Sharks, Carps and Dolphins in dental practice

Some years back there was a little known publication called "The strategy of the Dolphin".  It's content timeless and sooo appropriate for dental practice.  It goes like this;

Carps are bottom feeders; live by the motto I always lose, I can't win, have the bumper sticker "lifes a bitch and then you die".  There are also pseudo enlightened carps who subscribe to the same beliefs as the carp but hold to the belief that if they "hold a crystal they can walk in front of a bus"...that they have no ownership nor influence on what happens to them...it's just their "lot in life".   Their bumper sticker "don't worry....be happy"

Sharks swim close to other fish and wait for their moment to strike.  They live by the motto; in order for me to win, someone has to lose.  It's the way of the world and so I can't be held accountable for my actions by playing it "smart".  

Dolphins live by the motto "find the win/win".  They take out sharks in the natural world.  They ignore the bottom feeders.  They can play in turbulent waters, find the up wave, know when to get out of the water, when to speed towards sharks or when to be gentle.  They are wise and communicate brilliantly.  

In the sea of dental practice, the challenge is to recognize the fish first.  If there are carps and sharks in the waters, the next question of the leader is did you make them that way or hire them that way? 

People's natures (driven by values) need investigation and yet so much emphasis is placed on skill.  The challenge is to know how to recognize their values to determine nature rather than contend with incongruent natures.  What have you on your team Dr.?  What reasons can you identify as to how they got there?  Which fish are you?

I wish there was a knob on the TV to turn up the intelligence. There's a knob called 'brightness', but it doesn't work.

That's a line by Galagher and it made me think.  I'd like to find the knob that turns up the brightness for the dental profession.  I don't mean they're stupid...although sometimes I think they have difficulty seeing the light.  I also mean dentistry is not such a dark picture! 

I'm amazed at how much sifting I have to do to get past the "marketing" blogs, commercials for marketing or the throngs of dentists who promote cosmetics (the commoditization of what is a healing art) to get to anyone talking about the opportunities in the industry rather than lament about how the economy is bringing them down. 

What must it be like for those caring souls out there who really want some enlightenment that isn't about market more, blog more, facebook more or sign up for this marketing magic bullet?

Many are highly ineffective with the people they currently serve and don't know what to do about it except go get more people.  They don't feel good about selling and don't want to.  They feel like they're in a swamp with the alligators licking at their heels.  That's from a journal in the early 70's.. the golden days of insurance it was called.  For those not a old as me; there was a time when insurance paved the way for dentists who faced the same challenge that remains today; earning the investment of discretionary income.  The cosmetic boom with insurance paved another way to profit...it was and remains the easy way out but not the sure and sustaining way to practice...in my opinion.

Dentists, like many others, are drawn to cookbooks and sure fire fixes.  The challenge of today is really no different than it has been for many years.  It's just more acute as the rich days of cosmetic dentistry fade away.  Insurance maximums have remained the same in 30 years while fees have gone up and so now what?  The relatively "easy sell" of cosmetics that replaced the nuance of insurance has lost it's appeal.  Many dentists are losing considerable market share in part because of the economy, in part because people are sick of the same old message and largely because the health services, true elevation of health have not been the focus of their discussions with patients and faded in their consciousness.  Crap detectors go off regularly for the public and the profession, with throngs in the same game, now have to fight fee sensitivity as the shoppers have wised up.  

There is enormous opportunity to be truly distinctive.  If you look outside of dentistry, permeating other businesses is the knowledge that values are being honed in trying times.  People are looking for genuine, true, authentic service and resonance with their providers....be they dentists or otherwise.  Look at Starbucks and the drive of many others who promote in their commercials....we're making a difference because we care.

Yoo hoo....does anybody out their hear me?  What's next?  Will the enormous increase in dentists closing shop be a wake up call?  Could now be the pivotal time when dentistry returns to the healing arts? 

What ya think?

Dentistry goes back to the Barber shop it came from

Barbers were the first dentists.  From there it became a health profession. Have we really progressed are are we sliding backwards?

 For the first time in it's history, the dental profession has been treating ugliness as a disease.  The commoditization of what was a health profession brings some of us concern.  The slippery slope started in the early 1970's when dental insurance was a large part of what some called "the golden age of dentistry" - as in the streets were lined with gold, people still thought DDS spelled God and did as they were told.  Insurance benefits dictated treatment and more time was spent talking about benefits than health.  So called treatment co-ordinators really became insurance managers or sales people.  Not all were simply profiteers for sure but clearly there was a trend.

When insurance all but dried up, there came another tack; come get your bright, white jiffy teeth here, taking the profession back to competing with hair salons.  So have we really moved forward?

With millions of dollars spent on advertising to dentists, many were drawn and others followed like the pied piper to the town of "come get rich quick and easy" with one particular institute focusing on cosmetics...at the start.   It seems however, that some who were citizens of the town, who revered the leadership of the empire are finding the emporer has no clothes.  Beauty before health is like painting over rust.   Many physicians would agree and a good many take issue with the ethics of some plastic surgeons and they too have a debate in their ranks as to what is medicine and what is not.

A 10 year veteran of the dental profession on another blog was ranting about what he perceives as Dr. Slick and declared it more right to show up in flip flops and crocks - to be totally himself rather than align those in his profession whose eyes are filled with dollar signs.  He was passionate about authentic service.  We exchanged a bit more.  He reported that many of his generation are feeling like they were duped in to a profession that is no longer about health. 

There seems to be evidence gathering that he is not alone.  The question is, can the health profession of dentistry be brought back from the brink of extinction as institutions of truly higher learning struggle to get the attention of the younger crowd?  Has the new generation resigned themselves to what they perceive are realities; that people won't spend money on health?  Or, has the problem always been that there is so little available to the profession to genuinely and truly help them address the behavioral challenges of change?  Faced with a considerable challenge to have people invest in health, you would think these days we would have moved forward but it seems the challenge is being addressed in other ways; mitigating the challenge was first to have insurance pay for it and then when there were no buyers, the profession joined the ranks of the hair salons for the easy sell of quick image change - including the hot wax hand treatments and all; the dental practice becomes a spa.

To this writer, the problem is an old one and dentists just keep looking in the wrong direction.  Frankly it's rather pathetic and sad. 

Some dentists are burning out, some are doing numbers on the ceiling at night wandering how to get out of the swamp and some long to find work that has synchronicity with their souls. Some have been to boot camps and others find that getting people to say yes is setting off crap detectors.

I'll keep writing about this but you may notice at the time of this writing, I have one follower.  There's another outcome driving this writers passion.  It's about a summit; where masters of dentistry as a health profession first will come together to address all the behavioural issues.  It's an oddity in this profession because it will be dependent upon Dr. disgruntled, angry and frustrated asking for a command performance.

For details; go to my site and click on the Light My Fire Link or visit www.clickcoaching.ca/Summit.htm

Tell us you're interested and lets see if we can together, pull this profession back to health.

Don't confuse pampering with relationship based dentistry

Complimentary water bottles, wax hand massages, blankets, lip balm, warm towels, personal music, videos, muffins and the like; that's pampering not relationship.  Pampering doesn't effect behavior change and it doesn't earn trust.  It only means to me you value my attendance.  If I'm a client of record, it's a nice touch.  If I'm a new client, it doesn't signal this is a place where I will award my trust; open my mouth and my wallet. 

What makes people talk is the experience as a whole; is often only sensed and not articulated.  Feeling pampered is great but no amount of pampering will overcome the lack of skill to replace teaching and telling.  Look at the effectiveness of these practices and you'll still see a trend that the dentistry delivered falls under insurance maximums and they're still looking for more new patients when the problem is the effectiveness with those they have.

True relationship is an outcome of a resonance of values between what the practice (DR) stands for and what the client values; requiring processes and conversation to clarify the alignment.  A practice that truly builds relationship means that every team member holds in their tissues the operational values of the practice as a start and they can articulate them in the framework of dentistry, insurance, appointments, payments and every aspect which a person may experience.  Every team member can articulate the why behind each what; what we do, what we believe; what we have available in terms of technology and/or services.  How each team member interacts can set off built in crap detectors or give the client the sense awarding their trust appropriate.

The realtionship can be made or broken when treatment is discussed.  No matter how warm or friendly the experience leading up to this point; it's now a matter of guiding, facilitating and helping a person discover the meaning of any condition to ultimately choose to act now, later or never.

Going around the guards

They've been doing some construction around my house, blocking off the street for about two weeks. It's astounding the number of people who pass the "road closed" barrier, get out of their car, move two more barriers to proceed on their original course rather than go 30 seconds off their course; a block out of their way.

It's an interesting observation of people and change and makes me think about the barriers many dental practices unwittingly put up. 

The biggest barrier to relationship based dentistry is providing reasons for change by teaching, and telling.  Listening alone isn't enough. EQ alone isn't enough. To truly facilitate the clarification of values which drive all behaviors, a conversational framework is needed to replace questions, teaching and telling.

Water bottles, Ipods, coffee and syrupy customer service is like painting over rust if interactions lack the skills required so that people feel profoundly understood.

Learning and motivation is an inside job.  Until the client can place meaning on the problem, there is no problem!  Telling them what meaning they should place upon any condition risks creating defensive reactance which can strengthen their resolve for the status quo.

 Every decision to change involves ambivalence.  It's normal.  Dental professionals need to understand how to use a matrix of listening, delivering accurate empathy, different types of reflections to move people to action in as clients are facilitated to think out loud; metabolizing thoughts and feelings; identifying the congruence or incongruence with their values.

Motivational Interviewing is a semi directive, non judgemental communication skill that removes all barriers and sets a person free to choose according to their own values structure.  It's counterintuitive.  Over 80 clinical trials now support the methods.  

As Pascal stated in 1623, “People are more likely to be persuaded by the reasons they have themselves discovered than by those that come into the minds of others.” Apparently, while change seems continuous some human behaviors remain constant.  Remove the barriers so that people don't go around them either with defensiveness, silence, or no action or worse, choose a completely different route...another practice. 

Where have all the flowers gone?

We've had a ton of rain this month...the farmers struggling again with the elements; the things over which they have no control.  Makes me think of the many parallels to dentists.

A hunter seeks out opportunity, secures it and hunts again.  The farmer on the other hand, seeks out good soil, works to understand the envrionment, plants a variety of crops, nurtures them, culitvates, and fertilizes them.  The hunt for new patients is not fun for many.

To the farmer dentist, the concept is to build relationships but at the execution level it's a different story.  Some things they cannot control like the economy but others they can, like who they bring on board, how they nurture and cultivate them be it team or patients;  choosing to stick with what they believe in their souls or buying in to what they're told and sometimes it's by their teams.

A recent client (a veteran) wrote recently about the absolute joy in connecting with a new client who shared his valuing.  It wasn't that they chose the optimal treatment.  It was simply that he felt he could speak openly ...be his authentic self and learned a lot about this person in  less than an hour.  He felt connected - juiced. " Where are the people who are more like that" he asked.

Same fellow described the ugly front tooth of many years he saw on his near perfectly qualified receptionist.  So he fixed it, for nothing and hired her without inquiring as to why an attractive gal would let it be. 

With a big heart, you can hear her become the patients insurance agent - happily navigating the system for every person and affirming dentistry is expensive...too expensive; believing managing insurance is customer service.  What is she nurturing?

Looking back, Doctor believes he's had a number of sympathetic (not empathetic) people whose view of customer service had to to with managing insurance.  Sounds OK until we look a little closer.  Nothing of the values alignment between doctor to team has been explored; what they stand for (the soil), nothing of the alignment of values with patients (the environment) was being explored and so they planted seeds of the insurance dependent variety expecting it to produce.  In the absence of discussions of what people hoped for their future..only the here and now mattered; hence following the insurance agenda and making a farmer at heart in to a hunter. 

Doctor had it in mind to plant a certain crop (those seeking health and a partnership) and the team another thus attracting dependency relationships and external decisions via insurance...under the guise of customer service. 

Weeds spread, can take up a lot of time and choke out the flowers.  So busy they became with getting remedial care approved and paid for, they have no time to cultivate the flowers...don't realize they are even there.  The farmer grows weary with poor harvests.

Where have all the flowers gone?  Maybe they can't spring up for all the distractions of coping with the weeds.  Or maybe, there are new cultivating methods to be explored.

We need new patients...are you sure?

With what seems like a dentist on every corner, the competition for patients is high.  Many spend untold dollars on getting more people to walk through the door rather than considering their effectiveness with the people they currently have. 

They feel like they've "informed" their patients well ...done all they can do...taught...cajoled...and end up waiting for a problem to present so they can fix it.  So much for prevention.

Frequently when treatment is recommended, the response is "will my insurance cover it" leading many to believe their careers are inextricably tied to insurance benefits. 

We are taught to teach.  It come's naturally.  However, that which is more effective is highly counterintuitive.  There are skills needed to help people through change.  It's not just a matter of listening, asking questions and EQ.  There is a much more effective skill set available.  Check out Motivational Interviewing.   Motivational Interviewing in Health Care by Stephen Rollnick.  A great book to serve as an introduction.