Friday, November 30, 2012
I realize that I only have a handful of blogs left. This is putting a lot of pressure on me. I have been thinking about what to write for my last few blogs, and all this thinking has giving me writer’s block. I just don't think that any topic I write about is worthy.
I started reading all the past blogs. I thought about posting a “best of,” but I don't have time to read all of them. I just don't know. I guess I will just write what comes to my mind and one day I will be gone. It is kind of sad, but I just can't think.
I will give you an update on my lecturing. I have decided to redo my speaker packet DVD and have this drive the audience to my new lecture website. (Take a look at it and tell me what you think. It is still a work in progress. It is www.posteriorcomposites.com. Don't you just love the name?) I have my last planned gig for awhile in January, and that is it for now. So, I am going to have to get more jobs again. Ugh. This is a lot of work. I will keep you posted. I think I will blog from my site, but it is going to be very infrequent.
I want to talk to you about one of the things going on in my life. You all know I just bought out my father. He financed the second half of the buyout for me. When I bought the first half, I was also buying a house. I had a bunch of equity in the house, so I bought the first half of the office with the equity line from the house. Now I am paying off a first mortgage and a second mortgage.
A year or so ago, I wanted to refinance my house. I am paying 5.75% on a 30 year. This is not comparable to today’s rates. We did everything you are supposed to do. We locked in a rate and everything was sent to the bank. Well, after the appraisal of our house, it turned out that we owe more than what it is worth. That means we are stuck paying this rate.
Fast forward to now. I own my business outright and am paying a business loan through my personal account. I went to my local bank to get a loan to pay off my equity line and then start paying this office loan from out office account. This just puts everything where it belongs. It will also free up $150,000 equity in our home so we can refinance.
But this is not what the story is about. One stipulation that the bank made was that I get a life insurance policy on myself for the amount of the loan. Have you guys done this? What a pain. You don't just call the life insurance people and get insurance. Before they insure you, they want to know how healthy you are and if you are sick or not.
First, there was an 80-minute phone interview. They asked if I have ever had bronchitis (yes, when I was 9) and why I had a vasectomy. It was crazy. They asked any question they could think of to find out if I was healthy. They asked if I smoke. I smoke cigars, and it turns out that if you smoke more than 12 cigars a year, you are considered a smoker. It went on and on. The funny thing is that they did not, even once, did they ask me if I exercise.
They sent a nurse to my office to get a blood test, a urine test and height and weight. The nurse took my blood pressure and my pulse (78/118 and 56). I told her there was no way my pulse was 56. I am a marathon runner and my pulse hasn't been over 50 in about 5 years. I took my pulse and got 48. She said that if she wrote down 48, there was going to be a problem. It was too low. She wrote down 56.
Guess who called me the next day. The insurance company, wanting to schedule an EKG. The same nurse came in and said, "I told you so. Even 56 was too low."
Once again, nowhere on this form was a spot for amount of exercise or about how I eat. Anyway, it is going to take 30 days for the underwriters to review my application. Then I get the insurance. Then I get the loan. Then I get to refinance my house. c But the rate is going to be almost 3 points lower, and that is going to be huge. Then I will have all this nonsense paid off in 7 years. Next thing you know, I will be driving my cobra. I can't wait. Won’t I look good in that thing?
Tuesday, November 27, 2012
I am sorry about last week. I sat down to write the blog twice but was pulled in a thousand different directions. Then I realized I can't post a blog during the week of Thanksgiving week that isn’t about Thanksgiving. So I will hold the blog I wrote for later.
Before I forget, you must book the restaurant for your Christmas party. If you haven't done it by now, you are a bit behind the eight ball. I just called the restaurant that we were thinking about. It is going to be a stretch. I could tell they were wondering why people wait until the last minute. I thought I was on top of it by calling a month in advance, but I guess not.
This is going to be my first Christmas party as full-fledged owner. I am looking at the bank account a little differently this time. We have X dollars in the bank. The party is going to cost about Y. Then we have two weeks off paid and that is going to cost Z. So, X – (Y+Z) is a pretty small number, if not a negative number. Oh man. I am grinding my teeth already.
Anyway, Thanksgiving. Man oh man, do we have a lot to be thankful for.
I have to tell you that this job is so stressful sometimes. Okay most of the time. I am usually juggling about 4,000,000 things at once. I dig my own grave sometimes. I am usually five days behind in writing up my charts. But, sometimes this is good because when I do write them up, I remember the good stuff that I did. And a lot of the times I will pick up the phone and call the patients to see how they are doing. I love doing this.
I take a lot of photos of teeth during the day. I can't tell you when the last time I plugged my camera into my computer and transferred them. I think I have about 400 that still haven't been uploaded. I sometimes will send a case off to the lab and tell them I will write up the case and fax it to them. I forget to do that. I am going crazy most of the time, but it is a good crazy.
I leave my office as soon as I am done with the last patient and go straight to the ball field (I change in the car) and don't get home until 9 p.m. Then I go for a run. And I can't understand why I can't make it through a whole TV show at night before falling asleep.
I am a deacon at my church. One of the things I do for our diaconate is manage the Deacons fund with a few other guys. Members give to this fund so that when another member is in financial trouble, they can come to the DF and make a request. This fund is set up to help the widow or the single parent that might be living week-to-week when something like a car breaking down is not in the cards. A kid getting sick can throw a big wrench in someone’s finances. Loss of job, loss of a spouse: you name it, we have dealt with it. Managing this fund is a great dose of perspective that I need almost on a weekly basis. I see the financial pain people are in. I see the people that are financially and emotionally bankrupt and can't get out of it. They need financial counseling and emotional counseling, and they can't afford either. This fund is a godsend to the people that need it. But I can tell you that managing it is stressful.
I am so thankful for my wife (we just celebrated our 17th anniversary last week) and kids, the four apples of my eye. I love taking them to sports. I love throwing the ball with them and taking them to sporting events. I love watching them play and bringing them to church. I love the people they are becoming. I love the servants’ hearts that they have. My daughter is volunteering at an inner city after school program. I am so proud of her.
I wouldn't trade my life for anything. I am so thankful for all of it. I am thankful for a crazy, stressful job. I am thankful for the staff/friends I get to work with. I am thankful for living in the USA, where we are free to do a lot of things thanks to the pilgrims and the founding fathers and all the guys and gals (past and present) in the military protecting us. I am thankful for my community and my patients (especially the ones that don't hurt after I put in an all porcelain crown).
What a great job we have. Yeah, it can make you blow a gasket sometimes, but I have always told you about perspective. We work in air conditioning. Most of us work 4 days a week. We make a good living. We get to laugh when we work. Good stuff.
I am thankful for this blog (my biweekly therapy session) and you guys that read it. It is something in my life that I hold very sacred. I want to think it does some good and brings us all a bit closer together.
I hope you feel like you have a lot to be thankful for. The Bible talks about being content "in all circumstances… whether well-fed or hungry, whether living in plenty or in want." This means that Paul (the guy writing this part) was wealthy and had to learn to be content when he was wealthy. Sometimes this is pretty hard. And for those of us that might be struggling with things (marriage, finances, kids, sickness), the Bible talks about this, too. James 1:2 says, "Dear brothers and sisters, when troubles come your way, consider it an opportunity for great joy."
Anyway, this sermon is over. I hope you had a great Thanksgiving. I hope you had lots of great food, lots of great family time, and lots of football (God, please let the Gators win).
Thursday, November 15, 2012
Man, I only have about seven blogs left. Next week is Thanksgiving, so I might write one blog. Then I will have two a week for three weeks, and then it’s Christmas. I keep thinking about life without the blog, and it is kind of weird. I have been doing this blog for almost four years.
I know it is going to continue without me and I am looking forward to hearing what the new bloggers have to say. But, I am going to miss it. All day, I constantly wonder if this situation is blog-worthy. I must remind myself 50 times a week to “put this in the blog.” Of course, I forget.
I think back about all the funny things that I have written about. There have been some classics. I think about all the trouble I have gotten myself into. I have been through about eight new staff members. I have been through three or four staff members at the AGD. I have bought my practice, had a kid, been to three national championships and have run four marathons. We have been through a lot together.
If you are a long-time reader, leave a comment telling me your favorite blog. There have been some good ones, that’s for sure. The first marathon blog was really crazy and my last one was equally as crazy (the one where I got a ride to the start from an Englishman). I am starting to water up, so let’s talk about today’s topic.
I have had a really tough week. One of the things that gets me down is when a simple thing goes bad. I’m not talking about the bombed out tooth that you try to save. You know, the pulp exposure where you do direct pulp cap on it and you tell the patient there is about a 50/50 chance of needing a root canal. I’m not talking about the molar that has been hurting to chew and you find a crack. You tell the patient that that you will do a crown and see what happens. If the crack is into the nerve, you are going to need an RCT, too.
I am talking about the patient with the 27-year-old MODF filling. It was time to do something with this tooth. There is good and there is bad, and this tooth was in the grey area between them. I explained to the patient that if they waited until it got bad, they would not be able to control what happened. But, if they took care of it now, they could dictate what would happen. Then I recommended taking the filling out and doing an onlay. I believeed what I told them; I was not upselling. This is what I would to do to my teeth.
I took all the decay out and cleaned it up. It looked great. We prepped it for an onlay and everyone was happy. When they came back to put the onlay on, they said the temp was a bit sensitive. We blamed it on the temp not having a great seal, put the onlay on, and it looked beautiful. Three days later, they called back saying it hurt.
No problem. This happens all the time and 99% of the time, it is occlusion. I told the patient that we would get them in here to adjust that. I was a bit angry, but I knew that most likely, this tooth is going to be fine. They came in and I adjusted the occlusion. See you in six months!
Again, three days later, I got the call. This was not good. This is the kind of thing that really gets me down: a tooth that didn't hurt the patient (a friend from church) now probably needs a root canal. I told them to hold off as long as they could. I know it is annoying that it hurts when you bite on it and I know it is super-sensitive to cold, but let’s just see if goes away.
It didn't go away. I do root canals, but I referred this one to an endodontist. I was so disgusted with myself that I didn't want to be reminded of my failure anymore. I don't know why, but this kind of stuff really makes me feel like a sucky dentist.
At the same time this was going, on a patient came in with a broken tooth. It was a #3 MODFL amalgam and a little sliver of tooth that is left. He is an employee at the golf club about a mile from my office, and I was going to wow him with my gentleness and charisma. I told him that he needed an onlay and we would make it beautiful for him.
We did it and he was thrilled. He came back two weeks later for the cementation appointment and he said that the tooth had been a little sensitive. What? I told him that temps don’t seal very well but it will most likely be fine once I put this one in. And we started all over again.
He was back in today for his fourth occlusal adjustment. It doesn't hurt to hot and cold. It only hurts when he eats on it. It is just annoying, not painful. I danced around the fact that he is probably going to need an RCT. So much for wowing him with my gentleness and charisma.
I have been in a total funk all wee, and I know it is because of these two patients. Wait. I put in a couple crowns in the few weeks that looked okay before I cemented them. I cemented them and then my assistant cleaned them and told me that the patients said that the crowns felt high. I adjusted the crowns but saw a band of cement. I don't like seeing cement. That means the margins are not perfect.
Again, this really bothers me. I feel like a very average dentist. Do you get in these funks? I want to do good by these folks. I just feel like I am letting them down.
I am slowly coming out of it. I got a couple of complements today and that made me feel good. Maybe I need some antianxiety drugs (the AGD does not encourage taking pills to make you feel better, unless prescribed by a physician). What can I say? I am an emotional person. I hate being this way, but I guess being this way makes me a better dentist.
How are you guys doing?
Monday, November 12, 2012
Remember that I wrote most of this the day I got back from New York, so some of the info is old.
I want to tell you about my trip to New York. I gave a lecture to the New York AGD last Sunday. I was so excited about going to the greatest city on Earth. I asked a bunch of people in the know about where I should go to eat. More than one person that told me I should eat at Peter Luger Steak House in Brooklyn, so I thought I would treat myself to an awesome steak dinner.
I called to make reservations. On the fifth try, they answered. I told him I needed a reservation for Saturday night. He chuckled and informed me that if I wanted to eat at his restaurant I would have to call six weeks in advance. Oh. That totally took the wind out of my sails.
I got into La Guardia at about 5:00. Then realized I didn't know a thing about where I was and I was uncomfortable. I got in a taxi and I told him the address of the hotel. On TV, you can tell the driver that you’re going to 25th and 8th, and the taxi cab pulls away. But in real life, you give the driver the address and he asks you where that is.
I gave him the name of the hotel I was staying in, and he looked at me like I was an alien. I had to look up the directions on my phone. "My phone says to take a right in .3 miles." Welcome to New York.
I got to the hotel just in time to see the second half of the Gators game. We lost and that put me in a foul mood. I decided to venture out. There were plenty of sports on; I could go have a beer and watch someone else lose. I asked the young lady at the front desk for a sports bar that was close, but she had no idea. I googled "Sports Bar, Queens," in my phone and Yelp came up with about 10. It is awesome because it lists the closest to the farthest and rates them.
I decided to go to the one that was closest. It was 3.2 miles away and it got 3.5 stars. The driver came into the hotel, paid the young lady for calling him, and we drove away. We drove and drove and drove. I started to freak out. I told him that my said it was only 3.2 miles away. Then I realized he didn't speak English. But he did manage to tell me that he knew where the place was. We did finally get there and the fare was $25. Yeah, only in New York would it cost $25 to go 3.2 miles.
One thing I have learned about New York is that they jam a lot of things in small spaces. This restaurant was about 1,800 square feet. There is a bar on the left, a walkway not wide enough for one person, and high-top tables on the right that are barely big enough for two. They must have five TVs. I ordered the A--hole Burger (if something like this is one the menu, you almost have to order it). After dinner and a couple beers, I still felt like crap about my game so I went back to the hotel. I took a taxi and it $25 again. I guess the first guy didn't stick it to me. That is just the way it is.
The next morning, I was to meet the executive director of the NYAGD at 6:30. I got there 90 minutes early to set up and make sure all AV issues were taken care of. It took me seven minutes to set up, so I was 83 minutes early.
I am kind of new to this and I am still very nervous when I speak. Usually I get a lot of energy from the audience. When the audience is into it, I can relax and take a deep breath. The audience in New York was very different. They were a mix of many ethnic people. Maybe their customs are different or maybe they just are not big talkers. I usually try to start my lecture by asking the audience some questions to get to know them. When I asked a couple of questions and no one answered, I knew I was in trouble.
I have heard that this doesn't mean that they didn't like it but that they are just not very vocal. But I was starting to think I was bombing. I started to feel like a comedian that wasn't funny. I continued to ask questions, but I got nothing. I made jokes, but no on laughed. I started looking for the gong. I leave time in my lecture for discussion. Guess what. No discussion. The lecture ended way short of its intended time.
Don't get me wrong. I enjoyed my time there. I was honored that they took a chance on a new speaker like myself. But I wanted everyone (or at least someone) to like it. The worst thing was that my sponsor was there. When everyone left the room, it was me and two big wigs from the company. They just kind of smiled. Theirs smiles seemed to say, "You just bombed up there and we had to pay for it." We chatted for 15 minutes, but all I could think of was that they were just being nice to me and couldn’t wait to get out of there. This is a terrible feeling to have.
This feeling is hard to shake. The high I feel when I think I knocked it out of the park (like at the FNDC) equals the low I feel when I suck it up. I spent the next week wondering if I want to continue this lecture thing. If it is going to go like this, I don't think I can take it.
But who knows? Maybe they liked it. Maybe they were just quiet people. This was a very tough weekend. The Gators lost and I was almost was gonged out of New York.
Hope your weekend was better than my last weekend.
Thursday, November 8, 2012
I am back from NYC and the marathon that never happened. Yep, I paid for a plane ticket. I paid a ton of money to stay at a really nice hotel (really nice hotel in New York is still very small). I found out that the race was cancelled while I was in line to get my T-shirt and my race number.
That was tough to swallow. I am okay with them cancelling the marathon, but to do it on Friday afternoon was a killer. If they had announced the cancelation on Thursday or Friday morning, I would have stayed home. And, of course, the $280 entrance fee is non-refundable. Usually, I like to be kissed before this happens to me.
Anyway, I’m still thinking about the folks in New York and New Jersey and have been praying for you. I hope things get back to normal soon.
We did make the best of it in the greatest city in the world. We stayed about two blocks from Times Square. Wow! TV doesn't do Times Square any justice. There are buildings that have ads that are 30 stories tall.
The weather was cold; it was good for a Florida boy to experience 39 degrees in early November. Between Times Square and the weather, I now really appreciate having a back yard and great weather.
You know the saying, "In a New York minute?" Well, it is hard to not feel rushed in this city. There was no place to just sit and relax. I guess there is Central Park, but it almost seems manufactured. Everyone is working and totally in the rat race but when you do want to relax, even though you know you never will, there is this park in the middle of this city.
We did get to see a show. Spiderman was great. We went to Sparks for dinner (this place was made famous because John Gotti was killed on his way out of there) and got a very overpriced steak. But it was all good. We went down to Greenwich to shop. I got to experience New York. The best thing is that I think I got a pass for next year so I get to do it all again. I feel rushed already.
Oh, I got to fly first class on the way up there and it was SO SWEET. I can't help but think of that Seinfeld episode when Jerry is up in first class and Elaine is back in coach. How can you not feel that way? The seats recline flat. You can lie down! They bring you heated peanuts. They put a tablecloth on the tray when they bring your meal. It is unbelievable. We flew coach back and felt like second class citizens. They won’t even let you have entire can of Diet Coke.
I am reading the book “No Easy Day.” It is written by a Navy Seal about the mission that killed bin Laden. It is pretty good. It is a very easy read, and I need that right now.
Can you believe Christmas is only seven weeks away? If you haven't thought about your Christmas party yet, you are way behind. Get going on that. And don't forget, my Christmas blog will be my last. We have some good people coming in, so you won't be without good reading. It sucks that I can't do this for a living.
Today I want to talk about who pays. A woman who doesn’t smile came in. Her teeth were really bad. Number 7 was missing and all her others were badly decayed. Her husband, a nice-looking guy, wanted to fix it for her. They are not poor, but he wanted to know how much it was going to be so he could save the money. They made an appointment six months later.
We did a lot of caries control, taking the decay out of the adjacent teeth. We did a lot of build-ups. Then I made her a bridge from 6-8 and two other anterior crowns on 9 and 10. We made her a temp. They looked great. But the tissue on #6 was not quite right. See, I put the cord in tissue, for the impression, and it retracted. The problem is that it never came back. The bridge came back from the lab in a couple of weeks and it looked beautiful, except for the mesial margin of #6. The margin was a smidge over the tissue.
I told her I was thrilled with the way it looked (so was she), but I showed her my concern. She wasn't concerned. She obviously wanted them all put in permanently because she thought it was awesome. I told her I thought we should put it in temporarily and see what the tissue looked like in three weeks. She was fine with this.
Things looked pretty good three weeks later. She was thrilled. We took off the bridge and cemented it back on permanently. When I went to remove #9 and 10 to recement them permanently, they wouldn't come off. I told her that I was not going to break these crowns trying to get them off, but to call when they get loose or come off.
She came in when #9 broke off. But the build-up was in the crown and some of her tooth. The temporary cement never came loose, but the tooth broke. Luckily this tooth had a root canal and none of the margins were affected by the break. I did a reverse post and core. Where I do a post in the tooth, I put bond on the tooth and I put the core in the crown (self-cure build-up material such as CorePaste, don't forget to lube the inside of the crown) and then put the crown back on the tooth and it forms around the post. When I take the crown off, I have a post and core that the crown fits on. I did all of this and recemented the crown (permanently).
She went up front to show her husband; he was just as pleased as she was. While they were up front, I had a discussion with my staff in the back about how much I would charge. I put in a crown and it broke. I did the best I could and it still broke. Are we, as dentists, married to teeth we work on? How long are we married to them?
After the discussion with my staff, I decided to charge them for the post and core. I was going to charge them for it but give them a discount You know, something for my troubles. Just enough to pay the staff, for the supplies, and for the electric. I went out front and they were gone. It was the, "Thanks for your work. We are not expecting to pay for anything today." kind of gone.
That ended this discussion. I was NOT going to send them a bill because they would really be caught off-guard and probably get upset. What would you have done? If you do a crown and the whole thing breaks off, is there additional charge to do something else? I am assuming most of you are going to say that it is our responsibility. For how long?
I have to tell you that I don't agree with what I do. I don't think I should have to pay for some other problem they have just because I did a crown. Obviously, the tooth was not strong enough after the build-up. You might say that I should have done the post and core originally. Okay, I would buy that. But I am doing it later. Why should she get it for free if I do it later?
What if you have a patient who breaks an old crown off at the gumline? The tooth has an RCT, so you do a post and core and a new crown. A couple of months later, the crown and post break. Is it your problem? I know the answer; this is a rhetorical question. The person obviously has a bite issue.
We have talked about this before with other things. I hate this part of my job. I want to please everyone, so most of the time I don't charge. What other profession do people come in and get charged NOTHING? No other profession.
Have a great Thursday.
Friday, November 2, 2012
I had a blog all written about my trip to New York and all the things that could only happen there, but I feel like it would be insensitive to post it in light of what they are going through now. So I wrote another one. When they are all cleaned up and back to normal, I will post the other one.
One of the best things about being a general/family dentist is watching the kids grow up. Kids that used to scream and yell and run up and down the halls are now bankers, chefs, doctors. It is so awesome. One of those patients came in this week. He is 21 and we have always enjoyed having him here. He came in for fillings and he was playing with his ring. It was that he wanted someone to ask him about it. My assistant, taking the bait, asked him if he has a girlfriend and if she got him that ring. "No, but I have a boyfriend and we just celebrated our one year anniversary."
There was a very awkward pause and then we all chuckled a little and moved on. Then he asked us not to tell his parents because they don’t know yet. We all agreed that didn’t want to get in the middle of that and then we went on like nothing happened. After he left, we could not believe he had just told us that. Both of his parents are patients here and I like them both. I am really not going to get in the middle of that one. The law says I can't, but even if I could, there is just no way.
I guess when you get to know someone and you like them and they like you, they feel like they can trust you. And we like him just as much as he likes us. There is nothing he could really say about himself that would make us not like him (within reason). You treat us well, you come to your appointments, you floss occasionally, and we like you. Imagine how many people come to your office that you don't know anything about. We have the luxury of just knowing a little bit of people. Sometimes, that is enough.
Have you guys learned something about people that you wish you didn't know? Have you ever had to tell a parent something about a minor? Luckily, I haven't. How about something a wife tells you about a husband? We had a husband come to our office who wouldn't leave because his wife (who had threatened to kill him) was waiting in the parking lot. Yes, she was a patient, too. Talk about awkward the next time she got her teeth cleaned. Tell me your stories.
I am off tomorrow; I am going back to the Big Apple for the marathon. Fifty thousand people signed up to run. Crazy, huh? My wife and I are going for a long weekend and will return Monday afternoon. It should be great.
Have a great weekend and I will see you next week.
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The statements expressed on this blog to include the bloggers postings do not necessarily reflect the opinions of the Academy of General Dentistry (AGD), nor do they imply endorsement by the AGD.