Monday, July 21, 2014

It's Just a Tooth - Remove It

I really want to share with you all the awesomeness that was #AGD2014 Annual Meeting & Exhibits in Detroit! But alas, you’ll have to wait to see in it next month's AGD Impact. But I can tell you firsthand that, it was GREAT! I’m looking forward to the Golden Opportunity awaiting me in San Francisco!

Today, I had what Oprah calls an “Ah-ha moment.” That is to say, I was walking along with a friend during my hometown parade and I sarcastically said I should have brought business cards because I saw a lot of people IN NEED! As we continued to walk and talk, my friend questioned me about whether or not I accept the adult dental Medicaid plan provided under the Affordable Care Act. I simply said, “Yes, I do. But it’s VERY limited.”

Before anyone ostracizes me for taking PPOs, children's Medicaid and “insurance” at all, hear me out. My partner and I work really hard and although we do hate seeing the end-of-day adjustments, there are a significant number of patients that we HELP! We get them (with the plans’ help) into the office and present treatment to restore their oral health. Some find a way to pay the additional needs and some work within the confinements of their plan. For many in my area, this is the only way they can receive ANY necessary treatment. Also, we get a chance to educate and inform them.

Now, would I love to do 100% resin/porcelain? Of course. But, OMG, wait for it… I place amalgam! I know! (I feel like I just shared the dirtiest tale ever!) I believe there is always a time and place. If my patient can’t do the appropriate full coverage and I know I can’t appropriately isolate and restore in resin, then amalgam it is.

It isn’t always about reimbursement. We have been placing posterior composites at a downgraded fee for years in order to provide minimally-invasive, appropriate dental care to our patients.

While thinking about the limited plans, I feel that patients were given a bait and switch. Having been without benefits for many years, they were handed Willy Wonka’s Golden Ticket. They walk into the office beaming saying, “I’ve got dental insurance now and I am ready to have my work done!”

Unfortunately, then, you haveto sit them down (or, if you’re lucky like me, the treatment coordinator breaks the bad news) and explain that yes, although they have dental benefits, those benefits are limited. Sadly, breaking the news that a tooth is infected and needs an RCT is usually met with, “Does my insurance cover that?” When the answer is no, most will choose to have it pulled because “it’s only a tooth.”

It saddens me that in my young career I am already experiencing the frustrations of the red tape politics that is dental benefits.

Colleen B. DeLacy, DDS, FAGD

Friday, July 18, 2014

Young Buck, Meet Old Stag

The title refers to my father and I, so as long as he doesn’t read my blog, I’m golden!

I wanted to spend a few minutes of your time discussing how valuable a mentor has been for me in my dental career, with the hope that everyone will see the benefit in gaining such real world experiential knowledge.

All too often, I think we, as dentists, want to just do it our own way. We feel like we’re competing with our peers for the same patients and don’t want to share strategies with the enemy. We feel like we’re the greatest implant surgeon to ever walk this Earth, and that we have written the textbook on patient communication and case presentation (as I slowly raise my hand in admittance). I think this causes many of us to miss potentially game-changing relationships with mentors during our careers.

I went to a great dental school, where I feel they did their best at preparing me for the practice of dentistry. But its academia—there are politics, guidelines, rules of engagement. It’s just not the real world. Great learning experiences for sure, but not every day dentistry. The dean said to me, “Placing one or two implants as an undergrad under the supervision of the oral surgery residents won’t benefit you in the least,” and it still irks me. Oh man, if you could have taken my pulse rate during that first implant surgery in real life. I honestly am happy I didn’t faint onto the patient. I was sweating so much that I had to change my scrubs. It would have been nice to have an experienced resident (mentor) by my side for that one. This is where dad comes in.

I get the privilege of working alongside my father, as well as my mom, brother and sister-in-law, in my practice. I’ve been practicing for a little over four years now, and feel like I’m just getting into my “groove.” That point where you start to feel comfortable with the procedures, materials, day-to-day grind, and crazy patient questions-- yea those questions! It’s a fun and exciting place to finally be, but there’s always work to be done and valuable information to absorb from our mentors and peers.

I consider Dad my AGD instructor. He took me under his wing, showed me the ropes, answered my crazy questions, and even bailed me out midway through an extraction or two early on in my career. Not everyone has the chance to work with a close family member, but there are plenty of well-versed dentists in your community that are ready and willing to share their wealth of knowledge.

We know the absolute basics to get through daily dentistry when we come out of school—the rest is up to us to learn on our own. Or, better yet, alongside someone who has been through it, and already made the same mistakes. Do yourself a favor and find a dental mentor!

Donald Murry, DMD



Check out this AGD Podcast on the Value of Mentorship!

Wednesday, July 16, 2014

Employee Agreements

In the May 2014 issue of AGD Impact, Dr. Don Deems had a great article about how to take responsibility for employee behavior. It’s a great article and has some really great steps on avoiding the pitfalls of teams falling apart and how, as the leader of your team, you can create an environment that is fulfilling and positive. Of the many points he made, one that was mentioned was employee agreements. He did not expound much on this particular topic (no room in a one-page article), but this point resonated well with me.

More than 20 years ago, after I bought my practice from Dr. Roy Rasmussen (who, at 89 years of age, is still healthy, of sound mind and mostly sound body, continues to be an inspiration for me), I ran into the usual problems that we encounter so often. The receptionists were complaining about the assistants, the assistants were complaining about the hygienists and the hygienists were complaining about everyone. And they each told everyone, except the person they should have been talking to, that they were unhappy. It did not happen every day, but it happened with enough regularity to keep the office from reaching its potential, which hurt me financially.

I worked with a business coach and he pointed me to some wonderful training he had received from Tony Robbins, the man who brought us the “Personal Power” and “Get the Edge” personal improvement systems. There is one section that talks about an employee agreement. It is both simple and powerful.

Simply put, if Sally has a problem with Josephine, she does not tell Anne. Sally has to talk to Josephine directly. And Anne has to agree that if Sally does come to her with a complaint about Josephine, Anne is to direct Sally to talk to Josephine. That’s it. We all simply agree (regardless of position within the office) that Person A must talk to Person B and that Person C, if approached about Person B, must send Person A back to Person B without comment, but simply to support.

It all boils down to communication and relationships. I don’t expect my team to be best friends and socialize on a personal level outside the office. I do, however, expect them to be comfortable enough to sit down, face-to-face, in a private, supportive environment, and discuss like adults the issues that we are having with each other. It is simple, it is powerful and it has lead to peace in my office for many years. I now have team members (I don’t have staff, I have team members) who have been with me for 15, even 20, years. At first, I needed to be a neutral third party, sitting as an observer, to ensure the conversation remained civil and adult; that soon dropped as expected adult behavior reigned and became commonplace. The blame train ended.

Another important aspect in helping the employee agreements to be effective was personality testing and the information we learned about each other from this testing. I’ll discuss that in my next blog.

In the meantime, if you have not implemented the employee agreement in your office, try that now. And let me know how well it works for your teams.

Warm regards,

Larry Stanleigh, DDS

Monday, July 14, 2014

If I Knew Then What I Know Now

I recently read a great article titled, “If I Were 22: Embrace Your Ignorance.” The article is written by a Harvard graduate. He is looking back to when he was 22 and thought he knew everything, before he learned the hard way that he did not. I can relate to that feeling. I am 29 years old and one year out from dental school. I have been working in a private practice since July. The article rings true with what I’ve experienced over the past year.

After graduating dental school, I didn’t realize everything I didn’t know. I believed I was ready to step into the role as dentist, manager, and boss. As my one year mark approaches, I find myself looking back and thinking about what I would have changed or done differently if only I’d know this or asked that before starting. That’s the problem with hindsight: it’s 20/20. Since a lot of dental students are getting ready to graduate and begin their careers, I would like to take this opportunity to pass on some of the things I’ve learned over the past year.

I am not yet an expert in dentistry, and I don’t know if I ever will be. What I lack in clinical experience I try to make up for with patient care. Dental school teaches you the basics of prepping a tooth or making a partial, but there is a ton of on-the-job training that can only come with experience, and it all comes back to treatment planning.

CE is awesome! Take as much as you can to help fill in the gaps and get better. Read through the posts on Dentaltown, take courses, shadow other dentists/specialists in your area, and attend your dental society meetings.

I’ve realized that you never do the same thing twice in dentistry. Every time I think it’s just another crown, filling, or extraction, the circumstance, the mouths, or the people change. That’s why we have all heard the phrase, “We are practicing dentistry.” The moment you start to be overly confident or try to cut corners, it will back fire. Get proficient at doing everything the right way, and then try to improve your speed or technique.

Don’t be afraid to say you don’t know. Just make sure you go look up the answer. That’s why there are reference books. Keep them in your office and review them as often as you need. Google is also very helpful.

Finally, ask questions from everyone and treat everyone as a mentor. When I started working, people just assumed I knew everything about everything. We learn a lot in dental school, but classes and clinicals are no substitute for years of practice. So, ask your hygienists, front office, and office manager as many questions as you can. You can even shadow them for a day or two to learn about what they face every day. It is important to become knowledgeable in all the parts that make up a dental office, not just the dentistry.

As dentists, we are in a profession where we are surrounded with our successes and failures. This can be frustrating, whether you are a new graduate or a seasoned dentist. So maybe the best piece of advice I have is to remember that we are in a profession of life-long learning: there is always something new to learn.

Grant Glauser, DDS

Wednesday, July 9, 2014

Every Patient is a Fresh Start

About a year ago, I saw a patient first thing on Monday morning. Nobody at the office had had their coffee yet and we were a little sluggish. We seated the patient and proceeded to perform a DO and an MOD on #12 and #13, as charted in the treatment plan. We stopped once to give the patient a break when she stated that her jaw had locked up. We finished up and walked her to the front.

Later that same day, the office manager called me in to discuss something. Our first patient in the morning had written us an email stating that she would no longer be a patient at our office due to the unfriendliness of the staff. I was quite shocked by this email and tried to rack my brain as to what we did wrong. Did I inject slowly enough? Did I ignore the patient when she was having pain? Did I not ask her to let us know if anything was bothering her? Everything procedurally had gone very smoothly.

In her email, she stated that no one had said good morning or good bye when she left and that there were staff members just standing around. As she was the first patient of the day, there were no hygiene patients yet and the hygienists were hanging out at the front desk. I did not remember saying good morning and it was possible that nobody else did either. I called the patient and tried to discuss with her if she felt unwelcome and asked her to call me so we could figure it out. The patient never called back and never made another appointment with us.

After the initial shock wore off, I realized that it wasn't the patient’s fault that she was the first person on a Monday morning or that we were not all at our very happiest and shiniest. What I have tried to take from this experience is to always start every appointment with a friendly greeting and a smile. It is important to let go of whatever frustrations I have been dealing with. If the lab was late on a case or the staff is stressing me out, I can't let it show.

When I am feeling stressed, I try to remember the feeling when I received that email. A friendly greeting goes a long way.

Sarah Meyer, DDS

Monday, June 30, 2014

Quake

An oral surgeon recently invited me to his son’s wedding. At the reception, my wife and I were seated at a table that seemed reserved for dentists. The fellow next to me was friendly and the conversation rolled around to gratis treatment. He periodically volunteers for MOM (Missions of Mercy), which sponsors free medical clinics in economically depressed areas, particularly in Appalachia.

He had access to a portable dental operatory to provide basic treatment: restorations, extractions and denture services, mainly. In private practice, he was big on endodontics but knew that there would be no follow up here. Perio consists of oral hygiene instruction and maybe a prophy if time permits, which it usually doesn’t, as hoards of people show up for these free clinics.

I shared that I’ve been around the world with teams that treat indigenous peoples in hard-to-access regions where medical treatment is unavailable and dentistry unheard of. In many dialects, there is no word for dentist.

With the exception of two or three of my overseas trips, all I could perform were extractions, which don’t take much in the way of instrumentation: forceps, needles, syringes and local anesthetic, along with gloves, gauze, and cold sterilization; a stuffed duffle bag will suffice. And the relief from chronic and/or extreme pain is always greatly appreciated.

I once spent two days trekking through remote a jungle and climbing a rugged, rock-strewn trail behind a burrow that carried my supplies. In a village high in the Sierra Madre del Sol, the people spoke an ancient dialect, Chinentaco; only a few men spoke Spanish. To communicate, my guide interpreted from English to Spanish while another man translated further into Chinentaco. It took forever to explain how Septocaine works… or anything else.

The patient sat on a simple wooden chair that was perched on four rocks so I didn’t have to contort my back. Positioned under a shade tree in the village square, a villager grabbed hold of the patient’s head from behind to act as a headrest. It was primitive, but it worked. Still, it’s a long backbreaking day and the line never gets shorter.

Things were going well when my guide/interpreter was called away. Left on my own, I resorted to pointing and grunting with the next person in the tottery chair. After he was numb, I began to pull a particularly stubborn molar. Without the benefit of radiographs, I never knew what I was getting in to. I struggled for a while, thinking that this thing was never going to come out, when suddenly the chair shook and tottered, almost dumping the patient off. At the same time, I stood up to steady myself and saw that I was holding the tooth in the forceps. I looked at the tooth, and then at the villagers circled around me. They were all applauding and having a good laugh. His wife later brought me a small brown egg. It was the most meaningful payment I’ve ever received.

Later that night, while eating dinner around an open fire, my guide asked me what I thought of the tremor. I thought, “What tremor?” but then realized that the undulating ground had helped me extract that stubborn tooth. Whatever had happened, the Chinentaco man had been relieved of the agonizing pain he’d been in for weeks.

After relating this incident, my new dental friend at the wedding spent a lot of time explaining what the poor people of Appalachia are like, how they don’t understand modern hygiene and the benefits of modern restorative techniques. He intimated that I don’t have to go halfway around the world to help people. I didn’t have the heart to tell him that my roots are Appalachian and that’s why I do what I do. And I didn’t tell him that my office consistently performs pro bono treatment for the surrounding community. It doesn’t matter who you help—a good portion of the world needs assistance—as long as you selflessly serve.

Jim Rhea, DMD

Friday, June 27, 2014

Can I Interest You in... ?

We’ve all been there. It’s the end of the appointment, and everything went smoothly and as planned. You’re feeling good about your dental skills. Then you hear this from the patient:, “Doctor, do you have a minute? I was wondering if you were interested in purchasing ________?” Things just took a turn, and not for the better.

During my time as a dentist, I’ve been offered air purifiers, insurance, annuities, jewelry, makeup, vitamin supplements, gas utility service, satellite television, telephone service, pre-paid legal services, and kitchen/cooking supplies. I always wonder why people don’t try to sell me things I’m actually interested in.

I try to be understanding. I know people are selling these things to supplement their income. They would rather not have to bother me or their friends. However, I can’t afford to say yes to every one of them.

I do say yes to patients who ask for business card advertisements in their kids’ school play programs. I also advertise in sports programs for our patients’ teams. We all know the financial return on that investment is zero. Absolutely zero. I do it to support those patients that have supported my practice. I’m willing to help out.

So why do I not like when patients want to sell me something? I dislike this because I know may end up losing that patient.

Here’s why. No one likes to hear no. As soon as you say thank them but decline, they start thinking to themselves, “Sure, doctor wants me to buy his services but wont’ buy mine.” Eventually, especially if they happen to ask a second time, they start feeling bad about going to your office. That’s a normal human reaction. Who likes rejection?

By no means am I suggesting to never purchase things from patients. If you happen to be in the market for pre-paid legal services then, by all means, write the check. The patient will appreciate the business. As a matter of fact, my staff and I have purchased things from patients before. Okay, mostly my staff. They seem to like those jewelry parties.

It’s just that I can’t say yes to everyone. If I did, you would see me on one of those television shows about hoarders.

Here is how I’ve been handling this situation lately. I tell them a family member or colleague already has my business in that department. It works a little better in keeping patients. Most understand that we’d give the sales to friends or family before anyone else. But each time they come in, they still tell me how they can beat any price.

Oh well. I guess everyone loves you until you stop writing the checks. How do you handle such situations?

Andy Alas, DDS

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