Team Building

Thursday. Sorry about my tardiness; it has been a little crazy this week. But it is almost Friday. You can make it.

I am off on tomorrow, so there probably won’t be a blog. I am going to Washington DC to see my friend’s son play soccer. He is the captain of the Georgetown soccer team. My wife and I are using this weekend for a four-day getaway. We may try to sneak away to Annapolis or something, too.

But enough about my vacation. College Football starts this week!!!! Are you kidding me? I can hardly stand the wait! It is a new year with brand new expectations, and probably a new year to get disappointed, but it is okay. The Gators were on the mountain top at one point. We will rise again… someday.

I watched The Expendables this week. It is the movie with all the old and new action actors. Sylvester Stallone, Jason Stathom, Dolph Lundren, Arnold Schwarzenegger, Bruce Willis, Jet Lee and Stone Cold Steve Austin are all in it. I went in with very low expectations, but I was pleasantly surprised. It was decent. Some of the special effects were terrible and I had to look at Sly Stallone's terrible plastic surgery for two hours, but other than that, it was at least entertaining. Perfect for Netflix.

The topic du jour is the office team-building experience. Just yesterday I put a sign in the staff lounge with the date and what we are doing. I don't make anyone do it; I want it to be fun enough that everyone wants to go. Three Mondays from now (we don't work Mondays), I have time reserved at a gun range. This particular range has a virtual simulation with fake guns. They fire like real guns, but you shoot at a 360 degree screen with bad guys. The virtual simulation has good people that will come up to that you are not supposed to shoot.

We will go at about 9 a.m. and then I will take everyone out to lunch. With the downturn in the economy, we haven't been able to give big raises or even give out much profit sharing, so I want to do something fun that everyone can enjoy.

I have kind of matured in this sense. I used to want to do these huge things, like go to the AGD Annual Meeting & Exhibits with my whole staff. We would spend $15,000 on flying everyone up there, paying for their courses (that some would not show up to), paying for their hotel, paying for all their meals and drinks. And, of course, we missed a couple days of work. Two years later, 3 out of 8 staff members had moved on, grumbling about how little they got in their bonus. (Now, if you are a staff member reading this, I am not talking about you. I am talking about other people on your team. I swear.)

I just don't think all that goes very far. When I did that, I think I did it for me. I wanted all the other dentists to that I was so well that I could bring my whole staff 2,000 miles away from my office. I don't really think they care. I think they want to be appreciated and they want money. I have a staff member who has been here 17 years. She will say, "Do we really have to go to a Christmas party? Why don't you just give us the money?" She is half joking, but kind of serious.

My family is the reason for this topic. I told my wife about the team building day. She told me that I had better take my son because he loves that place. I told her that he is not part of the team. I know that she would want to go too, and I would want her to go, but my staff always tells me that I act differently when I am with my wife. Well, maybe. But that is because I am trying to blend two lives. Maybe I am exaggerating. It is not like I have a work personality and a home personality, but maybe it is a little different.

The girls cut up. They talk about their girls’ nights out and their girl parties. And I may join in the conversation and I may ham it up a bit. The girls do not care to talk about their weekend and stuff like that. Not that they are all huge party people (everyone is married and almost everyone is over 40), but sometimes there is a story worth laughing at. When that talk leaks over into a staff party, it might look unprofessional to outsiders. Am I making sense?

If that talk starts when my wife is around, I get a bit uncomfortable knowing that I have two worlds blending. I can get quiet and the staff think I’m just not the same around my wife. If I get a little crazy with the girls, my wife might say, "That was a bit unboss-like talk in front of the staff, don't you think?”

I think my wife is kind of the same way. I know the staff really like her, but she doesn't know that (as much as I tell her). I don't think she can help feeling like an outsider. As much as she is not, it is just a little uncomfortable. If we go out with the staff, she spends half the time trying to figure out where she fits in.

Please tell me I am not the only one with this issue. What do you guys/gals do? Is it easier for a female dentist who has a male spouse? Does he absolutely want to go to your team building events so he can ham it up with all the ladies? Or does he just tell you to go ahead and go to that party and that he’ll be right here on the couch watching the game if you need him?

What about when the spouse works at the office? I am not one to have the family work at the office. Not for any particular reason, but I have heard of so many bad experiences that I am jaded. But if the wife works at the office, does the team building become easier because then the wife is one of the girls? I can't be the only one that thinks about this stuff.

Tell me about your experiences.

Getting Organized

Greetings,

I was thinking about getting organized this week, and I think I took it a little overboard. I really want my life to be simpler, and getting organized is the first step. I say anything that makes your life easier is something you should do. My first step was getting my wallet organized. I have found the perfect wallet for my needs, with four separate compartments for cards, IDs, etc.

Now, when I take my wallet out, I am not rummaging through 30 things looking for what I need. Everything has a spot, and I am less stressed because of it. Why stop there? I figured, if organizing my wallet can impact my life so much, why not expand my thinking? I went through my entire day in my head, and the logical place to start getting organized is my shower. After all, it’s the first place I start in the morning. Shampoo and body soap now have their own shelf right in front of me. This saves me at least 45 seconds! Next, I reorganized my closet. All pants and shirts are now hanging according to work, home, going out, and casual. All short sleeves are together, all long sleeves are together. This gives me another minute of my life back. I am almost 2 minutes ahead and I haven’t even gotten dressed yet! If this keeps up, I figure I will have enough time at the end of the day to watch a whole episode of Bonanza.

I preprogrammed all of my favorite radio stations in my truck. Now, with just the push of a button, I am listening to what I want. You are all probably thinking I have a sickness, but I think I am on a roll here. I was hoping I could get some more ideas on little things to make my life easier. Before anyone suggests a universal remote, I have already done that.

Here are a few things that have crossed my mind but that I have decided against:

1. Buying extra hold hair spray so I only have to comb my hair once.
2. Velcro shoes to save time on tying.
3. Going to one color socks so I don’t have to worry about pairing them in the drawer.
4. Facial hair removal so I don’t have to shave again.

I may actually reconsider the hair spray idea. I would love to hear some other ways to simplify life. Everyone have a great week!

Scott

Loupes

Big day tomorrow. I am in the part of my marathon training where the miles are getting uncomfortable. We are scheduled to run 20 miles starting at 4 a.m. Wish me luck.

Today's topic is loupes. I think eye magnification is the best thing that happened to dentistry since the high speed handpiece. Okay, maybe I am exaggerating a bit, but I can't stress to you enough how important I think loupes are. Please tell me you have loupes. Please don't tell me that you think you can see without them. Please don't give me excuses for why you can't wear them. “They are too heavy on my head. I can't see out of them. They give me a headache."

Listen, if you are not using loupes, you are missing stuff. If you are using 2.5s, you are missing what the dentist using 3.5s sees. You definitely are not seeing what the guys that are using 4.5s are seeing. We could get into the microscope, but that is a whole other blog topic.

But you have to start somewhere. You have to have loupes. I tell my audience that if you are not using loupes, I am simply doing better dentistry than you. (Listen to me. I have given 4 lectures and here I am sounding like a big shot.). While we are on this topic, I bought the headlight for my loupes and I can't stress to you enough how awesome this light is.

I have gotten so used to my loupes that I can't work without it (the light is the same way). I had a problem with my loupes and I had to cancel patients. After that incident, I called up Design for Vision and ordered another pair. Yes, I have a box I haven’t even opened sitting in one of my drawers, just in case. They are fitted to my eyes and the focal points are set, so they can't rush me a pair or anything like that. If you need your glasses repaired, it takes at least a week and if you need a new set it is going to be three weeks. Hence, the back-up. Okay, I have beaten the "you have to get loupes" horse.

Today's other topic is the hygienist. What about loupes for the hygienist? We all probably can agree that it is best that hygienists can see more. Like dentists, they are doing fine without them, but they could be better with them. I have wanted them to wear loupes for a long time, and I keep telling them they should buy some for themselves. And they are obviously thinking, "If you want me to wear them, buy them for me." Who buys them?

I have one hygienist who has a pair but doesn't wear them because one of the above excuses. Let’s say I buy loupes for them (I have three hygienists). Does that mean that I have to write up a contract?

"I, _____________, do solemnly swear that I will wear my loupes that Dr. John has purchased for me. If I do not wear them I will be responsible for paying him back."

I think one of them wants loupes, and the other two will take them or leave them. If they don't have any sweat in them (if I pay for them), there is no saying if they are going to wear them. Do I tell them that I bought and they are going to wear them?

If they buy their own, I know they are going to wear them because they don't want to waste their money. What if I buy them and 3 years from now they leave the office? (When I was young, I used to think that no one would leave my awesome office. Now I am older and realize either my office is not so awesome or that people are just going to leave. I still think my practice is awesome though.) Do they have to pay me back? After 2 years of wearing them, do I give them the loupes?

I am going to get them for them (all three will not buy them if they have to pay, it is just as simple as that). I just have so many questions. What do you guys do? Help a brother out.

Have a great weekend.

john

Disability

Happy Wednesday to you.

I saw a really good movie this weekend called The Messenger with Woody Harrelson. It is about a soldier that was injured in the Middle East war with three months still to go in his stint in the Army. He was put with seasoned veteran (Woody) and their job was to let the next of kin know that their loved one had been killed in the war. I know, doesn't sound fun. This movie was very heavy but I thought was really, really good.

Today's topic is our bodies. I remember getting out of school in my physical prime and kind of laughing at the courses I saw about posture. I kept hearing about these special chairs that would save your body. “Yeah right! I am not going to spend $2000 on a chair!"

I was 26 and thought I was indestructible. I am 43 now and I am feeling pretty destructible. About three months ago, I was getting a stiff neck. I had no problem looking to my left but my neck would hurt if I looked to the right. I had trouble driving when I needed to look over before I changed lanes. No big deal. I just rubbed my neck and I thought it would go away.

After a month, it was still there. I realized that, although I think I have good posture while I work (the loupes I wear keep me from bending in to see), I can only see if I am about 22 inches from the subject. When I want to see the lingual of #11, I just bend over and see it straight on. When I want to see something like the mesial of #5, as I create the anatomy, I bend way over just to look at it. I can use the mirror, but sometimes looking at it straight on is nice. I started to realize this is probably part of the problem. Also, I am a left side of the bed kind of guy when I sleep. I would sleep on my belly with my head turned left. All this being said, my head didn't turn right very well.

Another month went by and I still had a stiff neck. Being the dude that I am, I was still not that concerned. I had trouble moving my head to the right. I was constantly be rubbing my neck where the trapezius muscle attaches to the base of the skull, stretching down about 4 inches. Yeah, right there.

So one day, I asked my wife if she wouldn't mind switching to the left side of the bed. She was not really happy about it, but she understood. We did this for about a month, but things were not much better. Another month gone by and finally this thing was on my radar.

Then I started getting pain. But it was in a different place. It was in the center of my neck, exactly where the back of my skull meets my neck. If I push on it, it hurts. Radar is definitely picking this up.

The heightened awareness started to become neurosis. I started thinking about my disability. This is it, Of all the things that I do to possibly injure myself... Chainsaws, ice skating (this is dangerous because we live in Florida and I don't know how to ice skate), snowboarding, driving, and flying, are just some of the stupid things I do that I could result in injury. But no. It is looking at the lingual of #11 that is going to be the end of me.

After pain radar went off, I started to notice other things. My left shoulder has limited mobility that I pretty much ignore. I have had feet problems for a long time that I just ignore also (I think I have plantar fasciitis), but limping around the house most of the time is hard to ignore.

Okay, so I have pain, in my neck. I have pain in my shoulder and in my feet. What the heck am I supposed to do about it now? I can't stop practicing dentistry. I can't stop holding the mirror. I just don't know.

But it was even more than that. I started to think about what it would mean if this were serious. What if I have some degenerative issue in my neck? What if my neurosurgeon tells me that I have to stop practicing dentistry? What if I need surgery and recovery would mean I have to be on bed rest (right side of the bed, of course) for 4 months? What if? What if? What if? I was going crazy.

I have maxed out my disability insurance. I think I would be entitled to something like $90,000 a year (after taxes) if I got hurt. That means we would have to have a significant lifestyle change. We would have to move. We would have to decide to do homeschool or not (heck, I wouldn't be working). But I couldn't just not do anything. What the heck would I do?

Could I teach? Would I have to move to Gainesville or Ft. Lauderdale? Could I consult? It is strange that I am thinking like this? It is very upsetting to me to think I wouldn't be able to do dentistry anymore. I have heard that some disability policies don't allow you to work. Do I have that one? I don't know. I haven't looked at the policy in 15 years.

Man, all this because I have a stiff neck. My mind goes crazy sometimes. But I am writing this blog to make us all think. Are you 26 and think you are never going to get hurt? Are you 40 and feel the same way? Things will change, my sisters and brothers. Trust me. You have to get disability insurance, but you have to take care of yourself. You have to sit better. You have to improve your posture.

(this is one of my buddies when he was putting implants on one of my patients. This is not good posture.)

Has your body started to give out on you? Do you have aches and pains? Have you had to use your insurance because of an injury? I would like to know.

Have a great Wednesday.

john

P.S. My neck has improved because I have made a custom pillow for my head. Also, as it turns out, I think my running might be doing it. Did I tell you that I am signed up to do the New York Marathon in November? I have been ramping up the training. I am doing about 30-40 miles a week. I noticed that my neck hurts the day after I run. I might have to take up rowing or something after this marathon.

Nagging Injuries

Happy Friday to you.

I haven't talked much about TV lately because, other than the Olympics, I haven't been watching much. But there are a couple of shows that I have really gotten into. My favorite TV show right now is Suits on TNT. It has good story lines, conflict, and good character development. I looking forward to Thursday nights even though we never watch it on Thursday because we DVR it (it is just nice to know it is there when we sit down). My wife likes White Collar and I have always liked The Closer (even though it is over). You guys watching anything good? Let me know.

Today's topic is that tooth. You know that tooth. The one you worked on 10 years ago. The one that looked good when you did it but maybe on the x-ray it looks like it might be failing.

Look at this photo. I finished this root canal 10 years ago. He is totally asymptomatic. Is the palatal root failing? I don't know. Is it going to blow up on him over the weekend? I don't know. Should I tell him what I see and worry him? don't know. It should be fine… right?

When I think about it, I have a bunch of these things floating around my practice. Maybe on a posterior composite restoration that I did and there is a little radiolucency at the bottom of a box. Is it decay? Is it air? Is it a radiolucent material bonding agent that got a little thick? I just don't know.

How about a crown with an overhang? How about a submarginated filling? (I have seen these things last forever with no issues.) What if you did a veneer 6 years ago and the margin is starting to discolor? Maybe the cement is wearing out or there is a microscopic opening.

I can't just go around redoing every little thing that might have something going on, can I? You know the thing that drives me is the fear that this patient with this "maybe" thing going on in their mouth would move away. What if they go to another dentist and that guy asks who their last dentist was with a sound look on his face? (You know you do that. I do that. I don't mean to, it just comes out.)

Of course, I want the best for my patients. I want to give them the best dentistry out there and I want my stuff to last. Is doing the best dentistry going in and redoing something that might be wrong? I don't think so. What are your thoughts? Do you have a bunch of "maybes" out there? What do you do if you do?

Short and sweet today. Have a great weekend. Thanks for listening.

john

P.S. The AGD put out a call for additional bloggers this week. We are looking for contributors. If you have something on your mind and want to give this blog a try, they want you to send in a blog post and they will see what they can do. Just send a sample entry to cassandra.bannon@agd.org.

Fraud

There are only 17 days until college football starts, but who is counting? The Olympics were a good distraction. I loved every minute of them. Anyway, hope things are well with you guys.

Today is the first day of school for the Gammichia family. And in perfect Gammichia fashion, my son hasn't left his room for the last 3 days because of his summer reading and math. I told a 13-year-old that he had to read three books and complete 30 math lessons, but he had ALLLLL summer to do it. All he heard was, "You can do it later."

Well, three days ago was LATER. He holed himself up in his room and never came out. He finished his math this morning. He is getting to be more and more like his daddy every day.

I want to talk about something that happened to me yesterday. Our house has weird plumbing. We have city water and city sewers, so everything drains to the city’s sewage system. We must have old, narrow pipes under the house because we get back-ups all the time. We live on a corner, so one side drains to one street and the other side of the house drains to another street. We have lived in our house for nearly nine years. I would say it was within a month of moving in that we had to have our pipes drained the first time. After that, we have had to have our pipes drained more than17 times. One time, it was a couple toys that my daughter flushed. Another time it was big roots cramping the pipe outside of the house. One time it was a whole roll of toilet paper that my second son shoved down there. It is comical.

On the kitchen and laundry side, it is always the type of food we are putting down the disposal. They say that rice is a big culprit, so now we hardly use the disposal because we are afraid of the food coming back up. We have had the company come and put a scope down all the tubes. We had someone on the roof putting stuff down the thingy on the roof. We have done it all. It is definitely better, but it still happens at least yearly. Guess who was back at our house yesterday.

In the past, we have always had this one huge company come out and help us. They have always been good, but sometimes I like the single employee company. I wanted to see if anything would be different. I know this gal from town. She is a police officer and she does plumbing on her days off. She came to our house and did her thing. When I asked how much it was going to be, she said, “I usually charge $225, but if you make the check out to me [not my company], I will only charge you $175.”

I hate this. Okay, listen. I don't know why I am like this, but I am. I am a stickler about rules. I kind of think I might be in the minority on this one, but I don't cheat. I don't cheat to win games. I don't cheat people out of money and I don't cheat on my taxes. I don’t think it is worth it. It is not worth winning the game. It isn't worth the couple of extra bucks and it sure isn't worth losing my license or the IRS finding out. If I come in on the weekend and a patient pays with cash, it goes into the safe, not in my pocket. This gal who is doing my plumbing is saying that she is not going to pay her taxes on this job and asking me to just help her out doing it.

I think I got it from my mom. She was always very honest when it came to money. Also, Bible says that if God gives us small things and we are honest with them, He will trust us with the big stuff. I pitched this blog idea to my assistant (she agrees with me most of time, hence why I tell her my ideas) and she disagreed with me. "So?" As much as I tried to tell her why I this way I feel, she doesn’t think it is a big deal.

You can try to justify it all you want, but to me, it is STEALING. You might not be stealing from a person, but you are stealing from an institution (the government). When I pay my taxes, I see the good in it. Do I wish it was less? Heck yes. But I think of the awesome roads I drive on. I think of the policemen that protect and serve my family. The firefighters. The Armed Forces that protect my country and my freedom. My taxes go to help someone who might be down on their luck and can't find a job. I don't think it is just the man bringing me down.

I don't know. Cheating is cheating. The government, the grocery store, the person who forgot their change, my patients. To me, it is all the same. Am I being too much of a goody two-shoes? Do you feel the same way I do? Do you take cash on the weekends? (Trust me, I am not judging. It is hard for me to put the cash in the safe. No one is going to know. It really is more trouble to put it all in the records.) Tell me what you think. Maybe you can sway me, but I don't think so.

By the way, I wrote the check for the lesser amount. Am I aiding and abetting?

Hope you are having a great Wednesday.

john

Holy cow, has the summer gone by quickly. The kids are back in school next week and we are back on a schedule. I know my wife will be happy. Having to keep three bored boys entertained is tough. They are now trying to pester each other to death, so the summer is exhausting at times.

If you remember, I talked about assistant reviews in my last blog. Everyone got a good-great review because they are doing well; they all got a raise. I thought it went. Rather, I was fooled into thinking it went well.

A week or so ago, one of our long-time assistants resigned. She said that things were changing at the office and that she did not like the stress. I have worked at other offices; I know stress and I know how hard other offices work their assistants and how they treat staff. Once again, I do not understand what they are thinking or expecting!

This particular assistant has never worked at another office. She was hired here right out of school and has learned basically everything here. We wonder if she understands some of the issues that other offices make their staff deal with. Yes, we are demanding and want things done a certain way. We do change protocols and rules to improve things, but some people do not like change.

We used to have a bonus system at the office, but we decided to get rid of it. It seems to me that patients could perceive that their care is influenced by cost and what will help the staff make bonus. I am sure you have heard the patients ask staff how much they make off a certain product or procedure. Now, my staff can honestly answer, “Nothing beyond my regular pay.” The PBS special seemed to harp on this compensation model, so we took away the bonuses. We did substitute it with a guaranteed Health Reimbursment Account that everyone gets to benefit from.

We hired a legal guru to help us rewrite our office manual. We needed to make it more official and compliant with OSHA and Florida worker laws. We were advised to set a continuing education or non-production pay rate for all meetings and CE, whether it was out of town or wherever. We made the compensation rate more than she advised, but from what we hear now, that upset her. Dr Jackson and myself try to be fair and do what is best for the business, taking into account that the employees are part of the equation. But I truly feel that, unless you do everything they want (and trying to make all 14 women happy can be difficult), people are always going to be irritated about something and the grass is always greener on the other side for some people. What can you do other than try your best and not look back if someone disagrees? My partner and I sadly realize that the odds are, in ten years, possibly none of our current staff will be here. We hope that is not the case. Just like in a marriage, things change and people change. Things will never always be the same.

We are looking for a new team member and hoping we can find one that appreciates the way we do things here, the honesty, respect and integrity we show patients and staff. If you know of anyone in the Ocala area with experience and a good attitude, send them our way.

Have a great week,

JJ

Friday

I hope you have had a good week. It has been pretty good here. While I reserve the right to change my mind, I kind of feel like things might be getting a tad (that might be a bit strong) better. I know the hygiene is still a bit of a struggle, but I am seeing some patients loosen up a bit and do what they need to do. They certainly are not coming in here and doing full-mouth rehabs, but it might be getting a little better. And this could be totally episodic and it could swing the other way next week, but at least we are not going down. Maybe we have leveled off here. How is it with you?

I saw a 20-year-old patient this week who has been battling perio disease for a long time. I think when this patient was 15, we sent them to the periodontist for ANUG. This patient had been on a two month recall, but was now up to a three month recall. Things were looking a bit better for them.

I asked how often they floss. I was talking to a 20-year-old, so my expectations are low to start. I mean, I didn't start flossing until I was about 28 AND I WAS A DENTIST. So when they said that they flossed about 2 times a week, I was encouraged.

Then I asked they brush, and there was a long pause I asked, "Are you trying to think, 'Should I tell him the truth or should I embellish?'"I thought they would tell me that they only brush once a day. They started by telling me, "It’s not every day..." I stopped listening at this point.

I was incensed. What am I doing here if we can't even get people to brush their teeth? What have we been doing for the last 6 years? You, kid, are wasting my time. I was so mad that I had to walk away. I had to go back into my office and count to 10. I went back up to the front as they were checking out and, not to alarm the parent (who was paying of course), told this patient that they have to at least brush once a day. We will start there and work up to 2 times a day. Now would it surprise you that this patient is a girl?

I don't get this generation. I mean, I guess I didn't brush my teeth in college because I was at an all-night party, drinking way too much and then passing out before I could find my toothbrush. What I meant to say was that I was studying throughout the night at the 24-hour library (this is what I told my parents). These patients are living with their parents and playing video games. Damn, I am out of touch.

And lastly on this short but sweet Friday blog, I finished a veneer case this week (first one in years). This was a retiring teacher who didn't have very nice teeth. All her life she has wanted nicer teeth. She has saved basically her whole life for this. You know patients like this; they are best.

She has been a patient here for a long time and the trust has been built. She came in one day and said she wanted veneers. Let’s do it! We had to do a root canal and clean her up periodontally, but basically we got her right in.

We brought her in and we spent the afternoon together. We prepped them down. You can see I did some crazy stuff (like on #6). This was an abutment to a 3-unit bridge, so instead of changing out the whole bridge, I did a veneer on #6. I talked to my ceramist before hand and we thought we would try it. As you can see on the temps, it looked pretty good.

Anyway, I thought the temps looked great. I gave her a smile, in these temps, that I thought she could only have dreamed of. This was $7000 well spent!!! I gave her a mirror for the big temporary reveal and .............crickets.

Okay, maybe she was just tired from all the work we did. Maybe she was uncomfortable from being numb. She was expressionless. Man, was I disappointed. Maybe I was just tired. Maybe it wasn't as good as I thought. I looked at the photos the next day and DAMN those temps were nice!

I called her to see how she was doing. Maybe I would get something from her after she got a good night’s sleep and then looked at her new teeth in the mirror. We talked and she told me she wasn't having any discomfort. But she didn't say anything about the appearance.

On Tuesday, I cemented in the final restorations. We spent a couple of hours together and got them looking very nice. We had an issue with an embrasure space, so the lab came and took them back and added to two of the veneers. Oh, it’s nice having a close lab.

Again, I gave her a mirror for the big reveal, and time she said something. "Oh." That was it.

Not, "Oh my gosh! I don't know how I can tell you how much you changed my life!" Not, "Oh my gosh, I just wasted my money." Not, "Oh, I have never felt so young." Just, "Oh." And it wasn't an expressive, It was just, "Oh." (By the way, sorry, but I didn't get final photos yet. The canine veneer looks so good!)

Again, I called her the next day and she seemed fine. I think she was happy. I guess she just isn't a person that gets excited easily, which is kind of foreign to me. I mean, people know how I feel. I am off-the-charts expressionfull. That’s a cool word, isn't it? I just made it up.

She still is talking about doing the lowers. I guess I will just lower my expectations next time. What I am saying is that part of the reward to what I do is making people happy. Yeah, yeah, the satisfaction I get when I know that I have done my best and it is good. No. I want to change people’s lives. I want the hug. I want the affirmation. I have to have it. I guess I just won’t get it from this patient.

Have a great weekend.

john

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I am so loving the Olympics. I am losing sleep because of it. It is not the events or the contest for me; it is the stories. The one that I just can't get over is the runner that doesn't have any legs below the knees. This story is so crazy. He is RUNNING an OLYMPIC EVENT without LEGS!!!! And to watch this guy run, wow.

How can the Olympics not inspire you? How can the stories not resonate with you? It is not the medals or the competition that will stick with me, but the stories of people overcoming obstacles. I will take these stories back to my life and say, "You know, this isn’t so bad. I know I can overcome this petty little thing." That is what is going to stick with me.

Missy Franklin, the 17-year-old female swimmer, won 3 golds and a bronze medal. She says she can't wait to get back to her senior year of high school. Can you image what her high school swim meets will be like? She is turning down gazillions of dollars so she can swim with her friends in high school.

And lastly, I am going on record and saying this publicly: I am not a fan of woman's gymnastics. I think about this 15-year-old kid that has been taken out of school and home-schooled so she could practice gymnastics for 15 hours a day for 8 straight years. Then put on a strict weight program so she will stay less than 80 pounds (or something ridiculous like that). She gets there and she has to put on all this makeup that makes her look like a doll.

I know, I am totally over thinking this, but I have seen it happen. I have had patients whose daughters were good at something, and they started this stuff. One was good at ice skating. They took her out of school so the mom and daughter (without the dad and the siblings) could move to Colorado to train. She was 10 years old. And to think: there are only 5 girls every 4 years that make it. You think the odds are bad for the NBA or the NFL? Try being an Olympic gymnast. The odds are about .0001%.

Okay enough of that. I want to talk to you about Twitter. You know what this is, right? Everyone is talking about it. You can't go five minutes listening to the media and not hear about it. I watch a TV show and on the bottom left corner of the screen, there is something like #suits. Watching the Olympics, there are ads that finish with #olympics. I assume this has something to do with Twitter.

But I have to confess, I don't get it. So you are telling me that I can say something on my twitter account (@johngammichia, just in case you want to follow me) and all my followers will be able to know it almost instantaneously? And if I follow you on Twitter, I can hear what you have to say instantaneously? You know what I say to that? So what? What am I going to say that everyone wants to know about? There is nothing you have to say that I need to know RIGHT NOW.

The big thing is actors and sport figures. Do I really want to know what they are thinking right now? I don't care what Angelina Jolie is doing right now. I don't care what Dwight Howard is thinking right now. I think the sports talk show hosts do, but you know what? When they report on it, I will hear it.

I know, I know. I am old and crotchety. I know I probably could tweet that I just finished a veneer case and send out a picture. But that would mean I need potential patients to follow me. That is work, just like Facebook. I have a page and I put a case on there about 3 times a year. Does updating it make it more likely that people will follow? Maybe.

I realize that, at 43, I might not be someone to ask about this. I had a single guy in my chair. He works and lives in downtown Orlando. I would think if anyone has his finger on the pulse of technology, it is going to be a guy like him. I asked him about Twitter and how much he uses. He said he has never tweeted or read a tweet. Hmmm. Is it something for 20-year-olds? Teenagers? I talked to a couple of 22-year-olds at my church; they all said they have very limited experience with Twitter.

Can someone please tell me that I am not crazy? Am I missing something? Is anyone using Twitter and loving it? Is anyone using it for dentistry and, if you are, it is working? Let me know.

Have a great rest of the week,

john

P.S. The AGD tweets! Follow us on Twitter @AGDadvocacy to learn about the latest local and national advocacy issues affecting you.

Leaving a Legacy

Happy Friday.

I am so tired. I cannot pull myself away from the Olympics at all. I find out during the day all the results then sit and watch them all night. Go USA. I would be interested to know if you blog readers like the Olympics, too. I think Americans love the Olympics. I know this because NBC spent $4.4 billion (that is with a B) for the TV rights.

Anyway, today I want to talk about your legacy. I often think about what are we here for. I want to tell you a story and then we can talk about it.

My assistant broke her ankle and she was in the hospital for four days. After surgery, they told her she couldn't put any weight on it for three weeks I think I told you but I needed to get a temp. I called all my assistant friends and put the word out. One of my friends called me with someone she knows, and she was able to help.

Things worked out pretty well. She was able to handle my dry sense of humor and I think she appreciated the type of dentistry I do. But about two weeks into her stay here, a 23-year-old man came in. He was a good looking kid that said his front tooth was loose.

At first, I thought this would be nothing. I asked him how long it had been loose. Two days. RED FLAG. I looked in his mouth and, sure enough, he had broken this thing horizontally at the gum line. I explained that he was looking a root canal, a post and core, and a crown. I saw his concern when I talked about cost.

I looked around and didn't see a parent or anything like that. I know that 23 is an adult, but usually this is still an age when parents come with them. I asked him how he felt about all of this. He said the he had an idea it was bad, but it was going to be hard to pay for. I asked him if he had family that was going to help him out with all this, and he told me he had never met his father and his mother is battling stage 4 cancer. He has a job at the local shooting range, but…

I told him that I was here to help and that I would do the best I could to keep the cost down. I told him that I would help him and if I needed to lower my fees to let him get it done, I would. I told him we could do a pulpectomy and do a temp post and core and see how long that would last just so it wouldn't be $2,200 at one visit.

He said that it might take him a month to save up the money to just do the minimum. So I said that if the tooth fell out before then, just to call me and we would work it out. After the kid left, this assistant said that she has been in assisting for 12 years and has never heard of dentist doing what I had done. She said she had never seen anyone give something away.

I was shocked. I give stuff away almost on a daily basis. Do you remember the Dunkin’ Donuts blog? Last week, a girl, 25 years old with no family, that worked at Taco Bell (for $8.10 an hour) came in with terrible teeth. She was so embarrassed about her smile that she was crying. There is no way she could afford to fix her teeth. I told her I would help her.

I want to help people. Don't tell me that am not making enough money because of it; I make good money. I have a talent that God has given me and I am going use it to help people. Sometimes for money and sometimes to help someone improve themselves. Simple as that. This assistant and I got along before ,but she definitely sees this practice in a different light now.

I have told you that undergraduate students hear about me and find out that I am someone that will allow shadows. They call me up and I let them come in and hang out. Well, for the last 8 weeks or so a young man was shadowing us from 7 a.m. to 3 p.m. every Friday. He started shadowing at a couple of offices, but after a few of weeks, he said he only comes here now. He told us he liked it here and that he kind felt like he was in the way there.

What we try to do is, when a young, bright, enthusiastic person comes in wanting to be a dentist, well shoot, this is our chance to set the hook. We treat him/her like family. We laugh, we play, we educate. We put some gloves on this kid and make him hold the suction. We let him assist on an extraction. This means the world to these young, impressionable minds. I want this kid to love our profession like I love our profession.

So I started thinking. What impression are you leaving? What is going to be your legacy? Do you have kids in your practice that want to be dentists? How about kids that have gone into dental assistant school? Or hygienists?

Don't tell me NO. Don't tell me that you are not influencing anyone. Don't tell me you are not leaving an impression on anyone.

I had a 82-year-old man in my chair the other day. He is a good ol' boy and he always wears a cowboy hat. Before he left, I asked if I could try on his hat. I put it on and everyone got a kick out of Dr. John with a cowboy hat on. My staff got out their phones and were taking pictures of me. It was fun.

That patient came back this week and told me he left the office and went to the hat store and bought me a brand new cowboy hat. I just thought that was so awesome. It is great doing this job sometimes. It is so nice that someone would think of me enough to go out and buy me something. This is a picture of me and my new hat.

That, my friends, is what this is about. Having a talent and using that talent to help others, using it to make others better. And to get them to think about helping others.

Have a great weekend.

john

Hey all,

Sorry about Friday. I had half the thing written and then just left the office. And when I leave the office, I really leave the office. I don't bring my computer home and really don't think about work much when I am gone.

My son comes home from Mexico today. He seems to have had a great time, but at home, we have not been ourselves. We are all just looking forward to having him home. We have gotten emails from a couple of friends that went, and some sent us some photos. Here he is. (He is a good looking kid, isn't he?)

Anyway, I saw a lecture a couple of months ago and I have been reviewing the notes. I think I talked about it before. The guy was Alan Atlas, a dentist out of UPenn. Very good lecture on adhesives. He began the lecture talking about composites versus amalgam. We all agreed that amalgam was the better material for longevity, but if we were getting a restoration, most of us will choose composite (as will our patients). So, we need to make composite better.

We talked about the negative of composites. He showed a study on composite that claims 30% have to be replaced within the first 6 years, and he talked more about failure. The number one reason for failure within the first five years is technique, fracture or sensitivity. Between 6 and 17 years, the number one reason for failure is secondary caries.

He went on to say that responsibility of the failure rests first the patient, second on the dentist, and third on the material. He said that the caries risk patient is that way for two reasons: diet and genetics. According to the lecture, for patients at low risk of caries, COMPOSITE did better than amalgam in a 12-year study. Hmmm.

This study is from the Journal of Dental Research from 2010. I still don't know about this. I have always said that you can find research to say whatever you want. There is an article for everything. For every article that says amalgam is a great product, you have two that say that is causes Lupus. Use a rubber dam; don't use a rubber dam. Bleach in a canal for an RCT; bleach is poison. Ceramic versus gold. You can find an article that will back anything you want.

In this case, we find an article that says that composite is holding up better than the gold standard. I know composite is getting better. The more we place, the better we get at it. The more research we do, the better the products become. I don't know about you, but I have not seen a 45-year-old composite filling that looks like the day it was put in.

I think composite is awesome. I have spent my life trying to make teeth with restorations look like natural teeth. I have 19-year-old composite fillings in my mouth. I have pictures of 16-year-old composite fillings that I did. But do I believe that, in a 12-year study, composite has a higher success rate than amalgam? I just have a hard time believing this.

Am I the only one that has a hard time with this? Do you just read this and then move on, and not really think anything of it? It is not going to change the way you practice… is it?

BUT, we are almost there. It is like last week’s blog: 22 years of success. Every day, I am more and more convinced (especially after all the reading I am doing) that we are on the right track. We are saving teeth and we are doing it better and for longer. Okay, that is going to be my last composite blog for awhile. Sorry about all that.

I have to go now. I have to get back to watching my 16-hour-a-day obsession with the Olympics. I can't stop watching. GO USA!!!

Have a great rest of the week.

john