Human first

I had two patient interactions this week that got under my skin. I hesitate slightly to write about them because they may come across as petty to some. But I think they illustrate an interesting perception about dentists and maybe health care providers in general.

The first thing was a patient that came in with “an emergency.” In my office, the patient gets to decide what an emergency is. We go out of our way to see people with emergencies as soon as we can. Quite often we see emergencies the same day that they call. This patient had made an appointment to be seen by a hygienist the day before and didn’t show up. They also didn’t call. Honestly, that’s strike one. I feel like grown ups that schedule their own appointment should be able to show up and if they can’t, a phone call or some other acknowledgement is the least a patient can do unless there’s some kind of emergency that keeps them from contacting us (which of course, we understand). As you may have guessed, they patient has missed appointments before. Furthermore, the patient showed up 15 minutes late for their “emergency” appointment the day after. No apologies for being late. Nothing.

I saw the patient and was pleasant and professional, but purposefully aloof. We took care of the emergent problem and made a plan for a long term fix.  I probably was not my normal “bubbly” self. Frankly, I was annoyed. The patient didn’t show the day before, showed up late today and had an “emergency” that consisted of a broken tooth that has been treatment planned to fix for years. Literally years.

phone photo smallLater that day we received a phone call from this patient. They wanted to give us some customer service tips. They told us that because we didn’t seem all that busy that I should have spent more time explaining what I was going to do instead of chit chatting about things that didn’t have to do with the patient.

You can’t make this stuff up.

The second interaction happened later in the week. We got an “emergency” call from a patient that we hadn’t seen for a long time. They prefaced the call with “I don’t have any money…” Of course we saw the patient, did and exam and made a plan. Furthermore, we helped explain ways that we could help them afford dental treatment and even helped them find another provider that might take their government provided dental benefits.

I understand that some people aren’t in a position to pay for ideal dental care. I feel bad for them and we always go out of our way to try and help them. But I always wonder how that same phone call goes with the grocery store.

“Hello, this is Kroger. How can I direct your call?”

“I need some cantaloupe, but I don’t have any money.”

“Ummm. Well, we have cantaloupe, but we sell them for $2.15. I’m not sure what else to tell you…”

So now you’re either totally empathizing with me (which probably means you’re in the dental field or you’re some other kind of health care provider) or you think I’m an insensitive jerk. But there’s a little bit more to this.

How do people get to a point where they feel this is appropriate? I’m pretty sure it’s because we don’t think of health care providers as people. The fact that we think of them as “professionals” means that we hold them to a different standard. It’s almost like we don’t think of them as providing a service in the same way that other service providers do. Because we have specialized skills and a license granted by the state, health care professionals are different.

In fact, they are somehow less human. Doctors are not allowed to be irritated by my behavior because they’re doctors and I’m a sick person. A nurse in the ER has to be nice to me even when I’m acting unreasonably because I’m the patient and she’s the nurse. Dental offices cannot hold me accountable for appointments that I’ve made because they are health care professionals and I’m a patient.

Patients and providers alike, I’m going to let you in on a little secret. We’re all human beings first. No matter the skills we’ve accumulated and positions we hold, we’re still just relatively fragile and mostly squishy bags of emotion and meat. All the degrees and training in the world won’t change that.

Since that is undoubtedly the case, I want everyone on each side of the patient/health care provider to acknowledge this. There are always consequences to the way that you treat others. That doesn’t mean your surgeon won’t do their best for you even though you treated them like a jerk. However, they may be less likely to worry about your feelings in a post op exam. And dentists, if you’re paternalistic and not particularly kind to your patients, they may well decide to find an office that they feel like appreciates their presence more.

For the people that treat everyone poorly, there’s probably nothing that can be said that would change your behavior. But if you ever wonder why people don’t like to be around you very much, you might take a look in the mirror. For everyone else, I’d like to make a suggestion.

If you’re a fearful patient, be honest with your dentist. Starting the appointment with “I hate dentists” goes over differently than “doctor, I just want you to understand that coming to the dentist makes me really anxious.” I’d much rather work on a patient who tells me the latter. Dentistry has lots of options available to anxious patients to make treatment easier. But if you just tell me that you hate dentists it doesn’t help me understand your fear and it makes me think you don’t like me. Who wants to work on a patient that doesn’t like them?

As an FYI…I hear that “I hate dentists” line at least weekly. Maybe more often. Every dentist will tell you the exact same thing.

For the patient who starts the conversation with “I have no money,” it’s kind of similar. I’d much rather you tell me, “doctor, I have concerns about how much treatment is going to cost. I don’t have much of a budget for dental care right now and I need to know my options before you get going.” I don’t know a dentist in the world that isn’t going to help with that. Seriously.

The point is that health care providers put their (scrub) pants on the same way everyone else does. It’s worth remembering that they are human and have feelings just like everyone else. They are likely to respond to the way you present yourself the same way everyone else does.

Health care professionals…this works the same way for you, too.

Questions or comments? Please leave them in the comments section below or email me at alan@meadfamilydental.com.  If you’re a dental peep you owe it to yourself to listen to my dental podcast. It’s called The DentalHacks Podcast and it’s made with 100% fresh squeezed awesome.

 

I started a podcast

Mead podcastingI don’t know if I ever had “regular” readers of The Blogging Dentist. But if I did, I probably made them think that I’m not writing any more. I’ve fallen down on the job. I’ve published inconsistently. I’ve been lame. What can I say?

Well…I started a podcast. I used to think that writing a blog took a lot of time. And it does. Kind of. But podcasting takes even more time. So the time I might have spent writing here has been spent getting a podcast up and running.

I’ve been listening to podcasts for a long time. For those who’ve never listened, a podcast is a radio show that can be downloaded from the internet. They’re usually free downloads and the best place to find them would probably be the iTunes store.

I like podcasts because they’re often done by regular folks in their spare time and this gives them a really nice authenticity. The typical podcaster is someone who’s an enthusiast on a subject (think Harry Potter, triathlons or Thai food. Or at least they used to be. A lot of radio stations and professional entertainers have come to realize the power of being able to syndicate your own show for next to nothing and have begun to use the format as well.

It’s actually a blast. I’m enjoying the interviews and discussions with my friends and colleagues. I’m enjoying the fact that I’m spreading ideas. In fact, that’s the same reason I like to write a blog here and at meadfamilydental.com.

There are a lot of similarities between blogging and podcasting. The similarities are all about being a “content creator.” So much of what dentists post on the canned “our blog” part of their websites is written by whoever it is that manages their office’s social media. When I read those blog posts they usually don’t seem authentic. I’d much rather read something a little less polished that I can tell was written by the dentist who is connected to that website.

That’s the spirit we’ve tried to bring to the podcast. The format is half interview and half group discussion. We’re interviewing people that my co-host (Jason Lipscomb) and I find interesting on topics that we find interesting. We call the group discussion “the Brain Trust.” It’s informal. Kind of like the discussion you’d have with colleagues at dinner when you’re taking some CE.

The DentalHacks PodcastThere are a lot of laughs and we don’t take ourselves too seriously. Which some may consider a fault. I think it’s our biggest strength.

So, go check out our podcast. I think you’ll enjoy it.

And I’ll try to start posting more here, too.

 

Dr. Oz is wrong about amalgam fillings

MrWrong

Dr. Oz is wrong about amalgam fillings. He’s super wrong. He couldn’t be more wrong if his name was W. Wrong Wrongington. An episode of Dr. Oz recently aired where several “experts” weighed in on whether your amalgam fillings are poisoning you. That was the question that all the promos for the show asked: “are your mercury fillings poisoning you?” So I tuned in with bated breath to hear his answer.

His answer, of course, was that yes, they are poisoning you. Seriously, you knew that was the answer, right? If he’s said, “nope, they’re actually pretty safe” that would make the most boring television ever. And Dr. Oz is not about boring TV.

A couple of “experts” weighed in that the problem is the mercury vapor that comes off of silver fillings. According to the experts, any time you contact your teeth together, like chewing or heaven forbid grinding your teeth together, you’re emitting toxic gas into your mouth. That, my friends, is pretty scary stuff. But since you can’t see mercury vapor coming off of your teeth, Dr. Oz and another “expert” did a demonstration to measure how much mercury is released when you brush your teeth.

The demonstration consisted of a plastic model mouth with a bunch of silver fillings in the teeth. The model mouth was kept in a clear box that was ventilated. Dave Wentz, the guy doing the demonstration with Dr. Oz, let everyone know that they do the demonstration in a box so they don’t let any of the toxic mercury out. Which is interesting since it’s very likely that many people in the audience have silver fillings. If they’re that worried about the toxicity of silver filling, wouldn’t they screen the audience to not let folks with toxic fillings in the door? But I digress.

So, they do the demonstration. Dr. Oz puts his hands in the gloves in the clear box and scrubs these amalgam fillings like he’s cleaning the grout in the bathroom tiles. And, low and behold, they measure mercury gas coming off the fillings!

So Dr. Oz is scrubbing away at these silver fillings and asks:

“…at what point should I be concerned. At what [mercury vapor] level is it more than we’re supposed to have?”

Anything over zero is toxic. We’re at 61. 61 micrograms.”

Then Dr. Oz comes up with: “Now how can anyone dispute that there’s no mercury coming off of amalgams?”

And his guest expert Dave Wentz replies. “You can’t. You really can’t.”

If you aren’t careful or observant, this seems like a smoking gun. Amalgam fillings are dangerous and they are poisoning you. I ask you to step back.

The first thing that jumps out at me is the language that is used to frame the discussion. I typically refer to amalgam fillings as “silver fillings.” I never have thought of this as the element silver, but the color of the fillings, when polished is silvery. The Dr. Oz show refers to them as “mercury fillings.” Neither of these terms is probably adequate. Amalgam is a generic term for something that is mixed together. When the term is used in metallurgy it means: “an alloy made with Mercury.” So probably the most accurate term for these fillings would be “amalgam” and not “silver” or “mercury” fillings.

Language matters. When I use the term silver filling I’m indicating the color. When Dr. Oz uses the term mercury filling he’s pointing out the scary, toxic ingredient of the filling. That’s used to frame the discussion, so right away someone who isn’t thinking critically is thinking, “whoa, I didn’t know they placed mercury fillings!”

The next thing that jumps out at me is the way that they created and measured the mercury gas. It is assumed that the model that they offer (a plastic typodont with a ton of silver fillings in a plastic box) is an accurate representation of what’s going on in a human being’s mouth when they have silver fillings and they brush their teeth. I’m not sure it’s fair to assume that for the following reasons:

  • There was no moisture in this model mouth. A normal human being has saliva flow, which keeps the entire mouth moist and lubricated. Moisture on a surface could clearly affect the amount of vapor coming off the surface of a tooth.
  • We don’t know when these fillings were placed, if they were placed correctly, or if they were polished. All of those things can make a difference in the amount of vapor that might come off of these fillings. It wasn’t mentioned on Dr. Oz’s show.
  • We’ll also ignore the fact that the quadrant of fillings he scrubbed had anywhere between 4 and 7 surfaces of amalgam. I did my best to figure out how many surfaces the teeth had but they never showed the far side of the typodont. In any case, that’s quite a bit of amalgam…more than the average patient has for sure.
  • The model had no lips, tongue or cheeks and also wasn’t breathing. Wouldn’t a more accurate measure come from actual patients with actual fillings that were actually brushing their teeth?

They have measured the vapor that comes off of teeth in human models, and it is true that there is a measurable amount. In fact, there’s some question about the most accurate way to measure mercury vapor released from a silver filling. Is the vapor in someone’s breath the most important factor, or would absorbed levels of mercury in urine and blood be the most important measure? The Dr. Oz show wasn’t interested in an actual discussion. They went from “hey look, there’s mercury vapor in this model” to “your fillings are poisoning you.” No mention of actual outcomes based research. No mention of the millions and millions of teeth saved by the use of amalgam fillings with virtually no verifiable reports of bad health outcomes due to amalgam fillings. Clearly the most important message was that there is scary, poisonous vapor coming off of your silver fillings. Awesome.

The final thorn in my side was the statement made by the guest who was putting on the tooth brushing demonstration, Dave Wentz. He says, “anything over zero is toxic.”

Alternative medicine advocates aren’t known for their nuance. Poisons are dose dependent. In other words, something that is harmless in small doses can become harmful in larger doses. That is the case for most things that are known to be toxic to humans. So, how do we know if we’re getting a toxic dose of mercury vapor? Well, the World Health Organization describes a “tolerable intake” of elemental mercury vapor to be 2 micrograms/kg of weight per day. So if we take an average male of 150 lbs, they can tolerate a daily intake of around 136 micrograms of mercury per day. So, are our amalgams delivering that much? The short answer is no. Dr. Oz was able to generate an impressive 61 micrograms by scrubbing on some silver fillings in a box. However, actual measured amounts in human beings are more like 1-3 micrograms per day, depending on how many surfaces of amalgam a patient has.

There are reasons to dislike silver fillings. However, there is no credible evidence that they will cause anyone harm. The outcry by many poorly informed people has led to the outright ban of this material in some countries and the sharp reduction of it’s use here in the United States. Amalgam fillings are durable, long lasting and safe. That’s what credible evidence states. Until credible evidence says otherwise, I think Dr. Oz is wrong. Really wrong. Super duper wrong. His name should be W. Wrong Wrongington.

That last part is just my opinion, though. The rest of it is the truth as we know it.

 

 

 

 

 

Triumph by comparison

I don’t have to outrun the bear. I only have to outrun you.

I’ve given a few presentations over the last several months. I have to say that my experience of them hasn’t been as good as the reviews that I got. That could be function of people being kind in their reviews or it could be a factor of my being hypercritical of my (and every) presentation.

Here’s my admission: I procrastinate a lot and I wasn’t as prepared as I should have been. There, I said it.

The good news is that since most dental presentations suck really bad, mine went O.K. I need to get my presentations done earlier, weed out the stuff that doesn’t work more aggressively and spend more time rehearsing. I’m lucky because I’m pretty comfortable with the presenting part, I just need to make my presentations tighter.

I’ve got a couple presentations coming up and I’m going to really discipline myself. We’ll see how it works.

 

The “loving headlock”

I’ve got dentist friends who have chuckled about having to do fillings on their kids. They’re proud of how well their little cherub handled anesthesia and glad to know they can get the job done. Good for them, I guess.

I live in fear of the day I might have to restore one of my kids teeth. I have two active, healthy boys. Sean, my oldest is somewhere on the autism spectrum, which actually doesn’t mean much to me. I just know him as Sean. He has little quirks, but in all he’s a pretty regular kid. Jake is a solidly built 2 year old who wants to do everything by himself, including brushing his teeth. The upside is that he wants to brush. All. The. Time.

Not kidding. I got up with him at about five minutes after 6am this morning. His first request was to brush his teeth. Which is fine, but he’s not much on spitting, so I mostly skip the fluoride toothpaste. He’s got an obsessing brushing habit, but he’s not really reaping the benefits of it yet.

Here’s the deal. I don’t want to do fillings on my kids. I LOVE children, but not as dental patients. I handle the really easy pediatric patients, but I can’t hold it together for most of them. I have great specialists that I can refer to. Mostly I do. My pediatric dental goal: “don’t be the experience that this person is telling his/her dentist about in 30 years.” It’s a simple goal. Usually achieved with a referral pad and a smile.

But what about my own kids? Would I actually pay someone else to take care of their teeth? Hell yes. In a second.  Don’t even kid yourself. I’m sure I’ve already given my children years worth of therapy topics and I’m not willing to give them any more when I can avoid it.

My plan to keep them out of the dentist’s chair? I call it “the loving headlock.” I brush their teeth first. Then, if they want to brush their own teeth, I let them. But I get the brush on each surface so I can see it with my own eyes. Buccal, lingual. All of it. How do you do this on two vital, healthy and squirming boys you ask? Let me explain…

I stand behind them and to their right (I’m right handed). I have them stand on a step stool. I take my left arm and wrap it VERY firmly around their chin. I take my left index finger and middle finger (recently washed) and prop their little jaws open. Then I brush. I brush so I can see the toothbrush clean each surface. If I can’t see it, I’m not sure I’ve cleaned it. So I make sure I can see it. It probably takes me about 45 seconds to do all of it. I know you’re supposed to do it for two minutes. But that’s voluntary brushing.

Sean handles this exercise like a champ. I’ve been doing it with him for the better part of three years, so he’s used to it. I give him props, because he’s really strong and could probably wiggle away more than he tries. Jake is still learning. But he’ll get there.

“How long are you going to do this?” you may ask.

I figure I’ll do it until they’re big enough to push me off. Maybe college?

So far, the results are excellent. We’re O.K about avoiding sweets. We avoid sugary snacks as much as possible and we try to eat at meal times and only designated snack times. The kids drink no pop, but they’re fond of juice which is just as bad. But so far, so good.

Hypocritical

Quick! Dental peeps, are you overdue for a preventive hygiene visit (aka…a cleaning?)

If you’re like most dentists I know, you probably are. So what does that say about us? What about a dentist with really nasty looking teeth? If you aren’t taking care of your teeth at least as well as your patients you’re kind of a hypocrite, right?

You would think that dental people have lower risk factors for dental problems. We’re supposed to know how to brush and floss and I’m sure our patients assume that we’re olympians in dental hygiene. (As an aside, did you know that I won gold in tongue scraping back in 1996? True story.)

The question I would ask of dentists and dental people in general…do you walk the walk? Do you have have a dentist that treats you? Do you go for regular visits? Would you do the treatment that you recommend for your patients?

One other thing. If you don’t have a dentist because you don’t think you’d trust your dental care to anyone but your awesome self it doesn’t make you superior. It makes you a douchebag. Get a dentist and show up. At the very least we ought to remember what it feels like to lean back in a dental chair at least a couple times a year.

By the way, I’m due for hygiene on 7/24/2012 and I was inspired to write this post because I think I broke a tooth.