How our beliefs affect seeing the patients we want

Oct. 1, 2010
 Dr. Frank Spear is the keynote speaker at the upcoming DDS Tech Fair, a virtual trade show set for Nov. 4-5 ...

by Frank Spear, DDS, MSD

Editor's Note: Dr. Frank Spear is the keynote speaker at the upcoming DDS Tech Fair, a virtual trade show set for Nov. 4-5 where dentists and team members can tour an exhibit hall, listen to CE lectures, and interact with their colleagues ... all from the comfort of their own home or office. This innovative online conference and exhibition uses leading-edge technology to bring dental professionals together with colleagues and manufacturers at the convenience of your personal computer. Registration is free. For more information, log on to

In 1969, Jane Elliott, a third grade teacher in Iowa, undertook an experiment with her students to illustrate how their notions of others influenced their behavior. Her exercise was made famous through a PBS broadcast on Frontline in 1985*. You may wonder how a third grade experiment could impact your dental practice, but after almost 30 years of spending time with dentists throughout the world, I believe the lesson is one that has the power to change the very fabric of your practice, business, and life.

Jane Elliott told her students that blue-eyed people were different than brown-eyed people. She told them that blue-eyed people were more resourceful, dependable, and intelligent. They deserved to be treated differently because they were. She offered simple behavior examples to reinforce her point. She said they should be offered the best because it was what they were naturally attracted to and accepted.

She told them that the brown-eyed people, though we could try our best to help them understand, would never be able to really value the best things. It wasn't really their fault; it's just that they were brown-eyed, and brown-eyed people were different from blue-eyed people. She and her students learned that when they accepted that belief, their behavior toward brown-eyed and blue-eyed people reflected it.

Last year, I set out to create a model dental practice. My vision is for a model that will identify patient behavior and consider our reactions to that behavior. It identifies patients as reactionary, proactive, discretionary, and regenerative.

  • Reactive patients only come in for emergency care, nothing more.
  • Proactive patients are the majority of patients in a general practice. They will do recalls and fix the teeth that need fixing, but they are fee and insurance dependent. A strong base of proactive patients is critical to the financial well-being and security of a general practice.
  • Discretionary patients are primarily appearance driven. They choose to do dentistry, rather then have to do dentistry, and aren't as fee or insurance sensitive.
  • Regenerative patients are the smallest group in any practice, and are the patients who want everything done and made as ideal as possible.

My experience is that most dentists discover that as their practice matures, they want to add more discretionary and regenerative care to their schedules. Those dentists who do a mix of proactive, discretionary, and regenerative care are the ones most satisfied with dentistry, have the most fun, and are the most profitable.

I am asked frequently how to attract discretionary and regenerative patients to a practice. This is similar to asking how to get more blue-eyed children in a classroom. My belief about the answer is simple. In every dental practice, it is the dentist's value for care, and his or her knowledge and skills to diagnose, treatment plan, and provide therapy, that determine what dentistry is delivered in that office.

Put differently, if the dentist isn't confident or competent at delivering discretionary or regenerative treatment, the practice will only deliver reactive and proactive care.

But what about offices where the dentist is trained to provide discretionary and regenerative care at a high level? Now what determines the level of care delivered? Again, in my experience, it is the beliefs of the dentist about his or her patients' values. I can't begin to remember the number of times I've been told by dentists that their patients "won't do that kind of dentistry," or that the people in their community "can't afford that kind of dentistry."

Consequently, they have chosen to see all the patients in their practice and community as brown-eyed, and they unfortunately treat them accordingly, offering treatment options the dentist believes are what patients want instead of giving patients the opportunity to express their values.

I have told my personal story to countless audiences. I began my professional life as an associate in a general practice where all the patients were brown-eyed. They were unaware that I was a trained prosthodontist, with skills only those with blue eyes could understand or desire, let alone pay for.

But I needed a job, and they needed care. Many of those patients had eyes that had been colored by the expectations of others. To my surprise, when the patients in that practice were informed of the possibilities, it turned out that several were blue-eyed and chose discretionary and regenerative care.

During the past 30 years, I have tried diligently to help other dentists see what I discovered as an associate in that general practice. Your practice will always have people who will exhibit behaviors from each of our models. The most successful practices find ways to include them all, knowing that the color of their eyes does not always reflect what they're really after or who they really are. Along with our faculty dentists Gregg Kinzer, Gary DeWood, Lee Ann Brady, and Bob Winter, we strive to bring that understanding to every course offered at Spear Education.

Do you need more blue-eyed patients? They are with you now, wearing the brown contact lenses that you inadvertently (I hope) applied. In Jane Elliott's class, the roles were later reversed, and the results confirmed that expectations and beliefs about how a person "is" directly impacts how we act toward them.

Note: The original broadcast from 1985 can be found at

As the founder and director of Spear Education, Dr. Frank Spear continues to be recognized as one of the premier educators in esthetic and restorative dentistry in the world today. He and long-time practice partner, Dr. Greggory Kinzer, maintain a private practice in Seattle limited to esthetics and fixed prosthodontics. Dr. Spear can be reached through

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