Art of Examination Archives - The TAO of Dentistry

Dentistry That Lasts

August 6, 2017

Filed under: Philosophy — Tags: Art of Examination, Comprehensive Relationship Based Dentistry, Leadership — Barry @ 10:14 PM

I started practicing dentistry in 1973…that’s 44 years ago. A lot has happened in those years. We went from the predominance of amalgam to chiefly metal free restorations. From bridgework to implants. I saw the advent of new materials, new equipment and all kinds of new technology.

Some of it, like veneers and implants, and digital radiographs changed dentistry. Other advances are now obsolete like air abrasion for cavity preparation. And some had questionable benefits, like computerized local anesthesia.

No matter how long you have been in dentistry I am sure you have seen many trends and fads come and go. That is why the best dentistry is principle centered dentistry.

I recently read a post on Facebook by an older very prominent dentist who confessed that as he got older he was becoming frustrated when he saw some of his work failing. He blamed it on patient’s non-compliance I sympathized with him. I too have gotten older and see the same phenomenon.

Years ago I bought into the idea of doing “predictable” dentistry – or dentistry that lasts. I came to realize through some pretty good mentors that the only way to get there was to do comprehensive relationship based dentistry. I was so taken by that concept that I wrote my first book, The Art of the Examination which spelled out the entire system. It’s that philosophy that attempts to create dentistry that lasts – not any trend or fad such as digital radiographs or lasers.

Younger dentists these days are enamored with the latest technology. The newer practices promote the latest fads and technologies rather than focus on great diagnosis, treatment planning and creating strong high quality relationships.

I came of age in dentistry when perennialism ruled. In other words we were taught everlasting principles that could create success through many generations. Preventative dentistry for example is a perennial philosophy. For those who have been around, I think you understand what I mean by some of the changes we see.

Less and less people see the dentist regularly. More and more full mouth implant cases are being done these days. Sure–a lot has happened culturally, politically and economically, but I still believe that comprehensive relationship based dentistry holds the answers to this cultural mismatch.

Comprehensive relationship based dentistry that is based on human universals which are features of a culture, society, behaviors, and psyche that stay consistent through time and place. These include leadership, trust, empathy and storytelling among many others.

We tend to throw the term comprehensive relationship based dentistry around as if it has lost its meaning. If we want to do our jobs properly with a sense of duty then we must do this type of dentistry.

Comprehensive means complete. If we do complete dentistry it starts with a complete exam in order to uncover every single etiologic factor of disease. Everyone knows that…it’s the practicing that makes it difficult. I am sure the dentist I mentioned above practices comprehensively.

It’s the second part—the relationship-based part where things get sticky. This is the part, I believe, that dentists truly have let go. Fully understanding and taking the time to create and maintain strong relationships is less common today than ever before. The cultural mismatch.

If the dentist is experiencing frustration because his or her work is failing because of non-compliance, then this can’t get fixed with more technical advances. These are relationship issues. These are leadership and communication issues. That is why it is impossible to do comprehensive dentistry with the human factor.

Dentistry is changing. The profession needs to step up from within. I see major gaps in thinking between the older generation of dentists and the younger dentists just starting out. There has been a paradigm shift. Blog posts and social media groups are questioning the future of dentistry.

Please weigh in with your feelings – what have you experienced and what do you see happening as we go into the future?

Comments (1)

Are You a Thin-Slicer?

June 22, 2015

Filed under: Art of the Examination — Tags: Art of Examination — Barry @ 3:26 PM

Every dentist has heard the story of the unlikely dental patient. You know, the old farmer who comes in wearing beat up overalls, doesn’t give much feedback and ends up getting full mouth reconstruction.

What we never hear about is how many dentists that farmer visited before he said, “Cap me.”

I’ll bet that number is high.

The lesson behind that story is “Never Prejudge.” And what a worthwhile lesson that is…but we just never seem to get it.

And I’m not just talking dentistry here.

We are built to judge…and prejudge. Malcolm Gladwell, the popular author of Blink The Power of Thinking Without Thinking, one of his many bestsellers based on some very interesting psychology research, refers to these snap judgements as thin slicing.

The term thin-slicing means making very quick decisions with minimal amounts of information.We thin-slice whenever we encounter a new person, a new situation or have to make a decision about something very quickly. According to Gladwell people make snap judgements quickly by relying unconsciously on thin slices of experiences.From an evolutionary point of view thin slicing can come in pretty handy.But when it comes to new patients…it may be better to think things out, take the time to get to know the patient.Yet. most dentists don’t.How do I know? Because in conversation with many dentists, including my coaching clients through the years, I hear the prejudging, and I constantly remind them to take the more analytic approach of taking the time to listen, be open-minded, suspend all assumptions, meet the patient where they are, and approach all patients without an agenda.But…

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

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

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

And this dentist actually lectures to students.

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

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

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

Make that your competitive edge.

Comments (2)

The Ultimate Productivity Tool

May 11, 2015

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

images

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

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

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

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

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

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

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

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

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

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

So what is the rationale for doing the complete examination?

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

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

Comments Off

Can You Hit the Curveball?

March 16, 2014

Filed under: Art of the Examination,Philosophy — Tags: Art of Examination, Comprehensive examination, examination — Barry @ 10:41 PM

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.

Comments (13)