Seventeen is young to decide what you want to do with the rest of your life. Deciding you want to become a dentist means that you are making a huge decision before you are aware of all the knowledge you will have to attain and the multiple skills and micro-skills in which you will need to become proficient.

It was a long time ago when I made that decision. I can’t even remember how I made it. I remember I was under pressure to decide from my parents and their friends. I remember telling others I thought dentistry was a good career because I had spent so much time in dental offices growing up.

That’s because I had malformed supernumeraries blocking the eruption of my centrals when I was seven years old. The dentist who suggested the supernumeraries should be removed, proceeded to remove the two good centrals by accident. This was followed by surgery to remove the supernumeraries and alas no centrals. This was traumatic to me at the time, but early in life, I learned to adapt to a dental prosthesis, having that replaced as I grew, and so on.

I wish now someone had set me down when I was in high school and given me real-world career advice like I did for my kids as they were growing up. Hoping they could avoid some of the mistakes I made, I would begin those conversations with Stephen Covey’s habit #2: Begin with the end in mind. And I would disqualify money as an end. Because money only buys people what they really want. I’d get my kids to think about what they really wanted to spend their lives doing.

Warren Buffet says he wanted to make money so he could be independent. In his biography, The Snowball, Buffet wrote, “It could make me independent. Then, I could do what I want to do with my life. And the biggest thing I wanted to do was work for myself. I didn’t want other people directing me. The idea of doing what I wanted to do every day was important to me.”

There’s truth in that for me. Independence is a universal thought that drives many of us, yet we are unique in our own lives…in how we ultimately determine and design our game plan to live independently.

If we had understood what we wanted to do for the rest of our lives when we were seventeen, then we could have better designed our careers to meet our adult desires. But that isn’t realistic, is it? It sometimes takes decades to a lifetime to understand ourselves.

Adam Grant in his book Think Again questions the unreasonable question kids are asked, “What do you want to be when you grow up?” In his book, he uses his cousin Ryan as an example of someone who chose to go into medicine because that’s a profession parents applaud. Once Ryan made his decision, he spent years staying on track.

Once you start, there is no turning back…financial debt…sunk costs…physical, mental, and emotional. We hit a certain milestone like owning our own dental practice and we tell ourselves we will be happy… that we will have all the things we want. But positive psychologists confirm that this is a poor prescription for happiness.

Positive psychologists say the road to happiness includes mastery, autonomy, positive relations, engaging work, and accomplishments. It’s a never-ending road. But each person takes their own road. There are many roads of mastery, freedom, positive relations, engaging work, and accomplishments.

Don’t get me wrong. I am not saying dentistry was a bad career choice for me. It is a great profession. The message of this blog is twofold. One, at the start of my predoctoral and doctoral education, at the start of my career in dental practice, and even midway through that career, I didn’t understand the complexity of what was before me–including getting to know myself well. And two, everyone needs to find their own happiness.

If you are reading this, you likely chose a career in dentistry. On your road of your own design, I believe you will find happiness in the continual act of mastering more, working with autonomy, fostering positive relations, and setting out to achieve new accomplishments. Money will be just a way to fund the things that really matter to you, and for many of you that will be making a profound difference in the health and lives of your patients. And when you segue, as I did, away from hands-on dentistry after practicing for four decades, you will find that new ways to use your people skills keep emerging. Your road to happiness continues.

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?

Positive psychology and dentistry are closely linked, especially for professionals who own their own practices. Human beings are all too good at focusing on what’s going wrong at any given moment. But the key to experiencing maximum success is determining what’s going right, and how to take full advantage of those strengths. 

What’s the tie in with dentistry? Dental patients come in all stripes and shapes, and the success of dentistry is dependent upon understanding people and strategies for dealing with what happens in your practice and personal life. During my study of positive psychology, I focused on: 

• Understanding how and why people tick from studies on human behavior and how the brain and body are wired. I thought a lot about the implications for my practice of dentistry and personal pursuits. 
• How to effectively communicate with and lead/teach others. 
• Research-based tools for interacting with people from a variety of backgrounds and experiences 
• Understanding happiness through personal fitness, gratitude, cultivating relationships, mindfulness, and savoring what is going right. 

During my study, I found my personal happiness was increasing through greater feelings of personal and professional success, improved physical health, and stronger social networks. So much so, that I proceeded to earn a Certificate in Applied Positive Psychology (CAPP). Having Type 2 Diabetes and having experienced significant treatment for cancer, living my life in the healthiest way I can physically, mentally, spiritually and socially has become of increasing importance, not for my career aspirations alone, but for me personally. I believe all four of these aspects of life go hand in hand for total wellness–and a life well-lived. 

Beyond Positive Psychology 

As many of you know, reading is one of my favorite pastimes, and I do it with alacrity and joy every day. Studies from the fields of positive psychology and emotional intelligence played heavily into my reading throughout my career, and lately, I have been immersed in studying the philosophy of Stoicism which, when rolled over with the above, has naturally taken my passion beyond the soft skills (behavioral skills) of life to a philosophy of “total wellness.”  

This philosophy and enjoyment of it have made my transition from practice to a “retirement” life outside of practice an enlightening and wonderful experience. I have not left Dentistry in total, because I have a lot more to share and say that I will be writing about in the future.  

For Every Problem…a Spiritual Answer 

Wayne Dyer used to say, “For every problem, there is a spiritual answer.” Now that I am retired with much more time to think about my practice, aging, longevity, and philosophy—and when I see young dentists online writing about their issues and problems, I am more convinced than ever that the answers lie in philosophy. And so, it has come to pass that all roads of my life have led back to philosophy, since my first consideration of it, when I began The Pankey Institute continuum almost 30 years ago.  

With a few exceptions, The Pankey Institute being a major one, the dental community continues to undervalue and neglect the role of philosophy in being the best health care provider and wellness influencer one can be. The fields of positive psychology, emotional intelligence, and success in dentistry are undeniably linked. There is scientific evidence to support this. Your philosophy of life and practice (or lack of this) impacts how you go through life and your career, how your life influences others, what you achieve, and how well you feel about the life you are living. To me, the fields of psychology, dentistry, and philosophy are inextricably linked. I’ll write more on this later. 

Dentistry can be emotionally taxing, and Stoicism helped me to get through some tough times. I am not referring to being a small “s” stoic. In truth, being a stoic can be harmful to a dentist’s emotional health because that implies suppressing feelings. I’m referring to capital “S” Stoicism…a practical philosophy which has as its goals freedom, happiness, and tranquility. And that is how I became fascinated with it. 

The first person I ever heard speak about “philosophy” in dentistry was L.D. Pankey. He used language I hardly understood. It was foreign to me. I studied his philosophy and the philosophy of Aristotle. The application was difficult. Mounted models in centric relation is one thing…but “virtues?” What was Pankey trying to get across?  

It was years later that I learned about the Stoics who were not theoreticians or academics, but rather real down-to-earth working people who considered Stoicism a new school of Greek philosophy that was practical. They lived it rather than studied it, and they were mostly happy emotionally resilient people.  

Their virtues included justice, fairness, and kindness to others. Applying these virtues takes work. It takes self-awareness to avoid making value judgments and creating narratives about situations and people that lead to stress. 

Hearing L.D. Pankey speak of “virtues” sounded old fashioned to me, but I knew there was more to him than mounting models. The essence of his message was how to achieve happiness, tranquility, and virtue…something I was sorely missing when I first went to Key Biscayne. By practicing the Stoic virtues of justice, fairness and kindness to others, I have found happiness. I have found that a virtuous life of inner coherence and outer harmony relieves confusion about life and practice.  

Many years ago, when I was first trying to create a successful dental practice, I fell in love with the word “production.” I believed that production was the key to success, so I read everything I could to become more productive.  

I took courses.

In the early years, there were so many courses that centered around how to efficiently double and triple book, how to bring in more “warm bodies,” how to sell more dentistry, and how to utilize more staff to get more done. I never felt like these strategies were the answer to my production issues. I barely became more efficient, and I never became more effective as I just ran myself down. 

In my books, I have written about my issues with stress, which I believe eventually initiated adult-onset diabetes. Through it all, I continued my quest to be productive. In those years I truly learned to become more effective rather than more efficient. Reading Stephen Covey’s First Things First was extremely helpful to prioritize my work and life. But I found that was only part of the solution. The real problem for me was not managing my time. It was managing my energy.  

Diabetes became my blessing and my curse.

In my quest to control high blood sugar and the fatigue that comes with it, I found more energy. I found more mental and emotional clarity as well. A fog was lifted. My diabetes forced me to eat better and to exercise.  

I remember listening to some of Anthony Robbin’s tapes in which he tells the story of living in a small apartment in southern California, being extremely overweight and feeling like a loser. The first thing he did was to exercise. I did too. Slowly at first, I began to run. I built up my time and distance. Now, twenty-five years later, my routine includes six hours per week in the gym, running and lifting and six hours per week doing hot Yoga. The results have been nothing short of amazing. My diabetes is under control, I lost weight, I multiplied my energy level and mental clarity went way beyond what I expected. 

My moods improved, I enjoyed my work more, patient behaviors didn’t get to me as much, my work improved, I learned new techniques and took more continuing education, and most importantly, I had the energy to have a life outside of work.  

Patients gravitate toward and stay loyal to dental practices in which the dentist and care team love what they do.  

When you are enthusiastic about your work and how you do it, you can’t help but talk about it, can you? You can’t help but show it.

This enthusiasm affects patients in multiple ways. 

• Your happy office is a delight to visit under most circumstances. 
• The confidence you exude makes potentially stressful visits more comfortable and allows patients to trust in your care.  
• Their curiosity in dentistry and what you can achieve together is peaked. They ask more questions. This, in turn, sparks the patient’s desire to make changes in their health and smile. 
• Because your happiness has spread throughout your care team, the support patients receive throughout their experience is exceptional. 
• You surround them with so much positive energy they feel free to get to know you too. 
• Consistent happy experiences lead to patients feeling like they are among family and friends. 
• And, you’ve all seen this. Patients want to emulate your happiness in their own lives. They want to be like you. 

What is happiness anyway? The definition that I like is “the ability to feel satisfied with your life, to enjoy yourself and others, and to have fun in the present.” This certainly is what your patients enjoy when they visit. 

So, what brings about happiness in dental practice? Perhaps, you’ll agree: 

• Doing what you love to do most of the time, applying your talents and strengths 
• Being outwardly focused on the well-being of others 
• Effectively motivating and leading others to optimal health 
• Being true to your own personal values 
• Ever be it dynamic–Pursuing your own vision of practice (in the case of the dentist) and a coherent practice vision to which you contribute (in the case of team members) 
• Working in a care team that is high functioning with high EQ 
• Effective systems that facilitate doing what you love most 
• Ability to successfully problem solve and adapt with confidence 
• Patients who appreciate what you do together  
• Continuously mastering higher standards of care 
• Multiple moments of true connection with others every day 
• Understanding of yourself and others 
• Satisfaction with your life outside the office 
• Optimism and gratitude 

In 2003, I was fortunate to dine with Pete Dawson and he spoke about his friendship with Dr. Morty Amsterdam and how he so enjoyed coming to Philadelphia. He spoke about L.D. Pankey. At one point he said something I will never forget, he said, “You know, L.D. was no fluke.” I asked what he meant. He told me, “L.D. really loved dentists and loved the dental profession. That is what drove him.”  

Dr. Dawson was no fluke, either.

Through his writings and teaching of over 50 years, he was a warrior for meaningful, excellent and dutiful dentistry. When news Pete’s passing came, tens of thousands of dentists all over the world wrote about how much he meant to their lives and careers. He had carried the torch of meaningful comprehensive dentistry into the hearts and minds of dentists for as long as I can remember. 

I carry a coin in my wallet which reads, Memento Mori. The Stoics used that phrase to remind themselves that everyone is mortal. “You could leave life right now.” When the news of his passing came, I was shocked. Joan Forest reported that Pete was prepared and yet on the Tuesday before he was still preparing lectures and writing a chapter for a new book. I guess that is what the keepers of meaning do right to the end. 

Excellence, duty, and meaning are the primary sources of Stoic joy.

Not the surface cheerfulness and pleasure that we have come to know on social media. The essence of what L.D. and Pete taught led to real inner happiness. I know it did for me.  

Erik Erikson, the developmental psychologist and psychoanalyst known for his theory on the psychological development of human beings, described the last tasks of adult development as generativity and keeper of the meaning. Erikson claimed that if one completed these tasks, the reward would be a full life. 

As the Pankey Institute continues passing on the knowledge of meaningful comprehensive dentistry to younger dentists (from one generation to the next) and to never waiver on the meaning of dentistry for patients and dental professionals, there is true potential for a new generation to become keepers of the meaning. And this makes me smile. 

When dentists are asked to use their imaginations to create a vision of the future, they usually see themselves as achieving their dreams, becoming successful and living the happy American dream. Using our imagination gives us a sense of control over our lives. I myself used the term “master of my own destiny” as my battle cry to create my practice philosophy. Was I accurate? Well, not to the degree I thought I would be. The old saying, “Man plans, and God laughs,” applies.

At the start of my career, I didn’t realize the effect that technology, the economy, advertising, and insurance would have on my plans. My definition of success at the start included words like accomplishment and achievement of a worthy goal. I learned the sense of well-being was to become an integral part of this.

Over four decades of practice, I learned that in order to live a life well-lived, certain components would be required. I could not have survived forty years if I had to go to work every day without the ingredients of a happy life.

The Ingredients of a Happy Life

The positive psychologists tell us that our well-being is dependent on five components. Dr. Martin Seligman, from the University of Pennsylvania, uses the acronym PERMA to describe these five.

P – Positive Emotion. For us to experience well-being, we need positive emotion in our lives. Any positive emotion such as peace, gratitude, satisfaction, pleasure, inspiration, hope, curiosity, or love falls into this category – and the message is that it’s really important to enjoy yourself in the here and now as long as the other elements of PERMA are in place.

E – Engagement. When we’re truly engaged in a situation, task, or project, we experience a state of flow. Time seems to stop, we lose our sense of self, and we concentrate intensely on the present. This feels really good! The more we experience this type of engagement, the more likely we are to experience well-being.

R – Positive Relations. As humans, we are “social beings,” and good relationships are core to our well-being. Time and again, we see that people who have meaningful, positive relationships with others are happier than those who do not. Relationships really do matter!

M – Meaning. Meaning comes from serving a cause bigger than ourselves. We all need meaning in our lives to have a sense of well-being. We need to create our own meaning with a sense of intent and purposefully design our own lives and practices accordingly.

A – Accomplishment/Achievement. Many of us strive to better ourselves in some way, whether we’re seeking to master a skill, achieve a valuable goal, or win in some competitive event. Flourishing in this way adds to the sense of wellness.

Happiness Is Subjective

All of the components together can be measured and hold the key to our well-being. Happiness, however, is about semantics. It’s about a subjective feeling.

Aristotle said it is “an expression of the soul in considered actions.” He called those actions virtues and said one could only measure the degree of happiness in a person’s life at the end of one’s life.

Freud said happiness can be found in lieben und arbiten—to love and to work.

And, Charles Schulz, the creator of the Peanuts cartoon said, “Happiness is a warm puppy.” In truth, we cannot completely describe happiness, but we all know when we are happy.

Because the state of happiness is a present tense phenomenon, I have chosen what will make us happy in the future by what makes us happy now. That is why I have chosen Martin Seligman’s definition of well-being as defined by PERMA as a guide to a sustainable career and a life well lived. All of the PERMA components of well-being — positive emotions, engaging work, positive relationships, meaningful work and achievement, can be built into our practices.

Why Is Happiness Like a Warm Puppy?

Having an experience or two a day of true connection with patients can make all the difference in being satisfied at work. This simple definition of happiness is a good way to measure how you are feeling about your chosen career and practice life, because, if in the present of your everyday practice life, you feel moments of warmth (like holding a warm puppy), you will hold up well against the difficult moments, and you will have a rewarding career in dentistry.

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.