‘I Thought You Said This Was Permanent’

I don’t know if you all have been reading my posts for a long time, but I used to give you book and movie reviews. 

I haven’t seen a movie in a real theater for a long time, but my kids wanted to see “Jurassic World,” so I relented. (We go to the dollar theater all the time, but that doesn't count, because all those movies are already out on video.)

The movie was fantastic, by the way. While waiting for the movie to start, we saw a trailer for “The Martian.” It looked good, so I borrowed the book (can you see a cheap theme in my life?), and I just finished it yesterday. Other than some slow parts in the middle, I thought the book was very good.

But what amazes me is that this was the author’s first novel, and the funny thing was that he initially was giving it away for free on his website after several publishers rejected him. One of the author’s friends said that the website download was too slow, so he put it on Amazon for the lowest price it would allow: 99 cents. Shortly after, he sold a bunch of copies at 99 cents each, and publishers started to notice. Next thing he knew, he had a book deal and a movie deal!

The movie comes out on Oct. 15. I am looking forward to 10 weeks after that, so I can see it at the dollar theater.

Anyway, to the topic de jour:

I have a 75-year-old patient. My father did a full mouth reconstruction on her about 14 years ago.

Today she came in with No.10 broken off at the gumline. I told her that we can save the crown if the margins are intact. But first we would have to do a root canal and a post and reverse core. 

She then got that confused look on her face. She said, “I thought your dad told me that this work was permanent.”

Hmmm… I was blown away by this. I was shocked that someone would think that dental work could be equated with forever. I was put into a position to talk to her about the difference between “permanent” cement and “guaranteed for life.” 

But this might be a great forum to talk about what to do when something fails. Man, this is a tough one, and I know that we are all different when it comes to this topic. We all have different philosophies when it comes to running a business. And, yes, this definitely falls in line with how we run our businesses. 

I know some of you are the strict type. You run your practice like it is a business (that’s funny to type). Everything is black and white. The fee is the fee, and if you don’t like it, then you can go somewhere else. You say things like, “This is our policy.”  

I, on the other hand, don’t do anything by the book. 

I don’t run my practice like a business. And, what I mean is, I am very loosey-goosey about policy, because to me it’s more about the relationship than it is about sticking to the policy.

On a side note, this is a business model; it just doesn’t always look like you’re running your practice like a “business.” Am I making sense? Because I give stuff away like crazy and my business is flourishing.

I am a very aware consumer. I go into a place and I think about what the ownership is trying to do. Is the staff friendly? Do they care about me or about themselves? How is the product? How is the execution? How do I feel when I am paying? Do I feel ripped off? Do I feel happy about giving them my money? Will I tell my friends about this place? 

And the question that I always ask myself (and what all your patients are asking themselves) is: Will I come back? 

All of these questions are running through my mind when I think about the way in which I run my business. 

I want people to like my place. I want people to feel like family when they come in. (We take photos of everyone when they come in so the next time we see them, we can greet them and call them by name.) I want them to not feel ripped off (even though dentistry is expensive). I want them to tell people about us and I want them to come back. 

So what do you do when a person who has been in your practice for 15 years breaks something that is 14 years old and says, “But I thought this was permanent?”

For me, it is to try to make the patient feel heard, try to educate her, try to make her take some ownership of it, and try to make her feel not ripped off. 

My loose policy on my work is that most of it is guaranteed.  

I think that I have told you this before, but if any composite restoration fails within five years, I do it again for free (I fully expect them to last for 15 to 25 years.) 

Now crowns are a different story. I think crowns should last a long time, more than 20 years. I usually will do crowns again for free if something fails within seven years. (Oh, my lab will also do it again for free, too. He also has a replacement policy). Between seven and 10 years, I will usually do it over for half price.

I know this might sound crazy, but I rarely do things for free. I will usually do one crown a year for half price (and sometimes less than that).

Things don’t really fail. I am not saying that I am all that. I am just saying that materials have gotten pretty idiot-proof and very strong.

But when they do fail, I just do it again. It’s the price of doing business.

I run my practice like a business—but it is my business. 

I sat the elderly patient who thought the work was permanent/forever and educated her on what those words mean (and I also told her “nice try”). We talked a bit more about how I was going to try to be conservative and save her some money, and we did the work. She was heard, she understood what we were doing, she was comfortable moving forward, and hopefully she was happy with the work and OK with paying the fee. 

Now that is a business model that will be permanent and hopefully it will last forever (see how I did that... bringing it around full circle?). 

How do you handle work that breaks? Do your patients think your work will last forever? Let me know your stories.

Have a great day, 

John Gammichia, DMD, FAGD