Wednesday, March 30, 2011

My Soul Needs Some Chicken Soup

I write to you so, so depressed. If you don't like sports you can skip this next part.

If you have read my blog before you know I am a huge Gator fan. My Gators came within milliseconds of going to the pinnacle of college basketball - the Final Four.
We were winning the game by 11 points in the second half. I think we were winning by 8 points with only 6 seconds to go. We grabbed a defeat out of the hands of victory.

I am so depressed. I was inconsolable after the game on Saturday. I still have a pit in my stomach today. It is going to take me awhile to get over this one. We were so close.

Man, that sucked. And now I have to watch two teams play that I think we are better than. I might not even watch. Thank God I have that wedding to go to to keep my mind off baskeball for a couple of hours.

Anyway, this week is Spring Break for the kids. And one thing they have done to pass the time (Monday it rained ALL DAY) is watch all the The Cosby Show reruns on Netflix. Occassionally, I will sit with them and watch it. Let me tell you, that show is great. Funny, family-oriented, wholesome. Not a bit of that on TV anymore.

I watched The Fighter this weekend. I have to say that I was a bit disappointed. This movie won all sorts of awards. I thought the acting was very good but the story was just not that good. It was goo,d but certainly not movie of the year.

I wanted just to tell you of some crazy patients that I have come across in the last couple of years. You know, a humorous interlude to this blog. I have a couple of patients in mind that should make you laugh, or at least snicker. As the staff and I sit in the lunch room and talk about our morning, lots of times we laugh about our situations. And I mean belly laugh with tears welling up in our eyes. I guess when you are dealing with people every once in awhile you come across some funny people. I don't mean to make fun of people but...

Patient #1
We have a man in our practice that we have nicknamed Sobbing Sam. He came to us originally because he needed a new dentist. Come to find out that he had recently broke up with his girlfriend who was a hygienist at his old dental office. Now, when I say recent, I mean a couple of weeks ago. Apparently he was still upset. He spent part of the New Patient Experience fighting back tears. He broke down a couple of times during our interview, but a couple of days later when he came for his cleaning appointment, he could not hold it back. He was a mess.

He was crying so much that my hygienist was drying the water out of his ears. This is a 50-year-old man crying like a baby in the chair. She finally said, "You have got to pull yourself together and let her go man. Come on, buck up." Women will do this to you.

Patient #2
I was seeing this woman who was referred by an old patient. The woman, also 50 years old, had an unrestorable tooth that needed to come out. Now, I am 42 years old and my dad is a dentist, so I have always had decent experiences. I know how past experiences can make people apprehensive at a place like this, but some people take this to an extreme.

She needed nitrous, which is not uncommon. But she asked if her mom could come into the room and hold her hand while she was getting this procedure done. While she was getting this done, holding her mom's hand, she asked my assistant if she would hold her other hand.

The extraction went without any issues, but after it was over she completely broke down. She was strapped to the nitrous nosepiece wanting a hug from her 75 year old mother while she was crying, saying something about "I miss my grandmother."

How do people become like this? These two are not alone. How does a 50 year old woman need her mother to get dental work done? I am having a hard time telling you these stories and trying not to sound like a guy who doesn't care about his patients, because I do. I don't have a problem with the dentist but I really don't like going to the doctor. Not because of pain but because they have to stick their fingers in uncomfortable places. But I still go and just deal with it. I don't need my wife to go and I certainly don't need my mom to go.

Pain is so relative. So many people fear shots, and it is an unhealthy fear. A fear that once was a "I hate going" transforms into this crying "I need my mommy fear." I get people in here that haven't been to the dentist in THIRTY YEARS because they had a bad experience when they were 7 years old. First of all, it was probably because you were seven and wouldn't sit still because you had to go to the bathroom. And I am pretty sure things have changed in the last 30 years for the better.

This fear is so irrational. I mean does it hurt sometimes, yes, but the pain from a needle injection might be ONE MINUTE. People let this a tooth fester for 3 years because they fear a one minute needle injection? That is irrational.

Just a couple more.
I was a young dentist and was not very accustomed to ways of the elderly. For instance, I didn't know what a wig looked like or why elderly people wore wigs. But one time, I went to put safety googles on an older woman and pushed her wig off her head.

Or when a hard of hearing elderly patient wants to tell you, in a really loud voice, about how his stool is coming out like a pencil. As a young dentist this stuck with me. Talk about traumatizing for 50 years.

I love working on people and I get a lot of laughs from it. I love knowing people and their lives and I love telling them about mine. One time I had a patient that was going through a nasty divorce and they were both patients. The husband came in and was up at the front desk and could see his soon to be ex-wife in the parking lot waiting for him.

He asked us to call the cops because he truly feared for his life. That was an exciting day, when the cops come to shake down a middle-aged woman who we think is packing, getting ready to off her husband in your parking lot.

Well, that is it for now. I am sure there are tons more funny stuff that I can't think of right now. My mind is still in a funk over the basketball game. I am so depressed I can't even write well. Cheer me up by telling me your stories of funny things happened to you. I am looking forward to it.

Thanks for listening. Have a great week and I will talk to you on Friday. I will try to shake myself out of my funk.


Monday, March 28, 2011

Crabs in a pot!

Well, things have been going very well at the office. We have had some of our best production and collection months lately. The staff made bonus so they are happy – oops, I did not mean to say that, now I am doomed, one of the girls will come walking through the door any minute, mad and upset.

Have you ever heard that old saying about how putting down others to make yourself look better is like crabs in a pot? One crab attempts to get out of the pot and the other crabs grab on to pull out and everyone falls back in the hot water! A national orthodontic association is sure looking like a pot of crabs right now. Many of you might have gotten the AGD alert concerning this issue.

I was totally unaware until that notice. It details an advertising campaign by this group. On their website, they have "Myths and Facts" about orthodontics. Some of the statements are accurate and legitimate; others, not so much. One supposed myth is that "My family dentist says he can straighten my teeth." Another statement says that “a dentist may see a handful of cases a year amid drilling and filling." Well, needless to say, this has gotten the attention of many people as being a broad-based statement that is inaccurate and degrading to what general dentists do.

I personally feel that general dentistry is the hardest position to do in the dentistry field due to the amount of broad-based knowledge you must have. I had the opportunity to go into endodontics, but felt I would miss the variety of work that I can tackle in general dentistry. We are all general dentists first, then specialize to meet our personal and/or professional needs. I like having specialists that want to do the cases I do not want to touch, but when one group feels they must put general dentists down to elevate their position, that is just wrong.

I forwarded the AGD email to some of my ortho friends. The response was unanimous: they were embarrassed and upset by the statements that this organization made. Many of them were totally unaware that this even existed. They stated they have been paying an extra $500.00 a year in dues to support a special assessment to fund an advertising campaign to educate the public on orthodontics. However, they did not know other dentists would be degraded to accomplish their goals.

Some were apologizing to me. I told them I did not want an apology, but to inform them of the issue and hear their thoughts on the topic. I know there are some dentists that possibly perform treatment beyond their training and skill set and should not, but others perform minor tooth movements or even more advanced cases and have the proper training and experience to do so with great results.

I am fortunate that I have received advanced training in all specialties via the Navy, and it has helped me understand when to punt a case to a specialist and when to tackle it. (All the football references have me thinking of Gator football already!). I have very good relationships with specialists that promote me doing cases and they will help out if need be. I understand that they have the special training, education and time that is required for complex cases. For this orthodontic organization to label general dentists as just there to fill holes and nothing more is unnecessary and untrue. The real myth here is that this campaign is helping the orthodontists' cause.

I believe that there have been enough complaints to this organization that they are going to remove these statements from their website. As of the writing of this post, it was still posted on the website. We all need to stick together as dentists and promote our special skill sets without trying to tear down another.

Have a great week!

Friday, March 25, 2011

Relationships, Service and Banking

OH MY GOSH!!!! GATORS IN THE ELITE EIGHT!!!! I am like a pig in poop today. I hardly slept last night.

Let me give you some background info. I have been a season ticket holder for the Gators for 12 years. I have actually been to the last three Final Fours that the Gators were in. I love college basketball.

I never thought it would come to this, but next weekend is the Final Four (I would never jinx us by making plans), and the semifinal games are on Saturday in Houston.
I have a wedding next Saturday. The daughter of great friends of ours is getting married. This would suck. I can't miss the wedding.

If the Gators win and go to the finals, would I get on a plane and fly to Houston just for one game? So many things would have to happen. The Gators would have to beat some really good teams. I would have to procure some tickets for that game, get a flight and a place to stay. It is not looking good. It is looks like I am going to miss this one. I guess it is a good thing because I don't have any money anyway.

Remember when we talked about x-rays and patients putting off x-rays? I told you that I put in an email to the Florida Dental Association's attorneys. Well, they finally wrote me back and here is the official word on x-rays in the state of Florida.

There is no law regarding how often one must take an x-ray. It is a standard of care issue that is governed by similar dentists in your community. Generally speaking however, the standard practice is every 13 months to coincide with the 13 month rule. The 13-month rule is actually Florida Board of Dentistry Rule 64B5-16.001. It says that before a dentist can delegate a duty to a hygienist or assistant, the dentist must conduct an oral examination. The oral examination, which usually include x-rays, must occur at least once every thirteen (13) months in order for the delegation to be lawful. The rule does not say that an oral exam must include an x-ray but most dentists do to make sure they have a good idea of the patient's oral health.

[Dave, I know this is going to help you.]

I have The Fighter at home, but I have been watching so much basketball I haven't even thought to watch it. I will let you know.

Okay - topic de jour. I saw a new patient last month. She was a banker. You know if you are in a small town and you have 4 bankers in your practice, they are all working for your business. It's always, "Why don't you bank with us?" or "What can I do to earn your business?"

At our office we have been with the same bank for over 25 years. It would take this bank actually closing down for us to change. Now, this patient gets the red carpet treatment (like every other new patient). Twenty minutes just to talk, you know personal touch, so they don't feel like a number. A thorough exam. Great service from my front desk people, then a nice hand-written note by me. I think this is a service that the Ritz would be happy about. After all this, I get an email from her and here it is:

"I received the nice note you sent, in your own handwriting, I might add. I appreciated it so much for you to take the time to do that.

You are absolutely right. Customer care is very important in any business along with a great team of co-workers for support. I feel very strongly about my team and the care I try to provide to all my business clients. Banks are a dime a dozen and most have similar products. I have been in lending and banking for over 30 years and I work very hard to stay on top of the needs of my clients. I would like the opportunity to meet with you and give you a proposal for our business client services.

Thank you again!"

What do you say to that? She gets it. She is picking up what I am laying down. And this is the kind of person I want to work with. But in the email I sent back to her I laid it on the line.

I told her that to me it has been and will be always about relationships and service. It is not .1 of 1%. But she has to understand that when I change banks, I am going to have 4 other pissed off bankers that didn't get my business (all thinking that they are the best)and that is really one of the main reasons why I stay at a huge bank that none of my patients work at (they did when it was a small bank).

Being part of the big impersonal bank goes against everything I stand for. But you know what? That big impersonal bank can give me the best rate. They don't know me from Adam but... Maybe I will put aside my need for service and relationships and maybe I do care about ".1 of 1%" in this case. I don't know.

I know it is Friday and I don't want to make this too long. Just giving you something to think about. We didn't even get into the "using patients for work" deal because, as you know, this can be a real slippery slope.

Tell me what you think. Have a great weekend. Did I tell you that the GATORS ARE IN THE ELITE EIGHT!!!

See you on Wednesday,

Wednesday, March 23, 2011

That Guy

Sorry about yesterday; I had a crazy day and was not able to write a blog.

Everything went okay this weekend. Nobody died and we all made it to church. I watched Grown Ups this week. I was pleasantly surprised. It was good. I also saw a movie called Listen To Your Heart. It was okay. It was worth the money (it was free).

Today's topic is "that guy." I have a patient. I think you might have this guy too.
He is in his early- to mid-eighties. He lives right down the road and he walks to the office. And he is at my office all the time. He just shows up, no appointment. He has never had an exam, but he came in because he had some pain. He has numerous issues, but his biggest issue is that he is missing a bunch of teeth (including some upper front teeth). I did minor restorations and made him a Valplast upper partial. I thought I was done with him. OH NO.

This is a man that has the pain tolerance of a 4 year old girl. He walks in and asks to see me to "adjust his partial." I bring him in the back and zip, zip and he leaves saying, "That feels so much better."

Am I supposed to charge him? I just made the partial 3 weeks ago, and I usually give an adjustment with a partial. BUT... then the next week he comes in again. Zip, zip. "Oh, yeah, that feels much better." No charge.

I am serious when I tell you this happens 10 more times. Zip, zip. "Oh, yeah that feels better." Each visit lasts about 2 minutes. I think he is kind of lonely. We treat him well and we're so nice to him, so of course he is going to keep coming back. He probably bugs the poop out of his family. We probably treat him better than his family.

And it is still happening. So last time, I had to say to him, "Mr. X, I am going to have to start charging you for these visits." He says, "Yes, of course. I was wondering about that."

He comes in again this week saying that he is having pain on the lower. I look in there, and he has a bunch of cavities. I realize he has never had a new patient exam. And it looks like he hasn't brushed his teeth in a week. He has so much plaque on his teeth, I can't even see the decay. There are so many things wrong with this whole situation.

I never did an exam. I have never cleaned his teeth. I have never taken x-rays.
I have seen this guy about 15 times, and have never looked around his mouth. He said the partial was rubbing his gums, so I relieved the partial. He said this tooth hurt; I saw a cavity on that tooth and I filled it.

You know, sometimes you don't do the things you normally do on elderly people because you don't want to take advantage. But me trying not to take advantage of him is causing me to not treat him properly. I sit here shaking my head in disgust with myself.

Here is a guy who frustrates me because he is at the office all the time, but really, now I am frustrated because he has taken me off my game. If he would have come in for an exam, we could have done it my way. If he didn't come to the office 10 times, I wouldn't try to rush him out.

I have to go. I have to call his daughter and tell her that we are going to have to start over. I will tell her we are going to have to do an exam, x-rays, and a cleaning before I see him again. And then when we do all this, then I can go back to seeing him once a week again.

Do you have this guy in your office? Is it a lonely thing? Tell me I am not alone in this.

Have a great Thursday.

ps. Gators play at 7pm tonight. Man, if we can just win two more games, I will be tinkling myself.

Monday, March 21, 2011

The Dreaded Full Moon


I am Dr. Scott Jackson, a dentist in Ocala, Fl. I would like to thank Dr. Gammichia for giving me the opportunity to share some thoughts on a few Mondays every Month. A quick synopsis of the last 46 years: I was born and raised in Hialeah, FL., where I owned and operated a crown and bridge laboratory before going to dental school. I graduated from the University of Florida College of Dentistry and received my Mastership from the Academy of General Dentistry in 2009. I also spent 8 years in the U.S Navy as a dental technician.

I am married to an incredible woman who is a registered nurse as well as a registered dental hygienist. She goes from cooking lasagna to painting walls to laying ceramic tile to changing the oil in her truck all in single day. To give you an idea, I got her an 18 volt drill for Mother's Day (with a holster). I have 3 amazing girls, ages 24, 22, and 16, and they are assisting me in going completely gray by the time I turn 50.

Did everyone in this part of the world survive the Super Moon? I don’t know if you’ve noticed, but during the full moon, and for approximately 48 hours afterwards, the strange dental patients come out! (I have been keeping track of this for a long time.) I wish I were making this up. I’m going to share with you what happened the last time we had a full moon.

Let’s start with patient #1. One of my front desk staff walks in my office at 8:00am sharp and says that she just got off the phone with Mrs. G. She said she was eating a Rueben for dinner last night (why do they have to tell me what they ate? I always have a hard time enjoying that food again), and the filling I JUST did fell out. Well, for one, I haven’t seen Mrs. G. in 2 years! She also tells me that Mrs. G. can only come in between 9 and 9:45am because her dog has an appointment at the groomer at 10:30. (Oh, and can she bring the dog to the appointment?) Now, at this point, without even searching online for the moon phase, I already know it’s a full moon; just a skill I have developed over the years.

Mrs. G. comes in at 9:15, visibly upset because I had “just put this filling in.” After taking a radiograph, not only do I have to explain to her that it has been 2 years since she has been in, but I have to tell her that the tooth that fractured is nowhere near the last restoration I did. Mrs. G. needs non-surgical endo on tooth #15, (that’s a referral in my office) followed by a core build-up and gold crown. I have to go retrieve her Yorkie from my laboratory, hoping that the floor is clean. She leaves upset, of course, convinced that I have somehow swindled her.

Patient #2, Mr. Z., shows up at my office at 2:30pm, and signs in. Well, guess what. Mr. Z. doesm’t have an appointment today; he has an appointment NEXT Tuesday at 2:30pm. He is here on the wrong day. Our front desk staff kindly tells Mr. Z. that he is here a week early, and that we really don’t have room to work him in today. Now, it’s been my experience over the years that most patients will take this news with grace. Some, even apologizing and turning red with embarrassment. But not during the full moon! Mr. Z. proceeded to have a meltdown in the waiting room that almost warranted the activation of 911. He stormed out yelling a few choice words that left the staff and the remaining patients in the waiting room wondering what just happened.

Now here is the really strange part: Mr. Z. came in the next week as if nothing ever occurred! Mrs. G. called a week later to schedule the gold crown, almost giddy on the phone. They honestly do not remember. This can’t be happening only in my office. I have to know that I am not alone. I would like to know the science behind this full moon phenomenon.

All is calm now while we wait for the next cycle. That night after work, we stopped by our local, family-owned restaurant for a bite to eat and some relaxation. The waitress walked up and asked if I wanted the special. Yep, the Reuben. I said,“Umm… I think I will just have a Caesar salad and a beer.”

Talk to you soon,


Wednesday, March 16, 2011

Putting off x-rays

Friday. Enough said.

Gators won, so I am okay for now.

Slept okay but had to get kids ready for school today, by myself, so that went about as well as expected. It is organized chaos. "Why did you do it by yourself?" you may ask. I worked on Monday this week so I could have today off because my wife is going to South Carolina with the girls to a "conference" for four days. I've got a baseball game and a basketball game on Saturday that I have to bring four kids to. Then getting the kids ready for church on Sunday. Those are the three big things. If I can succeed at all of them, I will be alright. Wish me luck.

In this economy (you know I hate saying that), there are things we have to deal with. One of things that I have heard from other dentists, and am dealing with myself, is people putting things off. I am not talking about someone putting off a crown they know they need; this is all the time, not just nowadays. It is the "No I don't want x-rays" thing that I am talking about. "I don't want the doctor checking me today, I just want my teeth cleaned." I have been thinking about this for a month or two, and I have to tell you that I don't have an answer for you.

Let's say Mrs. Warren comes in for a cleaning. She is 75 years old and has been a patient for 15 years. For the most part, you don't do much restorative work on Mrs. Warren. She doesn't like x-rays. She kicks and screams every time you tell her it is time for x-rays. She again tells you she doesn't want them. This is the third recall appointment that she has denied x-rays, so it has been two years. What are your choices?

1) You tell Mrs. Warren that these are the rules and if you don't want to abide by the rules in MY office, you can look elsewhere for your dental care.

Let's talk about this option for a sec. I don't think anyone is going to do this (at least in these times where patients are at a premium). We used to have this attitude and there are still times when putting your foot down is necessary, but this option scares me and I will tell you why.

Pre-med used to be necessary for a heart murmur. I had a patient with a heart murmur that didn't take drugs because she was a Christian Scientist. She didn't want to take drugs and filled out a waiver that said she knew the consequences for not taking the drugs and she was taking full responsibility. I had a hygienist that felt really strongly about not cleaning her teeth, and she got the other two hygienists scared. None of the hygienists would clean her teeth. A struggle of wills ensued and I lost. I ended up telling this patient that she was going to have to seek her dental care elsewhere. Two years later, they came out saying that pre-med was not necessary.

2) Do nothing.

I am not saying that x-rays are not important, but my point is this: let someone make their own decisions on their health. You make them understand the problems that could arise because of not taking the x-rays and make them sign something saying they understand.

There is this thing with Americans now a days, a kind of CYA mentality, and I will tell you what - I don't buy into it. If someone doesn't want to do something that could be detrimental to them, let them do it (or not do it). You can tell them it is bad and they can do what they want. Are doctors responsible for telling people that smoking is bad? Yes. Are they going to kick people out of their practice because they won't quit?

People have to start taking responsibility for themselves. PERIOD. And when it blows up on them, which it will sometimes, they have to lay in the bed they made.

3) This option is kind of a philosophy. I try to have a relationship with my patients (sometimes a pipe dream, I know), but this goes a long way when it comes to things like this. They don't think I am pushing products on them. They don't feel like a gravy train for me. Hopefully, they feel like I have their best interest at heart.

Now don't get me wrong - I have those patients that don't want anything. They have cracked teeth and gum disease and I haven't seen between their teeth in decades but that is how they want it. I have them fill out a form saying they understand what they are denying and we continue. I have a patient family where the mother doesn't want a single x-ray on anyone in the family because someone had cancer. They always say, "When you think I need an x-ray let me know and we will take ONE." I have a couple of families like that. You know, I am not that opposed to that.

I know I have responsibility for their care, but how far do you want to go with this? I think it is my job to inform before I perform. I informed and they don't want me to perform.

I don't know what else to say. I know I am babbling. I emailed the Florida Dental Association to find out if there is a law or a "requirement," but I haven't heard back yet. I read like 4,000 laws and I didn't see anything about x-rays (even though I know there probably is something that I missed).

Do you have an opinion on this? Is it different now that the economy has tanked? Would you have kicked them out of your practice 4 years ago?

Hey, have a great weekend. I got to go, my son is wailing and calling for mommy. I totally know what he means.


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.

Big Boy Toys

Hello all. This is my very first endeavor as an official blog writer. I was never the best writer in school; my transitions were not good, grammar, intros and conclusions were poor. Not to mention the punctuation and spelling, ugggggh. Fixing teeth is much easier for me, and more fun. I have enjoyed being an occasional ghost writer in the past. I have always told John how much I enjoy his blog and how it always seems so similar to what I am dealing with at my practice - almost Twilight Zone eerie, things were so similar. So I thought I would give it a go!

And now, little about myself. I am a 1999 graduate of the University of Florida. GO GATORS!!!!! I then joined the Navy and did two combat tours: one in Fallujah, Iraq, and the other in the Persian Gulf. I completed a two year comprehensive dentistry certificate program at the Naval Postgraduate Dental School at Bethesda, Maryland. I had the stress and challenge of running an AEGD program while in the Navy (teaching is no easy gig!). While in the Navy, I had the privilege of earning my Board Certification by the American Board of General Dentistry. My family and I go this summer to San Diego to receive my AGD Mastership award. After seven years in the Navy, I wanted to move home to north central Florida and settle down. I am now in a two-doctor partnership trying to raise three little boys. Life is busy but blessed! I like the challenges and variety that general dentistry holds. And now, on to my blog!

I have three boys: 15 months, 8, and 10. The older two are finally getting into cool stuff that, as an adult male, I would actually want to do. Like remote control cars, video games and Airsoft. I am not sure if everyone knows what Airsoft is. I did not know much at first. Well, my older son has been begging for one of the toy guns. His friends have them and he wants one as well. It is hard sometimes telling your kids NO when all of their friends are doing it. Oh, the responsibilities of a parent!

I told him first he has to pay for it, so he has been saving his allowance for months to get one. These “toy” guns shoot 6mm plastic BBs that weigh .20 or .12 grams. There are different types, ranging from $10 into the thousands. You have to be 18 years old to buy one but not to own one. Well, I decided to research these things before I created a mini “Rambo” and released him on the neighborhood to terrorize the squirrels and birds and, more importantly, his little brother.

My town has one of the few indoor Airsoft arenas in the southeast. I went over to investigate. There are adults dressed in full combat SWAT gear with these mega guns. I am into fire arms and recognize some of the scopes they have on these “toy” guns as being close to $1,000 - just for the optics! Man, these people are serious. I talked to the owners and decided to give it more thought. Of course, I go to the great wizard Google and find out all about them. I finally decide on the one I want to let him get and all of the safety gear.

I had one of my teenage patients come in for a hygiene appointment. Of course I do a soft tissue exam and notice this red and white crater-form lesion on his face and immediately begin to do my differential diagnosis. So I ask him “How long has this been here?” He replies, “A few days. I got shot during an Airsoft game.” Wow! That looks like it might hurt!

After that encounter, I decided I better do some first-hand research. One of the office hygienists informed me that her son has a gun he is trying to sell and that I could try it out. Great! The next day I took a look and it looks just like an M-4 carbine that I saw in Iraq. The gun is very realistic in appearance, aside from the bright orange tip.

I wanted to experiment and find out how it feels. So I “locked and loaded” and went out and asked my partner to shoot me in the back at about 20 yards. I stressed, “Just one time!” A few seconds later, wabammmmmm! I am jumping around and my back is on fire! Holy @##$@ @##@ @# that hurts. I knew immediately this was not going to fly with the kids or, most importantly, my wife. This thing could crack a tooth (see picture below of an actual Airsoft injury) or take an eye out. I do not want to spend hundreds of dollars on a gift that will not get used after the first impact.

Some might call this child abuse or cruel and unusual punishment, but I decided to tell the kids, “If you want to have and shoot one, you have to get shot by one.” I lined them up, firing squad-style, put them about 20 yards away, and gave them each one to the back. The older boy wants one of these guns so badddddd! He barely flinches and turns around fighting back the pain I see in his eyes and acts like it was no big deal. He realllllllly wants one, so he is toughing it out big time. The other kid is jumping and hoping around like a jack rabbit. “Ouch, ouch, ouch!”

A little later, we were eating dinner and began to talk about the Airsoft guns. Both very quietly said, “Dad, I don’t think I want one of those guns like that anymore. That hurts.” We lifted up their shirts and saw a 1cm red and white crater-form lesion. Of course, my wife freaks out, asking what I have done to her “babies.” I proceed to tell her the story and that this is how a Dad teaches his kids a hard lesson. Both of the boys said they were glad to get shot with the Airsoft gun and they would not want to shoot or get shot with that. I felt it was a mission well accomplished.

So, if you see an 8-10 mm crater-form lesion, you might need to add Airsoft impact to your differential diagnosis.

Have a great week.

Friday, March 11, 2011


Hope you are having a good week. I have a couple words for you that might make you feel better: IT'S FRIDAY!!!

Things are moving on this very here blog. We have new Monday bloggers. Scott Jackson and JJ Joyce are dentists in Ocala, and they have agreed to share the Monday duties. Both have been avid readers of the blog for a long time. They have both been guest bloggers and have done a great job, so I asked them if they would like to do Mondays, and they both agreed. They have both made it through the rigorous application process and background checks. I am so pumped and I think they are both going to bring stuff here.

I watched Social Network last night. Damn, it was good. I mean, I finished the movie and started looking up all the characters on Google to learn more. It is a must-see.

Okay, today I want to talk about Groupon. Let's be honest - I am dude: I am not an expert on coupons or online coupons. But you would have to be holed up in a cave for a very long time not to know about Groupon. You go online and there are "Daily Specials." Coupons for services. Coupons for restaurants. Coupons for things in your zip code.
The concept has been so successful that Google wanted to buy Groupon for somewhere in the neighborhood for SIX BILLION DOLLARS!!! [Yes, that is billion with a "B"]

In my town right now, they have a $600 laser hair removal for $99 at a spa. They are saying this is an 84% markdown. And the special only runs for a couple of days. A lot of dentists are putting there Zoom whitening on Groupon. You know, a $650 value for $99.

If you are the dentist and you contract with Groupon, this is how I understand it works. The customer pays Groupon, and Groupon pays you 50% of the coupon. That means the spa is getting $49.50 for $600 of hair removal. The laser dentist is getting $45.50 for a Zoom treatment.

Let's talk about the dentist for a minute. Look, we are all trying to get people into our office. I mean, I am thinking of putting on a tooth fairy outfit and waving my wand outside by the street (yes, it is that bad). And we all have to make decisions on how to get people in here. Some people do mail-outs and give a free exam. Some people put an ad in the local magazine. Some people get themselves in a local church bulletin. Some people sponsor baseball teams.

I have to tell you, I have tried them all. But I am opposed to doing the Groupon thing. First, because now people think you were ripping them off before. You have a $600 product that you are now willing to give away at $99? What happened to the person that just paid full fee? They are pissed.

So you do it to just get traffic into your office. You will do a whitening procedure for free basically just so someone will come to the office. You (and I) feel that if you get them to your office that they will be blown away at the service and be a raving fan of the office. They will schedule right then and there for a new patient exam and you will have a patient for life. Right?

Wrong. I have found that people who get a coupon or a raffle prize come in for the service, are wowed by the office, and never come back. They come in for the free exam and never get any work done.

Also, I think you are cheapening the service for every other dentist in the area. I have a friend who runs a home-grown family retail shop and he hates those warehouse stores. Something he sells for $100 is now going for $39 at the f!@#$%ing warehouse store. He buys his product from his wholesale rep for $50; he couldn't sell it for $39 if he tried.

So not only does he look like an idiot when the warehouse store has the product, but now everyone thinks he is ripping them off. We all know that one warehouse store sells an electric toothbrush for less than we can buy them from our rep. HOW DO THEY DO THAT?

Anyway, I am not sold on Groupon. I am not sold about the concept of getting people to come in and seeing if I can "wow" them. As much as I would love for more people to want my services, and as much as I am willing to pay to get people to see my office, I am not going to do it that way.

I don't know. This is just my opinion. What say you? Have you used Groupon? Are you doing more advertising? Is it working?

Hey, have a great weekend. March Madness is here baby, and I am so excited about it. The weather here in Orlando is so beautiful this time of year. I will be outside a lot this weekend.

See you Wednesday,


Wednesday, March 9, 2011

Free Day of Dentistry #7

Friday was the 7th Free Day of Dentistry, Gammichia style.

If you are new to the blog, I open up my office one day a year (around February, which is dental health month) to give away free dental care to anyone who is in need.
There were 12 volunteer dentists, working in shifts of 4 hours, in every one of my operatories.

We do fillings and extractions, and we do it on as many people as we can, on a first come, first served basis, from 7am to 4pm. It was an awesome day. Crazy, but awesome.

I was working on Thursday, and someone came into the office at 11:30am and asked where the line was starting. WHAT?!!!! Well, last year they got here late and were not able to be seen so now they got here early. Forty-five minutes later, another couple showed up. When I left the office at 4pm, there were 8 people in line!!! Are you kidding me? Wow. I knew it was going to be HUGE.

That morning I was on a local radio station telling people about it, but mostly the people that were here were people that have missed on other occasions. There was another dentist that did it the previous week, and he was sending his overflow to our office.

That morning, I left my house at 5:45am and I didn't stop until about 6pm. I swung by Dunkin' Donuts, and they filled up my car with doughnuts, coffee, and other goodies, and thanked me for doing such a good thing.

I got to the office and it was organized chaos. There were, now listen very carefully, one hundred and thirty people in the parking lot when I got there at a little after 6am. Incredible. The office was already hopping. I had a doughnut and got to work.

My job for the whole day was triage. I would see the patient, find out what teeth were bothering them, and take an X-ray. Then I would decide how we were going to treat them. Once I did that, I numbed them up. They waited to numb up in the reception area. We tried to have a log jam of patients waiting for the dentists as opposed to the dentists waiting on the patients.

One thing we found this year is that the teeth, in general, were worse than in previous years. More patients needed multiple procedures. We wanted to help people get out of pain, so when they came in with three things hurting them it was hard to pick one... so we did three things.

This means we were not going to see as many patients, but would do more procedures. We ended up seeing 115 patients, but performing much more dentistry than last year. It seems like we pulled less teeth this year. Doing fillings is much more time consuming, and you can see when you look at the numbers.

On Thursday, a local landscape nursery was overhauling my atriums and trying to make the place look presentable. One of the guys in line asked if he could help. I looked outside and one of the guys in line was planting some plants. Nice.

At 6:30am, a guy from my church brought the Men's Club grill and started firing up burgers and hot dogs. He had this big spread and cooked all day. I have a couple that I know that work for Campus Crusade for Christ and minister to the underserved. He used to be a DJ, so he brought all his stuff and played music all day. They had 12 kids from various universities with them that were on Spring Break; they all danced and served burgers all day. There was a fair amount of kids out there (under 5), and these college kids played with them all day.

I told you that all the food was donated and we had a pretty big spread in the back. But the best thing was the after party. One of my hygienists made gelatin shots and they were a big hit. We try to get better and better as the years go on. I guess what we are going to get better at next year is the AFTER PARTY.

Really, the day went off without a hitch. The afternoon doctors were a little slow to arrive, and everyone started to freak out, but everything settled down after they all arrived. I seated the last patient at 3:50pm, and he told me he got to our parking lot at 6:15am.

Think we were doing something good, or what? Twelve dentists and over 40 non-dentist volunteers. Five restaurants. Three dental companies. AWESOME!!!

Here is something that really warms my heart. There are over 4 dentist offices that did it this year. It is catching on. We have a gift. We have a talent. There is so much need. People are getting it.

Here are some photos of the day.

Some of the Gammichia Girls

My friend Eric, who worked hard to get the office looking good. He also provided all the orchids that we gave to the volunteers as gifts.

The parking lot was abuzz all day.

One of the many volunteers.

Yours truly, numbing up my 6,000th patient (or so it seemed).

Noah came with my wife and hung out all day. He threw out the trash. He went outside and made friends with some of the other little kids.

Another Noahism. On the way home, he said to my wife, "Man mom, with all those people at dad's office today, Dad sure is going to make a lot of money."

Have a great Wednesday,

Tuesday, March 1, 2011

When the spouse calls the office....

The owner has to know how much memory our computers need. The owner knows the computer repair guy charges by the hour but the clock starts when he leaves to start driving to the office. Wait... we are done with that topic aren't we?

By the way I thought we did a great job on last week's blog. Comments were great and I think very helpful to our ghost writer.

Dentistry from the Heart is Friday. Oh my gosh, it has been crazy. The planning is overwhelming. We have done all the work but now our job is making sure everyone that says they will help follows through.

The BBQ guy is supposed to get here at 6:30am. The radio station van is coming at 7am. I am supposed to call the radio station the day before to pitch our day. The breakfast and lunch have to be picked up. The dental supplies are already ordered. Shirts are here. I did some spring cleaning on the lawn this weekend to make the office look nice. The floral gift baskets for the volunteers have been ordered. I sent out an email to remind all the volunteers, especially all the absent minded dentists (present company included).

The phone is starting go crazy. So much so that we have recorded a voicemail and once someone starts to ask about it, we transfer them to the voice message. Did I forget anything? Gosh, I hope not.

I was watching TV and I heard the nominees for the best picture Oscar. I went right to my Netflix queue and put them all to the top of the list. This weekend I watched Winter's Bone ....zzzzzzzzzzzzzzzzzzzzzz..... oh, did I fall asleep there? This movie sucked. I was like, you have got to be kidding me. I could have made this movie. It wasn't anything. It wasn't compelling; it wasn't entertaining; it wasn't funny; it was nothing.

I have wanted to talk to you about a topic that is very near and dear to most of our hearts - when the spouse calls the office. Now, I know all of you spouses (men or women) that are reading this might get a little upset with me, much like my wife has done for the last 15 years.

I would get a call from my wife and it would go something like this: "Hey, what are you doing?"

I am going to give you time to think about that.
You are in the middle of filling from hell. You have two hygiene checks waiting, you are 5 minutes behind already, and your next patient is here.
"Dr. John, your wife is on line 3."

"Hey, what are you doing?"

I know, I know, it is not fair. I know she is probably in a world of s!@#$%t too and that question is like saying hello. Oh man, my wife and I have had so many fights over this.

When we first got married my wife was new to this town. She had no friends and no job, and I was not that busy at work. So we had time to talk. She would call and I would pick up.

I got busier, it was not that easy for me to come to the phone [first fight]. I know I am supposed to get butterflies every time my wife calls. I know we are a team. So we tried to make it so I didn't get ticked off every time she called. We tried to lay some ground work.

If someone was bleeding at home - yes, call.

If someone was dead at home - yes, call.

If you want to know if meatloaf is great for dinner - no, don't call. (I have told her a thousand times that I ate ham sandwiches for dinner for four straight years. Anything that she puts on the table is going to be great.)

What time is Noah's practice today? - text me.

Did you know that you have a study club meeting tonight? - text me.

If someone got a bad grade at school - it can wait.

If someone got in a fight at school - call me and tell me who won.

Don't forget to come home right after work because momma needs some lovin' - yes, call.

If you didn't know if it was important enough, call and ask if I am busy. If I am busy just leave a message. Now, this works great until the front desk is busy and my wife calls. "Is he busy?"

"No, let me put you through."

"Hey, what are you doing?" she would say.

"I am slammed like crazy and I can't talk."

"Well, I asked Michelle and she put me through."

And I am thinking to myself, "What part of two patients in the chair, two patients in the reception area waiting and two patients in hygiene that need to be checked made me look not busy? [Another big fight, but this one I blame on my front desk people.]

I love my wife, but I have to focus at work. She would say that she comes by and all I am doing is playing around. But playing around is part of the show. I know who is in the reception area and I know who is getting their teeth cleaned. I got a lot of things going through my head, like how much money is coming in that day and what bills are going out. I know what patient is next and what their likes and dislikes are. I know who is running behind and why. The playing is part of the show; it is part of me being focused.

I equate it to a good server at a restaurant. He/she has five tables. They know that table #1 has just ordered their entrees. Table #2 has their check, table #3 has appetizers and hasn't ordered yet, and so on. They are focused and their people are happy because of it. If I lose my focus, work suffers. If work suffers, so does my attitude.

A lot is riding on my focus. I know some of you are thinking that is a lot of bunk.
But it is true. Oh yeah, you are too "focused" to take a call from your wife?
Okay, maybe I am not slammed every minute of every day. But if I am not slammed and I do have a minute, I pick up the phone and call her.

Is there a perfect solution? No. Does she call and leave messages now? Yes. Do we have a perfect system? No. Has she been so ticked at me that she says she is never calling again? Yes.

I mean, she is the wife of the owner and she feels like a second class citizen (my fault). And if the front is busy, maybe they don't treat her like the owner's better half. There have been times that she has wanted to get in her car and come up here and give us all the business. She might leave a message and I won't call her back because I just won't have a second all day. [Another fight ensues] So we are doing more emailing and texting now. I can return the call or the text or email when I get a second.

Please tell me that we are not the only couple that has a problem like this. I know we are not. How do you guys do it? If you have a funny story, I am all ears.

Have a great day. Pray for me on Friday. I will be getting here about 5:30am and my staff will have already gotten started, so probably no blog on Friday. I will try to do one on Monday though.

P.S. I wrote this blog about noon and cancelled out of it and it didn't save, so I had to write the whole thing again. So if this one sucked, trust me the first one was way better. Ah, the joys of blogging.


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