Failure

Hey all,

I know some of you have been hit with some nasty weather lately. The whole eastern seaboard is practically under water. But for us here in Florida, it has been HOT. I mean hot!

I went running at 5:20 a.m. on Saturday and it was already 83 degrees. Oh my gosh, it is so hot. Needless to say the run did not go well, and just in case you didn't get enough heat, it got to 97 degrees later that afternoon. That is the kind of heat you really don't go outside in.

You go out to throw the ball with your kids, and you are sweating before you find your glove in the garage. You even can't do yard work (and yes JJ, I do my own lawn). I love doing my own yard, it gives me a sense of accomplishment. But this time of year I really start to loath my yard. It grows so fast, the hedges get out of control, the edge looks terrible.

I saw a movie called "The Next Three Days." It was the one where Russel Crow's wife got sent to jail for life for a crime she didn't commit. There was no way through the legal system that she was going to get out. So the movie was about his plan and his attempt to break her out of jail. I have to say I really like Russel Crow and I really liked this movie. I got "The Lincoln Lawyer" coming today.

Okay. I thinking about failure this week. I don't know why, I just was (I stopped trying to understand my mind a long time ago). I was thinking of my failures. It is amazing how your failures will stick with you. You can please 100 people and forget them the second they walk out the door. But if you hurt someone, put in a crown that is the wrong color, or have to give someone a refund—it sticks with you for a long time.

The particular instance that I was thinking about this morning was a long time ago. It was my first year out of school. I was a young budding associate and I thrilled to be working doing the thing that I loved. I remember like it was yesterday, I was doing 4 class III on this patient on the maxillary anterior. And as you know this injection can hurt. So I didn't really have any skill in making this as "comfortable" as possible.

I numbed her up and it hurt. We got through that part and started to work. And wouldn't you know it, that the anesthetic stopped working. Well I proceeded to give her a booster and even that hurt. The whole thing was a disaster. I mean, we all have patients like that. We all have things that just don't go so well.

Well, a couple of weeks later my boss came up to me and asked me about this particular patient because she called to complain that "the young dentist hurt her like she had never been hurt before." Man that stings.

Around year four I thought I was a hot shot. I had been through five Pankey Continuums. I had a guy that lived here in the winter that had a dentist in Boston where he was from. He would come to me when he had a problem. But I started to let him know that his mouth was being patched together and he really needed a full mouth reconstruction.

This went on for a couple of years. He finally told me that his dentist "was not that kind of dentist" and that he wanted me to restore his mouth. I was like a pig in poop. My first real reconstruction. He needed crowns on all his teeth. I did everything I learned: CR records, facebow, full wax-up.

All the treatment was accepted and we were ready to go. He was going to do everything in temps. Then he was going to go home for the summer wearing those new temps. I prepped the maxillary teeth one afternoon and did the lowers a couple of days later. The temps were awesome, his teeth looked great, and he was thrilled.

Then he left for Boston.

It was about nine months later before I saw him again. One afternoon, I touched up all the preps and took some impressions. Things were looking real good. So I saw him about 10 times more over the summer. Metal try-ins, non-baked porcelain try-in, occlusal adjustment, glaze appointment try-in, occlusal adjustment.

On the last day he was going to be in town we put them in. It was like heavens gates opened up. The looked so good. But because there were some phonic issues we were having, I didn't want to do anything too permanent. I put them in temporarily. If there was going to be any issues with phonics, I wanted to be able to make some changes.

I called him a couple weeks later and he was thrilled. I put it out of my mind. I was on cloud nine. Turns out about three weeks after I put them in they started to get loose. He at first let it be loose. Then the whole thing came out. So instead of going to the dentist up there to have him put the bridges in with temporary cement, he went to the drug store and bought the temporary cement.

He put the $30,000 bridges in with $3 cement from Walgreens. About nine months later I saw him again. The bridges were just hanging there. What do you think the abutments looked like under this bridge? EVERY ONE of the abutments had through and through decay. This was a very bad day.

In the anteriors he had root canals and post and cores. So I took all the decay out and did reverse build-ups on about seven teeth. That is retrofit a build-up to the bridge. I just put a little lube in the crown, put a self-cured, build-up material on the tooth, and seat the crown. When it is set up, the bridge or crown comes off and you have the original shape of the abutment. Ideal.....NOT.

I cemented them all in—the worst part of the whole thing. After I cemented them in, I never saw him again. This was about 10 years ago. I thought I saw him driving once. I saw his brother in the office for an emergency, but....it still hurts.

I don't think I did anything wrong. I don't think he was mad at me. I guess he just decided he was done. I didn't get to watch it. I didn't get to see if it worked. I didn't get to that feeling of someone being happy with me and staying in the practice. Telling all their friends about me. It leaves a bad taste in your mouth. When someone pays that kind of money you want them to have the BEST. And he got the "best I could do in that situation."

AND now it is out there. My work that is a ticking time bomb. I know that when it fails, if it hasn't already, someone is going to look under those crowns. I just wish it was going to be me.

Anyway, this kind of things leaves such a sour taste in your mouth. They make you feel like such a failure that you spend the rest of your life trying not to have that feeling again. I guess failure is good for something.

You got any stories for me? I would like to hear about them. Have a great Wednesday,

john


I might not write anything for Friday.
Maybe I will do a YouTube montage. I have seen some crazy ones lately....have you seen the "I love cats" one? WOW!!!

Saw This One Coming

Well, I hope your summer is going well. Here in Florida, it is a wet and steamy one once again. I have been trying to get my lawn mowed for two weeks, but it keeps raining. In my neighborhood, everyone has a yard person. One other person supposedly takes pride in the fact that he mows his own lawn, but now he has competition. Not only do I mow my own yard, but do it with a walk-behind mower! Beat that!

I have gained 20 pounds since leaving the Navy, and lawn work I actually enjoy somewhat. It relaxes me and I get some exercise while I accomplish something. The time factor is the only problem. Can you believe we are more than half way through the year?! Where has the time gone?

Do you ever listen to that little voice in your head? You know, the feeling in your gut when you meet a patient and it is saying, "Danger, Will Robinson!" I try to, but this time I ignored it and now I feel like the little bug caught in the Venus fly trap: Doomed! I originally wrote this prior to Dr. Jackson's tingle blog, but it falls right in line with what he was blogging about.

I had a new patient that was referred over by a specialist. Let’s call him Fred! He was congenitally missing the maxillary first molars and wanted the space restored. He was about to complete his ortho treatment in the near future. From the moment I met him I could tell it was going to potentially be tough. He just had that aura about him. I cannot describe it, but he was just sort of snotty and demanding. All he could talk about was how little money they had, on and on. (I seriously doubted that because I was told that they owned several businesses and he was wearing a gold, diamond-studded Rolex.)

He was always talking poor. Fred did not want implants due to cost. Fred was not sure if he wanted a bridge since it would "destroy his teeth," and there was no way an RPD would fly. We finally decided on a hybrid zirconia bridge, full coverage crown on #3 and a inlay on #4, and we would do the opposite on the other side eventually. After two or three conversations and a year later, he showed up on the schedule for the right side.

I went in, reviewed the treatment plan, and started the right side. Everything went well, the temporary was done, and he said we did not do the other side. I was surprised because I only thought we were doing the one side. But I had time so I said ok. That little voice told me to put down the handpiece and look at the chart. Well, there was nothing in the chart or signed treatment plan for the left side. So I sent the assistant to figure it out.

I do not get very involved in the financial side of the office; we have a very well-trained, competent staff that I have respect for and trust in, and they know my feelings about money. We need to be upfront and honest from the get-go so there are no surprises in the end. I feel like, no matter how hard I try, we still get burned sometimes.

That is when I had originally listened to the little voice or tingle. Since the original estimate was over a year ago, we had discovered that his insurance had a missing tooth clause and they were not going to pay. Also, the patient was under some idea that the first treatment plan for the right side was the cost for both, even though it was explained that it was for just one side and he signed the treatment plan and cost estimate. Since the original estimate (which was in writing that it was only good for 90 days), nothing had been reviewed with the patient and no other questions asked about the signed estimate.

The patient had a mini meltdown, saying that we were trying to change our fees and we messed up and took advantage of him. Wait, we have a signed treatment plan and estimate for that side for the full fee and estimated insurance payment. The fee was still the same and we were honoring it even though it was over the 90-day period and our fees had gone up. They only thing that had changed was that his out-of-pocket was going to be more since insurance would not pay. The total cost was the same. We could have even raised our fees to our normal rate since this was not going to be a covered service by his insurance company. Yet we are trying to rip him off!!!

I informed him later many dentists would have put that bur on the tooth as soon as he said do the other bridge and they would have said it was just too bad if he was not fully aware of the fees; he is an adult and should have thought about that first. ARGGGGGGGG.

Needless to say, we are halting all treatment other than what has been started. I have discounted my fees on this bridge to almost cost, even though I should not and do not need to because the patient was fully informed and we have it documented with a signed treatment plan for that work.

I found out later that the first thing he did was run over to the other dentist to complain about the office. I want my patients to have trust in my ability as a dentist and in my staff as honest and caring. If I have a patient that openly questions that and makes comments that references that they have lost that trust, I do not think that is a good relationship.

I feel that I have not many options long-term with this patient. I plan on telling the patient that I do not want to restore the other side and that since he has expressed his lack of faith in our office, that it would be best for both of us for him to find a new office. I hate having to do this, but I hate even more treating a patient that thinks we are trying to cheat them. I do not want to feel like I am running from the issue, but it is not worth the anxiety every time I see Fred wearing his gold diamond-studded Rolex on the schedule.

This is a no-win situation, but my blood pressure will probably be better with him gone.

What do you think?

Have a great week,
JJ

I am Steve Jobs

Happy Friday to you all,

Next weekend I am going on a little vacation. My wife and I (no kids) are going to Washington D.C. We have friends that have a kid who plays soccer at Georgetown. He is a great kid and is apparently killing it up there.

So we are throwing caution to the wind and just doing it. They have a daughter—who we really like—that is married and lives in New York City and is going to come down and we will make a weekend out of it.

They are all going to be there on Friday morning. I told my wife, why don't we leave Thursday night and stay with another friend up there. So we are leaving Thursday afternoon and getting to catch up with some good friends. Turns out, I have another friend (both of these couples use to live in Orlando and have moved away for work) that just had a massive stroke (43-year-old father of three) and is in the hospital and we are going to see if we can slip away and go see them.

All this to say that I am not going to be in town next Friday. It is going to be okay. You can do this. You can go one Friday without me. And I am giving you a week to mentally prepare.

I wanted to keep with the same Apple theme today. I got a comment from Wednesday's blog that I really liked.

"This is one of the AMAZING things about Apple that I think a lot of people could benefit from in the dental industry. One thing that everyone knows about Apple is that they design the user experience down to the last detail. Steve Jobs has been known to say that even the way someone takes a MacBook out of the case is designed and thought out in a way that will give the person the best user experience possible. The store is the same way. Every little detail from the fact that there seems to be 100 employees in the store to the fact that they can take payments right on their decked out iPhones is thought through.Could we bring this level of detail in the user experience back to dentistry? I think if we did we would see practice retention rates skyrocket."

Details, details, details.

This is what I am talking about. Apple worries about how we open our boxes. How are you with details? I am not talking about micromanaging, I am talking about putting you in your patients shoes. Walk in the front door and see what they see. Does your staff look up from what they are doing to greet YOUR patients. Even if they are on the phone.

Is it a warm environment? Sit in one of your chairs. Is it comfortable? Do you dirt? What about when you lay yourself back in the chair. Is there crap on the ceiling?

And listen, I know. I know for us older guys, it gets old. Not old like, "I hate this profession." Old like, "I am so tired of changing things." It seems like it was yesterday that I bought new furniture. I just painted this stupid office just a couple of years ago.

You sit back and say, "That is it. I am not changing anymore. If people don't like me or my office the way it is right now then...tough." But then, you know what happens is that you and your practice get stale. You start to resent the profession that is giving you so much.

Okay so we are going to walk into our office and sit in that chair with our eyes open now. We are going to see the dirt piled up in the corner. We are going to see the scuff marks on the runner. You are going to see the worn carpet. We are going to see the cuts in the "leather" on our chairs. We might even see some duct tape.

People are getting ready to spend a crap load of money at your office. How are they feeling? And you want them to tell others how great they feel after spending so much money. I mean, I just spent way too much money on a freaking laptop (I saw an ad for a HP laptop for $499. I spend $1,200 more than that) and I told all of you how awesome it is.

I mean really, is it that awesome? To me, it is a brand new laptop, they are always awesome when they are brand new. Is it $1,200 better? I don't know. I am off the subject (what a surprise), what we are talking about is how people are feeling when they walk into your office and how they feel at your office. I mean, we all know that our patient pools are shrinking. So we sure as heck better be WOWing the ones that come in. And if we have the attitude of, "I hate making changes," or "I am so tired of this," you are certainly running the risk of them looking elsewhere for that Apple feeling.

And you know what, I think it helps with complacency. We all know this job, as well as most, can be a grind. I think it helps in keeping things (and you) fresh and less stale. It gives us something to talk about. It gives the patients something to talk about. People come in and see the changes. The changes in you and the changes in office. I am not talking about breaking the bank either. I am talking about $500 for paint. I am talking about $1,000 for crown molding.

Think about it this weekend. What can you do to make your product a little bit better. Make the box patients are opening better. While I was typing this, I took a break and called a re-upholstery place. I bought the MAX package. This is premium ultra plush leather, ultra foam, and the new pads has a heater in them and a massaging system.

I have been wanting to do it for years, it is going to be about $1,400. I know, wow! I am tightening up as we speak, but....

I just bought it for one chair, but this is what I am talking about. My boring chair now just became a throne. And maybe I'm just one step closer to thinking like Apple and Steve Jobs.

Let me know what you think,

john

Apple

Greetings,

As you know I got a new MacBook Pro laptop.

IT IS CONSUMING ME.

Learning the computer, trying to load all my photos, starting to put my lecture together, putting the final touches on my speaker packet (which is going to be real cool)...

It is taking so much time. For one, because I am like a baby learning to read and I am a perfectionist. So I end up doing things 10 times, making it just a little bit better every time. In order to learn all the things the Mac does, I have been soliciting my friends. "Hey, do you have any time tomorrow to show me how to do X". I have asked everyone I know how to do things.

Then someone told me about One to One. Do you know this? This is something Apple sells for $100. It is one year worth of free one-on-one tech support. Any time you want, you make a one-hour appointment and you just go in there and they will teach you. I was like, "I am all over this. Instead of asking my friends, I can get personal attention from real techs!"

There is an Apple store in the mall right by my house (literally about three miles away). I went in there to sign up. It was about 12:15 on a Monday afternoon. I walked into the mall at the food court entrance and it was pretty empty. Only a couple of people eating lunch. Then I walked through the atrium, the middle of the mall and it was empty. I might have seen one person.



I was like, "Cool, I will be in and out of Apple in no time."

Let me tell you that I have never been in an Apple store. I have all Apple products at home, such as an iPod, iPad, iPhones, but I have ordered them all online. Monday was the first time I have ever been in a store. I walked into Apple and it was like a zoo. There were people everywhere.



There was more people in the Apple store than the rest of the mall.

It was like I was in the twilight zone. I was greeted by a 19-year-old in a blue Apple shirt and a ski hat (yes, it is still 95 degrees outside here in sunny Central Florida). He asked me how he could help me. I told him I wanted to by a One on One. He said it is usually reserved to the exact time you buy the computer. He made a call on his cool device attached to his ear and got the clearance. He took me to the back of the store. In my traveling the 60 feet to the back of the store I saw four people I know. One guy was buying a iPad 2 for his wife, two were taking an intro class because they just bought a desktop, and I saw someone I knew that worked there.

He got a card from the back and handed it to me. We went back to the front of the store, where it was quieter. This is where we were standing and he ran my credit card. We were not at the counter or anything. We were standing in the middle of the store and he swiped my card ON HIS PHONE. I was out of there (excluding me talking to my friends for a couple minutes) in about 15 minutes. I walked out of that store just in awe.

I was talking to a friend that knows the numbers to one of the Orlando stores (this store is in an average mall) and he told me they do $200,000 A DAY.

So lets talk about this a minute. They have a bunch of college-aged people working there, probably very cheap. But props to Apple because they had a lot of employees in the store. No one was really waiting around for service. So I would say they had great service. Apple has a superior product line. And the product line....everyone wants it. If it is not the laptop, it is the iPod nano for the kids. Or the desktop that really is on the desktop. Or the iPad 2. It is like a fad, but for adults.

They are always ahead of the curve (I am sure they are working on the iPad 5 right now). Did I tell you that at the food truck thing I did a couple weeks ago, the person taking the money on the food truck could take credit card? I was like 'cool.' Yeah, it is an app on the iPad. Yeah, the person signed right on the screen of the iPad. Oh my gosh, my head was spinning.

As I always do, I want to bring everything I see back to the office. Did you know you can scan checks on the iPad (another app)? So now that being robbed is so fresh in my mind (getting new alarm system installed on Friday), I was thinking we can get an iPad here. We can scan checks and run credit cards. Leaving nothing but the little cash we have in the safe. What about filling out health histories on the iPad and signing the iPad when they are done. It is practical and it has the "way cool" factor.

But as dentists do we have people waiting for our patients when they walk in? Do we have great service? Do we stay ahead of the curve? Do we have a product that EVERYONE WANTS? Do you have the "way cool" factor in your office?

I don't know about all of that, but it is interesting to think about. I have to get going. I have to go and figure out how to use iDVD and iMovie (if you don't know what this is....drop by the Apple store).

Have a great Wednesday,

john

Really?

Greetings,

I hope everyone survived the hot summer here in Florida. I just returned from an implant course down in Miami. I have taken a ton of implant courses over the years, but none of them actually let me place an implant on a live patient. I am pretty good at placing them in plastic models, but that really doesn't translate into placing them on a patient.

I have had this bug to put in a few, and this is hopefully going to allow me to gain some confidence. I really have no plans on doing anything complicated, but I figured I have about 10 to 15 patients a year that would be considered "straight forward." Next month's class will be my first, and frankly I am terrified. I will let you all know how it goes.

On a side note, if you haven't done a segway tour, you need to. A segway is one of those stand-up, two-wheeled peoplemovers that you sometimes see police officers riding. We did the 2.5 hour tour in St. Augustine not too long ago, and it was a total blast. Not only was it educational, but I felt like a 10-year-old again zooming around on that thing. They look a little intimidating at first, but it takes all of five minutes to become an expert on them.

Something has been gnawing at my brain the last few days. How do catchphrases get started? Who actually gets to start them? Do they get paid? There has to be a great satisfaction in knowing that everyone in the world gets sucked into using them. The latest catchphrase I've noticed, is..."Really?" A year ago this time, I don't remember anyone saying, "Really?"

I even catch myself doing it. If someone cuts me off on the road, I yell, "Really?" If anyone does anything that seems remotely questionable, you say, "Really?" How does this happen? In the 60s people said "groovy" when something was great. That faded away only to be replaced by "cool." Someone had to start the phrase or the expression, whatever it is.

Basically, I want to be the one who starts the next one. I don't even know how to go about it. Do I email the president? Or in his case, text him? Is there some "catchphrase" executive board that aprroves the phrase, then passes it on? Maybe there is a media contact person that has the title of "catchphrase spreader," I don't know. My goal is to replace "cool" or "awesome" with "static."

For example, if my daughter tells me, "Dad, I made all A's on my report card," I would respond with, "Wow, that is static!" You may see a nice car go by and just say, "static." I think it has a lot of uses, and its very versatile in different situations. Is anyone feeling me on this? It can have uses in dentistry as well. For instance, "Static Veneers!" Of course, you can only use this once the phrase catches on, or it wouldn't make much sense. There can be static jeans and static parties! You can have a static day! If I can only get this to the right person or people, it would be static! I am hoping that most of you will help me out with this, but I know some of you are saying to yourselves,

"static.......really?"

Have a static week,

Scott

UFCD

Hey all....its FRIDAY!!!

Our office has lots of windows in it. I can see the whole parking lot and across the street from our front desk. And some person had the nerve of unloading his new Bentley Sport Coupe from a transport truck in front of my office.

I looked it up. It costs....are you ready....$267,000. I was telling my staff, I could get one of those but I would have to live in it. Then they started teasing me, "The transport guy was told to drop it off at the Apopka dentist office. Problem was they dropped it off at the wrong Apopka dentist office" (please see Wednesday's blog).

I saw "True Grit" last night. I have to tell you, I think Jeff Bridges is so talented. He did a great job. I thought the movie was alright, though (maybe my expectations were too high. Like I was waiting for a 3:10 to Yuma or something). I thought Matt Damon was mis-casted (is that a word) in this movie. He just looked and acted so out of place. It was good, worth the rental.

My kids and I are watching "Chariots of Fire." This movie has such a great message, but damn is it hard to watch. I have the TV turned up all the way because the accents are tough to understand, and I have to keep pausing the movie to explain to them what is going on. Not that enjoyable of a movie experience.

Oh, don't forget my article is coming out in the September issue of AGD Impact. So if you don't get the magazine, call the AGD and get on the mailing list.

And my speaker packet was presented to the Florida Dental Association yesterday. I am still putting the thing together, but the executive director wanted it, so I threw it all together just for her. I am working on getting it all on DVD with a title menu...it is going to be cool. Maybe putting it in one of those tin embossed cases. Oh yeah.

Okay, I wanted to talk to you about my dental school, the University of Florida College of Dentistry (UFCD). I told you that I went up there a couple of weeks ago to see Gordon Christensen. At lunchtime, I asked one of the students to show me around. Now you have to understand that I haven't been back to the school in 10 years or so. But I have to tell you, I was not impressed.

Okay, maybe I am being unfair. But lets just say that it hasn't changed a bit. What I mean with haven't changed a bit is, there is still the same paint on the walls. There is still the same huge stain on the floor in the middle of the operative department. Nothing has changed.

No new paint. Like, I think white linoleum and teal have been OUT for a long time. No new kids design on the walls. No warm tones. The chairs are the same. The units are the same. Every room has a computer monitor in them, but that is about all for the changes.

During the tour, when we changed floors, he took me into the stairwell. I was in the stairwell and said out loud, "You actually take patients through this stairwell?" Not pretty.

I have to tell you that I have so much pride in my school. I have pride in the undergraduate school. I have pride in the athletic association, but my heart lies in that one building without any windows called the College of Dentistry.

My tour guide did not notice it. He lives it every day. He walks in that stairwell everyday and it doesn't phase him. He is just trying to get out of there. But me, I want to go back. Well, I wantED to go back.

I don't really blame anyone. I know the state is giving less and less money to institutions. I know it gets more and more expensive to educate students. Then the donations from the alumni are way done. What can you do? Then the students don't really see an issue with it. I mean, the dental fraternities wouldn't say, "Lets have a work day and clean up our school". Patients don't complain because they are just happy to get dental care.

Lets go back to the state giving money. No, I am not going to talk about the debt ceiling. But what I do know is that about two miles up the road from me, the Community Health Centers built a brand new dental facility that cost $1 million. Couldn't they just throw the UFCD a couple hundred bucks for some paint.

Oh my gosh look at the time....I have to run. Sorry to cut this one short. Last day of summer and I am taking Luke to play golf.

Have a good weekend. We might touch on this again on Wednesday.

john

The Dentist Down the Street

Happy Wednesday,

Summer is officially over. We treat three counties at our office. One of the counties went back to school on Monday. And the other two counties go back to school next Monday.

I finished Through My Eyes by Tim Tebow. It was okay. It was, for me, reliving the glory days. I would think that if you are not a Gator fan, this book wouldn't be any good.

My wife and I watched "No Strings Attached." I thought it would be a good romantic comedy. Well, it turned out to be an okay movie, but it offended my wife about 15 times before we could even settle down. I am starting to think most directors are making movies to please the 18 to 25 age group. I guess they are the ones going to the theater. Me? I am just paying $1 to see it on Netflix, so they don't care if I am offended or not.

Okay topic,

I work in a pretty small town. There are about eight dentists in my town. I think regardless of the size of your town, there dynamics in a city that are the same. There are the Esthetic guys. There is the "good, more expensive dentist"; there are the "good, but don't take all insurances" dentists; then there are the offices that "take all the insurances and run like a factory."

So we have that in our little town. We have the super expensive cosmetic dentists. We have the established, a little more expensive guy, the family dentist (that's me), and we have the dentist that takes a lot of plans and he/she is kind of not as good, but also not as expensive as others. And we have the new dentist that is pretty good at taking lots of plans to get established. Then, of course, the dentist office that has a super high volume of patients and staff (and dentists).

I get patients from all of them. I get second opinions, I get "I don't like that guy (or gal)". I get "I just had this tooth worked on and it still hurts".

You know all the reasons.

On a side note....what gets me the most is the ones that say stuff like, "I never really liked that dentist. I went to him/her for 12 years, but never felt comfortable there".

I got people that leave my office for a $12 bill, and this other dentist has people staying there and they don't even like them.

As you know I am very conservative in my dentistry. And my biggest issue with all these guys/gals is obviously over-treatment. Yesterday, I had a new patient and you wouldn't believe the stories she was telling me. Now, I understand sometimes that patients don't hear what the dentist is saying, and when they try to reiterate it, it sounds all crazy.

But this patient had a front tooth (#8) crown that she wasn't happy with. I took a look and WOW. She was a 70-year-old woman and her teeth were dark. This crown was not. The crown was at least 2 shades too light. After a couple of years, it started to move mesially and overlap on #9. So the woman went back and this dentist told the woman she had a crack in the tooth, it needed to be removed, and she needed a...you guessed it....a bridge.

Hmmm.

Then he/she told her that a bridge in the back needed to be replaced because of decay. This dentist showed her some phantom decay on some x-ray. I took a full mouth series and did a full work up on this patient and she needed a grand total of NOTHING. There was no crack in her tooth. There was no decay under her bridge.

This kind of thing just drives me bananas. Either this dentist is a complete shyster and a crook or a terrible diagnostician. Either way, I think money is fogging their judgement. My gut is this dentist is a shyster. Man, do I hate this. I hate this because of all the patients that are out there going to them. People in MY community.

I got another dentist down the street that has a diagnodent. Don't even get me started. Do you know how many people have come to me asking me if this dentist's treatment plan was fair. Twelve occlusal fillings. I found a grand total of none on over 90 percent of them. I want to picket outside the office. Put fliers on all their cars. "Don't go to this shyster. Come to me. I am a tad bit more expensive, but I am honest and fair!"

How would that look if I was in front of their office?

Now after talking to this patient for awhile, I found out that her brother and sister-in-law come here and they have been trying to get her here for a long time. She claimed she didn't want to come here because I was too expensive. I think she called here about #8 before she had it done and I was $300 to $400 more than the other dentist. She kept saying, "I should have come here."

Am I too expensive? Everything this dentist did has to be replaced, and they are telling you that you need something that you don't....who is too expensive?

When will people stop thinking that a $1,200 crown is the same as a $800 crown. I, as a small business owner and perfectionist, would not rest until my patient was completely satisfied. So if I put in a crown that is wrong or the patient doesn't like it, I will do it again. And if I feel like I can't please them, I chalk it up to a business expense and give them their money back. How many times have you heard, "I have hated these crowns since the day my last dentist put them in"?

A Cooper tire is a Cooper tire. One place charges $175 for the Roadmaster and another place charges $215. I get that. I price check.

But dentistry at one place is not the same as it is at another place. How can we get more people to know that? I have my picket ready....just tell me what to write on it.

Do you guys have this issue? Am I the only one?

Have a great Wednesday!

john

Dental Heroin!

I don't know about you guys and gals, but without accepting dental insurance, we would be struggling. We only accept PPO insurance, no HMOs. We are only in network with a few, but will file and accept assignment for most PPOs because the insurance companies are easy to deal with. They pay the claim on time and do not give us the run-around for a one surface composite and so on. However, almost without a doubt, 95 percent of our patient problems are related to insurance payments and the patients’ perception of what dental insurance is.

We go out of our way to help the patient understand THEIR policy and communicate with THEIR insurance company. Of course, it always seems to come back to an angry patient yelling at our staff about why the insurance did not pay and why they are responsible for the balance. We have all sorts of paperwork that informs them that they are responsible if the insurance does not pay. After all, it is their policy, not ours, and we are just the middle person trying to help them understand the policy, but that rarely seems to help. I would love to get rid of all insurance in our practice, but it seems like someone addicted to heroin; you cannot get away from it easily.

I understand insurance does allow patients to receive some care that they might not be able to afford otherwise, but many people feel it should cover all of their care. If we get a denial, they look at us like we did something wrong.

We have had patients come in and say they called the insurance company and were told that we should not have done that procedure or that we coded it wrong. In fact, we did not, and who are these people answering the phones (dentists or flunked-out dentists?) telling us we did the wrong treatment. Too bad we cannot get them for practicing dentistry without a license for giving dental advice.

What’s also frustrating is that the insurance plans seem to constantly change. We have more than 600 different plans we deal with and we just cannot stay up-to-date with all of them. We are using Eaglesoft to help try and head off problems, but there are still holes in the info.

Some might say I am looking a gift horse in the mouth, but most of the time that I have an irate patient, it has nothing to do with the dental work but something with the insurance policy.

I am hoping one day I will be in the position to have a dental insurance intervention and go to "fee for service" rehab, but with the economy, that might be a while. Maybe it will be called retirement.

JJ

The Art of Lecturing

I have had a better week. I have had a chance to catch up on a lot of things this week. I still have a long way to go, but I am calming down a bit.

Took the kids to see a Movie in the Park last night. It was Indiana Jones and the Last Crusade. It was pretty nice. We jumped in the car and brought snacks, bug spray, drinks, blankets and chairs. And got there at 8 p.m. and waited for dark. And waited, and waited. It didn't get dark enough to watch the movie till about 8:30.

Couple of issues....it is still 90 degrees out at 8:30 p.m. Then at 10:15 p.m. they paused the movie to let this train go by. Well, the train stopped and they never started the movie. Then there was another train. So I was thinking there was still 35 minutes left in the movie. They will start the movie in 15 minutes, plus 35 more minutes of the movie, a 15-minute car ride home....too late. I have my 7 year old who turns into a pumpkin at 9:30.

So we had to leave. I am not complaining, it was free. But these are the great family things that the kids will remember for the rest of there lives. "Remember the time we went to that Movie in the Park and watched half a movie?"

Anyway, I wanted to talk to you about my lecture I saw week. I saw Gordon Christensen on Friday. I have to tell you that I have seen him twice already, but I love his delivery and couldn't wait to see him again. I was also looking forward to hanging with Drew (my future associate who is in his third year of dental school) who got to go to the lecture for free because he is a student.

Anyway, left my house at 5:30 a.m. and drove to Gainseville. I got there with just enough time to get a cup of coffee and see a couple of friends. Then the lecture got started. He is a very friendly chap, and this day he was a bit to friendly. Meaning he spent quite a bit of time talking about Utah and his horses and his motorcycle. For me, I came in with my pencil sharpened waiting for him to hit the ground running.

Let me back up. I was assuming all of you know who Gordon Christensen is. Well, he runs Clinicians Reports (use to be called CRA). This is a large company that evaluates all products in dentistry. From sealants to impression materials, from curing lights to different types of porcelain, from Glass Ionomers to MTA. So you can imagine how much this guy knows.

I wanted him to tell me everything he knows in six hours. I was like READY....GO!!!

The lecture started at 8 a.m. and I wrote my first note at 10:30 a.m. That means he didn't say anything that I cared about for one and a half hours. We took a break shortly after and I talk to a couple of older guys and they were like, "This guy is so awesome." I said, "I love his delivery, but he hasn't told me anything yet." They said, not listening to a word I said, "I know, isn't he just great?"

I mean, he talked about things like getting the resin off of teeth after ortho and what burs and polishing methods he uses. Now it may be me, but I don't spend a good part of my day taking old resin off of the facial of teeth post ortho. I mean, it happens but it ain't worth 35 minutes of time during a lecture.

He talked about curing lights. I get that. Maybe he could say, "You need to have a good curing light and here are the ones that I like and why." Not 25 minutes on how the light emits or how important it is to clean off the end of the turbo tip. He talked about implants. And he told us how "mini" implants are taking over Europe.

Do you think he talked about his favorite cement? No.

Do you think he talked about impression material? No.

How about digital x-rays? No.

Did you think he talked about the research that is going on with materials for pulp exposures? No.

But he did mention a couple of times how they are doing it over in Europe. He did say something that I enjoyed and that I wrote like crazy, just they were few and far between. He talked about the generations of bonding agents. And blew me away with a couple of statements. He said there really is no such thing as dentin bonding. Let that settle in. No dentin bonding. He says the bonding you do to dentin, because of the temperature changes, is almost nothing after a couple of months. So all the bonding is to enamel. Now I don't know if I buy that, but he definitely had some tests to back it up. I bond plenty of build-ups to all dentin and I don't see all my crowns falling off.

He finished strong and talked a lot about porcelains. Did you know that the five-year failure rate to a PFM crown is 1 percent? Wow. And tell me again, why are we changing from this? Anyway, he likes all porcelain. In 1997, PFM's were 72 percent of all crowns compared to 16 percent all porcelain. In 2010, PFM's are now 44 percent of all crowns and 49 percent are all porcelain. Very interesting. If I needed a crown in the back it sure as heck would not be all porcelain.

Now if I need an onlay or an inlay/onlay, I would for sure do all porcelain. That is why I think that trend is changing. More all porcelain esthetic crowns in the front and more all porcelain onlays. This makes sense.

And lastly he said there are only 7 percent of dentists that have a CEREC machine. This blows my mind. I tell you Patterson does an awesome job of marketing. I tell you as much stuff as I get with CEREC on it....I would feel pretty inadequate when I thought about not having this thing. I get magazines devoted entirely to CEREC. There are lectures only for CEREC users. There are articles and forums and the like all for CEREC users. SEVEN PERCENT. I don't feel so inadequate anymore.

Have a great weekend. Talk to you Wednesday,

john

Taking advantage

Hey all,

It is the dog days of summer. It is so hot here. I was driving to my run on Saturday at 5:30 a.m. and it was 82 degrees. And I know that other parts of the country are really hot as well. We love it when it rains because it drops the temp about 15 degrees. Problem becomes that it is then 140 percent humidity. Well, it is almost over. And at least we have air conditioning and movies.

Speaking of movies ... I saw Due Date this weekend. OMGosh, it was so funny. Again, not a movie for kids because it had some really raunchy parts (that they could have left out), but if you could get past these it was a "fall off your chair with a belly laugh" funny.

I also saw X-men at the dollar theater with my son (two tickets=$2.50). I really enjoyed the other two X-men movies, but this one, not so much. I fell asleep three times in the theater.

I am going to tell you a story but you have to promise not to get mad or cuss at the computer. I want you to count to 10, then you can react. I am a giver. I usually am a sucker for people who are in a tough spot. If they ask me to help them, I usually don't ask too many questions and help them. It can be at the office or at home.

Most of you know that I do Dentistry from the Heart every year. One year, a local company sponsored the event. So at the end of it I made a PowerPoint presentation and I went to their headquarters right down street. They had all their employees in a room, and I gave a presentation on what their money went to and described the day and what a success it was. This was four years ago. A month or so ago I got a call from someone. He said he use to work for that local company. He said he had come on some hard times. He said he and his two kids were in bad dental shape.

"My kids have holes in their teeth and I don't have any money to help them, can you please help?"

Now I know how often you get these kind of calls or how familiar you are with this situation. But for me, when there are kids involved, I don't usually say "no." So for this guy I told them I would help them. I made an appointment for the following week for him and his two kids first thing the following Wednesday. Everything was set.

Tuesday, the day before the appointment, I told my staff that I am going to work on this family and they were not to be charged. So I put myself out there. I say to my staff they these guys are "worthy." The next morning I am driving to work and I get a call on my cell at 6:45 a.m. and I don't recognize the number (never a good sign). It was him.

He says, "I didn't hear from your office, just making sure we are still on for today?" I said, "Yep, we are looking forward to meeting with you and your family in about 15 minutes."

He says, "Well, here is the deal. I just dropped my mom off at the airport. So I can leave now and be there as fast as I can."

My mind starts to process this, I mean it is 6:45 in the morning. I am thinking to myself, "What the heck is going on here?" I realize he doesn't have the kids in the car. I said, "You are at the airport now, but you still have to go and get your kids?"

"Yes, but they are on the way."

I know where he lives and saying this was on the way was like saying I was going to go from New York to Florida, and that Nebraska was on the way. Anyway, so I started to get upset. I have learned to recognize when someone is screwing me and I tell myself I wasn't going to stay quiet anymore. So I began to let this guy have it.

"So you are calling me to tell me that you are going to come to your appointment, but you are going to be 50 minutes late for an hour appointment." Then he starts with, "I just wanted to call to respect your time." I said, "No, respecting my time would be to call me LAST NIGHT and either confirm your appointment or call and tell me that you have to take your mother to the airport, and see if we can work something out."

"But..."

I went on to say, "I put my neck out for you, I was going to do everything for free and you are at the airport." I was thinking that ideally I am $600 an hour and he gave that up so he could take his mom to the airport (a $40 taxi ride). I was so furious. Then there was a bunch of, "I am so sorry, this thing with the airport came up ... The kids really need this, I am so sorry." But I was not going to give in. I was not going to say it was okay, because it is not. I just said, "I am sorry this didn't work out for you." And I hung up.

I came into work and had to face my staff and tell them that our first patients were not coming in. Of course they looked at me like, "you are such a fool" (at least that is what I felt like). I told them the story and they were all aghast. They were proud of me for sticking up for myself and the office. Of course I calmed down. A free hour gave me a chance to catch up on my charts. I got a jump on Wednesday's blog. I can always use an hour.

Then I hear my phone buzz. I got a text. It was from him. "Doctor, I am so sorry. I know your time is valuable. This thing with my mom and the airport was an emergency. My kids really need this. Would you please reconsider?"

Okay, you promised not to cuss. Think about it a second and tell me what you would do. I mean even though this person screwed me, he is still hard up and his kids still have holes in their teeth.

Have a great Wednesday. I look forward to hearing from you,

john

p.s. Don't forget to rate the blogs. It really helps.

The Gym

Greetings,

I hope everyone is getting some exercise. We are hunched over in our chairs most of the day, and that can really take a toll on our bodies. I have been slacking lately, and I really need to get back in the gym. In my case, I often think I am in shape, but soon realize that I am not once I start exerting myself.

Case in point, at the age of 16, I won a free week to a popular health and fitness spa in Miami. At that time, there was no way I could afford to join a gym. I was so excited because I had heard so much about this place. This was my chance to not only begin what I thought was my bodybuilding career (chuckle, chuckle), but it was my chance to check out (and impress) “the chicks.” I woke up early my first day, and put on my best “chick-impressing” workout outfit. This consisted of a really tight tank top and those real short gym shorts that no one wears today because they look ridiculous. I had to wear the tank top because I was trying to show off my 11-inch biceps, and of course the two black hairs that barely showed on my chest. I thought it would be smart not to eat because I would run the risk of showing an unsightly bloated stomach (that was a mistake).

I arrived at the gym early, proudly flashed my one-week free card, and signed in. I was assigned a trainer that would give me a tour of the gym and help start my first workout. He was about 6 feet 3 inches tall, and looked like he had stared in a Tarzan movie at one point in his life. I was only 5 feet 4 inches and quickly approaching the 5 foot 6 inch mark that I reside at today. He starts the tour in the bathroom, which was really impressive with its sauna and steam room. That was all nice, but my focus was to get out on the main floor to pump some iron and show off. You can’t keep a peacock with his feathers locked up in a bathroom!

Tarzan walks me out to this pre- workout room with a few fancy programmable stationary bikes. They were way beyond their time in the 80s. He said, “Before I take you into the real gym, you need to warm up for 10 minutes on this bike. Keep the speed above 20, and I’ll be back in 10 minutes.” I didn’t really expect this, and I surely didn’t expect the “ab-crunching” class to be in this room (which consisted of 15 to 20 girls in really good shape).

I can’t really impress anyone on a bike, and I had no intention of keeping up the speed for 10 minutes. But I thought I better pretend to do what he says, or I will never make it to the weight room. He pushed a few buttons, and told me to start pedaling. I reached 20 on the speedometer, and he started walking away. I immediately slowed down, and in an instant this loud siren goes off in the room.

It might as well have been a fog horn with all the attention it drew. The whole ab class stopped crunching just to look at me. He turned around and told me I had to keep it at 20 or the alarm will go off! What? Ok, no big deal, I can do this. I couldn’t afford the embarrassment of going under 20 again. About three minutes into my 10 minute warm-up, I started to lose my vision. I was pretty sure I was dying, but I would choose that over facing the foghorn. My heart was pounding out of my chest and my skin was cold and clammy.

After the 10 minutes was up, I barely made it off the bike. I felt my way along the wall to get back to the bathroom because the only thing I saw was a white haze and black spots. I collapsed on a bench near the sauna and vaguely remember Tarzan trying to revive me. He gave me some orange juice and made me stay in there until I felt better (that took about two hours by the way).

Needless to say, I quickly learned the importance of a good breakfast and staying in shape. I also learned my lesson on when I should and shouldn’t be a peacock. Even now at 47, I always do a 10 minute warm up on the bike as a reminder. Ok, I’ll admit it; I still wear a tank top.

Have a great week…

Scott

I can't do it all

Oh my gosh. My head is spinning.

I know I wrote a blog like this a couple of years ago but I am feeling this all over again. I am so stressed out that I can't even stand it. If you are old enough, you will remember the old commercial, "Calgon, take me away!" That is how I am feeling right now. I am swamped at work. I am swamped at home. I am swamped in all other things, too. I mean usually I can handle work and I can handle home but all the other things are putting a wrench in my finely oiled machine.

I can't tell if it is because it is summer, but work has been so out of control. Summer brings different stresses. At the office, I see most of the younger patients. So everyone that is in school wants to get their teeth cleaned in the summer. That is great, and I am thrilled that they are getting it done here, but this also means that I am doing a ton of checks. This is usually not a big deal, but I have been doing a bunch of smaller procedures. That is a filling on Bobby, two fillings on Suzie. Not that I mind those either, but these appointments usually don't have a lot of wiggle room. I like to see about 6 patients a day because that means appointments are about 1-2 hours a piece, and that is tons of wiggle room. If I am seeing 10-12 patients, man I am a running around. You all know how it is. You have 30 minutes to do 18-MO. You seat the patient on time and do a couple of minutes of talking. Then you get started. A little block of Lidocaine. You go and do a couple of hygiene checks. You come back and you ask if they’re feeling numb. They say yes and point to the back of their cheek. We all know that they have anesthetic in their cheek and none of it hit the IA nerve. So you give them a booster. You hit the bull’s-eye and they are numb. And just as you begin to crank up the handpiece, the front desk calls letting you know that your next one is here. See, you didn't start the handpiece until the 25 minute mark of a 30 minute appointment). Now you are just begging for someone not to show up. At the end of the day, you are exhausted from running around like this. Then you sit at your desk and realize you haven't written a single chart up in the last three days. Arghhhh! Calgon, take me away!

I am getting the broken window fixed, getting the new safe bolted to the floor, and getting the computer guy out here to set up my new (awesome MacBook Pro) laptop to work with EagleSoft. Then there’s having the floor guys to come back to redo the floors after ordering new product and the like. I have insurance forms to fill out. I had to call the detective because there are unauthorized transactions on my account, and then a call to the fraud department at the bank (yeah, that is easy, trying to get someone on the phone at Bank of America. I am on the phone at least 10 minutes before I even talk to a person). Oh my gosh. I am dying here.

I go home and all the kids are wound up like toys. I get accosted when I walk in, "Daddy, can we do X?"(X = swimming, go for a bike ride, throw the ball, play the Wii.) Again, I love doing this, but this along with work stuff is exhausting. I fell asleep on the couch yesterday afternoon at about 6:15, after we went in the pool. Then my 21-month-old came over and wacked me in the stomach and woke me saying, "Daddy, daddy, daddy."

And there is still more stuff. Because it rains everyday here, the lawn needs to be mowed at least once a week, then edged. Hedges need to be trimmed and the weeds need to be whacked. Then my mower pooped out on me on Tuesday. You have got to be kidding me! I had to run after work to try to get my mower to the shop before they close at 5 (and it is across town). And my son, who now mowing lawns, needs the mower to get fixed fast because his lawns need to be mowed. Can you feel the stress? My "honey do" list is daunting and it keeps piling up. The pool is looking a little green because of all the rain, and oh yeah, I am the pool guy too. But I have no time to run to the pool store to get chemicals.

Then my poor wife asked me something simple like, "What do you think about sending the boys to basketball camp next week?" And what she gets out of her loving husband that she promised to love ‘til death do us part is, "I don't [bleep] care." I feel like I am failing at all things.

On Friday I am going to Gainesville to see Gordon Christensen speak. I have to get up at 5am to drive to G-ville to make it to the lecture on time. But you know what? I am so looking forward to the drive.

What gets me down the most is that I have been so busy I have not been able to relish in the good things that are going on. I think I forgot to tell you that I have an article being published in AGD Impact in September (trust me, I will remind you). I am so excited about that. I found some back-ups from my stolen computer. My kids and wife love me. I got a thank you card today. I really love thank you cards. Someone liked us enough to get the card out of the drawer, write it, find out my address, put a stamp on it, and send it. That makes my week.

I hope you all are having a good week. I know life can get crazy. And I mean really crazy. If it is, just remember to think about all the good things that are going on. I have to finish this so I can run home and go for a bike ride with my kids.

Have a great day,
john

Decay Under Sealants

Hey hey hey. It’s me. I don't know if you remember, but I traded blog days with Dr. Joyce when I was on vacation. So here I am on Monday. It worked out well because I am working today. By the way, this working on Monday thing stinks, but, I digress.

I have seen a couple of movies that I wanted to tell you about. I saw "Black Swan." Hated it. I saw "Horrible Bosses," like I said. It was very good, but don't see it with the kids (I saw this at the regular theater at regular prices. Wow. We saw the 4:15 showing and for 4 of us with popcorn and drinks, it was $65.) I saw Soul Surfer (at the dollar theater, with 4 kids, popcorn and drinks galore for $19). I saw "American Pyscho" with Christian Bale, and I hated this one too. And yesterday I saw "Thor." This is, by far, the worst Marvel movie so far. I have really liked all the others and this one just wasn't good.

I am almost done with my book on Bonhoeffer. It was 570 pages of histooooooooooorrrrrrrryyyyy… Sorry, I fell asleep for a second there. It was like reading an encyclopedia. There was zero action. No plot. No big ending. Just history. Anyway, next up is Tim Tebow's Through My Eyes.

Okay, topic of the day. I am a big sealant person. I think sealants are the bomb. I think when done well, they are so good at preventing decay. That being said, there are some problems with them. At least with me.

You know I use the Design for Vision 3.5's and I use a headlight (Perioptix - totally recommend them). I see very well. When I do exams, I see through a tooth. Do you all get this? I look at the color of the tooth. I look past the enamel. I am almost looking at the dentin. I get what the color of the enamel is so I want to see what color is coming through the enamel. I am feeling a tooth with an explorer but I almost trust my eyes better than my explorer.

So something that doesn't stick does not always mean there is nothing there. Sometimes, I will go into a tooth that I see an issue with. I still doubt myself sometimes, but almost all the time (I can count on two fingers when I was wrong) there is decay.

Going back to sealants. I am doing an exam, and I see a sealant. First, I am locked out of the tooth. I have no tactile sense on this tooth anymore. All I have is my eyes. But you know what goes on. We see virgin teeth and we want to seal them, as fast as possible. I check to see if I get a stick, and if there isn't any, I am sealing that puppy. What if there is a stained groove but no stick? I seal it. But we all know what that sealed tooth looks like. It looks like there is color coming from the dentin. Hmmmm?

What do I do? Do I start cutting through sealants every time I see color through them? I love sealants, but my assistant feels the opposite. She hates sealants because she sees the disasters. The disasters are the ones with color that I watch. Next thing you know, it is 3 years later and I feel that the color is getting bigger. I cut through the sealant and KA-BOOM, there is so much decay under this thing it is almost a pulp exposure. And it is usually on a 12 year old or something.

I did two today that were exactly this. I didn't watch them, but I saw this girl who was a new patient. The sealants looked great but the color didn't seem right to me. Got in them and HELLO. So this girl who "has never had a cavity before" has two giant fillings in her mouth (that look spectacular, if I don't say so myself).

While I was filling up these big holes I decided to do sealants on her second molars. I checked and checked with an explorer before I did them. We used to go under the assumption that even if there is a bit of decay and you seal over it, the sealant will starve the decay and it won't get any bigger. Sound familiar? I still do buy that, but what can I do but doubt sealants now? I just can't. One of my pediatric dentists does fissurotomies before every sealant. I think this might be a little overboard, but at least he knows before he puts the sealant on. I believe in them. I do them on my kids. But you can bet that I am checking their teeth before I put them on. And nowadays, I check them double after.

Thoughts? Let me know how you do sealants, and on whom. See you Wednesday (Mondays suck).

John

P.S. I think a rating system comes up at the bottom of the blogs now. (At least it does when I go back to them). Do me a favor and rate the blogs after you read them (email people won't be able to do this). Then I can start to know what you like the best and do blogs that way.