Specialists in Your Office, Part 2

In Part 1, I discussed having a specialist work inside your office. Now let's talk about some additional factors to consider when hiring a specialist for your practice.

In my office, the oral surgeon is with me one day a month. This means that I need to handle all of the postoperative complications; in the past, when a patient was referred to the specialist's office, he or she would handle the complications. I only saw the patient several months later, after all had healed. Now I am handling prolonged swelling after third molar extractions, missing healing implant caps with overgrown tissue, etc. I am learning more about oral surgery than I ever thought I would. Since my in-house specialist and I enjoy great communication, he is only a text or phone call away, and he advises me on how to handle things.

Upon hiring a specialist, you will find that your treatment planning will improve. You'll start asking questions such as: “Does this case require a sinus lift?” You'll need to know this since you are scheduling the patient and handling the finances. “Are these wisdom teeth full bony impactions, partial bony, etc.?” You'll become confident in deciding since each one has different fees that you need to explain to the patient. Everyday practice was a lot simpler when all you did was sign a referral slip and advise the patient to go see the oral surgeon.

My staff and I have also become a lot more oral-surgery aware. As such, you are able to quickly determine when oral surgery is necessary. The staff walks around in their specialty goggles now. And since they have a front row seat during these oral surgeries, they've become knowledgeable about the possibilities and difficulties a case can present.

After you've added a specialist to your staff, word will get out about the new addition, and there’s a possibility that you will get a phone call from your local specialist — who may not be happy about it. How do you handle this uncomfortable situation? Well, with the truth, of course.

In my office, our in-house oral surgeon cannot possibly treat every single case — he's already booked out two to three months. The result is that we still refer cases to our local specialists. Additionally, we have patients who love seeing our local specialists. They've developed a relationship with them, and we never try to sever that relationship. Sometimes patients tell us how a certain specialist extracted the wisdom teeth of their first three kids. Our response is to assure them that he'll be seeing child number four as well.

There also are those cases that absolutely cannot wait for your specialist's scheduled day. The patient may be swollen or in extreme pain. That patient is referred out immediately, and your local specialists treat them. So, if you get that angry phone call — and I think you will — keep all these factors in mind.

Another factor you have to consider when hiring a specialist is whether you — the dentist — should also work when the specialist is working. Depending on the specialty and the physical size of your office, my general advice is that you do not perform dentistry during the time the specialist is providing services. Your staff will need to be focused on assisting him or her, especially at the beginning of the relationship since they will be getting to know each other. Having your staff totally focused on working with the specialist will work wonders for making this new adventure run smoothly.

Finally, remember that patience is a virtue. If you have a specialist in your office once a month, then it will be five months before they've worked a full five days in your office, so it will take longer for everyone to get properly acquainted. Turning this new endeavor into a well-oiled machine takes longer; however, it will happen.

I encourage you to add specialty services to your practice. You will find that both you and your patients will be glad you did.

Andy Alas, DDS

Looking for Answers: Part II

Most of my life, I pretty much skated along without any physical health issues. Until I hit 50 years old.

My forties were full of some of the common stressors of modern adulthood, involving divorce and the family struggles that came with it, relationships, business, etc. We all hear about the effect of stress on health, and I’m here to attest that yes, stress does negatively affect you.

I began to have some problems. I was miserable. My general practitioner suggested that due to my age and my symptoms, I should have a colonoscopy. I was delighted since this would be an opportunity to get some relief and once again get to back to living normally — whatever that is.

As I was rejoining reality from my propofol-induced sleep, my internist friend came in, sat next to me, and said, “I don’t know whether you’ve got cancer or Crohn’s, but your colon is eaten up with ulcers.”

I wasn’t excited to hear either one of those C-words. I have several patients with Crohn’s, and they are sick folks. Our local area seems to have a disproportional number of Crohn’s patients, and it’s not something that I wanted. But at least I had an answer — or so I thought.

So now I’m a patient. I get to make those phone calls to front desk staff who sound bored and busy. I get to fill out piles of paperwork. I get to deal with insurance companies — I hate dealing with insurance companies. I get to meet nurses and physicians of all kinds. I get to wait in waiting rooms with other sick people.

Let me tell you, it ain’t fun.

Ultimately, I got a diagnosis of ulcerative colitis, a chronic inflammatory disease of the colon and a relative of Crohn’s. I was referred to this doctor and that surgeon. One surgeon didn’t want to do anything to help my chief complaint due to the uncertainties associated with my condition. He sent me to a specialist, where I wait for a couple of miserable hours, and then he performed an exam so rough and painful that I seriously considered waiting outside his office and socking him. Ultimately, I ended up in the care of a gastroenterologist who was young and brilliant. She did procedures and performed biopsies and exams and showed me charts of results.

What I didn’t get was answers, but that’s the nature of autoimmune diseases. The response to every question is: “We don’t know.”

So I looked around on the internet. I asked friends and business partners. I got some helpful and lots of not-so-helpful advice. I got some downright weird advice.

I soon realized that there’s a lot of therapy out there that I was clueless about. Maybe you are, too. It sure wasn’t discussed in dental school or in any of my science classes in college. But how do you talk about “energy therapy” in a science class? You don’t.

But there I was: Dr. Science. Mr. Rational Thought. Reiki Practitioner? (Look it up. You’ll laugh.)

Suffice it to say, when you’re not getting answers from the science-based community, you’ll likely look outside the box. We’ve got a handle on the scientific information out there, but there is a lot we don’t have a handle on.

More next month. Until then, eat your fiber!

Bruce M. Scarborough, DMD, FAGD

Be Careful What You Wish For

When I write, I try so hard to make myself sound like I have it all together. I try to make myself sound smart and make my practice sound so elite.

But when stuff happens to me at the office, I have to laugh at myself. I have to say to myself, “Nice going, Mr. Elite Dental Practice” and, “Oh, yeah! Everyone wants to emulate you.”

This week, I have another funny story. We all have this person whom we know. We know they are not just rich, but also wealthy.

I mean, this is my acquaintance’s house — well, it’s not her house; it’s one that looks just like it. She has family money and is the CEO of a big company. We run in the same circles, and before she was my patient, when I would see her, I would think to myself, “I wonder who her dentist is. I should be her dentist. I know I am better than her dentist.” (Wait, am I the only one who says that?)

One day, she came to me with a broken tooth, asking if I could help her. I was like, boom! Soon, I thought, I will see her husband, her kids, her parents, her neighbors. Yes! I have been waiting for this, I thought. 

She came in, and I worked my magic on her. She was so pleased. But this was the last I saw her. She was scheduled for a cleaning appointment, and she missed it. Then she told me that she broke another tooth. We made her a long appointment with me, and she missed it. Then her assistant called to make another appointment, and she missed it again.

Things were not going as planned.

It got to the point where I had to decide whether to start charging her for missing an appointment. To me, when you charge someone for missing an appointment, you are telling that person you don’t want him or her at your practice anymore. The patients sometimes say, “I am so sorry for missing that appointment; please charge me.” (If the patient is saying this, he or she probably is lying.) Patients don’t want you to charge them — and even if they say that and you charge them, they are probably going to be a bit ticked off.

Anyway, I charged my acquaintance $175 for missing her most recent appointment with me. We sent her a statement. About two months later, my front desk staff member came into my office and said that her assistant was on the phone, saying, “We got this bill for $175 from you; she wants to know if you will reconsider. See, Mrs. X is very busy. Also, you don’t want to lose her as a patient, do you?”

What?! Are people out of their minds?

As dentists, if our friends come to our practices, we roll out the red carpet for them. We want them to have the best experience. Why do patients not feel the same way about us as providers? Don’t our friends want to be good patients?

I got on the phone. I said, “No, we will not reconsider.” I explained that she hadn’t been charged for multiple missed appointments, but there had been one too many missed appointments.

I have learned a lot from this. I see a lot of people while I am out whom I would like as my patients, but now I know I should be careful with what I wish for. I have learned that sometimes, our friends don’t always make the best patients.

John Gammichia, DMD, FAGD

Good Things Come to Those Who Wait

Last week, my friend sent me a text message complaining that she had to wait for her hygiene appointment at her dentist’s office and that the delay was cutting into her appointment time. “What should I do?” she asked me. Then, before waiting for my response, another text message came through. She said she had voiced her frustration and that the front desk staff members were not going to have a good rest of their day. Yikes.

I tried to imagine what might have held up the staff that day: an anxious new patient who might have needed additional time, an equipment malfunction, or a child who may have had difficulty cooperating, or perhaps the dentist had an emergency patient whose front tooth broke while he or she was skateboarding, and the patient was, naturally, squeezed into the schedule alongside an extraction and a grafting procedure. Any of these (or worse, a combination of any of these) can likely throw off any perfectly laid-out schedule that appears flawless at the morning huddle. Has this happened to anyone?

I asked if my friend has strong connections with her providers, whether her schedule allowed for a wait, and whether it was going to be long time before she could get in again. It was probably worth it to stay, I indicated. “I love my hygienist,” she replied, “but I like to stick to my schedule.” Well, we like to stick to our schedules, too, as providers. We don’t like to fall behind, and neither do we like our front desk staff being scolded for it. I don’t like patients to wait longer than a reasonable amount of time. I recall a new patient once scornfully asking if we always ran late. Meanwhile, the delay was exactly three minutes, and her appointment happened to be during a massive New England winter storm. I believe the view of cars skidding and near-zero visibility answered her question.

There are wait times that are unacceptable, and our goal should be to swiftly bring patients in and out as a courtesy and as good service. But should there be unexpected and unavoidable delays, they ought to be managed with grace and solid communication. My friend was right: Had she been told upfront that the team was running behind, she may have rescheduled her appointment, and all would have ended well. It turns out, all did end well. She was seen by her favorite hygienist, had a fruitful conversation with her dentist, and ultimately left happy and satisfied. I was happy for her (and for the dental office for not losing a patient that day and for not being further scolded).

One of my text messages to my friend was: “Be nice to them; they treat people, not cars.” Patients sometimes cry and may have urgent needs and medical and physical barriers. Disregarding them to remain on a rigid time schedule goes against the very core of our objective — caring for them. My friend left the dentist office that day having received the attention and care she valued — and she admitted that was well worth the wait after all.

Zeynep Barakat, DMD, FAGD

The Little Things

She is the reason why I won’t eat crème brûlée today. I affectionately refer to her as “the witch,” and it’s a story that even my children know (though they still don’t know her name). I’m referring to a past significant other who treated me so poorly, it is remarkable I put up with it. Ah, youth. What we will do to avoid being alone. But I did learn something from this person that has changed so much in my life and has made it immeasurably better.

We were at the Robarts Library cafeteria at the University of Toronto eating lunch. I had a sandwich, a couple of cookies, and an orange. I finished my lunch only to be berated by her for hours afterward because I did not offer any part of my lunch. Did she overreact? Well, that is what she did with everything. However, during our relationship, I learned to be less conscious of myself and less self-absorbed and to pay attention to those whom I am with. It was the little things that made a big difference.

Last night, I took my wife out on a date, something we do with regularity, more than 22 years later. At the counter, I ordered her popcorn and a drink (medium popcorn, no topping, and a small Coke with no ice), just the way she likes it, and the young lady behind the counter thought it was so adorable that she had to comment. Later, after the movie, we went out for appetizers and drinks, and I took her to a little French bistro for small plates of food and wine pairings — just what she wanted.

Knowing her favorite flower, her favorite color, her favorite brand of perfume and what makes it her favorite, how she likes her coffee or tea prepared, what music she likes to listen to — these are the little things that have made my marriage and my life filled with moments of wonder, of affection, of love. The “witch” taught me to pay attention to the little things, and that lesson gets comments of how charming I am and notes of admiration from my wife on a regular basis. It costs nothing to just pay attention, to be “in the moment” and present.

And so it is in dental practice. In challenging times, the little things allow us to thrive and grow. In my practice, we once had coordinated uniforms. The clinical team was given a uniform allowance, and the team members went together to decide on color schemes and styles, and I just got uniforms to match what they were wearing. The administrative team members also were given an allowance, and they bought smart-looking outfits that were coordinated and changed every day as well. It was a relatively inexpensive perk I gave to my team that resulted in positive comments from our patients every single day. We looked like a professional, cohesive team, and our patients noticed.

And so we carried it on through. We purchased good coffee for the practice, high-end tea, quality hot chocolate — and the additional cost was only pennies per patient, but they noticed.

We have a family practice and a small waiting room, so we bought wooden boxes from IKEA and filled them with quality toys, games, coloring books, building blocks, and more for the kids. When they arrived, they dove under the chairs, grabbed a box, pulled it out, and played. Compact, clean, fun, and innovative, and the parents of these kids noticed that neat little detail.

We surveyed our patients about what magazines they prefer to read. We took those results and subscribed to a selection of these magazines that cover a cross-section of interests for all ages and both genders. And we kept them current, the most recent issue up front in the reception area and the next issues in the clinical area for patients waiting in the clinical chairs. Some patients would come a little early so they could have a good cup of coffee and read our magazines before their appointment started. Our patients felt like our office was their dental home.

Giving handwritten thank-you notes to patients who referred someone to us, telling a patient “thank you for allowing us to take care of you today” at the end of the appointment, thanking my team members for their work at the end of the day before they went home, holding team-based motivational trainings at least twice per year, ensuring the whole team (clinical and administrative) was committed to great continuing education (CE) by paying for it — all of these little things added up. The cost was relatively small, and the payoffs in goodwill, reputation, and patients being happy were huge.

Then, two years ago, I sold my practice and stayed on as a full-time associate, and the fellow who bought my practice eliminated all of these things, viewing them as unnecessary expenses. Now, three patients leave the practice for every new one who enters — and the patients have noticed. One woman, who has been part of the practice for more than 40 years (and we see her children and grandchildren), left the practice, saying the atmosphere is not the same and she no longer feels good about driving 45 minutes each way to see us for her dental care.

These are challenging times in Calgary, Alberta. The little things once set us apart from our colleagues and from other sources of competition for our patients’ hard-earned dollars. Pay attention to the little things, and you will be rewarded in unexpected and wonderful ways.

And now you will never look at crème brûlée quite the same way ever again. I promise.

Larry Stanleigh, BSc, MSc, DDS, FADI, FICD, FACD, FPFA

Just Push the Reset Button

All right, admit it! Who else grew up in the world of Nintendo 64 like me and, when angry about losing to a brother, friend, or neighbor, just pulled the game out or pushed the power button on the console?!

Man, was I the king of doing that!

If you don’t get my reference, pushing the power button is different than hitting a pause button to slow things down. Doing this literally stops in its tracks whatever game is playing (and the players, for that matter). The screen goes blank, erasing all history of previous game play. There is no record of how bad you lost in GoldenEye multiplayer (still my all-time favorite) or Madden. A total refresh.

… and then you run away because your brother is likely to hit you with the controller because now he’s ticked.

Why in the world would I pull out a N64 reference, might you ask? Simple: My message to my peers (you all get the upper hand because you’re actually reading this) is to reset the idea of what a dental visit is. For generations and decades, just the word “dentist” has brought negative, even painful, connotations to mind for most everyone. Going to the dentist was not a positive experience for most. Dentists were old, gray, and unhappy, and some even smoked cigars while working on patients!

Today is different. I cannot even begin to express to people I see socially, professionally, or outside the office how much of a 180 it is in my practice today compared to what they’ve experienced in the past. It’s incomprehensible, really. You have to see if for yourself, I tell them. It makes me smile a bit (on the inside) when I hear people’s idea of what going to the dentist is like. I graciously put my arm around them and pass them a business card.

Come experience what going to a dentist is supposed to be like.

Until robots take over our profession or humans stop growing teeth (hey, anything’s possible), we’ll be needed. Even with all those oral-hygiene speeches your hygienists give to your teen and adult patients, not much is changing with oral home care. And the only way a lot of these patients will come in and get the work they need done is if we — as a profession — hit the reset button on the console of dentistry. And I don’t mean coming in once, having a tooth pulled, and not seeing a dentist for another decade. That’s not a win for anybody. We need to convert those patients to ones who come to the office every six months. Problems are easier to fix when they’re small; we know that, but some patients still don’t see it. This is where “pulling the game out” comes in.

Get a coffee machine for the waiting room, buy a TV for your operatory, get trained in sedation, or improve your minimally invasive or cosmetic restorative techniques. Literally do any and everything to make people stop in their tracks and think, “Wow, this isn’t at all what I remember a dental visit to be.” Because if you don’t, we’ll never grab the large sector of the public that literally has nightmares about the last time they went in and had a tooth pulled.

Forget the pause. Let’s hit the reset button on dental visits. Our patients need it — and deserve it.

Donald Murry III, DMD