By John C. Cranham, DDS 

Every hour you invest in your practice is an hour invested in your future, so invest time in thinking about how you are spending your time. 

I am often asked if I have advice for young dentists starting out in practice. As I reflect on my own experience in practice and on conversations with other dentists in private practice, several thoughts emerge.  

There will be times when you are working in a chaotic, undisciplined environment because you are trying to care for as many people as you can fit into your day. You will become physically and emotionally tired. At some point, you will recognize that you can’t go on that way. You will need to create more disciplined systems for you and your team. You will need to develop your team members, so they can do more and save you time. You will need to hold yourself and them accountable.  

A young dentist must understand that when you run around and do many procedures, you could be confusing activity with productivity. When you’re working on highly thought-out treatment plans, you’re sitting down, you’re doing more well-organized dentistry on fewer patients. You’re also usually executing the dentistry better, which means fewer remakes.  

How do you position yourself to have the luxury of working on those types of cases? The advanced CE at Pankey and other top programs will move you along, but you need to be patient with yourself…and your patients. You will be bringing them along with you through the opportunities you have to educate them about their oral health, where it is headed, and what can be done. Don’t assume you will achieve your goals fast. Eventually, you will become known as the go-to dentist to solve problems and the cases will flow.  

Know your patients. Be thoughtful about moving them along. Enjoy them as you do. 

I’ve written about this before…for the first few years I felt my colleagues were surpassing me. They were doing more advanced cases and utilizing what they were learning at Pankey and Dawson. I had purchased a tiny practice filled with patients who valued dentistry when they were in pain. I aspired to do more than fill cavities. Sometimes I thought I would have to give up on my dream. But I kept talking with my patients, building relationships, raising their awareness, and eventually they began accepting treatment. I had to stay hopeful and employ the behaviors I was being mentored to employ before I could employ my advanced clinical skills.  

I learned a lot about people, not just dentistry, in my early years. I look back upon the experience with fondness now. 

By Mary Osborne, RDH  

Think for a moment: Is there a change you think you could make in your life that would contribute positively to your health? Is there anything you could be doing—or not doing—that could improve your overall health and wellbeing? Most of us can think of something we could do, or do more consistently, to improve our health. Next, ask yourself if the reason you have not made the change you need to make is because you do not have enough information. Our clinical training taught us that if we give people the right information they will change their behaviors. It’s easy to get disappointed in ourselves and our patients when that turns out to not always be true.   

Reflecting on our own past and current health challenges is a way to remind ourselves that health is a journey, not just a set of strategies. What makes perfect sense to us now, may not have been relevant 20 years ago. Often we have heard the relevant information before but were slow to act on it. We may have conflicting priorities, such as time, or money. We may have had fears or doubts. When we can look at our own journey with understanding and compassion we are better able to see our patients that way.   

I remember a patient who came to us with a lot of dentistry that needed to be done. As we talked with her about recommendations for treatment, her eyes welled up with tears. “It’s nothing,” she said when I asked her what the tears were about. Eventually she shared with us that she and her family had been saving up to build a deck on their house. Doing the dentistry she knew she needed would mean they could not build the deck. There was a time when I might have thought, “What’s more important, a deck or your dental health?!?” But I was moved by her struggle. I can’t judge what a deck may mean to her and her family, but I can relate to her sadness in letting go of something they had been saving toward.   

As you advise patients, it’s helpful to share that are you on a path to better health yourself, and that it is not always easy. In this way we can step outside of the role of “expert” and come to our conversations as fellow travelers. And when we do come as fellow travelers, we bring our empathy, our humanity, and we allow ourselves to feel compassion. We are likeable.  

One of my favorite books is Dr. Rachel Naomi Remen’s Kitchen Table Wisdom: Stories That Heal. She quotes the psychologist Carl Rogers, who said:  

Before every session, I take a moment to remember my humanity. There is no experience that this man has that I cannot share with him, no fear that I cannot understand, no suffering that I cannot care about, because I too am human. No matter how deep his wound, he does not need to be ashamed in front of me. I too am vulnerable. And because of this, I am enough. Whatever his story, he no longer needs to be alone with it. This is what will allow his healing to begin.  

Because we are on a journey of becoming healthier just like everyone else, we can sit side by side with a patient. We can say, “I get it. It’s not always easy.” We can allow ourselves to feel compassion—that urge to genuinely help someone, and gently invite them to understand they are no longer alone.

When L.D. Pankey returned to Coral Gables from the International Congress of Dentists in Paris, in 1931, knew he needed additional education if he was going to follow his personal commitment of not extracting any more teeth. With a recommendation from his new friend in Paris, Dr. Daniel Hally-Smith, the dentist, L.D. wanted to emulate, he signed up for a three-month summer course at Northwestern University in Chicago.

The program was designed to cover all the phases of modern dentistry including how to interview patients and do a proper clinical tour of the mouth so the student could determine what was really needed to give their patients optimum dental care. They were saturated with topics both technically and psychologically related to diagnosis and treatment planning concepts. Most of the information presented was focused on clinical procedures.

The patient psychology course was taught by George Crane PhD. During that summer, George Crane, a trained psychologist, was between his freshman and sophomore years in medical school at Northwestern. He had been hired to teach a summer course to physicians and dentists on how they could better understand and communicate with the patient.

At that time, there were no definitive textbooks about doctor/patient communications. During his lectures Dr. Crane brought in loose-leaf handouts for the class. The handouts later became the framework for his first book on applied psychology. Crane’s course was the highlight of L.D.’s summer, and it turned out Dr. Crane’s course became the foundation of what became the Pankey Philosophy.

Crane’s lectures were centered around psychology to be used by doctors to develop interpersonal relationships between the professional and the patient. The course included an overview of Carl Jung’s work, defining Jung’s four personality types: the introvert, the extrovert, the ambivert and the compensated types. The students also looked closely at the 1905 Binet-Simon Scale to determine the intellectual capacity of children. They studied the first “mental horsepower” test – otherwise known as the IQ test.

Later, when L.D. developed his own philosophy, he used much of the Crane course ideas for his Dental IQ, patient intellectual, sociological, and economic classifications. After finishing the George Crane course, L.D. felt confident that he had taken a giant step toward gaining the knowledge and communications skills that were needed in his practice.

Dr. Crane was a strong proponent of the balanced life and spent a great deal of time discussing Cabot’s “Cross of Life” which emphasized the need to balance work, play, love, and worship for a truly fulfilling life. The cross diagram was developed by Richard C. Cabot (1869-1939), who was a physician, philosopher, and Unitarian minister.

Following his graduation from Harvard University Divinity and Medical School, Cabot started his clinical work at Massachusetts General Hospital where he established a hospital based Social Service Department and became the first Chairman of the Department of Social Ethics at Harvard. Over the years, Cabot wrote twelve books on Medicine and Ethics.

Cabot also became a major educational leader in medicine by publishing monthly “Cabot Cases” in The New England Journal of Medicine. Each month physicians in local study clubs throughout the county would read and study the information provided by Cabot. They would try to determine the diagnosis for the patients in the case. The final diagnosis was provided the following month in The New England Journal of Medicine.

Crane assigned one of the Cabot books, What Men Live By, to L.D. and his classmates to read. The book explored how to achieve personal happiness. According to Cabot, happiness could be achieved by striving for balance in personal life. When explaining this concept to his patients and other professionals, Cabot recommended drawing a simple diagram with Happiness in the middle and four arms labeled Work, Play, Love, and Worship.

What Men Live By was published in 1913 and has long been out of print. Many of the references seem archaic; however, the basic principle of balance has stood the test of time. There are needs for all of us to be productive, to enjoy daily life, to have people in our lives that we care about, and to extend our interests beyond ourselves. An excess or a deprivation of any of these basic needs of life can set our lives out of balance, destroy our sense of self-worth, dull our enjoyment of life, or alienate us from our fellow human beings.

When L.D. Pankey developed his philosophy, he uses the Cabot Cross as a starting point for dentists on their journey to fine personal happiness.

Imagine your life depicted as a metaphorical four-burner stovetop, with each burner representing a major quadrant of your life, and those quadrants being:  

Obviously, there are many times in life, during which by choice or circumstance, we find our life is severely out of balance, for example, dental school, parenting children, starting a practice, and so on. 

The Four Burners Theory tells us that to be successful in business we need to initially “turn down” two burners to establish an initial beachhead. But frankly, we don’t want to hear that kind of message. Rather, we would rather hear that we can have it all and soon.  

This impatient, short-term mindset has now permeated our culture, even to the point where many people seem to think that somehow “having it all” is their birthright. But viewing life balance as a birthright is a problematic perspective, because it can never be fully realized, and if we cling to it too firmly, it becomes easy for us to start to feel like a victim. 

And victims don’t act. Instead, they blame-shift. They sulk. They over-think. And they fail to act in ways that will move them toward greater life balance. A much more realistic perspective is to acknowledge that our life is full of seasons, around which we need to be aware, adapt, accept, and respond appropriately.