By Mary Osborne, RDH 

There was a time when I thought “partnering in health” was just about getting people to take better care of their teeth. 

Many years ago, I had a patient who was excellent with her home care, but she showed up periodically with an acute periodontal infection. We asked about stress and her overall health, but she was not aware of any issues. We would treat the infection and she would be fine for a sometime. We knew she worked for National Public Radio, and one day we made the connection that her infections showed up concurrent with NPR’s fund-raising drives. That shared realization allowed us to help her see that her stress was affecting her dental health and her overall health. She was open to conversations about lifestyle changes that would help her be healthier. My relationship with her influenced my thinking and my ability to connect with my patients from a perspective of Whole-health Dentistry. I came to understand that I had been missing opportunities to influence the way people think and feel about health. I knew that I wanted my patients to see me as “a partner in health.” 

Unfortunately, most of our patients come to us with the perspective that we are fixers of teeth, not partners in health. 

In the culture today people are bombarded with information about what is healthy. From friends and families, social and news media, and a wide variety of health care practitioners, everybody expresses opinions on how they are supposed to take care of themselves. Why, then, are we surprised when our patients don’t know whom to trust? Why are we surprised when they shrug their shoulders or appear confused? It’s not always a case of conflicting facts but a case of various perspectives that people don’t know how to navigate. 

Think about where you place your trust. How do you decide whom to trust about decisions—whether it’s about your health, or about your finances, or about how you raise your children? When I ask myself that question, two criteria surface. They need to know their subject and to know me. I want that person to know what it is they’re talking about. I want them to be well informed. I also want someone who knows me, who understands my values. I want that person to have a sense of who I am and what is important to me. 

As we get to know our patients over the years, most of them come to see us as trusted advisors when it comes to their dental health—but fewer see us as trusted advisors when it comes to their general health. If we jump too quickly to making recommendations about their overall health, we are more likely to meet resistance. If we want to cross the bridge into influencing our patients’ overall health and wellbeing, I believe we need an invitation to cross that bridge.   

The Missing Piece in our quest to influence the overall health of our patients is the failure to invite patients to share their perspectives on health. Beginning a conversation with a new patient with the question, “What can you tell me about your health in general?” is an invitation for them to talk about their experience of their health, not just details. Instead of “reviewing” health histories, what if we “explore” health histories? As we connect and get to know each other we can learn to listen beyond information to hear attitudes, beliefs, fears, biases, concerns, barriers, etc. As you understand their perspectives on health issues that come up in conversation, it’s easy to ask if they would like your perspective on that issue. These conversations often lead to more questions and answers that invite more and more invitations from our patients to be their partner in health. 

More dental leaders are blogging on the subject of leading dental patients to improved health by learning what is important to them. Often, the next words we read are “We need to meet patients where they are.” What exactly does that mean???

To me, this doesn’t mean we meet expectations of low cost, faster care, with immediate results. This doesn’t mean we make promises that all their dental needs are met for the next six to twelve months. It doesn’t me the therapy we provide will solve an incipient or chronic problem for life. It doesn’t mean their insurance coverage dictates the value of the care we deliver. It doesn’t mean we are going to open our office after hours or on the weekend because that’s what someone wants. It doesn’t mean we guarantee a crown or veneers will last and never need to be replaced.

To me, this means understanding the individual patient, not patients (plural) as a population with trending, new expectations in 2022. It means focusing on the things each person thinks are important and relevant to their lives…where their priorities lie. Then, we can attempt to strategically tie what they value to their dental health to help them make a connection to a preferred future self. Most people, it seems, are unable to make these connections on their own.

Two Big Questions We Ask Ourselves

What do our oral health findings–ideally uncovered during a co-discovery exam, mean to a particular person? If our findings don’t have meaning to the patient, how can we possibly motivate the patient to take action? All of us struggle with these types of questions because we can’t force our values, our philosophy of oral health on others.

We can, however, create opportunities to reveal a pre-existing, unrealized value of health the patient has. If we find the patient is not health-centered, we can triage that person appropriately so we spend most of our time with patients who are health-centered.

“Revealing” Unrecognized Value Takes Time

Early in my career, I thought I could educate my patients to see the value of oral health the way I saw it. I found I was often knocking my head against the wall. Some people just didn’t value it. They wanted help when they were in pain, but preventing dental deterioration wasn’t something they felt needed immediate action. Moving forward with treatment was not on their personal agenda.

Gradually, as I read Bob Barkley, L.D. Pankey, Nate Kohn, Jr., and others, I realized they had gone through a discovery process of their own. The first task was to get to know the patient and understand the patient’s value for health and the patient’s oral health objectives. It was also to try to discover if their oral health circumstances were important to them so I could help them envision their preferred health future. But that takes time—time with each patient.

If your practice is primarily insurance dependent, you are underpaid most of the time. How do you compensate for this problem? You find ways to work faster. You find ways to see more people in a day. You delegate more. You look for a way to cut your lab technician’s salary out of your life. You buy in bulk and wake up in the middle of the night wondering why you got into dentistry in the first place.

It doesn’t have to be that way!

Many years ago, when I began spending time with new patients to learn if they are health-centered, I was able to better manage my time with them. If they valued health…if I could connect them with their dental needs on a deeper level, then spending even more time with them was well worth it.

Those who value health are the patients we can easily help understand why we take our comprehensive approach to restoring and maintaining optimal oral health.

You can be more productive per hour than you can imagine, IF you take the time to connect with patients on a deeper level and you strategically find ways to spend most of your time with people who care about their health in the first place.

L.D. Pankey wisely said, “People change, but not very much.” And that’s a critically important life lesson, one that took me years to accept because I thought my philosophy would psychologically trump theirs, and I would therefore win the day. I was wrong – very wrong.

When we have experienced a deeply traumatic event, such as an emotionally laden death, or the near-death of a family member, what is often left behind is emotional debris with the potential to follow us around indefinitely. Subsequently, we can become haunted by memories of what happened, or what we should have done to make things better. These kinds of recurring thought patterns can easily bleed over into our daily lives and negatively influence our behavior—and our future.

On a neurobiological level, this occurs as our brain is designed to keep self-preservation as its highest priority. Thus, possessing the ability to quickly recall traumatic events protects us from similar things happening in the future. But commonly, this constant re-remembering can lead us into a state of psychological paralysis, depression and/or chronic anxiety, and poor decision-making.

At the present time, many patients live in fear of going to the dentist, because they believe there is too high of an infection risk. Concurrently, they consider the process of addressing their dental needs as being a lower life risk. These shadows of fear can remain strong in their mind, particularly when they have a family member who is in a high-risk category. Simultaneously, some dental team members have made the decision to leave dentistry for similar reasons. However, both challenges are happening at significantly lower rates within relationship-based / health-centered dental practices, as these practices have already built strong, enduring bridges of communication within their patient pools.

The Shadow

A contagious virus is a concept most people understand. The level of anxiety this virus has generated world-wide is something many cannot successfully manage alone. We have all had patients whose past dental experiences were so negative and their thinking about it so distorted they cannot recall why certain situations trigger their dental PTSD. Carl Jung referred to the source of these recurring thoughts as “the shadow.” Buried memories and their emotional associations can be so strong that they take complete control over a person’s behavior.

Letting Go

The brain does not stop maintaining its focus on traumatic memories until it has come up with a rational explanation for why they happened and a plan for how to avoid them in the future. On this, Jung stated, “Until you make the unconscious conscious, it will direct your life and you will call it fate.”

CoDiscovery was designed to address the influence of the shadow’s influence on current behavior patterns, in much the same way as psychotherapy facilitates the exploration of the past and associates new meanings with those memories. It is intended to help patients associate new meanings with what they are learning about their dental past.

The “Rogerian” therapy model of unconditional positive regard, congruence, and non-judgementalism is an ideal format for patients to safely explore their fears, beliefs, values, and priorities. And that’s why Bob Barkley and Nate Kohn, Jr., Ph.D., leaned so heavily on Carl Rogers’ work. Bob Barkley put this re-experiencing process under an umbrella he called, “Three Phase Adult Education,” and the rest became history.

The Future

As optimistic as the future appears to be regarding the successful management and treatment of COVID-19, this pandemic experience has reshaped our thinking—our “shadows,” forever. How we manage these memories, conscious and subconscious, will have a lot of influence on our success going forward. If we demonstrate we are on the same side as our patients in preventing COVID-19’s negative impact, we create yet another strategic advantage we can leverage against our transaction-oriented competition. On the other hand, if we allow our patients’ fear-driven “shadows” to drive their decision-making, we will rue the day we allowed this proverbial cart to be placed in front of their psychological horse.

Bob and Nate had it right. CoDiscovery is the pathway to deeper understanding, hence better decision-making. And better decision-making is exactly what our profession needs right now.

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.