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GOALS ! A New Look

March 10, 2015

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




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.

Dentistry Been Very Good to Me

December 3, 2013

Filed under: Article,Business of Dentistry — Tags: , , , — Barry @ 10:21 PM



Sitting in a Barnes & Noble just chilling out after a hot yoga class and looking through one of John Wooden’s leadership books.  

I come across a lesson that reads:

“If you don’t have time to do it right the first time, how will you find the time to do it again?”

My mind wandered to where I originally heard that old piece of advice.  It was repeated over and over again in dental school…over 40 years ago.  I still use that advice in my practice and daily life.  Good thoughts from the old coach.

I took out my iPhone and posted on Facebook under the heading of Dental School Wisdom.  Within minutes there were a whole slew of responses.  The problem was that no one was responding to the Wooden quote, just to the phrase “Dental School Wisdom.”

It was as if I had just said the magic words like Niagara Falls in that old Abbott and Costello skit.  If you never saw the skit it’s worth watching and you will appreciate the emotional response I got toward people’s dental school experiences.

I was severely outnumbered.  I had a great dental school experience.  Some of the best years of my life.  Maybe it was the time, late sixties to early seventies, but I felt no pressure, and I wasn’t some sort of child prodigy.  Compared to what came before it, I thought it was a piece of cake.  After all when I finished I would get the prize…a license to practice that would enable me to have a great life.  I felt fortunate…still do.

But obviously, after reading the responses, I was in the minority.

It seems that dental school bashing is all the rage these days.  Whatever happened to gratitude?  While reading the comment thread I was reminded of a blog post written a couple of years ago on the Lolabees Blog.  It was called 10 Reasons Why I Hated Dental School.

That blog post produced a ton of comments that supported the “I hated dental school theme.”  What was I missing?

I follow Lolabees blog and noticed through the years that her blog posts attract many people who seem to want to leave dentistry.

Is there something inherently wrong with this profession?  Did I miss an important meeting?

Sure I would have loved to play third base for the Phillies, but Mike Schmidt was a smidge better than me.  Look I don’t apologize for liking dental school or actually enjoying the fruits of of last forty years of labor in a field that I had total control over.

But as an author and an educator—it bothers me that so much bashing is going on when I know there is nothing inherently wrong with dentistry.

So stop complaining!

Then, in a dream one night, the word Millennial kept flashing in my mind.

I’m a Baby Boomer.  I come from a generation where a job meant something different than it does to today’s young people.  Millennials would prefer meaning over money…and so they change jobs more often.  My generation was satisfied in finding a job that provided a good life and we stayed with it forever.

When I looked at the bashing from that point of view I softened my outlook.

You see…I am very sensitive about doing meaningful work.  I spent the last forty years creating conditions that afford me the freedom to do meaningful, and important dentistry…dentistry with purpose.  Basically that is what my two books are about.

It’s tougher to do that these days.  But if you are willing to create that opportunity…it’s still there, and the grass is still not greener.

The one problem that I see is that of all the attributes needed for a purpose driven dental career...self-esteem is number one.

I have to admit that even forty years ago…my self esteem was tested in dental school.  But I am not one to give the advice to just “buck up and take it.”

No, dental education has to improve— dental schools must build their students up rather than tearing them down and destroying confidence.  Maybe I was lucky.  Maybe I was just born at the right time.  Either way—if dentistry is going to survive as a profession, the dental schools must reform.













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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