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Even a Monkey Could Do It

June 4, 2013



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

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

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

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

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

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

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

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

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

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

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

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

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

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

That is the key to success.


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I Love Adam Levine

May 30, 2013

Filed under: Philosophy,Uncategorized — Tags: — Barry @ 10:56 AM



Let me start this post by saying I don’t watch The Voice.  I’m ambivalent about it.  But I couldn’t help notice the brouhaha that judge Adam Levine started when he was overheard saying “I hate this country.”  He was frustrated because one of the members of his team was voted off of the show by a public vote.

It seems that the person who was voted off was so obviously the best that he was stunned.  People I asked said the same thing.  So why did the public act so irrationally?  Or was this just his opinion?  Or do I have to go back and read Freakonomics and Predictably Irrational?

In other words why do people behave  so irrationally when the truth is so obvious?  Like I said I don’t have much stake in The Voice, but I do have a stake in this country’s health care system.

People who read this blog are a mixed group.  Many dentists read this blog and will understand where I am coming from…let me tell you a story that has been developing through the years:

This morning I had a patient come in to tell me she was leaving my practice after 15 years.  She was taking her family too, and she felt so bad because she loved our office,

But her insurance was changing, and “she had to go where they told her.”  She had tears in her eyes.

There was no convincing her.  She felt as if she was being forced beyond her will.  Irrational?  I know dentists think so.  But what about the lay people reading this blog?  How do you feel?  You see, this is why, as a dentist I support Adam Levine’s outcry.  Do I hate this country?  I can tell you that it gets pretty frustrating when we watch people confirm a system that will not work to provide the best care for them and their families.

It’s frustrating to watch the public vote for a system that breeds mediocrity.  It’s frustrating to watch the public en masse support a system that has no room for dentists to grow into excellence.

Dentistry may be just a small portion of the health care system.  But it is part of the system, like the mouth and teeth are part of every person’s health system.  Dentistry is a microcosm of what is going on economically and politically in this country.  And health care professionals are watching the public just confirm exactly what they don’t want — they are voting to walk over the cliff.

That’s what frustrated Adam Levine— he said it and retracted it.  I don’t think he hates this country and I don’t either – but it can sure get frustrating sometimes. We need more people to step up and support their true feelings—Adam knows talent…health professionals know health care.

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How to Keep the Fire Going

May 28, 2013

Filed under: Philosophy — Tags: , — Barry @ 9:31 AM



Generally I don’t like to give advice.  It’s usually never taken. 

The other day I was reading a blog post over at Spear education.  It was concerning dentists and their staffs having a “fire in the belly.”  I’ve always been intrigued with the concept of passion and burning desire so I took note when someone made a comment about not having enough fuel to keep the fire going.

Practicing dentistry or any other profession for that matter usually isn’t a problem of having the desire, but more a problem of sustaining the fire through the years.  After forty years, I know that is my biggest problem (as I write this after a long weekend of fun and sun).

Being a big fan of self-help literature and productivity, I have noticed that the most helpful advice in these areas is the advice that combats entropy by developing good habits.  Without paying attention to balancing our lives in all aspects, body, mind, heart and spirit, the system will break down and there will be a loss of energy to sustain one’s goals.

Napoleon Hill knew this when he wrote about the power of cosmic habit force.  In other words just having a passionate burning desire won’t get the job done.

This rarely discussed at seminars.  It is one of the biggest reasons for hiring a coach…to make you accountable.  Discipline is a great attribute, but so few people have it.  Behind discipline is willpower.

There has been much written about willpower.  Roy Baumeister is the undisputed doyen of willpower and he tells us that willpower is a limited resource.  Baumeister’s advice is to take care of the biology which will increase willpower and make you more disciplined and resilient.

Now there are two traits we can all use.

I have written in my special report for subscribers (You can get that by subscribing to the ADL Newsletter) that passion is a byproduct of mastery.  If we extend this argument, then in order to create this fire called passion, we must first learn to master the field…making mistakes, not getting along with patients and working for insurance companies can wear a dentist out—or suck up all that energy.

One of my favorite books on this topic is The Power of Full Engagement by Tony Schwartz and Jim Loehr. 

When I first went to the Pankey Institute back in the eighties, I heard the message of balance.  I took that message seriously.  Through the years I have continued to take better care of myself.  That, like taking the oxygen on the airplane first, has become my priority.  Working out, practicing yoga, eating right and getting enough sleep have done more for my practice than anything else.  This truly is about function, and I have never had an energy problem since I began following the advice in Tony Schwartz’s book.

Did I tell you I am a diabetic?  No excuses.

So, at the risk of not being listened to (because I don’t like to give advice), there is nothing more you can do for yourself, your practice and your so called passion than to take better care of yourself.

Happy Memorial Day




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Worry! Don’t Be Happy

May 6, 2013

Filed under: Happiness,Philosophy — Tags: , , — Barry @ 12:15 PM



I am a big fan of the positive psychology movement.  One of my favorite authors on the subject is the late University of Michigan professor Chris Peterson.  You would think that most positive psychologists would lobby for happiness for everyone.  Peterson was much more of a realist.  In his last book, Pursuing the Good Life, he posed the question: “can you be too cheerful?”

That’s a question I always wondered about.  After all, whenever I attend dental meetings and seminars…everyone is oh, so happy.  Life and dentistry can’t be all that good…I know my life has its ups and downs…just about every week, and sometimes daily.

But in public, most dentists are smiling, or at least talking about smiling.

In Peterson’s rant he sites a concept first discussed in 1899 by Thorstein Veblen, known as conspicuous consumption, which refers to the over the top and blatant materialism undertaken to show others how well off they might be.

He stretches that definition to a concept he calls conspicuous conservation which refers to people who take over-the-top ecologically relevant actions undertaken to show others how “green” they might be.

Quite honestly showing off how green or rich you might be kind of bothers me.

Peterson stretches the analogy to cheerfulness.  People who relentlessly display a positive stance.  I’m sure we can all identify someone like an ex-neighbor I had who always made a point to compliment me and tell me how great things were.  One week after a recent surgery and after losing ten pounds, she told me how good I looked.  And she didn’t know I just had the surgery.

Look, I’m all for the power of positive thinking, but I am aware the good things happen as well as bad things.  And Chris Peterson is not just another positive psychology happiologist…he confirmed that for me.  The goal for positive psychology is appropriate cheerfulness.

And Peterson tells us that appropriate cheerfulness and discontent with the status quo has likely led  to almost anything that has improved in the world.  I know that is true in my life.  I once took on the mantra of motivator W. Clement Stone who claimed he was always inspiration-ally dissatisfied.

So let’s keep it real…our lives and our practices can’t always being doing that well.  We all can’t be doing a big case everyday…especially if you live in New Jersey.







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The 9 Turning Points of Mastery

May 1, 2013


I received a complimentary DVD in the mail last week.  I don’t usually give these free discs much attention, but this time I slipped it into my MacBook and started to watch.

And man, was I surprised.

It was titled The Path of a Master, Nine Turning Points That Changed the Practice of Dentistry.  Don’t look for a link because it’s not available for distribution to the general public.  That’s a shame because rarely do we get to see the evolution of a master dentist with such great clarity.

Firstly, I want to thank Jeff Baggett and Bill Lockard, from the Pankey Institute, for putting this project together.  Both did a tremendous  job of telling a story that the dental community needs to hear.

Most people who watch the video may just see a story, but as someone who has practiced dentistry for close to forty years, and had my share of ups and downs, I was reminded of how we all are on the “hero’s journey” as described by mythologist Joseph Campbell.

Campbell used to quote the philosopher Soren Kierkegaard, who said, “Life can only be understood backwards; but it must be lived forward.”  The DVD brought me to a point of reviewing my own life and career.  It reminded me of what my friend Chris Sager the retired Executive Director of the Pankey Institute told me about L.D. Pankey.

He told me that when the Institute fist opened in the early seventies, students would follow L.D. around attempting to “touch the hem of his garment.”  But he said that L.D. was as human as anyone of us…more so in fact.  We tend to deify our heroes.  I identified with Bill Lockard’s narrative because it emphasized how human L.D. was, and that the nine turning points could have happened to each and every one of us if we were aware and prepared.  There are distinct differences between a master and the rest of us, but little has to do with talent.  Sometimes it has to do with preparation, persistence and luck.

I am amazed that in my own life I spent so much time planning and goal setting when it was those few turning points that made all the differences.  I am not knocking planning and goal setting, but I am reminded of another quote from my favorite mythologist/philosopher, Joseph Campbell:

“We must be willing to let go of the life we planned so as to have the life that is waiting for us.”

Pankey’s first two turning points occurred long before he became a dentist.  His story actually started with the story of Daniel Halley-Smith who he met years later on a trip to Europe.  Smith graduated Northwestern University Dental School in 1899 (where G.V. Black was the first dean), two years before Pankey was born.  He practiced in Chicago with Dr. Frank Davis who later retired in Coral Gables, Florida, where Dr. Pankey practiced.  Those of us who understand quantum physics also understand that (more…)

How to Teach so That it Sticks

April 15, 2013

Filed under: Philosophy,Uncategorized — Tags: , , , — Barry @ 7:33 PM



I asked a hygiene patient if he was flossing.  He immediately said that, yes, he was.  So I asked him why there was so much blood on his face.  He shrugged.

How many times do we give patients instructions only to find they are not doing the task correctly?  This problem isn’t restricted to oral hygiene.  Medical offices see similar issues.

Some of the things we ask patients to do require instruction…then feedback.  It also requires the patient to practice until it becomes a habit.  But if they do it wrong…they will always do it wrong.

That is why we have to check for mastery.

This message was hammered home to me during a recent Yoga class.  My teacher pointed out how if we do a posture wrong, we will continue to do it wrong…forever.  The technique must be corrected early…then the practice begins.

That’s why they call it practice.  Dentists rarely practice.  For them it’s always game time.  Back in school we practiced our preps and we practiced suturing…but later on we take it right to the stage.  If we get it wrong we rarely get better…in order to get better it takes a lot of desire, humility and vulnerability.

Remember the saying, “Feedback is the breakfast of champions?”

I digress.

Let’s get back to patients.  I gave my hygiene patient the floss dispenser.  He grabbed six inches and then it was all elbows.  We took the time to show him…and next week we’ll check him…check him for mastery.

Later on that morning I saw an elderly patient who had a lower partial denture made one week prior.  I asked her how it felt…she said fine.

I asked her to put it in (wondering why it wasn’t in), and she took it out of her bag…and then those elbows started to go to work.  I had to stop her because the frustration was too much to bear.

Once again I thought of how many partials and appliances are inserted without thoroughly going over things we take for granted.  How many meds are given?  How many wounds are dressed?  How many catheters placed?

Teaching takes time…learning takes more time.  It was John Wooden who said, “You haven’t taught it until they have learned it.”

I have been writing and speaking about relationship based dentistry for years—this is another example why I feel it’s the only way to practice.  Dental practices that value people over production get this.





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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



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!






Take Advantage of Luck

February 25, 2013

Filed under: Philosophy,Uncategorized — Tags: , , — Barry @ 9:30 AM



I took the courses, bought the newest technology and signed up for the latest marketing program, then why don’t I have the same success as everyone else who is doing it?

Have you ever asked yourself that question?

In frustration asked yourself, “What more do I have to do? 

I meet dentists all the time who invest fortunes in continuing education and new tools like lasers, Cad-Cam, digital impression systems, CT scans and every new shiny object that comes along, in hope of finding success.  Yes, there are plenty of examples of successful dentists who have achieved success but generally not because of a course, a product, a service and even (heaven help me) a mentor.

Many years ago I traveled a great distance to an over-the-shoulder course to watch a “famous” dentist practice.  I learned a lot during those two days.  Most of the dentists were taking notes on the materials and the equipment he was using.  But I paid more attention to his demeanor and his habits.  Some I liked, some I did not, but I sensed that his success in dentistry and life was more due to his personal habits than anything else.

Since then I have tried to constantly reinvent myself.

At first it was tough going.

I tried to copy him.  Everything about him…from his approach to staff and patients to what he ate for lunch.

It took me some years to realize that it was only a good start…so many things that worked for him, did not work for me.  Success was elusive.

Until I remembered one of America’s own great philosophers – Popeye, who said, “I am what I am.”

You are unique.  Role models are nice, but you have to develop -YOU- you must have a strategy for YOU.

Success is elusive—copying someone else’s business plan rarely works.  Most success comes from randomness, serendipity and luck, as described by Frans Johansson in his book Click Moments.

Of course, always remember what Louis Pasteur said, “Chance favors the prepared mind.”  By that I mean that most of the success we experience in our life comes at random moments and it seems that all of the plans we make don’t directly lead to success.

But when we work hard, create good habits, practice discipline then we are prepared when those moments come.  So if your strategy is to copy someone else’s secret sauce for success, you may be better of preparing your daily rituals to be better prepared when good fortune comes your way.

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Losing Your Religion

February 18, 2013



Time was expiring on my Groupon at a hot new restaurant in town.  We called ahead for reservations, but they didn’t accept them.  They asked if we had a Groupon.   When we arrived, the maître d’ seated us, throwing the menus on the table.  I sensed displeasure.  Twenty minutes later she took our order.  Are you starting to get the picture?  The only thing acceptable about the experience was the shrimp marinara which she threw on the table with the same gusto as the menu.

I am not a big fan of social e-commerce, for many reasons, mostly because of what they can potentially do to a business and the people who work there.

The maître d’ in this case was also the waitress, and the owner.  She was understaffed.  A lone busboy and another waitress helped her with the crowd.  The stress was palpable. 

I think “roller skates” is the term we use in dentistry. The scene reminded me of the way I practiced dentistry many years ago…when I participated in all of the dental plans.

I shouldn’t have been surprised.  This is what happens when we work with partners with incongruent business plans.

I changed my way of practice many years ago…to a practice driven by TAO—trust, appreciation and ownership.  Hence—the way—I practice.

I spend time getting to know each and every patient so I can serve their individual needs.  We serve the best food too.  High quality materials and and dental laboratories…really good shrimp marinara.  But what I really take pride in is the service…the very intimate caring service that can only be performed by a happy staff and a happy dentist.

Or else I couldn’t have survived in dentistry.

It all comes down to a business model.  When I decided not to base my practice on price, everything changed.

An insurance based practice doesn’t have the time to spend getting to know patients.  Dental insurance is nothing more than a (G)coupon for dental services.  The concept devalues the personal service so necessary in health care.

Yet so many health service businesses are using the Groupon model.  And dentists seem to be the number one perpetrators.  Examinations, cleanings, tooth whitening, Invisalign are just some of the services being devalued.  I met a girl last week who only goes to the dentist every six months by taking advantage of a Groupon deal.  This isn’t the dentistry that I grew up with.

I could say that I really feel sorry for the patients, but that would be presuming that the dentistry was just bad…I won’t do that, because I don’t know.

What I do know is that for a dentist to enjoy his work over a long period of time a certain amount of mastery and passion is necessary.  I can’t imagine working the way I used to.  So many dentists have a hard time living up to their business model and they let the wolves in the door.  And the wolves have changed the entire profession.

A business model is a statement of your philosophy…it should be sacred…and you never want to lose your religion.








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