Part 4 of 5: How the Creative Process Will Affect Your Dental Practice

MONEY is a byproduct of the CREATIVE PROCESS. In fact, I can prove that dentists using the CREATIVE PROCESS net 2-3 times as much as dentists trapped in the REACTIVE PROCESS. I can prove this with over 100,000 months of data that we can collected as we have worked with dentists one-on-one these past 34 years!

When you use the CREATIVE PROCESS in business the result is GROWTH, real growth in NET PROFIT. When you join together the organizational process of practice development with the Creative Process you always experience true growth, more freedom, control and peace of mind.

What I have found and why it is so important to dialogue and interview potential clients of the Schuster Center is the fact that we can predict who will be truly successful and who won’t. It is this simple and powerful. I can predict that in a 30 minute conversation. Do you want to CREATE SOMETHING DIFFERENT, SOMETHING IMPORTANT to you IN YOUR PRACTICE and LIFE or don’t you?

THOSE DENTISTS who have something very important to THEM to bring into existence ALWAYS PRODUCE AMAZING RESULTS in our process, and those who don’t are moderately successful but never break through because they have never truly gotten into the CREATIVE PROCESS. Sure it takes some longer to get there than others, but the joy is in the CREATION as well as the END RESULT.

I’ve watched men and women build airplanes that took then 10-15 years to build and they enjoyed every minute of the process because they were building something THAT WAS IMPORTANT TO THEM. In fact for many of these people, the very act of building their plane was more important than the end result of flying it. So it is with all creators; they end up loving the process as well as the destination or end result. This is why THE CREATIVE PROCESS IS LIFE TRANSFORMING. It changes the entire experience of LIFE and PRACTICE from reacting to life to CREATING what REALLY, REALLY MATTERS TO YOU!!

Dr. Michael Schuster, Founder of the Schuster Center

Stay tuned for: Part 5 of 5: The Conclusion: Make the Choice to Continue your Education in Dentistry

INTRODUCTION

Mary is a 50 y/o housewife married to an engineer and together they have two children, both in high school with one getting ready for college.  She has been considering changing dentists for a while because her present dentist just doesn’t seem to be keeping up.  She is not happy with the way her mouth feels and looks and wants a fresh start with someone new.  Her friends keep mentioning 2 dentists so she thought she’d try one and go from there.

CHAPTER 1

She calls Dr. A’s office and hears a recorded message giving her 5 options, so she chooses the one for new patients.  A lady answers and begins the conversation with multiple questions about Mary’s insurance.  She follows this with a full explanation of their policy regarding insurance, missed appointments, and financial arrangements.  At the end of the conversation, she gets Mary’s full name, address, etc.  Mary is then transferred to the appointment secretary and she makes an appointment with the hygienist, since this is what she has always done.

Upon her arrival at the new office on the day of her appointment, she notices that the office is new, fresh, and quite impressive.  The parking lot is full.  When she enters the reception room, she is impressed by the beauty and décor of the office.  However, she is a bit taken back by how many people are waiting and by the disheveled look on the front office staff.  She feels tension in the air.

The hygienist is very pleasant but seemed to be in a hurry.  X-rays are taken by her assistant as well as blood pressure and a review of the medical history.  The hygienist efficiently cleans her teeth and does a cursory exam.  Dr. A walks in and introduces himself.  He seems like a very nice person.  He examines her mouth, looks at the digital x-rays on the monitor next to the chair, and speaks in dental terms to his hygienist about his findings.   He sits her up and says that she has some problems and that the treatment coordinator will discuss how he is going to help her.  She is taken to a private room where she is told what the doctor is recommending, how much it will cost, and how she can have her work done so that she maximizes her insurance benefits.  Politely Mary tells her that she will have to discuss this with her husband.  She notices a frustrated look on the Treatment Coordinator’s face as she gets up to leave.  You see, the purpose of Dr. A’s practice is maximum profits and the Treatment Coordinator’s charge (which is tied to her bonus) is to not let anyone leave without an appointment.

CHAPTER 2

Not sure what to think about her first visit to Dr. A’s office, (something didn’t feel right), she decides to call Dr. B’s office.  She has her x-rays and records sent to his office (no one from Dr. B’s office asked her why she was requesting her records).  On the second ring, a lady with a very pleasant voice answers the phone.  After welcoming Mary, the lady engages in a conversation with her, filled with questions about how long she had been in town, where she was from, her family, how did she hear about the office, etc?   It was as though Mary had just met a person who was truly interested in her (actually she was) and it made her feel relaxed.  The lady then moved to the purpose of her call and described to Mary several different ways she could enter the office.  Mary thought it was best to come in for a cursory exam and consult with the doctor.  The lady asked Mary if she would like to go on line, complete the forms for the office, and email them or download and fax them, or if she would like the forms mailed.  Finally, out of courtesy, the lady quoted an estimated fee for the visit.  She ended the conversation with a sincere thank you for contacting the office and when Mary hung up…she said WOW!

Upon her arrival at this office, she notices that the building has been there a while, but that it appears to be well maintained.  She notices only two other cars in the parking lot and when she enters the reception room, there is only one other person there.  The décor is pleasant and comfortable and the sole front office person actually comes out into the reception room to greet her, indicating that she was the person with whom Mary had spoken when she called the office. This made her more relaxed, since she felt she had already bonded with this lady.   She is well groomed, pleasant, and is noticeably poised.  There is something unique about the office but she just can’t put her finger on it yet.

CHAPTER 3

She is escorted back into a small conference room and her medical and dental histories are reviewed.  Based on her phone conversation when she made the appointment, the receptionist confirms the purpose of her visit.  She also asks Mary if she was free to share why she had left Dr. A’s office.  Dr. B comes in and sits with her, choosing not to sit behind the desk in the room.  After a brief conversation relative to the referral source, Dr. B is informed by the receptionist about why Mary is there today.  Dr. B confirms that what he heard was correct and asks her to tell them him more about her concerns and she does.  Dr. B is curious, so he asks Mary to just keep talking about her mouth and what things are most important to her.  Then he asks some very simple, but powerful, questions.  With these questions, Mary begins to sense that this is a unique place and that these people truly care about her.  She realizes that it is about her.  There seems to be no pressure on her to do anything but share what is important to her.  She feels it is safe to trust these people.

He begins with:  “I can sense that you want your teeth, have you given any thought as to why?”  At first she says that she wants to be able to chew and she wants to be healthy.  Dr. B says that’s good but can you think a little deeper (sometimes this is awkward for Dr. B but he is absolutely convinced that he should go there)?  He notices her face begins to change and her body language indicates she is processing something in her right brain.  Finally, it becomes extremely clear that she has accessed something that has an emotional content and she says that she used to watch her grandmother take her teeth out and put them in a glass on the window in the kitchen and that at a very young age she knew that she never wanted to do that.  Dr. B is inwardly pleased, because he now knows that any decision she makes regarding her dental health will be connected to that emotion.  You see, the purpose of Dr. B’s practice is to help his patients make decisions that are in their best interests, based on their goals and values, and this moment is paramount for that to happen.

CHAPTER 4

They move to a treatment room and he very carefully examines Mary’s mouth.  He does it in a way that she is intimately involved, feeling a strong sense of being in control throughout the process.  The dentist and his assistant are speaking in a way that she can understand.  He checks the health of her gums, then the teeth, and then he checks her bite.  He is asking her questions the whole time.  At the end of this part of the visit, he sits Mary up and asks her three more profound questions.  First, he asks Mary how she wants her mouth to be when she is 80 years old and she shares her thoughts.  Secondly, after she tells him what it is that she wants, he asks her how she would like him to approach her mouth, meaning does she want to take care of things when something breaks or there is a problem or does she want to be more proactive relative to her dental health.  Finally, because she indicated that she would like to be more proactive, he asks her if this would be a good time in her life to step back and determine at a deeper level, the actual state of her dental health and to discuss the options that are available to her.

She said this may be a good time in her life but she is concerned about the upcoming expenses of her child entering college and that she has some concern about the stability of her husband’s job.  When she was told that after more detailed records were taken at another visit, she would have the opportunity to go over the findings of the exam with the doctor, work with him to co-create a path for her to reach her desired goals (with fees quoted in advance), and that she would control how fast she moved down that path while the doctor and his team would control the quality, she felt relieved.  In addition, she was told that the first step of this journey would be directed at stopping her mouth from deteriorating and establishing health and the treatment designed to restore her mouth would follow later.  She felt even more relieved and made the appointment for a more comprehensive exam.

CHAPTER 5

Looking behind the scenes at these two doctors, it is interesting to note that Dr. A is heavily in debt.  He has a million dollar plus practice with 12 employees (all paid hourly with no benefits; turnover is high) but is only netting $300,000.  He sees 75 new patients per month.  He does 2 hygiene checks every 45 minutes and sees over 20 patients a day on his schedule.  His debt is not only at the office but is also in his personal life.  He has not yet begun saving for his retirement nor does he have any money set aside either corporately or personally.  He is taking multiple medications for HBP, diabetes, and anxiety.  He is working over 200 days a year and rarely takes a vacation.  He hates Sunday evenings and Monday mornings.  He is deeply frustrated because he has been highly trained but cannot seem to get his patients to say yes to the treatment he recommends.  He rarely receives gifts and is continually putting out fires with disgruntled patients as well as between staff members.

Dr. B on the other hand, has very little debt. He has one front office person, a hygienist, and two dental assistants that share time at the front desk and in the lab.  They are all paid a salary, a 401k plan is in effect, and they get sick leave and a uniform allowance.  Turnover is rare.  His office is fully paid for and he has, at the age of 51, almost reached his retirement goals.  He has set aside within his corporation enough money to handle expenses for 6 months and has done the same in his personal environment.  His only debt is a new $60,000 digital pan that he hopes to have paid off in 3 years or less and an automobile note on the personal side.  He too is highly trained and rarely do his new patients say no to his treatment recommendations, although many have to do their treatment over time.  He sees just 6 patients a day on his schedule with 1 hygiene check per hour, works less than 160 days a year, produces $500,000 in his little country practice and nets $250,000.  He sees 12 new patients per month.  He is physically fit, takes no medications, and just loves to enter his practice on Monday mornings.  He now is working only 3 ½ days a week and takes 4 vacations a year.  From time to time during his day, he feels a gentle hum in his office and he gets the sense that he has created something that is spiritually right for his patients, his team, and yes, for himself.  He routinely receives gifts, cards, hugs, etc. from his patients.  His staff admires him and feels honored to be part of such a special office.  He is content.

CONCLUSION

If we look a little closer at Dr. B and what he did to achieve these results, we may be enlightened.  From the very beginning, Dr. B made a very remarkable decision.  He identified his most closely held values, things like honesty, integrity, a strong work ethic, empathy, a deep love of his neighbor, his commitment to excellence, among others.  Then he put these values into the very fabric of his practice.  He decided that it would be wise to hire individuals who shared those values, hence the great working relationships and minimal turnover.  Since he was committed to doing above average dentistry, UCR and the insurance game did not enter into the picture.

Relative to the financial aspect of his practice, he realized that he could not provide above average quality care with average fees, so he set his fees at levels that allowed him to do his finest.  (Knowing that this would exclude the disadvantaged in his area, he developed a plan to donate a certain amount of dentistry per year).  He also believed that it wasn’t how much he produced but rather how much he kept, so he created a budget, obtained an overhead of 50%, and kept his debt structure under control.  He didn’t like the idea of mass marketing so he developed a relationship based practice, where virtually all of his patients come by way of referrals.

Early on it became clear to him that his technical skills had to be elevated so he pushed hard with his C.E.  Soon his competency zoomed but then he saw how far behind he was with his behavioral skills and how difficult it was to present complex cases to his patients.   So he went out and developed his Emotional Intelligence or EQ.  At the same time he began a journey to discover what his beliefs about life were, from where did they come, whether they were tied to the truth, and how much they were inhibiting his growth as a dentist and as a spiritual being.  This three pronged approach has paid huge dividends.

So we can see that it was no accident that Dr. B ended up with this special dental practice.  We can learn a great deal from Dr. B and his journey.

Rev: 4/5/2011

Battle Creek dentist and Schuster Center graduate Dr. Sharon Dickerson peered into the mouth of a young Honduran orphan and saw too many cavities to count.

“Ugh,” she said.

That was when her daughter, Carly, had to remind her to mask her emotions for the sake of the frightened child in the chair.

click here for full story.

By Barb Stackhouse, RDH, M. Ed.
During the recent hygiene course I taught here at the Schuster Center, questions arose as to “how” each practitioner completes the technical part of the Dental Fitness exam. More specifically, a hygienist had concerns that the doctor’s initial exam was different than what she was finding at the first therapy visit. I have also had doctors comment to me that they are frustrated to see patients still in a disease state when their DFP scores are not really that bad.

So what is the deal with all of this? I personally had to figure this out for myself because I did it to myself! I did the DFP exam, reviewed a generally positive result with the patient, then started to scale the teeth and all of a sudden there was more bleeding around the teeth. I was wondering what I did wrong. I checked my instrumentation to make sure I was doing it correctly and not injuring the tissue. Everything was okay there… so what was going on?

I went back to how I was taught to probe. Correct angulations, long axis of the tooth, going interproximal, walking the probe around the tooth. All correct. But when I inserted a scaler and moved it around the tooth reaching into the bottom of the pocket, there was bleeding. The very base of the pocket is where the bleeding was coming from. The base of the pocket is where the bacteria like to hide. I was missing this with my probe. How could that be?

I want to be gentle with my probing. I don’t want to hurt the patient. I want to get accurate readings. Is that possible?

I began to assess how my probing was different from the scaling motion I used and I read and listened to what other hygienists were doing. I learned that the probe must be inserted and pulled slightly toward the tissue with a sweeping motion, much like a scaler, moving around the tooth while still placed in the bottom area of the pocket. Healthy tissue will not bleed when you do this. I have not had any patients complain. They don’t feel anything different than when I probe using the walking up and down motion. I still do the walking around to make sure there are no drop-offs into a pocket but I also take the time to circumnavigate the tooth while the probe is positioned in the bottom of the pocket.

I use the Perio Wise Probe by Premier because it is color coded and allows me to see the plaque on the tip. It is plastic and seems to cause less sensitivity to the patient. I know there are other thinner probes on the market that you may prefer for various reasons. My point is not to tell you what probe to use, rather to give you my opinion and share with you what has worked for me. As with any technique, I am still learning and welcome your comments, hints, and suggestions in this area.

Once you understand the differences in probing techniques, it is imperative to calibrate your scoring with anyone else in the office who will be probing and scoring this patient. This can be done much like examiners in a blind study would be calibrated. Every person who is doing the exam must be able to get very similar readings so that the results are accurate.

I suggest that you schedule 3 or 4 different patients (perhaps family members or friends who are willing to accommodate your process) and have each examiner complete a DFP score on each one.

Print out the results for each person and then do a comparison to see if there are any major differences. Keep in mind you will want to choose a variety of patients that do have some disease present to do this calibration. If you have some major differences, sit down together and assess how each of you enters the probe into the pocket area and how the measurement is recorded. Keep in mind this is a learning experience and be open to sharing information with each other without judgment. The purpose is not to criticize how someone does or does not do the DFP exam.

I believe if we truly care about the patient and we want the best for them, we will all want to complete the exam in the most accurate way possible. Patients will know when we are working together as a team for their benefit. They sense it and feel it in our actions and our communication.

Calibrating the exam results for DFP adds yet another element of trust between the members of your team and between you and the patient. Patients know when you have confidence in each other.

–Barb Stackhouse, RDH, M.Ed., is a Practice Development Coach and a member of the faculty at The Schuster Center for Professional Development as well as a Dental Hygienist.

By Chris Ellison

My story begins in the fall of 1990 when I was first diagnosed with high blood pressure. It was a highly stressful time in my life so my physician and I believed that stress was the cause. I did not fit the profile for those with hypertension. I was not overweight and my blood pressure had always been considered low, under 120/80. He gave me some medication to take and when I went back in four months, my readings were “normal”. He told me to discontinue the medication.

Fast forward to seven years ago, suddenly I was having headaches and blood pressure readings that were consistently high. I was again placed on medication. This was the beginning of an uphill battle. During the past seven years, I have failed more medications than I knew existed for the hypertension. Every time I walked into the office the doctor would say “you certainly don’t look like you should have high blood pressure”. Look the part or not, I had it and it kept getting worse no matter what efforts I made. I never expected to battle high blood pressure because as I said I was not overweight. As a matter of fact, most of my life, I was under weight and my blood pressure readings were usually low. So, despite family history, I expected to beat the odds when it came to this disease. My family tree said that I would certainly have high blood pressure, heart disease, diabetes, and kidney failure and not live to be 55 years of age. And seven years ago I started on the journey to being plucked from the family tree as my paternal and maternal grandmothers, my father and other relatives had been. My two younger siblings have been on dialysis for 5 years due to hypertension and diabetes and heart disease as well. Sounds pretty bleak, doesn’t it?

How do you beat the odds? Traditional medicine would tell you that it is by taking medication,  exercising and watching your salt intake. I was taking the medications and I was not using a salt shaker. My blood pressure continued to climb and I continued to fail medications about every 6 to 9 months. I suffered all of the side affects and very little of the benefits from the medications. Two years ago, my family physician began to be concerned about my kidneys as the blood pressure continued to escalate. I was referred to a nephrologist because they have better knowledge of medications that will control the blood pressure and take stress off the kidneys. I was treated by this specialist for a year when he essentially threw up his hands at the lack of success with the medications. So he referred me to his senior partner for a consult.

Once again, I was told how I didn’t look the part of someone who had high blood pressure even though by now I had gained 25 pounds. His solution was to start me on a new regimen of three medications. As was the usual when I took a new medication I would see some results for a period of time, but I would also start a new series of side affects. These side affects were dizziness, loss of ability to taste, headaches, drowsiness, lack of energy and just basically an overall feeling of lethargy. I managed to push my way through my days at work only to collapse when I got home. This was my pattern of life for three years. I had zero energy but by the grace of God I was able to keep going each day.

In November of 2006, I had a three month check-in with the nephrologist at which time he discovered what I already knew. My blood pressure readings had been spiking in spite of the three medications. His resolve was that sometimes it takes four medications to get things under control. I protested about the side affects. He essentially said that was the trade off that I would have to deal with to get this under control. He wrote the prescription for the medications and told me to call to schedule my next appointment in six months! I was to have blood work done for kidney function prior to that appointment as I had for all previous ones. At least my kidney function was normal.

You need to know a few things about what I had been doing during these episodes of highs and lows in health and in spirit. As previously stated, I was not a heavy salt user. I did eat too much fried food, I ate a lot of fruit and vegetables (I thought), I have never smoked and I do not drink alcohol. I had done on and off exercise programs, but my busy schedule always took over. I was praying for healing and I knew that God never fails to answer prayer so I believed that it would happen. I began to change my prayer because I know He always hears and answers prayer and sometimes the result doesn’t come because you are praying the wrong prayer. My new prayer was for Him to show me what I needed to do naturally for the healing to be complete.

In April of 2007, I began a very huge slide in the wrong direction. My blood pressure readings were consistently 200/100+. I called the nephrologist to get in for an appointment and I was told he didn’t need to see me – he would phone in a prescription for an additional medication and I should schedule an appointment for SIX MONTHS. I got the prescription filled and began taking it. The readings did not get any better and I knew that I was headed for a stroke or worse if things did not change. But I didn’t know what to do or where to turn in the medical realm. By now I was taking TEN PILLS a day and the blood pressure continued to be at 200+/ 100+. You can only imagine what I felt like on a daily basis. Again, I give God’s grace credit for my getting up and going every day.

On April 16, 2007, I was back in Dr. Schuster’s practice having a staff member take my blood pressure. I felt so lousy and the readings were consistent with what they had been for the past several weeks. Something else happened at that time. Dr. Schuster walked in just as Barb was taking my blood pressure. He saw the readings and said to me, “You have to go to Pritikin”. He said “I will send you if you promise to do what they tell you and to follow through with what you learn there when you come home.” He also said, “You don’t think it was an accident that I walked into this room at this time do you?” I knew it was no accident because I had been praying for this answer!

May 5, 2007, I embarked on a journey that would restore me to health. I left Arizona for Aventura, Florida and the Pritikin Longevity Center. I wasn’t sure what to expect but I knew I would be different when this experience was over.

I began my first full day at Pritikin on Sunday, May 6th at 6:30a.m. by going for blood work and then a consultation with my newly assigned physician. The preliminary health history I had completed was quite extensive and he proceeded to go through it with me confirming the things that had brought me to Pritikin. He assured me that if I followed what I would be taught there that I would be able to improve my blood pressure and overall health. We began by eliminating the diuretic I was taking because the diet there would serve the same purpose. That was one less pill I had to take daily and he assured me that we would eliminate a couple more before my two week stay was over. I was scheduled for a follow-up appointment on Wednesday when he would have the results from the lab. I was to have a stress test in the afternoon to determine the level for my daily exercise regimen. I had been told by my physicians at home that I shouldn’t exercise so this was a bit unnerving but I was going to trust the process.

For the next two weeks, I was immersed into a world that was all about me and my better health. I was experiencing a very new way of eating and living. My Wednesday appointment had a big surprise and that was a diagnosis of diabetes. No problem. This new diet regimen could help me with that. But the diabetes also explained why we had been having a hard time controlling the blood pressure.

I got up early in the morning, had breakfast and then headed to the gym. I took forty-five minutes of yoga (stretching and breathing), forty-five minutes of strength training, forty-five minutes of cardio and forty-five minutes of core and stretch alternating every other day between strength training and core and stretch.

I was learning to eat five meals a day, which consisted of lots of vegetables and fruits and grains and legumes with animal protein, only 3 times per week (fish, chicken, or bison: was I surprised at this one!). Lots of spices and seasonings that I had not habitually used (such as Mrs. Dash and balsamic vinegar) became my best friends. I was eating more food than normal, but I was losing weight.

Pritikin doesn’t just take you in and say eat these foods and do these exercises without giving you a very clear understanding as to the reasons behind the process. I attended 3-4 workshops daily on nutrition, health, exercise, stress management, and cooking prep to learn how to prepare the meals we had been exposed to. I came away with the equivalent of one+ college semester of health and nutrition information. They have a highly qualified, degreed staff that delivers the message of health at a level no physician is willing to risk. They are not just talking off the top of their heads. There are years of studies and research to back up their recommendations and hundreds of testimonials that confirmed what I was hearing and experiencing personally.

May 20, 2007 I got back on the plane headed to Arizona and now the true test of whether Pritikin actually worked. I had lost eight pounds and my blood pressure was consistently reading 120/78 or lower. The blood sugar levels were coming down but I would have to test daily to make sure that I didn’t need to go on medication to help reduce the levels. I was determined that in six months the term diabetes in reference to me would be a historical statement. But the question remained could I pull this off in the “real world?” I was determined to do it. God had showed me the plan and now it was up to me to implement it fully.

It has been almost four months since I returned from Pritikin. I have continued to eat mostly vegetables and grains with a little fish, turkey and chicken thrown into the mix. I have not been able to get to six days of exercise but I am doing better than when I went to Pritikin. I currently take one pill daily for blood pressure and as of the beginning of August, I no longer have to stick myself to check blood levels. I am no longer considered a diabetic. My blood pressure readings are around 116/70 to some days 90/70. I have now lost twenty-two pounds and need to go shopping for a new wardrobe. That’s not a bad problem for a woman to have. If I don’t exercise even though I am eating appropriately, my pressure will rise so it isn’t an option not to exercise. It goes hand in hand. The lifestyle change has to be complete and consistent.

I will always be grateful to Dr. Schuster and Patti for sending me to Pritikin. God definitely used them for my good. I am also grateful such a place as the Pritikin Longevity Center exists. It is so great to feel good and have energy rather than feeling like I was dragging a 100 pound weight around with me. I now recognize the person in the mirror staring back at me. I almost lost that person forever. Health cannot be taken for granted. We have to be willing to look outside the box of conventional medicine.

–Chris Ellison was a practice development coach at The Schuster Center from 1998 til 2010.

by Scott Cairns, D.D.S.

I graduated from dental school seven years ago. As I reflect back on those times, I think I was a fairly typical new dental graduate. Anxious, eager, excited, or scared,  I don’t know which adjective would have best described my mood at the time?

Typical also were the next four years. I went through all the routine stages of a newly minted dentist. Here too, I made many of the typical mistakes – clinical, strategic, and financial as well as many of the typical successes – clinical, strategic and financial. Only recently did fortune turn me down the atypical path. This path has been exciting and rewarding, but not free of dangers and fear. In many ways, this path, though rich with promise, is much more arduous than any I have taken thus far. Unfortunately, today’s dental climate has made the path I tread, the path of most resistance, a path that many of the readers of this text have traveled.

In my first years as a dentist, I was like a teenager. I new it all, especially when it came to all the accumulated knowledge of practice management. After all, I had been reading Dental Economics since I was a freshman in dental school; in fact, I had even read six years worth of back issues to catch up.

When I finally bought my own practice, I began to try to implement all the sage advice I had read. I knew that insurance was bad, so I tried to avoid participation; I knew hygiene was a profit center, so I added hygienists, I knew nightguards and bleaching were high production at little expense, and so many patients received these services. I was absolutely sure that bigger was better, so I built a large physical office. I knew I could borrow money today and satisfy my desire for immediate gratification – so that is what I did.

All the while, as I was busily implementing all my knowledge, I began to get hints that my knowledge was incomplete, if not fatally flawed. Something, I didn’t know what, was missing. I realize today, that I was becoming more and more a provider of commodity services, and less and less of a doctor, an educator, a healer, and a friend to my patients. At that time, I couldn’t clearly put my finger on what was happening, so I began a search for something. I didn’t know what I was searching for, just that something important was missing.

That was when my wife (a dentist) and I began our journey toward change. Fortuitously, we discovered a philosophy of care that was bigger and more enduring than our personal egos – we discovered that our purpose was service to people, not to teeth. We have spent the last few years developing our skills and our practice, to first better serve the best interests of our patients, but we struggle with this seemingly simple objective. It sometimes feels as if all of dentistry is conspiring to make this an impossible emphasis for a modern dental office.

Recently, I spent time with a group of dentists struggling and trudging along the path just like myself. As I looked at the group, I noticed the fear and frustration lurking in the shadows. As I looked harder, I noticed everyone had these personal demons haunting him or her. For some, these fears and frustrations were more brazen and bold, still others had them very well in check and controlled – no one had banished them. Perhaps it is the natural progression of developing a practice based on care rather than production. Perhaps it is impossible to exercise these demons – I don’t know. What I do know is the path to freedom is much more difficult than it intuitively should be. I don’t want to blame anyone of anything for the difficulty, but I think there is freedom and power in acknowledging those things that make it so difficult.

Anyone, after careful reflection, could come up with their personal list of obstacles – as I shared earlier my list included arrogance, a desire for immediate gratification, pride and ignorance. But, as I looked at a group of 23 intelligent, motivated dentists, I noticed the greatest and most innocuous demon was fear.

As a group, we are afraid of a myriad of things. We are afraid that we cannot provide the service; we are afraid of insolvency; and, we are afraid of what our peers will think. But the most common fear, and perhaps the most curious fear, is a fear of our patients.

I think it is safe to say, that among this group of gifted and blessed dentists, that fear of the patient was universal – even among the bold drivers of the group (although I suspect they don’t think of themselves as afraid – I know I didn’t until I reflected on those things which were holding me back.)

This fear can present in many ways: Fear that the patient will think we are over-treating; fear that the patient will think we have wasted their time; fear that the patient will think we are self-serving; and, fear that the patients will not accept the healthiest long term method of treatment.

So, where does this fear of our patients come from? I’m not entirely sure, but I have given this question considerable thought, and I think the fear comes from our lack of a relationship with our patients. For those fortunate patients, those whom we get to know best, we are never afraid to tell them the truth as we see it. We are never afraid of what they will think of us, we are certain that they trust us and are fully aware that we have their best interests in mind. The unfortunate many among our patients, do not however, always have this confidence.

I marvel at how long it has taken me to reach this realization – after all I have read 15 years worth of Dental Economics. But, if knowledge were the key it would be easy. The key isn’t knowing that you must know your patient; everyone familiar with L.D. Pankey is aware of this. The key is knowing your patient. Until we have the courage to set up systems in our offices, that without exception allow us to spend the time to get to know our patients, we will always be in fear of our patients, and our individual visions will never become a concrete reality. Not until then can we stop running scared.

–Dr. Scott Cairns and his wife Christina practice dentistry together at Cairns Family Dental Care in Glendale, AZ. Scott and Christina are both graduates of the Schuster Management Program.

By Barb Stackhouse, RDH, M.Ed.

The million dollar question these past few months has been, “How do I attract and hire the right people in my practice?” The real kicker is that it has to be done now because a team member has left. Does this sound familiar?

If you have ever been in this position, it feels very uncomfortable. Your thoughts begin to fill with fear and you wonder if you will ever find someone who will fit well into the position available. Rest assured these are normal feelings and you are not alone. Somewhere out there is a prospective team member who is wondering if they will ever find the right ‘home’ where they will enjoy being a productive part of a special office. The problem is you haven’t found each other yet.

One of the concepts about leadership that I teach in Retreat 2 is the leader must be the head follower. The question then becomes, “What are you following?” The leader must be clear about the vision and the philosophy they want everyone to become a part of. If the leader/ doctor is not following it, how can the team follow it, and how can you hire someone new to follow it? So, the first step is to clearly define what you are following and what is important to you. This will define the characteristics you are looking for in the person you wish to bring on board.

Set about making a list of the skill set and characteristics you are requiring for this position. You might make three columns on a piece of paper with the headings: Must Have, Would Like to Have, and Offering. In the first column under “Must Have,” you list the skills and characteristics that are the most important to you and that you feel are essential for the job. The second column under “Would like to Have,” you list all the skills and characteristics that would be an added bonus for this person. They are not essential skills but it sure would be nice if they had them. The third column under “Offering,” you list what you are offering the person who will eventually accept this position. Sometimes I think we forget all of the things we have to offer someone. It helps to list them and helps to ensure that our conversations with the new prospect will include our unique offerings.

This is also a great way to create an ad for the position. Once you have all of this in writing, it should be fairly simple to create a unique ad for the offer you are making. For example, if you want someone to be a long-term committed employee, you are offering job stability/security. If you want someone who values professional growth, you are offering continuing education opportunities. Your list will also help you to create questions for the interview process. Once you decide what skills and characteristics you are looking for and how this new person will fit into the “vision” you have for your practice, it will be much easier for you to discern whether or not this person is the “right one.”

There are also tests available that the prospective employee can take to help you know for sure what you are getting. There are three areas of the mind that can be tested. These are cognitive, affective, and cognative. The cognitive area measures IQ or a skill set. For example, a dental assistant may have the CDA certification which proves they passed a cognitive test measuring dental assisting skills. The affective area measures emotion or personality as we sometimes call it. The DISC™ profile is a good example of this type of test and we have used it here at The Schuster Center for years. Finally, the cognative area measures an individual’s modus operandi, or their way of “doing” things. It is the instinctive way one takes action to get things done. The Kolbe™ test can be used to measure this area of the mind. Recently, the coaches here at The Schuster Center became certified Kolbe™ consultants which means we are able to administer and give feedback to someone who wishes to take the Kolbe™ index. Within this we are then able to make comparisons based upon the requirements for the position to see if there is a fit. It is a great tool and we are excited to begin  offering it.

The best advice I can give you in the hiring process is to be patient. Easy for me to say when you are in a crunch for time. Adding a new team member changes all the dynamics in the office so finding the “right one” is crucial to your success. If at all possible, wait, and keep searching for the best fit. You’ll be glad you did.

–Barb Stackhouse, RDH, M.Ed., is a Practice Development Coach and a member of the faculty at The Schuster Center for Professional Development as well as a Dental Hygienist.

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