By Gary M. DeWood, DDS, MS 

A Strategic Approach to Patient-Centered Care

At the heart of the Pankey Philosophy is the understanding that optimal care isn’t something we do to patients—it’s something we do with them. Co-Discovery / Co-Diagnosis / Co-Creation. That truth is most clearly embodied in a subtle but powerful concept L.D. Pankey called “the holding program.”

This isn’t about delay or avoidance. It’s about creating space for trust to develop, for biases to dissolve, for patients to feel safe, seen, and understood. When implemented with clarity and purpose, the holding program becomes a key component of a well-defined, patient-centered dental practice.

Holding Space, Not Holding Back

Holding programs provide immediate, stabilizing care for urgent dental needs such as periodontal disease and decay, effectively “putting out fires” to address critical issues now. Comprehensive treatment is then postponed until the patient feels ready to pursue it and actively engages in asking about and discussing all available long-term solutions.

Putting a patient in a holding program defers comprehensive treatment until the patient is ready and the patient asks. It’s an investment in the relationship, marked by listening, asking, reflecting, and clarifying shared goals.

As Dr. Pankey emphasized after learning from Dr. Hally-Smith in Paris, our job is to present the best outcome, the most comprehensive treatment we can offer—what Dr. Pankey called “the optimum,” and then wait for the patient to agree that is exactly what they seek. If they are not ready to go there immediately, we allow them the time and autonomy to decide when (or if) they’re ready to pursue it. In the meantime, we support them with thoughtful guidance and honest feedback.

This approach aligns beautifully with the principles of ethical, comprehensive dentistry. It’s how we honor autonomy, avoid coercion, and create an environment where patients can move forward in their own time, with confidence and clarity.

Why the Holding Program Works for Patients and Practices

• Trust Grows in the Pause: Patients who would benefit from comprehensive dentistry can feel overwhelmed by cost, fear, or misunderstanding. Managing immediate needs is an experiential process through which we both learn. It helps us meet them where they are, while it lays the groundwork for a long-term relationship rooted in trust.
• Better Decisions, Less Regret: When patients feel rushed into care, they often second-guess the result they may have claimed as what they want. When they feel in control, empowered and informed, their decisions become more aligned for them—and they are more likely to be followed through on.
• Higher Engagement, Healthier Outcomes: People who feel respected are more likely to stay connected to your practice, choose to implement care recommendations, remain actively engaged in continuing care, and recommend you to their friends and family.
• More Meaningful Case Acceptance: This longer path may seem less efficient, but when patients choose to act on their comprehensive care needs because they believe in it—not because they felt they “should”—it’s a win for everyone.
• Co-Creation Leading to Visualization of the Optimum Plan: Pankey challenged us to know and visualize the final result before starting any dentistry. We have a responsibility to see and share the best plan for health and esthetics with every patient we get to work with. A holding program can serve to create the framework within which the patient can come to see the ultimate outcome by focusing on first steps and learning that the comprehensive vision is in fact what they are hoping to have for themselves.
• Stronger Referrals: Patients in the holding program often become your biggest advocates. Why? Because they feel heard, valued, genuinely cared for, and part of the practice family.

In a world where patients are inundated with transactional experiences, the Holding Program and Co-Creation approach stands out. It tells them: “You’re not just another case. You’re a person worth knowing, partnering with, and walking alongside.”—Gary M. DeWood, DDS 

The Ethical Foundation of the Holding Program

The concept of a holding program isn’t merely a pragmatic approach to patient care; it’s deeply rooted in ethical principles that prioritize the patient’s well-being and autonomy. When applied thoughtfully, the holding program embodies several key ethical considerations:

Respect for Autonomy: At its core, the holding program champions patient autonomy. It acknowledges that patients have the right to make informed decisions about their own healthcare, free from coercion or undue influence. By offering time and space, it empowers patients to understand their options, weigh the pros and cons, and ultimately decide when they are ready for comprehensive treatment. This respects their self-determination and ensures their choices are genuinely their own.

Beneficence and Non-Maleficence: While deferring comprehensive treatment might seem counterintuitive, the holding program is designed to be beneficent (acting in the patient’s best interest) and non-maleficent (avoiding harm). By stabilizing urgent issues and providing essential care in the interim, the practice ensures the patient’s immediate health needs are met. Simultaneously, it prevents the potential harm that can arise from rushed decisions, financial strain, or emotional distress when patients feel pressured into extensive procedures they’re not ready for. It allows for a more stable and positive path to long-term health.

Fostering Trust and Veracity: The holding program inherently builds trust by demonstrating veracity (truthfulness and honesty). It communicates to patients that the practice values their understanding and comfort over immediate financial gain. This transparent approach, coupled with active listening and patient education during the holding period, strengthens the patient-provider relationship. Patients are more likely to trust a practice that respects their pace and prioritizes their readiness, leading to better adherence to treatment plans when they are eventually undertaken.

Strategy Starts with Philosophy

This leads to a critical question: Have you ever clearly defined the core strategy that drives your patient-centered care approach?

It might seem like a boardroom concept, but in dentistry, especially relationship-based dentistry, strategy matters deeply. It’s why you hear me describe it as performance art.

A thriving dental practice isn’t built on volume; it’s built on values. When you can articulate your values—what you stand for, who you serve, and how you deliver care, you align your team, attract the right patients, and bring consistency to your communication.

Start by asking:

• What is our objective?
  Not just “great dentistry,” but what specific, measurable outcomes are we aiming for in our patients’ lives?
• What is our scope?
  Who are we best equipped to serve, and what kind of care do we want to provide every day?
• What is our advantage?
  What makes our approach uniquely valuable—and why do patients stay, return, and refer?

This clarity becomes your compass. It guides the decision to put a patient in a holding program rather than pressuring them into a plan they don’t yet understand or embrace. It helps your team recognize when to listen more than explain, and when to educate and leave space for the other person to think about the value of a preferred future.

The Psychology of Trust and Bias: Guiding Patients to Clarity Through Co-Discovery

The effectiveness of the holding program is profoundly supported by psychological insights into human decision-making, bias, and the cultivation of trust. When a patient is in a holding program, the goal isn’t just to manage immediate needs, but to strategically engage them in a way that allows them to overcome inherent cognitive biases and embrace care that is truly in their best interest. This is where the concept of Co-Discovery becomes paramount.

Co-Discovery: A Partnership in Understanding: Co-Discovery is a paradigm shift from traditional “diagnose and tell” dentistry. It’s a collaborative process where the dentist and patient explore the patient’s current oral health, their past experiences, their present concerns, and their future desires together. It’s about revealing truths and possibilities with the patient, not to them. This shared journey fosters a deeper understanding for the patient and builds an unshakeable foundation of trust. It is the experience that must precede Co-Diagnosis and Co-Creation.

Understanding Cognitive Biases: Patients, like all human beings, are susceptible to various cognitive biases that can cloud judgment and decision-making, particularly when facing complex or intimidating situations like extensive dental work. Common biases include:

• Anchoring Bias: Over-relying on the first piece of information encountered (e.g., a past negative experience or a perceived high cost).
• Loss Aversion: A tendency to prefer avoiding losses over acquiring equivalent gains (e.g., focusing on the pain or cost of treatment rather than the long-term benefits).
• Confirmation Bias: Seeking out information that confirms existing beliefs and dismissing information that contradicts them (e.g., only looking for online reviews that support their initial skepticism).
• Fear and Anxiety: These powerful emotions can activate “fight or flight” responses, leading to hasty decisions or avoidance, rather than thoughtful consideration.

Staying in the Question

Psychology offers powerful communication techniques to help individuals explore and resolve their ambivalence about change. Motivational Interviewing (MI) is particularly relevant here, emphasizing a collaborative, evocative approach for patient-centered care. MI principles are the very tools through which Co-Discovery is actualized; they enable you and your patients to “stay in the question” while gently guiding them toward their own insights and readiness for comprehensive treatment.

These are tools that I use with my patients every day:

Expressing EmpathyMotivational Interviewing : Acknowledging and validating the patient’s fears, concerns, and past experiences without judgment. This builds rapport and shows the patient they are truly heard and understood, which is foundational to trust and opens the door for genuine Co-Discovery.

Developing Discrepancy: Gently highlighting the gap between the patient’s current situation and their desired future state creates structural tension. In Co-Discovery, this discrepancy can be experienced by the patient themselves as they explore their own situation and values.

Rolling with Resistance: Instead of arguing or directly challenging a patient’s resistance, the practitioner “rolls with” it. This might involve reflective listening (“It sounds like you’re feeling overwhelmed by all of this”) or reframing (“It makes sense that you’d want to take your time to consider such a significant decision”). This disarms defensiveness and invites further dialogue, allowing the patient to maintain agency in their Co-Discovery journey.

Supporting Self-Efficacy: Empowering the patient by expressing belief in their ability to make informed decisions and take steps towards better health places responsibility on the patient. This can involve recalling past successes or highlighting their strengths, reinforcing their role as an active partner in Co-Discovery.

The Power of Socratic Questioning in Co-Discovery

Beyond Motivational Interviewing, Socratic Questioning is a technique that perfectly complements Co-Discovery by encouraging critical thinking and self-reflection. Instead of telling a patient what to do, the practitioner asks open-ended, thought-provoking questions that guide the patient to examine their own assumptions and biases. These questions are the engine of Co-Discovery, allowing patients to uncover their own “why” for treatment:

• “When you look at this image of your tooth, what do you notice about it?”
• “Given what we’ve seen, how do you think this might impact your ability to enjoy long-term health or comfort?”
• “What are your first thoughts about the path we’ve explored today?”
• “If we were able to achieve this [desired outcome], what difference would that make in your daily life?”
• “What have you heard or experienced in the past that might be influencing your current feelings about this?”

By employing these psychological strategies, particularly through the intentional framework of Co-Discovery, the holding program transcends mere waiting. It becomes an active, empathetic, and strategically designed period of shared exploration, education, and self-discovery. This deliberate approach allows patients to process information, challenge their own biases, build genuine trust in the practice and the proposed care, and ultimately arrive at a decision that is truly in their long-term best interest.

A Holding Program with Purpose

The holding program, done well, is not a sales technique. It is a reflection of your philosophy—a way to operationalize your strategy in real patient care. It honors the ethical principles of autonomy, beneficence, non-maleficence, and veracity.

In a world where patients are inundated with transactional experiences, this kind of approach stands out. It tells them: You’re not just another case. You’re a person worth knowing, partnering with, and walking alongside.

That’s not just strategy—it’s service. That’s not just good business, it’s the heart of the Pankey Philosophy.