Friday, December 17, 2010

Christmas Hodgepodge


I am working two days next week. I decided that if I am going to take a vacation I might as well do it right. I know I am going to be bored at home but that is what being on vacation is really about.

I am second-guessing myself now because all the college kids are going to be home and wanting that last minute appointment and I won't be here. I am looking at the bank account and it is not looking that pretty. But I guess this is the kind of thing that we all have to deal with. If we take a vacation, nobody is making any money.

But for me, I get the added pressure of my wife spending money likes it is water. Don't get me wrong - I know we have to buy presents for the family and I like a good sale too, but I AM STRESSING OUT HERE!!! (I love you honey and I think you are a great shopper. And I love that you saved $27 dollars at Publix using coupons and the Publix card.)

I love this time of year, and I am so moved by my patients. I get Christmas cards from my patients and I just love that. I love having a relationship with them. I love that they think enough of us here to put us on their Christmas card list. Some even bring cookies, some bring cakes (oh, I love a good rum cake), and some will even bring presents. I am so blessed.

The staff lounge table is getting filled with goodies and it makes me warm inside. Fat inside but also warm. Speaking of fat, I downloaded this app on my phone called Lose It. Have you seen this?

You tell it how fat you are presently (or how much you weigh), you tell it how pudgey you are (or your height) and then you tell it your desired weight and how long you want to take to lose the weight. Then it gives you a daily amount of calories you can have.

You enter all your calories per day. It has almost every restaurant in its database and almost every brand of food from the grocery store. (But what it doesn't have is Mrs. Brown's rum cake that she brought me, so I didn't enter the three pieces of that I whoofed down.) After every meal, you enter what you ate and try to stay under your allowed calories. I mean this is not rocket science but it is fun. I have been under every day so, tall, dark and handsome here I come (okay, maybe average height, dark and handsome).

Let's talk about The Christmas Letter for a second. Have you started getting them? I don't want to tick you off because I know a lot of you write the letter. In fact, my wife wrote a letter. Here are some Gammichia guidelines to the letter (and I gave my wife the same shpeel).

This letter is about information - not bragging. Tell me about your kids. Everyone thinks their kid is the best, so don't go over board with this. Tell me your kid was on the debate team and loves it. Don't tell me that she is the only 8 year old on the high school team.

Successes are great, you being rich is also good - for you. Tell me your job is going great and you are so passionate your work. Don't tell me that you went from a Mercedes Convertible to an Aston Martin.

Laugh at yourself. Yy wife told everyone I ran in a marathon and she added my little trip to the medical tent.

This could be my last blog for the year. I don't remember if I told you that I am going north for the week after Christmas. Remember the mountain home we went to in the summer?

We got the same house for a week after Christmas. So, on Christmas day afternoon, we are getting in the family truckster and driving to North Carolina. My kids have never really seen snow so it should be great. This week, they got 8 inches of snow.
We are going to try to get in a little snow skiing and some tubing. The kids are so excited they can't even stand it.

We have invited our two cousins and their families so it is going to be a crowded house this time. I will take lots of pictures. Hopefully this trip won't involve a trip to the hospital, but you just never know. Maybe if it does, I can put it in next year's Christmas letter.

But listen, all my babbling shouldn't take away from what this season means. We lose the meaning of Christmas in all the BS that we have created. If you are Bible-believing person, Christmas should be about celebrating Jesus coming to Earth for the redemption of man. That is, Jesus coming to earth to show us the way then to die for us.

But that is what is so crazy about the Christmas story: the King of Kings coming to earth to save us (from ourselves) but he came and was born in barn and placed in a pig's trough. Not really the way we thought it was going to happen, but that is a conversation for another day. But you know what? He did it for me and He did it for you and I am really glad He did.

Merry Christmas and have a blessed New Year. We have a lot to be merry about.

Thanks for reading,

Tuesday, December 14, 2010

What is wrong with people?

Hey all,

First, I wanted to show you the family photo that is going to go out in our reception area. I thought it turned out nicely.

My mom, her husband, my dad, his wife, my brothers and sisters, my wife and my kids. Like I said, I am going to put this picture out in the reception area with others around it to let people know me more.

On to today's topic -

I have gotten to be good friends with another small business owner. We are in the same Bible study and afterwards we usually get together to have a piece of pizza and hang out. Well, he was telling me about how it is going with his business, and I'd like to share that story with you.

It was 5:45pm and it was getting close to closing time (6pm) when he got a call from a regular customer asking if he could swing by because he is looking for a very special Christmas gift for someone.

"We close at 6pm."

"I know, can you please just keep the store open for me?"

"Sure, come on over."

The customer showed up at 6pm and started to look around. Knowing they were staying late, you think he would get in and out. It turns out that he stayed and shopped for quite a long time - 45 minutes.

My friend was staying afterwards for this man and he knew it and didn't even hurry. Finally, he chose something and it was a whopping $40. A $40 item for staying after for 45 minutes. My friend wrapped it up nice and made it really special for him. He said he made a $40 gift look like $80 (he takes pride in his work). He was telling me this story and I was just shaking my head.

If you're shaking yours, wait, it gets better. The next day, he returned it for a FULL refund because he found another present he liked better. Now you are officially ticked off for my friend. The icing on the cake - this customer was a dentist. There are so many things wrong with this story.

A DENTIST?!?! Someone who knows what a bad patient looks like. Someone who must have a family and know what it is like to want to get home to them. Someone who knows what is like to stay open for someone and not feel appreciated. This guy should know.

What would you do? In these times, we all are doing things that we normally don't do. If someone calls at the end of the day, do you stay open for them? Are you staying late to squeeze in one more patient?

I have to admit that in my younger days I would agree without even thinking twice about it. Now, I don't do it. Let me rephrase that - I rarely do it. I see patients until 3:30, knowing that I usually BS too much and run late with the last patient, and this allows me to get out at 4pm and not go over.

I am a people-pleaser. I want to make people happy, but this attitude has lost out to a couple of other things. The number one reason I don't stay late is the staff.
They are all mothers and wives and a lot of other things, and they have lives outside of here and to hold them hostage makes for a very angry staff. And two, the patient that does this to us is never the A+ patient. It usually is the person we don't know or the D- patient. The ones that do this to us usually don't appreciate it and/or don't care about us anyway.

I understand the occasional "front crown came off," or the "I know you were here to do a filling but this tooth really needs a crown, can you do it now?" We do what we have to do but...

The "can you stay open for me? I need to get a Christmas gift for a friend" (see above story) doesn't fly here. It never pays off. It is never the cost/reward ratio that works out. They are never so happy that they told 12 of their friends how well you took care of them. They don't send some homemade brownies for you telling you how much that meant to them.

"No good deed goes unpunished." That is just how I feel about it. Do you feel the same way? What would you do? Is it an age thing? Do younger dentists tend to stay later? Or, are you that guy? The guy that calls people at the end of the day?

I would like to know your thoughts.

Have a great Wednesday,
See you Friday,

Friday, December 10, 2010

The Gift of giving

Hey all,
Its Friday. Today is my Christmas party.
For the last couple of years we have been doing the same thing.
We have been starting with a "happy hour". This is a place where everyone can get together and meet. It is usually a place in or close to the mall.
We have some appetizers and a drink and then we send the staff into the mall all with $100.
They have an hour and a half to spend every dollar....ON THEMSELVES.
No presents for their family allowed. These people are so trained to doing for others, here at work and at home it is such a rarity that they only think of themselves.
Then we all get together for dinner and show each other what we bought for ourselves.
Now if they don't spend the $100, I get it back.
It is a fun time and they love it because they don't get a toaster or a blender or a coffee maker, or something they have to return, from me.

Just a light blog today....
I am thinking because it is the holiday season I wanted to talk to you about giving.
My wife does this online devotional every morning and thought this one was particularly powerful.
(this is only part of it)

2 Corinthians 9:7 (NCV): "Each one should give as you have decided in your heart to give. You should not be sad when you give, and you should not give because you feel forced to give. God loves the person who gives happily."

One of my favorite authors, Richard Foster, writes, "Giving with glad and generous hearts has a way of routing out the tough old miser within us. Even the poor need to know that they can give. Just the very act of letting go of money, or some other treasure, does something within us. It destroys the demon greed." God loves to see us give for no other reason than the joy of giving.

The true story is told of a self-made millionaire who had lived in New York City his entire life. Born and raised in a ghetto, he worked hard and achieved much. Anyone who knew this man would testify to the fact that he was generous--to a fault, some would say. One year, the man was disturbed by an attitude of selfishness and greed that seemed to pervade the Christmas holiday season and everyone around him. Not one to condemn, the millionaire decided that since he had been given so much, it was up to him to do his part in combating greed and came up with an unusual plan. Wearing a disguise, this man stuffed his pockets with $100 dollar bills and set out for a walk on the streets of New York City. When he saw someone in need, he whipped out one of the bills, pressed it into that person's hands and with a "Merry Christmas," made his way down the street. "It was the most wonderful part of my holiday season," the man reported, and he has been doing it every since.

God is much more interested in our motive for giving than in the gift itself. If that motive is tainted with greed, the gift simply does not count. A powerful way to guard against greed is to choose joy over greed. Giving with joy is Kingdom giving! Before you give, ask yourself, "What's in it for me?" If the answer is "nothing," then go ahead and give the gift.

There is a couple at our church that are two very special people. See I go to this white upper middle class church (and if you asked the pastor he would say the same thing....we want diversity but the general theme seems to be very WASP) and what makes them very special is that they are black and they have both have been homeless at one point in their life (the woman claims she has been homeless for 25 years of her life).
So the two of them started something that is starting to get traction at our church.
The woman has started collecting clothes to give to the homeless. Now I am talking homeless. Like she is going into the woods that she knows, from experience, where they sleep.
And in the winter this seems to be an even more needed ministry (it was 28 degrees here on Tuesday morning).

But one of the things that the men are getting behind is what her husband is doing.
He understands day labor. You know the place where you go if you are looking to do some work for a day. If you are an employer and you need a couple of laborers for the day, you just drive up and get a couple of workers (I am over simplifying it but you get what I mean).
Now the Day Labor place might only need 5 people that day and it is first come first serve. So the men will start to line up at 4am.
So you will have a crowd of people standing around the Day Labor place at 4am.
These are the men that this guy has chose to love on.
He will go to the local doughnut shop and has worked out a deal to buy a ton of doughnuts. Then they brew about 4 tanks of coffee.
Then he takes his doughnuts and coffee and sets up a table to serve...and oh yeah, he does it at 4am.
And that is what he does. He recognizes they are probably homeless and don't have food.
There are no stipulations, no questions, no strings attached.
He spends about a half an hour at each Labor Ready place and can usually hit four of them before the morning is over.
So a couple of my friends are jumping on board and going downtown with him and serving.
Now think about this for a second. A couple of very sheltered white guys going into some very different areas that they are use when it is pitch black out.
Talk about coming out of your comfort zone.
That is the type of giving and love Jesus talked about.

Like I said this kind of stuff is gaining traction. My family has been talking about how we can help.
We recognize that these men are hungry during the day as well and they unfortunately have to spend some of their money on lunch that day or choose not to eat.
My family is thinking about making the men lunches. Now this is something everyone in my family can do. We can make 60 peanut butter and jelly sandwiches, put in a bag of chips and a bag of cookies, an apple and viola....lunch.
I imagine my kids having hearts for others and not just themselves. I know that is crazy talk.
But the more the world tells them it is all about them, I just try to show them there is more out there. A lot of need. A lot of pain.
So maybe you not getting an itouch for Christmas is not the end of the world.
And I don't want to make it a Christmas thing. I want to do this all the time, to continue to remind them, continue to show them.

Something to think about this weekend (as you are out shopping for that itouch).
Have a great weekend.

ps My father and I have done some talking about me buying the rest of the practice.
Can you imagine talking about selling or buying this large in these times. It is definitely a tough time to do this.
These talks have a tendency to get sensitive but this time it has been good.
I will keep you posted.

Wednesday, December 8, 2010

Firing the Lawn Guy

Hey all,

Man, it is December 8th. It is really close to Christmas!

I have to beg you to go out this weekend and buy your stuff. Next weekend is going to get really crazy, and if you are like me, and usually wait until the last minute, you are going to go crazy again. Now I know some of you are saying, "I am going to do most of my shopping online." Well, it is time. If you do regular shipping you are getting dangerously close to the time.

Once I ordered something online on the 15th of December and it was supposed to be delivered on the 23rd, at least that is what the salesman said. The package arrived - and I am not kidding about this - on February 10th. I called the company and they no longer existed. I called my credit card company and got my money back and waited for a couple of months before I gave it away. Don't get into online trouble this year. Do it early.

Anyway, I am in a quandary. I have this patient that is also my lawn guy. He and I have know each other since I graduated from dental school. I used to play pick-up bball at my church and he was there. I don't think he went to church, but it was a good gym. He has been a patient and our lawn guy for almost 14 years. He does a totally awesome job, but the caveat is that he is very flaky when it comes to showing up.

Now, we have traded all this time. He has four children and it was pretty good even when his wife and kids came in. It gets kind of pricey when the kids get x-rays, cleaning, exam... Sometimes it would be $200 per kid. So a couple of cleanings a year for seven people. I pay $250 per month for his services. Usually, I have to pay him at the end of the year, but not much.

Now he is divorced and his ex-wife and kids are not patients here anymore, and we are really coming out-of-pocket for his services. So now I am paying more attention.

I am also paying more attention because I have more time to pay attention. It seems that in the winter he doesn't really come. As you may know, the grass does not grow in the winter. So he must think he doesn't have anything do and there's no reason to come.

Well, first and foremost I am paying him to come here. Secondly, in the winter, other things need to be done. We have a bunch of oaks that drop their acorns by the thousands. The parking lot gets filled with them, then we drive over them and it becomes a big mess.

(the acorns and the dying grass)

We also have something that looks like a maple tree that drops about a billion leaves. All this is making our property look less than pretty.

(Double-click on the image to make it bigger, but this is the dying grass and the leaves filling up the parking lot.)

As you all know, I am not a big fan of confrontation. But I have been trying to be more of a leader around here. It is my place and if I don't do it, no one will. So I need to buck up and say something to this guy. I need to tell my employees when they are doing something I don't like. It is better for everyone, but it is still hard.

So when my lawn guy was out there the last time, I asked him if he could come every week. I told him that even if he came just to blow off the parking lot and clean the place up, I would be happy. He agreed. I haven't seen him in 15 days.

Now here I am, in a quandary. I know what I have to do. It is time to make a change. But it is 17 days before Christmas. He still has 4 children.

But in these times when the new patients are down and the volume coming through the door is down, you want to impress the ones that do dawn your door. You want them to walk up to the front door saying, "Things are really looking nice around here," or at least not say, "Man, Gammichia is really letting it go around here." And I have to be honest, that is what it is beginning to look like around my place.

He usually comes on Tuesday; it is Wednesday and I haven't seen him. I thought I was going to see him yesterday and read him the riot act. I keep thinking I am going to see him today. But nothing yet. I think I am going to have to make a phone call.

Why can't people just do things right? Why can't he take pride in his work? Why can't he want to treat my office special because we are friends? Why do I have to hound people for good service?

I have a new printer/sign guy now (remember the blog about service?). Well, I started using someone else and it is the same thing. I have to bug him to get things done. I really could go to a website and make the postcards myself faster than he could do it.

I'm so frustrated that my lawn guy has put me in this position. Maybe he just doesn't want the job. I know he lives far away, but if he doesn't want it why doesn't he just say so? Honesty, communication. - what is so hard about that?

I'll let you know how it is goes. Wish me luck.

Now for blog business. It is getting close to the end of the year, and I don't think I have many more blogs in me. I will write a couple, and I have some ghost writer reserves, but this blog is eventually going to take a vacation.

It turns out the ratings system at the end of the blog didn't work out. Some IT issue. But let that not stop you from telling me how you like the blog or what else you want me to talk about.

Talk to you on Friday.


P.S. Just found out the Urban Meyer is resigning. Why don't they just kick me when I am down? I am in so much pain, and right around Christmas time.

Friday, December 3, 2010

Christmas Gifts

Happy Friday.

My wife is doing her annual girls' weekend this weekend, so it is just me and the four kids. Yeah, it is going to be bad. Heck, I don't even know for sure what time my 14 month old goes for a nap. Wish me luck.

Noah turned 7 a few weeks ago and I told you about the his party at the go-kart place. For about 9 months, he has been talking about his party and how he wanted it to be Monster Trucks. So my assistant made him a Monster Truck cake. I told you she makes specialty cakes, and she really overdid it this time.

The yellow thing on the bottom is a bus. Now that is cool.

He was like a pig in poop.

We recently took our family photos. I have to say that my family really did well. One of the real reasons I did the pictures is that I want to put my family in the reception area; I want people to know me. I want them to know that I am a dentist but I am also a son, a brother, a husband and a father. I am going to have a really nice display made of some great photos. I think it makes visitors feel a little more connected to me. And when I get the CD, I will do the same to you guys.

I've got to get my nose back to the grindstone, so I got a ghost writer to take over for today. It is really good stuff. Don't get ticked at me, I am just the messenger.

The holiday season is here. Have the cards started rolling in? This stuff gets me thinking. Every year, I probably get 50 cards from specialists I don’t know. I know they are saying, "I am still in business, so if your specialist starts to tick you off, then give me a shot."

I am good ok that. I actually think it is a good idea. But it is MY specialists that this blog is about. Take my oral surgeon, for instance. I send him ALL my wisdom teeth extractions, probably about 100 patients a year. Let’s say all 100 go to him, and 75 of them get the work done. If I extract a wisdom tooth, it is $250. But when they do it, the total is more like $2000-$3000. I don't know if it is the sedation or what... but this is not the issue. Okay, so 75 patients at the tune of $2-$3k each... carry the one… we are talking $150-$200,000 a year. Maybe I am too full of myself. Maybe I guess too high. Let’s say I only send him 50 patients a year and he works on 40 of them. That still is $80-$120,000 to my friend the Oral Surgeon.

Now what do you think an appropriate gift is for the conductor of this gravy train should be? I am not going to answer this question. I am just throwing it out there. I know this oral surgeon has a ton of referring dentists. But I am not talking about the dentist that is throwing this oral surgeon a bone (4 or 5 patients a year or something like that). I am talking about the loyal general dentist that has been faithfully referring all his wisdom teeth patients for the last 15 years.

How about the orthodontist? Let’s say I send him/her 2 cases a month (I send more); that is about $12,000 a month. That is $144,000 a year to their bottom directly related to ME. Now, what do you think an appropriate gift for someone adding $144,000 to the bottom line? To put it in perspective, last week I got a gift card to a fancy steak house from a specialist I DON'T EVEN REFER TO. It is an awesome gift and it is from a guy I haven’t referred even one patient to.

Now if you are a specialist, I am not mad, I am just thinking out loud. These are not actual numbers and I don't have any specialist in mind when writing this. But I know a lot of general dentists must feel this way. It is the main guys that I am calling out.

We know what kind of cars you drive. We have been to your houses. We sometimes go to your mountain homes. We have been to your hunting leases and driven your 4 wheelers and then you have taken us out on your Air Nautiques. And you send us chocolate covered pretzels for Christmas. Or you send us a basket of crackers and wine that I saw at the grocery store.

Again, I don't think of myself as that everyday guy. I am the one that talks so highly of your office. I am the guy that calls you to give you constructive criticism because I want you to do well. I am the one that likes you for you. I am the guy that is not leaving your practice. I think this kind of loyalty deserves more than your assistant’s trip to the local cookie store. Am I right, general dentists?

Now I know all you general dentists are thinking, "YEAH!” But I am going to through this right back at you. When was the last time you bought your specialist a gift? These guys/gals are cleaning up your messes all the time. They are the guys/gals you call to get you out of a hole that you have dug yourself into. These are the guys/gals that are defending you to your patients, telling your patients not to go to another dentist because the other guy is cheaper.

Oh wait! You don't know they do this. Dude, WAKE UP! Don't give me this "all my patients love me and they never have problems with me" crap. Get your head out of the sand and realize this is a symbiotic relationship. These are the orthodontists that see your kids. These are the oral surgeons that take out your kids’ wisdom teeth.

“NO!!” you are saying, "I send all that work to you, you should feel lucky to see my kids." But that is a slippery slope, my friend.

This year I want all specialists to make their general dentists to feel special. And I want all the general dentists to know how good they have it and send their friends a gift. They deserve it.

Thanks for letting me get that off my chest.

Good stuff from this guy. Like I said, don't get mad at me.

Have a good weekend.

Tuesday, November 30, 2010

The Christmas Party

Hey all,

Is this week dragging? Still got the turkey rolling around in there?

I finished reading The Charm School and it was pretty good (recommended by a reader).
Then I picked up The Hunger Games, a book my son read. He was saying how awesome it was but I was like, "You are 11. Your awesome is different than my awesome." But I read it and, well, it was awesome. So far, there are three books in the series, and I've started reading the second book already.

I have a story to tell you. I have a pretty good library of movies here at the office, and my patients can watch a movie on a screen I have mounted on the ceiling. One of my staff members said she had never seen The Shawshank Redemption.
Are you kidding me?!?! I told her, "Take this movie and don't come back to work until you have watched it."

Well, she watched it and left it on my desk with a sticky note that said, "Not really my cup of tea."

WWWWHHHHAAAATTTTT?????!!!! I wrote her a note that said, "You can NEVER borrow a movie from me again and I have considered taking you off my Christmas list."

Who doesn't like Shawshank? Is it the same person that won't help an old lady across the street. The same kind of person that doesn't like dogs. I just haven't met a person that... well I guess I have now. People are weird.

Let's talk about basketball. I am the assistant coach of my son's sixth grade basketball team, and it is officially over the top. We are practicing six days a week. We had a game Monday. We had a game last night. We have practice today, tomorrow and Friday and TWO games on Saturday. Come on. Are you kidding me? Oh and the other thing is we are finding out that we are not very good. We have been on the wrong end of a 40-19 and a 40-20 game. So we need more practice right?!!

But some of the best stuff coming out of basketball is my son growing up. So far he has had to ask me about some new choice words. A couple weeks ago, during dinner, he said, "Dad, what is a douche?" If you could have seen my face and my face. Classic. I think my wife and I both dropped our forks at the same time.

Of course you have to tell him. So we have this conversation at dinner, mind you the other two kids are quiet for the first time in their lives, as we explain the finer points of feminine hygiene to our older son. Then you should have seen his face - classic. "Ewwww."

I told him to go back to his school and ask Randy if he really knows what a douche is. And if he doesn't, tell him.

And last night he says, "Hey dad."

"Yeah, son."

"What are tits?"

"It's that Randy kid again, isn't it?"


So, basketball has been great. Lots of lifes lessons for us. Great stuff.

Real quick... have you Elfed yourself yet? OfficeMax does this thing every year with JibJab. Check mine out (with my dad and three of our people). It is awesome.

I want to talk about Christmas parties. I know, I know. "John, the last time you wrote about the Christmas party you got in big trouble."

For you newbies, the second blog I wrote was about my staff and my Christmas party. Big hit with the readers; not such a big hit with the staff. So my Christmas party is off limits.

What are you guys doing for a Christmas party? I know it has been a tough year financially. Are you bagging the party all together? Are you doing it with a lot less flair?

It has been in discussion with my dad and I for a couple of weeks. What do we do?
Money has been kind of tight, but it is Christmas. I think the staff kind of know that it has been tough for shareholders, and they don't want the party to be a burden. They don't want to have a party if they can't celebrate, and how can you celebrate if things are kind of terrible?

A couple of my staff members have actually said that we don't need to have a party.
And I thought about it. I thought it would take a lot of pressure off. But after a day or two I said, "We are having a party, dammit."

The party is not for the staff. Sure, they benefit, but the party is for me. I love being able to have dinner with my people. I want to be able to look down the table and see people having a couple of drinks. I want to see people laughing and enjoying each other's company (and hopefully mine).

When God created the world and he looked at it and said, "It is good." I am not putting me and God on the same level, but I want to understand that feeling. I want to look down the table and say, "This is really good."

I want to think, "Yeah, we have had a tough year, but we made it. My staff might not look the same but the ones I have, I really like and I am happy." These are the people that I am in the trenches with everyday. I want to celebrate with them. It is time to remember the laughs and the tears that we had all year. It is time to remember all the fun people that we worked on this year. It is to remember the crazy people we survived.

To me, that's what a Christmas party is for. I might go to a less expensive restaurant. They might get a smaller presents. But by George, we are going to celebrate. And I am looking forward to it.

I hope you are, too.

Talk to you on Friday.

Monday, November 22, 2010

Thanksgiving blog

Hey all,

For some of us, it has been a hard year. But Thursday is Thanksgiving, and I think we need to think about it in the big picture.

Let's just look at our lives from a 5,000 ft view. We live in America, for crying out loud. China has been in the news lately for wanting to be the leader in the world's economy and it may happen someday but... it is China. They have like 3 billion people living there. But they are not FREE people.

We are FREE. Think about that a second. Free to practice dentistry anyway we want. Free to write blogs. Free to have as many kids as we want. Free to worship any God we want (try worshipping Jesus in Saudi Arabia and see how that works out for you). Free to talk about our government (try this in North Korea). Free to talk bad about other countries (haha). But seriously, this is a great thing.

Dentistry has been very, very good to me (and I know it has been good to you).
Think about it...

We choose our own hours. We work in air conditioning. We work with people that we choose. We work on mostly nice people. We make a "good living" and we get to work on teeth. We have great dental organizations, such as the AGD (shameless plug).

Let's talk about a "good living" for a minute. I know this year has been down, but really, don't look a gift horse in the mouth. Maybe you don't have that sports car you want. Maybe putting money away is a bit of a struggle. But don't mess with happy. I mean if you are making over $100k, you are in the top 5% of all of the country and in the top 1% in the world. And most of us only work four days a week. Perspective, people.

Okay, let's say you hate your life right now. You still have a degree that lends itself to some good employment. I got an email from a UF grad yesterday. He is a periodontist who just sold his practice after 14 years. He said his practice was not what he wanted so he gave it all up, and now he is looking for an associateship or looking to be a consultant.

See, some people love dentistry but can't stand private practice (if you are out there, you are not alone). But all in all dentistry is the envy of alot of other doctors. I run with a bunch of physicians, and some of them have it real good and they make a bunch more money than I do but they also work until 8pm sometimes (at 8pm, I have been home, coached a football practice, taken my daughter to swim practice, ate dinner, brushed everyone's teeth and we are getting ready for bed) and work on Saturdays and Sundays. Dude... we have it so good.

I have healthy great kids and an awesome wife (better than I deserve sometimes). I have great friends and am blessed with a great church. I have so many things to be thankful for, it's just is hard to think of them all. I love my house, I love my 9 year old pick-up truck. I love being able to coach my boys and love taking my daughter to swim practice. I love that my kids love me regardless of what a poop I am sometimes. I love living in Orlando. What I can say is God has shown favor to me.

I know the poop might hit the fan soon, but you know what? I will try to find joy in that as well. There is an old saying, "God is good, all the time. All the time, God is good." And I try not to forget it.

My church puts on a free breakfast to anyone Thanksgiving Day morning. We use it as an outreach and most of our members come because it is free. We invite all the first responders to come and eat. So our town's police and firefighters usually show up. Maybe the guy who gave me a ticket will show up (can you say "loogie?").
Then, after the breakfast, we are traveling to Miami to see my wife's family for the weekend.

Then it is back home for church and Christmas pictures with the WHOLE family. Now for you "the whole family" doesn't freak you out but when you are talking about the Gammichias. That is a different ball game.

My parents are divorced, so my mom and her husband will be there. My father is remarried and him and his wife will be there and his two step kids. Then I have four brothers and sisters. None of my siblings are married so there is nothing crazy there. But getting 16 people to remember to show up could get hairy.

I am thankful for so many things, but I almost forgot, I am thankful for you. I love, I mean really love, writing this blog (what can I say it is cheaper than therapy) and I am thankful for the AGD for working with me on it and I am thankful for you who read it.

And Thursday is Thanksgiving, do you know what that means? That there are only 27 shopping days until Christmas. Can you believe that? Crazy talk.

Have a great Thanksgiving. Be safe in your travels and I will see you next Wednesday (by the by, we are close to finding a Monday blogger).


ps. I have tried to activate the rating system at the end of the blog. This is a feature that offers. So when you are done reading each blog there should be something you can click to rate that particular entry. Remember, I am sensitive so be kind please. But really it will help me write about stuff that you like to read. So if you vote it will help me write a better blog (if that is even possible).

Thursday, November 18, 2010

Hey all,

Yesterday, me and my bride celebrated our 15th wedding anniversary. She is the best thing that ever happened to me.
I love her more every day.

I am so happy that the Lord blessed me with a friend/partner/wife/hot body like her. She loves me in spite of me and it has been a great 15 years and I can't wait for the next 15. I know it sounds corny but "she completes me".

We are celebrating tonight. There is a place on Disney property called The California Grill. It is on the 15th floor of the Contemporary Hotel. The restaurant is all windows and every night at 9:30 pm they drop the lights so you can see the Disney fireworks right outside. Then it is back home for some more fireworks (if you know what I mean).

Now that you are done puking a little in your mouth, lets talk teeth shall we.

I have this case that is killing me. I want to talk to you about it.
Here goes....
I have known this family before our kids were born.
They had their daughter one day before my first son. Hanna is now 11 years old.
She was born with a cleft palate. Not a cleft lip but a cleft palate.
She is a pretty little girl but her teeth are kind of messed up because of the original surgery. She has a tiny mouth.

I originally sent her to an orthodontist at the age of 6. She had big teeth and a small mouth and I saw the writing on the wall. She was going to have major crowding issues and I wanted to see if we could alleviate a lot of her later issues if we did some early teeth movement.
Here is the other thing: The parents are great. They do whatever I say and they trust me.

Now she is getting older and she has straight teeth. But is having severe crowding issues still. She is going to be a four bi case, as they say in the biz. To all you non-dental people, this means that we are going to have to remove teeth in the middle of her mouth (premolars or what they use to call them is and cusp=tips of teeth. So the teeth that have two tips).
So she was going to need her four 1st premolars removed (again to the non-dental people, we have two sets of premolars, 1st premolars and 2nd premolars).
This would have been no big deal except she is missing #10, her upper left lateral incisor.

So then it was the big discussion.
Do we just take out #7 (the other lateral incisor) and move the canines forward and leave the upper premolars alone?
Personally, I don't like this method of doing ortho. I don't think the look is ever very good and I am looking for very good. I would want very good on my daughter and I would want it on Hanna too.
So I said no to the above. I don't want to take out the other central and move the canines into the lateral space.
The alternative is pulling the premolars, doing the ortho, and leaving a space for #10 (to do an implant later).

Easy right?
Well, there is more to the story.
In taking the panoramic x-ray we found that #11 (upper left canine) was coming really nicely because she didn't have teeth there resisting. I was just coming into place really nicely.
#6 on the other hand was ectopicly erupting. It was horizontal. Still this is not a big deal right?
Do a little oral surgery and put a band and a chain on this tooth and pull it into place.
No problem.
Well, as it turns out after the pan I wanted a better look at #6. So I took a couple PA's of this tooth.
And here are the PA's.

Can you see the problem?
#6 is moving horizontally and eating the roots of #7 AND #8.
Are you f!@#$%king kidding me?
Like this girl has not been through enough. Cleft palate, ortho, lower premolar extractions. She has been missing front teeth since she was a kid. Now this. Come on...

So at this point, I have a periodontist friend that has one of those iCat machines. I asked if we could get one, for free, so we can really see what was going on.
He said, no problem.
We made an appointment and had this x-ray done.
Well, indeed the roots of #7 and #8 were compromised.
Son of a !@#$%.
After much discussion with the orthodontist we decided that she still could keep #7 and #8 and they probably would be fine for a long time.
So our plan was still intact. Do oral surgery and pull #6 into place. Do ortho and leave a space for #10.

We send her to the oral surgeon for a consult.
He then proceeds to tell us that there is significant blood supply issues in this area.
See, what appears to have happened is that after her cleft palate surgery as a baby, scar tissue has built up in this area (probably causing the canine to more horizontally in the first place). This scar tissue has a very poor blood supply. He is concerned about a couple of things. One is that if everything goes well and we can get a band on the canine that moving the tooth is still going to be too difficult—because without blood you're SOL. You are not giving this tooth the right cells to make the moving process possible.
Now the second issue is without a blood supply, even if you take out #6 you might not have enough blood supply for her to heal properly just from the extraction.
You are kidding me, right?

So now this is where we are at. The surgeon scheduled the surgery on a day that I am off, so I can be there. He wants me to be there so if there are any forks in the road we can try to make the best decision together.
Is this case crazy, or what?

Any thoughts?
The parents are both, "You know, Dr. John, we are with you. Whatever you decide."
But I had to tell them that whatever we do to the canine is one thing but you have to know that the front two teeth have been compromised and we will just deal with it the best we can and hope they will last.

Tough one huh?
Have a great weekend.
Next week is Thanksgiving week. I might blog on Monday and do a Thanksgiving blog on Wednesday but it is looking like a crazy week.

Tuesday, November 16, 2010

Critical thinking

Hey all,

On a totally different note than this thread today, I want to talk about one thing: I have an idea.
I have an idea for a GPS app on my phone. What on earth am I going to do with this idea?
I am just going to come out and tell you because I trust all of you. Let's say you are using your GPS to drive through a town you don't know. The GPS doesn't tell you if the roads or this town is very safe. Do you know what I am saying? This way that the GPS is taking me might be the quickest but it doesn't tell you that there were 16 car jackings in this one mile area last year.
This would be good to know if I am driving my family around trying to find a gas station.
Well, what do you think? Should I go global or what?

The Smiley Silly Bandz thing was going fairly slow. We were getting $25 orders. But things changed yesterday.
I had an orthodontist call up and told me he wanted to buy every thing we had. So he just bought 150 packs. Now that is what I am talking about!!!
We have decided to make another order of 10,000 (I know leap of faith). We are going to put 500 in a jar and start selling the jars for $99.
Now this one...I AM going global.

Okay, lets move on shall we?

Stupid, stupid, stupid, stupid, stupid, stupid. They asked me if I would help coach my son's 6th grade basketball team ... and I said "yes".
I should tell you that I am already assistant coaching for my 1st graders flag football team, which is twice a week (he is also in soccer twice a week for one more week). I do a Bible study on Monday night. My daughter is in swimming two to three days a week. But other than that I am not really doing anything.
But 6th grade basketball is the next level. It is not the rec league that practices once a week, for an hour, and has a game once a week and the season is over in 4 weeks.
NOOOOO, this is practice four days a week, for two hours, with 2 games a week and the season lasts 2 and a half months. What have I gotten myself into?

But I said okay and I am doing it ... there is no turning back.
So we are on the second week of practice. I thought the first week went pretty good.
It is all the same kids I have been coaching since they were in kindergarten. I feel like I have some investment in them. There are only two kids that I didn't know already.
One of the players I don't know is the best player on the team (and he knows it).

I don't know if you know this but I am a talker ... I know HUGE shock to all of you.
I talk before, during and after the drills. If I see something that needs to be tweaked in the way someone is doing a drill, I will mention it and move on.
Dribble with your left hand more,
Set you foot and then go straight up for that shot,
Good effort,
Your shot looks really good,
I need crisper passes,
Use the pick, don't just go around it,
Come on run harder,
You play like you practice.
Things like this...

So this really good kid was doing a drill and I told him, "You did a really nice job on that drill."
And he stopped and said, "You know that is the first time you have encouraged me."
At first I thought, "you're a punk, move on."
I thought he was trying to manipulate me.
I mean, I don't know him well, so I didn't know if he was being honest or if he was just being a punk.
So like most things, I brought this back to work.
I was telling my assistant about this.
And she said, "Yep, you are critical."
"WHAT?!!", I said, "What do you mean?"
She said you are not much of an encourager.
Then my front desk person who was not minding her own business and eavesdropping said, "No, you are not."
And I look out of the room and she was shaking her head and saying like she was sorry, "You really are not."
I was shocked. We are a family and they all know how much I love them.
But these two were telling me how I am not much of an encourager but very critical.
Then I brought it back to my wife and talked to her about it and she looked at me like, "DUH!!"

So I started to think...
I think I get it from my dad. My dad was and still is very critical of me.
I know he loves me and I love him but that was the way he was brought up. And this is the way I was brought up.
But I didn't think it was me.
Okay, wait a minute ... I know it's the way I treat my wife. I tell her how sorry I am that I am this way with her (sometimes she gets the grouchy me).
But I didn't think this was the way I was with my kids and my staff.
So back to my discussion with my staff; they started getting on me about my coaching and how kids are fragile and they need encouragement and blah, blah, blah.
I have always tried to be an encourager to my own kids and the kids I coach.
What is wrong with being critical? At least what is wrong with being constructively critical?
But I guess, they are telling me, some things might get lost in the translation.
So when I say, "you are not going straight up with your jump shot", the kid hears "Why are you even on this team, you suck and you will never make anything of yourself in life."
What is wrong with being critical?
Should I say, "I really like you, you are a really good kid and I really like you and in fact a lot of kids like you, but you are not going straight up with your jump shot".
So we can't be critical anymore? Aren't we trying to teach them about life?
Are they really all trying to be NBA players? No, they are playing basketball and learning about life. And life, let me tell you, is not full of "attaboys" and "great jobs, people really like you."

So when can we be critical?
Lets just say you are in a game and you are down by 25 points. Is this the time to start busting some balls or do we still have to consider their feelings?

Now I get the whole thing about being less critical but...
But that was the way I was coached and I turned out okay.
Coaching back in the 80's is much different than now. My coach screamed at me so much and got so up in my face that spittle got on me.
Now you all are gasping right now at the horror. But you know what ... the military does it and they ain't doing so bad at making boys into men.
You know what you say when a kid drops out of high school and is kind of trying to find himself. "Yeah, that kid needs to go into the military."
Because the military isn't all about feelings, it is about getting work done.
Okay so maybe the military might be a little strong and the all-feeling thing might be too easy ... so maybe somewhere in the middle might be "just right".

At work, I started to say something like, "That was a really nice temporary but the margin could be a little more flush on the facial. Here let me show you what I am talking about."
Is this okay?
I walked around today and told everyone they were doing a great job and they all looked at me like, "What is up with you and what do you want from me?"

I don't know, and it just seems so fake when I do it. I swear I am trying to do it with feeling.
I guess I am just wired in a different way. Like, other than being an alcoholic, I thought the Great Santini did a lot of things right (If you haven't seen the movie ... go get it right now).

I definitely think, and don't kill me for this, I think women have it a bit easier than men.
We are hunters and killers ... you have seen the cavemen movies.
What do you say when you in are in touch with your feelings? You say that you are in touch with your feminine side. Why would we say this? Because girls are about feelings. Men are all about punching each other and seeing who can pee farther.
This softer way of doing things is tough for guys. Now I know I am generalizing but...

I see myself getting in a little bit of trouble so I am going to stop while I am ahead.

What is it like with you?
Are you a touchy feely boss (not that there is anything wrong with that)?
Are you a critical dentist?
Do woman have it easier?

Do you coach? What is your coaching style like?

Talk to you on Friday,
No what I meant to say is, "I really like you all and it was great being with you today. Have you lost weight. I will talk to you on Friday because you are such a good person."

Friday, November 12, 2010

And the winner is...


I'm about 7 hours from "Miller time." (The AGD doesn't condone drinking to make your problems go away; that's my idea, not their's.)

You know I like to tell you about the funny things that happen at home. David, my 13month old, is officially walking. Really, it's more like wobbling... it is so cute. But my wife was looking at David walking and asked if I thought one of his legs was longer than the other. I about died laughing. I am laughing while I am writing this because I am thinking about the way he walks and thinking about how crazy parents can get.

If you are not a parent yet you don't know this, but parents worry. They worry about everything from the first day the kid is born to when they have children and then they worry about the grandkid. They worry if they are blind, or deaf or have a learning disability. Parents know it isn't healthy but they do it all the time anyway.

"Honey, we have been to the pediatrician 15 times this year. You don't think 'one leg is longer than the other' might be something she would let us know about?"

I started watching Modern Family this week. I have heard so many things about this show that I DVR'd it. Well, I loved it. I laughed at one thing so hard the milk I was drinking came out of my nose. My wife, who was hell-bent against not watching it, loved it as well. I recommend it.

Topic de jour...

The Chamber of Commerce did this "The Best of Apopka" thing. (Apopka is the nice little town I work in.) It was announced that every category of service was up for the Best of:
best mechanic, best restaurant, best hair salon, etc. Of course, dentist was a category.

So I wanted to win. I have a few reasons for wanting to one. Partially because I want people to like me and to validate all my efforts. But also, I didn't want any other dentist to get more recognition (it is all about marketing and PR). I think there are about 11 or 12 dentists in Apopka.

The voting went on for a couple of months. I did some things to help myself out. I had my whole staff vote (10 votes!) and I put a flyer at my front desk letting people know that they still had time to vote. I didn't tell them who to vote for; I encouraged them to vote for their favorite dentist.

The voting ended two weeks ago, and we got a call from the local paper saying that we were in the top three. They were not allowed to tell us if we won or not, but they wanted to know if we would like to put an ad in a special section of all the top three winners. In all, I received three calls from the paper and 3 faxes wanting me to put an ad in the special section.

I took one of the calls. I asked if I was going know if I won before the paper came out. They said I would not, and I told them that I didn't want to run an ad if I didn't win 1st place. I can see it now: "Thank you for voting me third best dentist in Apopka.

So how do you find out if you won? Well, funny you should ask. They are having an awards dinner at the local town hall. For $20 a head, you come and have a spaghetti buffet and find out what place you came in.

There were about 40 categories, and three people from each category were invited, but there were only 200 spots. I know that may seem like a lot, but let's say "Best Bank" is a category. Each bank might bring 5 people.

I wondered if I should go to this dinner. My thought was that if I win and don't show for the dinner, I look like an unappreciative ____. But if I go and don't win, I look like all the other second and third place people.

I was confident and decided to go. On the day of the dinner I called the Chamber to ask for the dress code and they told me that I haven't RSVPed. Here is the thing: I usually tell my people, "I want to go to this dinner, can you take care of it for me?" And it happens.

Now my wife wanted to go with me, so she asked the person in charge to email her the information. This must have short-circuited our finely-tuned machine here, because it became a lot of, "I thought she was going to RSVP," and "Why would I RSVP? I just asked for the information?" (I'm not blaming anyone.)

I asked the woman at the chamber what we could do. She said that there are always available seats so just come a little late and we will find you two seats. I thought this was kind of a weird way of doing it, but I was game. We would get all dressed up and if we couldn't find a seat, my wife and I would go out for a nice dinner.

We showed up at the local VFW and it was a madhouse. We couldn't find a seat; half of the people weren't seated because they were in line for food. We told them we would wait. So she said that would be $40, cash or check. Hmm, now we have a problem. Between the two of us, we only had $6 on us and no check book.

She looked at us like, "You have got to be kidding." I looked at her like, "You have to be kidding. I have never been to a dinner where they wouldn't bill my office."

The night was not going well. We went to the bar, used all of our $6 to buy two beers, and stood there. We had been there about 35 minutes when I said to my wife, "You ready?" And she replied, "I thought you would never ask." We were out of there in about 30 seconds. We went to a quaint little place (that was not the VFW) and had a nice dinner.

I want to get involved in the community but I felt like this was kind of like a Hallmark holiday. It seems like they have this "Best of" just to sell ads for the newspaper and to sell tickets to the dinner. There are just 40 people that are really happy (oh, and the newspaper people are happy too). The others are ticked because they didn't win and and others are ticked because they bought a table for 6 at the dinner and a half page ad and won third place.

The voting stopped about 3 weeks ago, the dinner was Wednesday, and I still don't know if I won. I guess it is just as well, as I have a really bad attitude about the whole thing anyway.

The paper comes out on Fridays and one came in the mail today. I went to it to see if they have the winners. Nope. This weeks paper has all the ads and NEXT week is when they will reveal the winners. I guess I should have stayed at the dinner.

Well, we are off to the pediatrician to have David's legs measured. Just kidding. I have a full plate. I'm hoping there will be some funny stuff so I can bring it back here for you on Monday.

Have a great Friday and weekend.


Tuesday, November 9, 2010

Lights. Camera. Action!

Hey all,

Happy Wednesday!

On Friday, I told you about my daughter's birthday cake, but I realized I forgot to put the pictures in. Sorry about that, I know you don't care that my two of my staff members started a cake business. But, you see, the pictures would have brought this all together and I forgot. Would you forgive me if I put the pictures in now? It will be worth it.

(Don't forget to double click on the image and it will get bigger and you can see the detail)

This weekend was busy for me; I had to do two public appearances. That sounds so Hollywood, doesn't it?

My church is getting behind a Thanksgiving Day food drive called Bags of Love.
I talked to the ones that organize it and to the church. The church was going to announce it to the members and someone said, "Why don't you do it?"

"Whoa, you mean get up in front of the congregation and talk?"

"Yeah, just tell everyone about Bags of Love."

"Okay, I guess."

Sunday was the big day. Let me tell you - this was not easy. I could have easily gone up there and told everyone that Bags of Love is an envelope that has food items on it. You go out, buy a reusable bag, and you put items on the envelope in the bag.

I did that, but I have to do things like this with some style. So I thought I would bring my whole family up and talk about how my family prays for the poor but it was time to put our prayers into action and do something about it. I was going to tell them that around the dinner table we talk about how some people don't have this.

But when you get up there in front of 600 people, it is SO SCARY. Everyone is staring at you. I was shaking like a leaf. I had an idea of what I wanted to say, but once I started to hear my voice on the speakers, I thought, "Holy sh!t, I am totally freaking out here!" It becamce an out of body experience. When I got back to my seat, I had sweat coming out of every pore on my body.

On Monday, I was asked to do a TV show. Now, it is not what you think. It was not Good Morning America or Larry King Live. No. It was Joy to our Town, on Channel 55. Channel 55 is a local Christian station and they do 15 minute segments on things going on in our town. One of my patients works there and asked me to do a dental minute (or 15).

I got there about 9:30 for a 10am appearance. I was a basketcase. I followed directions to the studio and had a seat. I looked through the door and saw a small studio set up like a living room, with two leather chairs facing each other and a little coffee table. It was a tiny room with about three cameras and a couple of lights. They had me sign a few releases and then sat me in the chair opposite the host.

If you haven't done this, it is nothing like you see on TV. This room was so small that you had to duck under cameras and step over light stands, taped down wires on the ground. The only place that looked normal was the two chairs and the coffee table.

We talked about what we were going to discuss on the air. They put my mic on and laid down the ground rules: Do not look at the camera, look at the host. Talk more than you think is necessary; short answers are a killer. The people behind the cameras will give you cues to how much time is left. Is that clear?

"Uhhh, yeah."

"Can I get you some water?"

"Uh, yes, considering there is a squirrel in my mouth and I can't feel my tongue."

I think I did pretty well. I was much better than the day before, even though it was another out-of-body experience. I wasn't that nervous, if you can believe that. I was just trying to not forget the things I wanted to say. We talked about access to care and some options for the working poor. Talking about dentistry with someone I don't know is what I do almost all the time.

As an aside, I was doing some research about this issue and student loans was part of the discussion. Did you know that the most expensive dental school is a state school? The University of Southern California has a dental school and it is $65,000 a year to go there!

And here I am thinking $27,000 a year to go to the greatest school is expensive. Are you kidding me? University of Florida College of Dentistry is a steal! The problem is: 1500 applicants for 83 spots. Wow.

Anyway, we finished up the TV interview and I have to say, I am a natural. No, just kidding. But really, I wasn't too bad. They were going to tape eight 15 minute spots that day, so by the time I was done, they were already prepping the next person. "Thank you so much for coming. You remember how to get out."

Do you have any experiences with media? Do you do a radio spot? Tell me about it; inquiring minds want to know.

Have a great Wednesday.

Friday, November 5, 2010

The big D - and I don't mean Dallas

Hey all,

My daughter Madison turned 10 last week. Double digits. If she is 10, that means I am 41...s!#t! (I could swear I just started this profession.)

She had a great little party. I tell you this because my assistant and one of my front desk staff started a specialty cakes business. I don't think they have been paid real money for anything yet but they are doing lots of cakes for friends and such. They have purchased everything they need to make any type of cake. They made the cake for my daughter's party. It was pretty special.

SmileyBandz are in, and I have to say, they are pretty cool. I had an orthodontist come in and he bought 100 packs (for $1.19 each. We are selling them to our patients at $2 per pack). Now hopefully he will tell two friends, and they will tell two friends and so on and so on. And then you will find me on a beach in Malibu somewhere. Yeah, like that's going to happen...

I am reading a book called The Charm School, and I really like it. This is the second book I have read on my electronic reader, and I have to tell you, it is tough. I am still getting used to not having a book in my hands. I think it is ruining my reading experience.

One last thing before we get started: it is supposed to be in the 40s this weekend. Two days ago, it was 89 degrees here and today I am busting out the fire pit and the marshmallows. It is going to be nice. Good times.

Today I want to talk about divorce. (No, honey, if you are reading this, this is not about our marriage.) I want to talk about having a seemingly-wonderful family in your practice. You like the whole family, parents and kids, and they really like you.

But then things start to happen in their house. You only see them twice a year, but you start to notice things are different between the two of them. They used to come in together (sometimes the whole family came together). But now they come in individually. You can tell something is wrong when you ask them, "How's it going?"
The next time they come in they drop the bomb on you. "We are getting a divorce."

You hate it for them. You know they are both good people and it is tearing them both up. It affects everyone. The little kids appear to be okay, but the parents seem to go in stages. They are upset but quiet. The next time you see them they are a bit more outspoken about their spouse.

My assistant has to know. Most of the time she will break down and ask the wife (who will usually sing like a bird). I spend a lot of time talking to my patients, and my assistant is right there with me. So she will be invested as much as I am.
She is very personable and genuinely likes them. (I have to admit that when she is on vacation, some patients are visibly disappointed that she isn't here.)

My assistant and I will go back and forth. "You ask him."

"NO WAY! You ask her."

So when they are checking out or when the hygienist leaves the room, she will ask them. We once had a young couple that got a divorce but they continued to live in the same house. So she told us they had gotten a divorce and that they were living together, but didn't say anymore about it. We wanted to know what really was going on; it was like a soap opera. About three years later, my assistant just couldn't take it anymore and asked her. Crazy story, but she ended up marrying his best friend.

After all the dust clears, how does it affect our relationship with this particular family? We try not to schedule them on the same day. We have had a couple of bad scenes when the two come in at the same time. (I mean, they used to come in on the same day and when they left 6 months earlier, putting them on the same day did not seem like a problem.)

We had one man call and say that he wasn't going to be able to make it to his cleaning because when he pulled in he saw his wife's car in the parking lot and he didn't want any part of that. We had one woman waiting in the parking lot for her ex to finish. I think we had to call the cops that time.

The kids are a totally different story. Now I said earlier that the little ones seemed unfazed. If they are a teenager, you can tell something is wrong. Teenagers are kind of a weird bunch anyway, but they almost seem more reclusive. It is tough for me to watch.

Usually when the family unit is in place, one of the parents is in charge of the teeth. After the divorce, when the other parent has some teeth responsibility, it can be difficult. One parent brings them and they have 7 new cavities and they then blame the other parent because he/she doesn't make them brush their teeth, or care about what they eat or drink. Then we, as dentists, are kind of put in the middle. That isn't that big of a deal, it just something we have to handle.

Divorce must be so hard. I watched my parents go through it, and it was rough on both of them. When it happens to your patients, you go through it with them. It can be easier sometimes, but most of the time it is tough, as a professional, to handle all the emotions of your patients.

Just something to think about. Have a great weekend. If you need me, I will be hanging around the fire pit with a cigar and a glass of red wine (and a marshmallow on a stick).


Tuesday, November 2, 2010

The Scarlett Letter

Hey all,

I want to thank you all for commenting on Friday's blog. I truly appreciate your support and your translucency. I know I have said this a billion times, but I write to make you all feel less alone. This time, you all made me feel less alone.

I am still not over everything that is going on in my life so, let's talk about this a minute.

I have been a dentist for 15 and a half years. I have been paying for insurance for the entire time. Now, I am talking about malpractice insurance and general insurance. If someone slips on a wet spot on your floors and gets hurt, your general office insurance will take care of it. So why do I get all bent out of shape when someone brings a complaint to me?

Most of your comments were, "You are a good guy, don't worry about this a bit." I wish it were that easy. I know I should just say to them, "Talk to my people."
And I would if it weren't for that one question...

"Have you ever had a claim against you?"

It is everywhere. Every time you fill out any sort of dental application, any insurance form. I liken it to being arrested. Let's say you get arrested, then forever you have to answer the question, "Have you ever been arrested?"

Or, God forbid, you have been convicted of a felony (I haven't, but I sure have done enough stuff to know that I have been damn lucky). That stuff never leaves you. They don't ask if you were acquitted. They want to know anything about it. They just want to put you in this one "arrested" box.

So we are back to the question above. They don't ask you if the person that put a claim against you is a crazy lady. Or the guy that was coming after you is a vindictive man with anger issues. They don't care if you had to pay $1 or $3million. They put in you in this box and you are there forever. This is a box that I don't ever want to be in.

My father had a patient that he tried like mad to please. He did everything he could for her, and she was never happy. After countless appointments, he said, "I just can't help you anymore."

She got an attorney and went after him. He was 62 at the time, and he said, "You know what? I don't care anymore. I have been paying this malpractice insurance for 32 years and have never used it."

So he told her to talk to his insurance, and she did. Now, it is going to behoove the insurance company to just pay the plaintiff. I mean, before they hear anything, they know that if it goes to court it is going to cost them X. So if the settlement is less than X, why fight it?

Principle goes out the window. They don't care if they think they will win or not. They don't care if the doctor's name gets smeared all over the place. It is all about the Benjamins. This is a real problem. If they take a couple of these gold diggers to court and the court tells them to get lost, then the gold diggers will stop going down this path.

And I am going through a bit of the same thing. What if it is going to cost me $2,000 for her emergency room bills? Write it off as the cost of doing business.
Isn't that worth it to me and my stomach to not drag this out?

Just pay her, I won't have to check the "claims against you" box, and then I can sleep again (I am really sleeping okay). I have put this out of my mind; I haven't heard from them in about a week.

In the comments, some of you wrote to tell her to take a flying leap. That would be fine - if that would end it. But it wouldn't. She would go straight to an attorney and then all hell would break loose. I think she will still go an attorney and he will probably laugh at her. But all it takes is one attorney, who probably doesn't have anything to do right now, to decide to take a fishing trip into my records.

In closing, I think it is silly to think that, in this litigious world that we live in, we are not going to have to go through this. It is silly to think that we are going to go through life and not have to check this box. Physicians go through it and there is no scarlet letter. I remember in dental school one particular instructor told us that half of us were going to be sued in the first three years of practice. I thought he was crazy, but if you talk to enough dentists, they have all gone through it. If not peer review, then a settlement or a full-blown, knock-out fight in court. So many people have gone through it.

Another dentist called me because she had heard something was up and she said, while I was telling her about this issue, she is going through it with someone right now (and she is an LVI-accredited dentist).

I know this stuff happens and it must get easier as I get older. Because we learn, as we grow as professionals, that crap is going to happen. We just have to learn how to handle the crap better.

What do you think? Anyone wearing the "C" for claim on there scrub top?

I will talk to you on Friday,

Friday, October 29, 2010

No rain...but is it pouring.

Friday - yeah baby!!!

You know that it is smack dab in the middle of hurricane season here. While there have been a couple of named storms this year, not one has even threatened Florida. But even without the threat of hurricanes, we do still get a lot of rain and thunderstorms.

Yesterday it rained. Not alot - just a late evening rain for about 40 minutes. What's the big deal, you ask? Well, it hasn't rained here in 32 days; it has been driest October on record. So, while it wasn't much, we will take it. I tell you about the weather because, even though it is not raining outside, it is pouring in my office.

I have to tell you that I usually am a free-flowing idea kind of guy, but lately my mind has been on only one thing. I didn't want to tell you because I am kind of embarrassed. Not embarrassed, more ashamed.

As you know, I pride myself on being a very good dentist and treating people with exceptional service. But this year has been kind of rough. I don't have too many issues with patients, but lately I have had a rash of them. I have put off telling you, but now I am just going to come out and say it.

A woman come into my office for her first visit. She had gone to an endodontist and she didn't get along with him. Every tooth in her mouth crowned. Now, five years after her full-mouth reconstruction, she has 4 abscesses in the lower anterior.
The endodontist had diagnosed everything and even sent me a letter. I turned on the charm when she got here, and everything went really well.

I told her I would do 2 pulpectomies the first time I saw her, put some calcium hydroxide in the canals, and let them sit for a month. Then she would come the second time and we would do the same thing on the second two teeth. She loved me and told me so. She said she didn't have any money, but paid in advance for 3 of the root canals.

She came for the first visit and it went well. I told her I would see her in a couple of weeks for the second appointment to do the second two pulpectomies.
The second day she came in with a bit of an edge. No big deal - I had work to do.

We started the second two pulps (the second one being a retreat). I want to preface this next part with some philosophy. Lower anteriors are usually easy to get an endo access. But when they have crowns it is a bigger deal to me. I try to make the access very small and I want to make sure I have proper perspective when doing so. This being said, I don't routinely put a rubber damn on for my accesses. I usually gain access, then put the rubber damn on. (You now know where this is going.)

I got access, no problem, in the normal tooth. It was the re-treatment tooth that was giving me trouble. The access was fine but I couldn't get a file down the tooth. The number 8 file kind of hit something and bent and didn't get down. It was the hitting and bending that would lead to what happened next.

The file bounced out of my hand and landed on her tongue. No big deal. I was going to pick it up and before I could move to get it she shot up in the chair. I thought she overreacted a bit, but she spit it out and gave it to me. She laid back down and we went on. I finished both procedures without further incident.

Two weeks later she was supposed to come back to finish the root canals on the first two. She calls 15 minutes before the procedure and says, "I am not coming back and you know why."

This was coming out of left field to me. She claims that she left a message on the machine here at work. I never got it. It seems that what she said on the machine was that that night after the last procedure she had to go to the emergency room. She claims that when she jumped up to remove the file from her mouth that she hurt her back and when she turned sideways she hurt her neck. And then she said she was calling me today to ask me what I planned to do about it.

She said that all this happened at my office and as a result of me dropping a file.
She said, "I don't have medical insurance and I have all these hospital bills that are piling up and I don't know what to do."

I just sat there on the phone and didn't say anything. I couldn't believe this was happening. It was stunned silence. All these things are running through my head. She is crazy. She is some woman that doesn't have insurance and is looking for a big pay out. And she kept asking me what I was going to do about it.

I told her I wasn't going to do anything. She, of course, says something like, "I am not that kind of person that sues people." Then went on to say, "If you don't do anything, I might have to get other people involved."

I said, "Do you what you have to do." I told her that I would get some council on this matter and get back with her.

I've had time to think about it, and I have to tell you, it STINKS. I mean, it really stinks. Yes, I dropped a file in her mouth. Yes, she jumped up. But I think it would be the same if someone slipped and fell in the reception room. I know what you are going to say about the file and a rubber damn but...

I really care about the fact that she got hurt here. I wish it didn't happen. Should I feel responsible?

But I just didn't get the best vibe from her and there are a few reasons why. She came in for her first appointment with her "husband" and he did all the talking. She came to the second appointment by herself and I asked her where her husband was. She said that they are divorced but still living together, and the reason they got divorced is that he beats her. I was starting to put all the pieces together. Now I am in the middle of this thing.

I called my insurance and they are as much help as you guys would be if I asked you.
They said, "If you can find out how much they want and just settle amongst the two of you then we don't have to get involved but if you decide you want to get us involved we will start crawling all over everyone."

So it is going to come down to: how much will it cost me to make this thing go away? I do want to stand behind principle. "You are crazy, and if you want any money from me then you are going to have to go through my people."

I called her back and have left 4 messages on her home voicemail. Her ex-husband finally answered the phone yesterday and said, "She is in bed. She has been in so much pain that she hasn't really gotten out of bed in the last three weeks."

COME ON. Really? He and I went back and forth and he promised to send me all the bills from their hospital visit. I told him that I would look at them and then we would talk.

Apparently when it rains, it pours, and my friends, at my office it is pouring. I am in a bad mood and it doesn't look like it is going to get any better any time soon.

Have a good weekend. If you can encourage me with a nice comment that would really help.

I am going to drink... a lot (the AGD doesn't condone drinking to deal with your problems, but I think it may help).


Wednesday, October 27, 2010

The times... they are a-changin'

Hey all,

My mood hasn't changed since Friday so. It is supposed to be 92 degrees here today, this could be one of the reasons.

We have this nice (but old) building that was built in the late 70s. If you don't remember, we have 3600 square feet here. Well, air conditioning must be different now than it was 35 years ago. We have 5 (yes, I said Five) air conditioner units. Yesterday, one of the units stopped working. I swear I had sweat dripping down my back and my gloves were sticking to my hands. My assistants were grouchy yesterday because of tough working conditions. It sucks when you get up and you have pits.

I saw the Time Travelers Wife this weekend. YYYYYAAAAAWWWWNNN!!! I woke up half an hour later, looked over and my wife wass crying like a little girl. I leaned over and whispered, "I love you that much, too," and then went back to sleep. Hey, you have to take advantage of vulnerable moments like that.

I wanted to talk about... what else?... the economy. No, I am not going to talk about Obama; I am going to talk about how it is effecting the way we practice dentistry.

I want to give you a perfect example of what happens at my office. Three years ago, the dentist ruled the doctor/patient relationship. There were rules and policies in place that the dentist wanted. For instance, here we do a new patient exam. This is a 90-minute appointment that a new patient gets with me. We do X-rays, an interview with me, then data collection (cancer screening, bite, teeth and cavity check, TMJ, and perio).

We USED to be adament about not having the patient get a cleaning on the same day as the exam. This was a hygiene-driven rule. Looking back on it, it was kind of a stupid policy. The mindset behind the rule was that we needed to know the patient before we started treating them. We needed to know their dental health before treating them.

Let's say we scheduled the 90 minutes with me and then a cleaning afterwards and they needed premedication before a cleaning because of a hip replacement. Or they were going to be referred, because of major perio, directly to the periodontist. Then you have a hygiene spot going unused. Or what if they didn't show? Then you are screwed twice instead of once. Who cares if it was convenient for the patient? We had a policy and it wasn't going to be broken.

Now, if the patient wants to get their teeth cleaned on the day of the new patient exam, NO PROBLEM. I recognize there were some legitimate reasons for having those policies, but, we've relented.

A couple of other things come to my mind. The cosmetic guys really have been hit really hard in this economy. So the guys that shrunk their practice to veneers and full mouth reconstructions have either changed their hours to 10am-1pm three days a week or they are opening up their repertoire.

Ten years ago, a friend told me he didn't see kids. I was shocked. Kids are a huge part of my practice. Not the restorative part, but the cleaning of their teeth and seeing the whole family, from kid to great grandma. I wonder if he is reconsidering.

I have heard through conversations at study clubs that people that haven't been doing root canals for years are now picking the gutta percha back up. I am thinking this is a little bit dangerous.

I have tried to not get into doing things that won't be A+ stuff. For example, if I don't normally do root canal retreatments, I am not going to go out and buy chloroform (that is what they still use, isn't it?) and start that because my day is slow.

Okay, I know I tried to extract that #18 when I had no business doing so; I am chalking that up to a brain fart. But, I have definitely loosened up the reigns a little bit on my policies. It is not full-on "Whatever you want" policy, but it is getting close. If it is within reason, we are doing it. If it doesn't compromise A+ work, we are doing it. And you know what? I think the patients are really appreciating it. SERVICE. I keep preaching it and I hope we are doing it.

How are you practicing different? Have you loosened the reigns? Did you have stupid policies? Are you doing different procedures? How is it going?

Let me know. Don't tell me I am alone on this one.

Have a great Wednesday,

Friday, October 22, 2010

She makes how much?!?!

Hey all,

Hope everyone is having a good week. I had been having a really good week - until yesterday. It was a tough day. You know, you try to be good at what you do, you try to treat everyone nicely, you try to treat your employees well, and you feel like if you do all of that you might be able to make a pretty good career out of it.

Why does it seem so hard to do this sometimes? And what’s really hard is getting them all going at the same time. You could be doing awesome dentistry, but no one is coming in. Or lots of people are coming in but you just don't feel awesome about it. One day, your staff lounge is filled with gifts that patients baked for you; the next day someone says they were hurt at your office. Sometimes you can be looking at the new BMWs and thinking you would look good in that car (with your new Prada shades on) and then the next week you don't have the money to cover all the bills.

You have to be tough in this business. Just remember the higher you get the farther the fall is. The bigger you are the harder you fall (and I am getting huge in Europe!).

Now you know why some people will sell their practices to a management company because they don't want it anymore. "Take it and I will be an employee. That’s got to be easier than all this S@%T!" Okay, I am done with my pity party.

I have never talked about this, but it is something we all have to deal with. We have eight employees right now, and it has been as high as 11. Everyone that you have hired was been hired at a different time. Someone who is an assistant might have been hired when there were no assistants around. When you put out an ad to hire an assistant and you get four people applicants, it is very different than now, when if you put an ad out there, now you might get 50 applicants to choose from. When there is that much competition for a spot, you have bargaining power. When you have one good assistant and she has 4 offices to choose from you have to open up the wallet.

Now, my staff is pretty solid. I think things got a little crazy with babies and the economy, but I can't see me changing anything for a long time. I think everyone likes me and my style and is "picking up what I am laying down." (I don't know why but I like that saying, so you might hear it a lot). Sometimes staff encounter hardships, so I might give in to them a little more. You know, we’ve become a family and I want to help my family.

Now the real issue comes when they are friends. Because friends talk.

Pause for effect [go on, I’ll wait]…

You all know what I am saying. The assistant who has been at your office for 4 years is making the same as the assistant who has been there for 8 years. Before I go any further, all scenarios I use are totally fabricated. Fiction based on actual events, if you will.

So the two of them get together start drinking and of course start talking about work. They talk about their money issues at home and then it comes out. "Well, how much do you make?" Then everyone knows what everyone else is making. You, as a boss, are screwed.

They would never blame each other but they come to you. "I know it is slow but I have been here much longer then she has and I know I am more important." Translation: I am not going to ask for a raise now but it is coming.

I have a dentist friend that tells his staff that if they ever tell anyone how much they are being paid they will be FIRED. He tells them on the first day of work that the amount I pay you stays with you and never should get out. I am starting to agree with him. It would alleviate any pay issues.

This scenario used to be okay because of bonuses. In my office, the person that has been here the longest gets the best bonus. But now that there is no bonus, it is coming down to getting respect. And I get that.

I don't really think it is the money. I don't think that 50 cents an hour (a whopping $24 a week) is going to change someone's life, but it is the principle. And as much as I understand this, I don't know what to do.

I can give her $2 more an hour, but who gets a $2 an hour raise? And then you are talking about making her the highest-paid assistant in the Southeast. Who is she - Darrelle Revis (the best cornerback in the NFL, who decided he wasn't going to play until the Jets upped his contract to $20 million a year)? And quite frankly the assistant she is comparing herself to is pretty awesome too.

It’s a tough one. Any thoughts? What do you do? I am looking forward to hearing what you have to say.

The Gators have a bye week, thank fully. Have a great weekend.



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