Dentistry at a Crossroads: The big issues

What are the Big Issues? In dentistry, they involve decision-making. Making a decision implies that there has been careful and thorough deliberation and research of the dental practice. However, in my experience, many dentists tend to skip the stop-and-think step.

So in this first Dentistry at a Crossroads column, I am going to outline a system for astute decision-making that dentists can use when tackling the Big Issues.

The importance of a dentist's self-insight or self-understanding cannot be underestimated as the basis for decision-making. What we want to do is link the dentist's self-study with his or her self-understanding. One detail of this process that is often overlooked is developing the ability to accept feedback from auxiliaries and patients.

Dentistry is easy -- it's everything else that's difficult

After graduation, most dentists feel competent performing basic dental procedures. The problems in practice arise from poor organizational ability and basic knowledge of good human relations. In my case, the first few years of practice could best be described as "doctor-centered" because I was blind to the real needs of my patients and staff. In essence, I followed the random path of successful peers, and I devoted energy trying to change who I was as a person instead of channeling my activity into gaining satisfaction more suited to my talents, abilities, and desires. I realized that I must step back and understand my limitations, skills, aspirations, goals, and myself.

Many dentists express feelings of frustration that their practices and life don't match their expectations. That is, interoffice conflicts, not enough "good" patients, income barely meeting expenses, nothing left over for retirement savings, external forces dictating professional decision-making, continual staff turnover, frustration that clients won't accept your level technical abilities, and a permanent government connection from student loans.

How do you deal effectively with these discordant stresses?

Most dentists spend more time planning a vacation than planning their practice

At the outset of any serious thought about your vocation, you need to understand your practice. To have more than a superficial sense of the workings of a complex entity requires an in-depth appraisal completed in-house as a team or staff endeavor.

In my experience, the best intentions of outside consultants cannot equal the effectiveness of a team effort. I consider this to be valid because of the unique and intimate knowledge the staff has of the genuine workings of the organization and the patients. A consultant looking at the practice from the outside is unable to discern the subtleties of the inner workings of a complicated arrangement. In addition, each staff member has "skin in the game." Even though consultants are well-meaning, they're not truly accountable for results.

On the other hand, the aftereffect of an internal practice appraisal commits each member responsible for the results of their individual and collective efforts every day of the week and every month of the year. That is a major difference.

Where do you start?

At the beginning, ask yourself these questions:

• What are my goals today, this year, and in the next five years?
• Who am I?
• Does my self-understanding tie in with my goals?

It is also critical to ask "What is my practice?" Because the record of your practice is the best evidence as to what has happened.

To help in this process, I recommend a questionnaire developed by Dr. Nathan Kohn Jr. as a dental practice self-appraisal. I used this approach in my office.

The primary purpose of such a questionnaire is to help dentists think through their situation. It should not be viewed as a panacea. It is a guideline to growth, development, and progress toward goals you have in mind -- not yet on paper and not yet programmed into action. It may be used as a basis for decision-making.

Having your auxiliaries assist you and participate in the assessment is important. Even though the questionnaire is long, it is not truly comprehensive, and the objective is to include other problems that concern or interest you.

It is good training to assign some of the more detailed tasks to auxiliaries to study what is happening in the practice. This activity will increase their ability to understand their position and yours. The more time and effort put forth in attempting to answer the questions as carefully as possible, the more help you will be able to get in the construction of an operations manual. Your staff can fill out some parts of the questionnaire with the dentist checking and thinking with them in terms of their answers. However, on balance, the activity is a group effort.

Increased empathy and acceptance

One of the most profound results from our in-house appraisal was increased levels of empathy and acceptance of roles played by each team member. The staff gained a respect and appreciation for some of the problems confronting the dentist that they would never have realized without the process of analysis.

The scrutiny of the inner workings of our organization resulted in personal growth for everyone on the team. The connection achieved in our undertaking resulted in considerable improvement in our ability to communicate with each other and our patients.

We repeated the practice analysis several times, and each time it became less demanding. The workshop resulted in every staff member developing a sense of community and ownership in the practice. For example, by cultivating an environment that encouraged candid observations without fear of retribution, the practice benefited. The forthright comments from teammates provided breakthroughs in our most important procedures (such as our codiscovery examination) and increased effectiveness in our mission of patient education. Many of our advances would never have been realized without the genuine team perceptions.

Dealing with Big Issues in your office signifies decision-making, which should be based on knowledge grounded in careful inspection of your practice. Working as a team will result in realizing your expectations.

Suggested reading: Motivation and Personality, by Abraham H. Maslow

Note: Some ideas embodied in this article are the result of personal communications with Nathan Kohn Jr., written and verbal. His book, Selection, Hiring, and Training of Dental Auxiliaries, was published after he worked in my office; it is now out of print.

William T. Brown, DDS, practices in Des Moines, IA and writes a monthly blog, Dental Intelligence, to share information and experiences that have fundamentally changed the way dentistry is practiced.