Emotions can flare up rather unexpectedly. When it comes to our patients, we need to have our antenna up and help them step out of their fight-or-flight mode and dial into a better perspective. 

True Story… 

Recently, I was in Lowe’s and in the “returns” line ahead of me was a man who was attempting to exchange a Sears socket head for his Craftsman socket wrench he had purchased years ago. (Lowe’s has an agreement with the makers of Craftsman tools now that the Sears empire has collapsed, and you can buy Craftsman tools at Lowe’s featuring the same lifetime warranty.) 

The man wanted to exchange his worn-out socket for a new one, in the way he had done in the past at Sears. The socket head likely costs less than $5.00. The dutiful Lowe’s staff started up their standard exchange routine, wherein they attempt to gather personal information so they can track inventory and justify the exchange. The man refused to cooperate and give any personal information. He just wanted an exchange with no questions asked and no receipt required.  

The pitch in his voice rose, as he said, “I’ve got tools older than I am, and I’ve never had to do this before. Are you trying to accuse me of stealing this socket head?” Those of us in the line looked at each other and started to wonder how this happened so fast over such a small item. 

The cashier wasn’t particularly masterful at managing the awkward event. He responded by coldly reciting the store policy. The man then grabbed his socket off the counter and said, “Just forget it. I won’t be buying all that lumber over there on that cart or shopping here ever again.” And then he stormed out.

Everyone working that morning just shrugged and acted as if it never happened, apparently quite adapted to this type of customer behavior. I went on and returned my item and then purchased a few other things, but I couldn’t help but think about what had just happened…why and how it might have been managed better. 

Where Did the Breakdown Occur? 

Oftentimes what we see isn’t what is driving the situation. I think the socket might have been a symbol to this man of the breakdown of his great relationship with Sears. In other words, his anger at Sears for abandoning him was displaced onto these Lowe’s employees.  

Our culture has become coldly transactional, and this was a clear symptom of it. We’ve all seen patients figuratively fly off the handle for small and insignificant things. Back in my insurance involvement days, people wanted to argue with us over having to pay a $5.00 copay. 

Most people who come into our offices are somewhat overwhelmed and over-stimulated, and it is easy for them to conflate and draw the wrong conclusions about what is happening around them. When this happens, we need to quickly help them relax enough to get what they came for.  

What Would You Say? 

I keep thinking about what the Lowe’s cashier could have said to make a difference. Perhaps, “Aren’t those Craftsman tools amazing? How long have you had this socket? Wow! And I’ll bet you use it all the time! We’re so fortunate to carry these amazing tools now that Sears has gone out of business! Can you help me out? My boss needs me to track the store inventory, even when we do exchanges like this. I know this is an inconvenience, but can you share with me your name in case you ever have a problem with this new one?”  

…Thinking on our feet while chairside can be difficult when caught by surprise. I’m grateful that in my relationship based mode of practice, I can amend my policies on the fly, so people come first.   

Cogito, ergo sum is a philosophical proposition developed by René Descartes translated as “I think, therefore I am.” The proposition went on to become a fundamental element of a developing secular Western philosophy. Descartes asserted that the very act of doubting our own existence served as proof that we exist. 

But that’s pretty thin gruel.  

I believe Descartes got it backwards. I contend that he should have said, “I am, therefore I think.” Each of us has been given an amazing gift. In fact, we’ve been given many gifts such as life itself, but I am referring to the gift of thought and contemplation. And it’s a gift which can either “make us” or paralyze us into a state of inaction and failure. 

Success in practice today comes down to one thing and one thing only. Those of us who master the ability to think and solve problems quickly and efficiently with foresight will ultimately win the game, set, and match. The rest will be marginalized, consumed, controlled, oppressed, and limited by third parties. 

Our brains work like an executive committee of three members, each with its own primary purpose, which either work in harmony to achieve great things or which work at counter-purposes on a level that is counter-productive or even self-destructive. 

Our executive committee is made up of: 

1. A primal “reptilian” brain which is focused on very basic functions and maintenance.  
2. A rapid pre-cognitive information gathering, analysis, and response system designed for the purpose of self-preservation, known as the limbic system. 
3. A super-computer information processing system that can take new and stored information, reorganize it and then CREATE things like the Declaration of Independence or the Toccata and Fugue in D minor. It’s called our “prefrontal cortex.” It’s our brain’s CEO. 

How well we are able to coordinate these three aspects of our mind largely defines our future. And that coordination is only possible when we are clear about our central purpose in life and practice. Have you become clear about who you are…what you want for yourself…what you want for others? What are the sacrifices you are willing to make to achieve them? And how will others benefit from it all? These are the kinds of questions that help keep our executive committee on the right course, allowing it to be adaptable, as well as progressive in a rapidly changing marketplace. 

L.D. Pankey taught us that creating a written practice philosophy was the most important step in building the practice of our dreams. Why? Because it puts our executive committee on-task and keeps it there.   

“I think, therefore I am,” or “I am, therefore I think?” Understanding the distinction and leveraging it will make all the difference in the world. 

When the art and science of dentistry are reduced down to primarily being about production and code mining, its spiritual dimension is easily lost. Spend a few minutes on some dental social media sites, and you will quickly see this truth in black and white. 

Dr. L.D. Pankey warned us about this problem.

The key to becoming a truly successful professional isn’t just about mastering the technical skills and endlessly chasing after the siren songs of our materialistic culture. Such narrow pursuits are ultimately hollow and do not represent enough to carry us through life as a fully developed person. And they do not represent enough to carry us through life’s inevitable tragedies and periods of significant suffering.  

Creating a habit of connecting with our patients in deeply meaningful ways, helps us to form the emotional antibodies we will need to carry us through the inevitable not-so-good times, the times when all the money and material possessions in the world can’t solve our problem. These are the times when only love, support, and reciprocated empathy can start the process of healing our wounds. 

Never forget this central truth.

Chasing after the next new and shiny object may not be the best solution for our challenging situation today. The best solution may very well be sitting right in front of us in the form of a deeply caring patient.
 

L.D. Pankey, when talking about the assimilation of knowledge would say, “First you get it in your hands, then your head, and finally in your heart,” meaning objective understanding and competence was only a step in becoming a complete dentist. 
 
This, of course, was a hard message to hear as a young clinician, because after rapidly proceeding through Pete Dawson’s curriculum, purchasing three Denar articulators, and then going on to The Pankey Institute, I felt that I was ready to start practicing as a “comprehensive dentist.” 
 
But unfortunately, most of my patients and the citizens of my berg didn’t get the memo. Most of them just looked at me suspiciously, while others left. Fortunately, a few of them allowed me to perform my “complete exam,” collect study models and take 35mm slide photography. And then, I’d spend hours waxing up cases, and preparing a thorough written report containing all of my findings and recommendations. Finally, I’d make  a “case presentation” appointment and unveil the brilliance of my understanding of complete dentistry–about which I was sure the patient would be impressed and then have no alternative but to say “yes” to my plan for them.

From there, it was easy for me to visualize a completely organized schedule full of people who had said “yes,” and a projected level of income of my choice based upon how hard I wanted to work, and the number of hours I was willing to commit to being at the office. It all sounded so perfectly logical, and it all fits quite well with my left brain driven in the world view of dentistry.

But things didn’t work out that way very often. And since that time, I’ve have spoken and consulted with literally hundreds of dentists who’ve experienced similar frustrations. Many of them told me that they eventually gave up on their effort to try and practice comprehensive dentistry. Others took their practice to near bankruptcy via their determination.

You see, most of us missed Dr. Pankey’s message the first time we heard it, or even after the next two or three times.

We failed to recognize that the concept of complete care also hinged on how each patient felt, what they wanted for themselves, and what the solution would mean to them on an emotional level.

It was only after this difficult realization that things began to improve for me and my practice. The work of Carl Rogers, Bob Barkley, Lynn Carlisle, Avrom King, Sandy Roth, Mary Osborne, and many others, helped me to make some critical adjustments regarding how I was communicating with my patients–and perhaps even more critically– when.

Patient-centered dentistry is just that, patient-centered, not treatment centered.

This means we must first come to appreciate each person without imposing our beliefs and expectations upon them. This is a process that involves feelings first (their feelings not ours) before cognition–and before the discussion of any solutions. We must first be able to grasp the contextual meaning of the dentistry in each person’s life, and by so doing, better appreciate their perspective.

When we become better at doing this, we’ll feel that our knowledge has finally reached our hearts and the hearts of our patients as well. And it’s only at that moment that things will start to become easier and our patient’s behavior more predictable. It’s only at that moment that the “yes” to comprehensive dentistry will happen on a regular basis. 

According to Markus Zusak, author of The Book Thief, he had to rewrite his book 150-200 times until he was happy with it. And he began by imagining the end of the story, then the beginning, then the chapter headings, then the writing…over and over again. In the end, Markus had a New York Times Best Seller, with 8,000,000 million copies sold and a movie deal. 

One might be tempted to view Markus Zusak as an overnight success but knowing what I have just told you allows you to understand that’s not the truth.

So too is the case with relationship-based/health-centered dentistry. The creation of the practice takes years, starting much like Zusak’s book—beginning with the end in mind. From there, each aspect is assembled from finding and forming the right care team, to developing them, and to finding better and better ways to connect with patients: truly hearing them, understanding their struggles, and sensing their desire to feel better about themselves. 

Along the way, you will make mistakes, have misunderstandings, and outright fail. This will prompt you to rethink, revise, and redo. This is the true nature of success. We learn and move upward with better understanding. 

It has been said that the main difference between a vision and a dream is the work involved.

The later requires none. The former’s work never ends. A true vision is a principle-centered thought capsule aching to be validated by reality. It has an inherent truth built into it which must be realized. And as with Zusak, if it takes 200 revisions to make it happen, then it takes 200 revisions. So be it! 

The simple secret to success is the willingness to be flexible and to accommodate new understandings combined with a sheer force of will and perseverance that only a few are willing to make. 

Every message a person tries to convey to another person has two components to it, the content of the message, and the feeling or attitude associated with the content. Both are critically important, as both give context and meaning to the information being shared.  

In some instances, the content of a story is less important than the feelings associated with it.

In fact, sometimes the content may be a complete distortion or a fabrication. Regardless, the person may believe the story because the story has a specific meaning to the person. Consequently, it is critical that we try to catch the full flavor of meaning underlying the story. 

Do they believe that they are going to lose all of their teeth no matter what they do? Do they believe that it is normal to lose all of their teeth? Do they believe that they are not worthy of investing in themselves through dentistry? Do they believe that all dental work fails and is a bad investment? Do they believe that most dentists are dishonest? Do they believe that their problems cannot be resolved?  

To discover meaning, we must respond to the feeling component of their communication:

“You seem really upset about this, can you tell me more about it?” “I can see that you are really anxious, can you help me to understand why you feel this way?” “You seem really frustrated – even angry about what happened. Can you tell me more about it? Do you think you will ever be able to work with another dentist?”  

We are attempting to discover is what their story really means to them. How do they see this story and their current situation affecting them going forward? How important is it to them that they resolve their current situation? Do they even know what their situation really is? 

I was recently rereading one of Avrom King’s essays and stumbled upon the deeply profound statement: “Fear and love cannot coexist; where there is one, there is the absence of the other.” 

I have discussed in the past that the central intention of L.D. Pankey’s interpretation of the phrase “quid pro quo,” was love.

And when I use love here, I am referencing M. Scott Peck’s definition: “The will to extend one’s self for the purpose of nurturing one’s own or another’s spiritual growth.” 

Note, that this definition has a “quid”—the giving of the self, and it has a “quo”—the spiritual development. The “first” (the quid) begets the reward (the quo).  

Dr. Pankey famously demonstrated this “first” principle when he elected to not quote a fee at the beginning of his treatment process, and then at the end of it, asked the person to pay him based on their perceived value of what he had done for them. Think about that for a moment, because to act in that fashion requires a tremendous amount of courage and self-confidence.  

Do you think that you could ever get to a place in your life where you could act in a similar fashion…to give freely of yourself in the very best ways possible, and then risk the possibility that the receiver of that gift might not appreciate everything you have done for them on an appropriate level? 

There is only one reason why Dr. Pankey could do this. He had an attitude of abundance which radiated through everything that he did. And as a result, others believed in him and followed his leadership to discover a better place for themselves. In other words, Dr. Pankey’s love for others led to their spiritual development, which then led to him being appropriately compensated. 

I am not suggesting here that you should stop quoting fees to your patients. I think most people need to know fees (or at least fee ranges) to be able to successfully manage their personal budgets, but I am suggesting that you learn how to give generously on the front end of your relationships with people without an expectation beyond appreciation…because if you can’t earn their appreciation, you can’t really earn your fee. 

Now, back to the Avrom King quote. “Fear and love cannot coexist; where there is one, there is the absence of the other.” You can’t successfully take this risk, unless you, like Dr. Pankey, possess an abundant mindset, so are therefore capable of loving (in the M. Scott Peck sense) your patients? 

That capacity comes from within. We can’t facilitate growth and development in others without simultaneously facilitating it in ourselves. 

I’d like to tell you about my neighbor up here on Bent Mountain. His name is Mike Stockton. He personally designed the house we live in. He drew every line of it and then supervised, as well as participated in its construction. Mike had no formal training in architecture or construction. He just loved it and then studied it long enough to master it. His history is that of an artist.

We are all born with certain gifts and talents.

The key is to discover them, develop them, find ways to connect them with others in a fashion that they will be valued, and then to share them. Of course, applies to dentistry as well. We will only be willing to invest the time, energy, and attention necessary to master something if it brings us joy and satisfaction. That’s the pay-off—the ability to step back and say to ourselves, “That was pretty good, but next time I think I’ll try this instead and see if I can make it even better!”

But that’s not enough to be successful. To be a masterful and successful dentist, you also must be able to connect and inspire others to become better versions of themselves. And that, of course, includes team members and patients alike.

What else do you need?

You need to be able to promote yourself. You must be willing and able to share what you know and can do with others in a way that they feel it will be helpful. And there’s a word for that. It’s called “marketing.” Marketing is not a dirty word if it’s done from your heart and you deliver on your promises. No, let me correct that. You over-deliver on your promises.

When you go into that private coffee shop and they take a moment to create a heart in the froth of your latte, that’s marketing too. That’s caring enough about what you do to take the extra steps that demonstrate you sincerely care about what you are doing and how other’s feel about it.

So, now we have five key things:

1. Gifts and Talents

2. Mastery

3. Inspiration

4. Communicating What You Can Do to Help Others

5. Extra Steps that Show You Care

How others perceive how well you do these five things, will determine your financial future, because people will give you their money in exchange for your gifts, talents, skills, and caring when they perceive that you do the above five things exceptionally well and they benefit significantly as a result.

Passionately practice these things, and you will have a bright future ahead!

While communicating, we can learn to become more mindful of the emotions which are rising up in our body and the sensations we are feeling on an intuitive level. We can begin to notice what has happened that has triggered our initial response, as well as feeling the sensations it has created in our body.

This requires us to remain in a state of curiosity and observation rather than in assessment and judgment. And when we treat these thoughts and sensations with equanimity, we are less likely to react inappropriately during stressful situations.

When I mention staying curious, I mean to approach the experience with the curiosity of a child.

When we remain curious, we are inspecting our experience like a child who has seen a flower for the very first time. This helps take the power away from the strong emotions we might be feeling in that moment. To paraphrase Mary Osborne from this past weekend at The Pankey Institute Annual Meeting, “You are standing on the balcony, and not on the floor.”

This whole mindfulness practice is extremely important as it gives us a chance to hit the pause button.

And when we pause, we’re able to respond rather than simply react. Reactions are often what our limbic brain wants us to thoughtlessly do. And if we have developed an insensitive pattern of reacting over the years, it can lead to regret and suffering. Hence, by developing an ability to pause our limbic brain’s instant impulses, we become more capable of responding in a much wiser fashion.

Mindfulness is at the epicenter of a truly relationship-driven practice.

And it’s a skill which can be developed and enhanced over our lifetime. Hence, it’s at the epicenter of “knowing ourselves” as well.

Viktor Frankl believed the key to the successful creation of a happy and successful life was to aim toward a deeply significant and meaningful life purpose. On this, he commonly referenced Friedrich Nietzsche’s quote, “He who has a Why to live for can tolerate with almost any How.” Suffering is no fun, but suffering for a deeply significant purpose becomes much more tolerable when you know that the end will justify the means.

Loving Others

On love, Frankl said, “Love is the only way to grasp another human being in the innermost core of their personality. No one can become fully aware of every essence of another person unless they truly love them, because by love we are enabled to see the essential traits and features in the other person; and even more importantly, see that which is potential in them—that which is not yet actualized, but ought to be actualized.” So, this begs yet another challenging question: Do we love our patients enough to suffer with them, as well as help them to become more of what they are capable of becoming through our collaborative work in dentistry?

Finding Courage in the Face of Adversity

The practice of true relationship-based / health-centered dentistry represents a counter-cultural decision with regard to mainstream thinking and behavior, as corporate dentistry is rapidly moving the profession in the exact opposite direction. Consequently, dedicating oneself to a truly patient-centered philosophy requires courage, commitment, and perseverance. Additionally, one is likely to experience tepid local support for it, as most peers will be following a very different philosophy – a philosophy focused on what they want or need to get out of dentistry, and not what life expects of them. Regardless, the striving for a cause greater than oneself, allows us to experience more meaning in a month than most corporate dentists find over their entire career.

Regarding Success

Regarding the achievement of material success, Frankl wrote, “Don’t aim for it, because the more you aim at it and make it a target, the more you are going to miss it. For success, like happiness, cannot be pursued; it must ensue, and it only does so as the unintended side-effect of one’s dedication to a cause greater than oneself, or as a by-product of one’s surrender to a person other than oneself.”

Personal Meaning

As you can see, meaning and personal relevance can’t be bought, copied, or transferred. Rather, it’s an inside-out process which must be discovered within ourselves and then refined over time. If this is the kind of challenging, growth-oriented journey which motivates and inspires you, then The Pankey Institute represents the very best place to both begin it, as well as nurture it all along the way.