When we lose our way

This Summer has been giving me many special moments to slow down and reflect on life.

It's interesting that just like Nature, our live goes through cycles of seasons, each one bringing us pearls of wisdom that we use to shape how we experience life.

I'm a strong believer that certain situations in life, will have a tendency to repeat themselves, as if in a cycle, until we finally learn the wisdom needed to overcome them.

Maybe some questions have to follow us around for a while before we've lived enough of the answer.

I remember one of my first interviews after graduating from university.

Like most newly qualified dentists, I had spent the previous few weeks preparing for the questions I thought I might be asked.

Why did I want the job?

What were my strengths?

Where did I see myself in five years?

Then came a question I wasn't expecting.

“Do you think a dentist should be a leader?”

I paused.

Then came the second part.

“If so, can you give me some examples of when that might be relevant?”

I can't remember what answer I gave.

I remember the question, though.

Nearly seventeen years later, I still think about it.

At the time, I don't think I really understood what they meant by leadership. Perhaps I associated it with management. Being in charge. Owning a practice. Telling other people what to do.

I certainly didn't think of myself as a leader.

I was a newly qualified dentist trying to remember everything I had been taught while simultaneously hoping nobody would discover quite how much I still didn't know.

But I understand that question very differently now.

Quite contrary to what I believed back then, leadership in dentistry doesn't begin when we buy a dental practice.

It begins much earlier than that.

Think about an ordinary day in a dental surgery.

A patient sits in front of us with a problem and trusts us to work out what is happening.

We gather the information.

We make a diagnosis.

We explain uncertainty.

We discuss risk.

We help someone make a decision about their own body.

And ultimately, we take responsibility for the treatment outcome we provide.

Throughout that whole process, we are surrounded by a team of people.

When something doesn't go to plan, people look towards us.

When a patient becomes distressed, we are expected to remain calm.

When there is a medical emergency, somebody needs to take control of the room.

When treatment becomes difficult, our nurse often watches our face before deciding whether something is actually wrong.

We are constantly communicating much more than clinical information.

We are setting the emotional temperature of the room.

And perhaps that is leadership too.

Not authority.

Not hierarchy.

Leadership.

Dentistry asks an enormous amount of us.

We spend years learning anatomy, pathology, pharmacology, radiology, restorative dentistry and countless other subjects.

Then we qualify and discover that being technically competent is only part of the job.

We need to understand people.

We need to communicate risk without creating fear.

We need to manage expectations.

We need to recognise anxiety.

We need to navigate complaints and disappointment.

We need to work alongside nurses, receptionists, hygienists, therapists, technicians and other dentists, all with different personalities, experiences and pressures of their own.

And somehow, amongst all of this, we are expected to know how to lead.

But I don't remember anyone really teaching me how.

Perhaps that doesn't matter too much when everything is going well.

The difficulty comes when it isn't.

I've worked in many different dental practices over the years.

Each has had its own atmosphere.

There are practices where you walk through the door and people seem comfortable with one another. Problems are discussed. People ask for help. There is laughter in the staff room. Mistakes can be acknowledged without someone immediately looking for somebody to blame.

And there are other places where something feels different.

People are careful about what they say.

Their behaviour seems forced, rehearsed, as if someone handed them a script of what to say and how to say it. The natural flow of communication is lost.

Conversations happen behind closed doors.

Decisions seem unpredictable.

Nobody quite trusts anybody else.

The background chatter becomes louder.

People leave.

New people arrive.

They leave too.

Sometimes the practice is financially successful.

Sometimes it isn't.

But either way, the atmosphere is impossible to measure on a spreadsheet.

And yet everyone working there can feel it.

It has made me think a lot recently about leadership in dentistry.

Particularly practice ownership.

I wonder how many dental practices began with a thought something like this:

When I have my own practice, I'll do things differently.

Perhaps someone had worked somewhere they felt undervalued.

Perhaps they were tired of somebody else dictating how they should practise.

Perhaps they wanted greater clinical freedom.

Perhaps they wanted to build a team where people felt supported.

Perhaps they simply wanted to create the kind of place where they themselves would have liked to work.

So they built it.

Or bought it.

And suddenly the dream came with salaries.

Loans.

Equipment.

Compliance.

Recruitment.

Laboratory bills.

Empty diaries.

Patient complaints.

Staff disagreements.

Targets.

Tax.

And the responsibility of knowing that other people's livelihoods now depended, at least partly, on the decisions they made.

I wonder whether, somewhere along the way, the question quietly changes.

It begins as:

What kind of place do I want to create?

And slowly becomes:

How do I keep this thing alive?

Perhaps that is when another kind of leadership is required.

Because being able to diagnose a difficult dental problem doesn't necessarily teach us how to manage conflict between two members of staff.

Being able to remain calm during a medical emergency doesn't necessarily teach us how to give difficult feedback without making someone feel small.

Being clinically successful doesn't teach us how to build trust.

And being a dentist certainly doesn't automatically teach us how to run a business.

Yet practice ownership can suddenly require all of those things at once.

Maybe that's why control can begin to creep in.

Maybe fear sometimes looks like micromanagement.

Maybe financial pressure slowly turns every empty appointment into lost revenue.

Maybe disagreement begins to feel threatening when you already feel responsible for everything.

Perhaps somewhere along the way, we become so busy keeping the practice moving that we stop checking whether we're still travelling in the direction we intended.

Our compass looses the sense of direction and our senses become overwhelmed. We see ourselves trapped in our own little boat, in the middle of a vast ocean, not knowing which way to turn to find safety.

It's not surprising that burnout from practice ownership seems remarkably common.

I don't necessarily see burnout as a negative thing.

It isn't desirable or harmless, but it certainly isn't a sign of failure.

I'm sure we have all experienced exhaustion and overwhelm at some point in our lives.

I like to think of it as a signal, our body and mind communicating in unison, telling us it's time to change strategy, to check in, look at the map and figure out which direction we wish to take.

That's all it is really. Our body and mind telling us

"Hey. It's been a while. Let's check in for a moment."

Isn't it fascinating to find that, after so many years of hard work and dedication, so many former practice owners move into mentoring or coaching other dentists and practice owners.

Perhaps there is wisdom that can only come from having been through it.

Perhaps once you step outside the business, you can finally see the things that were impossible to see while standing in the middle of it.

Sometimes reaching the end of one journey, allows us the space to look back and see clearly where we lost our way.

Although I appreciate the importance of coaching and mentoring, it also makes me wonder whether we spend too much time teaching people how to cope with the pressures of dentistry and not enough time asking why we keep creating environments from which people need to recover.

A dental practice can have excellent turnover, excellent EBITDA, full diaries and impressive growth while simultaneously carrying enormous human debt.

The receptionist who is frightened to tell the principal that something has gone wrong.

The nurse who doesn't feel confident enough to question something she has noticed.

The associate who feels that every conversation eventually comes back to money.

And the practice owner lying awake at night wondering how they are going to keep everything running.

The result can be high turnover. Fear. Resentment. Distrust. People emotionally checking out.

And unlike the financial balance sheet, nobody necessarily reviews that one at the end of the month.

Perhaps none of them imagined dentistry would feel like this.

We often talk about creating successful dental practices.

But perhaps success deserves a wider definition.

Of course a business needs to make money.

People need to be paid.

Bills need to be covered.

Investment needs to be worthwhile.

Without financial stability, there is no practice at all.

But surely there is another balance sheet that matters too.

Do people feel safe speaking?

Do they trust one another?

Do they feel valued?

Can somebody make a mistake without being humiliated?

Can somebody disagree with the person in charge?

Do people still care about the work they are doing?

And does the person who built the practice still recognise the place they once dreamed of creating?

Because perhaps the greatest danger isn't simply burnout.

Perhaps it is spending so long keeping everything running that the business we created to give us freedom quietly becomes our prison.

I sometimes think back to that interview.

Do you think a dentist should be a leader?

At twenty-something, I wasn't quite sure what they were asking me.

Today, my answer would be very different.

Yes.

I think dentists lead all the time.

We lead patients through uncertainty.

We lead teams through difficult moments.

We influence the atmosphere of the rooms we work in.

And when we own practices, that influence stretches far beyond the surgery door.

Perhaps the question I would ask now isn't whether dentists should be leaders.

We already are.

The question is:

Who teaches us how to become good ones?