Wednesday, January 19, 2011

Other Offices

Oh man. I have so much s!@#$%t going on right now.

Our new front desk person was totally overwhelmed and succumbed to the pressure and quit (it could have been that she saw the front desk resumes that I had on my desk, that "accidentally" fell on the floor and she "accidentally read them"). I called our local dental society (they have a placement service) and they sent me 7 applicants.

But I went ahead and put the opening on Craigslist. Have you done this? I put the ad up at 8:30am and I had 15 resumes in front of me in ONE HOUR. So far I have received over 70 resumes. Crazy.

There is a young man who grew up in our practice. I'll call him Wes. In high school, Wes started talking about having an interest in dentistry. Over the break, Wes came in.

He came and shadowed for a week or two and loved it. He then went into college thinking dentistry might be for him. So he took all the appropriate classes and continued to come by during the summer and winter breaks. As a junior in college, he made the decision that teeth was his thing.

I backed him 100%. I think the world of this young man. I wrote him a fantastic recommendation letter (if I don't say so myself), and next thing you know, he has been accepted to the greatest dental school in the nation - The University of Florida College of Dentistry.

Before he went off to dental school, I took him out to dinner. And this is where I told him that I knew he had what it takes. I told him that I really want him to consider working at our office when he gets finished with school.

Wes now is in his second year of dental school. And after many talks and him coming to the office quite a bit to shadow, we have made a handshake agreement that he is THE ONE. He wants to work here and I want him to work here. It will be perfect timing. My father is 66 years old and he wants just a couple more years. So that is Wes.

Now, I talk to Wes about once a month. When I go up to a football or basketball game, I usually try to touch base with him and take him out to dinner. We have an open line of communication. He calls when he has a practical dentistry question (that is, when he learns something in school and he wants to know if that translates well to real life).

On his spring break and Christmas break, he still comes in for a morning or two. But this year was different. Wes was not this kid that wanted to be a dentist. He now was this young man that is/or is really close to being a dentist. His questions are more meaningful for him because I can tell he is starting to see himself here. Kind of like when you go to buy a house and you like it so much you start talking about how your furniture is going to fit in the living room.

In the 6 hours he was here, he brought a lot of spunk. A lot of energy. It is amazing how new blood can energize everyone, including me. I have someone to talk to. Someone to preach to. Someone that listens.

I think being here for a couple half days really energizes Wes, too. He sees his education leading to something. He gets to see what the prize is. (I know what you are thinking. "This is a prize?" Come on, don't be so negative.)

After Christmas, he went to his girlfriend's house and hung out there for a couple of days. It just so happened that she had a dentist appointment while Wes was there, So he went with her. And soon after he called me.

He had so many questions. He told me that the office looked like a SuperCuts for teeth. He told me that his visit opened his eyes for the first time and that he was finally able to appreciate what he was getting into here at my office.

This gave me an opportunity to tell him that this was a good thing. I told him that he should go to other places - and lots of them. I even went as far as telling him that he might consider, while working here, working at other places. Why just do it the way I do it?

He should want learn what to do and what not to do. Bring a well-rounded world view back to the office. Then he can start to build HIS practice here, not build up MY practice. It has to be his and ours. Something he can be proud of. Something that is his that he can come to work owning.

That was the first part of our conversation. The second part was more philosophy. Now, you know that if there are 10 dentists in a room and they all look at a problem there are going to be more than 5 ways to take care of this problem. This next part of the blog is my philosophy. Don't be mad at me because I might be different than you.

His girlfriend had a cavity under a filling (a filling that this dentist did). The cavity was deep and I think the pulp horn was nicked. But the next thing you know, she is getting a root canal. This is a 21 year old. To me, this screams "Red flag!"

He says, "What do you think?" Wow, that is a loaded question. This is how I delicately addressed this. I told him that every young person that trusts me with their teeth becomes my child. I treat them like I would treat my own children, which means I am super conservative.

I told him that what that dentist did is totally within the standard of care. Decay and the prep hits the nerve, you do a root canal (I don't, but I think it is the standard of care). But you all know what is coming next. Then it is probably a post and core and then a crown - on a 21 year old.

Now, some of you are saying, "Yeah, so what?" To me, this sounds like this dentist is treating this person like a tooth, not their own child. If this was my 21 year old kid, I would know that once I do an RCT, that opens the tooth up for a chance of failure. And the same thing with a crown. Once they get a crown, it is suspect to fail and then when she is forty she is going to have to redo this crown and so on and so on. This tooth was going to be fine with a big, deep filling. And like I said, it is still within the standard of care.

For me, if my daughter had a deep cavity, I would avoid the nerve the best I could (and I am not insinuating that this dentist didn't), even if it was going to be a carious exposure, in which case I would be treading very lightly.

She is 21, for crying out loud! She wasn't hurting, she just had some decay. I would do a direct pulp cap with some glass ionomer. I would say, when I do this, I do it with a great deal of certainty that it is going to be successful. I can count on one hand how many root canals I have had to do on people less than 25 years of age and I am talking between 10 and 20,000 fillings. I have done so few that I can remember who they are.

I told Wes that that is how I do things. That is why people come here. They are not a set of teeth; they are my responsibility, and I take that very seriously.
So she is getting a root canal. Does at 21 year old need a crown on a deep MO filling on #19?

To me, most of the time, the answer to that question is "No." I would do a filling and go from there. If it was huge, I would do an all porcelain onlay, preserving as much tooth as I could. But I can tell you again, I do not do too many crowns on people under 25.

This was a great conversation I had with Wes. I love that kind of stuff. I love talking teeth. I love talking philosophy. I love it when the person I am talking to is just as passionate as I am. That is why I talk to you guys.

I am looking forward to Wes getting more information from school and coming back to me with it. I am looking forward to not just me teaching him, but him bringing some of his philosophy to the table as well.

What do you think? It is honesty time. Do you find yourself not caring as much? I mean people can beat you down, and I understand that. Do you still have passion and do you treat everyone like they were your family? Let me know.

It is nice to be back. Have a great Wednesday.


Anonymous said...

keep pushing yourself.

Gene said...

There are so many shades of grey. I believe that I would want to do anything to avoid an endo even on a 30 or 40 year old. No pain, no symptoms and then straight there? Even if it was carious there were other choices to consider. We all are flavored by our past and perhaps being conservative had come back to haunt the other dentist.
Thanks for bringing to the forefront the discussion of philosophy in the time where economics seems to be so prevalent. Your writing has brought many smiles and also given pause to consider larger issues. Please keep up the great work!

Anonymous said...

I wish more dentists had your view of patients. I believe they are a human being attached to their teeth. Lifestyle has to be considered.

gatordmd said...

Thank you all for saying nice things.
Gene brings up a very good point.
Being checkered by our past. Who knows what this dentist went through to get to his/her philosophy.
We all know that one bad or real bad incident can change the way we do things.

Great stuff

Anonymous said...

I agree with your view John, but as you say sometimes one bad patient can spoil it for you. I remember I once had a patient who had very deep secondary decay on tooth 14 (or tooth 26 to us Canadians) and I was very cautious to remove the decay carefully and slowly but still had a small pulp exposure. I direct pulp capped the tooth with glass ionomer and restored with resin, much as you have described. I advised the patient that we had 'probably avoided a root canal' even though I had diagnosed him earlier as likely needing a RCT. So he goes home, ends up having some severe pain (the tooth was cold symptomatic only prior) and has the root canal done at another office. Then he calls me and berates my office that we wasted his time and that we should have done the root canal initally, saving him pain and a visit to another office. And here I was trying to do him a favour. So he left our office - and I totally understand why. So maybe the next time I see a carious lesion into the pulp, asymptomatic that it may be, its time to do endodontics. I agree that every situation and patient is different, but sometimes you try to be nice and end up being cruel.
Just my two cents,
keep writing


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