Sixth in a series

THE GOOD PRACTITiONER:THE STORY OF BRENT L BENKELIVIAN

J a m e s T. Rule, D D S , MS, Protessor EmeritusUniversity of Maryland Dental Schooi, Baltirrore

Murie l J . BebeaU, PhD, Protessor ot Preventive Sciencestjniversity of Minnesota School ot Dentistry, Minneapoiis

Dental Professionalism

Dr Brent Benkelman has practiced oral surgery in Manhattan, Kansas, since 1971. Havinggrown up in a tiny farming town in western Kansas, he opted for the lifestyle of a smaller com-munity after graduating from the University of Missouri at Kansas City School of Dentistry in1966 and completing his training in oral and maxillcfaoial surgery in 1969. His experiencessince then have revolved around family, practice, and community. With his family as his firstpnority, he has participated in various community activities, including a church-operated foodpatitry, an emergeticy shelter for the homeless, and Habitat for Humanity. He was nominatedas a moral exemplar in dentistry for his dedicated commitmenf to his patienfs and because heunderstands and cares about fhe ccmpiexities of his patients as human beings, placing hisown financial gain secondary to the interests of his patients.

Dr Benkelman's nominator, Nancy Habluetzel, hasbeen his friend for 20 years and his employee for

7. The qualities she saw in him on a personal levelwere "deepened by my observations and interactionswith him professionally." From her perspective, "Hischoice of Manhattan, a relatively small community,over more metropolitan areas exemplifies his commit-ment to people as opposed to his own financial gain."He is absolutely dedicated to his patients. "His firmrule is that we see people in pain, whether or not theyare able to pay, and without concern for how busy ourschedule is." He trains his staff to ask questions ofpatients who call with problems in order to determinewhich ones are truly emergencies. "If there is any rea-soti to suspect an emergency, Dr Benkelman willalways see that person. His fees also reflect his con-cern for patients, as he strives to minimize their costs.[His] practice includes many people who are unable

to make full payment at the time of service." Perhapsmost reveaiing, Nancy said, "Brent prefers not to beapprised of those patients who have not paid him-anexample of his desire to treat all people as worthwhileindividuals deserving of respect,"

Unlike the long-term relationships that many gener-al practitioners enjoy with their patients, oral surgeonstypically see their patients for more episodic care.Nancy Habiuetzel thinks that Dr Benkelman's satisfac-tions come instead from doing his best to make a diffi-cult surgical experience easier. "Dr Benkelman takesgreat pride in his ability to distract patients-hc tellsjokes and generally entertains as he attends to the seri-ous business of their dental heaith. iVlany people eventell us they didn't IŒOW he had taken the tooth out. Iconsider these comments to be not only an indicationof his surgical skills, but also of his genuine concern forthe weü-being-physical and emotional-of his patients."

Ouintessence International 483

Genuine concern for patientsetnerges as Brent Benkelman'strademark. Ms Habluetzel especial-ly remembers one busy morningwhen, despite a full schedule, "fourunscheduled people just came by tosee Dr Benkelman. Not one wasturned away; not one was made tofeel intrusive." In particular, sherecalled a woman in her early 80sfor whom Dr Benkelman hadextracted some teeth and placed animmediate denture, which anotherdentist had provided. Some months

cern, I just see him treat peoplewith respect. Brent is perceptiveabout the emotions of others." Hespends time with his patients, andhe talks to them in the same waythat he talks fo his friends. Nancysaid, "I think he's always open tothat possibility [of friendship].Brent is Brent. At a restaurant, ifthe food doesn't come right away,he will go around talking with peo-ple, whether he knows them ornot." Furthermore, with respect topatients, she said he presents him-

"Dr Brent Benkelman

understands and cares aboutthe complexities cf his patients

as human beings."

Nancy Habiuetzel, Dr Beniteiman's nominator

later the denture was giving hersome trouble, and rather than go toher general dentist she came to seeher oral surgeon. "Dr Benkelmanpatiently made the necessaryadjustments [and] as is his custom,he also visited with her. As she wasleaving, she asked him how muchshe owed him for his work, and hereplied, 'How about a hug?' Itbrings tears to my eyes as I picturethat lonely little lady giving andreceiving a much-needed hug. DrBrent Benkelman is a man whounderstands and cares about thecomplexities of his patients ashuman beings."

Nancy Habluetzel told me (JTR)that she thinks that one of Brent'simportant qualities is that "heunderstands what's really importantin life, and I agree that what'simportant in life is people. I thinkthat's what he puts first. I don'tmean that he doesn't want to makea good living, because he does; butI don't think that's his prime con-

self the same with the farmer aswith the ophthalmologist. He isalways the same. "He doesn't see-or he doesn't very much see-thathe's the doctor and you're thepatient. He isn't perfect. Don't getme wrong. He doesn't always liveup to these [expectations], but Ithink that's his philosophy."

Sometimes Dr Benkelman'spatients do become his friends. Onesuch person, LeRoy Johnston, saidthat their relationship started whenhe was on the operating table undergeneral anesthesia on a snowy NewYear's Day in 1980. That morningMr Johnston had spread hay overthe snow for his horses to eat. Hisfavorite filly was being muscledaway by the other horses, so hemoved some alfalfa off to one sideand tried to lead her there. The fillywould not be led and stubbornlykicked sideways, catching him inthe face. A couple of teeth hit thesnow, but they were the least of hisproblems. Fortunately, he remained

conscious, walked to the house,and eventually made it to the hospi-tal, where Dr Benkelman treatedhim. Brent remembers it clearly Hesaid that LeRoy had fractures inboth his midface area and hismandible, as well as lacerations ofthe lip and tongue. The surgerytook about 6 hours and was fol-lowed by a life-threatening bleed afew days later. All LeRoy remem-bers is that there were 60 or 70sutures.

Months later, completely healed,LeRoy was walking past Dr Benkel-man's building to see an orthodon-tist for follow-up care when the win-dow in Brent's office went up,LeRoy could see a patient sitting inthe chair. Brent leaned out and said,"Hey, LeRoy, you don't talk to meanymore?" LeRoy said, "In my mindI was blinking, 'Well, he patched meup and kicked me out, and that wasit.' !t never occurred to me that thiswas something different than thedoctor and a patient, right? So, Iwent in and we chatted, and fromthen on we started hunting togetherand fishing together and taking tripstogether and drinking beer together.It's been a 20-year deal. I always feltjust like I was his older brother."

It was not only with LeRoyJohnston that Brent made friends.When LeRoy sold his ranch andmoved further north another 30miles, Brent continued to join himfor hunting and fishing. LeRoy saidthey would go into a little countryrestaurant, and everybody wouldsay, '"Hey, Brent! Hey, Brent!' Heknew more farmers up there thaneven I did, and I was living there. Ithink he told me he worked oneverybody that was in the room,"LeRoy suspected that Brent re-ceived this kind of response allaround Manhattan.

Undoubtedly, much of the waythat people respond to Brent ismerely a reciprocation of Brent'sviews about them. Brent Benkelmanis an outgoing, generous, and friend-ly person who is the same whether

484 Voiume 32, Number 6. 2O01

he is in the office or elsewhere. He isalso an organizer, LeRoy said, "Youcome into a group and everybody isbuzzing around Brent," After a hunt,he likes to process his own deermeat into steaks, sausage, and espe-cially bratwurst. He then finishes offwith a big party at his house. Healso likes to plan New Year's Eveparties and kite-flying days onEaster, When he started to makebeer, he created an association oflike-minded connoisseurs. WhenLeRoy Johnston and his wife soldtheir second ranch and moved totheir new condominium in Man-hattan, Brent organized a surprisehouse wanning.

Quite apart from Brent's socialskills, however, LeRoy appreciateshis skills as an orai surgeon, evenwhen LeRoy is awake. He had awisdom tooth extracted by Brentunder local anesthesia, which was"like having a fingernail cut," Inaddition, LeRoy said he is an"incredibly honest" man who isextremely serious about his profes-sion. When a group of friendswould go hunting, LeRoy recalled,"We'd be waiting with our guns,two or three guys, and there wasalways a chance that we'd get a call.Brent would have an accident orsomething [to take care of]. He'djust drop everything for his patients.He would never worry about hisftm. He was very dedicated," LeRoysaid that interruptions such asthose happened quite frequently.

Through the eyes of others, DrBrent Benkelman Is seen as an oralsurgeon who is both competent inhis skills and dedicated to hispatients. His dedication apparentlystems from his egalitarian views ofall people as "worthwhile individu-als deserving of respect" and from"his genuine concern for the well-being-physical and emotional-ofhis patients," He enhances andimplements these moral qualitieswith a personality that is both gre-garious and generous, A look atboth his early years and bis profes-

(From ieft) Dr Benkelman with LeRoy Jotinston, Eric Turtle, andJim Turtle after a day of hunting.

sional life give further insight intoDr Benkelman as a person and as aprofessional.

Growing Up in Western Kansas

"Brent Layton Benkelman, bom ofhumble origins, in a pitiful littlecounty in western Kansas," This wasa typical Benkelmanian response toa request for background demo-graphics. Born December 23, 1941,he was the oldest and shortest ofthree boys. He said that he was theshortest "because being first born,they don't feed you enough," Beingthe oldest, though, he had theopportunity to be the ringleader, aposition he has never relinquished.

Small-town life. McDonald,Kansas, where Brent grew up, ispositioned almost as far in thenorthwest corner of Kansas as itpossibly could be; the Nebraskaborder is only 15 miles away, [ustacross the border is Benkelman,Nebraska, a town named after someof Brent's forebears, McDonald hadapproximately 300 people, andwhen Brent was in high school,they fielded a football team with

only 18 players. Furthermore, Brentsaid, "It was people farming smallfarms when I grew up there." Now,farming in McDonald "is no longera smali land game"; it is for peoplewith large holdings of land. As aresult, there are fewer farmers andsmaller towns, McDonald probablybeing one of them.

His father, Willie [CharlesWilmot), was a farmer whose experi-ence was typical for the region. Helived in town but farmed smallparcels of land both in McDonaldand in outlying areas. He was defi-nitely not a big landowner. Brentremembers that his father also soldcasualty and crop insurance, "tokeep his boys in beer and shoes,"Unlike most people in McDonald,Willie had degrees in civil engineer-ing and agriculture from KansasState University,

In the years that Brent lived inMcDonald, few farmers actuallylived in town. Mainly, Brent said,"There were the teachers, the mer-chants, a few widows, and a handy-man or two," There was otie block inthe community that containedBrent's house, a tractor store, avacant lot, and a house for the

Quintessence International 485

biacksmitb. His grandmother, hisgreat-grandfather, his grandmother'ssister, and his great uncle lived inthe next block. Brent said that in theback were "granaries, corn eribs,and Quonsets, and wbere we parkedthe tractors, and where the gardenswere, and the chicken house,"

Almost everyone in the commu-nity, except for a "few wicked peo-ple," as Brent put it, went tochurch. Catholics and Protestantswere about equally divided. Brentsaid tbat McDonald was basically areligiously oriented farming com-munity in which "everything prettymuch goes back to nature," Therewas a certain philosophy amongthose people, a certain fatalismabout weather. The whole yearcould stem on one little hailstormjust before barvcst. The whole cropcould be gone.

McDonald was full of frugal peo-ple who made ends meet, but onlyby the smallest of margins, Tbeysurvived by working bard and belp-ing eaeb other. Children in Mc-Donald were raised by the entirecommunity. It was iike an extendedfamily that seemed to go on forever.They were available for him, con-cerned about him, kept an eye onhim, and. Brent said, they would"tell on me when I did somethingwrong. Everybody i<ind of lookedout for everybody else, and if youdid something wrong, your parentsfound out about it, Tbe oniy thingthat got home sooner than you wasthe bad deed,"

Family life. Having his parentsfind out about his behavior was nota big problem. Brent has fond mem-ories of his immediate family, espe-cially of his father. Like Brent,Willie was the kind of person every-one in town knew. Adding to hissociability was bis excellent singingvoice, which allowed him manyinvitations to sing at weddings andfunerals, thus accounting for themajority of times he was ever seenin church, Willie was a fair-mindedperson who was full of encourage-

ment and high expectations. Brentand bis two brotbers understoodand accepted their father's expecta-tions, which served as a substitutefor heavy-handed discipline, Williepushed his sons to achieve andreadily supported everything theydid. In fact, everyone in the familyattended all the athletic events andstage productions in which the boysparticipated. Brent thinks theyshowed up not because they had to,but because tbey wanted to. It wasa matter of love.

"We all have acertain amount ofdues that we needto pay. It's not likeI'm going to suffer

if I give a fewthings away."

Dr Benkeiman onproviding free care

That sense of belonging wasextended to people outside tbeBenkeiman household, "Our placewas always a haven. If anything wasgoing on, everybody knew that ifthere was a light on in the kitchen,come on in. If it was after a bailgame, or if there was a dance, or ifwe were out on a date, somehowthere would always be cocoa on thestove. It was mainly our best malefriends, mine and my brothers. We'dcome in, and Dad would sit thereand talk with us about our games orour dates or whatever we wanted.All the kids would come in—he wasavaiiabie. He was not a father youdidn't want to be around. It waswelcoming. The whole experience

was very formative" Brent's motherwas an essential component of thatexperience as well, '"I would alwayssit and talk to my mom while shewas cooking or working in thekitchen. She imparted vaiues atidwisdom during those talks,"

In fact. Brent's entire MacDonaldextended family left its mark. Hisgreat-grartdfather lived with hisgrandmother, his grandfather havingdied when Brent was about 5, Brentdoes not remember his grandfathervery much, but neighbors had des-cribed bim as one of tbe kindest menthey had ever known. This appealedto Brent as an aspiration for himself.His great-grandfather was a generalstore owner and farmer who accu-mulated farmland in an unusual way,"During the dust bowl [drought]years when people had to sell out,they gave him deeds to the latid,because he had extended them [thekindness of] credit," Thus, likeBrent's father's land, his land wasscattered about. Brent's grandmothertaugbt piano and Sunday school andplayed piano at the church. His greataunt also was a Sunday schoolteacher Through eighth grade. Brentspent every Sunday with those twowomen. Their coUective influence onhim was great.

Brent remembers going to cburcheven in his earliest days. Churchcamp provided more intense experi-ences later on. Adding to the impactof the church was the fact thatalmost the only social event avail-able for Protestants was the Wed-nesday night church youth group.He said that religion became espe-cially meaningful to bim during bisadolescence when "thoughts ofbeing tbe rigbt sort of person werereally important to me. ,,, [I realizedthat] I needed to do things that 1learned in the Bible by example,"

College and Dentai Sciiooi

Brent graduated from high school in1959 after lettering four times each

486 Voiume 32, Number 6, 2001

year in band, foot-ball, track, and bas-ketball. He hadalways assumed tbathe would go to col-lege. In his class of12 he was the salut-atorian and provedto be tbe only onewbo earned a degree.He said, "I tbougbt Iwas above averageuntil I got to college,"

Brent attendedKansas University,and even tbough beenjoyed l̂ ö years asa sprinter and longjumper on the trackteam, he said tbat college was "nofun for me. It was psycbologicallydifficult. It was too large," His aca-demic background from McDonaldwas limited, and in terms of rela-tionships, it was "hard to go from atown of 300 to a class of 300, ,,-You have to remember that 1 wasgoing to a big liberal arts scbool,coming from a small farming com-munity. Most of tbe people from tbelarge towns didn't think very bigblyof anybody tbat came from tbe 'out-lands,' We were pretty mucb bickeypeople," It wasn't that Brent was notable to make friends; it was onlythat he bad to put up witb the snob-bisbness of tbe eastern Kansasurbanités toward tbe farm boys.This was a deterrent to tbe develop-ment of his characteristic participa-tion in community affairs, tbe onlyexception being a brief membershipin fhe Young Republican Club,Brent said, "Wben I got back to afairly intimate learning relationsbip,tike dentai scboo! [with classes of116], tbat was mucb better for me. Ittook me 1 year in dental scbool tofind my nicbe. After tbat I liked it,Voii knew everybody in your class,"

Before Brent left bome for col-lege, be bad mainly thought bewanted to be a farmer like bisfather. However, be bad no ideahow be couid ever accumulate tbe

Brent and his wife, Virginia, hosted a birthday celebration tor Nancy Habluetze(center).

buge acreage tbat was increasinglyrequired in modern farming. Inaddition, bis father bad not particu-larly encouraged bis sons towardfarming. Tben there were bis fa-tber's brotbers. Uncle Ward wasa physician in Montana, and UncleBob was a dentist in Denver, Brent'sgrandfather also bad a brotber wbowas a dentist, Tbe idea of profes-sional scbool pleased bis father,Witb tbese influences, Brent said bebegan to tbink about dentistry earlyin bis college career, "It seemed likea good tbing to do, because I reallyliked Uncle Bob," If Brent ever wereto have considered anything else, itwouid bave been tbe life sciences:human biology or wildlife biology.

The other reason Brent gives forturning toward dentistry was tbeliberal arts curriculum at KansasUniversity, wbicb perversely forcedbim to take some language classes.After a semester of Latin and aweek of Frencb, be decided it wasnot for bim, Tbe idea of speaking aforeign language appealed to Brent,if only he could have avoided learn-ing tbe grammar. Tbus, he took tbefinal step toward dentistry. Hisgrades were good enougb for dentalscbool after 3 years of college, andso, encouraged by his two dentistuncles, be took the dental aptitudetest and did well, Wbatever tbe

influences tbat ledto dental scbool.Brent said that bisdecision to applywas a turning point.Before tbat "I wassort of a wanderinggenerality. We all dobetter when we havea focus,"

Altbougb tbe pre-dominant focus ofdental scbool waslearning tbe tecb-niques of patientcare, he also beganto learn about tbephilosophy of caringfor people. Brent

said, "We were coacbed to tbink ofpeople as an entity, ratber than justa tootb. We were reminded of thata lot by tbe instructors that I bad.But tbat's difficult to do, Wben youare trying to learn specific talents,it is difficult to associate wbat youare doing to an entire situation,"Brent said that it was not until bebecame more experienced in oralsurgery that his sense of caringdeveloped more. "I'm a better lis-tener now tban I used to [be], I tryto perceive tbose tbings tbatpatients need rather tban the thingstbat I need, if I could go back andbe as skillful tben as I am now, I'dhave been a lot better off. Exper-ience is wonderful,"

Brent entered tbe University ofMissouri at Kansas City Scbool ofDentistry in 1962, spent 4 yearsdoing not mucb more tban study-ing, and graduated in 1966 at tbeage of 25, as he said, "just a pip-squeak," His dream during most ofbis years in scbool was to practicegeneral dentistry in Denver witbbis Uncle Bob, However, be badbegun to tbink about surgery earlyin his senior year, and Bob badsaid now was the time to apply.After he was accepted, he debatedwbetber to accept tbe offer, andBob bad said that now was tbetime. So he did.

Quiniessence International 487

Choice of Lifestyle

Brent stayed at UMKC for his train-ing in surgery, which he completedin 1969. In the last year of his train-ing he married Virginia Owings,and when he finished his program,he joined the Air Force as a way ofhaving more time to decide wherethey wanted to live. Missoula, Mon-tana, and Ft. Collins, Colorado,were possibilities. Tbey likedKansas City too, but Brent said, "Ineeded to be closer to the country.There were too many cars, toomany people." Being stationed at anAir Force base in Florida had madethem realize that they did not wantto be too far from their extendedfamilies. So they settled in Man-hattan, Kansas, a university town of25,000, which, as it happened, wasonly 305 miles from both families.Brent said, "Manhattan was aboutas small a town as an oral surgeoncould have ever been supported in."

When asked what he thoughtabout Nancy Habluetzel'sopinion that his choice ofManhattan was a signthat his primary inter-est was people asopposed to financialgain, Brent an-swered by referringto his childhood.Both he and Vir-ginia had grown upin a frugal environ-ment. While Brentdoesn't remembergoing hungry, therewere some years whenthe crops were bad andlife was tough. None-theless, regardless of howgood or bad the weather, thework of farmers never changed.That was what life was all about. Hesaid, "You worked six days a week.Sunday you got off. And that wasjust routine. Money was somethingthat just happened." He feels thesame about his own life today."What I do is I work, and I bave a

COMMENTARY

Brent Benkelman was nominated as amoral exemplar tor the compassionateand oaring way he treats his patients.We admired him and selected him forthis remarkably developed capacity. Ashis story unfolded, however, ouresteem deepened. His narrative illus-trates his caretui concerns about exe-cuting each of the roies and responsi-bilities of the health care professional,'and doing so with an uncommon bal-ance between personal and profession-ai commitments

For the young person aspiring tobecome a professional, there are impor-tant lessons to learn from Dr Ben-keiman's views of his professional obii-gations and how they relate to hispersonal life. More important, he modelsa Professional who is not onlysuccessful but very happy. He pursuescompetence as he expands his skills inoral surgery. He values learning andbuilds opportunity for iearning into daily

iiving, eg, reading journals ashe rides his exercise bike.

He habitualiy andactively serves his

associationthrough both

ieadershipand the low-lier tasks otmundanecommitteework. Heengages

in self-regulation— setting for himselfstandards for professional practice. Heis willing to speak to his peers aboutprofessional standards that he ques-tions. He unequivocaily puts the inter-ests of his patients above his own as heenters into the caregiving partnership,and he readily treats anyone in need. Toassure that everyone is treated respect-fully, he maintains a blind eye to thepatient's personal resources so as notto compromise the patient's right toknow the full range ot options. Theinability to pay is not allowed to interferewhen a real need presents. Yet even inthe giving, he allows the person tomaintain dignity by saying, "I'm notgoing to send you any bills. If you everwant to pay me, you can." Fuifilling theessential protessional obligation forsome measure ot pro bono work, he ismoved to engage in other forms ot ser-vice to his community. He attributes hisdisposition for giving to his roots in reli-gion and community.

Much of Brent Benkeiman's per-spectives on work, on personal worttiand achievement, and on competence,caring, self-regulation, protessionalmonitoring, and service to patients,profession, and community stem tromhis experience of growing up in theheartiand of America. Hard-pressed bythe Great Depression and the greatdrought of the 1930s, people in theheartiand developed respeottui per-spectives toward natural resources andwork. The land is important for survival,but peopie are custodians of somethingthey oannot control. Work requirescareful planning and cooperation, butits outcome is often uncertain. Peoplein the heartland have come to viewwork as having intrinsic vaiue regard-less of its outcome. If the outcome is abountiful harvest, the success is

certain amount of money to spend. Ihave to work. That's just a given. Ifyou can imagine yourself inside thatconcept, that's sort of my thinkingabout money. I don't think of my jobas earning me so much an hour. I

think of work as work. I work andthen I have so much money. That'ssort of the way I grew up. ... Myphilosophy is that if you make upyour mind to go ahead and dosomething and be diligent about it,

Volume 32, Number 6, 2001

attribtJted to the goodness of GodtBther than to the skills ot the farmer,though skiliful effort is both expectedand required.

The heartland concept of work ispresent in Brent's story. For Brent, workis not a means to an end, but a way otlife. Further, work is not all-consuming;it is balanced with other roles—those offather, husband, friend, and communityleader. Although one engages in allthese roles, there is a certain priority towork, especially when one is commit-ted to put the interests of others abovethe self, as is the health professional.For Brent, leaving a pianned recre-ational activity to handle an emergencywas common. The possibility of inter-mption did not deter him from planningand engaging in recreation. Yet he didnot express anger or disappointment athaving to abort his plans in order tccare for a patient. The experiences offarming prepares one to continue in theface of disappointment and spawns asense cf parsimony and frugality asone learns to live with uncertainty. Itteaches one to practice the adage"waste not, want not," whioh is part ofBrenfs internal value system.

The heartland perspectives en self-worth and the worth of others are aiscvisible through Brent's narrative.Anyone who grew up in the heartlandof America knows that what GarrisonKeiiior regularly asserts on ''PrairieHome Companion"^—that all the ohil-dren are above average—is, in a pro-found sense, essentiaily true. They alsoknow that, while everyone is aboveaverage, no one is superior. Are ali chil-dren truly above average? Clearly not;but the maxim represents an attitude:everyone should be treated withrespeot, and no one shouid considerhimself or herself superior. This world-view promotes a sense of equality:While individuals may be respected forpersonal qualities or achievement, no

cne is superior. This view tempers ten-dencies toward self-aggrandizement,just as it tempers intolerance towardthose who are disadvantaged. With hischaracteristic "me second" midwesternmodesty. Brent attributed his "Man cfthe Year" award from the Optimist Clubtc the faot that he mowed the iawns forthe tee-bali tournament. Clearly, he hasinternalized ihe heartland views onse if-worth.

Through Brent's story, we see aperson whc absorbed the vaiues of hisoommunity during childhood, thengrew tc model those values to others.The community unambigucusly com-municated Its centrai ideas of helpingcne another and caring encugh aboutethers, including the chiidren, to partic-ipate activeiy in raising those children.This inciuded "tattiing" on unacceptablebehavior when neoessary. For Brent,additionai values were instiiled by agrandfather who had a reputation forbeing "cne of the kindest men [people]had ever known," by a father who wasSC weiccming that teens stopped by"just to talk," by a family that attendedand celebrated each child's events,and by a community where church wasa centrai focus and everycne attend-ed—except tor "a few wicked pecple,"as Brent jokingly put it. These condi-tions helped to shape the hallmark val-ues of generosity and other-centered-ness in our current exemplar. Thelessens of childhood were welllearned, and they are reflected in DrBenkelman's views both about patientsand about relationships with friends,famiiy, and colieagues.

Growing up in McDonald, Kansas,set the stage for Brent's acceptance ofthe concepts of caring and community.However, Brent perceives that hissense of caring and his concept ofdentistry as a caring profession haveevoived. As he reflected on the mcdelof caring his dental faculty tried to

Continued on page 490

er to parents, and to be away frombig cities, as I did [forj the money."In fact, making money was difficultat first. In his first year of practicehe had to take out a loan to coverhis expenses, and it took 7 or 8years before he was financially com-fortable. Now things are different.His practice is thriving. Manhattanhas grown to 40,000, and KansasState University has about 20,000students. Now that general dentistsare referring extractions to sur-geons, for every thousand studentsat the university, there are probablyfive third molars to remove.

The Practice

you can do it." He said that while hewas considering dentistry as a careeroption, he does not remember everassociating the idea of dentistry withmoney "It was just something to do,a good way to get along."

Reverting to his discussion ofwhy he settled in Manhattan, Brentsaid, "Probably I came here asmuch to be close to the lakes andhunting, and to be able to get out tothe country quicker, and to be clos-

When Brent was trained, the scopeof oral surgery was considerablynarrower than it is now. Extractionsand management of fractures werethe primary foci. More advancedsurgical procedures had either notyet been fully developed or were ieftto physician-trained surgeons. Forexample, oral surgeons did noorthognathic procedures and placedno implants. When these proceduresbecame popular. Brent enjoyedlearning the skills. He has been plac-ing implants since 1984, virtuallysince the day they were approved bythe Federal Drug Administration.The same is true for other state-of-the-art practices in oral surgery,including sinus grafting and bonegrafting. Brent and his partner, whojoined him in 1991, also do a lot ofbiopsies, third molar extractions,and canine exposures.

Brent performed orthognathicprocedures for 10 or 15 years, butwhen his partner wanted to domore. Brent was happy to let himhandle all the orthognathic cases."I'd worry about them a weekbefore, and then I'd worry aboutthem for a week afterwards. Twoweeks of worrying about one caseis too much. Trauma you don't haveto worry about as much. You justhave to get right to it." Brent does

Quintessence internalional

wish, however, that trauma casescould be timed better, "I just hate towork in the middle of the nightanymore. It's easier during the day,"Nevertheless, fractures are a fact ollife. Within weeks before the inter-view, he had treated two traumacases: facial fractures in a boy whoran a motor bike into a truck, and adisplaced fracture in an edentulousmandible of a man who was hit bya steel pipe. On the first day of theinterview, a Sunday, he had visitedthe hospital to check on anotherman whose fracture he treated.

Regarding his approach to hisprofession. Brent said, "One of tbethings that I've always done is ,,,set my limits on what 1 will do, andthen I try not to ever cornpromise,[For example] I say I'm never goingto take out a tooth on somebodywhose systolic blood pressure isover 190 or their diastolic is over110, You compromise that and youstart having problems. Just littlethings like that. Decide on thethings that you know are going tobe right, and you never have tochange your mind about it"

Dr Ken Lyie, a long-time friendof Dr Benkelman's and a Man-hattan general practitioner, thinksthat Brent uses general anesthesiaand sedation much less than mostoral surgeons. In doing so, it is nec-essary to expend significant effortin communication. Perhaps, DrLyle said, "It's the 'Life on thePrairie' syndrome, in that he wantsto be able to be resourceful andhandle anything that comes along,,,, He is [also] very perceptive andhe wants to be tapped into thatpipeline, the psyche of that patientthat is under his care, and he wantsto read those vibes that arc comingthrough. Whatever it is he picks upon, he can't have it squashed out,because it limits his ability to deliv-er the type of care that he wants forthis person. We all reahze that thephysical aspect of care is only onesmall wedge of the pie. We do a lotof other things for our patients."

Coniinued from page 4S9

instill, he observed that it is difticult tobe conoerned about the whoie personwtiile tocusing on perfecting the skilisnecessary to treat a single tooth. Ittakes time to be able to see the per-son and his or her particular need asprimary and the tooth as secondary,Dr Benkelman now considers himselfa listener, one who needs to connectto ttie lived experience ot the person,to understand the illness and themeaning ot that iliness to the person.Only with this understanding oan theprotessionai heal the person, not justtiy the tooth. The fact that Dr Ben-keiman uses iess gênerai anesthesiaand sedation than is typical of hispeers is evidenoe ot his remarkableabiiity to reduce anxiety and instill oon-lidence, enabling the patient to under-go procedures without trauma. Heachieves this relaxed atmosphere withcorny jokes and puns and with a levelot acceptance that heips people seehim as friend and helper—even some-one who needs a hug—rather than asdoctor.

Brent's protound respect tor per-sons of all walks ot life and his tenden-cies to minimize achievements are tur-ther evidence that he possesses eachot the indispensable traits of theauthentic protessionai. Growing up inwestern Kansas, he learned a way ofbeing that involved modeiing himselfafter those admired in the communityand setting standards as a guide toaction. As a result, he does not end-iessly reflect on his actions, nor doeshe spend time arguing with himself

when temptation presents, instead, hesimply foilows the guideline he estab-lished tor himseit. This is not to suggestthat he does not evaluate his guide-lines, especially those that are basedon soientitic evidence, but it does sug-gest that he does not endlessly reflect.Action, rather than retiection, charac-terizes Dr Benkelman's life. In somecases, actions are the results ot habit.In others, they resuit trom thoughttuilyconsidered judgment, as in the case ofthe conditions tor treating a patient withhigh blood pressure, Finaiiy, DrBenkelman seems to have achie^fedthe kind of optimism Seiigman^describes as a quality that distinguish-es effective people, "Optimism worksnot through unjustitiable positivityabout the world, but through the powerot non-negative thinkihg."3p^i' DrBenkelman does not ignore his taults;but on the other hand, he chooses notto focus on them, perhaps recognizingthat to do so would be debilitating. Hewould prêter small nudges as he per-fects a way ot being that is consistentwith his heartland values.

References

1. Bsbeaj MN, Kahn J, Ethical issjss ih com-munlty denial health. In: Gluck GM,Morganstein VIM (eds). Jong's OommunityDental Health, ed 4. St Lojis- Mosby,1997:287-306.

2. Keillor G. Lake Wobegon Days. New York:Viking Perguin, 1985.

3. Seligmaii M, Learned Optimism: How toChange Your Mind and Yojr Lite. New York,MY: Simon S Soliuster, 1998.

Working with Patients

Humor and persistence. In gênerai,Brent said, ' i gitess my basic phiioso-phy of practice has always been todo tilings as easily for people as Ipossibly can, so that they don't feellike they've ever had to endure any-thing. So that it's more an, well, anenjoyable experience," He laughed atthat prospect, "When you're havingoral surgery, it's difficult to say that,but that's been my basic goal. Peopleare usually nervous when they cometo see me, so I think my use ofhumor allows them to [relax]," His

humor comes out in various ways,usually as "corny jokes and puns," asKen Lyle said. For example, NancyHabluetzel said that in discussingupcoming surgery with a woman andher spouse, he might say, "You arenot allowed to do housework for 3weeks," Or he might admonish anadolescent awaiting removai of athird molar to remember that thereshould be "no kissing for a tnonth,"Corny or not, the patients love it.Brent said he also uses humor to tryto get patients to take better care ofthemselves. Sometimes he tells them,"'You know, you have not been

490 Volume 32, Number 6, 2001

Standing close enougb to yourtootbbrush, and you're a dirtydog for not doing it.' I'm honestabout things like that, and theyunderstand that, but I'm notgoing to berate peopie, becauseit doesn't help."

Working with patients whodo not seem willing to takecare of tbemselves is one ofBrent's biggest frustrations.Nevertheless, he persistentlyencourages patients to get gen-etai care if they are not cur-rently doing so. No matter howhard he tries, though, somepatients "will be back and backover a 10-year period untilyou've got every one of theirteeth out. They won't brush,they won't see a dentist. That'sfrustrating to me. But still,you've got to do somethingwith them, I probably don't care asmuch about them as a whole as tdo somebody who's going to becompliant, but I try not to allowthat to temper the kind of treat-ment that I'm going to give them,i'm going to treat them just as gen-tly as anybody else, be as nice tothem, not scoid tbem"

In addition, when he disagreeswith the judgments of referring prac-titioners. Brent chooses to deal withthem directly. His typical approach,as Dr Lyle attests, is to let the patientknow about the difference of opin-ion and call tbe practitioner Whenasked if this annoys Brent's col-leagues, Dr Lyle said with a littlestnile, "Yeah! It's an annoyance, butit's the right thing. I can live withthat. I see it that Brent and I aresharing a common frustration. He isfrustrated with the fact that I don'tsee things clearly enough to knowwhat the correct answer is, and I feeithe same way about his view. Wejust professionaily coexist and workit out somehow." In the most com-plex cases, usually involving combi-nations of restorative dentistry andprosthodontics. Brent stops by DrLyie's office and they do work it out.

"eaching a grancldaugfiter to brusin her teeth.

Generosity and respect. AsNancy Habluetzei said. Brent doesnot like to know whether patientsare able to pay for treatment. Onereason is so that financial statusdoes not influence the treatmentoptions he offers, "What I wouldiike to do is to present them thebest possible treatment plan andgive them the alternatives and letthem make the choice. I thinkthat's what everybody should do, idon't think you should exclude aprocedure because you think some-body can't afford it, I don't thinkyou should omit something [that isless than ideal] because they have alot of money. People should knowwhat they can do and make uptheir own mind,"

More than that, though, Brentsaid, "If they're having pain, I sayget tbem in. If they don't have anymoney, I just do it. I don't care.That's been basically my philoso-phy," He doesn't even want his staffto itiquire about the method of pay-ment when patients call in. "itdoesn't mafter to me. If they're hav-ing a problem, tbey need to beseen," Sometimes patients refusenecessary treatment because tbey

cannot afford it. Rather thanturn them away. Brent has said,"This just needs to be done.Let's do it.' I put the bill away,and I say 'This is wbat you oweme, I'm not going to send youany bilis. If you ever want topay me, you can,' I've bad a fewpeopie pay me 2 or 3 or 4 yearsdown tbe road," Occasionally,someone takes advantage ofhim, but it doesn't seem tobother him. "We all have a cer-tain amount of dues that weneed to pay, you know. It's notlike I'm going to suffer if I givea few things away."

Giving away services andmoney to the community ispart of what characterizes bothBrent and Virginia. They bothsay that it is basic to their livesthat if someone calls, you help

them. It just spills over into den-tistry. If you have a skill, you utilizeit. "Maybe it goes back to that basicold Christian attitude [tbat] you dobetter [in caring for other people] ifyou give everything away. Could itbe possible tbat I actually feel a lit-tle bit guilty about being as success-ful as I am and baving everythingthat we have, so that it doesn'tbother me to give away the servicesthat I have to give away?" Asidefrom professional services. Brentand Virginia donate money in otherways as well. "A gift given in secretis the most fun. We give a lot ofthings anonymously, beeausc Idon't care to have my name on allthose lists," It also avoids bis gettinga lot of plaques of recognition thathe does not want.

From Ken Lyie's perspective,Brent's sense of community per-vades his concept of dental prac-tice, too. As he perceives it, "[Brent]thinks of his dental patients asbeing the community, as an exten-sion of growing up in westernKansas, and that part of our job asdental practitioners here is to takecare of people before we take careof ourselves,"

OuJntessence internationai 491

The Benkelman brothers (from ieft) BiW, Paul, and Brent

Investment in the Community

Wbat goes on outside Brent's officereflects what goes on inside. Hesaid tbat from "time to time" in tberougbly 30 years he has been inpractice he bas been active in vari-ous dental societies and medicalgroups: the Manhattan MedicalCenter (twice as president}, tbeMedical Staff at the Mercy HealthCenter, the local dental society, tbeKansas Society of Oral and Maxil-lofacial Surgeons, and the Mid-Western Society of Oral andMaxillofacial Surgeons, He servedfbe American Dental Association asa consultant on bospital and insti-tutional dental services for 4 years,was on tbe Kansas Dental Associ-ation's Council on Dental CarePrograms for 5 years, and has beentreasurer of the Kansas Society ofDentistry for Children for 4 years.Along with a number of surgerytalks to local groups, he has alsopresented on "The TreacherousMolar and tbe Maxillary Sinus" atan international conference inBelize, wbicb. Brent was quick tosay, was organized by a friend. Hisfriend also convinced him to makea few volunteer service trips toBelize, Locally, he participates in

tbe Donated Dental Services pro-gram and sees patients that tbelocal bealtb agency refers.

In tbe larger community, almostall of Brent's many activities, andVirginia's too, involve service tootbers. Often tbey revolve aroundtbeir churcb. For example. Brentsaid tbat when he was serving as adeacon, be belped to organize alocal food pantry network, wbicb isnow distributing 400,000 pounds offood eacb year. Since his role wasonly to belp set up the pantry. Brentsaid that for tbe last 10 years be bas"done notbing more than donatemoney" Within the cburcb itself, beis now an elder: in Brent's words,"tbe ruhng clan" Presbyterians lovemeetings intensely, and Brent saidtbat he hasn't worked so bard sincebe organized tbe Orst joint meetingwith tbe Soutbwest Society of OralSurgeons, wben be was president oftbe Midwest oral surgery group.

Other community activitiesinclude the Optimist Club, whicbnamed bim Man of the Year in1974, Brent said tbis bonor wasbestowed "because I ran tbe tee-ball program tbat summer, and ittook a real man to do that,"According to him, this consisted ofmowing the baseball diamonds

every weekend so the youngestchildren bad a place to play. Hesaid he doesn't do very much forthe Optimist Club now, altbough hedoes belp out witb tbree or fourprojects, including tbe sale cfCbristmas trees. Apart fromOptimist Club activities. Brent hasworked on an emergency shelterfor tbe bomeless, participated in alocal program in whicb people bothdonate housebold items and pro-vide home-oriented services forothers wbo need assistance, andbelped with Habitat for Humanityprojects. He said bis involvementwitb Habitat was minimal, "I wentdown and belped a couple of timesto build on one house, but now Ijust donate" Tbis comment is typi-cal of bis views toward all of hiscurrent community activities. Hisphrasing reveals bis intent to viewhis accomplishments honestly andwithout exaggeration.

When their children's activitiesstarted to reach beyond tbeirbome, tbe adult Benkelmanscbanged their focus of projects. Atchurcb Brent and Virginia taughtSunday Scbool for the junior highgroup for a time, and they chaper-oned tbe church youth group on aski trip lo Colorado, They also vol-unteered many bours for schoolevents. For the 8 years tbat theirdaughter ¡ami was in track. Brentofficiated at events from the longjump in high school to the triplejump at the Big 8 college champi-onships. When Jami graduatedfrom high school, he stopped offici-ating, Melissa was interested inmusic and plays. When she was inthe concert chamber choir. Brentand Virginia sponsored 49 studentsto travel and sing in Florida,Virginia said she just viewed it asher responsibility, "If you are in acommunity, you need to give backto the community, Tbe communityis supporting you, tben you need tosupport it," Brent agreed and addedwith a smile, "Virginia would havekilled me if I didn't. The more you

492 Volume 32, Number 6, 2001

involve yourself, and tbe morethings that you do, the more youbenefit from those things."

Currently

The word that best describes BrentBenkeiman's life and practice, hesaid, is "busy." He had taken a part-ner in 1991 to reduce his workload,but in the past 6 years or so he hasbecome excessively busy again. Forthe first time in his life, be nowresorts to making lists of things todo so as not to forget anything."When you get to be a certain age,you have so many things that inter-est you that it's difficult to get themdone,"

Brent presently works 4 days aweek, 10 hours a day, a schedule headopted after his father died. Atthat time, the Benkelman brotherssat down to go over his papers.They saw that Brent's father and histwo brothers had written to eachother year after year about gettingtogether, but they had never doneit. As a result. Brent and bis broth-ers. Bill and Paul, try to get togetherfrequently and do things they allenjoy. Additionally, each of themalso makes a deliberate effort totake off one day a week as an"advance" on their retirement whilethey are still active and able, "I takeTuesdays off. I consider that part ofmy ultimate retirement, while I amable to do the things physically,maybe not always financially, thatwe wanted to do. But I can get outand walk and hunt all day now. Imight not be able to do that,because of my knee, 4 or 5 yearsfrom now. So I at least have 45days a year of retirement that Iwouldn't have had otherwise."

One of Brent's goals is tobecome a better person. He wantsto read more and become "morewell-rounded" and less preoccupiedby things that aren't worth worry-ing about. Brent also said he thinksthat he is not very good at express-

ing his feelings about tbings. Hejoked, 'T try not to be too intro-spective, because I'm afraid of whatI'll find, I'd just as soon improvewithout knowing that I was bad tostart with. Sneak up on it! Let'shead off these bad tendenciesbefore I notice they're there!"Above all. Brent said, "1 am evolv-ing ... [and trying] to become amore positive, bigger person,"

upbringing, he said that he mightbe "a little overboard about notwasting money." He may also over-look the effect of his decisions onbis staff. For instance, on a busyday, if asked to see an extra patient.Brent will gladly make room in hisschedule. He doesn't mind stayinglate, but he forgets that his staff hasto stay, too. Generally speaking,though, Nancy Habluetzel thinks

'I guess my basic philosophy of practicehas always been to do things

as easily for people as I possibly can,so that they don't feel like

they've ever had to endure anything."

Dr Beni<etman

One would think that Brent isalready positive enough. He is usual-ly the personification of the Opti-mist's creed: "To look at the sunnyside of everything." Given his gener-ally positive outlook, a good friendwho is a general surgeon gave Brenttbe nickname "Dr Happy Tooth."For better or worse, that is now hisdesignation by the iVianhattan medi-cal community.

Nevertheless, Brent said heneeds to "learn how to listen a littlebit better," an aspiration that per-tains less to his patients than toother people around him. "I'm real-ly patient with [my patients]. Youknow, you can spend so much timebeing patient [thatj you use it allup." At times Brent thinks that hisrelationship with his employees iswanting. He admitted being tooabrupt with his staff sometimes,and he gets upset over small things,such as when someone makes anunnecessary photocopy of a docu-ment. Harking back to his frugal

Brent's flaws are nothing morethan the opposite side of the coinof his virtues.

Considering his perceptiveobservations and concerns abouthis patients, it is difficult to knowwbetber to believe Brent's depreca-tory assessment of bis introspectivecapacity. It is easy to sec, however,that action rather than reflectioncontinues to characterize his life.He is as busy at home as he is dur-ing his 10-hour workdays. Hisevenings and weekends are filledwith church, community, and pro-fessional activities. His role as elderalone consumes many eveningseach month. Whenever possible, his"retirement Tuesdays" are occupiedby bunting, fishing, or taking hisdog. Sunny, for a run. Time has tobe set aside for on-call responsibili-ties and continuing educationcourses, and he reads his surgeryjournals at home on an exercisebicycle in front of a large windowoverlooking reddish-brown prairie

Quintessence internationai 493

grass. Over the years. Brent hasalso found time to finish andrestore antique furniture, which isdisplayed throughout his house. Hisenergy level is not deficient, to saythe least. He also tends to be rest-less and impatient. However, hecommented that compared with hisyounger years, he is now the modelof placidity. Hours into the inter-view he said, "You would have

never gotten me to sit stili this long20 years ago." However, he saidthat he still does not like to sit stiilat a movie theater, and continuingeducation courses are torture to sitthrough. He doesn't even sit downfor very long while he works.

So Dr Benkelman continues tokeep busy doing the things that hehas always done. He does not phi-losophize about his egalitarian

approach to professional and per-sonal relationships, nor does hethink about how others judge himas exemplary for his dedication,generosity, and concern for hispatients. Instead, with his roots inthe understated, caring fellowshipof the western Kansas plains, hejust works steadily, and if someonecalls, be helps them.

A Note from the Authors

In 1996 we embarked on a project to identify dentists toserve as models of commitment to professional ideals.We hoped their stories would evoke a fuller understand-ing of professional responsibilities for young personsentering the profession. We also thought such storiescould serve as a source of inspiration and renewal tothose who are established in their professional lives.

To identify exemplars, we engaged in a national nomi-nation process using criteria developed by Colby andDamon (see box). We selected 10 individuals who notonly fit the criteria but exhibited exceptional commitmentto one or more of the ordinary responsibilities of the den-tist. We attempted to make selections from a diversegroup of nominees from the standpoint of gender, race,and religion. We also looked for diversity in professionalactivities and selected a mixture of practitioners and aca-demics. Each of these individuals will be featured inQuintessence internationai.

In-depth interviews were held in each exemplar's com-munity, usually over a period of 3 to 5 days. The interviewsfollowed a pattern of ethnographic conversations toexplore tiie nominee's conception of the factors that influ-enced his or her development. Our methods of analysistook seriously our nominees' conscious articulation of theirbeliefs, values, and life histories. Our interest was in themeaning they assigned to events in their lives. Thus eachversion of the story was returned to the nominee for com-ments, corrections, and final approval. In tfie accompany-ing commentaries,we share our impressions of the partic-ular virtues that define their character, as well as those

that prompted their peers to nominate them as exemplaryprofessionals. For a detailed description of the selectionprocess, interview questions, consent process, and analyt-ical methods, see Bebeau and Rule (1999).

Criteria for moral exempiars

• Stiows a sustained commitment to morai idealsor principies tiiat inciudes a generaiized respectfor humanity

• Dispiays a disposition to act in accord with moraiideals or principies, whicii wouid imply a consis-tency between actions and intentions and themeans and ends of actions

• Expresses a wiiiingness to risi< seif-interest forttie sai<e of morai vaiues

• Shows a tendency to be inspiring to others andthereby to move them to morai action

• i-ioids a sense of reaiistic humiiity about ownimportance reiative to the world at iarge, imply-ing a reiative iacii of concern for own ego

Colby A, Damon W. Some Do Care: Contemporary Lives ofMoral Commitment. New Ycrk: Free Press, 1992.

Bebeau MJ, Ruie JT Morai heroes in dentistry: A werk inprogress. Presented at a conference entilied "Role-Modelingand Mentoring in the Formation of Vaiues, Attitudes, andCharacter ol Health Professionals." sponsored by the Divisionof Medicai Education, Daihousie University, Halilax, NovaScotia, 3-5 June 1999.

494 3ï. Number 6, 2001