Final Farewell

I am not going to cry.

I have been thinking about this last blog for about six months. I have gone round and round, trying to decide what to write about. I found the link to the Jerry Maguire clip about Rod Tiswell.

I have decided not to talk about dentistry because I think dentistry is just a small piece of our lives. I want to talk about our lives and how dentistry relates to it. One of the reasons I wanted to write for The Daily Grind was I felt there was a big injustice going on in the world of dentistry and no one wanted to tell the truth. No one wanted to be vulnerable.

I wanted to tell the truth about life and I wanted to tell the truth about dentistry. I didn't want to paint this rosy picture of life and our profession. We know it is not always rosy and I knew only talking about my successes would not build relationships.

An open discussion about failure and the tough parts about dentistry and life, I think, breaks down walls and makes it easier to relate to. If, over these last four years, you didn't hear from me that life is hard, I have failed. If you haven't heard from me that I fail sometimes because this job is really hard, I haven't done a good job. I think I have done some really good things and I got to show them to you. But I tried not to make it about how awesome I am and how this job is so easy and if you can't do it like me you suck.

I wanted to give everyone a dose of reality. This life and profession is a mix of failure and success, good and bad. And as long as the good is more than the bad, the successes more than the failures, you are doing pretty good (probably better than most).

Life right now is so busy. I am the new owner of this practice and every day I leave here with three hours worth of work that hasn't been done. I go from work straight to a game and have to leave the game early to pick up my daughter at piano practice. I get home, eat, run, shower, wrestle with the boys, tuck in, say prayers, then fall asleep in front of the TV, only to wake up and repeat. And I know you are all going through similar things.

How do we do this job and not be clinically depressed sometimes? I have got to believe that any job that deals with the public and with money is going to have its challenges. So how do I deal?

Well, I think I would be remiss if didn't tell you that for me, it is Jesus. I am sorry, but I am going to get all Tim Tebow on you. I give it all to God. I look at all things through eternal eye wear. As a Christian, I believe I am His. My life is His, along with everything else. This practice is His. My kids are His. And if I believe this, I have to trust Him. I am now His instrument. I believe in WWJD (What would Jesus do?), and run my practice this way.

If a person comes in to my practice and is hurting and doesn't have any money, WWJD? I am pretty sure He would help them. If someone needed a 5-unit bridge and needed five implants and they had the means to pay, WWJD? He would see that he pays. I just do the best I can with the gifts (and just in case you needed a slap in the face to be reminded, being a dentist is a gift) that God gave me.

Do I walk around with Jesus-colored glasses and just smile all day because Jesus loves me? No. Do things go wrong? Heck yeah, but I try not to get too low. Things go right and I can get praised, and while that that feels so good, I try not to get too high (I try to boast in Him).

We all know that things could be going well at work and things could be falling apart at home. I have to think that I am really enjoying my work right now. My team is good and my patients are happy. But have a cousin, whom I love like crazy, who is 43 years old with three kids. He is dying of cancer; they gave him months to live.

Maybe things are good at home and then things are good at work, but then you hear about a pastor at a church down the street that left his wife and three kids to run off with his secretary. Yeah, life is hard. But I try not to forget that Jesus cried too. I mean He knows the end game, he knew what was to come and still cried when life got hard. He cried for His world. It is broken.

How do I deal? I just do the best I can do and give it to Him. If He thinks me blowing up and making tons of money and treating celebrities on a new reality show is right, then I will do it. If He dictates me getting the crap sued out of me and I lose it all and have to be an accountant, then I have to be okay with it and continue serving Him (I kind of would rather not do either and continue doing this).

That is why Christmas is so special. It is the celebration of God sending His son to earth to rectify this crazy, fallen world. And through Jesus we have a way to the Father (heaven) again. Remember this line from the Bible: "I am the way."

The blog has been a way for me to vent, celebrate, cry, cheer, laugh, and scream along with you. It has been a way to bring dentists together and to make dentists, who might feel alone, feel part of something.

I hope we have accomplished this. I hope you have liked it. I hope you have loved it and have hated at times (but come back to it). I hope you have agreed with me and have disagreed with me.Mostly I hope you have seen love in my life. I hope I have reflected Christ in all the things I have done. I’m not perfect, but I am me.

Just remember, as I say goodbye, this blog will continue and is in very good hands. You still must read it.

But for me, I have been blessed so much with this blog I can't even put it into words. Thank you for reading and commenting and being a part of my life for four years. I wish you all well.

God bless,

john

Organized Dentistry

OH MY GOSH! The finality is becoming a realization. This is the last week of me.

It has been great. Let’s not think of the end; let’s think about all the great times we have had together. No, I am not going to cry. I am not. I don't care what you say I am not going to cry. (I feel like Rod Tidwell in Jerry Maguire).

I ran the Mount Dora marathon (about 15 miles from my house) this weekend. See, I was ready for the New York marathon about six weeks ago. I didn't want to waste my training, so I found a marathon that was shortly afterwards, close to home, and cheap.

You know that Florida is pretty flat. At least, the places I train in are really flat. Flat is easy. This course? Not flat. I know the town is MOUNT Dora, but I thought in order to make the participants happy they would avoid hills at all costs. That was not the case.

It was very hilly. At one point, around mile 14, I was feeling pretty good. I got to this one uphill and decided not to waste my energy on climbing this one and decided to walk up. I found myself forcing my legs just to walk up this hill. Besides that, everything was feeling pretty good until about mile 21. Then I think the hills and the heat caught up to me because my legs started to cramp up. When this happens, there is not much more I can do.

I try to run but my calves just won't bend. So I walk, then try to run and get about 20 strides and it is like someone sticks a knife in my leg. Times for my last five miles were something like 11 minutes, 12 minutes, 12 minutes, 13 minutes, 13 minutes. There was a lot of walking and I ended up with somewhere around 4:23.

It’s over and I am glad about that. I just can't feel my legs and my calves are still tight. Getting up and down is still pretty rough.

In this second to last blog, I want to talk to you about organized dentistry. More specifically, the AGD. I have always told you that I am not the sharpest knife in the drawer. I am not a micro guy. I think I am good at observing and I think I might be good at expressing my feelings. l am relational. I am pretty good at teeth. Even managing this practice is out of my comfort zone. That being said, do I want to handle governing my profession? No. And that is why I am an AGD member.

I have been a member of the AGD since I was a wee little dental student. I have always felt comfortable knowing there is a group that has "got my back." Now, even more, I think we need to unite as dentists and fight the powers that are trying to change what we think is right and the principles that we all have worked so hard for. The government, who represents people, doesn’t know what we know and tries the best they can to save money. We need someone telling them what we know and how we think we can come to some agreement. Do you know this is what the AGD does? It fights for us.

The AGD has always been the “continuing education" academy. It keeps track of our CE. It offers us Fellowship and Mastership for us to continue to strive to get better. I think it is so cool to learn. They promote the continuation of us. I have always loved this about the AGD.

The AGD publishes two pretty awesome magazines. AGD Impact is a magazine that tells us what is up in the world of dentistry. It offers viewpoints, office management tips, new products and their opinions on them. I had one friend tell me, "I get a lot of magazines and I throw a lot of them away, but I always read Impact cover to cover." I think he is right. It is always good, cover to cover.

They also publish General Dentistry. It is more about the science of dentistry. If you are not familiar with this journal, it is a peer-reviewed clinical journal. That means that every article goes through a review process to make sure all the science and methods are legitimate. It is very well done and I always feel that I am getting the truth when I read it.

I have been a member of the AGD for a long time, but I have not been sitting on the sidelines. I was asked to be part of the Communications Council about 10 years ago. I think I wrote an article and got on their radar. I served for about 4 years (then the idea of the blog came up, so I had to say no to something). It was fun and enlightening at the same time. I got to see and get involved in how the organization works. But I want you to know that this kind of stuff, volunteering at the AGD, is for every member. You, too, can get involved. I don't know if everyone can volunteer at the national level, but there is so much to do even at the local and state levels. It is fun and you can feel a part of something bigger than just you and your office. They need people like you. I need people like you. Just ask.

Being a part of the AGD has been a part of me for a long time. I want to encourage you to have it be a part of you. I have only mentioned a few of the things that the organization does, but there are so many others (like the Annual Meeting, podcasts, this blog). They have put a lot of resources into this thing and without their backing, this thing would not be nearly as successful.

They believed in it and have always been very supportive. I can't thank them enough for everything they have done for me and this blog.

Okay, that’s all the bubbling I will do. I swear I am not going to cry.

john

Trying to Make People Smile

Hey all,

Happy Friday to you. Tonight is the night of our Christmas party. As the staff is a bit smaller, we all get along pretty well. I think this is the most fun I have had practicing in a long time. This owning thing is very stressful, but overlooking all that, liking the people you work with is key to your happiness. And getting together with people you like tends to be lots of fun. We are going to go out to dinner at a pretty nice place where we will have a happy hour outside and then go inside for dinner and gift exchange. I got 11 gift cards and we are going to have a White Elephant-type game and give those out. Then I will give the cash out. We will stay as long as people want to stay.

This is my third to last blog. I want to portray everything that I think is important in these last couple of blogs. I think I am going to talk about work today, the AGD on Tuesday, and then I will talk about life on Thursday.

How do I talk about work in one blog. I don't know what aspects are the most important. But in light of the Friend or Foe blog, I was reminded of a subject that I deal with everyday. I think it is important to us to know that dentists come in all shapes and sizes. In fact, some change their shapes and sizes. Okay I am not talking about heights and weights. I am talking about how they practice.

There are tons of types of dentists and it is important to know their roles and how we are all just trying to get along. We are kind of like restaurants. Do the Ruth's Chrises of the world hate McDonald’s? Do the Olive Gardens feel insecure around the Palm Steakhouses? No. I think we all have our wheelhouse.

You know, I have done almost all of the continuums at the Pankey Institute. I however do not totally practice that way. I have found my wheelhouse. I like doing restorative work. I feel like I am really good at that. I do not like doing removable. I think I am okay at it but it is not my favorite. I would never look down on someone that runs a removable-type practice. I would not feel insecure around Pankey-exclusive practices.

There are dentists that work in volume clinics. I know there are good people working there. I know there are dentists that are there just paying the bills until they can get a better job and there are dentists that like this type of practice. I think we have to respect all types of guys. There are guys that love teeth like I do working in a volume type practice.

But one thing that makes my blood boil is dentists that don't love teeth and who have stopped loving people. Don't get me wrong. I know this profession has a way of making people jaded. But if you don't love what you do, then you need to change how you do it.

When dentists start just doing this for themselves, when they see people as dollar signs, I don't have any patience for them. I have been in this profession for 17 years and some days I find it hard to love people. I have a hard time smiling when a woman is asking me to adjust her partial (that I added one tooth to) for the ninth time.

This profession is chickens one day and feathers the next. Or lemons one day and lemonade the next. It can beat a man down, that is for sure. But what job doesn't? If you stop loving people, if you stop wanting to make this dentist appointment the one that stops this patient from fearing the dentist, it is time to reconsider your career.

Sure, I want to kick some people that won't get numb after the 7th injection. Sure, I lose the love, but I find it again. Is it sometimes about money? Yes. But that can't be the reason we are doing this.

Back to the different types of dentists. We all got into this profession for mostly the same reason. We all go to different practices for different reasons. Do the McDonald’s dentists have anything to be ashamed of? No. Are the Ruth's Chris dentists better than anyone else? No.

We are all trying to make people smile. Let’s respect that.

Have a great weekend.

john

Friend and Foe

Hey all,

Only 4 blogs left. So much pressure.

I took half the family to the Georgetown game on Friday night. The wife got cold feet and decided to stay home with Madison and the baby. A 10-hour drive with a potty-training baby didn't seem like tons of fun. Georgetown won an amazing semifinal game. It was tied 4-4 after regulation and then it was still tied after two overtime periods. It went to penalty kicks.

My friend kick got blocked. OH MY GOSH! Please don't let the loss hang on him. If you don't know anything about penalty kicks, you each get 5 and whoever gets the most goals, wins. It was 1-1 after the first two kicks. Then 1-2 after he missed. It was 2-3 after the next two. Then we made our next two and they missed the last two (or our goalie blocked them). We won 4-3 in penalty kicks. WOW.

Then they had less than 48 hours before they had to play for the national championship. We went up against a perennial powerhouse in soccer. Indiana University has won 7 national championships in soccer (who knew?), and we were in the final game for the first time in Georgetown history. We lost 1-0 in the finals. We looked to have a bit of a hangover from the tough game on Friday. They were good (they had already beaten the #1 and #4 ranked team to get to the finals), and they beat us. What a season. Georgetown, national runner-up. Sounds really nice. Not as nice as National Champions, but what a run.

In the fan fare, you had to kick the ball 50mph to get a prize. I got it on my sixth try. I am still limping.

It was great being with all of this kid’s family and friends. We got in at about 1:15 on Monday morning. We let everyone sleep until 9 a.m., and then back to school. My boys had a great time. It was a great time.

Before I forget, I want to know what you do for Christmas. The comments are anonymous, so you can tell me without giving up who you are. My staff talk to all their friends from other offices and the stories continue to get taller. Yeah, the word is that a dentist down the road (single with no kids) is giving the staff $1,000 each (I don't think he has a large staff, but still…).

I mean, I love my staff. But I would have to get a loan to do something like that. We are going out to dinner and they are getting some presents and a Christmas bonus. But I can assure you the bonus is not even close to $1,000. Which brings me to my next question. What are you guys doing? The comments are anonymous, so feel free to tell me that you give $1,000 bonuses. I appreciate your feedback.

Now, the topic of the day. A friend from church called me up. I have known him for about 10 years. I like him and he likes me. We have been to a couple of parties together over the years, but we have never hung out. He asked for some professional advice. He said he needed a crown and a filling and it was going to be $2,500. He wanted to know what I thought of that price.

I told him that my crowns are about $1,150 and my fillings are about $250, so that seems a little high. He asked me to take a look at his mouth. We did a new patient exam last week. I told him that there was some good news and some bad news. The good news was that I found the tooth that needed the crown and filling. The bad news was that I found eight more cavities. This was a first for me. Usually people come to you for a second opinion because they went to the local clinic and they have never had a cavity before and this shmuck told them they have 12 cavities.

The cavities were obvious. We took a full mouth series and all of them were interproximal, but definitely there. Not just into the dentin, but really into the dentin. He said his previous dentist took two X-rays. So the last dentist took two bitewings on recall and he is missing things.

I have always been upset with dentists who overtreat and wondered how to blow the whistle on them. I have not had too much experience with guys missing things. Now, to be totally truthful, I know this dentist and I really like this dentist. He is about 10 years younger than me. He is a good guy with a good family. He is even in a couple of my study clubs.

What do I do? Do I leave this alone and not say anything? You know this is not my style. Look, I know people only take two bitewings to keep the cost down for patients. But this can come back to bite you, if you know what I mean. How do I talk to him without sounding condescending? How do I talk to him without it sounding like I know everything?

We don’t know what happened or why he missed this. We can talk for days on why we miss things. We can talk about all our systems that don't work. We all have room for improvement. I try to teach teamwork. The hygienists know that I am dealing with a ton of stuff in the treatment rooms and that I need their help.

While they are cleaning a patient’s teeth, they need to be looking around for stuff that I should focus on. They write it down and then I come in and key in on a couple of things. Do I miss stuff? Heck yeah I do. But I don't miss EIGHT of them.

I am going to think about how to approach this dentist over the new few days. My assistant asked me if I would want to be told. I want to say no, but I am always preaching that I want to get better. I just don't know if it is going to hurt. I am fragile. The problem is that I think I am awesome. I think I do everything well. Can I get better? Sure. But I need to think that what I am doing is good or I wouldn't do it. If someone else comes and tells me it is not, that is hurts.

I don't know what I am going to do. Any suggestions?

Talk to you soon,

john

P.S. Don't forget to tell me what you are doing for your Christmas party and what you are getting your staff.

Warning: Storms Ahead

Hi all,

It seems that my weekends get crazier and crazier. I had a 30th birthday party on Friday night. (Yeah, I have younger friends. We are the token old people there). I woke up at 5 a.m. to run 12 miles. I got home, showered and had to get my nine-year-old to the football field. Then breakfast with Grampi and off to the mall for Christmas shopping for Hilda (she was out of town - the perfect time to shop for her). After watching the SEC Championship game, also known as the national championship in my book (don't hate us because we are beautiful), I packed up all the kids and went to Altamonte for the Christmas fireworks. And that was just Saturday.

Remember when my wife and I went to DC to see our friends’ kid play soccer? Well, he plays for Georgetown. If you are not up on college soccer, Georgetown just made it the Final Four of the tournament. We had always said that if they made it this far, we would find a way to go. We started making plans as soon as they won their game on Saturday. The semifinal game is at 5 p.m. on Friday. We are going to all pack in the van and take the 10-hour drive to Hoover, Alabama to see Tommy play. Sure, it sounds crazy. But that is how we roll.

I have to cancel all my patients on Friday. Noah will miss a Thursday night and Saturday morning flag football game. Luke will miss a Thursday night soccer game. Madison will reschedule her piano lessons. Oh, and they all have to miss school on Friday and Monday. And, worst of all, no blog on Friday. So I will try to make it Tuesday/Thursday this week. As I write this, it kind of sounds stupid, but it should be fun. YOLO!

My creative juices started flowing last weekend. I have been talking to my new associate a lot, and I’ve started thinking about what kind of mentor I am going to be. Man, I have so much to tell him. Do I sit him down and tell him all the crazy things that have happened to me? Do I tell him how great this is going to be, knowing failure is a huge part of getting better? Do I tell him that all the grandiose ideas that he thought this profession was going to bring him are not reality? Do I tell him that probably around year three, he is going to think about how to get out of this profession? Should he go teach? Should he go back to school to be an endodontist?

These are not rhetorical questions. I really have to think about telling him reality. I started thinking about a couple of patients that have negatively impacted me so much that they are in the forefront of my mind when I think of the bad that comes with our profession. The good, too. I mean the good is in front of you every day. You see the smiles that you have saved coming in for a recall appointment. You see the kids growing up. You see the same families coming in year after year telling you how awesome you are. That is an everyday reminder of the fact that people like you.

But for me, it is the sting of failure that sticks. It is the sleepless nights of worry over an unhappy patient that make me twitch. I think this is where I will start with my new associate. I have to prepare him for failure. Not the kind of failure where a margin of one of your fillings chipped, but the kind where the patient is up at the front desk screaming and telling everyone in your reception area. Or the "I am going to sue the pants off you" kind of failure.

The story I remember is one where I didn't think I even did anything wrong. About 14 years ago (I remember it like it was yesterday), I had this patient that lived in my neighborhood. I think she even hung out with my wife at some point. Anyway she needed crowns on #14 and 15. I did them and was pretty proud of them.

A few months later, she came back saying that she was getting a lot of food caught between these teeth. I checked the area and there was a good contact. But I told her I would redo one of the crowns to see if we could move the contact around and rectify the situation. To make a long story short, I continued to chase around her issues. I redid the other crown. After several different crowns that all had great contacts, I started to think I was not going to be able to make her happy.

It got to a point where her husband started to call me (you know it is bad when the spouse calls). I finally told her I didn't think I could help her anymore. After tons of work trying to make her happy, I gave her ALL her money back. And to rub it in, they said, "We really do like the practice. Is there any way your dad might take us on as patients?" He said no. If I couldn’t make them happy, what would make them think he could?

I don't know if it was the failure or the fact that I had to give them their money back, but I remember going home so upset. I did everything I could. It cost about $5,000 to realize I was just going to have these kinds of people. I feel blessed that I was able to make it go away with a check.

There was a patient way back when I first started using rotary files. I broke one. I let her know and sent her to a specialist to have it removed. They may or not have gotten it out, but they finished the root canal and charged her (I did not charge her). Then she came back into my office upset that she got charged. (This could go either way. Sometimes I pay the endodontist to do his work so the patient is less likely to be ticked at me.) She came into the office telling my people that she was going to sue me. As a young dentist, this can strike fear of God in you.

Man, did I lose sleep over that one. I mean, poop can happen. As long as you are up-front with the patient and above the standard of care, you are going to be okay.

One time, a patient came in with #8 was broken at the gum line. I did a RCT, post and core and a crown. I thought I did a great job. A couple years, later the tooth developed PAP at the root tip. I sent her to my local oral surgeon to get an apecoectomy. Her husband, an attorney, called me up and told me that he wasn't going to pay for this, implying that he wanted me to pay for it.

He told me that unless I wanted a whole world of @#$%^ to come down on me, I should consider this. I was young and didn't know how to handle this. I think I would just pay for the stupid thing now. But then, I told him that I did the best I could. On the x-ray was a perfectly done root canal. Things like this happen, and if you want it done then you are going to have to pay for it. I basically said, "Do what you gotta do."

Nothing came of this because when I was talking to the oral surgeon about it he said, he told me to forget it and that he wouldn’t charge her. But all these things can take a young, energetic, excited dentist and make him bitter. I am not bitter, but it would have been nice if my dad had warned me of the pitfalls that I might run into. These things are going to happen and I am going to tell my new associate about them. I am also going to tell him that I will be right by his side the whole time. We are in this together. “You have an advocate and he is sitting right here.”

What would you do? Let me know.

Talk to you guys soon,

john

P.S. Every time I write my name, I know it is almost over. I am going to miss you guys. Did any of you look at my website? Any suggestions?