Friday, December 25, 2009

Friday, December 18, 2009

I Can't Stop.

Hi all,
As an aside this will probably be my last blog of the year. I am working Monday and Tuesday of next week and that is it for the rest of the year. So I probably will not be able to have time to blog next week, considering I have lots to buy and I don't have all my lights up on the house. I mean I did it all but then I went to Lowes yesterday and they had all their Christmas stuff HALF OFF. I bought about 10 boxes of lights. $3 for a box of C-9 lights...are you kidding me. $3 for a strand of those tubes light, oh I had to get 5 boxes of those.

So I want to say Merry Christmas and Happy Chanukah to all of you. Have a great New Year. It has been a tough year for some of us, but let me remind you how blessed we are.

I hope you all of you get some good family time this year and some good eatin'. I will see you next year.

My daughter said a Madisonism this week that I thought you would get a kick out of.
After Thanksgiving, I play nothing but Christmas songs at the house, in the car, and at work. I want to get in the mood.
Well we are in the car and the song Angels We Have Heard on High starts to play. So the lyrics are Glooooooooo-ooooooooooo-ooooooooo-ria, In Excelsis Deo.
So we are singing and Madison says, "How are we suppose to know what we are singing when they write the song in German?" . My wife and I totally busted a gut.

In my book Tim Keller is talking about how Success can be a god, which I can relate to.
Some of us are driven by success and we find our identity in success. Success becomes our god.
He also says that as he had counseled people in life he hears things from the affluent that he never would hear from the less affluent.
Things like, "Life isn't suppose to be this way."
He says he never hears this kind of talk when he is around the poor.
Why do we think that because we have money and we are "successful" s!@#$%t isn't going to happen? Do we think because we work hard and have some means that we are not going to have issues? No, but I think it does mean that we will work hard to persevere.

Okay about our topic.
I have to tell you that I only got one comment from yesterday's blog. I am not going to take it personally. I am not going to think that no one is reading. I am not going to thing that no one likes me.
I am chalking it up to too much eggnog on your behalf.
The one comment....
Word is getting around about what a great guy you are John and people are starting to take advantage of you. I do help certain people out in my office but only the ones I know, not people off the street. What I do to prevent the flood gates of what you are describing from opening is to volunteer at a clinic that is set up to help people in need. This way I help people who need it but it has nothing to do with my office.

I do agree with some of this commentor's comments. I especially like the "great guy" comment. But I get an e-mail (I don't know how they get my personal e-mail) and it asked me to help. What do I do ignore their request? It is 20 minutes out of my day, a day that I might add is NOT stocked full of paying patients at the moment. Maybe I won't help everyone "off the street" but I might help everyone that at least asked me.
Now this person says he helps "the one's he/she knows" but I have to tell you I am helping people I know from church that I don't really like.
Sometimes if you know them, you know that they are in a position that they are in, not being able to pay, because of their lack of drive. They are adults that are stupid and have been fired from their jobs and then their kid falls down while ice skating. Do you punish the kid because their parents are lazy asses?
See sometimes knowing people is worse then not knowing them. You just fill a cavity and let them go. You don't have to know why they lost their job, you don't have to see what kind of car they drive, you don't have to see their new blackberry with the data plan and cringe.

I have told you that I think of my talent as a gift from God. I told you that Jesus talked about us multiplying our talents and he talked about what it would look like if we didn't multiply our talents...not good.
He talked about Feeding the hungry, clothing the naked, visiting prisoners, and if you read between the lines, you might see fix or pull the teeth of the decayed.
"Whatever you do to the least of my brothers you did unto me."
My problem now is I can't stop. I can't say NO.
I know it is terrible business. I know in the long run it is not really helping me (meaning I don't think all of my patients that I don't charge are running out and telling their rich friends all about the gentle dentist they just went to).
I guess what I am going to do is go with the flow. As the economy is crappy, people are going to need me. If the economy gets better then people are going to need me, but this time they might be able to pay.
I will continue to help people with reckless abandon, and I am not going to think about it. If I have openings in the schedule I can either walk around the office and get pissed about seeing my staff huddled around the front talking and laughing and doing nothing or we can help someone in a bind. (This is not a jab at my staff, sometimes there is just nothing to do).
I think this is just how I would wanted to be treated if I was in a bind.
Will some people take advantage of this? Absolutely. Do they take advantage of me? Absolutely. But I try to not think about it. I don't want to not help the masses because one person is a total mooch. (At my Dentistry from the Heart free dental day, someone rolled up in a current model S500 Mercedes).

I know it is crazy. It is a terrible business model: to just help someone without any questions, to do it and never think about it again, and go home and feel God's pleasure.
It is in my genes. I just can't stop.

I am glad we had this talk (I feel like it was kind of one sided)

Have a great holiday,

Tuesday, December 15, 2009

Freebie Dentistry

The weather here in Central Florida is crazy.
It was 85 degrees here yesterday. Unbelievable.
Football is over.
In the fifth grade league, we had our best game I have ever coached on Saturday only to be followed by our worst game of the year on Tuesday. It didn't help that our quarterback couldn't play. So we played with our second string quarterback but in this league every kid can't play every quarter so for one quarter we had to play with our third string quarterback. One problem we don't have a third string quarterback. So we tried one play with this kid and he said to me in the huddle, "I don't want to play quarterback anymore."
The kindergarten/1st grade league...well it was definitely a challenge. Fun but a challenge.
But it is over. I am sleeping again.
Just to let you know we have already signed up for basketball.
The saga with the unhappy patient is over.
Spoke to everyone I could think of to ask advice. I have to tell you the advice was very polar.
I would say 30% of people whose ear I bent said, "Tell him to stick it and don't give him any money back."
The other 70% said to give it all back. Not just the $950 but ALL of it.
Here is my train of thought.
I want it to go away. If I give the guy $950 back it has an 80% chance of going away.
If I give it all back to him there is a 99% chance of it going away.
I have told you in the past I am sensitive. I am probably a lot like most of you.
I am a people pleaser, and I will do anything, even at my own peril, to please people (my wife may disagree).
After much deliberation I decided to give him the whole thing back, yes all $1700 back.
It f@#$%^!ing kills me to do it but I don't ever want to think about it again.
So I called him and told him that I have decided to give him the whole thing back.
But here is the kicker, he said, "Thanks, this is really going to help me with this credit card statement." Then he added, "I hope I can come to you for my future dental needs."
I said, "This I am going to have to think about." Knowing this was the last time I was going to talk to him or see him in a professional capacity EVER.
I wrote the check and the dismissal letter at the same time.
In the letter I told him that I wrote the check not as admittance of guilt but in my last effort to make him happy. I told him I thought the product was superior and my effort was over and above what the average dentist would give.
Good riddance.
I told you I am reading a book called Counterfeit Gods.
It is about how we substitute things such as money, woman, children, our house, etc, for God.
But the funny thing is that we are not the first generation to do this. He backs all the stories about us with stories in the Bible. Stories of people 2500 years ago doing the same thing.
It is short book, but it is intense.

Okay topic,
I have this patient that has really bad teeth. He had gum disease and crowding and his midline was off over 5mm.
I have him go to the periodontist to see what teeth could be saved. The periodontist and I came to the conclusion that the best thing to do was make him a denture. We did and he looked fantastic.
A couple of months later his wife came to me.
Let me back up...this is a working family. She is a businesswoman and he is a works for Universal Studios. They have a couple kids.
A normal working-class family. This is my wheel house. These are the people like me.
She comes in. She has some missing teeth in the back and some decay, but in the last 5 years she has been trying to reel in her dental problems.
She had her front 6 teeth redone with all porcelain crowns. She had more than 3 root canals in the same teeth. So from what I gathered, she spent more than $7,000 to have this done, which to their family was A LOT.
She came to see me because one of the crowns came off.
One first look, her crowns really looked good. I went in her mouth and oh my goodness.
The lingual (tongue side) of her crowns were so open. Some almost a millimeter. Now you non-dental people, a millimeter in dentistry is a huge number. Me saying a crown margin is open a millimeter is telling dentists how poorly this work was done.
I basically had to break it to her right then that the work was not very good (I said it professionally, but basically got my point across) and I said that all of this work was starting to fail.
So I didn't hear from her for a while but about a year later another of the crowns came off.
I put the crown back on and reiterated my concerned about the other teeth.
She knows she has to do something but just can't.
Recently she has written me a letter telling me how much she likes me and begging me to go on the dental plan that her company pays for.
There is almost no way out for her.
Okay so what do WE do? I am talking about you and me. I am talking about the patients you see that have a need and you know they can't afford it. I know this scenario is not just happening to me.
I have to tell you that this stuff kills me. I have such a hard time thinking "I can't help everyone. Everyone has a story, and if I helped everyone with a story then I would never work for money again."
Or, "I hate it that they have this problem but what am I going to do?"
My thing has always been that everyone is not the one sitting in front of you.
Meaning this person is the one with the problem. Not everyone else. We will deal with everyone else later. Right now let's deal with this person with this problem.
This year, by leaps and bounds, I have given away more dentistry than any other year.
I probably did more free work this year than I did in the previous three years put together.
I don't know if it is the Dentistry from the Heart day that I do or people have heard about me through word of mouth (maybe I am getting a reputation), but I have received requests from so many outlets this year.
I have received so many e-mails from people I don't know.
"I have a husband that is out of a job and his tooth is hurting so bad. Can you help us?"
Am I the only one getting this?
Then people at church start asking me. Then friends of people at church. Then it is neighbors.
Friends of staff that are down and out. Friends of patients.
It is coming from everywhere.
I have to tell you that I have a heart for people. I want to help people.
What do I do?
Do I just treat everyone that needs something?
I have to tell you, up until now it has been all fillings and extractions but the problems seem to be getting worse and worse.
Does this thing continue to pick up speed and the next thing you know I am seeing everyone?
Do I have to regulate who I take? Do I put in a spot in the schedule for freebies?
Tell me what you are doing.
I will finish up our talk on Friday. I would like some input from you first.
Have a great day, I just keep thinking, 4 more working days left. Then it is 3 days of 24 hours a day shopping (I told you I am a complete failure at Internet shopping, see last Wednesday's blog).
See you Friday,

Monday, December 14, 2009

Christmas Party Marathon

Your mission, should you choose to accept it, attend 4 Christmas parties in 4 days. You must exude the yule-tide spirit at each.

Yep, that was Ric's mission, although Ric doesn't recall Ric having a choice about whether or not to accept the mission. Thursday night the Bunco ladies were over to the house for their Christmas festivities (if you have not experienced the suburban dice game, you are really missing out guys). Friday was Ric's office Christmas party at our house, Saturday was our Sunday School Christmas party and Sunday was a Christmas party for the Venue Band (a praise band Ric sings in at church).

In between, Ric met with his banker and accountant for end-o-the-year planning. Ric doesn't want to give it away but Ric thinks Uncle Sam is getting a nice present from Ric this year. But it is on backorder so he won't get it until mid-April. Nonetheless, still a pretty nice present if you can wait for it.

Ric also saw a couple of emergency patients at the office over the weekend. That seems to come in waves. Ric can go months without one and then go several weekends in a row with one.

After all of that, Ric believes he is now ready for the holiday to begin. The air is cold and crisp, Christmas music is playing in the office and the procrastination on buying the kid's presents is well into its 50th week. Aaahhh, Ric loves the prospect of again filling the tree with presents that are purchased from the in-stock leftovers of area stores during frantic lunch-hours and the Friday remaining before the big day. We do it every year and, quite honestly, it is fun. Our kids all have birthdays in November and December so we are getting those presents early and Christmas presents just seem to get put off until later.

Well, today is one of those rare days where Ric is busy but his hygienist isn't so Ric better get back to prepping crowns.

Have a great week.


Thursday, December 10, 2009


Nothing going on except for flag football.
I am not even watching TV anymore. This is bad because I love watching TV. It is mindless. It helps me decompress.
If I do I put the TV on, I am asleep in about 10 minutes. I think I am getting old.
Okay I have a couple of short stories that I will turn into a blog.
One is about a patient.
Nice guy about 70 years old.
I did a bunch of restorative to the tune of $1000.
Then he is missing his posterior teeth on the lower. I went through all his options, and he decided implants were not for him.
I told him that I am not a big fan of the traditional removable partials. #1 because I don't do a lot of them. #2 is because I am an aesthetic guy and I don't like putting in clasps where you can see them. I told him that people say they don't mind and when they get them they wish they didn't make that decision. (Now I don't want all the removable guys ticked at me, that's just how I feel. Partials are fine.)
He said he wanted one so I told him I would come to a compromise with him. I decided to do a cast Valplast partial. So we would make a framework and the teeth and clasps would be in Valplast.
So I made the partial. Well it was easy to say, but not easy to do. I sent the framework back because I was not happy with the fit. So this first step took a long time and a lot of visits.
I finally was comfortable with the framework. We did the framework try in and bite registration. Then we did the wax-up and the processing.
We delivered the RPD. I was thrilled. He didn't like it. I adjusted it and he said he would try it.
He came back in two days and said, "this is not going to work."
Hmmm. Well let me do some adjusting. I am sure I can make this fit good and make you happy.
I can't remember but I think he let me adjust it and came back the next day.
He said, "This is not going to work."
I was a little disappointed in the lab and the way that they did the partial. I don't do these very often, but I can tell sloppy work when I see it.
Maybe, just maybe I said out loud, "I hate this lab and this is for sure the last time I am working with them." (I know this is a big no no but what can I say, I did it.)
He suggested, "why don't we try a different lab?"
Okay, I was thinking to myself, "He is not completely pissed, he is willing to do what it takes to do this."
I said, "Okay, let's do that"
I spoke to the new lab man and told him my dilemma. He was willing to take this case on.
We used the same metal framework. We decided to scrap the Valplast because it is hard to adjust. Quite frankly, I was thinking I just wanted it to be comfortable for this man. I started to lower my expectations because I just wanted him to be happy...not me.
I went through the next five steps again. I pulled the framework in a impression. Bite registration. Wax-rim. Teeth wax try-in. Then another wax try-in to make the occlusion perfect. The processed teeth came back, and I was thrilled when I put them in. The second process went so much smoother.
One problem. He wasn't happy. You know the kind that is shaking his head the second you put it in. Kind of like last time, it was the "this isn't going to work" shake.
I told him that sometime partials don't feel perfect the first time you put them in. I did some adjustments and he said, "Well I guess I will try them."
The next day or the day after he called and asked to "speak to me".
I was think to myself, "Son of a #$%!@*, you have got to be kidding me."
So we sat down and talked. I look over and he has the teeth in a ziplock in his shirt pocket. Now for you non-dental people...this ain't good.
He said, "This thing is not going to work."
Now I am a The Customer Is Always Right kind of guy. I take the posture of I will do whatever it takes to make this work even though I have done most of it already.
I told him that usually it takes time to get use to something foreign in your mouth, and I didn't think he was giving it time to work. If he does wear it, then we adjust it and he gives it another chance.
He was convinced he gave it enough time.
I told him that I am willing to do whatever it takes.
I asked him if he didn't mind me sending him over to my dad (down the hall) and see if my dad could see something I didn't see. He said, "No, he wasn't interested in that."
I said that I could refer him to a prosthodontists and see if he could make this thing work. He said he wasn't interested in that.
I said, well then if you want to get teeth in the back and you want to go away from the partial you can get two implants and I will give you the $1700 credit toward the abutments and crowns.
No he wasn't interested in this.
He said, "I don't want anything. I like you. I like your office. I want my wife to come here. I just don't want this partial and I want my money back."
Now usually this would be no problem. But what are we talking about here. I have probably seen him, and I am not exaggerating, 15 times.
I have paid the labs (between the two of them) $721.50.
So it is not as easy as giving him his money back. I told him this and I told him that I wanted to think about it and I would call him.
I thought about it and I thought about it. I wanted to give this guy his money back and rid myself of him, but I couldn't get passed all the work I did all the money I paid and how this guy was impossible.
So I called him and I told him that I was willing to give him back all his money minus my lab bill.
So I told him I would give him back almost a $1000.
He said, "What?" he goes on to say, "I am sitting here looking at a $2700 credit card bill and you're only going to give me back a $1000?"
Well of course I said, "Well let's not forget that you had a New Patient Exam with X-rays and you have 5 new beautiful fillings."
A couple of times as I was trying to explain how much I have spent on this. Time and money. And he would even go on to say, "Yes, I recognize how hard you worked and how you really tried and were doing everything you could and you have to be paid for your work."
But something was not computing in his mind.
He went on to say, "Someone is getting screwed here."
I could feel the steam building up in my head.
Remember I am still The Customer is Always Right kind of guy.
So I told him, "I am starting to hear a theme here. You were not happy with the first partial, you were not happy with the second partial, you are not happy with me giving you your money back. I am starting to think that it doesn't matter what I do for you, you are not going to be happy."
Then he is like, "No, no, no. I am not that kind of person."
Uh, well, yes you are.
Then he says, "Just send me the money and that will be that."
I said, "Okay."
Well, I guess he had time to think about it. So he called me back.
He started again with the, "I have a $2700 credit card bill to pay and you are only giving me back $1000."
Calgon take me away.
What the hell can I do for this guy?
I can hear his wife talking to him in the background. And we are going round and round.
We were getting ready to hang up and I could still hear his wife. So I said does your wife want to say anything, he said "she is saying something about getting a lawyer but just send me the money" and we hang up.
Oh, I was having such a good day.

Next story,
I was in Atlanta last Saturday. In the FanFare event before the SEC championship game there was tables set up for a silent auction. Now to me silent auctions are ALL for charity. The tables were filled with autographed memorabilia. I got all excited. I am a sucker for charities, and I am a sucker for autographed Gator stuff.
I went straight up to a Percy Harvin jersey and put a bid on it.
As I was leaving the table I asked the attendant what charity the money was going to. He said this is not for charity.
So they are having a silent auction to benefit the memorabilia company. Are you kidding me?
So I was walking away and I was thinking of erasing my name but I realized that I was the first bidder and what are the chances that I would be the only bidder. There was still half a day and someone is bound to out bid me.
Well I get the call yesterday saying I won the damn thing.
I had to break it to the guy that I would have been happy to pay but I thought it was going to a charity. I would be happy to buy it if he was willing to work with me on the price.
I told him I would have to bring all my son's x-mas presents back if I was going to buy him this jersey. He said he was not willing to budge on the price. I said, "Thanks, but no thanks."

Last one,
I want to get my wife a David Yurman bracelet for Christmas. "Want" being the operative word. I have been looking. So I went on e-bay yesterday. The first item was a bracelet for $50 and it was up in 45 minutes.
Wow, so I put my bid in for $55, what the heck. Now this bracelet would probably retail for about $600. So of course I thought the price would go from $55 to $555 in the last 10 minutes.
Just in case I e-mailed the seller. I asked if the bracelet is real.
I had a patient and when I came back to my computer, she had written me back and said it WASN'T. Only one problem...the auction was over and I had WON.
So I am pissed.
I now have a bracelet that I don't want.
Let's go back. I got to ebay. I type in David Yurman bracelet and this is the first item up.
After this is all over I look at the title of her item and it was this...
David Yurman .05 perfume with a free gift of a bracelet.
So she was selling the perfume and giving the "knock off" bracelet as a free gift.
It was a total con.
I wrote here and told her my story. I told her I was looking for a bracelet and I had no idea it was not real. I felt a little mislead by the whole process.
I told her I didn't want it but realize I am obligated to buy it but do I have any recourse.
She wrote me back and was very very kind.

Hi There,
I completely understand and I'm sorry about the confusion. There are a lot of people out there who can't afford the real thing so I give them a chance to own a similar item for way less. I would never think of tricking a buyer, that is why I put in my listing that the free item is not a David Yurman. I will retract your bid and all will be fine. Thanks again,

My faith in people restored. I wrote her back telling her I applauded her integrity and I appreciated her letting me off the hook.
What a week.
I hope yours was better.

Tuesday, December 8, 2009

Designs for Vision

Hey all,
Before I say a word I wanted to have a shout out to Dr. Ric for Monday's blog. Just awesome. The economy is real and is affecting a lot of dentists. I spoke to my Patterson rep and he talked about having to put a "hold" on seven of his dentists (meaning he is not allowed to sell them products anymore because they are so behind on their bill).Now he wasn't saying it like his profits are being cut, he was saying it like, "Oh, my gosh how bad does it have to be for these dentists if they can't pay the supply bill."
I appreciate Dr. Ric's transparency, and I hope you all liked it as much as I did. Great job Ric.
Finally I can talk about it. Gator football.
I know you all thought of me this weekend as the Gators were getting there asses handed to them. You were either all saying, "Oh my gosh, John is there, and he spent all this money and time and effort go and see the Gators play and man are they getting killed."
Or you might have said, "Ha, finally someone beat the Gators. Thank goodness I won't have to hear ESPN and John talking about them anymore, and I won't have to hear Tebow this and Gator that for at least 6 more months."
Either way I appreciate you thinking of me.
Well if you do care, I had a pretty good time in Atlanta. We went back to our favorite bar with the beer taps on the tables (Hello friend. Where have you been all my life?"). But really when you lose that night, the ride back is a bit of a drag.
We had a great run and you really can't be that upset.
Talking about being upset, there were two Gators in my section that almost came to blows twice during the game. When you mix alcohol and testosterone and a good butt whoop'n someone is bound to want to punch someone else (regardless of what team they root for).
It rained like crazy here in central Florida so the flag football games I was going to miss were rescheduled. So this week between the two teams I coach I have six games in 6 days.
Game tonight, Thursday, Friday, two games on Saturday, and the last game is on Monday.
Are you kidding me?
I wanted to talk about loupes.
In dental school I got this awesome deal on loupes. I bought the Designs for Vision 2.5.
I looked like Elvis Costello, but I could see like I have never seen before. And if you knew what kind of student I was you realized that I needed all the help I could get.
Before I go anywhere else I want to say that I am a big backer of loupes (or all types of magnification). I think they make people better dentists, and I think that if you don't have loupes you need to look at yourself in the mirror. Do you want to be the best dentist for your patients? If the answer is YES, then you need to get loupes.
I had those 2.5 for about 8 years. About 7 years ago I thought it was time to jump up in magnification, I think at my dad's pushing.
I was concerned about the decrease in field. But I made the jump to 3.5.
I have tried to go back to the 2.5 for a procedure or two, and it is like looking in the wrong end of binoculars, things are so small.
So last month I am finishing up a routine exam and I was taking my loupes off to just rap with the patient and they broke.
Mayday, mayday, we have broken loupes in room four.
The whole office stops what they are doing to help me because this is a major thing.
Because I have been using loupes for so long I just cannot work without them.
I occasionally try to do an exam on someone without my loupes, and I have to get so close to them to try to see it gets uncomfortable. "Can you please open more I need to just climb into your mouth so I can see?"
So we all realize how I rely on these things and they broke.
See the frame and the earpiece came apart. They are pretty well built and there is a cool piston on the earpiece so you can bring the earpieces out to get them around the ears when you take them off.
So you have a $1600 pair of glasses hanging on these pistons.
I tried not to panic. I have a patient in my chair.
I bust out my resin cement and put the piston back together. I put this fire out pretty quick.
I started to think about what I am going to do.
I called the company and told them that I needed my glasses repaired.
I told her the problem. She said it was my lucky day and that the frames had a lifetime warranty. See all the pistons and arms and everything were covered. So all the repairs will be free.
I said, "Awesome, so I am going to send them in."
"No problem," she said, "It will take about 7-10 business days"
"No, I don't think you understand. I use these glasses every day. I need you to rush the repair and get them back to me as soon as possible.
"Oh", she said, "in that case it will be 7-10 business days."
You see, everyone who wears these glasses is important. Surgeons, dentists, periodontists, urologists, OBGYNs, etc. Everyone who owns these glasses makes a lot of money.
There is no such thing as a rush order.
Okay so you have a product that is totally backed by the company but it doesn't do you any good because they can't repair anything fast.
So I was thinking to myself, I am going to have to go on a two week vacation before I have these things fixed. (Oh, that is going to happen real soon I would imagine...NOT).
In the meantime, I will just live with my self-repair for awhile. Just as I was thinking this the other side of the glasses broke. The other ear piece broke off the piston. This time the resin cement didn't hold. We tried it again. No luck.
So I did what any desperate person would do and cemented the pieces together with Superglue.
Don't we all laugh at our patients that Superglue their teeth together. Well I am sure the glasses people will laugh at my redneck butt when they get the glasses.
What was I suppose to do?
So I called my Design for Vision rep. She said she could send me a loaner pair.
Sounds like a good idea right?
Well the problem with that is that each pair of glasses is fitted to the individual. So the ones they will send me will be close but I wouldn't be able to see that great with them.
Does not sound like a good alternative?
So my choice is to work without them, use my 2.5's that are also glued together, or use a loaner pair, or go on vacation long enough to get these things repaired. Or the last choice was to buy a new pair.
I started to think about it. I need these glasses more than anything else in this office. If my suction wasn't working, would I think about doing anything else but fix it or replace it PERIOD. There would be no discussion.
I need them. My thought process was that if I have two pair I would never have to worry about them again. I would never have this decision to make again.
I would never have to think about vacations and glasses repair. I would never have to Superglue my eyewear ever again.
But factoring into this problem is that they are $1600. No the decimal point is not in the wrong place. Did I tell you that I am tighter than two coats of paint?
I kept saying to myself as I was dialing the reps number, "This is the best thing to do, this is the best thing for your patients, this is the right thing to do. I would like to order another pair of loupes please, this is the best thing to do. I know how much they are please just take my credit card number fast, this is the best thing for my patients, yes I know that it will take 3 to 4 weeks to have made, this is the right thing to do. Thank you, good bye."
Once you have loupes they have you by the you know whats. They should call you a month after you get your first pair and tell you that they will give you a discount on a second pair.
Because when these things break, full warranty or not, you are in big trouble.
As I sit here, it has been three weeks since I ordered my second pair. The Superglue is working like a charm (you have never seen a man be more gentle with anything in your life). And every day I tell myself, "It was the only thing you could have done."
Thank you sir can I have another.
Have a great Wednesday,

Monday, December 7, 2009

Jeremiah 29:11

Hello depression, welcome back.

I swear I wasn't like this before starting my business 3 1/2 years ago, and I have never been diagnosed so I don't mean to offend anyone with diagnosed depression ("what's the deal with cancer").

However, the voices are back.

Not the fun happy sarcastic voices.

The "YOU SUCK" voices.

Ever get those? Ever have one of those weeks where you are just worn down? One of those weeks where you are a walking panic attack. An actor who walks around the office smiling but has to hurry back to the privacy of my private office before the true emotions come through. A week where you know you have snapped at your kids and wife when they didn't deserve it. A week where you had unfounded, random fears of being diagnosed with cancer or having a family member die (yeah, I have those voices a lot). Then to cap it all off you hit a weekend where instead of relaxing and recharging you spend 6 hours rebuilding a hard drive in one of your operatory computers (can't wait to get that bill) and then spend Saturday seeing a patient in severe post-frenectomy/extraction pain who can't wear his new denture because of the inflammation.

I don't even know where to begin so if this is stream-of-consciousness and you don't like it - fine, skip to Wednesday. I'm lying on the couch now, ready for the healing to begin.

November was one of the worst collections months in the brief history of this office. It was a month where I am still juggling bills so that everything clears on time. It was a month where you realize that there is no such thing as a "profit margin" in a dental practice with the start-up costs we have. It was one of those months where I felt like Bernie Madoff - is this really a successful business or simply a fancy maxillo-mandibular-ponzi scheme.

It was one of those months where I had to expend all my energy juggling bills and fighting the pressure to "diagnose to help the bottom line". I don't know the technical term, but I don't think non-dentists can appreciate that pressure. Is it only me?? I am extremely conservative on my diagnosis. If a practice manager came in I'm sure the 1st thing they would say is to cut 2 staff members and the 2nd thing they would say is to start diagnosing more crowns. BUT I WILL NOT COMPROMISE, I WILL NOT SETTLE, I WILL NOT STOP FIGHTING. I hate the pressure of having a stack of bills on my desk and still diagnosing as if I am Bill Gates. I don't like leaving an operatory frustrated because the tooth isn't cracked a little more to justify a crown.

It is the holidays, I want to be generous and happy. I love giving things to people - that is my gift and my curse (thanks granddad). I employ a single mom, a young woman putting herself through college, and 2 new moms (one of whom's husband recently lost his job). I have a responsibility to these people. They have each worked so hard this year, and we are growing but there is just nothing extra. How do you do Christmas bonuses?? I am not going to be able to do much and that just bugs me.

There is an analogy that I use all the time in situations like this. If you enter a strange room and the second after you enter the room all the lights go out, if you continue moving across the room your mind will retain the brief image of the furniture in the room and you can navigate across the room without hitting anything. If, however, you stop, you lose that image and it is more difficult to make it across the room. I can self-diagnose and give myself that advice. It seems dark now but remember your vision, just keep moving forward, stay the course. I know we are doing fine (Mr. Banker if you are reading this - believe me, we are doing fine - promise). That said, it is a hell of a lot easier to cross the room with a freaking light on.

Well, I can't put it off any longer. I have to go through the stack of mail on my desk and start figuring out what bills to pay. Time to put on the iTunes and just do it. Hopefully next week will bring back some of the mania that everyone enjoys so much more.

Have a good week,


Friday, December 4, 2009


Hey all,

I haven't done a thing this week. I have had 3 flag football games this week. I haven't even watched TV. I am too tired to read, so nothing.
All my flag football teams are getting rolled on. The first grade boys are kind of having a hard time focusing (imagine that). We have practice one day, and all we do at practice is this ONE play. Then the very next day, at the game, we go to run this play and half the kids are looking up in the sky doing pirouettes and the other half has no idea where to go. One kid starting running the wrong way with the ball.
My fifth grade team is going pretty good. I think most of the kids are having a good time. We played an undefeated team yesterday, and I think we held our own pretty good. We were down 18-7 at halftime and on the last play before halftime it was our guy running all by himself and somehow got caught from behind. That was a game changer. We lost 38-7, but it was much closer. They scored two quick ones at the end.
Well the other coach got the "why isn't my kid playing" speech from one of the parents this week. It is so difficult coaching. You have to try to manage the game. You try to put kids in a position in which they can succeed. You tell everyone their pass patterns, and at the end of the game you get three kids coming up to you and telling you they didn't catch the ball today.
We played a team last week that practically gave it to the same kid almost every play. It's tough... and you are wondering why I can't sleep.

I am not going to tell you that I am leaving today to HOT-LANTA to watch the team I am not talking about in the SEC Championship game. And that is all I am not going to say about that.


I am a watch guy. I look at everyone's watches. I don't know what is about watches. I know some people are shoe people. My wife, she is a ring person.
Are we all like this in some way? Is there something you check out on people? Shirts, necklaces...tell me your thing, it's anonymous.
Anyway, I look at everyone's watches, and really I don't know much about watches. I recognize a nice watch, but to be honest with you I wouldn't know if it was $15 or $15,000.
Okay, I will be honest with you, I look for Rolexes. I don't know why. I heard one time by someone, "They make a statement," and I think this is true for me. For me, I think watches tell me volumes about people. I just know they are easy to spot, at least for me.
That being said, I am not much of a watch guy myself. But I have been. My father had a Rolex, when I was in high school, that I have always liked. So when I got out of dental school I wanted a nice watch. I was hoping he would give it to me, but that was not going to happen.
But one Christmas, my wife bought the watch from my father and gave it to me. I think I was 31 years old. I was thrilled.
About a month after the gift giving I went to change the date and the stem pulled right out of the thing-a-ma-jig that turns the hands.
Usually if you have a watch that breaks you throw it away. This watch is too expensive to just throw away. So I had to find a jeweler that is a Rolex certified guy. Well you know what I found out about Rolexes...they have to be serviced.
Yeah, they recommend that every year you get the watch tuned-up. So 10 years ago I paid my father $1000 for a 15-year-old watch. Then I had to have the thing serviced and put the stem back in the thing-a-ma-jig for the low low price of $650.
Isn't it great to have a Rolex?
I told you they make a statement.
So after a couple of years of having this thing (no, I never did service it again. Did I ever tell you about how cheap I am?) I didn't like the watch.
No, I said that wrong. I loved the watch. I didn't like who I was when I was wearing it. It made me feel like I was somebody.
So when I went out I would want people to see it. I found myself pulling up my sleeve so people could see it. "Does anyone need to know what time it is? No, well let me tell you anyway." I wanted for people to see the statement that I was trying to YELL.
When I am at work it was the total opposite. I didn't really want people to see it. I would be bringing someone up to the front, while saying goodbye and filling out the router (this is the form that I use to tell my front desk personnel how much the procedure is going to cost) and I know the person is really going to struggle to pay my bill. I know they have a bunch of kids that come here and they are just scrapping by to be able to afford my dentistry. Meanwhile, I am rolling around in my phat watch.
So there is a lot going on in my head when I wear this stupid watch.
First and foremost, the money doesn't make any sense. I mean who in their right mind is going to have a watch serviced for $400. I could buy 8 Timex running watches for the same price as the SERVICE on this watch. It made me feel more special than I deserve. I mean, if I need a watch to fit in or feel a certain way, well...I know, I totally need therapy.
And I didn't want my patients to feel like they are paying my high prices just to fund my luxury.
The reason why I am bringing this up today is there has been an episode that I want to tell you about. I want to wear a watch again. I use my cell phone to tell me what time it is and I hate it. I have to go in my pocket and pull the thing out to tell me what time it is. It is too much effort.
So I wanted to pull the Rolex out again. It is the only watch I have.
I stopped wearing it about 5 years ago because of all the stuff above and because the band was breaking. Turns out the band is silver and gold. Well as you know the gold on the band is soft.
And as I told you the watch is about 20 years old. The gold links have stretched out and they are starting to break. I have had them soldered and soldered and now I think I just need to have the band replaced.
I took the watch out of the jewelry box and sent it to the guy I have work on my watch.
He calls me and tells me that I indeed needed a new band and they cost...wait for it.....$1800.
He then goes on to tell me that they make off-market Rolex bands that will look just like a Rolex band and they are much cheaper. I was still having a hard time focusing after the above mentioned price so I asked him what the off-market bands cost. Just $850.
Now this is just plain ridiculous. We are talking about a 20-year-old watch. I just want to wear a watch.
"Or" he said, "I can repair the broken link for $50."
"DONE, now you are talking my language"
How do you think a gold Rolex with a black face with diamonds on every number would look with one of those Velcro bands on it? Trust me I thought of it.
I think spending that kind of money in any economy is foolish. I think maybe when my kids are gone and I have money to just blow I might pull the old Rolex out and buy a new band (in 15 years what do you think the price of gold will be? The band might cost $5000 by then) but for now I think it is back in the jewelry box again. I think for now in this stage of my life, the Timex Triathlon is looking real good.
Have a great weekend.
Hey does anyone have the time?

p.s., if anyone has a old Rolex band sitting around and wants to sell their favorite blogger a band...I thought I might as well check.

Tuesday, December 1, 2009

That First Phone Call


Hope you all had a Happy Thanksgiving.

Mine was great. We decided not to have it at our house because it was too much of a burden on my wife being that the baby is only eight weeks old (and very needy I might add).

So my sister volunteered.

Her house is not quite big enough for everyone so we did it outside.

It was great. The weather was perfect. Food was great. Company was great.

We finished dinner, and we all went into the living room and watched Willy Wonka and the Chocolate Factory (the old version). It was a great movie to just veg out on the couch.

I got in a little nap. The kids loved it.

The Gator Basketball team (I am not talking about the other Gator team) beat #2 Michigan State on Friday night and then beat Rutgers on Saturday. So we moved into the rankings yesterday at #13. We play #5 Syracuse next Thursday. I'll let you know how it goes.
About the other team that I am not talking about, if I was talking about them I would tell you that I just got my tickets to their SEC championship game on Saturday.

I just finished a book called Crazy Love by Francis Chen. It was recommended to me by a friend (shout out Ethan). It is one of these books that makes you think about life a lot and how we probably should be doing this a little bit better (or in my case, a lot better).

See this is why I don't read these kinds of books. Ignorance is so bliss.

I like to read about how other people are screwed up so it makes me feel a little less screwed up.

This book looked at me and I didn't like it.

I just started Counterfeit Gods by Tim Keller. I will let you know.

Okay about the marathon. I have put off talking about it for as long as I could.

This race was called the Space Coast Half and Full Marathon.

So this was my first half and full marathon together.

It is a small venue. The weather was perfect.

I wanted to run a sub 4 hour marathon.

So my running buddy and I decided to start with the 3:50 guy and see how long we could hang with him.

Bang it started, and we started going and we were going fast.

I was first thinking that people are running fast because it was the beginning of the race and they will settle down.

Well it didn't take me long to realize that this was the 3:50 pace.


It took me about 2 miles to realize that I couldn't keep this pace. About mile 5 we took our first walk break for about 30 seconds. Keep in mind that we train in a way that there are drinks every two miles. We stop and get drinks and then go. Sometimes waiting for everyone to get drinks will take about 2-3 minutes.

Mile 8 I was really struggling. Mile 11 I told my friend to go.

This is where my mind started to go. The 4 hour guys started to pass me. I didn't have a watch or an iPod or anything. I was all by myself and struggling.

I could have sworn I saw the 4:30 group pass me. Now I was pissed, and I was annoyed with myself.

I thought now, if I go on, I am going to come in at 5 hours. I was walking at every mile, sometimes twice a mile.

Then I started seeing the 13 mile signs.

I started to think I could just finish now. Now the sign was getting bigger. Half marathon go this way and full marathon go this way. Hmmmm? This is definitely not my day so why don't I just end the torture now? If I run the full marathon and it takes me 5 fricking hours, my friend, who I drove with, would be sitting around for an hour waiting for me.

I went to the half marathon path.

I finished in 2 hours and 1 minute.

Wait a minute, how then did a person with a 4:30 minute sign pass me? Either she was 30 minutes faster than her group or I was delirious and read her sign wrong.

Anyway I was done. I was so disappointed. I don't know what to think.

I guess I will be back at it next week. Maybe I will catch a later marathon and give it another try.

Next time I won't blow it in the first 5 miles.

I am still kind of depressed about it.


I wanted to talk to you about the phone call. In case you missed the first blog about this call, let me refresh your memory. Well because I am running out of time in the day let me just give you a link to the first blog.

This is something you have to talk to your phone call answering people about.

I know sometimes you go in your office and isolate yourself from the phone calls. You isolate yourself from the collecting money. You isolate yourself from conflict up at the front.

Well at least I tend to be this person.

So, because I know I tend to NOT want to get involved, I force myself.

I schedule meetings with my front desk staff once a month. It may be 20 minutes on the first of the month first thing in the morning.

We talk about procedure, we talk about patients, we talk about how they answer the phone. (I do the same thing with my hygienists. To talk about things like toothbrushes, fluoride, how they are handling certain patients, sealants, you know stuff like this). Constantly opening the lines of communication.

So in our front desk people meeting we talk about this conversation.

I ask them if they get this phone call and of course their answer is "all the time," and we talk about what they presently say.

Well this is what I tell them to try to accomplish on this phone call.

I want them to know the difference between our office and other offices. I want them to talk to this potential patient about the good in a new patient exam. I want them to spend time, for lack of a better phrase, getting to know this person on the phone. I want them to hang up the phone and say to themselves that that was an unbelievable phone call. That person was so awesome on the phone.

Now does this mean that everyone is going to want our type of dentistry? NO. You think that you are setting yourself up for so much failure. BUT, what it might do to that person is plant a seed for that kind of dentistry. They may go to another place and not get treated very well. They may go to a place that they feel like a number. They may go to a place that makes them start second guessing their decision. So when they do second guess themselves and they get tired of feeling like cattle, what do you think is the first place they are going to come back to? Hopefully, the office that treated them the way they wanted to be treated.

Now real quick about the CEO that has his/her administrative assistant call...

A couple of reasons why they have their people call, they don't really understand the type of office we are or they don't know what kind of dentistry they need. So you have to first get this person on the phone. If they don't want to come to the phone, well then you are better off not seeing this one. If they come to the phone there you are right back to the above paragraphs.

How do you get the person to realize they are calling the Ritz-Carlton of dental offices. I am not talking about stick your nose up Ritz-Carlton. I am talking about the five-star service Ritz-Carlton. And if the person is a CEO or some high-flooten job like that it shouldn't take them long to figure out this place is special.

We had our meeting today and one of my people said a couple of times she has had to say on the first conversation, "I am sorry Mr. Jones, maybe this is just not the kind of practice you are looking for."

I don't mind this. Trust me it is better to let people know up front. I have plenty of patients that I wish I would have told them this before the first appointment. (If you are my patient and you are reading this...that last sentence was definitely NOT about you).

Am I making sense? Am I rambling?

I would like to know if you have meetings with your staff. Do you have a full staff meeting and then have separate meetings as well?

Do you isolate yourself?

Do you know you should get involved but let your staff do it (trust me you are not alone)?

Let me know,
Have a great Wednesday,


Monday, November 30, 2009

Florida Football Free Post ;)

OK, happy to report that I am still thankful even after a 4-day road trip to both families.

Movie report - I'm not a huge movie guy, I really go for the popcorn and milk duds. This last weekend I went with my wife on a date to movie. Now, I'm too embarrassed to tell you what movie it was but let's just say it is very popular and is an astronomical event that occurs monthly - maybe you have heard of this movie, don't worry I won't spoil it for you (the director did that already).

This movie involves many mythical creatures/monsters and is apparently attempting to recreate a Romeo and Juliet storyline in the Northeast US but instead of Juliet we have a morose, co-dependent, breathy teenage girl. Romeo is a soul-less (literally) bloodsucker, and I guess Mercutio is a 6-pack ripped, shirtless teenage werewolf.

I don't have a problem with the theme, the content, or the double-standard we have with teenage guys being exploited for their bodies (that is an entire blog conversation in itself). What made the movie so frustrating was the fact that in the 200 seat, mostly sold-out theater there were at least 50 children under the age of 10. The 6-year-old boy if front of us was freaking out during the movie and his grandmother (yep grandma brought him) was having to calm him down the entire time, cover his eyes, hold him, etc.


I'm sorry, my kids are 12 and under so this falls right in my wheelhouse. They don't belong at this movie. It is not a movie for them. My wife and I were commenting on this on our way out of the movie and the parent in front of us turned around a said, "some kids really like these kind of movies." OK, fair enough. Some kids would really like crack if their parents allowed them to have it - doesn't mean they should. Parents need to be parents and say no sometimes.

Beyond that, as the father of a tweener girl, where is the outrage over the presentation of a female that can't exist without a boyfriend?? This is co-dependence at its most basic form. It concerns me that this movie that is so marketed to teenage girls proceeds to present them as shallow, breathy shells of humans whose entire existence is tied to a male figure (alive or undead).

All in all a very frustrating experience at the movie (but a great date).

So in summary, lots of travel, lots of eating, lots of family time, yada yada yada. . .get home and crash in my own bed.

Have I mentioned that I hate when payday falls within 2 days of the 1st of the month. I do payroll every other Monday so many months this does not occur. However, today is payday and tomorrow is the 1st of the month. That is just a lot of money going out of the practice and the voices like to discuss that amongst themselves during the night.

The voices are also happy to say goodbye to November - don't let the door hit you in the tail on the way out. I'm sure that no other practice saw a slowdown in November but we must be missing something. Phone calls were way down, cancellations/reschedules were way up. I'm ready for this recession thing to flatten out and sanity to return. I was reminding the staff today in our monthly staff meeting of the importance of asking for referrals and of pointing out to patients the quality of the work that we do.

Do you realize what goes into a simple periodic exam and cleaning? I think we take it for granted as dentists so you know the patient does not realize it. In our office a periodic exam consists of an oral cancer evaluation, comprehensive periodontal evaluation (including probing), occlusion evaluation, cavity check, scaling, polishing, flossing, fluoride (sometimes), oral hygiene instructions and home-care products. And all of this is "free" to most insurance patients.

Do you include this information on the walk-out statement that you give to the patient? We haven't but are going to start doing it. It is another great way to remind the patient of the value of that service - it is more than just making their teeth feel slippery and clean.

The voices are telling me that I need to run payroll so I better get going. Have a great week, I can't wait to hear how he marathon went for Dr. G.


Tuesday, November 24, 2009

Look Around

Happy Thanksgiving Everyone.

I don't know if I can beat Dr. Ric's blog on Monday, but I will try.
I hope today's won't be a letdown.
I was supposed to follow up on the "How much is a cleaning" phone call, but I will postpone that until next week because I totally didn't realize tomorrow is Thanksgiving.
Can you believe it is Thanksgiving tomorrow?
I can't.

Before I forget, our flag football team won on Saturday. We are 2-1, and I think we are getting a little better. We haven't played any of the elite teams yet but it feels pretty good to be where we are at right now. I am sleeping a little bit.

I saw The Blind Side on Friday. I loved it. I am biased because I read the book last year, and I have been telling everyone what a great story this was since then. I have been keeping up with Michael Oher's progress since then.
It is a real feel good movie. It made me laugh and cry.

Okay topic...
A joke to start this entry.
A monk decides to try to get closer to God and he goes into a monastery. All the monks at this monastery take a vow of silence. He was okay with this as long as he obtains his goal.
So he started and five years went by like nothing.
After his first five years he went into the head monk's office.
The head monk says to the monk, "You have really surprised us with your progress. We have really been impressed with you. And because of this we will allow you to say two words."
The monk said his two words, "Bed hard."
The head monk said, "Great talking to you. We will see what we can do to take care of this problem."
Next thing you know five years have gone by and the head monk brings him into his office and gives him the same schpeel.
The monk this time says, "Cold food."
The head monk says again, "It was great talking to you, and we will see if we can rectify your problem."
Again, five years goes by so fast and the meeting between the monks happens again.
This time the monk again gets two words to say.
He says, "I quit."
The head monk says, "It is just as well. You have been here fifteen years and all you have done was complain."

My name is John Gammichia and I am a complainer.

I don't think I have always been, but I think my personality has eroded to such. My wife is a bit of a complainer (I love you honey), and I think we are breeding complainers too. My kids are complainers.
I don't know if it is because, if you let it, this world gnaws at you. It wears you down.
If you listen to the radio (during this administration) they are all complaining. If you listen to the TV (during the last administration) they are all complaining.
I think it is becoming so much of what we hear and read (oh yeah everything in the newspaper is bad or people complaining).
But in the fog of my thoughts a hint of clarity has shown through.
We have so much to be thankful for, are you kidding me.
Look around.
Just in the room you are in right now. You have a computer and an Internet connection.
Okay that puts you way better off (that is of course if you don't think the Internet is the Devil) than about 90% of the world's population.
You are sitting in your office or your living room in air-conditioned air (for me it is air conditioned for you it could be heat right now. It was 83 here on Monday) which is better than 90% of the world's population.
You have to think of the big picture. It is all about perspective.
I have 4 awesome kids (okay I have 3 awesome kids and one that cries and poops all the time) that think I am the best (okay 3 of them think I am the best and one of thinks he got robbed).
I have a wife that I love and she loves the snot out of me and still laughs at my jokes.
I have a job that I love.
I have a staff that I love.
I have patients that I have built relationships with that I cherish (well most of them).
I have a God that knows every hair on my head and promises never to let go of me.
I have friends that are so great.
I have food to eat and then some.
I have clothes on my back.
I have an awesome house in a great neighborhood.
I won't bore you with all the stuff I have.
But I was trying to make a point.
What the hell do I have to complain about?
Do things have warts? Are things sucky sometimes? Yes.
Are people mean sometimes? Yes.
Do money problems get to me sometimes? Yes.
Do I have kid problems sometimes? Yes
Do I have wife problems sometimes? NEVER (I love you honey)
But let me repeat...LOOK AROUND. How can we complain?

We need to be more thankful. I need to be more thankful.
Why can't Thanksgiving be every day?

In closing, I am thankful to the AGD for letting me write this blog.
I am thankful for the peeps behind the scenes...Jason, Lindsey, the Cathys that make this thing happen.
I am thankful for all of you that read this blog. I am thankful for your comments (most of them), and I hope I have made an impression in your lives. I hope I am staying current and continue to talk about things that are relevant in your lives.

Have an awesome Thanksgiving.

Make this a day you look around and see the glass half full. Look around and count your blessings.
I will,

ps I am not talking about the Gators, but if I was I would tell you that it is Tim Tebow's last home game. I would tell you that we are playing FSwho this weekend.
Very emotional for me.

Marathon in 5 days. My knees are knocking and I am getting butterflies. Think of me on Sunday.

Monday, November 23, 2009


Thank you God for loving me, for creating laughter and smiles and kids.

Thank you Mom and Dad for being patient with me as a child, for allowing me to learn hard lessons under your protection and care. For equipping me with the desire to be an entrepreneur. For giving me such a good example of Christian parents and business owners.

Thank you Mel and Kay for raising a wonderful daughter and allowing me to marry her 16 years ago. Thank you for giving her the opportunities that I know required many sacrifices on your parts over the years.

Thank you Susan for being an incredible wife, mother and friend. Thank you for being a woman of faith. Thank you for allowing me to move from a legal career to a dental career without batting an eye. Thanks for putting up with the sleepless nights, financial tightrope walking, an a moody husband. Thanks for pretending that I am both funny and handsome. Most of all, thank you for giving me 3 amazing children.

Thank you Kayla, Brennan and Madeline for letting me be the tickle monster. For letting me hug you and cry even when you don't know why I need to. Thanks for making me laugh as you dress up like munchkins or create dances and skits that you perform. Thanks for singing songs. Thanks for promising me that I could be your prom date/live with you/work with you. Thanks for making me so proud to be called your daddy.

Thank you to the men and women who let me sit comfortably in my office and type this blog. Thank you for being the tip of the spear and protecting me and my family.

Thank you to the many AGD colleagues around the country who so patiently have answered my questions and given me instruction as I continue to grow as a dentist.

Thank you to all of my patients for trusting me with your smile.

Thank you to my staff for working so hard growing a business and being my cheerleader when you know I am down.

Thank you Jerry, George, Elaine and Cosmo for giving me so many reasons to laugh.

Thank you Dr. Gammichia and readers for allowing my voices to visit the blog once a week.

Thank you voices for letting me sleep well the past couple of weeks.

Have a Happy Thanksgiving and a safe holiday season.


Friday, November 20, 2009

How much do you charge?

Okay no one cares about bartering.

I only got one comment.

So on to the next topic.

But first, my week.

I have to tell you I have been a complete mess for the last couple of weeks.

I told you about the football, well I don't know if I have told you the extent of it.

When I told you I can't sleep, I really mean I can't sleep. On Tuesday I woke up at 3:30 am, Wednesday it was 4:30, and last night I was so exhausted I was able to sleep to 5:15.

So I am like a zombie.

Both our teams won last night and both the scores were 7-6.

The 1st grade team was chaos. They had never played in a game before, so it was a mess. Coaches literally lifting kids and moving them into place.

I told a kid to watch the quarterback. So he runs in and grabs the quarterback's flag. Problem is that the quarterback handed the ball off about 10 seconds earlier and was just standing there when my superstar took his flag.

Now the 5th grade game. This such a tough age. We are not executing very well and when someone else throws an interception or drops a pass or misses a flag well he gets to hear how stupid he is from the other 5 guys.

Oh and then there is me. I am using everything in my power to not yell out, "What the heck is the matter with you. The play is to the right and you are the only guy on our team to run left.

We are having fun that is for sure. The other coach basically said he was so stressed out that he wanted me to take over the play calling. I am telling you, it is not easy.

So it is not as much having fun but wanting your team to do well. It is at the end of the game and you have guys in the huddle saying, "coach I haven't got the ball yet," and things like that.

It is the second guessing of yourself. You are trying to do good for the kids and you end up breaking their spirits because you are such a shmuck.

Oh the joys of football.

I saw this movie Sunshine Cleaners (when you are up at 3:30 am you have plenty of time to watch movies). It was very good. Put this movie on your queue.

I am going out for pizza tonight with the family, then I am taking my son to see the movie The Blind Side. If you remember I read this book last year. It was one of my favorite books of the year. It was one of those books that you have to shut the book just so you can compose yourself or just stop and cry for a second.

It got a 2 star from my paper. I hope Hollywood did not screw it up.

Remember my friend who past away last week. He has a son that is turning 9 on Sunday.

He and his son had plans to go to Disney for his birthday (Disney lets you in for free on your birthday). He asked his mom if it would be alright if me and my son would go with him on Sunday.

They asked me.

So my son and I are going to take this young boy to Disney on Sunday.

I am totally consumed with my life right now, but I wanted to still talk a little about work.

I wanted to talk to you about a certain phone call. Because it is Friday afternoon and my life is so crazy, what I might do is throw it out there. Touch on it a bit and then talk about it on Wednesday of next week.

The phone call is when someone calls your practice and ask, "How much do you charge for a ____?"

This phone call has so much going on it has given practice management speakers material for a whole weekend course.

How about this one, "My name is Janice, and I am Mr. Stein's administrative assistant and he would like me to make him a cleaning appointment."

(I am posing this to dentist that choose to do a new patient exam first before any cleaning.)

So what is behind this call? What do you train your staff to say?

I am mortified when I go to the front, and I hear one of my peeps answer the phone and do their greeting and then they listen. Then I hear them say, "We charge $80 for that."

Then its, "Oh, your welcome" and hang up.

Some of you might be saying, "What is wrong with telling someone the cost of the cleaning?"

For me it is a philosophy thing.

I have to admit I am probably higher priced than other dentists. Nothing crazy, but if someone is cleaning teeth around town for $75, I am might be $80.

If someone is doing crowns for $1000, I might be $1100.

But there is so much more to my office than just a cleaning or a crown.

Let me try to explain this...

Let's say I need tires, and let's say I am a Cooper tire guy.

I will call 10 places (after I have check out the Internet) and ask them what they charge for the exact Cooper tire that I have on my truck right now.

So I am asking each place what they charge for the same tire.

So for this price I am getting four of the same tires, installed and balanced.

Apples to apples.

So I get why people are calling.

They are thinking I am selling the same Cooper tire that the next guy is selling.

And I believe I am not.

I believe there is so much more to my shop than just selling this tire.

And quite frankly, at my shop I am selling a much better tire.

Now how are you going to inform the caller of this if you just say, "$80...Oh, your welcome"?

To me this is what the caller is saying, "Hi, my name is Stacy, and me and my family are new to the area. It has been 8 months since we have been to the dentist and it is time. I don't know anyone in the area, and I don't even know what dentist to call so can you please tell me if I should come to your office or not? And, oh, by the way, how much do you charge for a cleaning?"

How would you answer this question?

Would you say, "$80...oh, your welcome"?

Or the caller could be saying something like this, "Hi, my name is Stacy and I have lived in your area for about 10 years. I go to your competitor. My kids have been telling me for a while now that they don't like their dentists. I have heard such great things about your practice. I was just calling to see how you treated me on the phone. I was just calling to get a feel for the way that you do things. I want you to win me over. And, by the way, how much do you charge for a cleaning?

I get that a lot of people are money conscious right now. Shoot, I am money conscious right now.

And they just want to know how much you charge, and I am over analyzing things.

But let's say you go overboard with your personality on the phone and you talk to this person.

They were not saying anything other than "how much do you charge?" They weren't new to the area or wanting to change dentists. But you gave them the Ritz-Carlton personality. You went over the top explaining your philosophy, and you told them how you were going to treat them.

You not only told them how much it was going to be, but you have planted a seed.

I have talked too much about it. I will give you more on Wednesday. Cliff hanger, yeah.

What about the administrative assistant call?

This is a tough one.

Okay, so you have a person that is very busy, so busy that he can't make a call for himself.

I have done this myself.

To me this call is all about telling someone about your practice. This call is about you the dentist and how you are going to be treated and does this person want to conform to your practice philosophy.

At my office we take at least an hour to do a new patient exam, and we usually don't clean the patient on the same appointment.

This really chaps some people.

People are busy, and I totally get that. People don't want to spend all day at the dentist office, and all they want is their teeth cleaned. I get this.

But we have to do our job, and we have to do it well.

If they don't want it done the kind of way we do it then maybe this isn't the place for them.

Now dentists, don't you hate letting someone go like that. Can't we just work something out.

I mean this guy seems to have it together. I mean he has an administrative assistant calling for him. He must be important, and he must have some cash.

We all know this guy is trouble if he won't conform to your style.

I will end on this...

I had a patient that came into our office and got nasty with my staff. Husband and wife were both professionals.

Talking about how much money they had and all that.

But every time they would come in I would have multiple stories of how rude they were to my staff.

It got so bad that I had to call them and asked them very nicely to be nice to my staff.

It continued and I eventually had to ask them to leave my practice.

Wouldn't it have been nice to kind of set the ground rules before all the nastiness started.

You can get a lot of that accomplished on that first phone call.

Or you can just say, "$80...your welcome."

Wednesday, November 18, 2009



Well, football season if officially underway.

There comes a time in a season when the coach understands that his team is not as good as he thought and his coaching ability is not good enough to change the above.

I am at this point. One game and I am at this point.
I love these kids, I mean my son is one of these kids, but what we lack in skill we can easily make up in slowness.

We were, however, competitive this Saturday. We lost 18-6. They went up on us 12-0. We scored to make it 12-6. Then we moved the ball to the 2 yard line and were about to tie this thing up and we threw an interception.

But we still felt good about this game.

We were stopping them. We got them into a 4th and goal situation from the 12 yard line. All they did was hand the ball off. I figured they were giving up on this set of downs. But this little running back somehow went by about 5 of our 6 guys and was never tackled.

He scored. This was the back breaker.

Next game tomorrow. I will let you know.

Noah said a Noahism on Monday that I thought I would just pee my pants.

My kids watch this show Phineas and Ferb. It is a great show.

We are sitting around relaxing and cuddling on the coach and watching a kid show.
This show is on and the mother in the show is at a multicultural fiesta and (and don't ask me where they were going with this) she singing and dancing to a Jewish and Mexican song...something about a Matzah ball burrito (I am not kidding) and he said out of nowhere, "She must be French."

I don't know why it was so funny to me, but I am still laughing as I am writing this. I think it was because he had no idea what he was talking about and he just said something that just came to him.

Out of the mouth of babes.

I'll tell you this kid keeps me rolling. He turned 6 on Sunday.

We got him this Razor SPARK scooter. Have you see these things?

Well they have taken this Razor scooter and added this doo hickey on the back. It is something you press down with your back foot. It is not a brake but what it does is comes in contact with the ground. The cool thing is this doo hickey is made of flint. When you push it against the ground sparks fly out the back. Now I am not talking about little sparks. I am talking about it looks like a lit sparkler coming out the back of this thing. It is wild.

Last item of useless trivia...


I don't know who these people are but they sure do have taste.

I go to the rating system a couple of times a year, and we are still ranked at the bottom part of the first page.

Last time I checked we were 17th on dental blogs rankings, but I think we have gone down since. Some of the ones ranked higher than ours haven't posted anything in over a month. So I don't know how they rank them.


Topic du jour...bartering.

I remember when I was growing up my father was always involved in bartering in one way or another.

At one point he was in something I want to say was called Bartering of America or something like this. You got a service from someone and you were accumulate points and could use those points at another business that was also in Bartering of America.

Problem with all my dad's bartering was he was always getting screwed.

I guess what would happen was that he would do work for someone, now the work was not half-ass work it was the best he could do (this is the way we do things, if you do it do it well), and then he would always expect the other person to follow through.

You know, give us a call. And do the best work he could do. Yeah...right.

The second part was always the shakey part. It would be my dad running through hoops to make this guy live up to his end of the bargain.

He/she wouldn't show up. Sometimes the job would not be done to average standards because the person is trying to get out of spending any money on this job. And my father would always be disappointed or feeling he got the raw end of the deal.

Here is the way I do it.

I go into something with zero expectations.

I only barter with people I know or that have been referred to the practice.

I might have my lab man call with, "I have a friend with a retail shop that is really in a pinch...will you do this for him?"



My role as a dentist is to help people. I would basically do this for free if I could. I love teeth and I love most people, so if things don't work out and they decide they want to be punks, well then fine.

Knowing this, I kind of expect either people not following through or trying to get the best of me.
So the first thing I always try to do is get the people to do their work first.
This is sometimes hard to do but this will put all problems behind you.

I don't really have a system, but I just try to be smart about it.

Last thing about bartering. I can do something in about 90 minutes that may cost in the $900 range.

I start to feel bad when someone comes to my house and paints the whole inside of the house, you know it is like a 4 day job, to pay me back.

I kind of feel like a heel when I work for 90 minutes and they are working for 4 days.
We trade with our lawn service. He has a family of 5. They come in for their twice a year recare, and I get our yard done for THE WHOLE YEAR (at the office and my home).


Does anyone have any crazy barter stories to tell?

Does anyone have a system?

Has anyone been on the wrong end of a barter deal that you want to mention?

I would like to know. If we get some good stories then I will post them.

Hope you are having a good week,

Just think two more days until Friday.


ps Marathon in 11 days.

Today is my 14th year anniversary. We are going to try to get away for a couple of hours tonight. Our poor neighbor has agreed to watch the baby.

Wish us luck.

Monday, November 16, 2009

What a Wicked Weeked

Have you seen it? I have now seen it twice and I think it may now have surpassed Les Miserables as my favorite musical.

I am speaking, of course, of "Wicked" the story of the Wizard of Oz told from the perspective of the Wicked Witch of the West. So clever and funny. The musical score is phenomenal, and I don't want to give anything away but the entire community of Oz is destroyed when they try to replicate the big bang using a Hadron-like particle accelerator. OK so I made that up but I don't get many comments so I just wanted to make sure you were still reading 3 sentences in. In all seriousness, if you have a chance - go see it.

In world news.

Why do we risk the total destruction of the universe as we know it to find a particle of energy - infintesimally small that lasts for a millionth of a second?? Don't know what I am ranting about, go to this site and learn about the Large Hadron Collider.
Built near Geneva, Switzerland, this particle accelerator will fling protons around a 17-mile loop at 99.99% the speed of light hoping to replicate the forces at play during the "big bang." Now, I don't want to get into a big "how the universe was formed" debate - cuz this is a dental blog and we all know that God created everything.

However, one of the theoretical side effects of this machine is the possible creation of microscopic black holes. Now, I have watched enough sci-fi television and movies over the years to know that black holes tend to be bad, and I have no desire to go forward or backward in time or have the universe destroyed. Now, of course, they say that won't happen but at this point does anyone really know???? Isn't all of this theoretical?? What level of certainty is OK for us to go ahead with an experiment that adds virtually nothing to the knowledge base of mankind - will this let us cure cancer, reverse aging, improve the vocal abilities of the Backstreet Boys?

So let me get this straight - no real benefit and on the downside, possible destruction of entire universe. I'm not real big into making pro/con lists, but in my feeble mind that cost-benefit analysis comes out at a big no-go. But my voice means nothing so smoke-em if you got-em cuz the machine gets turned on soon.

On the dental front I have had to hire a new front desk/patient care coordinator.

I hate having to bring on a new team-member because it interrupts the flow of the office and you are never quite sure how it will work out. That front desk voice/face is so key in the growth of an office and it is the person that I have the least observation of in a normal day (I can overhear things in our small office but not like I can with my hygienists or assistants). Luckily I have found someone that I think will be awesome and she starts right after Thanksgiving so all should be well.

My point in bringing up the hiring, however, is not to talk about the people I hired. Rather it is to talk about the other applicants that were not interviewed. Quick background, I placed an ad online for the position. I did no print advertising at all. We are a paperless, digital office, and if you cannot use a computer to find a job posting and email a resume you will not survive in my office. I am also an insurance-based practice - I'm not ashamed of it, I love providing phenomenal dental care to patients that couldn't afford it without some sort of insurance coverage.

Because of that, however, the front desk position must know how to file insurance, pre-determinations, etc. Since I am a 3-year-old practice I need someone with experience up front. I am not opposed to hiring no-experience employees - I have done it several times with great success. This is not one of those times though. I need someone with experience and I made that very clear in the job posting - 2 years DENTAL experience.

As of today (3 weeks after the posting) I have received 150 resumes. One-Hundred and Fifty. Of those - 20 (twenty) had any dental experience. I got handwritten resumes, resumes that had nothing other than the person's name and phone number, resumes that never explained why they felt their 20 years of experience as an assistant to the traveling secretary would help them in a dental office setting. Resumes that broke your heart because they were willing to learn on their own time the things they needed.

How does a small dental office get that many resumes off of one posting for a front-desk position. I don't care what the pundits say, the recession is not over and the economy is not better - people are still losing jobs, finances are still tight. I wish I could help more than the 5 1/2 employees that I have but I can't.

I'm glad the search is over because it was emotionally draining to read those resumes every day.

The voices have spoken, now they want to go do some dentistry.

Have a great week.


Friday, November 13, 2009

Study models

Hey all,

I am feeling a little better today.
All in all it has been a real tough week outside of work. Work, however, is going pretty good.

I think our team is really settling in. It was tough after the 3 lay-offs and everyone was pretty down. But time is healing this wound and our team is working very well together. You can just feel it. And this really does change the feel of the office. And I know patients can feel it.

I finished my book Born to Run. It was about ultra marathoners. These are people that run more than marathons. Like 50-100 miles. And they race. Crazy people.
It was a pretty easy read. It was an okay book (sorry Chip).

I watched a movie called State of Play on Monday. Russell Crowe and Ben Affleck. I got to tell you, I think in real life I wouldn't like Russell Crowe but he is a really good actor. I like every one of his movies. This was no exception.

Baby David is getting bigger and is sleeping a little better. My wife is like a walking zombie, because when he does sleep you are worried something is wrong. He is sleeping like a baby and you jump out of bed thinking, "why haven't I heard from him?"

But I think we are almost out of the weeds. I will tell you what... with every kid the first two months are so hard. So if you are pregnant or wanting to get pregnant remember what I am telling you now. The first two months are tough. You continually want to put this thing back in the womb.

Okay enough trivia.

I am eating lunch and a front desk person comes to me and tells me there is a Dr. So And So on the phone and he wants to talk to you.

I say, "Do I know him?" and she says I didn't.

Damn, I hate getting interrupted at lunch for people I don't know.

Anyway, I get on the phone.

This dentist is on the phone, and he is kind of a fast talker.

From what I get he is a dentist in Illinois. He has a patient that lives in my town. He is going to be doing anterior esthetics on this patient sometime after Thanksgiving.

The dentist says he does a lot of work with DaVinci labs and that he got my name from DaVinci. (Now I have never in my life done anything with DaVinci, so I don't know how they got my name. Even though I am world famous. I had two people from Egypt read my blog last week. World conqueror, that's me)

He was wondering if I wouldn't mind taking study models and a bite registration on this patient for him.

He goes on to say that this patient is going to be looking for a dentist so after he is done with all his work so he promises to tell the guy to come to me (for those of you not paying attention this is called "blowing smoke up my @#$%@!).

So how does someone interpret this request? Well let me tell you how I interpreted it.

"Hi, I am a dentist so much better than you, I am this awesome cosmetic dentist somewhere other than your poe dunk town. I have this patient that lives in your poe dunk town that would rather spend zillions of dollars in my office flying back in forth than come to you as a dentist. But he lives in your poe dunk town so you can handle doing a cleaning can't you?"

Or something like that. This is how I felt. So as the dentist is talking to me this is what I am thinking.

I am kind of in shock. So I agree to help a brother out. I didn't think about it. I didn't question him. I didn't anything. I just was going to do it.

I was a little hurt, I was belittled a bit, but I didn't question.

We called this fella and set him up to take study models and a bite.

He comes in on Wednesday and I wasn't here (I had to leave early for the funeral) so my assistant did it.

She tells me about the appointment the next morning. She told me she sat him down and started to grill him about what all this is about.

Because I think she kind of felt the same way as me. I mean you have a guy in your town that does very nice work and you are flying half way across the country to get your work done. She wanted to know the scoop.

So she starts to get the 411. She tells me, "GET THIS!"

Turns out this patient HAS NEVER BEEN TO THIS GUYS OFFICE. Turns out that this dentist got some work done at this patients company and couldn't pay him.

So they decide to barter off the remaining debt by doing veneers.


Are you kidding me?

Yeah, so the patient is scheduled in Illinois for all of Monday after Thanksgiving, all day.

He has never had an exam. He has never had x-rays. He has never had his teeth cleaned.

He has never had an esthetic evaluation.


Now that I think about it, why would this guy be calling me for study models? Why would he have not already had photos, models, and all the stuff you need for anterior esthetics.

My assistant actually said this to this patient, "Are you crazy?"

"You haven't even had your teeth cleaned. Your gums are not healthy. You have discolored lower teeth that can be bleach to get an accurate color for the top."

And she started giving him the business (not over the top, but making him think about his teeth and about his dentist for the first time).

This is the craziest story. I mean is this kind of stuff happening to you too or is all this crazy stuff only happening to me?

Don't get me wrong. I don't have any problem with bartering. In fact, I love bartering with people.

But I barter tree trimmers. I barter painters.

Would I barter health or dental care? I don't think I would.

Do people think about dental care the way I think of tree trimming?

Do people think that all dentists are alike?

I recognize the fact that all painters are not the same. I realize there is probably a very wide range of quality of painters.

If I would get a quote to paint my house you could get a range of $2000-$8500.

Now are the $8500 guys just ripping you off?

No! They are doing the job $6500 better than the other guy. They are sandblasting off the old coat, they are priming, they are caulking, they are using superior paint, they are meticulous about the job. They are cleaning up after themselves. They are not getting high before or during the job.

But if you just want your house painted and you don't care about how long it lasts or if you don't care if water comes in your house after it rains or if you have to clean up paint cans when the painters are done then by all means go with the $2000 guy.

Is that what patients think of dentists?

Tell me they don't.

Tell me that when they are leaving a quality-oriented office to go to the dentist that is "on their insurance list" (not that some of these dentists are not quality) they recognize they are giving up stuff.

Tell me they don't think that all veneers are the same or all cleanings are the same or all fillings are the same.

Tell me people recognize the difference between dentists.

Every patient that walks in the door I ask them how they got here. How did you find out about us?

When they answer "Your office is just up the street from my house" I know I have so much more work to make this patient understand who we are.

I know he knows that he can get a paint job for $2000.

But when they leave and say, "That was the most thorough exam I have ever had." I know that I am on my way of impressing on this patient what we are all about.

How about when people call your office and ask how much you charge for a cleaning.

Do you say, "$85"?

Then they say, "Thank you" and hang up.

They are not comparing offices they are comparing prices.

Kind of like we do when we are getting tree trimmers.

This phone call has just given me an idea of another blog. We will get into this call later.

I can write a whole series on this phone call.

I have given you much to think about this weekend.

I am going to talk about the way I barter next week.

But I would like your thoughts if you have any before next week.

Have a great weekend.


First flag football game this weekend.
Marathon is two weeks from Sunday.


PLEASE NOTE: When commenting on this blog, you are affirming that any and all statements, and parts thereof, that you post on “The Daily Grind” (the blog) are your own.

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.