I heard Dr. Bruce Baird use the term “boss-hole” while lecturing at the Productive Dentist Academy workshop a few years ago. I immediately understood its meaning, though his gentle and cultured Texan drawl toned it down significantly: “I would have used a different term”… I thought to myself.
I understood “boss-hole” because for most of my career I’d been a boss-hole. A higher-than-thou presence in the office, run like a dictatorship, forcing any and all to walk on eggshells, spending their days either celebrating or fearing me.
I know of several employees who quit because of a ‘toxic work environment’ that I’d created. Ten years ago, I didn’t suffer much blowback because employees in a dental practice were there for my taking. There was no shortage of applicants. Having said that, creating that kind of environment was never my intention. In fact, looking back and reliving, writing, and explaining who I used to be brings me great shame. I have a physical sensation understanding that others will read the words below.
I feel my skin crawl and I want to hide. The truth of the matter was that despite my behavior, I legitimately and sincerely did care about the people who worked for me. I wanted to be their friend, and… I wanted them to be my friend.
I frequently opened my wallet, gifting hundreds of dollars of my personal income, to help my employees pay rent or buy Christmas presents. But acts like that did not make up for the disparaging and shaming communication in front of patients, nor did they make up for the incessantly cold temperature running at my whim.
WHY WAS I A BOSS-HOLE?
I believe my boss-hole-ship was created by a combination of factors. There was a diminished empathy resulting from the many years pursuing academics and a sense of entitlement that came with the three letters following my name. Also, somewhere along the way, I got the idea that I needed to be celebrated – as a reward for the hard work I’d put into becoming a doctor. And, add to that poor and outdated mentorship.
But most of all… most of all… I was encased in an isolating profession lacking examples and inspiration into the kind of leader my team deserved.
EMPATHY AND AN OUTDATED MODEL OF LEADERSHIP
Studies show us that as education increases, specifically as it applies to dentistry, empathy declines. The highest empathy scores are shown among first-year dental students. This may be due to the fact that more emphasis is placed on courses that include communication in those early years.
Empathy starts to reduce in the 3rd year and is found to further decline in providers with specialty training1.
With a lack of practiced empathy, it’s easy to focus solely on our own needs as opposed to considering those of the people around us, whether they be patients or team members. Furthermore, getting through the eight post-high school years, necessary to gain those three pretty letters offset by a comma settled after our last names, can be exhausting. The education is filled with a never-ending struggle of self-doubt, fighting perfectionism at every corner, and exasperating learning. We all want to have that hardship recompensed in some way; and to most of us, the reward at the end of that journey is being called ‘doctor.’
When we are referenced as such, our chest puffs out, our eyes open wider, and it feels as if our bodies should be levitating off the earth a little. We confuse the honor that has been bestowed upon us as healers into a form of self-indulgence. I believe this happens to many new doctors. And, with time, with difficult patient interactions, our perception of who it is we really are, as doctors, is humbled. That inflated sense of self is almost self-leveling with years, though it does take hostages along the way.
POOR MENTORSHIP
What I found to have affected my poor leadership most was the influence of a thirty-plus-year senior dentist who had injected himself as my mentor. I’d met him shortly after graduation as a referral source. I remember being led into an outdated conference room filled haphazardly with diplomas. Each one in a different frame, all without a sense of organization. This unwelcoming consultation room was the preliminary place of making a patient subservient to the all-knowing doctor. There were no photos of patients, or smiles, or laughter, or even family. No photos of the team, just the doctor and his many distinct certificates. I felt terribly intimidated. And at the same time, special to have been ‘chosen’ as his mentee. After that meeting, Dr. Northwestern took me under his proverbial wing, and we talked on and off for more than a decade.
Conversations involving shaming me were quite frequent. I was shamed for not wearing a white coat to greet patients. I was instructed to communicate with patients by first and foremost displaying my level of education. I was to use terms like gingiva, caries, periodontium and was never to dumb down the language, no matter how confused the patient may seem. If I did, I’d lose the air of authority. When patients didn’t follow through with my recommended care, rather than showing empathy and inquiring deeper, I became more arrogant and displeased with wasted consultations. It showed in the operatories, in our hallways, and in team meetings. But no matter how hard I tried, I was nowhere near as successful as Dr. Northwestern. I was shamed and belittled for accepting HMO and public aid patients; for serving underprovided populations.
Each time I spoke with my mentor, I’d been led into a pervasive cycle of self-loathing with each day feeling more defeating than the next. My thinking was that if I wasn’t happy, if feeling inadequate was the norm, there would be nothing wrong with making others feel inadequate. That was life, I thought. And so, my poor leadership ensued.
In the final conversation I had with Dr. Northwestern, about four years ago, he shamed me for posting a photo on our Happy Tooth website. It depicted myself and my business partner neither wearing a lab coat. He insisted that I looked like I could have been a receptionist or an assistant, as if there was nothing worse.
How would patients distinguish me and applaud me for my professionalism if I looked like everyone else?2
It was in that conversation that Dr. Northwestern told me I was incapable of change, and he would no longer offer his advice; I was a lost cause. I remember feeling heartbroken and scared. I remember feeling deserted, feeling alone. I was running a failing practice, which I hated, which hated me, and now nothing would ever change because I had no one to depend on, no one to ask advice of. Dr. Northwestern’s desertion of our mentorship was likely one of the best things that could have happened to me.
Because it was in the depths of that darkness and loneliness that I had to do some introspective consideration. I needed to look in and figure out who I was without this man, without his outdated theories, analogies, and recommendations. And as I courageously began to delve into my core values with the help of a life coach, I finally, after 15 years of practice, figured out who I was, who I needed to be, and how to fulfill my passion and purpose. I began to create a future on my own terms, without a pressed lab coat, without the classical music in the background, and in an office not just filled with photos of patients and friends laughing but practicing in that kind of atmosphere.
I was finally free to be me. With that inception, everything changed, and everyone noticed. Out of the boss-hole that’d been grown in the shadow of Dr. Northwestern came ‘me,’ a human committed to helping patients become healthy, but more importantly, a human committed to creating a healthy atmosphere for our team to thrive.
AN AWAKENING INTO ALL THINGS HUMAN
Finding myself sans my misleading myagi wasn’t the only part of the equation. The moments that matter… that really matter… you remember for a lifetime, and my significant change came in that kind of flash. There came a break, there came a time in my practice when patients, their families, my teammates, even me—we all became human.
People were no longer objects available for my taking in monetizing a strenuous education. This specific awakening came during a time when my grandmother, a woman who’d loved me the most in this world, fell ill; her end was near. She lived in Poland, and my ability to visit with her was limited; it could have even been self-imposed out of fear of watching her age. She was constantly on my mind. I remember entering the operatory and seeing a woman, just like my grandmother, a Polish-speaking, grey-haired elderly woman in the presence of her daughter, her caretaker. She was in pain. She needed my help.
I believe that was the first time, as ashamed as I am to admit it, that I connected a tooth, to a mouth, to a human and back into my heart. I was not treating a symptom; I was treating the beloved woman who’d made me feel my whole life like I mattered. Embarrassingly, and uncontrollably, my eyes began to water. I admitted to the patient and her daughter their resemblance and how much I’d missed my grandmother. It might have been the first time that I also became human in the eyes of my patient. It was truly a life-changing moment for me. A veil had lifted, and all I was capable of seeing from that point on was what I had to offer other humans and not what I was there to take. I believe with good reason that the patient interaction mentioned above was the first step I took from being the boss-hole into servile leadership. And from that point on, with coaching, and reading, with writing and practicing, it felt good to change. I left in the rearview a model provider that deserved to be cherished for no other reason than his letters.
I left in the rearview the toxic and unreasonable expectations, the barking orders, and the shaming comments made in front of patients. I left in the rearview mirror the dental textbook language when speaking with patients. I left in the rearview the boss-hole I once was.
Change wasn’t immediate but it ensued. What came next was flow (as defined by scientist Mihaly Csikszentmihalyi) and more smiles, and laughter. With changes came newly rediscovered relationships with the team and patients. With the changes burnout reduced. With the changes, profit increased multifold. With the changes came a sense of joy and a practice I’m truly honored to call home, a team I’m honored to call family, and patients I’m honored to call friends.
A LINGERING QUESITON
As I write this, a question lingers in my mind: why didn’t I know better? Your question may linger: didn’t you see how you made others feel? I don’t know how to answer that, other than to say that I was, in fact, clueless. I have nothing and no one to blame for making those decisions; it was all me. I can’t assign blame for trusting a mentor whose role in our relationship was to be fawned over. I chose that relationship, and I should have known better. I’m deeply shamed and disturbed by my past leadership. What’s more is that back then when I thought about change, it was far too daunting and scary, and quite honestly, I didn’t know if it’d be possible. I’d beaten myself into believing that my existence in the practice was simply the way it had to be.
I could have kept going as I was, though there was very little about my days that I enjoyed. I dreaded waking up in the morning and was constantly late for work. I was making an above-average income for an average American, but not for a dentist in our area. I will reiterate this once more: change was difficult, and the road was long, fraught with curves, dirt passages, hills, and valleys. But the change and the effort were well worth it. With the help of the Productive Dentist Academy, creating new systems, prioritizing relationships, profitability skyrocketed. My hourly production quadrupled and still continues to grow. We were, we are, able to reward our team members with highly competitive salaries and endless gifts and bonuses. Our team is the best we’ve ever had; many of whom have been with us for almost a decade and a half.
If you find yourself in a place similar to mine, where as you pull up to the office you have an incessant desire to pull back out, something is off; but that something can be manipulated and changed into an advantage. Putting people first, prioritizing relationships, viewing teeth as connected to the human and then into our hearts makes a tremendous difference in the lives of those around us, in our own lives.
REFERENCES
- Sherman JJ, Cramer A. Measurement of changes in empathy during dental school. J Dent Educ. 2005 Mar;69(3):338-45. PMID: 15749944
- Interestingly enough, I received that same unsolicited call earlier this year when our new website published in a similar way.
ABOUT THE AUTHOR
Dr. Maggie Augustyn is a practicing general dentist, the owner of Happy Tooth, a faculty member at Productive Dentist Academy, an author, and an inspirational speaker. She obtained her Doctorate of Dental Surgery from the University of Illinois at Chicago (UIC). Augustyn is passionate about reading, researching, writing, and speaking on topics that encompass the human experience, including our struggles, pain, and moments of vitality.
Maggie Augustyn, DDS, FAAIP, FICOI
Her personal mission is to inspire individuals to embark on a journey toward a more authentic self-actualization. She has a notable presence in the media and is a frequent contributor to Dental Entrepreneur Woman. Dr. Augustyn takes great pride in her role as a contributing author to Dentistry Today, where she publishes a column titled “Mindful Moments.”
She has also been featured on various podcasts and is a sought-after national speaker, emphasizing the significance of authenticity and self-discovery.
FEATURED IMAGE CREDIT: Pathdoc/Shutterstock.com.
