In this ecomony

Hey all,

Eleven days until my marathon. It is too late to do anything really meaningful in my training, so it is what it is. It is going to be a real struggle but I guess that is why it is called a marathon instead of "a nice little stroll through the city." 45,000 people entered in this race!!! Isn't that crazy? How do you manage that many people? I guess we are going to find out. Look for the "Chicago Marathon" blog; it is bound to be a classic.

I almost forgot - Silly Bandz. I know you know what they are. Well, have you ever seen a tooth silly band? We haven't. I Googled it, and there is nothing on it. So our office made them. We called a company and had 5 "Smiley Bandz" made. A molar, a tube of toothpaste, a thing of floss, a set of lips and a toothbrush. And we have packaged them in fives.

I think we are going to sell them for $1 to $1.50. We are going to go to the ADA this weekend and sell them to all those toy companies. I will also get the word out to our local pediatric dentists. I will tell you how it goes. I know the window for Silly Bandz is closing fast and I probably should have done this a year ago, but...

Topic -

I know I have talked about this before, but it keeps coming up so I am going to talk about it again. In this economy, consumers have some high expectations. And providing good service a given. You have to deliver a good product but if you don't do it with good customer service, you are done.

That is a good thing about this economy - the companies that have no business being in business are going out of business. I don't know how it was with you, but in Florida, we were forced to work with guys we just didn't like. The guys that were good and nice, they were booked out years in advance so if we wanted anything done, it amounted to, "Thank you sir, may I have another?"

I had a sign company that I was working with. They have been my sign company for over 6 years. We have this electric sign that has fluorescent lights behind it. It is about 18 years old, and is always giving us trouble. They are doing some minor repairs on it about two to three times a year.

Last year I had them place some bars on the sign that stick out. Now I can hang a banner out announcing something going on in our practice, like our Dentistry Day from the Heart, or a teeth whitening special that we do in December around the holidays, etc.

The last two times I called my sign guy, they said they were going to do it and never called me back. Hmmm. I chalked up the first one to, "It is just a $175 order." Maybe they are a big company and they don't deal with little things like that.

The second time I called them, they dropped the ball again. At that point it became a "Fool me once, shame on you. Fool me twice, shame on you."

About three weeks, ago I called another guy that I have worked with in the past. This is the company I used to make my business cards and they did a pretty good job.
When I talked to him about this he told me he could do it. We both laughed at the poor service I got from the old place. I wanted him to make me a banner to market this Candy Buy Back I am doing for Halloween. He said no problem.

Usually when I put the ball in someone's court I just forget about it. But I was doing some thinking when I was running the other night, and realized this guy has not called me back. So I called him.

He gives me the "I am so sorry, it is on top of my pile. I am so going to get to it today." I could not believe this guy forgot about me. I hung up the phone shaking my head.

And when I was running last night, I realized that about 4 months ago I got the ball rolling on changing my letterhead. To put into perspective how overdue this is, I changed the colors in the office to warmer tones about 2 and a half years ago. Browns and tans and dark wood stuff to make it warmer. My letter head is still teal (hello 80s!).

About 4 months ago I had the guy in and we talked about what I wanted. I wanted what I have now but just with a different color paper. We narrowed it down to my top three. He printed them up and brought in about 9 different styles. We picked one but wanted to make some minor changes. We told him the changes and that was the last we heard from them. Are you kidding me?

Most of the time I try to delegate responsibility. One of my staff members was in charge of this whole deal. So I called and left a message on the machine and told this person (I know she gets the messages), and told her I wanted it done NOW.

At about noon today I was in my office and called her (from my phone in the back to her phone in the front because walking up there would be too much effort), and asked if she had followed up with the letterhead. She said she called and left a message and hadn't heard back.

Then I just sat there. I sat there in silence not knowing if I should blow a gasket right there or breathe and count to ten backwards. I did nothing and she said, "Do you want me to call them again?"

As calmly as I could, I said, "Yes, I think that would be a great idea."

As much as I want to pick on my staff, the ownership of this issue is definitely the printer. This guy has been our printer for about 20 years. We do everything through them. This kind of service is unacceptable.

I can't stand incompetence. I can't stand when I have 40 things to do on my desk and I check one of them off because I put the ball in someone else's court and they drop it. i have filed it away in the "taken care of" file.

And I am probably going to keep using this same printer because it would be too hard to switch; he has all our .jpg files and all our stuff. All we have to do is call and say, "I need 400 business cards," and they show up. But they have gone down on my happiness scale. And one more ball-dropping is going to be fairly costly to them.

But what is happening in your office? Do you get that call from a friend saying, "I called your office last week and tried to get a New Patient Exam appointment and I am waiting to hear back from your office. I think my previous dentist sent my x-rays?"

John, count to ten backwards. This makes my blood boil like you wouldn't believe.
I go to my staff and ask them about it. "Yeah, I called that doctor and requested the x-rays and they never sent them."

Then I say, "Okay, but do you see how this is making us look?"

Not calling back is totally unacceptable. You give the office a week. If they don't call you back or you don't have the x-rays in your hand, you call them again.
But after you call them again you call the patient again and tell them, "I tried to call your previous dentist and they dropped the ball. I called them again. We will give them one more chance and if they don't send them this time you are going to have to either go and pick them up or we will take some new ones."

But not doing anything is not the Gammichia standard. And it is my friend telling me this. How many times does it happen when it is not my friend? How many people are we dropping the ball on and just losing before they even come in the door?
We spend all that time talking internal marketing to our patients. They finally send one of their friends and we blow it before they even meet me.

Customer service - it will make you or break you. Go up front today and just talk to your peeps about how they do stuff. Go over you process. Do you have checks and balances? Does your front desk person have 65 post it notes for things to do?

It is YOUR office. It is YOU the patient is coming to see. I just hope they make it in to see YOU. Because we are about 90% and that has to improve.

I would like to hear you thoughts.

Have a great Wednesday,
john

Orthodontists, beware

Hey all,

I am at a meeting today, so I got a ghost writer to post today. He is a little ticked, to say the least.

I have been biting my tongue long enough. I want to preface this blog by saying that, if you are an orthodontist, I would love your feedback. I would love to hear about the reasons you cannot accomplish what you know is a successful case. In fact, I would love to hear anything from you because another issue I have with you is that you are fairly poor communicators.

Ouch! I am not starting out very friendly, am I?

Orthodontics

I don't know a thing about how to move teeth. I don't know the stresses that are on orthodontists. I don't know the limitations to moving teeth. I don't know anything. I know what a Bolton's discrepancy is, but that'ss about it.

But I do know is what a good bite is supposed to look like. It kind of looks like Class I. ONE. It is the first bite classification that we learn in dental school.
It is what we learned at the first day of the first continuum at the Pankey Institute. Mid-lines lining up. About 30-40% overbite. Anteriors actually touching. Canines lining up so that when the jaw moves to the left or right, the canines guide the occlusion. I think this is called CANINE GUIDANCE. What I also know that when someone's teeth are in a good class I occlusion, their teeth last longer.

This is something I know because I have seen it. I know from looking at 5,000 65-year-olds with all their teeth. I know that having a good bite will make teeth last longer with less dentistry. Simple.

So why is it that only about 40% of my patients come back from the orthodontist with a bite I can be proud of? And I feel like I refer to really good orthodontists!

Here is my deal. Regardless of what the orthodontists think, WE, the general dentists, are responsible for this patient. They see this patient for 2 years but we have to see them for the rest of their lives.

While I can't speak for the rest of the general dentists, I feel responsible when I refer someone out. It stands to reason that, when I give a patient a recommendation to an orthodontist, I am somewhat responsible for the result.

So when then come back to me and their front teeth don't touch, I feel responsible.
When they come back with a 10% overbite and they don't have canine guidance, I feel responsible. All because I know the long-term implications to a bite that doesn't have canine rise.

Before I forget, I am not sending you a patient of mine to straighten their teeth. Straight teeth might be what my patients and their parents are looking for, but not me. I have seen tons of people with perfect bites that have crowded front teeth. And these people are far better off dentally/occlusally than the straight-toothed person that has no bite to lock into.

I live and die by my results. I want my patient to be happy with my dental work. But really I do dentistry to make me happy. Let me explain.

My patient doesn't know anything about dentistry except what they can see and feel. They can feel a shot, whether it hurts or doesn't. They can see if a filling looks good or not, and if it is a "white filling." They know if it hurts afterwards, and if it looks okay, they are thrilled. That is what the patient knows.

Me? I know about the decay. I know about the bonding materials that will make this thing last longer and not have any sensitivity. I know the composite materials I put in this restoration. I know the matrix bands I use. I know anatomy and making this thing look like a tooth. And I try to do this at a fair price.

When the filling looks good, and I know all everything that went into it, and I call them the next day and it doesn't hurt them, I know they are going to be thrilled. But most importantly, I'm thrilled.

I can't imagine that you, as an orthodontist, can't see what I see. Are you seeing this kid in this end-to-end occlusion and resting well at night? Are you thrilled with this result?

If not, then what the hell are you doing sending them back to me? And you send them back to me with a form letter with your signature on it. "Looks great, great kid. Thanks for your referral."

NO, it doesn't. I am supposed to tell you that it doesn't look great?!?! You should know.

If it doesn't look good, you know, and I know it. Why do you send that letter? It should be a hand-written letter telling me why this case looks the way it does. It could tell me the issues you were having. It could tell me about this kid's non-compliance. It could mention that the teeth, regardless of the force, would not move. It could tell me that the narrow palate was too much to compensate for. It could tell me about how the angulation of the mandible was a crutch that you couldn't overcome. But don't insult me by telling me the result was great.

The worst part of it is the money. Not that I think that it is not worth it. I am not talking about how much money it costs. I am talking about what some parents have to go through to afford orthodontics for their children. They go into debt to have their kids in braces. There are parents who can't afford it but still do what is ever in their power to pay for their kid to go into braces. They take money out of their 401k. They keep buying their clunker cars. They don't go on vacations. And all so they can do for their kids what they think is best for them.

This is very hard for me to swallow. I take this very personally. I know my patients and, sometimes, I know their struggles. Sometimes I will do things for a reduced price in order to make it more feasible for them to afford it.

Then, when it is all said and done, I have to go out in the reception area and lie to them? I go out and they say, "She got her braces off. Doesn't it look great?"
And I smile and say, "They sure are straight."

We both know that she has non-working interferences, she is end-to-end on her molars, and her anterior teeth don't touch. But they sure are straight.

Is he alone on this island? Is he the only one frustrated? I don't want this to be an orthodontist-bashing session; I want it to be constructive. I do have to agree with him on some of this. I agree that communication has to improve, but I think it must start with him.

You can comment now. But remember, no ortho-bashing. Just tell us what is on your mind.

Have a great weekend,
john

P.S. If you are an orthodontist, take a deep breath, marinate on this. Do not spit your venom yet. He is not saying that you don't care about all of the things he cares about. He knows you are passionate about your work. He knows you care about the money and how the parents have to sacrifice to have the work done. He knows you are good at what you do.

Think about this being the first step in treating your patients better.

Hey all,

On Monday, David, Noah, and I all went for haircuts. Here are some photos.

Now, THAT is a mullet. Business in the front, party in the back.

He almost has a real comb-over going on.

(That is my sister. She owns a hair salon in Orlando.)

"Okay, you stand in front of him and distract him, and you stand behind me and hold his shoulders."

"Daddy, I love my new haircut."

Noah, Noah, Noah. Man, I am telling you he is one funny six year old. In the car on our way home from getting hair cut, he said, "Dad, when David came out of mommy's belly button, could you see inside?"

"You mean could I see her guts and stuff?"

"Yeah", he said.

I said, "Yeah, I could see all of her guts." While I am saying this, I am thinking is it time to tell him that kids don't come out of the belly button. So I continue, "Noah, I think it is time I told you that babies don't come out of the bellybutton."

"Well, where do they come out of?" This is where I almost said, "Ask your mother," but I was in this so I might as well go all the way with it.

I said, "The babies come out of the pee pee hole." He said, "WHAAAATTT?!!!!" Listen, I was not going to get into all the parts of the anatomy with my six-year-old; pee pee hole is simple.

I hear him back there talking to himself, "How do the?... What can you?... David came out of the?..."

"Dad," he said, "How can a baby come out of there?"

"Well" I said, "God made women very strong and their skin stretches to let the baby out." I said, "It hurts, but they can do it."

"WOAH!!" he said. It was quiet in the car for a minute or two, and I wondered why the questions about babies, because I know he didn't want to know all that.

So I asked him, "Why did you want to know about babies and mommy's guts and everything?"

He said, "I just wanted to know if you could see the stomach and if you could see the stomach, could you see food in the stomach?" So all that because he wanted to see if you can see food in your stomach. I am telling you, he is hilarious to be around.

I ran 22 miles this weekend and I did great. The Chicago Marathon is less than 3 weeks away. I am not saying I am going to break any records or anything, but at least I feel better about it. I think I did so well because the weather is changing a bit here. It was 74 degrees at 4am on Saturday. This is a big change from 82 like it was last month. I am a sweater so being a little cool is better on my body (let's not get too excited: it is supposed to be 92 this afternoon). And Chicago will be much cooler than here... I hope. So I am excited about that.

Topic -
BPA... You guys been hearing much about this?

Well, it is a chemical whose derivatives are in dental sealants. And they are saying that after a sealant is done this derivative metabolizes into actual BPA. Who are "they?" Well, all you have to know is that CNN and other major networks are running news bits on the controversy regarding dental sealants, all sparked from an article published in the Journal of Pediatrics.

BPA is bisphosphenol-A, a toxic chemical that is an endocrine disruptor. BPA is used in many plastics and also used in the lining of metal cans, and they think it might be linked to a variety of medical conditions in adults and children. Some physicians say it can cause "disruption" in very small doses.

Don't think I am all that smart and I know all this off the top of my head. I just did a Google search to get all this information. The article I was reading quoted a doctor saying that "you can get more estrogen in your mother's kiss than you can get from a sealant."

The article also went on to say that the biologist Fredrick von Saal, the well-known critic of BPA from Missouri, still had his kids' teeth sealed.

But after I read this and let it sit for awhile,I started to think. What if this thing got traction? ( We all know it doesn't take a lot for something to get traction. It doesn't need facts or truth to get traction.)

If this thing got traction, do you know how much trouble our industry would be in?
If BPA is plastic and most of the stuff we use is resin - resin fillings, resin cements, sealants, composite crowns, all the composite veneers - this is all going to come into question? WOW.

Think of the world of crap our profession would have to go through. What would our profession be without resin? Amalgam was getting a bad rap in the mid to late 90s,
but we had an alternative that everyone loved. It was easy to say, "I just won't use amalgam if it is going to cause my patients to be concerned."

But we don't have that alternative to resin. Gold, ceramics but that is it, and both of those are much more expensive. Can you imagine if some needed 8 fillings, and you had to do 8 gold inlays? You have just increased the cost of dentistry by 500%. (Maybe more, as gold continues to go up past $1600 an ounce).

I have never been the "world is falling in" kind of guy. But I don't know about this stuff. I want to hide my head in the sand and hope it goes away. But I know how media is, I know our profession, and I know there is a big to-do about access.

This could be a pretty bad thing. I am not saying I want to put bad things in my patients' bodies. No - I want the scientists to find that it is not a bad deal. I want my products to be safe to my patients. I want to go on, and my life not to change. Is that too much to ask?

Have you heard of this? Do you know enough about this that you can enlighten us? Have patients started asking you about this? If you don't know about this, you might want to brush up on it because people are going to start asking you about it.

Have a great Wednesday.
John

P.S. I am going to the Florida Academy of Cosmetic Dentists annual meeting this weekend - should be fun.

P.P.S. I just realized the ADA annual meeting, for which I have signed up to volunteer (I was supposed to host a little-known speaker named Gordon Christensen), and have signed up and paid for 7 classes at, is on the same weekend as the Chicago Marathon.

I swear, I am such a dumbass sometimes.

I may not know aerodynamics, but I did stay in a Holiday Inn Express last night

Quick write-up today as I just have a half-day today and it is packed.

I hadn't planned on addressing it at all, but as I was driving in today I passed a pack of cyclists. Interestingly, my blog must have made the papers because all but one of them were wearing loose fitting shirts. Amazing, I don't know how they could tolerate the heat in a loose fitting micro-fiber shirt. And since I mentioned it here, I never said in my prior blog that there were not benefits to choosing your wardrobe based upon your activity. There are multiple fabrics that are moisture-wicking that are not skin tight also. I never said I run in cotton shirts and shorts, I just said I run in loose fitting shirt and shorts - amazing that micro-fibers can be made in a variety of sizes.

Now, on to dental issues. I attended the Kansas AGD Annual Meeting last Friday and had an awesome time. The speaker was one I have been wanting to hear for quite some time and he was amazing. If you have not had the opportunity to meet and/or learn from Dr. Lou Graham, you are missing out. As the KAGD President, I spent some time with him before and after the meeting and he is just a wonderful man, very down-to-earth and practical in his dentistry. I love learning dentistry from wet-fingered dentists!

OK, better leave it at that today. I am going to let the voices relish in the fact that the KC Chiefs are 2-0 and the Dallas Cowboys are 0-2.

Have a great week,
ric

Dunkin' Donuts

Hey all,

I was on my way home on Wednesday when, as I was pulling up to an intersection,I saw what I thought was someone hitting a garbage bag with a car, and garbage flying everywhere. It reminded me of when the bird flew in front of that Randy Johnson pitch.



Well, it turned out was a man on a motorcycle being hit by an oncoming car. The stuff flying everywhere were pieces of his motorcycle, and then I saw the guy flying across the intersection. I want to say he flew about 75 feet (to quote Clark Griswald, "50 yards").

I was pulling up to a red light. My heart started to race. What the heck do I do?
I started to call 911 but, as I was dialing, I saw this guy start to move. I threw the phone down and ran to him. I didn't know what I was going to do when I got there, but I ran.

He was starting to try to sit up. I put my hand on his shoulder and told him that he was in an accident and it would be best if he just laid down. He was scraped up pretty badly and his leg was starting to bruise. He had a 4 inch gash on his side but he was not bleeding anywhere. I did a quick check of his teeth and they appeared to be okay, so I maxed out all my emergency skills.

He could move all his extremities and he was fairly aware. Next thing I know, there were about 5 people around me. Someone was flashing some sort of badge but he was not a police officer; he could have been a correctional officer for all I know, but it looked official. I called out for someone to call 911. Some woman was walking around this guy praying out loud calling for Jesus' blood to pour out on this man. A couple of people were milling around trying to make heads or tails of the whole thing.

There was no sense in me asking him if he is alright because he wasn't. But he wanted to try to get up. I put my hand on his shoulder and told him getting up would not be a good idea. He pushed against me; I pushed him down.

It was about 4 minutes of me just kneeling beside him with my hand on his shoulder staring at him and making sure he didn't do anything to make his condition worse. Then I heard all the sirens. Within 2 minutes of me hearing the first siren there were about 12 policeman, 2 fire trucks and an ambulance.

But I am shocked at the casualness of the police officers. I mean, a guy lying in the middle of the street cut open that was just flying through the air after being hit by a car is a big deal to me. To the cops it was like... whatever.

I am not saying they weren't concerned, but it was so everyday for them. It is kind of crazy how this stuff happens really everyday for them and it could get kind of -for lack of a better word - boring.

Anyway, it wasn't boring for me. But after I saw that everything was under control, I kind of just went back to my car, pulled around the fire truck and nine cop cars and continued to drive home. Just in a day's work.

Okay - topic de jour.

I have a patient, very nice, 38 year old female, couple of kids, been a patient for 5years or so. After her cleaning and exam tells my staff she wants to talk to me. I never know what to think of this. Most of the time I hate people wanting to talk to me. Because most of the time it is not to thank me for just being such a great guy and they are thankful everyday for what me being their dentist has meant to them and their family.

So I bring her in a room and she wants to ask me a favor. OH BOY, it is one of them. I already know what this is. She wants something big from me. What is going to be? Her son is on a baseball team and she wants me to be the sponsor? Her daughter is in dance and they are having a performance that needs a title sponsor? Is she starting Amway and she wants me to try some products?

Then she tells me the story. She gets coffee every day at our local Dunkin' Donuts.
She has gotten to know one of the employees and she couldn't help but notice this girl's teeth. She is 25, cute, getting married in a couple of months and has held off getting her wedding pictures because her teeth are so bad. My patient has asked me if I could take care of her.

There are a couple things that I can't say "No" to, and they include people that can't eat and people that can't smile. I said I would see this person and I would see what I could do.



WOW!!! She wasn't kidding.

Do you guys ever get this? Do patients ask favors of you? Is it because I do my dentistry from the heart? Is it because I am just nice? Is the word getting out?

I mean I don't even really know this patient very well. I know she probably knows I go to church, but that is all.

Okay, let's say this happens to you. A patient says that she knows someone that makes $9 an hour needs and $2,000 worth of dental work. And there isn't any way they are ever going to be able to afford it. So they put it in front of you.

Do you say NO? Do you say I will split it with you? Do you say I will do it for a discounted price and have the patient pay you? I didn't know what to do and I still don't do anything.

Sometimes, I feel like if I say I will do it for half price the girl is not going to be able to pay for it. But I know what you are going to say. You are going to say that the patient has to pay something to give it value. So do I charge her $200? Will this make her value $2000 of treatment. But again the $200 would not be for me (because it doesn't do it justice, but it is for her)
I don't know but I think I will do this next time but this time I just went ahead and did it. I think it took me 2 appointments and it took a total of 2 and a half hours.




I got to tell you, I love making people be able to smile. I changed this girl's life. I had fun. I could take photos. Did I tell you I changed this girls life.

You can say I am a fool. You can say that I can't help everyone. You can poo poo all this but....
What better marketing can I do?
I called her to see how she was doing, and she said she was doing great. She also told me she gave the owner of the Dunkin' Donuts my card. She said everyone is noticing and she is giving everyone my card (I really hope she is not telling them I did it for nothing).
And, OH!! That patient that asked me for a favor? I sent her before and after photos and I am pretty sure she is a patient for life.

What would you do?

Have a great weekend,
john

I've got a 22 mile run staring me in the face for tomorrow. So, if you need, me I will be on the couch all day after my run. It is going suck because all I will be able to watch on TV is college football. It is really going to suck.

Who's the boss

Hey all,

I just signed up to do the Halloween Candy Buy Back. This is what it is: I will buy back all your Halloween candy. I will pay kids $1 per pound of candy. Then I will send all the candy oversees to our troops. I haven't done it before, but I have heard about it and have always been jealous of the guys that do it. So, I just did it. I am having a banner made for my sign (which I can use every year) and am making a press release as we speak.
Hey, I think this would be good press. And I can rid the world of dental decay one kid at a time. Not much going on otherwise.

Today's topic is going to be on Office Hierarchy. Who is the boss?

I am going to speak from a dentist's perspective. So let's talk a little about the different styles there are. I am going to list them in no particular order, and I am not going to knock any style because they all have benefits and issues.

There is the dentist that is a dictator. This style is, "This is my office. I dropped all the Benjamins to get this thing going. I am the chief. I like to make all the decisions and all decisions that I don't make have to go through me." The good about this one is the employees, for lack of a better term, "know who's boss."
Now, if you are an employee and are reading this or one of my employees reading this, don't get all bent out of shape. Let me explain myself.

When you come into a dictator's office there is none of this, "I think he/she should do this and when he/she does it, I think they should do it this way." No, this doesn't happen, because this is not even in the realm of possibility. Because if you mess around like that you would be gone in a heartbeat. This kind of dentist does not mess around. It is like North Korea: if the government hears about you complaining or talking bad about them, you end up in jail or you end up floating in a river.

The issue with this style is that you are on an island at work and, while that might be just fine for some dentists, to me, making all the decisions is very difficult and draining.

The second style of running an office is the exact opposite of the first. In this style, the dentist hates managing an office so he/she farms this job out. You will see this type of dentist hire an office manager and let this employee run the show, so to speak. The way they feel important is having the office manager give them a report. They can get involved if they so chose, but if things are running smoothly then they try to stay out of the way. This style is appealing to the dentist because they don't have to manage people or insurance or missed appointments or anything. And if something does go wrong they can blame someone else. They get to do dentistry and be concerned about teeth and that is all.

The issue I find with this one is that when there is an issue in the office and they want to change it, they get frustrated because they don't know how to communicate. So they leave it alone (hoping it will get better, even though they know it won't). And the only time they really speak up is when they are so pissed off they explode in anger. They yell at the staff but the only one they are really mad at is themselves because they should have spoken up when this fire was a spark and they know it.

The next management style is an office democracy. The dentist and the staff constantly work together to make decisions. For the dentist that likes to make decisions but doesn't want to hold all the responsibility, this is the perfect place to be. This gives the staff some ownership. In theory, they would be invested in how the office does. The job becomes a little less than a 9-5 thing.

But the issue is that have you ever tried to get 9 women and one man to agree on something. You give people decision-making power, and they might take this a little too far. One person is a little more forward than the others and the quiet person feels slighted because they haven't been heard. Or when you make a decision that wasn't what everyone wanted (say it was a 60-40 vote), 40% of your staff is going to be upset. (Please see the present American government.)

These are the three that I am going to cover today. Of course, there are blends of all of these, but I think I have hit a majority of the ways to govern.

Now here is my take. I have seen all of them. I have a friend that is a dictator. He is a super guy, but has always built a wall between him and the staff. He doesn't get emotional. Most things are black and white. There are things you can do and things that you can't. If you talk about him behind his back, you will be terminated.

There is complaining. I don't think they even have much of a Christmas/Holiday party. This is just how he rolls.

I am a people person. I am an approval-seeker, so I want constant feedback from my staff. So this style doesn't work for me, but I can tell you when poop is hitting the fan you will hear my say, "I wish I did it like he does it."

Democracy. I think it is awesome for our country, but it is tough in a dental office. I do govern this way sometimes. Like I said earlier, some people are going to be upset. Now you know that I have an alpha dog assistant and she kind of chews my ear off everyday about the way I should do things. Then she goes around and makes others understand (being very politically correct) her train of thought. Now, with the staff I have now, everyone really gets along and making a decision is easy. But this way doesn't work all the time in my office, or it might not work at all in other offices.

The office manager way of governing is the way my father did it. And it worked well for him. He is not a very confrontational guy, so if there was ever a staff issue, the office manager took care of it. She took care of insurances, she took care of getting the carpets cleaned, she talked to the lawn guy about the dry spots in the grass, she ran the staff meetings, she hired and fired. She did it all. The problem is, we don't have an office manager anymore so now we are kind of aimlessly governing.

For the first 10 years of practice, I was able to punt all decisions. If I was having a staff issue all I had to do was go to her. Let me tell you, this is a great way for a young dentist to get started. I was so concerned about not hurting a patient and getting my dentistry right it was nice not to have to deal with ANYTHING.

Now though, I think I am a combination of all three. There are times when I am a dictator. It is not always, but I have found it in me to put my foot down on some issues. It is tough for me, but I realize to be a good leader and to make myself happy sometimes I have to do it MY way.

I run the office like a democracy most of the time. I feel like it gives the staff some ownership and it makes them feel heard. And I think they make good decisions most of the time. I mean, they are consumers too. They know how about customer service. Just as long as they know they are making a decision that I would make. "How would John do it?"

And I think I run the office with an office manager sometimes too. The way I do this is by giving staff responsibilities. I will make someone responsible for a project. I tell them to make it their own. I will ask someone to get the carpets cleaned. I will ask someone to be in charge of a marketing plan for us. I will put someone in charge of all our aquariums. So everyone will be an office manager at some time or another. It seems to work. Again for me it is all about making them own this place, which I hope gives them more of a reason to like their job. And when they like their job and do it well, I am so much happier.

That's that. What do you think? Am I missing something? How do you manage?

Have a great Wednesday,
John

I want to be aerodynamic

Driving my kids to school a couple of weeks ago:

Despite its reputation, Kansas is not perfectly flat. Particularly on the eastern edge of the state, we have a number of rolling hills and the drive from my house to my kids school (although only a few miles) is pretty hilly. Since it is also in the suburbs, it is a very popular area for bicyclists to train and ride for exercise. It is not uncommon on the weekend to run into packs of 15-20 riders out for what must be a 2 or 3 hour ride - between the hills and the ever present wind, it can be quite the workout.

I am not a bicyclist. I do have a bicycle, but I also have a circular saw and no one would say that I am a carpenter. I enjoy riding, but it is not my chief form of exercise - that would be running. I know what you are thinking, the guy in the upper left hand corner of this blog post does not look like a runner. I agree, God did not bless me with long legs or a thin torso - but I run none-the-less. Most evenings you can find me running on one of the many trails around the Kansas City area. I will be the big guy in the baseball hat, baggy shirt and baggy shorts. Actually, if you do see me biking I will look the same, except with a helmet, baggy shirt and baggy shorts.

This is what makes me laugh at the "bicyclist" I saw when driving my kids to school. Anyone who has watched even a snippet of bike racing knows that the bicyclists look like European NASCAR drivers. They are wearing tight, skin-tight, singlets with the names of sponsors all over them. They are very brightly colored and just look fast. They are slick and shiny, and on a 130 pound man, probably improve aerodynamic efficiency and can result in seconds being saved off of a time trial or kilowatts of power being saved on a mammoth climb in the Alps.

However, to the easily 250 pound man riding up the hill a couple of weeks ago, I do not think a skin tight racing suit is reducing your aerodynamic drag. I'm pretty sure it is your gut. I too am gasto-intestinally challenged and find that my gut reduces my aerodynamics. I don't think cramming that into a sausage casing is going to help me any. Just because I dress like an athlete doesn't mean I am one. In fact, since it appears you are trying to exercise for health and possibly weight loss, increasing your drag will only increase the calories burned - work smarter, not harder.

I love to take these random moments and make tenuous links to my practice. And since I celebrated my 4th anniversary of my 1st patient on Saturday, I am going to take the liberty to do just that. See, the reason people dress like Lance Armstrong when they are riding the bike is because they want to imagine that they are Lance Armstrong. They put on the clothes not for the purpose for which they were intended. Lance Armstrong doesn't wear those clothes so that he feels like a bike rider; I'm pretty sure you can ride the Tour de France in jeans and a sweatshirt. He wears those clothes because they make him better at what he does.

Our practices are the same way. The reason my practice works and survives is because I do things that make me better. Dr. G. does the same thing - what works for him may be silly if I do it and vice versa. This works for so many of the things that we have discussed on the blog over the past year - what clothes you wear, what equipment you use, what CE you attend.

The best armamentarium is the one that makes you better at what you already do very well - it is the icing on the cake (pardon the caloric analogy). I didn't start my practice trying to look like it does today, it looks like it does today because I have continued to fine tune it and adjust it. I have become more stream-lined and aerodynamic in all phases of my practice. I can dress my office up in signs and music and fancy gizmos but if I'm not already good without those things, people will notice. It is called a dental PRACTICE because we never get it right - we are always adjusting and fine tuning. If we get bored or feel like it is stagnant, maybe we need to look and see if it is time to increase our aerodynamics. Maybe it is now time to wear a skin-tight suit to work with ads for GC America and AGD on your back.

Or maybe it is time to realize that the practice you are frustrated with is not really what you wanted it to be. You were like the guy dressed like Lance Armstrong but frustrated because you can't climb a simple hill in a Kansas City suburb without hitting your cardiac max. Maybe it is time to take off the costume and embrace who you really are. May your practice reflect you - not your dad, mentor, management consultant, colleague.

That's it from me today. I'm going to let the voices enjoy doing some dentistry.

Have a great week!

ric