Dr. Brenton Young

	Do you know what you’re missing? You might be surprised.

	A friend forwarded an e-mail to me, sometime in 2002, with the subject line, “I don’t normally forward these, but you HAVE to see this.” I clicked on the link and started watching a video of two teams passing a basketball. The scrolling text below the video told me to count the passes made by the team in the white shirts, while ignoring the passes made by the team in the black shirts. I focused intently on the white-shirted team. At the end of the video, the text asked if I’d counted 34 passes. Score one for me! I had in fact counted every pass. Then the text asked if I had seen the gorilla. I was sure it was a lame joke, certain there had been no gorilla, but I backed the video up and watched it a second time without counting passes. Sure enough, midway through the video, a person wearing a black gorilla costume walked to the middle of the court, stopped, beat his or her chest and then walked off. Total on-screen time: 9 seconds.

	I was incredulous. As a dentist, I believed my attention to detail was better than average. Surely this was some video sleight of hand and not a mistake on my part. But I had fallen into the trap of Harvard psychologists Christopher Chabris and Daniel Simons, who created the video to test selective attention. Their 1999 research showed 50% of people would miss the gorilla. They found no pattern in age, gender or education level to explain who saw it and who didn’t. What they did find was people missed the gorilla specifically because they were not looking for anything out of the ordinary. Our brains are wired to expect the expected, and as dentists we are trained to do the same. As the adage goes, “If you hear hoof beats in Georgia then you should expect a horse” rather than a zebra-or, in this case, a gorilla.

	Chabris and Simons dubbed the phenomenon “inattentional blindness.”  In their 2010 book, The Invisible Gorilla and Other Ways Our Intuitions Deceive Us, they build on that research, sharing some incredible examples of how our memory and attention are not completely reliable. We think we see the world as it is, but the authors tell us “our vivid visual experience belies a striking mental blindness.”  This is not a bug in our software, so to speak, but rather an inherent limitation. Because the brain is a closed system, it has finite resources. We unconsciously allocate those resources, choosing what to “see” and what to ignore.   

	This blindness can affect the dental practice as well. Feeling rushed and overly busy, we walk into a hygiene check, look at the bitewings and completely miss the decay. Similarly, a dentist who is completely focused on the practice’s “bottom line” numbers may overlook the fact that the entire office is not functioning at its best and is slowly coming apart at the seams.  

	Chabris and Simons cite many examples of the limitations of our brains, but they do not propose a remedy for this blind spot in our attention. While each story is interesting, the book lacks an overarching story line to tie the vignettes together.  

	Nevertheless, the findings make us aware of our own limitations. We can create processes to compensate for these blind spots and reduce error. Having your hygienists review bitewings and comparing their findings with your own is a good way to reduce the chances of missing an important finding. Periodic team sessions with a practice manager may help the dentist take a more global view of the practice, thereby raising team morale and increasing overall production. Such practices take into account the holes in our attention and close them to the gorillas that we can all miss.

	The Benchmark column is written by the directors of the Atlanta Center for Dental Excellence, an alliance of practicing clinicians dedicated to progress in dentistry. The ACDE advises dental companies on product development and marketing, and provides PACE-approved high-level continuing education. To learn more, visit 

Brenton Young, DDS, is co-author of A Survival Guide to Clinical Dentistry and has lectured at the UNC School of Dentistry and internationally. His work with the ACDE focuses on the impact that EQ (Emotional Quotient) has on a dentist’s success in the dental office and in his or her personal life. Dr. Young is married with two college-age children and practices general dentistry in Shelby, North Carolina. 

Articles

 Do you know what you’re missing? You might be surprised.

The invisible gorilla

	At some point every dentist has been “in the weeds.” On a day when you least expect the schedule to fall apart, in walks an emergency toothache, the 6-unit anterior all-ceramic crowns are not going to place and hygiene is backed up. No one, dentists included, likes to be kept waiting, and the longer the wait, the greater the frustration.

	One complexity of running a dental office is keeping the flow of patients moving at a reasonable pace and minimizing frustration. I have a very busy practice in rural North Carolina, where large crown and bridge treatment plans are not the norm. My day is made up of small unit appointments stacked back to back. Staying on schedule is challenging on a good day. On a bad day, the flow can quickly stagnate. So I’m always looking for ways to keep things moving smoothly.


	Several years ago while sitting on the deck of a friend’s fishing boat, I watched a large “mega-yacht” pull into the marina and head for its slip. It was impressive to watch the crew work with the captain to maneuver into position and slip gently into their dock. I wondered if they had worked together for so long that communication was not needed anymore, but I learned from a crew member that they stayed in constant communication using small Motorola radios so they could talk themselves through each stage of the docking procedure.

	When I got back to the office, I ordered a Motorola CLS 1110 two-way radio and low profile earpiece (model HKLN4477) for each member of my team. Until then we had used a communications board with flashing lights and beeps. This worked fairly well but provided a small amount of data, telling me when I was needed but not why. It required me to look at the board each time it beeped, and every time I lifted my head, I had to slow my pace, endangering the tight schedule.


	The beauty of the CLS 1110 is that I can keep my head down and work while staying in constant contact with the flow of the office. Any team member can talk to me without interrupting my work or her own, which optimizes the efficiency of the entire team. A front desk member can easily alert me that I have a phone call without having to leave her desk to track me down. My hygienist can let me know when she is ready for me and can give me information about a patient that I might need to know before walking into the treatment room. In one brief communication, my assistant can tell me patient A is ready for anesthesia and patient B is ready for treatment. Through it all, I stay on task. What’s more, the CLS 1110 has a tone button that I can press to alert my staff that I have heard a message and am on my way.

	The CLS 1110 has multiple frequencies, so in a multiple-doctor practice each dentist can be on a separate frequency. Changing from one doctor’s frequency to another is cumbersome, but not overly so. Other than that very minor criticism, I can find no fault with the CLS 1110 at all. Its battery life is more than sufficient for a day’s work, and the batteries are recharged every night. The earpiece is comfortable and not overly obvious, though my patients will sometimes ask me if I am listening to a local baseball game.

	These radios have helped keep my schedule running smoothly for 6 years, and I can’t imagine working without them. Hold on a second…I need to run-there’s a hygiene check in room 4.
	
	????? - 5 stars out of a possible 5.
	
	

The Benchmark column is written by the directors of the Atlanta Center for Dental Excellence, an alliance of practicing clinicians dedicated to progress in dentistry. The ACDE advises dental companies on product development and marketing, and provides PACE-approved high-level continuing education. To learn more, visit theacde.com, or contact Molly Thompson at info@theacde.com.

Brenton Young, DDS, is co-author of A Survival Guide to Clinical Dentistry and has lectured at the UNC School of Dentistry and internationally. His work with the ACDE focuses on the impact that EQ (Emotional Quotient) has on a dentist’s success in the dental office and in his or her personal life. He is married with two college-age children and practices general dentistry in Shelby, North Carolina.

 At some point every dentist has been “in the weeds.” On a day when you least expect the schedule to fall apart, in walks an emergency toothache, the 6-unit anterior all-ceramic crowns are not going to place and hygiene is backed up. No one, dentists included, likes to be kept waiting, and the longer the wait, the greater the frustration.