By John C. Cranham, DDS  

Sometimes you can see clearly where you want to go with your dental practice. I can vividly remember driving my car to St. Petersburg for my first class taught by Pete Dawson. It was 1989. When the class was over, I drove my little car all the way back to my 800-square-foot office in Portsmouth, Virginia, and arrived at four o’clock in the morning. I had just bought the office from a doctor who did mostly silver fillings—maybe only four crowns in the entire year. I remember I could visualize what I wanted to do with “my” practice but deciding the first steps was overwhelming.  

A dental office can be the loneliest place in the world. I had to figure out the attainable steppingstones. We didn’t have the internet back then. Finding mentors and connecting with supportive, sharing colleagues was more difficult. In dentistry today, it’s easier to find those steppingstones. One of the most rewarding things I do today is helping dentists develop. 

I caution dentists to not assume they will achieve their big goals fast. There is a temptation to give up when progress is slow. You’ve got to stay on the path to get to where you want to go. Think about your goals and steppingstones every day but be kind to yourself if it takes more time than you visualized.  

Remember that everyone is different. All your buddies are going to be in different cities, different socioeconomic areas, and different practices. They’re going to have different opportunities. Social media can be your enemy when it comes to self-confidence and determination. There will be certain people that develop faster.  

I can remember being very frustrated the first year or two in my little town of Portsmouth. There were dentists going through the same classes I was and were already doing the kinds of cases that I wanted to do but wasn’t doing yet. During the first two years in practice, I sometimes wondered if I would ever do the kind of dentistry I wanted. But I kept in conversation with my patients, eventually they began accepting treatments, and the floodgates finally opened.  

One of the greatest things about this profession is we can always strive to be great. I don’t think I’m there yet. It’s the striving part—the working at it and seeing things improve that makes it so fun and rewarding. I love it.  

People ask me, why are you setting BHAGs at this stage in your life? You’ve already accomplished so much. Why are you totally reinventing your practice systems? Why are you going fully digital after practicing on analog articulators for 35 years? 

What I’ve been able to do in dentistry is constantly reinvent myself, and I feel like I am growing in what I can do. So, I say it’s because reinvention is awesome. It’s fun. And my staff knows that if I get something working well, I’m going to find a way to make it even better tomorrow. 

By Paul A. Henny, DDS 

How are you doing in your quest for a “positive” life? 

Martin Seligman PhD spent most of his career at the University of Pennsylvania advancing the concept known today as “Positive Psychology.” He states that Positive Psychology is “the scientific study of what makes life most worth living.” Along the way, Martin identified five core elements highly associated with psychological well-being and happiness. He believes understanding these five elements helps us to create more fulfillment, happiness, and meaning in our life. 

In Part 2 of this two-part series, we’ll pick up where I left off with the third core element in Seligman’s model. 

R – Relationships 

Relationships and social connections are essential for the creation of meaningful lives. Human beings have been social animals since the earliest of times, hence we are hard-wired to bond and depend on each other. That worked particularly well when we functioned in small social units or “tribes.” The tribal unit allowed us to easily ascertain who was friend or foe. It also allowed us to know who to pay attention to, ignore, and with whom we should invest our time and energy. 

In our modern-day world, the historical notion of tribes has largely been broken and replaced by sub-sects of people who are clustered together around common interests, agendas, and values, brought together in new and different ways. Social media now connects people from around the world in ways we never could have imagined 20 years ago. So, this has created a situation where we don’t know our neighbors, but we do know intimate details about our friends in Australia, Tampa, and Kansas City. 

Since we are less tribal in the historical sense, we have lost our ability to easily trust those who are around us, as we can no longer assume they share our values and priorities. That is WHY the relationship-based practice model is so valuable today.  

The relationship-based practice model is a vehicle of connection that can be used to co-discover our similarities as well as areas of disagreement. Alignment of values, goals, perspectives, and efforts are key to successfully advancing health. Strong interpersonal relationships are the key to the door which opens up all of those possibilities. 

M – Meaning 

Some people work to live, while others live to work, with the latter meaning that a person has been successful at merging their life purpose with their daily work. And when work becomes meaningful on a deeply personal level, it evolves into becoming much more than just a “job.” 

With the ever-expanding discovery of connections between oral health and whole health, dentistry now stands at the forefront of a huge new opportunity – the opportunity to help others to grow, develop, and maintain whole health over their entire life  

A – Accomplishments 

Living a values-driven, purposeful life, integrated with how we practice, aligns ourselves with the achievement of deeply meaningful accomplishments on a daily basis. Helping others in deeply meaningful ways, and then being rewarded with appreciation and appropriate compensation, establishes a self-sustaining cycle, and a successful model for living.  

That’s why you will commonly see relationship-based dentists practicing into their 70’s. Their sense of purpose as they continue to accomplish meaningful work is what motivates them to return to the office and continue striving to help patients, coach younger dentists, and create an-ever-happier positive environment. 

An Easy Acronym to Remember: PERMA 

A great to start your day might be to remember what each letter of PERMA stands for: 

• Positive Emotion 

• Engagement 

• Relationships 

• Meaning 

• Accomplishments 

How will these five elements of Seligman’s model fit into your quest for a sense of wellness and happiness today? How will these fit into your quest to serve and help others? 

By Paul A. Henny, DDS 

Martin Seligman PhD spent most of his career at the University of Pennsylvania advancing the concept known today as “Positive Psychology.” He states that Positive Psychology is “the scientific study of what makes life most worth living.” Along the way, Martin identified five core elements highly associated with psychological well-being and happiness. He believes understanding these five elements helps us to create more fulfillment, happiness, and meaning in our life. 

One of our Pankey colleagues, Barry F. Polansky, DDS, spent a lot of time and energy studying Seligman’s work. In his last decade in practice, Polansky turned his attention to writing books to help new dentists find wellness and happiness in dentistry. Polansky’s 2017 book The Complete Dentist: Positive Leadership and Communication Skills for Success is an excellent guide to starting and running an effective and meaningful dental practice. 

In this two-part series, we’ll take a look at Seligman’s positive psychology model in relation to how we feel about our work in dentistry. 

Seligman’s Five Core Elements: 

P – Positive Emotion 

This represents a “glass-is-half-full” perspective toward life, commonly called an “abundance” perspective. This positive world view is critical because it has a heavy influence on how the brain functions. Our brain is a memory-driven cybernetic solution-seeking organ, with a primary purpose of creating and supporting a successful life. When our mind is in a positive orientation towards our environment, we are typically in a very observant and creative mode of living. In this mode, we constantly scan our environment for relevant bits of information and experiences that are potentially useful in the advancement of our desires.  

When our desires are positive and life-affirming, we are co-creating our experience: We see and experience to a large degree what we expect to see and feel. That is why having a clarified positive vision and purpose for our life and practice is essential for well-being. 

E – Engagement 

L.D. Pankey famously said, “Know Yourself.” What interests us most? What worries us most? In what circumstances are we most comfortable? Under what conditions are we most productive? What are our personal strengths? What are our habits? What are our triggers? What do we aspire to do? What about ourselves would we like to change? 

We all direct most our attention toward the things that interest us or we fear. And it is what we pay the most attention to, whether at work or elsewhere, that we develop the most while engagement with things of lesser importance wither away. It’s healthy to go into ever deeper relationship with the things we value. Clarifying what we believe we are good at and what we will enjoy is a key first step to successful practice development. 

Defining our values is essential so we know when to keep “first things first,” as Stephen Covey likes to say. 

Mac McDonald is a Visiting Faculty member at Pankey, his 2017 book Unchanging Points of Light: Finding Your Way in the Dark is an example of the positive power of values clarification. 

My discussion of Seligman’s five core elements will be continued in Part 2. 

By Paul A. Henny, DDS 

In Part 1, we looked at personal boundaries in dental practice. I mentioned scarcity bias and how it is prevalent in undifferentiated dental practices but not so much in dental practices where providers and patients mutually share the values and agenda of the practice. Because scarcity bias is so human, so ingrained in us, I want to discuss two things in Part 2: healthy relationships and also how to address scarcity bias as it occurs in our differentiated dental practices. 

Insight Into Our Boundaries Leads to Healthy Relationships 

Healthy interdependent relationships are only possible through first understanding our personal boundaries (Who am I? What am I responsible for? What am I not responsible for?). That’s critical because psychologically speaking, boundaries are like fence lines with consciously regulated gates.  

The aphorism “Good fences make for good neighbors” prevails.  The same logic applies to the practice of dentistry and the nature of the relationships that we create—consciously or not, within it.  

And Now, We Circle Back to Differentiation  

Healthy interpersonal boundaries lead us toward more interpersonal authenticity, which leads us toward higher-quality communication of our values and purpose. Higher quality communication leads to a more sophisticated level of collaboration and healthy results, including healthy interdependent relationships, self-reflection, self-responsibility, improved oral and total body health, improved mental health, and a constantly growing reputation for your values. That’s differentiation. That’s personal authenticity. That’s success. 

Addressing Scarcity Bias 

Once we understand ourselves well and we communicate consistently with personal authenticity, we still have the challenge of “knee-jerk” scarcity bias in our patients. This is where patience comes in and empathy—understanding and recognizing their feelings. 

People are biased toward the here and now. The mind is naturally focused on meeting immediate needs at the expense of future ones. We procrastinate important things such as dental treatment unless we have an urgent need for it. We fail to make investments, even when the future benefits are significant or the costs of not doing so are substantial. 

When the dentist and patient participate equally in a co-discovery examination process and co-discovery consultations to discuss health history and current findings, and the patient is empowered and becomes comfortable mentioning everything on their mind, we have already begun the powerful process of leading each other through understanding what is happening in the body and what is happening in the mind (feelings and thoughts). We can start to talk about what the patient would like to achieve long term—the patient’s beyond-the-moment oral health goals. We can start to talk about what is possible to achieve together and introduce the notion that we can take steps at the speed that is mutually comfortable for us. 

Inspiration to do “the work” is often planted with just a few words that create a future desirable image in the patient’s mind. If we have the patience to let the inspiration grow, without overwhelming the patient, scarcity bias can dissipate. Often patients come back to the conversation the next time they visit us and say, “I was thinking about what we talked about, and I think I am ready to…”  

Negotiating health goals between two adults starts as an invitation to agree upon common goals. We can start early in the doctor-patient and hygienist-patient relationships by instilling the thought that preventive health care is a partnership. They can’t do it alone and you can’t do it for them. Everyone must play their part responsibly. 

By Mary Osborne, RDH 

There was a time when I thought “partnering in health” was just about getting people to take better care of their teeth. 

Many years ago, I had a patient who was excellent with her home care, but she showed up periodically with an acute periodontal infection. We asked about stress and her overall health, but she was not aware of any issues. We would treat the infection and she would be fine for a sometime. We knew she worked for National Public Radio, and one day we made the connection that her infections showed up concurrent with NPR’s fund-raising drives. That shared realization allowed us to help her see that her stress was affecting her dental health and her overall health. She was open to conversations about lifestyle changes that would help her be healthier. My relationship with her influenced my thinking and my ability to connect with my patients from a perspective of Whole-health Dentistry. I came to understand that I had been missing opportunities to influence the way people think and feel about health. I knew that I wanted my patients to see me as “a partner in health.” 

Unfortunately, most of our patients come to us with the perspective that we are fixers of teeth, not partners in health. 

In the culture today people are bombarded with information about what is healthy. From friends and families, social and news media, and a wide variety of health care practitioners, everybody expresses opinions on how they are supposed to take care of themselves. Why, then, are we surprised when our patients don’t know whom to trust? Why are we surprised when they shrug their shoulders or appear confused? It’s not always a case of conflicting facts but a case of various perspectives that people don’t know how to navigate. 

Think about where you place your trust. How do you decide whom to trust about decisions—whether it’s about your health, or about your finances, or about how you raise your children? When I ask myself that question, two criteria surface. They need to know their subject and to know me. I want that person to know what it is they’re talking about. I want them to be well informed. I also want someone who knows me, who understands my values. I want that person to have a sense of who I am and what is important to me. 

As we get to know our patients over the years, most of them come to see us as trusted advisors when it comes to their dental health—but fewer see us as trusted advisors when it comes to their general health. If we jump too quickly to making recommendations about their overall health, we are more likely to meet resistance. If we want to cross the bridge into influencing our patients’ overall health and wellbeing, I believe we need an invitation to cross that bridge.   

The Missing Piece in our quest to influence the overall health of our patients is the failure to invite patients to share their perspectives on health. Beginning a conversation with a new patient with the question, “What can you tell me about your health in general?” is an invitation for them to talk about their experience of their health, not just details. Instead of “reviewing” health histories, what if we “explore” health histories? As we connect and get to know each other we can learn to listen beyond information to hear attitudes, beliefs, fears, biases, concerns, barriers, etc. As you understand their perspectives on health issues that come up in conversation, it’s easy to ask if they would like your perspective on that issue. These conversations often lead to more questions and answers that invite more and more invitations from our patients to be their partner in health. 

Kelley Brummett, DMD 

Recently, I completed growth conferences with everyone on my team. The beauty of a growth conference is that it’s all about growth. It’s all about effort. It’s all about meeting each other and becoming more aligned with the mission of the practice. If I have something I want to share with a team member that’s a concern or something new I would like them to achieve such as mastery of a new skill, I think about how I’m going to communicate it. And as I do growth conferences with the individuals on my dental team, I am cognizant that they are likely to want to receive feedback differently as individuals.  

I’ve discovered that if I ask my employee upfront how they like to receive feedback, they pause to think before responding. I wait patiently for their response because I know the response will save both of us time and energy. For example, there are some team members who want the short and skinny of it—“Give it to me straight now.” They don’t want you to hold back. There are some team members who need to be gently warmed up before they can hear the message and require thorough explanations of why. 

I’ve discovered it helps to frequently ask the “how do you like feedback” question of my team to get their buy-in of my feedback. The beauty of “feedback” is that even criticism can be framed in a positive way as the next identified step in working towards a goal.  

Those of us in dentistry know that sometimes we move fast, but there are times that we need to sit back, think through what somebody gave us information about, and then come back and have a conversation. Mary Osborne has guided us to have conversations with patients that allow us to slow down and learn more about them so they can think, hear themselves speak, and learn about themselves. I’ve decided the feedback question is also a good question to ask patients. “How do you like to receive information? Would you like to know all the details or for me to summarize?” 

I’ve learned from Mary and experiences with patients that “staying in questions” helps them grow. Staying in questions also helps team members grow. Staying in questions helps us providers grow. So, feedback—how do you give it? How do you like to receive it? How do you handle it? I encourage you to think about this. 

By Michael (Mike) Rogers, DDS

Close to my office there is a small strip center that includes a realty group and a small church. At one end, there is no sign to show what it is, but it has a drive-through window. Every day there is a significant line of cars going up to that window. Cars line up waiting their turn, and the line is so long the cars snake through the parking lot, out into the street, with hazard lights flashing. 

I have a friend who loves to create stories about what is going on in strangers’ lives. Why is someone driving so fast? What meal are they going to create with food in a shopping cart? Why are two people arguing?  

Fantasized from some level of observation, my friend has captured what this drive-through is all about. He believes that because the drive-through is adjacent to a church, you can pull up to the window and are given a donut along with a prayer. It’s a small ministry for people to have a better day. That’s not a bad narrative but no real basis for the story. I say that as the line of cars grows longer, the prayers gain power. I get a warm feeling of their impact on others. 

I find we make up stories in my office as well. We make them up about why someone didn’t show up for an appointment, why someone didn’t move forward in care that has been advised, or why someone won’t pay a balance. Our tales are based on some level of observation, but they are tales none the less. 

I try to remember to look at these moments in three ways. 

• What do I know? 
• What do I think I know? 
• What do I want to know? 

We practice this in our office. I encourage my team to not live in “what I think I know.” This state of mind too often leads to creating stories that reflect a judgement. If I hear a team member begin to create a narrative based on a circumstance with the phrase “I think…,” I try to politely make them aware of what they are doing. They most certainly recognize when I do it and politely let me know. I just grin to hide my disappointment in myself. Maybe someday, I’ll say, “thank you.” 

In relationship-based practices, we have such marvelous opportunities to help people be healthier. Asking questions about what we’d like to know and sometimes creating self-discovery for the patient as well. We often get repeated moments to connect and learn with each other. The need to make up stories is dissolved when we get to hear their story. Sometimes that story is fun, other times hard. We get to walk along that story with them. What a gift to live a life in that connection! 

Recently, a member of the realty group on one end of the strip center came in to see me. I couldn’t resist asking what the line of cars is about. It turns out it is an Ignition Interlock site for people that have had a recent DUI. You go up to the window for your installation time of the small handheld breathalyzer to prevent your car from starting after drinking alcohol. 

I haven’t shared that with my friend. I like his story better. 

Introversion and extroversion are psychological preferences first outlined by Carl Jung and then implemented in psychological models such as the Myers-Briggs type indicator (MBTI). The terms introversion and extroversion share the Latin root vertere meaning to turn. These preferences enable individuals to relate to the external world in different ways

Extroverts gain a significant part of their sense of self via feedback from others. Consequently, they thrive on interaction, which is energizing to them. They find more isolating situations stifling.

By contrast, introverts tend to develop their sense of self individually through reflection and clarification. They thrive in quieter and less stimulating environments, such as small gatherings with others whose thinking and values are aligned with their own. (I think this is why introverts tend to thrive in small person-centered practices that are values-driven–where their values are commonly shared by team members and patients alike.)

A Pankey Institute study in the 1980s showed that most dentists lean toward introversion. This makes sense because the profession requires full attention to small details all day—both physically and psychologically. Consequently, most dentists will say something like, “I love the technical aspects of dentistry, but I’m constantly frustrated with my staff and patient management responsibilities.” And in response, they will delegate the latter to others, creating a psychological wall between doing what they enjoy and the responsibilities they find too frustrating.

On the other hand, dentists who are more gregarious and outgoing tend to build up practices more quickly but struggle to stay on task because they thrive on social interaction. Consequently, these dentists tend to benefit from consultants who help them create systems where they “stay at the chair” and produce for the team.

If you lean toward being an introvert, you will likely discover that your practice grows more slowly, but with more intention. That can be a good thing and a strength if you learn how to leverage it. Why?

• The more conservative approach introversion brings to decision-making is more values-driven. Consequently, it’s not as heavily influenced by the environment and emotions as it is by personal insight. Thus, behaving more like an introvert helps us to identify smart risks that are worth taking because they have long-term, values-aligned potential.
• Additionally, Introverts are very sensitive to the environment. They tend to spot “warning signals” from team members and patients.
• Running a dental practice is a long-term investment, much like what Warren Buffet said about stock investing, “You need a stable personality. You need a temperament that neither derives great pleasure from being with the crowd nor against the crowd because this is not a business where you take polls. It’s a business where you must think.”
• Additionally, introverts can be more creative IF they structure their work environment in such a way that it tends to support their creativity. That’s because it is the nature of extroverts to mimic the opinions and behavior of others. Having a more solitary thinking style allows a person to tap into more creative solutions.

Introverts can learn to be more extroverted and many adults become ambiverts as they experience life. Certainly, in my case, I grew in my ability to engage in both patterns of listening and talking more equally—and effectively, despite being an introvert at heart.

From my blogs, you probably have ascertained that I am drawn to human psychology. I agree; both the psychological and clinical aspects of dentistry interest me. One of the benefits of lifelong learning is that I have learned to enjoy the business and social operations of my practice more over the years, and any psychological wall I started to build (between them and the clinical side) has been intentionally torn down.

Workplace environments are more enjoyable when there are variety and balance. If you are an introverted dentist, I recommend that you have extroverts on your team to encourage conversation and draw out the group’s perspective on various challenges. If you are an extrovert, I recommend hiring introverts in key positions whose instincts and intuition you deeply trust, so you can listen to their thoughts before making final decisions.

Susan Cain is the author of Quiet: The Power of Introverts in a World That Can’t Stop Talking. Cain says weighting our teams to having everyone be like us is “a colossal waste of talent.” It’s my opinion that businesses, dental practices included, are better served by taking a yin and yang approach to team hiring to create a balance of the two personality styles.

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.

One of the hardest things in dentistry is to know when to keep pressing onward or deeply reconsider a situation and move on in a new direction.

Everyone knows that perseverance and “grit” are key to success. Anyone who has worked their way to the top can tell you about their moments of doubt, horror stories and wounds acquired along the way. But never re-assessing, never changing course is problematic as well, as it is analogous to sailing with a fixed rudder. It is only a matter of time before you run your boat aground.

Do you have both a plan and a strategic planning process?

Successful management of the direction and functionality of a practice requires the use of both approaches, and that is why every practice needs to not only have a plan but also a strategic planning process. A strategic planning process is an iterative process of self-reflection. It is constant and not just an event. Because it is a “process” of constant reassessment, you can discover when to reimagine and change course. Dwight D. Eisenhower spoke to this truth when he said, “Planning is essential, but plans are useless.”

Where are things breaking down?

An objective way to arrive at an answer is to begin to analyze where things are breaking down. The work of Simon Sinek is helpful in making this analysis. He says we can have breakdowns in the areas of HOW, WHAT and WHY.

Breakdowns in specific areas of a practice are often breakdowns in HOW. This is when people are not executing well-designed and well thought through processes and procedures. This may be driven by a lack of knowledge, understanding, ability and/or desire. And these represent objectively correctable problems. For example, if the margins of our crowns are consistently substandard, we need to go back and figure out where our processes and thinking are breaking down. If a team member is failing to execute their responsibilities in an appropriate fashion, the same approach holds true.

Are you climbing fast in the wrong direction?

Failures can also occur at what I would call a “strategy level.” This is a more global level above execution, because it involves more of why we are attempting to do what we are attempting to do. Simply put, poor strategies will lead practices in the wrong direction. Steven Covey’s metaphor of having our life ladder up against the wrong wall applies here. We can be climbing fast, while simultaneously climbing in the wrong direction.

Does your work feed your soul?

Failures can and do originate on a WHY level. An example of this would be a person working hard and making bank, while hating being a dentist. This represents a failure on the visionary or philosophical level. Failures on this level represent spiritual depravation. In this case, we are going through the motions, yet very little of what we are doing feeds our soul. As a consequence, people often attempt to fill this void in a dysfunctional way, perhaps, with alcohol, drugs, sports, extreme exercise regimens—or something else that easily becomes an addiction.

If we have HOW and WHAT breakdowns in a practice and still have our WHY worked out, staying focused and working through issues and problems is appropriate. However, if the reason things are not being executed well and the reason our strategies aren’t effective is really because our heart isn’t in it, then we have a spiritual crisis on our hands.

Without first addressing our inner nature and our inner truths, we will never be successful at addressing more downstream challenges such as HOW and WHAT. L.D. Pankey was speaking to the essential nature of this truth when he said, “Know yourself.”