Tuesday, January 27, 2015

Fire, Fire!

“They call me the Fireman, that’s my name.”

That’s the first line from George Straight’s song “Fireman. I haven’t been able to get that out of my head since recently having a string of “fires” to put out. Unfortunately, or perhaps not, they haven’t been the types of fire he refers to in the song.

We probably all have experienced cycles in our practices when everything runs smoothly and others when there seems to be an unusual amount of dental emergencies, post-op flare-ups, appointment cancellations, or staffing interruptions. A couple weeks ago, a retired dentist friend stopped by and asked how things were going, and all I could say was that I had been spending my time “putting out fires.”

I began to evaluate each of the situations to see how many of them I could have prevented. Were they the results of poor planning on our part? Could some have been prevented with early intervention of a minor problem? How many were the result of the patient’s own neglect, procrastination, or lack of knowledge? And, how about the possibilities of some being natural disasters or acts of God?

All of this “fire control” made me think of two books I read last year, on the recommendation of an AGD friend. It’s interesting the similarities you’ll find between forestry management and fire fighting to dentistry. The first book, “The Big Burn: Teddy Roosevelt and the Fire That Saved America,” by Timothy Egan, told the story of a tragic fire in Colorado that gave the impetus for expanding and reorganizing the U.S. Forestry Service. The second book was “Young Men and Fire,” by Norman Maclean. This is a true story, horrific and heroic, about a failed fire fight that lead to the death of several smokejumpers. My love of analogies went into high gear and I found there to be some interesting parallels. I won’t give all the details of the books because they are good reads, but I will try to illustrate the basics.

In “The Big Burn,” key points were the need for excellent communications, organization, and leadership. These attributes were lacking in many areas when the fire broke out, and this resulted in one of the largest and deadliest forest fires in U.S. history. These three things—communication, organization, and leadership—are extremely important in a dental practice. Many dentists, including myself, find these more challenging than the clinical skills required to be successful.

Communication needs to be bidirectional. We must keep our ears open and mouths shut more often. When we communicate with patients and staff, we need to be certain that we use language they understand and then ask if we are clear. I actually have had new patients tell me that we were the first office to actually listen to what they wanted or expected before we told them what they needed.

Organization is, for me, the second most difficult function of running a dental practice. Written job descriptions and procedures are very important to help the staff have a clear and secure feeling about their functions. I’m kind of old school—tell me what to do, show me how to do it, and I’ll do my best to get it done. But this works great if you only have to do this for one assistant one time, and he or she never leaves. But, in reality, it’s better to have written procedures and policies in place; then it’s much easier to start new staff and maintain consistency.

Leadership is the hardest for me and a lot of other dentists. I think, by nature, many of us who pursue this career never thought about having to lead a team of people to accomplish our goals. That is why there is abundance of courses available for leadership development, and these should be some of the first courses taken by the new dentist soon after dental school.

In the second book, “Young Men and Fire,” the importance of good planning—which also involves contingency plans for possible complications—was the significant parallel I found to dentistry. A comprehensive treatment plan for ideal treatment is needed. Sure, often we see patients for an emergency situation as their first encounter. We should put out these little fires, and then try to get the patients to allow us to present a plan for ideal treatment. Even if they cannot do everything right away, they deserve to have the opportunity to understand what they need, and then we can make a staged treatment plan to achieve the desired goal.

I can’t count the number of times in the past that I have seen beautiful porcelain crowns or veneers on anterior teeth and then discovered that the posterior teeth have advanced breakdown from decay, attrition, or advanced periodontal disease. Excuse the cliché, but this definitely is not seeing the forest for the trees.

I’ve decided the best way to handle “putting out fires,” is to approach them as opportunities rather than irritations. I will strive to learn from any unexpected post-treatment events so as not to repeat them in the future. I will use emergencies to make the patient comfortable, find a solution to the immediate problem, and educate him or her to help attain the health needed. When I find a fire too big to handle alone, I will call upon my interdisciplinary team of specialists to help me.

Thanks for letting me share, 

Terry G. Box, DDS, MAGD





An Open Letter to Anti-Fluoride Fearmongers Everywhere

I have a few words for my anti-fluoride fearmongering friends.

Full disclosure: My office is a fluoride-friendly practice. Still, out of respect for our patients’ autonomy, we would never force anyone to accept fluoride application against his or her will. It is a recommendation for which we are happy to discuss all of the potential benefits and risks in great detail before obtaining their informed consent to include it in any treatment plan.

I won’t delve into the decades of evidence-based research that demonstrate the safety and efficacy of fluoride usage in the prevention of dental caries, or explain the biochemical mechanisms by which its application reduces the incidence of tooth decay. That information is readily available online, in textbooks, and in libraries across the globe. With a few clicks of a button, anyone with an Internet connection can access the required reading of dental school syllabi and data from the most recent and advanced scientific studies around the world.

As much as I believe in the value of fluoride, I fully support individuals who are respectfully inquisitive of its effects, as well as other innovations in medicine, biotechnology, and public health. Skepticism is healthy, natural, and essential to sustaining intellectual discourse on important issues in an objective manner. There is just as much merit in exploring the benefits of fluoride as there is in investigating its long-term effects for potentially harmful consequences.

I don’t have a problem with doctors, patients, or activists who are vocal about their concerns with fluoride. No matter which side of the fence you’re on, I believe everyone has the right to express his or her opinion.

However, it’s one thing to raise awareness for a public health issue that you are passionately committed to by calling for more research into uncharted scientific territory. It’s another to fortify your claims through the proliferation of misleading publications; incite panic with scare tactics designed to invoke public hysteria; and make ignorant blanket generalizations about the medical, dental, and science professions that insult and discredit the education and experience of the individuals within those fields. 

When confronted by learned, experienced professionals armed with research and data that point out holes in your arguments, you retreat into false neutrality in an attempt to relinquish accountability for your grossly negligent statements. 

“I’m just putting the information out there.”
 “I’m entitled to my opinion.” 
“I just want to call attention to the subject and get people talking.”

Well, you now have my FULL attention. And, if you were looking to “get people talking,” you have DEFINITELY come to the right place.

I often hear the argument, “Even dentists can’t agree on whether fluoride is good or bad for you! as a reason to doubt our profession and the safety of fluoride. While it’s true that we have long been divided on the issue of fluoride, the one thing that we ALL recognize is that the overwhelming majority of research on the subject has shown fluoride to be a safe and effective means of reducing dental caries. 

Points of contention do not detract from the caliber of our training or knowledge in our field; rather, they indicate a willingness to allow differing professional opinions to peacefully co-exist as we all work toward the common goal of helping our patients achieve optimal dental and overall health.

Yes, there are unethical and careless health care professionals and scientists willing to bend the truth about their research, products, or services just to advance their careers. But what profession IS completely devoid of dishonesty? In EVERY industry, from engineering to entertainment, banking to beauty, you will find self-serving, money-hungry, or fame-obsessed scam artists eager to exaggerate or flat-out lie to their consumers in an attempt to cover up their mistakes, generate publicity, and get ahead.

You know what else I love hearing?

“Why should I take your word for it? Just because you have an advanced degree doesn’t make you an authority! Just because you’re a ‘doctor’ doesn’t mean you know everything!” 

Oh, it’s ON.

Let me tell you something about my profession. As a discipline that combines art, science, and service to others, dentistry is constantly evolving to include new findings, techniques, and approaches to care. I have never professed to know everything there is to know about dentistry—nor would any of my colleagues. A huge part of our commitment to being doctors is the pledge to engage in lifelong learning, which we honor through our participation in continuing education, involvement in research initiatives, and teaching rising generations of dental professionals.

I’ll never be an “expert” in the subject of dentistry because there’s no such thing when your field is in a constant state of growth and development. But, with education, hard work, and an open mind, I’ll probably get a LITTLE closer than someone who views my pursuit of higher learning as a wasted investment of time, effort, and money and thinks a degree is nothing more than a fancy piece of paper.

Life experience, travel, and human interaction are ALL necessary to expanding our horizons and achieving a greater understanding of the world we live in. But none of those things can act as a substitute for education. Education is the ONLY thing that can propel us forward as a society. It can bridge boundaries between opposing cultures and philosophies. It can unearth life-altering discoveries in myriad disciplines. And it can extinguish fear, hate, and ignorance.

But when people disrespect the importance of education, they have already lost.

Furthermore, when you accuse doctors and scientists of “bullying” you by presenting hard science and reflections stemming from firsthand clinical experience that counter your own personal views and things you’ve read online, you realize that your creative interpretation of that word dishonors victims of actual bullying. Vilifying academics and professionals for their contributions to humanity doesn’t make you a valiant crusader against obfuscation and elitism. It makes you glib.

All I ask is that if you’re going to take a strong stance on any health issue in one way or the other, at least do it with an ounce of integrity. Don’t cite data from scientific articles that you cherry-picked from your search engine results just because their titles contain words that sound like they might reinforce your standpoint without first carefully assessing the strength of the studies and their relevance to your argument. Even if a paper has been published in a well-reputed journal, this distinction is virtually meaningless if there are major flaws in the research methodology, multiple confounding variables or indicators of bias, and/or inappropriate statistical analysis and planning. 

Nobody is trying to take away your First Amendment rights. But if you insist on utilizing flawed science to support your position, expect to receive some harsh scholarly criticism from those of us who are well-versed in the material. When faced with your morally irresponsible dissemination of misinformation to the masses, it is not our job to make you comfortable. But it is our job to educate you.

Just doing my part,

Diana Nguyen, DDS


Friday, January 23, 2015

New Year’s Resolutions

At the beginning of a new year, it’s natural to reflect on the past year. It was my fourth year of practice in 2014 and I can see obvious progress from where I started, but I know I have a long way to go to become the clinician I want to be. I know I am exponentially better at communicating with patients than I was when I first graduated. I am a natural people-pleaser and I had a hard time at the beginning really drilling home (pun intended) all the treatment that would be optimal for each patient. No one likes to hear that they have cavities and I had a tendency to call every cavity “a small cavity.” I have learned my lesson, and now I tell patients what they need to hear, regardless of how I feel they will take the news.

I know my clinical skills also have improved; the area in which this is the most obvious is in endo. I am so much faster and more effective than I was four years ago. My RCTs look better on radiographs, and I sleep better at night knowing that the patient received a quality service. Sheer volume of teeth and practice, as well as several continuing education (CE) courses, are to thank for that improvement. Looking ahead, I have some personal resolutions to improve in myself as a person and as a dentist. My resolutions for 2015 include the following areas:

Time management: I will be having my first child in the spring. Right now, I consider myself good at time management, but it will be exponentially more important when I have a human being to look after. I hope I can still find the time to work out, take CE, and read. I am not fooling myself though, and I have limited expectations on how much “free time” I will actually have. Fortunately, I have a very helpful and accommodating husband.

Communication: When it comes to communication, especially for patients and staff, there is always room for improvement. I work in a group practice and I always enjoy hearing how other doctors describe treatments and post-op instructions—and generally how they speak with each patient. There is always a new way to approach things, and I have taken bits and pieces from various doctors and incorporated them into my own vernacular.  

Clinical skills: As part of the Nebraska MasterTrack class, I will be taking CE on restorative and endo this year. If time and money permit, I also would like to take classes on implants and ortho. Time will tell what a newborn allows me to accomplish, so I am not getting my hopes up too high.

Budgeting: I need to get better at budgeting my personal finances. I am going to have to start paying for daycare in a few months, so my husband and I are going to have to make a few changes—mostly about buying things for our house and going out to eat—though we are actually fairly thrifty people to begin with. I also want to learn more about business finances. I am not currently in charge of any practice-related budgeting, but hopefully that will change in the future. Anything I can learn in the meanwhile will only help me down the road.

Happy New Year!

Sarah Meyer, DDS

Wednesday, January 21, 2015

Friendly Small Talk

In addition to a daily yoga class, dental schools should really look into adding a class on small talk to their curricula. This would prepare someone like me to speak when I don’t necessarily have anything to say. When your profession requires you to interact face-to-face with nervous humans on a regular basis though, this skill becomes quite important.

I never have been one to use extra words or to draw out a conversation. Part of this comes from being an introvert, but it is also how I was raised. My Eastern European heritage tends to avoid unnecessary banter and disingenuous smiles at strangers. I like to keep the chitchat to a minimum and get on with my day. I am constantly surprised at how many adults will happily slip into a long conversation with you in the middle of the work day. Perhaps my patients are just trying to avoid returning to their offices—while I am trying to move on to my next patient.

Prior to a procedure, I usually have a lot to say, just talking about the dentistry being done and answering any type of questions the patient may have. I take photos of their teeth, to which patients usually show an immense curiosity or cringe with horror. Nevertheless, prior to a procedure, there always are plenty of things to discuss.

The times in which I am usually at a loss for words are at recall exams. On these occasions, things are usually going pretty smoothly; my hygienist tells me that the patient looks great, and there’s nothing new to report. My job is to come in and do my exam, which is usually quick if there is nothing new of note. However, I likely have not seen this patient in six months or longer, so I feel like I need to spend a few light minutes in small talk—to break the ice and hopefully even put a smile on the patient’s face before sending him or her off to the front desk to schedule the next recall visit.

For conversation starters, I have a few frequently used topics that I will share with you, and I hope you will share some of yours in the comments below.

Children: If a patient has kids, he or she will instantly light up when you inquire about them. Now being a parent myself, I totally get it. This is really the only conversation topic that I will ever have a hard time cutting short—even if I am having a busy day. Also, if a new patient mentions to me that he or she has children, I usually make a note of it in the chart so I will remember to ask how the kids are doing during future visits.

Compliments: I look for something that the patient clearly spent some thought and time on. It could be a unique bracelet or cool shoes. As someone who enjoys shopping myself, I appreciate when my efforts are rewarded with a compliment.

Food: Who doesn’t like to talk about food? I had a patient complaining about how chia seeds kept getting stuck in his teeth, which led to a conversation about how chia is becoming a trendy health food. Ask if your patient has had lunch yet, or if he or she can recommend a good place to go to in the area. Favorite foods and recipes will get anyone talking.

The holidays: The holidays have passed, but they were recent enough to still entice conversation. Ask patients how they spent their time or about any great gifts they received. 

Happy New Year and I hope you all had a great holiday season! Now let me know what gets your patients talking!

Lilya Horowitz, DDS



Wednesday, January 14, 2015

New Year's Resolutions

I thought it might be appropriate at the beginning of the new year to list a few resolutions. Some of these may warrant further elucidation in a future blog. But, to get us started, in true David Letterman-style, here’s this year’s Top 10 list. Starting with No. 10:

10. Compliment your staff; affirm to them—daily if possible—that their work is appreciated. They will be better employees, the office will run smoother, and patients will notice and appreciate it.

9. Give your hygienist that extra time he or she needs, especially on difficult cases. Your staff members don’t like to feel rushed; I know I don’t.

8. Invest time in your staff; learn one personal thing about them each month. Do they have kids? How many? How old? Do they have pets? What do they like to do with their free time or on vacation?

7. Give back to the community. You can do this by:
  • Helping folks in need, maybe by writing off a balance if they are having financial difficulties due to health problems or joblessness.
  • Supporting a teenager who is working to serve the underprivileged here or abroad.
  • Supporting anyone else who may be serving the underprivileged.

The list of needs in our immediate and expanded communities is endless.

6. Carve out time for your family. Make an effort to get together with scattered kinfolk— parents, kids, and grandkids. How about planning a family reunion? As a corollary, how about spending less time on the computer and more time with your spouse? (I’ll be right back—I have to go say hi to my wife, Kate.)
And…

5. Plan a monthly date time with your spouse or significant other.

4. If you don’t have a significant other, make it a goal to get one—or to connect with a very close friend on a very regular basis—one who you can confide in and be honest with. The fellowship of a partner or close friend will keep you grounded.

3. Take time to enjoy your passions, like reading, hiking, skiing, or biking, or just hanging out and shooting the breeze with friends.

2. Enjoy dentistry more by removing life’s little irritants: If you don’t like making dentures, refer them to someone who does.

1. And, finally, stay fit; don’t turn into Quasimodo, “The Hunchback of Notre Dame,” like too many other dentists do. Allow your receptionist to pencil in a 15-minute afternoon break for you to enjoy a coffee or tea, a brisk walk, or just time to stare out the window and recharge before the final evening push.

There are so many other resolutions you might consider. And, of course, it’s not easy sticking to your goals. However, I did make one resolution about 30 years ago that I’ve managed to faithfully keep: “Never…ever…make another New Year’s Eve resolution.” I’ve broken all of the others, despite good intentions, but keeping just this one clears me of any guilt trip.

Happy New Year!

Jim Rhea, DMD

Monday, January 12, 2015

Grateful

So here we are early in 2015, and it is one of those times—of many—during the year that causes me to pause and reflect. It is the time when I look at my list of courses that I want to take and subjects that I want to learn more about, and I prioritize it so I can “make it happen.” And then I think about how lucky I am to look forward to learning more, to growing. Gordon Christensen, DDS, told me very early in my career that I should spend 10 percent of my time outside my envelope of comfort. If I spend less than that, I will stagnate and decline. If I do much more, I will make mistakes that could be very negative in their consequences. At 10 percent, I will continue to grow and enjoy this amazing profession that we all love so much.

Growing up in Toronto, the second youngest of 13 children, I shared a bedroom above the garage with three brothers. I remember looking out the window as a young boy watching my dad “work” on his car. It was many years later that I learned he was just checking the oil, the battery, the timing belts, etc., but I was fascinated and that started my love of the automobile, an avocation I still enjoy today. But an automotive career was not to be as auto mechanics was something that did not come naturally to me.

My mother was the third youngest of eight children, the oldest being the famous musician Percy Faith. Musical talent was in our blood, our genes, and I enjoyed some success in classical music as a pianist and in jazz as a clarinetist and saxophonist (alto and soprano). Even though I had talent, it was hard work and it did not come naturally enough for me to consider being a musician as a career either.

Science—particularly biological sciences—did come naturally to me, and the childhood wish that I would be a doctor when I grew up was something that I could achieve, and that is what I pursued. With my father dying suddenly at the start of my university undergraduate education, I struggled as to how to help support my mother and go to school. My marks suffered and I did not gain entry to medical school in my first years, and I finished my bachelor of science with no acceptance beyond that.

So I considered my alternatives and, being on the dean’s list in my final year, I was offered an opportunity to complete a research degree with a lucrative scholarship—so off to do my master’s I went. The academic world is so different; it was fascinating, but the work was really hard. I learned that I love to read about research, love to talk about and teach about research, but I hated doing it.

As I neared the completion of my graduate degree, I returned my focus on my chosen path to medicine. But what if I did not get in? Hedging my bets, I also applied for a career in dentistry and as a teacher. After six years of not getting into any program, I was now accepted into all three and was faced with an enviable decision to make.

It is now the early 1980s and the first season of “St. Elsewhere” had just been completed. In the final episode of that season, Canadian comedian Howie Mandel, who played one of the interns, said to his fellow graduates, “You know, we just spent a year of our lives and all we did was eat, sleep, and work.” And that was the revelation I was looking for. I never wanted a year of my life to go by like that. Life is too short and too precious.

I chose dentistry—and, boy, am I ever grateful. I love what I get to do for a career. It’s hard work, but it keeps me charged, it keeps me going, and it continues to be rewarding. I get to set my hours, within reason. I get to take vacations when I want to. I get to continue to learn. I get to be my own boss. I get to interact with an amazing team of staff who work with and for me. I get to work with my patients to enhance their health and change their lives. I get to earn a comfortable living. It’s hard to find anything that could possibly be better. Different perhaps, but better? Not for me.

Recently, while reflecting on things, I came across a project started by a photographer in Australia, called the “365 Grateful Project.” I hope to post, on as many days as possible, on my practice’s Facebook page (with ties to Twitter) a statement of what I am grateful for, with the hashtag #365grateful.

So, I sit here typing this blog, feeling grateful. This is going to be a great year, and I hope you also will start a project of gratitude. If you do, let me know, so I can follow you as well.

Back to the grind—which, today, does not feel like one.

Warm regards,

Larry Stanleigh, MSc, DDS, FADI, FICD, FACD

Friday, January 9, 2015

New Year, New You!

Come Jan.1, unlike many people I know, I hide as far away as possible from my local gym. It’s maybe a bit counterintuitive, but gosh I hate waiting among the masses for a bench or rack or—gasp—elliptical machine. Yes, men can use the elliptical, too! Don’t get me wrong—it’s nice to see the hope and determination of those newbies who have made it their goal to get in shape, change their ways, and reclaim that mid-30s body!

{insert bicep flex here}

All fine and dandy, but you know what’s even cooler? Walking into the gym in June and seeing the remaining 10 percent of those same people, still pushing, driving, and grinding to meet that goal. This is what I enjoy most about New Year’s resolutions!

So, I ask all of you, what are your dental resolutions for 2015? The ones you’ll keep working at for the entire year? Put a gym in your break room? (Man, wouldn’t that be sweet?) Go chartless? Learn to place implants? Pick up the latest and greatest CAD/CAM scanner/milling unit? Open a new office location? Hire an associate? Lots of options—and lots of opportunity.

I challenge you this though—make yourself a better dentist. Plain and simple. We’re all at different points in our careers, but I think we can all agree there’s something—or some things—we can better ourselves at. May it be clinical skills, treatment planning, or staff management, no one is perfect. We hear it from the day we graduate dental school, but it’s true: keep learning.

Even more importantly, outside the doors to that spiffy new (gym in the break room) dental office, are the resolutions you have for yourself and your family. I know I devote way too much valuable energy and time to dentistry, even outside of my 8 a.m. to 5 p.m. daily schedule. I love it, can’t get enough of it—but it comes at a cost.

Family must be your priority, and this never rings truer as my wife and I just welcomed a baby boy into our lives a few months ago. I’ve got the sleeping, diaper changing, and daycare drop-offing down, but I’m still learning this whole balancing work vs. family thing. I’m sure I’m not the only one. Balance in our lives makes us better able to treat our patients appropriately, smile at our staff sincerely, and accomplish our tasks more effectively. Slow down, take things in stride. Rinse and repeat. I say this not to lecture, but to remind myself. It’s one of my resolutions.

So, go ahead and set some lofty goals. Ones you know you’ll still be grinding at come summer time. They’re the only ones worth making. But remember to keep it manageable and never forget your support system. You can’t do it without them.

See you ’round the gym…in March!

Donald Murray III, DMD

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