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Can Being Positive Help Grow Your Practice? SGLC 1

August 26, 2016

Short Guide to a long careerHello again! It has been a long time since my last blog post – and a lot has happened in the world. I promise not to give you any of my political opinions – that would be a short guide to a very short career.

In the meantime I want to let you know that the TAO of Dentistry is alive and well. I have been working on a new book project, and it has taken up significant time. I also published my third book, an e-book, that is available for free when you join the Academy of Dental Leadership. The e-book, A Short Guide to a Long Career is also the title of this blog post.

For those who have already downloaded the book, I will be discussing the 31 tips that get e-mailed to you every two weeks or so. There is so much packed into that little book that when I re-read it I thought I had so much more to say – and besides I would love to hear from the dental community on how to create a thriving sustainable dental career.

I have decided to add commentary to Short Guide to a Long Career, through a series of blog posts beginning with this one. The titles of the post will be numbered to follow the e-mails that subscribers receive.

As I mentioned, for the past months I have been writing another book on leadership and communication. I have also furthered my education in Positive Psychology. Those two things have added to my own perspective about creating a long sustainable career in dentistry.

Essentially the relatively new field of positive psychology comes down to helping people “live a life worth living.” It is about thriving and flourishing rather than just surviving and languishing. Positive psychologists work in all domains from the military to medicine to education. While studying positive psychology, I couldn’t help but think about the philosophy of Dr. L.D. Pankey.

For so many years I referred to what I learned at the Institute as a “philosophy.” That word isn’t very exciting. Dentists would fall asleep whenever I invoked words like “philosophy,” “virtues,” or “Aristotle.” But throughout history from Lao-Tzu and Aristotle to Abraham Maslow and Carl Rogers, it’s truly only been about living a life worth living.

The positive psychologists have backed all of the “philosophy and psychological principles” up with real science. In other words – this stuff works–it’s real.

My book is about how to make your career in dentistry worth doing – long term.

Dentistry has changed. There is still plenty of opportunity in dentistry. Try to remember why you went into dentistry. No better yet…imagine the day you were born. Imagine what your parents wanted for you more than anything else. Now think about the day you leave dentistry…is there anything you will regret. This book is about helping you find what it is you want from your work in this field – yes it’s more than money. But achievement is there as well. It’s about Martin Seligman’s Well-Being Theory and PERMA—

Download the book…let’s discuss PERMA and well being through the comments below. Let’s also discuss the Commitment Equation.

Do You Do Emergency Crowns?

November 3, 2015

 

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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.

 

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The Martian – A Self-Help Movie?

October 27, 2015

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I am a sucker for self-help books. I am not into the Kardashians, Dancing With the Stars or Entertainment Tonight, but put a self-help book in front of me and I’ll devour it in a day or two.  I have read them all – under the hope of becoming a better person, improving my business or my favorite…setting and achieving goals.

I am not alone.  Self-help books moved from a niche position to being a cultural phenomenon in the late twentieth century.  It is estimated to be an $8 billion a year industry in the US alone.

A self-help book is one that is written with the intention to instruct its readers on solving personal problems. The books take their name from Self Help an 1859 best-seller by Samuel Smiles.

Some respected psychologists like Mihalyi Csikszentmihalyi have argued that self-help books will clearly not help people to become thin, rich and well-adjusted; indeed they will probably have no effect whatsoever.

Worse, some have claimed self-help books are actually bad for us by promoting ‘false hope syndrome’.

And that is what brings me to America’s first self-help movie, The Martian, Matt Damon’s new blockbuster that is drawing massive attention and attendance.

For many it’s a thrilling story, but for me, the sucker for self-help, it was another guide to goal setting.

I mean if his goal was to get back to earth from Mars (that’s 50 million miles), then what the hell, my production goals are a joke.  Take a look at that photo of him—all smiles and thumbs up.  Talk about having a good attitude.

Without giving away the plot (duh), I will attempt to point out some of the many self-help principles Damon used to get back to earth…principles that have actually guided me through my own personal journey.

  1. Be a life-long learner.  Commit to knowing your work as they taught me at the Pankey Institute many years ago.  Damon’s character was a botanist.  Think how handy that knowledge could be when you are stranded on a planet without water.
  2. Be a goal setter and monitor your progress.  These two go together because just setting a goal without understanding your deadlines and progress is just a dream.  Our film’s astronaut knew exactly how many days he had to get back to earth and how much rations he needed to get there.  The story really takes off when they have to figure out every component of his rescue was necessary.  As an author I can tell you that writing a book is nothing compared to getting home from Mars – so reaching your monthly production goals—piece of cake.
  3. Fail Forward.  Look, no one bats .1000.  Murphy’s Law is always in play, besides, what kind of movie would this be if nothing ever went wrong.  The key is to pick yourself up and use the failure as a learning experience.  It’s a good thing Matt was familiar with Thomas Edison’s lessons learned from inventing the lightbulb.  After failing 10,000 times he told a reporter he learned 9,999 ways it didn’t work.
  4. Be Persistent. Overcome Resistance and Do the Work.  Those three points may look like three separate lessons but they are all related.  Everyday we face resistance.  Our tendency is to put things off.  Damon could not…he was in survival mode.  He had to act with a sense of urgency everyday.  To me this is life’s greatest lesson.  The clock is always ticking.  Our job is to continue to move the ball down the field.  Most of us (and I mean our patients as well) don’ understand that without forward continual motion we get stuck.  Sure there is resistance—our job is to overcome it.  Calvin Coolidge said it best:

“Nothing in the world can take the place of Persistence. Talent will not; nothing is more common than unsuccessful men with talent. Genius will not; unrewarded genius is almost a proverb. Education will not; the world is full of educated derelicts. Persistence and determination alone are omnipotent. The slogan ‘Press On’ has solved and always will solve the problems of the human race.”

 

5. Have Fun.  Once again, as you can tell by the picture above, Damon continued to maintain a positive attitude throughout his mission.  Tough to do?  Sure, but attitude means everything.

6. Leave Your Legacy.  Once again, I won’t ruin the movie for you but understand that Damon had people on Earth that needed him back.  He becomes a mentor—a teacher—because in the end we are all here to pass the baton.

Enjoy the movie.  Hollywood has an agenda.  How else can we learn life lessons these days?  The Kardashians?

 

 

 

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The Most Annoying Man in the World

July 13, 2015

Filed under: Business of Dentistry,Self-development,Uncategorized — Tags: , , — Barry @ 12:51 PM

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Yes…that would be me.  Well I used to be a lot worse.  You see I am a devotee of hot Yoga.  I have been practicing at least three days each week for five years and I have reaped the rewards.

I want other people to take advantage of the same health benefits I have enjoyed.  So I push it.  Occasionally someone takes me up on it, but most of the time I hear reasons why they will pass:

“I’m not flexible, I can’t take the heat, Ninety minutes in a hot room, are you kidding?, How much?

I was being nice when I called them “reasons.”  But in reality those reasons are nothing more than excuses.  People don’t like making excuses, so they give you what they think are very legitimate reasons for not doing something.

That’s why I think I could really be annoying.

At the end of the day it’s the people who go to the gym, go to Yoga or participate in any form of physical exercise on a regular basis, that truly value their health.

They have placed positive meaning on their health...and my pushing doesn’t do a thing to change that…hence, I annoy them.

You would think, as a dentist, I would know that.  After all, who listens to more excuses than a dentist?

“My dog is sick.  Something came up.  I just threw up.  My car won’t start.”

Doctors…you’ve heard them all, haven’t you?

Nothing but excuses – or reasons why they can’t make it in.  The real reason?  They haven’t prioritized dentistry.

Does that surprise you…that anyone can’t find the value or meaning in taking care of their teeth?

Oh, do I hear you saying that they have a high fear or they can’t afford it?

Reasons!

At the end of the day they don’t get their teeth fixed.  Now don’t get me wrong I am not hardhearted about these reasons, and I never get angry when I hear them.  Even after a cancellation.

You see, these reasons are just an indication that some good dialogue is necessary.  I used to get upset…even angry…and that’s when I really was the most annoying man in the world.

Our culture loves reasons.  How about the reasons why people don’t want x-rays?  How many have you heard?  Or, forgive me…the amalgam issue…or the one about the hard pretzel breaking their tooth?

We love stretching the correlation implies causation issue don’t we?  It sounds so good…but in the end, just more reasons to believe their particular truth.

I used to argue…to no avail…and be labeled, yes...the most annoying man in the world.

No more!

I don’t used bullshit reasons in my own life…and I don’t get angry when people choose to use reasons to justify their behavior.

Dentistry can get quite emotional.  Destructive emotions like anger, frustration, guilt and inadequacy can truly ruin a good relationship.  People used to avoid me in the supermarket if they missed their last check-up.

No more!

These days I am much more likable.  Much easier to get along with.  And a funny thing happened….

Gandhi was right…he advises to be the change you seek in the world.

And you will attract people who share the same values as you do…people who truly value their health.

Try it…it’s quite calming

 

 

 

 

 

 

 

Dental Study Club Visits Lancaster

June 29, 2015

Filed under: Happiness,Self-development,Uncategorized — Tags: , , — Barry @ 12:28 PM

 

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I am a big believer in study clubs.  Our club, the Three Knots Study Club has existed for ten years.  We meet yearly at a different location for educational and social reasons.

In the past few years we have fished the Everglades, explored the coast of Maine and hiked the hills of Asheville North Carolina.  This year one of our members hosted our meeting in Lancaster Pennsylvania…the heart of Amish country.
We certainly got a good look at how the Amish live…this trip was way beyond the typical tourist experience.

I had seen the pretzel factories, eaten enough funnel cake and shoo fly pie and sat behind many buggies in traffic to satisfy my curiosities but actually meeting and spending time with the Amish was a true learning experience.  It was truly a close up view into a culture that stands in direct contrast to the way we live in America today…and even without the modern amenities there’s a lot to learn from these quite progressive people.

Progressive?  Let me explain.  Everything is relative isn’t it?

The one thing that stood out while visiting the Amish farms and observing their family life was a great sense of moral responsibility and empathy for one another.  The lack of modern amenities blended in after a while.

What was really noticeable was the how they worked and related to one another.

Everyone working on the farms were craftsmen.  The animals were well taken care of, as if they were part of the family.  Mostly though what stood out was the care they placed in making sure everyone was taken care of…in the family and the extended family.

Progressive?  Or has the rest of society redefined progress as nothing but more and more material wealth, say as measured by the GDP (Gross Domestic Product).  When does it stop?

Of course the Amish aren’t the only ones who measure success by other standards than material wealth.  In Bhutan the new economic paradigm is Gross Happiness Product which uses natural and social capital values to assess the true costs and gains of economic activity.

I remember first being introduced to the Pankey Philosophy many years ago.  In the center of Dr. Pankey’s Cross of Life was three words…Reward…Material and Spiritual.  Through the years I continued to see our culture lose it’s balance with way too much emphasis on the material…at the total expense of the spiritual (if you have an issue with that word…think ephemeral or intangible—think purpose and gratitude).

As a matter of fact it was through Dr. Pankey’s original philosophy that I heard the term “moral obligation” in relation to dental practice.  It was a driving force in my writing my first book about the examination.

Morality and character are the drivers of a sustainable career in any profession…are we losing it?  Observing the Amish shows that we differ in more ways than air conditioning and electricity.

I am not suggesting anyone give up all material possessions…just to take a step back and realize that as an old movie title said…“The Best Things in Life are Free.”

This weekend we didn’t run the rapids in Montreal, see a Broadway show or ride horses in the Texas hill country…we just ate some really good home cooking and watched another way to live that could hold promise for our future.

 

 

GOALS ! A New Look

March 10, 2015

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

 

 

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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.

The Path of Most Resistance – Key to Goal Setting

January 13, 2015

Filed under: Business of Dentistry,Self-development — Tags: — Barry @ 10:59 AM

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January 10, 2015.  The second Saturday of the New Year and my 8 AM Bikram Yoga class is way too overcrowded.  It happens every year.  January always shows an increase in attendance at Yoga, gyms and Weight Watchers.  “It’s okay,” I tell myself, all will be back to normal by February.  Leo the Sage tells us to set a yoga goal this year.  I think to myself, “I set that goal four years ago…I need a new goal for this year.”

Later on I tell Leo, “It won’t work, human nature will take over, they’ll be gone…something will stop them, I’m a dentist, I know all about objections.”

Fear, money, time, procrastination.  The list goes on, but it’s all about resistance.  Resistance is the enemy and resistance essentially is fear.

During Leo’s rap (he never stays on script, that’s what makes him a sage.), I hear references to so many other things beyond Yoga.  I wish all the dental lecturers would slip in some good self-help in their lectures, but that will never happen.

During the second posture I hear Leo say, “Pulling is the object of stretching.”  I think about my other goals…like writing this blog post, or the book I promised myself to write this year.  That’s what writing feels like sometimes, pulling.

Yoga is easy I think, it’s been four years…three days per week.  It’s become a habit, like my examination process.  But writing and meditating, those are my demons.

The blog post…easy peasy…the book, that’s a stretch goal.

“Pulling is the object of stretching.”

A few postures later, the standing bow pose, one of the more difficult balancing poses, Leo tells us, “Go ahead, fall out…but get back in.”  I think about all the times I have fallen out…and got back in.  That’s the key…the getting back in.  So many people are too worried about the falling out part.

Once the fear comes…just breath…slow down the heart rate.  I think to myself, “I didn’t write yesterday…get back in that chair today.”

“If you fall, get back in.”

When we do the fixed firm posture, a severe back bend, I feel proud because this is one posture I have had a lot of success with over the past four years.  I remember when I could barely go back 20 degrees.  Now I can can place my head to to floor…not perfect but pretty damn good for an old man.  Many of the new kids on the block can’t do it…they’re 20 degree-ers.  Leo tells them to just go where they can’t go anymore…”go to your edge…feel the resistance.”

I laugh…because I have been there.  So many are afraid of the resistance.  They back off.  They would be surprised to know how far they really could go.

” Go to the edge…feel the resistance.”

The resistance is your friend.

Psychologist and goal expert Heidi Halvoson tells us:
“We are often reluctant to set very meaningful, difficult goals for ourselves. But well over 1000 studies show that when people set difficult and specific goals for themselves, they are vastly more successful and vastly more satisfied and happy with their lives than when they just say ‘well, I’m going to do my best'”.
 Fear comes in many different forms.  The first step is to recognize it for what it it…and then meet it and slay it.  Here are some examples and things one might say in a Yoga class:
  1. Fear of failure – I can’t do Yoga, I’m not flexible enough.  One might also say… I can’t meditate, my mind wanders, or I can’t write, (speak in public).
  2. Fear of embarrassment – I look like a fool doing this stuff…I’ll never be as good as that young girl.
  3. Fear of losing control – like passing out in class?  Ooh, how embarrassing.  In four years, I never saw that happen, and I’ve been in some pretty hot rooms.
  4. Fear of rejection – All classes are beginner’s classes—after four years, I’m a beginner.  Once you think you’ve arrived, you already begun your descent.
  5. Fear of confrontation — confront who? you say.  Confronting yourself…the biggest obstacle.
  6. Fear of isolation – Joe Campbell once said of all heroes—when you reach your goal—you thought you would be alone, but you are one with all the world.
  7. Fear of change – ahh the good old comfort zone.

I think about three words all the time…destiny, innovation and change.  The world is always changing, and we must change with it.

See how much you can learn in just one Saturday morning Yoga class?

 

 

 

 

The Game of Dentistry—and Blackjack

September 8, 2014

Filed under: Business of Dentistry,Self-development — Tags: , , — Barry @ 12:05 PM

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The day after Labor Day…the unofficial start of the new year.  The Tuesday after Labor Day has always been my New Year’s Day and I haven’t been in school since 1973.  I left the beach in St. Maarten on Sunday, where I made my yearly goals, read a few good books, worked on my tan and played a lot of blackjack.

I read Doctored, The Disillusionment of the American Physician by Sandeep Jauhar.  It’s a good read, and I highly recommend it for all health care professionals who are concerned with the changing nature of health care delivery in America.  I related.  I feel it should be required reading for younger dentists who are facing the long career.  It’s about the ups and downs of balancing a life in medicine between creating a good lifestyle and being a good doctor.

Jauhar struggles with providing his patients with the best care while earning a good living during his early years when his responsibilities at home are demanding more time.

I felt his pain…especially since the recession hit and third parties began to flex their muscles.

In case you don’t know, I’m all about the private practice of dentistry...what they now refer to as fee-for-service dentistry.  There was a time when we didn’t make that distinction.  A time where you just went to work and focused on your dentistry without interferences.  Today, in order to maintain and sustain a fee-for-service practice the dentist must have an approach…a philosophy if you will.  Jauhar writes about taking control of the two things that you can…mastering your craft and controlling relationships.  It’s funny, but that is essentially what this blog is about…controlling relationships as best as you can through trust, appreciation and ownership and providing excellent care through complete dentistry.

The book was very helpful…especially when I got to the blackjack tables at night.  Because life is a little like blackjack.

Let me explain.  Blackjack, like life is not very complicated.  It has rules, and if you know them and don’t stray too far from the guidelines you’ll be a winner…in the long run (those are key words).

The game is set up so the dealer or the house has a very slight advantage.  That means that if you play, for arguments sake, one thousand hands, the dealer will win approximately 510 of them and you will lose 490.

The dealer plays by the rules—she never waivers…no emotion.  The dealer also gets relief every 40 minutes so they never get tired.  They do deserve the slight edge because after all it’s their house…and they serve free drinks.

That kind of control is available to the player as well.  Play right (master the craft) and control the quantity of the individual bet.  That’s all you need to know.

You see out of those 490 wins that every player will get they don’t alternate between the player and the dealer.  Many times there are streaks.  Imagine that a streak started that lasted 10 hands…and the player kept increasing the best (called pressing the bet), well I can tell you that winning, and winning big is now in the player’s future.

When that train slows down and the streak goes to the dealer…then revert to the minimum bet.  Of course the player must play the game correctly.

The vast majority of blackjack players lose…even those who play right…who know what the “book” says.

Why?  Emotions and energy.

Let’s take energy first.  You have to be prepared to play blackjack…if you to be able to last.  That means don’t show up to a $25 table with $100.  No one can sustain a losing streak…you need excess energy (cash).  Just like practice, you need to show up everyday with excess energy…mental, physical and emotional.  That’s what all the self-improvement stuff is all about.  That’s what makes sustaining a dental practice difficult.  No one particular case, but the entire population of patients we see that visit us with difficult technical problems.  It’s the emotional issues that wear down most dentists.  Be prepared.  Not everyday is going to be a holiday.

And how about emotions?  I can’t tell you haw many blackjack players get blown out because they don’t exercise discipline and consistency.  Listen…here’s what the book says…player hits on 16 when the dealer has a 10 or picture showing.

ALWAYS!

That situation occurs a lot…and yet I see most players get nervous (fear) when it comes up.  Mostly, they stick…and sometimes they win…but mostly they lose.  When asked, they say they hope the dealer is going to bust and they are afraid to bust.

Huh?  The dealer has a 10— the odds are they can’t beat the dealer with their weak 16…and by the way, hope is not a strategy.

People live their lives the same way, with fear.  Or they take unnecessary risks…like betting the house on one hand.  They go for broke…even after playing a disciplined game…they go all in.

Stay consistent, follow the rules, manage your energy and relationships…it’s they keys to blackjack, and most games…after all life is a game.

 

 

 

 

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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Get Out of the Comfort Zone

January 6, 2014

Filed under: Business of Dentistry,Self-development — Tags: , — Barry @ 10:30 PM

Among-the-snow-and-trees-Vrksasana

 

On Friday morning January 3rd, 2014, I woke up to the first snowstorm of the year.  Six inches covered the ground and would be a big obstacle for me to get to my 9:30 hot yoga class.  I could feel the resistance that pressed against my covers, but I pushed them off and began my ritual of showering and drinking 72 oz. of water.  Then I checked the web to see if the class was cancelled…Luckily for my bladder, the class was on.

I live in the woods.  The plows never come down my road…it’s dirt and gravel, so I had to mash my way through the snow to get to the class.  When I arrived I was met by four other hearty souls and the teacher.

The reward:  the best hot yoga class ever—and the heat felt sooo good.

That’s usually the payoff for breaking through resistance.

We face resistance everyday of our lives.  We have this preference for comfort and low stress.  Yet, as I always say, “The insecure path is the secure path in the end.”

Just last week I started a complex restorative case involving ten upper teeth.  The case included an implant, several veneers and crowns, and some pink porcelain.  My patient traveled over three hours for the appointment.  I worked slow and methodically to get all of the information required for the case.

I checked the impression and was pleased that I captured every margin.  I placed the temporaries and sent my patient on his way home.  An hour later, my son Josh who is also my lab technician, informed me that I would have to retake the impression.

“Why?”  I asked.

He said although the margins were great, because we would be using refractory dies that the pulls in the non-strategic areas would not allow him to get accurate dies.  I would have to call the patient back for another impression.

I felt resistance.

My patient would have to take another day off from work, drive six more hours, have his temps removed and have another impression…yes,with local anesthesia.

I felt resistance.

I didn’t want to make that call...yet I was the only one who could make that call.

So I did, and he totally understood.  He wants the case to come out as perfect as possible.  I felt better having broken through the resistance.

Everyday, no matter what line of work we are in or no matter what goals we set for ourselves, we will meet resistance.  When you feel that uncomfortable sensation in your gut, that’s resistance.  Telling you to stay put.  In your comfort zone.

Pushing through is the key to success.  So as we begin this new year…if you have made resolutions, realize that you should still being going to the gym in April…and along the way you will feel lots of resistance.

 

 

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