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Stoic Dentistry

How to Go Fee-For Service and Save Your Life

May 4, 2021

Filed under: Control,Philosophy,The Stoic Dentist — Tags: , — Barry Polansky @ 12:45 pm

I first attended The Pankey Institute in the late eighties. I was at the lowest point of my career. Admittedly times were a bit easier for a young dentist back then, but in many fundamental ways they were the same. The fundamentals never change but how best to use them are something you must always stay on top of. Over the past thirty years things have changed but the fundamental wisdom of dental practice has stayed the same.

For that reason I believe…hold on everyone…that the best and really the only way to have a fulfilling career in dentistry is through comprehensive relationship based fee-for-service practice. Let me explain.

On the first morning at the Institute I remember feeling overwhelmed. It was like the first time I sat down to write a book…I was focused on the herculean tasks of creating the practice of my dreams…an unbearable project. Every moment of that first week tested my competence and potential to succeed…and then there was the comparisons and contrasts I made with the other students. But I paid attention and took notes.

In a lecture late in the week, the instructor was discussing how to schedule this new type of practice. He told us to reserve just a morning to practice what we were learning. I returned home and secured every Thursday morning for practicing the Pankey way. That included a lot of new techniques for me and my staff. It was an easy way to introduce the new school of thought to my staff.

How do you eat an elephant? I used to ask myself…one bite at a time.

The lecturer that day, Dr. Irwin Becker who later became my mentor was more right than he even knew. Just about the same time, during the eighties, two psychologists, Edward Deci and Richard Ryan from the University of Rochester were beginning to formulate their now groundbreaking self determination theory of human motivation.

Let’s face it, writing a book or designing a fee for service dental practice takes a lot of energy and motivation. Back then and sadly today, the advice comes down to “Just Do It.” Deci and Ryan put some science behind human motivation for me…and then I backed into it…but years later, while studying positive psychology, I was gratified that I took Dr. Becker’s advice; otherwise I may not have had an accomplished and fulfilling career.

Let’s look at the science.

Deci and Ryan defined motivation as the “energy required for action.” How many times do we attempt to accomplish a worthy goal but run out of steam. We need drive. Many people never even try. It was the Stoic Seneca who said, “It is not because things are difficult that we do not dare; it is because we do not dare that things are difficult.” Installing a fee-for-service practice is difficult…if we dare to do it. It requires resources like drive and energy.

Deci and Ryan went on to further describe the elements of the drive and motivation they were describing. Firstly they noted the difference between extrinsic and intrinsic motivation. The extrinsic drives were the material rewards we are all familiar with, as well as status and recognition. The intrinsic drives included passion, curiosity and purpose. What they found was that intrinsic motivation was more effective in every tested situation, excluding when our basic needs haven’t been met (See Maslow’s Hierarchy of Needs. That’s a discussion for another post.)

Then something interesting occurred to them. They separated motivation again into controlled motivation, a form of extrinsic motivation and autonomous motivation, a form of intrinsic motivation. If it is work you have to do or are being forced to do, that’s controlled. Autonomous motivation is doing work you choose to do. Deci and Ryan found that, in every case, autonomous motivation destroys controlled motivation. Remember that the next time you are being coerced or seduced into work…I’ll leave the politics up to you dear reader.

The psychologists further explained autonomy by saying it occurs when we are doing what we are doing because of “interest and enjoyment” and because “it aligns with our core values and beliefs.” In other words, it is in alignment with the other intrinsic drives: curiosity, passion and purpose.

When we are the masters of our own destiny, we are also more focused, productive, optimistic, resilient, creative and healthy. In retrospect, this is what I found on those Thursday mornings.

In the years following the development of the Self Determination Theory, companies like Google and 3M found comparable results. Google allowed workers to spend 20% of their time pursuing projects of their own liking. The result was products like Gmail, Google Maps and Google Earth. 3M did the same years before–using autonomy as the driving force behind their 15 Percent Rule. That created products like the Post-It Note.

Autonomy as an intrinsic driver works—so starting slow to install fee-for-service just one morning per week is a sound idea.

And then there is the riddle of mastery. Mastery sits atop Pankey’s Ladder of Competency…the question is how does one achieve mastery? Once again it has been reduced to “Just do it.” But there is more science.

In a 1953 paper by Harvard psychologist, David McClelland, a leader in achievement and motivation theory wrote an original thesis titled The Achievement Motive. Deci and Ryan acknowledged that this thesis may have described an intrinsic driver even more important than autonomy. They called it competence, but it now is known as mastery.

The pursuit of mastery has been the subject of numerous scholars and authors from Theresa Amabile and Robert Greene to George Leonard. Most agree that mastery is the desire to get better at what we do. It is the need to continually get better, to improve and to make progress. It is the royal road to growth and flourishing…and the opposite of languishing and drudgery…the low rung on Pankey’s Ladder of Competency.

Working toward worthy goals is pleasurable. Making progress produces the neuro-chemical dopamine. According to Dan Pink, author of the popular book Drive, “the single biggest motivator by far, is making progress in meaningful work.” At my lowest point in dentistry I felt stuck. Hopeless. My work had lost its meaning. Today we call that burnout. Those Thursday mornings turned on the light…the light of hope.

We need the freedom to chase mastery. That freedom comes from autonomy. Without the intrinsic driver of autonomy it is difficult to sustain the drive necessary to achieve mastery…this is based on our biology, not just some story, fairy tale, or business myth.

So after installing the Pankey Thursday mornings where I could practice autonomously, applying the lessons I needed to learn, I slowly put the complex elements of comprehensive relationship dentistry together. I started with the comprehensive examination and built on that by learning all of the components from the mundane mounting of models to the nuances of advanced occlusion. It took time…but driven by dopamine and progress, slowly I was installing my model practice.

I realized that learning the softer behavioral skills were just as important as the technical, so in time I learned about case presentation. Through the years I learned new skills like digital photography and Power Point. This is the essence of mastery. I am retired now and looking back I see how that moment when Dr. Becker suggested the Pankey Morning changed my life.

Today things are different. There is pressure on young dentists to go right into corporate dentistry or practice in a way that seeks the extrinsic motivators only. Many of the newer models of practice are an assault on autonomy. This is a mistake, but the young dentist doesn’t realize it for years to come, and I hear rumblings on social media…about the drudgery and burnout and professional exits.

My new book, The Porch, is a fable about a dentists who is losing his autonomy and breaks down. By finding a mentor and keeping his eyes on the ultimate prize he goes from despair to hope.

There is a way to enjoy dentistry…start with one morning per week and you will see, as I did that fee-for-service comprehensive relationship based dentistry is the only way to practice that makes sense.

IF YOU ORDER A COPY OF THE PORCH OVER THE NEXT TWO WEEKS–RECEIVE A FREE COPY OF THE ART OF CASE PRESENTATION—-LEARN THE INDISPENSABLE SKILL TO SUSTAIN AUTONOMY.

The Dental Warrior

April 26, 2021

Every morning I awaken to the Serenity Prayer downloaded onto the desktop of my computer. To many this has become a boring, humdrum banality that we take for granted…unless of course you have a problem with alcohol. During these very difficult days of the Covid-19 Pandemic I began to read it more closely and observed how much sound judgment it contains.

Many people associate it with Alcoholics Anonymous. When I was in dental school during the seventies I used to pass an AA Meeting Hall on the way home. I never had a drinking or drug problem…but I was curious and went in one night. They welcomed me in and served up some good coffee and donuts. I remember the meetings starting with a reading of the Serenity Prayer. Recently I looked up the origin.

The prayer was written by a protestant theologian, Reinhold Niebuhr in the mid-thirties. He needed a topic for discussion for an upcoming sermon. It was meant for everyone…not just alcoholics. Alcoholics Anonymous(AAadopted the prayer in 1941 when an AA member saw it in The New York Herald Tribune and asked the AA secretary at the time, Ruth Hock, to see if it could be printed in distributable cards. And so it has since become the mantra of AA.

When I read The Serenity Prayer these days I see ancient wisdom. I see Epictetus when I read it.

Who? You might ask. Epictetus was one of the most prominent Stoic philosophers…a slave and the teacher of Marcus Aurelius. He is known for his handbook The Enchiridion which is meant to keep the philosophy close at hand. For those literary types he was also the center of the main theme of one of my favorite books, Tom Wolfe’s mega-bestseller A Man in Full.

My new book, The Porch is a tribute to Epictetus and the Enchiridion. It’s a reminder for dentists about how to use and apply philosophy in dental practice. You can order a copy of The Porch right here and for just a short time get a free copy of my book The Art of Case Presentation.

Those two books helped me to realize that philosophy…specifically Stoicism, was more about practical application than about thought, meditation and reflection. Real philosophers are warriors not librarians. Philosophy can guide us …offer us help, but only if we make it accessible. Alcoholics needs actionable counsel…and so do we during these most difficult times.

Epictetus 101 tells us to “control what you can and ignore the rest.” Like the Serenity Prayer he was all about knowing what we can and can’t control. He advised his students to carry his handbook with them…so the counsel would always be at hand— accessible – hence I keep the Prayer on my desktop. It reminds me of what Socrates and Dan Goleman, the neurobiologist, consider the fundamental rule of “know yourself.”

Let’s break down the simplicity of the Serenity Prayer. It includes some very key words like, courage, acceptance, wisdom and serenity. The first three words remind me of Aristotle’s Four Cardinal Virtues. Notice that the virtues are verbs – they require some actions. Let’s examine the warrior nature of these virtues.

First courage. It takes courage to get through each day. It takes courage to act in the presence of fear…to do the right thing. Mostly, it’s harder to do what we know is right than to sit back and do nothing. Aristotle considered courage the chief virtue because without it the other virtues could not be practiced. The Jospeh Campbell, the mythologist, would tell us that we should “slay the dragon ‘thou shalt,’ as a sign of maturity and courage.

Second virtue: acceptance. That does sound fairly passive…but I would substitute the virtue of gratitude here. To understand acceptance we have to look at its opposite…denial. The word denial implies a world of “should.” When the world doesn’t behave as we think it should…we get upset, angry and frustrated. The answer is acceptance. Accept everything…take nothing for granted…only as granted. Accept as if we had actively chosen the outcome. For that mindset we must be grateful for everything.

My father taught me as I was growing up, that life is unfair. If it were fair…s**t wouldn’t happen. But, as you know…”s**t happens”. But through acceptance I never feel victimized. I deal, accept, move on and take positive action…of what is within my control. Acceptance and gratitude are liberating virtues.

Finally the virtue of wisdom. Wisdom gives the warrior clarity and perception. To know what is up to us and what is not up to us. Without clarity we don’t know how to act. Socrates considered wisdom the chief virtue.

This is a blog primarily for dentists who are trying to reconcile their work lives and their personal lives. I hope this helps…because it truly is about the universal reward for being a warrior philosopher, and that is the final word in the prayer…serenity. After some tumultuous years in practice I realized that serenity was what I was looking for.

The great Stoic philosopher Seneca said, “Our character is the only guarantee of carefree happiness.”

Bill W. the founder of AA used to say of the Serenity prayer, that it tells us “accepting the things we cannot change.” Acceptance must not be confused with apathy. Apathy fails to distinguish between what can and what cannot be helped. Apathy paralyzes and acceptance liberates. But acceptance, he used to say, required moral courage, to carry on when things look hopeless.

By becoming a philosophical dental warrior you will gain the most important thing in life: serenity and peace of mind.

Time to Rethink Dental Education

April 19, 2021

Filed under: The Porch,The Stoic Dentist — Tags: , , , , , — Barry Polansky @ 1:30 pm

Adam Grant, in his new bestselling book, Think Again, The Power of Knowing What You Don’t Know (highly recommended), describes a few character traits that set the great presidents apart. Experts found that of the best character strengths the great ones had, that intellectual curiosity and openness to experience distinguished them from the rest. Grant said, “They read widely and were eager to learn about developments in biology, philosophy, architecture and music…”

In other words these leaders had a different mindset…rather than a certain skillset. Maybe dental schools (and other professional schools) should consider focusing more on mindsets rather than skillsets.

For those of you who study philosophy, Stoicism or positive psychology, you will recognize intellectual curiosity, openness to experience and love of learning as character strengths that come under the heading of the core virtue…wisdom.

When I look at the current state of the development of dental education over the past 50 years I see not much has changed. The focus has remained on training dentists in technical skills (techniques, materials and equipment have changed), rather than on training dentists to think more critically and to become better leaders.

It’s time to rethink dental education.

Through my years I have witnessed the coming and going of trends and fads that promised dentists happiness, freedom and success if they mastered the associated skills. From business management and sales and marketing skills to technical skills in cosmetics (veneers, Botox), implants, sleep dentistry and splint therapy, all made the promise of success.

I agree that mastering technical and business skills are the key to mastering dentistry…anyone who thinks otherwise is crazy. It is the job of dental educators to produce competent dentists…first and foremost.

Yet…something is missing…and that is becoming more and more apparent every day. With the rising costs of dental education, the rising incidents of burnout and suicide and the decline in trust by the public…I have to look at the dental education as a way to improve the existing conditions.

Maybe…it’s time to rethink dental education.

A good method of finding insight is to use what the great investor Charlie Munger would do…he would use inversion. His philosophy was to “invert, always invert.” That is not unlike the philosopher Aristotle who would explain the virtues by describing his golden mean by looking at their opposites (see diagram above). So, if our job is to find the truth— then lets look at the inversions of the strengths of curiosity and the love of learning.

First let’s take a look at the opposite or absence of curiosity and learning. Words that come to mind are orthodoxy, complacency, laziness and dogma. Then there is the condition of an excess of a love for learning — know-it-all-ism. Know-it-all-ism can be just as bad as the lack or opposite of a love of learning because it can lead to over confidence and arrogance.

Sometimes it is hard to detect the laziness and complacency in dental education but the arrogance sticks out like a sore thumb. Adam Grant suggests that we look for three behaviors that are emblematic of complacency, orthodoxy and arrogance: preaching, prosecuting and politicking. They all defend their current position until the status quo is upheld.

Preachers love to tell us why their point of view is the right one. Prosecutors take on the role of an attorney defending their position, and politicians just do whatever is popular. Grant recommends that we look at all sides of an issue by becoming scientists.

One of the roles of any doctor or health professional is to be a teacher. The word doctor comes from the Latin word for “teacher,” itself from docēre, meaning “to teach.” Yet, dental schools spend very little time educating students how to become better teachers and leaders.

Never forget that another primary role is to be competent technicians.

By neglecting the role of teacher and leader…who suffers? The patients, the community but mostly the practitioners. And that is what we are seeing in dentistry today.

How can we fulfill our role if we are not trained to be teachers and leaders?

Something else I have noticed through the years is that the best students—the A students, don’t make the best dentists. Just asking ourselves why that is can reveal more about the system than about attaining mastery and excellence.

The late and very great Peter Dawson would talk about teaching dentists critical thinking. Too many dentists focus on the outcomes of treatment and then claim success without waiting long enough to observe that actual results. Critical thinking is about being process oriented so that many future failures can be avoided…this is not only about technical dentistry but behavioral dentistry as well. Maybe it’s time for dental education to heed Dr. Dawson’s advice.

My new book, The Porch, is a tale about a dentist who suffers through depression and burnout until he meets a mentor who teaches him the real tricks to the trade. He then goes on to clinical success and more. What more you ask? Find out by reading The Porch.

Courses in positive psychology and leadership development at the dental student level would go a long way to making the dental profession better. In the end the students will achieve all of the things they became dentists for: mastery, freedom, happiness and peace of mind.

Maybe—just maybe it’s time to rethink dental education.

If you have any thoughts or feelings about this important issue please leave comments below….just don’t preach, prosecute or politicize.

Jeopardy! and Dentistry-The Ultimate Game of Life

April 12, 2021

Filed under: Philosophy,The Porch,The Stoic Dentist — Tags: , , — Barry Polansky @ 1:52 pm

The Pandemic, with the creation of new time schedules, has had most of us crying out to develop new habits. That is not an easy task, so I decided to entertain myself by reverting back to an old habit: watching Jeopardy! every night. I was always a big fan of the show and its iconic host Alex Trebek. I used to be a better player…my recall isn’t as good as it used to be. These days I watch with a different perspective…how the game of Jeopardy is like the game of life.

Recently I watched a smart young attorney competing. In order to prepare she admitted to doing the NY Times Crossword Puzzle for one thousand consecutive days. Now that’s gritty. Apparently it worked as she plowed through the questions and reached Final Jeopardy in a “no lose” situation. She was $3000 ahead of the second place contestant…but she had only accumulated $10,000…a paltry sum when you consider the amounts most formidable contestants earn.

I was impressed with the amount of knowledge she had accumulated…it just didn’t transfer over to dollars. Isn’t that the point of the game? To win as much as you can and return for another day. I made a note that her style of play would cause her to lose the next night when she would play, not necessarily a more knowledgeable opponent, but one who knew how to play the game…the ultimate game.

Through my years in dentistry I have met many talented professionals who did okay, like the attorney above, but never reached their full potential because they never realized the game they were playing. When you know your ultimate game…your entire game plan changes. Let me explain through the Jeopardy example.

Take a look at Jeopardy’s three most successful champions in the photo. The guy on the left, James Holzhauer, long before he racked up $1.69 million as a contestant on Jeopardy!, he made a living as a sports gambler in Las Vegas. Holzhauer also has a very high IQ…but a big part of his game was taking big risks.

I’m not suggesting that we have to be gamblers…but in life we all need to take appropriate risks. All three of the greatest Jeopardy players were risk takers…and do you know what they were betting on? They were always betting on themselves. Our attorney, even when she was confident rebuffed the idea of taking a risk. In that moment of truth…something interfered. She had what the cognitive psychologists call loss aversion. It’s very common. Everyone likes to win but some people are just afraid to lose.

This isn’t a good strategy for Jeopardy, and it isn’t a good strategy for life or for a career. We have to take risks. I remember my career…every course I took I lost a little sleep over how I would pay for it or how much I would lose by being out of the office. Every new technique I learned I worried about the outcome and considered staying with techniques I knew. Taking risks is what moves the ball downfield. Our attorney contestant was smarter than she believed.

The guy on the right in the photo, Brad Rutter is the highest money winner of all time across any television game show, with total “Jeopardy!” winnings of $4,688,436. He has never lost “Jeopardy!” to a human opponent. Watching him play was amazing. He never lost his cool. He would ring the buzzer mostly when he knew the answer. So many contestants on Jeopardy these days don’t seem to have the emotional stamina to compete. Every answer is an adventure. Maintaining emotional composure in life is no easy task…especially when we take risks.

Serenity, tranquility and steadiness are worthy goals in life. Yet…so many of us chase the external returns.

I have seen Brad Rutter go “all in” and lose. He shrugged his shoulders and actually crawled back to win the game. Too many contestants just “lose it” after a bad call, as if their complete identity were at stake. Once again, as in life, we have to play to come back another day…so peace of mind and tranquility at all costs is the objective of the ultimate game as well as the prize money.

And then there is the guy in the center. Everyone knows Ken Jennings.  He  holds the record for the longest winning streak on Jeopardy! with 74 consecutive wins. That was no accident. Jennings knows how to play the infinite game. This is a game where there are no winners and losers as author Simon Sinek tells us. Jennings watched other contestants like Holzhauer and learned how to take the proper risks…and he watched Rutter and learned to stay calm under pressure…but mostly he watched the host Alex Trebek…who he became.

Trebek died on November 8th, 2020 after a long-standing illness. He hosted Jeopardy! for 37 years. He was loved and respected by all. Ken Jennings has stepped in to be his “temporary” replacement. And what a job he has been doing. Jennings knew how to play the infinite game and he watched the exemplars in the game…until doors opened for him where he didn’t even know the doors existed.

Life has rules. Wisdom…the virtue that Socrates thought was the chief virtue in life, is the virtue that guides us in knowing the game we are playing…the ultimate game…the infinite game. Life is the essence of risk and struggle…all of us must master fear…even the attorney who lost her championship the next night.

My new book, The Porch, is a fable about a dentist who uses the wisdom of learning about the ultimate game of life. His lessons taught him about the necessary tools to succeed and live a life worth living. Check it out…and if you order now I have a special offer for you.

There Are Teachers and There Are Teachers

April 5, 2021

Filed under: Epictetus,Philosophy,The Porch,The Stoic Dentist — Tags: , , — Barry Polansky @ 10:00 am

These days everyone wants to skip the line. Everyone is looking for instant success rather than putting in the time. I’m for that as well. I mean who wants to put in 10,000 hours to become a master at anything like Malcolm Gladwell and Anders Ericsson suggest in their bestselling books. Who doesn’t want a good hack?

Even when I was in dental school, students were looking for the easy way. Most of us learned dentistry like chefs learn how to cook…very procedure oriented. There is a story told by Stoics of a student who approached the great teacher Epictetus and said, “Tell me what to do.” The wise sage responded,”It would be better to say, ‘Make my mind adaptable to any circumstances.'”

His advice was to learn how to learn. We shouldn’t pay attention to teachers and friends who are only interested in showing us the shortcuts and the hacks. We need to pay attention to the principles…every field has them.

Harrington Emerson once said: “As to methods, there may be a million and then some, but principles are few. The man who grasps principles can successfully select his own methods. The man who tries methods, ignoring principles, is sure to have trouble.”

When we take the time to learn the principles and apply the principles we can solve most any problem that occurs…as Marie Forleo tells us in her best-selling book, Everything Is Figureoutable, yes—everything is figureoutable. This is one of the keys to mastery. Being able to figure out solutions no matter the circumstances.

I am a big fan of Jim Cramer…the Mad Money guy on CNBC. I watch him every morning. Sure, he gives out stock tips, but more importantly he discusses the principles of investing. Every day is a new day in the stock market and only those who adhere to the fundamentals of investing will make money in the long run.

Years ago, I used to go to the racetrack. There is an old horse racing adage that claims you “can beat a race but you can’t beat the races.” There’s a lot of wisdom in that quote, and it applies to just about any field. Some might say the same thing about the stock market. But we don’t want our profession to become a game of chance…that won’t happen if we learn and follow the principles…our “odds” of success will go up exponentially.

How does this apply to dentistry you ask?

Remember, our ultimate game is to win over patients to accept the care they need for optimal oral health and for us to competently provide that care…and in order to win, we need a process backed by principles based on perennial wisdom. Just like the best stock pickers don’t speculate on every stock and the best horseplayers do handicap their spots…the best dentists choose their big cases wisely.

When I go on social media (way too often), I see magnificent cases of stunning dentistry. Some are simple cases and others are intricately complex. Because I am retired, I am like the boxer that Paul Simon described in his classic song…“In the clearing stands a boxer, and a fighter by his trade…” but I do carry the reminders of every case that cut me down and I tell myself that “I am leaving, I am leaving…but the fighter still remains.”

So I look at these cases on social media and wonder. I wonder whether the dentist followed protocols…principles based on a philosophy. I spent fifty years in dentistry…the early years…with no real philosophy. Then after writing The Art of the Examination and clarifying my philosophy, I never broke protocol. And still…

Cases failed. I’m pretty good at picking stocks…and still I pick losers. And horses…I used to be a legend in my time at the track…but still losers.

So I wonder how these dentists do their cases. I wonder whether what I am seeing on social media is an illusion…and whether the cases will stand the test of time. I know from my experience that collective success over time on Wall Street, the racetrack, and work depends on having a guiding philosophy composed of principles we learn from the best teachers and mentors.

I say best because not all teachers are equal, and many will just give you some how-to tips without teaching you how to figure things out.

I have a couple of lifehacks for you…Can you guess what they are?

Clarify the philosophy by which you will approach your dentistry and life.

Ben Graham, Warren Buffett’s mentor and teacher taught him a philosophy for investing. It was pretty simple: 1). Develop a worldview–or a philosophy on how the world really works. 2). Create methods or systems and be consistent. 3). Be aware of your temperament –the world and the markets are very fickle.

Ben Graham was a Stoic.

My new book, The Porch, is a fable about a young dentist who changes his life and career based on philosophical principles…order you’re copy and begin to learn the secret sauce of success in life and dentistry through philosophy.

Use that philosophy to guide you in learning…in communicating…in leading…in solving diagnostic and treatment puzzles…in doing your hands-on work.

As the wise sage Epictetus said, you will make your mind adaptable to any circumstances.

Louie—A Cautionary Tale

March 29, 2021

Filed under: The Porch — Tags: , , — Barry Polansky @ 1:40 pm

When I was just a small boy, growing up in a quiet suburb of Queens, in New York City, I used take the bus to school every day. Back then we had to walk a mile just to get to the bus stop. I don’t want to sound like Abe Lincoln, but we got used to it…rain or snow. Everyday. Walking along with us…but really all by himself, alone, was one of my neighbors...Louie.

Louie wasn’t going to school. He was starting his long commute into Manhattan which he repeated five days per week. Sometimes I would see him reversing his route later in the day. It was a long time ago and I can’t recall how old Louie was at the time. My only reference now is that he had two daughters who were some years younger than I was, and they went to a closer public school.

Louie, otherwise, was a pleasant chap, but my memory of him and his circumstances at the time was one of pity…like that old comic strip character, Sad Sack. Every day he would move along slowly, head down, with the weight of the world on his shoulders, slumped over and plodding along, there was never a smile on his face. I vowed, as a young kid…never become Louie.

I did my best to avoid that fate.

I followed a straighter path that would lead to a much happier place…I went to school and became a dentist. The phrase, “master of my own destiny” became words I tried to live by. I was fairly successful. I chose dentistry (at least I thought I made an active choice at the time), because it was a profession, and like medicine, law and accounting it would give me the opportunity to be the commander-in-chief of my own fate. At least that is what I believed.

I had no reason to suspect otherwise. I was raised by parents who taught me the meaning of self-direction and freedom. Everything I had learned was confirmed by my own experiences…except the riddle of Louie. So I followed the well worn path of college and then professional school.

After school I went into the U.S. Army Dental Corps for some much needed practice and experience. Then I jumped right into private practice. Things were different in those days…it was an easy transition. I never had to get a job, I made a living right away. But…about five years into practice, things took a turn, not financially but emotionally.

I had become Louie.

I wasn’t happy, and I blamed everyone else for my unhappiness…family, patients (oh, those damn patients), staff, the supply guy, even the waitress at my favorite luncheonette. I didn’t know what was wrong with me. I sought outside help but the courses I took just taught me that doing better dentistry was the answer. I would make more money and that would make me happier. NOT!

So, probably unlike Louie and so many others, I took the ball in my own hands. I started to read books on self-development and philosophy. I came across a quote which has become my mantra: “If it’s to be, it’s up to me.” This became my anti-Louie strategy. It wasn’t an easy fix…but persistence and resilience pays off.

In life there is no such thing as instant pudding.

After a few years I learned about a dentist in Florida…Dr. L.D. Pankey. I went to the Pankey Institute and for the first time I met people who spoke my language. I was introduced to a book which L.D. used as a resource for his philosophy: What Men Live By, by Richard Cabot. This wasn’t a book that a kid from the streets of Queens, who drove a cab to get through dental school, would naturally gravitate toward.

Early in the book (not a page turner), I came across a word that resonated with me...drudgery. Right then I began to have visions of Louie. I knew that whatever Louie had fought and lost, Dr. Pankey had fought and won. I knew that I had found the answer.

I also realized that drudgery wasn’t about dentistry and that it was common in the world of work. Early in my journey for answers I realized that blaming my feelings on dentistry was not the way…soon enough I learned the opposite, that dentistry was a great profession, but only if I crafted the way I worked.

“If it’s to be, it’s up to me.”

And so my journey began. I read books, I studied, I reflected, I found wonderful mentors. I failed, I fell down…got back up and persisted. I felt like quitting…but I kept going.

Today, I am retired. After close to fifty years I can look back and say it was worth it. I avoided becoming Louie…or anyone else who dreads going into work everyday.

If you identify with with Louie…there is hope. There is a brighter future…there are known pathways and everyone is capable of finding a way.

Meaningful work is very different than drudgery.

Mike Rowe’s show “Dirty Jobs,” on the Discovery Channel, was his attempt to “tell better stories of men and women who master a trade.” He demonstrated that meaningful work is very different than drudgery…and meaningful work comes in all shapes and sizes.

A doctorate does not guarantee happiness. There was a point in my life when I thought that I could have continued driving a taxi and been happier. I could have found more passion for interacting with people in my cab than I did in my dental operatory. But with so much invested in becoming a dentist, I just couldn’t give up. Thank God I found my meaningful purpose and began making meaningful strides on “the road to mastery.”

Any trade, even dentistry, can be dull and dreary, or it can be pursued on this amazing road, becoming joyful. It’s on the road to mastery that we find our passion and purpose, but first we need to recognize what is most meaningful to us and apply energy in pursuit of it. It’s not only about “doing better dentistry.”

These days I have a passion for telling stories to improve lives.

That’s why I continue writing for and about dentists. Creating a life of personal purpose and wellness in dentistry is the “better” story that I aimed to tell in my latest book THE PORCH, which is fresh off the press and available now in print and digital form on Amazon.com.

THE PORCH is the story of a dentist… I think of it as a fable. Others may think of it as a fairy tale. My co-author, Deb Bush, thinks of it as an allegory for 21st century dentists. But every reader of the preliminary manuscript found it compelling. It resonated with their own experience in dental school and dental practice.

Dentistry Post Corona: The Good, the Bad, and the Ugly

December 22, 2020

Filed under: The Stoic Dentist — Barry Polansky @ 8:08 pm

The Great Pandemic of 2020 has created mass disruption in the lives and work for most people. In a current bestselling book, Post Corona, author Scott Galloway has an interesting perspective on the many various changes that we have seen and reveals his theory of what the “new normal” will look like. But don’t be shocked to discover it will just be more of the same.

As the premise of his book, Galloway uses a quote that is often attributed to former premier of the Soviet Union, Vladimir Lenin: “Nothing can happen for decades, and then decades happen in weeks.” Of course Vlad was speaking about the Russian Revolution, but we can apply that logic to what we have witnessed over the past 11 months.

In other words, social and business trends that were already in motion went into turbo mode. The virus has acted as an accelerant. It has affected every one of our lives and every market in the world. Take e-commerce as an example. We have been using Amazon.com for years, yet e-commerce has only grown at a rate of 1% every year. Just before the pandemic, e-commerce was 16% of the economy. Then, from March 2020 through April 2020, that number jumped to 27% in just 8 weeks…just like Vlad said.

Think about other instances like virtual meetings and the emergence of Zoom. I hope you bought their stock. Zoom was around before the virus…now look at it. Stay at home stocks have been on a tear. With gyms closing and people social distancing, Peloton and Lululemon’s Mirror have really taken off.

And what about dentistry? Early on, dental practices were seeing the effect of fears of close contact and aerosol transmission. Then things eased up…practices became busier. Now, with the rise in cases, the fears are returning. One thing we must respect is that we have no control over other people’s behavior. And we have no control over the pesky virus. The vaccine is coming but human behavior will prevail.

As a retired dentist, people continue to ask me one question: “Is it safe to get my teeth cleaned?” My answer, as a dentist, is always yes, but as a patient they will be asking that question for a long time to come…vaccine or not. Dentists must see this through the eyes of their patients.

Galloway, in his book Post Corona, tells us that the existing trends will continue to accelerate…the good ones like stay at home practices, the unpopular ones like masks and excessive PPE, and even the ugly ones like misunderstandings in business and within families. So what do we do?

As a good Stoic, I would advise firstly to accept what we cannot change…the circumstances. Just like a war…it’s unfortunate and not fair but a Stoic accepts the challenge and moves forward. It never pays to get frustrated or angry. Now is the time to build resilience and pay attention to leadership and communication skills.

Yes, the troops are coming, and there is a light at the end of the tunnel (I love clichés), but basic human behavior will prevail in the end.

Can We Go into the Water Yet?

April 20, 2020

Filed under: The Stoic Dentist — Barry Polansky @ 1:30 pm

I bet many of us feel like we are living in a movie these days. I’m sure you have compared this pandemic to any number of movies. One of the biggest questions we all have on our minds is when will it be safe to go back to work, and what will it be like? The first movie that comes to mind is Jaws. In that movie everyone wanted to know when it will be safe to go back into the water. And now, forty five years later, people are still asking a similar question: whether it’s safe to go back to work.

Let’s explore the parallels.

The year Jaws came out, 1975,  I was serving as a Captain in the Dental Corps at Ft. Dix N.J. During my time there I came down with Hepatitis B. I became infected from working on a patient…without gloves. Remember kiddies, this was 1975…there were no rules. It was the Wild Wild West in health care. As we all know, hepatitis is caused by a blood borne pathogen. I became quite jaundiced and severely ill. I spent two weeks in the hospital. I started feeling better after one month.

I felt good enough to go back to work, but the U.S. Army had other plans. I couldn’t go back into the clinic until my liver enzymes were back to normal. I was tested frequently not only by the military, but also by the county Board of Health. I remember how diligent they were about the testing. They were serious…I couldn’t go back to work until I was cleared. That was mostly to protect anyone I would come into contact with. I was a known carrier, unlike the infamous Typhoid Mary who carried her disease covertly. I’m sure the public was grateful that the government was acting so responsibly. That was their job.

Like today, the public health department’s job is to protect the public. That trust must exist for us to function as a society. 

Fast forward to 1981. I was practicing full-time in my own private practice when the AIDs epidemic arrived in the U.S. By then I had learned my lesson and I was one of a small number of dentists who wore gloves on a routine basis. But I was in the minority. AIDs changed our entire profession. By the time it was over (if it ever truly was over) the life of every dentist changed forever. This time around I learned how serious government could be in enforcing public health regulations. They meant what they said (for those who are interested look up the case of Kimberly Bergalis). This was a classic example of the combination of blood borne pathogens and dentistry.

One thing I noticed during that period was the public awareness of dental practices and sterilization techniques. AIDS changed everything. It wasn’t the isolated patient who wanted to see how instruments were being sterilized. Many people stayed away during the height of the crisis. Yet in time the fear eased up. But not before more stringent rules and regulations were enforced. And once again the public was grateful.

Safety is a big concern for most humans. 

Behavioral psychologist Abraham Maslow formulated the Hierarchy of Needs. At the very base of the Hierarchy are physiologic needs like food and sleep followed by safety and security needs. His theory stated that people would not seek satisfaction of higher needs (love, belonging, self-actualization), until the basic needs were met. Modern dentistry has been focusing on the higher needs for some time by developing more and more elective procedures. Patients will be demanding safety when practices reopen. Patients have been deciding on the essential nature of dentistry forever. 

As long as it is safe…then elective procedures become essential to fulfill their higher needs. 

Now…almost 40 years after AIDS we have a new pathogen – the corona virus– Covid-19. The biggest difference is that this one is an airborne pathogen. And that makes all the difference in the world. Fear is ubiquitous. There is a new shark in the water. It does not show its fin. Like Typhoid Mary. In the movie Jaws there were people who went back in the water and defied the local police even though the beaches were closed. The small New England town was divided by those who didn’t believe the shark was a threat. Martial law was imposed to keep every safe.

Today’s pandemic presents similar issues. People demanding to get back to work. People not wearing masks in public. People congregating on open public beaches. Protests. 

This post is not about the biology or epidemiology of Covid-19. It is about human behavior and public trust. As long as the fear remains and people do  not have the absolute certainty of safety, they will not return to dental offices except for essential services (pain based). The other part of this is that it is the job of governments to protect the public—no matter what. Until they know it is safe, dental practices will have to operate under new rules.

Forty five years after Jaws roamed the ocean it is safe to go back into the water, but rest assured we do know one thing…there will always be new and more dangerous sharks to worry about.

Time Has Come Today

April 14, 2020

Filed under: Philosophy,The Stoic Dentist — Barry Polansky @ 10:01 pm

One of the more frequent conversations I hear during the recent pandemic is people not knowing what to do with all of the time in isolation. I hear people saying that with all of this time they can finally get things done – yet as each day goes by they spend more time watching more Netflix.

Readers of this blog know that I retired from clinical dentistry almost two years ago. As a retired dentist I feel a bit arrogant giving advice to the still working. I could never imagine what it must feel like to practice during these trying times. Certainly I practiced through some tough times like the HIV epidemic, but this is much worse. I hope I don’t offend anyone.

But this may be the best time to finally get some very important things done for the future of most dentists. One thing we know: things will not be the same, and I just can’t figure out the tele-dentistry thing. As dentists we are so used to the word “production.” The problem is that most dentists are finding this almost impossible. Having virtual Zoom meetings with staff can only go so far when it’s production we’re after.

As an observer of young dentists I have noticed how many have developed an overachieving mindset. How tough it must be to stay at home and develop new workout routines or cook new recipes while their practices are suspended in limbo. I don’t envy the young dentist who is devoted to self-optimization.

I thought back to my career and how I put my practice together forty years ago. I spent innumerable hours reading, taking notes and working on a practice philosophy. Writing policies and systems. It was something many dentists never found the time to do. Most just went to work everyday with one goal in mind: produce dentistry.

But it was these hours I put in up front that gave me the production capability that enabled me to build a successful practice. And now many young dentists have the time to sit and reflect on what’s most important in their lives, and to create that vehicle to get them there.

I am reminded of a story from author Steven Pressfield from his book Virtues of War. It is a great lesson of leadership and with all of this down time, one to think about.

Alexander the Great and his armies were finishing up after a battle when a young man ( future philosopher) approached the great warrior. One of the soldiers told the young man to kneel. He pointed to the lad and said, “This man has conquered the world! What have you done?”
The young philosopher replied without an instant’s hesitation, “I have conquered the need to conquer the world.”

And so the lesson is to get to “know ourselves.” This is philosophy – the first step in developing a strategy for our lives and practices. Most do not take the time to do this…now we have the time—I can think of nothing more productive.

The Sacred 40%

February 3, 2020

Filed under: The Stoic Dentist — Barry Polansky @ 10:25 pm

When did dentistry change from a profession into a business? Well, I guess it has always been a business it just seems that today it’s primarily a business rather than a vocation, a calling or a profession. When did the meaning of dentistry become what it matters to the dentist rather than the patients?

Let me give you an example. I am a diabetic and every time I go to my endocrinologist I pass a dental office that caters to Dentistry for Diabetics. I always wondered about what that office does different than other dental practices. Do they just treat diabetics? Do they focus on special diets? What makes them unique? What is their value proposition?

One day my endocrinologist asked me the same question. Both of us wondered what made this office unique. Both of us were aware that diabetics do have special concerns however we both never heard of a dental specialty for treating patients with diabetics. Through further investigation I found that the concept was originally created by a marketing guru who was selling the concept to dentists.

So what’s new?

Over the past fifty years the focus has turned from patient care toward business and marketing. Years ago, dentistry was protected from “outsiders.” Not today. Non-dentists are allowed to enter the field and literally take over through retail tactics, unethical marketing and even ownership of dental practices depending on the state practice acts.

So what’s new?

What’s new is that some dentists are making incredible amounts of money. And others are suffering through the worst era of burnout and depression that the profession has ever known. The numbers are staggering. Where will that take the profession in twenty or thirty years? What will happen to passion, purpose and mastery.

Author Jacob Needleman in his book Money and the Meaning of Life said that money is important, it is emotional and desirous but it is secondary. Secondary? To what? you say. Whatever is primary. Primary includes all of those spiritual things that we cannot touch and feel like purpose, passion, mastery and happiness.

So then if business, money and marketing isn’t the royal road to happiness for many or most dentists, what is?

In her 2007 book The How of Happiness, positive psychology researcher Sonja Lyubomirsky elaborates, describing happiness as “the experience of joy, contentment, or positive well-being, combined with a sense that one’s life is good, meaningful, and worthwhile.” That would be the opposite of burnout and depression.

She describes happiness in the pie chart at the top of this post. A full 50% of our happiness is fixed or set through genetics. Some of us were born lucky…others not so much. No matter how well you eat or sleep or how much you meditate or exercise, that 50% doesn’t change.

Ten percent is dependent on our current circumstances whatever they are. Okay let’s say that you consistently can’t make your payroll, or you haven’t had a new patient in a month or your staff is holding you hostage. Well, those are fairly common circumstances these days. But are they worse than the circumstances than Holocaust survivor Viktor Frankl or POW John McCain had to endure? The question then is how to survive horrendous circumstances.

The answer is the sacred 40%

That 40% are the source of our thoughts, feelings and actions. The Stoic philosopher Epictetus said this is all we truly own. It is the source of all of our reasoned choice. When we don’t take control of our thoughts and feelings and what truly matters, our actions, then we become victims of our genetics and our circumstances. A full 40% of our well-being is volitional – we have total control. Forty percent is a lot.

Viktor Frankl the author of Man ‘s Search for Meaning said it best: Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.

This is the heart and our of Stoicism. Knowing this isn’t good enough. Applying our freedom of choice is the key no matter the circumstances. The sacred 40% is where our freedom lies.

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