prefrontal cortex.” It’s our brain’s CEO. 

How well we are able to coordinate these three aspects of our mind largely defines our future. And that coordination is only possible when we are clear about our central purpose in life and practice. Have you become clear about who you are…what you want for yourself…what you want for others? What are the sacrifices you are willing to make to achieve them? And how will others benefit from it all? These are the kinds of questions that help keep our executive committee on the right course, allowing it to be adaptable, as well as progressive in a rapidly changing marketplace. 

L.D. Pankey taught us that creating a written practice philosophy was the most important step in building the practice of our dreams. Why? Because it puts our executive committee on-task and keeps it there.   

“I think, therefore I am,” or “I am, therefore I think?” Understanding the distinction and leveraging it will make all the difference in the world. 

I wrote this article 20 years ago for The PankeyGram, and it is still relevant today.  

As I walked into the room, the nurse was applying medication to a hand wound my grandmother had received from a fall a week earlier. My eight-year-old son, Tim, and I had traveled a thousand miles to say goodbye to my grandmother. At 89 years of age, her body was finally ready to give in to breast cancer, and her mind had fallen victim to Alzheimer’s disease over previous several years. 

I knew she would hardly know who I was, and if she did remember, the memory would be gone moments after I left. However, my father was an only child, and it was important to help him through these difficult times. My son also needed to learn about his roots. 

It was sad to see her unable to hold herself up in a chair, and she seemed so frail and weak. I said hello to her, and she opened her eyes enough to gaze at me. Her air-filled voice repeated, “I’m so tired. I’m so tired.” I held her hand and comforted her the best I knew how. I showed Tim to her, and she struggled out a sincere smile towards him. I told her stories about my family, my job, my tree we planted in honor of my grandfather, and how full and complete our lives were. It was as if I was trying to justify her life through the one, I was able to live now. 

We had brought some cinnamon cookies with us, and I offered one to her. Her dry frail hand reached for a cookie. She slowly nibbled on it.  

As you spend time with someone who is close to death and appears to have lost everything, one naturally thinks about how unimportant much of one’s life can be. I thought about the worldly parts of my life: the cars, the boat, my home, or ability to travel. I thought about the simple function of life: walking, running, feeding ourselves, dressing ourselves…. We have so much when we are healthy. Being a dentist, I reflected on how trivial teeth seem at a moment such as this. I pondered these thoughts as the first cookie disappeared, then another. 

My grandmother’s exhausted manner seemed to temporarily dissipate. She had found pleasure in nibbling the cookies. With her eyes closed and body relaxed, my attention focused on a collage of colorful photographs hanging next to her bed. Looking down at me was a picture of my grandfather, almost as if he approved that I had come. 

My grandfather was a righteous man who always felt it was important to do things the correct way. His home was not large, but it was perfect. Every part of it was neat, crisp, and clean. The saying “everything has a place and every place has a thing” describes how well he took care of his belongings. In the same manner, his and my grandmother’s health had been important to them, including their teeth. They both had most, if not all their teeth until the end. Even at the time of my grandfather’s death at the age of 84, he was scheduled to have some major dental work completed. My grandfather had been comprehensive about caring for his health and life. 

My grandmother was now working on a fifth cookie. I watched as she gently grasped it, lifted it to her mouth, bit and sighed with pleasure at its wonderful taste. Suddenly, I realized that because she had her own teeth at age 89, she was able to find some pleasure in what most would consider horrible existence. She could still eat and experience the pleasure of taste! What had seemed small in the scheme of things a moment ago had renewed importance. 

Many patients judge the competence of a dentist based on whether they are free of pain. However, a dentist’s true competence is measured by whether patients still have the ability to eat at the end of their lives. This can only be achieved with a comprehensive long-term approach to dentistry and helping people understand the importance of this type of care.  

No matter what you do in this world, you need to treat people in a personalized, comprehensive fashion. Now I look at every patient with the hope that when they have lost everything else, including their mind and most body functions, they might enjoy the ability to eat and the sense of taste. 

As her hand reached out, her fragile voice whispered to me, “May I please have another cookie?” 

Dentistry can be emotionally taxing, and Stoicism helped me to get through some tough times. I am not referring to being a small “s” stoic. In truth, being a stoic can be harmful to a dentist’s emotional health because that implies suppressing feelings. I’m referring to capital “S” Stoicism…a practical philosophy which has as its goals freedom, happiness, and tranquility. And that is how I became fascinated with it. 

The first person I ever heard speak about “philosophy” in dentistry was L.D. Pankey. He used language I hardly understood. It was foreign to me. I studied his philosophy and the philosophy of Aristotle. The application was difficult. Mounted models in centric relation is one thing…but “virtues?” What was Pankey trying to get across?  

It was years later that I learned about the Stoics who were not theoreticians or academics, but rather real down-to-earth working people who considered Stoicism a new school of Greek philosophy that was practical. They lived it rather than studied it, and they were mostly happy emotionally resilient people.  

Their virtues included justice, fairness, and kindness to others. Applying these virtues takes work. It takes self-awareness to avoid making value judgments and creating narratives about situations and people that lead to stress. 

Hearing L.D. Pankey speak of “virtues” sounded old fashioned to me, but I knew there was more to him than mounting models. The essence of his message was how to achieve happiness, tranquility, and virtue…something I was sorely missing when I first went to Key Biscayne. By practicing the Stoic virtues of justice, fairness and kindness to others, I have found happiness. I have found that a virtuous life of inner coherence and outer harmony relieves confusion about life and practice.  

On January 10th, 2020, The Wall Street Journal published an article on the changing patterns of retirement. It is worth a look. After 43 years in the world of dentistry, I have now survived three years as a “retiree” and have a few comments about preparing for and transitioning into this significant life event.  

Preparation Tips 

1. Before you “pull the plug” on work, start to figure out what you would like to do when you have more time. My unhappy retired friends generally failed to do this. I suggest you build on the things you like to do. Include personal time and together time with your spouse. Look forward to a new challenge such as learning a new language or trying your hand at gardening. If you are not now in a service club or a similar group, you will have the time to try that.  
2. With your spouse, discuss how you will manage money. Long before retirement, create your retirement budget and financial growth plan. The Pankey Institute curriculum will help you with this.  
3. Be genuinely interested in others. The happy retirees I have met talk much more about the new friends they have made than about themselves. They are outward-focused and active listeners.   

Transition Tips 

1. Create a schedule and stick to it. If you used to get up at 5:30 am and liked doing so, don’t change. Just get up and do something you did not have time to do in the past.  
2. Be committed to your plan. Intentionally stick to your financial and time management budgets.
3. Stay involved in dentistry if you love it. Keep your membership in organized dentistry and your study club. Be a mentor and continue to learn. If I am fortunate, I will help a few young dentists be more successful and avoid some of the errors I made. 
4. Meditate on L.D. Pankey’s Cross of Life. Be committed to spending social time with your family and friends, even volunteer for their causes. And don’t forget your spiritual life. I’ve been amazed at the nice folks we’ve met at church who are interested in us as people and not as what we did in our careers

Final Thoughts 

If you are 30 and have not started to think about retirement, it is time to start. The successful economics of retirement takes time and commitment. If you are nearing the years when you will retire from practice, start thinking about your future lifestyle now. Keep in mind that a life well lived is a happy one. Continue intentionally “giving back” after retirement, and you will continue to make memorable, good things happen for yourself and others. 

When the art and science of dentistry are reduced down to primarily being about production and code mining, its spiritual dimension is easily lost. Spend a few minutes on some dental social media sites, and you will quickly see this truth in black and white. 

Dr. L.D. Pankey warned us about this problem.

The key to becoming a truly successful professional isn’t just about mastering the technical skills and endlessly chasing after the siren songs of our materialistic culture. Such narrow pursuits are ultimately hollow and do not represent enough to carry us through life as a fully developed person. And they do not represent enough to carry us through life’s inevitable tragedies and periods of significant suffering.  

Creating a habit of connecting with our patients in deeply meaningful ways, helps us to form the emotional antibodies we will need to carry us through the inevitable not-so-good times, the times when all the money and material possessions in the world can’t solve our problem. These are the times when only love, support, and reciprocated empathy can start the process of healing our wounds. 

Never forget this central truth.

Chasing after the next new and shiny object may not be the best solution for our challenging situation today. The best solution may very well be sitting right in front of us in the form of a deeply caring patient.
 

L.D. Pankey, when talking about the assimilation of knowledge would say, “First you get it in your hands, then your head, and finally in your heart,” meaning objective understanding and competence was only a step in becoming a complete dentist. 
 
This, of course, was a hard message to hear as a young clinician, because after rapidly proceeding through Pete Dawson’s curriculum, purchasing three Denar articulators, and then going on to The Pankey Institute, I felt that I was ready to start practicing as a “comprehensive dentist.” 
 
But unfortunately, most of my patients and the citizens of my berg didn’t get the memo. Most of them just looked at me suspiciously, while others left. Fortunately, a few of them allowed me to perform my “complete exam,” collect study models and take 35mm slide photography. And then, I’d spend hours waxing up cases, and preparing a thorough written report containing all of my findings and recommendations. Finally, I’d make  a “case presentation” appointment and unveil the brilliance of my understanding of complete dentistry–about which I was sure the patient would be impressed and then have no alternative but to say “yes” to my plan for them.

From there, it was easy for me to visualize a completely organized schedule full of people who had said “yes,” and a projected level of income of my choice based upon how hard I wanted to work, and the number of hours I was willing to commit to being at the office. It all sounded so perfectly logical, and it all fits quite well with my left brain driven in the world view of dentistry.

But things didn’t work out that way very often. And since that time, I’ve have spoken and consulted with literally hundreds of dentists who’ve experienced similar frustrations. Many of them told me that they eventually gave up on their effort to try and practice comprehensive dentistry. Others took their practice to near bankruptcy via their determination.

You see, most of us missed Dr. Pankey’s message the first time we heard it, or even after the next two or three times.

We failed to recognize that the concept of complete care also hinged on how each patient felt, what they wanted for themselves, and what the solution would mean to them on an emotional level.

It was only after this difficult realization that things began to improve for me and my practice. The work of Carl Rogers, Bob Barkley, Lynn Carlisle, Avrom King, Sandy Roth, Mary Osborne, and many others, helped me to make some critical adjustments regarding how I was communicating with my patients–and perhaps even more critically– when.

Patient-centered dentistry is just that, patient-centered, not treatment centered.

This means we must first come to appreciate each person without imposing our beliefs and expectations upon them. This is a process that involves feelings first (their feelings not ours) before cognition–and before the discussion of any solutions. We must first be able to grasp the contextual meaning of the dentistry in each person’s life, and by so doing, better appreciate their perspective.

When we become better at doing this, we’ll feel that our knowledge has finally reached our hearts and the hearts of our patients as well. And it’s only at that moment that things will start to become easier and our patient’s behavior more predictable. It’s only at that moment that the “yes” to comprehensive dentistry will happen on a regular basis. 

Many years ago, when I was first trying to create a successful dental practice, I fell in love with the word “production.” I believed that production was the key to success, so I read everything I could to become more productive.  

I took courses.

In the early years, there were so many courses that centered around how to efficiently double and triple book, how to bring in more “warm bodies,” how to sell more dentistry, and how to utilize more staff to get more done. I never felt like these strategies were the answer to my production issues. I barely became more efficient, and I never became more effective as I just ran myself down. 

In my books, I have written about my issues with stress, which I believe eventually initiated adult-onset diabetes. Through it all, I continued my quest to be productive. In those years I truly learned to become more effective rather than more efficient. Reading Stephen Covey’s First Things First was extremely helpful to prioritize my work and life. But I found that was only part of the solution. The real problem for me was not managing my time. It was managing my energy.  

Diabetes became my blessing and my curse.

In my quest to control high blood sugar and the fatigue that comes with it, I found more energy. I found more mental and emotional clarity as well. A fog was lifted. My diabetes forced me to eat better and to exercise.  

I remember listening to some of Anthony Robbin’s tapes in which he tells the story of living in a small apartment in southern California, being extremely overweight and feeling like a loser. The first thing he did was to exercise. I did too. Slowly at first, I began to run. I built up my time and distance. Now, twenty-five years later, my routine includes six hours per week in the gym, running and lifting and six hours per week doing hot Yoga. The results have been nothing short of amazing. My diabetes is under control, I lost weight, I multiplied my energy level and mental clarity went way beyond what I expected. 

My moods improved, I enjoyed my work more, patient behaviors didn’t get to me as much, my work improved, I learned new techniques and took more continuing education, and most importantly, I had the energy to have a life outside of work.  

Every message a person tries to convey to another person has two components to it, the content of the message, and the feeling or attitude associated with the content. Both are critically important, as both give context and meaning to the information being shared.  

In some instances, the content of a story is less important than the feelings associated with it.

In fact, sometimes the content may be a complete distortion or a fabrication. Regardless, the person may believe the story because the story has a specific meaning to the person. Consequently, it is critical that we try to catch the full flavor of meaning underlying the story. 

Do they believe that they are going to lose all of their teeth no matter what they do? Do they believe that it is normal to lose all of their teeth? Do they believe that they are not worthy of investing in themselves through dentistry? Do they believe that all dental work fails and is a bad investment? Do they believe that most dentists are dishonest? Do they believe that their problems cannot be resolved?  

To discover meaning, we must respond to the feeling component of their communication:

“You seem really upset about this, can you tell me more about it?” “I can see that you are really anxious, can you help me to understand why you feel this way?” “You seem really frustrated – even angry about what happened. Can you tell me more about it? Do you think you will ever be able to work with another dentist?”  

We are attempting to discover is what their story really means to them. How do they see this story and their current situation affecting them going forward? How important is it to them that they resolve their current situation? Do they even know what their situation really is? 

I was recently rereading one of Avrom King’s essays and stumbled upon the deeply profound statement: “Fear and love cannot coexist; where there is one, there is the absence of the other.” 

I have discussed in the past that the central intention of L.D. Pankey’s interpretation of the phrase “quid pro quo,” was love.

And when I use love here, I am referencing M. Scott Peck’s definition: “The will to extend one’s self for the purpose of nurturing one’s own or another’s spiritual growth.” 

Note, that this definition has a “quid”—the giving of the self, and it has a “quo”—the spiritual development. The “first” (the quid) begets the reward (the quo).  

Dr. Pankey famously demonstrated this “first” principle when he elected to not quote a fee at the beginning of his treatment process, and then at the end of it, asked the person to pay him based on their perceived value of what he had done for them. Think about that for a moment, because to act in that fashion requires a tremendous amount of courage and self-confidence.  

Do you think that you could ever get to a place in your life where you could act in a similar fashion…to give freely of yourself in the very best ways possible, and then risk the possibility that the receiver of that gift might not appreciate everything you have done for them on an appropriate level? 

There is only one reason why Dr. Pankey could do this. He had an attitude of abundance which radiated through everything that he did. And as a result, others believed in him and followed his leadership to discover a better place for themselves. In other words, Dr. Pankey’s love for others led to their spiritual development, which then led to him being appropriately compensated. 

I am not suggesting here that you should stop quoting fees to your patients. I think most people need to know fees (or at least fee ranges) to be able to successfully manage their personal budgets, but I am suggesting that you learn how to give generously on the front end of your relationships with people without an expectation beyond appreciation…because if you can’t earn their appreciation, you can’t really earn your fee. 

Now, back to the Avrom King quote. “Fear and love cannot coexist; where there is one, there is the absence of the other.” You can’t successfully take this risk, unless you, like Dr. Pankey, possess an abundant mindset, so are therefore capable of loving (in the M. Scott Peck sense) your patients? 

That capacity comes from within. We can’t facilitate growth and development in others without simultaneously facilitating it in ourselves. 

In 2003, I was fortunate to dine with Pete Dawson and he spoke about his friendship with Dr. Morty Amsterdam and how he so enjoyed coming to Philadelphia. He spoke about L.D. Pankey. At one point he said something I will never forget, he said, “You know, L.D. was no fluke.” I asked what he meant. He told me, “L.D. really loved dentists and loved the dental profession. That is what drove him.”  

Dr. Dawson was no fluke, either.

Through his writings and teaching of over 50 years, he was a warrior for meaningful, excellent and dutiful dentistry. When news Pete’s passing came, tens of thousands of dentists all over the world wrote about how much he meant to their lives and careers. He had carried the torch of meaningful comprehensive dentistry into the hearts and minds of dentists for as long as I can remember. 

I carry a coin in my wallet which reads, Memento Mori. The Stoics used that phrase to remind themselves that everyone is mortal. “You could leave life right now.” When the news of his passing came, I was shocked. Joan Forest reported that Pete was prepared and yet on the Tuesday before he was still preparing lectures and writing a chapter for a new book. I guess that is what the keepers of meaning do right to the end. 

Excellence, duty, and meaning are the primary sources of Stoic joy.

Not the surface cheerfulness and pleasure that we have come to know on social media. The essence of what L.D. and Pete taught led to real inner happiness. I know it did for me.  

Erik Erikson, the developmental psychologist and psychoanalyst known for his theory on the psychological development of human beings, described the last tasks of adult development as generativity and keeper of the meaning. Erikson claimed that if one completed these tasks, the reward would be a full life. 

As the Pankey Institute continues passing on the knowledge of meaningful comprehensive dentistry to younger dentists (from one generation to the next) and to never waiver on the meaning of dentistry for patients and dental professionals, there is true potential for a new generation to become keepers of the meaning. And this makes me smile.