One day an elderly woman came into the office without an appointment. Mrs. Blanchard was a tall woman wearing a large, flowered hat and a black ribbon around her neck. She had the airs of an aristocrat. She had been referred to the office by her next-door neighbor who told her Dr. Pankey was the dentist who did not believe in pulling teeth. When she came in, she refused to sit down and asked to talk to the dentist immediately. When asked why Mrs. Blanchard was there she told the receptionist it was both professional and personal.

L.D. escorted her to his private office. She immediately said, “Dr. Pankey I understand you do not extract teeth.”

L.D. Said, “I do not extract teeth; however, if you need extractions, I will send you to a good oral surgeon in Miami.”

She interrupted, “That is the reason I am here. I do not want to lose my teeth.” She had ready been seen by two dentists and both said she needed dentures. Her plan was to have only Individual teeth extracted when she was in pain. She asked if he would be willing to try to save her teeth. Because she was a walk-in they made another appointment for a proper examination, x-rays, and time for a consultation.

When she came back, he told her he thought she could keep most of her teeth; however, he couldn’t promise all of them. He also told her he had been studying with some of the best dentists in the country and would do his best. Although she did not ask him, he quoted her a fee large enough to allow him to redo work if necessary. She showed no concern about the fee, so they got started.

She needed a couple of extractions and endodontic procedures. During the healing time, he did simple restorative dentistry. Her treatment took three and a half months. L.D. told her everything he was doing and why. She became extremely interested in the process. He used the Munson articulator and followed Taggart’s 1912 “chewing in” technique. All the crowns were done directly in the mouth using compound impressions, amalgam dies, and denture card wax to create a functionally generated path. When everything was completed, he put her on a three-month cleaning regime. Happily, the dentistry lasted until Mrs. Blanchard was 81.

Being a little eccentric, Mrs. Blanchard never wanted to sit in the reception room. When she did come in for her cleanings, she preferred sitting in L.D.’s private office. One day, during the midst of the Great Depression, she was in his office paging through an American Dental Association journal that she had found on his desk. An article about the upcoming International Dental Congress meeting in Paris, France caught her interest.

When L.D. came into the room she asked, “Are you going to this meeting in Paris?” He said, no I am very busy here with my practice and keeping my staff working.”

Two weeks later she returned and asked to see L.D. As usual, she was sitting in his private office when he came in. She said, “I still think you should go to the International Congress in Paris because you have great potential. I want you to go, and I want you to travel first class. I would like to pay all your travel expenses, all your office expenses including your staff, and compensate you for the time lost in your practice. When you go, I want you to travel all over Western Europe because that is where our civilization came from. You need to see London, Florence, Rome, Vienna, Heidelberg, and of course, Paris. Now, are you willing to go?”

L.D. was totally taken aback. Mrs. Blanchard had a great deal of gratitude for the time L.D. had spent learning how to treat her problem and for the care and understanding he gave her during and after her treatment. The enormity of her gratitude and appreciation was whelming.

After talking to his wife and his staff, he did go to Europe, and he did go to the Congress in Paris. Little did he know what a profound impact this gift would have on his life. Mrs. Blanchard had given him the opportunity to expand his knowledge of dentistry and the potential to become a leader in dentistry.

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?