The Well-Referred Dentist

The Essential Hidden Steps to a Profitable & Anxiety-Free Practice

Bita Saleh

• Publisher: Morgan James Publishing
• Year: 2019
• Print ISBN: 9781642795615
• eBook ISBN: 9781642795622
• Topic: Business
• Subtopic: Pharmaceutical, Biotechnology & Healthcare Industry
• Index: Business

The Well-Referred Dentist is a comprehensive guideline that helps dentists finally have the practice of their dreams.

In The Well-Referred Dentist, Dr. Bita Saleh addresses the missing factor that is essential to patient compliance in all stages of dental treatment by identifying and resolving the patient's "triad" of obstacles – their fears, anxieties, and limiting beliefs. As a highly-skilled and dedicated dentist for 30 years, Dr. Saleh has discovered an effective process to alleviate the triad of obstacles experienced by patients. Now, she shares her step-by-step program to show dentists how to:

• Quickly recognize the hidden signs of fear, anxiety, and limiting beliefs
• Discuss this sensitive topic with patients so they can reach a mutual resolution
• Resolve their patient's triad of obstacles in the most time-efficient manner
• Help patients requiring urgent care reduce their fears and anxieties by 35% in 4 minutes
• Create a customized plan for each patient that identifies and resolves the root cause of their issues
• Create an easy-to-follow maintenance protocol
  

CHAPTER 1:

My Story

I want to congratulate you for being here. For me, writing this book was about peeking around the corner every day and sending you a gift filled with so much gratitude. I want you to know that your patients will feel the depth of this gratitude as well. For the first time in their lives they will view you as their lighthouse instead of a house of horror that causes them fear.

Pursuing this profession for me was not by accident or something that I fell into when looking the other way. Ever since childhood I wanted to be a dentist.

Dentistry to me is a unique combination of art, science, and indescribable beauty. The following describes my love and testament for teeth in a way that only a dentist may understand. As I try to explain the story of teeth in the way that I have witnessed, I find that words fail me in my attempt to capture their uniqueness. The flawlessly efficient way that they function every moment of every day is only recognized and respected by those who understand their way. A significant part of their story includes the truth that they undergo insurmountable stress every day as their humans clench and grind in each and every way. They help us eat and speak and feel confidence in the world and yet we forget to care for them because that requires too much work. Despite the lack of care, they continue to faithfully serve without entertaining the thought of abandoning their post. They patiently tolerate being worn down by the bruxer, who endlessly abuses them throughout the night like no other. Oral health becomes fragile when overwhelmed with this negativity, yet its strength up to this point is nothing short of limitless courage and humility. Teeth are endlessly devoted as they continue to serve us until they can no longer stand the stress of being neglected. It’s a world within a world, dependent for its survival, upon loyalty and team-work within its intricate parts. Teeth support and rely on one another for the dance of occlusion to play out perfectly, similar to what musicians in a concert would do to create music together beautifully. They love to dance in balance where very little strength is involved, and yet when viewed as a whole, they’re a testament to their dedication to what true strength is all about. Even though each tooth seems fragile on its own, together their strength cannot be denied as a whole. Their beauty is subtle, not loud or crass and yet the beauty of a smile is entirely dependent on all the teeth in the pack. As dedicated as loyal servants, carrying the secrets passed down through generations, teeth are not afraid to use their power to set boundaries when misused or abandoned. As witnessed by anyone experiencing a toothache, the intensity of the pain created by a fractured or diseased tooth is nothing less than the devastation created by a gunshot through the head. Above all teeth are understood and loved only by a privileged few, who spend a lifetime observing, studying, caring, and adoring the details of their smallest curvatures, intricacies, and sensitivities so that they can speak their language, which is pureness and truth.

I have often wondered how could the dentistry that I love doing so much bring those who I have vowed to serve so much fear and trauma. Through the years I realized that there was a reason that I felt the traumas of every patient. As an empath, I had no choice but to find the courage to be in the trenches, experiencing the fear and anxiety of my patients. In order to save myself so that I could continue doing the dentistry that I loved, I had to figure out a way to save my patients, while they sat in my chair, from the trenches.

I was in my mid-twenties when I graduated from dental school. A one-year general dentistry residency followed and that’s where my most critical learning took place. It was here that I learned surgery and sedation and most importantly how to do it fast without loss of quality.

Some things in life stay with you forever. One such example happened one day when I walked into the oral surgery clinic where I was assigned and saw the waiting room filled with patients who needed their teeth extracted. There were three of us in the clinic that day. If no other patients were added to the schedule throughout the day, I estimated that we each had to do roughly three extractions every fifteen minutes, which meant fifteen minutes per patient.

My first patient was a lady in her mid-fifties who needed three surgical extractions. She had the deer-in-headlights look, which meant she was so nervous that she couldn’t find the words to express her fear or her needs. I slowed down to take the time needed to calm her down before applying a numbing agent. As I was comforting her, my supervising oral surgery resident stopped by at the doorway of my operatory and said: “You need to grow some hair on your chest.” I was surprised but not offended by his comment. I knew my patient was too frozen with fear to care so I just chalked it up to that being what was required of me there and so I started to numb the patient. The next time he stopped by, it was fifteen minutes later, at which point I had numbed the patient and managed to get all three teeth extracted with the help of my speedy high-speed drill. It was obvious that I got the job done as was evident by the tooth powder in the operatory; blood splattered everywhere, and pieces of bone and sectioned teeth scattered all over the tray directly in front of the patient.

He said, “Wow, you grew hair on your chest fast!” Soon after he departed, the patient asked if we were done and just as quickly as I said “yes” she fainted. Oxygen was brought in and the assistants took care of her as I walked into another operatory ready to anesthetize the next patient.

It broke my heart to have not had permission to be there for her, either before or after, the treatment. That day I learned that my heart and my ability to show compassion or to be present for a patient who clearly needed to be comforted, were not part of that day or any other day, at least while I was there.

It wasn’t until my one-month rotation in the jail ward that I – for the first and only time in my career - felt lacking compassion was useful. The patients awarded me the nickname “Dracula” because by then, I was well trained in hiding my compassionate side. I had to repeatedly stick patients with needles in an attempt to find a working vein to draw blood from.

The choices for a patient needing to undergo dental treatment were either local anesthesia or sedation. If a patient was not able to be cooperative, their dental treatment was scheduled in the operating room under sedation.

Private practice was not the same. The job I procured as an associate dentist in an established medium-size private practice a year later allowed me a few more minutes to develop a relationship with and gain the trust of the patients – however this had to be done quickly and efficiently. At the end of the day, my boss was concerned about two things: production/collection and profits. I did manage to change my boss’s viewpoint of me from being described as “she is very presentable” at the beginning of our working relationship to “she’s the best associate dentist I have ever had the pleasure of working with” toward the end of our working together.

I never took time off for holidays, never took shortcuts and always made sure that I treated each patient with respect while I delivered impeccable dentistry. I loved dentistry, I loved to learn, and I loved to serve, so much so, that I didn’t realize he was paying his hygienist more than he was paying me. I realized I knew nothing about the business of dentistry so I counted myself lucky to have been offered a position right after the completion of my training (even though I had to move to a city where I knew no one) and so I tolerated the low salary for one year until it became clear that our ethical values were so vastly different that there was no choice but to part ways.

This decision was not made easily. It was hard leaving a job that paid for my livelihood despite the unfair salary. However, I knew in my heart that being profitable should not mean compromising patient care.

The only way I knew how to create this type of culture was to own and operate my own practice. While I was looking for a small practice to purchase, I supported myself working for other dentists part-time and covering for emergency care at the local dental society.

Finally, after six months of searching, I found a small practice where the owner was retiring. The purchase went quickly and suddenly I found myself being handed the keys to a small dental practice where the furniture, the paint and the equipment had not been renewed for at least thirty years. But that was all I could afford, and I wasn’t complaining.

I remember the moment that the previous owner handed the keys to me and left. I looked around and took in the old musky scent of the place, walked into my tiny private office and burst into tears. I allowed myself the feeling of being overwhelmed for only a few intense minutes. I quickly remembered the old saying: “you need to grow hair on your chest.” So, I pulled up my big doctor pants and walked out of my tiny private office into what was now my dental practice. It was a good thing that I didn’t allow myself more time to wallow because soon after my first patient stormed in, in a state of panic, with her recently cemented crown in her hands. After evaluating the tooth, it became apparent that there was no sound tooth structure existing above the gum line. This crown should have never been made with these existing conditions. Discovering this truth for myself was a hard pill to swallow but telling this to the patient who had recently paid for a crown, were two vastly different terrains in a mountain of “supervised neglect” that I had to learn to claw my way through.

There were many other patients who came in with similar situations who I had to deliver similar bad news to. Instead of placing blame where it was needed (that being the previous dentist), they walked out thinking I was the one milking them dry of all their money. This is the amazing part that I want you to pay very close attention to. This is where the first face of fear emerges. It is called “fear of change.”

As I did my best to describe to them why their recently completed dental work was failing, they chose to believe the retired dentist even though he was long gone. What he had accomplished, which was something I had not yet done, was establishing a trusting relationship with the patients.

For me, the first step toward accomplishing the development of a trusting relationship with these patients, involved realizing the power that “fear of change” had on people. They would rather continue believing that the guy who was their dentist for thirty years had their best interest in mind even though the evidence to the contrary was staring them right in the face. This was my introduction to witnessing “cognitive dissonance.”

The truth was that I was a highly accomplished dentist who knew dentistry and knew how to work fast. I was likeable with social skills that granted me the opportunity to be blessed with a large circle of friends. However, my patients saw me as a young pretty little thing who had just gotten out of dental school with a lot of debt. I often wanted to scream, “that’s not why your mouth is falling apart.” The reality of what I didn’t know yet, was how to recognize the signs of fear and anxiety and how to deal with it.

My pitfall was not lacking the knowledge to be an extremely competent dentist, but instead was lacking the knowledge to recognize the signs and how to effectively interact with patients suffering from dental fear and anxiety. If you asked me anything about dentistry, I was able to confidently give you the correct answer. I was able to create the most comprehensive treatment plans meant to bring the patient’s dentition to complete health. Unfortunately, these comprehensive treatment recommendations were often not accepted by patients and so remained as being comprehensive only on paper filed in the proper section of the patient’s chart. I learned that each time a patient asked, “how much will my insurance cover,” it really meant “I’m not accepting all your treatment recommendations and so I’m staying within the confines of my insurance coverage and limitations.” Therefore, my comprehensive treatment plan, instead of serving as a roadmap to healthy dentition for the patient, was slayed and sentenced to a future of existing as nothing but artwork on paper filed somewhere in the patient’s chart. I was really starting to wonder whether my training had taught me “fantasy dentistry” instead of “real-life dentistry.” In “fantasy dentistry” we were taught to do amazing comprehensive dentistry but in “real-life” we had to teach ourselves how to manage the obstacles of patient behavior before we could ever dream of doing the beautiful dentistry that we were taught.

A few years later I was volunteering at the California Dental Association meeting when I was invited to the “wise elders table” where that day’s speakers sat. Eagerly I accepted and prepared myself to catch the lifeboat that I was sure the sage advice of these elders would provide me. However, their advice consisted of learning more about dentistry and dentistry alone. I began to realize that helping patients with their fears and anxieties was something no one practiced or talked about. I wasn’t even sure myself at the time, of the great effect that patients’ fears and anxieties had on a dental practice, but what I did know was that I was tired of my patients not following my recommendations.

Not only did my patients remain unhealthy, but also the production and collection numbers in my business stagnated and did not improve. I went home every day exhausted after working ten-hour days while I took every word and every gesture to heart. I felt everything that my patients felt but I didn’t know how to help them. I wasn’t able to build a wall so thick that nothing could penetrate. It was as though I was born to feel everything. My personal life was minimal because I was always working, and these were the thoughts that kept me awake at night:

Why can’t I connect with my patients?

Why don’t they trust me?

Why don’t they accept my treatment plans?

Why don’t they see that I have their best interest at heart more than anyone else does?

What good is all my expertise in dentistry when I’m not given permission to do what I know best?

I love teeth but I’m not sure how to help the people those teeth belong to. What would it take to win these patients over?

I feel like I’m failing every day. I feel the fear and anxieties of these patients, but they don’t talk about it and I don’t know how to help them, even if they did talk about it. Because of this my overhead is through the roof and my business is not growing. These problems haunt me day and night. I’m afraid if I don’t figure this out, I’ll end up losing my practice. Why didn’t they teach us about this in dental school? Maybe I should have gotten a psychology degree before applying to dental school.

The answers to the problem of fear and anxiety were nowhere to be found. There was no training and no manual for this huge part of real-life dentistry. So not knowing what to do with the existing patients, I made up for it by spending a lot of money in advertising to bring in new patients. The new patients called and made appointments and came in, but again and again, the same fear and anxiety that I had no idea how to deal with showed its ugly head in the new patients – in a hundred additional different ways.

The truth was that I had to repeatedly remind myself that I was a great dentist. I had small hands and I was gentle and kind by nature, but what good was all that when my patients were too afraid to accept my treatment recommendations. As the thoughts mentioned above ran around in my head, every day I was frustrated that I didn’t have the answers to change anything. How do you change a patient’s inability to trust their doctor? Although I felt that the fears and anxieties of my patients comprised eighty percent of my practice, I did not have the knowledge base or the expertise to help them so that they could obtain dental treatment with ease and comfort. Regardless of how hard I worked, I often felt as though I had failed. There were many years at the beginning of my career where I had to walk on the edge. I wasn’t able to make enough money to pay my loans and overhead and was afraid that I won’t be able to stay in business. This was in a time when banks were not lending money to doctors in general, so life was tight. Because I was always working, I didn’t have time to socialize or have a personal life. I was frustrated that I couldn’t do the dentistry that I was trained to do. Something I had worked so hard for most of my adult life was now making me unfulfilled and unhappy. I felt that if I knew how to help patients with their fears and anxieties then they would accept all my treatment recommendations, they would not cancel or no-show for their appointments and they would not be so dependent on their insurance limitations and coverage. As a result, I would be able to make enough money to pay my bills, grow my practice, and have enough time to have a personal life. I didn’t want to instead be married to a practice that consumed every second of my life leaving me exhausted, drained, and unfulfilled.

With the passing of each year I became busier and, and as a result, my earnings increased. And as I gained new patients, their fear and anxiety followed. Each evening when I went home, I was drained and exhausted with no hope that this problem could or would ever change. I figured that this is how it’s supposed to be. This is what owning a dental practice and being responsible for patients looks like. This is how it’s always going to be. With this realization came much despair because the future did not look satisfying as long as the problem of fear and anxiety remained unsolved.

I have traveled down the road that you might be traveling right now. It might be slightly different but it’s nevertheless the same. After travelling down this road for many years I realized I had to go back to school to learn what I had never learned in dental school. I had to learn how to help my patients resolve their fears and anxieties. I knew that for someone like me who wasn’t able to build a wall of protection to block out my patient’s negative feelings, travelling on this road would be much harder. As I shared my frustrations with others it became more and more clear that these feelings were shared by many other dentists.

This was not an easy decision to make because committing to a decision like t...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Table of Contents
• Introduction
• Chapter 1: My Story
• Chapter 2: Roadmap to Clearing the Triad of Obstacles: Fears, Anxieties, and Limiting Beliefs
• Chapter 3: Recognizing Fear and Anxiety in Patients Determines the Difference Between a Good vs. a Great Dentist
• Chapter 4: The Different Ways That Trauma, Negative Beliefs, Fear and Anxiety Affect the Patients in a Dental Practice
• Chapter 5: Gain Permission from the Patient to Treat Before Beginning Treatment
• Chapter 6: Proper Preparation of the Patient in Advance of Their Session
• Chapter 7: Muscle Testing Is One of the Most Reliable Ways of Discovering the Truth
• Chapter 8: Centering
• Chapter 9: Meridians
• Chapter 10: When Wanting and Doing Are Complete Opposites
• Chapter 11: Creating a Customized Meridian Sequence – from Blockage to Free Flow
• Chapter 12: The Story and the Homework
• Chapter 13: Case Studies
• Chapter 14: Four-Minute Protocol Reduces Dental Anxiety by 35 Percent
• Chapter 15: Operation and Ethics for Dentists Treating Dental Fear and Anxiety with Energy Psychology Methods
• Chapter 16: Obstacles
• Conclusion
• Acknowledgements
• Thank You
• About the Author