New Patients / Patients of Record

Often a dentist or team member can believe: A new patient or patient of record wants to be efficiently informed on two or three things:

• What do you want me to know about my dental health?
• What and how do you want me to do “it”?
• What is this going to cost? Or isn’t dental insurance going to pay for this?

A Story of Dr. R. A. Green from the Past to the Present:

A retired physician of seventy-five years of age was enjoying teaching at The University of Chicago Medical School. At the time of this conversation, I was attending Northwestern University Dental School and working part-time as a Doorman at The Hotel Pearson. The Hotel Pearson was a residence hotel; the physician was a resident of the hotel. The hotel was located where the Ritz Carleton presently stands on Pearson Street, one block East of Michigan Avenue; the time frame was the early 1960’s. That evening, as the retired physician walked out for some fresh air, he engaged me in a conversation, which he had done on previous occasions. I remember asking him about, what he was teaching?

His reply has stuck with me all these years. He said, “I am trying to encourage the young Interns and Residents to slow down and listen.” Slow down and listen, I replied with a question lingering in my voice. He said, “Yes, if I can help them begin to create opportunities for a patient to experience “deep listening” and then stay “present” with and for a patient, the Intern/Resident will notice, in time, a patient will diagnose their own ailment (at least offer enough important information to be able to develop a very accurate differential diagnosis); a wonderful place to start, a beginning!”

He went on to say, “If I can encourage the Intern/Resident to continue to listen deeply, a patient can reveal how they want to be treated. And, if the Intern/Resident can listen just a little longer, a patient can initiate a conversation about how they want to pay for the services to be rendered. Deep Listening accomplishes a greater understanding of the patient, which leads to a better diagnosis, and can lead to a more successful practice model than running from room to room, thinking you only have three – five minutes to do all of the above, while not accomplishing any of the above. I am really trying to encourage them to slow down and listen!”

Now, almost sixty years later, I am sitting and reflecting on my lifetime in dentistry and work with patients, team, and dentists; I too have been involved with teaching and coaching, myself and others, for over sixty years. While I strive to have conversations concerning many different aspects of dentistry, which surface while being present, with and for others, the bottom-line in a relationship-based life and practice are very similar to that of the retired physicians’ message, nearly sixty years ago.

My response is also altered and influenced, due to an early encounter’s with Dr. L. D. Pankey, soon after I had met him in 1968. In a conversation, he had asked me to tell him about my office and the flow of a day in my office. His response to my description of my usual day was, “Why don’t you Slow Down and become more Affective, you are Efficient Enough!” A similar message, and it had a heightened impact upon further reflection: “I have heard this before and it sounds very familiar!”

What is it you do intentionally, on a regular basis, to slow down and become more Affective (Affective Domain), for you too are Efficient Enough?

Hmmm… Isn’t that interesting!

As a small business owner emerging from the Covid crisis, one of the issues we face is how to manage employee compensation in a fair and open manner. Are we paying our employees a fair wage for what they do in the demographic area that we live in? Often it is not possible to know what the competition is paying.

In our current job market, skilled labor knows that they can be tough negotiators. Under current National Labor Relations Act rules employees have the right to discuss wages, hours and working conditions with others. Pay discrepancies can result in potential claims of discrimination and resentment. A mix of new hires and old hands, in particular, may lead to conflict about wages.

Your Wage Budget & Scenario Analysis

One way to address this as an owner is to create a spreadsheet that establishes the range of wages you are able to pay for various positions based on your requirements and your budget. It might look something like this:

In my case, I need to know not only what I am paying and whether I am competitive to get the best talent. I also need to know how any changes will impact my overall budget. As I am considering changes in my current employee wages and what I can pay a new hire, I need to know my overall business finances.

I also need to not manage my practice revenue to cover the luxury items I want in my personal life but instead to grow and sustain my business. I need a business growth mindset plus the attitude that Dr. L.D. Pankey promoted when he admonished dentists to learn to live on less than they make. Our teams make it possible to be in business. People come first. We’re in a people business.

Professional Guidance & Standards

My state professional association conducts a survey of offices every few years that provides a reasonably accurate picture of wages and benefits based on a number of demographic variables. That information, along with discussion of this issue with my peers, provides me with an idea of what the range of wages should be in my area.

My industry ideal is to keep total overhead for staff as close to 25% as possible, but in today’s economy this is becoming more difficult. I have found it helpful to define the market value of the various positions in the business and to understand the difference between the team members who produce income and those who do not.

Ask & Answer for Yourself a Few Questions

Where are your wages relative to your peer group? Are you underpaying, or overpaying, some of your people, and if so, what will you do about it? Where are your wages with respect to your budget and to what business analysis considers Ideal?

Something Most Dentists Don’t Do

You can take the information from your spreadsheet and share what you have learned with your team on an individual basis.

Each person needs to know that there is a range of pay for what they bring to your business. When they reach the top of the range, often due to longevity, that is all you can offer in wages. You might consider offering additional employee benefits, for example, additional vacation time. But know that what you offer will very likely be shared with everyone else.

Your wage budget worksheet allows you to develop an open and fair discussion of compensation. It helps remove much of the emotion that often gets in the way when employer and employee seek to justify levels of compensation. Your team members need to know you respect and value them, and to grasp that to remain in business there must be a profit and a budget for the business that makes sense for all concerned.

Relationship-Based Dental Practices Have an Advantage

Although recent news and chat forums indicate wages are rising for dental workers and this is putting pressure on dentists to increase their fees, we have much goodwill we can use to counterbalance this. Employees are not apt to jump ship when they like the environment in which they work…where their work is respected, their work is meaningful, they enjoy their co-workers, and solutions are found to reduce stress.

Dentists, who are truly relationship-based in their philosophy of dental practice, offer a totally different working environment than the many dental practices, in which employees describe their workplace as toxic. You can leverage the goodwill of your team members to help recruit the right new employees and stay in budget.

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In the comments below, I’d love to hear how other private, fee-for-service dental practices are currently mindfully managing hiring and wages.

When we have experienced a deeply traumatic event, such as an emotionally laden death, or the near-death of a family member, what is often left behind is emotional debris with the potential to follow us around indefinitely. Subsequently, we can become haunted by memories of what happened, or what we should have done to make things better. These kinds of recurring thought patterns can easily bleed over into our daily lives and negatively influence our behavior—and our future.

On a neurobiological level, this occurs as our brain is designed to keep self-preservation as its highest priority. Thus, possessing the ability to quickly recall traumatic events protects us from similar things happening in the future. But commonly, this constant re-remembering can lead us into a state of psychological paralysis, depression and/or chronic anxiety, and poor decision-making.

At the present time, many patients live in fear of going to the dentist, because they believe there is too high of an infection risk. Concurrently, they consider the process of addressing their dental needs as being a lower life risk. These shadows of fear can remain strong in their mind, particularly when they have a family member who is in a high-risk category. Simultaneously, some dental team members have made the decision to leave dentistry for similar reasons. However, both challenges are happening at significantly lower rates within relationship-based / health-centered dental practices, as these practices have already built strong, enduring bridges of communication within their patient pools.

The Shadow

A contagious virus is a concept most people understand. The level of anxiety this virus has generated world-wide is something many cannot successfully manage alone. We have all had patients whose past dental experiences were so negative and their thinking about it so distorted they cannot recall why certain situations trigger their dental PTSD. Carl Jung referred to the source of these recurring thoughts as “the shadow.” Buried memories and their emotional associations can be so strong that they take complete control over a person’s behavior.

Letting Go

The brain does not stop maintaining its focus on traumatic memories until it has come up with a rational explanation for why they happened and a plan for how to avoid them in the future. On this, Jung stated, “Until you make the unconscious conscious, it will direct your life and you will call it fate.”

CoDiscovery was designed to address the influence of the shadow’s influence on current behavior patterns, in much the same way as psychotherapy facilitates the exploration of the past and associates new meanings with those memories. It is intended to help patients associate new meanings with what they are learning about their dental past.

The “Rogerian” therapy model of unconditional positive regard, congruence, and non-judgementalism is an ideal format for patients to safely explore their fears, beliefs, values, and priorities. And that’s why Bob Barkley and Nate Kohn, Jr., Ph.D., leaned so heavily on Carl Rogers’ work. Bob Barkley put this re-experiencing process under an umbrella he called, “Three Phase Adult Education,” and the rest became history.

The Future

As optimistic as the future appears to be regarding the successful management and treatment of COVID-19, this pandemic experience has reshaped our thinking—our “shadows,” forever. How we manage these memories, conscious and subconscious, will have a lot of influence on our success going forward. If we demonstrate we are on the same side as our patients in preventing COVID-19’s negative impact, we create yet another strategic advantage we can leverage against our transaction-oriented competition. On the other hand, if we allow our patients’ fear-driven “shadows” to drive their decision-making, we will rue the day we allowed this proverbial cart to be placed in front of their psychological horse.

Bob and Nate had it right. CoDiscovery is the pathway to deeper understanding, hence better decision-making. And better decision-making is exactly what our profession needs right now.

As the Pankey community begins to re-open its practices, reports indicate that most patients are responding with high levels of trust and gratitude. This represents a clear indication that the investments we’ve made in building truly helping relationships with others are paying back significant dividends at a most critical moment. Relationship-based / health-centered dental practices are designed to give the kind of meaningful caring and support that relationship-starved people truly need as they venture back out into this brave new world. 

The truly person-centered Pankey practice model aligns well with research which shows longevity and happiness aren’t just linked to healthy diets, habits, and genetics, but also to the consistent presence of positive social engagement. My mother frequently spoke of these types of happy people as being “givers.” She’d say, “They are givers – not just takers, and they pass this attribute along to their children, because, well, that’s just who they are.” 

Abe Maslow called these types of personalities “B-Loving” individuals—individuals who self-actualize through their unconditional love of others. These are the folks who buck today’s meta-trend of consuming more, contributing less, and living a silo-type of existence. And we look forward to seeing them on our schedules, enjoy spending time with them, and feel a tremendous sense of loss when they finally pass.  These folks are the ones who intuitively know that the loving attention they give to others, no matter how simple or brief, is an ever-expanding positive experience that yields out significant benefits to themselves as well. 

When you add up all of those moments, hour after hour, day after day, year after year, you end up with the smiling and joking Betty or Bob. They’re the ones who are the first to give you a hug when you’ve had a bad day or experienced a personal tragedy. And they’re the ones who alter the course of our lives through a laugh, a smile, by demonstrating strength, courage, and irrepressible hope. In short, they are miracle makers. 

As practitioners of relationship-based / health-centered dentistry, we need to remind ourselves that we’re miracle makers as well, because we’re also in a perfect position to listen intentionally, care more deeply, and help more significantly. But that’s only possible when we choose to see dentistry as being a helping profession and not just about teeth, technology, production – and now PPE! 

On a personal level, I’ve found myself sharing my feelings about what we’ve experienced with my team and patients, and I’m finding myself opening-up on an emotional level more each day. As a result, we’ve ascended to yet another tier of caring as a team.  We’ve used this communal tragedy as an opportunity to strengthen our social bonds through love and understanding instead of allowing fear to drive us further apart.  Abe Maslow would likely say that we’re self-actualizing on the individual, group, and community levels through B-Love. This represents a key realization, because in spite of all the new stress which has been thrown into the middle of our lives, we’ve been able to see the huge practice development opportunity the situation has created for us.   

Those of us who have grown technically, intellectually, and spiritually through The Pankey Institute have “givers” hearts (just go to one Pankey Alumni meeting and you’ll understand exactly what I’m talking about). Consequently, this communal tragedy plays right to our natural strengths, inclinations, and existing practice structures. So, in spite of all of the changes surrounding us, it’s time to confidently step forward and demonstrate principle-centered leadership. And by so doing, we’ll be holding fast to what we already know is true – that the secret to living is in the giving. 

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!”