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July 2nd, 2018

Clinical Leadership: Diagnose the Mouth, Not the Wallet

By Victoria Peterson, CEO & Co-Founder

Clinical leadership is an often-overlooked aspect of dental practice management. I view clinical leadership as the most critical component of “practice management”. Developing a system to articulate the dentists’ philosophy of care to both team and patients is essential.

So how do you lead your team in clinical parameters and care for patients? Clinical leadership comes down to:

  • Discipline to comprehensively review diagnostic materials
  • Confidence to share all the issues you see
  • Team collaboration to align the standard of care


When it comes to diagnosis and treatment planning, it’s not uncommon to shift focus from comprehensive care to critical care. Patient rejection, insurance limitations, and lack of time play a role in degradation of the discipline to fully document the clinical status of the patient. A tremendous amount of discipline, and strong communication skills, are required to maintain an open-mind to treatment planning. One key productive dentists have found is to “diagnose the mouth, not the wallet”.

Your team can play a key support role. Teach them how you interpret radiographs, medical and dental histories. Comprehensive diagnosis evaluates the patient’s health through several lenses: restorative, periodontal, endodontic, aesthetic, and occlusion. Add to this lifestyle risk factors, such as sleep apnea, coronary heart disease, diabetes, and the diagnostic situation gets complicated pretty fast! This is where leadership and systematic training comes into play.

Traditional examinations flow tooth by tooth, with the attempt to “diagnose” all that is wrong with that particular tooth. This method is time consuming and causes brain fatigue. The clinician is forced to make 32 critical decisions filtered through multiple lenses. At the end of exam, you have 32 puzzle pieces, a resistant patient and a tight schedule. Is it any wonder the temptation to put down the explorer and simply talk about the “worst one” is so prevalent? As a leader, I encourage you to try this:  work with your team and teach them to look at the whole mouth through three different filters.

First time: from the point of view of a general dentist. Look for areas of imperfection that need to be restored – cavities, fillings, and so forth.

Secondly: as an endodontist. What is going on around the apex of the tooth? Are there cysts or fractures that could impact the nerve of the tooth?

Third: as a periodontist or oral surgeon. Look for impactions or teeth that aren’t salvageable, perhaps candidates for implant consideration.


Clinical confidence comes through repetition over time. This is particularly true of younger doctors. There are two aspects of confidence as a leader: internal belief in your skills, and communication skills to articulate to your patients and team. The best way to master both is to work on the communication skills first. This includes body language, tonality and words. At PDA, we call this the one-act play. Mastering the communication skills helps you to connect so that more patients say yes, which quickly leads to the experience needed to gain clinical confidence.

As the clinical leader, there are many opportunities to expand the scope of services for the practice. Begin where you are today; there is not right or wrong here – just evolution. If you currently prep one tooth at a time, then begin to expand your vision to quadrants, and continue until you’ve trained to full-mouth rehabilitation levels.

The hallmark of leadership is that others are following. To assist your team in aligning with confidence in your clinical capability, be willing to invest in them. Develop a comprehensive plan, based on their health goals. Then deliver. Your team becomes living testimony to your great work. Once their smile design is complete, and their mouth is healthy, they will have first hand knowledge to share with the patients.

My research into emotional intelligence clearly shows that patients choose to say “Yes” only when they experience the emotion of “confidence”. Creating congruency throughout your team creates the atmosphere of confidence in your office.


Great leaders collaborate and ask questions. Cardinal rule of collaboration: Never contradict the team in front of the patient!

If you find that your treatment coordinator, hygienists or assistants are out of sync when co-diagnosing or supporting development of a treatment plan, take the case behind closed doors and explore.  “We had a difference of opinion on this case. I preferred to restore with a crown, you indicated a filling. Can you share with me why? Let’s work on understanding each other’s point of view.”

A great tool to use to help develop collaboration is to once a month pull a few new patient files, bring up the x-rays, histories, periocharts, etc. and have a blank treatment plan that everyone walks through start to finish. Doing this once a month for three months in a row and then once a quarter keeps everyone on the same page.

Each clinical continuing education event, will shift your philosophy or technique. Collaborating with your team to keep everyone working together on the same page. This is the power of clinical leadership. Its up to you to set the standard of care, lead critical change, and guide your team to come along with you.

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