Wearing all the Hats

As a private practice dentist I wear a lot of proverbial hats. These are not just "dentist" if that was the case my work life would have its ups and downs but be quite a bit easier. Not that dentistry is easy. But on many days between patients or at lunch I have items like advertising, employee reviews, strategic planning, business management, human resources development, taxes, and payroll. All these are part off my overall position. I have to be a dreamer and inspire my team to grow as employees within their position. I have to run team meetings. I oversee fire safety and emergency management. Planning for emergencies. Do we close because schools are closed for snow? Close early for a storm that is on the way? Treasury management and long term planning for growth of the practice and on my to do list everyday. Equipment purchases and continuing education for the team. Deciding to stay in network with specific insurance companies or to joining new ones. Garnering feedback from patients on the office, its systems and whether or not we are meeting our goals.

In fact on my "day off" yesterday I was in the office for almost a full day reviewing resumes and posting an open position for our office on several recruiting web sites. Also paying our bills and examining a potential direct mail campaign. While also being a leader for my team and holding them accountable on their own individual projects and items they are responsible for within the office.

You are probably wondering why someone would want to do all that? I sometimes wonder that as well....mostly after a tough day of clinical work and there is a stack of items on my desk to take care of after the work day is over. I spent two years employed by a University Hospital as a resident and a couple of tenures for a corporate dental company after finishing my graduate dental program. I value those experiences and in fact keep in touch with several folks from each section of my career growth. But right now today and most days I would not trade all those hats I wear for any one.

I enjoy trying to excel at all of them. I wouldn't be who I am as a clinician or practice manager if it were not for those past experiences and the wonderful freedom we are granted in the United States of America. Our free system of education and equality for all regardless of race, religion, or sex makes dreams like mine possible. I am not sitting here misty eyed, saying everything is perfect in this country. But the fact that I am able to get up everyday and try to grow something that puts food on the table for all my employees, vendors, and cares for a lot of people along the way that is to me what the American dream is and I plan on holding onto it with a death grip for the near future.

Today its been all guitar rock, my assistant has developed a taste for the newly discovered Led Zeppelin and I've been throwing in a lot of Eric Clapton. I'll have to tell you tomorrow about the really interesting dental reconstruction case we worked on this morning...

Challenging yourself to help others

I'm back in the office today after a very short vacation(ie 3 days off) and our second patient today was a special needs child. It's really not fair to refer to him as a child as he will be 18 any second now. He is very heavily Autistic and non verbal. Which makes, as you can imagine doing dental treatment a real challenge. We get better and better at it and in fact I feel we have a special rapport. Through the years, due to a fall in the past, he has needed a crown and then eventually an extraction of a front tooth. His parents care very deeply about this young man's appearance so we chose to do an implant some time in the past. I went to the operating room with the Oral Surgeon who at the same time removed his wisdom teeth and we placed the implant, which I later restored. Due to a functional habit of some grinding and actually percussing his front tooth, fractures developed in his crown and a decision to make an abutment and crown that were one unit was made. To make it slightly less technical, an dental implant has three parts generally the part placed within the bone(like the root of a tooth) and the abutment which is the sub structure upon which the dental crown is placed.

So for him the substructure and the crown were manufactured as one unit to give it strength and that unit will be torqued into his dental implant. The reason I wrote this headline is because it is always a challenge to choose to take care of patients who require more. More diligience, more heartfelt worry, more management, more sedation, more learning....more chair side manner.

But in my mind that is why I chose to become a Dr., Dentist, care giver, whatever title I really wear. I chose to do two years of elective residencies that often placed me in situations where I was very, very challenged. And doing those things made things like taking care of this patient less of a choice and more of a responsibility. At the end of the appointment, or day this is why we choose to take care of other people. Its not always easy, and its often not even profitable. And more than I like its not even appreciated.

But when I return from time away from my office, team, and patients I find this why I am doing exactly what I am doing. Without this part of my life I am not sure whom I would really even be.

I've been playing a lot of smooth jazz by Fourplay today not just to relax folks but also because I did a lot of reading while listening to it yesterday and its a chilly rainy day outside and it seems to fit.....

P.S. I've got to figure out a new way to embedd music but needless to say I recommend you tune into Fourplay's version of Stevie's Higher Ground on youtube or somewhere.

P.S.S. I'm going to learn how to format this darn blog one of these days.

Why do I need to quote the textbook to insurance companies?

Today I ran into a situation where I new what needed to be done for the patient's best interest.
I knew that my prosthodontics professor from dental school would also agree. I knew that if I looked hard enough I could find a quote in the dental text book exactly explaining the reason for the the procedure.
Sure enough I had better line up all these references, have them sworn in, a notary on hand to stamp it and possibly video testimony in order to get this patient's dental insurance to do their job: pay their portion.It is amazing the time, effort, employees, and general attentiveness required to get dental insurance companies to help take care of the patients who pay their salary. I can't imagine the effort we take applied to lets say getting that fender fixed after your fender bender in front of the grocery store. I'm pretty sure it would be easier than getting that occlusal guard payed for for the patient with the bruxism problem.
I guess these are problems that only a percentage of the population ie dentists can complain about. But really what it leads to is less care and more trepidation and trouble for the people receiving and delivering the care.
On a musical note we have been listening to a lot of Texas singer song writers like Townes Van Zant, Jerry Jeff Walker, and Robert Earle Keen. We've also thrown in a dash of early 90's rock like Soul Asylum and the Spin Doctors. Fourth Of July

Striving for perfection

Realistic Goals are very important in the practice of any career or art. Dentistry is difficult sometimes because one does not always have the ability to be perfect. The human body does not function within a vacuum and one needs to deal with that fact. Teeth and smiles may be multi colored. Stained by external forces or internal, angled or malposed in a way that although nature allowed it, was not necessarily designed that way. I have been to cosmetic coures that discuss the angle and shape of the anterior teeth being related to the golden proportion or golden mean often seen in art. But a great number of my restorative patients' bodies and dentition have not necessarily followed that manual.

My expanded duties assistants often places a portion of some of the filings placed in my office as she is very very proficient at it and enjoys it and is one of the most professional dental assistants with whom I have had the pleasure of working. But today allowed me a little time to work on preparing and filling an anterior tooth on an older gentleman whose teeth had seen some life. Matching the exact shade, shape, and angulation of his tooth to maintain his smile was a challenge. What is perfection? Is it really achievable by us I am not sure I have the answer to that question. But I do know striving for it is key to my pursuit of happiness in my career on a daily basis.

Preventing tooth loss

The last few days we have had to deal with some dental heroics that were done for patients in the past.The number of "Baby Boomers" who have teeth that have very extensive past procedures is large. Many of these folks had large fillings, usually mercury, placed in their teeth in their teens, twenty's and thirty's.

Those fillings then had to be replaced often with crowns. Years later they would need root canals, posts and crowns. Unfortunately the only replacement often for these failed products are titanium implants.

Implants are a great service that we often do here at East Springs Dental. But unfortunately due to circumstances of the patient we are not always able to do these for certain patients. As with this gentleman I was speaking with, we often are either making or adding teeth to removable partial dentures.

I hope that we see a day where dentures or removable partial dentures are a thing of the past but unfortunately that does not seem likely. This is where preventative care becomes so very important. If we can delay the age that the individual gets their first filling due to dental caries.
We've mostly been listening to a lot of classic rock at the office this week with a little bit of modern jazz and town tempo rock/Lounge like Zero 7.

Unattended Smiles

We are usually closed here at East Springs on Wednesdays. But at the end and the beginning of the year we are often very very busy with things that have been let go for far too long. I have a love hate relationships with these situations. Large amounts of decay, folks who are suddenly beset with dental needs they avoided for so long. As a dentist I hate that part, but as a dentist I also love being able to be fast, efficient and single minded at repairing these situations. Today we will be restoring a young man's front teeth that will require root canal therapy, fillings and all porcelain crowns. Like a lot of people this young man has a lot on his mind and has been in and out of the dental chair over the years. I hope this particular situation will help turn into one of my patients who sees the value of consistently going to the dentist and maintaining one's smile rather than putting out fires ever two to three years.
We are still listening to holiday music in the office but my patient rooms seem to be revolting a little bit and some classic stones and mo-town have appeared. My office has had the latest Bon Iver album, self titled Bon Iver on rotation heavily. I'll be including this with some of the other "best of" albums of the year in my brother's Christmas gifts. When you stop and consider that Justin(pretty much Bon Iver) had such a heavy part in making Kanye West's amazing album this year you start to get a sense this guy is a powerful force in music. His cover of I can't make you love me by Bonni Riatt is amazing.

I Can't Make You Love Me/Nick of Time

Bon Iver "The Wolves (Act I and II)"

Bon Iver | Myspace Video

It's Monday in the Dental office!!

Mondays and Fridays alike can be very crazy with emergencies at the dental office. Luckily today we have had only a few. I am reminded of a particular situation that rings true with almost all of my experiences with maintaining anything that you would like to have for a long time. The same can be said of one's teeth. I pride myself on being able to "make things work" for people and fitting great dental work into their budget.

That being said we had a situation today where we tried to make something work for someone instead of doing what I had recommended a short while ago.....and now we are exactly where I thought we would be with that person's dental condition. We need to as much as possible do the best thing we can the end result is much more important than either "insurance coverage" or deductibles. Duct taping things together is not the way to get a reliable result. The final solution is much more important than "what's the cheapest thing" and the "cheapest thing" is most often not the best thing.
    In the office we've mostly been listening to Pandora stations of Christmas music, either a She and Him Christmas station or an Anita Baker Christmas station.
She & Him - The Christmas Waltz by MergeRecords