Barry F. Polansky, DMD
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I am a student of dentistry. I study the clinical, unemotional, and technical side of dentistry, as well as the soft, emotional, and very mysterious aspects. The technical always comes much easier. The more one studies and practices, the more one gets it. Most people struggle with the soft side. It's hard to learn, because it's hard to teach. Just when you think you have mastered a soft skill, a patient comes along to throw your theory out the window.
Heinrich Zimmer, a mentor of Joseph Campbell, once said, “The best things can't be told; the second best are misunderstood; the third best have to do with history.“ To which Campbell responded, “Now the vocabulary through which the best things are told as second best is the vocabulary of history, but it doesn't refer to history; it refers through this to the transcendent.“
I have found that so much of dentistry is truly transcendent. This article will attempt to explain one of those things that “can't be told.“
Those who have read my book, “The Art of the Examination,“ know that I consider the examination a complex system that starts with the initial contact and leads to some sort of presentation that asks the patient to accept complete dentistry. I believe that the examination is a complex, nonlinear, dynamic system. Hopefully, after reading this, you will do a complete examination on every one of your patients, because you will see how this nonlinear dynamic system leads to case acceptance.
You are already familiar with these types of systems. You have heard of the “butterfly effect,“ in which seemingly trivial inputs — like the flapping of a butterfly's wings in one location — can disproportionately determine later conditions elsewhere. My theory holds that the manner in which you conduct your preclinical exam is like the flapping of the butterfly's wings, and your success in case acceptance is the outcome.
So what does all this have to do with a butterfly?
Well, this seemingly simple metaphor is really backed up by a lot of mathematics. Maybe Heinrich Zimmer was on to something. Perhaps there are universal laws that have never been properly articulated.
Marcial Losada is an expert on the mathematical modeling of group behavior. For years, he studied the characteristics of high performing teams. As part of his work to help business teams with poor performance become more successful, he built a laboratory especially designed to capture the behavior of teams in action. Through one-way mirrors his assistants videotaped, recorded, and captured all interactions on specially programmed computers.
Every single word and gesture was analyzed. Losada tracked three dimensions: whether people's statements were 1) positive or negative, 2) self-focused or other-focused, and 3) based on inquiry (asking questions) or advocacy (defending a point of view). Losada's results were amazing.
After analyzing more than 60 teams, he found three groups: the high performers (25%), who scored the highest in profitability, customer service, and evaluations by superiors; the “flounderers“ (30%), who were not making money and left dissatisfaction in their wake; and the rest who had a mixed profile — some good, some bad, but nothing consistent. He quantified the trait of influence and called it connectivity.
As he studied the groups further, he found that according to the three dimensions, the high performers stood out with an unusually high positivity ratio, at about 6:1 positive to negative statements compared to the low group at 1:1 and the middle group at 2:1. The high performers achieved greater connectivity also by asking questions as much as defending their own views, and casting attention outward as much as inward.
Losada graphed his results mathematically. He concluded that there is a positivity ratio of 3:1 or higher, which leads to success and flourishing. He called this ratio the “Losada Line.“ Those who study complex systems are familiar with a butterfly-shaped attractor on the graph, as shown below. The wings on the butterfly stretched high and wide in the high performers.
Those groups that didn't show this butterfly pattern showed behavior that was not conducive to success: they lost their good cheer, their flexibility, and their ability to question, and languished in an endless loop in which people defended their own position and became critical of others. When I read this study, I immediately saw its value not only in terms of flourishing in practice, but more specifically how we could use the three dimensions in our comprehensive examinations.
Along with a well-designed preclinical examination that assumes the dentist has no defined agenda, we can now be aware of keeping our positive to negative statements above the Losada Line, or 3:1, as well as asking questions instead of defending a position (the Buddhists would say clinging to a position), and finally, always staying other-focused.
As if Losada's work isn't convincing enough, John Gottman, the world's leading expert on the science of marriage, confirms everything in couples that Losada found in groups. Gottman's work was done in what he called his “love lab“ at UC-Berkeley. Gottman used very sophisticated methods to measure not only the language of married couples interacting, but he measured heart rate, sweat gland activity, and other physiological changes during conversation. He captured all verbal and nonverbal communication.
What he found was amazing. He followed the couples for years and predicted, based on those early conversations, which couples would stay together and which would divorce. Malcolm Gladwell, in his superb book “Blink,“ reported Gottman's work as intuitive, but after reading the research it is obviously the butterfly effect in action.
Gottman confirmed that married couples had a positivity ratio of 5:1. Any way you slice it, being positive during group or couple interaction pays off in big dividends. Marketing mastermind Ted Levitt tells us that marketing is nothing more than creating and maintaining relationships. In his classic essay, “Marketing Myopia,“ he tells us that our relationship with a customer is nothing short of a marriage. Think of what Renee Zellweger told Tom Cruise in the movie, Jerry Maguire: “You had me at hello.“
I suggest dentists should take the preclinical examination very seriously. Don't present treatment quickly. Take your time. Build your relationship consciously. Ask questions. Stay focused on your patients. Keep your positivity ratio at least 3:1. Too many dentists resort quickly to a present and persuade mode. I call these the default positions for dentists.
When the conversation isn't working, they immediately apply methods to persuade, and then pull out their X-rays, models, and diagrams to present. My suggestion is to sit back and converse using the three guidelines. In the end, the preclinical examination will lead to healthy, flourishing case presentations that will lead to disproportionate success.
Let's not stop with the preclinical examination. What about our day-to-day communications with staff? What about having a positive, inspiring, and effective staff meeting? Can't the butterfly effect be applicable here? If Gottman or Losada were flies on the wall in your staff meeting, would they say that your practice was flourishing or languishing, based on the level of communication?
Think about Joseph Campbell's response to his mentor's quote. He refers to the vocabulary of the day. Gottman and Losada spent hours studying the effect of language on the success of a group. How important is language? As leaders in our practice, we must use what I heard someone call “future-based language.“
In other words, leaders are very cognizant of using proper language to make sure communication is providing a hopeful future. Most dentists, as I said earlier, fall into their default language — the language of the day — whether it's persuasion, manipulation, or presentation. This language, or any language, is responsible for the actions, good or bad, of the intended audience.
The default language generally leads to what I call the default future ... and that means usually nothing changes. This is probably why most staff meetings turn into gripe sessions that fail to get anything accomplished. To create your “invented future,“ you must use future-based language.
This is why vision is so important. This is why great practice leaders are very clear about the outcomes they want to achieve before they start a case or a new office project. They spend more time working out their vision than they do devising a strategy. When there is a clear vision, the strategy works itself out.
Once again, the butterfly effect is at work. Taking the time to create a vision is like the flapping of the butterfly's wings. How much stress can we get rid of when we use the leverage of the butterfly effect in everything we do, from examinations to staff meetings?
Barry F. Polansky, DMD, practices in Cherry Hill, N.J. Author of the book, “The Art of the Examination,“ and publisher of “Dental Life,“ he is on the visiting faculty of the Pankey Institute. Send him an e-mail at [email protected].