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I would like to share with you 5 Key Lessons that Lincoln Harris has taught me (out of hundreds!). It was a tough list to whittle down to just Five. I have learned so much from this incredible Dentist, Mentor and Leader in Dentistry.
When I first asked Linc to come on the podcast, I thought to myself, ‘This guy is ridiculously gifted in every aspect of Dentistry. What should the theme be for this episode?!’
I then settled on timeless, non-clinical lessons that I have picked up from him over time:
Lesson 1 – The Stages of Grief
I sometimes noticed that as I was explaining a treatment plan to a patient, their body language started to shift. They started to fold their arms. What was going on here? The penny dropped when Lincoln taught me how the stages of grief apply to Dentistry!
Lesson 2 – When Dentistry get complex, slow down
We all want to be efficient Dentists. However, Lincoln Harris taught me that the more complex Dentistry becomes, the more you need to slow down. This has been powerful.
Lesson 3 – Photos – Every patient, every time!
How that fits in to the workflow of a consultation
Well, I was already taking a hell of a lot of photos before I met Lincoln. But now even the emergency patient that has been squeezed in at 4.50pm on Friday afternoon will get a few clinical intra-oral photos!
Lesson 4 – There is no evidence for what is the best treatment for YOUR patient. How we give our patients too many options
I have agonised and agonised over what is the best treatment plan for patients. You then end up sounding unsure of the plan yourself. Sometimes we have to go with our gut!
Lesson 5 – How to overcome being uncomfortable discussing fees with patients
We all have a number. Above this number, we get a funny feeling in your stomach. What’s your number?
If you enjoyed this episode, then do check out eMax Onlays and Vertipreps with Jason Smithson!
Click below for full episode transcript:Episode Teaser: Sometimes you do have to say, look, this is not the right time in your life to do this because this type of dentistry is better not to do until you can really do it well and right at the moment I'm going to make too many compromises. It would be better for you to spend nothing than to do half a job.
So let’s keep you stable. We’ll keep your maintenance cycle. We’ll maintain your teeth as best we can. Make sure you don’t lose any more. But this is not the best time for you to do it because we have to make so many compromises. You probably won’t be happy and you’ll have still spent most of your money.
Protruserati, I want you to think of a dentist who has inspired you a lot. Think of a dentist who has taught you so many clinical and non clinical gems. Think of a dentist who you really admire because they are just brilliant at everything they do and you just love interacting with their with their sort of content whether they put content out there or any sort of messages that they send you any mentorship they give you and you’re just in awe of that dentist.
For me, that dentist is Dr Lincoln Harris who I’m so so so happy to be sharing this episode with you guys. He has been such a huge Influence in my career, in my career trajectory. He’s one of the dentists. He’s probably the main dentist. Alongside with great dentists like Chris Soar, Tidu Manku and what not. Who has really pushed me to general dentistry.
I would say Lincoln Harris is what we call a super GP. A super general practitioner, super GDP. He is just someone who, I look at his cases and I look at his content and I think, What? Why are you so annoyingly amazing at everything? But he made me realize that as a GDP, you can strive to that level. As a GDP, you can do complex dentistry.
As a GDP, you can make your career extremely rewarding. So Lincoln, thank you so much for inspiring me so much. I’m so pumped that you came on the podcast. I met Lincoln Harris in Singapore. In 2016 he did the RETP course, which is Rapid Efficient Treatment Planning. And then I saw him in 2017 in Sydney alongside Pasquale Venuti on posterior quadrant dentistry.
And gosh, I’ve been following this guy on social media ’cause essentially, if you dunno about Lincoln Harris. There used to be a group called Stile Italiano, but recently I found out from an old Italian nurse of mine that it’s actually not Stile Italiano, it’s Stile, Stile Italiano.
So from Stile Italiano, we see this beautiful before and afters, this is around about 2013, 2014, like, everyone would just post these stunning before and after photos, right? And it was great, someone would post stuff before and after, and you get like a thousand likes, and people were just like, oh my god, that’s so beautiful, and we’d all admire dentistry from all over the world and it’s great.
But then Lincoln came along and said, you know what, we can do it differently. Now with no disrespect to Steele Italiano, these guys are great. Some of their blog posts online are just so educational, so brilliant. But what Lincoln did is he evolved that group into his own group, which is Restorative Implant Practice Excellence.
So we call it RIPE. And now it’s part of RIPE Global. The purpose of this group was that when you’re posting your dentistry, he wants you to post full protocol. Okay, every single photo, before, during, after, all those messy bloody bits in between, and wow. Like, I think so many of us have learnt so much from Facebook Dentistry.
For real, I mean, I know we can learn Dentistry off YouTube, however scary that may sound to some patients. But it’s true, we learn from videos, we learn from photos, we learn from descriptions. So, all these dentists all over the world, through the platform that Lincoln founded, R. I. P. E. It’s just amazing what you can learn on R. I. P. E.
So I’ve posted about four or five cases on R. I. P. E. And I get messages from dentists all over the world. Sometimes saying, hey, that case you did, can I ask you about that? So, I mean, Lincoln’s started this amazing community. So let’s speak to Lincoln today. And the topic I picked, because what topic do you pick for someone who is just so talented in almost every single domain you feel as though he, I could do one on implants, ortho, anything with him, right?
He’s like I said, he’s a super GP. So the topic I picked with him is the five lessons that he’s taught me. Okay, the five key lessons that he’s taught me that I’m so keen to share with you all. So join us with five lessons with Lincoln.
Before we get to that, I’m going to give you the Protrusive Dental Pearl. And again, this is a lesson that Lincoln gave me so I’m going to share this with you all now. I can’t really remember because now, we actually recorded a few months ago, and now I’m posting the episode up now. I don’t remember if we actually discussed this in this episode or not, but here’s the pearl I want to share with you.
Sometimes when you have a patient in front of you, a new patient, and you’re not 100 percent sure of the treatment plan. Like you don’t know whether you should do a fiber post and a crown, or you should do an extraction, an implant, or whether or not you should have orthodontics or not, and whether or not you should remove that wisdom tooth or not as part of this bigger picture for that patient.
Sometimes we agonize over it. And we agonize, and we agonize, and we think, and we think, and we think, and then we present the treatment option. We seem unsure. We present it in a high pitched tone. We present it with these facial expressions that is not going to fill the patient with confidence. So my advice that I learned from Lincoln is just go with your first plan.
Like make a plan that you think is appropriate, that’s clinically appropriate. Go with that one. Yes, you can refine it later. Yes, you can come back to the patient later. Say, you know how to think and I’m suggesting this, that and the other. Or sometimes if a case is too complex, you can always say, hey, let me think about it.
But then when you’re at home and you’re treatment planning it, just go with a reasonable plan. You don’t have to agonize over 10, 15 different scenarios. Like I used to do this. I used to be like, oh, I don’t know what to do. Should I do a bridge, a denture, blah, blah. And then when I stopped doing that and I just went for, okay, here’s what my gut instinct says from all the knowledge I’ve gained from courses, from all the mentors I’ve been taught by.
Here’s what I think today. Now, a few years from now, I might think differently. But according to what I believe today, according to my perception of dentistry right now, here’s what I believe, and as long as you care for the patient and you meet their goals, then I think you can’t go wrong. So, that’s what Lincoln taught me, and I’m passing it straight over to you guys.
So let’s just jump in right to the episode. And before we do, I want to wish you all a really happy new year. Thanks for making 2020 great for the podcast. I know so much has gone on the world now. Don’t want to sound like a broken record here and echo what everyone else is saying about an unprecedented year and the pandemic and whatnot.
It’s been a crazy year. Okay. I wish you and your family all the best, all the best for 2021. I hope you have a fantastic year. I think we realized more than anything that health is wealth. And I really hope that you have a stronger and better 2021 and this damn virus will shut the hell up. Let’s just join Lincoln Harris because I’m going to shut up now. Thank you.
Lincoln, welcome to the Protrusive Dental Podcast. It is amazing to have you on.
Thank you so much for having me. It’s been, I’ve known you for a while and it’s good to catch up. It actually is quite funny doing podcasts because it’s just like someone said. I’ve got to do that work and I said, it’s just like talking to someone for an hour and then you call it a podcast.
That’s it. And then I mean, I had a Mike Melkers on here as well. He’s obviously a buddy of ours, mutual buddy of ours. And it’s just like that, with these great clinicians that I respect so much and it’s just amazing to have you guys on. In fact, for you, Linc, this yellow background is for you. So you’re the first Australian, first Aussie I’m having on the podcast.
Right, so what, we’re having yellow screen.
We’re having a yellow screen behind me for that very reason. So it’s an absolute honor to have you on. Now, for those people listening right now-
Is that to remind you, like, of the sandy beach? Or the deserts of the central whatever? They’re red, by the way.
Well, it’s your color, right? You know, the Australian cricket team. I love cricket. Do you like cricket?
So cricket, that’s a game where you have sticks and you hit balls with them or something?
I sense what you’re saying.
There’s two games people get interested in. One they have a ball and a stick and the other one they just have a ball.
Yeah, I’m talking about the one with the stick as well.
Yeah, righto, righto. Righto. No, I don’t know very much about cricket. Well actually, to be fair, this will offend obviously a good portion of your audience but as a child I found the cricket ball quite hard and I didn’t really fancy trying to stand in the way of its progress towards the ground lest I miss and its hardness was inflicted on my face. I never really took to cricket for some reason.
Maybe that’s enough trauma from a young age. But obviously you’re Australian, but there’s so much more to you than that, Lincoln, which is exactly why I wanted to bring you on. For those people listening and watching right now, very few people, probably some of the newer grads, maybe, that’s my perception, who don’t know who you are, well, I’m going to give a small introduction, in my own way, of you, and then I’d like you to tell the more official one, if you like.
So, Lincoln, to me, you are someone who I’ve been learning from for many years. I saw you create the Facebook group, Restorative Implant Practice Excellence some years ago. How many years has it been?
Five years ago. So I’ve been qualified for seven years, yes. I remember in my first year out of dental school actually, joining this group. And I loved what it was about. Everyone posting full protocol moving away from just the before and after. I love the ethos behind it. So since then I’ve been following what you write, because you’re a good writer. You blog your videos, your restoring excellence Academy. I went to, I flew from Singapore when I lived there to Sydney to see you in Pasquale. And when you came to Singapore, I came to your RETP course. And that’s where I took this photo. Do you remember this photo?
Okay. Yeah. Yeah. I think we should put that photo away. It’s a pretty dodgy photo.
I want anyone who’s looking at this photo, anyone who sees this photo to know that it was not my idea. It was yours.
No, this photo would be far worse if I was facing the other way, so it’s not too bad.
It’s too far. Look, it’s early in the morning here, like at night, it’s not over there, but this is before breakfast here, so you need to-
For those of you who are not culturally aware, this is Lincoln giving me an Indian blessing. So this is a, I was blessed by Lincoln and I’ll never forget that blessing. So Lincoln, that’s my crappy introduction of you. Please tell the few people at home who don’t know who you are a little bit about yourself and what you do.
Ah, so I’m a general dentist. I’ve always had a general practice in the same place for 20 years and all I try to do is dentistry the way I was taught, which is actually a lot harder than it sounds.
And I have had a few educational adventures along the way, so I think this is like my third evolution of educational adventures. And so currently I’m a dentist. Part of the time and the other part of the time I teach and run a teaching company. That’s where our really, our goal is to bring education closer to the dentist.
So, instead of dentists traveling so far to get education, we bring the education to them. So, that’s where I am now. And I have been very fortunate to get many benefits from dentistry. And look, different personalities cope. Dentistry is a tough business. It’s a very, very difficult profession. It is difficult technically, it’s difficult emotionally, and it’s difficult.
You can do quite well financially, but that’s also not easy. So it is difficult on every level. And so, part of it is helping people understand that actually is normal. So a lot of when I teach it’s normal to struggle in dentistry because it’s really hard.
It’s not that there’s something wrong with you and everyone else is just sailing along. It’s just a really, it’s a really difficult thing to do. And to do it well is even more so. That’s really what pushes me every day is to one, do the best I can for my patients and two, to help other people do the best they can whilst acknowledging that dentistry is tough, it takes training, it’s stressful, it’s-
Some people I know get trapped in the profession like they’re earning a good living but they don’t really like it and if I can help a few people not end up that way, that would be great but that probably happens in every profession to be fair.
That’s true, but I like your mission, I think it’s very noble and I think what we’re going to be talking about is exactly this stuff, the bigger picture type stuff, because when I was thinking about, okay, so if Linc’s going to come on the podcast there’s so much, literally so much you’ve taught me over the years from tiny things like stopping bleeding when you’re trying to try and impress or take a scan or for a crown and everything’s profusely bleeding, little hacks by using what’s your, I’m trying to think what the favorite…
My favorite’s Viscostat Clear.
That’s it, Viscostat Clear. Soak it in there, leave it for a while, and all those little clinical gems that I’ve picked up, but if I just focused on that, I think I’ll be doing a disservice. Because I think for you, I want you to focus on the bigger picture stuff. So I’m going to go through with you just five of the many, many hundreds of things you’ve taught me, the bigger picture type stuff.
Because I think if we can download these sort of core principles that you’ve taught me into some of my listeners and watchers, that would be I think that’ll make a great episode.
Okay. Well, I will do my best to come along for the ride.
I know you will. So let’s start straight away. So number one thing that you taught me. This was when, this is something I learned from the blogs that you write, but then also when I came on your RETP. So that’s Rapid Efficient Treatment Planning course when I saw you in Singapore, and this is basically when I am communicating with my patients and I’m presenting a treatment plan, when I was a few years qualified, I’d noticed that sometimes their body language would change as I’m speaking to them.
And sometimes these men, typically these men, would start folding their arms, okay? And I was trying to think to myself, wait, what is happening? And I saw myself losing control of the conversation and I feel like I wasn’t being listened to anymore. And then when you taught me that actually this patient is going through grief and that was a real light bulb moment for me.
So please can you just tell us about grief, the stages of grief, and how it applies to communication treatment planning?
It’s not actually how it applies to treatment planning, it’s how it applies to everything. So, first of all you need to understand what grieving is, because we associate grieving with death. Okay, but grieving is not death, grieving is a sudden shocking change in your life. So, and that can be different levels, okay. It can be like more shocking or less shocking but anything that it causes us to suddenly go, oh wow, you know like to stop and things that we thought were true are suddenly not can cause grief.
So, things that can cause grief besides the loss of a loved one. Okay, a whole bunch of dentists around the world suddenly got confronted with the fact that their practice was going to be shut for six weeks, or eight weeks, or twelve weeks, and they didn’t know how long. Okay, that’s a sudden shocking change in your life, and so you will go through grief.
So the first thing you’re going, and you need to understand the stages of grief are not a fixed pattern that you follow step by step in equal amounts of time, like you might skip one stage, go straight to another stage, or you might do all the stages backwards, or you might get stuck in a stage for months and months and years and become bitter and angry and depressed and whatever, okay, but obviously there’s usually an element of denial, like we will all recognize this in ourselves that when we were told our Practices, we started to get the idea, our practices might shut, we’re all going no they won’t, no it’s not necessary, it’s not going to happen, this is just going to be like the flu all of that sort of stuff.
Okay, so that’s, and then you can get angry and go, this is ridiculous, and start trying to blame people and so on. And so this can happen in treatment planning as well. So the patient comes to us and they may well think that we never know how much other things cost in general like we know for retail stuff because you can see it online. But if you go to the stonemason and ask him to do a new benchtop made out of stone you just often there’s, we can’t appreciate the cost in another person’s business and so we can have ideas that are completely unrealistic and our patients have this too.
So they come to us and they might be thinking, I want my teeth fixed, I got a budget of five thousand, that’s a lot for me. And then you start talking about, well, not only are your teeth got problems, but they’ve got more problems than you thought. And now you’ve got problems with your occlusion, which is a word they don’t understand.
And then next thing you’re talking about four times more. So what you’ve done is you’ve given the patient a large and shocking change. And if you do that to a patient, for whatever reason, okay, I see you folding your arms right there. Okay. If you do that for whatever reason, you can push your patient into grief and they will go into denial like I don’t really need this dentistry, you’re just trying to rip me off, or anger, that’s ridiculous, or depression, oh my teeth are terrible, I’m just going to give up, I’m going to let them all fall apart, or bargaining like well maybe, and we’ll see a lot of bargaining with patients, so they go for it.
Well, maybe it costs that much to fix it properly, but can you just, like, can you just patch up my front tooth that’s fallen out three times?
Okay, so we’ll see this pattern.
Yeah, and so that is essentially your goal during communication and treatment planning is to never trap the patient in the corner with grief. So you need to think about how you communicate with them gently and give them space and time to adjust. Okay, and that also goes for not just good communication, but actually it’s just good sales. So really, so here’s the thing. You’ll hear patients come in and they go, I hate veneers because they always look terrible.
And what you actually say to the patient is, you only hate bad veneers because good veneers you don’t notice. So people say, I don’t want to be a salesman in dentistry. Well, you only notice sales when it’s bad. When someone is really, really good at sales, they just seem like a really helpful person who solves your problems.
So that’s what good sales is. A good sales is a great thing to be. You listen, you work out how you can help someone, and you do it with sensitivity to their budget. That’s good sales. Okay. So but bad sales you notice. Like bad sales is trying to push something down someone’s throat and that’s you know, that’s not.
So you don’t notice, that’s why we often have this bad idea about people who sell because we only notice it when it’s bad. And also from a pure sales theory people, the vast majority of people are not ready to buy for 60 to 90 days after they talk to someone about a new product or service that’s a significant purchase.
So, it just so happens that if you go through a treatment planning process properly and methodically and allow the patient space and time and so on, which helps avoid pushing them into grief so, then, it also it just happens that also correlates with the ideal amount of time from pure, like, straight up sales theory, like, and probably they’ve worked that out somewhere along the way that, that people need time.
Okay. I don’t know. And this is very hard to do, particularly when you’re younger. It’s extremely difficult when you’re inexperienced and you’re not busy to be patient and take the time and let the patient take the time. So this is, ah, like I couldn’t deal with it.
It almost goes against the grain of what some of the gurus, the sales gurus, teach you in terms of the C word, closing. And that’s where you came in and you explained the fact that yes, these patients are grieving and to recognize the stages of grief in our patients and then to give them space. So it almost goes against what they teach, which leads us nicely to the second lesson, which is beautifully easy is that when treatment plans get more complex, slow down.
And the conversely when treatment plans are simple just be quick and that really really helped me to gain clarity when I was treating planning and communicating to our patients.
Yeah, and also the reverse is true. If you’re really fast, you’ll only do suitable treatment plans. If you slow down, your treatment plans will become more complex, so watch out. So, if you don’t like doing complicated dentistry, don’t do good consultations. That’s absolutely true. And look that it’s so obvious. It’s obvious to me now. It wasn’t always. Like imagine any significant purchase. So, when we start doing complex dentistry, it’s as much as a car. Okay, sometimes it’s a good car, sometimes it’s a second hand beater, but it’s a significant expenditure.
And you can’t just go, well, it’s an investment in your health and all this nonsense. Okay, it doesn’t, there’s people who can’t afford good oncology who die because they don’t have enough money and you’re thinking that you can convince someone to have enough money for dentistry if they don’t have enough money.
That’s silly. So but certainly any significant thing that we spend money on in our life, most people, there’s a few who won’t, like about 5 or 10 percent, but the vast majority of people will want to think about it for some time and they will need to understand it fully. So, for sure you should slow down.
Now my practice has slowly progressed from a straight up general practice to one where the vast majority of my patients are complex. And you don’t need to take, you can slow down by using staff if you want to, you can train staff to do the slowing down process for you, so they can do some of the records and things, and they can draw out the process if you don’t personally want to spend the time with the patient over that period, but for sure, you can’t talk about really complex dentistry.
Now, there’s a couple reasons why you can’t. In most well regulated countries, if you don’t spend the time, you’re not going to get proper informed consent. It’s just how it is. And what took me a really long time to realize is that informed consent is not a thing that gets between you and the treatment plan that you want to do. Okay, because first of all, if you really want to do a treatment plan, you are treating yourself, you’re not treating the patient Really?
If you do informed consent really well, you actually get happier patients and you generally do better work so and like sometimes people say, well, if I tell the patient all of this stuff, all the things that could go wrong and so on, they might not go ahead and I go, that is actually the point of informed consent.
It’s not how do I do a procedure and cover myself legally and convince the patient to do it anyway because I want to, it’s actually this is your chance to say no and, but when you do that with a genuine intention, then the patient will just recognize that you’re trying to do the best you can.
And this comes, I’d like to tell you that this is because of great wisdom, but it actually just because I’ve made mistakes.
Of course, of course.
Okay. I’ve done big treatment plans with inadequate, informed consent. And, well, it’s like Warren Buffett says, when the tide goes out, you see who’s wearing pants. So, when the complaint comes, you see who’s got good, informed consent. Because you don’t care about informed consent until someone makes a complaint or there’s a problem, or they go to another dentist who says your work wasn’t good, or they go to a regulator. And then you’re going through your notes and you go, oh my goodness, we didn’t write anything, you know, I haven’t got documents, I haven’t got signed things, I haven’t got anything signed.
One case I had she complained about the cost of an implant or something, and we had a dispute. And I went through, and there wasn’t, there was no clear piece of paper, there was like a piece of paper that had the cost of the implant on it. But, it was all just, I felt embarrassed looking at it.
So, watch, you don’t want to feel embarrassed when you re-read your notes in two years time. And, if you do all of that really well, if you spend the time to document properly, and to thoroughly explain what you’re trying to do, and why you need to do it, and give the patient time to think about it, and don’t let the patient make rushed decisions.
So, I remember ten years ago, I used to be in Dentaltown a lot and there was a bit of a trend at that time of the patient wants veneers, I need to get them in the chair this Saturday before they change their mind. And now I think, what are we thinking?
You want the patient to change their mind before you do the veneers, not after. Like, when they’re going you know what, I’m not sure I wanted to do this. I think it was your idea and then like you’re in trouble. So a lot of the slowing down actually just comes from me learning to do informed consent properly and then from that I started to see the benefits to patient acceptance. So my patient acceptance, like treatment acceptance, is super high. It’s like 95 percent even for expensive stuff.
Can I just ask you a question on that note, right? So when you’re getting informed consent from a patient. Let’s say you’re going to be doing eight upper veneers, a small cosmetic case in eight upper veneers maybe and you’re consenting that patient. What techniques, what consent methods for example, I’m not a massive fan of signed documents.
I don’t think they’re worth the paper they’re printed on. However, to satisfy the regulators, we may need that. But that doesn’t necessarily mean the patient has actually understood what’s gone wrong. So what techniques do you employ to make sure you have got that good consent that, like you say, contributes to patients liking you and saying yes because they trust you?
Just to back up, they trust you but also you said that the purpose of informed consent is to give realistic expectations. That’s really the purpose of it. So if you want to not use the word informed consent, let’s just use the term. Setting realistic expectations that you won’t disappoint. Okay? That’s what informed consent really is about.
Okay? Like, there is a small chance that you could have a numb lip. That’s setting an expectation. Okay, I’ll do the procedure, but there is a percentage chance that you’ll have a numb lip for the rest of your life, which, unless you’re a saxophonist or a singer, you’ll probably live with. So, that’s what informed consent is.
It really needs to be thought of as setting expectations. There is a reason why you should do written things that people sign, okay? And that is because people absorb information differently depending on who they are. I am an auditory learner. Auditory and visual. So I never take notes in lectures. Okay, I just listen and I look and then like for surgical procedures I can watch someone do it and then I can do it and not as good but I learn by watching and hearing I have right behind me on the shelves a textbook that is still in its plastic wrapping. It’s a great textbook.
Okay, people have told me how great it is, okay, it’s still in its plastic wrapping and that’s not that I don’t learn by reading. It’s just that it’s not my preferred method. But for other people it is. So you can imagine me being an auditory person and I’m very good at verbalizing things. I want to teach the patient all the stuff by speaking.
But not all patients learn very well that way. So, and there’s a lot of things they forget. Like they come in a week later, I had a patient recently and he said, So, are you saying my denture is going to be removable? Not fixed on the implants and I said yes that’s right because if you remember our conversation the fixed option was going to be another 10, 000 or something and you couldn’t afford it so we’re going to do a removable option at this point.
The patient had forgotten. So the reason you do written is to cover more types of communication. So for me doing so first of all, eight veneers is not a small cosmetic treatment plan for me, okay, so-
No, I thought for you, I was thinking more in terms of you, I was thinking more in terms of you because I see all the full arch cases that you do, so I was thinking in the mindset that, okay, for Lincoln, eight upper units would be nothing, so that was where I was coming from.
Sometimes eight units you can spend nearly as long doing them as, but and it can be a lot of work in eight units but, so I have, first of all, the most important thing is you kind of got to be slightly paternalistic, which is you’ve actually got to, first of all, satisfy in yourself that the patient understands what you’re talking about and that they are comfortable actually wanting this procedure.
I quite commonly tell the patient, I’m not sure if you’re ready for this, okay, and this is very difficult to do without a lot of experience, so I’m not sure that you could do it two or three years out, but and there’s a whole bunch of things that I won’t let the patient go ahead for, so, like if they come in for implants and they’ve got uncontrolled periodontal disease and they smoke, okay those two things, okay, I can cope with the smoking if their gums are perfect, but I cannot cope smoking and perio together, absolute contraindication.
And so one of those two things changes. Well, preferably both, but at least, if they smoke, but their gums are perfect, I can cope with that. If they have perio and they smoke. Absolutely no go. And this, you might say, well that’s very wise, Lincoln. That’s because I did a full arch implant case, which I’ve now removed.
Six years later, and we’d lost 50 percent of the bone in two years. So that type of thing is very hard to learn. So what we were talking about informed consent and how I do written.
So I was just saying, yeah, I mean, I think I love the way that you phrase it into realistic expectations to the patient. And just so we also touched on the, I mentioned about the forms. I’m not a big fan of them. But you raise a good point that people are different, people absorb information in different ways. So I take your point and I respect that. Is there anything else that you want to touch on in terms of slowing down and consent forms how to actually get the consent in terms of, is it just forms? Are there any other techniques that you might use?
So, there’s a few things. Obviously, almost every single one of my patients has a full set of photos, so we’re going to show them their teeth on the photos. That also is part of the, both the consent and the acceptance process because people are very visual these days, and they, if you show them their teeth with the big hole in it, there’s just no doubt that it needs treating.
Okay, and actually most people think their teeth are worse than they really are. So that’s, you show people a really healthy set of teeth and they go yuck. Okay, because they don’t, they think their teeth are all white and they’re full of stains and stuff. So, the consent process for me involves photographs, I show them all the radiographs.
It takes time. And the more complex the treatment, the more time it takes. So it’s not uncommon for me to have spent two hours with a patient before we lay a scalpel or a burr on their tooth. So and it often the consent process also involves preliminary treatment to see whether you can stabilize the mouth.
So it’s very common as part of my consent process or realistic expectations or just good professional behavior to put the patient through, say, a perio program or an oral hygiene program or a caries reduction program and see how that goes. And so there’s a lot of my patients who I basically come in going, I want a makeover or I want a, essentially what they’re asking for is a rehab and I’m saying, not until your mouth is clean, okay?
So, because now you go, oh, that’s pretty tough to look at that much. A wheelbarrow full of money in the eye and say no, but actually all you need to think about is how much fun it would be to do that dentistry and then give the money back. Yeah. Well, it’s not very fun. So you, it’s not that hard to, and it has a side benefit.
When you stop trying to rush, so right now, like we’ve come out of Corona, my practice is booked up. Okay, we’ve got tons of new patients, super busy. When I say tons of new patients, tons of new patients for me is not the same as I hear people say like I see 50 new patients a month whereas for me a busy week is I see like 4 to 6 new patients a week.
The benefit of slowing down is first of all your acceptance rate tends to go up. Secondly, you start to get really busy but you won’t start to get really busy for about 6 to 12 months after you start this process because it takes time for the machinery to start working its way around. And thirdly, from a large corporation point of view, the best way for a dentist to operate is to have a space tomorrow.
Because you can fit in a new patient in a way that requires no loyalty. So, if you have a toothache, the patient will go pretty much anywhere to get it fixed. From a dentist’s mindset point of view, being booked up for two or three weeks is far better. So, dentists do their best work when they’re not worried about filling tomorrow’s.
So their best consultations occur when they’re booked up. And how do you get booked up? Well, I can tell you how not to get booked up. How not to get booked up is to massively expand your practice and put on 10 more staff when you, the moment you get slightly busy. So once you start getting busy and you start getting a little bit of a waiting list to see you, don’t be too quick to put on another dentist.
That’s your goal. I mean, if you want to become a business owner with a large stable of dentists, then go for it, and that’s acceptable and it’s appropriate for a lot of patients, but if you really love your dentistry and you really want to do stuff that’s a little bit more complex and a little bit more challenging, then don’t be in a hurry to add more capacity because…
Brilliant, so that’s not rushing in both those ways. So that’s lesson number two. When treatment plans get more complex, slow down and generally not to rush. And you put some really lovely gems in there about the consent process, which I’m sure people gain a lot of value from. You touched in there about the value of photos. So I’m actually going to skip to number five of the five things, which is you taught me to take photos of every patient every time. Now I was already good at taking photos, but it was, you’re very strict with me. You said to me, Jaz, you must take photos every patient every time and repeat every patient every time.
And when I got into that discipline. It just makes sense. I mean, a lot of my listeners and watchers already know, I’ve said in many episodes before the importance of taking photos and whatnot. Can you just briefly summarize to those new grads, maybe just the value and how much we can improve by taking photos?
Ah, look, there’s probably some, probably soon we’ll have some way to video the teeth or scan them or whatever, but first of all, we weren’t the ones who can’t, like, orthodontists have done this for a long time, so you might think of orthodontists as like the original cosmetic dentists, okay?
Every single one of their patients is documented, and in fact a lot of specialists, prosthodontists, everything. So, if you’re going to high level specialties, then you have to document everything to this level all the time. And they do it for good reason, because you actually can sit there and ponder the case, you can follow the case, you have a track record, but you’re never going to remember what the distal buccal cusp of the 2 7 looked like in five years time.
When the patient comes in and you’re trying to work out whether it’s got worse or not. So there’s many benefits. For me, number one is I can plan better off a photo than I can in the mouth. This is because of the nature of our eyes. Our eyes have tunnel vision. We always, our eyes are very bad camera and there’s only a tiny spot right in the middle that has high definition.
And also our eyes have a massive computer program behind them that lies to us. For instance, right now. Everyone who, almost everyone in the world can see their nose all the time, but your brain filters your nose out. And now that I’ve said that you notice that you can see your nose. So and our brain filters out the part of the eye where the nerve comes in, it filters out all the blood vessels and all of this, where it’s just like patching over the information with extrapolation.
And anytime you’re doing, say, cricket, your eye is not actually telling you what you see, it’s telling you what it thinks you will see in about 60 milliseconds time to allow you to have time to react to stuff so you don’t get run over by buses and hit in the head by cricket balls, otherwise you would actually not be able to catch a ball.
So, our eyes lie. So, photos pretty much don’t, unless they’ve been photoshopped. And so, the photo forces you to see everything. If you look at a photo of someone’s mouth, you go, oh, look. Like, when you look at it with just your eye, you focus on one thing. You go, oh, look at the big chip on their front tooth.
And you’re ignoring the fact that there’s blood pouring out of their gums on the other side of the mouth. And so, you take a photo, it forces you to look at everything and you’ll also notice this because you’ll go to a wedding and you’ll take a photo of the bride and groom and then you get home and look at the photo and you’ll realize there’s a palm tree growing out of the groom’s head, which you never noticed when you were taking the photo, okay, because there’s one right behind their head and it looks like there’s a tree growing out of their head, but when you were there, you never noticed that, so the photograph you can see more because it shows you everything all at once and it doesn’t tend to draw the eye to one thing so you ignore everything else.
And secondly, the process of taking photos trains your eye to see more. Because the moment you take the photo you realise that the photo doesn’t look very good because there’s a whole bunch of problems. There you cut out an amalgam to do a composite. Take a picture of the tooth and you think, oh that’s a lovely cavity prep, and then you look at it and immediately you notice there’s stain everywhere, all over the margins, the fissures, there’s amalgam dust all over the rubber dam, and this attention to detail you can’t see, so you can see better when you take photos.
Communication is better, you can show the patient, they’re very visual, it’s very, very easy to show someone that their teeth are worn. When there’s a picture of their teeth being worn right in front of them on a 60 inch television. For planning, you can use it for smile design, you can follow cases, I have cases.
I just saw a patient yesterday, I saw 2009, when she was mid teens or late teens. And now I’m seeing her again. And I can actually look, she has ironically for this, she has a protrusive pattern of parafunction with like she has every sign of high levels of occlusal activity that you could imagine.
So she’s got breaky facial, she’s got large masseters, she’s got huge lingual tori, she’s got thick bone around her teeth, she’s got teeth that are generally flattened, her incisors are shortened, she has significant pain in her temporalis and all up the top of her head where the temporalis attaches, so she’s got everything.
And so then I can look at the photo from 2009 and go, have her teeth worn significantly or not? You, you could never remember that. And it also saves time. Okay, regulations are different in every country, but I’ve looked at the regulations here. It doesn’t say you have to chart teeth. It says you need to record the teeth appropriately.
And so in Australia. recording the teeth appropriately, there is nowhere that it says you have to sit there, go on a little diagram of a tooth that looks like a circle with sides, which is not representative of a tooth, and click a button on the mesial to show a mesial filling. Like, compared to a photograph where you can see that that’s amalgam filling, or it’s a composite filling, or it’s not actually It’s on the contact, it’s on the buccal cusp, but on the mesial end of the buccal cusp from a forensic point of view is much more so it saves time.
That was a paradigm shift for me, Linc. When I saw you do the live exam on your RETP course and you had to go look around for a couple of minutes and then a decent look around and then you had all the photos and you sort of said that exactly what you said there. Why are we charting teeth?
I still haven’t got to the stage where I can quite implement it in the UK. We’re just so used to going through our system of charting, the mesial, then the middle and whatnot. But in my ideal world, I would like to follow your model. I think it’s great to have a good close look, but then have the photos and then the nurse can just follow along and the assistant can follow along and just do the charting for you. It just makes so much more sense and you can give the rest of the consultation for the things that matter, i. e. informed consent.
So the thing that’s interesting actually is that my exam process, in a standard, an RETP, the online version is on rightglobal.com now, so if you can’t ever come to the live one, and we’re about to change the live one to be much more comprehensive and focus more on really complex stuff rather than just the whole range of things because the original RETP is online now.
Can I just say as well for those listening and watching, I paid a lot of money for RETP and I got every penny’s worth. 1, 600, 1, 700, how much ever it was, and it was so worth it for me. It was a great program. And then part of, when you launched, right? Global. And I was like, wait for 30. I get to access the whole RETP and all those other full day programs, which by the way I paid also thousands of dollars for.
Interfere into this episode and just tell you about Ripe Global and Luke from Ripe Global. He has very kindly given the Protruserati a discount code. So I’m just going to read these out.
So you can get, I mean, I’m sure you’ve all seen Ripe Global. They’re everywhere on Facebook, social media. All these amazing cases, video content, free monthly masterclasses. I mean, what’s not to like? It’s been fantastic. But I’m going to share some coupon codes that Luke has kindly provided so you guys, the Patruserati, can get a discount.
So if you want to join the standard monthly membership and you’ve been umming and ahhing, now is the time. You can use the code RIPELEARN, that’s R I P E L E A R N. Ripe Learn to get 20 percent off their monthly membership. If you want to pay a year in advance, you get 30 percent off and that’s Ripe Annual is the coupon code.
Ripe Annual. And if you want to get 30 percent off the premium annual memberships, you get extra videos, extra content. It’s Ripe Jaz. Jaz is J A Z, just one Z. So Ripe Jaz. And again, if you go to protrusive.co.Uk to the episode under the show notes, you will have access to all these codes in case you join later, but the expiry for all these coupon codes is 31st of January, 2021.
So if you’re listening a few years later, I’m sorry, you miss out. So if you’ve been sitting on the fence, now is the time to really capitalize on this coupon code for the Protruserati and join and watch these amazing clinicians share dentistry in a way you’ve never seen before.
But then also, I hadn’t done Alina’s program, I hadn’t done several other programs, so okay, it was still like I wasn’t kicking myself all that much because there was still so much for me to gain from that, but I just thought the value of that was just mind blowing.
It is. And look, the best way to do something is to do something that has a good purpose. And our purpose is to make education more widely available at a price that people can afford. And to make it better. So and you can do that with online when you have the ability to scale and so RIPE Global is really built around that idea that we can make education both better and more accessible and less expensive but you can only do that with scale, so you can’t do that being expensive, so and it has been going terrifically well, but the so RETP is online there, but the key part is that, you can do a very thorough exam.
So my standard exam is most of my patients have a complex issue, so they’re going to need a full arch radiograph. So anyone who mentions implants or any type of complex, I’m going to get a cone beam. I like, I’m just not, once you get used to cone beams with your treatment planning, you just really can’t do without it.
And people go, well, a lot of people like to then have a song and dance about radiation. First of all, the amount of radiation that we generate in a patient’s life compared to like medical people is inconsequential. That’s the first thing. And secondly, very rare for a dentist to get sued for taking further records.
It’s very common for them to get sued for not taking further records. And I’ll give you an example of not further records that I haven’t been sued for, but which I have had stressful moments over and paid money out on. And that’s where an implant goes missing. So like you place an implant and then a week later it’s gone.
And so the obvious thing is it’s somehow fallen into the patient’s mouth and they haven’t noticed it. And, but the most common thing actually happens to it’s gone into the sinus, and in the sinus you can’t get an x ray of an implant unless you do a full arch radiograph. And, so the first, I didn’t realize this when I was inexperienced and I, cause it’s always when you’re doing a simultaneous lift.
So you do a simultaneous lift with implant and the lift pops and the implant or they put too much, but who knows what happens. And the implant goes up into the sinus. And if you take a PA trying to find it because the patient’s lying on their back, the implant has always fallen to the back of the sinus where you can’t.
You can’t, you can never get that on the X Ray, so. Anyway, so it’s always, almost always full arch radiograph of some sort. So an APG or a cone beam and then we take a full set of photographs. And we do the same process pretty much every time because then it’s really fast. Full set of photographs which takes me like a minute, 40 seconds. I immediately give the camera to the assistant to upload the photos, so they’re done by the time I-
You still take all your own photos, I think, yeah?
Yeah, I do because I think about outsourcing it. Sometimes it gets outsourced when it’s a patient. It comes in through therapy rather than through, or what you’d call hygiene. So we have new patients that come in via the hygiene department. So they’re just like your regular check up type patients. And Caitlin will take the photos for them. But if the patient is coming in to see me, specifically, it usually means they’re complex and I’ll take it. Because while I’m taking the photo, I’m looking at their teeth and starting to think. So it doesn’t really help me that much to have someone else take the photo.
And it still takes a minute, 30 seconds. And then in the chair if they’ve got any interproximal areas where I need radiographs like bite wings or PAs. Now, I will tell you that I have a flat fee for new patients.
So it’s not expensive. It’s just a single fee. It doesn’t matter how many x rays, photos. Whatever, everything in the first visit is included, and it’s not expensive. So, whilst the average treatment plan that I do is quite expensive, I am one of the least expensive for new patient consultations. Now this kind of goes against people’s philosophies a little bit because they go well, if the patient wants to do something extensive, they will pay a lot for a new patient exam, but actually not true because if you go and test drive a cheaper car like a Kia or a Great Wall or something, okay, you won’t pay to test drive it, okay, and that’s a cost to the dealer, but if you go and test drive a Bentley, not only will you still not pay to test drive it, even though it costs a lot more to test drive a Bentley than a Kia, They’ll probably give you champagne and some nice French cheese to go with it.
Okay, so when you’re spending more, you don’t actually expect to pay more for a consultation. You expect to pay less and get better service. So, and the other part of that is that when you have a flat fee, none of my patients have concerns about radiation or x-rays, but when they have to pay for every single x ray, okay.
I never thought about that.
When my patients pay for every single x-ray individually a la carte. They quite commonly have concerns about if this is necessary, okay? So what I’ve discovered is actually there’s a strong correlation between patients’ radiation concerns and how much they’re paying for the x-ray. So they have big concerns for cone beams and it’s not because of the number of micro receivers they’re getting, it’s because of the number of macro dollars they’re paying.
Anyway, that’s so whatever full arch radiographs I need, now sometimes you’ve actually got to look at their mouth and go, but most of my patients come in and go, look I want an implant or I’m thinking about replacing my back teeth. I mean, you’re never ever going to do a consultation for anyone about replacing their back teeth without a cone beam.
It would just be ridiculous, right? You know, unless they’re just had bum surgery for cancer and radiated their jaws and whatever, but even then he’d probably still take one. So yeah, well, maybe not because of the radiation will be an actual time to not use radiation if they’ve just had been irradiated for cancer.
But yeah, so, but there will be somewhere and if I’m not sure, take an OPG. So if you’re not sure whether you need OPG or a cone beam, take an OPG because if you take an OPG and then you take a cone beam, the patient’s got almost the same amount of radiation as a cone beam. But if you take a cone beam and they only need an OPG, well then they’ve just got it like, ten times as much, so.
Full arch radiographs if needed. Photos. Intraoral radiographs if needed, so I can look around the mouth very quickly and decide if they’re needed. And I’m doing it in this order because those things take time to upload. And to be available. Then it’s muscles of mastication, headache history, smoking history, TMJ assessment saliva glands, lymph nodes, soft tissue, pathology, check perio diagnosis, occlusal diagnosis, ortho diagnosis which we record all of that, and of course the assistant is typing, so by the time I finish examining, the notes are very comprehensive and done.
And then I go back to the consultation. So the actual exam part of my, say one hour with a new patient who’s got complex needs, the actual exam part, even though it’s incredibly thorough and our notes are much more extensive than average, takes about five minutes. Which leaves 55 minutes for finding out what their goals and concerns and what their long term objectives with their mouth are.
And then showing them the state of their mouth. And pretty much these days I never ever treatment plan complex stuff on the first visit. So I never would. I don’t do it for a few reasons. I don’t do it because they haven’t had time to consent. You can’t consent to complex procedures instantaneously.
They haven’t had time to understand what they want to do. And it’s just not effective like I’m always going to treatment plan basic urgent care and then see them again for a second consultation in 6 to 12 weeks and almost never on the first visit. If you present complex treatment plans on the first visit, your acceptance rate will be like 30, 40%.
I’ve definitely learned that first time myself, absolutely.
Yeah. If you go through a process of being professional, as in like doing what a dentist should do, which is making sure they’re healthy and stable and they can maintain their mouth before you do complex work and getting proper planning and taking your models and getting a diagnostic wax up and doing a mock up to check that you haven’t made them look like a horse and all of this stuff, that whole process takes time.
And if you go through that whole process, your acceptance rate goes up massively. And one of the reasons it goes up is because if you give someone a treatment plan after six months, Interactions with you and your team, so they’ve come in, they’ve seen me, they’ve seen my therapist, they’ve had perio done, they’ve had oral hygiene, they’ve had a couple visits with her, they’ve had some fillings done with her, I’ve done an endo that was urgent, and then they come back for a consultation after that amount of relationship, and I give them a treatment plan that’s 27, 000, and they can only afford 19, 000, they’re going to tell me, because they have enough relationship to say, it’s too expensive.
Can we do something that’s not so expensive? And most of the time you can. And so part of having really high acceptance rate is having enough communication, interaction between you and the patient so that they can tell you whether it works for them or not.
Now, sometimes you do have to say, look, this is not the right time in your life to do this because, you know, we’re this type of dentistry is better not to do until you can really do it well and right at the moment I’m going to make too many compromises. It would be better for you to spend nothing than to do half a job. So let’s keep you stable. We’ll keep your maintenance cycle. We’ll maintain your teeth as best we can.
Make sure you don’t lose any more. But this is not the best time for you to do it because we have to make so many compromises. You probably won’t be happy and you’ll have still spent most of your money.
I love that and I think I’m going to make that the snippet, the opening snippet of the podcast, what you just said there, because I think that’s such a difficult thing to come to terms with, to say to a patient. Just like you said earlier, you see you got the wheelbarrow of money sort of analogy, if you like, to actually say no, but for the right reasons. I really love that. In the interest of time, Linc, I’ve got to move on to the next points. How are you doing for time?
Yeah, I’m fine.
You’re fine, yeah? Okay, fine. So we covered those two. Let’s talk about the fact that the patient in front of you, there’s no evidence for how to treat the patient that’s in front of you. So you do, you came to UK and for tubules, you did a little bit about torpedoed by the literature and that, that was a bit of a flavor and also RETP courses as well.
You mentioned that there maybe 72 ways to do a restoration, for example. But there’s no evidence to say what’s the best for that patient, that unique patient in front of you. And when I absorbed that from you I really started to go with my gut instinct. I was I became better at just being a bit more decisive rather than really pondering every small nuances, which really probably wouldn’t make that big of a difference. .So if you just expand briefly on that.
So there’s actually two parts to why you found it easier and one of them is communication. So if you are ever unsure what to do with a patient you haven’t asked the patient enough questions like if you said anything I could do endo but I could do an implant but I could do endo but then what if the endo doesn’t work and then I have to do an implant?
Well ask the patient. It’s very simple. You say, look, I think and as dentists, because we’re not well trained. So dentists are not well trained. This is not a criticism of universities. They just don’t have enough time to train a dentist. Well, it’ll take about 12 years. Okay. And we would, it would take as long as ophthalmology, because what we do is about as hard as ophthalmology.
We’re a surgical specialist who is trained for as long as a general medical practitioner. Actually, less long than that. So, there is a reason why you don’t feel competent when you graduate, it’s because you haven’t been trained for long enough. So, we don’t have confidence as dentists for the early part of our career.
And often, we keep that up for a lot of our careers to actually tell the patient what’s best. Because we get so trained in, have to let the patient, we actually can’t let the patient make the decision of what’s the ideal treatment for them. We can let them be involved in the decision. They can guide us to what they want to achieve and they can say no.
If you have a patient who’s got a tiny incisal corner off and then you offer them all the available options including an extraction and they say, well, just pull the tooth out, okay. You can’t, there is nowhere in the world, it’s defensible to say well the patient, I offer the patient all the options for their small distal incisal chip on their 2, 1 and they chose to have their front tooth extracted.
That’s, so the idea first of all that you gave the patient all available options is not true. You never give the patient all available options. Secondly, the idea that you are removed from your responsibility in any way by what the patient chooses is also not true. So, if you go to a surgical specialist for, say, a sore knee, and he looks at your knee and determines that you need an arthroscopy, okay, to do something or other he doesn’t give you 19 options.
He gives you two, which is do the arthroscopy or don’t do the arthroscopy. Okay, and so that’s the, most of the time in dentistry, we give people too many options and it’s because we haven’t listened. So, now the problem with the word evidence based dentistry or evidence based medicine is that people forget what it is.
So, and it would be better to be called knowledge based dentistry because mostly, There is not a study or a group of studies that directly relate to this patient. So you’re taking your knowledge. So if you’ve read a lot of literature, you’re taking that knowledge. But it doesn’t ever directly, or almost never directly, apply to that particular patient that’s in front of you.
So because for it to do so, all of the patients in the study, or studies, and there’ll be like seven, there’ll be like a hundred studies at least for one single clinical decision will all be on populations different to your patient. So, unless that population of the study directly relates to the patient right in front of you right now, they’re all 37 year old bricklayers whose mother had severe caries and father had a denture from the age of 20.
Then, there’s too many variables, so but, we also forget that if you look at when Guyatt and Sackett wrote the paper on evidence based medicine, it was using the best available evidence and combining it with the patient’s wishes and with your clinical experience, okay? One third process of evidence based medicine is the best available literature.
Two thirds of evidence based medicine is the patient and the practitioner. It’s not 99 percent is the best available literature and 1 percent is the patient and the practitioner. That’s absolutely not true and it is a misrepresentation of evidence based. And the word evidence is often used to argue with people without actually any support.
So if you want to argue with someone or like if someone says something and you don’t want to believe them, you just go show me the evidence. So, it’s mostly a debating tactic. And a lot of the time when we go to a lecture and they show us evidence, if you actually read the evidence, it wouldn’t support what they said anyway.
So, it’s quite commonly that they’ve only read the, not always, but often they’ve only read the abstract. And the abstract sometimes the abstract doesn’t even follow. So you can’t, so you do, all of us use the best evidence that we have available to us, okay, and you can’t read everything, particularly if you’re a general practitioner.
It’s impossible. But what you can always do is spend more time listening to the patient. So, and helping them understand the consequences. So what I like to do in my practice is very simple. It’s work out what the patient has, work out what they want, and find a way to get from what they have to what they want at a price they can afford.
Wow, nice dentistry.
Without long term regrets. You’ve always got to have that bit in there. Took me a long time to work that bit out, without long term regret. So that means, if someone comes in to me and says, I want you to pull out all my teeth and do a full arch implant case, because I’m sick of maintaining my teeth, I sit there and go, you do realise, that in 10 to 15 years time, or 20 years time, all of your implants could be failing, and I could be removing them, bone grafting and redoing them, and that the teeth can fall off your fixed prosthesis, and I could be redoing it, and every time I fix your fixed prosthesis, it might cost a thousand dollars, because I’m not going to guarantee it forever.
A lot of maintenance cost. Can you afford that? And so that’s the difference between a consultation where you go I’m meeting what they want at a price they can afford without long term regrets. So, like I get a lot of patients, a lot of ladies come in and they want nice teeth and they don’t want ortho.
And I go, well, you’re 35. I have patients who are 95. If I cut your teeth up now, particularly that heavily, when you’re 45 you’ll still want to look beautiful and when you’re 55 you’ll still want to look beautiful and if at 55 your teeth are all snapping off and I’m doing implants, which is great for me, you will have regrets.
I’m getting deja vu. I’m getting flashbacks from RETP.
I didn’t, I think when you were there I wasn’t as long term focused because I was still, I still had to get slapped around by life experience a bit more before I can have some of these viewpoints.
No, no, this is four years ago. No, this is exactly the sort of stuff you taught me then. And the, that exactly, that exact dialogue where, you know, I know that when you’re 55 you’ll still want to look beautiful. I remember the first time I said that to the patient, I felt like, yeah, it’s Lincoln inside me. No, it’s a really great thing to say to patients. I really do think it’s a great way of putting it into perspective for the patient, you know?
You still want to look good. Yes, I know it’s what you want, to look good, but I know that when you’re this age, you’ll also want to look good. And that just really, when I said that to patients, they’re like, oh, crap, you know, that. Yeah.
Yeah. And look there. There are also cases to be fair, where I have done ortho and then I’ve done veneers and I should have just done veneers. Like you’ve got mild crowding. Sometimes you go, okay, I can put the patient through six or 12 months of ortho, and then I do veneers, and then I spend the rest of my life worrying that they’ll relapse okay. Of their orthodontic states after I’ve done veneers. And I should have just that tiny bit of crowding I should have, it would actually been more minimally invasive to the patient to have only done veneers.
Because I put them through two procedures, I could have put them through one. I’m not talking about cases where you’ve got massive crowding, like where you’ve got to cut into dentine. I’m just talking about ones where you’ve got mild crowding and you’re so focused on doing ortho for every case that you do ortho unnecessarily for a case that probably should just be a veneer case.
But what’s really important with treatment planning is make a decision, take responsibility for it. And then move on. Okay. You, you, if you agonize for 17 days over a trim plan, it’s probably not going to get any better and people will still be able to question it and argue about it and say it was wrong no matter how you do it.
So you make the decision, make it quickly, talk to the patient. If you can’t make a decision, ask the patient more questions, make your decision, live with it, move on.
Beautifully said. And that leads us a link to the final of Lincoln’s Lessons, and this is about something that I struggled with a lot in the early years before I came to RATP, and you know what?
I haven’t mastered it, and I’m gonna get better at it, and I know I will. But it’s about how uncomfortable dentists can get, and particularly, I do believe that the less experienced you are and also depends on your mindset, on your limited beliefs that you have on money, okay? So I would find it difficult early years to charge above a certain point because that point was where I started getting uncomfortable and you helped me massively to overcome that barrier and so if you could just give a flavor of that element of RATP in terms of why are we so uncomfortable with discussing fees at various stages of our career and how we can overcome that.
We’re uncomfortable discussing fees because we are one of the only types of healthcare. If you’re in private practice, that is almost completely unsubsidized for anything extensive. So, like if you have a, if cardiologists had to just sit there and tell the patient how much it was going to cost for, to have a stent put in your heart in full, you know, paying full freight.
They would be uncomfortable too, but particularly if they had to do that when they were 22 and they weren’t fully trained they were still a registrar, their first year of cardiology training you had to sit there and look the patient in the eye and go it’s going to be 27, 000 pounds for this, is that okay?
Okay, they would be uncomfortable too, but they don’t get to do that and by the time they do have to do that, they’re usually 45, they’re well off and they have a office receptionist who does it for them, so that’s part of it. Part of it is that we are in a surgical specialty that pays, patient have to pay full freight.
So that’s part of it. And we have to start doing that early in our career when we don’t have experience, we don’t have a lot of confidence and we don’t have a lot of money. It’s very hard to talk about something that costs more than we personally can afford. The other part of it is that we get beat on in the media all the time, so we just generally have this self consciousness about costs of dentistry because we’re always getting hammered for it, and it’s not our fault, okay, it’s not our fault that dentistry is expensive, everything is expensive, it’s just most things are subsidized by the government.
So, there’s a few reasons why and also We’re not very good at communicating costs in our early days so we do get a lot of rejection and it takes time to get over that rejection and particularly if you start trying to present big treatment plans in your first visit, you will get a lot of rejection.
I still would if I did that. So but I call it the emotional price. Everyone has a price where when their treatment plan goes above that price, they get uncomfortable. So, every person will be different. Like for some people, it’s going to be 2, 000, 2, 000. Well, when, mostly when you’re a graduate, it’s really low. It’s like 1, 000. And that’s because as a graduate-
I could, I could tell you when I was first year out of dental school, because of the national health system that was working under at that point where the maximum barrier of the health fund, the treatment was something like 250, right?
So that was the ceiling of anything that you could do. That was within the NHS. So then if they wanted a fancy aesthetic option that was perhaps not in there, then as soon as it got to about 300 pounds, I was like, whoa, I’m going way above that other barrier. So that was a limiting belief that I had. And yeah, that was very difficult to overcome at that stage in my career.
Yeah, and it is There’s several things that overcome it. One is realizing that it’s there. That’s the first thing. So it’s like any type of psychological boogeyman. Once you can give it a name and look it in the eye, it’s less scary. So, you know, everyone has an emotional price. That’s the price where your treatment plan goes from being uncomfortable to comfortable.
And I have one. It’s just got bigger over time. So when I first graduated, it was 1000. I remember the first time I did an 11, 000 treatment plan, I actually was so afraid, I had to practice saying it, so that I wouldn’t just choke. I would sit there going, Okay, and this treatment will cost, choke.
I can’t say it, the words won’t come out. Okay so, and we train people in RETP and you can watch that happening online, but the practice helps. So practicing something uncomfortable, you don’t avoid discomfort, you just confront it. So if you’re doing a treatment plan that’s more expensive than you’ve ever done before, practice saying it so that you can say it, deadpan.
Like it shouldn’t be like, ha ha ha ha. Should be like the weather. Today it’s cloudy and raining. Today the treatment plan that you need to meet your goals is going to be 15, 000. Is that going to work for you? Okay, and it’s okay to say it’s expensive. Don’t like I get all these courses and they come up with this like as if you can just change the words that you use and you know, yeah, like, oh, it’s going to be an investment in your health.
That’s nonsense. Like, first of all, investments grow in value. Okay, your teeth depreciate. You can’t like do your set of ideas and then sell them on eBay for more in five years time. That’s not true. Okay, so they amortize really, it’s like a 100 percent write off in the first year, so And it’s okay to say it’s expensive.
It is expensive. Your dentistry, they go, look, how much will it be? Look, it’s going to be expensive. And, and in the first visit, part of my process now for softening people up to the price so that they don’t get a big shock when we finally get to it is to give them a range right up front. So the very first visit, you always give the patient a range on their overall treatment plan but it has to be massive.
Like, it’s common. I gave a patient yesterday a treatment plan range because we won’t plan her treatment. It was a new patient. I won’t plan her treatment for about 3 months. Do exactly what I say, okay? And the range I gave her was a minimum of 12, 000 and a maximum of 100. Now, that’s much less threatening, and then I say, look, it’s like a house renovation.
How much does a kitchen cost? It depends. It depends if you get Gaggenau appliances and fancy marble bench tops, it’s going to cost more than if you have LG and Lemonex. So teeth are the same. If you do a hundred square meter kitchen with a butler’s pantry, it’s going to cost more than a tiny little one.
So the patients can understand that. So, I give them a big range in that way that they don’t get a shock. But as far as your emotional price goes, you need to practice. It’s harder when you need money. So like try not to be financially stretched too much like if you have if you start a practice and then you immediately buy a big house and two fancy cars-
And the student loan.
It will be more difficult to talk about the price of expensive dentistry than if you don’t, okay? Because you, it’s always harder when you need it. As your wealth increases, it gets easier because as your assets go up, and it doesn’t seem such a large amount to you anymore, so-
No one ever spoke about that until I came to RETP. No one ever spoke about that, you know, maybe it’s because you’re a dentist and some of these people in sales are not dentists, but it was the first time I heard it. In that way about that discomfort and why we get it and it is to do with our own wealth as well and I never heard it and it just made so much sense to me.
Yeah, a lot of is actually like psychologically. It’s like a projection. We’re putting ourself In the patient’s shoes, and then we’re going, okay, if I was them, could I, would that be comfortable for me, okay? But then there’s also other things like rejection, we’re afraid of being rejected and we’re afraid of the patient saying that we’re a rip off to the neighbor, And, you know, getting put in the media, like dentists ripping everyone off again, and so on.
So there’s a whole bunch of things. And, we all have different philosophies too, like some people just have a philosophy that dentistry should be the bare minimum possible and other people have a philosophy that we’re basically real estate developers of the mouth and that both of those are fine and a good example of that is that I love the fact that Yosemite National Park is very underdeveloped like for a big American park there’s not a lot of development in there but I also like some of the Italian coastline that’s been heavily populated for thousands of years, and it’s also beautiful.
So both, untouched and touched by man can be beautiful in their own way. So I think that there’ll be philosophical differences to come into it as well. But definitely everyone has a price that they find it difficult to treat and plan over, and their treatment plans will tend to stay just under that, and it’s good to recognize what your price is.
So, you know, just ask yourself, am I comfortable with a 1, 000 or 1, 000 treatment plan, or 2, 000 or 20, 000? At what point are you starting to feel a little bit tight in the tummy? And for me, it started at 1, 000, then it went up to like about just over 10, 000 for quite a long time. And then I started doing rehabs, it jumped up to 50, 000 Australian.
And then it stuck there for years and years. And years and years and then, then it got stuck at like 80 and I don’t know what it is now, it’s probably 55 or 60, 000 pounds is my emotional price now but I don’t really know and also you kind of get, you just get used to it, like, and not all my treatments are expensive, like yesterday I saw a patient who needs a filling. And a scale, and that’s fine. I’m not too posh. So, yeah. I like doing fillings. They’re kind of easy.
Well, there we have it. Ladies and Gents. Lincoln Harris still does a distal occlusal and a lower premolar. And look, yeah, I’m only adjusting there. I mean, your work is inspirational.
You are someone I look up to a lot and I will continue to follow your teachings and especially with RIPE Global. Can you just tell us, just before we finish, what have you got planned? What’s the future of RIPE Global for the next couple of years?
So we’re just being, RIPE Global, we expanding massively with our online education, but we want to make it so much better. So we actually now employ, did you watch the movie Extraction?
Not, not yet.
It’s about Chris Hemsworth.
Yeah. I saw bits of it. Yeah. I saw bits of it. It looks, it looks really cool.
Yeah, so our cinematographer is the same guy now, so, ah, we yeah, so that’s how we push the boundaries.
So that is cool.
[Lincoln] Look, right level is so simple. We want to make education better, more widely available, and lower cost. And how do you do that? You just take it closer. So, stage one is significantly increasing our online content and making it better and making better production values and really stepping up the quality of the online, which is, to be fair, quite tricky during coronavirus because we have a director.
So our content director is actually a movie TV director and we can’t travel. So it’s a little bit tricky at the moment. But that’s step one and step two is teaching facilities in multiple continents so that they’re closer to the audience and particularly the high quality ones that I like to use in, like the ones we have in Sydney, they’re not available in everywhere in the world, so and the way we teach hands on, It’s driven by aviation.
When you can’t learn to do dentistry just theoretically. It has to be repetition. You can’t like do one crown prep and then you’re good to go. You need to sit there and you need to do like well, normally in the first, our first hands on module, we do 20 crown preps in a day and a half. And that’s not because we want to teach people to be fast, it’s just that to train the hand you have to do things again and again and again and again.
Okay, like none of us would fly with a pilot who had read everything about flying but had only landed a couple of times. Experience counts, so to really ramp up the quality of teaching so people get and with the online it makes it so much easier. You can put all of the theory online, people can have it done, and when they come to the hands on they just do hands on, they’re not sitting there spending two thirds of the hands on.
Listening to a lecture and watching a demonstration. So that can all be online first. So that your time is much better value. So that’s the third, second step. And the third step is to become accredited as an education provider. So and you know, to do that people say, well, why? We’ve built the company so that we can list it on the stock market in a few years and you go, well, why?
Because I don’t want to sell out. I don’t want to have to sell the whole company to a venture capital one day. So there’s a ton of people investing in it right now and from all over the world, there’s like 20 different countries, people who have invested in RIPE Global. And actually quite funnily, one of my patients also invested and he owns a software factory.
So he’s like causing the queries and helping fix it. It’s vertically integrated. So anyways, that’s RIPE Global. Make it better, make it more widely available, make it less expensive.
Well, I think it’s a great vision. I look forward to when you set up in Europe. I think I don’t know if you’re allowed to reveal where I think Prague was it?
Oh, look, Prague, Prague was definitely our first but, we obviously have to wait until we can travel again and then we will go and look at it more closely when we’re ready so and then probably, I’m thinking the first places we’re likely to go is, Prague and then probably South Asia and then potentially Middle East but we’ll see.
Well, that sounds amazing. I’ll put all the links and stuff for those that are watching, listening in usual places on the website and whatnot. But definitely worth checking out. And I’ve recently contributed to RIPE Global Arts due to goop soon. And I’d like to get involved even more.
So it’s a great thing where you are welcoming contributions from all over the world who can add absolutely to this community of expertise you have is fantastic concept.
Yeah. And I think that’s where we want everything, so we’ve got endo stuff coming soon. There’s a lot of restorative stuff, so obviously there’s a lot of my restorative stuff, there’s a lot of occlusion stuff from Michael Melkers, there’s soft tissue grafting, there’s bone grafting stuff, and there’s a whole bunch of endo lectures coming soon. We want to have everything, and we don’t just want to have like little webinar y things, they’re appropriate sometimes, but we actually want full on a two day lecture on one topic.
You can watch all 12 modules, and Get CPD because we are accredited for the GDC. So the and for the U S and New Zealand and wherever else as well. So, but we are really pushing to how can we do this better and as soon as we can travel, the TV production team and the cinematographer will be off to all of our teachers and I mean, you can already start to see that the effect on the quality of the content that’s coming out now from having a director who works for us full time, I said to him, I want education to become cinematic and he’s delivering, so-
I’m salivating. Honestly, I’m salivating and I’m really excited for the future. You’ve got great UK guys like Tom Sealy on board as well, and I’m a massive fan of his. He’s a good friend. So look Linc, thank you so much for coming on podcast. I really appreciate it. Honestly, to me, you really are someone, a massive role model and to give you a time up to come on the show after you’ve taught me so much over the years, and I’m actually looking forward to learn even more from you. Thank you so much.
No, no worries at all. And you’re welcome to learn more because the way I’ve learned most stuff is by painful mistakes. And so, I’m sure you’ll do that along the way as well because you can’t progress unless you do.
Absolutely. Well said. Well said.
Thank you for having me. It’s been a pleasure. And great to catch up with you again.
You too, Linc. Thank you. Protruserati, thank you so much for listening all the way to the end. I always appreciate it, that I always really appreciate you coming all the way to the end to hear my little outro. So obviously I’m hoping you gained a lot of value from that and I’m hoping I picked good lessons.
I mean, I know loads of you out there are Lincoln Harris fans, or you’re already part of Ripe Global, so I’m sure you have your own five or six lessons that Lincoln has taught you. And I’m sure, I mean a lot of these I covered were nonclinical. You can’t even believe the number of clinical gems that I’ve learned from Lincoln Harris.
So Lincoln, again, thanks so much for all you do for our profession. And once again, if you’d go on the show notes on protrusive. co. uk or on the Protrusive Dental Community Facebook group, you could find those coupon codes I shared with you. So you can get your discount for 31st of January, 2021 for Ripe Global.
So thank you so much for Ripe Global for offering that to all our members. And I will catch you in the next episode in 2021. Thank you.