I’m sure there are many aspects of your work that are really fulfilling, and I’m sure there are aspects of your daily work that you wish could be easier, maybe even less stressful. What about your work brings you joy? What would it take for you to provide your best work? What would it look like? What would it feel like?

I took an informal survey of dentists and hygienists about what they would need to have an ideal day. When I examined the dentists’ answers, I realized the answers would resonate with every member of a dental team.

The top five answers from dentists were:

1. Having the appropriate instruments to provide excellent care.
2. Opportunity to gain knowledge and skills.
3. Excellent performance/execution of their work.
4. Opportunity to implement new learning.
5. Working with patients who are grateful for their care.

All hygienists desired “time to provide appropriate care for each patient.” Specifically, they asked for:

1. Time to select and sharpen instruments for each person and for the specific procedures they will be doing.
2. Time to properly assess each person’s unique periodontal condition, including time to accurately measure gum pockets and recession, minimal attachment/thickness, and to assess bleeding (blood thickness, how much bleeding, and where it is coming from—is it systemic or localized?).
3. Time to explore possibilities with patients regarding their current condition, past condition, and potential future.
4. Time to debrief and collaborate with the doctor to explore the next steps for the patient.
5. Supportive teamwork across the practice to provide the best care.

Speaking of collaborating with team members, I invite you to ask your team members what their ideal day would include. Discuss, as a team, your shared ideals, and expectations. Consider where expectations do not match and discuss why this is and what must change to meet shared agreements.

Understanding and affirming the needs of others will have a positive impact. The exercise of writing down what works, what could be better, possibilities, goals, and a pathway towards implementation of superior supportive teamwork is likely to increase your practice joy factor.

In recent years, dentists, physicians, and the public have become highly aware of the interrelationships among occlusion, oral inflammation, airway problems, and systemic health. As dentists, we’ve stretched our care domain to coordinate patient care across all settings of care. Often, we are dismayed at the growing prevalence of chronic diseases among our aging patients. We want to help improve their lives. We know of ways to do this.

To do our best for our patients, it does matter if the patient has diabetes, cardiovascular disease, sleep apnea, gastric reflux, or poor nutrition. It does matter if we want to be master problem solvers in collaboration with our medical colleagues. Looking for oral and systemic health interrelationships every day with every patient is a basic element of many dental practices. Collaboration with physicians is a basic element of my practice.

Has your approach to patient care extended into at least the first phase of integrative dental medicine? This is the phase of sincerely asking the Why questions and searching for solutions. While I was in practice with Dr. Pete Dawson, for 40 years, I heard him say, “We’re going to ask why about problems until we don’t have to ask why anymore.” He called this “finding a better way.”

The 3 Pillars of Integrative Dental Medicine

In 2019, Dr. Shanley Lestini and I published a book titled The Shift: The Dramatic Movement Toward Health Centered Dentistry. In this endeavor, we were fortunate to have the support and input of two of the world’s most preeminent clinicians and educators, Dr. Peter E. Dawson and Dr. Bradly Bale. It was our goal to influence dentists and medical physicians toward fostering solutions together for their mutual patients in three pillar areas of integrative dental medicine:

1. TMD and Occlusion
2. Inflammation & Infection
3. Breathing and Sleep Disorders

Finding a Better Way Is Up to All of Us

My goal in this essay is to fuel your passion for operationalizing what we all know will make us better doctors – that which will enable us to be truly health-centered dentists. It comes down to relentless curiosity about the causes of diseases, the modalities for eliminating those causes, and how our best “individualized” efforts with a patient will have the greatest positive impact on the prevention, elimination, and management of health conditions that adversely affect their quality of life.

“We’re going to ask why about problems until we don’t have to ask why anymore.” – Peter E. Dawson, DDS

In this era of heightened awareness surrounding the intricate connections between oral health, overall wellness, and the growing prevalence of chronic diseases, we, as healthcare providers, find ourselves at a crossroads. It is our commitment to improve the lives of our patients that propels us forward. Embracing the principles of Integrative Dental Medicine (IDM) beckons us to explore the “Why” questions and seek innovative solutions. Don’t miss your chance to embark on a journey that redefines the boundaries of healthcare with the upcoming course “Integrative Dental Medicine: Creating Healthier Patients & Practices” – for more information visit the course page.

In our office, we routinely take our patients’ blood pressure, and we have a variety of cuffs. Most commonly, both hygienists use one of the convenient, digital wrist cuffs. A few months back, they noticed a trend of higher BP readings than they thought were appropriate. We wondered if the wrist cuffs were giving us accurate readings. We did a little research and I decided to reach out to my own primary care physician to ask her advice.

I learned two important things about taking blood pressure:

1. My physician recommended that we give our patients three to five minutes sitting up in the dental chair, relaxed, and not moving. While pleasant chitchat to reduce anxiety might help, we were advised to steer away from asking any medical history questions and other questions that might produce a bit of anxiety before taking the patient’s blood pressure.
2. One of the challenges with wrist cuffs is that the cuff is supposed to be at the level of the heart. In a dental chair, the patient is likely to rest their arm on their leg unless we instruct them to do otherwise. She advised that we have the patient take the arm that is wearing the cuff and place it across their chest to hold it at the level of their heart. To be at heart level, the hand shouldn’t come up to the shoulder but be horizontal with the elbow.

My physician asked me if we have arm cuffs that go above the elbow. I told her that we have two digital arm cuffs. She said she prefers using the arm cuffs herself because they tend to be more accurate than a wrist cuff, especially in picking up subtle variations.

This great information has enabled us to take blood pressure readings with more confidence and would be valuable to share with your team members who measure blood pressure. 

In your dental practice, it’s important to create a restorative partnership with your assistants, hygienists & front office team. Make the handoff between your team seamless, build a stronger team & create lasting patient connections. Check out our three Pankey Team Courses that are coming up: Team Series. 

A quick, easy way to create a mission statement for your dental practice involves your team. Last year, I called a team meeting to discuss what we want the practice to be like each day for ourselves and our patients. I wanted us to discuss what we could focus on.

We sat around the table in our break room. I asked the team members to take turns going around the table throwing out one word, two words, or a phrase that they felt described our practice. After a moment’s reflection, someone started the process. They had words. They had phrases. They developed whole sentences. And the beauty of this was that I didn’t have to say anything. I just sat there and listened.

If you are asking a team to be part of a mission, I think it is important that you allow them to create the mission. By the end of the meeting, we had a mission statement that we wanted to reflect on and revisit. A week later, we had a conversation about the statement. The team changed a couple of words, and then, Voila! We had our mission statement. It was a mission to which everyone had contributed.

Our next discussion was about how we wanted to be reminded of our mission and how we wanted to make patients aware of the mission. The team decided to put the mission statement on the break room wall, where we would see it daily, and to frame it for the reception area wall, where our patients could see it.

We also met to discuss our values. The team went around the table, listing our practice values. After collaboratively sorting the values, the team developed a list of our top values. This list also has been framed and displayed in the reception area.

We want to share our values and mission with our patients because they are like family. Our top priority is helping them understand their health, so they can make better decisions to improve their health.

Curious to know the wording we settled on? Our mission statement follows: “Devoted to impacting our patients’ lives by investing in their health while establishing relationships through our exceptional care in a safe and comfortable environment.”

In your dental practice, it’s important to create a restorative partnership with your assistants, hygienists & front office team. Make the handoff between your team seamless, build a stronger team & create lasting patient connections. Check out our three Pankey Team Courses that are coming up: Team Series.

A quick, easy way to create a mission statement for your dental practice involves your team. In 2022, I called a team meeting to discuss what we want the practice to be like each day for ourselves and our patients. I wanted us to discuss what we could focus on.

We sat around the table in our break room. I asked the team members to take turns going around the table throwing out one word, two words, or a phrase that they felt described our practice. After a moment’s reflection, someone started the process. They had words. They had phrases. They developed whole sentences. And the beauty of this was that I didn’t have to say anything. I just sat there and listened.

If you are asking a team to be part of a mission, I think it is important that you allow them to create the mission. By the end of the meeting, we had a mission statement that we wanted to reflect on and revisit. A week later, we had a conversation about the statement. The team changed a couple of words, and then, Voila! We had our mission statement. It was a mission to which everyone had contributed.

Our next discussion was about how we wanted to be reminded of our mission and how we wanted to make patients aware of the mission. The team decided to put the mission statement on the break room wall, where we would see it daily, and to frame it for the reception area wall, where our patients could see it.

We also met to discuss our values. The team went around the table, listing our practice values. After collaboratively sorting the values, the team developed a list of our top values. This list also has been framed and displayed in the reception area.

We want to share our values and mission with our patients because they are like family. Our top priority is helping them understand their health, so they can make better decisions to improve their health.

Curious to know the wording we settled on? Our mission statement follows: “Devoted to impacting our patients’ lives by investing in their health while establishing relationships through our exceptional care in a safe and comfortable environment.”

A great doctor-patient relationship is the key to delivering quality care. The ideal model to help people move toward optimal oral health is based on a behavioral approach that we can use every day. This approach is allowing the patient to drive outcomes.

An illustrative example:

There is a stark difference in a patient’s emotional response between being told, “You need a filling,” and saying, “You have decay in your tooth. How would you like us to address that?”

The principles of this approach are not difficult.

1. You need to honestly commit to always placing the best interest of the patient first. You cannot fake this. All of us know when others are not sincere.
2. Letting the patient drive the outcomes is a habit developed from committing to this approach and intentionally choosing your words to put the ball in your patient’s hands, then waiting for their response and listening well to clearly understand the outcome desired by the patient.
3. Is the outcome congruent with your philosophy and standard of care? Does the patient need more information and time to come to an understanding of what is in their best health interest? How might you lead them there? Most folks really do want the best for themselves and their family. They will make good decisions if we provide the proper environment and education.
4. You, the patient, and your team must be comfortable with the means necessary to get to the outcome desired. Both you and the patient must be comfortable with the time, energy and dollars involved in reaching a mutually agreed upon goal. A key element in eliminating stress and dependence on insurance, is painting the picture for your patient that they are in control of the outcome–not their insurance company. You and the patient have the patient’s best interest at heart, not a third party. I say this again. You are working on behalf of your patient, and with this approach, they are in control, not an insurance company.

Does this approach take more time and effort up front? Yes. However, once you adopt this approach you will be forever glad you did. Patients who enter your practice through this system will value you, your staff, and your care. They will commit to more and better dentistry and pay with gratitude. You and your staff will have lower stress and more fun because you are dealing with people you understand at a deeper level. Long-term, these people will refer new clients just like them.

I didn’t invent this model. I learned it from great mentors like L. D. Pankey and half a century of folks participating in The Pankey Institute and passing forward the priceless and timeless value of this approach.

Mentorship from the Institute will help you on your way to long-term success as a thriving dentist. As my colleague Dr. Barry F. Polansky often writes, “Mastery in dentistry is a continuous journey.” It’s a lifetime of learning, practicing, and reflection that enables us to more easily and fully transform the health of others who present themselves for our care. The journey, itself, propels us forward into greater and greater connection with our patients and our true selves.

Pankey Institute mentoring and encouragement made all the difference in my life and the lives of countless others. When I try to sum up the dental professionals and patients this “approach” has positively impacted, I get lost in counting the millions we have touched as a community dedicated to putting the dental patient’s best interest first.

I have spent the last 27 years developing my abilities to restore patients to the dental health they desire. One of my favorite aspects of dentistry is creating a customized plan to help patients achieve their dental health goals, and I do this by hearing each patient’s story, so I not only see the care they need but know the person that needs it. I look forward to that challenge with every patient I see.

Let me share with you my routine for setting the stage at every dental visit for a successful interaction. As I come into the room, the patient is sitting up in the dental chair, and I sit down in front of them knee to knee. Then I say, “Tell me how you feel about today’s appointment,” or “Tell me what questions you have about what we are doing today.”

This does two things:

1. It sets the stage for “I am here for you as your friend and doctor.”
2. It prepares me to be present with them. I get to hear where they are before we start that appointment.

Once we establish what they are thinking and feeling, I ask their permission to lean back the chair. It signals that I am ready to initiate the procedure.

This routine gives them comfort, and when the procedure is done, I can sit them up and basically go through the same two questions: “How do you feel about today’s appointment? What questions do you have moving forward?”

Before and after every procedure, there is intentional time in which we are in relationship. I have found this to be very beneficial in how we move forward with patients. A very small amount of time and intention helps optimize each patient’s time with me, and I believe is a key to the success of my practice.

For support organizations and dental service organizations (DSOs) to scale, they focus on developing a branding patient experience and a predictably profitable business model. They seek to maximize:

• efficiency while serving the needs of consumers,
• provide a wonderful patient experience, and
• increase both their top and bottom financial lines.

Dentists who have chosen the private practice way of life may want to reflect on the following 12 things DSOs strive to do in 2022, and then apply these tactics to their own business model. These tactics have been among the top topics of conversation at DSO meetings in 2021 and 2022 and will sound familiar to those who follow The Pankey Institute. Why familiar? Because they are top topics also discussed among private practitioners and many are addressed within the Pankey Institute curriculum.

1.Monitor more aspects of your clinical and business operations to determine what is working well and what problems need solving. Then solve the problems as rapidly as you can. As the practice leader, open your eyes and ears, and lead.

2. Track key performance indicators and seek growth in those KPIs.

3. Cultivate a positive practice culture and work environment in which employees want to work and patients want to visit. Team members should constantly check in with each other to communicate what is happening “now” and intentionally tune their senses to know how they can help one another. The goal is both a wonderful patient experience and a wonderful team experience.

4. Design systems and protocols with intention, follow them, and assess them for improvement. Make sure team members understand the Whys.

5. Invest in training your clinical and business teams. Especially important in the last two years are to:

• • Realize the potential of each team member and affirm they are valuable to the practice.
  • Educate clinical and front office teams in how to best engage and support patients with special attention to facilitating the treatments patients need. DSOs have targeted implant treatment and doctor-supervised, clear aligner orthodontics as two niches to focus their education efforts on with staff and patients.
  • Educate front office team members in how to appropriately maximize lead conversion, so the cost of expensive digital marketing can be contained. With increased new patient acquisition, reserve more time on the schedule for new patient appointments. In 2022, if new patients must wait, they tend to go elsewhere.

6. Maximize clinical technology to improve the patient experience and increase the efficiency and accuracy of clinical records, diagnosis, treatment planning, dental lab communication, and manufacturing.

7. Maximize practice management technology to improve the patient experience and increase the efficiency and accuracy of business operations, for example, AI enhanced software that automates billing and online collections or reviews insurance claims for accuracy prior to submission.

8. Migrate to a Cloud-based PMS system to ensure the security of your data.

9. Block schedule to do more procedures in a single visit. Patients and clinicians benefit from this efficiency. Maximize spaces in the visit—as you transition from one procedure to another, to enhance relationships with conversation.

10. Deploy a dental assistant to assist in hygiene, for example, to help clean and turnaround hygiene operatories between hygiene patients. This way, the hygienist’s relationship time with patients is not shortened or eliminated in the race to meet clinical demand.

11. Ensure adequate front desk coverage, so there is always time for those personable conversations that ideally occur when each patient arrives and leaves their appointment. Manage your human resources so almost all phone calls are answered live during business hours by a receptionist well versed in optimal conversation with dental patients.

12. Frequently ask, “What is our branding patient experience? What can we do better to meet the desires and needs of our existing patients and the prospective patients we target?”

Looking at this list, I can’t help but think that Dr. L.D. Pankey would smile. Just because you don’t have a corporate support organization helping you run your business doesn’t mean you can’t do these things on a smaller scale and possibly do them better.

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

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

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

Two Big Questions We Ask Ourselves

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

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

“Revealing” Unrecognized Value Takes Time

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

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

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

It doesn’t have to be that way!

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

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

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

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

The Pankey Institute is the world’s oldest, most prestigious learning center for advanced dentistry. Our Traverse City, Michigan dental practice has been involved with The Pankey Institute for the last 27 years. You will often hear or read that the purpose of the Institute is to narrow the gap between what is known and what is practiced. And the unique thing about this nonprofit organization is that the faculty promote and facilitate learning around the behavioral aspects of dental care as well as the technical aspects.

The technical things we do in dentistry are transactional. Those are the clinical procedures we perform every day. But the behavioral training we receive at The Pankey Institute is truly transformational. It transforms how we approach patient care, placing focus on building relationships of trust based on genuine concern for what is in the patient’s best interest. It transforms how we thoughtfully and collaboratively lead our patients to improving their oral health. It teaches and encourages us to provide the highest standard of clinical excellence so our patients can achieve optimal oral health, comfort, and beautiful smiles.

During our years of association with The Pankey Institute, we have learned how to predictably manage and treat complex dental cases, and how to help patients who, at first, are anxious and lack trust. We’ve learned how to understand where individual patients are coming from and work from that basis to open their minds to what is possible for them and help them access fine care.

The greatest benefit of returning to the Institute for continuing education has been the total immersion that we experience at the Institute as we learn from, interact with, and are mentored and encouraged by like-minded individuals. We’re learning from some of the best dentists in the world. They’re flat-out experts in what they do. They flat-out care about their profession and want to help other dentists become the best they can be. They also want to help the dental professionals on our care teams, whether they are clinical or administrative, become more effective in their roles.

The year 1994 was the first time I attended a course at the Institute in Key Biscayne, Florida. And now I have progressed through the Pankey continuum of courses to where I am part of the visiting faculty to help teach and mentor other dentists. And, I am now the Coordinator of the Pankey Scholar Program, which is the pinnacle of the Pankey Learning Experience.

Since 1994, our dental practice in Traverse City, Michigan, has grown to be the largest “Pankey practice” in the world, and we’re proud of that because of what it means for our patients. We have a common culture here–among our five dentists and all team members, and a vision of patient-centered, comprehensive care that is easily articulated. It positively impacts our work, our lives, and our patients’ lives. It has enabled us to provide a consistently wonderful patient experience.

The Pankey Institute is the voice, the home, and the hope of private care dentistry. The Pankey Institute experience and its supportive community of learners has helped our practice thrive as a private practice that offers expertise in restorative and cosmetic dentistry, including full-mouth reconstruction, implant dentistry, and IV sedation. At Traverse Dental Associates, we are facing today’s business challenges well, we are proud to provide the finest care, and we are strongly committed to private practice.

If you are new to the Institute and I have not met you yet, please let me know. You are the life blood of our profession and may one day be a standard-bearer, if not a missionary for The Pankey Institute, the Pankey community, and everything it represents. I look forward to meeting you.