 Uncommon
Sense
By Brian Beirl
D.D.S.
In 1985 I found
myself in a dental practice of my own making. However, it was
not the practice I had imagined I would have. I was incredibly
busy with little time to develop relationships with my
patients and staff. The dentistry provided was always
convenient but not always what was the most appropriate for
each individual patient. The dental practice consumed most of
my time and deeply affected family and personal relationships.
How did I arrive
at such a place? I had followed the common sense of others. I
attracted as many patients as possible, through insurance
plans, print advertising, yellow page advertisements, catering
to all groups, and providing all services and extended hours.
I had become an “expert” by attending the hot weekend
seminars. This approach led me to a practice that was out of
control. Rather than feeling excitement for dentistry, I was
tired.
That year I heard
Dr. Harold Wirth speak at the Hinman Meeting about the
uncommon dental practice that leads to an exciting practice
life. I realized I would need to recreate my dental practice.
To do this, I needed to look at my practice differently and
use what could be considered uncommon sense.
Following Dr.
Wirth’s suggestion, I attended the Pankey Institute’s
Continuum Level One, which is focused on the complete
evaluation of each patient. When I implemented complete
evaluations in my practice, there was a ripple effect
throughout all areas, and my previous common sense approach no
longer applied. Some of the affected areas were treatment
planning, treatment complexity, education, scheduling,
personnel, referrals, practice growth, office environment,
insurance philosophy, and financial arrangements.
Uncommon Sense
about New Patients: Have you heard the story about a panda
that walks into a restaurant and has dinner? After finishing,
he gets up, takes a pistol, fires it into the ceiling, and
begins to walk out. The alarmed waiter shouts, “Hold it, what
was that all about?” The panda turns and throws him a
dictionary. “I’m a panda! Look it up!” Opening the dictionary
the waiter reads, “Panda: an animal that eats, shoots, and
leaves.” Commas can be quite important.
Unless you have a
pediatric practice, you likely see very few new patients a
month. By this, I mean “actually new” patients. The vast
majority of our “new” patients have been patients somewhere
else. Therefore, we do not provide, new patient experiences
but rather New, Patient Experiences. The comma is important.
What are you
providing your patients that has meaning for them as
individuals and allows them to make intelligent, informed
decisions concerning their present and future dental health?
Glossy brochures, a dental “spa” experience, and other
external patient perks will not create a meaningful
relationship. A meaningful relationship with our patients is
the keystone to the practice many of us envision, and it is
frequently lacking in today’s common sense dental offices.
Today’s dentist
should be uncommonly thorough, as many of us were initially
trained in dental school. I believe it is our responsibility
to provide our patients our best comprehensive evaluation
including a preclinical interview with the patient to discuss
the patient’s previous dental experiences, current chief
concerns, and longer-term health and esthetic objectives. I
always include radiographic and other appropriate imaging,
multiple sets of diagnostic study casts that are face bow
mounted on a semi-adjustable articulator, digital photographs,
and an esthetic evaluation.
This new, patient
experience should be positive, unique, valuable, and
memorable. We must allow for non-patient time for diagnostic
work-up and to develop an appropriate treatment plan that
takes into account the patient’s immediate concerns,
intermediate objectives, and long-range goals. You can plan to
do the treatment in stages, based on sound dental principles,
and not compromise the best long-lasting results for each
individual.
Uncommon Sense about Branding: Brands are powerful and have
associated emotions. Just think of Mercedes, Porsche, Volvo,
GM, Coca Cola, Pepsi, Nike, and UPS. What is your practice
brand? Does it represent the style of practice you desire? Too
often, more time is spent on designing a logo than defining
what the dental practice is really about.
Rather than
delegate your branding to an ad agency, take the uncommon
approach. Spend significant time thinking about the practice
you would like to have. Envision what you would be doing most
of the time, how you would be treated, how you would treat
others, and what systems should be in place to support this
vision. Then, gather your staff together away from the office
to discuss what the practice should become. With your
co-workers, develop a clear vision of your present brand and
what you want your brand to be before hiring someone to design
a logo, office sign, or advertising. Ask what do you, your
co-workers and your patients think of when they think of your
dental practice? Do your thoughts match? What changes can be
made to have them become more congruent? Don’t stop there!
Make changes to become the brand you envision.
A bustling dental
practice reminds me of the iron ore carriers I worked on in my
youth. Once under full power, even with full reverse it takes
14 miles to stop a heavily laden freighter. The momentum of a
dental practice is much the same. Despite this, I made the
decision to change. You can, too.
Uncommon Sense
about Co-Workers: The common dental vernacular for the staff
has become the “dental team.” Much of this is related to Dr.
W. Edwards Deming’s 14 points of business philosophy that were
embraced by corporations and dental consultants decades ago.
All over the country, every morning, dental teams are
huddling. Is it working?
The average dental
employee turnover per office, per year hovers around 25%. What
are the reasons for this disruptive and costly turnover? I
believe dental employees have not been encouraged to look at
dentistry as a career. Managing groups of people is a
monumental task, and I think it is time to look at our dental
co-workers in an uncommon way. The dental team analogy may not
be appropriate for the modern relationship-based dental
practice. Teams connote competition. Who are we competing
against; Mr. Tooth Decay, other dentists?
With the amount of
dentistry that is needed and wanted inside and outside of our
dental offices, there is no reason to compete with our
colleagues. If anything, it is a time to raise the bar and
lift the profession to the highest standards of care.
Evidenced-based dental research should guide our dental
treatment decisions, and appropriate treatment in our
patient’s best interest should be the basis for our treatment
plans.
Teams need a coach
or manager along with frequent directions. They need a game
plan and pep talks. From my experience, this becomes very
tiring for everyone involved. Relatively speaking, teams have
rather short-term goals: the super bowl, the gold medal, and
the national championship. And if you have noticed, they
change players frequently, and the “team” looks different year
after year.
I prefer to work
with my co-workers like a string ensemble. Professional
musicians are gifted in their own area of music and many play
multiple instruments. They work on their skills individually
and as a group when they rehearse. They do not need a
conductor to begin their performance, and they take cues from
each other. They make beautiful music together and help each
other stay on key. They are non-judgmental and want to engage
their audience. They ask to be compensated fairly, and above
all, they desire recognition for their efforts. In an
ensemble, everyone is responsible for creating a memorable and
meaningful individual and group experience.
Uncommon Sense
about Fees: Nothing seems to perk up dentists’ ears more than
a discussion of dental fees. Dentists arrive at fees in some
very interesting ways. Commonly they base them on the fees of
other dentists in their area, a national dental organization’s
geographical survey of fees, a formula related to their lab
fee, an insurance reimbursement or what insurance allows, a
per unit price or per service choice (charge per procedure),
or a practice tradition adjusted on some time interval. Many
dentists use a combination of these to determine their fees.
If you think about
it, basing your fees on hearsay, lab fee, capitation, or the
insurance-prescribed usual and customary makes about as much
sense as attempting to diagnose and fee estimate a patient you
have never examined. Do these fees have anything to do with
the complexity of the individual patient’s treatment plan?
In dental school,
we had to achieve so many crowns, so many extractions, and so
many root canals. When we went into practice, it was quite
easy to transfer this mindset to the running of a business.
The ever-present insurance company was helpful in perpetuating
this piecework-manufacturing model. But is this popular model
congruent with arriving at the appropriate fee for each
individual case?
Uncommon sense is
not about the most expedient or even easiest way of doing
things. It is pursuing the best and most appropriate treatment
regardless of self, insurance company, or tradition. In
thoroughly knowing your patient and the patient’s
circumstances – both dental and non-dental, we are in the best
position to make the correct diagnosis and at the same time
develop a fair fee for all those involved. Fees should
compensate you for the care and time you take to study and
develop a well-thought-out treatment plan for the most
appropriate, individualized treatment. This includes the time
you take to understand and evaluate, with care, skill and
judgment, the complexity of the case, and the circumstances,
temperament and objectives of the patient.
I remember when my
practice had a carefully typed fee sheet covered in plastic in
the front desk drawer. The plastic was necessary because the
sheet was dragged out for every patient. The receptionist
would add up the numbers like they were items on a menu. Very
convenient, very structured, and very unchangeable until I
thought it was time for a fee adjustment. Now we have
computers. We can enter our fees and have them ready to select
and record at the end of the appointment. Even though we can
change them much easier, do we? And if we do, why do we?
Would you approach a builder and say, “I would like you to
build a custom house. How much will it be?” Is this any
different than the inevitable question you hear at your local
dental meeting, “How much do you charge for a crown?” We are
curious about what others report, even knowing that there is a
vast difference in the care, skill, and judgment needed among
patients, among quadrants, and among individual teeth.
When you see an
estimate for building a house, the architect learns of your
individual needs and wants. You both learn about each other’s
philosophies of home design and what is expected of each
other. The architect gathers information and takes notes on
what information you present. Preliminary plans are drawn and
changes are made. Eventually a final set of plans are
presented and explained to you. It is then and only then that
the architect can give an accurate fee estimate based on time,
complexity, and materials.
Many of us have
gone through this in our lives. The point is that the
architect generates a fee for the design work. Interestingly,
the charge is in relation to the complexity of the project.
When you utilize care, skill, and judgment in the diagnostic
work-up, consult with specialists, and develop a treatment
plan, do you realize that you are the architect of the case?
You are also the
builder. Dentists differ from other professionals in that we
do not typically separate care, skill, and judgment in actual
performance of dentistry from the lab costs when we determine
our fees. Even plumbers and car mechanics charge separately
for parts and labor.
Not to belabor the
analogy, but don’t we have to maintain the house after it is
built? We have no trouble charging our patients for hygiene
maintenance. It takes a little uncommon sense to ask what your
time is worth to maintain the dentistry based on your
individual circumstances, experience, unique training, care,
skill and judgment, not to mention the complexity of each
individual case and the results anticipated.
Uncommon Sense
about Retirement: Kaiser Wilhelm III lived from 1859-1941. His
life spanned a time when the world was almost constantly at
war. You may be surprised to know that he had a great
influence on how many of us live our lives. In 1908, he
appointed his friend Otto von Bismarck (famous for battleships
and jelly donuts) to create a first of its kind social program
in Germany. It would be a pension provided by the government
to help the elderly in their later years. At what age would it
begin? Otto von Bismarck literally picked the figure 65 for
one very important reason. The average life span of a German
at the time was 47! The Kaiser held the purse strings very
tightly.
When Franklin D. Roosevelt was designing this country’s Social
Security plan he merely used the German program as his
template and adopted 65 as the age at which it would take
affect. So the common sense is to plan our retirements around
the age of 65.
What does
retirement mean to you? I have asked this question over many
years to dental groups from all over the country. Invariably
there is a common answer that surfaces that can be recited
almost word for word from group to group. “It’s doing what you
want to do,” they say.
What does this
have to do with 65? In fact, if retirement is doing what we
want to do, what are our reasons for not “retiring” now? Just
imagine if you have the practice life that you entirely enjoy,
the time and financial means to spend time with family and
friends, and the ability to “give back” to others in whatever
way you wish. Isn’t that doing what you want to do? Look at
your practice and your life in an uncommon way.
Uncommon Sense about Happiness: John Locke was a
well-respected British philosopher who had a significant
influence on the founding fathers of our country. He lived at
the time of the Enlightenment, and the emerging focus of
philosophy was on the rights of the individual. John Locke
wrote about “life, liberty, and the pursuit of property.”
Until Thomas Jefferson penned “life, liberty, and the pursuit
of happiness” in the Declaration of Independence, it was
common sense for many to accept their circumstances. After the
declaration, people began to look at life in an uncommon way.
They were empowered to create new possibilities that allowed
them to experience uncommon success and happiness.
What begins as
uncommon sense many times becomes common sense over time. Here
are some thoughts on the pursuit of happiness. Surround
yourself with great people. Create an environment that you
love, and attract the people that are looking for the same.
Become the best that you can be, and consistently hold out for
what is best for others.
back to top |
