When L.D. Pankey returned to Coral Gables from the International Congress of Dentists in Paris, in 1931, knew he needed additional education if he was going to follow his personal commitment of not extracting any more teeth. With a recommendation from his new friend in Paris, Dr. Daniel Hally-Smith, the dentist, L.D. wanted to emulate, he signed up for a three-month summer course at Northwestern University in Chicago.

The program was designed to cover all the phases of modern dentistry including how to interview patients and do a proper clinical tour of the mouth so the student could determine what was really needed to give their patients optimum dental care. They were saturated with topics both technically and psychologically related to diagnosis and treatment planning concepts. Most of the information presented was focused on clinical procedures.

The patient psychology course was taught by George Crane PhD. During that summer, George Crane, a trained psychologist, was between his freshman and sophomore years in medical school at Northwestern. He had been hired to teach a summer course to physicians and dentists on how they could better understand and communicate with the patient.

At that time, there were no definitive textbooks about doctor/patient communications. During his lectures Dr. Crane brought in loose-leaf handouts for the class. The handouts later became the framework for his first book on applied psychology. Crane’s course was the highlight of L.D.’s summer, and it turned out Dr. Crane’s course became the foundation of what became the Pankey Philosophy.

Crane’s lectures were centered around psychology to be used by doctors to develop interpersonal relationships between the professional and the patient. The course included an overview of Carl Jung’s work, defining Jung’s four personality types: the introvert, the extrovert, the ambivert and the compensated types. The students also looked closely at the 1905 Binet-Simon Scale to determine the intellectual capacity of children. They studied the first “mental horsepower” test – otherwise known as the IQ test.

Later, when L.D. developed his own philosophy, he used much of the Crane course ideas for his Dental IQ, patient intellectual, sociological, and economic classifications. After finishing the George Crane course, L.D. felt confident that he had taken a giant step toward gaining the knowledge and communications skills that were needed in his practice.

Dr. Crane was a strong proponent of the balanced life and spent a great deal of time discussing Cabot’s “Cross of Life” which emphasized the need to balance work, play, love, and worship for a truly fulfilling life. The cross diagram was developed by Richard C. Cabot (1869-1939), who was a physician, philosopher, and Unitarian minister.

Following his graduation from Harvard University Divinity and Medical School, Cabot started his clinical work at Massachusetts General Hospital where he established a hospital based Social Service Department and became the first Chairman of the Department of Social Ethics at Harvard. Over the years, Cabot wrote twelve books on Medicine and Ethics.

Cabot also became a major educational leader in medicine by publishing monthly “Cabot Cases” in The New England Journal of Medicine. Each month physicians in local study clubs throughout the county would read and study the information provided by Cabot. They would try to determine the diagnosis for the patients in the case. The final diagnosis was provided the following month in The New England Journal of Medicine.

Crane assigned one of the Cabot books, What Men Live By, to L.D. and his classmates to read. The book explored how to achieve personal happiness. According to Cabot, happiness could be achieved by striving for balance in personal life. When explaining this concept to his patients and other professionals, Cabot recommended drawing a simple diagram with Happiness in the middle and four arms labeled Work, Play, Love, and Worship.

What Men Live By was published in 1913 and has long been out of print. Many of the references seem archaic; however, the basic principle of balance has stood the test of time. There are needs for all of us to be productive, to enjoy daily life, to have people in our lives that we care about, and to extend our interests beyond ourselves. An excess or a deprivation of any of these basic needs of life can set our lives out of balance, destroy our sense of self-worth, dull our enjoyment of life, or alienate us from our fellow human beings.

When L.D. Pankey developed his philosophy, he uses the Cabot Cross as a starting point for dentists on their journey to fine personal happiness.

L.D. Pankey famously said, “People change but not very much,” and hearing this for the very first time represented an “aha moment,” as it put into proper context an important realization I had previously ignored.

As dentists, we know a lot, and we have worked very hard to acquire that knowledge. As a consequence, we naturally want to use it to help others. But there’s a problem. Often times others act like they don’t want to be helped. Often times others act like they don’t want to be better. Often times others act like they don’t want to map a course toward a higher level of health. So, we struggle to make sense of it and even judge others as a result of it.

Developmental psychologist Jean Piaget, PhD told us that the motivation to change comes from within the individual, from their perception that they’re in a state of “disequilibria,” wherein what they’ve been doing in the past (including what they believed to be true) isn’t producing the outcome they want. And as a consequence, the person is confronted with an uncomfortable truth. They can’t keep on doing what they have been doing and expect a different outcome. They’re going to have to suffer through some personal change if they sincerely desire to experience something different in their life. And executing the change is going to cost them something namely time, energy, and money. In other words, significant change can’t be done for them or to them. It’s an “inside-out” process that they will have to do for themselves.

Some people will look at their need to change and ignore it. They will say to themselves the cost is too high for them to pay, or they will simply rationalize away their need to change in an elaborate form of denial. Others will immediately confront the challenge, learn what they need to know, figure out a way to pay the price, and move on. So, what’s the difference between these people?

Perception… values… readiness.

What Can We Influence? 

In our world as dentists, we can build up a person’s understanding of their situation through CoDiscovery, and therefore we can facilitate how they frame, prioritize and think about what they have learned. But we can’t make them change. We can’t cause them to act. We can only honor where they are with it all and stand ready to assist them when they are ready to move forward.

Significant change often requires a change in a person’s value structures and the hierarchy of those structures. Piaget called changes of this type “accommodations. Piaget said that they are made at the person’s own pace after the person senses that he or she is in a state of disequilibria. And so, Dr. Pankey was right. Those who change do so not because we are highly skilled at “case presentations.” They do so because they want to, and it may occur only a little bit at a time.

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. 

Fifteen years after graduating from dental school I was searching for answers.

I barely knew what questions to ask because there was no guidebook to learning how to practice dentistry and live the life I imagined. I read every book including Juggling for Dummies. Then I stumbled across The Pankey Institute, and I knew my search was over. Back then the program consisted of five continuums. At C1, I was lucky enough to meet Dr. William Davis, the co-author of the then recently published book A Philosophy of the Practice of Dentistry, with Dr. L.D. Pankey.

At the end of classes one day, I stayed behind to talk with “Bill” about philosophy.

I always had an interest in philosophy, but Bill discussed how Dr. Pankey applied philosophy to a dental practice. We spoke into the evening and through the week. I told him that this philosophy sounded a lot like a garden variety of personal development. It was loaded with quotes from Napoleon Hill and Dale Carnegie, yet I felt there was more to it; after all, Pankey had studied “real” Aristotelian philosophy at Northwestern University.

I was never satisfied with the explanation of the philosophy consisting of the graphical “Pankey Crosses.”

From that week on I took my studies deeper. My search for answers continued, but now I was on a path. I realized that if I was going to apply philosophy to my practice it required behavioral changes. The Pankey Philosophy was more than a moral philosophy which is projected and leads to judgements about the way others do dentistry. I realized that this philosophy was a personal and practical philosophy which was designed to direct my own behavior.

The examination process became very important to me, because by continually perfecting it, I could focus on my behavior and the changes it made. Those personal changes lead to more success and more enjoyment. Slowly I began to appreciate dentistry. I focused on the “apply your knowledge” arm of Dr. Pankey’s Cross of Dentistry. Then, while taking courses in positive psychology, I realized that in order to make real changes I would have to focus on my “character strengths and virtues.”

“Dr. Pankey and the Greek philosophers used the word virtues.”

Dr. Pankey and the Greek philosophers used the word virtues. I never truly knew what that meant. Somewhere I read that a virtue is a habit of the mind that is consistent with nature and reason. It can be argued that when L.D. Pankey spoke about care, skill, and judgement, he was speaking about virtues. Not surprisingly the positive psychologists have written about character strengths and virtues.

They have defined twenty-four separate strengths divided into six virtues: wisdom/knowledge, courage, humanity, justice, temperance, and transcendence.

By studying these strengths and virtues and working them into my daily habits, a funny thing happened. Not only did I become a better dentist, but I became a better leader for the first time in my practice. Leadership was the answer I was searching for, and character was the answer to leadership. It has been a long and worthwhile journey that may have ended differently without understanding Dr. Pankey’s philosophy was a personal and practical philosophy that had real meaning for my life.