Wednesday, April 23, 2014

102 Years Old, and Counting

Have you ever made a house call? Probably not; dentists seldom get the chance.

Kate and I moved to a home in Gloyd that backed up to an elderly couple’s farm. Like their parents, Tom and Selma were college educated, unlike most other local people. Shortly after I opened my home office, they hosted a three-day family reunion, including a Canadian branch that had escaped slavery via the Underground Railroad.

Selma was classy with a gentle spirit. An accomplished artist, her works were displayed internationally. In contrast, and despite a successful detective agency in Chicago, Tom’s heart and mannerisms never left the country. He always wore the quintessential overalls, flannel shirt, and work boots common to our rural area. His guttural southern drawl complemented his missing eye, shot out during a stakeout gone wrong.

Tom phoned my office late one afternoon. “Selma’s mom has got a real bad toothache. Been in bed and won’t eat. For the last two days she hasn’t had anything to drink.”

“Bring her over around five, Tom. I’ll take a look.”

“Aren’t you listening, doc? She’s confined to bed. Ya gotta come over here.”

“That’s fine; I’ll stop by after we close up for the day and …” He’d already hung up. Gruff old coot. Well, anything for Selma.

Kate was excited about a house call. I, however, was a little nervous. After all, Tom was a big, no-nonsense guy. We grabbed a sterile pack containing mirror, explorer, and perio prob, some gauze, latex gloves, a small flashlight, and a prescription pad.

Kate and I were greeted by growling dogs that sounded ominous in the dark. “Gi on outta ‘ere,” someone shouted. My heart skipped a beat as I quickly turned to leave; but Tom was talking to the dogs, not us. He opened the creaky screen door and stood aside as Selma welcomed us. “Thanks so much for coming. Can I get you anything? Coffee or tea?”

“No, thank you.” We wanted to get right down to business but Tom insisted on showing off his wife’s art work displayed throughout the house: pastoral scenes depicting horses, cattle, red barns, farmhouses, and family picnics near the pond.

“They stole my farm for that damn lake and then wanted to tax me for lakefront property,” he growled. He had shown those paintings to the assessor.“You don’t see any nautical scenes, do you?” He didn’t pay extra taxes.

He finally took us down a long hallway, into a bedroom where Selma’s mom lay supine in a hospital bed. Kate gasped. Grandma was stone still, her hands folded just so on her chest. I almost imagined a lily delicately placed in her intertwined fingers. I’m not here to pronounce her dead, am I? I’m just a dentist, for crying out loud.I looked to Kate for guidance, but found none.

Tom explained. “Started with a bad toothache. She stopped eating days ago and now won’t drink anything. I can’t get her mouth open to look. You might try forcing it a little.”

“I’ll try, Tom.” How hard can that be? The old lady couldn’t weigh more than 89 lbs. But when I touched her mouth, she sprang to life, shaking her head and tightly pursing her lips. I softly coaxed but Tom leaned in and whispered that Mother was a little hard of hearing.

He bent close to her ear and screamed, “Mother, it’s the dentist!” Startled, I stumbled backwards into Kate, catching her off balance. She fell against the wall and knocked into a picture, which crashed to the floor. It was a portrait of Selma’s mom. Mortified, I looked at Tom, who stared at Kate while she picked up the picture. I apologized; he glanced at me and grinned.

In the meantime, Mother had opened enough for a quick glance. Her teeth were in pretty good shape except for the one that needed to be extracted. I called an oral surgeon who asked me why she couldn’t be moved. I laughed in the phone. “Bill, you’ve got to come over here and see for yourself. And don’t worry about the dogs.”

He soon arrived and I chuckled softly while he gazed on the surreal scene, because Dr. Bill was seldom lost for words. He had Selma’s mom taken by ambulance to a hospital where she was rehydrated and the tooth was extracted.

A few months later, I saw our neighbor out back in his horse field and asked how his mother-in-law was doing. “Her? Oh, she’ll live.” Selma’s mom was 102 years old, and counting.

I have never since been on a house call. But I would recommend one if you’re contacted by someone in need and the situation allows. My one-time visit possibly saved a life—she was frail and terribly dehydrated—which prepared me for subsequent missions overseas. Stepping away from the comfort zone of my high-tech office reminded me of the true meaning of the healing arts.

Jim Rhea, DMD

Monday, April 21, 2014

Top Ten

We speak with patients everyday. However, some things just never come up in conversation. Here is my top 10 list of things I do NOT hear from patients in my dental office:

10) Doc, don’t take this personally, but I love dentists.
9) I left my cell phone at home so it doesn’t disturb you.
8) Doc, your fees are so low. Are you sure you are charging enough?
7) Are you sure you only have to do a filling? Can’t you do a crown instead?
6) Wow, I just love that dental office smell.
5) Man, I hope this filling turns into a root canal.
4) You know, I’d rather have dental treatment than have a baby.
3) I’ve always felt dentists are underpaid.
2) Can you increase the volume of your handpiece? I can barely hear it.
1) My favorite part is the shot.

What could your patients say that would shock you?

Andy Alas, DDS

Monday, April 14, 2014

Insurance for Life

Just when I thought life as a dentist could not get any more exciting, I began to face some serious decisions about disability, retirement, and death at a very young age. As much as I like to plan ahead (vacations, parties, outfits, etc.), thinking about at what age I will retire, when I will die, and how to make sure my family is financially secure when I am gone can get pretty depressing.

Like many recent graduates these days, I signed up for disability insurance when I was in my general practice residency. I was making some cash (finally!) and knew that it was better to lock in a policy when I was still young and healthy. I am only now starting to decide if I would like to increase this policy. Unlike malpractice insurance, disability insurance is optional and many dentists cancel their policy or do not sign up at all if they never lock in a reasonable rate. The premiums can go up so high that it does not make sense for them financially. On the other hand, when you are a recent graduate and you are making (hopefully) a fraction of your income potential, you do not want to spend the extra money every month on something that seems so far away (retirement) and unlikely to happen (long-term disability).

Long-term disability indicates that you will be disabled and unable to work for a period longer than three months; you should have three months worth of savings in your bank account to get you through any period where you would not be able to work before your benefits kick in. How many 30-year-old young professionals are responsible enough to have taken this precaution? My own informal research has indicated not too many. When I was in dental school, I was afraid of going skiing. I knew one unfortunate accident and I could face the horror of missing clinic, resulting in delayed graduation date. These days, the possibility of losing a few months of income, which your insurance will not cover if you are out of commission for less than three months, is equally as terrifying.

You can become disabled at any age. But for most of us, retirement and death are hopefully far on the horizon. Why do I need to think about this now? How prepared can you be for all of life’s unpredictability and not drive yourself crazy in the process? While dentistry is a relatively stable profession, I cannot help but notice tons of recent articles in the media about how tough it is out there in the job market. Many individuals that were successful for years in various fields have lost their jobs later in life and are having the hardest time of all finding employment, faced with fierce competition from recent graduates. Having a sense of security for those later years in life can be priceless. How many dentists between the ages of 30 and 35 have already started saving for retirement? Does it make sense to increase your policy to have you covered for life in case something unfortunate occurs, or to use that extra money for savings and/or investment purposes? There are many options, and they should be carefully evaluated based on your individual needs.

In addition, you have financial advisors and/or insurance brokers trying to reach out to you constantly via email, LinkedIn and other forms of social media. Everyone has a different plan and they try hard to get some one-on one-face time. I try to avoid this sales tactic since it is time-consuming and dealing with salespeople is not my favorite activity. However, it is important to talk to a few different sources, get your facts straight and ultimately make an informed decision about your financial future, rather than pushing it off until you are older. As for more seasoned dentists reading this blog, what advice do you have for the younger generation? Is there something you would have done differently if you could go back and change things? Please share your thoughts in the comments.

Have a great week!

Lilya Horowitz, DDS

Monday, April 7, 2014

What Does AGD Membership Mean to You?

According to the AGD, “Membership in the AGD provides general dentists, students, and dental team members with the education, advocacy, and information they need to advance themselves in the dental profession while providing their patients with the best care possible. AGD membership represents a dedication to lifelong learning and overall oral health for the public.”

I have now been in private practice for 11 years, and can appreciate what my fellowship and membership in the AGD truly mean. I have begun to participate in more AGD-affiliated CE events, and have quickly realized that the caliber and level of education is superior to many that I have enrolled in previously. More importantly though, my membership is morphing into many new and exciting opportunities I hadn’t realized existed. What began as a goal to become an AGD Fellow has now become much more.

We have all, at times, set our mind to accomplishing a goal. I have a tendency to become consumed by the goal. Upon receiving my FAGD, I simultaneously researched mastership. With that, I discovered that the road I was preparing to embark on would be challenging and a test on my personal stamina- particularly because at the time, my state did not have an established MasterTrack program. Using the AGD website, I searched for constituents that had an existing MasterTrack program (one that wouldn’t cost too much in time out of the office and additional travel expenses). Fortunately, with a little prodding, less than 12 months after receiving my Fellowship, I will be attending Session 1 of the reactivated Wolverine III MasterTrack series here in Michigan. #CEjunkie in full force!

My AGD membership is more than the obvious dedication to lifelong learning. It is becoming an opportunity for my own personal growth and advancement as a person. I would have never imagined myself stepping up to blog here, for example, but my experiences with the AGD are overwhelmingly positive and I can’t imagine not sharing or inspiring other colleagues to join and become active in such a worthwhile organization. Additionally, there are many opportunities at the local, state and national level. That being said, I couldn’t have foreseen the whirlwind my last 12 months have been. My involvement in the AGD Fellowship program has extended to becoming a board member and a course manager for the 2014 AGD Annual Meeting & Exhibits in Detroit.

What has defined your AGD membership? Are you maximizing the potential that the AGD has instilled in you and your colleagues? Are you ready for the next level? The AGD invites you all to volunteer, and the payback is well worth it!

AGD membership to me means that the AGD provides me with superior education for myself and staff, opportunities to lead and inspire, and the environment to be comfortable learning and honing my skills and knowledge. Membership is an investment in me as well as my professional future.

It is your time to define your membership. What will it be?

Colleen DeLacy, DDS, FAGD

Friday, April 4, 2014

Change in Everything

I was walking by the Sony Store recently and saw an amazing 80-inch TV on display. I was amazed! My tech-envy made me want to have it in my home. I checked the price; it was only $25,000! (I say this with my tongue firmly implanted in my cheek). Reality set in. Our family room is not that large and our 52-inch TV is plenty for our home. And given what I paid for it, many years ago, it can be replaced for about $1,000.00 today. I know, given a few years (or maybe just months?) the big Sony TV will come down in price. In fact, I recently saw a Samsung 80-inch TV that was only $6,500, but it did not have the picture technology of the Sony.

My wife puts up with my geekiness and the desire to have gadgets. I think it is a requirement for being a dentist. We sure do love our gadgets. And the pace of change continues unabated. I graduated in 1987 and there is no procedure I do today, that is the same as what I did when I graduated. Everything has changed. It can be scary to stay on top of everything. But I really liked what Dr. Don Deems wrote in the January 2014 issue of AGD Impact: “You don’t need to be the first kid on the block to have the latest and greatest of everything. Instead, slow down and remember the fundamentals of providing your best dental and patient care, and your practice will do well. Simplification can have far-reaching effects.”

When I graduated, I quickly realized not how much I knew, but how much I didn’t know. Fortunately, I was in the Canadian Armed Forces and I was posted to the Army base in Calgary where I worked in a dental clinic with four other dentists, all more experienced than I was. What an amazing learning opportunity. I could practice the basic skills I learned in school with an experienced dental assistant who guided me in the non-clinical stuff that I needed to learn. I could take my time and learn how to be a good dentist. As my commanding officer said, “First you get good. Then you get fast.”

After three incredible years as a clinical dentist in the Forces, I then worked as an associate in a shopping mall practice. There I learned more skills, particularly in the business of dentistry. It was in this four year associateship period that I had the opportunity to have lunch with Dr. Gordon Christensen. He was in Calgary delivering a lecture on faster, better, higher quality dentistry. He reiterated the comment about being good before being fast. He told me that I should spend 10 percent of my time outside my envelope of comfort. If I spent less than 10 percent, I would stagnate. But more than 10 percent of my time outside of that comfort zone puts me in danger of burnout, mistakes or worse. An even 10 percent keeps us growing, learning, improving—and we all win.

Twenty years ago, I bought the practice I have operated ever since and those lessons have served me well. I am still a geek, and a gadget guy but I don’t have all of the latest gadgets. I have enough to keep me happy and wow my patients every day, and my patient care is consistently at the high level I desire and expect. I am doing the best I can. I’m pretty fast now, for some routine procedures, giving me the time to continue to develop relationships with our patients. It’s pretty fun.

So now I create lists. Each year, I start with a priority list of what I want to learn more about for continuing education (CE). Next is a list of equipment (gadgets) that I want to consider purchasing in the coming year. Because I am still hungry and still growing, the idea of no longer doing dentistry just is not part of my life equation.

Embrace the changes; we know they will continue unabated. Don’t run out and get every latest and greatest item for your practices. First you get good, and then you get fast. Slow down in everything else and enjoy the journey. The saying about stopping and smelling the roses is still valid, if not more so, today.

Thanks for reading. There’s a new Star Trek collectible series that I want to consider…

Warm regards,

Larry Stanleigh

Monday, March 31, 2014

Dentists Like to Fail

I know it sounds crazy. But the longer I practice, the more I am convinced that we, as dentists, are ready to fail at each new pursuit.

Allow me to explain.

When I try out a new dental technique, update software at the office or install new systems, I always do it on a Monday. My office is open on Fridays and closed on Mondays, so any installations or changes to are complete on Mondays. This allows me to completely focus on the task at hand. If training is involved, my staff can focus on that. It is easier when there are no patients to take care of, no hygiene checks, etc.

I recently had a friend add text/email patient reminders to his office. He had read my blog on the subject and was excited to try it out. Within a few weeks, he had failed to successfully integrate it into his office. It took him a few weeks to figure out what went wrong, but I knew the first day that he would fail.

He had scheduled his computers to be updated and his staff trained on a regular work day. Yes, his staff was supposed to learn new software in between making hygiene recall appointments and setting up for crown preps. He was supposed to be on the phone with the software company in between recall exams. Do you think he and his staff saw the new software recall system as a benefit or a hindrance?

The introduction to a new piece of equipment, software, etc. is important. You and the staff must see it as a positive experience. How positive do you feel about constant interruptions? That is how my friend rolled out the new system. When I called to see how it was going, he told me that his staff had never really taken to it so he discontinued the service. We’ve all been there. We go to a continuing education course and are excited about a new concept. We think about how great this will work in our office, but the idea falls flat.

Where does this pattern start? I blame dental school. Remember the first time you tried prepping a tooth for a crown in lab? Or your first cavity prep? Were you encouraged by the faculty or discouraged? Did anyone ever congratulate you on a great first try? Or were you just told you would need to try again? It seems that every time we tried something new, we were trained to fail the first time around.

I overcame this in dental school by trying to learn to succeed. In lab, I noticed very quickly that nothing ever got signed off before 5 p.m. They wanted you working away in lab despite your best initial effort. But when the professors wanted to go home, everything was suddenly good enough to sign off on.

So a buddy and I (who shall remain nameless) would sneak out of lab, go grab a drink, and go bowling on campus. We’d return at 4:45, just in time to hear our instructors explain how much our work had improved! I learned that sometimes it is okay to get things right the first time around.

Do yourself a favor. Set yourself up for success. Dedicate the time necessary to introduce new products or techniques into your office. Nothing is more is more disappointing than having YOUR idea, which YOU are paying for, fail because YOU sabotaged it.

Andy Alas, DDS

Thursday, March 27, 2014

This Just In: Dentistry in the Media

If you haven’t seen this commercial, you should watch it now. Courtesy of the Food and Drug Administration, it emphasizes the consequences smoking can have on your teeth, gums and mouth. When this guy doesn’t have enough money to buy his cigarettes, he removes pliers from his pocket and extracts his own tooth.

We’ve all seen it. A patient sits down in the chair, opens their mouth, and we find all sorts of staining, calculus, pockets, recession, attachment loss, bone loss, inflamed and angry gingival, and overall very poor oral health. We ask if they smoke or use tobacco, and they say yes. What I’ve been pleasantly surprised about is the education these patients have already received. They are on board with the consequences tobacco use has had on their teeth, and they admit they already thought it is a major contributing factor. I always ask if they have thought of quitting and ask what I can do to help. I’m happy to say I’ve even gotten a few to quit and have enjoyed being their cheerleader in the process at our dental appointments.

Now, let me turn to a different announcement I’ve read recently regarding periodontal disease and the risk factor of smoking. Delta Dental’s new plan for employees’ limits their cleanings for ‘healthy adults’ to one per year. Employees in Michigan, Indiana and Ohio can complete an online risk assessment survey and may qualify for additional cleanings if they have certain risk factors and/or a history of periodontal disease. The issue that the American Dental Association and American Academy of Periodontology have with the risk assessment is that it “does not include several known risk factors that would possibly warrant additional cleaning benefits, especially smoking.” Delta sent a letter to network dentists announcing the change and recognizing smoking as a risk factor, but “excluded smoking as a risk factor because it did not want to reward employees for ‘bad behaviors.’” Needless to say, dentists and patients are upset by this change.

Another interesting approach by Delta is the option to include a genetic test looking for the Interleukin-1 gene. A positive test would make employees eligible for additional cleanings in the year. Dr. Vorrasi, chair of ADA Council on Dental Benefit Programs, questions this move by saying, “If Delta honestly wanted to assess risk of periodontal disease, why would they exclude the most recognized factors in favor of a genetic test that is unproven?”

Katie Divine, DDS


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