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A Prominent Dental Disorder: The Shoulds Douglas Carlsen, DDS

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Let's observe a childhood scene of a typical young dentist. Sitting around the dinner table, a father of three might ask the oldest child, "What did you do today?" The reply, replete with various deeds and exploits, would seem to take forever. Next, the second oldest would comment on her accomplishments and abilities. When it would come to the third child, often a nervous wreck, the day would seem insignificant. Whether our young dentist child is number one, two or three doesn't matter as much as the true underlying question: "What did you accomplish today?"

The drive to succeed and the fear of failure are established early in our lives. Dr. Bob Levoy has noted that dentists often come from controlling families. With the trauma of expectations at home and school, families often wind up with neurotic children. And perfect dental school candidates!

My previous three articles have centered on practice transitions and an overspending lifestyle. Many of the problems associated with these issues involve guilt and the stresses to succeed. Many dentists develop an early appetite for guilt, brought on by a hefty portion of childhood shoulds: I should only get As on my report card; I should do well at sports; I should keep my clothes immaculate; I shouldn't injure my (future doctor) hands; I should control conversations with my peers.

This translates later in life to a more "mature" list: I should live in an upscale home; I should belong to affluent community clubs and boards; I should always wear proper clothes and accessories for my life's station; my spouse and children should represent me well in appearance and manners; my children should be intelligent and have a "proper" (not public) education; I should attend cultural events regularly; I should spend more time at home with my family.

Professionally, the list includes: I should have a successful practice; I should manage my staff easily; I should do all phases of dentistry well; I should employ attractive employees; I should do "complete dentistry."

Additionally, for young doctors: I should work in an upscale area; I should have my own practice; I should take continuing education courses from the "hot" speakers.

For mid-career doctors: I should keep up with my journals; I should do full mouth cases like a successful dentist; I should have a really nice office – my staff and patients deserve it; I should do what's hot in dentistry like Invisalign and place implants; I should own high-tech equipment.

In later years, the list evolves into: I should have saved more for retirement; I should find a proper replacement doctor before I retire; I shouldn't cut back to two or three days a week – what would the patients or my mom think?

Am I making you nervous? Many of us face the shoulds and the guilt that follows daily. Some of us blame others for the stress, such as the government, a spouse, the staff or our parents. Some of us use drugs and alcohol to escape. Some of us seek help. Many of us hang in there and do the best we can, yet wonder why we don't feel as important or as wealthy as we should by now.

You might have noticed an omission from all the needs and shoulds enumerated above. Where's the spouse, other than "representing me well?" See below.

Sarah Nelson, MD, states, "Medicine is unique… in the permission society gives the doctor to be a workaholic." Her recommendation? A balanced family life. "We can use our compulsivity constructively to… build a good family support system to include more open sharing of ourselves as real people. We can use our history-taking skills to really listen to our loved ones."¹

Shawn Worthy, PhD, describes "shoulds" as one of the core irrational behaviors related to Rational Emotive Behavioral Theory, identified by psychologist Albert Ellis in 1993. According to Ellis, emotional difficulties take simple preferences like desires for love, approval and success and turn them into dire needs, musts and shoulds. Worthy further notes that "Musts or shoulds, when turned inward, create depression; when turned outward, create anger. Also, self-worth may be irrationally contingent upon arbitrarily self-created criteria."²

My thoughts: We know of the importance of a balanced family life and personal responsibility. We have seen the Pankey (Aristotle) Cross of Life, achieved through a balance of work, play, love and worship. We understand that balance is often teetering in a dentist's life. And might our self-worth be contingent upon success-driven "needs" promoted early in life by others, especially parents? I personally relate to all of the above.

So why am I, the guy that harps about investing and debt, writing about this stuff? Because the "shoulds," subsequent guilt and aberrant behavior are often deeply ingrained in the pre-dental child. As adults, the disturbance might affect spending, saving, overall happiness and ability to manage others.

In my lectures, I often provide exercises to find pre-retirement and retirement visions and goals. The overwhelmingly favorite goal isn't travel, a larger house or attending proper events. It's spending time with grandchildren and family. Sounds like more balance.

Let's deconstruct several of the shoulds:

I should have a successful practice. What's success? How about being able to work at something you love? If you enjoy your work and can make a living, you are a success. If you make $1,000,000 a year and hate your job, that's not success.

I should do all phases of dentistry well. Bogus. I referred out all endo, ortho, extractions, implants and jerks. I loved doing straight restorative. Others love doing a bit of everything.

I should do complete dentistry. Offer complete dentistry. Keep in mind that complete dentistry only happens after establishing a strong relationship. In the final analysis, dentistry is about relationships, not equipment, bonding agents and block scheduling.

I should employ attractive employees. This is rampant in our profession. If you believe this, you're still in high school. Your staff should have attractive, clean smiles… and clean fingernails!

I should have my own practice. I know life-long associates that retire earlier than many practice owners. Also, military docs live quite comfortably on great pensions that start between ages 55 and 60.

I should keep up with my journals. Have a staff member toss out any journals older than two months. Join a study club. You'll learn more and have more fun. Yet you should always read Dentaltown Magazine.

I should have a really nice office. Change that to a really clean and neat office. A gorgeous office is great, yet often sucks up half a million dollars or more in retirement wealth.

I should do what's hot in dentistry like Invisalign and place implants. What's hot in dentistry is service, not bells and whistles. Implants, ortho and CAD/CAM systems are wonderful, yet never replace great service.

I should have saved more for retirement. This is common mantra from those approaching retirement, yet seldom heard from post-retirement doctors. Complaints about money are rare from retirees… they learn to budget with what they have. I do hear, "I should have retired or cut back years earlier" and "It's great to be with grand kids and family." The only "should" heard is "I should have prepared for less social interactions in retirement."

I should find a proper replacement doctor before I retire. Several years of mentoring and sharing, all with proper guidance of a competent consultant and attorney, often produces a different practice than the elder doctor expects. Frequently, the change occurs several years after the final sale. You can't control your family from the grave, except for money, docs. Same for your practice. Sell it straight, without all the stress placed on your family.

My spouse and children should represent me well in appearance and manners. A futile attempt to control. I'd rather display a happy spouse and kids in mud-soaked Levis at Spaghetti Factory than a family I don't know wearing Prada and Lacoste to Ruth's Chris.

I should spend more time at home with my family. Yes! A weekly date night with your spouse is a must, as is a family day for all. To work one less day per week and spend it with family will produce real and spiritual wealth beyond your fondest dreams.

Final note: As for the spouse, hardly mentioned at all above: the man or woman of your life is your best consultant and psychoanalyst. Listen and you shall thrive.

Where did I get this information? From a bunch of really old dental farts. If any could do it over, they'd spend less time at the office and more with their families.

References
  1. Find article at www.ncbi.nlm.nih.gov/pmc/articles/.../pdf/canfamphys00251-0054.pdf
  2. Worthy is Professor of Human Services at Metro State College, Denver, Colorado.

Author’s Bio
Douglas Carlsen, DDS, founder of Golich Carlsen, has provided independent financial education to dentists since retiring from his practice in 2004 at age 53. Golich Carlsen, an approved AGD PACE organization, delivers common sense consulting, efficient CE lectures, and smart continuing education CD/workbooks – all backed by academic research. Visit www.golichcarlsen.com for archived articles, information on services and to sign up for Dentist's Financial Poll and Newsletter. Contact drcarlsen@gmail.com or 760-535-1621.
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