According to a recent survey released by the John Templeton Foundation, people are less likely to feel or express gratitude at work than any other place. And their feeling of appreciation toward their current jobs, ranked dead last on their list of things they are most grateful for.

Oddly, this outcome isn’t because people don’t crave receiving gratitude at work. Ninety-three percent of those surveyed agreed that their bosses are more likely to succeed if they expressed gratitude more often, and only 18 percent thought that expressing gratitude made their bosses “weak,” or hurt the organization. Additionally, the majority surveyed reported that hearing “thank you” from others at work made them feel better about themselves and more motivated.

So, What Gives?

Why is something which is so obviously appreciated and helpful so frequently withheld? Why do Americans actively suppress gratitude at work, even to the point of robbing themselves of happiness and all its benefits?

The answer lies within the nature of our “reptilian” brain which lies buried underneath or logical neocortex. Our brainstem, midbrain, and limbic system are constantly surveying the environment to determine if we are safe as well as where we are within our tribe social status-wise, as well as how our tribe ranks relative to other tribes.

As a result, we are slow to give support and appreciation to others because it might change the organization of our social structure in such a way that we might personally lose out. Another way of saying this is that we are all built on a neurobiological level to be inherently selfish.

Overcoming Our Silence

The role of gratitude in dental practice should be a positive, intentional one that makes every single care team member feel values. When they feel good about themselves and their contributions, performance will rise. To this end, we must consciously work at overcoming our tendency to remain silent and ignore other people’s contributions and exceptional performances. And how can we do this?

1. Make gratitude part of your practice culture from the top down. One of the biggest takeaways from research on workplace gratitude is that your care team needs to hear “thank you” from the doctor regularly. This is because it’s up to the people with the most social, political, and financial power to clearly, consistently, and authentically thank, in both public and private settings, those who have helped their status. In other words, we need to lift everyone else around us. Rising tides should lift all boats.
2. Gratitude should also be built into your performance reviews and staff meetings, where time can be allocated for each person to say “thanks” to others on the team for being thoughtful and pitching-in at critical moments.
3. Thank those who seem to never get thanked. Thanking those who do important, but easy-to-take-for-granted work is key. Your office cleaning crew, your UPS delivery person, the mailman, your accountant… You get the picture. These simple gestures improve morale and increase trust, and therefore increase performance.
4. Aim for quality thankfulness, not quantity. Forcing your team to be grateful to one another won’t work if they’re harboring resentment and other unresolved issues which remain untouched. Hence, forcing gratefulness as a strategy is not “cultural,” its superficial and doesn’t work. Instead, it can feed upon the power imbalances which undermine gratitude in the first place, and therefore make expressions of gratitude feel inauthentic.

The key is to create times and spaces that foster the voluntary, spontaneous expression of gratitude such as morning huddles and regular team development meetings.

Many of you are already doing these things, but are you doing them frequently enough and with the right intentions?

In Seth Godin’s blog, he writes:

“In all markets, the market leader gets an unfair advantage. That’s because casual and unsophisticated customers choose the leader because it feels easier and safer. The strategy then, is not to wish and dream of becoming a big fish. The strategy is to pick a small enough pond. By engaging with the smallest viable audience, you gain the reputation and trust you need to move to ever bigger audiences.”

As dentists in private practice, attempting to be everything to everyone dilutes our value while it simultaneously puts us in direct competition with large DSOs and every other iteration of a business model that has deep pockets, the ability to survive big mistakes, and time on its side.

Instead, we need to know our strengths, make certain they match up well with our target audience, and then relentlessly become better and better at serving our target audience well. That is what L.D. Pankey, Bob Barkley, Peter Dawson, Frank Spear, John Kois, and many other dental leaders did.

None of these people pursued a business model which aspired towards a practice full of undiscriminating patients. Instead, they targeted a small market segment. That segment is composed of those who value improved health, appearance, and function. Avrom King called those folks the “values elite. They helped their market segment on a very high level, and by doing so, they created their future.

Many of us are successfully doing this still. That is how you compete against “the corporates”—you don’t.

Few people have worked as tirelessly to advance the thinking of L.D. Pankey and Bob Barkley as Rich Green DDS, MBA. Recently, I ran across some of Rich’s quotes that truly capture the nature of his experience in dentistry.

A behaviorist’s definition of learning is changed behavior demonstrated. As my personal growth allowed, I relaxed and thought more about creating an experience in which my patients had the opportunity to learn something, which would challenge them to change behaviors that had negative impact on their life and health. The more I looked at those “learning moments,” the more they appeared. The learning occurred as I helped patients clarify what was most important to them and what they wanted to learn. As I facilitated a learning process with my patients, they were able to discover for themselves those two things, and then they were able to take their own steps in personal growth…People tend to support what they help to create.

Below Rich is speaking of his long-term work with Don Clifton and The Gallop Organization.

As we studied the uniqueness of individual private practices, one finding was the tendency of a dentist and team to unwittingly create barriers to the patient’s progress when what they really wanted was to create pathways to greater health. The barriers were typically caused by an impatient or judgmental attitude and the “teach and tell” method of attempting to change behavior.

In this last passage, Rich speaks to the central theme Bob Barkley taught across the country following the publication of his book, Successful Preventive Dental Practices. In the mid 1960’s, Bob worked closely with Nate Kohn Jr, PhD to dramatically reorganize how he interacted with his patients. In so doing, he largely abandoned what Rich refers to here as “teach and tell,” in lieu of what Bob called “CoDiscovery.” Because Nate Kohn, Jr. had his PhD in Educational Psychology, he exposed Bob to the latest thinking in learning science – and much of it had been influenced by the work of Carl Rogers, PhD.

It fascinates me that we can now go back and understand how all of this evolved, as well as why Bob chose to do things in a very specific way. Perhaps most important is how it all evolved through the hearts and missions of both Bob and Rich. And this last point is key, because if the motivation behind a person’s use of CoDiscovery doesn’t emanate from their heart, from a deeply sincere desire to help others grow and realize greater health through that growth, it won’t work. Instead, it will be perceived as being manipulative and thwart the desired outcome.

The “unwittingly created barriers” will block the passage of the relationship to the next interpersonal level — the level necessary to establish enough trust to proceed to the needed care. CoDisovery is an intentional practice, born out of a personal philosophy toward life and practice. This heartfelt way of interacting with others sometimes feels slow, but it is the fastest way I know to truly help others.

If I were to select one word most strongly associated with a successful relationship-based, health-centered practice, it would be the word growth.

What kinds of growth? The kinds I am thinking of are growth in knowledge and growth in sophistication of attitudes toward people and dentistry. As I meditate on this, I am enlarging my hope for and commitment to fostering personal growth … interpersonal growth … care team growth … patient growth … and, of course, practice growth. I welcome you to come along with me as I breathe fresh energy into leaving 2020 behind and growing in 2021.

Notice I didn’t mention a single word about teeth or techniques. I didn’t mention a word about technology, or what you must physically own to achieve growth. And that’s because growth isn’t a material thing; it’s a spiritual thing.

Growth can be promoted, or it can be impaired by the way we think, and consequently the things that we do and say day-in and day-out. And what we do repeatedly is driven by what we believe … what we believe about ourselves … what we believe about others … and what we believe about the purpose of dentistry.

What is your purpose in dentistry?

Each of us have a purpose that is driven by our philosophy … our world view … our perspective of things … and therefore what it all means to us. This changes as we grow in knowledge and sophistication of attitudes.

Avrom King said that it all boils down to these three questions:

1. Who am I?
2. Why am I here?
3. What is it that I am trying to achieve?

All three of them are philosophical questions, and all three lead us to answers which directly influence almost everything else. If we do not understand who we are on a values and beliefs level—what Mac McDonald likes to refer to as “the deep structures of ourselves,” we cannot predictably lead ourselves in any desired direction. And as a result, we cannot predictably lead others in a desired direction either.

Growing with Purpose

Growing with purpose requires Hope and Agency. If we do not hope for something of greater meaning to ourselves and we think we have truly little personal agency, we flounder.

In a world where we believe we have minimal personal value, everything around us starts to look scarce, and everything around us starts to look scary, so we’re tempted to take short cuts. We’re tempted to just grab what we can get for ourselves as quickly as possible. After all, who knows what tomorrow will bring? If we “stay on shore” with feelings of disempowerment and a little too much wine and whining, we ultimately achieve very little with our lives.

If we “stay on shore,” we will attract others who similarly think and behave. Like attracts like. Avrom King liked to call this “King’s Law.”

We tend to create our practice in the exact image of what we believe about ourselves, and consequently, that could be some version of heaven or hell. All of this happens because we choose to grow or to not grow.

Growth requires hope, courage, attitude, energy, and action, i.e., self-determination and self-control. Talk is cheap, so what will you do to master these? Surround yourself with a vision of your preferred self … your preferred career … your preferred dental practice. Acting on that vision leads to a next step and a next. In doing this, you will attract “likes,” and this positive reinforcement will help keep you on the road of your personally purposeful life. How much growth is happening in your practice today?

Can you see the green shoots of enthusiasm and creative change all around you, evidence of constant renewal? Or do you see an ossified structure struggling to maintain the status quo? Are you surrounded by people who are down, frustrated, and thinking that they have no other choice but to keep plodding on as they are?

Who are you?

Why are you here?

What is it that you are trying to achieve?

Philosophy Matters.

And that’s why L.D. Pankey, Bob Barkley, and other of our dental heroes constantly talked about it.

L.D. Pankey famously said, “People change but not very much,” and hearing this for the very first time represented an “aha moment,” as it put into proper context an important realization I had previously ignored.

As dentists, we know a lot, and we have worked very hard to acquire that knowledge. As a consequence, we naturally want to use it to help others. But there’s a problem. Often times others act like they don’t want to be helped. Often times others act like they don’t want to be better. Often times others act like they don’t want to map a course toward a higher level of health. So, we struggle to make sense of it and even judge others as a result of it.

Developmental psychologist Jean Piaget, PhD told us that the motivation to change comes from within the individual, from their perception that they’re in a state of “disequilibria,” wherein what they’ve been doing in the past (including what they believed to be true) isn’t producing the outcome they want. And as a consequence, the person is confronted with an uncomfortable truth. They can’t keep on doing what they have been doing and expect a different outcome. They’re going to have to suffer through some personal change if they sincerely desire to experience something different in their life. And executing the change is going to cost them something namely time, energy, and money. In other words, significant change can’t be done for them or to them. It’s an “inside-out” process that they will have to do for themselves.

Some people will look at their need to change and ignore it. They will say to themselves the cost is too high for them to pay, or they will simply rationalize away their need to change in an elaborate form of denial. Others will immediately confront the challenge, learn what they need to know, figure out a way to pay the price, and move on. So, what’s the difference between these people?

Perception… values… readiness.

What Can We Influence? 

In our world as dentists, we can build up a person’s understanding of their situation through CoDiscovery, and therefore we can facilitate how they frame, prioritize and think about what they have learned. But we can’t make them change. We can’t cause them to act. We can only honor where they are with it all and stand ready to assist them when they are ready to move forward.

Significant change often requires a change in a person’s value structures and the hierarchy of those structures. Piaget called changes of this type “accommodations. Piaget said that they are made at the person’s own pace after the person senses that he or she is in a state of disequilibria. And so, Dr. Pankey was right. Those who change do so not because we are highly skilled at “case presentations.” They do so because they want to, and it may occur only a little bit at a time.

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.

Seth Godin recently asked, “What are the symptoms of a marketing problem?” and continued… 

We have a ‘marketing problem’ when: 

• There are people who would benefit from your work who aren’t engaging with you. 
• There’s a change you seek to make in the culture, but it’s not happening. 
• You’re having difficulty persuading other people of your point of view. 
• The service or product you make isn’t resonating with those you seek to serve. 
• You’re fighting in a race to the bottom, and it’s wearing you out. 

If you have a marketing problem, how much time are you spending working on a marketing solution? …You can’t solve your marketing problem tomorrow by simply repeating what you did yesterday. 

At the Root of Your Problem

Broaden your thinking and consider what is at the root of why you aren’t doing more of the dentistry you want to do and building a larger base of patients you enjoy. There are two primary reasons why dentists fail at meeting their desired practice goals: 

1. They’re not very good at delivering on the promise, and therefore aren’t getting very many internal referrals and excellent digital reviews. (Marketing doesn’t solve this. Other things do. This isn’t really a marketing problem, is it?) 
2. They are not well known in their community for being the genuinely caring and “honest” type of dentist that patients crave most. And they are not well known for being the perfect fit to compassionately and predictably solve complex oral health problems to significantly improve quality of life.  (Marketing can help solve this, but how?) 

Resolving Your Problem

Most dentists naturally focus on developing their skills and then struggle in the shadows with an amazing skill set that few people seem to appreciate. How do you best approach resolving issue #2? That depends on what it is that you’re trying to achieve. What is your purpose? And what are the principles and philosophy that stands behind that purpose? Because it’s your principles and philosophy that you need to be promoting and projecting out into the public sphere, not just the flash…not just the “how to”…and certainly not the doctor dancing around the office and bragging about how great he or she is.  

Patients need to be genuinely impressed and more than satisfied so they spread high praise in your community. You and your entire care team need to give them things to talk about…what it is different about your approach….the relationship they have with you…the experience they have in your office…how well they are informed…the excellent results they enjoy…  

Clearly speak about your principles and philosophy in mindful, emotionally intelligent conversations with patients. Clearly write about your principles and philosophy of practice on your website. Listen and read “well” what patients say about you. What do they love? This is significant content for your website, blog and other external marketing.  

It comes down to: What is it that you can do that is deeply significant to your target audience, and how can you best convey that information and feeling to them on a consistent enough basis that they want your care?  

The foundational, solid relationship you build with them using highly attuned emotional skills will support treatment acceptance congruent with what they value and congruent with what you explain is in their best interest to meet their oral health and smile objectives. 

That’s what marketing is about, and it is both an internal and external process that must be constantly fine-tuned and consistently evolving within yourself, within your interactions, and within your messaging inside and outside of your practice walls. 

Life is a lot like a game, it’s a series of physical, emotional, and financial interactions with our environment and others. Sometimes we “win,” and sometimes we “lose.” And sometimes all we can do is just learn, so that the next time a similar situation comes around, the outcome will be more favorable for us. In this context, we can also view life as a series of negotiations… negotiations with ourselves, negotiations with others, and negotiations with our environment.

On this, psychologist Jordan Peterson, Ph.D. states: “You can’t negotiate from a position of weakness. You need to understand that if you want to advance your career and yourself you must negotiate with others. And this is because, even if you are competent at what you do, but you remain silent, you will be ignored. So, in the grand scheme of things, what you can do will not even be considered. You will just be a part of the background which is keeping everything functioning for everyone else.”

To develop ourselves, and to become successful, we must, therefore, be both competent AND strategic. We must be able to say to ourselves and to others (directly and indirectly), “This is who I am. This is what I believe. This is what I can do to make your life better, easier, or more fulfilling.” But that kind of posture, that kind of clarity, and that kind of purposefulness, is only useful within the context of a helping relationship, where the meaning of “better,” “easier,” and “more fulfilling,” can be discussed and negotiated.

In the posture of a helping relationship, we are in a position to make a better offer than doing nothing. Truly helping relationships with our patients require personal power, and personal power is both principle-centered and reciprocal, as the power actually comes from the other person and their belief in us.

In situations where we have no personal power, because we have not or cannot establish a truly helping relationship, we rely on other means to advance our agenda, such as leveraging convenience, emotions, pride, deception, loyalty to a third party, fear, and so forth.When we do this, our principles are lost, as is the greatest potential for the other person to believe in us.

Remember, you have the personal power to continually reassess relationships with patients and choose whether or not proceeding with a relationship in its current form is helpful. Helping the other person have personal power… creating experiences that earn trust… choosing to manage relationships with our patients first… then, offering true help and discussing why it is better… this is the path that positively influences everything else downstream.

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. 

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.