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Passion lost and found

Oct. 1, 2009
In this column, we ask members of the Pankey Learning Community to reflect on finding fulfillment and success in dentistry.

by Bradley S. Portenoy, DDS

For more on this topic, go to and search using the following key words: patient relationships, practice fulfillment, practice success, Dr. Bradley Portenoy.

In this column, we ask members of the Pankey Learning Community to reflect on finding fulfillment and success in dentistry. Throughout the year, we will present reflections as diverse as the many individuals who write them.

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When I started my career, I was passionate about doing my best to succeed. but I didn't envision how rewarding dentistry could be. I started by purchasing a small, insurance–free practice. I wanted to build a big, busy office. “Success for me will come,” I thought, “when I have 10 people working for me, and I am happily jumping from one room to another.”

Within a few years, I had what I thought I wanted. I began accepting some insurance as partial payment, and I found myself treating tons of teeth. I was fast, good at selling treatments, and working so hard that I foresaw burnout on the horizon. One day it struck me that I knew and remembered certain teeth more than the people attached to them. I felt some of my patients were only there because I worked with their insurance.

My situation was no different than that of many colleagues, except for one thing. I had purchased a patient–centered practice from a retiring dentist who loved his career, and I had failed to see the success of the practice he had developed. I had taken a comprehensive, patient–centered practice and deconstructed it. I wanted what I had destroyed.

There are few places that teach patient–centered, comprehensive care. Thankfully I found one, the Pankey Institute, and took to heart its core philosophy — know your patient, know yourself, know your work, and then apply your knowledge. I learned to look inward to decide what type of dentist I want to be. I learned I want to know my patients and I'm eager to spend time with them, really get to know them, and do the best dentistry possible with them. I learned that excellent and rewarding dentistry involves treating the mouth as a system of muscles, joints, tongue, and teeth — all playing together to create harmony.

While I could envision what I wanted and philosophically “got it,” changing how I behaved was difficult. I used to ponder what I could accomplish if fear were not an obstacle.

Doing a comprehensive exam, diagnostic workup, and treatment plan of the whole mouth was a big leap. What would patients say if I wanted to take study casts and photographs of their mouth? I was scared to ask patients if I could do a complete examination and then give them a separate review–of–findings appointment.

I was scared to present to my patients an outline of how they could keep their teeth in maximum comfort, health, function, and esthetics for their lifetime. Imagine that! I was scared to offer my patients an optimal level of care because I feared they might reject me and my practice. After all, rejection would affect the bottom line.

I had to realize that practicing comprehensive dentistry takes a commitment unlike any other I had experienced in my profession. I had to choose and then commit without compromise to practice the way I wanted to practice. I learned to implement changes with flexibility and wisdom. Here is what I do:

  • I accept that I am not for everyone. I'm OK with that. Not everyone wants comprehensive care.

    The rewards of a lower–volume, high–touch office didn't come to light immediately. Spending more time with patients took some time to pay off. But as I learned more about them, I realized how much of each patient's dental condition I had been missing and how much dentistry existing patients needed.

    I also came to understand that downtime (which I had defined as when my fingers were not in someone's mouth) was the greatest time to study a patient's photographs, radiographs, and study casts. Downtime has become the most profitable time because I use the information I have recorded to create virtual patients at my desk. I think about what the patient needs and wants. I think about how I can phase treatment so most patients can afford the dentistry they need and want.

    When I began seeing patients for more comprehensive appointments, I was able to slow the pace of my practice. It was still profitable because I came to know patients better and help them have optimal care. Just as important, I felt great at the end of the day!

    I think the greatest reward of a comprehensive practice is not money or time; it's being able to touch the lives of patients by having true relationships. We see patients in what I call “life bites,” which are snapshots we take at appointments. We don't see patients' day–to–day minutiae, but rather the ebb and flow of their lives. We are invited into these “snapshots” for a brief period of time. In return, patients want to know more about me, and I know they care about my life.

    I'll never forget the patient who asked me during a long appointment if my wife and I traveled. He had waited too long to start traveling before his health failed and his wife died. Imagine that I am trying to bring his mouth to health, and he is giving me a precious life lesson. I shared the horror as a parent told me she lost her teenage son. At each recare appointment, I watched as life slowly returned to her eyes. She taught me about the wonder of the human spirit, and its ability to love and live — even in the face of tragedy. Babies, weddings, graduations, achievements, and tragedies — countless stories told to me are all part of the tapestry of the human heart. This tapestry is a gift we can only experience if we slow down and listen to patients.

    Often I hear how my dentistry has changed lives. Some patients are able to eat without a piece of plastic floating in their mouth. Some now smile, no longer embarrassed by their teeth. Some are pain–free after years of suffering. Many are no longer cocooned in shells in fear of their dental health. I cared about and helped these people, and that is now how I define success.

    Profitable practices are inevitable when you care at an extraordinary level. Slow down. Don't be afraid to care and be complete in your dentistry. Seek CE and mentors who will guide and encourage you in creating a patient–centered practice.

    Success is inevitable.

    Bradley S. Portenoy, DDS, maintains a private practice in Rockville Centre, N.Y. He is the attending dentist in prosthetics in the Department of Dentistry at Nassau University Medical Center, Board Director of the Nassau County Dental Society, a Pankey Scholar, and on the visiting faculty of the Pankey Institute. You may reach him via e–mail at [email protected].

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