I’d like to think I’m a pretty good dentist. I’ve developed my skills with practice and a constant drive to learn. I’ve hired and retained an office team that really goes the extra mile for patients. But above all, my goal has been to be reasonable person with an equally reasonable team. I think patients like dealing with an office full of reasonable people.

What do I mean by this? Well, if I put a filling in last year and a piece of it breaks off…I’m going to fix it for you and not charge you for it.

Could we charge for a new filling? Sure. Probably some would. Frankly, if a filling of mine comes out in a year, I can’t help but think that something went wrong with the placement of it. In most mouths, a filling should last awhile. How long? Well, that’s a complicated question. But let’s just say a year is usually too short of a lifespan for a filling.

Another example of reasonable. It’s the holidays and you’ve got a day off. This is your one day to knock out all the Christmas shopping. You remembered that you had an appointment with us when you woke up, but time just slipped away from you. You check your cell phone and realize that your appointment was an hour and a half ago and you completely missed it. You call in a panic and Kathy teases you and sets up a new appointment. Can we charge you a late fee? Absolutely. Will we? Probably not. Why not? Because we’re reasonable.

Being reasonable is one of the things that makes me enjoy being human. Sometimes all it takes to make someone’s day better is being a little flexible about expectations. Everyone has a occasional bad day. Sincere apologies are worth their weight in gold.

Of course this totally goes both ways. I like to brag about how my office runs on time. Often we run ahead of time. I only see one patient at a time, so the time that we reserve is actually reserved especially for you. Every once in awhile…I get behind. Usually it’s a procedure that went much longer than I expected or a dental emergency that just couldn’t wait. Every time this happens, it throws me off my game. I hate being behind. I almost always walk out into the waiting room to apologize and let the patient know what’s happening. I can’t remember a time when the patient gave me a hard time. It’s because most people are reasonable.

Very occasionally we run into patients who aren’t kind and understanding. In fact, they’re just unreasonable. I have quite a few stories of patients who’s expectations were unrealistic and they were happy to tell me about how I had failed them.

I’m not going to tell you those stories, though. Why? Because I’m a reasonable person and it doesn’t help to dwell on them.

Instead, I’m just going to ask myself a question. When I’m in a situation where I’m unhappy with the service I’m receiving…am I being reasonable?

The check stops here

Imagine yourself sitting at a long table of friends in a restaurant. You’ve all come together for a big meal. Everyone is hungry, the restaurant is supposed amazing and the company is lovely. It’s been awhile since you’ve all been in one place and it’s nice to see each other. It’s only slightly awkward that one of the guys, Bill, is wearing handcuffs. It works out O.K. a couple of your friends help Bill eat and his conversation is dazzling, so it ends up being no big deal. 

Dinner is amazing! Seven courses. The finest wine. A terrific dessert. One of the best meals you’ve ever had. Then the waiter brings the check. Your buddy Joe picks it up and takes a peek. The look on his face says it all! Dinner was awesome, but clearly…so is the bill. And Joe passes it to Fred. 

Fred looks at the check and the color fades from his face. Then he passes it to Jill, who just glances at it as she passes it to Mike. Mike grabs a pen and adds it all up and figures a tip. “Yup,” he says. “It’s right.” Then he passes it to Larry. Larry gazes at the check and starts laughing…hard. Then he passes it to you. You don’t even bother seeing how bad the damage is. You just pass it on to Steve.

And so it goes. All the way around the table. Finally, John puts the check in front of Bill. He looks up at the table sheepishly as everyone else gets up. Slowly, the table clears except for Bill. Alone. With the check.

The Patient Protection and Affordable Care Act was signed into law on March 23, 2010. Some of the act has already gone into effect, but much of it will continue to go into effect over the next year and a half. On January 1, 2013 an excise tax on medical device manufacturers will go into effect. The tax will cost manufacturers of medical devices 2.3% of their revenues. Many have complained that it will kill innovation in medical technology. A 2.3% haircut on revenues at the level of the manufacturer is noticeable. A startup company may be operating on pretty tight margins so 2.3% of their revenues could amount to a large percentage of their profits.

I’m a dentist. Also, I’m a human being and I generally think about things in terms of how they will affect me. I love Ultradent, GC, Tulsa Dental and the rest as much as the next dentist, but they’re going to pay this tax. Not me. Right? Well…I’m not so sure.

Yesterday I received a fax from my primary dental supply company. They have received notice from dental supply and equipment manufacturers that this tax is going to cause them to raise their prices at the beginning of the year. The fax said that the increase would be upward of 5-6%. The supply company wanted me to know that they’re going to do their best to hold the line, but in no uncertain terms, they were going to have to pass this cost increase on to their dentists.

One of the other problems with this tax is that the people affected by it don’t know how it’s going to work. The regulators tasked with clarifying this are still working on it. By my count this tax will go into effect 47 days from today. I’ve talked to a lot of people in the dental lab industry who are way more knowledgeable about it than I am who are just not sure how it’s going to affect them. Dental labs aren’t sure whether they will be considered manufacturers and thus pay the tax on their lab output, or will they simply be paying higher prices for their raw materials. Dentists aren’t sure how it’s going to affect them, either. If you’re doing chairside CAD/CAM restorations does that make you manufacturer? The rumors are flying around and I’m here to tell you, I don’t have any specific answers. I’m not really sure that specific answers would be all that important, though because people are getting ready to react whether they have the information or not.

If you’re keeping score you’ve followed the fallout of the tax from manufacturers who pay it directly to suppliers and labs. The manufacturers are raising their prices and passing that onto the suppliers and labs. The suppliers and labs are going to pass the tax increase onto dentists in the form or higher prices for supplies and lab fees. So now, the providers (dentists and doctors) are holding the check. Many dentists that I’ve talked to are planning on raising their fees to cover the added costs that are heading their way. For better or worse, the dentists will pass the check to patients and insurers of patients.

What about dentists who participate with dental benefit plans. Many dental benefit plans limit the fee that a dentist can charge an insured patient. This is one of the selling points for employers that buy dental benefits for their employees. Costs can be limited because the dentists have agreed to a certain fee set by the dental benefit companies. When you add an additional expense on top of the dentists current expenses (labor, supplies, rent, etc.) and no ability to raise their fee, the dentist that works with dental benefit companies will have reduced profit due to the increased expenses.

Do you remember our friend Bill? You know, the guy with the handcuffs? He couldn’t pass the check because his hands were bound. So he kind of got stuck with it. That’s how providers are going to be in the current scenario. Since I’m a dentist, I tend to see everything colored by those lenses. But when I look at the bigger picture I see physicians dealing with identical problems. Most physicians and hospitals are contracted with many medical insurance companies. Many of them are operating on pretty slim margins as well. How many of  you believe that insurance companies are going to happily increase their reimbursement for medical and dental procedures because of the new costs imposed by the health care law? Yeah…me neither.

As far as I can tell, this indirect tax is actually aimed at doctors and dentists that participate with insurances. Since the actual implementation of the tax is still mostly a mystery, this could change. Since people generally respond to incentives, I could see dentists and doctors moving away from participation with insurance because the added costs of the new health care law seem to be aimed at providers.

Am I ready to take off the handcuffs?

License to Floss

I saw “Skyfall” this afternoon. It was a dream come true, really. I was there alone, so I could gorge on popcorn and Sour Patch Kids in the dark while watching the suave Englishman create cinematic carnage. Good stuff, all the way around.

The highlight of the movie was the bad guy, as it often is. Javier Bardem makes a really nasty villain and I think he should get another Oscar for his portrayal of a rogue MI6 agent wreaking havoc on Bond, “M” and the rest.

I suffered some wounds, too. The basketball sized bucket of popcorn that I ate caused gingival trauma on a blockbuster level. It happens every time I eat movie popcorn. And I do it every time I see a movie. You’d think I might learn, but I don’t. By the time I made it to the car I had discovered no less than 4 separate popcorn husks burrowing into my gums like the henchmen of a Bond villain.

Instead of pulling out a Walther PPK (customized to my palm print, no less) I whipped out my mint flavored waxed floss. I flushed out the bad guys in a matter of seconds. They never had a chance. You see, I have a very particular set of skills. And with the right tools, I’m very dangerous.

I’m like James Bond that way. James Bond with floss.

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.


developing habits

In 2009 I picked up a habit. It was a habit that I had all through dental school. When I was in dental school we were all positive that we’d quit, and probably most of us did. I mean, I dabbled in it between 1997 and 2009, but it didn’t really stick. Now, I’m finding that it’s a really tough habit to break.

No, I don’t smoke. I’m talking about the rubber dam. Actually, not the “rubber” dam, but the “nonlatex” dam. It’s just that the name I know it by is rubber dam. Old habits die hard. And new ones are kind of the opposite.

Ever since I started reading and posting on DentalTown I realized that the dentists that I aspired to be like used the dam. And they used it effectively. Most importantly, they took pictures. It was like rubber dam porn. They showed these amazingly clean endo accesses, bone dry restorative fields and perfect isolation for seating crowns and onlays. I wanted that. But it was my habit to isolate with cotton rolls and high volume evacuation. I could think of many reasons NOT to change my habit.

  • It would take too long
  • Patients don’t like it
  • Rubber dam retainers (clamps, for those that like to scare their patients) pinched the gingiva and hurt
  • My assistant wouldn’t like the change

But in 2009, I finally decided to suck it up and give it a try. I don’t exactly remember how it worked. I think we (my assistant and I) decided we’d try it on every composite case that came through the door for a month. If we didn’t love it, we could always go back. But we didn’t.

I couldn’t have developed this habit without Shelly’s help. I think at first she didn’t really like it. It was different and kind of uncomfortable. Patients didn’t know what to think about it, because it was different from what we used to do. But we kind of slogged through. At first, I felt defensive about changing up the routine. After awhile, we developed a team technique for placement. We can essentially place a dam relatively comfortably and  quickly within a minute or less. I have a pdl syringe in every set up and can use a dam painlessly. I give palatals routinely to allow for retainer placement on the upper.

How do patients react to it? Half the patients love it and ask for it. Most of the other half tolerates it without a lot of questions with a very small percentage of patients that can’t tolerate it. But dentistry is SO much more fun with the dam on and I work so much faster once it’s placed. Shelly and I often wonder out loud how we worked without it!

The rubber dam is a great habit that I’ve developed. Your mileage may vary, but if you’re wondering…you ought to try it.

What’s the next habit I’m looking to acquire? I’ve taken a few classes from David Clark and he advocates using Aluminum Trihydroxide powder blaster to remove all traces of biofilm once you isolate your field. I love the concept. But it’s another habit I’m going to have to work to acquire the habit. It’s messy as heck and to use it efficiently I’m going to have to add an air line to my operatory set up. I’m sure I’ll get there, but it’s a process.

What habits do you have? Are they habits that you’re proud of, or do you need to work to eliminate them? I’d be interested to hear!

Don’t just do something, sit there!

Last week we had an emergency patient. She left a message on the answering machine over the weekend because her tooth was “killing her.” The appointment went kind of like this:

patient: “The tooth really hurt all weekend long. I was ready to take it out myself with pliers!” (they always say this)

me: “Tell me more about ‘really hurt.’”

p: “Any time I drank anything cold it would give me these little zingers. Ice cream REALLY hurt. Also, I couldn’t really chew anything on it. All I really had to do was press on the tooth and it would get really sore. I look some ibuprofen but it didn’t really help.”

m: “Wow. That sounds really awful. How does the tooth feel now?”

p: “It feels better now. The gum is a little bit sore, but other than that it’s fine.”

So I did an exam and took a PA. The tooth had a small occlusal amalgam that was serviceable. The patient was a regular and never missed a preventive maintenance appointment. The radiograph was within normal limits. No widening of the pdl, no evidence of radiographic decay. I couldn’t elicit the patient’s chief complaint with hot, cold or a tooth sleuth. Percussion was negative. The palatal gingiva looked slightly irritated. So slightly that I may have been seeing things that weren’t there.

In short, I couldn’t find anything. The patient told me that she was in serious pain throughout the weekend, and I couldn’t find the source of her problem.

There’s something incredibly unsatisfying about that. Dentists are trained as diagnosticians and surgeons. We’re supposed to figure out what’s wrong and then fix it. The patient is looking me in the eye and telling me that she was really hurting and she wants me to a) tell her why it was hurting and b) make it so it doesn’t hurt again.

I did have a differential diagnosis list forming in my mind and I laid that out for her. She may have gotten some food impacted between a few teeth (e.g. “Did you eat any popcorn this weekend?).  That can be very painful, but it almost always resolves itself with some effort at hygiene or by just working its way out. Or maybe the patient accidentally bit on something hard (think olive pit, chicken bone) and didn’t really remember doing it.

Who hasn’t had some kind of transient tooth pain at one time or another? If the patient has a low pain tolerance, this kind of thing could account for it as easily as anything else.

The bottom line was that the patient wanted an answer. And I wanted to give it to her. But I had nothing. Zip. Nada. My training as a diagnostician gave me nothing to go on.

My training as a surgeon said “let’s do something!” Hey look, when patients present with a problem, I gotta fix it, right? And if I don’t, I look ineffectual.

Put that drill down, cowboy.

Everyone remembers the radiograph of the patient that had endo in every tooth on the upper. The patient kept having pain and the doc kept doing root canals. The moral of the story was that the patient suffered from severe, chronic sinusitis and ended up needing surgery for her sinuses, not her teeth. How do you think that dentist looked after a mouthful of root canals placed without solving the problem?

I’m here to tell you that there’s nothing wrong with a good, old fashioned “let’s wait and see.” So long as the patient is comfortable, what’s the rush? Let the patient know that you have some ideas about what may have been happening but you’re not sure. Let the patient know that you’re there for them and if it happens again, you want to see them right away.

John Kois says “the best dentistry is no dentistry.” Especially when working from a lame differential diagnosis.


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.


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.



Less Tylenol

They’re changing Vicodin. According to the FDA, it’s got too much Tylenol (acetaminophen) in it. So they’re going to “fix” it.

Combination drugs containing hydrocodone and acetaminophen like Vicodin, Lorcet, Norco and similar generics are incredibly popular for treating pain. They’re typically used in treating acute post surgical pain, ideally for short term use. Since 2007 the use of these drugs in patients 60 years and older has increased 32%. In other words, these medications are being used for chronic pain conditions more now than ever before. Some are lobbying the FDA to outlaw the use of these drugs to treat chronic pain, presumably because of their “habit forming” qualities as well as the toxicity of high doses of acetaminophen.

The FDA is requiring that these combination drugs be reformulated using less acetaminophen by January of 2014. The most common formulations right now are Vicodin 5/500 (acetaminophen/hydrocodone), Vicodin ES (7.5/750), Lorcet 10/650, or Vicodin HP (10/750) The maximum “safe” dose of acetaminophen is 4 grams or 4000 milligrams per day, with no more than 1 gram (1000 milligrams) in a dose. Some have questioned if even these safe levels are too high due to the effect of acetaminophen on the liver. In high doses, acetaminophen is toxic to the liver. Every label of every product that contains acetaminophen is required to explain this in detail. The problem is, most folks don’t read the label.

It’s likely that this “overdosing” of acetaminophen is of two types. The first type is from ignorance. Many cold remedies and over the counter pain formulations contain acetaminophen and consumers don’t realize it. If someone has the flu, they may take a flu remedy with acetaminophen as well as a Tylenol to bring down a fever. This can inadvertently cause an acetaminophen overdose.

The second type of acetaminophen overdose comes from those who are abusing the drug. Hydrocodone is an opiate drug like codeine, morphine and heroin. It can cause intense euphoria and is used by many to get high. Someone who uses opiate medications often, whether for pain or for recreation, will become tolerant to the medication. Tolerance is the tendency to need more of a drug to get a similar effect from the drug. This is very common in abused drugs, but also happens with many  “non-abusable” drugs.

People who use combination drugs to get high are at high risk for serious liver damage. Once you’ve gained a tolerance for the medication, you’re going to use more or you’ll go into withdrawal. Some make the argument that keeping the acetaminophen amounts high in these medications will discourage addicts from taking too much. Personal experience tells me that someone who has become dependent on an opiate medication is usually not making decisions based on liver toxicity. They’re trying to avoid being sick from withdrawal.

We know now that we need to be more aware of potential acetaminophen overdoses. So what’s the solution? I have a couple thoughts:

  • read labels: If we could count on people to read the label we wouldn’t see so much accidental liver toxicity. So patients need to be told explicitly that the medication they’re receiving had acetaminophen in it by you and your staff. Along with explaining it verbally, it probably need to be explained in writing. Post op instructions that can be reviewed after the fact or on a website would be a great place to explain this again. It’s probably worth making sure the patient knows that they need to read every label of over the counter medications to be sure of what they’re taking. (duh)
  • do the math: If you’re doing a procedure where you think it’s appropriate to prescribe a combination drug like Vicodin, make sure you do the math for the patient. Explain that the patient should not take any more than x tablets of a medication per dose and no more than x doses per day.
  • smaller doses: With the new FDA changes, combination drugs will have no more than 300mg per tablet. But in the mean time, I would prescribe Lorcet 10/650 with instructions to take half a tablet. The tablets are scored to be broken in half so it’s more like prescribing a 5/325 dose.
  • avoid acetaminophen: Let’s face it…dental pain is almost always inflammatory in nature. Acetaminophen isn’t an antiinflammatory. We’ve got better options. Even if you want to prescribe an opiate. Vicoprofen is generic now, so you can prescribe a 7.5mg hydrocodone/200mg ibuprofen dose on a generic cost basis. Even better is a newer medication (not generic yet) called Reprexain. It allows you to prescribe 200mg of ibuprofen with with either 2.5, 5 or 10mg of hydrocodone. I have to thank my friend Matt Ray for this info as I hadn’t heard of it before. This gives a doc a lot of options in prescribing for pain. Since I usually recommend taking acetaminophen along with ibuprofen this new medication gives a lot of flexibility.
In a perfect world our patients would be completely aware of what’s in every medication that they take and they would never mistakenly (or intentionally) take too much Tylenol. The same perfect world would be inhabited by awesome flossers that don’t drink alcohol and aren’t overweight. Since we don’t live in a perfect world it falls to us as doctors, to educate and help them manage pain and avoid medication toxicity.
Did you like this post? Do you have questions or comments? Please leave a comment in the form below. I really enjoy the comments section and I’ll make sure to reply to any !


my most valuable url

I got this in my email last Saturday:


B***** M****j
Email: *********
Phone: (989)***-6***
Preferred Method of Contact: Email
Preferred Appointment Time: Morning

I am looking for a new dentist and would like to make an appointment if you are accepting new patients.  Thank you!


and this one today:


Kevin ***d
Email: t******
Preferred Method of Contact: Email
Preferred Appointment Time: No Preference

I have severe tooth pain. I think I have cavities.


Both of these leads came directly to my email and my office manager’s email  from my “make an appointment online” link. You can see that link here:

My office website/blog does pretty well on Google. At least it has up to this point. With all the new changes to Google Places I’m not sure, but my expectation is that we’ll come out in pretty good shape. Maybe even better than before. We’ve got a lot of good Google reviews, so when my site shows up in the top 3 or 4 on Google’s first page, people often check out the site. This is where having great blog content comes in!

They see my site and maybe they browse around. They get the feel for the office from my regular postings and you’ll find that I link to my “make an appointment online” page in almost every one of my blog posts. I learned from my friend Mike Barr that your website needs to not only have engaging content but a “call to action.” If they like what they see, you have to make it easy for them to take the next step. Thus, the “make an appointment online” link.

Getting them to email you is only the first part. Many websites have one of these links. I make it my business to email the patient back as soon as possible. You know why? Because most websites that you ask for more information about never do anything with the request. I can’t tell you the number of times I’ve taken the time to fill out a “request for more information” form online and never gotten any response at all.

My goal is to have that prospective patient say to themselves or anyone else around them, “I’ve never been treated so well before!” Or, “wow, the dentist took the time to email me back!” They’re going to have a different kind of experience at my office, and I want them to know that from the very beginning. Here’s what I wrote to one of my most recent requests:


Hi *******! We’d love to have you! Are you having any troubles with your teeth, or are you looking to have a cleaning first? We’ll get back to you first thing on Monday morning to get you set up. Thanks for emailing!

Alan Mead DDS


The prospective patient replied:


Thank you for the quick reply! I don’t really have any problems with my teeth that I know of, I’m just a little overdue for a cleaning. I am also interested in your Gold Plan, as I do not currently have dental insurance. Thank you


I think I answered her email on my phone, but I can’t remember. All I know is it took about 2 minutes. I saw her as a new patient this morning. She joined our “Gold Club.” It doesn’t always work out that smoothly, but usually it’s just like that. If I don’t get to it immediately, my office manager does. We just write a friendly, personal email or make a quick call to welcome them. So simple, so effective.

Do you have an appointment form online? If you do, do you answer it immediately and with a kind, personal welcome message? If you don’t have something like it, I highly recommend it! It’s been working really well for us!