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?

The Inquisition

I realize that I only have a handful of blogs left. This is putting a lot of pressure on me. I have been thinking about what to write for my last few blogs, and all this thinking has giving me writer’s block. I just don't think that any topic I write about is worthy.

I started reading all the past blogs. I thought about posting a “best of,” but I don't have time to read all of them. I just don't know. I guess I will just write what comes to my mind and one day I will be gone. It is kind of sad, but I just can't think.

I will give you an update on my lecturing. I have decided to redo my speaker packet DVD and have this drive the audience to my new lecture website. (Take a look at it and tell me what you think. It is still a work in progress. It is www.posteriorcomposites.com. Don't you just love the name?) I have my last planned gig for awhile in January, and that is it for now. So, I am going to have to get more jobs again. Ugh. This is a lot of work. I will keep you posted. I think I will blog from my site, but it is going to be very infrequent.

I want to talk to you about one of the things going on in my life. You all know I just bought out my father. He financed the second half of the buyout for me. When I bought the first half, I was also buying a house. I had a bunch of equity in the house, so I bought the first half of the office with the equity line from the house. Now I am paying off a first mortgage and a second mortgage.

A year or so ago, I wanted to refinance my house. I am paying 5.75% on a 30 year. This is not comparable to today’s rates. We did everything you are supposed to do. We locked in a rate and everything was sent to the bank. Well, after the appraisal of our house, it turned out that we owe more than what it is worth. That means we are stuck paying this rate.

Fast forward to now. I own my business outright and am paying a business loan through my personal account. I went to my local bank to get a loan to pay off my equity line and then start paying this office loan from out office account. This just puts everything where it belongs. It will also free up $150,000 equity in our home so we can refinance.

But this is not what the story is about. One stipulation that the bank made was that I get a life insurance policy on myself for the amount of the loan. Have you guys done this? What a pain. You don't just call the life insurance people and get insurance. Before they insure you, they want to know how healthy you are and if you are sick or not.

First, there was an 80-minute phone interview. They asked if I have ever had bronchitis (yes, when I was 9) and why I had a vasectomy. It was crazy. They asked any question they could think of to find out if I was healthy. They asked if I smoke. I smoke cigars, and it turns out that if you smoke more than 12 cigars a year, you are considered a smoker. It went on and on. The funny thing is that they did not, even once, did they ask me if I exercise.

They sent a nurse to my office to get a blood test, a urine test and height and weight. The nurse took my blood pressure and my pulse (78/118 and 56). I told her there was no way my pulse was 56. I am a marathon runner and my pulse hasn't been over 50 in about 5 years. I took my pulse and got 48. She said that if she wrote down 48, there was going to be a problem. It was too low. She wrote down 56.

Guess who called me the next day. The insurance company, wanting to schedule an EKG. The same nurse came in and said, "I told you so. Even 56 was too low."

Once again, nowhere on this form was a spot for amount of exercise or about how I eat. Anyway, it is going to take 30 days for the underwriters to review my application. Then I get the insurance. Then I get the loan. Then I get to refinance my house. c But the rate is going to be almost 3 points lower, and that is going to be huge. Then I will have all this nonsense paid off in 7 years. Next thing you know, I will be driving my cobra. I can't wait. Won’t I look good in that thing?

See you guys soon,

john

Happy Thanksgiving

I am sorry about last week. I sat down to write the blog twice but was pulled in a thousand different directions. Then I realized I can't post a blog during the week of Thanksgiving week that isn’t about Thanksgiving. So I will hold the blog I wrote for later.

Before I forget, you must book the restaurant for your Christmas party. If you haven't done it by now, you are a bit behind the eight ball. I just called the restaurant that we were thinking about. It is going to be a stretch. I could tell they were wondering why people wait until the last minute. I thought I was on top of it by calling a month in advance, but I guess not.

This is going to be my first Christmas party as full-fledged owner. I am looking at the bank account a little differently this time. We have X dollars in the bank. The party is going to cost about Y. Then we have two weeks off paid and that is going to cost Z. So, X – (Y+Z) is a pretty small number, if not a negative number. Oh man. I am grinding my teeth already.

Anyway, Thanksgiving. Man oh man, do we have a lot to be thankful for.

I have to tell you that this job is so stressful sometimes. Okay most of the time. I am usually juggling about 4,000,000 things at once. I dig my own grave sometimes. I am usually five days behind in writing up my charts. But, sometimes this is good because when I do write them up, I remember the good stuff that I did. And a lot of the times I will pick up the phone and call the patients to see how they are doing. I love doing this.

I take a lot of photos of teeth during the day. I can't tell you when the last time I plugged my camera into my computer and transferred them. I think I have about 400 that still haven't been uploaded. I sometimes will send a case off to the lab and tell them I will write up the case and fax it to them. I forget to do that. I am going crazy most of the time, but it is a good crazy.

I leave my office as soon as I am done with the last patient and go straight to the ball field (I change in the car) and don't get home until 9 p.m. Then I go for a run. And I can't understand why I can't make it through a whole TV show at night before falling asleep.

I am a deacon at my church. One of the things I do for our diaconate is manage the Deacons fund with a few other guys. Members give to this fund so that when another member is in financial trouble, they can come to the DF and make a request. This fund is set up to help the widow or the single parent that might be living week-to-week when something like a car breaking down is not in the cards. A kid getting sick can throw a big wrench in someone’s finances. Loss of job, loss of a spouse: you name it, we have dealt with it. Managing this fund is a great dose of perspective that I need almost on a weekly basis. I see the financial pain people are in. I see the people that are financially and emotionally bankrupt and can't get out of it. They need financial counseling and emotional counseling, and they can't afford either. This fund is a godsend to the people that need it. But I can tell you that managing it is stressful.

I am so thankful for my wife (we just celebrated our 17th anniversary last week) and kids, the four apples of my eye. I love taking them to sports. I love throwing the ball with them and taking them to sporting events. I love watching them play and bringing them to church. I love the people they are becoming. I love the servants’ hearts that they have. My daughter is volunteering at an inner city after school program. I am so proud of her.

I wouldn't trade my life for anything. I am so thankful for all of it. I am thankful for a crazy, stressful job. I am thankful for the staff/friends I get to work with. I am thankful for living in the USA, where we are free to do a lot of things thanks to the pilgrims and the founding fathers and all the guys and gals (past and present) in the military protecting us. I am thankful for my community and my patients (especially the ones that don't hurt after I put in an all porcelain crown).

What a great job we have. Yeah, it can make you blow a gasket sometimes, but I have always told you about perspective. We work in air conditioning. Most of us work 4 days a week. We make a good living. We get to laugh when we work. Good stuff.

I am thankful for this blog (my biweekly therapy session) and you guys that read it. It is something in my life that I hold very sacred. I want to think it does some good and brings us all a bit closer together.

I hope you feel like you have a lot to be thankful for. The Bible talks about being content "in all circumstances… whether well-fed or hungry, whether living in plenty or in want." This means that Paul (the guy writing this part) was wealthy and had to learn to be content when he was wealthy. Sometimes this is pretty hard. And for those of us that might be struggling with things (marriage, finances, kids, sickness), the Bible talks about this, too. James 1:2 says, "Dear brothers and sisters, when troubles come your way, consider it an opportunity for great joy."

Anyway, this sermon is over. I hope you had a great Thanksgiving. I hope you had lots of great food, lots of great family time, and lots of football (God, please let the Gators win).

Thanks,

john

Failure Sucks

Man, I only have about seven blogs left. Next week is Thanksgiving, so I might write one blog. Then I will have two a week for three weeks, and then it’s Christmas. I keep thinking about life without the blog, and it is kind of weird. I have been doing this blog for almost four years.

I know it is going to continue without me and I am looking forward to hearing what the new bloggers have to say. But, I am going to miss it. All day, I constantly wonder if this situation is blog-worthy. I must remind myself 50 times a week to “put this in the blog.” Of course, I forget.

I think back about all the funny things that I have written about. There have been some classics. I think about all the trouble I have gotten myself into. I have been through about eight new staff members. I have been through three or four staff members at the AGD. I have bought my practice, had a kid, been to three national championships and have run four marathons. We have been through a lot together.

If you are a long-time reader, leave a comment telling me your favorite blog. There have been some good ones, that’s for sure. The first marathon blog was really crazy and my last one was equally as crazy (the one where I got a ride to the start from an Englishman). I am starting to water up, so let’s talk about today’s topic.

I have had a really tough week. One of the things that gets me down is when a simple thing goes bad. I’m not talking about the bombed out tooth that you try to save. You know, the pulp exposure where you do direct pulp cap on it and you tell the patient there is about a 50/50 chance of needing a root canal. I’m not talking about the molar that has been hurting to chew and you find a crack. You tell the patient that that you will do a crown and see what happens. If the crack is into the nerve, you are going to need an RCT, too.

I am talking about the patient with the 27-year-old MODF filling. It was time to do something with this tooth. There is good and there is bad, and this tooth was in the grey area between them. I explained to the patient that if they waited until it got bad, they would not be able to control what happened. But, if they took care of it now, they could dictate what would happen. Then I recommended taking the filling out and doing an onlay. I believeed what I told them; I was not upselling. This is what I would to do to my teeth.

I took all the decay out and cleaned it up. It looked great. We prepped it for an onlay and everyone was happy. When they came back to put the onlay on, they said the temp was a bit sensitive. We blamed it on the temp not having a great seal, put the onlay on, and it looked beautiful. Three days later, they called back saying it hurt.

No problem. This happens all the time and 99% of the time, it is occlusion. I told the patient that we would get them in here to adjust that. I was a bit angry, but I knew that most likely, this tooth is going to be fine. They came in and I adjusted the occlusion. See you in six months!

Again, three days later, I got the call. This was not good. This is the kind of thing that really gets me down: a tooth that didn't hurt the patient (a friend from church) now probably needs a root canal. I told them to hold off as long as they could. I know it is annoying that it hurts when you bite on it and I know it is super-sensitive to cold, but let’s just see if goes away.

It didn't go away. I do root canals, but I referred this one to an endodontist. I was so disgusted with myself that I didn't want to be reminded of my failure anymore. I don't know why, but this kind of stuff really makes me feel like a sucky dentist.

At the same time this was going, on a patient came in with a broken tooth. It was a #3 MODFL amalgam and a little sliver of tooth that is left. He is an employee at the golf club about a mile from my office, and I was going to wow him with my gentleness and charisma. I told him that he needed an onlay and we would make it beautiful for him.

We did it and he was thrilled. He came back two weeks later for the cementation appointment and he said that the tooth had been a little sensitive. What? I told him that temps don’t seal very well but it will most likely be fine once I put this one in. And we started all over again.

He was back in today for his fourth occlusal adjustment. It doesn't hurt to hot and cold. It only hurts when he eats on it. It is just annoying, not painful. I danced around the fact that he is probably going to need an RCT. So much for wowing him with my gentleness and charisma.

I have been in a total funk all wee, and I know it is because of these two patients. Wait. I put in a couple crowns in the few weeks that looked okay before I cemented them. I cemented them and then my assistant cleaned them and told me that the patients said that the crowns felt high. I adjusted the crowns but saw a band of cement. I don't like seeing cement. That means the margins are not perfect.

Again, this really bothers me. I feel like a very average dentist. Do you get in these funks? I want to do good by these folks. I just feel like I am letting them down.

I am slowly coming out of it. I got a couple of complements today and that made me feel good. Maybe I need some antianxiety drugs (the AGD does not encourage taking pills to make you feel better, unless prescribed by a physician). What can I say? I am an emotional person. I hate being this way, but I guess being this way makes me a better dentist.

How are you guys doing?

john

New York, New York

Remember that I wrote most of this the day I got back from New York, so some of the info is old.

I want to tell you about my trip to New York. I gave a lecture to the New York AGD last Sunday. I was so excited about going to the greatest city on Earth. I asked a bunch of people in the know about where I should go to eat. More than one person that told me I should eat at Peter Luger Steak House in Brooklyn, so I thought I would treat myself to an awesome steak dinner.

I called to make reservations. On the fifth try, they answered. I told him I needed a reservation for Saturday night. He chuckled and informed me that if I wanted to eat at his restaurant I would have to call six weeks in advance. Oh. That totally took the wind out of my sails.

I got into La Guardia at about 5:00. Then realized I didn't know a thing about where I was and I was uncomfortable. I got in a taxi and I told him the address of the hotel. On TV, you can tell the driver that you’re going to 25th and 8th, and the taxi cab pulls away. But in real life, you give the driver the address and he asks you where that is.

I gave him the name of the hotel I was staying in, and he looked at me like I was an alien. I had to look up the directions on my phone. "My phone says to take a right in .3 miles." Welcome to New York.

I got to the hotel just in time to see the second half of the Gators game. We lost and that put me in a foul mood. I decided to venture out. There were plenty of sports on; I could go have a beer and watch someone else lose. I asked the young lady at the front desk for a sports bar that was close, but she had no idea. I googled "Sports Bar, Queens," in my phone and Yelp came up with about 10. It is awesome because it lists the closest to the farthest and rates them.

I decided to go to the one that was closest. It was 3.2 miles away and it got 3.5 stars. The driver came into the hotel, paid the young lady for calling him, and we drove away. We drove and drove and drove. I started to freak out. I told him that my said it was only 3.2 miles away. Then I realized he didn't speak English. But he did manage to tell me that he knew where the place was. We did finally get there and the fare was $25. Yeah, only in New York would it cost $25 to go 3.2 miles.

One thing I have learned about New York is that they jam a lot of things in small spaces. This restaurant was about 1,800 square feet. There is a bar on the left, a walkway not wide enough for one person, and high-top tables on the right that are barely big enough for two. They must have five TVs. I ordered the A--hole Burger (if something like this is one the menu, you almost have to order it). After dinner and a couple beers, I still felt like crap about my game so I went back to the hotel. I took a taxi and it $25 again. I guess the first guy didn't stick it to me. That is just the way it is.

The next morning, I was to meet the executive director of the NYAGD at 6:30. I got there 90 minutes early to set up and make sure all AV issues were taken care of. It took me seven minutes to set up, so I was 83 minutes early.

I am kind of new to this and I am still very nervous when I speak. Usually I get a lot of energy from the audience. When the audience is into it, I can relax and take a deep breath. The audience in New York was very different. They were a mix of many ethnic people. Maybe their customs are different or maybe they just are not big talkers. I usually try to start my lecture by asking the audience some questions to get to know them. When I asked a couple of questions and no one answered, I knew I was in trouble.

I have heard that this doesn't mean that they didn't like it but that they are just not very vocal. But I was starting to think I was bombing. I started to feel like a comedian that wasn't funny. I continued to ask questions, but I got nothing. I made jokes, but no on laughed. I started looking for the gong. I leave time in my lecture for discussion. Guess what. No discussion. The lecture ended way short of its intended time.

Don't get me wrong. I enjoyed my time there. I was honored that they took a chance on a new speaker like myself. But I wanted everyone (or at least someone) to like it. The worst thing was that my sponsor was there. When everyone left the room, it was me and two big wigs from the company. They just kind of smiled. Theirs smiles seemed to say, "You just bombed up there and we had to pay for it." We chatted for 15 minutes, but all I could think of was that they were just being nice to me and couldn’t wait to get out of there. This is a terrible feeling to have.

This feeling is hard to shake. The high I feel when I think I knocked it out of the park (like at the FNDC) equals the low I feel when I suck it up. I spent the next week wondering if I want to continue this lecture thing. If it is going to go like this, I don't think I can take it.

But who knows? Maybe they liked it. Maybe they were just quiet people. This was a very tough weekend. The Gators lost and I was almost was gonged out of New York.

Hope your weekend was better than my last weekend.

john

Who Pays?

Hey all,

I am back from NYC and the marathon that never happened. Yep, I paid for a plane ticket. I paid a ton of money to stay at a really nice hotel (really nice hotel in New York is still very small). I found out that the race was cancelled while I was in line to get my T-shirt and my race number.

That was tough to swallow. I am okay with them cancelling the marathon, but to do it on Friday afternoon was a killer. If they had announced the cancelation on Thursday or Friday morning, I would have stayed home. And, of course, the $280 entrance fee is non-refundable. Usually, I like to be kissed before this happens to me.

Anyway, I’m still thinking about the folks in New York and New Jersey and have been praying for you. I hope things get back to normal soon.

We did make the best of it in the greatest city in the world. We stayed about two blocks from Times Square. Wow! TV doesn't do Times Square any justice. There are buildings that have ads that are 30 stories tall.

The weather was cold; it was good for a Florida boy to experience 39 degrees in early November. Between Times Square and the weather, I now really appreciate having a back yard and great weather.

You know the saying, "In a New York minute?" Well, it is hard to not feel rushed in this city. There was no place to just sit and relax. I guess there is Central Park, but it almost seems manufactured. Everyone is working and totally in the rat race but when you do want to relax, even though you know you never will, there is this park in the middle of this city.

We did get to see a show. Spiderman was great. We went to Sparks for dinner (this place was made famous because John Gotti was killed on his way out of there) and got a very overpriced steak. But it was all good. We went down to Greenwich to shop. I got to experience New York. The best thing is that I think I got a pass for next year so I get to do it all again. I feel rushed already.

Oh, I got to fly first class on the way up there and it was SO SWEET. I can't help but think of that Seinfeld episode when Jerry is up in first class and Elaine is back in coach. How can you not feel that way? The seats recline flat. You can lie down! They bring you heated peanuts. They put a tablecloth on the tray when they bring your meal. It is unbelievable. We flew coach back and felt like second class citizens. They won’t even let you have entire can of Diet Coke.

I am reading the book “No Easy Day.” It is written by a Navy Seal about the mission that killed bin Laden. It is pretty good. It is a very easy read, and I need that right now.

Can you believe Christmas is only seven weeks away? If you haven't thought about your Christmas party yet, you are way behind. Get going on that. And don't forget, my Christmas blog will be my last. We have some good people coming in, so you won't be without good reading. It sucks that I can't do this for a living.

Today I want to talk about who pays. A woman who doesn’t smile came in. Her teeth were really bad. Number 7 was missing and all her others were badly decayed. Her husband, a nice-looking guy, wanted to fix it for her. They are not poor, but he wanted to know how much it was going to be so he could save the money. They made an appointment six months later.

We did a lot of caries control, taking the decay out of the adjacent teeth. We did a lot of build-ups. Then I made her a bridge from 6-8 and two other anterior crowns on 9 and 10. We made her a temp. They looked great. But the tissue on #6 was not quite right. See, I put the cord in tissue, for the impression, and it retracted. The problem is that it never came back. The bridge came back from the lab in a couple of weeks and it looked beautiful, except for the mesial margin of #6. The margin was a smidge over the tissue.

I told her I was thrilled with the way it looked (so was she), but I showed her my concern. She wasn't concerned. She obviously wanted them all put in permanently because she thought it was awesome. I told her I thought we should put it in temporarily and see what the tissue looked like in three weeks. She was fine with this.

Things looked pretty good three weeks later. She was thrilled. We took off the bridge and cemented it back on permanently. When I went to remove #9 and 10 to recement them permanently, they wouldn't come off. I told her that I was not going to break these crowns trying to get them off, but to call when they get loose or come off.

She came in when #9 broke off. But the build-up was in the crown and some of her tooth. The temporary cement never came loose, but the tooth broke. Luckily this tooth had a root canal and none of the margins were affected by the break. I did a reverse post and core. Where I do a post in the tooth, I put bond on the tooth and I put the core in the crown (self-cure build-up material such as CorePaste, don't forget to lube the inside of the crown) and then put the crown back on the tooth and it forms around the post. When I take the crown off, I have a post and core that the crown fits on. I did all of this and recemented the crown (permanently).

She went up front to show her husband; he was just as pleased as she was. While they were up front, I had a discussion with my staff in the back about how much I would charge. I put in a crown and it broke. I did the best I could and it still broke. Are we, as dentists, married to teeth we work on? How long are we married to them?

After the discussion with my staff, I decided to charge them for the post and core. I was going to charge them for it but give them a discount You know, something for my troubles. Just enough to pay the staff, for the supplies, and for the electric. I went out front and they were gone. It was the, "Thanks for your work. We are not expecting to pay for anything today." kind of gone.

That ended this discussion. I was NOT going to send them a bill because they would really be caught off-guard and probably get upset. What would you have done? If you do a crown and the whole thing breaks off, is there additional charge to do something else? I am assuming most of you are going to say that it is our responsibility. For how long?

I have to tell you that I don't agree with what I do. I don't think I should have to pay for some other problem they have just because I did a crown. Obviously, the tooth was not strong enough after the build-up. You might say that I should have done the post and core originally. Okay, I would buy that. But I am doing it later. Why should she get it for free if I do it later?

What if you have a patient who breaks an old crown off at the gumline? The tooth has an RCT, so you do a post and core and a new crown. A couple of months later, the crown and post break. Is it your problem? I know the answer; this is a rhetorical question. The person obviously has a bite issue.

We have talked about this before with other things. I hate this part of my job. I want to please everyone, so most of the time I don't charge. What other profession do people come in and get charged NOTHING? No other profession.

Have a great Thursday.

john

Don't Tell My Parents

I had a blog all written about my trip to New York and all the things that could only happen there, but I feel like it would be insensitive to post it in light of what they are going through now. So I wrote another one. When they are all cleaned up and back to normal, I will post the other one.

One of the best things about being a general/family dentist is watching the kids grow up. Kids that used to scream and yell and run up and down the halls are now bankers, chefs, doctors. It is so awesome. One of those patients came in this week. He is 21 and we have always enjoyed having him here. He came in for fillings and he was playing with his ring. It was that he wanted someone to ask him about it. My assistant, taking the bait, asked him if he has a girlfriend and if she got him that ring. "No, but I have a boyfriend and we just celebrated our one year anniversary."

There was a very awkward pause and then we all chuckled a little and moved on. Then he asked us not to tell his parents because they don’t know yet. We all agreed that didn’t want to get in the middle of that and then we went on like nothing happened. After he left, we could not believe he had just told us that. Both of his parents are patients here and I like them both. I am really not going to get in the middle of that one. The law says I can't, but even if I could, there is just no way.

I guess when you get to know someone and you like them and they like you, they feel like they can trust you. And we like him just as much as he likes us. There is nothing he could really say about himself that would make us not like him (within reason). You treat us well, you come to your appointments, you floss occasionally, and we like you. Imagine how many people come to your office that you don't know anything about. We have the luxury of just knowing a little bit of people. Sometimes, that is enough.

Have you guys learned something about people that you wish you didn't know? Have you ever had to tell a parent something about a minor? Luckily, I haven't. How about something a wife tells you about a husband? We had a husband come to our office who wouldn't leave because his wife (who had threatened to kill him) was waiting in the parking lot. Yes, she was a patient, too. Talk about awkward the next time she got her teeth cleaned. Tell me your stories.

I am off tomorrow; I am going back to the Big Apple for the marathon. Fifty thousand people signed up to run. Crazy, huh? My wife and I are going for a long weekend and will return Monday afternoon. It should be great.

Have a great weekend and I will see you next week.

john

Investing

I want to talk to you about a patient that came in the other day. He is a successful nurseryman and has been a patient here for about 15 years. We live in a medium-sized town that was built on the business of indoor foliage. What? People around here grow plants. There are one-acre facilities and 50-acre facilities, all greenhouses. And when he was making money hand over fist, he invested in a bank (I know because he was telling me about it).

To me, bank people were always a different kind of investor. But when he was here, he asked me if I wanted to invest in a small hometown bank. Remember back in '06 when there were tons of small banks starting? They all had the notion that if they get enough accounts, one of the big banks would them. I opened account with Southern Community Bank because I knew the owner. Then it became Florida First Bank, then it became 5th 3rd. Everyone who owned a bank was rolling in it.

He wanted to talk to me about investing in a bank, and this always perplexes me. I really think most of my patients think that I go home and roll around in the cash that I made that day. What part of the fact that I am driving in an 11-year-old car don't you understand? I told him he was asking the wrong guy because I don’t have any money.

Don't get me wrong: I know I make a great living. But saving? I max out my 401k and, uh, that is about it for savings. All the money I make gets put into educating my children or debt reduction. I just bought the second half of a practice when I still owe on the first half.

Looking at the numbers for the week, they seem okay. I look at the numbers for the month and I take a deep breath because I have a little money in the bank. But I am only six months past the last time I had to dip in to my equity line so I could pay my staff. I look ahead and see that Christmas is right around the corner and I know I am going to be taking 10 days off and then there’s the Christmas party. And now I start to sweat again.

What business do I have investing in a bank?!? Right now I am investing in myself and, quite frankly, I don't know if that is such a smart investment. But I am all I’ve got.

Do I see where one day I might be out of this huge hole I have put myself into? Yes, in 7-10, years I am going to be in great shape. But you also know what happens in 7 years? I will have two kids in college and one kid in the 10th grade. Okay, not so great shape?

I told this guy to hit me back in 15 years when I will only have one kid in college and three kids out of the house, have no debt on the office, and will own my house. FIFTEEN YEARS!!!! I will be on easy street then. OH YEAH!!! Oh my gosh. I will be 58 years old. Holy crap.

You know what? In 15 years, I hope the economy is back because then I will be ready to invest in a bank and maybe I might be ready to buy a new car. My poor truck will be 26 years old, but at least I will have one of those cool "antique" license plates. Have a great day!

john

The Great Debate

I hate to keep saying this, but my life is crazy. Trying to run a business and live my life is hectic, to say the least. Now I am getting a loan from the bank across the street to pay for the first half of the practice. This was originally paid with the equity line on my house. I am going to pay off the equity line and move everything over to the office.

In order to get the awesome rate that I got, I agreed to move my banking from one of the BIG banks to this small, service-orientated bank. We are moving all the deposits and credit cards to this bank. What a huge undertaking! I never knew it would be this complicated. Any automatic withdrawals have to be changed and we have to leave a little money in this bank just in case things come in. We have to get new checks. Ugh. But this will free up equity in my house so that I can refinance it. I know this is a good thing, but it is making my life crazy.

I want to talk about politics today. I am not going to try to sway you to a certain way politically, but it is something that affects us. I have a free-standing building on a corner lot. My lot would be an awesome place to put a sign endorsing a candidate, but I have reservations about that. Listen, I live in a staunchly republican small town. They did a political hobnob here, sponsored by the Chamber of Commerce, complete with a fake election. Romney won with 86% of the vote. I wasn't kidding when I said staunchly republican.

I try to stay away from using my property as space for signs. I want to be neutral about this stuff at work. When I was younger, I did not have any problems talking about politics, religion or sex in the office. Now, I shy away from it. I don't want to offend anyone. Listen, I am a person that can help you with your teeth. I don't want to turn you off in anyway. I don't even have any college affiliation stuff around here because people get sensitive about it. In the south, if I put Gator stuff all over, I might just turn off a Seminole fan or an Alabama fan (I don't really care if I turn off any Miami or Georgia fans).

I had a guy come in today who said that he is moving. He is 80 years old and he said Florida is too conservative. He said Florida doesn't care about the poor or education. He dropped off his lawn mower at his normal mower place and when he went to pick it up a couple weeks later, they had a big sign outside endorsing a guy he doesn’t agree with. He picked up his mower and told the owner that this would be the last time he did business there. This is what I am trying to avoid. Maybe I am at an age where I need all the patients I can get. I can lose patients that like me; how easy would it be for them to leave if they didn't like me? I don't talk about politics or religion at the office any more. I am not putting a sign up endorsing any candidates this year.

Maybe I won't care about pleasing everyone when I reach my dad’s age. Maybe I won't care about people leaving and the days of me wanting to please everyone will be gone. Maybe I will even stick a huge endorsement ad on the corner where everyone can see. But today, this empty spot on the corner is advertising me.

What do you guys do? I know you care about the election, but do you care about it enough to throw a sign up?

I have pretty strong opinions about the way the country should go. I have to admit that, if I went to a place of business that endorsed the "other guy," I might consider not going back there. When I drive in my neighborhood and see people who agree with me, I give a little tap on the horn. When I see people with opposing signs, I pretty much lay on the horn (because that might change their mind). But my business is sacred, and I leave it alone. How about you?

Have a great Wednesday.

john

More Questions Than Answers

FRIDAY! Nice, huh? I have big weekend planned; I’m taking my boys to the Gator game on Saturday. Hope things are well with you.

I still really love Shark Tank. I think it is a Friday show, but we watch in on Wednesdays because that is a day we are usually home. This Wednesday, we ate dinner and then everyone piled into the van and went for ice cream. Then we came home and watched Shark Tank as a family. We talked about people's ideas and about how mean the Sharks were being to the people and to each other. We talked about what it takes to make a small business happen. I think it is good for my kids to see something like this. It definitely gets their entrepreneurial juices flowing.

I want to talk to you today about having associate. As you know, I am the sole owner of the practice and my father is now my associate. This has brought about some challenges that I want your advice on. I know I am not the only one going through this. If you are not going through this, make sure you listen because you may go through it in the future. I my case, my father says he wants to work one more year. At first, this seemed like a long time. It isn't.

You might buy out a dentist who is late in their career. It is a great practice and you want him/her to work there for a year or two to not scare off the staff and the patients. Or maybe you plan on bringing in a young associate.

Let’s say a new patient calls. This patient hasn't been referred to your practice. He is a father who just moved into the neighborhood and keeps driving by. He has a wife and three kids. Do I let the associate see them, knowing he is leaving in a year? Would you have a young associate see them? New to the practice, just getting his feet wet, you don't even know if this young dentist is going to work out.

What about the older patient that was referred by a friend to my father? Slam dunk. My dad will see him. The guy is missing a couple teeth and wants to get implants. He needs a bone graft then implants placed. By the time the implants are integrated, there is a good chance my dad is going to be gone, so I might be finishing this case up. But my dad uses a different periodontist than I do. I don't even know what implant he uses.

These are valid issues. We talked this week about him sending his patients to my periodontist. It is not that I don't like his periodontist. I just like mine better. I have a relationship with him, and I know I can just pick up the phone and talk to him. It is the same with my orthodontist.

This is no different than if a middle aged dentist were to bring in a young guy. Does the young associate only get emergencies and their family? Remember, the associate, regardless of age, is working off of production; they want all they can get. But is it right for the patient to get used to a dentist and then have them leave in less than a year? Is it right for the health of the practice?

As I write, this I am thinking about the future. Does the patient come to a practice because of the dentist? I know all of us think they are there because of us. And I agree with you, kind of. How many times do you hear about a patient following a hygienist? How many times do you hear that a patient liked the dentist but left because the front desk was terrible?

I think people come to my office for a lot of reasons. There are friendly faces when they walk in and a warm reception area. We don't make you wait. The hygienists are sweet and gentle. People like the way we handle the checkout. We call the next day to see how you are doing. It is the whole experience.

The dentist is part of it, whether that is me, my dad, or an associate. If my dad meets a new patient and a I slip in after a year, only one of the many good things in our office has changed. I think this is what I am going to go with. My dad still sees new patients, but I try to make sure they see me. I will walk by his operatory, introduce myself, and welcome them. I poke my head in and ask them if everything is okay. I make a joke and then move on.

What do you think? Have you had an associate? Have you been an associate? What were the arrangements?

Have a great weekend.

john

P.S. Go Gators!

P. P. S. On Monday we are having a team-building experience. I am taking all my staff to a local gun shooting place. They have virtual shooting ranges, with bad guys popping up and stuff. They use real guns that have kick but only shoot lasers. Then we are going to have lunch. I am so looking forward to it. It should be lots of fun.

Passing the Buck

Good Wednesday to you,

Hope things are going well for you. Things are pretty busy here. I have been reading the same book for about a month. Every time I get back to it, I have forgotten everything I have read. Netflix is making money off of me like crazy. I get two movies in and they sit there on the TV cabinet for a couple of weeks. I finished watching a movie on Sunday. The problem is that I started it the previous Monday. Life is crazy.

It has rained a lot lately, so baseball games got cancelled and rescheduled. This is the reschedule week. We have three baseball games, a football game, and two piano practices. My marathon (NYC) is in two weeks, which means I am not able to slack much on my runs. I went to a game yesterday, then straight to my Seattle Study Club meeting, got home at 9 and then went out for a run. AND let’s not forget that the Gators are on fire! There is a lot of buzz around these parts, so I am going to take the two boys to the game on Saturday (after a 16 mile run). My daughter told me that her birthday is only eight days away. I said, “Oh yeah!” But I knew good and well that I had forgotten this very important date.

And if you think this is not enough, next Saturday I get on a plane to speak in New York City. I fly in on Saturday to speak on Sunday morning. I will be home by 6 p.m. on Sunday night. I will work for four days before I get on another plane to go back to New York to run the marathon. Man, I love my crazy life.

Okay, let’s not have this be all about me (as much as I like that). I want to talk to you about warranties. I have a specialist in town that I really like. She does very good work and she gets my patients in right away. She claims is that if she works on a tooth, she takes responsibility for it. A guarantee, per se. I like that. She is a specialist who takes responsibility for her work.

I do this. I have an unwritten guarantee on all of my work. We have spoken about this in the past. If a filling is less than five years old and it fails, I will repair it or replace it at no cost. If a crown is less than, say, eight years old, the same rule applies. I am a consumer and a small business owner, and I try to run my practice the way I would want to be treated.

I sent a patient who was hurting and swollen to this specialist. To her credit, she saw my patient right away. I think there were some antibiotics at first and then they rescheduled for a procedure (I am being very vague on purpose because I have been told in the past to watch my rhetoric). The procedure was tough for the patient but she was relieved to be out of excruciating pain. But after the completion of the procedure, she never was without pain and couldn't bite on the tooth. She went back to talk to the specialist and discuss her pain. She was told that everything looked good and left with a $100 exam bill. The patient came back to me and told me that she hasn't been able to chew on this tooth ever since the procedure. It has been about a year. WHAT?

I know this specialist and she claims that she won't do anything that won't succeed. I called and left a message that was never returned. When I saw the patient on the schedule again and realized that the issue wasn't resolved, and emailed the specialist. This email also went unanswered. Sound fishy? I thought so too.

I called again and finally got the office manager on the phone. When I call to talk to the doctor and the office manager gets on the phone, I feel like the doctor is blowing me off. She is telling Sally to talk to me because she doesn’t want to.

Look, we all have teeth like this. We have all worked on teeth and thought we did an awesome job, only to find out that the tooth still hurts. We all do fillings that are shallow that somehow hurt people so much so that they need to have a root canal. We all have teeth that fail that we don't know why. So why is talking to another dentist that knows failure such a big deal? I didn’t think it was her fault; I thought maybe the tooth was cracked.

I didn't want to take the tooth out without consulting her first. But I get to talk to her office manager. She told me that she has everything on this tooth documented and that on such and such date they told the patient that they didn't find anything wrong with the tooth. They referred her to a facial pain specialist and that they were happy to make her new patient appointment ($650) with this doctor, but the patient declined.

This dentist is not taking any responsibility for this person’s continued pain or for punting her. They are claiming it is not the tooth at all and classifying her as a facial pain patient. Listen, I refer to this specialist and I think this guy is the smartest dude there is in town, but this thing is starting to look and smell and feel like a duck.

If it were my patient that was in pain, I would take responsibility for this tooth. I would have an arrangement with the other doctor that he/she would see my patients and if they thought there was something that I missed, their exam is on me.

What do you think? Is someone skating on their responsibility? Am I being too cynical? Have you ever done a root canal that failed? I have. It is rare, but it happens. I call my endodontist and ask them to help this patient for me and tell them to send me the bill.

To me, that is what it looks like when a guy takes responsibility. Am I wrong? Let me know.

Have a great Wednesday,

john

You Stink!

Well, I have been a bad little blogger. I have been busy and out of fresh ideas lately. I guess it is that thing they call “writer’s block.”

I have been lovin’ the football season. I have been pleasantly surprised by what the Gators have been doing this year. Seeing the Seminoles choke to NC State and then the Bulldogs get their tails spanked by old coach Steve Spurrier was fun.

My house has been full of sick people lately. Two kids and the wife with fever, cough, etc. Just picture the scene from the movie Outbreak when they walk into a room and everyone is lying around moaning and acting like death warmed over. I had to have a repairman over to the house, and he nearly went running out of the house in fear for his life. Everyone is better now, thank goodness.

A new patient came in. Let’s call him Frank. He came in for a second opinion on a crown that was done at another office. You know the tone of voice and certain words they say when they are unhappy and blame the other dentist for something. I always tread lightly with these situations, especially if I know the previous dentist has a good reputation and does good work. I addressed his issue and he seemed happy. He asked how he could get established and get a cleaning. I informed him that the front desk would be more than happy to assist him with his request.

We have a new patient policy. At our office all adult patients must see the doctor first for a comprehensive exam and proper diagnostic radiographs. We typically like a full mouth series, unless we suspect third molar issues (then it is a panograph and bite wings). According to Florida state law, prior to being seen by a hygienist, a patient must have an exam by the dentist to authorize by indirect supervision prophylaxis or other hygiene services. As a military man, I follow the rules. I know many offices let new patients schedule right into hygiene. But from my understanding, this is not allowed.

What is not very clear in Florida dental law is the requirement for radiographs. It is a grey area. What it says and how all the attorneys I have spoken with interpret it can vary. The attorneys say that the Florida Board of Dentistry and Florida law do not strictly mandate the need for radiographs, however, it is viewed as normal and customary to have radiographs to review as part of a thorough and complete exam. It is a general liability issue as well. So, in a few words, the law says, “You need to take darn x-rays!”

A few weeks had gone by when one of our hygienists noticed Frank on my schedule and on her schedule immediately after for a prophylaxis. The note in the appointment stated that the patient did not want any x-rays. My hygienist knew this would not go over well with me. She called the patient several hours prior to the appointment to inform him that radiographs would be needed.

Boom! Frank exploded, ranting about how he should not have to take x-rays and his other dentist did not take x-rays. He asked why we would need to take them, and my staff told him it is required by law; he called us liars and asked if we were saying his other dentist was breaking the law. [No, but maybe he wasn’t very thorough if he never consulted radiographs]. Frank went on to say that if we would not give him a cleaning without x-rays, then he use the internet and tell everyone that we “suck.” Then he hung up.

My office manager called him back to try to explain again. She offered to fax over a position paper from the Board of Dentistry that explains why x-rays are needed. Frank would not hear anything about it. Instead, he just went on and on. The office manager listened patiently before she asked, “Sir, can I say one last thing?” She told him that we are sorry we cannot help him, but if we discover that his making or writing libelous or slanderous statements about our office, he would be held responsible. Goodbye!”

Today, a discharge letter and the position paper info sheet on radiographs are being sent to Frank.

How else do you deal with this type of character? I know there is no way I want to treat this person after this encounter. We strive to meet people’s needs and desires, but this was a no-win situation. What else could we have done? I know my staff is not rude or hostile to patients. I just do not see how this could have been avoided. Any ideas?

Have a good week,

J.J.

Bad Crowns

Happy Friday. I forgot to mention the Gators in my last blog. I have a bit of a bounce in my step this week because we beat the #4 team in the country. I was in the third row on the 40-yard line for that game. What a great atmosphere. But what is even going to be better is if South Carolina and the Gators can take care of business this weekend: then next weekend will be Battle Royale in the swamp. I already have my tickets to that #3 against #4 game. And basketball media day was Wednesday. Oh my gosh, I am so excited about basketball!

I want to talk to you about something important. I don't know if you know this or not, but I have been the blogger for The Daily Grind for almost four years. I told the AGD that I will be retiring from blogging at the end of the year. I have a lot of irons in the fire right now. Most of the time, I am going crazy trying to get everything done. As the new 100% owner of my practice and trying to get this speaking thing off the ground, I feel like it is time.

I am totally going to miss it. It has been a huge part of my life for a long time. I don't know if I will continue to blog, but I just can't commit right now. It has been four years and about probably close to 600 blog posts. Wow. My fingers hurt just thinking about it. The AGD promises some new and exciting writers for The Daily Grind.

Today's topic is bad crowns. In the last two weeks, I have had the same thing happen twice. One was an old patient that decided to go somewhere else to have an implant restored. I don't know why. But when the implant crown came off after 3 months, she decided to come back. The other was a new patient that was unhappy with an anterior crown that was done just a few months back.

The old patient had an implant on #30 restored and it was a mess. The implant was great but the abutment was too small. There was plenty of room but the abutment was taken down too low. The crown looked like a tabletop with no anatomy. I told the patient that I could put this back in but it wasn't going to stay. I told her that she really needs a new abutment and a new crown.

She has insurance but, as you know, the insurance is not going to pay for a new abutment and a new crown. I told her that I felt bad for her and I might discount the stuff a little bit, but it is going to cost her about $1,500. I am not upset that she went somewhere else, but I am still a little shocked sometimes when I see crap dentistry like this. But what am I supposed to do? It is what it is.

I told her I am not going to get involved, but if someone wrote me a letter and told me that something I did failed and was going to have be done over, I would give them their money back. Now, between you and me, I don't know the scruples of the other dentist but to do substandard work tells me a little about this guy. If I were to get this letter, I wouldn't be concerned about someone suing me or anything because my stuff is good. But I would think that someone is doing this kind of work may fear some legal ramification. This letter would maybe make them want to write a check for it to go away.

The second woman came in unhappy with the new crown she got on #8. She has veneers that are about 10 years old One of them broke and a dentist redid this one to match the others. I am not saying this is easy; I know it isn't. But this tooth looks like a Chiclet next to her other teeth. If I was her, I would be unhappy too. I told that I would need to redo this tooth to make it look like the others. What else could I do?

She has the same issue with her insurance. I told both of these patients that they could go back to the dentist who did the work; neither of them wanted to. It looks like both of them are going to pay me (without insurance) to redo some very new work. This just baffles me. If I paid $1,000 for something and it wasn't right, you can be sure I would go back there and get it done right. I do understand losing confidence in someone. But the first one went to another dentist to save money (I am assuming), and now she is back and going to pay twice. If she has the money, why didn't she just come here in the first place?

When I do something, I am my own worst critic. I send stuff back to the lab even after my patient says they love it. I will not stop until everyone is happy. If we are both happy and a couple of weeks later they come back and say they don't like something, I fix it. And if that means doing it again, so be it.

Do you guys get this? I would think that in these hard economic times, people wouldn't be throwing money around like this. Do you just tell them like it is? "Sorry, but it is going to cost you $1,200 to fix." I don't know. Maybe I am trying to save the face of dentistry or to uphold our reputation as a whole.

Hey, have a great weekend.

john

Go Gators.

Are You Up on Technology?

Hey everyone,

Hope you had a good weekend. I got an email this weekend from the organizers of a big meeting. They are interested in my lecture and are planning on reviewing my application, but they had a few questions. They were wondering I have any availability on June 17, 2015. Uh, let me check my calendar. Yeah, it looks like I am wide open. Pretty funny, huh?

I went to Gainesville a couple weeks ago to present a lecture. The night before the lecture, I was able to spend some time with Wayne (I think this is what I called him, but it is not his real name). We had a few beers and talked about teeth. He sees dentistry in an interesting way.

He started asking me questions about my schedule and how it works. He is presently in a two-week class on the business of dentistry. Hilarious. This class on the business of dentistry is probably a total of 10 hours. I am also taking a class on the business of dentistry; it has been going on for 17 years and I am barely pulling a C minus. The class promises to finish in about 17 more years and I am hoping to pull my grade up to a high C.

Wayne is worried about technology. He said that he’s been hearing a lot about CAD-CAM. I told him that I have no problem with CAD-CAM and I think it is an awesome piece of equipment, but our practice just doesn't cut enough crowns to justify having one.

He also asked about digital impressions. I again told him that $40,000 was a lot to make up. It costs $5-$8 per impression and we do 60 crowns a year (that is about 50 impressions). You do the math. It just doesn't make sense for our practice. He started to ask another question, but stopped. “Spit it out, Wayne.”

"But what if people get the impression that we are not up-to-date on our technology?"

Hmm. I had a hard time explaining to him that just because you don't have two of the top three expensive pieces of equipment that dentistry has to offer (CAT scan being the other one, and no I don't have that either), doesn't mean you are not up-to-date. I also had a hard time explaining to him that there is a small amount of people that care more about your technology than about you. up-to-date If your patients like you and trust you, they do not care so much about your equipment. Some do, and I am not sticking my head in the sand and pretending that it doesn't matter, but most patients pay more attention to you than your equipment.

I don't have these pieces of equipment, so market the things we do have. I accentuate the positives. Like in life, if you continue to dwell on the things you don't have, you are going to be a very unhappy person.

I hope to create an environment that values relationships. I have created an office that cares about the needs of the patient before the needs of staff. This office puts service above self. It is up-to-date on the latest CE and does dentistry really well. We are moderately up-to-date on technology, as well. We have digital x-rays and have monitors on the ceiling that impress people, and we have paperless charts. But I am not trying to impress people with my technology; I am trying to impress people with my thoroughness.

This has worked for me for the last 17 years and it is going to have to work for me for the next 17 years. I want people to tell their friends that I was an awesome dentist, that I was friendly and my staff was helpful. I want them to say that this office was so comfortable and warm. Will they mention that we had cool, current technology? Maybe.

Wayne asked what would happen if the guy down the street has a CAD-CAM. I didn’t know what to say. Will I lose a patient because I don't have one? Maybe. I guess I have never really been concerned that I wasn't current enough.

If the guy down the street does have a CAD-CAM, do his patients tell their friends that their dentist hast a one-visit crown machine? Heck yeah he does. And if I had one, I would be marketing the crap out of that thing. But I don't, and I don't care.

I do have a lot to offer, folks. I sound like Stuart Smalley again. "Because I'm good enough, I'm smart enough, and doggonit, people like me!"

It just is funny how younger adults see the world. Some of them have never been consumers. They have never gone to a mechanic and felt ripped off or felt helpless because they don't know what they are talking about. I go there and don't care about the machines they have. I just want to know that they know what they are doing, they do it well and they do it at a fair price. I care that they talk to me in a way I understand and I don't feel like they are doing stuff just to make money. It is the same with dentistry and my patients.

Have a great week. I will talk to you soon.

john

I Don't Want an Exam

Well, things have settled down here a little. I think the course went well and it is such a relief to have that behind me. I have another lecture in NYC in three week and another lecture/hands-on in January, but that is all I have scheduled right now.

I did a massive push to get gigs about a year ago and got about 8. It has dried up, so I have to do another push to get gigs again. I was hoping some people would hear about me and call me, but I guess I am not that lucky. The feedback has been very positive but no one has called yet. I have just hired someone to build a website for my lecture so meeting planners can find all the information they need about me. This is a risk, especially if no one goes to the site. But I am trying this thing for a couple of years and we will see what happens. I will keep you posted.

Today I want to talk about the patient that is not very compliant. I have been in this biz for about 17 years and I have seen everything, but still some things amaze me.

I have some friends at my church who go to a dentist near their home. We have gotten to know them well and they both said they wanted to come to my office. The wife came in first for a new patient exam and really liked it here. A couple months later, the husband came in. He has the dental issues. He had braces to try to improve the bite and the cleanability of his teeth and he has been battling gum disease. He has been "keeping it at bay" for about 10 years.

It has been a couple years since he last had his teeth cleaned. You know that a couple years is a long time to wait for perio maintenance. I did perio probings and he had an alarming amount of 5mm pockets and only about 40% of bone on the lower anterior. He has great teeth, a pretty good occlusion and no decay, but the perio is a concern.

I mentioned this and told him that I would put him on a "shorter leash." I want him to come in every three months for a bit while trying to avoid another trip to the periodontist. He said his insurance would not cover that. I told him that his insurance would cover the extractions of those lower teeth. I made it very clear that I recommend him coming to see us every three months for now. He scheduled his next appointment for six months.

I just shook my head. He has been around the block with his perio. He knows what is going on in his mouth and he does not want to spend the extra $170 a year to make sure he doesn't lose his teeth. This kind of stuff baffles me. You are probably thinking that I should not be so hard him because maybe money is a concern for his family. It isn't. I know this couple. They are DINKs (duel income, no kids). The $170 is not the problem.

People are weird. These people are great people. I am not really mad at him. Maybe I am just mad at myself because I must have done something wrong. I must have not educated him enough. I must not have told him the severity of the issue. But I think I did. He knows. He knows what gum disease is and he knows he has it. He knows that being here more often is going to prevent the advancement of this disease. But he just doesn't want to spend $170 out of pocket. This is not my fault.

It baffles me. I know they like it here and I know they trust me. But who do you think is going to have to pick up the pieces when Humpty Dumpty comes tumbling to the ground? You guessed it: me.

What do I do? Do I kick them out of the practice because he won't listen to me? Do I bring it up every single time he comes in and pester the crap out of him? We all know that is why people leave practices all the time. "The hygienist wouldn't stop telling me to floss." Or, “They just kept bothering me at my old dental office." Do I just pretend it isn't there?

I don't know the answer. Do you have one? Let me know what you think.

Have a great weekend.

john