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The King of Drills

April 29, 2013

Filed under: Art of the Examination — Barry @ 10:54 AM

 

John Wooden at a ceremony on Oct. 14, the coac...

I spend a fair amount of time reading other dental blogs.  Two of my favorites are Spear Education and Lee Ann Brady’s blogs.  I enjoy these two because they are intellectually stimulating.

Blogs should be a source of worthwhile conversation…after all they are really forms of social media.

A recent post on Lee Brady’s blog related to one of my favorite books, The Checklist Manifesto by Atul Gawande.

Gawande is a surgeon who has made a second career out of writing…and he is excellent.  The book that preceded The Checklist Manifesto, Better, is the one that really stimulated my intellect.  In that book he thoroughly discusses the idea of improvement, a subject that hasn’t slipped the minds of so many great thinkers in the business community, like E. Edwards Deming who helped the Japanese auto industry get better at making cars.  The ancient philosophy of kaizen is one of continual and never ending improvement.

One of the reasons I wrote The Art of the Examination was because I needed a process, a checklist if you will, that I can measure my performance by and continually improve.  Through the years I have found that I can add a certain amount of style to the exam process…but never abandon the process.

That’s sort of like watching an athlete like Peyton Manning play football…but before every game he practices the fundamentals.  Watch him if you doubt me.

I always wondered how dentists get better at their job.  Through repetition?  You see most of what we do is during the game…we don’t drill (as in practice).

Dentists practice dentistry…but they never practice.

Sure, 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.  Yet most people (dentists are people) take these skills for granted.I wondered why, if these skills are so important, why don’t we practice them?   I will list some of them at the end of the post.

One answer may come from the legendary basketball coach John Wooden.  Most coaches make a distinction between drills and scrimmages.  Scrimmages are game simulations…like a dentist role playing with his staff, or doing a role play at a practice management session.  Drills are where the real coaching occurs, because he could work on specific individual skill areas—the key skill areas.

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.”

The biggest problem for dentists is that it’s always game time…and we always score a little.  But the goal is to win…to score a lot.  As long as the catnip is present we will never slow down enough to practice those sweet soft skills.

As promised here are a few of those skills:

  1. Listening skills.
  2. Sales skills.
  3. Storytelling skills.
  4. Relationship development skills.
  5. Interpersonal skills.
  6. Coaching skills.
  7. Negotiating skills.
  8. Delegation skills.
  9. Questioning skills.
  10. Conceptual skill…seeing the big picture

These are just a few.  There are many more discoverable ones.  Look out for an upcoming blog post that will offer some free coaching around these areas.

 

 

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Top Eleven Reasons People Fix Their Teeth

April 3, 2013

Filed under: Art of the Examination,Business of Dentistry — Tags: , — Barry @ 2:25 PM

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I was just thinking about some of the reasons why people get dentistry done.  With tongue firmly planted in my cheek—I give you my Top Eleven Reasons People Get Their Teeth Fixed.

When looking at things from a different perspective we can still find valuable lessons.

1. Trauma– This includes anything from an elbow in the face during a pick-up basketball game to breaking a tooth on a frozen Milky Way (Just happened yesterday to a patient).  There is nothing like a traumatic incident to bring on sudden awareness.

2. Embarrassment or shame.  Okay, you know this one.  Grandma didn’t fix her teeth in 60 years but when her cute grand-daughter tells her, “Grammy, your teeth look funny,”  she calls the the dentist.

3. Getting married or taking photographs.  Oh, those Kodak moments.  If not full mouth reconstruction it’s a good dose of bleach that can do the trick…maybe even a snap-on smile?

4. Got married or hit the lottery.  Nothing like a windfall to get someone off the couch.  And by the way…getting married only applies to a spouse who can afford it.

5. Someone puts a gun to your head.  As long as we’re on the subject of spouses…no one is responsible for more dentistry than dissatisfied mothers and wives.

6.Their insurance covers it. Oh, but for insurance.  Every dentist has heard the claim…”if I only had dental insurance,” or “if my insurance covers it.”  Here’s a stunner…most people leave their benefits on the table every year…because most insurance doesn’t stop out-of-pocket costs.

7. They are losing their insurance.  Patients work for the same company for thirty years and never get past a few fillings and cleanings, then they retire and boom…  They try to get thirty years of dentistry done in two weeks.  Speaking of two weeks…how many patients try to get all of their end of year benefits in every December.

8. They are getting an extreme makeover.  Yes, teeth belong with weight loss and botox on the extreme makeover list.  Less popular these days but still a big reason.

9.  A stranger makes a comment about their teeth or smile ( I said a stranger, not a family member).  Yes, shame is shame and can really work motivational wonders.
10.   The hygienist told them something needs to be done.   Hygienists still have some clout, much more years ago.
11. The dentist told me them to do it.  Well this one has been losing ground for some time now.  Lots of reasons for this…think about it.  The answer lies more with cultural reasons.  I do remember a time when this could have been the number one reason to get teeth fixed.

 

Hopefully I didn’t sound too cynical.  There are always positive lessons to take from anything.  If you look back on your own career in dentistry you will probably see many serendipitous moments when you thought that things aren’t going to get better…and then that frozen Milky Way patient walks in.  Bad luck for him… but you’re back in the game.

The key is that many business strategies are based on capturing these moments.  The practices that stay open long hours, have 24/7 emergency services, the extreme cosmetic practices, the ads that prompt patients to get their work done before the year ends.  And now with social media and e-mail campaigns many dental practices are trying to capture these moments.

So my advice?  You can never tell when the moment comes so be prepared.  Louis Pasteur said, “Luck favors the prepared mind.”

How?  Be prepared technically to take care of any issue the patient presents with.  Always, always, always keep examination, diagnosis and treatment planning as your number one priority,

Never abandon the process—and you will be one lucky dentist.

 

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What is the Practice of Dentistry?

April 1, 2013

Filed under: Art of the Examination,Case Presentation,Philosophy — Barry @ 10:00 AM

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I practice Bikram yoga.  It’s Hatha Yoga on steroids.  We do it in a hot room, heated to 105 degrees and 40% humidity.  It can get uncomfortable if you are not used to it, but once you acclimate it’s really good for you.  Acclimation takes time and practice.

Besides all of the medical benefits I have enjoyed, like lower blood pressure,  more stable blood sugars (I am a diabetic), great looking skin and better balance and flexibility (but I still can’t touch my toes after two years), I have learned a lot about the concept of “practice.”

I always felt that the word practice was sort of a misnomer when it came to dentistry.  I mean dentists don’t practice like pianists, tennis players or even magicians,  consciously and deliberately practicing everyday.  Conscious and deliberate are the operative words.  After graduation most dentists don’t do much consciously and deliberately.  Many dentists get better just because of the repetition.  Yes, my composite resins do look a lot better…but only because I paid attention.

But there are many skills that we use that could bear a little deliberate and conscious practice.  Like communication skills.

I realized the methods of deliberate practice while doing Bikram Yoga.  Every class is the same – a beginner’s class.  Sure people get better…but it takes years to master every pose.  Yoga practice forces me to slow down the mind, like meditation with a purpose.  If you don’t slow down the mind you can’t focus on the complexity of the posture’s demands…muscular and respiratory.

Recently I handled my puppy at a dog show.  My regular handler didn’t get to the ring in time.  I was flummoxed.  There were way too many things going on at the same time.  I blew it.  I wondered if practice would help.  They say athletes need to slow the game down in order to get better.  Football players say the speed of the game is the biggest difference between college and the pros.  Breathing works,  It slows down the heart and the mind.

Just as I set her front legs down she dropped her tail.  When I brought the tail up…boom, there went the back legs.  When I zigged…she zagged.  Then I sped up and lost it.

Does that sound like some your days in the office?

The answer is practice…conscious and deliberate.

It forces you to focus on the technique and continually reduce the effort.  Mistakes are made and tolerated.  When it doesn’t go right, you take a step back, and try again.

It’s interesting that in practice there is always a teacher.  In yoga they call the teacher a guru.  There are semantic differences between the east and the west, but in the end practice should be monitored by a teacher, coach, mentor or guru.

To me the greatest advantage of deliberate practice is emotional control, because it is the toughest to learn and sustain.  I have studied emotional intelligence for years, yet just knowing about it doesn’t correct it.  It’s like knowing about nearsightedness…you still can’t see.

Slowing down the emotional brain or quieting the mind can be done with therapy, drugs or meditation.  Meditation is probably the most effective…it’s also a practice.

That’s why I do yoga.

 

Don’t Ignore the Truth

March 20, 2013

Filed under: Art of the Examination,Philosophy — Tags: , , — Barry @ 1:04 PM

 

 

untitled-5-3 Predictable results depend on paying attention to a process and not ignoring any steps.  One missed step can follow through the entire case and leave the dentist and technician wondering what went wrong.

As a dentist and a lab owner I get to see some of the innocent omissions that can come back and haunt the dentist.

The other day a new technician brought me a set of study models sent in from another dentist.  She asked me if I thought they were mounted properly because the bite was open and it looked a little funny to her.

I told her to drop the pin and put the casts into maximum intercuspation.  She asked me why the dentist would take an open bite.  Hmmm, I wondered, “Do you know the difference between centric relation and centric occlusion? I asked.

It seemed like a good opportunity to explain what we know about occlusion and how we apply it in the lab.

I could tell tell that she was interested by the eager look in her eyes.  As I went through the explanation she began to understand the reasons for doing everything.  I was reminded of a book I read years ago, The Greatest Management Principle in the World, by Michael LeBoeuf.  In that book the author explains that managers need to go around the workplace and explain to employees “why” we do things rather than just telling them “what” to do.

Invariably, I have always felt that telling people why, always raises their commitment to the work and puts more meaning in the work.

I also believe that employees feel a greater amount of respect when the manager takes the time to explain things to them individually.

This same principle works for patients as well…I called it a “reason why” philosophy in my book, The Art of the Examination.

Of course, it takes time to do this but you will see it is time well spent.

After explaining the process to my new technician, I asked her for the “first point of contact.”

She looked confused.

I said, “there is no way to know if the models are mounted correctly unless we verify the mounting with some information like the first point of contact taken from the doctor’s examination process.

She said he never sent it.  I then directed her to my chart which has a summary of my entire exam process that starts with the mouth and ends with the presentation structure.  I showed her the first question on my checklist ( I am a big fan of Atul Gawande’s book, The Checklist Manifesto).  The checklist showed her the following question: “Do the models accurately represent what you saw in the mouth?”

Now her eyes really widened.  She really began to see the practical application of the knowledge of occlusion.

Now she said she had a job to do.

“What’s that?” I asked.

“I have to call the doctor and get that information.”

Now that’s great learning!

 

 

 

 

 

How to Get Clear

January 28, 2013

Starts with Vision

In my long career in dentistry I notice one trait that dentists seem to have.  They seem to get in there are “do” things.  Most of the time they acquire the knowledge and then they “do.”  It’s not only dentists.  Bookstores are filled with titles that fall into the “how to” category.  The self-help genre sells millions of titles promising people how to do anything.  We all want to achieve…it comes with our software.  So we believe that the key skills for success are knowing and doing.

I would like to add one more key skill to the mix.  Maybe the most important skill of all, the one that every leader must possess to be effective.

That skill is vision.  Seeing clearly where you are going, or the “where” you are taking your patient.

We have all heard it before—Covey said, “Begin with the end in mind.”  He called it a habit, but it is really a skill. And it requires practice and developing a style.

Think about writing…even this blog post began with a vision.  There are two types of writers.  Those that just write by the seat of their pants and those that use outlines.  Some use “jot” outlines and others use a very elaborate outlining process.  But all three have some ideas where their writing is going.

And so it goes with treatment and life planning.

I recently read a quote from Dr. Peter Dawson,

“This is why I have such great disdain for the hurry up…exam.  Unfortunately, this is typical ‘usual and customary’ dentistry.  It is what most patients expect, but it certainly sets aside any competent dentist who goes beyond these expectations.”

Disdain?

A strong word, but I agree.  Why do dentists do a hurry up exam.  They just don’t take the time.  Most know what to do.  Most can do it.  But most don’t have a style or process of visualizing the future.  The real shame is they don’t take the time to clarify their future.

Everything starts with the examination process…a dental exam or a self exam, it doesn’t matter.  In order to find problems we must take the time, and then discover new places to go to.  Get as clear as possible.

I call the skill of vision, getting clear.

It may be the most worthwhile skill you develop.  It will turn you from a dentist to a leader.

 

 

 

 

 

How to Interpret a Story

June 18, 2012

Mary Osborne is one of dentistry’s greatest treasures.  She is a wonderful teacher and a master storyteller.  I was recently reading LeeAnn Brady’s blog and came across a video of Mary telling one of her favorite stories.  I had heard the story before but this time it took n new meaning.

That is the power of story.  It touches each of us in a different way each time we hear it.  Take a listen.

This time I was reminded of one of my favorite lessons about why I spend so much time with new patients during my comprehensive examination.  When I teach this principle I usually refer to Stephen Covey’s works on trust.  I love when he says, “With people, fast is slow, and slow is fast.”

When I quote that I usually get a lot of blank stares reflected at me.  Think about case acceptance…when you take your time with patients up front, they make their decisions must faster.  And when you rush people through an exam, it seems they never make a decision.  This is what Mary’s story means to me.

What does it mean to you?

I am in the middle of training a new puppy, Annie.  The same principle works with dogs—so it’s just not with people.

3 Reasons for a Comprehensive Exam (you never considered)

June 3, 2012

Filed under: Art of the Examination — Barry @ 10:02 PM

There are plenty of reasons to do a comprehensive examination that are obvious:

The collection of data and essential record taking are the two that fulfill the dentist’s obligations.  The more subtle rationale for dentists who want to create relationships and go on to do more complete dentistry is to establish rapport and share professional philosophy.

I have found that instituting a comprehensive examination on all adult patients, literally changed my practice and became the source of everything good that has happened to me in dentistry.  I have been doing a complete exam on patients fo over twenty years.  Looking back I realized a few hidden benefits that helped create success.

1. Establishing Excellent Habits- Aristotle said, “We are what we repeatedly do.  Excellence, then, is not an act, but a habit.”  By providing a structure the dentist doesn’t have to think about how to treat each and every patient.  The examination and everything that it involves, the preclinical exam, the co-diagnostic exam, complete series of radiographs, oral cancer screening, mounted study models and photographs, becomes an automatic response.  Over the years the diagnostic skills get honed to excellence.

2. Creating a Culture of Excellence- The behavior of every group is (more…)

Relationship-Based Dentistry Brings Satisfaction.

April 8, 2012

A new patient waited for me to do her examination.  She held a book in her hands.  When I entered the room, the first question I asked was, “What are you reading?”  She told me, and so began my preclinical interview.  I learned she was an avid reader and she was recently diagnosed with diabetes.  Audrey H. became my patient.  I completed her dentistry twenty five years ago.

Audrey never missed a dental appointment.  She always carried a book with her, and we traded reading lists.  My first questions to her were always, “What are you reading and how is your blood sugar.”

Through the years she slowly lost her ability to read.  First she went to Large-print, and then to audiobooks.  She had a difficult time controlling her blood sugar and eventually had to go on dialysis.  Through all of this, she never missed an appointment.  Audrey couldn’t drive after a while so she would take a taxi to her appointments.

Eventually she went to an assisted living facility.

She still came for her hygiene appointments. (more…)

One Thing that Will Give Your Exam Process a Quantum Leap

April 28, 2010

Filed under: Art of the Examination — Tags: , , — Barry @ 2:12 PM

I have done a lot of examinations in my career.  Readers who are familiar with my book, The Art of the Examination, know how much stock I place in the examination process.  As the years go by I only become more firm in my admonition about the importance of a comprehensive examination.  I know what it has done for my practice and career, and I know what it can do to practices when it is not included in the daily management.
As the owner of Niche Dental Studio, I get to (more…)

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