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The Quest To Excel by Dr. John A. Wilde

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Categories: Practice Management, HR and Accounting;
The Quest To Excel

by Dr. John A. Wilde

Attaining excellence isn’t easy in any venue, and that’s especially true in our demanding profession. On his ladder of competence, the vaunted Dr. Lindsey D. Pankey Jr. pronounced 2% of dentists masters, 8% adepts, 36% students and 54% indifferent. Graduation grants a learner’s permit that allows participation in the game, but as Pankey illustrated, from that inception, careers diverge.

This journey to distinction is not one giant leap; it consists of a multifarious collection of small yet exceptional achievements, and this article will examine one such example. Insatiable curiosity and indefatigable will are essential to achieve distinction, but I contend the critical point in achieving one’s deepest goals is contingent upon how one defines the duties of our hard-won and arduous metier.

I am in the business of fixing teeth or, perhaps more grandly, restoring mouths to optimum health, comfort, beauty and function. There’s nothing wrong with this! Dentistry is an enterprise that, when done well, rewards abundantly. However, poor performance can result in bankruptcy and fiscal failure.

After my discharge from the U.S. Army, I started a practice from scratch. Being the sole source of income for my family of four was highly motivating, and through unstinting labor, I created an extremely lucrative and efficient office. By age 40, I was debt-free, and income from investments far exceeded the living expenses of my family of six, so I could have retired. Let me brie y share the ingredients essential to my financial accomplishment.

From my practice’s inception, my mindset was one of constant growth. Foremost to achieving this was having abundant space, which for me was five fully equipped operatories. Two were for my highly profitable expanded hygiene program, where adding a fully dedicated chairside who received one-third of a hygienist’s salary allowed us to go from eight to 12 patients a day with only a modest rise in overhead. (Regarding hygienist recruitment and retention, how would you, doctor, enjoy a day without chairside help? Has it been a minute since you broke down and set up a room, scrubbed and sterilized instruments, or exposed images? I’d stay home.) Two rooms were for my use, and our fifth served as an invaluable overflow space for emergencies, removable appliance adjustments, suture removal, ortho care and much more.

I required seven cross-trained staff to maximize our facility—two in hygiene, two chairsides and three to effciently and effectively manage the front. This approach has merit, but let’s consider a second definition, which I claim more fully as my own. This approach affords the greatest opportunity to enjoy practice. After laboring for 40 years, I assure you, it needs to be fun.

Our office existed to maximize long-term oral health and create abiding patient relationships. I was indifferent to a good month, even a good year—I wanted a lifetime of accomplishments bedrocked upon working with dedicated, skilled staff and on patients who were trusting friends. Practicing in the Rust Belt municipality of Keokuk, Iowa, I never presented a $10,000 case, so my achievement necessitated high patient volume and spectacular treatment acceptance. Many outstanding endeavors were required to achieve my goal, but let’s begin at the beginning by contemplating our new patient experience, which illuminates the essence of my philosophy.

Beyond your practice’s reputation in general, the first opportunity to make a great first impression occurs when a patient calls to make an appointment. I would counsel staff, a bit tongue-in-cheek: “If you can be pleasant only once a day, be sure that blessed event occurs when a new patient calls to schedule an exam. They are our office’s lifeblood.”

With three dedicated office staff and seven individuals willing and able to assist, we always answered our phone and usually by the second ring, because it’s critical to “get ’em while they’re hot.” Because we preblocked two new-patient exam times a week, we usually saw the caller within a few days. After the call, the appointer filled out our standard form and placed the record on my desk.

I contacted each new patient on the day they scheduled, usually to their utter astonishment. After welcoming them to our dental family, I asked if they had questions. My intent was to foster a relationship, so I desired a significant conversation. After a little probing, anxiety (often related to experiences at other dental practices) was frequently identified. Such comments allowed me to discuss topical anesthetics, gentle injections, N2O, conscious sedation, etc., and to assure them they’d be in control of every appointment, because I promised to stop whenever they wished. New-patient exams had been by far our highest failure rate, but after I began calling, exam no-shows dropped to almost zero.

When our new patients arrived, they were greeted warmly by their preferred appellation by our smiling receptionist. (If we scheduled a 40-year-old lady at 10:40 a.m. and someone matching her description arrived at 10:30, one can risk calling her by name, because no sound is sweeter to the ear.)

Medical history completed, an assistant would lead the patient to my private office, where she was given a hand mirror and guided through our cosmetic evaluation form:
  1. On a scale of 1 to 10, how would you rate the appearance of your smile?
  2. Are you concerned with chipped teeth?
  3. Are any teeth or restorations discolored or unattractive?
  4. Are your teeth crooked or crowded?
  5. Would you like whiter teeth?
  6. On a scale of 1 to 10, how important is it to keep your teeth for a lifetime?
  7. What plans do you have to obtain this goal?
Query 6 is thought-provoking, because many haven’t identified retaining lifetime natural dentition as an aspiration. Or, based on parents and older family members’ experience, they assumed dentures were inevitable.

Question 7 lays the seeds of personal responsibility. We are establishing that defining and declaring a desire to retain one’s teeth is critical, and that it’s a personal responsibility for individuals to obtain the knowledge, materials and techniques needed. (Of course, we are here to help!)

Form completed and blood pressure taken; while the patient reviewed and signed her medical history, my assistant notified me to begin my portion of the appointment. Promptly. Smiling and greeting her by name, I shook hands and introduced myself as John. We chatted for 10 minutes, getting to know each other and searching for commonality. (Tell me about your kids. Are your girls into soccer too? What team? Etc. I recorded these notes on her record.)

The second portion of the interview began when I asked:
  1. “How may I be of service to you?” This established the dynamic that I was there to serve, and I recorded their first statement (chief complaint) verbatim because it was imperative that I fully addressed this desire. (If it’s not crystal clear, I have devised standard forms for everything. There are many ways to do things, but only one is best, and a carefully considered and delineated approach is preferable to just shooting from the hip.)
  2. “Are you having oral discomfort? Any sensitivity to temperatures, sharp edges, food catching or floss tearing?”
  3. “Do your gums bleed when you brush, or do you spit out blood in your toothpaste?” A positive response allowed me to evaluate her awareness of periodontal disease and its relationship to systemic health.
  4. “Do you have headaches?” was the first portion of my TMJ screen. I would delay other conversations until after my clinical exam, but I identified and treated TMD frequently. (Definitively treating TMD is master-level care that requires eliminating all symptoms with some form of orthotic, then performing a full-mouth occlusal equilibration that took an hour.)
  5. “Please tell me about past dental care. Were there complications? Were you pleased?” Forewarned is forearmed, and one has the opportunity to assure a patient that the unfortunate event won’t happen here.
After returning the hand mirror so my patient could reevaluate her aesthetics, we reviewed the results of our cosmetic evaluation. Besides tooth whitening, veneers, crowns and bonding, I performed orthopedics on kids, offered full ortho, and was very enthusiastic about Six Month Smiles, which created an ideal cosmetic result without attempting to correct Class 2, Class 3, overbite, overjet, etc., on adults.

One doesn't trip and fall into excellence, but many have achieved this estate, and their efforts have left clues. As is the case with patient responsibility, it is incumbent on those striving for excellence to take responsibility, create an ideal path, then strive diligently for the desired goal, for as Eleanor Roosevelt said, “The future belongs to those who believe in the beauty of their dreams.” Enjoying the reputation of excellence and working in its ambiance is a sufficient reward.

Author Bio
John Wilde After working through eight years of higher education, paying 100% of all costs, Dr. John A. Wilde spent his next two years in the U.S. Army Dental Corps before beginning a practice from scratch in Keokuk, Iowa. He was debt-free at 30 years old, owning his home and the practice he’d designed and built outright. He was financially able to retire at 40 and fully retired when he was 53. He has published six books and written more than 200 articles. Contact: 309-333-2865 or jwdentist@hotmail.com
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