Taking Care of My Patients

 The Pandemic and politics have made our lives miserable and are the reasons that I don't blog much.

I told you that I used to post my work on several dental forums over the years and had a reputation as a significant clinician. I rarely post my work any more because very few dentists on these forums are interested in pursuing excellence.

An older dentist posted the following recently:

Very impressive, Gerald. Thank you for the brilliant skill you employ while caring fir your patients. Thanks for inspiring us to think differently about what we do. 

The post concerned the influence of dental insurance on the quality of care and the ability to deliver excellence to your patient IF the dentist participates with insurance.

The discussion yielded the following:

Participation with insurance does not permit the patient to have access to the BEST POSSIBLE DENTAL CARE.

Insurance limits the materials the a dentist can use.

Insurance precludes dentists from hiring and paying for the BEST staff members.

Insurance prevents a dentist from using the BEST dental laboratories.

I will not have the stockholders of the insurance companies preventing me from deliver excellence in clinical dentistry  because they want to make more money.

YOU are MY PATIENT and no one will dictate the quality (or lack of)  of your  treatment.

No Rumors!!!

 Rumors are impossible to deny once they create a life of their own.

THREE WEEKS AGO, the wife of one of my patients developed symptoms of  Covid and tested positive. My patient called me a week ago to report the results of the test and I immediately called my physician to ask for a prescription for a Covid test. My test and Jeanine's test both came back NEGATIVE. The last time we saw our patient was 20 or so days ago.

Before I received my test, I CLOSED our office for Monday and Tuesday out of an abundance of caution so that everyone associated with our practice would be safe. I would never put my staff or my patients at risk so we did the right thing by closing.

We have no illness in our office or our families.

Rest assured that we will always do the right thing to keep you healthy and safe including the installation of FOUR UV AIR FILTERS and an even greater attention to our sterilization of our rooms between patients.

What do we know?

MASKS PREVENT DISEASES LIKE COVID.

WEAR YOUR MASKS.

No Way to Select a Physician or a Dentist

It is quite common to select a physician or dentist by checking reviews.

In MY OPINION that is an unwise way to select people to take care of you.

Why??????

Many Doctors and Dentists hire a service to write good reviews for them. Or many put their patients on the spot and request  positive review prior to leaving the office.

More commonly, a 'good dentist' is a dentist that accepts your insurance and doesn't hurt giving Novocain.

The BEST WAY to select a dentist is to use OBJECT MEANS to your evaluation such as the following:

1. The BEST clinical dentists are those that use a rubber dam when they place a bonded posterior resin. Unfortunately only 5% of dentists use a dam ....the BEST 5 %.

2. The best clinical dentists have thousands and thousands of world class continuing education

3. The Best dentists will have many examples of their work to show other patients.

4. Better dentists post cases on dental forums for constructive criticism.

5. Better dentists TEACH at a dental school or to local dentists.

It is a good idea to use Yelp or Google to find a great restaurant. It doesn't work so well to find great people to take care of you.

Do No Harm

The most traumatic treatment that can be performed on a live tooth is the preparation of the tooth for a crown;  Preparing a tooth for a crown in a young patient 20-40 is the most detrimental. I have not placed a crown on a live tooth for a 20,20 or 40 year old in almost 25 YEARS.

If a crown is placed on a vital tooth in a young patient, the chance that the tooth lasts an entire life is very low while the probability of an implant is high. In my practice, the placement of a crown is the dental treatment of last resort, regardless of the age of the patient.

Notice what happened to the tooth when the mercury amalgam was removed. The entire cusp fell off because of expansion and contraction of the metal.

No healthy  tooth structure was removed to restore either tooth. One or both of these teeth would have been crowns or onlays in other dental practices.

Do no harm.

My Ibuprofen is Made in China

I don't know about you but I am very concerned that the majority of our generic drugs are made in China.

20 years ago, China was making baby cribs for Americans. Shortly after we started importing the cribs, we found out that the paint used contained LEAD. The Chinese became indignant when we complained and said, "You told us that you were concerned about price. You didn't say that you wanted safe."

China has always cheated.

I do not feel comfortable about taking drugs made outside of the United States.

How do YOU feel about that?

Shake Your Head

You know that dentists are only permitted to see emergency patients during the Pandemic. I was scheduled to see a patient for a new patient examination on May 18 but the patient called stating that he had  a problem.

The patient sent me an X-Ray of the painful tooth and stated that his tooth hurt and the gum tissue was swollen. I looked at the X-Ray and sent it up to Root Canal Experts so that Dr. Banchs could look at to see if he should see the patient for a 3-D Scan? The tooth had a previous root canal but the tooth was still infected. Dr. Banchs that that it would be beneficial for him to see the patient and we gave his office the patient's cell phone number.

A few hours later, I get an email from Root Canal Experts stating that the patient did not want to pay for a consultation.

When Tricia told me this, I asked her to call the patient and cancel his upcoming appointment in our office.

As EVERYONE knows, I am interested in taking care of my patient in the best possible way and always doing the right thing. Obviously this person was not interested in Excellent Clinical Dentistry and cannot stay in our office.

If a patient wants mediocre dental care, there are many, many dental offices to select from. If a patient wants EXCELLENCE, they have a handful of dental offices capable of delivering that quality of dentistry.

For me, it is about taking care of patients that want to be taken care of..
It is NEVER about the money.

Simply Amazing

Last night at about 10:30, I received this very kind note via email:

Dr Benjamin, When my son Steven was in third grade, 8 yrs old, he fell and chipped his front tooth on his way home from a birthday party. He was terribly distraught when he get home so I called you. Even though it was a Saturday, you told me to bring him into the office. He had gone to bed and had fallen asleep and I told you that so you said to let him sleep and to bring him in on Sunday morning. You fixed his tooth (using a blue light) and he was once again a happy camper. His mother was also very appreciative. He is now 40 years old and he just had to have the procedure redone. What a good thing you did that day so many years ago. I thought you might like to hear his story and to hear how your great work lasted 32 years! Thanks once again. Sincerely,

32 years ago was a period in my career before I went on a CE (Continuing Education)  explosion that ultimate includes about 7200 hours of World Class Continuing Education. Back then, a was a young average dentist. My work has almost always stood the test of time. The oldest crown that I can keep track of is about 45 years old. A crown that I placed on my wife's tooth, 1 year out of school laster 30 years.

I am very grateful for Steven's mother's email. Do you really think that Steven's mom remembers or cares about what I charged her 32 years ago?

Physicians and Dentist Must Stand Up for Our Patients and ourselves.

https://www.youtube.com/watch?v=Mvlqh0JN55M&feature=youtu.be

You MUST WATCH this video by an ER Doc who is complaining that physicians are told what to do by MBAs rather than be allowed to take care of their patients.

Take care of patients. Do the Right Thing.

Watch the video.

Just so You Know

As you know, most dentists are closed by order of the Department of Health except to perform EMERGENCY treatment. As one would expect, there are always dentists who will cheat and just continue with their regular scheduling.

My online colleagues say that they are seeing 10 emergency patients a DAY.

Our office has been closed for 3 weeks and I have had 3 emergency calls. THREE.

WHY?

Because the treatment that we provide is performed at the highest possible way that I can. ONE PATIENT PER HOUR..

Do my crowns fall off? NOPE

Do my bonded resin fillings fall out or rot out? NOPE

Are you having a crown placed and then develop a toothache? NOPE.

I do my very best to take care of YOU. You may pay more at the time of treatment but you won't have 'issues' with my work and if you go out 10-20 years, you will see that you actually paid less than at other offices.

Think about that.

Just So That You Know.

I was looking for an email address and an email popped up dated October 18, 2007. Our office Recession began July, 2007 when the headlines in the New York Times read: Congress starts to pay attention to Wall Street ie the Housing Credit Crunch.

The problem? I had no patients despite sitting in my office for 10 hours a day. And no one told me that we were on the verge of the Great Recession.

I sent an email to the manager of the lab I had been working with explaining my woes and the possibility of moving to Saratoga Springs.

This is the email that Tom sent to me:

Dr. B.,

You're one of the finest dentists I've know, clinically and professionally. Your patients have ben receiving the finest in quality care with you as their dentist. More people need to understand that. Maybe a move to a more patient friendly area would be best. They certainly would never be better served with you as their dentist.

Tom

This was very gratifying to see again especially at a time when again, I have no patients.

UNKNOWNS

The Unknowns are by definition, unknown.

That said, it is often common to hear someone say, "How could I know the unknowns."

Many dentists will often ask, "How could I be EXPECTED to know the unknowns?"

The truth is that most often, the unknowns that the dentist claimed were unknown, were only unknown to him or her  BECAUSE, they were to lazy to learn the KNOWN facts.

It is true, that you can NEVER KNOW THE TRUE UNKNOWNS, but it is our obligations as professionals to learn everything that we can because most things ARE KNOWN.

When People (and Government) Doesn't Want the People to Know the Truth

This Issue

Views 204 

 

Citations 0 

 

1

Clinical Trials Update 

March 24/31, 2020

Despite Law, Most Clinical Trial Results Still Not Posted

Anita Slomski, MA

JAMA. 2020;323(12):1124. doi:10.1001/jama.2020.2814

Less than half of US clinical trial results are reported on ClinicalTrials.gov in accordance with US law, according to a recent study in The Lancet.

Of the 4209 trials due to report results by January 2018, only 40.9% did so within the 1-year deadline, and 36.1% of the trials were still unreported by September 2019. Surprisingly, US government-sponsored trials had the lowest compliance. The authors blamed lack of enforcement.

A separate Science investigation backed up the findings. Of the more than 4700 trials the publication examined, 55.3% were reported late or not at all.

Making Things Better: Not Political

This is what I wrote in the Digital Comment section of the NY Times in comments about Thomas Friedman's column.


The Federal Government knows how much taxes each person has paid over the last year and it knows the business account that the money was sent to. Tomorrow morning everyone who earns under $4 million a year will have all of their tax money returned and immediately distributed by their employers. The money is returned to the taxpayer and in, effect, no one will have been laid off and no one will have missed a paycheck. In addition, employers agree to keep all employees and everyone returns to work in 10 days. I too agree that the saving of a relatively few lives is not worth the collapse of the entire economy which will take years to return to normal. Life is not without risk but far more people will die from depression, suicide, drug addiction and wife and child abuse than died of the virus in the next few years if we don't return to work.


Sometimes we need just a little of perspective:

Americans who have died from the flu this season : 16,000

Americans who have died from the Coronavirus to date: 484


Do I think that the Coronavirus is a health issue? 
I do not think that the United States was prepared for a Pandemic.

 In 2010 Bill Gates warned that America would face a Pandemic and was woefully under prepared.

In Early January our INTEL COMMUNITY told the White House that it needed to prepare for a Pandemic based on information gathered from China. (Washington Post, 3/20/20)

Do I have all the answers???? NO!!!!!!
And no one would ask me anyway.

Just a Thought from Jim Collin Author of "Good to Great"

Good to Great Quotes Showing 1-30 of 227

“When [what you are deeply passionate about, what you can be best in the world at and what drives your economic engine] come together, not only does your work move toward greatness, but so does your life. For, in the end, it is impossible to have a great life unless it is a meaningful life. And it is very difficult to have a meaningful life without meaningful work. Perhaps, then, you might gain that rare tranquility that comes from knowing that you’ve had a hand in creating something of intrinsic excellence that makes a contribution. Indeed, you might even gain that deepest of all satisfactions: knowing that your short time here on this earth has been well spent, and that it mattered.”
― Jim Collins, Good to Great: Why Some Companies Make the Leap... and Others Don't

Cut Rate Dentistry is NOT Better than no Dentistry

I see that a local dentist is advertising implants for $1,000.

Personally, I would not have discount dentistry using cheap implants from Korea or China.

 Not in my mouth.

Several years ago one of the labs used a non-proprietary implant screw to hold the post to the implant and all of the cheap screws came lose which meant that I had to start from scratch at no charge to the patient.

I contacted the lab and told them that under no circumstances were they to use non proprietary  parts. A PROPRIETARY SCREW  is made to specific high standards with assurances of quality. A knock off screw has no assurances other than it will be cheap.

It is your body and your choice.

You know my standard: If you were MY BROTHER, this is what I would do.

Not In My Office (NOT POLITICAL)

One of the headlines this morning on CNN said:

White House MD: Trump doesn't need to be quarantined after interactions with 2 people who tested positive for coronavirus

I would bet a year's pay that the physician allowed his patient to tell him what good medical practice is when he refused the recommendation to quarantine.

In our office, my patient is my boss EXCEPT when he or she is hesitant to do the right thing to address infection or function. (Aside: this means that I rarely mention Cosmetic Dentistry to any of my long time patients because a great smile is NOT essential to their health.)

If a patient ignores my recommendations for important dental HEALTH issues, I will ask them to leave our practice.  

MY JOB is to take care of my patients and if someone doesn't want to do that, they have almost a 1,000 dental offices to receive their dental care. 99% of my patients follow my recommendations.

If a new patient presents either as a regular dental patient or for a cosmetic consultation and they then go to another dentist for a second opinion,  I will not accept them as my patient. If a patient does not quickly see that I will ALWAYS PUT THEIR BEST INTEREST ABOVE MY OWN, they cannot stay in our office.

If I were the President's MD, I would have insisted on a Caronovirus test and/or quarantine.

Do it right of get someone else to take care of you.

"You Don't Know How Good it is Not to Have a Toothache"

I met a person about 10 years ago and about 5 years ago, he became my patient. I noted that 3 or 4 of his crowns had come off and were missing and his teeth were very sensitive to cold. A few of his teeth needed root canals as was evident from the x-rays and he was referred to Root Canal Experts.

"I don't mind having a root canal, but will they be able to get me numb? Dentists don't get me numb enough and I feel everything."

My response as always was, "Don't worry, you are now in a different realm with Dr. Banchs and this office."

All the root canals were completed, all the  crowns were replaced after Dr. Banchs completed his work and the 30 year old mercury amalgam fillings were removed and replaced with strong bonded white filling.

And he NEVER felt a thing.

He was in for a cleaning and a filling last week and I said, "It must be nice to have dental problems all the time" to which he responded, "You don't know how good it is not to have a toothache."

Finding people who believe and practice excellence to take care of you is extremely important to your health and happiness. Don't believe that a dentist is a dentist and a surgeon is a surgeon.  Like every profession there is the good, the bad and the exceptional dentist.

Choose excellence.

Slow Year

2008-09 were the slowest time in my career.

2020 is coming close to starting off like my slowest years.

A patient told me yesterday that patients don't come to our office for regular dentistry because  I am a COSTMETIC guy.

That is NOT TRUE...90% of what I do is 'regular dentistry' such as fillings, crowns, cleanings, x-rays.

Please correct your friends when they say that I am a Cosmetic guy and if they want excellent general dentistry.

Why We Don't Like Government (NOT POLITICAL)

I need to get a replacement Registration for my car at the DMV. I go online and find and complete the correct form and go to the DMV in Saratoga County this morning..Virtually empty....YES.

I go up to the check in desk and the lady says, "That's the wrong form!!!!!! That should have been changed online.... Fill out THIS FORM.

I sit down and complete the form and I answer the exact same questions on the new from with the exception of whether I had MODIFIED my vehicle (after the Limo deaths).

Government does not have a right to make mistakes that inconveniences the citizens. The DMV needed to ACCEPT the form that is currently online and THEN change the forms.

20+ years ago, I was returning from seeing my ill Father in NJ and when I went to get onto the New York State Thruway, there was a 2 hour, 10 mile backup to collect $.35. THIRTY FIVE CENTS!!!
I and others wrote Governor Pataki and told him that if he could not collect $.35 more efficiently then he had no right to inconvenience motorists. And so it was. The first toll on the Thruway was removed.

The person at the desk should have called her boss to call her boss and tell them to immediately change the form online...And she should have taken my completed form.
'
Thomas Friedman, Journalist for the NY Times wrote of the escalator in Virginia being out for over 2 years and how the passengers just adapted...Nope, someone needed to be fired. Government controls everything and it does not have the right to make dumb mistakes.

But you can have a Caronavirus test anytime you want.................NOT.

Doing the Right Thing

The Golden Standard in Health Care is, "What would you do if this was your son, your wife or your mother?" It is THAT simple because there would never be money involved.


This is a case that I did several years ago in  which a 21 year old Skidmore male student came to my office requesting that I fix his chipped tooth. As you can see from the top photo, it is obvious where the existing resin filling ends because of the brown stain. Rule #1 in my office is to NEVER place a crown on a live tooth for a 20,30 or 40 year old patient. That said, MOST dentists would have placed a crown on this tooth EXCEPT if it was THEIR SON. I removed the old filling and bonded in a direct  layered resin restoration that to the average person, looks perfect.

Isn't this the way that you want ME to take care of YOU?  And take money out of the equation and just DO THE RIGHT THING?

It is distressing to see money dominate all aspects of health care instead of  doing the right treatment for the RIGHT reason.  Please tell your friends that they don't have to have their teeth cut down (and destroyed) for a crown most of the time. And if the do and they are under 50, they have a $6,000 implant and crown in their future.

The Call from the Coroner's office

I never wanted  any of my patients go missing and have to be identified by dental records. But as Mick Jagger says, "You can't always get what you want."

A relative of a patient called late last night and told me that someone had been found and that dental records were needed immediately. This morning I was contacted by the Coroner's office and I sent the requested information.

I received a text from the official this evening:

I just wanted to thank you, again for your care of your patients, always 24/7. I know how difficult it was to receive this phone call. You took such great care of XXX, your dental attention and treatment, superior. I wish you a Happy New Year, Never retire. I appreciate what I experienced today; a caring, appreciative, talented dentist who went into the profession to help people. You happened to also be greatly talented. You help a family have closure. Great appreciation for helping me today. XXX , DDS, Forensics

Doesn't make me happy...In fact, the opposite.

Don't Believe It

I constantly see an ad on TV for Mini- Implants. The dentist says that Mini-Implants are really good and are much cheaper.

Wrong and wrong.

Ask a surgeon who has to take out mini-implants due to infection. The mini implant does NOT integrate into the bone like regular implants. What does that mean? It means that the bone does not grow around and attach to the bone. And what does that mean? It is much easier to lose an implant. Do mini-implants have a place in dentistry? Sure in an 80 year old man who can't eat with his dentures....Go for it.