Dentistry's Growing with Grace Podcast
Changes in Modern Dentistry
An interview with Brittany Flanagan, Dr. Henny’s Patient Coordinator
Robert F. Barkley was born on August 23, 1930, and grew up in the small downstate farming community of Ipava, Illinois – population 600. He later entered and graduated from Northwestern University Dental School in downtown Chicago.
After some deliberation, and two years of service in the Air Force, Bob set up a private practice in Macomb, Illinois with his wife Phyllis and their growing family. He described Macomb as being “the largest town between Ipava and the Mississippi River.” It was also home to Western Illinois University, where Bob had completed his pre-dental studies.
So, it was there that Bob established his family practice, and like most newly minted graduates, Bob thought he was practicing a superior brand of dentistry relative to his peers.
Within a fairly short period of time however, Bob noticed that much of his dentistry was failing. He concluded that his techniques and materials were the cause, so he set about to learn more about cast gold restorations. As a result, he included more of this approach in his treatment plans and was fairly sure that this new strategy would work. “I assured myself that better quality repairs were the answer,” he said.
While this change helped increase Bob’s income, it came with an unanticipated side effect – many patients were turned off because they believed that Bob’s dental solutions were too elaborate and too expensive; many patients left the practice as a result.
Persistent in his new strategy, Bob soon developed a reputation as a “gold man”. While this is not a negative description in dental circles, the citizenry of Macomb developed a decidedly negative tone when they described Bob using the term. Bob, in their eyes, had gone “big time” and had left their perceived simpler needs behind.
About that time, Bob attended a lecture by Dr. Clyde Schuyler. Dr. Schuyler told Bob that he needed to learn more about a broader range of clinical dentistry, and that Bob already knew, “how to sell more things than he knew how to do”. Dr. Schuyler’s words stuck and set Bob on a path of learning even more about the clinical options for his patients. From that point on, the more Bob learned, the more he saw in each patient’s mouth – but this time, he knew what to offer and how to improve their care on an even higher technical level. This new-found confidence and knowledge led Bob to develop even more elaborate treatment plans, resulting in even higher total case fees. In his mind, this new strategy would lead to an even more successful practice, but it didn’t turn out that way at all.
While Bob’s recommendations were sound, his patients could not understand the value behind what he was suggesting. Was there really that much wrong? Was there really that much to do? It soon became apparent that there was a flaw in this new strategy as well. Here was Bob, a highly trained dentist with a full set of skills and treatments which could clearly benefit his patients, yet few people seemed interested.
Bob was forced, yet again, to dig deeper for solutions.
It was at this point, that Bob focused on the conflict between how he felt dentistry should be practiced, and the way the people of his community seemed to want him to practice. He summed it up by commenting, “…it seemed that a decision had to be made whether to work for the classes or the masses. Reluctantly, I chose the former. I would offer what I knew was best for the patient, and let the chips fall where they might.”
And fall they did.
Some patients left his practice disgruntled, and others just left confused. Even some childhood friends refused to associate with him. During this time of turmoil, a high school classmate (one of his favorite cheerleaders at that time) came to his office seeking help for her debilitated mouth. Four children had been birthed since high school, and she was convinced that between her family heritage of “soft teeth” and the well-known “drawing out of calcium” from the teeth during pregnancy, that her dental future was dim. As a result, Bob was cautious due to being fully aware of his failure to sell proper dentistry to many others before her. He tried a new strategy, and recommended that she improve her hygiene habits as well as address some of her basic needs in the most affordable way. Bob thought that surrendering to a more pragmatic approach would win the day – after all, he did not want to compromise his long-standing relationship with her. So, an appointment was set, but the scheduled appointment time came and went – she had failed to show up.
What could have possibly happened?
Bob recalled that he nearly cried when he saw her again – this time in public – and not in his practice. She had, in his words, “committed dental suicide” in another office and was now wearing full dentures.
This event was so emotionally troubling to Bob, that it became the catalytic event which would change his life forever. It also set the stage for creative solutions Bob would later develop and share with tens of thousands of dentists around the world.
It was at that point that Bob committed himself to “making prevention pay off”. He wanted to be certain that – especially for those who could not afford extensive care – a preventative strategy would be both more successful and less expensive than extracting teeth and inserting dentures (surrender).
Bob also committed himself to becoming a student of an even wider range of both scientific and behavioralistic concepts. From Dr. Sumter Arnim he learned how to successfully treat and manage dental caries and periodontal disease. From Dr. L. D. Pankey he learned restorative methods and the need to create a principle-centered philosophy, as well as the inter-relationship between behavioral and clinical dentistry. And through Dr. Nathan Kohn, a PhD Educational Psychologist, Bob deepened his understanding of interpersonal communication, the requirements for behavior change, and how people learn.
Bob Barkley’s most recognized legacy is based on his creation and development of what is commonly known today as “Preventive Dentistry” – a concept that rarely existed outside of academia at the time. In tandem with this, Bob toured the country teaching a five-day learning and skill development program which dentists could use In their practices. This approach was often augmented with phase-contrast microscopes, and bacterial samples taken from the patient’s mouth and used to help the patients better understand their disease process as well as what they could to do about it.
Bob Barkley’s most overlooked legacy is related to his development with Nate Kohn of what is known today as “co-diagnosis” or “codiscovery”. These were concepts that Bob pioneered and taught extensively as well. (Anyone who has had a chance to see videos of Bob working with patients can testify to his masterful ability to engage people and lead them though a facilitated learning process). The co-diagnostic process became the linchpin of his practice success, as it allowed people the opportunity to value proper dentistry and consistently request it.
As you can see, Bob’s influence on dentistry was both broad and deep considering his premature passing at the age of 46 in 1977. His death in a chartered airplane crash brought a tragic end to a highly influential career. Fortunately, Bob’s influence lives on through the work of many others who continue to be amazed at the progressive nature of his thinking.
The purpose of the Bob Barkley Study Club and Codiscovery.com is to keep this wonderful legacy alive, as well as build upon these timeless concepts for a better future for dentistry.