By David R. Rice, DDS 

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

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

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

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

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

 Here are the four keys: 

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

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

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

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

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

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

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

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

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

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

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

Culture Lifts or Sinks Ambition 

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

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

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

Counter Learned Helplessness by Empowering Self-Confidence 

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

Unleash Teamwork and Creativity 

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

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

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

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

By Mary Osborne, RDH  

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

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

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

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

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

Here’s how to become an instant leader.

A while back, I sat in on a Facebook Live interview with a dentist who was discussing practice management for young dentists. Like so many times, the interviewer asked the guests, “What’s the one piece of advice you would give to a dentist who is just starting out in his or her career?” And like so many “experts” the dentist replied, “Learn leadership.”

It was like asking for advice on how to live a long life and responding, “Keep breathing.”

Yes, leadership is the right answer, but have you ever looked at the number of books available on leadership? Today I looked on Amazon and found 60,000 leadership books.

Young dentists need better answers.

Young dentists need more practical answers—answers that allow them to apply what they know. Leadership comes in many styles and sizes. Leadership is a universal concept. Did the dentist mean the Leadership Lessons of Abe Lincoln…or the Navy Seals? There is a big difference.

A better question might have been: Where should I start regardless of style, personality or even mission?

What is the one thing that all leaders have in common?

The answer is followers. No one can be a leader without followers, and in a dental practice, followers are patients and staff. Not one of them will take one step forward if they don’t believe that you are the doctor that will take them where they want to go.

What is it that the followers in a dental practice want to know?

They have two silent questions in their mind. You must answer the two silent questions for them to trust you. And they must trust you to follow you.

The first question is: “Do you care about me?” So that is your starting point. Don’t take for granted that you are being perceived as someone who puts their patients and staff ahead of themselves. It takes lots of time to develop the mindset and habit set that leads to this perception. As a young dentist you need to start there and work on this.

The second question is: “Can you do the job?” or “Are you competent enough to do the job?” As a young dentist, understand that you are still in your apprenticeship stage of your career. That means there is plenty more to learn. In my career I remember taking many technical courses that were disconnected and I had to make sense of them. It was more like a self-directed apprenticeship.

Who can help you become a leader?

Mastering leadership, trust and technical dentistry is a combination you will find at The Pankey Institute. I tried numerous CE programs and read thousands, of books. But it was the inspiration and mentoring I received in the Pankey community, and the discipline of journaling (reflection) that I adopted mid-career that kept me on task towards mastery.

Today I would advise the young dentist to find a mentor or mentoring community, and when you find them, ask, “Do you care about me and can you do the job?”

That would be my advice to any young dentist looking to learn about leadership, trust and even mastery.

As the Pankey community begins to re-open its practices, reports indicate that most patients are responding with high levels of trust and gratitude. This represents a clear indication that the investments we’ve made in building truly helping relationships with others are paying back significant dividends at a most critical moment. Relationship-based / health-centered dental practices are designed to give the kind of meaningful caring and support that relationship-starved people truly need as they venture back out into this brave new world. 

The truly person-centered Pankey practice model aligns well with research which shows longevity and happiness aren’t just linked to healthy diets, habits, and genetics, but also to the consistent presence of positive social engagement. My mother frequently spoke of these types of happy people as being “givers.” She’d say, “They are givers – not just takers, and they pass this attribute along to their children, because, well, that’s just who they are.” 

Abe Maslow called these types of personalities “B-Loving” individuals—individuals who self-actualize through their unconditional love of others. These are the folks who buck today’s meta-trend of consuming more, contributing less, and living a silo-type of existence. And we look forward to seeing them on our schedules, enjoy spending time with them, and feel a tremendous sense of loss when they finally pass.  These folks are the ones who intuitively know that the loving attention they give to others, no matter how simple or brief, is an ever-expanding positive experience that yields out significant benefits to themselves as well. 

When you add up all of those moments, hour after hour, day after day, year after year, you end up with the smiling and joking Betty or Bob. They’re the ones who are the first to give you a hug when you’ve had a bad day or experienced a personal tragedy. And they’re the ones who alter the course of our lives through a laugh, a smile, by demonstrating strength, courage, and irrepressible hope. In short, they are miracle makers. 

As practitioners of relationship-based / health-centered dentistry, we need to remind ourselves that we’re miracle makers as well, because we’re also in a perfect position to listen intentionally, care more deeply, and help more significantly. But that’s only possible when we choose to see dentistry as being a helping profession and not just about teeth, technology, production – and now PPE! 

On a personal level, I’ve found myself sharing my feelings about what we’ve experienced with my team and patients, and I’m finding myself opening-up on an emotional level more each day. As a result, we’ve ascended to yet another tier of caring as a team.  We’ve used this communal tragedy as an opportunity to strengthen our social bonds through love and understanding instead of allowing fear to drive us further apart.  Abe Maslow would likely say that we’re self-actualizing on the individual, group, and community levels through B-Love. This represents a key realization, because in spite of all the new stress which has been thrown into the middle of our lives, we’ve been able to see the huge practice development opportunity the situation has created for us.   

Those of us who have grown technically, intellectually, and spiritually through The Pankey Institute have “givers” hearts (just go to one Pankey Alumni meeting and you’ll understand exactly what I’m talking about). Consequently, this communal tragedy plays right to our natural strengths, inclinations, and existing practice structures. So, in spite of all of the changes surrounding us, it’s time to confidently step forward and demonstrate principle-centered leadership. And by so doing, we’ll be holding fast to what we already know is true – that the secret to living is in the giving. 

As I watched the pandemic unfold from my vantage point in New Jersey, somehow the innocence of a child passed through my mind as I thought, “That won’t happen here.” As the pandemic got a death grip on the New York Metro area, the stark reality of “It happened here” came into full view. At first, we spread the patient visits with gaps for safety and eventually just closed our doors except for emergencies. As the weeks have turned into months, the economic impact and the sense of isolation has started to metamorphosize into a NEW reality. The phrase of “epic proportions” and “uncharted territory” were thrown around on every news cast.

Is this journey really uncharted?

Are we really cast to a horizonless sea? Haven’t we been preparing for this type of event through our education, study clubs, reading, and conversations within the community we call the “Pankey Family?” These examples come to mind:

After reading Gene D. Cohen’s book The Mature Mind, I learned that I’m resilient. I survived the big “C”, a 300-year flood in Havasu Falls, and my wife’s health issues. I realize “I’ll be able to get through this.”

Through the Gallup’s Strengths Finder and the leadership program with Dr. Richard A. Green at Gallup, I learned that my strengths are Ideation, Strategic, Learner, Communication, and Maximizer. Today I trust that the ideas and strategy will come to me. I have leveraged the Strategic strength over and over again.

The book How to Think Like Leonardo DaVinci by Michael J. Gelb tells us that when DaVinci was faced with challenges such as these, he trusted the answers “would appear.” He trusted the challenges would “seed the unconscious” to find a solution.

Waiting for the Unconscious…

While waiting for solutions to challenges, I’ve learned to free my mind and spirit by “chopping wood and carrying water”—TAO! So, when my practice closed normal operation, I went to Home Depot and bought paint…a LOT of paint. On day two I started painting my office. At first, I thought I would paint just the reception room, but as time went on, I had time to paint the entire office. I know myself, and I was doing all I could not to jump onto the “downward spiral” that I learned about in The Art of Possibilities: Transforming Professional and Personal Life by Zander and Zander.

Staying in Community

As the weeks went by the first solution to pop up was creation of a protocol for dealing with virus containment. If a patient did need to come in for emergency care, I needed to have a strategy. Joan Untershuetz and Denny Byrne presented new information last year at their Inspired Facilitation workshop about how the brain needs community. So, I formed a Zoom account and started weekly team meetings. We discussed what we were each doing to stay safe. This piqued my curiosity to wonder what patients were doing to stay safe and could they help me develop a protocol that would help them feel safe?

I recalled Dr. Irwin M. Becker lecturing in C1 on first steps to integrating this new way of practicing. He challenged us to select patients that trusted us already, and he called them “friends of the practice.” I asked my current team to list those they consider to be friends of the practice—those who put smiles on our faces when we see them on the schedule. The list was formed. The ball started to roll. I facilitated my first ever Patient Focus Group and asked two simple questions:

What have you been doing to keep your home safe from Covid-19?

What would you need to know in advance of an office visit in order to feel safe?

New Dimensions of Individualized Care

The focus group responses helped me understand that the protocols they were following at home ran the gamut from washing hands and taking off shoes to something resembling a chip manufacturing plant. I realized that individualizing the protocol could be another level of “values-based relationship-driven” individualized care.  I learned that my patients had high trust in my ability to forage through the regulations and come up with a safe protocol, and they thought it would help them to know the what, how, and whys before they came to the office.

Thanks go to several colleagues who helped by reviewing and critiquing my office protocols as they developed. Much thanks to Joan Untershuetz, Richard Green, Rolando Cibischino, Christine Shagaki and Dennis Stiles for letting me bounce ideas off of them and for their in-depth critiques.

Something else I did to stay in face-to-face contact with patients was to implement a form of “teledentistry.” After watching a presentation by Laurie Owens from DevDent at one of the ACT Dental CE online CE days, I set up an account with Doxy.me and now have regular telehealth hours. I get a push notice when someone is in the “waiting room” to have a tele-dialogue.

A Journey? Yes…Uncharted? No

There are boundless opportunities to put our best Pankey training to masterful use. We were all taught to slow the practice down and be more intentional. We were taught about personality styles and values. Open dialogue and full transparency can be the threads we hold with our patients to deeper levels of trust and appreciation. I feel poised and ready to bring my best self forward in these times that hold endless possibilities for values-based, relationship-driven, uniquely individualized care.

Referrals can be a real challenge, especially for those invested in building a strong relationship with their patients. It’s a bummer to let go of the many years you’ve put into developing a patient’s trust, but it happens all the time. You just have to make sure the trade-off goes as smoothly as possible.

Everyone has patients that move or need to leave their dental practice for whatever reason. As part of the service and care we have provided I like to give them a referral to an office where I know they will get the same level of care and quality.

Referring to Another Pankey Dentist

I may not know every dentist that has gone through Pankey, but I know a lot about them. I know they care passionately about dentistry based on their commitment to education and being the best dentist they can be. I also know they have learned the same approach to clinical care that I have and really understand how to connect with their patients. Many have created their own individualized, relationship-based practice.

One of the best resources I have for referrals to dentists in the Pankey family is the “Find a Dentist” link side banner on the Pankey.org website. I can type in their area code and find members of the Pankey Alumni association anywhere my patients are moving to. I use this resource all of the time.

I also know that I get patients referred by other Pankey dentists every month. That’s why when I look at the dues and fees I pay to belong to dental organizations, my Pankey alumni membership is the easiest one to pay. What I get back in rewards is a small cost to market my practice to other Pankey dentists looking for a new dental home for their patients.

What’s your favored referral process? Let us know! 

Fostering long-term relationships with other clinicians is an admirable goal. In my last blog, I talked about a study club I’ve been part of for forty years. How we’ve kept it going this long comes down to timing and commitment. We were brought together by Pankey and continued to develop our clinical and personal interests throughout our careers. Read on to learn how we’ve kept our study club going this long …

Relationships, Friendships, and Support From Study Clubs

During our regular study club meetings, we argue dental techniques, philosophy, and technology. We discuss our business successes and failures and share ideas on how to improve. Individually we offer to mentor our younger colleagues. We have provided solace and support after death and divorce, as well as tough love in situations where a member needed honesty as well as support. 

We continue to come to meetings even though several members drive sixty miles or more to attend and several others are now retired. Although we refer patients to one another, we seldom see one another except for at our meetings. We challenge each other to think critically, demand proven research before adopting new treatment modalities, and continue on a path of learning.  

Other members of the group are now approaching retirement. In fact, one member of the group just celebrated his eightieth birthday. We know these facts will force us to consider disbanding. However, when we poll the members we find that no one wants to quit meeting. We may have to meet less often, but we will not give up on the relationships, friendships and support.

For those considering joining or forming a study club, we encourage you to take the risk and commit to making your group one of perennial sophomores.

What do you love about study clubs? Let us know your thoughts! 

Dr. Amy Hunt recalls the similarities between her biological family and her Pankey family that make her proud to return to Key Biscayne every year.

Dr. Hunt’s Take on the Pankey Family

Every summer, our extended family gathers in the coastal town of Morehead City, NC for a reunion. Our “special home base” is a relatively small cabin built by relatives in the early 1950’s. It’s perched on a large oyster bed on Calico Creek where the tides rise and fall under the house. Over the years, babies have grown up, cousins have married, some relatives have died, but we all carry our favorite memories of special times shared together on the shoals of Calico Creek.

The weekend culminates with a traditional NC barbecue feast and promises to return again next year. As is true with many meaningful events, the work is shouldered by a few of the most committed organizers in the family. We have cousins Helen, Kevin, and Richard to thank for making this tradition a reality.

As I think of these reunions I am reminded of another “family reunion” that I look forward to each year … the annual meeting of the Pankey Institute. Like my biological family, we have grown up and are now growing older together. This special group includes many of the friends and mentors who have helped shape me into the mother, wife, and dentist I am today. I love to “return home” every September. I have an opportunity to reconnect and renew friendships as well as create new ones with like-minded people.

We learn, laugh, and even dance together. The veterans pass on their wisdom to the next generation while they in turn share their unique perspective and insights. Like the reunions on Calico Creek, the safety of being with family allows us to be our most genuine selves. Please mark your calendars to “come home” to Pankey this September.

What do you love about being a part of the Pankey family? Please leave your thoughts in the comments!