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Dr. Madoff I Presume

February 8, 2016

Filed under: Ethics,Leadership,Philosophy — Tags: — Barry @ 2:30 PM

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I don’t watch much TV these days, but last week I found myself watching two made-for-TV specials, one about Bernie Madoff and the other about O.J. Simpson.

Most would agree that these two were possibly the greatest monsters of our time. Most of us got to witness the behaviors of these two men. Madoff was particularly interesting to me because we came from the same town, and we went to the same high school.

My brother-in-law was in his graduating class. And Peter Madoff, Bernie’s brother was the president of my college fraternity.

Yes…they walked among us.

No real surprises there, but something struck me about the screenplay. Three times during the show Bernie Madoff repeated the line: “Trust is the basis for all long-term relationships.” Most of us who watched it heard the line because it was repeated again and again.

But most of us probably let it go by like a sudden chill in the room, or a fleeting pain.

Not me. This blog is about Trust, Appreciation and Ownership, and I have been writing about the importance of trust for dentists, in every human interaction…it is not only the basis of all long-term relationships, but the entire substructure of any well-functioning organization from a family to a country to a planet.

A few days later I got a phone call from a dentist who questioned what would happen if Bernie became a dentist, or a doctor rather than going to Wall Street. It could have happened considering his socioeconomic background.

Now, granted people like O.J. and Bernie are special cases…people who totally lack even a trace of empathy, and we all know that the opposite, people like like Mother Theresa, are just as rare.

So they don’t shock me.

What shocks me is the public’s reaction…to the SEC. The SEC is a government agency that is set in place to protect the public.

Who can we trust if we can’t trust those who are there to protect us? My friend, the dentist, was saying that we see this in our profession all the time…frtom every angle…the dentists, government, corporations, insurance companies and even the public itself.

In 1979, during the more idyllic days of dentistry, I traveled to Los Angeles to hear a presentation of alternative ways to deliver dental care. This one discussed the new retail dental office concept that was being set up in L.A. The first one was in a Sears store in El Monte California, a small industrial town just east of Los Angeles.

Two very polished salesmen spent two days trying to convince dentists that this was the future of dentistry. They were brothers, very well trained and very convincing. I left L.A. with a bad taste in my mouth…not because of the business model, but because of the way they objectified patients.

That was in 1979. I lost track of that concept, but not the language that I continued to hear over the last 35 years, from non-dentists and dentists alike who have objectified the patient experience and used trust as their method to persuade.

Very effective…and unethical. A paradox that would make anyone shiver.

Trust…the force that can be used for good or evil. We can choose to be Luke Skywalker or Darth Vader…yet mostly we sleepwalk through these choices.

I have witnessed dentists and doctors using the force for good and evil…it all comes down to —who are you?

For years, we in dentistry have seen outsiders take what used to be a “noble” ethical profession and turn it into business as usual. Who protected the profession?

Certainly not the dentists. Most went along with the status quo. I wonder why? Because we sure express our displeasure to each other.

Certainly not the insurance companies or corporations. They only talk about the human side of dentistry but continue to look at numbers and take away our autonomy- in one way or another.

And most important…not the patients. Many actually are crying out for more of the same.

At the end of the Madoff movie there was a voice-over as Bernie, thinking he was innocent, was blaming the system…the SEC, the public who he cheated because they wanted to make money because of their own greed.

He has a point…yes, my dental friends…we see this playing out everyday.

 

 

 

Danny Collins – Dentist?

April 20, 2015

Filed under: Philosophy — Tags: — Barry @ 5:33 PM

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I love movies that teach life lessons.  Al Pacino’s new film, Danny Collins is just that kind of movie…great acting, very entertaining and if you’re attuned…a great message.  It’s one of those “what could have been” movies.  If only Danny Collins would have seen a letter from John Lennon, written to him forty years ago, what could have been.  In reality Danny Collins is everyman.  I won’t give up what happened in the movie but let’s say Danny Collin’s career may have turned out differently.

He may have used his creativity to write and perform original songs rather than covering other artists after his early success.  His whole career was about following the money rather than following his bliss.

Hollywood has never been kind to dentistry.  I remember scenes from Little Shop of Horrors, Marathon Man, and Leaving Las Vegas that didn’t shine a positive light on dentistry.  Danny Collins stays true to form.  The aging Collins as a burned out singer tries for redemption by finding his only son to make amends.  He winds up staying in a Hilton Inn in New Jersey.  When his Mercedes pulls up there is a lone display that highlights the week’s big event: a meeting of the New Jersey Dental Professionals.

Now, I try not to be cynical but I believe there are no accidents, and the director specifically used dentists as a metaphor for lost dreams.  I guess to those in Hollywood dentistry isn’t an exciting profession (my apologies to Bill Dorfman).

Let’s not kid ourselves, dentistry usually is a default vocation.  I for one told myself the reasons I chose dentistry…but I made them up.  Friends would always mock me, “are you going to spend your whole life putting your hands in people’s mouths?”

I would always answer it’s better than being a proctologist, besides the money is good and you can make your own hours.

So what does all of this have to do with creativity?  Dentists aren’t folk singers.  No, but Danny Collins was more about creating a career and creating a life than it is about creating hits, and that’s what we all share.

The movie makes the point that making a lot of money isn’t the key to happiness.  He burned out early, all the while making a fortune while abandoning his passions and ignoring the traits that people usually use to describe someone at their funerals…like compassion, empathy and kindness…the issues of character.

In my own career…the early years were my burn-out years.  Dentistry was just a job.  Later on when my mentors showed me the light, I created a career, that’s what saved me.  Now, at the end of my career I am discovering my calling…writing and teaching.

But I came of age when it was much easier to create a career in dentistry.  I regained my autonomy by attempting to master the art and science of dentistry.  That alone made me more passionate and helped me to sustain the career.

These days it’s harder.  Young dentists, with their outrageous school loans must subjugate their autonomy to other forces.

This has become my pet peeve because the world of work is so important to a person’s success and happines, regardless of whether they are a rock singer or a dentist.

Work matters.

Today young dentists are graduating and joining dental service organizations and working in corporate dentistry.  They are promised the autonomy, but end up singing other people’s songs.

I am sure you have heard the warning by so many philosophers through the ages…”don’t die with the music still inside of you.”

Before leaving the blog, take a look at what Wayne Dyer has to say about this.

 

 

 

When You Care More Than They Care

February 2, 2015

Filed under: Philosophy — Tags: , — Barry @ 5:42 PM

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A few weeks ago I had a visit from an old patient who had left my practice and now lived in another city many miles away.   I restored his mouth more than twenty five years ago.  We actually became friends.  He was a science teacher at the local Junior High School, and had taught both of my sons.  He was “up North” and decided it was time for him to apologize.

“Apologize?  For what?” I asked.  He told me how his wife had convinced him to leave my practice years ago and that now, as he was reflecting on his life how much the work I did meant to his current health condition.  He was coming back to express his gratitude and to tell; me “thank you.”

So how should I feel about that?  I am a dentist who has devoted my life to creating a practice that is based on sound relationships…in modern times, that in itself has become quite unique.

Well, I felt…ambivalent.  I cared, but I didn’t care.  I thought about that for awhile and concluded that was a very healthy response on my part.

For many years I agonized when situations like that came up.  Long time patients who I truly did great dentistry on, decided to leave for an HMO or PPO.  It bothered me...I did my best not to bear the burden of guilt, or to think what I could could have done differently.

So much wasted emotional energy.  I wonder how much emotional energy the patient has invested, because it seems so easy to just call another office looking for a better deal.  On a positive note, I have many “gems” in my practice.  As a matter of fact, most of my existing patients are true gems.

I recently inserted a complete case for a man that he claimed changed his life…I could just tell by the look on his face, the highest level of appreciation.  He didn’t even have to give me that extra gift certificate to The Capitol Grill.  In other words, we don’t have to talk about levels of appreciation—we just know when it’s there.

Last week I told a patient that he needed a crown.  I explained how the decay was approaching the nerve.  I drew pictures.  I used great word pictures.  He reluctantly scheduled an appointment.  “Oh,” I thought, “so much convincing.”

Then I thought, once again, why do I care so much when they don’t care.  I think that is my best case for creating a relationship based practice.  How often does this happen in practices that do not take the time to really care.  At least I felt good about all my efforts to create great relationships.

I truly believe most health care professionals really do care.  And there in lies a great disconnect.  I am reminded of an old Lenny Bruce skit…he called it “Thank You Masked Man.”

For those too young to remember Lenny Bruce, he was one of the first “dirty” comedians.  He paved the way for George Carlin, Richard Pryor and Lewis Black.  Times were much different in the sixties…there was lots of censorship..

Anyway—back to the skit which I have placed here for you viewing.  Click on the video.

I liked the video, not because Bruce was making his political statement about homophobia, but more because how the Lone Ranger felt about being thanked.  He knew his place in life.  He was a helper, and his job didn’t depend on being thanked.  He continued his job, unfazed by any level of gratitude that the townspeople displayed.  His was a healthy response.

I think dentists need to take on this “care but don’t care” mindset.  It’s good survival practice.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Face Behind the Mask

January 18, 2015

Filed under: Ethics,Philosophy — Tags: , — Barry @ 10:00 AM

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There I was in the belly of the beast.  Well, not exactly, but that’s how I felt when they wheeled me into the cardiac catheterization lab at my local hospital.  Before you start worrying, I’m okay.  A little blip on my stress test culminated in this recent episode.

Before I get too far along, let me just throw out this little piece of advice:  if you are over the age of sixty, it wouldn’t be a bad idea to get a stress test.  I’m okay, but this may be the best preventive medicine I know of…and as a dentist, I am all about prevention and prediction.

Back to the lab…the first person I meet is Steve.  He has an identification badge on his smock.  He makes small talk and I accommodate.

“Hi, I’m Steve, what’s your name?”

“Barry,” I tell him.

“Nice to meet you, what do you do?”

“I’m a dentist,” I say.

“Oh really…I could use a good dentist, where is your office?”

Okay—at this point I’m thinking I’ve heard this conversation before…too many times.

So I tell him where my office is located and he tells me it’s too far…he goes to a guy in another town.  Just for the record that town is further away than my office…but this is small talk remember, and to keep it up I ask him what that dentist’s name is.

He struggles to find the name.  “Hmm, I forgot, but he’s a really nice guy.”

At this point I’m wondering if he even has a dentist or am I just involved in some conversational dream, but then I think about my own practice and the state of health care in America today.

Are we all involved in some conversational dream…or can we not establish relationships anymore?

I think about the TV show Cheers, the bar where everyone knows your name.  Remember Sam Malone, Rebecca, Diane, Carla, Norm and Cliff, Dr. Frasier Crane and of course, Woody.

I wonder if Steve remembers the name of the guy at Starbucks who serves him his coffee everyday.  Times certainly have changed.

I still remember Dr. Weltman and Dr. Kaplan my doctor and dentist when I was growing up in the Bronx.  One thing I do remember is how my parents trusted them, they were “go to guys” for everything.

Today healthcare has become a commodity.  Doctors look at computer screens rather than into the eyes of patients.  Patients shop online for Groupons and deals for elective healthcare.

Now if you’re a dentist reading this, I am sure you built your practice on some degree of friendliness, after all dentistry is an intimate, personal service.  I don’t believe healthcare workers created this level of commoditization…it’s just the times we live in and I’m sure how we got here is quite complex.  I also believe that those old “mom and pop” enterprises of years ago were on to something.

They really knew their customers.  Intimately.  Those relationships were the basis of the many rewards they received from their practices.  From the patient’s perspective…everyone ends up on the metaphorical table eventually.  It would be nice if you knew the name of the person on the other side of the mask.

 

 

 

 

Spirit- Body- Mind The Natural Order of Things

December 16, 2014

Filed under: Philosophy — Tags: , , — Barry @ 10:38 AM

 

Breathe. Think. Move.  Three simple words repeated over and over again by Leo, my Yoga teacher.  There is no better instruction for Yoga than those three words…in that order.  The first step or the starting point is to breathe, followed by a thought and finally a movement.  The Latin word for breath is spiritus.  Thinking is carried out by the mind, and finally movement is carried out by the body.  I repeated the three words to myself in silence.  “Why?” I asked myself, if the key to Yoga is spirit, mind and body, do we get it wrong by telling ourselves that it’s all about body, mind and spirit?  We get it backwards and that could make all the difference in the world.

The breath is the starting point, without the breath there is no rational thought.  The mind cannot think straight when there is a lack of oxygen.  The breath is the spiritual energy of the Yoga…the foundational component.  Everything is built on the breath yet we tend to put the most emphasis on the physical…the tangible…the material components.

The edict,  form follows function applies here.  So many of us want to look good but we fail to apply the fundamental principles to get it right…whether that be in in Yoga class or at work or in life.

Most of us get the order of things wrong…we want to start every meal with the desert. 

At Yoga I am pretty good at focusing on the breath, but on this day I was even better because this new insight allowed my mind to  focus even more acutely.  After all what are we, but our minds?  I felt as if the roof had been lifted.  My postures were better…I looked better, I felt better.

At the midpoint of the class Leo started to speak more about a stable base.  I thought more about a secure base.  How wonderful it would be to go through life knowing I had a secure base.  Would that make a difference in my life?

Dentists who practice with an understanding of occlusal principles know that the masticatory system is built around a secure base…so is Yoga, and so is life.

Mindfulness is all the rage these days, yet how can we apply mindfulness without the energy to overcome the distractions of our monkey minds…our comparing minds.

Comparing minds?  Like when you are watching someone else’s postures rather than your own, or looking at someone else’s dentistry on Facebook, or just constantly counting everyone else’s crayons.

In order to slow all that down we need a secure base.  That secure base is the breath…the spirit.  That’s why it comes first.

Viktor Frankl said:

“Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”

 It is in that space that we get to use our minds…our rational minds rather than our monkey or comparing minds.  That’s mindfulness, and that is where form follows function…but it requires a secure base…the spirit.

Society teaches us to envy those with great wealth (great postures too)…but I have always wondered about the man who doesn’t have any invisible means of support.

Take the time to build the foundation in everything you do.  Use the spirit, the breath to take control of the mind.  Reap the external rewards by paying attention to the natural order of things.

 

 

 

 

 

 

The Garden of TAO

August 18, 2014

Filed under: Happiness,Philosophy — Tags: , , — Barry @ 12:37 PM

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I love metaphors.  They help me explain things better. Metaphors not only make our thoughts more vivid and interesting but that they actually structure our perceptions and understanding.  And perception, as you know is everything.

Think of the metaphor, “time is money.”  I used to think of that as a rule.  That I should live my life and run my practice like that.

Until I realized that that metaphor was causing me all kinds of stress.  But who was I to argue, after all, I had heard that metaphor throughout my entire life as if it were handed down from high above.

I’ve since learned that time is not money…time is time, and money is money, and these days time is worth much more than money.

Recently I was assessing my last forty years in dental practice.  I was using Clayton Christensen’s ideas from his book How Will You Measure Your Life?

Tough times make one very reflective.  Christensen advises to look back on your career and focus on all of the people you have helped through the years.  We tend to focus more on our setbacks.  It’s called a negative bias.

So I did.

Over the past forty-one years I have seen over 31,000 patients.

But my practice these days has slightly less than 1000 active patients.

Well, they’re more than patients—they’re members.  People who have subscribed to my approach to dental and health care.  People who know, like and trust me.  People who have mutual trust, appreciation and ownership of their health.

The nutriments of a healthy,  long term fee-for service practice….and the title of this Blogsite.

They’re like family members.

I am sure there would have been more.  People have passed on, people have moved…things happen.

Of course, there are people who just didn’t “click.”

There is an online marketing concept known as 1000 true fans.  It was taken from the idea of the long tail in using keyword search.  The idea is that a business doesn’t have to serve the entire market—just the long tail, to thriveWired magazine editor Keven Kelley created the concept of 1000 true fans from the long tail, and describes many successful businesses as thriving by concentrating on that “niche” market.

Then the metaphor came to me.

Through my years I have been developing and growing my garden…my Garden of TAO.

By using my examination process and nurturing the above mentioned nutriments of trust, appreciation and ownership…I have grown a very nice garden.  Trust, appreciation and ownership are blended into the soil.  They make relationships grow and thrive.

It takes time to build a garden.  Great relationships, in contrast to what the practice management people tell us, take time.  I didn’t know that early in my practice.  It’s the reason I wrote and developed the Arts of Examination and Case Presentation.

Of course, like any gardener you have to be very protective of the beautiful flowers you are growing.  You must tend to the soil, provide nutriments and supplements, but most importantly, keep the weeds out.

That is one of the reasons I am purely fee-for-service.

I have my own philosophy developed through the years.  The last thing I want is to hybridize the garden with foreign thoughts and ideas.  That’s how I maintain my autonomy…that’s why I have learned that time is not money.  You can always lose your money…time is more precious.

 

 

 

The Dental Question for Our Age

August 12, 2014

Filed under: Philosophy — Tags: , — Barry @ 1:46 PM

 

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Picasso once said, “Computers are useless. They can only give you answers.”  There are many interpretations of that quote but I see it as very appropriate these days…there are too many answers and not enough questions.

Being a long time listener of Anthony Robbins, I am also fond of his quote:

“Successful people ask better questions, and as a result, they get better answers.”
Just yesterday a patient came in that I hadn’t seen in seven years.  His mouth was a wreck, and he knew it.
It was so bad that all I had to do was shrug my shoulders to get the point across.  He then explained to me, “I don’t have dental insurance so…”
I put my hands up to signal him to just stop.   “So…so what?” We had a good relationship so I didn’t feel uncomfortable interrupting his thought pattern.  Besides in my book Art of Examination I referred to the “famous nine words: ‘At risk of insulting, you must tell the truth.'”
I repeated his question in the form of a game.  I asked him to finish the sentence in any way he wanted that might change his perspective, not only about his dental condition but his overall health…hell, maybe even his financial condition or even his relationship issues.
“Go on, give it a try,” I said.
He seemed lost.  Stuck almost.
“Okay,” I said, let me help you.
If you asked me the very same question I would have said…”I don’t have dental insurance so…”
Well, I’m not going to give you the answer.  Please leave your answers in the comments below.  Our answers say so much about the way we look at our lives.
It was interesting to me that this patient’s thought process had drifted to a point that would never have happened before our cultural devolution.  Is our culture teaching answers that lead to our ultimate demise?  Is entitlement a function of nature or nurture?
How would our grandparents have answered the question?  How do successful people answer that question?
Looking forward to hearing your responses…and feel free to use this line of thinking when trying to motivate others.
Leave your comments below.

The 7 Triggers of Fascination

July 7, 2014

Filed under: Marketing,Philosophy,Uncategorized — Tags: , , — Barry @ 10:00 AM

Carl Rogers Quote

 

 

I am obsessed with human motivation.  For over forty years I have studied what makes people tick.  For myself it is an exercise in self-development…but in my practice, I believe it is a key to helping people improve.  Now I’m not a psychologist but I’ve done my share of literature review from Maslow to Carl Rogers.

At a recent study club meeting I presented the Art of Case Presentation from my book by the same name.  Afterwards I heard someone say, “You can’t change people.”

Later on I reflected on that statement.  I was bothered by it—more about the attitude behind it than the validity.  Did I really waste forty years of research and study, and over a year in writing a book if that were true?

I will say with all humility.  I am living proof that people can change.  People are capable of changing, and as a dentist I see myself as a change agent.

Change is difficult…I’m sure you know that, but it starts with the subjectivity about change rather than the objective nature of change.  If you say you can…you can.

My discomfort with the declaration caused me to do more reading and reflection.  I am fully convinced that all change starts with the emotional brain.  We must find our own emotional reasons to begin and maintain changes.

There are many books written that discuss the role of mental triggers…things that enter into our minds and get our attention.  One such book, Fascinate by Sally Hogshead (see a review at the end of this post) discusses 7 triggers that communicate ideas, they are:

  1. Lust
  2. Mystique
  3. Alarm
  4. Prestige
  5. Power
  6. Vice
  7. Trust

These 7 triggers instantly reach the emotional brain and provide meaning for the observer.  It’s the meaning that compels us to pay attention and possibly inspire action.

Dentists spend a lot of time trying to appeal to all patients.  Maybe it is true that we can’t change everyone…after all during my career I have seen upwards of 30,000 different patients, but only about 1200 remain active in my practice.

So how well am I doing my job if “changing people” is going to be part of my job description.

One story, reproduced below , that guides my thinking, has really helped me through the years.

 

“STARFISH”

A friend of ours was walking down a deserted Mexican beach at
sunset. As he walked along, he began to see another man in the
distance. As he grew nearer, he noticed that the local native
kept leaning down, picking something up and throwing it out
into the water. Time and again he kept hurling things
out into the ocean.

As our friend approached even closer, he noticed that the man
was picking up starfish that had been washed up on the beach
and, one at time, he was throwing them back into the water.

Our friend was puzzled. He approached the man and said,
“Good evening, friend. I was wondering what you are doing.”

“I’m throwing these starfish back into the ocean. You see,
it’s low tide right now and all of these starfish have been
washed up onto the shore. If I don’t throw them back into the
sea, they’ll die up here from lack of oxygen.”

“I understand,” my friend replied, “but there must be thousands
of starfish on this beach. You can’t possibly get to all of
them. There are simply too many. And don’t you realize this is
probably happening on hundreds of beaches all up and down this
coast. Can’t you see that you can’t possibly make a difference?”

The local native smiled, bent down and picked up yet another
starfish, and as he threw it back into the sea, he replied,
“made a difference to THAT one!”

-By Jack Canfield
and Mark V. Hansen

 I guess that’s how I judge how far I go to change people.  In the end it really comes down to values—shared values.

The shared values creates the political climate in the practice…for me—it’s about the values of TRUST, APPRECIATION AND OWNERSHIP.

Hmmm…I should write a blog about those three words.

 

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Can You Hit the Curveball?

March 16, 2014

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 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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