Going from ignorance to perfection is a path of several downhill steps. Going uphill through the

Oct. 1, 1997
Going from ignorance to perfection is a path of several downhill steps. Going uphill through the five levels of learning suddenly gets easier.

Going from ignorance to perfection is a path of several downhill steps. Going uphill through the five levels of learning suddenly gets easier.

Barry L. Polansky, DMD

A Tiger Woods` tee shot, a Michael Jordan lay-up and a Ken Griffey Jr. home run are sights to behold. These ultimate performers capture our attention because they make the difficult look easy. The results of years of commitment to practice display themselves for these athletes routinely. We may think that some sports figures are overpaid, but we never question the very best.

Does every field have their equivalent superstars? I think so. Just the other day I hit dentistry`s hole-in-one, the three pointer at the buzzer, the grand-slam home run. I took a four-unit bridge off of the model and inserted it into my patient`s mouth without any adjustment. The perfect case; nobody cheered, except me.

It was a good time to reflect. Twenty years ago, I could only have accomplished this task by accident. Understand that everything about this case was perfect - marginal fit, contacts, occlusion, contours and esthetics. The true hole- in-one. Bragging rights were in order, and don`t think I didn`t let the patient know.

"Kim, that`s no easy feat. Everything had to be perfect to get that result. That`s why we spend so much time taking continuing education courses - so that we can get that kind of fit, and look how much time we saved. Years ago, this procedure might have taken more than an hour and we still might not have gotten it right."

Kim kidded, "So Doc, because this was so quick, do I get a discount? You do get paid by the hour, don`t you?"

We laughed, but it made me think, how our profession is so tied to time. So many of us live under the tyranny of "time is money" that we forget the things that really are important - like the quality of the results we are creating and the quality of the doctor-patient relationship.

Imagine if we were paid by performance. Imagine if we spent the time to produce a quality result every time because we weren`t being paid for our time or a specific procedure. Imagine that insurance companies recognized the variations in quality (that may take more imagination). Speed is the killer of quality.

I never pass up a chance to educate patients because I feel this is my best marketing, so I took the time to convert Kim into a missionary. There is no better time for this than after the insertion of the perfect case. My own professional development followed a pattern that I read about known as the "Five Levels of Competence."

Level 1: Unconscious Incompetence

Let`s go back to the beginning, my first year in practice. George Carlin described it best in his comedy act under the heading of "things I like: A guy who doesn`t know what he`s doing, but won`t admit it." The ultimate in ignorance, the unconscious incompetent just goes on like one of the Three Stooges trying to fix something, never really understanding what he`s doing.

Because many of us practice alone, this level can last a long time if we don`t get any feedback. In some cases, it could last a whole career. You can have 30 years of experience or experience your first year 30 times. To a comedian, this might be funny, as long as the dentist wasn`t working on him.

A more serious observer would look at it differently. Goethe said of the same situation, "There is nothing more frightening than ignorance in action."

What dentist hasn`t observed ignorance in action? I admitted to Kim that I was in that stage for a number of years. This can be a big admission, but I was ready to be real honest because it helped her to appreciate the process. Incidentally, patients appreciate honesty!

"So Kim, some of that dentistry that I did for you back then may be falling apart now because I didn`t know what I was doing then. But, I didn`t know it, so will you forgive me?"

"Sure Doc, so how did you wake up?"

"That went on for a few years. My dentistry would be quite inconsistent i.e; some good, some bad. After a few years, I saw problems with the work and I started to blame the patients. As if it were their fault, you know - not brushing and flossing. But I knew it didn`t look like the work I saw in seminars and textbooks. I always made excuses for not trying to do that kind of work. After all, it took too much time. That`s when I became conscious of my incompetence."

Level 2: Conscious Incompetence

For me, many things came together at once, but I think the thing that woke me up was that dentistry was not fun. I knew my work was not good. The speed and stress were killing me. This became the most difficult level because, at this point, I still didn`t know what I was doing but now I knew it. If change was going to come, then I would have to commit to it.

I decided to burn my bridges. It was painful. Costly. Procedures took longer. This wasn`t the time to raise my fees to compensate for the time (although it was tempting).

Frank McCourt`s Pulitzer Prize- winning memoir, Angela`s Ashes, describes the feeling of burning one`s bridges when he is leaving Ireland to come to America and its promise of freedom."It`s too late now. I`m on the ship and there goes Ireland into the night, and it`s foolish to be standing on this deck looking back and thinking of my family and Limerick ..."

There always are regrets, but, to reach a new level of freedom, we must leave things behind.

I began by reading everything I could about success and philosophy. New habits were more important than new skills.

Slowly, I began to incorporate new techniques until I became proficient. I would manipulate every patient`s jaw into centric relation (a la Pete Dawson), just to improve my skill. I didn`t even understand why I was doing these things. I read dental texts every night and went to every quality seminar I could find.

Slowly, I started to see my work improve. My staff noticed, too. Pride set in, but it was a struggle.

This is the level that tests ones tolerance for failure. Many times, I felt like quitting. I thought I would never get it. Mentors are good to rely on in this stage. One of my mentors always would reassure me that everyone "gets it" eventually. He was right.

"That`s similar to my story, Doc. I`m a manicurist and I used to blame my customers if their nails broke or their polish chipped off. Until I learned how to do their manicures correctly."

"Learning any skill follows the same stages. In dentistry, though, it`s too easy to hide our ignorance."

"But isn`t it worth it when you complete a job like this?"

"It sure is, especially when you reach level 3."

Level 3: Conscious Competence

At this point, I was seeing the fruits of my labor. The only problem was that to get consistent predictable results required an enormous amount of time. I still had to concentrate on many of the new tasks. I was more skilled, but not quite expert. Like driving a manual transmission car at first - being very aware of each shift change. Now, I really felt like raising my fees. After going through Stage 2, I needed to be compensated for my new competence.

"Well, I guess you deserve that much," said Kim.

"That was the first time that I thought about being paid for my performance. It was still taking me longer than it should have, and my fees weren`t equivalent yet. Actually, I kept thinking how I could have made more as the unconscious incompetent - but there was no turning back now."

"So what happened?"

"The learning curve shortened considerably. I had achieved a new level of understanding and was meeting new friends along the way. I started to understand what some mentors had said, that the only difference between who you are today and five years from now is the books you read and the people you meet. My education became an exciting, dynamic process and I unwittingly slipped into Level 4."

Level 4: Unconscious Competence

To use the driving metaphor once again, this is when you perform without thinking. Everyone has experienced being on cruise control. Getting there took nothing more than practice. The definition of "practice" is "to perform something habitually or repeatedly." The key is to do the right thing habitually until it becomes a part of you. Now the work not only is consistently good, it`s easy.

It actually takes less time. "So Kim, don`t you think that expertise is worth something?"

"Absolutely! You definitely deserve the very best. But you said there were five levels?"

"Yes there are. The fifth level is Supercompetence."

Level 5:Unconscious Supercompetence

The fifth level is the level of the master. In sports, we see it all the time: Tiger Woods, Michael Jordan and Ken Griffey have mastered their games and make it look easy. Commitment and practice have enabled them to reach the top in their fields. The public adores them for their skills and they get paid accordingly. They perform superbly without thinking about it. Once the competence levels are reached, it`s time to change the paradigm of payment. Time is no longer money. Our compensation should be based on our performance - delivering what we say we are going to deliver - every time."

"So, Doc, are you saying that you are a Supercompetent?"

"No Kim, not yet, but as Michaelangelo once said, `I`m still learning.`"

P.S: Recently, I discussed these five levels with a younger colleague. He commented that he felt that he was already at Level 4 and was trying to get to Level 5. That may be, but it also may be that he was at Level 1. Joseph Campbell used to say, "He who knows, doesn`t and he who doesn`t know - knows." Think about it!