Tuesday, March 15, 2011

Having the build-up vs. crown talk

Happy Hump Day to you.

First, to the email subscribers: JJ's blog was put up and then I did something wrong and posted a half-finished blog. This blocked JJ's from being emailed to you. Blogger will only allow one emailed blog per day. His blog was actually posted Monday but since it was written a couple of days back it posted a couple of days back. Soooooooo, all this to say sorry we screwed up and to tell you to go back to Monday and see JJ's blog. It is a great first blog.

If you don't know already, I am a HUGE college basketball fan. I spent the whole weekend watching basketball. I am a fanatic during the year, but I get kind of crazy in March.

I woke up at 4:15 this morning worrying about if the Gator guards have what it takes to get us past the second round of the tournament. Is this life or death stuff? I have enough sleep problems as it is, and now I am waking up thinking about basketball? I think I need a sports therapist.

If the Gators lose this weekend, I am definitely going to need some anti-anxiety medication (I guess this is where I have to tell you the AGD doesn't condone taking of prescription drugs due to sports stress.)

At the Free Day of Dentistry, I got to see how a bunch of other dentists do things. On a side note, I got a cease and desist letter regarding DFTH. It has become apparent that someone has trademarked DFTH and found out that I was helping people under that name. They told me that if I wanted to pay money to use the name, I was more than welcome to do that. Like I have always said, "Never let a good deed go unpunished."

Anyway, I was doing triage. Triage is where I would see a patient in my room, find out what the problem was, have an x-ray taken, and anesthetize them. Then I would write on their chart what they need. Everyone was fine with this system.

Occasionally, there would be some minor differences of opinion. Like, if there was a large cavity and I recommended a "big filling on #14." And the dentist said, "I looked at it and it didn't have an opposing, so I extracted it."

I was talking to another dentist who is a friend of mine. Now, most of the time, dentists can be friends but not know a thing about the way the other dentists practice. They might be conservative in their political views, but crown every tooth they can. They might be a general dentist that likes to do all their own surgeries, like apicos, crown lengthening, bone grafts, tissue grafts.

You never really know about how the guy or gal practices unless you have numerous talks about dentistry and philosophies, go to their office and observe for a couple of days (we all do that, right?). And even then you still might not know. I mean, all of you know the way I do things because you have heard it (over and over) and you have even seen it.

Me and this dentist used to go to the same church. She was the first person that I asked to be my associate (she shot me down in a blaze of glory). During my triage, I put on the paper that this tooth needs a filling. Then she came to me and said, "This tooth needs a crown."

I said, "I know. But last time I checked, we were not doing any crowns today." It was almost like she didn't know how to do a big filling. Not saying that she doesn't know how - it was just weird. Kind of like if someone came to me and asked me to do an implant today. I know the philosophy behind it, but I have never done it, so I would be really uncomfortable with it.

A little background info: She is a super person and I really like her. She has a great heart. She worked for a company-owned office for about 5 years. I don't know much about these places, but the few times I had situations with them, it was all the same - bottom line, bottom line, bottom line. "What did you produce?" Not "How well did you treat the patient?" Not "Did you build relationships?" Just "How much did you produce?"

In my opinion, they are wolves in sheep's clothing. They paint a pretty picture. They have nice post cards sent to my office... But in my experience, they push crowns. So when this dentist gets out of the corporate office and now owns her own practice, that "crown at any cost" mentality is living on.

I think I am a conservative to the nth degree. I know I am a little polar when it comes to this, but it works for me. I see it working and I keep doing it, kind of an evidence-based philosophy. But when someone doesn't know how to build-up a tooth, it worries me.

You know about the "I know I need a crown but I can't afford it right now" build-up. And the "I am not comfortable doing this because it is so big" build-up. Then there's the "I can't tell you if this is going to last and I won't guarantee this once you leave this office" build-up. [By the way, in my evidence-based view, they always last, so don't give me that it isn't going to last.] I do it all the time.

This is real life. The real life where I have a couple kids and I am making 30% less than I did 2 years ago. Real life where the car needs work and the kids' tuition is due. Real life where the last thing I need is a f!@#ing tooth to break.

Real life where I am driving a 2001 Ford truck that has 174,000 miles on it. I know that at anytime this mode of transportation is going to go bye-bye. I haven't saved for a new car. I used to have a credit line I could dip into, but the bank took that away (because my real life house is worth half of what it used to be). All I need in my life right now is for a transmission to go out.

So, when some tells me they don't even know how to help someone through a tough spot, it kills me. Now my dilemma is whether to stay quiet or not. Like I said, I like her. We see each other all the time at dental functions and community functions. Do I force my opinion on her?

I force my opinion on all of you; why would she be exempt? There is no selfish ambition. I don't want to come across all high and mighty. I just think I would be respecting our profession. Our dialogue might make both of us better.

My conscience is getting the best of me. I feel like I have to do something. I am thinking about starting a little email relationship with her. A "What would you do here?" kind of thing. "Because this is what I did and I wanted to get your opinion." Nothing too bold, nothing too self-righteous.

Have you ever had this situation? How did you handle it? I have learned over the last 10 years or so why dentists don't partner up so much, or why some partnerships break up. It is hard to have these conversations, even if it is with the dentist sharing a practice with you.

Have a great Wednesday. See you Friday.


PS Don't forget to read the blog just below this.... our new Monday blogger is a scroll down away.


kaz said...

couple of things:

1. unless i'm doing something wrong, there's no other blog below the one posted today

2. john, there is no dilemma. let it go. you'll come across preachy, and she won't want to hear it.

Go Bucks!


Anonymous said...

Every one is different.

Ultimately it is the patients choice. I tell people there is simply more than one way to fix a problem and leave it at that.

gatordmd said...

Go Bucks?!!
I am not talking to you until after the tourney is over.
But if I was I would say this...
You must be an email alert person. If you go to the Daily Grind actual site all the blogs are set up vertically. And Monday's blog is right under yesterday's blog.

But to anonymous....
I applaud you for giving you patients options. I think that is probably rare.
I would think most patients aren't given options.
They trust their dentist.
Now if their dentist is telling them they need a crown and they really need a filling...isn't it our responsibility to make our profession better?


gabbay said...

Everybody should think about this, i think good coordination make easy for both...


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