Why Dentistry Will Never Get It



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.

images-2A 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.


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!




What Does Dentistry Have in Common With Baseball Part II



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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What Does Dentistry Have in Common With Baseball? Part I

Cover of "Moneyball: The Art of Winning a...



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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Why Trust Prevails

images-3 “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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What Was Old is New Again




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.


Don’t Get Caught Up in Stinkin’ Thinkin’



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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Is Your Team Playing the Same Game as You?






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.



One Way to Motivate Patients





In a recent post I explained that one of the most important roles for a dentist is to be a motivator.  Motivation is a leadership skill that too many dentists confuse with education.  Sure education is important, but I know a lot of smart people who never get off the couch.  This blog is committed to making you a better presenter so I want to remind everyone to never lose sight of constantly and consistently motivating patients to “be better.”

Now that could mean a lot…I can write a book about that (actually I am completing that book right now—The Art of Case Presentation).  “We are always presenting,” and “Doctor, you are the message” are two of the topics I cover in the book.

The mouth you see in this blog post belongs to a new patient I saw last week.  What do you think he needs more than anything?  Like the smoker and the overweight person…he needs some motivation.  Obviously he knows the score…he just needs some really good emotional reasons to get moving.  And that is our job.  Or you could argue that our job is just to inform him or that our job is to just make it go away.

The problem with those last two job descriptions is that we tend to “educate” and inform by implying the word, should.  I know a lot of dentists who should all over their patients...I like the term, musterbate (they must do it, or else something bad will happen).  Did you ever should on a smoker?  How far did you get?

So I sat with my patient during our preclinical meeting and asked some questions.  Mostly the questions concerned the obvious orthodontic condition.  I asked the thirty five year old if he ever considered straightening his teeth…he said he was okay with the way they looked, so he saw no need.  I followed up that question with, “Can you think of any other reasons why braces would help you?”

He looked befuddled.  I gave him time to answer but he really had no clue.  So I told him (I educated him about periodontal disease and function and even the oral-systemic connection), but he appeared unmoved…interested, but unmoved.

Then I asked him about his parents.  How were their teeth?  He said his dad still had his teeth but his mom had lots of problems with her teeth.  I asked if she wore dentures, but he didn’t remember because she died early.  “From what,” I asked.

“Heart attack,” he said.  But he said it with emotion, and as if something clicked,  I saw the emotional gap closing.

That is the goal of presentation…to close the emotional gap.

I write about this a lot in my new book, but I wanted to share this story with you because it clearly illustrates the distinction between motivation vs. education.

Dentistry doesn’t do the public any great favors by overemphasizing cosmetics…we can actually devalue dentistry by focusing on things that are superficial for many people.

Science tells us that when we give examples of other people, our brains don’t get the connection.  The gap stays open because our brains see the other as a stranger.  Our job is to get so close that the patient actually visualizes what will happen to him in the future.  Difficult to do?  Yes, but we can do it with morphing software which will eventually be available, but we can also do it with surrogates like our parents.

When we close the emotional gap we also swing the cost-benefit ratio way in favor of the benefit side.

Leadership skills and presentation skills are what will make the most successful and effective dentists of the future…I have always contended that and that is why I have devoted this blog and to those ends.



Dentistry – A Contact Sport?



I am a follower of the Spear blog.  I recommend visiting it daily.  You never know what topic will appear, from clinical to management issues they really do a nice job.  I comment often.

Today’s post, The Dental Practice Ecosystem really struck a chord with me.  Imtiaz Manji very succinctly describes the nature of the activities in a dental practice.  It took him just one blog post to describe what has taken me years to develop and to write about in my books, The Art(s) of Examination and Case Presentation.

Essentially this is what he says:

But there is a simple, universal internal logic that drives success in any practice. It’s what I call a dental practice ecosystem and it goes like this:


  • You can only collect what you produce. 

  • You can only produce what’s in the schedule.

  • You can only schedule what patients accept. 

  • You can only get acceptance on what you present.

  • You can only present what you diagnose and treatment plan.

  • You can only diagnose what you have learned to see.

From the bottom up this is what my books describe.  More importantly his description, to me, is like asking someone to define football, and they tell you essentially it is blocking and tackling.  Win the game at the line of scrimmage and you win the game.

Sure, it’s a bit more complex than that, but I see so many dentists getting out of the game when the real action occurs at the face-to-face contact between doctor and patient.  My own success really took off years ago when I realized the importance of this and concentrated most of my efforts at the point of contact.
Dentistry is a lot like football—it’s a contact sport.

The One Skill That Leads to Success





I continually get into arguments with dentists and lab technicians about our role with patients and with other dentists.  There just seems to be so much complaining clients who just don’t do what we want or expect them to do.

Last week, on two separate occasions I was discussing this issue with a dentist and a technician.  I asked them what they did when they faced this very frustrating situation.

Both replied in exactly the same way (which, by the way, I have heard over and over again, whenever the subject arises).  They both said, “I educate them.”

As if this education process somehow leads to more compliance.  Well, it usually doesn’t.  But it does absolve the dentists and technician because at least they feel they did the proper thing…the right thing…the moral and correct thing.

It just doesn’t work.  And that is more frustrating.

I suggested to both, like I always do, that instead of trying to educate their clients it might be good idea to motivate them.  The technician said it was just semantics.

Well, it’s not…there is a big distinction between education and motivation, and a good motivator can save a lot of time and be much more effective.

The late Thomas Leonard, founder of Coach University, was very emphatic about making distinctions of words.  You might say it was the basis of his coaching style.

Making the distinction between educating your patients and motivating them will change the way you approach all of your patients.  When you take on the role of motivator, it will not make your job easier…just different.  You will notice that there is an art to motivating people…moving them from what is to what could be.

The business of dentistry is all about changing people, not unlike gyms and diet centers.

Sure, some education is necessary, but to truly be effective we need to motivate.  Do I have to mention flossing?

Motivating patients is an “art.”  That is why I named my books The Art of Examination and The Art of Case Presentation.  If we don’t get our clients to act when they must…we have failed them.  Tough job, yes, and probably the one role we have that we haven’t been trained to do, and the one role when mastered can lead to more success than any other.