Exceptional Dental Practice Management

Sometimes We Forget

I saw this video today and I realized that sometimes I forget how lucky I am. When I see a video like this and I think about the very small things that I let bother me, I realize that I need to remember to put things in perspective more often. Sometimes we just need to be more aware of the path our thoughts and emotions are taking and stop for a moment to monitor ourselves. Look at the kids in this video, they are full of the hope to overcome their very serious problems. Look at the doctors and nurses and the love and joy they bring to their work. They are all proud of the way they are facing their challenges. They have learned what matters. Think about the things we get upset with over the course of a day. Our boss says something that we think may have been a little insulting and we pout or get quiet hoping he'll ask what's wrong so we can let him know we're offended. Or another staff member is kissing up and it just drives you a little crazy. One person isn't pulling her weight and look, that one is texting her boyfriend. Tragic? No, just annoying if you focus on it. In all honesty, whether we like it or not, it's part of the human condition. People do things they're not supposed to do, not everyone sees things as we do, speaks as we speak or works like we work. It's ok. Fix what you can and learn to accept the rest. If you find yourself getting annoyed, just hum "Stronger" to yourself and think of these kids. They'd love to have your problems instead of theirs. In memory of my brother Charles Otranto who fought his brave fight against cancer until December 5, 2011.

Watch It!

"Watch your thoughts, they become words.
Watch your words, they become actions.
Watch your actions, they become habits.
Watch your habits, they become your character.
Watch your character, it becomes your destiny."   ~Unknown~

Sometimes we're careless; and we tell ourselves it's no big deal.  It is a big deal.  It's a big deal that affects you as we as others.

Watch your thoughts.  How often do we notice that persistent voice that plays in our head throughout the day.  It may go something like this: "Why is she doing that?  That's really annoying.  She always does things like that.  She drives me crazy...."  And it goes on and on all day in there.  The fact is we can't stop the first thought from entering our mind, but we can direct the path that the next thought will take us on.  We can assume the best, hope for the best, and expect the best.  Which leads us to:

Watch your words.  Words can become weapons, they can fly out of our mouths and sting and cause damage for days and weeks to come.  They can cause irreparable harm.  The real danger is that once untamed thoughts are verbalized, we can begin to believe and become dedicated to them.  Which leads to:

Our actions.  Watch your actions.  Your actions become the next layer of building the story of who you are, so make them good.  What seems like a good idea in one moment, can be a disaster when acted upon.  Actions, be they good or bad, become:

Your character.  Your character is who you are.  Really.  It's not who you think you are, or who you'd like others to think you are.  It's the reality of you and it leads you to:

Your destiny.  You built it and it began with your thoughts, which lead you to speak the words you spoke, good or bad.  Remember you had the choice.  You led yourself down the path to happiness or the road to hell.  You make yourself who you are.  And that's the best news there is.  You make yourself who you are.  Every minute.  You still have a chance to make yourself who you wish you were.  

The Enemy of Excellence

"Minimalism breeds mediocrity.  It is the destroyer of passion.  Minimalism is one of the great character destroyers of our time.  It is the enemy of excellence and a cancer on society.  The problem is, culturally we encourage minimalism."        ~Matthew Kelly - The Rhythm of Life

It's hard to get people to do what you want them to do, isn't it?  Life seems to teach you that you're not going to be able to get others to work to the level of excellence that you'd like from your employees.  You start out with high ideals and then reality sets in and you begin to lower your expectations.  After all, not everyone is raised the way you were, not everyone is as passionate as you are, and let's face it, your employees don't benefit financially as much as you do, so how can you expect them to give so much?  If that's what you tell yourself, you've given up.

In The Rhythm of Life Matthew Kelly discusses the effects of minimalism on individuals and society in general.  He says that minimalism eats away at character, therefore impacting society negatively, and creates low self-esteem as the consequence not of failure, but of not even trying.  "A person gripped by the mind-set of minimalism becomes very self-seeking and contributes little to the common good..."

What is the mind-set of a minimalist?  "What is the least I can do?  What is the least I can do and still keep my job?"  We see this all the time among staff in a dental practice.  You have your A-players.  They are your best staff members.  They're the ones you know you can depend on to go the extra mile, give a little more, work a little later, keep at it until it's done and done well.  You don't even have to ask, they see what needs to be done and they do it.  

Anything else is minimalism.  I don't see any middle of the road between striving for excellence and anything less.  You can't strive for mediocre any more than you can strive for just enough.  Striving means working toward a goal.  The least I can do to get by is not a goal, it's merely survival.  It's clinging to someone else's best and hoping they'll carry you along, too.  The problem is, there's no satisfaction in it.  Sooner or later, resentment will creep in.  The person who has passion in her work will get sick and tired of the one who is dragging them, and the rest of the team down.  They will lose respect for the person who is supposed to uphold the standards and pretty soon they'll either lose their passion and forget about excellence, or they'll move on to another place where passion and excellence mean something.  The minimalist is also going to become resentful of the hard worker.  Come on, if she didn't work so hard, the minimalist wouldn't stick out like a sore thumb.  It's amazing how much effort the minimalist can put into discouraging someone else from striving for excellence in order to be able to keep giving so little to the job.

I remember someone once telling me, "The devil you know may be better than the devil you don't know."  In other words, "if you think this employee is bad, just wait, the next one may be worse!"   For a short time, that thought paralyzed me.  I found myself hanging on to employees that just could not meet the standards we expect in our practice.  I worried about patient perception concerning turnover, and I worried that the next person would be less capable than the one they were replacing.  I heard other managers voicing the same concern for their practices.  Then I realized that this fear was actually supporting minimalism.  If we allow fear to keep us from striving to build our practices with people who strive for excellence, aren't we guilty of minimalism ourselves?  We have to have the courage to do the unpopular thing.  Patients may lament about the sweet front desk person you replaced, because that's the extent of their experience with her.  You may dread training a new employee because it takes a lot of time and effort, but that's what excellence demands.

Strive for excellence in yourself when interviewing and hiring.  It's easy to be taken in by someone with a great personality, wonderful appearance and who says all the right things.  Let's face it, it's easy to say the right things.  The answers that an interviewer would want to hear are pretty obvious.  You have to verify everything.  Call references and call past employers.  Don't brush off intuition or a feeling that something isn't quite right.  Do the work at the beginning to give yourself a better chance of hiring well.

"What is the most I can do?"  Begin by asking this of yourself and then ask it of everyone else.  What is the most you can do?  Listen carefully for the answer and therein lies character and passion.

 

The Character of a Hero

I just returned from visiting my brother Charlie in Pennsylvania.  Charlie is my big brother and he's fighting his sixth bout with cancer.  He started his fight when he was in his early 20's.  That was back when they didn't know much about how to use radiation so they gave a lot of it.  As a result, Charlie has dealt with radiation poisoning ever since.  About 12 years ago he was diagnosed with stage 4 malignant melanoma on his scalp.  He went through some pretty rough surgery and seemed ok for a long time, so he got back to his life.  Three years ago he was coughing a lot and went for a check-up.  The melanoma had metastasized to his lungs and esophaegus.  He just finished his third round of chemo.  He's wiped out and his breathing sounds horrible.  His coughing fits are nerve-wracking and scary.  He never complains.  He never says much about feeling sorry for himself.  He brushes off the worry that we have for him and gets on with life.  He worries about the rest of us.  When I was there this weekend, he kept trying to entertain me with outings.  Walking down the hall is an effort, and he's worried that I'm bored.  I was happy to just spend time with him.  He talks about the things and people that matter to him and it's all very simple.  His family and friends matter.  His cat Bandit and his dog Pudge matter.  His love appreciation for his wife and sons is immense.  Making sure that everyone is ok matters to him.  He's the patriarch of this family and he's in charge.  He may have cancer, but cancer will never have him.  It's all so simple.

How often do we forget how simple life really is every day?  We get so worked up about cancelled appointments, staff mistakes and other things that don't really matter in the long run.  What matters in the end is people.  It matters how you care for them.  It matters how you show them you care.  It matters how you make them feel when they're around you.  That's what's important.  You may be thinking that it's easy for me to say that, I don't own a practice, so I can't possibly care like an owner does.  Well, if the practice doesn't do well, I'll be out of a job, so you bet I care.  What I know is this:  If you treat people right, both staff and patients, the practice will thrive.  If you are a staff member and you give it your best and keep trying to improve, work with your boss as an asset, and treat your patients well, you will thrive with the practice.  

What happens when we give in to self-pity and exaggerate every negative thing that happens?  We become victims, helpless to help ourselves.  What if we give into frustration and lose our patience with our staff and patients?  Everyone suffers and the practice does, too.  It's easy to fall into the trap of negativity and victimhood.  Maybe it's just as easy to focus on the positive.  It may just be a matter of consciously trying to see what's good, rather than worrying or complaining about problems.  It will at least make us easier to be around.  Or, like Charlie, we may inspire everyone around us and fill them with pride.  Try this the next time you feel over-worked, over-stressed or misunderstood: brush it off and get on with life.  You might be surprised at how easy it is to do, and how much more pleasant life can be without all the drama.

Do me a favor, next time you feel yourself getting annoyed with someone at work, stop and say a prayer for Charlie Otranto.  I bet when you're done, you'll feel less annoyed.  At any rate, Charlie would like to know you're praying for him and it would make me happy, too.  See, a lot of good can come out of ingoring a little bad that really doesn't matter much anyway.

 

 

Bully

When you read the word bully, who do you think of?  We've all had a bully in our life, whether we realize it or not.  Bullying can be as obvious as name-calling or intimidation, or as subtle as disappointment or disapproval.  Let's look at the obvious first.

Most of the time bullies are pretty easy to spot, even when they try to disguise themselves by acting as if they are helpful, or sharing critical confidences about others with you.  I remember working with two women who could never pass up an opportunity to gossip about someone else, including each other.  They made life miserable.  The problem is, often a bully can be nice, and even enjoyable to be around.  It's when you turn your back that the knife will be inserted, even as your heart is being blessed.  Every now and then you may think that you've made some progress with a bully, only to be blind-sided when they get you again.  Unfortunately, bullies often drive good employees away.  They erode their self confidence and try to stunt their growth and progress in the practice.  Why?  Because bullies are insecure and can't stand to see anyone else do well. 

The benign bully may not even realize that they are intimidating someone else.  This type of bully usually just wants to control someone else.  Guilt is the weapon of choice for a subtle bully.  They use guilt to keep people in line and make them think like they think.  Got a complaint? You'll wish you kept it to yourself.  Feeling overworked? Did you forget how lucky you are to have a job?  Shame on you!  The guilt bully will teach you.  You'll learn how to repress your feelings, swallow your opinions and make you wish you'd never opened your mouth.  They're counting on your work ethic, decency and love of your job to keep you coming back for more.  How do you know if you're dealing with a benign bully?  You change your mind, your story, or your request when you really don't want to, just so they'll be happy with you.  Benign bullies can be great people and lots of fun to be around.  You'll know it's them when you express dissatisfaction and rather than finding a solution, or allowing you to vent and get their opinion,  they act wounded or try to invalidate your concern.

Ok, here's the tough part, look in the mirror.  Chances are you are looking at someone who has bullied someone else at some point in the past.  How do you rate yourself on a scale of 1-5?  It's hard to say it, but I fall somewhere around a 3 on the benign bully scale.  I'd give myself a zero on the more deliberate bully scale.  That doesn't let me off the hook though.  I'll need to watch any comments that induce guilt. 

So, what can you do if you're feeling a little squirmy right now because you've realized that you have some bullying tendencies?  First, if you're a mean, deliberate bully, knock it off.  You hurt people and make them feel insignificant.  They don't like you because of it, so you're hurting yourself, too.  You have to make a conscious decision to change, and it won't be easy.  You should be encouraged by the reaction you'll get, though.  Most times, a person who's been bullied will gladly accept better treatment.  They'll embrace the new you and welcome an improved relationship with you.  They'll be surprised, but they'll usually quickly adapt to the change. 

What if you're being bullied?  Approach the bully and ask them why they are acting that way.  Ask them to stop.  If they don't, ask your supervisor or manager to help you work toward a solution.  Be objective, just state the facts.  Be willing to face the bully, don't just dump the problem on someone else.  Honesty and openness are the best weapons to combat bullying.  Stand up, try to affect peace, and then move on with your life.  If the bully changes, that's good for both of you.  If the bully stays the same, that's their problem.  You know who you are, be secure in that.

Finally, what if you are a manager who has a bully on your team?  Don't turn a blind eye.  If you do, you're letting someone down.  Don't let it play out, letting a bully have extra rope won't hang them, but it will trip everyone else out.  Being a manager means accepting leadership.  You are asking others to follow you.  Don't just lead the ones that are easy to lead.  Make a real difference and lead bullies to a better way.  Everyone will thank you for it, maybe even the bully themself.

The Dignity Of Discretion

A reader commented on a post I wrote recently.  She said that she just went to work in a dental office at the front desk.  She was surprised, and I think dismayed, at the amount of personal information her office manager discussed throughout the day.  She said she is 50.  I'll turn 52 next week and I've noticed the same thing and I wondered if it's a generational thing.  I don't remember co-workers being quite as open about their personal lives when I first started working 34 years ago.  I do think that people share much more than they used to at work

Here's the problem: when you tell too much at work, you are inviting people to judge you.  I remember working with a very pretty young woman a few years ago, who seemed compelled to report on her personal life every morning.  It got to the point that staff members were waiting at the front desk for her to arrive so they could hear all the details of whatever she had done the night before.  Now, these details were extremely personal, always racy, and often demeaning, even though she didn't seem to realize that.  It started to bother me to see what it was doing to our staff.  These nice, very down to earth ladies were becoming voyeurs.  A voyeur is defined as  an obsessive observer of sordid or sensational subjects.  Not what I wanted to see our staff dissolve into.  My first step was to talk to our staff members and help them see how they were contributing to her degradation by encouraging her to talk about these things.  Once they realized what was happening, they agreed to stop their part in it.  I then talked to her and told her that they weren't asking because they admired what she was doing.  They were titillated by it.  She was becoming a living, breathing soap opera.  She seemed to get the picture and said she'd stop.  Within a week she was talking again.  I realized that it made her feel important.  She didn't have anything to replace it with that would enable her to reproduce the feeling of popularity and importance she got when she opened the door into her personal life. 

I've noticed that people get competitive with this kind of talk.  They seem to have a need to top each other with something more bizarre or shocking.  It escalates because no one objects, no one says, "Enough."  Even when we know it's wrong to encourage someone to talk in a way that demeans them, we want to know more, we want to be shocked, maybe we want to feel superior.  When we urge someone to tell more, we need to stop and ask ourselves why we are doing that.  We need to learn to tactfully guide the conversation to a more dignified subject.  I know I sound like an old fart, but that's ok, as long as you believe me and do the right thing. 

It's a bad feeling to go home and know that you've revealed too much about your personal life.  Once it's out, it's out.  What you put out about yourself, is the information that will shape people's opinion of you.  If you want to be respected, use discretion.  If you want to be interesting in the long term, use discretion, leave them wanting more, rather than giving them something to talk about. 

You: Ethics Czar

   

Why not?  If not you, who?  Bruce Weinstein, Phd., emailed me about an article he had written for Business Week titled We Need An Ethics Czar.  You can, and I hope you will, read it here.  I'll paraphrase and build off of it, but go check out the entire article yourself.
    Why should you be an ethics czar?  First, if you have accepted a leadership role you are in a position to set standards.  Make them high quality and live them.  Everyone should see themselves as leaders in what they are doing.  If you are in a management position, you should inspire that in those you lead.  There is no honor in riding reign over a group of people who need you to dictate their every move.  A good leader gives others confidence and as you read the article you will see that's true.  So here are Dr. Weinstein's code of conduct for ethics czars.

1. Lead by example - always be honest, even if it's a hard truth.  React to stressful situations with compassion rather than hostility.  Own your mistakes, don't blame others.  I think we often act like things are ok when they are not and then feel angry at staff for not seeing what we need them to do or change.  Pent up frustration leads to hostility and before we know it blame.  Better to sit down with a staff member and be honest, listen and find solutions and build a better relationship.  On the flip side, if you are the person who is hearing a hard truth, be big enough to understand that someone is trying to help you succeed and listen and try to find a better way.
2. Praise generously - we forget sometimes that people need to hear they are doing a good job.  I once worked for someone who could not give praise, or wouldn't.  I give a lot in my job and I like to hear that I'm doing good.  A consultant told me that it was needy of me to want that.  If that's true than human beings are a needy lot.  People will work harder and better when they get verbal feedback.  Sometimes the opportunity is missed or the need is not noticed.  I recently had a staff member email me about a mistake I didn't know they'd made yet.  She said it kept her awake all night.  My response was never to lose a night's sleep over something like that.  We will fix it.  It did give me the opportunity to tell her that I admired her dedication and hard work though.  We don't always know the heart's of our employees and I think that often, care more than we think they do.
3. Criticize to build up, not break down - this is a biggie.  No one comes to work hoping to do a bad job.  Some might come just to get through the day and collect a paycheck, but that's where your ability to inspire can make the difference.  Shaming generates resentment, teaching inspires gratitude and respect.  So, you choose, do you want to walk away from someone who is fantasizing a horrible, slow death for you, or would you rather they are filled with a nice warm feeling about what a great person you are? 
   
4. Be Kind, Unwind - often we find ourselves trying to pull more and more effort out of our employees.  We need to remember to spend time building celebrations and lighter moments into the days and weeks.  Pay attention to birthdays and special days and celebrate them.  Take the staff to lunch  or make lunch and bring it in, just to say thanks.  Now, here's the tough one for many of us.  Take time to relax, youself.  I know that I will become tense if I don't find time for outside interests.  There comes a point when you have to turn out the light and believe that you will have another shot at it all tomorrow.  Now, go home a live the other parts of your life. 
   
5. Punish fairly - make sure that you take any emotion out of it when discussing a mistake or problem with an employee.  One thing that my boss is good at considering is intention.  Many times errors are not a matter of intention.  Sometimes people just don't have as good an ability to think on their feet or prioritize as we'd like them to have.  They aren't bad, insolent or insubordinate, they're just different than you.  Teach them and work with them and try to show them how to do what you want them to do.  Be objective.  Now, if there is a matter of poor behavior, deal with it in a way that reflects the punishment that fits the behavior and be consistent - 'this is what happens when anyone does this' and make it the same for everyone.
6. If it's to be, it's up to thee - step up to problems and deal with them.  Don't avoid awkward or uncomfortable situations.  Set standards and stand up for them.  Often, others are counting on you to do that and are relieved that you will. 

    If you want an ethical workplace, build one.  If you want an ethical world, work for it.  It starts with you.  And me. And her, and him and them.  Spread the word, that's a start in itself.

Living In Person

   

Do you live life in person?  What I mean is this; Are you the person you want everyone to believe you are?  Are you really you, or do you show the world one persona, yet harbor a lot of angry or ugly thoughts in your heart and mind.  Down here in the South we have a saying for it, it's called 'blessing your heart while stabbing you in the back."  The problem is that Southerners aren't good at hiding what they're really doing, so everyone knows it when it's happening.  Back up North it's less subtle, it's more like, "Hey, you talkin' to me, do I have to teach you a lesson?"  Ok, so I've been watching too much Godfather and Rocky and it's taken me back to my childhood.  Sorry.
    Anyway, are you who you seem to be?  Please tell me you're not one of those people who talk behind a co-workers back with another staff member, and then fall dead silent as she approaches.  Duh, she knows that you're talking about her.  And let me tell you this, it hurts her.  Is that what you get up in the morning and go to work to do?  Is that what your boss was hoping for when he hired you?  Is that who you are inside and who you want to show to the world?  I don't think so.  I think you're jealous and you're trying to bring that person down to where you feel you are. 
    I was once the person who walked down the hall and heard the conversation abruptly stop.  I had my heart blessed and my back stabbed.  Ouch, it really does hurt!  And it was all because I was living my life in person.  I like to work hard and do a good job.  It's a part of who I am. I can't work any other way and I don't look around to see what everyone else is doing. ( Well, actually, now that I manage the practice I do have to keep track of what everyone's doing, but I don't compare myself to them.) Some co-workers don't love seeing someone else work hard because they judge themselves against others and it makes them envious when the boss recognizes a hard worker.  Rather than work harder themself, they try to make the other person stop living life in person.  They try to make them ashamed of their own work ethic. 
    Are these co-workers bad?  Probably not, they are just making the mistake of judging themself against someone else, and that breeds jealousy and an unhealthy type of competition.  They can't live life in person because they've done this so often, they can't find themself anymore.  They can't live life in person if they don't know who will show up.  They live life in reaction and they lose themself in the process. 
    Are they doomed to keep repeating this with everyone?  Not necessarily.  Let me tell you something, they are miserable.  They don't really enjoy being this way, even if it seems so to their victims.  They are experiencing inner turmoil that feeds and grows upon this very behavior.  They can either decide to stop themselves, or someone can insist that they knock it off or leave.  Here's how they can find out who they are.  They can begin to judge themself against themself.  They can take a look at how they performed and behaved yesterday and decide to improve on that today.  Once they begin building upon themself, they won't need to drag anyone else down.  These aren't bad people, they just got off track somewhere.
    As a manager or leader, don't give up on them.  Find a way to discover who they really are and help them see it, too.  Let them know you see their good points and call them on their unacceptable behavior.  That requires living your life in person rather than just fuming about it until you get fed up and fire them.  That requires living life in the here and now.

It's The Best I Can Do, I Can't Get Any Better

    This is a scary sentence.  It tells me that the person saying it is finished.  They aren't a work in progress.  They've settled, given up, thrown it in, whatever, they aren't going to try to improve or learn.  I had a team member say this to me once, and I realize now that it was the beginning of a process that was leading to "I quit."  It took me a long time to realize that she was in the process of quitting when she uttered those words.  The reason for that is, she had quit on herself.  It just wasn't worth it to her anymore.
    My daughter is studying to be a certified Yoga instructor. She practices Iyengar Yoga. At dinner this evening she said that she was taught not to praise the students in their poses too much.  The reason?  They can always make an adjustment that would make the pose better.  They are never finished adjusting, improving or changing.  That's how I 'd like staff to think of themselves.  Praise them, but always encourage them to keep reaching.  I have used too much praise with a new employee in the past, only to find that six months or a year better she was still at the point close to which she began.  For her part, she was wondering what happened, why did all the praise stop?  Why was I telling her she needed to become more efficient?  Why was I pushing her to develop new skills?  She had been given the feeling that she was close to perfect.  She didn't understand that excellent at six weeks is not the same as excellent at one year.  That's why it's wise to be prudent when praising.  People need something to strive for.
    I can't do any better really means, "I don't think this is important enough for me to do the work to improve.  And for some things, maybe that's right.  For other things changing and improving are crucial.  First of all, it keeps us on the cutting edge.  It also keeps our interest up.  Finally, it gives us more job satisfaction.  We avoid burn out and stimulate our thought processes.  If nothing else, it's the right thing to do.  Our team counts on it and so do our patients.  Don't confuse the best you can do in the moment, with the best you can ever do. We can all keep getting better and better.

Rights and Responsibilities

We've gotten to the point where everybody's got a right and nobody's got a responsibility.
                                                                               ~Newton Minow~

      If you spend any time out of your house and around other people, you may have noticed that people are very quick to talk about their rights and what they've got coming to them.  But...if you ask these same people to take responsibility for something, they have a million reasons why they just can't.  Of course, there are those who are willing to step up and take responsibility, but they can be few and far between.

     It's the same in dental practices with both staff and patients, sometimes.  Let's talk about patients first.  So many times we face the frustration of patients who know their rights, but then won't take responsibility for their own oral health.  Think about the patient who refuses x-rays, but then glares at the dentist when he finds out he has undiagnosed interproximal decay.  Or the one who won't crown a molar with multiple incomplete fractures and a large amalgam, who is now asking why you didn't do something sooner, when she is sitting their with most of that tooth in a zip lock bag on her lap.  Can't you just stick it back on with something?  Whose fault is it? 

     Now let's think about staff.  How much time is wasted in your office trying to determine who should be responsible for tasks?  The front desk may think she doesn't have to help take out the garbage because she doesn't work in the back.  Or maybe the hygienist thinks that lab work is the assistant's job.  The assistant may think that she shouldn't have to help the hygienist when she's running behind, and on and on.  The entire staff may be very savvy about their right to be paid overtime, or to be paid if the dentist wants to meet with them over lunch, even if he's supplied the lunch, but may easily forget the times they left early or were given some other benefit just because the dentist appreciates them.

     Dentists, don't think I'm letting you off the hook, either.  How seriously do you take your responsibility to your patients and staff?  How about that patient that refuses x-rays?  Do you just avoid confrontation and let it go, or do you take the time to sit down with that patient and explain why x-rays are necessary?  Do you teach your staff how to explain the reason behind crown broken down teeth and all the benefits of treatment and consequences of ignoring these conditions, or do you just figure it's the patient's problem and they'll learn when they're holding their tooth in a baggie?

     Do you see your staff as co-workers, and your self as part of an interdependent team, or do you see your staff as somehow less than you?  What is your responsibility to them.  You expect so much from them, but can they expect anything from you?  Do you make sure that your expectations of them are clear and do you recognize the fulfillment of those expectations?  Do you handle it or support your office manager when an employee is not doing what they should?  Do you give and ask for feedback?  Are you considerate of your staff's time and do you thank them when they go beyond what is necessary in response to what is needed.

     All of these things work best when people understand that they have a right to be responsible for themselves.  Just going to the dentist does not remove the patients responsibility for their own decisions about how they will take care of their teeth.  Just showing up for work does not fulfill your responsibility to your job.  Just writing out a paycheck doesn't mean you've done your job as a boss.  The only way to success is to be responsible, and to share responsibility in a way that creates symbiosis.  Work with the patient, work with the staff member or co-worker and work with the boss to make sure that the patient, the staff and the practice all thrive.  It's not only our responsibility, it's our right.  When we recognize the honor that lies in being responsible, that's when we desperately want that right.

Dr. Roy Shelburne's Nightmare Continues

In May I wrote about Roy Shelburne, a Virginia dentist who was accused, and has now been convicted of Medicaid fraud.  He will spend the next 2 years in a Kentucky prison.  He is to report to prison on August 20.  I can't imagine what he and his family are going through or what the next two years will be like for them.

I've been contacted by people who support Dr. Shelburne, as well as by those who feel that he is guilty.  I've read what both sides have to say and I've read both the news reports and statements made by Dr. Shelburne himself.  I've personally corresponded with Dr. Shelburne by email and was surprised to find a man who is sad, but not at all bitter, who is worried about his patients and his family.  I expected anger and cynicism, but found neither.  I believe he is innocent of knowingly committing any crimes.  As a manager, I know that staff makes mistakes and if I were to be held legally accountable for their mistakes, I'd probably be in trouble, too.  I imagine any one of us would.  People make mistakes.  After reading this interview on the Dental Economics blog with Dr. Shelburne, I am more convinced than ever that his conviction is wrong.

There is a fund that has been set up to aid the Shelburne family.  After reading the Dental Economics article and corresponding with Dr. Shelburne by email, I feel compelled to contribute.  I can't give much, I have college tuition to pay, but I will do something.  I've been fortunate to enjoy a wonderful career in the dental field and have been graced with generous mentors in the dentists I have worked with.  My contribution will be in gratitude to those dentists in the hope that one of our own will find any measure of relief in that gesture.  If you want to contribute or send words of encouragement to Dr. Shelburne you can visit Shelburne Aid to do so. 

Lesson From Randy Pausch - Part 3

"It’s very important to know when you’re in a pissing match. And it’s very important to get out of it as quickly as possible."   ~Randy Pausch~

We've all been in one of these pissing matches that Randy talked about.   You never feel yourself getting there, you become vaguely aware that you're in it once you are, and it's tricky to drag yourself out.  It's the patient who starts out by wanting you to do something for free.  This is always so affronting and it's hard not to get emotionally involved.  But, once you engage in back and forth, nobody walks away feeling very good.

Think about getting into a pissing match with a staff member.  I saw an attempt at one the other day when a staff member was contacted about a show of impatience that was unnecessary and rude.  Her response was that others had done it, so she thought it was ok.  When that explanation was deflected, she went on the give other reasons which were dismissed as soon as they were given.  Finally, she was told that she needed to take responsibility for her actions and just apologize.  Think of how much worse it could have been if the other person had gotten drawn into a debate.  By deflecting the excuses the problem was handled quickly and without drama.

When you feel like things are taking on a life of their own between you and another person, that's the time to look at what's happening and take control of yourself. 

Lessons From Randy Pausch - Part 2

"When you see yourself doing something badly and nobody’s bothering to tell you anymore, that’s a very bad place to be. Your critics are your ones telling you they still love you and care."  ~Randy Pausch~

We've all been there.  A staff member just isn't cutting it and you have to find a way to teach, lead and motivate them into better performance.  One thing that I find quite often is that people don't want to hear that they need to improve.  People react in all sorts of ways, too.  It almost always starts with defensiveness.  People love to hear what they're good at, so it makes sense to start with a few positive comments.  That opens them to listening to you.  Unfortunately, the door often starts to slam shut when the critical feedback starts, and that's what they need to hear the most.  I find it frustrating and unnecessary to have to deflect all that so we can get to the topic that really needs to be discussed.

When I read the quote above by Randy Pausch, it was the magic phrase that kept the door open.  When I was faced with an employee who wanted to tell me why I was wrong about her performance, I stopped her with that quote.  After a moment of uncertainty I could see that she realized the truth in that statement.  That's when we began to get somewhere. 

When someone has the courage to take the time to give critical feedback, it is a sign of caring.  It means that they believe in your potential.  It's not easy to give this kind of feedback.  No one enjoys telling someone else that they are lacking in their performance.  Having this quote to back you up can work wonders and pave the way for communication and improvement.

Lessons From Randy Pausch - Part 1

I wrote about the passing of Randy Pausch a few days ago.  There are many great lessons in his Last Lecture and I urge you to buy the book or watch the video, preferably both.  I want to take some of my favorite quotes from the last lecture and apply them to managing a dental practice.  Let's start with this:

"Have something to bring to the table, it will make you more welcome."

There are so many ways to apply that suggestion.  When you interview candidates for a position in the practice do you try to find out what they will bring to the table, or do you just try to seat them?  Just having earned a hygiene license or dental assisting certification isn't enough, they must bring something that will add to the team.  When you have a team meeting does everyone just show up, or do they bring something that will challenge, inspire or integrate the team? 

As a manager, do you just go about making sure that reports are run, people show up on time and patients are seen or do you bring something more.  Something that serves everyone and makes it easier for everyone to perform to their fullest capacity.

As a dentist, do you just examine, diagnose and treatment plan, or do you conduct a co-discovery with your patient and staff and educate the patient so that they can make an informed decision about their care?

There is a difference between just showing up and showing up with something more to offer.  When you show up wanting to give more than is expected, there will always be room for you at the table.

Randy Pausch Died Today

If you haven't heard of Randy Pausch yet, he was a professor at Carnegie Mellon University and the author of The Last Lecture.  He was a devoted husband and loving father of three and he died today of pancreatic cancer. What made Randy special wasn't the fact that he had pancreatic cancer, it was the way he took the time with what time he had left, to try to make us aware that it is important to respect the time we have and use every minute of it.

Professors at Carnegie Mellon are asked to give a lecture that would be what they would say if they knew it would be their last one.  Shortly after Randy agreed to give a last lecture, he received his diagnosis and with it, the knowledge that in all likelihood, it would be his last.  He fought and endured every treatment that offered hope, but he did the lecture to leave something of himself for his children.  In the process he touched the world and changed the way many think about how they use their time. 

Randy's message held up a mirror to anyone who heard or read it.  How do we think, what do we value, how aware are we of the fleeting nature of our time on earth with those who we love?  Randy talks about his childhood dreams and how many of them he achieved.   He talks about a coach who pushed him hard.  When the assistant coach talked to him about it he told Randy, "That's a good thing, when you're screwing up and nobody says anything to you anymore, that means they've given up on you."  Randy realized that "our critics are often the ones telling us they still love us and care about us, and want to make us better."  Can you see how pointing that out to a staff member you are trying to help improve could make a difference?  Randy would have liked to think that he inspired that difference.

Randy talked about running up against obstacles.  "Brick walls are there for a reason.  They give us a chance to show how badly we want something."  I've come up against brick walls many times in my life.  I remember thinking that it was unfair and that I was tested more than others.  I'll never think that way again.  I'll see brick walls as a chance to verify the honesty of my desires. 

I could go on about the lessons Randy gives us.  I don't want to take away your chance to watch the lecture or read Randy's book.  I suggest you do both.  Visit Randy's site and you can watch the video or order the book.  Knowing he was dying, Randy could have fallen into self-pity, he could have spent every moment of his last days with his family, he could have complained and railed at God and fate.  He chose to use his time making the world aware of our precious moments of time.  He reminded us of the precariousness of our existence.  He left his children a legacy that embraced all people.  He showed us that now is the time to live.

You're Not Alone In There

There's more than one of us in each of us.  Bear with me, I'm not talking about multiple personalities, I'm talking about the internal struggle that we often deal with.  We all have an angel on one shoulder and a devil on the other.  Which one do you listen to more often?

Maybe you're a glass half empty person, but guess what?  You could just as easily be a glass half full type of person.  You just have to choose to listen to that part of you, it's in there.  We all have the power to be optimists rather than pessimists, kind rather than cruel, generous rather than stingy, accepting rather than judgmental, it goes on and on.  You have the choice and you make a choice every time you act.  It's the one you choose that determines your character.  It tells everyone who you are. 

Most people act without examining the reasons and evaluating the likely outcomes of their actions.  Then they feel like victims when things don't go well.  We are only victims of ourselves when we make the wrong choices.  At the end of the day, you're alone with yourself and you know if you made the right choices and you have the opportunity to evaluate what works and to avoid what doesn't.  No matter what you can get others to believe about your intentions and motives, you know the truth and you will either rest easy or squirm. 

The Love Of Duty

Remember that it is nothing to do your duty, that is demanded of you and is no more meritorious than to wash your hands when they are dirty; the only thing that counts is the love of duty; when love and duty are one, then grace is in you and you will enjoy a happiness which passes all understanding.
                                                                         ~W. Somerset Maugham~

    When I think of our duty as human beings, I think our highest duty is living our lives to help others.  Some people hear the word duty and think of it as something that must be endured.  When they hear the word service, they think of it as something that puts one person below another.  They see duty and service as something they'd prefer to be on the receiving end of, rather then be the one giving.

    Others hear the word duty and feel uplifted.  They hear the word service and wonder if they are worthy and prepared to be of service.  Their imaginations immediately take over as they embrace the thought of helping others.  That is the grace that is in the love of duty. 

    That is the feeling that you have to experience to understand the joy that can be found in making someone's else's day, lightening someone else's load, or putting someone else's interest before your own.  As you watch the other person's reaction you realize that shared joy is more rewarding than a moment of solitary satisfaction.

    I have a friend that works for an oral surgeon.  She is a beacon of joy.  People are happy just to be in her presence.  Do you think she sees what she does as duty?  She sees it as no more than a way to live.  In living a life of kindness and happiness, she flourishes and creates her own circle of love.  Everyone loves her and she loves them right back.  Everyone wants to be around her and call her their friend.  She has the life she wants, and enjoys every minute of it.

    So why then are so many people unhappy?  Why do they see others as competitors rather than comrades?  What is it that they think they will risk by giving to others?  Giving takes patience.  The results may not be immediate, but with time, they will be undeniable. 

    When we help our co-workers perform better, we don't lose importance or status, we gain trust and appreciation.  When we go above and beyond for a patient, we earn their regard and respect.  When we accept the dentist's vision for his practice and adopt it as our own, we become part of a success story that benefits others.  That is grace and the reward is happiness.

   

Do It Anyway

 

Mother Teresa's Anyway Poem

 

People are often unreasonable, illogical and self centered;
  Forgive them anyway.

 

If you are kind, people may accuse you of selfish, ulterior motives;
  Be kind anyway.

 

If you are successful, you will win some false friends and some true   enemies;
  Succeed anyway.

 

If you are honest and frank, people may cheat you;
  Be honest and frank anyway.

 

What you spend years building, someone could destroy overnight;
  Build anyway.

 

If you find serenity and happiness, they may be jealous;
  Be happy anyway.

 

The good you do today, people will often forget tomorrow;
  Do good anyway.

 

Give the world the best you have, and it may never be enough;
  Give the world the best you've got anyway.

 

You see, in the final analysis, it is between you and your God;
  It was never between you and them anyway.

 

Working in the healthcare professional gives us the opportunity to come into contact with many different people every day.  Some are our patients and some are our co-workers or staff in other offices. 
So many times we go through our days reacting in kind.  If someone treats us badly, we get even.  If someone hurts our feelings, we retreat rather than try to understand what caused it.  If people misjudge us, we throw up our hands and walk away, rather than explain.
We don't, and won't ever understand what makes others do the things they do.  We can only be responsible for what we say and do.  I like Mother Teresa's message of taking responsibility for our own behavior despite the actions of others.  At the end of the day we are faced with only our own choices and behaviors in the mirror.  There's not much more comforting in life than liking what you see and feeling good about what you did each day.  Rather than living life in response, live life with intention.

Roy Shelburne, DDS Endures A Medicaid Nightmare

    I read the following story on Dentaltown.  It was written by Dr. Roy Shelburne of VA. about a living nightmare he and his family are experiencing.  It's long, but I hope you'll read his letter and the speech his son gave to his dental school class at VCU.  If you feel what is happening to Dr. Shelburne is a travesty, please write to the judge in his case before June 1. Contact information is provided.  You can find more ways to help here.  You can email the governor of Virginia here.

From: Roy S Shelburne

 

It is with great sadness that I am writing to inform the dental community that I was convicted of Medicaid Fraud and 9 other related counts on Thursday, March 6, 2008; 3 days before my 53^rd birthday and after 26 and a half years of practicing dentistry in a small town in southwest Virginia called Pennington Gap. I am writing to alert you as to what’s going on in the state and to warn you! This situation has devastated my life and my family. The guilty verdict carries with it a possible sentence of 120 years in prison and a monetary fine of 1.5 million dollars. I don’t mean to alarm you; however, I don’t want any of you to suffer the same consequence either!

You may have read about this case in your local newspapers or have seen it on the news.  There were many allegations regarding up coding, unnecessary treatment, multiple billings, and miscoding of treatment provided. There was also suggestion of physical abuse and cruelty of my patients, although there was no testimony to that effect. The truth is that I would never do anything to hurt a child or anyone else for that matter. None of the allegations are true! The government provided expert testimony that supported their position and we provided expert testimony that supported our position regarding the charges of Medicaid fraud and the related treatment provided. Of course there are two sides to every story and I don’t want to mislead you. We did make errors. Everything we did was not perfect. I admit to you now and admitted to the court that I made mistakes and my staff made errors. Nothing that was done by intension and nothing we did for our patients could be remotely labeled as fraud or abuse. I admit that we made errors; however, it is my belief that the decision made by the jury was not based on the facts; however, the verdict was made based on our lifestyle.  (How can a lay person sitting on a jury make a determination as to the appropriateness of treatment when the profession as a whole has great difficulty agreeing on what is appropriate when it comes to treatment?) The bulk of the government’s case was based on the fact that I operated my practice like a business. The government made their case based on the house I live in and the cars I owned. (During the course of the trial the prosecution showed the jury pictures of my home on more than one occasion. They even showed a picture of my daughter’s car as if that had a bearing on the allegations of Medicaid Fraud.)  Scary, huh?  Prosecution by lifestyle: as the government presented the jury with what was described as a “lavish” lifestyle.

The result of this case could have a profound effect on you and your practice of dentistry especially if you are now accepting or plan to accept Virginia Medicaid. This decision has set a precedent. From what I understand the government has used this as a test case. With their success, it is my belief that they will now take their efforts state wide. If you now take Medicaid or plan to take Medicaid in the future, you are now a target.

Because this case involved Medicaid Fraud, there were additional counts of Racketeering, Structuring, Mail Fraud, and Wire Fraud. These additional counts pertain to the alleged receipt of fraudulent monies from the act of Medicaid Fraud and this allowed the government to confiscate everything I owned and to place it under a protective order prior to being convicted of any wrong doing. On October 27, 2006, federal agents came to my home, arrested me, confiscated my vehicles, seized all my bank accounts and took control of everything I owned. Agents, at the same time, located my children in Charlottesville and Blacksburg and confiscated their vehicles as well. (I have a son graduating from dental school at VCU in May, a daughter in medical school at VA tech, and a Daughter at ETSU in the doctorate program in audiology.) I was transported by agents to Bristol Virginia in handcuffs and leg chains, spent the night in jail and was arraigned in federal court the next day. I entered a plea of not guilty and bail was arranged. My assets were placed under a protective order and only those things that I absolutely needed to live were made available to me a month later. Two vehicles were sold by order of the government, all bank accounts, business and personal, were emptied and the proceeds were put in a trust account. I had to pay for the transport of the vehicles and for the storage of the vehicles while confiscated, over $ 5,500. The government now has taken possession of this trust account.

We have requested that the conviction be set aside and are awaiting that decision. I have very little hope that the Judge will grant our request. We also hope to mount an appeal of the conviction; however, the appeals process must wait to be initiated until after sentencing.  I will be in prison during the appeals process. This is where I am.  Unless a miracle happens, I will be sentenced June 9, 2008. As mentioned before, the conviction carries with it the possibility of 120 years in prison and can carry a fine of up to 1.5 million dollars. Please pray for me and especially my wife and children who have been devastated in the process. Your letters could help in the sentencing process if received before June 1, 2008. (See below for the details if you are inclined to provide a letter.)

In the meantime, I want to make myself available to you to answer any questions you might have or to further explain the situation as I understand it. Don’t hesitate to call 276-346-3863. If you get the machine, please leave a message.   My email address is: roy_shelburne@yahoo.com. Contact me at your convenience and I will get back in touch with you. Everyone in the dental community needs to know what happened and that the same could easily happen to you.

In addition to putting the word out I need to ask for other help as well! I have had the pleasure of going to dental school with many of you; I have met many of you through the MOM projects in Wise and Grundy over the years, and some of you I have met in other ways. If you would be willing to write a letter of support of me to the court that could be helpful during the sentencing phase in June. I would deeply appreciate your help in this area. Furthermore, I ask that you talk to your colleagues and alert them as to what’s happened. You may direct your letters of support to:

Judge James P. Jones

Chief U.S. District Judge

180 West Main Street

Room 104

Abingdon, VA 24210

Please mail the letter directed to Judge James P. Jones to:

Dennis E. Jones & Associates

Attorneys at Law

P.O. Box 1237

1 Flannagan Ave.

Lebanon, VA 24266

Or you can attach your letter via email to:  dejones@bvunet.net

To be completely open with you, because of the enormous financial burden to defend this case I have nothing left to use in order to mount an appeal. My credit cards are maxed, my property has been mortgaged, my credit has been tapped out and I have nothing left in reserve; therefore, my fate has been secured. The inevitable result will be: I will be in prison and my wife and children will be left to fend for themselves.

As I have said, I do not want this to happen to anyone else! It will be my pleasure to answer any questions you may have regarding what has happened as well as suggestions as to how to best prevent it from happening to you. Beware! It is very possible that any one of you could be next! It is my understanding by comments made by the government during this proceeding that this case is just the first of many in the government’s effort to “clean up the Medicaid system”.

Thank you so much for your time taken to read this letter and for your concern.

Again, should you have questions or would like to talk, please call: 276-346-3863. My email address is roy_shelburne@yahoo.com.

 

Sincerely yours,

 

Roy Shelburne

Ross, my son’s announcement to his Dental class at VCU:

Ross will be graduating from the Dental School at VCU, May of this year and I thought it might be helpful for you to see what happened from his perspective. The following is his announcement from Ross to his class.

 

From Ross to the Dental Class of 2008:

 

I wanted you to hear it from me instead of the newspaper or word of mouth, etc.  If you're in a hurry, the first two paragraphs and the last paragraph should suffice, the rest are details.  I could have written four or five times more, but I think I got the point across through my ramblings.  I'll warn that I didn't have time to proofread. This should scare any dentist. I know it's scared everyone I've told it to.

 

I guess the easiest way to state this is just to lay it out:  My father, Roy S. Shelburne DDS (VCU class of '81), was just tried and convicted of 10 charges ranging from from healthcare fraud, wire fraud (in this case, filing insurance claims electronically), racketeering, money laundering, etc.  The maximum sentence would call for 120 years in federal prison and his license to practice dentistry was immediately void upon reading of the verdict.  He is the first dentist and (I've been told) only the second healthcare provider convicted of RICO.

 

The total amount of healthcare fraud (if you believe the prosecution's "expert" witness) was around $8,000 over the course of almost 5 years. Let me repeat that, a jury believed my father plotted and schemed to defraud Medicaid for $8,000 over 5 years...a period where his practice had production numbers well over two million dollars.  They also believed that over those 5 years my father also knowingly withheld overpayments by Medicaid, who in some cases neglected to reference the amount paid by the patient's primary insurance carrier, resulting in a benefit for a procedure being dispersed twice.  The total of those overpayments, over 5 years, was around $4500, again out of over two million $.  Both were (by the prosecution's own admission) based on circumstantial evidence.  The forms you submit to Medicaid to tell them to recoup the overpayment are commonly destroyed by Medicaid ~10 days after processing.  My father had an employee that was in charge of finance issues such as filing claims to private insurance and Medicaid, keeping track of payments, and sending forms for the return of funds to Medicaid.  There were copies of some of the forms used to inform Medicaid of overpayment involving procedures cited in the indictment in the handwriting of that employee.  Forms for all of the acts cited were not available, but despite a complete lack of hard/objective evidence to support the prosecution's claim of intentional overbilling, the jury found him guilty.  I still can't believe that with nothing but circumstantial evidence they were beyond a reasonable doubt.  A jury of 12 dentists would have had a good laugh and acquitted him in 30 seconds.  The wire fraud refers to a error on a electronically submitted Medicaid claim. 

 

 

It all began about 5 years ago when I got a call from my mother while I was in class saying that my father's office had been raided by the FBI.  My father found out about it while listening to a keynote speech at a Dental Conference in California when my mother asked, "are you sitting down?"  They confiscated every chart, every financial record, everything except the equipment.  It would be 3 years before they would indict him.  During those three years he was under constant watch by the FBI, who had agents that pulled my two sisters and myself out of class to question.  Sometime in 2006, they froze all of my father's financial accounts, seized all our vehicles (including leased vehicles), and came in the evening to arrest my father in his sweat pants and t-shirt while he slept on the couch.  They could seize all of this without a conviction because of the use of the RICO (racketeering law)...yes, the same law used against mobsters and drug kingpins. After 9/11 the interpretation of RICO became broader to give law enforcement a method of searching and seizing assets of lesser organized crime and terrorist cells.  The thought was that if you couldn't get a legitimate reason to issue a search warrant or indictment, RICO and the Patriot act would make it easier.  Most RICO indictments are settled before they start since any funds the defendant would have to put up a defense are frozen by the government beforehand.  However, we decided to fight.  My father was offered plea bargains but would never admit to something he didn't do, even if it meant going to jail.  It took them 3 years of review all those charts to scrounge up the circumstantial evidence needed to get an indictment.  During that time Medicaid did 3 audits of its own and in each stated that they found no irregularities in Dr. Shelburne's office that would warrant suspension of Medicaid or license.

 

The basis of the whole thing is healthcare fraud.  According to the government, if you receive funds by fraud (or apparently in this case) or by overpayment by Medicaid that is not recouped (even by accident) and any part of those funds is used to buy supplies, bills, etc you have committed money laundering.  What's more, the government doesn't even have to prove a "dirty" dollar is connected, they don't have to trace it.  It is sufficient enough to say there was an ill-gotten $ and it was spent.  If there was no healthcare fraud, then there was no dirty money and you can't launder clean money.  Their racketeering charge comes from them being able to classify the family business as an "Enterprise."  It was a family limited partnership setup by a firm that does them for thousands of families.  So, unbeknownst to me, my dad, mom, sisters, and I were a crime syndicate.  The same law used against the Gambino family.

 

 

 

The hardest part for me during the two weeks I've sat in on the federal trial, aside from hearing the verdict being read, was listening to basic principles and rules of dentistry and diagnosis being twisted and misrepresented throughout the trial.  The most outrageous to me being the basis of the prosecution's "expert" witness' evaluation of my father's work.  All the numbers are still a blur but I believe the total number of patients involved was less than 100, I think around 75.  For the majority of the reviews, all the dentist had available to determine whether treatment was warranted was pre-op radiographs and the progress notes . From the pre-op radiographs alone, she disputed with my father about the presence of either buccal, lingual, and occlusal caries and indication for treatment.  The prosecution used this testimony, where she stated caries was not evident radiographically and twisted it to make the claim that my father performed unnecessary work, based solely on the pre-op radiographs where caries was not radiographically evident.  She did have the opportunity to do an in-mouth exam in about 20 of the patients, a couple years after the work had been done.  In one such case, she stated she could only find 1 of 11 buccal composites my father had done, a subsequent review by another dentist noted that there were indeed 11 restorations, well color-matched.  So she missed 10 out of 11 when she did have access to a first person review.  I was also told that the conditions under which the examinations on behalf of the government took place were poorly lit, lack of instrumentation, and no magnification (loupes).  She also testified that a tooth was "like a house" with definite corners separating surfaces, that an overhang on a crown was a "like putting boots on a rooster,"  and that her personal philosophy towards preventative dentistry was to wait until a cavity was big enough to hurt, then treat it.  This witness had worked in the same clinic as some of the other local dentists that would testify. They even twisted our witness' statement that a restoration "was not clearly evident solely upon pre-op radiographic evaluation" to make it sound like "Dr. ________ said there was clearly no indication for treatment."  There were even professors at our school that had reviewed the charts and were going to testify on my father's behalf before the prosecution objected.  The only person that had access to all the normal diagnostic tools used for treatment planning/diagnosis, including the presence of the patient and their wishes, was my father. Everyone else that has reviewed the procedures in question only had the pre-op radiographs and in a few rare instances an in-mouth review post-op a couple years later.

 

Another local dentist testified that he had seen one or two root canals in a former patient of my father fail, but only one patient, whose oral hygiene had been previously charted as poor and was high caries risk. The prosecution used this to make the claim that 100% of my father's root canals seen by that dentist were failures...and I will concede that 1 out of 1 or 2 out of 2 is 100%.  Never mind that his endo failure rate over 22 years is well below the national average.

 

I also had to listen to the prosecution try and get a dentist to say that if a root canal is done properly and done well, it will never fail or need to be retreated.  The lawyer tried to claim that if a root canal was not "filled to the end, it was doomed to failure" as he pointed to a post in #11 on a panorex saying it was gutta purcha before my father corrected him.  Right after he asked why the lengths of fills varied between teeth pointing to how the root canals of #9, #10, and #11 weren't the same length (imagine different size teeth needing different lengths of gutta purcha).  Listening to them try and say a progress note that didn't contain every minute detail (i.e. not explicitly saying that an extension of an occlusal restoration onto a buccal or lingual via fissure meant that you were trying to cover for fraud).  I heard a lawyer and a dentist try and debate whether there was an absolute standard for determining where a mesial/distal surface became a lingual/buccal surface.  I've heard them argue that properly delivered crowns and restorations will never fail due to any other reason than doctor error.

 

Again, the expert witness' basis for necessity of treatment was pre-op BWX in the posterior, a panorex for any anterior areas that didn't have PA's, and a in-mouth exam under poor conditions 1-3 years post-treatment. 

 

Our expert witness was an insurance claims reviewer/investigator that reviews hundreds of charts a week.  Her review of the charts and patient in-mouth exams revealed around $100-150 in miss-billed treatment, compared to the ~$8000 of the prosecution's witness.

 

I have a complete transcript of the prosecution's cross of our expert witness, if anyone wants to laugh/cry at the inaccuracies about dentistry the prosecution tried to argue. 

 

 

I come from one of the poorest areas of Virginia, the southwest corner. A place where its common to be hated for being successful and prospering, even when it is deserved and earned.  The majority of the population lives near or below the poverty level and they hate anyone that doesn't.  The jury of my father's "peers" was made up of twelve locals ranging from farmers to mechanics, etc.  The words mesial, composite, and pulp chamber might as well have been Japanese to them. I could see their eyes glaze over whenever anyone would mention something about dentistry or any important factors in determining the presence of healthcare fraud vs. human error and bad notes.  The things they did recognize, however, were the pictures of our house, pictures of my sister's car that had been taken while she was followed by FBI agents, and stories of my family going on "lavish" vacations.  They made sure to emphasize words like "Mercedes" and even referred to my parents house as the "CAVITY CASTLE."  I believe the jury made up their mind the second they saw our house. To them, you can't have such nice things unless you stole the money to buy it.

 

I'm sorry to inform them, but their witness' claim of ~$8,000 of "up coding" over 5 years wouldn't pay for much of the vacation, house, and cars.  If were going to intentionally defraud Medicaid, wouldn't you do it for more than a couple hundredths of a percent of your revenue, or a couple thousandths of a percentage if you believe the insurance claims investigator.  And wouldn't you charge for nitrous if you were in it for the money?  (My father has never charged for nitrous, even through he could). 

 

They also chose to omit the parts in the progress notes where my father didn't charge for some services, even on the patients they were claiming he "took advantage" of.  They accused him of turning orphanage kids into "dental cripples" by trying to treat rampant caries instead of just do full mouth extractions.  Some of the patients included in the fraud case even came to testify that Dr. Shelburne was one of the only people that treated them with respect and care.

 

Disgruntled employees claimed he "only cared about money" based on the fact that he would make them come in early for morning "huddles" where they would discuss which patients would be coming in, what procedures were scheduled, etc so that they would be prepared.  They have huddles at Wal-mart and Home Depot.  Heaven forbid you would be prepared and ready for the day.

 

No other dentists in Lee County accept Medicaid, my father is the only one willing to accept the reduced fee schedule and care for them.  Now there are no dentists in the county that accept Medicaid, and I feel sorry for the children.

 

The prosecution even tried to say that my family going on mission trips to Honduras to give free dental care or a week and his contributions to the MOM project were selfish endeavors.

 

The government probably spent over a million dollars over 5 years investigating and trying my father over less than $10,000.

 

I have learned a couple things from this ordeal:

    -Y ou're not entitled to anything, even your own hard work (according to the government).

    -If you don't want to lose everything and go to jail over less than $10,000 in coding mistakes make sure your assistant, hygienist, or whoever writes the note including EVERYTHING.  (Speaking of which, an assistant described a lesion on a tooth as a freckle and the prosecution tried to prove that was not an indication for treatment). 

    -And finally, despite what common sense would tell you, the law is written in such a way that a "pattern" of two instances out of 100,000 claims for a total of $6 dollars overpayment can be money laundering if you ever spend a cent out of that account for something as innocuous as office supplies. 

 

 

There's a lot more to the story, and I might be a little bias but:  Anyone that has met my father and anyone that knows anything about dentistry when hearing the full story would know my father is innocent and doesn't deserve what he's been put through.

 

 

 

All of this brings me to yesterday, 3/6/2008:  the worst day of my life. After a two week waking nightmare of listening to testimony, truths, half-truths, and outright lies being spread in a federal court of law, the day came.  The jury deliberated for about 8 hours total over two days.  About an hour before it was announced that they had reached a verdict, they requested clarification of one of the jury instructions and we knew it wasn't going to be good.  Hope eroded and reality took its place, they were going to take my dad away.  I sat with my family and prayed.  The hour between the jury's question and their final decision was agonizing.  My little sister in denial, "they can't take you away."  Me apologizing for all the bad things I had done and for all the times I didn't call home just to say "I love you."  We returned to the courtroom to hear the verdict, sobbing, me holding my youngest sister, trying to defuse the panic attack she was experiencing.  All she could say was, "they can't take my daddy away."   I held her and told her "it will all be ok" as convincingly as I could, not knowing for sure myself.  A part of me still held onto a hope that the next words I would hear would be "not guilty," but it was not to be.  The first charge was read, followed by "guilty".  The second was read, followed by "guilty" and so on.  My heart getting heavier each time I heard the word.  I had never really thought about what a guilty verdict would mean, it seemed impossible to fathom.  My undying optimism had prevented me considering the worst outcome and now my mind was filled with repercussions.  With a simple word, 12 people had taken a remaining lifetime of joys away from my father.  He will likely not see his daughters' marriage, the birth of his first grandchild, the passing of his parents, and so much more.  He will learn of these events through letters and phone calls.  My family will be deprived of my dad, I will no longer be able to call him when I have a question, I can't ask him for advice or help when I begin practicing dentistry, I won't be able to call on him when I don't know what to do as a father, he won't be there to give my sisters away at the altar, he won't be there at my 26th family Christmas.  He will be deprived of many things most of us take for granted.  Everything he's worked for his entire life has been undermined.  His livelihood and license have been taken away.  And my mother has been deprived of her husband and best friend.  I now have to make sure everything's alright, that everyone's taken care of. All these thoughts rushing through my head while I hug my sisters and mother.  Its amazing how fast your life can change.  You only have a moment to feel small and powerless before realizing all you can do is meet the new challenges you're faced with and I'm more determined than ever.

 

Finally, I am so thankful for everyone's thoughts and prayers.  I have no doubt they provided the silver lining to the day:  My dad's sentence hearing was scheduled for June, so at least he gets to see me graduate from the same dental school he passed through 27 years ago.

You Can Do Anything

    If you think that there is something you can't do, check out my friend, Ed Brenegar's post Yes, You Can, on his Leading Questions weblog.  When you're there, take the time to view both of the videos he has posted. 

    They are about Rick and Dick Hoyt who compete in the Ironman triathlon.  The thing that makes them exceptional is the fact that Dick's son, Rick is physically disabled and confined to a wheelchair.  The spirits of both the father and son drive them across the finish line with Dick providing the physical power.  I've never seen such an amazing example of will and determination.  The sheer love that drives Dick and the faith that the son places in his father is inspiring. 
    There's not much I can add to Ed's post.  If there is something that is defeating you, or stopping you from trying to reach your goals, watch the video.  After that, you may say "I don't want to do this", or "I'm not interested enough in changing or improving", but you won't be able to say, "I can't do it."

It's Deja Vu All Over Again

    I can't take credit for the title, Yogi Berra said it first, but I know what he means.  Something is happening again.  It's something that I didn't think I'd be lucky enough to experience twice in my career, never mind back to back.  You may have read my last post about my boss, Jeff Price, retiring.  As I said, he is a wonderful man.  Well, how lucky am I?  My new boss, Nigel Morgan is wonderful as well.
    It's a big risk to buy an existing practice.  The practice is evaluated based on the patients and production that exist for the selling dentist.  Experience has been gained and trust has been earned after years of treating the patients.  A new dentist agrees to pay a price for something that was built on relationships built by another man over many years.  He can only trust that the patients will be open to remaining and building a relationship with him. 
    Anyone who meets Dr. Morgan likes him immediately because he is genuinely a nice guy.  He's young but has presence and insight that is beyond his years.  He has the compassion for and interest in others that is usually developed over years of maturing, interacting and just plain trial and error.  It's an innate quality in him.  He's open to feedback and secure enough to listen to ideas and advice.  He is generous with thanks and appreciation of others.  He has a quick smile and even though a first day as a new owner has to be daunting, he maintained a pleasant disposition and enjoyed his day.  It's a pleasure to work with someone like that and makes you want to do whatever you can to support and help him. 
    So, it's deja vu all over again.  We're all feeling pretty good about each other and lucky to be in such a great situation.  When people work for a common  goal and treat each other respectfully and kindly, great things can happen.  Why would anyone choose any other way?  Once you've been in a situation like this, you want it to continue forever.  If that's not possible, you at least want it to happen all over again.  We know how lucky we are and we're determined to keep it that way.  Welcome Dr. Morgan,  glad you're with us and we're right behind you.

A Wonderful Man

"This isn't good or bad. It's just the way of things. Nothing stays the same."
                                                                        ~Real Live Preacher~

    Today is the day that Jeff Price, DDS, who I've worked with for the last nine years, sold his practice.  He sold it to someone of equally fine character named Nigel Morgan, but this is Dr. Price's tribute today.  You'll be hearing plenty about Dr. Morgan in the years to come.  Dr. Price has had more impact on me professionally than everyone I've ever worked with, combined.  I've learned to treat all patients compassionately, whether they made it easy or not. I've watched him treat all patients with equal respect, and enjoy people for who they are.  I've heard him say, "You have to meet people where they are right now" so many times it's ingrained in my thinking. 
    When I first started working with Dr. Price I knew this was different.  He loves dentistry and he's an excellent clinician.  He is generous with his knowledge and made every day a learning experience. He is a patient mentor and fed my desire to learn about dentistry. Working with him made me see what I do as a profession, not just a job.  Many people with his abilities could become arrogant or conceited.  He detested being put on a pedestal and brushed away too much praise or attention for his skill. 
    Working with him all these years has been a privilege and an amazing opportunity.  In the last few years he has struggled with neck, back and shoulder pain as the result of a bike accident.  Many days I could see the pain wearing on his strength and will, yet he persevered.  He knew that his clinical career would be shorter than he wished, but he would not leave until he could find someone that he knew would serve his patients with skill, care and compassion. 
     A few months ago I wrote a post about change. I wrote it on the day Dr. Price told me about his decision to sell the practice.  I quoted Dr. Seuss as follows:
    "Don't cry because it's over, smile because it happened."

    I hope that Dr. Price, his staff, his family and his patients can heed this advice.  It hurts to lose a thing of value.  We must all acknowledge the end of something wonderful and move on to the next wonderful thing.  Dr. Price is going back to Chapel Hill to study Oral and Maxillofacial Radiology.  Dentistry is not over for him, the road is just turning in a new direction.  His practice will move forward with Dr. Morgan continuing the tradition of compassionate care, with the same staff who served with Dr. Price, working alongside him. That is how life is.  It changes.  We do with the change what we will. We can make it a heaven or a hell, it's up to us.

    Thank you Dr. Price.  You made a difference in many lives.  Remember what you told me several times, "Happiness is a journey, not a destination."  Enjoy your journey.  You are, quite simply, a wonderful man.

    "..Therefore be at peace with God, whatever you conceive Him to be, and whatever your labours and aspirations, in the noisy confusion of life keep peace with your soul. With all its sham, drudgery and broken dreams, it is still a beautiful world."
Be careful. Strive to be happy
Excerpt from DESIDERATA by Max Ehrmann
 

The Strength Of Apology

"We've gotten to the point where everybody's got a right and nobody's got a responsibility."

Newton Minow, chairman of the FCC

   

There is power in having the ability to offer a sincere apology.  I allows you to take some measure of control of the direction of a problem.  It must be an apology that you really mean.  You must have accepted responsibility for your part of a problem or wrongdoing and you must be willing to admit it and finally you must want to make things better. In his book 3 Seconds, Les Parrot, PhD lists 3 elements of a good apology. 1. You have to understand what's wrong, 2. You have to admit to what's wrong, and 3. You've got to rectify what's wrong.
 
    You have to understand what's wrong.  Many times when we see things going south, we rush to apologize without even knowing what we're apologizing for.  Sometimes, by apologizing without understanding what's wrong, not only does the original problem go unsolved, we may later feel resentful for apologizing for something we didn't feel responsible for.  If you don't understand what's wrong, how will you know what to admit to doing?  How can you give a sincere apology?

    You have to admit to what's wrong.  If you don't believe you were wrong or understand why the other person is upset, you can't give a good apology.  You may not be completely to blame for the problem, but you can try to find out what part you are responsible for.  Many times, people are so threatened by what they see as conflict, that they avoid talking sincerely about problems and really hearing what the other person is saying.  They look like they're listening, but actually they've shut off to what the other person is saying.  They've gone inside themselves and are seeing the conversation as an attack and they are busy formulating their defense.  They usually end up shouting an insincere or sarcastic apology and now a problem that could have been solved quickly will escalate into a fruitless striving for understanding.  This is destructive to relationships and stunts the growth of the individual who refuses to take responsibility for their actions.

    You have to rectify what's wrong.  We once had a patient approach the front desk with what he expected to be a problem with his insurance.  He was defensive when he approached the front desk assistant.  I could hear the conversation from my office.  As he stated his case, the receptionist began defending herself and telling him that we couldn't do anything about his problem.  The patient was becoming very agitated and I could see he didn't feel that he was being heard.  On her part, the receptionist felt she was being attacked.  In reality, the only problem was defensiveness on both their parts.  She looked at me for help and I walked over and told the patient what I thought I had heard him ask for and asked him if I was right.  He said I was.  I looked at the receptionist and said, "Even though this isn't the way we normally do this, it will be ok to give Mr. So and So what he wants.  We'll make a note on his chart so that in the future we'll remember to process his claims this way.  The patient was happy and thankful and the receptionist felt ok about it.  I told her that her mistake was in trying to defend herself rather than try to solve the problem.

    Being willing to take responsibility and apologize for mistakes takes a lot less time than debating, deflecting and defending.  You have the power to choose how to respond to conflict.  If you see conflict as a threat, you will spend a lot of time avoiding discussing the situation, delay understanding and inhibit solution.  If you can just look the problem in the eye, determine the part you are responsible for and make amends, you can go on to more productive and enjoyable pursuits.

   

More, More, More!

    Does it ever seem like all your staff wants is more, more, more?  Do you feel like the cartoon character who stands looking hopeless and helpless with his pockets turned out to show that they are empty?  If you find yourself thinking that your staff can never be satisfied and that they are always expecting you to give them perks and treats, you may need to do some thinking about how it got that way.
    First, let me tell you this, I could not imagine myself or my co-workers demanding anything from my boss.  We absolutely know it would not be tolerated.  The reason for that is because he is a strong and absolute leader who is very clear about what we are about.  We are about caring for our patients.  Everything we do is toward that goal.  He appreciates us and occasionally treats us to lunch to show it, but we understand that everything extended beyond a paycheck is a gift.  It is his choice to give it or not.  When he does we appreciate it and let him know that.  That is how adults behave.
    How do some staff members develop an entitlement attitude?  Some of them arrive with it firmly in place, implanted within them, no doubt, by overindulgent parents.  Others learn that behavior on the job.  Every time they step over a line and get away with it, they are encouraged to step a little further over it the next time.  It rarely ends until the boss gets fed up and then it usually ends badly. 
    Why do dentists allow this to happen?  I think it's because they dread confrontation.  I also think that they hate the hassle of training new employees.  Sometimes they want to be friends with their employees.  They want a nice guy persona and don't think they will have it if they deny employees requests.
    All of this causes dissension and distracts from patient care.  The key is prevention.  Don't let an attitude of entitlement take hold.  Let the staff know that character is important and greed is not a good character trait.  Talk about it in your staff meetings.  Focus on developing integrity and doing the right thing.  Be free with compliments and praise.  Sometimes that's all they really wanted anyway.  Keep priorities at the front of everyone's mind, realize that in a leadership role, you sometimes have to make unpopular decisions, but can do it in a way that let's everyone down easily.  If you are fair, you will be respected, and that will take care of the rest.

Caring, Compassion, Charity

    I've been tagged by Galba Bright to participate in the Caring, Compassion, Charity meme that was started by Alex Shalman.  My assignment is to write about a cause that is close to my heart and to list the things I'm going to do about it.
    I wrote about my cause initially about a week or two ago.  It hurts my heart to see children suffering with pain caused by tooth decay and neglect.  I cringe when I look at their x-rays and I am in awe of their toughness and dignity.  They don't whine, they don't complain and they are grateful for what we do for them.
    I'm lucky to work for a dentist who cares.  We treat these children without fee and they get the same as everyone else.  Knowing that we not only give them a healthier mouth but also a healthier outlook on humanity is very rewarding.  These kids know we care and that we are making a difference for them.  Someday in the future, they will remember that and it may help them make a good choice for themselves or extend a hand in caring to someone else.  The things I will do to help make a difference are:

1. I will go to  schools and talk to children about oral care at home and about making good choices in the foods that they eat. 
   
2. I'll screen the children so that they don't get into the condition of those we've seen.
   
3. I will meet with parents and let them know that their kid's teeth are important.  I'll try to get them to make sure the kids have toothbrushes, paste and floss.
4. I'll try to get other dental offices involved so that more kids can be helped.
5. I plan to talk to the local newspaper and see if they'll do a story about the need for more dental care for underprivileged children in our town.
6. I'll write to manufacturers of dental products to see if they'll donate toothbrushes, paste and floss to us.  Colgate, Crest, Oral-B, are you listening?

I tag Ed Brenegar from Leading Questions
        Gretchen Rubin from The Happiness Project

        Tom Jablonski from The Servant Leadership Blog

        Henrik Edberg from The Positivity Blog

        Timothy Johnson from Carpe Factum

Thanks for including me Galba and sorry it took so long for me to catch on.  I'm going to blame the distraction of the wedding.  Guess I can't use that excuse much longer.

It's Never Too Late

    What makes a person make one choice over another?  Why does one individual go all out to get it right, while another just gets by with doing as little as possible?  It may be the way they were raised, their personality type or it may just be a matter of looking ahead at the results of their choices.  Every action we take has a consequence, some more profound than others, that's for sure.  I don't advocate second guessing every move you make, but when you have that moment when you have to decide, "Should I redo that composite because the shades a little off?  that's when you say something about who you are.  Sure their lip will probably cover it, but you'll know it could have been better.
    As a staff member when your boss asks, "Who left the top off the cavit again?", you could shrug and look innocent or you can step up and admit that you did it.  When a patient starts talking just as you walk out of the room in a hurry to get something, you could act like you didn't hear them or you could come back in and give them your attention. When you hear a crack as a patient bites down on a provisional you just cemented, do you convince yourself you didn't hear it or see the cement oozing through the fissure or do you start over?   When you find an insurance request in a stack of paperwork you could shred it or deal with it.  What would you do if you stopped for just a moment to think?
    It's really not about the consequences that someone else will impose on you.  It's about the consequences you impose on yourself.  It's about who you are becoming.  Just because you are an adult, it doesn't mean you're a finished product yet.  You are always evolving in character and attitude.  That's great news for some of the seriously undercooked among us.  It gives us another chance to improve.  We have that chance until the moment of our last breath.  The right choice and the wrong choice live inside us all the time, available to us at any moment.  It's never too late to begin to be better.

Who Do You Think You're Kidding?

    "What you do speaks so loud that I can not hear what you say."
    ~Ralph Waldo Emerson~

    Sometimes our view of who we are and how we act is not based in reality.  It is our ideal vision of ourself.  It is what we want others to believe we are even though we know we're not quite there yet. 
    For other people, it's a smoke and mirrors routine that they think will lead others away from focusing on the reality of who they are.  There is one saving grace in all this.  It is the awareness that what we wish we were is better than what we actually are. 
    Having that awareness gives us something to strive for.  People can change when they want to .  They can develop better character habits.  Character traits are inborn, character habits are born of repetition.  It's not easy, but if you want to be a certain way bad enough, you can do it.  It takes focus and living with awareness. 
    I used to tend to let myself get aggravated by the behavior of others too easily.  One person I work with tended to push my buttons.  I was convinced that she did it on purpose and I used to think to myself, "I can't stand it when she does that."  Well, in reality, I don't know if she does it on purpose and I have found that I certainly can stand it.  I've lived through it for years now, I think I'll survive.  One thing that helps is to ask myself if it's worth a confrontation at this point in time.  Today the answer was, "Not at this moment, but in ten minutes it might be.  I'll wait and see."  Ten minutes later the situation had changed and 30 minutes later I wasn't even thinking about it any more.  So, I learned to deal with my knee-jerk reaction and channel my focus more productively.
    I really wanted everyone to see me as fair and wise, but when I was reacting to this person's idiosyncracies I'm sure I didn't appear to be either.  My actions were shouting just the opposite to everyone.  They were saying, "Look at how uptight I can get over something someone else is doing.  I have no self-control or tolerance in this situation."  So no matter how loudly I proclaimed my leadership, my actions were saying, "Who do you think you're kidding?"  Another real bummer in this whole situation is that while I was suffering, the other person was pretty much unaware of the whole drama.
    Now that I've gotten a handle on this issue, I plan to address my martyrdom syndrome.  It's a quieter suffering, but when I give in to it I can really give any saint a run for their money.  In my imagination, no one else notices, but now that I think about it, I'm wondering just how loudly that horn is blowing. 
    The point is this, pay attention to whatever it is that you would like others to believe about you.  Then be honest with yourself.  Is that how you really are?  If it is, congratulations, you must be very content.  If it's not, don't despair, pay attention.  Use every opportunity to practice being the way you want to be.  Before you know it you won't be practicing anymore.  You will have developed the character habit you wanted.

Service Heart

    When I find something I love, I like to share it and I want the people I share it with to love it as well.  That's how I feel about The Happiness Project Blog written by Gretchen Rubin.  The other day she wrote about developing a Service Heart.  Here is an excerpt but I encourage you to read the whole post:

   "And many household managers talked with pride about what they call "the service heart"— the joy of giving their employers exactly what they want, when they want it, and how they want it. As butler student Dawn Carmichael told me, "I loved knowing what made my employer happy. I know that sounds weird, but making him happy made me happy.”

    I love the idea of finding joy in giving an employer what they want, when they want it and how they want it.  It seems that often the employer is knocking them self out trying to give the employee what they want and keeping them happy. 

     I know how lucky I am.  I work for a great dentist, who happens to be a very decent person.  I have so many opportunities and have learned so much from him.  You can bet I want to make him happy with what I do.  I really do get a lot of satisfaction when I know I've given him what he wants and taken some of the burden from running the practice off his shoulders.

    I think we sometimes forget ourselves in our thinking.  We get off on the wrong track.  I think most people are good and want to do the right thing.  We start to feel entitled to expect our employers to focus on our needs excessively when we lose sight of our purpose.  I know that the number one need for employees is to feel appreciated.  But...when is it enough?  There comes a time when everyone needs to focus on the business of caring for patients and strengthening the practice.  That is when a service heart takes over.  If you didn't come by one naturally, then try to develop one.  Take a day and focus on serving and give what is wanted.  You might find you have a service heart after all.

 

Tom Morris's Definition of Insanity

    If you've read this weblog for a while, you've probably caught on that I'm a big fan of author and philosopher, Tom Morris.  I often go to his website for inspiration and words of wisdom.  His take on the definition of insanity really interested me.  I'll use some excerpts, but you can read the whole text here. I urge you to take the time to visit Tom's website, it's full of inspired writing.  We've all heard the popular cliche that the definition of insanity is doing the same thing and expecting a different result.  I've been accused of that myself.  I was comforted somewhat to hear Tom's thought on that.

"Sometimes you have to keep doing the same thing over and over until the world catches up with you, notices what you're doing, and is ready to make the most of it. On occasion, you just have to continue on until the right person with insight and resources crosses your path. If you changed too quickly, in the face of apparent defeat, you'd miss that meeting with destiny that could have been yours had you just been tough enough to keep doing your thing, over and over, expecting a different result."

Tom was talking about his experience in trying to get his first book published and being turned down 36 times before finally achieving success.  J.K. Rowling of Harry Potter fame had the same experience.  If either of them had worried about the sanity of persisting in their goal, look what the world would have missed out on.  Tom goes on to say:

 

"It would have been foolish and unreasonable in the extreme for either of us to continue submitting the exact same manuscript to one and the same publisher, over and over, expecting a different result. If I had written the identical letter, verbatim, and mailed it to the same editor thirty six times over a period of months, I can imagine someone legitimately asking "Are you insane?" And, at some point, there might have arisen a different result, in the form of a restraining order, but that's not what I would have been hopefully expecting."

So, it's important to know when and how to persist.  My problem has sometimes been in not wanting to take no for an answer when there was only one person to whom to propose my plan or plea.  That's when relationships become strained and feelings finally must get hurt to make the insanity stop.  My idea or request may have been reasonable, but not to that person and not that many times.  So, why couldn't I have read Tom's essay a lot sooner?  Oh, well, I learn best the hard way, I guess.  Finally:

 

"I remember the old quote from Mark Twain: "If at first you don't succeed, try, try again. Then give up. There's no sense being a damn fool about it." There are limits. But they are quite a bit farther out than the recent urban insight about insanity would give us to believe. Sometimes doing the same thing a second time when it hasn't worked the first is indeed just foolish. But sometimes it's shrewd. Wisdom consists, in part, in knowing the difference. Flexibility is a virtue. But in most matters, flexibility properly kicks in only after persistence has been given a fair chance."

Maybe the thing to do is to stop and regroup and try to figure out if you're being wise or just stubborn.  I can say that when I've gotten myself in an uncomfortable position, it was due to stubbornness as much as persistence. But...when I call upon what wisdom I possess and use flexibility to look at a situation from many points of view, it is then that I get somewhere.  Maybe not exactly where I want to be, but somewhere a lot better than insanity would lead me.

 

That's What It's All About

    I was lucky to witness true compassion in action today.  We had a young man come in for a recare appointment.  His mother does not allow fluoride treatments and resists x-rays.  The young man is a heavy soft drink and sweet tea drinker.  My boss constantly suggests fluoride, insisted on bitewings and counsels the boy about avoiding sweet drinks.  The bitewings showed extensive caries requiring an expensive amount of treatment.
    My boss realizes that this will be difficult for his family to afford and upsetting for them to hear.  He told the boy that he would be there for him to help him tell his family.  He suggested setting up a consult so that he could inform his mother of the fees and show her the x-rays.  This young man seems to have a depressed demeanor and I'm sure that my bosses heart-felt concern meant a lot to him. 
    Watching my boss treat this boy with kindness and consideration made me realize again how proud I am to work for him.  The concept of servant leadership is popular right now.  Some people bristle at the term servant and think it means being subservient to others.  I think my boss showed his whole staff the strength and character involved in truly serving someone.  We will follow him in anything he asks of us because he served.  The respect he earns with the way he treats others goes beyond what can be gotten from any bonus program or pay raise.  The priveledge of working with someone of that caliber and witnessing such decency and empathy has no price.  That's what it's all about for me.

Dump The Grudge

    "The weak can never forgive.  Forgiveness is the attribute of the strong."
                            ~Mahatma Ghandi~

    When I read this quote, I become aware of my weakness.  I often am satisfied that I have done the right thing, been the bigger person and extended forgiveness.  What I've sometimes come to realize is that I've offered the words, but withheld the absolution.  I've said that I've forgiven, but kept the grudge.

   

"Holding a grudge is like drinking poison and hoping the other person will die."
                        ~Oprah Winfrey~

    Our grudges hurt us more than they hurt the other person.  We are the one experiencing the feelings that a grudge brings with it.  We are trapped in the past, wondering how the person who caused us this pain can go happily on their way.  Well, they believed you when you said you forgave them.  Hanging on to old hurts won't change anything.  You can't drag someone else back into the past with you.  At some point you have to decide to get over it and really mean it.  Move on. 
    I once had a grudge that I was having a problem letting go of.  I wanted to maintain and continue my relationship with the other person because I held him in high esteem.  I thought that we should keep re-approaching the offense so that we could put it behind us.  It just made matters worse.  I finally realized that I wanted him to see and feel my experience of our problem the way I did.  I was asking for the impossible.  Each person can really only have their own experience.  They are looking out through their own lens and can never really feel our pain or disappointment exactly the way we felt it.  If we insist on that before we move on, we'll never go anywhere with that person and the relationship will be lost.
    At work or at home, it is never productive to hold a grudge.  If you can't forgive, you lose something.  Withholding forgiveness gains nothing.  You don't come out on top, you don't teach the other person a lesson.  You lose a relationship and you may loose the esteem of anyone who witnesses the whole scenario.  If you want to forgive and are having a hard time, challenge the negative thoughts and feelings as they come up.  Focus on the outcome you would like to have and do whatever helps you leave that grudge behind you.   

Regrets

    I've had a few.  We all have at some time or another.  Who couldn't say that there are many things they'd do differently given a second chance.  The dictionary defines regret as a sense of loss, disappointment or dissatisfaction.  I can identify with the sense of loss in regret.  Most of the things I regret make me sorry for the time lost that could have been spent building something better.  Many of my regrets are over things that could have been avoided. 

    One of the worst things about regret is that it can follow you into the future if you allow it to.  Then there are two things to regret.  The troubled past event and the present that is distracted by remorse.  Dragging regret around serves no one and repairs nothing. 

    So how do you work away from the oppressive feelings that can weigh on you and make you wish for one more chance?  Give yourself that chance.  You can't erase the past, but you can close the door on it.  You can agree that whatever hurt or wrongdoing caused the regret  is over and well left alone.  You can move on wiser and determined not to repeat the past or drag it around with you.  Even constant apology is not a great idea.  Every time you apologize anew, you remind the other person of the grievance that you are determined to relieve yourself of guilt over.  Just move on  and do better.  That's all anyone can do. 

    Many times small offices can experience hurts and jealousies, competitiveness and gossip.  Life in a fishbowl can get territorial and feelings get hurt and intentions go awry.  Once the crying's all done, the regret sets in.  Apologize and move on.  Oh, and don't forget to move on without repeating the behavior or the apology is nothing.  Accept apologies, too.  Don't hold grudges hoping that the other person will learn a better lesson if you don't let them off too lightly.  Accept them with all their faults and human flaws.  Remember, a relationship that survives a hurt and moves on must have a certain amount of value and importance to both people to endure the pain.

After I wrote this I read Dr. Tammy Lenski's article about letting go of unresolved conflict here.  This is an excerpt of the article that recounts a story that former president Bill Clinton relates about Nelson Mandela's release from prison:

“Mandela made a grand, elegant, dignified exit from prison and it was very, very powerful for the world to see. But as I watched him walking down that dusty road, I wondered whether he was thinking about the last 27 years, whether he was angry all over again. Later, many years later, I had a chance to ask him. I said, ‘Come on, you were a great man, you invited your jailers to your inauguration, you put your pressures on the government. But tell me the truth. Weren’t you really angry all over again?’ And he said, ‘Yes, I was angry. And I was a little afraid. After all I’ve not been free in so long. But,’ he said, ‘when I felt that anger well up inside of me I realized that if I hated them after I got outside that gate then they would still have me.’ And he smiled and said, ‘I wanted to be free so I let it go.’ It was an astonishing moment in my life. It changed me.”

Mind The Gap

     The gap I'm talking about is the one between knowing what you should do and actually doing it.  It doesn't matter if the gap is as wide as the Grand Canyon or a thin as a thread, if it exists, the result is the same.  We've all had times when we know we should do something,and we don't quite understand why we don't just do it.  Managers can sit down with a staff member and clearly spell out what you expect of them or the changes you want them to make.  You can put a lot of time into planning how to explain what you want and present it with compassion and confidence in the employee only to watch them carry on as usual afterward.  Why does this happen?
     I have a theory, I always do, it doesn't mean I'm right though.  I tend to do what I'm told and makes changes in performance very well.  That's not my gap.  The changes I'd like to make are in my thought processes and reactions.  For instance, I have a person in my life who likes to make digs at me and instigate arguments with me. I tend to give them just what they want.  I get defensive and complain and just generally get upset.  Then they can then do their part.  They can act like they had no intention of upsetting me and even end up looking victimized.  Knowing that this person knows that I know what they're doing and that they have once again achieved their goal makes it harder to close that gap for me.  I thought that the other person's actions were the catalyst for my result, but they're not.  What she does gives her the result she earns.  She lessens my regard for her. My reaction is the catalyst for the result that I go home with at the end of the day, frustration with myself for once again reacting in the expected way.  The gap is the change I need to make. The reason for the gap is fear and insecurity. The thing that keeps the gap open is the box that I am in which is wide open and easy to jump out of.  There is another box at the other side of the gap.  That one contains the result of making a change.  That box is closed and it's contents are unknown because I haven't closed the gap to get to it and open it yet. 
     So, my theory is that it's more comfortable to stay in an uncomfortable box than to make a change that will show me what's in the unknown results box.  When you think about that it doesn't make sense, does it?  I know I don't like the situation the way it is, so why should I hold on to it?  It's all a matter of challenging our thoughts and being aware of what we are feeling before we react. It also helps to prepare ahead of time.  Now, when I know I'll be with this person I try to tell myself that I know I'll probably be challenged and that I don't have to play the game.  I can just float through the encounter.  I also try to find compassion for the other person.  I imagine that someone who keeps picking at someone else must have something that bothers them about themself.  Something about me reminds them of what bothers them.  Or maybe I'm completely wrong, but I'm going to try it and see if the gap slams shut for me.  What do you think?

Just Be

     Many times you hear people say that "if only" something would happen their life would be so much better.  I used to think of that as hope, but I've come to see it for what it truly is;  a barricade to progress.  When you keep waiting for conditions or someone else to be just the way you want it before you behave or become just the way you want to be, you are letting external forces drive you. 

     Aha! So that's why you never get anywhere and why things never change.  You're waiting for the magic bullet. Sometimes you have to start living as if everything were aligned perfectly to give yourself a chance to get where you want to be.  This is a fact, nothing will ever be perfect, or, if by some miracle everything did become perfect for one bright shining moment, it won't stay that way long.  So you could spend your whole life waiting for something that will never happen.  You could waste all that time that you could have been striving to be your best and instead end up with a worn out list of excuses for why you just stayed the same. 

     Don't wait for perfect.  In your personal life and in your professional life, take what you have and do the best you can with it that day.  If you can make some things better, do that, but don't sit in the corner watching for problems and making lists of what's wrong.  There's probably less wrong than right anyway.  Take the list of what's right and work with it.  Just be OK with what you're doing be OK with the people you're doing it with.  That's how things get better and that's how you become your best.

Smarter Focus

    One of the most important things I have learned as a manager came from my boss, Jeff Price.  He has reminded me over the years not to take things that staff or patients say or do personally.  I couldn't figure that one out.  If I, as a manager, am supposed to make the staff and patients feel that I care about them, then how could I not take things they said or did personally?  Would that mean we were all just playing a part and that nothing really meant anything?  Was I supposed to care about them without any thought for myself and my needs?  No, of course not, that's not what he was saying.  You can care without drama and you can let the chance for hurt feelings go right on by.  It's all about discerning what's important and what's destructive and choosing important.
    What he was saying was not to dig too deeply  looking for hidden messages.  Take things at face value and ask questions as needed,but give people the benefit of the doubt. In the end, the most important thing was to know myself.  If someone doesn't like something I say or do in my position they have the option to talk to me about it, I'm always willing.  If I don't like someone's attitude or comment I also have some choices.  I can take it and shape it any way I want.  I can carve it into an insult or slur.  I can squint at it and wonder if they really understand what they are saying and just shrug.  Or I can let it go and go on about my day.  The most important thing to remember is that it's not all about me.  Not everything that others do is meant to challenge my authority, undermine my progress or hurt my feelings.  As a matter of fact, keeping my feelings out of it at work is the best thing I can do as a manager.  Then I can make objective decisions and act in the best interest of the practice as a whole, and the patients in particular.  If I have to say no to a staff member, their feelings about that are just that, their feelings.  It is not a good idea to take it home with me and second guess my decision or feel guilty.  If it's important enough to them, they have the ability to find a better approach or a way to show me that what they want is worth re-considering.  But, the main thing is, I have a practice to run.  Everyone needs something and it is important to spend my time giving what is needed and being a catalyst for progress.  When feelings become an issue, progress takes a back seat.  Feelings are a fact of life and they will enter into the day in some way most days.  It's how you handle them and where you place your focus that counts.  As a manager, having someone like my boss who will let me know when I veer off course is extremely important.  It's easy to get into omnipotent thinking and a few wise words, in the right measure, are something to be grateful for. It's a safety net. If you are trying to manage without a net, maybe it's time to find someone who won't be afraid to tell you  how it really is when you need to hear it.  It is a sign of integrity to be able to tell someone when they are getting in their own way and it is a practice in humility to be able to hear it and make good use of it.  Both are part of the foundation of good character. 

The Right Stuff To Lead

    Do you have what it takes to be a leader?  Michael McKinney who writes the Leadership Now Blog says that we may be all wrong about what it takes to be a leader.  Think about the bosses you've had in the past.    The worst ones probably pop into your mind first.  They are the arrogant know it alls who took credit for the work you did and berated you for even insignificant mistakes.  They were great at telling you all about how brilliant they were, but slow to notice your achievements.  They may have even been likeable and lots of fun, but not very productive.  Without a personality to hide behind and subordinates to do the real work, they'd probably have been in trouble. 

    Now, once you calm down, yes, even the memory of a bad boss can drive your pressure up, you will probably remember another kind of boss, a really great boss, with admiration and affection.  The one who made you feel like you could achieve whatever you set your mind to.  The one who rolled up his sleeves and got into the work with you.  The one who believed in you and accepted you as you are and showed you what you could become.  That person probably had all the right character traits that are so often overlooked when we describe a leader.  Who thinks of decency and honesty?  We want go-getters and wheeler dealers.  Integrity would be nice, but who's got the time for that?  Think about the wonderful characteristics of courtesy and consideration for others.  Those are the people who get walked on and passed over, right?

    Not so fast.  They may not be the first traits that people think of when they think of a leader, but they should be.  They are the people that last and make a lasting impact on a business and the people associated with it.  The big shots and big mouths burn brightly for a time, but they burn out and stay out.  Character stands firm.  There are many roads to leadership and some are more difficult than others.  People who want to lead with character and for the right reason may lose their way at times, but they will persevere until they find the right direction again.  It is that ability to look at themselves and what they have done and are doing and accurately assess it, that will keep them true.  What matters is having the integrity to see their mistakes, admit them, ask for forgiveness and correct their path.  It is their desire to find ways to give each person what is best for them, no matter what they are given, that inspires the people they lead.  It is knowing that they must continue to develop themselves in order to continue to encourage development in others that makes them and their team succeed.  Good leaders can rev people up to get the job done with enthusiasm just as easily as they can instill the calm needed to tackle a delicate procedure with precision.  They basically have what it takes to help everyone shine.  They have the right stuff to lead well.

   

Perseverance

 That which we persist in doing becomes easier for us to do; not that the nature of the thing itself is changed, but that our power to do is increased.    -Ralph Waldo Emerson-

    Perseverance is an important, but all too often overlooked, character trait.  When you interview a potential candidate for employment you might take note of how she presents her appearance, how well-spoken she is, whether she seems intelligent.  You may ask what she enjoys most about her profession, what experience she brings and what she hopes to achieve in the future.  But, do you ever ask about perseverance?  The next time you are interviewing someone ask her about something that she achieved that was hard for her.  Ask about a personal change that was difficult and required persistence.  Watch her expression as she describes it.  Most of the time you will see pride in that achievement. If you do, pay attention, she may be what you're looking for.

    Have you ever started training someone for a position and find that they make steady progress for a period of time and then stop dead?  What happens?  First of all, you have to be realistic; the initial progress will be of a greater magnitude because there is so much to learn.  Once the beginner's stuff is out of the way though, that's were the really great employees will separate from the average workers.  The great ones will look for more to learn.  They'll want to learn the hard stuff.  The average workers will want to rest, possibly for the long run.

The road to success is dotted with many tempting parking places.  ~Author Unknown

 The great workers will resist the temptation to park.  Actually, the best won't be tempted much at all.  Everybody takes a break now and then, you need it to recharge.  Once the break is over the best are dying to make more progress.  The two phrases I dislike hearing the most are, "That's good enough" and "I'm as good as I'm going to get."  I believe that people all have the capacity to increase their skills and knowledge every day.  They simply need curiosity, desire and will.  That is what turns knowledge and experience into wisdom.  Emerging from difficulties stronger than when you began, makes one wise.  Sharing what you learn with others makes one a  mentor.  A  wise mentor knows that if you create a village of persevering learners who strive for excellence, you will most likely create a culture of success.

Can You Own Your Life?

    Do you take personal responsibility for yourself and what you do?  Many times in life you hear people blame what happened in their past for the problems and shortcomings in their present and their lack of hope for anything better in their future.  Even in dentistry, you hear 30 year old women say, "Well go ahead and pull these teeth, my grandmother had dentures, my mother had dentures so it's just a matter of time till I have dentures.  They become a self-fulfilling prophecy.  They write a script that casts themselves as the victim.  For some reason or another they decide to play that role.
    Not everyone does that.  Some people make the decision to take personal responsibility for themselves and what they make of their lives.  They don't drag their past behind them.  They know it's time to leave it alone and give it a rest.  They  take the lessons they learn and the strength they gain and they decide what they want to be. They make a conscious decision to live a rewarding life.  They leave sadness and hardship behind and are glad to abandon it and look at what is before them.  They own their decisions, both good and bad.  They take a step and then another in the direction they want their life to go.  They succeed at living. 
    At work, do you own your actions and decisions or do you try to find someone else to blame?  Did you make that mistake because someone gave you bad information or distracted you or didn't tell you what you needed to know?  Are you thinking of excuses just in case things don't work out well?  When things get tough do you decide to quit rather than sit down to the hard work of finding out what needs to happen to make things better?  When faced with a difficult decision do you fall apart and hot potato it to someone else?  When a conversation becomes distressful do you go on the defensive and try to tear the other person down?  Must they be wrong so that you can be right? 
    Decide to be different.  Make a decision to take every day as the gift that it is and marvel at it.  Make it your own and live it the best you can with positive purpose and the anticipation of what it might bring.  When it brings joy be joyful.  When it brings pain, mourn for the loss, but remember the joy and trust that it will return.  Bring your best self to everything you do.  Make the choice to go positively through your workday letting annoyances slide past you and never missing an opportunity to say thank you and to encourage someone else.  You can own yourself and your life.  It's a decision only you can make.

The Sensitive Type

    How does life come at you?  Better yet, how do you take what life throws at you?  Some people seem to weather any storm and keep on going.  They know that not everyone will agree with them and that's OK.  If someone treats them poorly or rudely they think, "Gee, too bad they have such a bad attitude, it must really make them miserable."  They can't even fathom letting someone else's bad attitude affect them.  What a great way to be.
    Others may stumble over adversity and suffer some bumps and bruises, but they nurse themselves back to normal quickly and keep on going till the next trial shows up.  Still, they accept a little rain falling into their life and remain pretty upbeat.  They don't let it make them feel bad about them self.
    Then there's the sensitive type.  Sometimes they're referred to as being thin-skinned.  Not much rolls over them without hurting.  They feel every slight, real or imagined, and they take it to bed with them.  I think most people have times in their lives when they've been all three.  A lot of it may have to do with the amount of stress you're under at any given time.  The ones that are consistently thin-skinned are the ones who can make themselves, and others, miserable.  I think sometimes it becomes a habitual way of thinking when it comes from stress.  You have a few difficult encounters and you start to think you're doing something wrong.  If a few more pile up on top of that, you may find yourself in the habit of sensitive thinking.  Most times those whom we feel have wronged us have no idea there's even a problem.  Maybe you guessed, but I'm speaking from experience here.  I went through a time of being highly sensitized to what I thought others were thinking about me.  Nearly drove me crazy.  I realized that it didn't matter.  People will think what they want and if they want to think poorly of you, anything you do to try to change their opinion will only reinforce it.  You are giving their opinion currency, and when you place that much value on something out of your control, you become impoverished by it.  If someone is willing to watch you suffer over their mistreatment or opinion without giving you relief, then what are they really worth in your life anyway?  When you understand that, you are free and the master of your own happiness. 
    My best advice to the thin-skinned, especially at work, is to stop thinking.  That's right, stop thinking of the thing that's bothering you.  Lower it's currency.  Find something more valuable to think about that will give you a better return on your investment.  When you think, you invest your time, your happiness, your disposition and your mind.  Garbage in, garbage out applies here.  Instead of seeing the person that you think is thinking poorly of you as the enemy, try to see them as someone who has some good traits and focus on those.  Understand that they been through the same thing you're going through, with someone else.  Have compassion for yourself by not indulging in sensitive thinking and have compassion for the other person too by giving them what you want from them; the benefit of the doubt.  Chances are, they aren't even thinking what you think they're thinking anyway.  So why waste any more time?

Secret History

    "If we could read the secret history of our enemies, we should find in each man's life suffering and sorrow enough to disarm any hostility."
                                                                   -Henry Wordsworth Longfellow-

    How often do we stop to think about that?  We look at people and see what they are presenting with their behavior or statements and fail to realize that it is superficial.  There's always something else under all that.  Even pleasing presentations may be the result of painful or abusive past experiences.  It's all in the choices a person makes regarding how to move on.
    Some people allow difficulties to make them bitter and cynical.  The response they will then receive from the world will reinforce that outlook.  Others so desperately want to avoid any more pain or abuse that they will go out of their way to be pleasing, often at the expense of their own desires and needs.  They stack up better next to the bitter cynic, but they may both just represent extreme ends of the spectrum.  In the long run neither approach may bring true lasting peace and contentment.
    When you are dealing with people that you manage, or who manage you, keep Mr. Longfellow's words in mind.  We really don't, and probably won't, know what is behind another person's words and actions.  We can allow ourselves to react with anger, hurt, or disappointment, but we would only be using our own secret history.  We also have one, and many times our own reactions are based on that.  Keep that in mind and use it.  As a manager you must learn to keep it out of your dealings with employees.  By being mindful of the past, you can avoid living there in the present.  You can only be strengthened by the lessons of the past when you have tamed your response to them in the present.   If you always react to authority with defensiveness, you may miss some valuable insights.  If you react to change with fear, you are destined to remain just as you are.  If you approach problems rigidly, you'll end up with more problems.  But if you lead with the determination to discover the right thing to do, and you treat your team respectfully, then you will get somewhere.  You may also write something good in the secret histories of everyone involved.

The Pursuit Of Happyness

    My husband and I went to see The Pursuit Of Happyness last night.  It is an inspiring, if sometimes grueling, account of Chris Gardner's pursuit of his dream.  He wanted to be a stockbroker so that he could provide a better life for his wife and son.  I saw Chris Gardner on Oprah and he was amazing.  He is a person who carries a lot of scars from his past but uses that pain to help himself and help others.  He doesn't feel sorry for himself, but I got the impression that he does feel sad that he didn't have what all kids should during their childhood.  He was determined to give his son the father he didn't have.  He didn't perpetuate the experience into another generation. 
    Chris's pursuit was so much more painstaking than many of us have had to experience.  He knew what he needed to do to be happy.  He was able to recognize happiness when it arrived.  Can you say that?  I know I can't say that I always do.  Many times I think I have it bad when what I really have is a temporary inconvenience.  Minor setbacks can seem like major collapses when we don't hold them up for comparison to real catastrophes.  We can spend so much time thinking about what we don't have that we forget all we do have.  What's wrong can often take precedence over what's right in our lives.  That's how we know we have it good.  Chris's life had so much wrong in it, that when something was right it had such an enormous presence it could not be overlooked.  When he finally reached his goal, the sheer relief and joy was palpable. 
    So, I for one, am lucky not to have such a huge deficit of happiness and luck in my life.  I've had my losses and problems but they are outweighed by the good things.  How do I keep that at the front of my mind when something troubling happens?  I think it would be by conditioning myself to react to negative thoughts with positive ones.  For instance, if a staff member's performance is disappointing for a period of time I can recall some outstanding examples of performance from her.  I can then reminisce about that with her.  I think that might get a better result than listing the problems with her present performance.  If she knows that the positive was outweighing the negative and that it was memorable, she might be inspired to improve.  Maybe not, but it's worth a try. 
    Sometimes we all feel like our contribution is not appreciated the way we think it should be.  Here again, when that thought enters your mind, think of things that have been done to show appreciation to you in the past.  Nobody says you can only enjoy that once.  Enjoy your memory of that appreciation.  You'll be more likely to do other things worth appreciating if you're not moping about the lack.  We can't make others think the way we do or respond the way we feel they should.  That would be the pursuit of unhappyness.  You'll get there pretty quickly, too.
    Basically, what I got from this movie is that it does not matter how hopeless something might seem, you can find a way to come out OK.  You need to rely on yourself.  One point that Chris makes is that the right to the pursuit of happiness is granted to us in our constitution.  He notes that we are not granted happiness as a right just the pursuit of it.  It is something we must gain for ourselves.   Don't count on things or persons outside yourself for your happiness. It will then be out of your control and can be taken away as quickly and easily as it is given.  That is how you can effectively lead and manage your team in the right way. Allow your team the right to pursue happiness and satisfaction in their job, but don't think that you can make them happy. You can show them the way and give them what they need to pursue success.  Then you will know you have done your job well.  I think that is a good way to pursue happiness in the workplace.

Stop Signs

    I was driving with my son Erik yesterday and he made a remark that showed a lot of insight for a 22 year old.  We had stopped at a stop sign and he said, "Mom, you can tell a lot about a person by the way they act at a four-way stop."  You know what he means.  Do you try to rush the stop and beat the other guy out?  Do you out and out cheat and just go, without even pretending to really stop? Do you give the guy who did that to you an inappropriate gesture?  Do you wave everyone on even though your turn has come and gone?  Or do you follow the rules and accept that not everyone else will without letting it drive you nuts?
    I agree with Erik.  I never really thought about how I handle a four-way, but I will pay more attention to that in the future.  It's such a simple thing, but I'm sure there have been some nasty incidents over it.  It's really a matter of civility and cooperation.  Apparently someone thought that people of driving age should be able to handle it maturely.  Most people do, but when they don't it really annoys others.  I think that's because we hate to see someone get away with doing the wrong thing.  It's a simple day to day occurrence that we take for granted until someone shows a lack of consideration and compliance.
    How many times at work do we just behave in ways that we don't think much about?  I think the thing I can relate most easily to the four-way stop is the instruments in the ultrasonic.  We've all worked with someone who will just dump their instruments on top of instruments that have been through a cycle but need to be removed and rinsed.  Rather than take the ten seconds to do that, they will just plop theirs on top and start a new cycle.  Eventually someone will come along and do the right thing and take everything out and rinse it.  If everyone took the easy way out we'd soon be stalled due to a lack of sterilized instruments.  That's where the civility comes in.  I think what has happened to the person who is taking the easy way is that they've learned to ignore the little inner voice that tries to make them uncomfortable about their shortcut.  Instead, they've given life to a voice that says, "All right! You got away without having to rinse those instruments again.  Nobody will figure out it was you."  Well, people do figure it out and it makes them think less about that person in some way. 
    Begin to pay more attention to the way people act at stop signs.  Pay more attention to the way you act at stop signs.  How do you feel about what you do?  Act in a way that lets you feel good about your behavior.  At work, see if you naturally do the right thing at every turn.  If you don't, try to change that.  Feeling good about yourself and what you do is freeing.  You can go about your day with confidence knowing that no one is shaking their head and trying to figure out what makes you tick.  It's one less thing to worry about and you will enjoy your day much more.  At the very least, you will be setting a good example.  I was happy that my son realized that a person's behavior in small things can say a lot about them.  It tells me that he is aware of his own behavior and has a code of ethics that matters to him.  He wasn't being judgemental, he was just being observant.  So, try thinking of it this way; if someone whose opinion you cared about was observing your behavior, how would you act?  OK, now you know what to do.