Goodbye Gremlins

November 23, 2015

How to Overcome the Past and Get the Practice You Want.

As a new dentist, I learned everything I could about building and growing my practice, including meeting key individuals who mentored me along the way. At the time, one particularly influential person in my life was an endodontist. He told me I could do certain root canals on patients in-house, recommending that I focus only on the front teeth and not the molars. For anything more complicated than front teeth root canals, he suggested that I refer those cases out to a specialist.

One day, a patient of mine needed an emergency root canal on a molar. The endodontist wasn’t available, so I was faced with a dilemma. I decided to perform the root canal myself. To my surprise, everything turned out fine.

What happened on that day shattered a long-held belief that I had about root canals. Prior to that patient, I was fearful of performing root canals—particularly on molars. But when necessity forced my hand, I realized that it wasn’t so bad! Afterward, I decided to get more education so that I could become better and better at root canals. Now they are a breeze! Today, when patients need a root canal, I can offer care and treatment for their situation immediately. By doing so, my patients’ lives are made easier, I can deliver optimal care, and it increases the value of my practice. After completing several successful root canals, I wondered, ‘Why did I ever think that I couldn’t do root canals for my patients?’

What’s Holding You Back?

After a few years, I learned that my former anxiety about root canals was a limiting belief. A limiting belief is just what the name suggests—a belief that you have about yourself that limits you and your life in some way. Limiting beliefs hold people back from their true potential.

What are the beliefs that are currently limiting your life? Where did those beliefs come from? Believe it or not, as new dentists, sometimes our educational institutions are sources of limiting beliefs. Dental schools usually teach students to stick to the basics and nothing more. Other times, we are our own worst enemies and a lack of self-confidence contributes to limiting beliefs. Whatever the case, limiting beliefs can and do affect everyone.

As dentists, limiting beliefs may prevent us from having an ideal career—the kind of practice we dream about—and they may even prevent us from delivering optimal care for our patients. I can attest that limiting beliefs can be overcome. Overcoming limiting beliefs may seem difficult, but the results are powerful and life-changing.

Based on my own experience and after reading books by Bruce Tuckman, Rick Carson, Anthony Robbins, and others (see sidebar above, “Recommended Readings”), I’ve formulated a strategy for overcoming beliefs. These tactics helped me and I hope they will help you, too. Details on each of the steps are in the paragraphs that follow.

Overcoming Limiting Beliefs

Identify your limiting beliefs.
Change your behavior when you encounter limiting beliefs.
Develop new ideas about your limiting beliefs (the “forming” phase).
Start learning and practicing new and different beliefs (also called the “storming” phase).
New beliefs and behaviors replace old, limiting beliefs (also called the “norming” phase).
You enter the “performing” phase—when the new beliefs are predominant and become muscle memory.

Common Gremlins

In some of the continuing education (CE) courses that I teach with the Dr. Dick Barnes Group, I refer to limiting beliefs as “gremlins.” This concept comes from a book, Taming Your Gremlin, by Rick Carson. I’ve read that book at least four times and every time I read it, I understand it a little more deeply.

In the book, readers are asked to identify their gremlins. To start, look at the things that you tell yourself you can’t do—those are limiting beliefs/gremlins (whether you call them limiting beliefs or gremlins—they are the same). Some common limiting beliefs/gremlins include:

I can only prep one to three teeth at a time.
Only surgeons or surgically trained specialists can do implants.
New dentists should stick with drill-and-fill dentistry.
My patients can’t afford large-case dental treatments.
If I go outside my comfort zone, I might be sued.
I have to use the cheapest lab to control costs.
I don’t want to look like I don’t know what I’m doing.
I don’t have time to get any more training.
I can’t do large-case dentistry; I should
refer those cases out.
If staff members leave my practice, then they
must not like me.
I can’t handle the ups and downs of owning a practice; maybe corporate dentistry is for me.
I can’t afford a hygienist; I should do cleanings myself.
I can only do what dental insurance will cover.
If I present large-case treatments, patients will assume I’m taking advantage of them.
Failure is scary; therefore, I should stick with what I know.
I’m a lousy leader.

All of those ideas (and likely some additional ones of your own) may be holding you back and preventing you from achieving the kind of success that you’ve dreamed of. If you continue thinking, ‘I can’t, I can’t, I can’t,’ then you might not have a very satisfying or profitable career. Most likely, you’ll be stuck with the kind of routine dentistry that won’t allow you to produce at the level you want. Once you identify a limiting belief, you can recognize it when you bump up against it. The next step is figuring out how to get around it.

Take a Break

After you identify the limiting beliefs that are holding you back, why not do something different—something better? Tony Robbins, motivational speaker and self-help author, says that when you bump up against a limiting belief, the first thing you have to do is “break state” with whatever you’re doing. Breaking state is literally stopping what you are doing. Robbins says that your physiology must immediately change. In other words, disengage from the task for a minute.

Therefore, if you’re in the middle of a procedure and it’s not going the way you anticipate and you start thinking, ‘I can’t do this,’ the first thing to do is take a step back and breathe. Push back, stretch, or do whatever helps. Then tell yourself, ‘I am the last dentist on earth and I have to get this done.’ Then get in there, get it done, and learn how to control the situation. When you allow fear to creep into the situation, you lose control. But if you break state for a minute or two and take a deep breath, you can regain control and completely change the direction of the outcome.

After taking a breath, replace the negative thoughts with positive ones. Instead of telling yourself, ‘I can’t,’ replace the phrase with, ‘I must.’ Doing so immediately changes your perspective and can give you the drive and determination to do what you once thought was impossible.

A few months ago, a new hygienist in my practice told me that she can’t see eight patients a day because her hand hurt. She said that she was disillusioned with her career choice and didn’t think it would work out. My response to her was, “Sit straight up and take a deep breath. Then let’s look at your posture.” After just a few hours of working with her new positioning, posture, and chair-settings, she saw new possibilities for her future. What they taught her in hygiene school was her limiting belief. Today, she’s my top-producing hygienist and her hands are pain free.

Although an important first step, changing your mindset is usually only a part of the process of changing a long-held behavior. You may need additional education, training, and experience to overcome a limiting belief. But identifying your gremlins, taking a break, and changing your mindset are essential steps towards lasting progress.

Tuckman’s Stages of Development

In the 1960s, educational psychologist Bruce Wayne Tuckman (b.1938) researched group development—how groups work together to accomplish their goals. In 1965, he published an article, “Developmental Sequence in Small Groups,” which included his theories about how groups change and develop. Tuckman initially identified four stages and later added a fifth one. Tuckman’s ideas are useful for groups but I believe they can also apply to individuals. I’ve adapted and modified the stages so they apply to individual development.

The Forming Stage

The first stage of development is forming. Individuals are excited about a new goal and try to understand what’s involved. At this stage, they are usually motivated and excited, but often relatively uninformed of what is involved in the task ahead.

During forming, it’s often helpful and sometimes necessary to have a leader or mentor who plays a dominant role. A good example is a dentist who wants to overcome a limiting belief that “large-case dentistry is only for specialists.” This goal requires outside help and direction. Dentists who want to learn how to implement large-case dentistry should go to CE or take other classes to learn what they need to know from a teacher/mentor. During the forming stage, a dentist decides to change a behavior, signs up for CE, and is excited about learning a new skill and the additional opportunities it can provide.

The Storming Stage

The second developmental stage of achieving a goal is called storming. Storming can be a frustrating phrase—so much so, some dentists never move beyond this stage. For dentists, this phase usually involves actually attending a seminar and learning advanced techniques. As an instructor, I’ve noticed some dentists who take CE course after CE course without becoming confident in the skills they learn—those dentists are stuck in the storming stage. During this stage, dentists learn theoretical knowledge and may begin implementing that knowledge into treatments for patients, but the skills have yet to become habit.

In storming, setbacks are inevitable, and dentists need a system in place to overcome them or their confidence can be dinged and they may terminate the whole process. To survive the storming stage, start by taking on large tasks in small increments, make sure you have a good lab to support you, enlist the help of a trusted mentor if necessary, and prepare to be resilient.

Take Incremental Steps

At the beginning of the storming stage, dentists sometimes don’t have a true understanding of what is involved in achieving the goal. During storming, dentists soon discover (as Aristotle once said), “The more you know [about a subject], the more you know you don’t know.” That’s why, during storming, it’s important to start small. If dentists are overwhelmed by too much information, it can stop the progression.

By starting with small steps, a large goal is more approachable. For example, in the full arch course with the Dr. Dick Barnes Group, I give doctors “simple” tasks first—like working on posterior teeth. I don’t want doctors to “practice” on anterior teeth for obvious and apparent reasons. Instead, I recommend that doctors work on a tooth in the back, with a buccal bone.

It can also be effective to simulate procedures on mannequins before trying them out on patients. I utilize mannequins when teaching dentists how to do implants. At the ImplantEZ II course, we use computerized mannequins that allow us to simulate the implant process without adding the additional pressure of working on a live patient. With this approach, dentists can sense how the treatment will feel and what complications may arise without serious repercussions. Using a simulation approach can help dentists get over the fear of, “What happens if there’s a complication?”

Find a Good Lab and Mentor

An additional strategy is to do large-case work with a lab that offers specialized help. Some labs assign doctors a rep, who will be there to “hold your hand” while you get experience in large cases (and often throughout your career). A good lab has a built-in support infrastructure with customer service representatives, dedicated doctor relations reps, technical support, and many additional resources to help dentists progress.

Without help and a way to break through the difficulty inherent in anything new, some doctors may sabotage themselves. In addition to the support of a good lab, a mentor (often an instructor or veteran dentist) can be extremely valuable. A mentor can help a new dentist have the confidence to implement the seminar techniques into the day-to-day activities of his or her dental practice. A mentor can help keep the dentist progressing towards his or her goal.

Bounce Back Quickly

The key to surviving the storming stage is to remember that you are going to have ups and downs when learning any new skill or accomplishing any goal. Resilience is important to survive this phase because you’re going to get knocked down. As the saying goes, you will need to pick yourself up, dust yourself off, and try again. After working through the inevitable setbacks, take a deep breath and figure out what you can do better next time (instead of focusing on what you did “wrong”). Eventually, you will learn from your mistakes and if you keep trying, it will go more smoothly the next time.

After dentists experience success and can see what they’ve accomplished, it’s such a celebration! Succeeding with that first case is important because afterwards, dentists usually have an epiphany that they can do it—and it’s a breakthrough moment towards achieving the goal.

A colleague of mine, Dr. Bill Black, helps dentists learn oral surgery techniques. Recently he told me about a doctor who came to his oral surgery course, learned some techniques, saw them applied in action, participated in the event, and returned home and implemented his skills in his practice. The dentist sent an email to Dr. Black that read, “I’m on top of the world right now!” That’s the benefit of breaking through.

Eventually, experience with the new skill starts yielding consistent results and the dentist moves from storming and into the norming stage.

The Norming Stage

This stage is when the new technique, skill, or behavior is becoming comfortable and results are more consistent. The norming stage is sometimes also called the “Aha!” phase because during norming, dentists often tell me, “Now I get it!” In this phase, dentists understand the techniques involved in the new skill and have practiced the new skill enough to know what to do and how to overcome any setbacks. Any stumbling blocks that previously may have disrupted the process during the storming phase are inconsequential in norming, because the dentist knows how to address them and they are overcome with minimal disruption. With norming, the dentist starts to feel a sense of confidence and momentum.

The Performing Stage

The performing stage occurs when norming behavior (confidence with a new skill) becomes “muscle memory” and the dentist knows what to do almost instinctively. This stage is achieved through hard work and usually results after practicing on many cases. Reaching this stage is confirmation that the structures and processes that you have set up work well. The dentist is now completely competent and can handle decision-making without supervision. Once you get to the performing stage, the change is complete, the goal is achieved—and it’s transforming.

The Adjourning Stage

Tuckman identifies a final stage as adjourning—which is when the task ends. For dentists, adjourning is a stage when the goal is achieved and it becomes part of their everyday practice.

Once you are at the adjourning phase, take a moment and enjoy the transformation that you have worked so hard to achieve! It’s an incredible accomplishment and you will feel an immense sense of fulfillment. When you overcome the things that once held you back, you are no longer “just looking at the trees,” you’re seeing the entire forest!”

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