When I bought my dental practice in Glendale, Arizona, eight years ago, they were offering patients a choice of flavors for topical anesthetic. I truthfully thought it was silly and that we would stop doing it. With experience, however, I came to realize that giving a choice was valuable for both patients and team members. Today we are still offering a choice of flavors.

When a patient is seated, the dental assistant will say, “As you know, as part of the process for getting you numb, we will be using a topical anesthetic. We have five flavors and you get to tell me which flavor you would like to use today.”

It is really interesting to listen to the dialog, but also to realize what is happening for the patient. The choice gives the patient an opportunity to settle into a conversation and something to focus on other than that they will be getting an injection and the logistics of that.

The process almost creates a fun, quirky conversation, as the patient thinks about the choices. Sometimes patients say, “You choose, and I’ll guess which one it is. Let’s see if it really tastes like that.” When patients pose themselves this challenge, the whole time I am giving the injection, they are trying to figure out which flavor of topical we have used.

Sometimes patients ask, “Which flavor is your favorite?” or “What do other patients like most?” In this case, we talk about it.

We have the mint flavors everyone else has but we also rotate in cherry, strawberry, bubble gum and pina colada. In summer, we offer watermelon. At any one time, we typically have five flavors and they vary throughout the year. A patient who has come in a few times, may even start the conversation with, “Do you have any new flavors for me to try today?”

One of my favorite conversations is whether the pina colada actually has rum in it and how funny it would be if we could just use the rum. An ice-breaker conversation such as this is a great way for us to ease the tension at the front end of an appointment that will require anesthetic. It truly adds an element of fun that has become for us a practice distinguisher.

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.   

Every one of you knows from your own experience with care providers that you want to have complete trust in them before accepting their recommended treatment. Your dental patients are no different, and that trust is affected by their entire experience with everyone on your care team. The dental experience in relationship–based practices increases this desire, because listening well to others is one of your priorities. Patients become at ease confiding their concerns with you and celebrating high points in their life with you. In your dental practice, listening well and acts of kindness generate positive emotions and positive memories of their dental experience.  

The Golden Rule 

Under daily situational stress, personal psychological stress, and oftentimes lingering physiological stress from the day before, preoccupation with internal concerns gets in the way of being truly present for the patient. The benefits of discussing this occasionally within team meetings foster a continuing positive culture of everyone striving to intentionally apply the Golden Rule with patients.  

When that aspiration is sustained and everyone on the team “takes care of” patients by “treating others as you would want to be treated,” the emotions experienced by patients are positive and support treatment acceptance. And, the genuine care you give others has a way of stepping down your own stress with the release of oxytocin.  

I’m speaking to all team members from the front to back when I say, “Practicing being truly present for patients until it becomes a natural habit is one of the greatest things you can do for them, yourself, your fellow team members, and the business.” 

A Few Extra Minutes  

If appointment times are increased by five to ten minutes, the clinical care team has more opportunity to converse with patients without stress developing, and in just a few more minutes a lot can happen. Conversations between care team members and patients help establish trust. These conversations also disclose patient feelings, concerns and unanswered questions. The sharing of this information with other team members can be used to create an optimal patient experience in this and future appointments.  

It takes just a minute more to share this information appropriately in handoffs to tee up the doctor-patient conversation about treatment and to support scheduling the next visit before the patient leaves. By the latter, I mean the business team at the front and the patient always need to be prepared for the end of the appointment when the follow-up treatment fee is presented and scheduled. This preparation includes communicating the why behind the treatment and true concern for the patient’s welfare.  

Same Page, Same Language 

Patient confidence grows when every team member is on the same page, is aware of the patient’s expressed goals and concerns, supports the treatment plan with why it is recommended and enthuses about the expertise of the practice. Using the same language helps too.  

In a relationship-based practice that focusses on these details, this is possible, and more treatment is accepted. If team members stop occasionally to ask themselves, “How was that handoff,” you will discover ways to improve how everyone “takes care of” patients through shared knowledge, empathy, and language. And knowing the Pankey community as I do, I see in my mind’s eye care teams around the world coming together at the end of the day to say, “Nailed it!” 

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. 

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.

It seems that “empathy” has become one of the most popular buzzwords in dentistry, and in spite of the popularity of its use, few people understand what it is and why it is so important.
Confusion may be rooted in dictionary definitions such as “the ability to understand and share the feelings of another.”

Can we really understand and share the feelings of another?

Avrom King used to say, “There is no such thing as a second-hand feeling.” It’s impossible for us to fully understand the feelings of another person. In truth, the best we can do is contemplate intellectually what a person MIGHT be feeling and then project our feelings upon our thinking.

Our feelings, and our patients’ feelings are unique to us and them. They cannot be fully explained or understood by others. Yet, they are valid because what we feel is our reality.
Our brains function based on mental models or “thought constructions.” These thought constructions may be fairly accurate, total fabrication, or something in-between. But in all cases, they are still our reality. And the only way for us to square the inaccuracy of our thought constructions with reality is to test them against what we perceive to be reality.

Perceptions are open to review. They change.

And, there is another problem. Our perception of reality is a thought construction as well. In other words, our brains function by testing our thought constructions against our thought constructions, and then we call the most successful ones “beliefs.”

Because a belief is still a thought construction, it is always up for review with regard to accuracy, unless of course, we don’t want to do that. And in that case, we choose to become dogmatic instead of continuously being open to refining our version of reality.

So, why is understanding this important?  Because beliefs, dogma, and empathy all fully infuse the relationship we have with ourselves as well as our patients.

What we think they think influences how we think.

Let me say that again. What we think they think influences how we think. So, if we come into a new relationship with beliefs about ourselves and other people which are rigid and dogmatic, then it is very unlikely that we will find the whole truth, and most certainly, we will never even come close to understanding our patient’s perspective. Yet, our patient’s perspective is the complete source of their motivation to act or change their perspective.

Empathy is an attempt to understand another’s thoughts and feelings.

Giving others quality attention signals we are interested in understanding what they think and feel. It signals that their thoughts and feelings are important to us. Empathizing is an act of caring about another person. When we give others this kind and quality of attention, it allows them to feel safe and accepted. And in that space, they are more likely to re-assess their beliefs about dentistry, dentists, and what dentistry might be able to do for them. Consequently empathy, non-judgmental acceptance, and behaving in a transparent authentic fashion is the pathway towards facilitating change in others. This is what Carl Rogers called “congruence.”

When patients feel supported and risk committing to change, we call it trust.

Change in attitudes, beliefs, and perspectives is what causes patients to commit to significant change, which at the end of the day is a risk…a risk taken because they feel like the people around them will support and care for them along their journey toward new understandings, perspectives, and experiences. And when that happens, we call it “trust,” which is at the foundation of every enduring and meaningful relationship.

When asked about The Pankey Philosophy, L.D. Pankey famously responded, “What do you mean when you ask me about The Pankey Philosophy? I am not familiar with the document, although I do recall writing an essay entitled A Philosophy of Dentistry by L.D. Pankey.”

Most dentists are comfortable acknowledging that L.D. Pankey was a great philosopher and that he was the first well-known philosopher in dentistry, but most dentists don’t think of themselves in a similar fashion; rather they like to think of themselves as being prototypes of practicality. This is why most dentists never even think about the value of writing a Philosophy Statement.

Just what is a philosophy statement?

A philosophy statement is a statement of core beliefs, and a validated philosophy is a philosophy statement which has been affirmed through its frequent use, reference, and revision. It is, therefore, a living creed around which a person or group of people live their lives.

A great example of a validated philosophy statement was how Wilson Southam and the Group at Cox operated a number of years ago. Cox was a progressive dental equipment designer and manufacturer located in Stony Creek, Ontario. Wilson Southam was an investor, a co-owner, as well as the philosophical leader of the company. Cox had developed a philosophy around which all of its equipment would be designed – a concept is called, “the computerized dental cockpit,” fashioned similarly to how a fighter pilot might operate. And Cox preferred to sell its equipment to only those who understood its philosophy…only to those who understood the “why” behind the “how” and the “what.” Cox believed in this so strongly that it held workshops centered around its philosophy at Stony Creek.

A philosophy statement can also be called a “core beliefs statement.” A good example of a philosophy statement is the Nicene Creed, co-authored after the center of the Roman Catholic Empire was moved from Rome to Constantinople. At that time, Christianity was in a fractured state, with many different sects, and with many different belief systems. The Nicene Creed was co-created by the Roman Catholic leadership with the intention of having it function as a unifying document around which everyone could agree, so that the church could again move forward.  It states, “We believe…. We believe.”

It’s a well thought out basis for behavior.

So, a philosophy statement represents a statement of beliefs, which is so basic and so fundamental that it provides a rational and comfortable basis for you and your care team to determine what it is that each member of a care team should do, as well as what they should choose not to do.

William James was a physician who lectured at Harvard in the late 1800s on Philosophy and Psychology. He is considered to be America’s first psychologist and was thought of as a “pragmatic philosopher.”  In this regard, James said, “There is nothing more practical than having a personal philosophy.” In the case of dentistry, an applied philosophy (validated philosophy) is practical as well, as it naturally leads to an organically-driven team, deep in mission, and high levels of personal autonomy and interpersonal trust.

A philosophically-aligned team is essential for the creation of a philosophically-driven community.

Barkley a year or so before his untimely death in 1977, said during an interview with Avrom King said: “If I had one wish that could be granted, it would be that every dentist would take the time to create a written philosophy statement.” Let’s talk about why Bob would make such a statement.

The creation of a relationship-based/health-centered practice is a perfect example of the creation of a philosophically-driven community, with the word community being used as a reference not only to the creation of a care team, but also to the patients of a practice, its associated suppliers, mentors, and facilitators. All of the members of this community are philosophically aligned through either careful selection, development, or both.

A community of this type begins with the creation of a care team which has co-authored a written statement of philosophy. This is because you cannot have a true health-centered dental practice without a philosophically-aligned care team which listens well, are true helpers, and who facilitate healing in each other, as well in those with whom they come in contact. One or two people acting alone, simply cannot apply a practice philosophy as others, who are in contact with patients, will create too much confusion and mixed messages in the minds of the patients.

A personal philosophy statement starts the ball rolling.

The dentist might begin the process of thinking through a personal philosophy statement by answering these questions:

1. Who am I? (What are my values and core beliefs?)
2. Who do I want to become? (How do I want to see my life unfold?)
3. Why do I feel this way? (What is my personal purpose in this life?)

To develop your philosophy-driven community (care team, patients, suppliers, mentors and facilitators) the dentist next shares his or her personal philosophy with care team members and leads them in co-authoring a practice philosophy statement.

Remember: A philosophy statement is a statement of core beliefs, and a validated philosophy is a philosophy statement which has been affirmed through its frequent use, reference, and revision. It is, therefore, a living creed around which a person or group of people live their lives.

A co-authored and applied practice philosophy statement produces multiple benefits.

Here are four concrete benefits of co-creating a written group philosophy statement with your care team:

1. It will establish a standard of behavior for everyone to live up to and aspire towards.
2. It will allow for that standard of behavior to be used in a situationally appropriate fashion, and therefore not be used dogmatically, as everyone recognizes that every person and every situation is unique.
3. It will function as a centripetal force…as a kind of principle-centered psycho-social glue which will hold the care team together during times of change and challenge.
4. It will function as the foundational document out of which a practice vision (where are we going long-term) and a mission statement (how we will get it done) can evolve.

How many of us have had a patient call who was really upset with us or our office?

The other day, my office manager came to me and said, “Mrs. Jones called and is super upset.” We had just completed an upper and lower reconstruction. Due to the complexity of the case, I opted to place the lowers in permanently, but I placed the upper in with temporary cement, in case there were any modifications that she wanted made prior to finalizing the case with permanent cement.

My office manager continued, “her new bridge is loose, and she said she is going to get an attorney because she paid a lot of money for this and it is already failing.” I told my office manager it was in with temporary cement, and the patient must have forgotten that I told her this, which in fact was the case.

I asked my office manager to bring her in immediately, and I would take care of it. Mrs. Jones presented, and I greeted her with a smile. I said, “I will take care of you immediately.” I proceeded to remind her that the upper arch was in with temporary cement, and she said, “Oh yeah! I forgot about that.”

After allaying her concerns and asking her if she had any difficulties over the last month, to which she said no, I opted to place the restoration on with permanent cement.

I reminded her that there was one other section, which still needed to be put in permanently, but I would do this in the future, since I was unable to tap it off at the time. (Sometimes, when the seal is really excellent, even temporary cement will hold very well.) I reassured her that all should be well and to always remember that “We’re here for you!”

This can be one of the greatest statements you can make to a patient. So often they feel “discarded” once their work is completed, and you “have their money.” Or they feel like they are being bothersome if they contact you to make any adjustments. They feel that any issues they are having will work themselves out, or they will just get used to it.

I remind them that we are always there for them and want to make any needed adjustments or corrections to the work we’ve done before any other problems arise. We want to be proactive in taking care of their issues and not be reactive. Often it is a very simple correction.

Letting a patient know “We’re there for you” can go a long way to creating a patient missionary and can be one of your greatest practice builders. “We’re there for you” is one of my favorite messages to convey to my patients, and I repeat it often.