Friday, June 5, 2009

Why didn't you go to the orthodontist that I recommened?

Oh my gosh, what a great time for the Magic to play the worst game of their lives.
The whole town is grumpy today. Not only did we stay up until midnight to watch this game but out team got beat like a red headed step child.

I wanted to talk to you guys a minute. I just wanted to tell you how much I appreciate your comments. And lately I have received a bunch. I appreciate you reading and I covet your thoughts. And listen, if you have a critique on the blog I want to hear it. I am sensitive but I am trying to give you what I think you want. If I don't know what you want then I can't give it to you.
Am I making sense?
Like one comment said, " have an interesting blog." Interesting?! Is that like I have a great personality.

Todays entry is going to be short.
I wanted to talk about the specialists a minute. Not talk about them but about referring to them.
Specifically I wanted to talk about me sending my patients to certain specialists.
Over the years I have widdled my specialists down to one or two doctors per specialty.
My periodontist and I work great together. I like the guy and I trust him with my patients. I trust his judgement and his work.
My is more geography. If they live in the North part of town I send them to this guy and if they live in the south side then I send them to this guy.
Oral Surgeons...well I like a bunch of them. But I try to use just one or two.
I do like consistency and I think it is easier

I specifically want to talk about referring to a specific specialist.
Let's say for this purpose we talk about orthodontists.
I see a 10 year old kid in my office and tell them that I recommend a certain orthodontist. I give them a referral sheet. The ball is now in their court.
Let me back up. I refer to certain people because they are good. Not because they send me gifts, not because they send cupcakes to my staff. Not because they are close to me. Not because they are nice or drive nice cars or have a nice office.
I refer to them because they are good. PERIOD.
But if the good ones wanted to send me gifts that would be so awesome and I would definitely take it. I like steak, just in case someone is reading this that knows my specialists.

Now are my specialists expensive. I honestly don't know. I think they are in the ball park as the rest of the specialists in the area. There is an orthodontist in town that is very good but he is 25% more than anyone else. I don't refer to him.
Could ortho from my guy be $500 more, maybe. But over 2 years of month to month payment would be like $20 more a month.
(I know this isn't chump change and I don't like to trivialize money but it could be the difference between good ortho and crappy ortho. )

So we have established that I send to only the guys that I think are great specialists. And I have put the ball in their court and I expect them to do the right thing and go to MY orthodontist.
So why then do some of them come back to me a year later in full braces and their orthodontist is someone I have never heard of.
So now I have to watch for the next two years as these kids get there teeth straightened.
Now I say that sarcastically. I could straighten teeth. I do not, however, know how to do orthodontics.
To the lay person out there, straightening teeth is not what orthodontists do. Well they do but they also put teeth in the most ideal position to improve function.
Now to a dentist like me, function is so much more important than straight teeth.
So after one year and a half or so the kid is so excited because he is getting his braces off in two months. And I am saying to myself the teeth are not even close to where they are suppose to be.
Then the mom says, "Well doc, what do you think of the braces? I mean how do you think it is looking."
And I am thinking to myself, "Well, I think they look straight but I think the ortho sucks. I think if I told the truth you would be pissed at me. And if I told you the truth and got all over the orthodontist he would be in braces for another year and a half while he corrected his own mistakes"
And I say, "I think they look real straight." Meanwhile cussing under my breath.
Now I know I am going to get a bunch of comments because I don't speak up and be an advocate for my patient.
I want you to know that I do.
I have called and called the orthodontists that I don't know. I wait on hold for 15 minutes while the doctor comes to the phone. Then he doesn't know the patient I am talking about. Then I just ask him to take a note of my concern. I say to him very gently, "THE TEETH DON'T INTERCUSPATE."
Then he always says, "I will see what I can do."
They just don't care or they are just not that good at what they do because the kids always come back at their next recall and they are out of braces and there teeth don't intercuspate.

I have gone down the road of fighting the good fight. I have told the mom the truth and quite frankly they don't want to know. All they see is that their kids teeth are straight and they are happy.
I try to show them what I am talking about in the kids mouth and their eyes start to glass over.
And they don't want they kid to be in braces for another year.

So now I am their general dentist for the rest of their childhood and sometimes longer than that. And I have to look at their straight teeth that are now in cross bite. Or I have to look at their straight teeth that are in end to end occlusion and see them abuse their teeth.
I have to see the results of bad orthodontics for a long time.

You know the ones that are your new patients and you say to them, "You never had braces right?"
And they respond, "Oh, yeah I had them."
Now, just think if you were that person's childhood dentist. Because you are for some of those people out there.

Am I rambling?
Are you guys having to deal with the same thing?
Do you have a gentle way of tell parents the bad news?
Be gentle with me.
Have a great weekend.
Go Magic,

All because the mother wanted to save 500$ to go to an orthodontist that their neighbor goes to.
Yeah that is probably a better source of referral, your neighbor. Yeah what does the dentsist know.


Anonymous said...

I think you are going to increase patient compliance on this by doing one simple thing: Before the patient leaves your office, have your receptionist call the specialist's office and hand the phone to the patient to appoint their visit with the specialist. One minute of effort and the patient is committed thoroughly.

Anonymous said...

We have a general dentist in our town of 35,000 that does ortho and for some reason people swarm to him. We have sveral orthodontist her that I work well with that we do treatment plans together and he asks my opinion before he finishes so when I refer to one of these guys and my patients. Come back with brces on and tell me their orthodontist is Dr so and so and I can't help say he IS NOT an orthodontist. He is a general DDS like. I am. I can't give my opinion and he does not correspond to me or any other DDS. We all have lost families to this guy because he ALWAYS tell them "I can take care of all your needs in my office so you don't need to see TWO DDS's. I wrestle this all the time. I refer all my molar endo's to a specialist and several times the patient calls back in a couple days and says I just went to Dr so and so---again a general dds. The hard thing is I have referred for retreats several times from this DDS . We have talkwed about dismissing patients to go elsewhere but? I guess I feel patients that do that don"t really value my opinion. A real "kick in the teeth" HA

Anonymous said...

Thank you much, John for the time and energy you put in to pour your heart and passion about your hot buttons. Most of us have just about enough energy to take your info in and say "YES!!!!!" I do agree with that, but do not have the energy to respond. I do appreciate your sports interest. I am a KC Royals Fan who used to be a Cub fan, am about 63 and in my 30th year of practice. My specialists are pretty well pruned down at this time and pretty good and easy to communicate with. The two orthodontist are pretty solid. One rents my office out as a satelite one day per week. The oral surgeons are upstairs in my medical bldg and bail me out from time to time as well as give great service. Both the Ora Surgeons and the Periodontist help me with implants. As a side note about your past exploits....Marathon... I signed up with the Lymphoma Society to do a walk/jog marathon in October and a 100 mile bike ride in November, Did a triathlon with them a year ago ion Des Moines but picked up about forty pounds while recovering, hovering around 255 and wanting to get back around 200.... more on that later... Keep on blogging... we love ya.....

gatordmd said...

Thanks guys for all your comments.
I so appreciate the feedback.
You know you can always email and tell me what is bugging you and I will blog about it.
I really covet the encouragement.
Anyone going to the AGD annual meeting?

Anonymous said...

Hi Dr. John! I'm actually a patient of yours and I've been following your blog for a while now. I wanted to comment on this particular post because I do see the orthodontist that you recommended. After I got my braces on people asked me if I had researched other Orthodontist and checked prices. Honestly I didn't. I didn't even think about it. I just trusted your recommendation and I'm so happy that I did. Dr. Principe and his staff are wonderful. I look forward to my appointments not just because I'm excited about getting my teeth fixed, but also because you can tell that Dr. Principe really does care! So I just wanted to thank you for caring enough to send me to an excellent orthodontist that you knew would take good care of me.
Thanks to you and your staff for being awesome. Besides great dental work and the prettiest fillings you ever saw, you guys make me laugh and that's the best part.

Kim C.

Unknown said...

After reading this post and the one about your frustrations trying to get Frank Spears advice on a case both you and your father had problems with, I'm wondering if you have thought about adding a Prosthodontist the that list of specialties you refer to (perio, ortho, OMFS)...

gatordmd said...

Thanks Kim,
You have made my week (maybe my month). I printed your comment and put it up in the staff lounge, so I think you have my made staff's week.

gatordmd said...

Good point Josh,
You must be an avid reader because I wrote the Spear blog over a year ago.
I think I just might.

Anonymous said...

I love that you care so much for your patients and for your work...but please don't be quick to dismiss what $500 means to some families!

Katty, Westside Orthodontics said...

Hello Doc, Your points are well taken but you see especially in this climate, cost might be a significant driver of people's decisions. I get a lot of patients through simply because people love the 25% savings I give members. It is a lot of money for many people these days. Greetings Katty

gatordmd said...

Katty and Anonymous brings up a point that about money.
I have never discounted money. I know how people struggle and $500 is five hundred dollars.
I am sorry if I have ever given the attitude that money is not important. I do care about money and I do care about the financial strain dentistry puts on families.
The point was for a less than 10% reduction in fee it is not worth the far reduction in service and skill of the orthodontist.

Thank you guys for commenting it means alot to me for you to be honest.


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