I don’t mind talking about dentistry…anywhere, anytime.  So, when a friend approached me in the gym and asked how business was, I told him, “It’s been slow.”  He then felt compelled to tell me, “Well, if you guys would lower your fees, you’d get more business,” as I stared at the gap in his smile that he never fixed.

Funny how people reduce complex problems down to a simple cause.  Most people can’t live with the idea of unsolved complex problems.  The answer to getting more business into a dental practice is not to simply lower fees.

But I love to talk dentistry, so I told him a story.

I asked him to imagine a dental experiment in which a dentist did the exact same procedure on ten different patients.  Let’s say it was a simple single surface filling on a lower molar.  He was following me because he was familiar with the terms filling and molar.  I didn’t want to confuse him, and I didn’t know how much dentistry he knew.

The procedure, I told him, required an injection, some drilling and then putting in the filling.  He nodded.  Then I asked him, “Do you think the procedure would be exactly the same for each patient?”

He gave me an understanding look…he was a master of the obvious.  He said, “No, each patient was different.”

“Yes, some would move, some would cry, some would scream, some would salivate too much…the variables are endless…and those ten scenarios only included the patients who made it for their appointed time,” I said.

Once again, full comprehension.

So I asked, should the fee be different for each one?

Now he looked baffled…actually upset, stymied, dumbfounded.  No answer.

I felt sorry for him, because my intention is to educate not aggravate, so I proposed a different solution:

“What if the dentist added a drug to the Novocaine that filled each patient with a high level of trust…love almost.  A strong feeling of attachment was created by this drug.”

He laughed and said, “Sure…can’t ever happen.”

“What if I told you that the drug already exists…and actually we humans can create our own.”

I had his attention.

“It’s called oxytocin.  It’s a hormone and a neurotransmitter (was pushing it with this word) that women secrete during childbirth.  I even use it as a dog breeder to help the girls give birth and start lactation.  It’s been called the hormone of love.”

He was wondering where I was going with this, so he said, “Why don’t you guys use it?”

“Because it’s not available here in the U.S.  The Swiss have a version that’s inhalable.  But we really don’t need it.  Recent research shows that if a person feels that they are around someone or something that expresses love, trust or the desire to bond, then their levels of oxytocin increase.  In other words we can manufacturer it ourselves.”

“So what good does that do us,” he said.

“Well, if there wasn’t all of this distrust in our culture, if there wasn’t so much self-interest going on, if people , including dentists didn’t worry so much about getting theirs, well, that would be a solution.”

“When pigs fly, ” he said.

Not really, if each of us takes the responsibility to really care about the other…things will change.  If not, capitalism in health care will need more and more regulation.  Or we can just lower our fees.

 By the way this conversation was a presentation of sorts…can you see why?

Overcoming writer’s block – crumpled paper on wooden floor – crushed paper

Do dentists see themselves as creatives?  I don’t mean mean dentists who write or paint…but rather in their everyday practice of dentistry.  It is my belief that people bring creativity to their job…and dentists are no exception.

In many ways dentists are like writers.  Let me explain.

Years ago, before I created my examination process, I would gather up all of the information from the clinical examination:  the radiographs, the models and the charts.  These days I have added study models and photographs.  Either way, I would sit down at my desk, get a cup of coffee, close the door and get ready to create my plan.  Sometimes I gave thanks that there wasn’t much to do…a simple case.  Other times, especially when the amount of material I collected seemed overwhelming and confusing,  I would sip my coffee and look blankly at the viewbox.  I would pick up the models, and many times nothing came to me.

It was the same feeling I would get when I get writer’s block.  Brainfog.

There are many ways to cure writer’s block, like going out for a walk and coming back later, but when you’re facing a deadline you have to produce something.  When a reporter gets writer’s block he just writes a bad article.  When a dentist gets writer’s block he creates a bad treatment plan.

Writers use outlines and other techniques like freewriting to create ideas.  Mind maps work well too.

One thing I always rely on is a guide.  When I sit down to write, I always put three words on top of the page: Topic, Angle and Purpose.  Those three words keep me focused.

I am a big believer in using guides.  When I create a presentation…I always use guides.

When I treatment plan I also use guides.  My treatment planning guide always sits out on my desk while creating treatment plans.  It has become a habit, regardless of the simplicity or complexity of the case.  For me it was about avoiding the brainfog of writer’s block.  And guess what?  My treatment plans make more sense.

I became more confident in my treatment planning process…because I actually had a coherent thought process.

This may sound obvious to many dentists, but what I have found out is that most dentists don’t work with a process.  They don’t have an examination process, a treatment planning process or a case presentation process.  Many operate by the seat of their pants.

It’s funny but some writers actually like writing by the seat of their pants, without guides or outlines.  It works well for them.  It works because they have erasers on their pencils…they can revise.

Dentists don’t get second chances.  Your Treatment plans are your gift to your patients…your creativity.

If you would like a free copy of my guide, become a subscriber to the ADL Newsletter.  As a bonus I will be sending out the many ways I use it to put my treatment plans together.  For those familiar with the Art of the Examination this is new information that I never wrote about in that book.

In my last post I left you with one word: humility.  That was unfair because in the comments I realized that I didn’t tell you how to become humble.  And believe me I am not so arrogant that I think I can tell you, but I have learned a few lessons in my time.

And some of those lessons were learned at, of all places, the racetrack.

With Orb winning the Kentucky Derby last Saturday,  I was transported back to a time when I spent many of my leisure hours at the track.  I admit it…I was part of the subculture,  I already had the name…Doc, so I fit right in.  I used to spend a lot of prep time handicapping the races, and I did quite well.  I was known around the rail as someone who knew how to pick winners.

But picking winners is not easy.  I remember one guy, let’s call him Lenny because that’s a great track name too, who would always ask me who I liked, and then he would go and bet another horse…usually the favorite, because in the end, his decision making process led him to consult with what psychologist Robert Cialdini (Influence), calls the social mirror.

Lenny would cash a few tickets, and sometimes he would hit a long-shot…but there was no consistency.  No rhyme or reason to his betting.  But he was convinced that his process was responsible for his occasional success.  His losers?  Well, he always cursed his losers…they weren’t his fault.

I did much better, but I eventually lost interest and stopped going.  Years later I ran into Lenny at a local ice cream shop.  Same old Lenny, still chasing his dreams...he never stopped to figure out what he didn’t know…still telling everyone how good he was doing.  Lenny proved the old adage:

“You can beat a race, but you can’t beat the races.”

What did he need?

Humility…it probably could have saved him a lot of money.

So what is the connection to dentistry?  Most dentists don’t know what they don’t know.  They give themselves credit for the winners and blame their staff and patients for the losers.  There’s a lot more to interpersonal communication than meets the eye.  The late Walter Hailey once told me, “You have to kiss a lot frogs to succeed.”

I’d rather “know my frogs.”

You can learn humility in other places as well…on the golf course, at the poker table or at home with your spouse.

Life is the teacher.  But some people never get it…and what I learned a long time is that winning is a habit…and so is losing.

Many years ago dentistry was a simple profession.  Patients came in to get their teeth fixed, filled or cleaned.  Occasionally they would get their whole mouths fixed up.  And sometimes just get a tooth pulled.  And things were pretty much cash and carry.

Most people stayed with their dentist for years.  The family dentist was like the family doctor or lawyer or accountant.  Ahh, life was so simple back then.

A lot has changed.  And a lot hasn’t changed.

As the world and industries change, the requirements of jobs change.

The cost of dentistry has skyrocketed.  That is not a complaint, everything goes up especially wages.  Those who watch the economy notice that prices have far exceeded wages.

With those economic changes have come cultural changes like the growth of dental insurance, and the loosening restrictions on advertising professionals.

Then there was the cosmetic dentistry revolution of the nineties when everyone wanted their teeth whitened but not necessarily fixed.

And dentists began to feel the heat.  They didn’t do as well as when times were much simpler.

But some still thrived…a minority who understand that when times get tough it’s time for a new strategy.  But most of dentistry doesn’t understand what that strategy should center on.

Relationships.

But here’s the rub…most of us think we’re really good at relationships.  So most of the continuing education dollars are spent on how to place implants and veneers rather than how to build trust.

We learn how to build complex 4 on 4 cases that we rarely get to do because we haven’t learned how to build the trust to make it happen…consistently.

Most dentists don’t have coaches.  Not mentors or teachers, but coaches.  A coach is someone who observes the way they practice and provides feedback through critique and correction.

Most dentists get cases accepted and never really understand what they did right…or wrong.  If they get to do many large cases they chalk it up to the halo effect.

Wikipedia defines the halo effect or error as a cognitive bias in which one’s judgments of a person’s character can be influenced by one’s overall impression of him or her.  In other words one gets credit for being a great communicator when really they are just a good dentist.

So, why won’t dentists get this, and why will organized dentistry continue to change so that only the very astute will be able to thrive and do the cases they love?

Because it takes a lot of humility to admit we need help in these interpersonal skills.  We must lose the arrogance that tells us we are master communicators.

We must ask ourselves what skills are essential for doing, actually doing great dentistry consistently?

We must be willing to be coached.

We must take ownership of understanding our own present skill levels.

We must truly understand what makes a great dental professional.

I think it’s humility!

In my last post on this blog I made the comparison of creating discipline in hitting a baseball with examining and communicating with patients.  Soon afterward  dentist-friend wrote me that the analogy can include staff as well.

I agreed.

I reminded him of another post I wrote concerning our definition of placing people above or below the line, and how we have a tendency to judge things as either this way or that way. 

I don’t know about you but dentistry has certainly changed over the past forty years, and our approach must change with the times.  There certainly was a time when my “boundaries” were a lot tighter than they are today.  To use a baseball analogy again, I see a lot more curve balls and cutters these days.

 Anyone can hit a fastball.

When it comes to patients my philosophy is to meet people where they are.

Of course, that doesn’t mean I have to bend my rules and change my policies to accommodate them…I just have to have more patience and more discipline.

I meet so many dentists who use phrases like “oh, that patient has no value for what I’m trying to do, maybe this isn’t the practice for them.”

Nice thought to discuss over a Miller Lite, but in this economy, where patients really need deep communication I like the approach to give them more of a chance.

I am seeing four patients at the present time that are in their late twenties, very poor dentition and personal circumstances that almost prohibit complete dentistry.  All have accepted care…and I am confident that when things get better, I will have played a big role in their lives.

The role of a mentor, a teacher. 

Taking time to understand them and build trust is the key.  I have written blog posts about motivating rather than educating…I want to quote myself, and hopefully you will quote me as well:  “You don’t have to know how The Force works, you just have to trust it.”

Patients, staff members who don’t trust the “force” have no place in a relationship with me.  I am quite sensitive to that…it never seems to work out in the long run.

Too many dentists are too quick to pull the trigger and tell a patient that this isn’t the practice for them.  Maybe it’s not.  Certainly, I have behaviors (boundaries) I won’t tolerate, we all know what those are.

So many of these patients are looking for someone who will work with them.  When our focus becomes one of growing people, we will grow along with them.

The guy down the street can’t do it any better than you.  Or any cheaper.

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I am a baseball fan, and I love using sports as a metaphor for life.

A few years ago Michael Lewis wrote a great book that was turned into a popular film, called Moneyball.  The book was about the Oakland A’s general manager, Billy Beane and his plight to assemble a competitive baseball team in a league where the big market teams had huge financial advantages (did I say the Yankees?).

Beane realized that there were certain skills that ballplayers possessed that actually lead to more runs, and those skills didn’t necessarily belong to the high priced stars of the game.  In other words he looked for specific skills rather than star power.

One of those skills was having discipline at the plate.  And one player that exemplified this was Scott Hatteburg, a relatively unsung player who developed and practiced skills to become a more disciplined hitter.  (Note to my Phillies—stop swinging at the first pitch).

Hatteburg developed 5 rules:

1. Develop the ability to hit almost anything.

2. Create the ability to know what pitches he could “do something with,” or p[itches he could look for.

3. The ability to look for those pitches.

4. The ability to spot and avoid those pitches he knew he couldn’t do anything with.

5. Repeat all of the above.

What does all of this have to do with dentistry and presentation?  Take out the word pitch and replace it with patient.

For those who are familiar with the life of L.D. Pankey, you know how much emphasis he placed on the four skill areas of examination, diagnosis, treatment planning and communication (presentation).

In 1932 he left his thriving dental practice to take a three month program at Northwestern in Chicago to study these four disciplines.

These are the time honored skills that make dentists effective and successful.  These four skills enable the dentist to understand the game at a deeper level.

Don’t be swayed by the big stars who place their beautiful photos on Facebook…the best dentists are the quietly confident ones who understand the subtle aspects of dentistry.  Learn to “read and react” to your patients…these are skills that can be learned, developed and practiced.

I once took an implant course with a dentist who wanted to use my book, The Art of the Examination, as a reference.  During the program he explained that he didn’t think it was a good idea because it wasn’t what he was teaching (how to place implants).

I accepted his premise, but I disagreed…it’s worthless to know how to do something if you don’t know why, who, where, and when.  Is that what is being taught in dental school and CE programs today?  The disconnected “how.”  That’s not art.

In Part Two of this post I will explain some of the benefits of knowing why, when, who and where…Billy Beane saw those advantages when his team became more competitive.

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“A little girl and her father were crossing a bridge.  The father was kind of scared so he asked his little daughter:
“Sweetheart, please hold my hand so that you don’t fall into the river.”
The little girl said:
“No, Dad.  You hold my hand.”
“What’s the difference?”  Asked the puzzled father.

“There’s a big difference,” replied the little girl.
“If I hold your hand and something happens to me, chances are that I may let your hand go.  But if you hold my hand, I know for sure that no matter what happens, you will never let my hand go.”

In any relationship, the essence of trust is not in the bind, but in its bond.  So hold the hand of the person whom you love rather than expecting them to hold yours…

The bond between a parent and a child or between husband and wife is self evident.  Trust is mandatory.

That trust also exists between a student and a mentor.  I believe a dentist is lucky if he or she can find that relationship in life.  It’s not always available and seems to be more difficult to find in these trying times.

As dentists, we too are mentors to our patients.  Our role is to take our patients by the hand and lead them across a threshold from the world in which they live to a world of health.  In the terminology of Joseph Campbell, the mentor guides the hero from their “ordinary world” to a “special world” by providing the lessons and the tools to make the journey easier.

Think about the relationship between Obi-Wan Kenobi and Luke Skywalker.  In order for the mentor to affect the hero to move him to another plane, the first threshold is to develop trust.  Without it nothing happens.  The mentor’s role is to push the hero through any resistance.

People really do want to change…as I have said so many times...they are begging to be lead.  They are just looking for someone to trust.

In my new book I write about being a “transparent leader,” one who is all about helping his patients without having an agenda.  Being transparent is the key.

Ultimately trusting your dentist will get the patient through any difficulty.  Patients don’t have to understand how the “Force” works…just to trust it.

In my book I write a lot about persuasion and influence, storytelling and photography, but without trust—nothing matters.

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In my first year of dental practice, 1975, I realized that case presentation was a skill worth learning.  One of my very first purchases was a book of illustrations that visually described everything I did in practice.

I still use the that book.  Of course, with the advent of implant dentistry I have to use some newer illustrations but the book still does a nice job.

There was one picture that I rarely showed to patients (picture above).  I didn’t show it because I was taught in dental school that the Focal Theory of Infection was incorrect.  Since my book of illustrations was published in Germany I assumed that the news hadn’t reached Europe yet.  I didn’t want to misinform my patients.

Man, has my thinking changed since then.  But I digress.

The other day I was explaining the oral-systemic connection to a patient, and lo and behold I discovered that the illustration was most effective in getting my point across.

The picture isn’t 100% accurate, but it certainly cleared things up for my patient.

So what do we learn from this?

Once again I was reminded of the principle I read about in Made to Stick by Chip and Dan Heath; that most of us suffer from the curse of knowledge in presenting to our patients.  What we know hurts us when we are trying to communicate clearly.

Our role is to motivate…not educate.  I have no need to discuss the focal theory of infection with patients…unless I can do it without causing confusion.  Once we confuse…we lose because people shut down.  In my new book, The Art of Case Presentation, I discuss the science behind the brain shutting down (and as a bonus I’ll tell you how to get a clear path to the reward center).

Feel free to use the illustration when discussing the oral-systemic connection.  Give it to your hygienists…it will make their lives easier.  Most important…keep your presentations brief, simple and clear…use simple illustrations.

We are binary thinkers.  We tend to think in terms of either/or, as if we only have two choices.  Well, chocolate and vanilla aren’t the only two flavors in the world.Sometimes this type of thinking can hurt us.  When I first heard an explanation of L.D. Pankey’s method of identifying patients as being above the line or below the line, I began to put patients into one box or another.

What I found out is that most patients fall on the line.

If we wait for above the line patients to come in and accept everything we say…it’s going to be a long wait.

If we label patients as below the line we will fail to give them our best effort.

That sounds logical.  But through the years I have heard many dentists and consultants categorize patients just that way.  It’s wrong!

Your patients are a reflection of you.  You make the difference in whether they are above or below the line.  My line is different than your line.  Every patient has a home.

The difference between practices is how the dentist builds the culture through her policies and systems.

The major difference lies in the dentist’s ability to clearly present dentistry, in a manner that effectively creates positive action in the patient’s behalf.

In other words, poor presentation skills equal a lot of below the line patients.

Essentially, that is why I created this blog…case presentation is the great differentiator of dental practices.

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One question that I always get asked is, “Do your hygienists sell dentistry for you?”  I am always taken back by that question because I feel that the ultimate responsibility of selling the case belongs with the dentist.  However, there are certain roles that significantly contribute to the selling process.

Just the other day two staff members approached me just as I was about to sit down and start drilling.  With gloves on and mask in place they informed me that the nine o’clock patient didn’t want his teeth cleaned.  He just wanted a filling place and then he wanted to leave.

Okay…stop action.

If you are a dentist…what would you be feeling right at that moment?

What was I being asked to do?  De-glove and de-mask to go into the next room and tell the patient to get his teeth cleaned?  Of course not.  But how many times during the course of the day are there “opportunities to persuade” that staff members can easily handle.

Now I’m not saying they have to “sell a complex case,” but there are moments when just positional leadership can be quite effective.

In this instance I hold myself responsible for not inspiring my staff to take on the leadership role of persuasion.  And in speaking with my coaching clients, I know that transferring of leadership is something that dentists need to learn.

Dentists have lots of responsibilities during their workday.  They are constantly leading,  and the one responsibility that never goes away is motivating and convincing patients and staff to do what is right for the practice and for health.  Many grow weary of this task…and actually stop doing it.

I feel for the dentists…it is one reason I take leadership so seriously.

So, if you are a staff member…any staff member, take a leadership role and start persuading patients to take action for their own good.  Learn the “reasons why” people should take care of themselves.  Learn the reasons and learn how to best reach patients.

In many cases it’s a lot easier than we think…people are really begging to be lead.

If you want to help your boss—take the lead.

I guarantee it’s appreciated.