Dentistry With Our Hearts (Part II)

Yesterday I spoke, FOR MONEY, for the first time. I drove down to Miami to speak to a study club. I have two words for you: Awe. Some! It was a great crowd. They were very conservative and they loved my stuff. Lots of nods and lots of great questions. Afterwards, lots of people came up and thanked me. I think they liked it. I was nervous as heck, but it turned out great. So, it has officially started (on the drive down, I got a call from the Florida AGD asking me to speak for them. Nice!).

Okay where was I? Dentistry with our Hearts. We started triage at about 5:50 in the morning. We have two rooms designated to seeing people first, talking to them, taking an x-ray of the problem tooth or teeth, and then numbing them up. Then they sit in the reception area and wait to be called. I have always thought that this is the fastest way to see people and it is easier on the treating dentist because they can get started right away and not worry about the numbing at all.



Remember I was telling you about the last minute oral surgeon? Well, she was an absolute superstar. She is 6 months out of her residency and she worked like a dog. At one point, she asked me if it was okay if she got a glass of water.

I gave all my kids permission to miss school so they could be there. My oldest is 12, so I put him in the oral surgery room. He loved it. "Dad! Did you see how long that tooth was?"

I overbooked the dentists. I did this because things come up and inevitably someone has a family crisis or something. But everyone came, so in the morning, my dad and I did not have a specific job. I walked around saying I was “eye candy” for the event. I made sure everyone was happy and had all the supplies they needed.



As I was walking around, I realized that it was really happening. My friends came and were thrilled to be there. Patients were being treated and they were thrilled to be there. People were outside working and serving and they were having a good time. My staff also realized how awesome this event was. To me, this is what heaven is going to look like: all of us working to help each other.



The dentists and people that were working were hearing the stories of the patients, hearing their pain, sharing in their lives. The patients were so thankful. It definitely warms the heart. I can't tell you how many times the volunteers came to me to say, "You HAVE to have me back next year."

We saw 60 or so patients before the afternoon break. We were cranking. Lunch was brought in and everyone took a break to eat. Some guys worked through lunch because they didn't want to stop. We ended up seeing 112 patients and had to cut off the line at about 11am.

It was an awesome day. But it wasn't over. We decided to have an after party this year. One of my staff members made about 50 JELL-O shots that we started on during the clean up stage. Then we crossed the street to have a beer or two at Chili's (thanks to Captek). Then, the aftermath.



We saw a ton of people and the oral surgeons were doing some serious cutting and bone removal. Do you know how many calls I received that weekend? None. Are you kidding me? My cell number is on the machine at work so people know how to get a hold of me. No calls. Crazy.

I didn't any get calls during the week, either. I got cards that were full of thanks I got emails and calls from people I don't know thanking me. It was awesome. There were patients patting me on the back.

The utopian feeling lingers and it is really nice. Are you thinking about doing it? You really should. Write me and I will tell you how to do it. Jgammichia@aol.com

Have a great weekend.
john

Dentistry With Our Hearts

Wow. I had a crazy weekend. Friday was our 8th annual Dentistry with our Hearts. It was a huge success. Before I tell you about that day, let me tell you about what had to happen before. If you don't know about it, Dentistry With Our Hearts is a day we open up our office to treat as many patients as we can for free. We limit the day to just fillings and extractions (cleanings just take too long).

But before that can happen, I sit down with my staff about 7-8 months to start the planning. We pick a Friday in February (Dental Health Month) and start planning. Last year we did it toward the end of February to avoid inclement weather. But by that time, the media blitz for Dental Health was over. So this year, we threw caution to the wind and did it the first Friday in February. The weather was perfect. And as far as the media blitz goes, well, I will talk about that at the end of this blog.

We divvied up jobs. We need people in charge of marketing; t-shirts; supplies; dentists and non-dentists; volunteers; food for the volunteers; food for the people outside; donations, a DJ. Then there is the rental equipment, including chairs, Port-O-Lets and barricades.

When the planning starts, we talk about it at every monthly staff meeting. We tighten up and give each other advice. When we get back from our Christmas break, we are just about going crazy. We go from having meetings bi-monthly to twice a week.

A week before the event, things start to happen. The signs go up at our office announcing the date. There are several marquees (banks and insurance companies with digital signs) as you go through town that announce the date. I have a place on my sign where I can add a banner. A local radio station has me on Thursday morning and we talk about the day. And even though the phone number is never given out, the phone starts to go crazy. We create a designated voicemail box that we put people through to (we are still trying to run a business here).

Last year, a dental school classmate told me he really wanted to be a part of this next time. We made plans right then that he would stay at my house and he would be a dentist volunteer. I thought that was a great idea and started to call more of my classmates. Next thing I knew, I had 5 of my classmates coming from out of town to serve with us. Along with them, we brought in 7 local dentists (who called me wanting to help). Adding to that, we have about 40 non-dentist volunteers.

I was in charge of dentist volunteers. We have had the same oral surgeon since the inception. I called him with the date. My staff talked to his staff. But when I sent the final email out on Wednesday to tell the dentists how excited I was about Friday, he was shocked. He wrote me back saying he had no idea that DWOH was in two days. I wrote him back saying, "That is not even funny. Don't mess with me. We have two rooms reserved for you."

He wasn't kidding and he had a full schedule that couldn't be changed. Crisis. My staff went into panic mode on Thursday. I was fine just doing the morning without an oral surgeon, but they wanted one. So on a day’s notice, a local oral surgeon changed her day and agreed to help. People even surprise me sometimes, and that is hard to do.

The day before, the office is stripped down and supplies are loaded in every room. Barricades are put in the parking lot, Port-O-lets and chairs are delivered. We dot the i’s and cross the t’s, and go home hoping things go well the next day. (Oh, when I left work to go home, there were 5 people in line for the next day.)

My friend arrived Thursday night and we just hung out, not knowing what the next day would bring. We got up at the crack of dawn (5:15am) and got on over to the office. We rolled up on the office and things were already buzzing. There are about 100 people in line and most of them were already filling out paper work. Local churches were there getting their booths set up. The grill man was setting up in the dark. My friend’s eyes were wide open.

We started to triage at about 5:50am. The staff and volunteers were in full work mode. Breakfast was spread all over the staff table in the back. Dentists started rolling in. People were everywhere, like a well-oiled machine.





This is where I will stop today. I will tell you about the rest of the day on Friday. But I will leave you with a link from the Orlando Sentinel. I called them to see if they might write something in the paper announcing our day. They decided to do a feature piece. Turns out, it was on the FRONT PAGE of the Orlando Sentinel (above the fold). Click here to watch the video and read the article that was in the paper (the still shot that the video opens with is the one that was on the front page of the paper on Saturday).

Talk to you Friday.
j

Changes

I hope all is well with you. We have had a change in dynamics at our office. About 8 months ago, we had a senior dentist approach us about working in our office. It sounded like he was in a real pickle. He had sold his practice and was forced out but then realized he wanted to continue working. He needed a place to temporarily “grow roots” for a few years. He is a very nice man and we wanted to help him. We have an extra chair and would benefit from having him at the office. We came up with a contract and off we went.

Well, he practices very differently than Dr. Jackson and I do. He advertises himself a “biologic” dentist. He does not believe in fluoride. Many of his patients are on the holistic side with a different view of the dental world, or, world in general. His approach to hygiene is different than ours. Many of his previous patients followed him and brought their ideas of how a dental office should run. At our office, we have developed guidelines and somewhat strict procedures on how we bill and collect payment for treatment. Many of his patients are used to a very “liberal” way of how the billing and financial side of the practice works, so several of his patients are less than nice to the front desk staff. Needless to say, the front desk personnel are many times up in arms frustrated mad with him and his overly demanding patients. They can get very rude and demanding, always throwing out, “This is not how it used to be done!” Our staff just politely and professionally explain our policies, hold their ground, and move one.

The hygienists are going batty trying to figure out how to manage his patients from a perio perspective. They are used to a very conventional, standard approach. We are not overly aggressive with scale and root planning, but we do them if clinically supported. We all know that many times patients don’t want to do it! Our staff explains to them it is the proper treatment and, in some cases, we will have to dismiss the patient if they do not decide to accept treatment (this is very rare). His view is that it is okay if the patient does not want the correct treatment. He wants the hygienists to just continue on with a regular adult prophy. Some view this approach as supervised neglect. The staff are so confused on how to deal with him on this issue.

We have invested in special supplies and equipment that I will never use but is in the “biological” dentistry realm, I guess. He has patients drive hundreds of miles for amalgam removal using a special ion beam that binds the mercury vapor and reduces exposure during removal. I do not know about all this, but I will only remove amalgams after a long conversation. I explain that I have not found any peer-reviewed, properly designed study that indicates amalgam removal will cure disease or produce other health benefits. It will likely not cure M.S., Lupus, or any other ailment. I know this could be a blog in itself and no nasty dissenting emails, please. I know there are different opinions on that subject. I will remove amalgams that are not failing after a long discussion if the patient understands it is for cosmetic purposes only and is aware of the benefits or risks involved. However, amalgam removal is a large portion of his practice.

He is driving the office mangers crazy at times. Besides dealing with the staff running around frustrated, he often wants to do things differently than the contract we signed. We agreed on a certain things in the contract and he frequently wants to change them. He always wants a check. It went from once a month to every two weeks, and now he wants one every week. We could say no and stick to the contract, but he always seems so desperate that we feel bad and try to bend to help him out. At times, we feel that if we give an inch, he tries to take a mile.

Having him work here has made me realize even more how differently dentists will practice and do things. It makes me realize how difficult it will be to find a future partner or associate when Dr. Jackson packs it up and rides off into the sunset. When it comes to how I think certain things should be done, some things in my mind that are black and white but some things have several shades of gray. I worked closely with many dentists while in the Navy, but rules and regulations kept everyone on the same page. I am trying to be understanding and accepting of alternative treatment styles, but still feel I need to protect the reputation of the practice. I also want to keep the staff headed in the right direction and have some sort of consistency and organization.

I have observed one very interesting thing. It turns out that the staff really seem to like to know the rules and expectations, and when someone tries to change them or get out of step they really get angry. I feel good knowing that they have all come to understand and believe in how we do things and want to maintain it. This accomplishment is much easier said than done.

Well, the journey continues.

Have a great week,

JJ

Ode to the Dental Assistant

Tomorrow is my free dental day. “Dentistry with our Hearts” is a day we open our doors and treat as many patients as we can for free. I put a dentist in every room (eight) and we go as fast as we can. It is a crazy day. It is first come, first served; last year people got here before I left work on Thursday. We cut the line off at 130 people and that was at 6:30.

A lot of the stuff is donated: supplies, anesthetic, food for the volunteers (about 40). There is even a DJ and a grill master outside feeding the masses. T-shirts are donated. It is awesome. I may have a chance to write blog tomorrow, but if not, I will talk to you next Wednesday.

I was just thinking about my yesterday while I was getting ready for work. I had a very busy day and I was reflecting on it. And you know what? I started to think about how hard my assistants worked.

Yeah, the same assistants I talk bad about most of the time. Well not bad, but not great. I have two assistants mostly. Mine, who I met at one of my associateships 16 years ago, has worked with me for 16 years and in this office for 15 years. The other assistant is my father’s #1 assistant and has been with this practice for 34 years. That alone will tell you a little bit about them.

My assistant Chris is pretty special. In my lecture I have a list of the top ten things you must have to do awesome fillings. Chris is one of the top ten. Now, I know she can't be duplicated, but you have to have someone like her.

Our relationship is so unique. I always say she is my office wife. I literally sit 3 feet from her 8 hours a day. First, I have to like her and she has to like me. I can understand "a working relationship.” But Chris and I are friends. Her family is friends with my family. I love her husband. She gets invited to all Gammichia parties (her family even came over for Thanksgiving last year).



I know most of you are not that friendly with your assistant. We have a weird relationship. I think it works because she is a little older than me (13 years). But let’s put personal stuff to the side. She is a great assistant. She is responsible. I think in the 15 years she has worked here, she has missed about 3 days of work. She is on time EVERY DAY.

She believes in me, almost to a fault. Or rather, she believes in the kind of dentistry I do. If I don't think I can save a tooth with a filling and think it is going to need a crown, she will pipe up, "Oh, sure you can. I have seen you do bigger fillings." Then I have to explain to her and the patient why she will no longer be working here anymore.

She is awesome with the patients. God forbid she go on vacation. All I hear is "Where is Chris?" There are a couple of reasons for this. When people are getting work done, we are chatting. It makes their appointment not suck so bad. I am relaxed and can do my thing.

She knows me. If I move my head, she knows what to do. If I am quiet, she knows that I am into some serious tooth issues and she won't talk. If I change things in the middle of the procedure, BAM!, she changes gears without a lot of huffing and puffing.

Her and I like the same things. We talk politics and religion. We talk kids. And in all these subjects, she thinks she knows it all (did I tell you that she is 13 years older?).

You and I both know when people have been in a practice for that long, they can have a tendency to cop an attitude. And they can mark their territory in an office. A telling sign is how they work with new people. Chris is great with new assistants. I know you dentists see your assistants running the new girl ragged. You see them abusing her emotionally and physically, saying that if she can survive this abuse, she can make it here. I know what you dentists do and allow. And if you don't think it is going on then you are turning a blind eye to it.

But Chris will show them the ropes and ease them into it. She keeps them away from me until she thinks they are ready. This is not for them; it is for me. She knows I am getting crotchety in my old age and doesn't want me to be upset and doesn't want them to be put in a position to fail. She is not concerned about a new assistant taking over her job.

She is the queen bee around here and I let her be. I let her because I know she always considering me. Simple as that. She might show her teeth to other people in the office, but I am okay with it because she has earned it. But she is also approachable. I can talk to her about what I like and how I want things (and she will at least make it look like she is listening). I can also tell her when she is not playing well with others.

She is the assistant that can talk to me. People say I am intimidating, but certainly Chris doesn’t think so. She will tell me when my hair looks like crap and she will tell me when it is time to trim my eyebrows. She tells me when I have a wild hair growing out of the side of my ear. I mean, men are stupid, really. We need someone to take care of us. You have all seen the guy with nose hairs hanging out like crazy. You think, "Someone needs to tell that guy." Well, if I miss something at home, Chris is the one that is going to tell me.

In my first 18 months of practice, I went through 7 assistants. No lie. I know how hard it is to find that person. But I also know what it is like to love to come to work. Partly because I love dentistry and partly because I like Chris (and the others). I think I am a better dentist because of her. She lets me be me and doesn't judge. I couldn't do it without her.

I hope you all have someone like her in your office. Maybe I don't tell her enough. If that is the case, I hope she reads this.

Have a great Thursday.

john

All You Care About is Money

I know, I know. I told you I wasn't going to talk about money again for awhile. Has it been awhile?

Lately, I feel like I am getting some flak for "being expensive" or because "all I think about is money." But I feel like I am a fair, conservative dentist. I try to be the guy that saves people money.

Sure, my exam is thorough and when we are done taking a full mouth series and a Panoramic (which I don't charge for), the exam can be in the $225 range. But I think I am doing a pretty good exam. Perio charting (which most 50-year-olds have never had done), oral cancer screening, looking around, looking at their bite and teeth and joints. We have a sit-down conversation in a consultation room. Patients get my time. Isn't that what patients want? To feel like they are being cared for and not rushed? Or do they just want the $55 x-ray and exam done by the big teeth corporations? I think they want the former.

After I do a thorough exam and find some cavities, I tell them that they have some restorations that are broken (I show them the big broken filling with the intraoral camera; I am not making things up here). And I think that I can do a filling and restore that tooth to good again. No, I don't think you need a crown (which most dentists would do at 500% the cost of a filling).

My fillings are expensive. But are they really? I do a better job than the schmo down the street (if you are a dentist down the street from me, I like you; I am just being creative with my words). I use the BEST products. The filling I do is superior. So I am $20 more than another dentist. Maybe it is $50. Didn't I just tell you that most dentists would put an $800-$1,100 crown on this?

So when I hear from my staff (I never it hear it from the patient. They tell my assistant the person answering the phone) that all I care about is money. WHAT?! Are you fricking serious? I go to the best continuing education. It costs money to have a nice facility and good staff members. And all this costs about $20 more per filling.

Look, I get that money is a big issue. I get that dentistry is expensive. I know. But I feel like some people are killing the messenger. I am who I am. I am the dentist that does really nice work and hopefully the dentist that people go when they want to like their dentist and feel cared for. I am not a regular dentist, and it will cost a bit more. But for patients to come here and say that all I care about is money? Well, that hurts.

I am going to stretch here and tell you I am like the Hilton. The Hilton is a beautiful hotel. They have awesome beds, great sheets and pillows. They have great staff that say, "It is my pleasure." They have things in place to make you feel so good. And after a stay there, you feel special. Then you check out and say, "Man, that was a little bit more than I meant to spend."

Then the next time you try a bargain motel. You don't have a very good night’s sleep. You are just a number there. You get the bill and don't think anything of it. But you start to think, "Remember that Hilton? Yeah that was really was nice."

You can't blame the Hilton for being more than you wanted to spend. We as dentists feel like we are being thorough and find stuff. Then the patient always thinks we are trying to find stuff that doesn't exist (you aren't doing that, are you?).

It might be a bad time for them, I know. But if you look at me through a microscope, you are going to find warts. And maybe I used to just brush it off. Maybe now I am a bit more sensitive to criticism. I don't know.

I am trying to make this place worth the $225 exam and the extra $20 filling. It would be easy to just lower the price and work faster and make people feel a little less special, but I don't want to do that. I want people to say, "Remember Dr. Gammichia? Yeah, he really was nice." Or even better, "I love my dentist and I will stay there forever."

I am not bitter. Just sensitive, I guess. I will keep at it.

Have a great weekend.

Beer me,
john

Product Review

Hope things are going well for you and that you guys are busier than me. It has been such a grind lately. I think this lecture thing better take off soon because I might need that to pay the rent.

My father read my blog last Friday about old guys selling their over-priced stuff to the young guys who can't afford it (because the banks won't lend them the money). Even though it wasn't about him and me, it prompted him to come to me. We have agreed on the price and to the terms. Now I have to draw up a business model and go to the banks to see who will give me the best deal. It all sounds easy, but I know this is going to be a long process. I am getting tight just thinking about being the only owner of this sinking ship.

I’m making it sound worse than it is. I love this practice and the people that come here and the people in it. It is a great practice, but buying a practice that has decreased in production for the last 4 years is scary.

I want to talk about some filling products that I have tried recently. I have used the sectional matrix and BiTine ring for a long time. In the last 5 years, I changed my ring the Triodent V3 ring. This ring is so sweet. I kept using the sectional matrix.

But I bought a sample of Triodent’s SuperCurve matrix. Have you tried these? Wow! The sectional matrix is about 25% of a circle and the SuperCurve is about 50% of a circle. It wraps around the tooth. You might not think it would make that much of a difference, but it does. The gingival 1/3 of this matrix bends in to form the CEJ. It is pretty cool.

I usually work with Patterson. They have this deal where, during the year, you build up reward points. Turns out, at the end of the year, I had 1,200 points (each point being a dollar). I had to use $900 before the end of the year or I would lose it. Instead of buying things I really needed, I bought the SonicFill system from Kerr. Have you seen this?

Now, I struggle with using something that might not be as good as the stuff I am presently using. So I did my research and everyone really likes it. Reality and CR are all giving it great props. I used it today for the first time. Let me tell you that it turned out really nice. A lot of my stuff is not really material-dependent, but if it is less expensive and it reduces my steps, then I might try it.

While I was buying the SuperCurve matrix, I bought some 360° Cervical Matrix. This is basically a form guide you put on a facial filling after the composite and before the curing. It is clear; you put it on the filling and cure right through it. Wow, is this thing nice. I have always worried about whether or not the filling is tight in my facial box and about it pulling away at the margins. This thing takes care of both, and then afterwards the margins are like a baby's butt.

One last thing. I’ve started sealing my margins after a posterior composite. Burgess says that the occlusal wear is reduced by 15% if you use a sealer. That sold me. I bought Bisco’s BisCover LV. Not only do I feel better using it because I know it is going to make my fillings last longer, but it makes them look so good.

I know it is good to hear about it, but the proof is in the pudding. Here is a case I did this morning.

30-MO

 

I told you.  Really nice filling.  And this took me about 15 minutes.  No joke.  Adding the photos to the appointment made it 35 minutes.

Have you used these products before? What do you think? Do you have any products that I should know about? Have you checked out the AGD’s Product Review Directory? Let me know.

Hope your week is going well.

john

Why Not?

Greetings,

I hope everyone is healthy and happy as we start out 2012. After a long discussion with my family and some close friends, I’ve decided to email the owner of the Miami Dolphins and express my desire to be considered for the head coaching job.

Hopefully by the time this blog goes out, they will still be interviewing (which will increase my chances). If I get hired, I will probably have to give up the AGD blog because I will be spending a lot of time going over game film and interviewing my potential staff. I will miss writing to you all and I will miss dentistry to some extent. Maybe I can work a month in the off season? We’ll see.

The way I see it, I have a good shot now that virtually every big name has turned the job down. As a matter of fact, I have a few things going for me:

1) Miami is my hometown, and who wouldn’t want a hometown boy?

2) I’ve been watching the Dolphins play for the last 45 years, so I have an intimate knowledge of the team and what they need.

3) I couldn’t care less if Jeff Ireland stays on as the general manager. Shoot, why not have someone else do all the work?

4) They wouldn’t have to hire a team dentist (I may want a slight bit more cash in the agreement to cover both jobs).

5) I can give a locker room speech after each game. Granted, I am only 5’6”, but if I had something to stand on, I could tell the men how proud I am of them and maybe give out a game ball.

6) I can talk to the media because I know all the coach lines. For instance, “They made more plays than we did”, or, “The refs made some bad calls out there.”

7) I wouldn’t demand a large salary. I would take half of what they were going to pay Jeff Fisher! That will save the owner over 20 million dollars over 5 years. Maybe we can use that to get a quarterback. Who knows?

I do have some good friends with football minds. I might be able to talk Dr. John Gammichia into being my offensive coordinator. I mean, he has only called some peewee league plays, but there can’t be that much of a difference. I went to dental school with a couple of football players that might be able to work with my defensive and offensive lines. There is so much to think about right now that it’s a little overwhelming. I am going to be up long hours trying to figure out how to keep Tom Brady off the field.

There is also the small snag in my partnership contract saying that I can’t leave for more than a few months. I am still working on that one. If it all works out, I can get the Dolphins back on top in just one contract period. After that, I could go right back into dentistry, or maybe travel for a couple months. I would love to be able to travel in Europe. Other teams might want me once they see my results at Miami, but relocating out of Florida is something I may not want to do. Time will tell.

I wouldn’t forget about all of you out there either. Being the head coach, I could probably score a few tickets to some games. Just shoot me an email and let me know how many you need. I can have a Dental Block! (Total pun intended.)

Of course, if Mr. Ross hires someone before he gets my email, then I guess I will have another blog here in a couple weeks. It also means that I will have to see Mrs. Smith next month for that 16th denture adjustment. My plans for traveling in Europe will be shot down, too. The sad part is, we will have to all suffer through another bad season for the Dolphins.

Talk to you all in a couple of weeks (maybe).

Scott