Randy Shoup, DDS
We each have a symbolic wire that emerges from our shoulders and loops over the top of our head. From the end of this wire hangs a window, indelibly suspended in front of our face. This window is called the "Belief Window", and our every conviction is written on it. Every experience, every reality passes through it; it filters our perceptions and defines our beliefs.
Let`s say, for example, that you believe all Dobermans are man eating savages. Your belief window would then have "Dobermans are man eating savages" written on it. One day, while walking down the street, a dog owner with a pet Doberman turns the corner in front of you. You "see" the dog through your belief window, scream and run in terror. How you act or react is based on what you have written on your belief window. Your actions are always consistent with your beliefs.
Everyone has countless beliefs on their windows. Some are written with a pale yellow marker that barely makes an impression. Others are etched so deeply they obscure the vision of everything.
Our beliefs are as unique as our fingerprints. Each person progresses through life with a singular set of circumstances and unique experiences. As we interact and grow as individuals, these beliefs create a patchwork quilt of images and opinions on our "windows".
Some life experiences give us positive images to put on our belief window: I like school and I can make good grades. I am a valuable and good person. All people should be treated with respect and kindness.
Some life experiences give us imprints that make the world a scary place: People whom I trusted hurt me. School is a constant put down and I know I will fail. I am born to lose. It`s a dog eat dog world.
The beliefs we hold largely determine our behavior. Actions are a truer indication of beliefs than words. People commonly profess to believe certain things, yet act in a manner contrary to the stated postion. In truth, our actions are always consistent with our beliefs. If you want to know what someone believes, watch what they do - not what they say.
Finally, each person must have the world conform to their belief system. That is, it is not enough to simply react based on the belief window. Once a belief is established it must be defended at all cost. It`s not acceptable to say, "I have an irrational fear of Dobermans and make impulsive decisions because of this fear." Instead, we rationalize our beliefs to give them the appearance of sound judgement. The person who ran screaming from the friendly slobbering Doberman will justify such behavior by stating, "I saw a mean look in that dogs eyes", or, "He growled at me!", when in fact the dog was wagging his tail and had no teeth.
The investment in proving that the behavior was appropriate and rational is huge. This process creates the "self fulfilling prophecy". If you imprint a belief on your window you will act in a manner that makes the belief a reality. For example, a person may believe they are not smart enough to succeed in college. They enroll and quickly fail. However, this same individual can program a home computer or operate a complex machine at work. The person harboring the belief always has a rational explanation for the contradiction. We create the circumstances by which our beliefs are reinforced and proven.
Dentists have a unique set of beliefs etched on their collective windows. They persist despite the fact that these beliefs are sometimes founded on erroneous information.
Let`s look at some of these beliefs and see if the reality of the world matches the behavior of the dentist.
The Belief: My patients cannot afford cannot afford my best and finest services. .
The Behavior: Since the dentist *believes* his patients have no money for inlays, onlays, implants, or cosmetics, there is no need to present high-quality treatment. Why get shot down when the outcome is inevitable? At the mention of any dental treatment, the patient asks "How much?" and "What will my insurance pay for?" Dentists typically translate this questions into "The patient has no money." To avoid this dance of rejection, the dentist and the team start the dentist-patient relationship by asking volumes of questions based on what insurance coverage the patient has. This behavior reinforces the atmosphere of an insurance driven practice. This cycle is self perpetuated. The dental team creates the very atmosphere that precludes the effective communication of treatment with the patient.
The Reality: The dental patient has money. Patients wear designer label clothing, go on vacations, and buy birthday and holiday gifts. Patients go to gambling casinos, own motorcycles, speed boats, and exotic toys. The economy is booming and unemployment is at record lows.
In the face of this conspicuous consumption the dentist has him herself convinced the patient has no money. It is an erroneous belief. Dentists are challenged by money because dentistry is a low priority purchase. As Sandy Roth would say, "The patient price tests and dentistry loses.
Dentists also superimpose their own financial situation onto the patient. Reportedly, over 60 percent of dentists have not funded a retirement account; almost half are still paying on last years taxes. Many dentists cannot afford the very dentistry they present. The belief becomes "If I cannot afford my own treatment how do I expect my patients to afford it?"
The Belief: You can`t find good help these days.
The Behavior: Two components support this belief. The first is that we have low expectations of the candidate pool. If there is no likelihood for a quality candidate, there is little excitement during the hiring process. All candidates are mediocre, so one selection is just as good as another. With no expectations for finding a "diamond in the rough", we hire the first available candidate to deal with a critical staff shortage. When the candidate proves to be less than ideal, it reinforces the perceptions and beliefs. The new employee is a constant disappointment and soon gives notice. The frustrating process begins again, fullfilling the expectation of failure.
The second belief is that the perfect employee is born, not made. When each candidate lacks some aspect of the "perfect package", disappointment mounts. Not enough investment is made into weaving the new thread into the fabric of the practice. We expect new employees to magically train themselves. "If they don`t already have the skills to succeed, then I can`t teach them!"
Both of these components reinforce the belief. Would this same dentist, if faced with a dire thirst, go to the same dry well and pump the same empty pump time and time again? Dentists are guilty of returning to the same sources, even those that have proven fruitless in the past. When the well is dry - look for a new well!
The Reality: We are in a changing ".com" world. The old tradition of hiring a team member for life is gone. Employees now have a myriad of choices and opportunities from which to choose.
Dentistry, however, can offer something unique in today`s job market: a sense of family. Dentistry has a remarkable opportunity to provide a substantially more enriching environment for employees outside the traditional scope of candidates. For example, hotel and hospitality employees can be naturals for the dental office. Concierge, front desk, and banquet salespeople can make a smooth transition to front office, office managers, and treatment coordinator personnel. Look to computer training schools and beauty colleges for possible candidates for dental assistant positions. By being open to a variety of sources and by being willing to develop people into the type of employee you want, dental offices can fish from a much greater pool of candidates. It is important to make a heavy investment in the personal or human currency when attracting a candidate. The human need for belonging, respect, appreciation, and accomplishment are some of the most powerful motivators when people select jobs.
The Belief: The bigger my office the more successful I am. I need to have a staff of 10 people or more and be booked two months in advance to be fulfilled and happy.
The Behavior: Dentists grow cookie cutter practices with high overheads and ever increasing pressures. It seems more important to be busy than to be happy and profitable. In most offices the main priority is to get the patients scheduled for their treatment. Since the patients won`t accept big treatment (Belief#1), then we must schedule a series of fillings done one or two at a time. The office days fill up with a parade of patients having one or two services performed. The time spent transitioning rooms for the next patient further increases overhead. The number of team members grows because the team feels swamped with all the room, instrument, charting, and clerical work.
More front office people are also required to process repetitive insurance filings for the same patient. Keeping the schedule full becomes a nightmare, due to cancellations and no-shows
The dentist rushes all day from room to room. The team is frustrated because the dentist is always running behind. Even when the doctor has an opportunity to perform a couple of crowns or a bridge , the case eats up valuable time. These cases always seem to be "difficult", because the team is less experienced with them. The team consequently dreads the next crown or bridge case. This fear drives the doctor to recommend procedures that are easier to perform.
The hygiene schedule is based on 30 minutes for adults and 20 minutes for children. A progressive office will schedule one hour for adults and 30 minutes for children, which leaves no time to discuss periodontal disease with the patient.
In offices such as this one over 90 percent of hygiene appointments are for routine prophys. The hygiene team becomes frustrated at the lack of opportunity to do more in-depth work. This type of practice has a high new patient flow (possibly 20 to 40 new patients per month). The doctor may see the new patient first or the hygienist might. The new patient examination takes 10 to 15 minutes culminating with the dentists` proclamation of what the patient needs.
It`s all rushed. It`s all on a deadline. The doctor is stressed. The team is stressed. Overhead approaches 75 percent or greater. Accounts receivable are two to three times the monthly production. The schedule is booked solid for two to three months. Insurance programs flood the practice with more bodies than can be accommodated. If a patient cancels, no one cares because the empty spot becomes an oasis of calm in the midst of a frantic day.
The Reality: Approximately 80 percent of dentists surveyed said they would not choose dentistry again. It is no wonder. Dentists think that if they are running all day on roller skates with a high cash flow they are successful. The reality is the exact opposite is true.
Keeping one patient in a chair and doing quadrant dentistry is far more profitable than putting four patients in that same chair and doing one or two fillings on each of them. The demands placed on the team and supplies is significantly less for one patient than four.
Dentists may claim they do not have enough time to convert their office to quadrant dentistry. This is another example of the belief forcing a warp in reality. Dr. Omer Reed makes a compelling case that an office with one restorative chair doing comprehensive treatment can be more profitable over the course of a year than a three chair office.
Dentists can become so vested in this petrified mindset that change feels like a viloation. Yet, remodeling the office to accommodate more comprehensive treatment with fewer patients decreases the number of hours worked per day, as well as staff and supply overhead. More importantly, it increases profit.
The Belief: If a patient does not accept my recommended treatment plan, I need to show them more x-rays, models, and diagrams until they understand and say yes.
The Behavior: Dentists try to turn their patients into dentists. Generally, a dentist will look into a patient`s mouth and speak a secret language to the assistant who dutifully writes down these proclamations. The dentist then disappears into his or her secret office and emerges with a written plan to fix the offending mouth parts.
The dentists uses articulators, x-rays, models, diagrams, and charts to support his airtight explanation of the problems in the patients mouth and what is needed to return it to health and function. It is well thought out, logical and possibly brilliant. In return, dentists expect wholehearted accceptance of the plan. If the patient hedges, asking " How much will it cost?, or "What will my insurance pay for?", the dentist assumes the patient did not fully comprehend the magnitude and scope of the treatment. So the dentist launches into another rendition of the presentation, sure that this time it will soak in!
The Reality: Dental patients are not dentists. They don`t think or act or feel or respond like dentists. They act just like regular people - thank God!
All the dental hardware used in a treatment plan presentation will not push a patient`s buttons. People respond on an emotional level to treatment plans and money issues, rather than at an intellectual and logical level.
Each patient will react to three emotional issues regarding dentistry: 1 Look good. 2 Feel good, and 3.Last a long time. Patients prioritize these three issues in varying proportions. Some have as their primary motivator the desire to look good. Other patients prefer that their dental treatment last a longtime. Some patients are primarily focused on how their teeth feel and the health issues surrounding the restorative materials.
Dentists rarely address any of these issues. It is precisely these three elements that must be addressed and satisfied before a patient will accept treatment.
Simply asking questions that address these three priorities takes the patient a long way down the road to treatment acceptance. Try asking, "Mrs. Smith how would you like your teeth to look when we are done?", or "Mr. Jones, how long do you expect to these restorations to last? Would a couple of years be satisfactory or do you expect and want long-term durability?"
Look good, feel good, and last a long time are concepts every patient can understand. Giving patients control over selecting the treatment empowers them. A patient undergoing the treatment they want as opposed to the treatment forced upon them will be far more co-operative and compliant.
These are certainly not the only beliefs that cloud the vision of dentists. It is sometimes difficult to distinguish what is an erroneous belief and an accurate assessment. Challeging a belief provokes its visceral defense. Change within a dental practice requires more than merely working on the systems in place; systems and procedures are driven by beliefs.Without a change in the belief system there will be no change in behavior.
An office that institutes either minor or sweeping policy changes is doomed to revert back to the old ways. An office that concentrates on changing and redfining its beliefs need not design elaborate procedures and policies. Behavior that supports the belief will flow naturally. When a dental team has developed a solid and cohesive belief system, all of the activities will subsequently be consistent with the overall roles and goals of the office.