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What We Can Learn About Dental Practice – Playing Blackjack

February 21, 2019

Filed under: Art of the Examination — Barry @ 10:56 AM

Would you like to learn how to win at playing Blackjack? If you have about five or six hours I can show you how. I offer no guarantees but at least you will learn a system that you can take back to your dental practice —and there I will guarantee the results.

Fifteen years ago I wrote my first book, The Art of the Examination. 

In that book I explained what was to become the heart and soul of my practice for years…the key system to which all other systems were connected. Intellectually I totally understood the importance of the system and felt qualified to write that book. Like playing blackjack, I understood the rules and felt that if I just followed the rules I would win. But life doesn’t work like that and in dentistry and in games of skill...it takes practice. While playing Blackjack I noticed a few things…things that would prohibit other players from ever winning over the long run. They might win a hand here and there…but they would always leave broke, and mostly frustrated or angry.

Like many dentists that I know…leaving work frustrated and angry.

Let’s face it, who has the emotional temperament or resilience to keep going when you always get bad cards…or bad patients. What I realized is that we have little control over the cards or the next patient who walks in our door.

And just what are bad cards? I have won when I had a 16 and the dealer showed a 10. I have won with 12s. I have lost with 20. In all of those cases I played my hands as “the book” told me to play…like the dealer (the house) plays. Like a robot, very boring.  With patients the same thing…I have had all kinds of patients accept all kinds of dentistry…and have people who I felt needed and could afford good dentistry, refuse treatment. But I always played by the rules I developed in my book and I always did a comprehensive examination on every patient…no shortcuts. Like a robot. No deviation and my staff learned to align themselves around the examination process.

I can write a book about that word process. I did.

I told you if you want to win you had to commit to playing for a long time. As time went on I began to realize that I did have control over some things. At Blackjack I could control the amount that I bet. When the cards heated up I would increase my bet (press the bet for those of you who never gamble). Those players who never pressed, rarely won. Occasionally they would go for broke and put all their chips on the table…just when the dealer gets her third blackjack in a row. Sad to watch.

In your dental practice you too have things you can control. Like the conversation…and with practice that gets better in time. You can also control the amount of time you spend with the patient. For those of you who have seen me speak I often talk about “slowing down” because when working with people slow is fast (their ability to make decisions) and fast is slow (their inability to make decisions). When you think about it there are so many things you can control or influence. So many dentists don’t take the time to provide this level of service. Many jump to conclusions by judging the patient way too prematurely, never getting the opportunity to get to “yes.”

Like busting before the dealer ever gets to play her cards.

When I began to practice playing Blackjack and practice my examination skills I began to win more…and more. You can too. Last week as I was leaving the casino I saw one of those losers walking to his car and cursing at the moon about how unlucky he was. Then he steeped in dog pooh. I couldn’t help smiling because he knows how to play, yet all he needed was a philosophy and good systems. Then…I looked down and on the ground was a twenty dollar bill just waiting for a new owner…I guess you might say I am lucky.

Do You Do Emergency Crowns?

November 3, 2015





Everyday, all over the world, there occurs an opportunity to raise dental intellect.  In case you haven’t noticed there has been a shortage of dental intellect and that may be a big obstacle to achieving better dentistry.

I heard former Arkansas Governor and Republican Presidential candidate Mike Huckabee talk about curing the health crisis in this country by educating people about the chronic illnesses of diabetes, heart disease, cancer and Altzheimers.  He contends that by educating the public we will save billions of dollars in healthcare costs.  I agree…but it’s difficult when no one is listening.

Huckabee has an emotional stake in this cause.  He’s a diabetic.  His personal story about weight loss and diabetes is quite compelling.

I am a diabetic.  I have personal stake in controlling my health, and I do.  But not everybody takes their health that seriously.  That is why it’s up to the health professionals to act as leaders and communicate the importance of all health, dental or otherwise.

So, let me get off of my soapbox and explain how many dentists ignore this, by not taking the opportunity to communicate, educate, motivate (choose any word you like), and lead people toward better health.

Patients show up to dental practices everyday with urgent problems.  The emergency is generally pain, but it may include swelling, infection or cosmetic compromises.

In my practice I treat the emergency.  Even if I have a twp hour hole in my schedule…I treat the emergency.

After years of doing it this way, I am convinced it is the right thing to do.  I never do definitive emergency treatment.

In my youth I did.  I did emergency crowns, veneers, root canals, and even once I did a complete maxillary restoration.  Most of the time, all I did was create a short term relationship that never changed anyone’s long term heath, or attitude toward health.

Leaders understand the value of providing long-term value.  They have a different set of drivers.

This causes me to think about what is driving dentistry these days?  Who is driving dentistry these days?

I think that is a problem that effects the whole dental community, from patients to doctors and staff.  Short term thinking has long term effects (Strawberry shortcake anyone?)

Dentistry has changed over the last 50 years.  I wonder if this short term thinking had anything to do with it.

I used to call this single tooth dentistry, or body part dentistry…but it goes much deeper.  It’s a way of living.  A philosophy of practice and of life.

My solution?  When a patient comes in with an urgent problem…they are at their highest emotional level.  They listen because they truly have skin in the game.

What an opportunity!

Step back.  Take care of their felt need (not yours).

Use the opportunity to explain (this is a skill in itself) why dentistry is important.  They are all ears at this point.  You may not succeed with every new patient, but at least if enough dentists began to do a complete examination geared toward long term health—well that might just make a dent in the universe.

That is why I promote the complete examination for every new patient.  Sure it takes time…but time well spent for all concerned.  Help make the complete exam a standard operating procedure.  So many mistakes can be traced back to ignoring this one thing.

I think that is what Mike Huckabee means when he says chronic disease is our biggest problem.  We need leaders at every level…especially at the level of the health care professional.








Are You a Thin-Slicer?

June 22, 2015

Filed under: Art of the Examination — Tags: — Barry @ 3:26 PM
Every dentist has heard the story of the unlikely dental patient.  You know, the old farmer who comes in wearing beat up overalls, doesn’t give much feedback and ends up getting full mouth reconstruction.
What we never hear about is how many dentists that farmer visited before he said, “Cap me.”
I’ll bet that number is high.
The lesson behind that story is “Never Prejudge.”  And what a worthwhile lesson that is…but we just never seem to get it.
And I’m not just talking dentistry here.
We are built to judge…and prejudge.  Malcolm Gladwell, the popular author of Blink The Power of Thinking Without Thinking, one of his many bestsellers based on some very interesting psychology research, refers to these snap judgements as thin slicing.
The term thin-slicing means making very quick decisions with minimal amounts of information.We  thin-slice whenever we encounter a new person, a new situation or have to make a decision about something very quickly. According to Gladwell people make snap judgements quickly by relying unconsciously on thin slices of experiences.From an evolutionary point of view thin slicing can come in pretty handy.But when it comes to new patients…it may be better to think things out, take the time to get to know the patient.Yet. most dentists don’t.How do I know?  Because in conversation with many dentists, including my coaching clients through the years, I hear the prejudging, and I constantly remind them to take the more analytic approach of taking the time to listen, be open-minded, suspend all assumptions, meet the patient where they are, and approach all patients without an agenda.But…

Making these behavioral changes takes time…because our natural instinct is to thin slice.

Most of our judgements come from visual cues, but when we give someone a chance to put the verbal and vocal information into harmony we may see a different picture.

I know a dentist who made prejudgements by looking at the car the patient was driving.

And this dentist actually lectures to students.

When I first wrote The Art of Examination I thought it was overkill.  Too much analysis at every level.  Through the years though, by practicing what I preached, my experience with patients grew in a different way.  I was able to become more intuitive, and although I still didn’t, and don’t make snap judgements, I find I get it right more often than not.

So next time that old boy with the coveralls sits in your chair—take the time to listen.  Don’t prejudge.  I have found with all of the competition these days, that’s the one thing that will distinguish a dentist…no matter what the setting.

If you’re content that the dentistry you are doing is better than the office down the street…whether they accept insurance or not…don’t be fooled.  Patients who feel they are not being listened to will leave.

Make that your competitive edge.





The Ultimate Productivity Tool

May 11, 2015

Filed under: Art of the Examination — Tags: , — Barry @ 10:00 PM



Most dentists are always on the lookout for ways to increase their productivity.  Today’s marketplace is overloaded with new tools to make the dentist more efficient.  An alternative to efficiency, and one I have been obsessed with since reading Covey’s 7 Habits twenty five years ago, is effectiveness.

Becoming more effective trumps efficiency everyday, and it doesn’t require a huge investment in technology.  Efficiency is the language of hardware, machines and computers, but effectiveness has its own language…the language of human interaction.

Years ago practice management people taught dentists to “fill their chairs” with warm bodies.  Ergonomics, the study of people’s efficiency in their work environments was all the rage.  I was there when four-handed dentistry was actually a fresh concept.

I started in dentistry when most of my colleagues were still standing.  Ergonomics in dentistry helped dentists become more productive while staying pain-free (their back pain, not dental pain).

Today, we have all kinds of gadgets and devices that promise to make our work easier, but I’m not sure if it will make us more productive.  Production is a function of effectiveness.

That is why I placed so much emphasis on the complete examination…because it is still, when done correctly, the most efficient way to create effectiveness in a dental practice.

Yes…the complete examination is and always has been the Ultimate Productivity Tool available to a dentist…and it’s so cost efficient.

For many dentists it sounds counter-intuitive to spend so much time doing a complete examination when they could be producing real dentistry.  I agree that the exam is not very productive, but it gives the dentist the capability to produce so much more dentistry.

How would you like to spend every morning doing implants, crowns and veneers?

Not only is that dentistry more effective for the dentist and the patient but it is meaningful as well, and when a dentist spends time doing meaningful work…well that’s just what happy dentists do.

So what is the rationale for doing the complete examination?

  • It allows the dentist to slow down and create a trusting relationship.
  • It allows the dentist to think…to take the time to make the most rational decisions about patient treatment and care.
  • It is sacred time, so that it can’t be interrupted with distractions, allowing for more focus.
  • The dentist preserves his or her mental energy and can preserve energy for when it’s most needed.
  • The exam helps the dentist organize and align the practice so everyone knows exactly what their role is at all times.

I could go on and on…I actually have in my book The Art of the Examination, because it is an art.  With practice this art becomes the Ultimate Productivity Tool.  I felt I needed to write this blog post to remind dentists of the importance of the comprehensive exam in this rapidly changing world of dentistry.  This will never change.


GOALS ! A New Look

March 10, 2015

Filed under: Art of the Examination,Self-development — Tags: , , , — Barry @ 10:58 AM




We all know how important it is to set goals, don’t we?  From the day I began practice, everyone advised me to set production and collection goals, after all goal setting makes perfect business sense.

In the late eighties I was enrolled in a so-called “business school for dentists” with the main focus on establishing monthly production goals.

Everyone on staff was focused on production.  We set SMART goals.  SMART is an acronym for specific, measurable, attainable, realistic and timely.  We set up bonus systems when goals were reached.  As time went on we really turned up the heat by setting big “stretch goals.”

But then I noticed something happening: we kept raising the bar until we achieved some unintended consequences.
Goal setting is the standard of operations in the business world.  There is a popular study that is cited from the 1979 Harvard Business School MBA program in which 3 percent of the students wrote down their future goals.  Ten years later that 3 percent of students were worth ten times the worth of the rest of the class combined.

This study never occurred…it is pure urban myth.  Today that myth is being totally exposed by studies that reveal the downside of goal setting.  According to a new study from the Harvard Business School, titled “Goals Gone Wild,” there are many side  effects from goal setting including:

•    Too narrow a focus that neglects non-goal areas.
•    A rise in unethical behavior.
•    Distorted risk preferences.
•    Corrosion of organizational culture.
•    Reduced intrinsic motivation.

These studies confirmed what I was feeling during the eighties.

I am a big fan of building culture, and when our entire culture centered around production I became uncomfortable.  Although I don’t remember compromising my ethics, I certainly saw the possibilities.  I am a big fan of the importance of intrinsic motivation to our well-being.  My focus on the extrinsic rewards were the reason I sought guidance burnout years ago.  This obsessive desire to focus on extrinsic rewards ended up being the cause of my unhappiness in dentistry.

So what did I do?  I turned it around…I focused on process over product.

I still had an idea of a specific result I wanted to see each month, but I focused more on how to get there.  In other words, I identified areas of focus that would get me that destination if I diligently applied myself.  This was how I developed and committed to my master systems of examination and case presentation.

These two processes are not even “productive,” but they give us the capability to produce more dentistry.  Pretty counter-intuitive.
Author Peter Bregman in his new book 4 Seconds, says, “A goal is a result; an area of focus is a path.  A goal points to a future you intend to reach; an area of focus settles you into the present.”
When I concentrated more on examination, diagnosis, treatment planning and communication, everything changed.

What we pay attention to is what gets rewarded.  We become better, and build a better culture when we take our eyes off of production goals.
Not only will the dentists reach his destination but in the process he or she will become better dentists.  The culture will be built around the process instead of the targets.

Through repetition we can get better at preps and impressions but what about the skills that really matter, the ones that make or break the success of a dentist…the non-technical skills…the soft skills.
By slowing down my exam process I was able to see how poorly I was doing at certain things, how well I did at others, what needed improvement and what made the biggest differences.  In other words, the exam process is a compilation of many key skills that matter.
Legendary basketball coach John Wooden understood the role of extrinsic goals.   Wooden held his drills without a basketball in the player’s hands.
Why?  Because the ball tempted the players to take a shot—and not work on the drill.  Scoring was so tempting.  John Wooden called the basketball “catnip.”  Production and collection are the dentist’s catnip.
But the goal is to win…to score a lot and grow.   As long as the catnip is present we will never slow down enough to practice those sweet soft skills.

Wor$hiping Fal$e God$

December 29, 2014

Filed under: Art of the Examination — Tags: , — Barry @ 10:43 PM


Breaking rules always comes back to bite us.  All patients come into my practice through my new patient examination process.  Except this one time!

The patient wanted a cleaning and then have her teeth bleached.  She had a baby at home and time was a big issue…so we allowed it.  Her first appointment was for a cleaning.  When I did my examination I noted significant wear for a thirty two year old.  I backtracked and told her I needed to do a complete exam, which she scheduled.

On the morning of the exam, I overheard a conversation between her and my receptionist.  The talk was all about insurance.  If I’ve heard it once….

This time however I saw the image of that Gary Larson cartoon of a dog owner explaining to his dog Ginger what she should and shouldn’t eat (no porkchops Ginger – they cause pancreatitis), and what Ginger hears (blah, blah, blah, Ginger, blah, blah, blah…Ginger).

In other words, it’s hard to train dogs and it’s even more difficult to lead people.  The information my receptionist gave to the patient about dental insurance was just perfect.  All she heard was what the insurance covered…next to nothing.

So I did my examination.  It was great.  A wonderful opportunity for the patient to understand her own mouth and good dentistry.  Everything went as expected: sore tight muscles, a centric slip, clicking on opening, significant wear.

Then I noticed something on her x-rays.  She had no fillings, but she did have four crowns and two root canals.

I asked her, “How did this come about?  You have no history of decay and yet these four teeth have been maximally restored.”

She said it was because of the grinding and the wear.  Then she put two and two together…the slip, the clicking, the wear the sore muscles…and now the history of pain.

The ravages of occlusal disease!

No one had ever done a comprehensive examination for her.  I felt she really appreciated the diagnosis.

She got it and I felt fulfilled.  Then she turned and asked, “When can I get my teeth bleached?”

This is what dentists are up against these days.

When I thought about the insurance conversation and the examination I thought of the The Ten Commandments…you know the scene in the movie in case you never read the Bible, where Charlton Heston (playing Moses) comes down from the mountain with the two tablets.  Do you remember when he raises the tablets and smashes them out of frustration because the people were worshiping a Golden Calf?

Well, at that moment I felt like Moses…frustrated, alone, trying to convince yet another patient of the principles of dental health when all they’re interested in is the false gods of insurance and cosmetics.

Leadership is a lonely line of work. 

But it is the most important work we do.  The definition of a leader is a person who has followers.  People will follow when they get to know, like and trust…that you will lead them to the promised land…instead of the land of four crowns and two root canals.

I wish our education system put more emphasis on leadership instead of trying to get these lessons out of watching old movies.  Maybe then the idolatry will end.





Can You Hit the Curveball?

March 16, 2014

Melrose Incarnation Baseball - 060708 - 053-4x6


 Spring is coming…very slowly, but they tell me it’s on its way.  With spring comes baseball and lots of sunshine and fresh air.  I can’t wait.  I admire Major League baseball players for their skills and their devotion to mastering a very difficult sport.  Most ballplayers start early by learning to hit the ball.

They say that most ballplayers can hit a fastball, and what separates the average hitter from the very best is the ability to hit the curve-ball…or the slider…or any off-speed pitch.

It’s the same with dentists.  Most can hit the fastball…the low hanging fruit, but only the best can hit the off-speed stuff.  Major League dentistry is mostly curve-balls – from tough technical cases to tough patients, if you want to succeed in dentistry these days you must hit the curve ball.

Like learning anything it all starts with the fundamentals – hitting the fastball until proficiency develops and then adjusting to circumstances.  Just like driving a car…paying conscious attention to every detail until driving becomes automatic.

That’s why I get concerned when dentists ask me if I recommend doing a comprehensive examination on every patient.  I never flinch—my answer is always “yes.”I wrote that 10 years ago in The Art of Examination, and my reasoning holds true today, even though the business of dentistry has changed.

The comprehensive examination is the fastball.  It must be mastered before it can be altered.  If you watched me bring patients into my practice you might question “how” I do that…you might say it doesn’t look like what I wrote…but it is.

I have earned the right to alter it by doing thousands of exams-and if you really watch, they may all look a little different, but I accomplish everything I need…nothing gets left out…I just adjust for the various curves the each patient shows.

My examination process, at this point, is a habit.  It’s automatic.  That is the biggest reason I tell dentists to do the exam on every patient…so it becomes a habit…for them and the staff.

When everyone is on the same page, the examination process becomes the culture of the practice.

The collective mind of dentistry has devalued the examination process…and that’s a big problem today.

Dentistry has changed and dentists meet all kinds of resistance everyday.  Creating alternate treatment plans, and completing treatment over time are acceptable ways to help patients accomplish their goals.  As I said before the examination is your best opportunity to get to know and understand your patient.  The goal doesn’t have to be to “sell” them all the dentistry you can…the goal is to know and understand how you can help them…now, and in the future.

It’s worth the time investment…I guarantee it.  It’s a win-win.

The examination is the source of all meaningful dentistry.  If I have learned one thing in forty years of practice it’s that no two patients are the same.  They come to you with different needs and circumstances.  Your job is to figure out the puzzle—the dental puzzle and the human puzzle.  Patients are the curve-balls and we must learn how to adjust.


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By-Products of an Examination Process

February 17, 2014

Cover of "The Checklist Manifesto: How to...



By far the most important lesson I ever learned in dentistry…one that I wrote a book about…and one that changed my life even more outside the profession than within the profession…was to commit to a comprehensive examination process.   For that I thank my mentors Peter Dawson and Irwin Becker.  That one change in my philosophy lead to the creation of more positive habits, more consistency in behavior and more success than anything else I ever applied.   That’s a bold statement, but if you have committed to a comprehensive exam process then you know how true it can be.   One of the advantages of doing a consistent, comprehensive examination on every patient is that it reduces the number of errors we make in treatment planning our patients.  Make no mistake— planning treatment for patients…all patients…is the most difficult thing we do in dentistry.   Why?   Because regardless of the eventual treatment, we are doing it on the most complex system ever created — the human body…both the physical component and the mental/emotional component.  Dentistry and medicine are complex fields if only because of who we work on – people, not machines.   And so many dentists…and those who have a lot to say about health care in this county – devalue it.   Why?  I’ll let you answer that because the number of reasons is equal to the number of dentists who don’t do it.  That alone is a good reason to do an exam on every patient.   Some years ago I wrote about and praised the book, The Checklist Manifesto by Atul Gawande.  I still recommend it.  In that book I compared his “checklists” to our examination process.  He wrote about complex situations like what goes on in the operating room and in preparing airplanes for travel.  Of course these situations can be a matter of life and death…but that doesn’t reduce their meaning for what we do in our everyday lives.  Checklists lead to better predictability and control.  Is there a goal you haven’t been able to achieve?   In a new book, The Upside of Down, author Megan McArdle refers to Gawande’s book in an effort to explain how to reduce errors by creating a checklist/process.  She reminded me of a quote I once read by W. Edwards Deming:

“If you can’t describe what you are doing as a process, you don’t know what you are doing.”

I firmly believe this, because the examination process for me was the starting point for understanding everything I know about this field.   McArdle then cited University of Penn sociologist Charles Bosk who studied types of errors we make.  His work focused on medical mistakes. This is where it gets interesting.   Bosk classified four types of errors:

  • Technical errors.  These would include things like the drill slipping…these things do happen.
  • Judgement errors.  Includes errors of waiting too long to treat or using questionable techniques.

Both of those types of errors occur with some frequency and although I hate to say it…are expected.  Into everyone’s life a little rain falls.   The next two types are not expected and this is where taking the proper precautions and using a process can keep us on the straight and narrow,

  • Normative errors – or failing to get and use all of the information that is available about a patient.  This one calls into question the personal fitness of the doctor.  This is why dental schools taught us why cheating was so bad.  These are the ethical errors.
  • Quasi-normative errors – these are the ones that dentists do because someone suggested that they do it.  Hmm…who might that someone be?  I call this the Flip Wilson error…the late comedian who became famous for saying “the devil made me do it.”

So why do these last two types of errors occur?  It’s easy to blame people, but if you could build fail-safes into your process, then it’s more likely you will avoid these errors.  No guarantees, but what McArdle says makes sense:

“People who commit normative errors are generally too focused on outcome and result, and not enough process.  They are willing to cut corners, to bend rules, and that is a very dangerous thing.”

So the lesson is,  if you want to minimize the risk of catastrophe, you focus on the process much more than the outcome.   But there’s more.  The examination process even beyond dentistry, helps us understand ourselves better.  It can be a self-development tool…it was for me.  Remember what Socrates said, “The unexamined life is not worth living.”   And he wasn’t talking about teeth.

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To Prep or Not to Prep

July 16, 2013



The second a dentist sees teeth he wants to fix them.  I guess it just comes with the territory.  Or is it just good old American pragmatism.  I used to be that way until I took the time to really understand people.

That thought process lead to the writing two books, The Art of Examination and the forthcoming Art of Case Presentation.

The photo on the right was recently posted on Dentaltown. The post was titled, “She Wants No-Prep Veneers–What Would You Do?”  It spurred a slew of comments that caught my attention.

Now…I know the title asked a direct question…but my first thoughts centered around how she knew what “no-prep veneers were.”

The comments answered that question…it was Lumineers she wanted.

I recalled a quote from Theodore Levitt, the ex-editor of the Harvard Business Review who said:

 “People don’t want to buy a quarter-inch drill, they want a quarter-inch hole.”

And so it follows that patients don’t want no-prep veneers…they want…

That’s for the dentist to find out from the patient.  Even the guy at Home Depot asks what I am going to use the quarter-inch drill for.

The comments in the post are fairly enlightening.  Most of the commenting dentists wanted to do bleaching or orthodontics.  Many voted against any veneers at all.

Reading through the comments lead me to some perceptions about the state of dentistry.

One thing I see is that most dentists truly want to stay with conservative treatments…bleaching and orthodontics.  I feel the same.  However the public’s perception is that dentists tend to want to destroy teeth.  I guess that’s why the media portrays dentists as “drilling for dollars.”  The comments confirmed what I have always felt about the dental community…that they are caring concerned professionals who want to help their patients.

Another thought I had was how obsessed we are with whitening teeth.  Have we been lead to believe that whiter teeth equals cosmetic dentistry.  I am sure that if a dentists had a serious conversation with the patient she would come up with a few more things than just whitening.

Stop looking…this isn’t about fixing her…it’s about understanding her.

Who is she?  Dentists should REALLY get to know their patients...it’s part of the examination and diagnosis.  Only then, once we have articulated the problem…can we present the case.

In order to do that we must approach our patients without an agenda…like the guy in Home Depot.

Another thought, which was also expressed by the author of the post, is that the patient came in with a knowledge of Lumineers or no-prep veneers.  Okay, I know the various methods to treat prostate cancer but I will always defer to the professionals to help make my decision.

The state of advertising in health care these days is a blessing and a curse.

Doctors must work through it…by becoming better leaders and staying true to their diagnostic abilities...above all to keep the human component in dental care.

I have faith.







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Even a Monkey Could Do It

June 4, 2013



It can be difficult for patients to choose a dentist these days.  The Internet is filled with photographs of beautiful dentistry.  Dentists and technicians share their best work with the world online.

Patients take a look at the photos and judge the quality of the dentist, and the practice by the quality of the photos.

But as they say, “the menu is not the food.”

In a new book, The Art of Thinking Clearly, author Rolf Dobelli discusses 99 ways that we make mistakes by not thinking clearly.  Dobelli does a great job of using entertaining examples of how we think about things that  lead us to making poor decisions.

One such bias, he calls the outcome bias warns people to never judge a decision by its outcome.

Imagine there was a sample group of 1000 monkeys, and you asked them to speculate on picking stocks by throwing darts at the Wall Street Journal.  What happens?  After one week, half of the monkeys show a profit and another half show a loss.

We carry on the experiment until we eliminate all of the monkeys but one.  You know how that works, you’ve seen reality TV.

At the end…the remaining monkey is next year’s Warren Buffet (take a look at the photo).  The media is all over him.  He becomes a guru.  The big guy on Wall Street.

The reason this happens is that we tend to evaluate decisions based on the result rather than the decision making process.  Don’t laugh, we see this all the time on Wall Street.  The analyst that predicted the crash becomes the next guru.

It happens in dentistry as well.  We see these gorgeous photos and believe the dentist is Picasso rather than asking how he got there.  What was the process…because process is what breeds consistency.

Dentistry has evolved to promote this type of thinking.  The cosmetic revolution, advertising and the Internet have allowed snapshots to sway patients to make decisions.

There was a time when patients chose dentists for their wisdom and judgement…two traits that don’t seem to be valued these days.

Process is the key.  In choosing a professional the patient should be more interested in the process the dentist used to get the result rather than the result itself.  All dental practices are based on some philosophical principles that lead to consistent behavior that produces outstanding results consistently.

As a practicing dentist, a teacher/coach and a lab owner, I am convinced that the dentists who are most successful are the ones who create and execute a process.  Anyone can do a beautiful case occasionally.  My advice: commit to an examination, diagnosis and treatment planning process.

That is the key to success.


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