Reality check?

After a slight hiatus from writing for Dental Economics, I read the letter from Dr. Rick Singel titled "Of Dreams and Nightmares" ("Letters," June, Page 22) and felt compelled to respond on behalf of all of the "dreamers." You see, I, too was once a dreamer before starting my scratch practice of 6,000 sq. ft. — in a city where I knew absolutely nobody — with my wife Ann, who is a pediatric dentist. You want to talk about a "monstrous nut to crack every month," I can easily empathize. The thing is, I am still a dreamer and probably always will be. Without dreams and goals, what do you have besides stagnation and acceptance of mediocrity?

Dr. Singel, I resent your comments and implications that due to the size of the "nut," we dreamers have to alter our ethics and treatment modalities to accommodate the increase in overhead. I have always been and probably will always be the biggest advocate for new practice start-ups. For that matter, I am one of the biggest advocates for practice revitalization. Your inference is that those who choose to have the dream office (new or updated) must alter their perception of what is necessary treatment for the patient. While this type of epidemic does occur in our profession, it is not solely a problem for those who follow the dream. I have even seen ethical standards dropped in my small town — not from the construction of a dream office, but from greed and misguidance. Have you bought a new car or house since you started your practice? If you have, your inference would dictate that you, too, may have "discovered" some necessary treatment in order to help pay for the newly acquired nut.

I also would venture to guess that by the tone of your letter, you harbor resentment for those who choose to venture out and pursue something better than the average. Dentistry is full of people like you who maintain a stance of negativity and discouragement. I have seen too many eager and capable young and old dentists alike succumb to the mentality and perpetual barrage of "you can't" vs. "you can." Maybe your office could use a little revitalization, or maybe your staff could use a little shot of motivation. Studies have proven that surroundings play a very large role in consumers' buying experiences.

Maybe a change in office scenery allows you the joy of coming to work, and, because you now like coming to work, you can recommend with absolute certainty the treatment which is best for the patient and the situation — no patching, no watching — just definitive, permanent, and enjoyable dentistry.

Some very wise people have taught me "You don't know what you don't know!" Dr. Singel, you need to investigate this "dream" thing a little bit more before scrutinizing or judging those who have pursued it. I am personally inviting you and your office staff to spend some time with me, my practice, and my team so you can see for yourself that it really isn't the way you think it is, and that feeling warm and fuzzy isn't all that bad!

Kudos to Dr. Feuerstein

Dr. Feuerstein, your article on spring cleaning was great ("Tighten Up," April Dental Economics, Page 98). I read it, and then went to one of our monthly study club meetings where another dentist presented it to the group.

You are doing a great job sharing with us, and I enjoyed reviewing your Web site — lots of good info. Thanks for this and lots more in the past.

Power dressing?

What was he thinking? I am referring to the "Viewpoint" article on Page 16 of the June issue of Dental Economics. Who does Dr. Hong think he is, a lawyer or an accountant? He is a dentist — a professional who works in a dirty area.

After I read the article, I happened to also read the magazine, The Week. On page 24 of the June 27, 2003 issue is an article titled, "When Neckties Kill." It is a discussion from the British Medical Journal on the dangers of wearing a silk tie when treating a patient. It quotes the article, saying, "Ties dangle, brush up against patients, and soak up all sorts of unpleasant substances."

What is a dentist to do? Dress for success to sell a case, run to the back and change clothes, treat a patient, then run back and change clothes to sell another case? Or, do we only have certain days we devote to selling cases?

I was a periodontist for more than 30 years. For the first 15 years, I wore "The Uniform" — shirt, tie, and white lab coat. For those years I realized that the tie was getting material on it. Then I had an epiphany. I was a craftsman of the mouth, not a lawyer. It is the same thing as seeing an auto mechanic working in a shirt and tie. I changed to scrubs, and I was amazed at the positive reception.

We are endangering our patients' health working on them in anything but scrubs or a coverall. I feel that the article is not accurate. If more dentists wore scrubs, the public would come to see this as the appropriate uniform, their health would be preserved, and we wouldn't have this "dress up" nonsense.

I also wonder how OSHA would look upon working in the clothes that Dr. Hong recommends. I don't believe that a lab coat is sufficient to meet the OSHA regulations and infection control necessary for surgical procedures. How do you keep the handpiece spray off the tie? Nowhere in the article does he mention that the clothes he recommends are not to be used when treating a patient.

Rebuttal from Dr. Hong

Dr. Liebman, dentists are professionals, and you should take great pride in that fact. I believe that dentists are better than lawyers or accountants, and thus there is no reason why we should not dress better than they do.

If a lab coat is worn correctly and buttoned, a tie will never "dangle." To the best of my knowledge, the British do not have OSHA regulations and therefore are not required to wear lab coats when they practice.

In addition, I beg to differ with your insinuation that lab coats are not OSHA compliant. In fact, it states very clearly under the OSHA Guidelines for Bloodborne Pathogens (1910.1030(d)(3)(xi)): "Appropriate protective clothing, such as ... lab coats, clinic jackets, or similar outer garments shall be worn in occupational exposure situations." The mere act of wearing scrubs does not guarantee OSHA compliance. Scrub shirts are not sterile items, and therefore cannot be worn into the office (you would have to change into it when you arrived), and cannot be worn outside without an outer garment (such as a lab coat).

There are definite benefits to wearing scrubs, especially if you are performing surgery. However, when I am performing 12 laminate veneers for a patient, I do not think that scrubs are appropriate. When a patient selects me as the provider for his $20,000 cosmetic case, I choose not to do it in a $13 scrub shirt.

A frosted viewpoint

I have been a private practitioner for 22 years and also taught in the diagnosis department at Boston University Dental School. I have read Dental Economics since its inception. Some of the articles irritated me, but overall it is a positive and informative journal.

I have never written a letter to a publication, but after reading Dr. Hong's Viewpoint I couldn't resist. Patients come to see a qualified and trusted person, not a $140 shirt. Add the phrase "selling cases" to this article, and I'm frosted.

My method of treatment planning and case presentation is quite different from most I have read in Dental Economics. For all our patients, our first priority is to treat their "chief complaint" — be it pain, cosmetic concerns, or they're in need of a prophy. Let's say that on examination of a new patient, I discover a dental nightmare — recurrent caries, severe gingival inflammation, gross calculus, numerous teeth in need of restoration, etc. Here are my own dos and don'ts on how to approach this patient:

Don't
• Suggest the patient received poor or inadequate treatment by the previous dentist
• Take unnecessary radiographs if recent diagnostic ones can be obtained
• Sit the patient down and try to sell a complex treatment plan after all the information is gathered (radiographs, charting/probing, diagnostic models)

Do
• Address patient's chief complaint
• Obtain all information needed including a good medical history
• Reappoint patient for hygiene, caries control, or any other treatment you feel is needed immediately. It may take six months or six years, but once patients know and trust you and realize you have their best interests at heart and not their money, you won't have to sell anything. A dental practice is about relationships; it's not about production, quadrant dentistry, etc.
• Like your patients, put their best interests first, and don't worry — you'll make a great living.
• Have fun in your practice with both the patients and your staff. Life is short; scheduling for production is a drag.

There's more than one way to run a practice. I'm not saying mine is the best, it's just the best for me.

Just another point of view for you, Joe.

Dr. Hong replies

Dr. Kanelos, to briefly address your comments, 1) When dentists "present" a case, we are, in essence, selling the case since there is an associated dollar value to a treatment plan. I agree with you that dentistry involves relationships and trust between the patients and ourselves, but there is a definite perceived value in the services we provide.

2) Most of my patients are affluent professionals, and for them, $140 shirts and $100 ties are the norm, not the exception. Patients do notice how one presents him or herself, and how he or she dresses, whether they choose to mention it or not.

A matching viewpoint

Excellent article, Dr. Hong, so I assume I'm doing the right thing. I wear a shirt, tie, and dress pants every day except sometimes on Saturdays (I may change that). My office is in Rockville, Md.

I see other doctors who wear khakis and scrubs and I just don't get it. I like Hugo Boss, Barneys, and, of course, a great pair of Prada shoes.

Thanks for the article. The patients always compliment me on a few things — my white teeth, office design, and my attire. Thanks, I'm on the right track!