by Jack D. Griffin, Jr., DMD
I don't specialize in cosmetic dentistry; I guess that makes me a practitioner of ugly dentistry. I don't have many movie stars in my practice and the most famous person I work on is the cashier at McDonald's. But I do have ears and they work fairly well ... when I want them to.
My ears particularly hear negative things well. Have you listened to us dentists lately? We bond plastic to teeth better than we bond to one another. Instead of being "colleagues" to each other, we often sound more like a bunch of narrow-minded, self-serving, paranoid "professionals." Take time and really think about what we say to and about each other. If the "mouth is a reflection of the soul," we have some problems.
When you're in a room with other dentists, what do you hear? What is the tone and context of "dentist-speak?" What do you sound like when you listen to yourself?
The economy has been flourishing and so have most of our practices. For many of us, busyness is at an all-time high. But when the recounts are finished, or the stock market tanks, or Greenspan speaks the wrong way, the economy will someday sour. When that happens, we may feel the pressure that comes with lower production. How long will it take for the lack of unity within the profession to bite us in the rump? Think of what a mighty force we would be if we were really unified. The future vitality of our profession will only be as great as the power of our cohesiveness. All of us - including myself - go into attack mode when we feel threatened or challenged; it's that "cornered dog thing." But attacking others only lowers us. Trying to lower the status of others never raises our own status. Bickering, complaining, and whining about others only compromises our potential. We need to remember that we are all "colleagues" and not just "the competition." Different isn't the same as wrong.
Unfortunately, we don't just stop at bashing other dentists. We openly and consistently criticize patients, employees, and ourselves, as well. This doesn't even include our open bitterness toward insurance companies, OSHA, organized dentistry, the price of Gluma, and trying to keep up with which generation of bonding agent we are on. We can sound like a bunch of squawking hens! What's up with all of this negativity? Looking for reasons to hate and separate is unhealthy. Sure, all of us have things that bother us, but we could be more productive if we focused more on the good stuff and less on junk that we have little influence on anyway.
We are all fortunate to be around other dentists socially, at meetings, CE courses, and on the golf course. I don't walk around with a tape recorder, but the following are examples of things I have recently heard other dentists saying. Often, the comments are narrow-minded and defensive in nature. Frequently, they are divisive to the profession. Sometimes they are just plain goofy. What bothers me the most is that - after looking in the mirror - I have been guilty of saying or feeling some of these same things at different times. How embarrassing!
Attacking each other ...
Recently, I was taking a refresher course for the FAGD exam. A dental materials guy gets up and goes over some tin-silver-gamma 2-alloy-corrosion stuff that I tried forgetting years ago. It was like repeating a bad dream. When the discussion on mercury came up, the usual stuff was said. "There is no free mercury after amalgam sets, and since only the free-Hg is poisonous, there is no risk to the patient." A well-meaning woman dentist asked, "How can you say for sure that there is no harm to the patient?" Obviously, this was the wrong question to ask. How dumb could a dentist be? How dare she imply that the stuff we put in our patients' mouths might be dangerous!
An older dentist, obviously around long enough to be trained by G.V. Black himself, said, "Lady, you're what's wrong with dentistry!" He let her know that just by having the guts to question the safety of amalgam that she was ignorant, and that she must be some kind of flag-burning rebel. She probably even voted for Ross Perot! What kind of moron would have the audacity to question the safety of all those slick-looking silver fillings he had placed over the last century? Of course, he was just a little defensive. Instead of providing her with some facts or scientific knowledge, he basically cut her head off.
While he was attacking her, he revealed a bit about himself, when he said, "Almost all of the composite build-ups I've placed have fallen out." Now there is a well-trained dentist who has the right to attack! Because of this well-researched clinical "evidence," he surmised that amalgams are superior because his "silver fillings" didn't fall out. Of course, his technique couldn't have anything to do with it; it couldn't be that he may have no clue about adhesive dentistry. It couldn't be that he considered himself an expert and passed judgment on a technique or material - like we all often do - after only a few flailing attempts ... could it? Throwing stones at someone without being in their shoes - or even without having as much experience - is counterproductive. It just divides us even further.
Then the dental materials instructor also took the defensive side. He stated that amalgam is safe and still is the material of choice for posterior restorations. He put up a slide to "prove" the safety of silver fillings. The slide showed that the average life span for dentists is about the same as for the general population. Since we are around amalgam more that anyone else, it must be safe! He just tossed this out as evidence that mercury fillings were really much more dangerous, then dentists would all croak before the rest of the population. Again, the implication was that even raising the question of safety was ridiculous.
Even though the "expert" and his information were bogus - i.e. the life span of dentists only could be fairly compared to people of the same socio-economic class, access to quality health care, education, etc. - it's the defensive posture and intolerance for the other side that is bothersome. Nonsensible tactics and statistics are just tossed around as a rallying cry for the flag-wavers on one side or another. This is no way to run a profession! Do we want to end up looking like the Gore and Bush election-team lawyers?
I never woke up in the middle of the night sweating and crying out, "We're killing people, I hear dead people calling my name; I must stop placing mercury." I have never had one of those nightmares with dying children holding pictures of my amalgam carrier and me! I do only posterior composites, because my patients usually prefer them and I enjoy doing them. The problem isn't that one material or the other is better; the problem is the hatefulness and defensiveness of one side or the other. Quality fillings of composite or amalgam can be great for the patient. The problem comes when we get so passionate about our own agenda that we become hateful and illogical.
The series of debates between Dr. Dickerson and Dr. Stevens in Dental Economics was interesting. Dialogue must occur to try to find the truth. However, narrow-minded commentary made just to cover one's self merely creates division. It is self-centered to say that everyone who practices in a different manner than me is ignorant. Why do we focus on what divides us, instead of focusing on our commonality? Most of us are genuinely concerned about patient comfort, providing long-lasting comfortable dentistry, running an efficient practice, and having a happy staff. No one has all of the answers about anything; we must be committed to learning more and lashing out at each other less.
At the same meeting, a discussion came up about the proper time to place a porcelain onlay/crown vs. a three- or four-surface posterior composite. Many of us have placed numerous "composite crowns" that have been in the mouth for years. These crowns are considered a success when they are affordable and the patient can function normally without any pain. I also realize that the crowns don't always work perfectly and that, if the patient lives long enough, the filling will have to be replaced with something else. I have been ripped by another dentist for doing less than "ideal" work because he believes that no filling larger than two surfaces can be placed in the posterior, only onlays or crowns. Terrific!
I'm sure some dentists would put their family in a sports car, instead of a Hummer, even though the Hummer is built like a tank and would hold up better if the family were in a car wreck. These dentists had a choice between that Mercedes or BMW and the Hummer, so was it stupid for them to buy the less durable and less safe product? Of course not! Lots of other factors are involved with my choice, such as cost, ride, room in the garage, and the look of the car. Having a dislike for other dentists because they have different values is shallow and unhealthy for us.
Finding fault - real or perceived - with another dentist is easy to do. We can find something to complain about any time we let that little negative man inside of us out. Think about those things we jab other dentists about: they place too many crowns, they don't do enough crowns, they have too big of a sign, they advertise too much, they charge too much, they charge too little, they hire only Pamela Anderson look- a-likes, they hire only old cranky women, they see too many patients, they don't see enough emergency patients ... and on and on the list goes. Sometimes, complaints are a result of jealousy; sometimes they are based on ignorance; and sometimes they are made by dentists who think they will look more glorious when compared to the more wretched. My advice: Make sure that the "plank" is out of your own eye before you try to point out the "speck of sawdust" in your colleague's eye! Let's act like we are the contented bunch of colleagues that we ought to be.
Attacking patients ...
I overheard two dentists talking behind me at a hockey game recently. I didn't know them, but I heard them solving all of the problems in the dental world. Instead of ripping other dentists, they spent almost two entire periods annihilating their patients. We all have patients we dread seeing. Some are those miserable sorts who even complain about the texture of the toilet paper in the restroom! They are the same ones who need a crown on No. 2, but only have a 5 mm maximum opening and a tongue that likes to lick handpiece burs. These patients always forget their wallets!
One of the guys started talking about a lady who had received a new denture a few months earlier. "We've done 15 adjustments and she still isn't happy. She's in the chair so much, she is growing roots to it! She's a bitter old woman and no one can make her happy. It makes me hate denture patients!"
Anyone who does dentures has the occasional tough cookie. Is it a healthy attitude for us to just call patients we can't please a bunch of psychos? Why treat unhappy patients as if they all need a lobotomy? Instead, we would be better served to look at our lousy impression, or incorrect bite registration, or inability to prepare our patients mentally for a new prosthesis. Instead of lashing out, we could take all of that energy and maybe improve our technique. Even denture patients are real people with real feelings. Remember, they were smart enough to choose us to be their dentist!
The other dentist started talking about those "darn nurse patients" that just can't be pleased. He was talking about them being "a bunch of complainers - too picky and most are just nuts." What bugs me most is that I've felt the same way about some patients. Some crown patients know the Vita shade guide better than I do! They'll say, "Put a touch of D2 at the incisal edge, Doc."
It's too bad that these two dentists at the hockey game talked so loud that everyone else around could hear them. Our true colors show when we don't think anyone else can hear or see us. The real character of a person is revealed when we are alone - or think we're alone! What good does it do to call all tough-to-please patients nutty? That is no way to run a patient-centered practice.
One of them continued the tirade between slap shots. "I did this endo on this salesman," he said. "The guy felt it while I filed, even after almost two gallons of lidocaine. I told him there was no way he was feeling pain because his lip drooped to his knees! He's just a pain. I even found four canals, obturated densely to .5 mm from each apex, and the chump still complained of cold and bite sensitivity. I did a great job! He's just a complainer! He has already paid his bill, so I just wish he would go somewhere else!"
It couldn't be real pain from another canal, a cracked tooth, or another tooth, could it? Because we don't know the answer, we can't assume the patient must not really have a genuine complaint.
Remember, these people provide our living! If some of these patients are so stupid, how come they were smart enough to pick us as their dentist? Was it just our blind bad luck that this person ended up in our office? Instead of trying to understand those difficult patients, we justify our frustrations by pulverizing them in every way possible. Every treatment failure we have can't always be 100 percent the patient's fault! How do we improve if we can't admit mistakes, make corrections, and learn from them? Isn't it just remotely possible that they really do feel those sensations, or see that color difference, or feel that roughness?
A genuine compassion for all patients is almost impossible to have, but we must try. A dentist I know likes to say about difficult patients, "I'm happy they left the practice." While it certainly is a relief when some people go elsewhere, it should always hurt us a bit when someone chooses to leave our office. We need to be genuinely concerned and really ask, "What could I have done better?" We will never get smarter and improve our relations or techniques if we don't evaluate ourselves honestly. Of course, being so sensitive that we want to drive off of a bridge any time a patient requests his or her records be sent to another dentist isn't healthy either, but neither is assuming that all patients with complaints are wackos! Maybe the problem really is partly inside of us.
Attacking the staff ...
A friend of mine had two hygienists. One of them quit and he replaced her with a new hygienist at a higher salary than the more experienced hygienist that stayed with him. Since salaries in his office are kept confidential (yeah, right!) he expected that everything would be cool. Of course, a war ensued when the tenured hygienist found out. The dentist's response was, "How goofy for that hygienist to be upset ... what business is it of hers what others get paid! I just wish the staff would grow up!" Who actually caused the problem here? We can't blame our management inefficiencies on the employees! That is no way to manage a staff.
There is no question that some staff members can be aggravating at times, and it's too bad that they can't leave all of their personal troubles at home. Am I the only one that says when a staffer is in a foul mood, "She must be having problems at home again." Sure, it happens, but many times we are the cause of some of their stress! We have no right to be angry with the staff members when we cause their grief.
We have all of that schooling in our heads, and then act surprised when staff members catch on to things that we thought we would sneak by them. If you think you are hiding stuff from the office staff, guess again! They probably can estimate how much money you take home within a few thousand dollars. We have no right to get mad at them when they discuss things among each other. After all, aren't we always flapping our jaws about them?
A dentist I know was having a staff problem. He felt that they all were ungrateful and didn't appreciate their jobs. He made them call him "doctor" because "By God" he'd earned it. He felt like he never needed to thank them verbally. His way of saying thanks was handing them a check on Friday. He also quit having staff meetings because they were too negative with too many complaints. He would say, "They don't know how lucky they are to have this job! They could be flipping burgers instead! The only thing that makes an employee happy is money. Let her work in a 7-Eleven for awhile and she'll beg for her job back."
Study after study shows that employees are more concerned about being appreciated and stimulated in their jobs than they are about money. In today's economy, we must pay our employees well and treat them well.
We can't get away with anything less or we'll constantly be turning over our staff. That leads to tremendous inefficiency!
Many of us have the guts to criticize and complain about our employees when we haven't even given them a clear description of what we expect from them. We think they are clueless or can't anticipate when we have failed to be consistent in our expectations and in our teaching.
Whenever we return from a seminar, we change our entire technique, and then are impatient when staff members forget something. We don't give them a fair chance to succeed. Frankly, many of us haven't written task lists or "job descriptions" because we are too lazy. Sometimes, we act like we don't know what we want them to do; we only know what we want them not to do when they make us mad! We think that anyone with "half a brain would know by now what I want done and when." Actually, we are the brain-dead ones for expecting what we haven't taught well enough. We don't talk to them as friends or co-therapists, and instead often heap disrespect on them.
We all know that praise and respect are even more important to employees than money. To think that we can sit on a pedestal and treat them any way other than how we expect to be treated ourselves is management suicide. Our staff is critical to our professional success. To think of them as mindless robots or whining servants is no way to build a practice.
There is no question that we can pull our hair out over our staff if we lose control and let the mayhem get to us. But, we can't let our managerial shortcomings be an excuse for non-constructive open criticism.
Let's strive for unity ...
Whenever humans are together, conflict eventually will follow. No two people agree 100 percent on anything. The problem is that dentists - myself included -often focus on the negative. We forget that we live in one of the most prosperous times ever for our profession; we need to step back and think about how truly lucky we are. We are extremely blessed to have all of the treatment choices we have today. We are lucky to have the trusting patients in our practices that allow us to share in their dental health. We are fortunate to have the loyal and dedicated staff that we have in our offices; they are really the backbone of our success!
We often complain as if we have the worst job - and lives for that matter - in the world. Let's all quit nitpicking and get our collective acts together. We really do have a terrific opportunity as dentists, and we need to try to bring the joy back into our practices. The best times we will ever see is the time we currently live in. We need to be colleagues, and not competitors, while we strive for unity in all phases of our lives. Our greatest enemy isn't the other dentists in our area, it's not our patients, and it's not the staff. Our greatest adversary is our attitude and the tongue it controls!