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Are you being held hostage?

Sept. 1, 1998
The business lunch was going like they typically do. Dr. Henning was telling me the "proper" things to say about his practice, which left me wondering why he was even bothering to meet with me. Finally, he heaved a deep sigh and dropped his head down as his fork played with the remnants of salad on his plate. Then, his eyes made slight contact with mine as he muttered in a barely audible tone, "You know, I feel like I`m being held hostage."

You are if you let fear of change dictate your actions ... or lack of action.

Diane R. Hourigan, DDS

The business lunch was going like they typically do. Dr. Henning was telling me the "proper" things to say about his practice, which left me wondering why he was even bothering to meet with me. Finally, he heaved a deep sigh and dropped his head down as his fork played with the remnants of salad on his plate. Then, his eyes made slight contact with mine as he muttered in a barely audible tone, "You know, I feel like I`m being held hostage."

The comment brought me back to the early years in my own practice when I, too, had felt like I was being held hostage. Not wanting to impose my experiences upon Dr. Henning, I asked him what, specifically, made him feel that way.

"All the years of going to school and building my practice and, now, in my prime practice years, I can`t do what I want without facing hostility and roadblocks from my staff, the insurance companies, or my patients. When I go home, I have to face my wife and children. I feel like I am failing them by not providing the lifestyle I envisioned when I was in dental school."

"What kind of hostility?" I probed.

"My hygienist insists on scheduling an hour for each patient. I noticed that she always is finished in 40 to 45 minutes and then just hangs out in the staff lounge until her next patient shows up. When I ask her to help with chart audits or confirming patients, she agrees ... and then doesn`t do anything! She insists on keeping her own hours rather than the hours the other staff members keep. Quite frankly, she makes about 70 percent of what I do without any of the responsibility. I resent having her in the office."

"Have you talked to her about it?"

"Yes. She will improve for about a day and then she is back to her old routine. The only reason I have her here is that she has been with me for four years, the patients love her, and I`m afraid they will go with her if she leaves. Plus, she technically is a good hygienist and I`m afraid I won`t find anyone else with her clinical skills if I let her go."

"Who else is holding you hostage?"

"My assistant and I seem to have an ongoing battle about her being on time in the morning. I want her in the office 15 minutes before patients show up, but half the time she walks in the door at the same time as our first patient. It seems like such a petty detail, and yet, it drives me crazy. My day starts off on the wrong foot and then I seem to be acutely aware of every little mistake she makes. I don`t want to nag her, so I don`t say anything unless she makes a major error.

"Don`t even get me started on insurance companies or the occasional demanding patient! Is it me or does everyone have these problems? I fully understand why dentists have such a high suicide rate."

"Why don`t you change things?"

"I have tried," he replied, "but nothing I do works. I`m afraid everyone will leave - staff and patients alike - and I will be left with nothing. They have worn me down. It`s easier just to grin and bear it."

I`m sure none of you ever have had a conversation or thoughts like this, but perhaps you know someone who has. Let`s take a closer look at the real source of Dr. Henning`s feelings about being held hostage. The best way to discover the real problem would be by having him look in the mirror.

Notice how he described his situation. Would you jump out of bed every morning ready to go to work, if you were being held hostage? By being afraid of the consequences of being the leader in the practice, he has created in his mind the idea that he has no control over anything that happens. He lets his fears dictate his actions ... or lack of action. Add to that the inability to make decisions and you have the formula for a less than inspiring practice life, which spills over into this doctor`s personal life.

Overcoming fear

Take a moment to think of a time when you were afraid of doing something, but you did it successfully despite your fears. Perhaps it was your first patient. Remember how you pretended like you had done the procedure hundreds of times before? How long did it take you to figure out how to stabilize your hands, so the patient wouldn`t notice how hard they were shaking as you gave the injection? Where would you be today if you had let your fear in that moment cause you to leave dental school?

Now, remember how great it felt to have successfully completed your first patient? Picture that moment in your mind and try to remember what you said when you were done. Go ahead and re-experience that successful feeling now. See it, hear it, and feel it. While experiencing that feeling of success and confidence, think of a situation you need to change. Then, decide to change it. Is fear really a reason to keep you from having what you want? Fear just means you need to prepare for something. Stop indulging in the fear. Get the message it has for you - prepare and take action!

In Dr. Henning`s case, I asked him, "Who do you know who`ll be totally committed to your practice 10 years from now?" After some hedging, he finally agreed that it would be only him. The next step was easy. I asked him to list what he was no longer willing to tolerate in the practice and change it!

"Wait a minute!" he cried out in obvious frustration. "If I knew how to change it, I would have done that a long time ago!"

"You are just confused," I replied, "and confusion means you are about to learn something because your brain is searching for an answer." In decision-making, the real power comes in actually making the decision about what you will no longer tolerate. After that, you decide upon the outcome you want and the strategy to be changed. You also should include why the change should be made, how it must change, and who it will affect. Writing this down will help you get very specific about what you need to do. Most people already know what they want. They let the steps they need to take - which usually are difficult ones - stop them from taking action. They waiver back and forth and remain stuck in the situation (see Figure 1).

Once a decision is made, it is time for implementation. Decide exactly what needs to be done, who will do it, and when it will be completed (see Figure 2). Also ask:

* How will the details be managed?

* What if it doesn`t work? (This is asked to help you create an alternative plan, not to create panic about all the things that might go wrong!)

* What are our resources for support and help?

* How long will this implementation take?

* How will other systems in the practice and the structure of the practice change?

When to make the change

We are our own worst enemies when it comes to fear, control, and making change. Rather than making decisions about how we want things to be and making plans to get there, we let all our fears, reasonable or not, get in the way of taking action. We create in our heads all the reasons why we shouldn`t do something, rather than moving toward what we really want. Anthony Robbins, founder of Robbins Research International and co-founder of Fortune Practice Management, has an expression that has been invaluable in leading him to his massive success. "There is always a way if you are committed."

Perhaps this is the time to check your Wi/Wh Quotient. Are you spending more time winning or whining? I believe dentists are winners who sometimes forget how they controlled the fears that could have, yet didn`t, stop them from graduating from dental school. May I suggest the next time you find yourself whining, catch yourself, and immediately ask what you are no longer willing to tolerate. Then, take action!

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