Thursday, January 31, 2008

I messed up... again

You know this mouth of mine really can get in the way sometimes.

Something happened to me yesterday that I should blog on this.

But in hind site I think it may have been offensive to some people and for that I apologize.
I really am sorry. I want this to be blog that is fun and representative of me and who I am.
I promise it wont happen again.
Well....I promise I will try to think before I type.
Thank you for your patience with me.

Monday, January 28, 2008

So we all can't be Greek scholars

I was church yesterday at a "delve into the word" session. It was given by the Senior pastor of my church. We were going over a story in the Bible verse by verse, and almost word by word. It is kind of fun because when I read a story I do it in about 45 seconds and then it takes these guys about an hour and a half to expain it to me. (Hang on, I am getting to the dental tie-in). While we were talking about a couple of words, in this case it was "Jesus sighed". So some very smart dude in the back (me) asked what the literal translation from the Aramaic was. I mean did it mean "he breathed" or "coughed"?

Let me back Orlando we have a Presbytarian seminary, so some of the professors come to our church. One of the scholars at the seminary likes to come to these kinds of things. When I asked the Senior pastor this question about the translation, he thought that Dr.K might field this question. Now Dr. K went into this deeply profound message about where the story took place, the type of language they used. He took these two words to another level.

This was so the picture of dentists. At least me.

I go to school and learn a great deal of information. All of which was important. But I must be honest with you, I haven't retained it all. How could you possibly? I still feel the same way about education now. I get about 10 CE things a day and most of them look good. But is it going to help me. I mean really help me, the way I do dentistry and the way I practice.
Like my good friend Jorge says, he is a "meat and potato" kind of guy. I thought about it for awhile and I thought that was pretty profound. I mean I think I have become a meat and potato kind of guy.
I have done up to C5 of the Pankey Continuums but I have to be honest with you, I haven't retained it all. Remember "meat and potatoes".

I understand the Pankey philosophy and I buy into 100%. I know how to treat a severely compromised mouth. But these kind of people are not walking into my practice on a daily basis. You know who is... the person with a broken tooth. The person with a bunch of operative needs. EVERYDAY.

I have to deal with business questions EVERYDAY. I have to deal with management situations EVERYDAY.

I mean I told you about how busy my day is. When is there time to pick the General Dentistry (shout out to the AGD) magazine? I do the 45 second read but certainly do not do the hour and and half read (I am trying to relate to the beginning of the story, see how I am tying it all together). I can't even go to the bathroom at home without a kid sticking his or her hands under the door, Daddy, daddy, daddy.

Am I making any sense here? There is the guy who spends all his waking days studying Greek to translate the Bible and there is the guy who spends all his waking days researching the elasticity of a certain bonding agent under wet certain conditions.

Then there are people that run churches and there are dentists.

We dentists have to wear about 10 hats per week. Endodontist, prosthodontist, husband, periodontist, office manager, IT tech, banker, researcher, dad, HR representative, PR rep, plumber.

I love to take Frank Spears courses. I think his stuff is so well done, his lectures and his work. He spent a whole day teaching us about the pathology of the TMJ, (I can't remember the correct termology) I, Ia, II, IIIa and IIIb.
And he goes on to say he spent all this time so we can recognize the people not to treat. So of the 3 people a year that needs major reconstruction it is important to know that 3% of them have an TMJ problem that is a red flag.
But because of the fact that I am not doing this everyday it is something that (there I go again) forget. I do a New Patient Exam that looks at the TMJ but nothing ever jumps out at me that is a problem.
I wanted to get better at doing dentures, so I took a denture 3 day Pankey course with Mussad (something like this) and then I went back home and didn't do a denture for 3 months. My philosophy has always been if I can't do it well I don't want to do it. Guess what? I am no longer doing dentures.
So my point is....
We can't be the PhD and the clinician. I can't be. I want to know about all the bonding agents but, did you know there are over 85 bonding agents?
So I get REALITY and CRA and have to trust them.
So I have to ask the Greek scholar to translate the word "sigh" for me but...
I have to accept who I am and where I am at in my life.
Am I making sense?
Can you please comment? Because if you don't comment I don't know you are reading. I need to know I am loved.

Thursday, January 24, 2008

Its just a filling

Have I ever told you how much I love doing fillings.
If I see fillings on the schedule I start licking my chops.
Now I know what you are thinking. Come on now, they are boring. Well you must not being doing them in a way that is exciting.
Ever since I got out of school, I have loved doing fillings. I want every one of them to look just like teeth. It has become my personal life goal to make a filled tooth look like a natural tooth.
I was the only kid in school that would ask to do posterior composites. I took the elective course and then went into the clinic and they wouldn't let me do it.
None of the instructors knew how to do it. It is funny as I talk to some of the younger dentists in town they still are not doing many posterior composites in school. Now, I do 100% composites (not that I have any problem with amalgam). In my practice and I have been doing composites exclusively for about 10 years and the schools still aren't sold on them.
Again I digress.
Fillings are a way I can put my signature in people mouth. I believe they are so powerful to people when you are replacing an amalgam with composite. I find this is a way to WOW a patient without doing $6000 worth of veneers on them.
I take a intraoral photo of the filling before. I am not talking making a big deal out of it. I am not printing it up (unless they want it). I am just taking it. I may take a shot at the midway point to show them how much destruction the decay did. This makes me look better because they say, "How are you going to do this." I just sit back and say "just watch". I have a mirror on my overhead light and some of the patients want to watch. But next thing you know I have resurrected this tooth.
I take a picture of this and then at the end I have a before,during and after photo on the screen. I tell them what I did and how I did it.
They usually ask questions but mostly just say "WOW". It is so powerful. I call most of my patients at home at night to see how they are feeling and most of them will comment on the fillings and how there spouse couldn't see where the fillings where? I always get a kick out the vision I get when I think of two non dental people looking in one of their mouths looking for a filling.
Now some people don't like doing them because they don't make as much money.
You have to put your fees such that if it takes you an hour to do a crown, and it takes you an hour to do 3 filling. So if you like doing fillings you should get paid the same as if you are doing a crown (think of the net not the gross).
I do 3 fillings in an hour and I make about 75% of a crown fee. But gross money is the same.
But I don't have to bring them back for cementation, I don't have a lab fee. I don't have room time.
This also makes me not change my treatment because of money. If they need a filling they get a filling. I am not thinking to myself, If I can only do more crowns.
I probably do more fillings than the next guy because I think of the "cycle of restoration". I think if I can just do one more filling on this tooth before crown then I have save the tooth from being cut down for another 10-20 years.
So I may do a big filling. But I find if I make this thing look like a tooth the patient is more pleased because I have explained to them the benefit to one more filling. I explain that because it is big it may not last as long. Still they are cool with that.
I have found I am doing more all porcelain inlay/onlays and loving it.
I am taking a root canal tooth and just covering the top of the crown. I put the margin anywhere and the onlay looks just like a tooth. This might be the subject for another blog.
But fillings... I do all kids teeth with composite. Parents LOVE IT. I do pulpotomies just like before. I take out the coronal part of the tissue. Formo for 5 minutes and then IRM. Then I put a sectional matrix on it and do a big filling with a Compromer.
Tooth looks great, no stainless steel. Now I wouldn't do it if my stuff wasn't lasting. I have extracted for baby teeth because of failure in my 12 years. So the stuff is lasting. I check my own work, so if I did it and the kid was 7 and I took the tooth out when he is 12, (because the permanent tooth was coming in causing problems), I check the margins of my filling. Like money in the bank.

Speaking of checking my work...I have been paying close attention to my fillings since I graduated from school. At every recall I look at all my old fillings and see how long ago I did them. I have to say some of my patients have beaten them to death, but other fillings look really good.
I don't think I can count on one hand how many fillings, I have done, that I have replaced. And I have done a lot of fillings. I am thinking I do 20 a week (I have a 23 filling day once) that is 1000 a year, that is 13,000 in my lifetime. This is a pretty good clinical trial.
Now my filling technique has evolved over the years. I started doing my anatomy with a white stone. Then I went to a small dove tail diamond. Now I still use a small dove tail but after that I take the pointiest diamond they make and I do terciary grooves with. I have talked to my lab technician about how he makes certain type of anatomy.
Speaking of lab technicians. My lab dude is now my patient. This to me is quite an honor because people see and appreciate the type of work you do. He and his whole family come to me, even his mother.
Now if you are doing stuff and you don't think people see your are mistaken.
I am going to make a list for you and you think about this (we will be talking about this again) because I am a real stickler for excellence leaving my office. But more importantly things that are NOT excellent leaving the office.
People that see your work.... (what are they saying about you?)
You, the patient, the patient's family, maybe your patient's neighbor, your assistant, the assistant you fired, your lab technician, your orthodontist, your orthodontist's assistant, your periodontist, your endodontist (he or she has to see your work when they have to dril through it), the patient's next dentist.

Think about it, we will talk later.

About the photos
One has a filling a did awhile back, an occlusal on #18 and a MOF and #19, this was a a recall appointment. I don't know how old they are. You can tell my anatomy is kind of straight lines.
The next photo is a DO on #29 (this filling came out real nice) but I put this photo in because tooth #30 has a DOFL porcelain onlay on it.
Double click on the image and you can get a full screen of it.

Tuesday, January 22, 2008

What's he got that I ain't got?

I am in the park of my neighborhood playing with my kids on Monday.
Our subdivision has 500 homes in it. So some people can walk to the park and others can drive. Now up pulls this sweet brand new Infinity SUV. I don't know anything about Infinitys but this one was big. It looked like a souped up Armada.
Out walks Dr.So and Sos wife with her 7 year old. She is the wife of a dentist and they live in the neighborhood.
I don't really care if someone has a nice car. I think it is a depreciating assest but if you have money to burn, and you think it is cool, go ahead.
The problem I am having is that she has got her house on wheels and he drives a Hummer. They have a third car which is a Jeep Wrangler for weekend drives if they want to put the top down. They live in the biggest house in the neighborhood and ON A LAKE. They have a screened in pool. They have a huge yard with a batting cage in the back yard.
His three kids all go to private school.
I remember talking to him and he bought his son a truck, no problem right?
Well his son was only 15.
Before I forget. I really like this guy. He is nice as all.
But what the heck.

For me it is week to week. I know I make a lot of money and I try to spend it wisely. I budget, I tithe, I save, and I am truly cash poor.
Let me back up. "I budget". Maybe that is a stretch. Sometimes I feel like if you have money it is hard to budget. Some people budget so they can afford to live. We budget because we want to get out of our house debt faster. So, because of this, budgeting in our family is don't spend more than you make. It is hard when the wife is beat from running around after the kids all day and doesn't want to cook and says lets go out. "No problem honey."
We really want to get the house and office debt monkey off our backs, because it really hangs over you. But...

Have you ever read The Millionaire Next Door? Well this book talks about the habits of millionaires. It talks about how they all budget, they all save, they all tithe (as a whole), they give alot to there kids college and they are all cash poor.
I totally buy into there way of thinking.
But I don't always do it. I like to spend every once in awhile. I like taking my wife out to a fancy dinner that cost way too much because it is fun. I like taking a vacation for no reason because I need a break. So I retire a little at a time. I don't understand the mentality of working your ass off and then being so tired at 65 that have to retire.
I take 5 weeks off a year. I work 4 days a week. I have got the life.
Which brings me back to the dentist in the neighborhood.
My assistant says, "why don't you go over there and see how he does it."
I thought about how he might do it. If it is legit, I mean, no stealing off the top, paying all your taxes, no insurance fraud. (I am not saying everyone who makes more than me is illegit).
If someone is going to make that kind of money, does he or she run 3 chairs at a time? Maybe stick an emergency rct, post and core and crown in the middle of a busy day. So this maybe means working through lunch and running an hour late at the end of the day. I have no problems with someone else doing it this way, but I can't do it. Do they pay their staff well? Are they running their staff into the ground? Always having to deal with staff turnover?

I thought about it awhile and said, "No."
I don't care how he does it. I like the way things are going here. We are totally relaxed all day. We never go without eating. We stay after work about 10 minutes about once a week. I have got enough problems (mostly self induced) and time issues (see two blogs ago), that I don't need anything else.

I have been to the lectures that say, "I numb up patient number one, go numb up patient number two, prep a crown on patient number one while number two gets numb."
He claims that if you are taking more than 5 minutes to prep a tooth you are wasting time. So this guy produces more in the first hour of his day than I do in one day.
I don't roll like that. I have 15 minutes of BS time with each patient. There is no pressure, no running around, you have relationships with you patients and they come back.
So I don't have all the stuff he has. So what.
I get to spend alot of time with my family. I am content. Why would I ever want what he has when I have what I have.

Talk to you Friday.

Monday, January 21, 2008

ReState of the Blog Address

Well, after two weeks of the blog I wanted to restate the mission statement of the blog.
I thought we had some real breakthroughs and some real failures.
In the breakthrough department, I think I am connecting with some people that long to be connected with. I was getting some good comments and I am encouraged by this.
But in the failure department is where I have succeeded the most. As you know I have written about the people that are close to me. I wrote about my wife, my dad, my kids and my staff.
I would say I write in a style that is honest. That kind of style is supposed to encourage other people that things are not always as rosy as people lead on to be. But it is this style and the words I have chosen that have hurt the people I love.
I apologize if I have given the impression that the above people are not the most important people in my life.
I have chosen to delete the Christmas Party blog because of the above. It was inflammatory toward my staff and it hurt them and their husbands. I never intended this to be hurtful.
I wrote about my feelings, but I could have done it in a way that would not offend.

In the future, I will still try and connect with people but I will do it in a way that is honoring to others.
I will still write about Hilda and the kids. I will still write about my office and the crazy things that happen.
I will try to make it fun and funny but not at other peoples expense.
Thanks for your patience with me.
I hope to get better at all the things I do.

Wednesday, January 16, 2008

Is it me or am I going crazy?

First I would like to say that I am sorry about the length of my last post. I am new at this. In the future if I have something to say that is long I will break it up into a few days.

Now, I know we are all busy people but I think I might be at my all time busiest.
I am am on this crazy train and I can't get off.
I think it might stem from my perfectionist personality. I want everything to be perfect so not only do I take longer to do something, on the things I prefer not to do I do them anyway because I want to make them right.

I will tell you about my days.

I know I am going to run out of time so I will tell you about Mondays through before I go home on Tuesday.

Monday doesn't count, because I have the day off and I am so unproductive it is almost worse for me to have the day off. I get nothing done. My wife thinks it is her free day. "I am going to the grocery store (or the doctors or church or the mechanic, whatever), can you watch Noah (my 4 year old) so I can shop and relax?" I am happy to do it. But Noah is a pistol. He demands 100% of my attention, so no I can't sit in front of my computer and get work done.
Then it is, "John we should just go to the park today the weather is going to be great." Again, don't get me wrong I like going to the park and relaxing, but my day off actually becomes my "day off". We do our thing until 2:30 because this is when we have to start to go pick up the kids from school. So the day seems to go fast from 8am,when I bring the kids to school (they love that and I do to) until 3pm when I pick them up. Then from 3-9pm it is me and the 3 kids. Baseball, basketball, homework, wrestling, dinner, showers, brushing teeth, reading, prayers, bed.
So Monday is not a work day it is rest day.
It is what God did on the seventh day. I need it.

So Tuesday...
Alarm goes off at 5:45 to go to work, (one snooze). No breakfast (its for sissies), just brushing, flossing, shaving and hair, then out the door. I try to be at work at 6:35 to get some quiet time in before the morning huddle.
I work, until about 4pm. I will get an occasional break in the schedule but it is usually filled with phone calls to other doctors or writing up charts. I have a stack of charts on my desk to call Dr. So and So about Billy's frenum. Or call Dr. So and So about how Sarah's ortho progress.
It is endless.
Like I said I get off at 4pm but my work doesn't end there. During the day there is almost no time for my to write up charts. I am computerized, with EagleSoft, and I have all the templates, but it takes forever. If I did a filling I know there is a template for that, but if it is ever different than the normal filling I like to write it down. You know, "Deep, near exposure, I put Vitrebond on the axial pulpal line angle. Or I told patient it may be sensitive do to blah blah blah. There is always something I feel like I will want to remember the next time. So I am usually two days behind on writing my charts.
I stop seeing patients at 4pm and I used to get the call from the wife at 4:06pm. Anyone else having this issue. "What are you doing? When are you coming home?"
Now listen, I know being at home with 3 kids 8 and under is tough, why do you think I come to work?
I have to explain to her this is OUR lively hood. In order for OUR practice to continue to be successful I need to put in the time. I am at work only4 days a week. Those days are going to be long. I am not staying at work because it is fun to be by myself and write up charts. I am not staying after work to deal with staff situations because I love confrontation. I am staying after because I HAVE to. So you can not call me putting pressure on me to get home. She understood and now waits to call until about 4:30.
Am I the only one that feel like the office will suck if you stop making it run?
I feel like if I don't hard at it it will go away. Things are good right now, I mean real good, and I feel this is proportional to the amount of love and effort I put into it.
I have told you I work with my dad. It is great. But he has given me the reigns of this thing. He totally has senioritis.
He goes home at 3pm. This is great for him, but this does not allow us time to interact after work. Have a conversation, anything. He said today, "Call the decorator and see if can come in an help us redo the wall in the reception area." and then he leaves to go home.
"WHAT!!" Apparently he did not see the 40 charts on my desk with all the other crap piling up. "I will get right on that." (See above photo).
I know I am rambling. My thought are all going everywhere.
It is 5:45 and I have to go home. Just in enough time to eat, hang with the kids for a half an hour and off to a bible study. Only to get home at 8:45, take a shower, brush and plop in front of the TV to veg. Read then bed at 11pm.

I will tell you the rest later.

Monday, January 14, 2008

Marathon Blues

I told you I was going to do my first MARATHON and I didn't get any responses. Nothing like, DON'T DO IT!!!
As you may know, yesterday, I did the Disney marathon with 18,000 of my closest friends .
Lets go back to last November when I broke my wrist playing basketball. I got to meet my new orthopedic surgeon and he said, "you are a moron, you are old and you are a DENTIST for crying out loud" in not so many words.
It was at this time I felt like I was getting fat a high rate of speed, and I needed to do something about it.
So I took up running. Okay maybe not running, jogging. I have always hated running and told everybody who ran that I thought they were loners and masochists.
I use to run about 1 mile before I looked like I was shot, "...go on without me." I hated every minute of it.
Then I found someone at church (who also lives in my neighborhood) that was a runner. I never knew how much easier running was with a partner. (you have to call this person you run with your "running partner" not just "partner" could lead someone to believe other things about you, "not that there is anything wrong with that").
We started at 2 miles, then we pushed 3, and so on. Next thing you know we are at 7 miles (and we got this far because we got lost doing 6) after about 5 months.
My "running partner" is 48 and wanted to do a marathon before he was 50. I got a email talking about marathon and half marathon training. I talked to him about it. Next thing I know we were signed up.
This was a 6 month training program that was three times a week. Two short runs during the week and a long run on the weekend. We ended up doing our weekday stuff around the neighborhood and did the weekend run with the group.
The group met at 6am the first day in June to do a 10 mile jaunt. Trial by fire.
I did it. I felt like I could do this. Next thing you know I am doing 12, then 14. I don't mean to blow over this because, before this weekend, going from 10-12 was the hardest run of them all.
Next thing you know I was getting up at 4:30 to do 16 miles. Two month later I am getting up at 3:30 , at 40 degrees (I know you northern people chuckle at this one, but this is fricking cold to Floridians) to do 20 miles.
People always say if you do 20 you can do the marathon. This is the biggest bunch of horse crap you will ever hear. It is not like when you finish 20 you say, "I feel great, lets just mosey on over and do 6 more miles." No it is more like, "get me to the car, I need to go to the hospital."
Now if the hospital is 6.2 miles away we may have something here.
On an aside, I did train to 24 miles and I felt great about my training.
Now we get to yesterday.
The race (I love how they call it a race, so I guess I can say I came in 3000 place) was on Sunday morning. I stayed on Disney property because they recommend that you get to the race area at 4am. This means a 3:30 wake up call (it is funny that they tell you to get a good night sleep, but want you there at 4pm. Things that make you go Hmmm.)
I carbed up the night before with a pasta dinner. I had my energy drink in the morning and I was there right on time. What a zoo. It was organized chaos.
Me and my "running partners" from the training group met before the race. We were then asked to move to the start. One thing that struck me was the amount of port-o-potties, I mean I saw at least a hundred of them before you got to the starting area. But yet people, men and women were darting into the woods to pee.
I digress.
The race started, it was tough going. I found one of the hardest thing to do was running with so many other people. You expand a lot of energy trying no to run over people or avoid being squished. You start in corrals. Now my corral had about 2000 people that registered to finish at the same time (does that give you an idea of how crowed it was). It did eventually thin out and I finished with about 50 people within 15 feet of me.
I felt great at about 14-18 miles. But things started to go at about mile 21. My lungs felt great but my legs, more specifically, my calves started to reject the whole thing. They would start to cramp up, and I mean bad. It was like someone stabbing an ice pick in my right calve. So I started to walk more to try to work it out.
Then my mind started to go. I was getting real irritable. People started to walk, but they would walk in the middle of a 4 foot path. You would think the courteous thing to do would be to move to the outside. I found myself wanting to either shout at them or just go up to them and throw a serious elbow. But as irritable as I was my legs were my primary issue. So all the running and the training could not help you through the last 5 miles of this race.
I eventually finished the race at 4:30 on the nose. Yes, that is four hours and thirty minutes. I did however beat the four other guys I trained with. Not that I was bragging but they all had the same issues with cramping. Maybe it was the conditions, 72 degrees and 95% humidity. It was like running in pea soup.
But what no one warned me of is the emotion at the finish line. I can not explain it. I finished the race and just started to cry. I wasn't happy or sad. I just was a wreck. I mean, I was a wreck physically but I guess I was also an emotional wreck. I almost completely lost it with the woman who gave me the metal. It was all I could do to not break down and ask her to hold me.
But when I did find my wife it was like a river. It is very hard to explain. But when I did talk to the other guys, one of them said he was the same way.

Last thing, but I warn you if you are queues when it comes to body parts turn away now, this part may get a little graphic.
I think we are close enough now, after 6 blogs and all, that I can talk to you about some intimate stuff.
One problem I had when I first started was chaffing. I was chaffing in spots I didn't know people could chafe. When I got home from that first 10 mile run my nipples were on fire. So I was introduced to stuff called Body Glide. It looks exactly like deodorant but it is hard Vaseline. You just apply to the areas you shorts and shirt will rub.
When I run I use running shorts, yes the really short ones (my wife tells me my legs are hot).
But for long runs, I use a longer style of running shorts because they have pockets for PowerBar gels (affectionately known as GUs).
Well, apparently these type of shorts, during long runs, will ball up in between your legs. Then they will rise up on you. Well, not to be graphic but I chaffed. I mean I chaffed bad. But you don't really feel it until you come down a little. I didn't really feel it until I got home and I sensed some discomfort. Then I took a shower and ZAUWWY!!. I had chaffed up UNDER THERE.
I was in so much pain, that night. I laid down in front of a fan and just prayed for bedtime.
I was not a pretty sight. But the worst part was my loving wife asked if she could do anything for me. "Well," I said "I am really hurting and I need some talc powder." She said, "Sure, where do you need it?"
Needless to say, our relationship went to another level last night.

Wow. I have to stop this is getting a little long. I really enjoyed writing today. I hope you enjoyed reading. I mean life is just funny sometimes.

Friday, January 11, 2008

Coaching Third Graders

I was going to talk about teeth today, but something happened on Monday that I have to tell you about.

My son Luke is truly a gifted athlete. I have been throwing and shooting the ball with him since he could stand. Now I am not saying he is going Pro or anything, but he is a “baller.” (I mean his dad is 5’10 (with heals on) and his mother is 5’4, I think the only thing he could possibly go pro in is golf). He can play all sports and play them well.
Not only is he a good athlete, he’s an all around good kid (he has got a great heart) and I like being around him. So much so, that I coach him in two of the three sports he plays. (My son goes to our church’s school. So we play other private Christian schools around town. There is a pretty organized league called the Association of Christian Youth Sports, ACYS.)

I have coached his flag football team for three years and just started the basketball season. I know you all are starting to chuckle before I get to the good stuff.

Coaching flag football to third graders can make you laugh and cry. My staff loved to laugh at me. Monday was practice day and Saturdays were the games, so they couldn't wait until Tuesday morning so I could tell them the stories from the past weekend.

Coaching brings a lot of interactions with the kids and with the parents.

Well, I started basketball practice last Friday. I get out of work at 3 p.m. so I can jet to the school and get a practice in right after school. The first game is this Saturday so I have been trying to get at least three practices in before our first game. I don't work on Monday’s so we met for practice right after school.

We have seven kids on this third-grade team. Buddy is one of the kids, and he has a second grade brother, Josh. Their mom asked the school if Buddy and Josh can be on the same sports teams. The school, being very accommodating, said no problem. So Buddy and Josh are on my team.

Now Josh is the youngest kid on the team and the smallest in stature, but he is not that far behind in skill.

So, we begin our lay-up drills. This is two lines, one doing the shooting, one doing the rebounding. Easy enough.

Josh, being the youngest is a bit immature. So in the line he is always cutting up. So, the first time I saw him messing with some of the other kids I pointed out that I see him and I wanted it to stop. I turn around again and he is pulling some other kids pants down. I again gently told him to stop. Well, the third time is where things started to go bad.

I took Josh aside and I told him, “You are going to have to sit out a couple of minutes because this is what is going to happen …” and before I could get out my reprimand he says, “Whatever.”
I said, “What did you say?”
And he said, “I said, WHAT EVER”.
I then said, “Listen, Josh, this is not how you should talk to people.”
He says, “This is how I always talk to people.”
Trying to stay calm, I said, “Well, I don’t care how you talk to people you shouldn’t talk to me this way, it is disrespectful…”
And before I could get the last bit out he says, “Blah, blah, blah.” He actually said this.
Now let’s just take a deep breath and think about how wrong this is on so many fronts. And I am not even done with the story.

I know this sounds weird, but I don’t blame Josh. So, I didn’t stick my size 10 shoe in his mouth. He did not want to participate in the rest of the practice. So, he was no longer a problem during this practice.

After practice Josh’s mother shows up. I began to explain to her all of the events and when I was telling her what went down with Josh, she went on to say to me, “Yeah, he does that sometimes.”

Somehow, she knew that he didn’t practice. So, she went on to say, “Well you know, if he doesn’t practice he won’t get to play.” What she wanted me to do was not play him during the game. So she wanted me to be the heavy. She wanted me to “discipline” Josh.

Thankfully, that is the end of the story but do you see what I am saying? I send my kids to this school because of the education but more for the environment. I was looking for a place where my kids can be around kids that are like him. Kids that live with boundaries and when they try to push beyond those boundaries, they get smacked back in.
Ted Tripp is the dude that wrote Shepparding a Child's Heart. He speaks about the Circle of Blessing (Galatians 3). If the child goes outside of it, he will not receive the richness and the blessings that are in the circle (where there is obedience and respect). You want your child to have richness and blessing, so you should use corrective discipline.

Is it me or is this stuff kind of intuitive?

I mean the Bible says, “Spare the rod, hate the child” Proverbs 13:24

Now, Josh is 7, if he never gets corrective discipline (Bible talk for smack in the mouth or soap in the mouth, for you non-spankers) for talking back or for being disrespectful; how does he learn?

What is it going to look like when Josh is 15? I feel bad for Josh. I have been thinking a lot about this. The team and I have practice this afternoon. I will take Josh aside today and explain to him that I want him to succeed. Tell him what I expect out of him and what will happen if he steps out of line. I will tell him I like him a lot, and the things that he does or says will never change that. (I kind of think by saying this stuff he was testing to see what kind of a guy I was. “I am going to push this guy away and see if he will still love me.”)

I will tell you how it goes. Wish me luck.

Last thing, totally unrelated. I am running my first marathon on Sunday. I have been training for about six months and it all comes to a head at the land of magic, Disney World. I have to be there at 4a.m. I will let you know how it goes.

Wednesday, January 9, 2008

Ms. S strikes again

As I finished writing her a refund check, I had this awesome feeling like “it’s over, and it only took $500 to make it go away.”

I NEED to tell you this story.

Ms. S came to me about two years ago. My periodontist referred her to my practice with a caveat. The caveat was that she was “a little different.” I told him, “No problem, I am used to different. My whole family is a little different.” (Mistake #1)

When she came in for a new patient exam she didn’t seem that bad to me. She was very nice and pretty funny. Her mouth was pretty healthy, but she was missing #14 and she was already set up to have the implant done by my periodontist (whose name is now “mud” around my office).

I think she got a cleaning at my office; yes she did get a cleaning because I remember a big stink around the office because she has a heart murmur and she would NOT take American-made antibiotics. She would only take Amoxicillin that was made in France. (Coo-Coo clue #1)

Then, for some reason, we didn’t hear from her for a long time until one day when she called to set up an appointment to have the crown done. As it turns out, she had gone to another dentist in town to have the abutment placed and the crown done. But she wasn’t pleased, so she wanted me to do it.

The other dentist is a guy I know. So, I called him up. He said, “Yeah, I know her. DON’T touch her with a 10 foot pole.”
He went on to tell me that he put a crown on and the next day she made him cut it off and give her her money back. She said it was too tight and there was no fixing it, so take it off. (Coo-Coo clue #2)

I thanked him and said to myself, “How hard can it be? I can do this. It’ll be the easiest $1000 I’ve ever made.” (Mistake #2)

I saw her. The abutment was already placed. Both opposing teeth were virgin. I mean this was a slam dunk.

So, I reprepped it and placed cord. I took an impression and made her an awesome temporary. She said it felt great. I even gave her a discount because it was so easy. I only charged her $900 (Mistake #3).

I called her the next day to see how it was going. She said things are great; see you in two weeks for the cementation of the permanent crown. Well, the cementation appointment went on without a hitch. She said it felt great, but just in case; let’s cement it with temporary cement--just to see. So, the next day when I called her she said it was not tight but it seemed to be catching food at the gum line.

“Huh?” I said.

She came back in and I took off the crown and made her another temporary. I told the lab to try to close the embrasure space. We had her come back in a couple of days later to try the permanent crown again. This crown, again, felt great, but we cemented in with temporary cement--just in case.

Well, the next day she called me telling me she was having teeth pain, headaches and general soreness in her mouth.

“Okay, let’s get you back in here and see what we can do.”

Well, after checking the occlusion in every way, I found nothing. I assured her I thought things really looked good.

Well, that lasted about a week.

“I want a new crown, this one is no good”.
Back in the office. Cord. Impression. Temp. The temp has always been perfect for her. (What can I say? I make a mean temporary.)

Well, you know how the story ends. So, I can just say we went round and round. Finally, she started to ask me about the makeup of the metal inside the crown. I called my lab technician and got all the information about Captek crowns. She boiled it down to the fact that while she was not allergic to the gold, platinum, or palladium, she was allergic to the trace metals in the crown (even though she has other PFMs in her mouth, amalgam fillings and an implant and abutment). (Coo-Coo clue #3)

At this time, I had had enough. I sat her down in the consultation room and said, “I feel for you, and I am trying to do the best I can. But I think I have given you everything to the best of my ability. I feel like I have given you $900 worth of product. I have made you two crowns and about four temporaries and adjusted each one about three times each.” I continued, “I want you to be happy, so you can stay here and I can continue to try, I mean, we can make you an all porcelain crown, but whatever I do from now on you are going to have to pay for. Or, I can give you back some of the money you paid so that you can try to get what you are looking for somewhere else.”

She, of course, wanted to go somewhere else. She told me she would go to her old dentist in New York. I told her I would come up with a reasonable figure to refund her. We agreed to part ways. My thought process was: I charge $400 for a temporary crown, so I was going to charge her that and I would take $100 for the rest of my troubles. I wrote her a check for $400.
She came in for the check and when she saw the amount she just shook her head. “This is not enough.”

I said “How much do you want?”

She said she wanted $500.

I told her I had lost way more than the $900 she spent on the crown. The hundred dollars was just a drop in the bucket.

I get about one Ms. S every two years. I think I do a pretty good job on my New Patient Interview getting to know people, but….

I should have listened. “Don’t touch her with a 10 ft. pole”, he said. I said it was going to be a slam dunk. More like slamming my head against a wall.

Thanks for listening, this was such good therapy for me.

Wednesday, January 2, 2008

State of the Blog Address

Hi all. My name is John Gammichia. I have been thinking about doing a blog for years and I finally got the nerve to start putting things down on virtual paper.
Since I am going to do this thing I think it important you get to know me.
I am a general dentist from Orlando, Florida. Well, it is a suburb of Orlando called Apopka. I am 38 years old. I graduated from the University of Florida College of Dentistry in 1995. I am married to my college sweetheart Hilda. We just celebrated our 12 year of marital bliss (It makes my wife laugh every time I say that). I have three awesome kids. Luke is 8, Madison 7, and Noah is 4. I am about the luckiest person in the whole world.
We live in a great house in a quaint neighborhood. We go to this great church (that has a school, our kids go there) that is about 3 miles away.
I practice with my father in a Family and Cosmetic Practice. I absolutely love (today) what I do. I have a passion for dentistry that I hope shows. I hope I have the same passion to have meaningful relationships with the people I work with and the people I work on.
So yeah, I am a general dentist from Apopka, Fl. Doesn’t sound that exciting does it?
Well, let me tell you it is quite the opposite. Almost every day there is something that is going in my blog that will make you laugh, and somedays it will make you cry. But it is my real desire to give you someone real to read about. I want you to know that I am someone that fails on a daily basis. I fail in dentistry, I fail in management, I fail in being a husband and I really fail at being a dad. But with those failures comes growth and with growth comes success. Some are small steps; some are huge, ground breaking stuff.
I am so looking forward to this. I hope to have a long, real, and truthful relationship with you.


John Gammichia DMD


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