I'm Sick of It

Hey all,

Hope everything is well. I just watched Despicable Me this weekend. Now, that is a good movie. I didn't think it was going to be good, but it is. I really liked it. I finally finished reading The Book Thief. It was a huge success you know, "National Best Seller." I didn't think it was that good.

I have just started reading Samson and the Pirate Monks. This book is about a pastor from Tennessee who was a sex addict. He claims he spent over $300,000 on porn and prostitutes, all while holding a job as a senior pastor. It is about his addiction and his walk to recovery. He was a guest speaker at our church, so I bought the book.

This time of year in Florida, the weather is so hot and cold. Literally. It was 48 this weekend and it is 83 right now. Yesterday it was raining; today is beautiful. This weather takes a toll on peoples’ immune systems. Sickness is running rampant around here.

One of my hygienists got sick about three months ago. It started with a cough that lasted about a week. You could tell she was fighting it off. Then it turned into a full-blown sickness. Of course, she was still coming to work and everyone kept telling her, "Girl, you need to see a doctor." Then the other hygienists started sniffling and fighting it off. Then it started at home. One of my kids got sick and the others slowly followed. First it was the baby and we thought he was teething. But then my daughter was fighting it off like mad.

So both areas of my life are filled with snot and coughing. Then I started to have pain in the back of my throat. You know the kind: when you swallow, you feel like someone is shoving an ice pick in one spot.

And this has gone on for a couple of weeks. It is bad in the morning and I take an ibuprofen. Then I manage through the day and take another ibuprofen before I go to bed. Meanwhile, there is a third person at my office that is now hacking. She sounds terrible. "Girl go to the doctor."

Now my third child and my wife are sick. I don't have a chance. But I remain strong. I am a runner and I don't think I have been really, really sick in about 3 years. My body is a finely tuned machine (well, this is what I tell myself). But the sore throat persists. I am still running and feeling fine except for the ice pick in my throat.

For the last couple of weeks, I have been stressed out and unable to sleep. I have been waking up in the middle of the night sweating and not able to get back to bed. I start worrying about paying all the bills and buying out my dad.

So, with the combination of the ice pick in the throat and the 12 hours of sleep in four days, I have succumbed to sickness. My whole body aches. I am freezing cold all day and all night. I take steaming hot showers and I am still cold. I wrap myself in 3 blankets and I am still am shivering. But my life doesn't stop. I feel like I have to go to work.

I had to coach yesterday too. I went from work straight to the ball field and dealt with 15 kids. Then straight home, where I was asleep by 7:30 (which I haven't done since I was eight). I woke up after 11 hours of sleep and I felt a little bit better. But here it is, 2 p.m., and my body is begging for bed.

Looking back on it, where did I go wrong? When do you tell your sick, snotty, coughing staff to go home? You have patients that have changed their schedule around to get a cleaning. They keep the kids home from school and plan their day around it. They take off work, and then you call them in the middle of the day and tell them that your hygienist went home early because she was sick. They put on a nice face, but inside they are ticked and inconvenienced.

On one hand, you want your hygienist to put a mask on, throw in a cough drop and gut it out. I mean, cancelling a whole day of hygiene can't be good for business. You lose that production and then you might tick off you patients in the meantime (as I alluded to earlier).

Other times you want to force them to go home. But the hygienists are dealing with the same things you are dealing with: bills, family, stress. If they go home, they don't get paid (some of them haven't been here a year to get sick days). If they do have "wellness days” and go home, then they lose those days. And just like you and me, they don't want to use them except for our vacations during the summer or Christmas.

That all seems fine until I am sick. I am sitting here miserable and shaking. I am so cold and my body is rejecting being out of bed. And all because they didn't want to go home. Ugh. I feel like crap and all I know how to do is blame my hygienists. It kind of makes me feel better.

Have a great Wednesday,
john

Dentist vs. Physician

Let’s talk about the timeless age old debate. Which came first - the chicken or the egg? No, the real debate: is a dentist a doctor or is a physician the only real doctor? I think maybe the only other health care doctor other than a dentist that takes more of a beating is the chiropractor (as Rodney Dangerfield stated, “I get no respect!”). If you read my blog last week, I ended it telling you to go to YouTube, look up Dentist vs. Doctor, and watch the extra normal video.

My wife works at a hospital as an RN part time. She has commented that when people hear her mention Dr. Joyce, they ask what type of doctor he is. When she responds they say, “Oh, he is just a dentist!” This will make more sense if you watch that video. It appears from the comments that some physicians and dentists take this issue very seriously.

We have all sorts of doctorate degrees: PhD, PharmD, DMD, DDS, MD and so on. Each of them specify or indicate an advanced level of education and knowledge that come with the title. By no means do I think or feel I am a physician. I have a Doctor of Dental Medicine degree. I spent 4 years after undergraduate and then another two years of formal accredited education learning about the diseases and conditions that are associated with the oral cavity, head and neck. When I sit back and think about it, what I find amazing that not only do I examine and diagnose, but also perform surgery if needed (removing and repairing living human tissue), sometimes all in the same hour. Someone has to be well-trained and knowledgeable to do that and cause no long-term ill effects. For that accomplishment, one is worthy of the title Doctor!

How many times have you heard about someone going to their internist or general family practitioner with a suspicious looking mole and having it removed and biopsied. This is almost never done anymore. Sorry Michael J. Fox, but Doc Hollywood delivering babies and setting a fractured arm in the same day just doesn’t happen. (I used this reference because the town they filmed that movie in is just up the road from me.) It is an instant referral to the dermatologist and you know the rest.

Most of the physicians that I know understand and respect what we do. They know they need us and we need them! I think most of this inaccurate perception is from the general public. We are just dentists and you can pick one up at any Saturday morning garage sale. I guess this all started back in history with dentistry springing off from barbers. It has been the scarlet letter we have had to bare for many years. Being the redheaded step child of the medical/dental community has its advantages. When it comes to health care overhaul, dentistry has stayed out of the spot light. We have had to deal with insurances, but dentistry has still been able to operate as more of a small business model with not as much government regulation.

This issue has lead into the reality of compensation. I cannot quote or verify this info, but the last reports that I saw had the general dentist making considerably more money than a general family practitioner. I think a lot has to do again with government infringement on medicine and insurance dictating fees. Private practice medical doctors have a business to run and profit margins. Many MDs that I know have to see sometimes hundreds of patients a day to pay the bills.

Have you heard that dentists do not save lives but real doctors do? I have, on numerous occasions, drained a space infection that left untreated would have killed someone. This happens in third world countries, but not in our society due to the care. Dentists know that typically when a patient shows up to the E.R., it is usually a six hour wait and a Rx for an antibiotic and an analgesic, and they are told to go find a dentist. How many times does a podiatrist or psychiatrist directly save a life? Most physicians besides surgeons, oncologists or emergency room physicians probably directly save lives. All the rest are just like dentists.

I did not want the responsibility of having to be tied to a pager or on call for the hospital rushing out at 2 a.m. for an emergency. I know not all physicians have this lifestyle and dentists do have emergencies. I like the fact that I am out every day at 4 or 5 p.m. and go work out or hang out with my family. Dentistry can be very stressful, but quality of life is important.

I heard the jokes in dental school. Dentists are just dropout medical students that could not hack it! I never applied to medical school and only know one person in my class of 70 or so that was a flunked-out med student. I actually know some that dropped out of dental school and went to med school because they did not have the hand/eye dexterity. Imagine trying to carve a precise 5mm x 5mm x 5mm deep box in the side of an object in a dark wet hole and while looking in a mirror with an object that occasionally moves and makes unpleasant sounds. Sounds easy, right?

I think young people are starting to figure out some of these details. I attend a presentation yearly for the University of Florida, College of Dentistry that talks about admission statistics. The number and quality of applicants has been going through the roof the last ten years and it has become ultra competitive. They have a 4.0 GPA, they volunteer , etc… Many of these students could probably go to any medical school they wanted but chose dentistry as a career choice. This should tell you something.

We could go on more about this subject, but I feel this is mainly a misconception from the public about who we are and what we do (not from physicians). Some physicians may think and act like dentists are second-class citizens in the health care world, but for the most part, they appreciate us. I also know some dentists that think they are physicians and walk around like they are doing brain surgery every day. Dentists and physicians are different animals, but both worthy of the title of Doctor. Most physicians I believe value and respect us and want a dentist on the front line of battle with them. I feel the same.

Have a great week,
JJ

Ferrule Effect

Hey all,

First I wanted to address my last blog. I was angry and I might have sounded a bit harsh to corporate dentists. I might have brushed them all in the same stroke.

I thought there were some great comments, here is one:

First, let me say that I think your blog is great dentists both young and old. But I find your latest post a bit disturbing. I have worked for a group practice and private and if you are naive enough to think that over treating is just occurring in the multiple-doctor practices then you are sadly mistaken. I like you agree that far to often than we'd like we see patient coming in for second opinions with what can only be described as "aggressive" treatments. But I feel safe in saying that just because a private practice doesn't have a "CFO" managing daily production doesn't mean that they don't have daily financial goals. I feel it does it disservice to the dental profession to group "all" the dentists that practice a group setting as over treating and just-concerned-about-the-money people. It would be equivalent to saying after one bad experience to McDonalds that "all" McDonalds have bad service. To make a generalized statement about group practices is simply unfair. Again, let me state that I agree with you concern over dentists that over treat. But please be more conscious about generalizing all group practices and consequently all dentists that work in a group practice in the same boat.

I have to say I totally agree with this person. I think over treatment is a common problem, industry-wide, and I don't think all corporate dentists or multi-dentist facilities are bad.

I apologize for my curtness and I appreciate his/her comment. I will be more conscientious about my words. Again, I am sorry for being somewhat of a jerk.

I was doing a bridge on an 88-year-old woman on teeth 5-8. She is frail, but #6 was broken down below the level of the bone and it had to be done. Two days earlier I had done a huge filling on #8. I decided that there was too much filling on this tooth and it wasn't going to last, so I was just going to add it to the bridge. I prepped it with 5 and 7.

While we were making the temp, the filling broke off in the temp. I had to go out and tell the husband that I needed to do a root canal and post and core to fix this tooth. He agreed, so we reappointed and let them go.

Today, I did the root canal and post and core, and then I went to prep the tooth to add it to the bridge. The tooth was basically at gum level. As I was prepping this tooth, I started to think about the ferrule.

I remember talking about this ferrule effect in the first CE course I took right out of dental school with John Kois. John Kim describes it as this:

“This is something that's often confused. The ferrule is the ring of metal that goes along the gingival margin of a crown or a core buildup. It's not a ring of tooth structure. The tooth structure is removed in order to place a ferrule. The theory is that a ferrule will help distribute lateral forces and prevent fracture after you do a post and core.”

I think I remember the ideal is 2mm. Well, I have to be totally honest with you. I have never considered the ferrule. If the tooth has 2mm of good tooth structure, great. If it doesn't, I don't change my treatment one bit. I have never sent anyone for crown lengthening to get a ferrule.

I have never seen anything fail and said, "Damn, I should have sent her for perio surgery," or, "Why are all my post and cores failing?" They just don't fail.

Today, I was prepping and I saw the tooth margin. But I was prepping my core material and this didn’t bother me one bit. There was some tooth that I was prepping, but it surely wasn’t 2mm all the way around. It might have been 2mm in about 25% of the prep.

It is weird. I know the theory. I know what the books say. But I also know that this tooth is going to be okay. I know this patient is 88. I know that they are from Boston (their son is a great patient of mine) and are only here until April. And I know that this is going to add about 10 weeks before I can finalize this (the time doesn't bother me - I was just thinking).

I just did it. I packed my cord. I took my awesome impression and made another awesome temp. And in two weeks, I will cement this crown and not think about it anymore.

And I am writing this thinking, "I wonder if you guys are going to nail me to the wall on this one." You know I try hard to do things right. You know that I care and that I watch my stuff coming back. If anything fails within 5 years, I am doing it again for free. And if any crowns fails before 8 years, I usually do it again for free or for a significantly reduce the fee. But this is not the topic for today.

Do you consider the ferrule effect? Do you stop what you are doing and send someone over for crown lengthening? Do you think less of me? Be easy on me.

Have a great Wednesday.
john

Moving In

I do not know about your town (big, small or in between), but it is interesting to see a new dentist move into town. We have had some new ones move in and their welcome by other dentists is mixed. Some of the current dentists welcome them with open arms; others act like they are jumping their gold claim!

My town is full of good orthodontists. Lately, the grumbling has been that four more orthodontists are coming to town. I can see why the other people would be nervous. There was another specialist that moved in recently and some of the dentists that have been in town awhile seem to be stirring up some rumors about them.

It can be really hard for a new young gun out of school to move into a small to medium town. I withhold judgment until I feel proof they are good or bad. John’s blog about the corporate offices is so true to my area, as well. Mainly, they have new graduates working there. Working for certain corporate offices can already put a strike against you in some dentist’s minds.

How many dentists and specialists per capita is an ideal number? I know it would vary based on age and demographics of the population and specialty. I bet there is some organization with that info out there.

If you get a chance, go to YouTube and look up dentist vs. doctor extra normal video. I find it hilarious. Read the comments – people take this very seriously. I will write about this in an upcoming blog.

Have a great week,

J.J.

Discount Dentists

Happy belated Valentine’s Day. I took my wife out to dinner and a movie last night. We saw Contraband with Mark Walberg. It was okay, nothing great. This is the kind of movie I would put in the back of my mind for Netflix, but she likes action movies. She really wanted to see Mission Impossible IV, but it is not showing anymore.

Anyway, I hope you all are doing well. And I hope you are enjoying the blog. We are consistently getting over 1,000 readers a week. I remember a couple of years ago we were thrilled with getting 300 readers every week. It just keeps reinforcing to us that dentists need other dentists. Like a quote from the Bible about "iron sharpening iron." That is what we are trying to do here.

Today’s topic is something that I have been talking about for the last year or so, but it happened again and I want to talk about it. I am sure that, like me, you are losing patients to "the guy on my insurance." I am okay with this because I understand that it is hard out there for my patients. If they have to go discount dentist to get their teeth cleaned, I am okay with this. How bad could it be for them? That is my stumbling block: how bad is it?

I had a dad come up to me at church on Sunday and say, "My son needs to come see you. His dentist told him he needs a root canal." The dad comes to me and the mom and kids go to the local corporate dentists. The kid is 20 years old. When I asked him, he said the tooth didn’t hurt.

I told the dad that his son probably has a cavity that needs to be filled, but that if it doesn't hurt, there is a very small chance he is going to need a root canal. I told him that the corporate dentists have a knack for over-treating (if you are a corporate dentist and want to talk, email me at jgammichia@aol.com). They have a CEO and CFO that want them to meet a quota for the day, and sometimes their judgment gets clouded by "the man."

I told him to make an appointment and I will look at it. The dentists that say they are going to save money would have cost them a root canal, post and core and crown, when the kid probably just needs a filling. That is $240 at my office and it would be about $2,000 out of pocket. Coming to me could save them $1,760. Hmmm.

A 55-year-old woman with a lot of decay came to me for a second opinion. She knew about the decay and wanted a treatment plan. She had a tooth that was in bad shape but it could be saved. She had an $8,500 treatment plan full of extractions and bridges and a bunch of crowns. I looked around and things were bad, but not that bad. I could do a bunch of fillings and a couple of crowns, nothing crazy. Her discount dentist was going to pull out the tough ones and do bridges and then do crowns on everything else. (I don't know about you, but I don't do too many bridges for an extracted tooth any more. I do implants. I think they use bridges for the quick buck.) This patient would be saving about $3,000 by coming to me, and I am supposed to be the EXPENSIVE one!?!

How do high-quality, fair, relational dentists, like us, get this message across to the public? This is what I have decided to do. We have these community magazines. You get them in the mail, thumb through them (I do, too), then throw them away. I never thought anyone noticed these magazines until I was at a "Taste of the Town" event and they put my picture in the magazine. I had so many people email me and stop me and tell me that they saw me in that magazine. I am going to buy space in this magazine and write an article telling the above story.

I am going to buy space in the local newspaper (not the Orlando Sentinel) and write these stories. I have got to tell people. I don't care that they see me. I just don't want them to see the discount dentist, the wolf in sheep’s clothing. I feel like I have some responsibility to people and to my profession.

What do you think? You think I am nuts, don't you? Is this happening to you? Don't you just want to shake people and say, "Why are you going there?!"

This is my soapbox and you can't make me get off.

Have a great rest of the week.
john

Root Canals

Greetings,

Well folks, as you can see, or probably have already figured out, I didn’t get the Miami Dolphin gig. They picked “the tall guy,” which I’m cool with. They just have to realize that they had a true dol-fan that they passed on. Honestly, I thought I would get a call for maybe an assistant position. I guess it was the “west coast” offense they wanted to install (which I know nothing about).

So, I was driving back home to Ocala from the Panhandle of Florida this weekend. I-10 seems to go on forever (I think it was just a coincidence that the air smelled funny as I went through Tallahassee, hehe), and it gives a person a lot of time to think.

One of our reps was in our office last week helping us organize our endo armamentarium. Now, through the years, I have had several different endo kits. After dental school, I was told that the way we were taught is outdated and this is the way I need to do it. I bought all of this new equipment: files, motors, gutta percha, etc. A year went by before I was told that there was a better way to do endo.

Evidently, someone had done some research somewhere and the results showed that what I was doing didn’t work. Well, I didn’t want that! I did some exchanging and buy-back deals and then I was set with the “right system.” Ah, finally I was doing something right.

Time went by, and guess what. You can see where I am going. Today I am on my 8th “right system.” I agree that it’s a little confusing. Constant taper, different tip size, same tip size, different taper, single cone, lateral condensation, continuous wave, vertical condensation, back fill, biogeneric cement, and on and on.

I have realized that (I know I am slow), for the last 17 years, I have been maintaining teeth that have been endodontically treated by people other than me. For instance, many patients in their 80s have a mouth full of silver points. Sure, some of them had to be retreated. The root canals I performed using all the other 7 systems before the one I’m using now seem to be surviving. I didn’t think they were good and yes, some of those had to be retreated.

My endodontists have had to retreat some of their own endo over time as well. I see radiographs sometimes that make me wonder how that worked, but it was done 20 years ago and its fine. I’ve seen hundreds of endodontically treated teeth that look like they were filled with a 15 accessory point, and they seem to be fine.

I’m beginning to believe that identifying the canals is 90 percent of it, and almost everything else is pretty forgiving. Now, granted, doing tooth number 15 that distally inclined on a patient that gags takes amazing skill and talent; I am thankful for my specialists. Am I off on this?

Have a great week.
Scott

Dentistry With Our Hearts (Part II)

Yesterday I spoke, FOR MONEY, for the first time. I drove down to Miami to speak to a study club. I have two words for you: Awe. Some! It was a great crowd. They were very conservative and they loved my stuff. Lots of nods and lots of great questions. Afterwards, lots of people came up and thanked me. I think they liked it. I was nervous as heck, but it turned out great. So, it has officially started (on the drive down, I got a call from the Florida AGD asking me to speak for them. Nice!).

Okay where was I? Dentistry with our Hearts. We started triage at about 5:50 in the morning. We have two rooms designated to seeing people first, talking to them, taking an x-ray of the problem tooth or teeth, and then numbing them up. Then they sit in the reception area and wait to be called. I have always thought that this is the fastest way to see people and it is easier on the treating dentist because they can get started right away and not worry about the numbing at all.



Remember I was telling you about the last minute oral surgeon? Well, she was an absolute superstar. She is 6 months out of her residency and she worked like a dog. At one point, she asked me if it was okay if she got a glass of water.

I gave all my kids permission to miss school so they could be there. My oldest is 12, so I put him in the oral surgery room. He loved it. "Dad! Did you see how long that tooth was?"

I overbooked the dentists. I did this because things come up and inevitably someone has a family crisis or something. But everyone came, so in the morning, my dad and I did not have a specific job. I walked around saying I was “eye candy” for the event. I made sure everyone was happy and had all the supplies they needed.



As I was walking around, I realized that it was really happening. My friends came and were thrilled to be there. Patients were being treated and they were thrilled to be there. People were outside working and serving and they were having a good time. My staff also realized how awesome this event was. To me, this is what heaven is going to look like: all of us working to help each other.



The dentists and people that were working were hearing the stories of the patients, hearing their pain, sharing in their lives. The patients were so thankful. It definitely warms the heart. I can't tell you how many times the volunteers came to me to say, "You HAVE to have me back next year."

We saw 60 or so patients before the afternoon break. We were cranking. Lunch was brought in and everyone took a break to eat. Some guys worked through lunch because they didn't want to stop. We ended up seeing 112 patients and had to cut off the line at about 11am.

It was an awesome day. But it wasn't over. We decided to have an after party this year. One of my staff members made about 50 JELL-O shots that we started on during the clean up stage. Then we crossed the street to have a beer or two at Chili's (thanks to Captek). Then, the aftermath.



We saw a ton of people and the oral surgeons were doing some serious cutting and bone removal. Do you know how many calls I received that weekend? None. Are you kidding me? My cell number is on the machine at work so people know how to get a hold of me. No calls. Crazy.

I didn't any get calls during the week, either. I got cards that were full of thanks I got emails and calls from people I don't know thanking me. It was awesome. There were patients patting me on the back.

The utopian feeling lingers and it is really nice. Are you thinking about doing it? You really should. Write me and I will tell you how to do it. Jgammichia@aol.com

Have a great weekend.
john

Dentistry With Our Hearts

Wow. I had a crazy weekend. Friday was our 8th annual Dentistry with our Hearts. It was a huge success. Before I tell you about that day, let me tell you about what had to happen before. If you don't know about it, Dentistry With Our Hearts is a day we open up our office to treat as many patients as we can for free. We limit the day to just fillings and extractions (cleanings just take too long).

But before that can happen, I sit down with my staff about 7-8 months to start the planning. We pick a Friday in February (Dental Health Month) and start planning. Last year we did it toward the end of February to avoid inclement weather. But by that time, the media blitz for Dental Health was over. So this year, we threw caution to the wind and did it the first Friday in February. The weather was perfect. And as far as the media blitz goes, well, I will talk about that at the end of this blog.

We divvied up jobs. We need people in charge of marketing; t-shirts; supplies; dentists and non-dentists; volunteers; food for the volunteers; food for the people outside; donations, a DJ. Then there is the rental equipment, including chairs, Port-O-Lets and barricades.

When the planning starts, we talk about it at every monthly staff meeting. We tighten up and give each other advice. When we get back from our Christmas break, we are just about going crazy. We go from having meetings bi-monthly to twice a week.

A week before the event, things start to happen. The signs go up at our office announcing the date. There are several marquees (banks and insurance companies with digital signs) as you go through town that announce the date. I have a place on my sign where I can add a banner. A local radio station has me on Thursday morning and we talk about the day. And even though the phone number is never given out, the phone starts to go crazy. We create a designated voicemail box that we put people through to (we are still trying to run a business here).

Last year, a dental school classmate told me he really wanted to be a part of this next time. We made plans right then that he would stay at my house and he would be a dentist volunteer. I thought that was a great idea and started to call more of my classmates. Next thing I knew, I had 5 of my classmates coming from out of town to serve with us. Along with them, we brought in 7 local dentists (who called me wanting to help). Adding to that, we have about 40 non-dentist volunteers.

I was in charge of dentist volunteers. We have had the same oral surgeon since the inception. I called him with the date. My staff talked to his staff. But when I sent the final email out on Wednesday to tell the dentists how excited I was about Friday, he was shocked. He wrote me back saying he had no idea that DWOH was in two days. I wrote him back saying, "That is not even funny. Don't mess with me. We have two rooms reserved for you."

He wasn't kidding and he had a full schedule that couldn't be changed. Crisis. My staff went into panic mode on Thursday. I was fine just doing the morning without an oral surgeon, but they wanted one. So on a day’s notice, a local oral surgeon changed her day and agreed to help. People even surprise me sometimes, and that is hard to do.

The day before, the office is stripped down and supplies are loaded in every room. Barricades are put in the parking lot, Port-O-lets and chairs are delivered. We dot the i’s and cross the t’s, and go home hoping things go well the next day. (Oh, when I left work to go home, there were 5 people in line for the next day.)

My friend arrived Thursday night and we just hung out, not knowing what the next day would bring. We got up at the crack of dawn (5:15am) and got on over to the office. We rolled up on the office and things were already buzzing. There are about 100 people in line and most of them were already filling out paper work. Local churches were there getting their booths set up. The grill man was setting up in the dark. My friend’s eyes were wide open.

We started to triage at about 5:50am. The staff and volunteers were in full work mode. Breakfast was spread all over the staff table in the back. Dentists started rolling in. People were everywhere, like a well-oiled machine.





This is where I will stop today. I will tell you about the rest of the day on Friday. But I will leave you with a link from the Orlando Sentinel. I called them to see if they might write something in the paper announcing our day. They decided to do a feature piece. Turns out, it was on the FRONT PAGE of the Orlando Sentinel (above the fold). Click here to watch the video and read the article that was in the paper (the still shot that the video opens with is the one that was on the front page of the paper on Saturday).

Talk to you Friday.
j

Changes

I hope all is well with you. We have had a change in dynamics at our office. About 8 months ago, we had a senior dentist approach us about working in our office. It sounded like he was in a real pickle. He had sold his practice and was forced out but then realized he wanted to continue working. He needed a place to temporarily “grow roots” for a few years. He is a very nice man and we wanted to help him. We have an extra chair and would benefit from having him at the office. We came up with a contract and off we went.

Well, he practices very differently than Dr. Jackson and I do. He advertises himself a “biologic” dentist. He does not believe in fluoride. Many of his patients are on the holistic side with a different view of the dental world, or, world in general. His approach to hygiene is different than ours. Many of his previous patients followed him and brought their ideas of how a dental office should run. At our office, we have developed guidelines and somewhat strict procedures on how we bill and collect payment for treatment. Many of his patients are used to a very “liberal” way of how the billing and financial side of the practice works, so several of his patients are less than nice to the front desk staff. Needless to say, the front desk personnel are many times up in arms frustrated mad with him and his overly demanding patients. They can get very rude and demanding, always throwing out, “This is not how it used to be done!” Our staff just politely and professionally explain our policies, hold their ground, and move one.

The hygienists are going batty trying to figure out how to manage his patients from a perio perspective. They are used to a very conventional, standard approach. We are not overly aggressive with scale and root planning, but we do them if clinically supported. We all know that many times patients don’t want to do it! Our staff explains to them it is the proper treatment and, in some cases, we will have to dismiss the patient if they do not decide to accept treatment (this is very rare). His view is that it is okay if the patient does not want the correct treatment. He wants the hygienists to just continue on with a regular adult prophy. Some view this approach as supervised neglect. The staff are so confused on how to deal with him on this issue.

We have invested in special supplies and equipment that I will never use but is in the “biological” dentistry realm, I guess. He has patients drive hundreds of miles for amalgam removal using a special ion beam that binds the mercury vapor and reduces exposure during removal. I do not know about all this, but I will only remove amalgams after a long conversation. I explain that I have not found any peer-reviewed, properly designed study that indicates amalgam removal will cure disease or produce other health benefits. It will likely not cure M.S., Lupus, or any other ailment. I know this could be a blog in itself and no nasty dissenting emails, please. I know there are different opinions on that subject. I will remove amalgams that are not failing after a long discussion if the patient understands it is for cosmetic purposes only and is aware of the benefits or risks involved. However, amalgam removal is a large portion of his practice.

He is driving the office mangers crazy at times. Besides dealing with the staff running around frustrated, he often wants to do things differently than the contract we signed. We agreed on a certain things in the contract and he frequently wants to change them. He always wants a check. It went from once a month to every two weeks, and now he wants one every week. We could say no and stick to the contract, but he always seems so desperate that we feel bad and try to bend to help him out. At times, we feel that if we give an inch, he tries to take a mile.

Having him work here has made me realize even more how differently dentists will practice and do things. It makes me realize how difficult it will be to find a future partner or associate when Dr. Jackson packs it up and rides off into the sunset. When it comes to how I think certain things should be done, some things in my mind that are black and white but some things have several shades of gray. I worked closely with many dentists while in the Navy, but rules and regulations kept everyone on the same page. I am trying to be understanding and accepting of alternative treatment styles, but still feel I need to protect the reputation of the practice. I also want to keep the staff headed in the right direction and have some sort of consistency and organization.

I have observed one very interesting thing. It turns out that the staff really seem to like to know the rules and expectations, and when someone tries to change them or get out of step they really get angry. I feel good knowing that they have all come to understand and believe in how we do things and want to maintain it. This accomplishment is much easier said than done.

Well, the journey continues.

Have a great week,

JJ

Ode to the Dental Assistant

Tomorrow is my free dental day. “Dentistry with our Hearts” is a day we open our doors and treat as many patients as we can for free. I put a dentist in every room (eight) and we go as fast as we can. It is a crazy day. It is first come, first served; last year people got here before I left work on Thursday. We cut the line off at 130 people and that was at 6:30.

A lot of the stuff is donated: supplies, anesthetic, food for the volunteers (about 40). There is even a DJ and a grill master outside feeding the masses. T-shirts are donated. It is awesome. I may have a chance to write blog tomorrow, but if not, I will talk to you next Wednesday.

I was just thinking about my yesterday while I was getting ready for work. I had a very busy day and I was reflecting on it. And you know what? I started to think about how hard my assistants worked.

Yeah, the same assistants I talk bad about most of the time. Well not bad, but not great. I have two assistants mostly. Mine, who I met at one of my associateships 16 years ago, has worked with me for 16 years and in this office for 15 years. The other assistant is my father’s #1 assistant and has been with this practice for 34 years. That alone will tell you a little bit about them.

My assistant Chris is pretty special. In my lecture I have a list of the top ten things you must have to do awesome fillings. Chris is one of the top ten. Now, I know she can't be duplicated, but you have to have someone like her.

Our relationship is so unique. I always say she is my office wife. I literally sit 3 feet from her 8 hours a day. First, I have to like her and she has to like me. I can understand "a working relationship.” But Chris and I are friends. Her family is friends with my family. I love her husband. She gets invited to all Gammichia parties (her family even came over for Thanksgiving last year).



I know most of you are not that friendly with your assistant. We have a weird relationship. I think it works because she is a little older than me (13 years). But let’s put personal stuff to the side. She is a great assistant. She is responsible. I think in the 15 years she has worked here, she has missed about 3 days of work. She is on time EVERY DAY.

She believes in me, almost to a fault. Or rather, she believes in the kind of dentistry I do. If I don't think I can save a tooth with a filling and think it is going to need a crown, she will pipe up, "Oh, sure you can. I have seen you do bigger fillings." Then I have to explain to her and the patient why she will no longer be working here anymore.

She is awesome with the patients. God forbid she go on vacation. All I hear is "Where is Chris?" There are a couple of reasons for this. When people are getting work done, we are chatting. It makes their appointment not suck so bad. I am relaxed and can do my thing.

She knows me. If I move my head, she knows what to do. If I am quiet, she knows that I am into some serious tooth issues and she won't talk. If I change things in the middle of the procedure, BAM!, she changes gears without a lot of huffing and puffing.

Her and I like the same things. We talk politics and religion. We talk kids. And in all these subjects, she thinks she knows it all (did I tell you that she is 13 years older?).

You and I both know when people have been in a practice for that long, they can have a tendency to cop an attitude. And they can mark their territory in an office. A telling sign is how they work with new people. Chris is great with new assistants. I know you dentists see your assistants running the new girl ragged. You see them abusing her emotionally and physically, saying that if she can survive this abuse, she can make it here. I know what you dentists do and allow. And if you don't think it is going on then you are turning a blind eye to it.

But Chris will show them the ropes and ease them into it. She keeps them away from me until she thinks they are ready. This is not for them; it is for me. She knows I am getting crotchety in my old age and doesn't want me to be upset and doesn't want them to be put in a position to fail. She is not concerned about a new assistant taking over her job.

She is the queen bee around here and I let her be. I let her because I know she always considering me. Simple as that. She might show her teeth to other people in the office, but I am okay with it because she has earned it. But she is also approachable. I can talk to her about what I like and how I want things (and she will at least make it look like she is listening). I can also tell her when she is not playing well with others.

She is the assistant that can talk to me. People say I am intimidating, but certainly Chris doesn’t think so. She will tell me when my hair looks like crap and she will tell me when it is time to trim my eyebrows. She tells me when I have a wild hair growing out of the side of my ear. I mean, men are stupid, really. We need someone to take care of us. You have all seen the guy with nose hairs hanging out like crazy. You think, "Someone needs to tell that guy." Well, if I miss something at home, Chris is the one that is going to tell me.

In my first 18 months of practice, I went through 7 assistants. No lie. I know how hard it is to find that person. But I also know what it is like to love to come to work. Partly because I love dentistry and partly because I like Chris (and the others). I think I am a better dentist because of her. She lets me be me and doesn't judge. I couldn't do it without her.

I hope you all have someone like her in your office. Maybe I don't tell her enough. If that is the case, I hope she reads this.

Have a great Thursday.

john