By John C. Cranham, DDS  

Sometimes you can see clearly where you want to go with your dental practice. I can vividly remember driving my car to St. Petersburg for my first class taught by Pete Dawson. It was 1989. When the class was over, I drove my little car all the way back to my 800-square-foot office in Portsmouth, Virginia, and arrived at four o’clock in the morning. I had just bought the office from a doctor who did mostly silver fillings—maybe only four crowns in the entire year. I remember I could visualize what I wanted to do with “my” practice but deciding the first steps was overwhelming.  

A dental office can be the loneliest place in the world. I had to figure out the attainable steppingstones. We didn’t have the internet back then. Finding mentors and connecting with supportive, sharing colleagues was more difficult. In dentistry today, it’s easier to find those steppingstones. One of the most rewarding things I do today is helping dentists develop. 

I caution dentists to not assume they will achieve their big goals fast. There is a temptation to give up when progress is slow. You’ve got to stay on the path to get to where you want to go. Think about your goals and steppingstones every day but be kind to yourself if it takes more time than you visualized.  

Remember that everyone is different. All your buddies are going to be in different cities, different socioeconomic areas, and different practices. They’re going to have different opportunities. Social media can be your enemy when it comes to self-confidence and determination. There will be certain people that develop faster.  

I can remember being very frustrated the first year or two in my little town of Portsmouth. There were dentists going through the same classes I was and were already doing the kinds of cases that I wanted to do but wasn’t doing yet. During the first two years in practice, I sometimes wondered if I would ever do the kind of dentistry I wanted. But I kept in conversation with my patients, eventually they began accepting treatments, and the floodgates finally opened.  

One of the greatest things about this profession is we can always strive to be great. I don’t think I’m there yet. It’s the striving part—the working at it and seeing things improve that makes it so fun and rewarding. I love it.  

People ask me, why are you setting BHAGs at this stage in your life? You’ve already accomplished so much. Why are you totally reinventing your practice systems? Why are you going fully digital after practicing on analog articulators for 35 years? 

What I’ve been able to do in dentistry is constantly reinvent myself, and I feel like I am growing in what I can do. So, I say it’s because reinvention is awesome. It’s fun. And my staff knows that if I get something working well, I’m going to find a way to make it even better tomorrow. 

By Paul A. Henny, DDS 

How are you doing in your quest for a “positive” life? 

Martin Seligman PhD spent most of his career at the University of Pennsylvania advancing the concept known today as “Positive Psychology.” He states that Positive Psychology is “the scientific study of what makes life most worth living.” Along the way, Martin identified five core elements highly associated with psychological well-being and happiness. He believes understanding these five elements helps us to create more fulfillment, happiness, and meaning in our life. 

In Part 2 of this two-part series, we’ll pick up where I left off with the third core element in Seligman’s model. 

R – Relationships 

Relationships and social connections are essential for the creation of meaningful lives. Human beings have been social animals since the earliest of times, hence we are hard-wired to bond and depend on each other. That worked particularly well when we functioned in small social units or “tribes.” The tribal unit allowed us to easily ascertain who was friend or foe. It also allowed us to know who to pay attention to, ignore, and with whom we should invest our time and energy. 

In our modern-day world, the historical notion of tribes has largely been broken and replaced by sub-sects of people who are clustered together around common interests, agendas, and values, brought together in new and different ways. Social media now connects people from around the world in ways we never could have imagined 20 years ago. So, this has created a situation where we don’t know our neighbors, but we do know intimate details about our friends in Australia, Tampa, and Kansas City. 

Since we are less tribal in the historical sense, we have lost our ability to easily trust those who are around us, as we can no longer assume they share our values and priorities. That is WHY the relationship-based practice model is so valuable today.  

The relationship-based practice model is a vehicle of connection that can be used to co-discover our similarities as well as areas of disagreement. Alignment of values, goals, perspectives, and efforts are key to successfully advancing health. Strong interpersonal relationships are the key to the door which opens up all of those possibilities. 

M – Meaning 

Some people work to live, while others live to work, with the latter meaning that a person has been successful at merging their life purpose with their daily work. And when work becomes meaningful on a deeply personal level, it evolves into becoming much more than just a “job.” 

With the ever-expanding discovery of connections between oral health and whole health, dentistry now stands at the forefront of a huge new opportunity – the opportunity to help others to grow, develop, and maintain whole health over their entire life  

A – Accomplishments 

Living a values-driven, purposeful life, integrated with how we practice, aligns ourselves with the achievement of deeply meaningful accomplishments on a daily basis. Helping others in deeply meaningful ways, and then being rewarded with appreciation and appropriate compensation, establishes a self-sustaining cycle, and a successful model for living.  

That’s why you will commonly see relationship-based dentists practicing into their 70’s. Their sense of purpose as they continue to accomplish meaningful work is what motivates them to return to the office and continue striving to help patients, coach younger dentists, and create an-ever-happier positive environment. 

An Easy Acronym to Remember: PERMA 

A great to start your day might be to remember what each letter of PERMA stands for: 

• Positive Emotion 

• Engagement 

• Relationships 

• Meaning 

• Accomplishments 

How will these five elements of Seligman’s model fit into your quest for a sense of wellness and happiness today? How will these fit into your quest to serve and help others? 

By John C. Cranham, DDS 

Even today, after decades into family life, dental practice, and continuing dental education, I sit down every January to outline my BHAGs (Big Hairy Audacious Goals) for the year. I block out the first Monday after Christmas to do this, but for the previous month, I’ve been thinking about what new goals will excite me most. I commonly do this type of thinking while I am exercising and driving.  

It’s during these alone times that I can intentionally mull over the things I could do next. I pay close attention to which possibilities excite me most. Oftentimes, these are goals that I feel will benefit others. 

Successful people have the ability to create daily behaviors that direct themselves towards their goals and take them forward on steppingstones. One of the simplest, yet powerful things I witnessed Dr. Pete Dawson do is how he started each day. He would go to his desk and spend 15 to 20 minutes writing six things on a 3×5 card. These weren’t a To Do list. These were six things that would direct him toward his next BHAG. He would place the card in his breast pocket. He did this day in and day out. 

Two weeks before he passed, Pete came to my lake house on oxygen. When he arrived, I had to help him out of the car and into the house on his walker. I looked at his shirt pocket, and there it was, the 3×5 card.  

We don’t have to use 3×5 cards to make notes for ourselves. We can use our phones. But it is powerful to reflect daily on steps that will take us in the direction we want to go and record those steps to lock them in our memory.  

In dentistry, we need to carve out habitual time to think about our goals and steppingstones. We need to carve out time to take the identified steps. The point is to have a system in place where you are thinking about it every day, because there is so much coming at us all day long that we are at risk of drowning in the noise.  

When we get caught up in the mundane, life is less interesting and less fulfilling. At least that has been my experience. When you sense you are becoming bored, you might just need to identify the next big goal that excites you. The challenge of getting there will bring you back to full life. 

By Paul A. Henny, DDS 

Martin Seligman PhD spent most of his career at the University of Pennsylvania advancing the concept known today as “Positive Psychology.” He states that Positive Psychology is “the scientific study of what makes life most worth living.” Along the way, Martin identified five core elements highly associated with psychological well-being and happiness. He believes understanding these five elements helps us to create more fulfillment, happiness, and meaning in our life. 

One of our Pankey colleagues, Barry F. Polansky, DDS, spent a lot of time and energy studying Seligman’s work. In his last decade in practice, Polansky turned his attention to writing books to help new dentists find wellness and happiness in dentistry. Polansky’s 2017 book The Complete Dentist: Positive Leadership and Communication Skills for Success is an excellent guide to starting and running an effective and meaningful dental practice. 

In this two-part series, we’ll take a look at Seligman’s positive psychology model in relation to how we feel about our work in dentistry. 

Seligman’s Five Core Elements: 

P – Positive Emotion 

This represents a “glass-is-half-full” perspective toward life, commonly called an “abundance” perspective. This positive world view is critical because it has a heavy influence on how the brain functions. Our brain is a memory-driven cybernetic solution-seeking organ, with a primary purpose of creating and supporting a successful life. When our mind is in a positive orientation towards our environment, we are typically in a very observant and creative mode of living. In this mode, we constantly scan our environment for relevant bits of information and experiences that are potentially useful in the advancement of our desires.  

When our desires are positive and life-affirming, we are co-creating our experience: We see and experience to a large degree what we expect to see and feel. That is why having a clarified positive vision and purpose for our life and practice is essential for well-being. 

E – Engagement 

L.D. Pankey famously said, “Know Yourself.” What interests us most? What worries us most? In what circumstances are we most comfortable? Under what conditions are we most productive? What are our personal strengths? What are our habits? What are our triggers? What do we aspire to do? What about ourselves would we like to change? 

We all direct most our attention toward the things that interest us or we fear. And it is what we pay the most attention to, whether at work or elsewhere, that we develop the most while engagement with things of lesser importance wither away. It’s healthy to go into ever deeper relationship with the things we value. Clarifying what we believe we are good at and what we will enjoy is a key first step to successful practice development. 

Defining our values is essential so we know when to keep “first things first,” as Stephen Covey likes to say. 

Mac McDonald is a Visiting Faculty member at Pankey, his 2017 book Unchanging Points of Light: Finding Your Way in the Dark is an example of the positive power of values clarification. 

My discussion of Seligman’s five core elements will be continued in Part 2. 

By Bill Davis, DDS 

During the first two years of the book project, the institute was still at the DuPont Plaza Hotel in Miami. My schedule was simple. I would fly down on the red eye from Detroit Monday night after my practice time and stay at one of the apartments used by the visiting faculty next to the hotel. Dr. Pankey and I would meet for breakfast at 8 a.m. Then, we would go over to a room in the Institute to talk and I would record everything. 

At our very first meeting, I realized why everyone was taken with Dr. Pankey and his philosophy. We sat down for breakfast and started with the usual small talk. Then L.D. looked me directly in the eyes and asked, “Bill, may I ask you a couple of questions?”  

I looked back at him, and I said, “Yes, of course”.  

He then asked, “Do you tell your wife you love her every day?”. 

I was a little taken aback by the question and said, “I think I do”. 

L.D. then said, “You should.”  

From that day forward, I made it a point to tell Pam I loved her every day. If I was out of town, I would always call long distance and now I text her. That question made me realize how important Dr. Pankey felt it was for us to stay closely connected to our loved ones. I am sure that gesture has helped me during my 57 years of marriage to my best friend Pamela.

L. D.’s second question was, “Do you save regularly for your retirement?”

I told him, “Yes, I do. At the end of the year, when all my bills and taxes are paid, I send most of the remaining money to my Merrill Lynch investment account”.  

Dr. Pankey told me that was okay, but not a good way to save real money. He recommended that when I got my paychecks, one from the university and one from my private practice, I immediately sit down and write a separate check for 10% of my total net income for the week and put it in the investment account.  

Then he said, “Live on the budgeted remaining 90%.”  

I realized he was following his philosophy and wanted me to be sure I could take care of my family. Over the years, his advice has been spot-on. These first two questions were my introduction to his philosophy. 

To be continued… 

By Bill Davis, DDS 

My academic goal in the early 1980’s was to be promoted to full professor at the Medical College of Ohio in Toledo. The Dean of the College of Medicine where I worked was my patient. We had been able to do a complete restoration for him using the Pankey Mann Schuyler technique, including the Functional Generated Path. Over the eight weeks it took to do his dentistry, he allowed me to take three hours a week out from his very busy schedule. During our time together, he developed a great deal of gratitude and appreciation for the complexities of restorative dentistry. At the end of his treatment, he told me he was about to retire as the Dean.  He said he wanted to get me promoted to full professor before he left. go beef up my CV for the promotions committee, he recommended I write ten more scientific articles or a book. 

I had no idea what it would take to write a book, but it seemed easier than writing ten more articles. So, off I went to find something to write a book about. The very next week I was at the Pankey Institute, as a visiting faculty member, helping in a C3 class. C3 was the heavy restorative week. The students would equilibrate their models, develop the anterior guidance, do onlay preparations on two opposing quadrants, do wax-ups, and finally cement gold castings.  

Once the student had completed posterior mandibular wax-ups, the visiting faculty would spend most of the night casting the wax-ups into gold in the in-house laboratory. The next day the student would seat the mandibular restorations, prepare the maxillary posterior teeth, do the FGP, and wax-up the maxillary preparations using the stone FGP. The nighttime castings were done by the visiting faculty, and I had volunteered to help with the castings. 

At that time, Christian Sagar was the executive director of the institute. I told Chris I was looking for a topic to write a book about, maybe something for or about the Institute. He told me he had just hired a professional writer to help Dr. Pankey write his philosophy. I told him if there was anything I could do related to the book project, I would be happy to help. As it turned out, Dr. Pankey liked the writer very much, but he became frustrated because the writer knew nothing about dentistry. For example, the writer asked, “What is a facebow?”. This made communication difficult between them. 

It was about a month later when Chris called me and asked if I still wanted to work with Dr. Pankey on his book. I said, “Absolutely.” Again, I had no idea what I was signing myself up to do. The next week, I flew back to the institute for a quick meeting with Chris and Dr. Pankey. We all agreed that I would come down one Tuesday a month and interview Dr. Pankey. I planned to tape all our conversations and then have a local court reporter type them up. I would use the typed transcripts as working documents as we developed the book. 

To be continued… 

By Mary Osborne, RDH 

Dr. Rachel Naomi Remin says, “Doctor, you may know what’s best for the disease the patient has but that’s not the same as knowing what’s best for the patient.”  

It’s difficult to let go of our own assumptions about what we’re supposed to do, how healthy this person should be based on our criteria, and what is the best path forward in every situation. Our clinical training leads us to believe that we’re supposed to know what’s best for our patient. 

There is another quote, from Dr. Albert Schweitzer, which has challenged my thinking about patient care for a long time:  

“Patients carry their own doctor inside.”  

I believe that every one of us has opinions, ideas, and knowledge about our own health. That is the doctor inside. Dr. Schweitzer said patients come to us knowing we have expertise, but “we are at our best when we give the physician who resides within each patient a chance to go to work.” When we do that, we help people become healthier. 

There is a place for our solutions. There is a place for our expertise to show up. But if we slow ourselves down a half step, we are often amazed at the answers patients come up with. They can be downright creative and elegant. The reason they are elegant is because they are their solutions, and patients are more likely to follow through with solutions they conceive. I’m not saying we shouldn’t guide them to understanding the advantages and disadvantages of their solutions and other possibilities that you we know are out there, but we should be open to allowing them to think about solutions and not prejudge their choices. 

For example, if a patient says she or he doesn’t have time to floss, I was trained to say, “Well, don’t you watch the evening news? You can do it while you’re watching the news. Right?” That’s about me having the solution. But now I sit back and say to the patient, “Well, it sounds like you’re very busy. Is there any time at all during the day when you’re sitting, and you feel that you could floss easily?” When I ask the question, they usually have a better answer than the nightly news. It’s a better solution because it’s their solution. They have bought into it at some level.  

In many cases, we see the “treatment” for a problem as we’re seeing the problem. That’s something that we take a great deal of pride in. But when we come together with our patient, sitting eye to eye, we can often come to a much more elegant treatment plan, one that moves us more comprehensively toward our goal of improved health. In between what is and what is possible, we encourage the patient to discover the level of health to which they aspire. We come to mutual agreement about going forward in a certain way to accomplish some things that are bigger and better than just solving “a problem.” 

By Barry F. Polansky, DMD  

An excerpt from Spare the knives…save the dental souls! published in Dental Economics, March 1, 2002 

For many in our profession, the daily onslaught of difficult procedures, rejected treatment plans, assistants who just don’t get it, the end-of-the-month cash-flow crunch and other office “fires” can lead to a fate not unlike the victims of the Chinese torture. 

The ancient Chinese employed a form of slow execution called “The Death of a Thousand Cuts” in which the victim was sliced repeatedly with a knife. Each individual wound was superficial and nonlethal, but the accumulation of hundreds of cuts proved fatal and caused much more pain and suffering than one sure stroke. 

Henry David Thoreau said, “The mass of men lead lives of quiet desperation.” I’ve come to believe that, in dentistry, there are a higher proportion of people in that category than normal. We start our dental practices to give ourselves more life; yet, inevitably, our practices slowly suck up the lives we have. 

Ironically, it wasn’t the dentistry that caused my distress. It was the “business” of dentistry that devoured my soul. All things being equal, I love the clinical side of my profession. But all the problems that confronted me in my practice—social, financial, and physical, during the normal day-to-day routine were overwhelming. The business of dentistry is hard! Unfortunately, I didn’t quite recognize that at first. 

Like many people, I studied philosophy at college, enjoying the sense of order that a well-constructed framework of ideas could bring to an otherwise indecipherable argument or problem. So, when faced with such a myriad of problems in the early days of my practice, quite naturally, I began to search for a philosophy of dentistry that would help me make sense of the issues at play. 

I looked to successful dentists to find my mentors, and, at the time, there were some great ones—Pankey, Dawson, Reed, Becker, Barkley. What I learned was a real eye-opener! I thought the antidote to my woes would be advanced clinical skills; however, these dental gurus were talking just as much about staff management, financial control, and the philosophy of running a business as they were about how to cut a great crown prep! I was surprised, but it made sense. I put these ideas into effect, and my practice turned the corner from that time on. 

Paul Henny DDS

I wrote about this topic last October in The Never-Ending Interview and wanted to revisit it to connect the timeless teachings with my most recent thoughts. Bear with me as I recount some of the history from that previous article. 

Dr. F. Harold Wirth had a very successful restorative practice in downtown New Orleans but he always felt that something was missing until he met Dr. L.D. Pankey and was influenced by his teachings. Dr. Wirth became a missionary for Dr. Pankey’s philosophy of dentistry and life, and he gave Dr. Pankey most of the credit for developing a deeper understanding of people, both physically and emotionally.  

One of Dr. Wirth’s key messages from the podium was that dentists are always presenting the case, even from the beginning of their first encounter with the patient. Another key message was that the patient’s feelings matter in accepting care and the patient interview should be forever ongoing. 

He said, “Every time the patient comes in, you’re doing a presentation. As a matter of fact, I think the interview is forever ongoing. It might only be one word, but every time the patient comes into your office, you should be interviewing them.” 

He said, “Ask questions that have to do with how the person feels. A case history is exploring what happened. An interview is about how they feel! You need to understand the difference!” 

We might ask, “Since I last saw you, have you noticed any changes in your oral health? How do you feel about these changes?” We might ask, “How do you feel about the appearance of your teeth?” or “How do you feel about the restorations we did?” We might ask, “At your last visit, you talked about the possibility of doing ortho; how do you feel about that now?” We might ask, “You mentioned last visit that you weren’t looking forward to Thanksgiving because it was difficult to eat all your favorite foods. Would you feel good about revisiting the possibility of replacing your denture with something more stable?”  

Do you feel better after a long conversation with someone who knows you well on the emotional level? I know I do. Over time, those kinds of conversations cause us to feel more positive and hopeful. They occur when a person gifts us their full attention while making no attempt to judge. And because we experience no judgment, we share more feelings, which leads us into an even deeper level of self-understanding. 

Doctor-patient conversations that tap into how a patient is feeling on an emotional level enable patients to grow in trust and to become more open to the possibilities we offer.  

In her recent blog series, Mary Osborne has encouraged us to journey toward health with our patients as fellow travelers because we all have health issues we hope to resolve. We can make connections over shared feelings and hopes. These connections bond us so we can pursue a mutual, positive goal with our patient.  

What I love and sticks with me from Mary’s blog is that the medical health review during each preclinical interview is an ideal time to check-in about feelings regarding health in general. So, if you and your team are not doing that now, you might want to add a question about the patient’s feelings about their current health. It’s ideal if the doctor or hygienist  asks the question. It may be as simple as “How do you feel about your overall health?” Wait for the patient to think and speak.  

One of my favorite quotes is this: 

Any kind of gesture that pulls another living soul out of despair is indistinguishable from magic. – Michael Xavier, Author 

The medical history review is a prime opportunity to demonstrate we care. Expanding our preclinical interview to routinely ask one or more questions that surface feelings related to health will give us opportunities to touch hearts on a deeper level. This will engender greater trust so patients more readily accept us as partners in their health.  

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.