Enabling vs supporting

Dentistry, Lifestyle

Today, I attempted to do some fillings on a highly anxious nine-year-old girl. She was sobbing practically non-stop, grasped tightly to her stuffed animal, and basically blocked/ignored all of my various behavior management techniques. Mentally she did not succumb to the oral sedative, she could not care less for my tell-show-do spiel, and she could not bring herself to stop crying well enough to tell me what was frightening her. The mother denied any past emotionally-distressing dental visits and claimed she behaved perfectly fine with her other medical doctors. Needless to say, I accomplished nothing in the office and her parents were made aware she will likely need to go under general anesthesia to get her dental treatment done.

Very few of my appointments are completely aborted like this one was. In fact, the rarity of it is probably why I am so heavily bothered right now; and I only wish I could have more effectively understood this patient’s disposition. In a child with a learning disability or mental health issue, (at least to my aberrant mind) there is more of a justification to why that individual may not be able to tolerate such a procedure. However, a supposedly healthy, ‘normal’ nine-year-old (with a stuffed animal?) without any previously traumatic dental appointments acting with such resistance really makes me question her resilience and coping skills for other difficult situations in her life.

There are some psychology concepts we briefly discuss in pediatrics such as (B.F. Skinner’s) operant conditioning, and positive/negative reinforcement and how each influences desired behavior. I also try to stay mindful of the developmental milestones children should be achieving, and try to raise awareness and arrange appropriate consultations when they are clearly not being met. The patient I had today clearly exhibited extremely fearful behavior (i.e. crying uncontrollably), still relied on comfort objects (i.e. stuffed animals), and willfully refused to be verbally interactive. Let’s assume she is not developmentally delayed; when someone exhibits such uncooperative misconduct, and realizes it provided her the outcome she desired (i.e. not getting dental work done) – my concern is, could that moment reaffirm in her mind that poor behavior rescues her from all circumstances she deems uncomfortable? What is the lesson she took away from today’s visit?

It begs the question though, where does parenting style play a part in all of this? In the few moments I was in the room with her, this parent met the criteria of a stereotypical “helicopter mom”; in that she hovered closely over the child the entire time (never once out of reach) and a bit overly involved in trying to pacify her daughter throughout the process.

Now, by no means do I profess to be the perfect parent. Far from it in fact. As you may know, I have two young boys. One has a borderline addiction to Minecraft and the other has a very unhealthy affinity for watching scary YouTube videos featuring Slender man. One tends to be clueless about his surroundings, messy and irresponsible with his belongings; while the other can have uncontrollable temper tantrums, often times is quite passive-aggressive, and (no joke) may one day turn out to be a kleptomaniac. At eleven and eight years of age – they already seem to know the full catalog of curse words, they consistently stay up past their bed time by at least an hour, and disobediently raid our pantry in search of sugary snacks.

In retrospect, I am starting to realize just how often I inadvertently enabled my children’s undesired behaviors over the years; all under the guise of trying to be ‘supportive’. Like when my son forgot to turn in multiple assignments throughout the school year, and my wife and I pleaded with their teachers to accept their work late. Even with minute challenges, like tying their shoe laces for them or cutting up their meals into bite-size pieces – these were obstacles they could have easily overcome and a great opportunity to build up their confidence.

It is perfectly natural to want to protect our children from difficult situations, or experiencing failure, or enduring pain, or undergoing embarrassment. Before we know it though, they’re older – and if we have shielded them from all of their struggles, I feel we may have deprived them of developing essential coping skills and the ability to build up resilience.

“We don’t grow when things are easy, we grow when we face challenges.” ─ Unknown Author

Within my own life, I know conflict has always helped me be more confident and grow as an individual. There is a sense of empowerment when we face fears and overcome obstacles. Lately, I not only ask my children to exercise perseverance and more independence through the problems they face within their own lives; but also, allow them to suffer more consequences and tackle some relatively uncomfortable situations without parental intervention.

I wish every child I treat in my clinic could have a pleasant and pain-free dental experience. Many kids unfortunately are overwhelmed with fear and anxiety before they even step foot into our office. “We are a sum total of all our experiences.” (BJ Neblett). I do not presume to be able to correct the behavior of every child within my one-hour appointment. Their past dental experiences, their environmental influences, their parent’s parenting style, and much more are all considerable factors. Fortunately we have various treatment modalities, and perhaps with time and enough positive experiences, even the nine-year-old with the stuffed animal can one day feel comfortable getting work done in the dental chair.

Thank you so much for taking the time to read this post. Please feel free to express your own thoughts and feelings on this matter, I love to hear various point’s of view.

Vacations vs burnout

Dentistry, Lifestyle

Contractually, I get ZERO paid vacation days a year. That is not to say I cannot take time off. In fact, my employer is quite accommodating of my vacation requests. However, when I am not in the office and not seeing patients, I am forfeiting any and all income for that period of time. Needless to say, that causes some internal conflict.

When I was younger, I remember someone telling me about the concept of ‘opportunity costs.’ They pointed out an example of how because Bill Gates’ net worth is worth so many several billions of dollars; that it literally would not be worth his time to pick up a $100 bill if he were to drop it on the ground. In fact, he called it a ‘poor investment’ of his time.

In the early part of my dental career, that same decision-making process always stirred in the back of my mind. Essentially, when I go on vacations, not only do I not bring in an income but I am also spending money on restaurants, hotels and flights. The other thing that weighs on me is that I work in pediatrics – so the times when it is usually most convenient to go on a trip (i.e. summer time, spring break, winter session) we are usually the busiest and therefore, the most productive. For these reasons, in my first few years of employment, I practically took no time off.

As time has progressed; I am settling into my career, my kids are getting older, and, more recently, with my health issues – I realize more and more how finite my life and time with my family really is.

I have said it before and I will say it again – I feel blessed to practice pediatric dentistry. Truly, I do not think any other profession could have brought me this level of satisfaction in my life. However, I work in a heavy Medicaid office where I am constantly surrounded by patients in pain from rampant decay, frequently get grief from parents about appointment wait times, and unfortunately, am often times immersed with a sense of hopelessness on whether we are even making an impact. Honestly, it can all start to wear on you a bit.

My family took a week long vacation last week to Yosemite National Park and a quick trip up to San Francisco. On our way back to Las Vegas, we drove along a small stretch of the Pacific Coast Highway. Lots of beautiful sites!

In the weeks leading up to the trip, I couldn’t help but feel a little more pep in my step. Just planning for it, packing for it, and the anticipation of it made me excited and really gave me something to look forward to. Since coming back (a week ago), I have put in a request for even more vacation days.

My goal from here on out is to find that right balance between work and play. Admittedly, going in to work every day feels quite repetitious and mundane. However, it is hard for me to say that I have truly felt burned out by it. I never dread going in. I look forward to conversing with the families and my co-workers. Conversely, I do want more time with my family, and want to get out and explore the world.

I wish I was rich enough to leave $100 bill on the ground. Heck, I would pick it up even at the risk of my back giving out. Seriously though, I feel fortunate that I am now stable enough financially, settled enough professionally, and (thankfully) healthy enough physically to take some time off of work and enjoy life a little more with the ones I love.

I am always interested in what others experiences are, please feel free to agree/disagree and give me your take on things! Thanks for taking the time to read this post.

Cystoscopy and medical clemency

Lifestyle

It’s funny…when I started this blog, it was supposed to be my mechanism of blowing off steam for my days doing dentistry, or a way to tell a tale about repairing something around the house for the first time. It was certainly not my intention to discuss urinating blood and getting a cystoscopy for the first time. Yeah, you heard me right, a cystoscopy – the procedure where the urologist shoves a little camera lens up the urethra to evaluate the bladder.

It is hard to say exactly what my favorite part of the procedure was. Perhaps it was when I was asked to wait – “naked from the waist down” – for the doctor to arrive. Or was it when not one, but two nurses (one teaching, one training) entered the room to place local anesthetic up ‘there’ – in preparation for the procedure. No, it was definitely the grand finale, when the doctor came in (about 30 minutes later) and inserted a tube up my penis. Ah, good times.

As I mentioned in my last post, I suddenly started to see blood in my urine several months back. After numerous visits to the urgent care and ER, multiple blood tests, and all the financial costs that come with those appointment (on a high-deductible insurance plan mind you); I am happy to say so far the problem seems to have resolved without incident. With a family history of prostate cancer, suffice it to say, I was relieved when my PSA (prostate-specific antigen) levels came back within normal limits.

The cystoscopy was just like, the cherry on top, so to speak. The hematuria thankfully has not returned in well over a month; and the urologist seemed to suggest what the ER doctor speculated – and that is, perhaps a small kidney stone may have came and went, and tore up some of the lining along the way. I have heard personal accounts, from friends and family members, of how unfathomably painful kidney stones can be and I just want to say for the record – I just feel so blessed to have been spared any cognizance of that whole ‘passage’ experience, if in fact that is what happened to me.

I do still have a slight, unexplained, lingering lower left abdominal discomfort from time to time. Both the urologist and gastrointestinal doctor I visited do not seem to think anything of it. At least for the time being, I am enjoying having normal-colored urine again and pray to God to never again have to endure a camera scope my bladder.

I write this post…with some, almost scary degree of coincidence; because a dear friend of mine, her husband actually recently had routine bloodwork done and discovered a largely elevated PSA and got the diagnosis (from the same urology office in fact) of (prostate) cancer. :::sigh::: I do not know his family history of such disease. But I do know he is not much older than me, and I know he has a daughter the same age as my oldest son. I know his CT scan had some lymphadenopathy involved and that means he has a very scary road ahead of him.

Even though my cystoscopy took place several weeks ago, I still vividly remember the feeling I had laying half-naked on the urology operatory bed. Besides feeling embarrassed and vulnerable; worst of all, there was still this terrifying anticipation and uncertainty about what results would come of this procedure. I partially joke about having medical bills piling up on me, shrinkage when the nurses put the lidocaine up in me, etc. – but the reality is, I was incredibly fortunate to be given clearance and another chance in my life. I have countless reasons to feel relieved, thankful, hopeful, optimistic, what have you. I am not so quickly dismissive, and now feel a thousand times more empathetic, to struggles and health issues like the one my friend’s husband is having.

Alright, thank you so kindly for taking the time to read this. I am glad to give more details about my cystoscopy to anyone that wants it, and please feel free to share your own stories with me. Take care!

Hematuria and an Uncertain state of Health

Lifestyle

Every weekday morning I tend to start my day basically the same way. I do my morning routine in the bathroom, and simultaneously peruse through the days headlines in my News apps and check in on the stock market performance. Then, I head downstairs for breakfast, make myself some oatmeal while I Youtube last nights Stephen Colbert monologue. I sort through some left-overs in the refrigerator to take for lunch. I pour the kids a bowl of cereal before I wake them up. And then I am off to work. I love those mundane, predictable, uneventful moments in life.

So on March 1st of this year, imagine my surprise when I am standing over the urinal in the men’s restroom at work and peeing out blood. An hour or so passes, I go again and regrettably have the same outcome. Panicked, I start hydrating like crazy, and fortunately it appears to have resolved.

I told my wife later that afternoon about the concerning occurrence(s) and she immediately forced me to schedule an appointment with a urologist – whose soonest availability was 3 weeks out. Beggars can’t be choosers, I took what I could get.

Two weeks later, however, the horrifying hematuria returned with a vengeance. That day – almost every time I ‘went’ and despite how much water I drank – the toilet bowl appeared like it was filled with blood. My wife encouraged me to go to the Urgent Care.

At the UC, I provided a urine sample and blood to run some diagnostic tests. The physicians assistant (PA) that was examining me wanted to help rule out any sexually transmitted diseases, urinary tract infections, etc. The blood work thankfully all appeared within normal limits and the urine culture results also looked good once they came in a few days later. The PA was impressed (relieved?) to know I had already lined up an appointment with a urologist for the following week, and deferred to him for a more thorough and absolute diagnosis. That was Monday.

As before, a plethora of water consumption seemed to really help eliminate the hematuria. Throughout the week, things appeared again back to normal. However, my wife and I – both with a foot in the medical field – knew the underlying cause of this issue needed to be investigated. We couldn’t help but to Google search causes of visible (non-symptomatic) hematuria, inquire with some close friends and family that are physicians, and honestly just prayed it was not anything too serious.

By Friday of that week – with only a mere 5 days and counting until my scheduled (and long-awaited) urology appointment – to my dismay, the blood came back yet again. This time, my radiologist brother and pharmacist wife insisted I just go to the hospital ER and get some imaging done. The ER doctor ordered a CT scan of my abdomen and pelvis with contrast.

After receiving my CT scan, I must have waited in the ER waiting room for at least a couple of hours before my doctor came out to give me the results. Let me tell you, those couple of hours were daunting. The mind has a cruel way of playing out all the worst-case scenarios in dire detail. However, perhaps those hours were the rude awakening I needed to re-evaluate my life. A time to reconsider the things (and people) I tend to take for granted. A time to count all the blessings that were bestowed on me throughout my life.

I thought about how my wife has been so worried about me; and in that moment truly appreciated what her unconditional love meant to me. I thought about not being able to see my two boys grow up; and wondered to myself what great things they would do in their lives. I wondered how I would break the news to my beloved office staff; how I might phase myself out of my professional career and contemplated if patients would even notice my absence.

The ER doctor eventually came out, and apologized for the long delay and stated she had been called away on a code. She stated that the CT scan did reveal a left-side small kidney stone, but everything else imaging and blood work wise appeared remarkable. As for the blood in the urine, her theory was that I may have already had a small stone pass and that it could have damaged my ureter along its pathway. However, she too was pleased to discover that I had an upcoming urology appointment.

As of this posting, my urologist appointment was two days ago. While they concurred that there does in fact seem to be a small kidney stone present; they want to do additional testing to include a cystoscopy of my bladder and a prostate-specific antigen (PSA) level check.

Knock on wood, the bleeding has stopped since the day of my ER visit last week. Unfortunately, no sign (or really, pain for that matter) of a kidney stone passing. But I wake up every day now feeling different. I have a rejuvenated attitude about my life. I feel genuinely lucky to be here each day. I put my phone away when my kids talk to me; they get my undivided attention. I appreciate and take the time to notice the trees and the sky and the world around me.

I no longer read news headlines and stock reports, now my mornings are spent perusing my photo albums. However, still turn on Stephen Colbert – he’s too wonderful! I wake my kids up before I pour their cereal…just to get a few extra minutes in with them each morning.

I still have a lot of stuff to figure out with my health. I actually try not to think about it too much. I am trying to live in the moment and not worry quite as much about what the future holds. I will surely keep everyone posted. Thank you for taking the time to read this blog post, and please always feel free to share your own experiences! Until next time…

Annual Meetings

Dentistry, Lifestyle

There is a certain sense of euphoria and absolution I am feeling right now. It is the complete anthesis to the doubt and trepidation I was suffering from this morning; especially just minutes before our virtual meeting went live.

By the way, I have officially relinquished my duties as the President of the Nevada Academy of Pediatric Dentistry (NVAPD). My one year term ended earlier this month.

I have written about taking on that position in a previous post. COVID-19 created challenges this year no other president in our organization has ever had to face. I say that not to gloat; but the truth is the advocacy efforts increased tremendously, communication became far more critical, and good leadership in general becomes exponentially more difficult in times of crisis.

NVAPD annual meetings historically take place within the first few weeks of January. If you are lucky, planning that event could potentially be the ONLY responsibility the presidency title may call for. My year though, fugetaboutit. State budget cuts, PPE (personal protective equipment) shortages, disastrous legislative policies, dental office closures, the list goes on. This past year, MY year, was ridden with issues that needed to be addressed.

I do not want to insinuate that I handled these matters on my own. I had an incredibly helpful executive committee, I coalitioned (if that’s even a word) with other local dental societies, and I basically did my best to raise awareness and garner support from our members against policies that could have devastated (I mean devastated) dental coverage for underprivileged children in Nevada. That effort took a plethora of emails, some conference calls, drafting letters, making public commentaries, and conducting surveys.

So luckily for me, around October 2020, my advocacy efforts started to stabilize. Dental practices had pretty much found their footing and figured out how to stay safe opening up their office for patient care. It afforded me a chance to begin planning that upcoming NVAPD Annual Meeting I was still responsible for.

Historically, our meeting is a two-day event. Day one is generally a Basic Life Support (BLS) /Pediatric Advanced Life Support (PALS) course in the morning, and an Infection Control class in the afternoon. Day two is typically a one-hour business meeting in the morning, followed by a full day lecture by a keynote speaker.

My to-do list was as follows: 1) find a venue 2) find speakers for each event 3) find sponsors 4) promote the event to our members and 5) host the event.

Finding “a venue” was probably the easiest item on my agenda. In the past, we have rented a small classroom at our UNLV Dental School campus for day 1’s events, and a grand ballroom at a local casino for day 2. Each year there are generally about 50-60 attendees. We normally cater breakfast and lunch both days, with snacks kind of strewn in there somewhere. In this age of social-distancing, I had but to find a virtual platform to utilize and that was it. This past year, Zoom (no financial disclosure to declare) became a household name. Although I have been an occasional attendee, I had never actually ‘hosted’ a Zoom meeting – let alone held a conference on their platform. After some perusing, researching, reading tutorials and watching demos – I signed up for their Zoom Video Webinar package, allowing up to 100 attendees. It was a little confusing at first learning the lingo (co-hosts, panelists, etc.); but once you play around with it enough, it is remarkably simple yet powerful! The invitation and registration process, branding and marketing…there really was an impressive array of features available. Other state dental societies had made their CE free this year for their members as kind of a good faith gesture; I wanted for us to be able to do the same. Fortunately, purchasing this package for a month (or two) was reasonably priced ($55/month at the time of this post) and was a cost our organization could afford to absorb (especially considering casino ballrooms can set you back upwards of 10 grand).

Finding a speaker was a little more of a challenge. For most of the courses (BLS/PALS and Infection Control), I recruited the speakers from last year and fortunately they were available to help us again this year. However, I could not just as easily reuse the keynote speaker and topic. But perhaps I put too much pressure on myself about for finding one. We are relatively limited in pediatric dentistry for the subjects we discuss (behavior management, sedation, pulp therapy, etc.). Initially I was bent on finding someone that had some notoriety in the industry and maybe even a big social media presence. The harder I looked, the more discouraged I became – especially to find many of the topics and/or speakers had already presented recently (or were about to be presenting) at other state’s conferences. To make matters worse, I spoke to two individuals prior to the end of October that ultimately ended up declining my invitation to headline our conference. My confidence shattered, I was contemplating canceling that component of our meeting. Lucky for me, in early November, a pediatric dentist in our community just happened to check in on me, and ultimately put me in touch with a friend of his from Texas that does a lot of orthodontics in his practice. Perfect!

The year 2020 surely must have been a brutal financial year for many companies. In the past, companies welcomed a chance to set up their booth in the back of our conference hall and promote their products to everyone. But we were going virtual this year. I had to get creative. I took some initiative, wrote a carefully worded letter, and created a tier for our potential sponsors; in exchange for their financial support, I tried enticing them with their company logo on our website and on our advertising emails, and even a short video of theirs played during our virtual meeting. I reached out to many of the organizations that have supported us in the past – only a small fraction of those even bothered to respond to my email, and all that did informed me they were suspending such activity this year. So, that was a fruitless effort. I did manage to secure one dental anesthesiologist that recently moved back to Nevada and wanted to introduce herself to the community. Yay!

For the advertising portion, I was able to return to my graphic design roots for this meeting. I Google searched attractive event fliers, found one that I thought was visually pleasing, and fired up Photoshop to design a similar one for our event.

From October 2020 until basically the date of the event, I was sending out email reminders to our members about registering. Around December 2020, I started to feel my blood pressure rise in anticipation of this upcoming meeting. I learned to operate Zoom fairly proficiently; held several practice sessions with my executive committee and guest speakers. We wanted to make sure polls, Q&A, chat, etc. were all being displayed properly, as well as any PowerPoint presentations and videos we needed to broadcast.

After tuning into another state’s annual meeting, I decided to contact the president that orchestrated it and asked how I could mimic it. She was incredibly kind, probably spent a couple hours on the phone with me answering my questions, and ultimately I was able to assemble it. The best part of pre-recording the video (which, mind you, took long hours and several weekends to construct) was that I was able to time it perfectly to the hour I had available.

I initially purchased and downloaded Animotica from the Microsoft Store for my movie editing, but that had very basic/limited features and I found it difficult to use. After a little more investigating, I wandered upon HitFilm Express (no financial disclosures to declare). Let me tell you, AMAZING piece of FREE software! It had tons of transitions, some built-in text effects, sound-editing features, you name it. Highly recommend it!

So, there you have it. I apologize for disappearing for so long from this blog. I got tunnel vision on this project for the past several months, and any and all free time I had was devoted to this. Honestly, the past year was filled with a constant stress of tending to something or another NVAPD related. But overall, I would say the event went well, as did my year as president. I am however, looking forward to a little time off to just read, learn Spanish, play tennis with the kids, and try and clear my plate of responsibilities for a minute.

If you need any help planning a similar event, or have your own experiences you wish to share, I’m all ears! Thanks for taking the time to read this post!

On-line Reviews

Dentistry, Lifestyle

I work as a pediatric dentist in a heavy (and I mean heavy) Medicaid office. Generally speaking, these types of offices have high cancellation rates, low fee reimbursements, and occasionally long wait times. One facet is not independent from all of the others. When the office receives such low reimbursement and has a high no-show rate, we are forced to double book patients in anticipation some patient, and occasionally entire families, may not keep their appointment(s). It is a necessary evil. Thankfully, I have the help of a well-trained staff, and together we have learned to tough through those overwhelming moments when everybody decides to show up. We understand everyone’s time is valuable and we try and respect it by staying on schedule whenever possible.

Usually, if our office receives a negative review, it almost always is not directed directly at me. Someone will leave disgruntled remarks about an insurance issue they faced or, like the other day, voice their frustration about our office policy on needing to perform a ‘consultation’ before we are able to schedule a new patient for any dental treatment. The irony is that the lady had enough time to leave a lengthy 1-star review for an office she had never visited yet claimed we tried to “waist” her time and gas by making her drive to our office so we could properly evaluate her child’s behavior and treatment needs.

I do not know if it is because I take pride in my chair-side manner, and the fact that I thoroughly try to explain my thought process in developing my diagnoses and treatment plans to each and every parent; but when I received a negative Yelp review the other day, I couldn’t help but take it hard. We had an anxious 6-year-old girl come in last week, brand new to a dental setting, who had multiple decayed teeth, an abscess and has been in pain for the last month. The mom, who was in the room initially, was very pleasant and seemed to understand the options I had presented. I recommended we try and save some baby teeth with cavities, while the abscessed one was better off being extracted. I also informed her that because the patient is new to a dentist, perhaps giving an oral sedative to relax her a bit may offer her a better experience. She completely agreed and went up front to schedule. Just moments after they left for the waiting room, the grandmother of the child comes in and adamantly proclaims she wants all the infected teeth extracted, stating they are “just baby teeth” and that she knows what [baby] “root canals” are like and she does not want her [grand-daughter] going through that. Oh, yeah, and she wanted it done right away versus scheduling for a conscious sedation like I had recommended.

5-Stars for those two smiles!

A quick side-note if I may: Baby teeth are IMPORTANT! They save space for the adult teeth to erupt into, they keep bone in the jaw stimulated and strong, and they can potentially spread their infection along to the adult teeth.

I am used to parents minimizing and misunderstanding how important baby teeth are. Heck, I did before I specialized. Now it is my job to educate them on not only how best to keep them clean and healthy; but also explain the duration of time we naturally need to have them around for in our mouths. Most are receptive and appreciative to get that information – and start to see some value in the baby dentition. This grandparent, however, had already made up her mind that those teeth should be pulled. After I started to get the sense that she could care less about my recommendations; I basically told her I do not feel that [extractions] is in the best interest of the child, I cannot allow her (who, mind you, was not even the legal guardian) to dictate the treatment that I provide, and I encouraged her to seek care elsewhere. Keep in mind, at no point did I change my tone or demeanor, I simply said something she did not like hearing. Sure enough, shortly after this encounter, a Yelp review appears saying how “rude” I was for stating she was trying to dictate my treatment and how she did not understand how I deal with kids all day.

I am pleased to report MOST on-line reviews about our practice are positive. In spite of our mildly lengthy wait times, people usually find the service we provide efficient yet thorough. In fact, that is the most common source of new patients coming into our office – beating out word-of-mouth, pediatrician and general dentist referrals. Luckily this ladies complaint will fade into the abyss of compliments and praise we receive from most people that visit us. And as I have said before, I try to be empathetic, the sweet girl has been having pain and that is never easy for a loved one to witness. Nonetheless, the sheer audacity of coming into a dentist’s office and telling them how to do their job is a bit overly brazen if you ask me.

Look, I get that everyone is entitled to their own opinion. I strongly believe that. God knows I have left my share of positive and negative reviews. For the few negative ones that I have been inclined to leave, I always appreciate when a business owner responds and goes out of their way to contact me to make things right. But this is not a ‘Taco Bell screwed up my order so let’s give them a 1-star review,’ kind-of scenario. In other industries too, but especially in health-care, you should put the majority of trust and treatment decisions on the person that went to school for it.

I will admit, I love getting positive reviews. I check at least a couple times a day to see if we have any new postings. I think it is human nature to feel that sense of accolade and approval from the people you work hard to serve. And while I have little concern that the recent negative review will damage my clinics overall stellar reputation in any significant way; I cannot help but feel a little outraged at the temerity some people have. I am used to the occasional snipe about our wait-times, and understand our office policies may piss some people off; but I draw the line when people can come into their friendly neighborhood pediatric dental office and treat it as if it is their local fast food joint – order whatever they want and have it done immediately at their beck and call.

This post feels like a bad review about bad reviews. Thanks for letting me have this rant and get this off my chest. I do not think anything changes for me, I still plan to leave both good and bad reviews for other businesses; overall I still find them useful and effective. Personally, before I post the bad ones, I think maybe sleeping on it and letting emotions settle down first is always a good idea. Maybe the less bridges we burn, the better sometimes. Anyways, as always, let me know your thoughts! Thanks for visiting!

Thankfulness and Gratitude

Lifestyle

I want to explore and talk about this in more detail sometime soon, but I feel like I spend an inordinate portion of my life feeling down. I know varying degrees of mental illness is prominent within our society. We have celebrities committing suicide. We have, unfortunately all too often, mass shootings where the shooter sometimes leaves behind their deranged ramblings. And on any given day, you have someone walking down the street crazily yelling at themselves. It is certainly a societal problem that, thankfully (hopefully?), seems to be getting more public attention and awareness.

In my own life, I imagine I suffer from what I can only best describe as depression. Fortunately my thoughts have never gone to dark places like suicide or bringing harm to others. However, and probably to my own disservice, I have never sought any treatment from a therapist or guidance from a qualified healthcare professional. Part of the reason (and these are probably more ‘excuses’ than ‘reasons’), is the onset of it hits me so randomly. I will say though, it is usually when I am alone with my thoughts that I seem to suffer from it the most. When I am at work, distracted, I am normal and fine.

That leads me to maybe my other ‘reason’ for not yet pursuing care – which is to say that I do not really know the etiology. I think there is a tendency to chalk it off to stress or occupational burn-out; and I maybe justify and downplay it by convincing myself that this is just how our world works. Everyone from the Starbucks barista to cardiac surgeon experiences work-related distress. Especially now, with the COVID-19 pandemic raging still, there is fatigue, isolation, job and financial insecurities, and so many other possible stimuli for us to feel sad.

Before we were social-distancing, quarantining, and economically locking down; before we were afraid come into contact with something a stranger may have touched minutes prior; I did have a regular gym/exercise routine in place. The endorphins and the other benefits that come with working out regularly certainly helped my general well-being back then. I know I experienced sadness back before COVID-19 came into our lives, but – like work – exercising was a wonderful, healthy distractor and really helped minimize the toll depression can take on someone’s quality of life.

“You say you’re ‘depressed’ — all I see is resilience. You are allowed to feel messed up and inside out. It doesn’t mean you’re defective — it just means you’re human.”― David Mitchell, Cloud Atlas

I will be honest, I seriously doubt the melancholy mood I find myself in from time-to-time meets the criteria for ‘clinical’ depression. I doubt depression can be so easily turned on and off by being at work or getting in a good exercise routine. I certainly do not want to offend anyone going through much more serious bouts of this disorder, and of course, wish them all the best to manage it. I constantly look for things that help manage my own mental anguish. I want to try meditation and conditioned breathing exercises, a healthier diet, and (once COVID subsides) a more regular vacation schedule. I also notice I am easily overwhelmed, and have been making more of a conscious effort to slow down, stay in the moment, and try to appreciate what is in front of me.

In those rare moments of happiness and peace that my mind affords me, I take a step back and appreciate how truly blessed and fortunate I am. Perhaps the worst part of talking about depression is my sense of guilt about it. I have truly been given a wonderful life. I am surrounded by a loving, beautiful family. I work in a profession I absolutely love and with co-workers I adore. My family and friends are all in good health. So when that greyness starts to set in, and that absence of emotion begins to haunt me, it is hard for me to describe or explain when so many blessings have been bestowed upon me.

I am no expert on this matter. As with all my posts, I try and articulate what I go through with as few grammatical errors as I possibly can. I did come upon a website/blog I would recommend: https://www.blurtitout.org/ that goes over depression in great detail and has many resources for support.

I want to wish everyone a happy and healthy Thanksgiving 2020! Thank you for visiting my blog. If you have personal struggles and stories you would like to share, by all means, reach out. Have a blessed day!

Empathy and Ethics

Dentistry, Uncategorized

Not to come off as conceited, but I am pretty good at what I do. I practice evidence-based dentistry. I follow guidelines set by the American Academy of Pediatric Dentistry. And probably the most important thing is that I try and approach every child’s case with empathy.

When I was in dental school, I came across a video of a young physician giving a lecture to a class of dental students who, not long before his speech, had been diagnosed with Stage IV terminal lung cancer. He had been given something like a 6 month life expectancy. This doctor spoke about the ascent in his medical career, how his professional choices were always guided by his pursuit of wealth and acquiring materialistic things. He ultimately achieved what he thought was the pinnacle of ‘success’. He shared photos of his mansion, his multiple fancy cars, him posing with A-list celebrities, you name it. A luxurious lifestyle indeed.

And then, tragedy struck. After exercising one day, he felt a pain in his back. A physician friend evaluated him, and the grim diagnosis was made. In this lecture, he talks a great deal about regrets. Regrets in valuing the wrong things in his life. How, when he would view his patient’s charts – that is all they were to him, charts; not patients, not people with stories to tell and families at home that cared for them. The irony being, that he was now a chart on someone else’s stack.

I keep that doctor’s lecture in the back of my mind with every exam that I do. I tell the parents I talk to, that the recommendations I make are the same for their child as they would be for my own. I try and enter every exam and every treatment procedure with a mindfulness of ‘how would I want myself and/or my loved ones to be treated?’ As a health care provider, I feel like that principle and way of thinking has been a guiding light for me.

I had a residency instructor tell me once “you will not be able to satisfy everyone.” I am glad to have gotten that advice early into my career. I spend a good amount of time explaining to parents my visual and x-ray findings. I try to present in detail my treatment recommendations for their child. And I thoroughly try and answer any questions they might have. If they continue to have any disputes or doubts, I will attempt to resolve those concerns but, beyond that, I am a big believer in families getting second opinions as other dentists may be able to be more accommodating to their desires and expectations.

I have had parents wanting to extract cavitated but still very much savable teeth because they “were just baby teeth.” I have had parents decline any form of sedative being given to their child despite the kid being extremely uncooperative for their exam and needing lots of dental work done. I will try, to some extent, to hear the parents out, understand their point-of-view, present my own side of the story, offer my experience and insight; and hopefully we all can find some common ground to accomplish what needs to be done. However, never do let parents flat out dictate my course of care; and if I get the sense that they are dismissive of or lack trust in my training and experience, then I often times feel it is best for all parties involved to go their separate ways.

Probably one of the most hurtful and offensive things I have heard is when a parent believes my treatment recommendations are financially motivated. Coming up through professional school, we all take the Hippocratic oath to practice in the best interest of our patients. And, while that hopefully sets the high standards of care by which most (if not all) medical and dental professionals care for people; it is undoubtedly idealistic. Honestly, I cannot blame people for having that perception and that kind of cynicism that their doctors might be driven by greed.

When I draft a treatment plan for a patient, I take into consideration their age, their health history, their behavior and temperament, their nutritional habits, their home oral hygiene routine (or lack there of), all to try and gauge their cavity risk. I can proudly say I have never made a clinical decision where I put my own self-interests above what I think is best for my patient. But I do have a genuine concern for the direction I think the business of medicine and dentistry seem to be going. With the rapidly rising costs of tuition for these professional schools (nearly an average of $300k for dental school according to Student Loan Hero), with constantly decreasing reimbursements from insurance companies, and with dental schools graduating and saturating the job market – I hate to say it, but I think it may be a legitimate thing to wonder if all that debt burden starts to affect the way we practice in some way.

On that somber note, I want to thank you for reading this post. Hopefully there are some interesting points for discussion somewhere in all of this. As always, I welcome any thoughts and input. Until next time…

Associateship vs. Ownership

Uncategorized

Yesterday, an owner of my office informed me they would be letting one of my assistants go – effective immediately. It is perhaps worth noting, this decision was not made on my recommendation. Nor was it based on any ineptitude the assistant had exhibited while on the job. In fact, the assistant had wonderful chair-side manner, patients adored them, they were always punctual and reliable, and got along extremely well with others in the office. I cannot dispute that there was certainly a valid reason for deciding to lay the assistant off; but it was not a clinical one and the loss of this employee is devastating to our entire office.

This is not the first time staff has come and gone without my having a say in the matter. My bosses are very considerate of my input and often times ask me about the goings-on of our location. They have given me ample leeway to practice dentistry the way I want. But moments like this make me realize I am not in the drivers seat for many aspects of how this office operates.

I graduated in 2014 from my pediatric dental residency. By now, I am confident enough in my clinical skills to be an owner of my own office. A couple of things weighed in on my decision to remain an associate.

First and foremost, outside of the patient exams and treatments and the corresponding clinical notes, I leave work and I go home to my family relatively carefree. My two kids are still young, and I enjoy being able to spend some time with them without the distractions and worries of running an office.

Second, I have it on good authority from several friends that own offices already, that staffing by far is the biggest headache. Employees call-out, quit, embezzle, and constantly demand raises; all of that minutiae I currently have the luxury of being oblivious to. Of course, it impacts me and I have to be at least a little concerned. If claims are not being collected adequately, it could likely impact my pay. Likewise, if we fall short too many assistants, some patients may need to be rescheduled on account of the insufficient staff and our production numbers are not the best.

Third, I have considered and investigated turn-key dental offices and new build-outs; and no matter what option I go with, the debt burden is ridiculously high to buy an existing or to start-up a new dental office. Pediatric dental offices especially do not come on the market very often, but the couple that I have seen would have set me back $500k-$1M easily. The wound from my student loan debt is still too fresh, and I did not feel ready to take on yet another ginormous loan.

Last, I have yet to learn the human resources and front-office side of the practice; all the billing and coding, the hiring and firing, the employee benefits packages, etc. Not that I couldn’t pick it up quickly, or even out-source a lot of it, I just have not taken the time to learn it. That is not as much of a deterrent for me as some of the other issues I mentioned above.

While I absolutely love my life as an associate, I would be remiss if I did not mention that there are two recurring fears I live with every day. The first is that I am not in control of my own fate. They could suddenly decide to close the office down one day, or I could be replaced with a new graduate willing to take lesser pay. Fortunately, I have a severance clause in my contract that helps protect me (in part) from the latter. As for the former, my family and I live a lifestyle so below our means that I could literally be out of work for years without feeling the pinch of unemployment.

The second, and probably most unbearable part of being an associate is honestly, incidents like the one that happened yesterday. We lost a phenomenal member of our team, and I had zero say in it. That really sucks. I guess there are going to be pro’s and con’s to everything in life.

And this probably goes without saying, but I thought it might be worth mentioning – your earning potential as an associate is of course always going to be less than if you were the owner of the practice. For me, that difference in income is worth it because I do not have to worry about the staffing, payroll, office supplies, leasing, you name it.

I would be interested to hear other people’s thought processes and internal reasoning on their own professional decisions with staying an associate vs. opting for ownership. Thank you so much for reading this post!

Student Loan Debt

Dentistry, Lifestyle

Just FYI, this will likely be a recurrent topic on my blog. In some form or another, I will write about matters of finance.

So, admittedly, I do not live a glamorous lifestyle. We certainly spend money on the essentials in life; we buy all the food and clothes we ‘need,’ we both have reliable transportation, and we isle shop at Costco and unwittingly rack up those $100-200 bills a couple times a month.

When I started dental school, in 2007, I sat through an insanely brief presentation on student loans, our tuition costs, and some repayment options we may have when we finished. Throughout my 7 years of dental training, I never gave that presentation or my debt burden a second thought. I obliviously signed the paperwork to qualify for loans, I ensured my tuition was being paid; but terms like ‘compounding interest’, ‘principal’ and ‘deferred payment plan’ did not really resonate with me at the time. I wish it had.

I accrued well over $200k in student loans over that time period. I remember in 2014, sitting in-front of my work computer during my lunch break just feeling so stressed out and overwhelmed. I had finally seen my overall tuition payback amount, compared it to my bi-weekly paychecks and just felt so helpless.

Two websites saved me.

The whitecoatinvestor.com. My brother, the physician, luckily turned me on to this website. It was JUST what I needed. I even received his book one year as a Secret Santa gift. Authored by an E.R. doctor that discussed personal finance issues: student loan debt and refinancing, saving for retirement, and investing, among other things. The site has become immensely popular, he’s grown from just blogs, to podcasts, offering online courses, and authored additional printed books. It certainly may not be for everyone, he found a niche and speaks to a specific audience of high-income earners; but the philosophy works across the board, and the premise of saving, investing, and quickly paying down debt should be universally followed.

Also mint.com. That overwhelming feeling I described earlier, came largely from being unorganized with my finances and not really having a short- and long-term plan. I will say, this website a) has a lot of advertising and b) invokes a lot of trust out of its users in that, a lot of highly sensitive account information could be potentially compromised. If you can bring yourself to trust their encryption algorithms, then this site offers fantastic budget tools, income vs. expense tracking, and even allows goals to be established.

I guess it is worth mentioning, I have no financial interest in either of the sites above. In fact, if anything, I would like to extend a thank you to Dr. Jim Dahle (founder of WCI) and Intuit (maker of Mint.com) for helping me get on a better financial path.

Once my wife and I put a plan in place; monitored spending, set goals, budgets, basically used many of the tools on Mint, we started chipping away pretty quickly at the debt. When my wife decided in 2013 to go back and earn her Pharm D degree – only to graduate 3 years later with yet another $200k debt to our household – we at least now had a better understanding of what it would take to manage that momentous amount.

In August 2017, we submitted our last payment to the lenders for our student loans.

A couple of things I attribute our quick payoff to:

  1. Re-financing our student loans. At the time, our interest rates on our federal student loans ran about 6.8% to as high as 7.4%. Thanks to the advice of WCI, I immediately found a company to re-finance with and cut those rates in half. Another approach I took was, in the process of re-financing my home loan to a better interest rate, I took equity out of the house and put that cash towards a significant portion of my student loan principal.
  2. High-income earning. I think it is mathematically infeasible to pay off $400k in 3 years any other way. Fortunately we pursued professions that pay relatively well; supplemented by a disciplined lifestyle and controlled spending habits, we were able to pull off the impossible. In case you are wondering, we have a joint account and unanimously put money towards any and all debt.

To this day, we live comparably to where we were in 2017. We still set goals and we still control spending. Now money that once was going towards student loan debt is much more appropriately being redirected to saving for retirement, a down-payment on a dream house, helping our kids with their own college tuition costs, charity, etc.

You know, I do remember one useful thing from that financial loan seminar at the beginning of dental school. He said,

“If you live like a dentist when you’re in dental school, you will live like a dental student when you’re a dentist.”
Christopher A. Kypuros

I am not yet where I want to be financially. I still have to work for a living. But I am blessed to not have a mountain of student loan debt weighing on me everyday. Student loan debt is out-of-control in this country. There was an actual game show about it for goodness sake (Paid Off with Michael Torpey)!

Dave Ramsey had a bell he would invite guests that recently paid off their debt to come and ring. I have always wanted to ring that bell. However, just the sheer feeling of living stress-free from student loan debt is in and of itself an amazing, cathartic reward.

I would love to hear your achievement in paying off debt. And I would be happy to answer any questions you have about my own story. Thanks so much for taking the time to visit and read this post!