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May 2019

How Can I Boost My Perio Department? My Soft Tissue Management Program Is Non-Existent!

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How does a dental practice know if they have a true periodontal therapy program or if they are just a “prophy palace?” In this episode, The Dental Practice Fixers, Dr. Richard Madow and Dr. David Madow discuss ways to provide better patient treatment AND boost revenue by correctly diagnosing and treating periodontal disease. Most adults in the United States have some form of perio disease – so let’s learn how to treat it correctly – and how to answer the question “Why didn’t my last dentist tell me this?”

And then of course there is the “Call Of The Week.” We continue the theme by asking an office manager if they have a soft tissue management program. It’s a weird question, but one word really tripped her up. Most importantly, did she schedule the patient? Listen and find out.

How does a dental practice know if they have a true periodontal therapy program or if they are just a “prophy palace?” In this episode, The Dental Practice Fixers, Dr. Richard Madow and Dr. David Madow discuss ways to provide better patient treatment AND boost revenue by correctly diagnosing and treating periodontal disease. Most adults in the United States have some form of perio disease – so let’s learn how to treat it correctly – and how to answer the question “Why didn’t my last dentist tell me this?”

And then of course there is the “Call Of The Week.” We continue the theme by asking an office manager if they have a soft tissue management program. It’s a weird question, but one word really tripped her up. Most importantly, did she schedule the patient? Listen and find out.

If you have a question that you would like answered on our podcast, please send it in to podcast@madow.com. We will do our best to get yours answered!

If you have a question that you would like answered on our podcast, please send it in to podcast@madow.com. We will do our best to get yours answered!

Related article: Top Five Reasons You Have A Lackluster Perio Department


How Can I Boost My Perio Department? My Soft Tissue Management Program Is Non-Existent!

(Dental  Practice Fixers Podcast is brought to you by the Madow Center for Dental  Practice Success. To find out how we can help to increase the success of your  practice check out madow.com or call us at 1-800-258-0060). 
    
  [Music playing]  
    
  Dr. Richard Madow:  Hey there I'm Doctor Richard Madow; welcome to episode  fifteen, season two of the Dental Practice Fixers Podcast. We've got a great  question from a listener today, without giving away too much of the question,  I'm just going to say that this is something we've encountered in a huge  percentage of the dental practices that we work with over the years. When Dave  and I visit a practice, when our coaches do, it's something that many of the  people don’t realize is an issue, or they realize it’s an issue but they don’t  know how to tackle it. I'll just it enough said there, this is something you  absolutely need to listen to and we know that it will help your practice. So  again, I'm Doctor Richard Madow, I'm here with my partner, friend, co-host  I'll leave it up to you to now introduce yourself. 
    
  Dr. David Madow:    Doctor Dave, Doctor  David Madow, how are you all doing? Thanks so much for being a part of the  Dental Practice Fixers, we really appreciate that you’re here joining us,  watching or listening, whatever you’re doing, we appreciate you. 
    
  Dr. Richard Madow:   All right let’s go  and do the questions. 
    
  Dr. David Madow:        I'm just going to  read the question Rich- 
    
  Dr. Richard Madow:   Please. 
    
  Dr. David Madow:    It’s a great topic. 
    
  Dr. Richard Madow:   It’s a short one but  a good one. 
    
  Dr. David Madow:    It’s something that we encounter all the time even in our  coaching, going into offices, seeing what they're doing, the question is 'I  don’t think my soft tissue management program is as good as it could be. Any  suggestions to boosting it?' And it comes with thanks, he says thanks from Dr.  Silvertan in Michigan. I don’t know where in Michigan but somewhere in  Michigan. 
    
  Dr. Richard Madow:   Dr. Silvertan or Dr.  Silverton 
    
  Dr. David Madow:         It says Dr. Silvertan 
   
 
  Dr. Richard Madow:  Ah man, I hope its Dr. Silverton; I want to call him Dr.  Silverton. I have an old Silverton guitar from the early seventies. 
    
  Dr. David Madow:        Oh is it from Michigan? 
    
  Dr. Richard Madow:   Its actually from New Jersey, it was made in Neptune New  Jersey by Danelectro Guitars. [Crosstalk], anyway who cares about that, let’s  get to Dr. Silvertan or Dr. Silverton’s question. Wants to boost soft tissue  management program. 
    
  Dr. David Madow:         It’s a great question and then  congratulations for realizing that your soft tissue management program is not  as good as it could be, and realizing that maybe you should boost it. Rich  what percentage of the offices that we have dealt with over many, many years  would you say had a really good robust, if I can use that word, soft tissue  management program in place? 
    
  Dr. Richard Madow:    Fewer than 20%. 
    
  Dr. David Madow:        Absolutely, most  do not. 
    
  Dr. Richard Madow:    So let’s say  congratulations Dr. Silverton for realizing because that’s where it starts  right, for realizing that this is an issue and that you could be doing  better because many practices, you know  what’s funny we've heard this from dentists, from coaching clients  that they understand that they should have a  good soft tissue management program but nobody in their area has perio  disease. 
    
  Dr. David Madow:   Wow I'd like to move  to that area. Wow that’s incredible. 
    
  Dr. Richard Madow:    I want to move to an  area where nobody has any diseases at all. 
    
  Dr. David Madow:         That would be great, let me know where that  is. 
    
  Dr. Richard Madow:    Isn’t where that all  starts? 
    
  Dr. David Madow:        Thinking that their dental population does  not really have- 
    
  Dr. Richard Madow:    Well it starts with  realizing that you need to be diagnosing more perio. 
    
  Dr. David Madow:        Yeah and the good news about this and this  question is that, I mean we don’t have, somebody is not writing saying 'how  can I do crowns in one day?' Yeah you can do crowns in one day but you can be  spending a hundred thousand dollars upfront to do that. The good thing about  this is you really don’t need to be investing in any expensive equipment, any  systems, you just have to do things a little differently, diagnosing and  treatment planning, that’s all and when you do that you’re going to see a  tremendous difference in your practice, in your production, in your  collections, in your revenue. 
    
  Dr. Richard Madow:    Invest in a couple  perio probes. 
    
  Dr. David Madow:        That’s all you  need. 
    
  Dr. Richard Madow:    Okay I'm going to  give a suggestion to him. 
    
  Dr. David Madow:        Yeah sure. 
    
  Dr. Richard Madow:   I'll just be very brief, I think it starts with a team  meeting, doctor, hygienist, assistant for an office team meeting to talk about  why you feel like the soft tissue management program or perio [inaudible  04:09] lacking, present the statistics that what it is you can find a million  different stats but let’s just say 70% of adults in US have some form of perio  disease and you want to really become a place where this is diagnosed and  treated, because if you’re not doing it you’re just letting your patients  lapse into worse and worse perio disease. So let’s start with the altruistic  nature of a soft tissue management program. The US population has periodontal  disease and it's our job to find it, to diagnose it and to treat it, it all  starts there. 
    
  Dr. David Madow:        And if you’re not doing it, forget about  the revenue for right now, more altruistic and well you’re doing the right  thing covering yourself, because if you’re not diagnosing perio, you’re  setting yourself up for some serious malpractice suits, and it's a disease  that people walking around with and coming in your office and if you’re  ignoring it and especially doing other work on top of that it is a disaster,  it's a mess and now these days especially knowing the periodontal disease is  linked to cardiovascular disease and other things, it’s something that has to  be dealt with. It's not an option; you have to do it. 
    
  Dr. Richard Madow:     You know it’s funny we know and we've heard it  and we know for a fact that one of the top categories of dental practice  lawsuits is failure to diagnosis periodontal infection. I just wonder when  some lawyer, because you know these lawyers right, they're pretty sharp,  somebody dies of a heart attack and then they're going to, the dentist will be  sued for not diagnosing perio disease, we’re supposed to say if this dentist  would have diagnosed perio disease they could have said well what’s meant to  cardiovascular disease you need to see your physician, that theoretically  could happen and that could be crazy. 
    
  Dr. David Madow:        I'll tell you what else is happening right  now, I guarantee this is happening, doctors watching us right now, they're  watching us or listening to us and they're saying to themselves 'ah I know all  about that,' but I bet you that they don’t have a really good soft tissue  management. They might even think they do but I bet they don’t because most  don’t. 
    
  Dr. Richard Madow:    I agree. 
    
  Dr. David Madow:        Most don’t. 
    
  Dr. Richard Madow:  [Inaudible 06:08] time and time as supervised neglect and  some people will challenge saying 'well the legal definition of that is not  what you were about to talk about but screw the legal definition let’s just  talk about kind of maybe layman, not layman’s but lay-dentists’ definition of  supervised neglect, and that is you see a patient, they're a great patient,  they're coming every six months, they've got maybe a little five millimeter  pocket here, a little four millimeter pocket there, a little inflammation, and  you're just giving them a regular cleaning, you bill them for exam & profy  and you say 'okay so let’s just pay attention to flossing and see if it will  get a little better,' and you’re not treating them as a perio patient. You’re  neglecting it and you’re in charge and they're coming in and you’re kind of  patting them on the back and you're kind of saying everything is going to be  fine, meanwhile they have active disease, it may not be a high level but they  have active disease and we're just letting it slide. 
    
  Dr. David Madow:         And God forbid they go to another dentist  down the road, they move, they change dentists for some reason and they go to  a dentist who is on top of things and they’ve got periodontal disease, guess  who is going to be trouble? You’re going to be in tremendous trouble, so stop  right now thinking that you’re doing everything right, because according to  our stats going into offices over many decades, chances are you are not, now  if you are, congratulations but chances are you’re not. Okay where does this  start, set a team meeting, educating the team, I say make sure the team  totally understands what periodontal disease is, the prevalence, how it's  treated, what can happen if it's not treated. Again in lay terms, they don’t  have to take a periodontal course in dental school. 
    
  Dr. Richard Madow:    They don’t have to  become board certified periodontists. 
    
  Dr. David Madow:        But in lay terms  make sure your team understands exactly, exactly what periodontal disease is.  I was in a restaurant a couple of weeks ago and the waitress she was taking my  orders smiling and you could just, I could see clearly that she had [perio].  She had [crosstalk] but I'm thinking does she go to some dentist who like pats  her ‘Betty you’re doing fine, everything is good,’ a lot of people do that and  it’s supervised neglect. 
    
  Dr. Richard Madow:  But her name wasn’t Betty either [inaudible 08:15] and then  of course then where do we go? Every patient whether it’s a new patient or a  recall patient oh we care whatever term you want to use, gets a full exam and  a full exam includes full periodontal probing, charting, pocket depths,  bleeding points, necessary x-rays. 
    
  Dr. David Madow:        Fremitus, you’ve  got to do it 
    
  Dr. Richard Madow:    If someone is not in  perfect periodontal condition they are a perio patient and we treat them that  way, and it may involve very simple treatment, maybe some limited periodontal  therapy, maybe full blown, scaling and root planing with the idea that you may  have to refer them to a periodontal specialist, whatever it is, treat the  disease even if it's low level; they are a patient with periodontal disease. 
    
  Dr. David Madow:         And the best news is that when you do it  right, we're never going to say here 'do unnecessary treatment, treat things  that don’t need to be done,’ you're never going to hear that from us. We went  through phase without dental practices but we actually hired coaches and  consultants that tried to do things like that. We're on to that, we would never  ethically ask you to do something that's not necessary but if you said 70% of  the American public 70-80% I've heard has some form of periodontal disease,  don’t let it go, treat them, treat them right and it will be more revenue for  your practice which is kind of a good thing as well.  
    
  Dr. Richard Madow:    It's a great thing  but I think when you have the initial team meeting, again if you remember from  the last podcast episode, there was an office manager who thought that fees  were too high, you know that kind of stuff happens. So let’s not start with  the idea 'hey we're going to make more money by treating soft tissue  management program, or by having a better periodontal program or strategy and  practice,’ we're going to do this and it’s true, it’s for the good of the  patients and the good of the practice and we want to do our best to be ethical  and have a high standard of care, not get sued and worry about things like  that and that’s why we're instituting this great perio program. 
    
  Dr. David Madow:         You know what we found over the years that  when you’re doing things totally for the money and when you examine a patient  and you basically have dollar bills in your eyes, and that’s all your thinking  and that's all your team is thinking, you've got gold charts on the wall, and  you've got a [inaudible 10:32] - 
    
  Dr. Richard Madow:    Gold charts in the  treatment room. 
    
  Dr. David Madow:        You know look,  Rich and I both understand that dentistry is a profession but it’s also a  business and we realize that you need income, you need to make a good living  and that’s fine. 
    
  Dr. Richard Madow:    And we want to help  you make that. 
    
  Dr. David Madow:        That’s a good thing but when you totally  base your practice on money and on income and that’s a problem, but when  you’re truly treating disease and helping patients, the money is going to come  to you, you’re going to be fine, do it the right way. 
    
  Dr. Richard Madow:    Let’s cover  something that I know many people are thinking that actually is one of the  reasons that people are a little hesitant, it’s a hurdle, a good one, a hurdle  and that is they're afraid that the patients are going to say 'well doc, or  Jane or whoever,' you know my hygienist is Farida, she's fantastic. 
    
  Dr. David Madow:        Farida. 
    
  Dr. Richard Madow:    ‘Farida. I was in  here last time and you didn’t tell me I have this, what happened?’ I think  people are afraid of that question or with the new patient, ‘well my last  dentist never told me anything about this, what’s going on here?' And they  kind of take the defensive and they think the patients are accusing them of  wanting to make more money. How do we handle that? It’s a great question. 
    
  Dr. David Madow:         We always start with being honest, I mean  when you’re honest about something you rarely can go wrong, well so there's  nothing wrong in saying 'well Betty, or whatever your name is Mrs. Jones, Mrs.  there's new research out there, we're always learning, we're always taking new  courses, and although you looked pretty good at your last cleaning, we're  realizing now we're seeing some gum inflammation and we have now learned that  the evidence, the science is out there that if you have gum disease it could  be linked to more things going on your body, such as heart disease and such  things as well. We want to make sure we treat this, catch it in an early stage  and take care of it very conservatively, very easily which will hopefully take  care of your problem and that will be, if we let it go, if we ignore it, if we  let it go then you could have not problems not only in your mouth, infection  could move to other parts- 
    
  Dr. Richard Madow:    I love the word  infection. 
    
  Dr. David Madow:        Nobody wants an infection. 
    
  Dr. Richard Madow:    Nobody wants an infection  and that’s a fantastic strategy for the patients who are already in your  practice and for a new patient my favorite strategy is something like 'well I  can’t tell you what your last dentist saw because I wasn’t there, all I can do  is tell you what we see today and this is what we see today and we really take  a lot of time and as you can tell and care to diagnose every issue that you  may have so that we can help you get better before it’s too late.’ 
    
  Dr. David Madow:        Agree, never blame another dentist even if  the work coming in doesn’t look good, we've gone over that just it’s never a  good thing to say something bad about a previous dentist, it's just not good. 
    
  Dr. Richard Madow:    I think we pretty  much nailed this, everybody in the office has to be on board. Kind of last  episode I think we talked about Max the office manager who was not on board  with the fees that the dentist was charging the patients. So, it’s not a good  thing, so every single person in the office, not only the hygiene department  but the assistants who are going to be coming in contact with these people and  the front desk. Everybody needs to understand periodontal disease to a certain  point and they feel that we're doing the right thing. If you let anybody on  the team  feel that this is just another  profit center, we shouldn’t be doing this, we're over treating, that’s a big  problem and if you can’t straighten that out, that person is not right for  your practice. 
    
  Dr. David Madow:         Did I tell you I was in a plane one time? 
    
  Dr. Richard Madow:    No you never told me  that. 
    
  Dr. Richard Madow:    And they made the  announcement if there's a doctor on board ring your bell and like this guy  opposite row I could see rung his bell and the flight attendant came over and  said ‘sir can you help out,’ and he said 'I'm a board-certified periodontist.' 
    
  Dr. David Madow:         Did that really happen? 
    
  Dr. Richard Madow:    Yes. 
    
  Dr. David Madow:        What did the  flight attendant say to him? 
    
  Dr. Richard Madow:    Next. 
    
  Dr. David Madow:        Exactly. 
    
  Dr. Richard Madow:   First of all does he  have to say he's a periodontist and then a board certified, oh you know what  this patient is having a heart attack they're about to die, if he was regular  periodontist he [inaudible 14:24] to help but the fact that you’re a board- 
    
  Dr. David Madow:        So you think he should have just said a  dentist. 
    
  Dr. Richard Madow:    Yeah. 
    
  Dr. David Madow:        I'm a dentist I  can help out, trained in medical procedures, I can help this. 
    
  Dr. Richard Madow:   A board certified periodontist. 
    
  Dr. David Madow:         What is that? 
    
  Dr. Richard Madow:    Exactly, before we  get the call of the week which cleverly is linked to this question by Dr.  Silverton, I just want to say something that Dave and I talk about from time  to time and we call it lazy expenses and that means money that you’re paying  out every month that you don’t have to be and if you go through your charge  card bill, you'll be amazed you’re still paying for AOL or some kind of web  service that you set up that you don’t use anymore or maybe you just have been  paying for Netflix or some music service that you don’t use anymore, get rid  of that lazy expense. One lazy expense that we've seen is people that are  overpaying for their credit card processing. You don’t know it because some  bank called you two years ago and said 'I can save you money on your credit  card processing and they showed that they could save you money and so you got  that and month after month you’re probably paying a lazy expense. Check out  Fattmerchant, they do it differently, they do not charge an average  percentage, you’re being paid by your credit card, I mean you’re being charged  by your credit card processing company an average percentage every month, an  average percentage every month, Fattmerchant just charges you a really low  monthly fee. You will save money and get rid of that lazy expense, so check  them out. bit.ly/fattmad fat is spelled F-A-T-T-M-A-D. So its bit.ly/fattmad,  that’s a landing page that we've set up just for you and the reason we want  you to go to that page, that website landing page whatever you want to call  it, is because when you do that they'll give your equipment at no charge. 
    
  Dr. David Madow:        Wow. 
    
  Dr. Richard Madow:    We use Fattmerchant  for our credit card processing at the Madow Center and you should use it to. 
    
  Dr. David Madow:         Would you say that lazy expense they kind of  add something on to their typical credit company. That’s similar to a hotel  having a rate of like 139 dollars but then you get there and then they charge  you like resort fees. 
    
  Dr. Richard Madow:    I don’t know because  that’s a flat fee, so it may be more like a tax, because that's a percentage.  Something that doesn’t have to done but hotel man that’s ridiculous. You go  book online The Hilton in Manhattan wow its expensive its 249 dollars a night,  wow I'll book it and you get there and it’s like 350 and by the time you check  out it’s crazy, the city tax, the state tax, the local tax, the amusement tax,  the Javits Center tax they have in New York, all kinds of stuff. 
    
  Dr. David Madow:        If you are  following us and we appreciate that and if you just feel like you’re in your  practice and that you could be doing much better but you just don’t know how  to do it. You know that you’re kind of right here but you want to be here, you  want to be doing better in your practice, we invite you to attend one of our  Madow Masterclass days, here in Baltimore Maryland at the Madow Center For  Dental Practice Success, it’s a full day or almost a full day, it’s a very  limited number of doctors that attend. Each one we keep it small intentionally  and during this day we will show you pretty much from start to finish how we  can help you build your practice and grow your income, increase your revenue,  it’s a great day, we invite you to hang with us, me and Rich and our coaches  for a full day. To find out more we've got some coming up right now and by the  way they do fill up.- 
    
  Dr. Richard Madow:   I think we need to schedule another one. 
    
  Dr. David Madow:        We really  should, you can schedule right now by going to masterclass.maddow.com. We've  got some coming out really soon, check them out, we’d like to see you join us,  hang with us, it will be fun. 
    
  Dr. Richard Madow:   Let’s do a call of the week. 
    
  Dr. David Madow:         Sounds good. 
    
  [Phone  call] 
    
  Terry:   Thank you for calling the office of doctor *, this is Terry how may I  help you? 
    
  Dr. David Madow:   Hi Terry I'm kind of new in the area, and I'm looking for a  dentist and everything I read about now it says make sure you have somebody  that has, I think it's called a soft tissue program. I want to find out if you  all have that? 
    
  Terry: Um- 
    
  Dr. David Madow:    Some type of soft  tissue- 
    
  Terry:     Um well not necessarily a program but we do check the soft tissue and measure  your gums, take gum measurements and everything. 
    
  Dr. David Madow:  Okay but you don’t necessarily have a program in place or  anything like that? 
    
  Terry:     No, never heard of that, a soft tissue program. 
    
  Dr. David Madow:        Soft tissue  management I think, soft tissue management I got written down here.  
    
  Terry:     No, never heard of that, we do, do things called like if you have like gum  disease, like bone loss we do something called scaling and root planing and  periodontal cleaning which is basically under the gum line and you have to be  numbed for it but as far as an actual program I've personally not heard of  that. 
    
  Dr. David Madow:   Okay. 
    
  Terry:     It sounds like you may want to see like a periodontist. 
    
  Dr. David Madow:   Ah I see. 
    
  Terry:     Yeah it sounds like that, something a periodontist would do. 
    
  Dr. David Madow:   Right, well thank  you very much for your help. 
    
  Terry:     No problem. 
    
  Dr. David Madow:        Okay thank you bye-bye. 
    
  Dr. Richard Madow:   Interesting. 
    
  Dr. David Madow:        These things just keep writing themselves,  you can’t make these things up. 
    
  Dr. Richard Madow:    Well look I mean I'm  going to defend her for a second. 
    
  Dr. David Madow:        No you cannot defend her. 
    
  Dr. Richard Madow:    It was a very odd  question. 
    
  Dr. David Madow:        Okay I’ll give her that. 
    
  Dr. Richard Madow:  You could never have anticipated that question in a team  meeting that someone is going to call and say 'do you have a soft tissue  management program?' She was really thrown by the word program. That threw her  for a loop. 
    
  Dr. David Madow:        Yeah the  [inaudible 20:02] thing she said, I think she said they do soft tissue  management but they don’t really have a program. 
    
  Dr. Richard Madow:    Well I don’t know  what she thought that meant, like a TV program, I'm not sure what she meant.  
    
  Dr. David Madow:         I don’t know but I'm not going to defend her  as much because it was not a difficult question, if she'd been trained even  understanding, look we talked about it the first statement on the show, get  your team to understand, on a fairly simple level what gum disease is and why  so many people have it and why we're treating it. She could have given a  simple explanation, 'oh you called the right office, yes every patient that  comes in here we thoroughly check your gums and we check the gums for  infection and if we see anything, we can mostly likely treat you very easily  here.' That’s all she had to say. 
    
  Dr. Richard Madow:    I agree she could  have just said 'yeah we absolutely, we don’t call it that,' she could have,  just kind of stipe on here, she could have said 'we don’t have soft tissue  program but we absolutely check gum disease here, let’s get you in for a full  examination.' 
    
  Dr. David Madow:         I mean did she have to say that 'sometimes we  numb you up and we clean under your gums.' Nobody knows what that is. 
    
  Dr. Richard Madow:   Absolutely not, nobody wants to hear that. 
    
  Dr. David Madow:        Nobody wants to hear that, that’s right. 
    
  Dr. Richard Madow:    But I love how at  the end she was ready to send me to a periodontist. 
    
  Dr. David Madow:         Doctor Perio dentist.  
    
  Dr. Richard Madow:       That sounds like an Irish guy, Doctor Perio Dentist. 
    
  Dr. David Madow:         [Inaudible  21:17] 
    
  Dr. Richard Madow:    I mean that call  within a minute and ten seconds, she's already referring you and not knowing  anything about you. 
    
  Dr. David Madow:        Yeah a good point, I called to become a  new patient, she’s already diagnosing me- 
    
  Dr. Richard Madow:    And referring. 
    
  Dr. David Madow:   Referring me. 
    
  Dr. Richard Madow:    So the bottom line  is she didn’t really understand the question but she could have easily said  'why don’t you come in, meet the dentist, we’ll do a full examination and if  you do have  gum disease, chances are we  can treat you here.' 
    
  Dr. David Madow:        We are very in-tuned to gum disease,  continued education, we know how to treat it, we do all the time; we see it  and we'd love you to come as a patient. 
    
  Dr. Richard Madow:    We still have a  program. 
    
  Dr. David Madow:        If you want a  program you've got to see a periodontist. 
    
  Dr. Richard Madow:    I hate to say it but  I think the fact that she made no effort to get you in, as a matter of fact  she tried to get you out, and she’s going to get an F. 
    
  Dr. David Madow:        I say she gets  an F-o-dontist. 
        
  Dr. Richard Madow:   Okay, great stuff,  we will see you. That was season two episode fifteen of the Dental Practice  Fixers, I'm Doctor Richard Madow. 
    
  Dr. David Madow:        Doctor David  Madow and we will see you next time, thanks for being with us. 
    
  [Music  playing] 
  
   

My Office Manager Thinks My Fees are Too High

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What happens when a doctor recommends treatment to his patients but then passes it over to the office manager to discuss the financial aspects as well as schedule? This seems fine but very few are actually getting appointed. Why? Because the office manager is uncomfortable handling this because she feels the dentistry is too expensive. What do we do? This is a question that was sent in to The Dental Practice Fixers, so please listen to what Dr. Richard Madow and Dr. David Madow have to say. Then of course we do the call of the week. We call an office
asking a fairly simple question – I need a crown. Fairly straightforward, right? But then we reference something on the office’s website about what the crown is actually made from. That’s when the call goes a bit downhill! You need to listen to this one.

If you have a question that you would like answered on our podcast, please send it in to podcast@madow.com. We will do our best to get yours answered!


My Office Manager Thinks My Fees are Too High

Voice Recording: The Dental Practice Fixers Podcast is brought to you by the Madow Center For Dental Practice Success. To find out how we can help increase the success of your practice, check out madow.com or call us at 1-800-258-0060
 [music playing]
 Dr. David Madow: So you’re pretty good at presenting treatment plans and by the time you turn it over to your office manager, she’s not only a little bit on control, but she doesn’t want to talk fees because she thinks your fees are too high. We’re going to talk about this. Episode 14, the Dental Practice Fixers. Welcome, welcome, welcome. Dr. David Madow, along with…
 Dr. Richard Madow: Dr. Richard Madow. Thank so much everybody for being here. We love the nice comments we get on the podcast. So please keep reviewing us on iTunes, sending us great emails even if you want to critique us and tell us you don’t like the podcast because of this particular reason. 
 Dr. David Madow: Go do that.
 Dr. Richard Madow: We’d love to hear that.
 Dr. David Madow: By the way, real quick. A coffee clink, that we’re here live together in the studio.
 Dr. Richard Madow: Yeah it’s great to be here. 
 Dr. David Madow: Coffee clink.
 Dr. Richard Madow: You know how important this mug is to me. I feel like [cross talking - 0:01:16.3]. This was a present from Dr. David Moffet all the way from Australia. Using it quite a bit at the office ever since. Thank you Dr. Moffet if you’re watching. Tonight you should. Okay. Speaking of that, we love your questions for the podcast. So please, please keep sending it like Dr. Eddie M. did from New Jersey today. Here’s his question. It says Dental Practice Fixers, up until now I have been presenting all of the treatment including fees. My acceptance percentage is pretty good but not great. How is your acceptance percentage?
 Dr. David Madow: It’s pretty good. Do you want to find them? 
 Dr. Richard Madow: Pretty good. Everyone loves my office manager. And I thought she could do this very well. So I talked to her about getting more involved. She told me she was not comfortable with presenting fees, because she thinks my fees are way too high. What should I do? Dr. Eddie M. in New Jersey. Well the first question I always ask somebody from New Jersey is what exit. 
 Dr. David Madow: 107, 101.
 Dr. Richard Madow: No that may be only the Garden State Parkway like, not the New Jersey Turnpike. But okay, Dr. Eddie M. from New Jersey. I was pretty good at presenting treatment. Acceptance percentage has not been fantastic. He thought maybe his office manager could have better rapport with the patients. So he says, hey let’s call out match. It’s like our [inaudible - 0:02:41.0].
 Dr. David Madow: That’s a good one. 
 Dr. Richard Madow: I love you to get her more involved but – and I agree and you’d probably agree with this too. That maybe for complex cases is one thing, but it starts, always the best use of the dentist’s time talking about routine treatment. And a really talented office manager/treatment coordinator should be able to do a great job of that. Agreed. Maybe not. 
 Dr. David Madow: Seriously, I did that just to throw you off a little but it didn’t work. Yeah totally agree. The dentist I think should be discussing treatment only to an extent, and then you’ve got to have a professional that totally understands everything and can explain it to the patient in  very simple terms along with financial.
 Dr. Richard Madow: Yeah financial. I always felt like, unless the case was really complex, I didn’t want to be involved with the fees. I enjoy telling a patient about periodontal disease. That’s weird in choice [inaudible - 0:03:37.7] about their teeth. How fast to get through this issue? I told him about a crown, what it is, why they need it and how we do those things. But then when it came to money – not that it’s a dirty, filthy topic, but I still know it’s better handled by a talented team member.
 Dr. David Madow: Absolutely. No question.
 Dr. Richard Madow: And we can even say hey. Let me concentrate on the dentistry and Carol can talk to you about the finances. 
 Dr. David Madow: I don’t think the dentist should be involved in the financial part, because then what happens if the patient starts questioning and asking about insurance? It’s not in the shoes of the dentist to be involved. Nothing to do with financial at all.
 Dr. Richard Madow: Should we go a little lower doc? Okay so anyway, so this dentist – maybe they were a little behind the curve on that, but not wanting to say to stop. And good, good job Dr. Eddie. And then my office manager said she thinks his fees are way too high. [inaudible - 0:04:23.5]
 [cross talking - 0:04:26.8]
 Dr. Richard Madow: The older brother always tells the little brother what to do. I’m 60 years old dammit. Stop telling me what to do. 
 Dr. David Madow: I totally took care of the baggage in another episode.
 Dr. Richard Madow: No I don’t want to work. I just want to bang on the table the whole day.
 Dr. David Madow: I get it. Well I see with that a much deeper problem than somebody than an office manager not being able to talk about treatment plans or financial with patients because she thinks the fees are too high. It goes deeper than that because if there’s somebody working at the front desk especially an office manager, first of all she’s got – I’m assuming she’s got people that are working under her who’s she’s talking to. But not only that, every time a phone call comes in and they ask a question about some type of treatment. In her mind, in her heart she believes that this office is way too expensive. That’s a major problem.
 Dr. Richard Madow: I agree. It’s a huge problem. Let’s face it, we know that dentists in general although we have seen exceptions, earn more money than their team. I mean that’s the hierarchy of earing in the dental practice. And let’s say that you’re a dental office manager, you’re making a great salary but you might have a more [inaudible - 0:05:33.5], some debts and all kinds of things that you’re – spending is very – you got to be really careful of what you spend. And then you hear that a crown or whatever, somebody’s treatment will be thousands of dollars and you think to yourself, wow I’m glad that I’m not faced with that situation. Because I don’t know how I can come up with two, three, four thousand dollars for now. It would be a struggle for me. And we totally get that and it’s important to know that. But I think the office manager has to be comfortable that excellent quality healthcare does have a cost. This cost is fair, it’s reasonable and she’s being paid her paycheck because of these fees and we’ve got to think that the patient is getting a really good value. That’s the main thing. If you don’t believe the patient is getting a good value, it’s going to be tougher for you to present and to collect.
 Dr. David Madow: Well it’s interesting what you just said, and I’m wondering there are two levels and we’ll know the answer to this because this question will just [inaudible - 0:06:28.4] for you. But does the office manager think that dentistry itself is very expensive? In other words, no matter where you go, if you’re going to get dentistry it’s going to be expensive and it’s not worth it. Or does she think this office’s fees are way above what they should be. 
 Dr. Richard Madow: Great question. Let’s say B. 
 Dr. David Madow: That’s the way I took it.
 Dr. Richard Madow: I wasn’t sure but I’m glad you brought up.
 Dr. David Madow: I took it that way. 
 Dr. Richard Madow: Okay. Let’s say that she feels this particular office is overpriced so to speak.
 Dr. David Madow: Especially, how does she know and maybe – let’s say she’s called around. Let’s say this office is in the top 20% of fees in the area. That’s fine as long as the quality of care is really good, and the dentist cares and he’s doing really good work. She should be – some old consultants used to say, we should be proud of our fees.
 Dr. Richard Madow: I never liked that.
 Dr. David Madow: I put all kidding aside. You should be because let’s say I needed some type of not dental treatment. Some of kind of medical, surgical procedure. I want to go to the person that is the best even if the fees were higher than the other surgeons. I want to go to the person that I felt was really going to help me and same thing with a dentist. If I were…
 Dr. Richard Madow: Not everyone can afford that person. Let’s face it.
 Dr. David Madow: Right.
 Dr. Richard Madow: I just saw, I think it was a survey online that 86% of dental practices are in the top 20 percentile when it comes to their fees. 
 Dr. David Madow: Absolutely. And do you know that 50% of the dentists are or 49% of the dentists are below average. 
 Dr. Richard Madow: Well I’m not away in [inaudible - 0:07:58.7]
 Dr. David Madow: I think it’s – I hate to say this with some dentists but it’s kind of true.
 Dr. Richard Madow: So look to your left, look to your right if those things are above average. Okay, so let’s get back to this question. 
 Dr. David Madow: What do we do?
 Dr. Richard Madow: Let’s just say that this practice is – well one thing is if they are in the typically top of fees or top 20 or 10% or whatever. There better be a reason. So this practice should be providing really really high quality dentistry. Great patient care, they take their time with their patients, don’t rush them in and out, a fee for service practice. All those things that would justify fees on a higher end.
 Dr. David Madow: Yeah. Now it goes down to – it gets down to this office manager. Nothing can be done to make her really feel that she’s working for a great dentist, who does great work, who really cares about his patients. That means you need a fix. If that can’t be fixed, I got to tell you something. The dentist needs to move on and find somebody that really believes in his or – I don’t know if it’s his or – from Dr. Eddie M. His work. You cannot have an office manager that’s second guessing you, that doesn’t believe in you, that thinks you’re too expensive, that thinks you’re ripping people off. You cannot have that. 
 Dr. Richard Madow: Well maybe it’s up to the dentist to teach the office manager why their fees are worth what they are. And let’s just say it’s scenario A where this person thinks in general, dentists are so expensive. There’s so many – right and a lot of people think that. Maybe they shouldn’t be working in a dental practice but I think we should give them the opportunity to learn and let’s use the old analogy that everybody understands. If you’re a car salesman and you’re selling KIAs versus selling BMW, well KIAs are great cars. Very reliable, they last for a long time, they look great and all those things. But BMW is more expensive for many reasons. I’m not a super car guy but I would imagine they drive incredibly well, all those things. If you were the BMW salesman you got to believe that that cost for the BMW is justified. You’ve got to believe that yeah maybe KIAs are great cars, but this car is worth every bit of that $65,000 MSRP or else you’re not going to be able to sell them, and same with the dental practice.
 Dr. David Madow: Okay what does this doc do? He’s got an office manager who does not believe in him, does not believed in his fees. What’s the 30 second version, how does he fix it? What does he do?
 Dr. Richard Madow: A very frank meeting. Max, tell me why you think my fees are just high? Well you know, blah, blah, blah. So let’s find out the reason first of all. Is it because she personally couldn’t afford dentistry? Is it because she thinks all healthcare is so expensive or Dr. Eddie’s fees are so high? Then address it from there and Dr. Eddie better be able to justify why his fees are what they are. 
 Dr. David Madow: We’re not so sure his fees are that high. 
 Dr. Richard Madow: It’s true.
 Dr. David Madow: We’re not so sure. I just wonder if the office manager [inaudible - 0:10:40.7] goes to Dr. Eddie and her family goes to him as patients. I wonder if they do. If they do, that’s a really good sign because they believe in his dentistry.
 Dr. Richard Madow: Or maybe he’s given them a huge discount. 
 Dr. David Madow: He maybe, yes. I mean bottom line is Dr. Eddie has to get his team to believe in him. It’s never to what it’s about. If she does not believe in him, and his fees, maybe they got a beautiful office and let’s face it, it’s a business. You have to charge. If she does not believe in it, then he needs to find somebody who does because there are plenty out there that will. 
 Dr. Richard Madow: There’s something else. I know we need to move over to the call for the week in a second. And again this is lot of [inaudible - 0:11:19.9] because – basing on this question have been set. Maybe Dr. Eddie is flaunting his wealth. Maybe he’s pulling up in a different fancy car every day and all the fancy clothes and coming in with expensive [inaudible - 0:11:34.4] and thousand-dollar shoes. I doubt that’s the case, but you never know. And then I think maybe the practice manager would be suspicious that he’s kind of charging so much and breaking at the…
 Dr. David Madow: That’s a good point. We don’t know if that’s the case but it’s a good suggestion for all dentists. Even if you’re very very wealthy which we hope you are, don’t flaunt it. Be a regular person. 
 Dr. Richard Madow: Be a regular person, save well. Sure. Do the things that money can buy if you’re already near comfortable in your savings and take a great vacation and drive a nice car. But don’t be snobby about or rubbing rubber [cross talking - 0:12:13.6].
 Dr. David Madow: That’s when it comes down to it. Yeah so I think we’ve [cross talking - 0:12:19.2]. You want to get on with the call? 
 Dr. Richard Madow: Before we get on with the call, let’s just say that – we hope that all of our listeners here have this meeting with their team and talk about why good healthcare is expensive and why it’s a great investment, and why it’s somebody who’s struggling with our bills, and he’s faced with a $2500 dental treatment plan. You can show that person why it’s worth it for them to spend that money instead of spending on something else. So I mean it’s a really important conversation to have. We need to talk about the costs of things. 
 Dr. David Madow: So let’s take it even one step a little bit deeper. If there’s anything, anything at all in your office that’s festering, this is a problem, it’s a big problem. But the worst mistake Dr. Eddie could do is let it go. That’s the worst thing possible. You got to take care of any situation or any problem and deal with it. Deal it with here. It may be easy, it may not be easy. You just can’t ignore it and you’ve got to do something about it.
 Dr. Richard Madow: I totally agree. My uncle is festering. I love to hear that. You remember really quickly before we do the call of the week. Talk to our folks about TBSE.
 Dr. David Madow: Let’s do that. Absolutely.
 Dr. Richard Madow: TBSE stands for The Best Seminar Ever, that we produce every fall in Las Vegas. We didn’t name it the best seminar ever. It’s the 25th year. I think about – we used to call it The Super Fall Seminar. Maybe in its 4th or 5th year the attendees started suggesting that hey this is the best seminar. We should call it that. 
 Dr. David Madow: I’m going to tell you it’s nice. It still is. No question about it.
 Dr. Richard Madow: Incredible speakers, two days. Everybody in the same room. You’ll love so much practice growth and motivational information. It’s this November at the incredible Tropicana Resort Hotel in Vegas. So if you want to learn more, just go to tbse.com. Stands for The Best Seminar Ever.com. You’ll see who the speakers will be this year, learn a little bit about the venue. See how inexpensive it is for the doctor and team to have a great educational vacation. I know a lot of people say edutainment. I’m trying to figure – is there a word combined, education and vacation. But they’re kind of the same ending. They might be tough. It’s eduvacation. Starts to sound a little weird. [cross talking - 0:14:39.6]. It’s a great educational vacation.
 Dr. David Madow: You’ll have a great time.
 Dr. Richard Madow: And we’re gonna be of course hanging out with everybody. Tbse.com.
 Dr. David Madow: Maybe we could plan a live podcast or something. 
 Dr. Richard Madow: It’s super cool.
 Dr. David Madow: Keep on that [cross talking - 0:14:53.9]
 Dr. Richard Madow: It will be hilarious. 
 Dr. David Madow: We’re going to be asking live questions maybe.
 Dr. Richard Madow: We’re going to do it.
 Dr. David Madow: Let’s try it.
 Dr. Richard Madow: I’m not sure when but we’re going to do it. TBSE.com. We’ll see you in Vegas.
 Dr. David Madow: We hope to see you there. Real quickly also two things, so if Rich and I can send you a check for $50 every month or $100 or $500. Would you cash it? Would you take it?  Probably not going to be able to do that, but we’ve got something, I think it would be kind of similar: changing your credit card processing for a company that we’re using. We believe in Fattmerchant. We use Fattmerchant here, we’ve talked about Fattmerchant before. It’s a really simple way. It’s a really simple way to change. You just go online and change it. And I guarantee because it depends on the file you’re doing. Some docs watching this are doing very low volume. Others are doing an extremely high volume, but again, it’s like sending your check or it’s like Fattmerchant sending you a check every single month because we’re saving all your credit card processing. Why wouldn’t you do it? It’s so simple to change. Go to BIT.LY/FattMad all one word. I’ll do it one more time and if you’re watching the video which we hope you are, it’s right below us. BIT.LY/FATTMAD, also while we’ve got your attention, we hope we still have your attention, I think the call is going to be great today. I know that. I know and I feel it. But if you want to take your practice and you’re struggling and not sure you reach this clientele, you really want to improve your practice, you’re not sure how to do it. We encourage you to attend one of our Masterclasses. They’re at the Madow Center for Dental Practice Success in Baltimore, Maryland. And most of them sell out and we keep them very very small. Go to masterclass.madow.com, you’ll see our schedule and we’d love to have you attend for a day. It’s a great day of learning with me, with Rich, with our coaching team. It’s something that will really help your practice and your life. We hope to see you there. 
 Dr. Richard Madow: Alright. So call of the week. Let’s just say that you’re a patient looking for a new dental office. You know you need a couple of crowns, you pick a dentist, you go on their website to do due diligence, you have a question on something you saw on their website, you were committed to find your new dentist to get a couple of crowns done. How tough could that be? 
 Dr. David Madow: Usually enough.
 Dr. Richard Madow: Let’s find out.
 [phone ringing]
 Female Voice: This is Amy.
 Dr. Richard Madow: Hi Amy, are you seeing new patients now?
 Female Voice: Yes we are. 
 Dr. Richard Madow: Good. I have a question for you. I was told maybe a few months ago I need a crown. So I was just Googling around and I came upon your website. I saw you had a little section about crowns and caps. And I was reading and said a crown can be made of either porcelain baked onto a metal substrate. I wasn’t clear what that meant. What does that mean? Baked onto a metal substrate.
 Female Voice: Well it’s just a porcelain crown that what they did – they built the crown but then they make it – it’s kind of hard for me to explain. Basically it’s just porcelain. It’s a porcelain crown. They have to put a retainer and filling on it first and they have to build a crown on that. That could mean what they’re talking about putting them on a metal. But it’s basically just a porcelain crown. So you’re going to get a temporary prior to that. 
 Dr. Richard Madow: So the whole crown is just made out of porcelain?
 Female Voice: Right. 
 Dr. Richard Madow: Okay I understand.
 Female Voice: It’s a porcelain crown.
 Dr. Richard Madow: I understand. And I needed – let’s just say I think I need two crowns, I mean you might find differently but how long would that take to do two crowns do you think typically?
 Female Voice: In one day – are they on the same side, are they on the opposite side, upper or lower. It can also depend. If they’re on the opposite side of the mouth, we have to do two different appointments. 
 Dr. Richard Madow: I’m pretty sure they’re both on the right hand side. 
 Female Speaker: Right hand side. Okay each crown usually takes about an hour and a half. So you’ll be here a little over two hours. 
 Dr. Richard Madow: So each one takes an hour and a half. Okay great.
 Female Voice: Yeah but it can usually – if they’re right next to each other, he can usually can numb the whole area and then he can get that completed within probably getting up preps and ready with about a little over an hour. Then he has to make the temporary so that would take about 15 minutes. 
 Dr. Richard Madow: So more efficient if they’re right near each other?
 Female Voice: Yeah. Otherwise if they’re on the opposite side of the mouth or if one is upper, one is lower, we have to use and make two different appointments because your whole area will be numb. You won’t be able to eat on that side. 
 Dr. Richard Madow: Got you. Hey thanks so much for the information. I really appreciate it.
 Female Voice: You are welcome. Thank you.
 Dr. Richard Madow: Thank you, bye.
 Female Voice: Bye, bye. You’re welcome, bye, bye.
 Dr. David Madow: Oh boy. Another great…
 Dr. Richard Madow: I always like to start with a pause.
 Dr. David Madow: What’s the pause?
 Dr. Richard Madow: We both went to University in Maryland Dental School way back in the ag days. Remember Dr. [inaudible - 0:20:00.8]? The club instructor.
 Dr. David Madow: Yeah.
 Dr. Richard Madow: Nicest guy in the world. No matter what piece of crap you will present him with, he would always start with a complement. It’s such a good technique. 
 Dr. David Madow: I like your tie today. 
 Dr. Richard Madow: It’s exactly right. 
 Dr. David Madow: The press sucks.
 Dr. Richard Madow: If you have nothing good to say, you don’t know [inaudible - 0:20:16.4] simple. If they have nothing good to say about the work you are presenting, it was [inaudible - 0:20:22.1] so you can go [inaudible - 0:20:23.8]. You always [cross talking - 0:20:25.9]. Well I like the tie anyway. It’s so funny. So I’ll just say she was nice and friendly.
 Dr. David Madow: I’m not going to disagree. I won’t disagree with you.
 Dr. Richard Madow: Friendly, was willing to take the time to explain, maybe incorrectly but explaining anything the person asks. So at least we’ll give her a little bit of credit. It’s funny, as you remember on this – I mean the voice menu thing, if you’re a new patient who wants to make a new appointment, press 1. You think oh man I’m going to get that, the killer on this thing. 
 Dr. David Madow: You have to close her. 
 Dr. Richard Madow: The close. She’s going to be able to – on any new patient. 
 Dr. David Madow: The call was crazy because she obviously was way in over her head. She didn’t even really understand exactly what a crown was. Let alone, porcelain baked to a metal substrate. 
 Dr. Richard Madow: Okay. Let me talk about that teeth here. See this all the time, you go on a dentist website, they got some pre-purchased, every bullshit to describe dental procedures. And that’s fine, we don’t expect you have the time to write up every single – there are a hundred procedures described on these websites. You don’t have the time to do that. But they use this lingo that no potential patient will possibly understand. It’s too scientific. I wouldn’t say on the website, it’s porcelain baked onto a metal substrate. Somebody that works in a dental office doesn’t even know what that means. 
 Dr. David Madow: I don’t even know what that means.
 Dr. Richard Madow: Exactly.
 Dr. David Madow: Metal substrate. I think in my biology class.
 Dr. Richard Madow: Do you expect a potential patient knows what that means? Say porcelain for looks, metal for strength. I don’t know, whatever. Make it simple so that anybody can understand it. Don’t put this crap on your website that’s way too technical. It just confuses people. 
 Dr. David Madow: I don’t even think we need to get that detail at all. Somebody comes in for a crown it could be explained to them, but it’s a covering, it’s a protection for the tooth to make it stronger. Something like that. But they don’t need to know all this stuff. 
 Dr. Richard Madow: The materials that are utilized. Unbelievable.
 Dr. David Madow: Maybe it’s beautiful porcelain, it’s going to match your other teeth. Something like that. 
 Dr. Richard Madow: I’ve seen websites telling they can be made of Emax. I don’t even know what that is. 
 Dr. David Madow: Nobody cares.
 Dr. Richard Madow: Exactly, unbelievable.
 Dr. David Madow: Ridiculous.
 Dr. Richard Madow: It can be made of Emax, [inaudible - 0:22:43.8]. I don’t know what that is.
 Dr. David Madow: Pardon me. I passed a sign the other day. We were driving along, there’s a dental office. They had a big – what do you call it, like a sidewalk sign trying to be –
 Dr. Richard Madow: Like a sandwich board?
 Dr. David Madow: Kind of be aware. But it’s out on the sidewalk and you take it in at night. And it’s something like: we do CEREC crowns, same day CEREC crowns. Something like that. Who probably driving by doesn’t know what that –
 Dr. Richard Madow: No idea.
 Dr. David Madow: I mean you could if you really wanted to put same day crowns, but I’m not so sure I’ll be putting that out on the sidewalk.
 Dr. Richard Madow: Even so, please CEREC crowns there’s [inaudible - 0:23:14.9]. 
 Dr. David Madow: I know it got some kind of marketing campaign but nobody knows that.
 Dr. Richard Madow: Not much.
 Dr. David Madow: Nobody knows.
 Dr. Richard Madow: Well we’ll get into that in a different time.
 Dr. David Madow: Getting back to the call, she was surely, she was purely asked a question that was out of her lead. She didn’t really know how to explain. You can tell by her voice. Yeah she didn’t really know.
 Dr. Richard Madow: She didn’t know what a metal…
 Dr. David Madow: Metal substrate, no.
 Dr. Richard Madow: And I like how she said each one takes an hour and a half so you’ll be here two hours…
 Dr. David Madow: Two hours. She’s good at math.
 Dr. Richard Madow: She’s good at math. 
 Dr. David Madow: And only is she’s something else. What’s – it’s like the old philosophy that if – it’s got to be next to each other to do in one appointment because you don’t want to be – I mean if somebody came to your office and they needed a crown on number five and number 20, you wouldn’t do it one appointment? 
 Dr. Richard Madow: I wasn’t getting any clinical but I was thinking the exact same thing. Well it’s from the old, old days. If somebody wants two crowns and they want to be in there, do both crowns. It’s easier for the patient. I don’t buy that stuff that they can’t eat. Bullshit. So you tell them not to eat for a few hours. They’re happier because you’ve done both crowns in the same appointment. Your efficiency rating and profit per hour goes way up. So I totally…
 Dr. David Madow: [cross talking - 0:24:24.2].
 Dr. Richard Madow: I know. Unbelievable. And then a patient knows they need two crowns, they push for one for a new patient who wants some appointment.
 Dr. David Madow: That’s a closer. 
 Dr. Richard Madow: And how did she end the call? 
 Dr. David Madow: She ended the call with quick thank you very much, something like that. So never asked your name, never asked for your phone number, never asked if you want to set up – she cannot get back in touch with you.
 Dr. Richard Madow: Zero. And the best opportunity I think is right when the clinical question started. Well the best thing for you will be to come in and [inaudible - 0:24:55.5]. He or she can answer any questions you have. Can you stop by tomorrow at 2 PM?
 Dr. David Madow: Free complimentary exam. Just get them in. Do something.
 Dr. Richard Madow:  She didn’t do that. And then at the very end, she still had the opportunity to say we’d love to see you, can you come in tomorrow? 
 Dr. David Madow: I’ll go back to my point. I’ll do this on almost every call. Most doctors are in the back doing their work, doing their thing. Probably doing great work, doing their thing and they think that [inaudible - 0:25:20.9] at the front desk, she’s so great. She’s so great on the phone. She gets all the patients and meanwhile, how many calls come in like this that [inaudible - 0:25:30.4] doesn’t even ask to set up an appointment.
 Dr. Richard Madow: Well if I push – not push the one, I already got the person that wasn’t this good. We got the best…
 Dr. David Madow: I wonder if you would have gotten like some assistant who was in the middle of taking an impression. She wouldn’t have taken off.
 Dr. Richard Madow: Maybe she wouldn’t pick up the inventory [cross talking - 0:25:45.3]. Anyway, I hate to say it but I think we both agree, she gets an F.
 Dr. David Madow: F.
 Dr. Richard Madow: We’re so sorry to hear that. That will conclude Episode 14, Season 2. Dental Practice Fixers Podcast. We will see you…
 Dr. David Madow: Next time.
 Dr. Richard Madow: Thanks so much everyone.
  
   

Is it OK to Use CBD Oil in My Dental Office to Help My Patients’ With Their Anxiety?

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CBD oil is everywhere. In case you are not familiar with it, CBD is extracted from a variety of the cannabis (marijuana) plant, but it does not contain THC. And since there is no psychoactive component, it is legal all across the United States. Many are using it to combat anxiety, to help get a better night’s sleep, for pain issues and much more. But is it OK to recommend that our patients use it for anxiety in the dental office? This is a question that was sent in to The Dental Practice Fixers, so please listen to what Dr. Richard Madow and Dr. David Madow have to say. Then of course we do the call of the week. We call an office asking a fairly simple question – I need a lot of dental treatment and do you accept Care Credit? Fairly straightforward, right? Well you must hear this response! If you have a question that you would like answered on our podcast, please send it in to podcast@madow.com. We will do our best to get yours answered!


Is it OK to Use CBD Oil in My Dental Office to Help My Patients’ With Their Anxiety?

 Female Speaker 1: The Dental Practice Fixers Podcast is brought to you by The Madow Center for Dental Practice Success. To find out how we can help increase the success of your practice, checkout madow.com or call us at 1-800-258-0060.
  
 Dr. Rich Madow: CBD Oil, what is it all about? Is this something we need to know more about? Is it something we could be prescribing to our patients to help with anxiety or other issues? Is it something maybe the dentists and hygienists should be using for crown prep? I'm not so sure but we're going to explore some of these questions and, of course, much more in Episode 13 Season 2 of The Dental Practice Fixers Podcast. I'm Dr. Richard Madow here with my co-host, cohort, business partner, brother, and co-trouble maker, Dr. David Madow. How are you doing today, Dave? [Crosstalk] How are you doing today, Dave?  
  
 Dr. Dave Madow: How is it going? I'm doing fantastic. How are you doing, Rich?  
  
 Dr. Rich Madow: Doing great, glad to be here. I just want to real quickly thank everybody for all the positive comments that we've been getting about The Dental Practice Fixers Podcast. Tell your friends, give us some good ratings, do whatever it takes. We're growing and growing and growing and we really appreciate it and also send in your questions. Speaking of that, we've got an interesting question today. Don't we?
  
 Dr. Dave Madow: We do and I'm going to go and read it because it's one that we've never actually gotten before. So let's get right into it, Rich. The question is, Dear Dental Practice Fixers.  
  
 Dr. Rich Madow: It's us.  
  
 Dr. Dave Madow: [Laughs] What do you guys think of CBD oil? But it goes further like there's more, it's more than just that.  
  
 Dr. Rich Madow: Okay.
  
 Dr. Dave Madow: She said, I am considering using CBD oil in my practice on one of my patients to alleviate anxiety and maybe some other issues. What do you guys think? Is this a good idea? Signed, Anonymous.   
  
 Dr. Rich Madow: I'm just curious, Dave. Do you know where Anonymous is located?  
  
 Dr. Dave Madow: [Laughs].  
  
 Dr. Rich Madow: It wasn't a joke. I mean, sometimes [crosstalk] why not because sometimes I know when I read the questions many times, I anonymize them by their request but actually go to their name and location. So that's not the case here?
  
 Dr. Dave Madow: Okay. No, no, yeah, I didn't know. I thought it was joke, you know, where anonymous is generally located. Okay. I do know where this anon- okay, I do know where this anonymous originates. I'm going to... to not [inaudible 02:44] on some particular areas, is it okay if we just say Maryland?  
  
 Dr. Rich Madow: Okay. Well, that's an area, Maryland.   
  
 Dr. Dave Madow: Let's say it's a female dentist in Maryland. Good enough?  
  
 Dr. Rich Madow: Okay. Then, there are several thousand. Perfect. No, I was just curious what part of the country because obviously different parts of country have different attitudes towards-
  
 Dr. Dave Madow: Yeah, that's a good point.  
  
 Dr. Rich Madow: CBD oil, medical marijuana, all kinds of issues. So I think it's interesting to know that.  
  
 Dr. Dave Madow: That's a great point. So we got to answer this question.  
  
 Dr. Rich Madow: Okay [crosstalk]. What's your take? Go ahead, give your take on it.
  
 Dr. Dave Madow: I still... let me think. The question is first of all, Dental Practice Fixers, what do you guys think of CBD oil? So if we just take that part of the question only and nothing else, whether it should be used in the dental practice or not. I happen to be a fan... I personally happen to be a fan of CBD oil. I've done a lot of reading on it. I've actually used it over one year plus personally. I didn't say I personally used it personally but if I did, I did make sense. But-  
  
 Dr. Rich Madow: Yeah, you're not supposed to smoke it.  
  
 Dr. Dave Madow: [Laughs] Well, actually it's very interesting, Rich. I think there's three ways to actually take it and one would be not really smoking but one would be vaping. Now, I'm not a fan of inhaling any kind of crazy stuff into my lungs or anybody else's lungs so I don't vape CBD. I don't really believe in vaping, first of all. But the other two ways are to eat it in edibles and then make it with like cookies or gummy bears into some sort of edible. And the other way, the third way is probably the most common way; is to you have it like, you know in an oil-based or water-soluble liquid and just put a few drops in your mouth. If it's oil basically on your tongue, if it's water-based, you just swallow it. Now, Rich let's back up for one second because we might have some viewers and listeners that don't even know what we're talking about, CBD oil, well, what is that? So CBD oil, if I can get this right, it stands for Cannabidiol, CBD. It is totally legal everywhere in the United States. It is not marijuana. I repeat that, it is not marijuana. But so it's not psychoactive, it doesn't get you high. Go ahead, Rich.  
  
 Dr. Rich Madow: I was going to say it's actually so mainstream. I'm sure some of our listeners received this as well. I just received a Bed Bath & Beyond catalog and it had CBD oil on the back cover, big displays, get your CBD oil. I'm guessing it was in the Beyond section but that's, you know, [laughs]. I mean, you can even get it in Bed Bath & Beyond so that's pretty mainstream. 20% off, you feel fine.
  
 Dr. Dave Madow: Please, did they have 20% off coupons? I can't remember that.  
  
 Dr. Rich Madow: No, lend me some money.  
  
 Dr. Dave Madow: It's funny Rich, I was with the family in Jackson before. We went into some juice place and just juice and smoothies. And one of the options in your smoothie was they could put like, I don't know if that's the right word but like a CBD oil in the smoothie for like a few extra bucks. It was very interesting. It's pretty much like you said: Bed Bath & Beyond, smoothie shop, it's really everywhere.  
  
 Dr. Rich Madow: Right. And the point being, it's legal, it's somewhat mainstream. It doesn't get you stoned, your patient, you know, you're not going to want to take some and lessen the pain. I mean, there's nothing wrong with some.
  
 Dr. Dave Madow: Well, maybe you can [crosstalk].  
  
 Dr. Rich Madow: So maybe and I think it's a really good idea that you brought it up for people that aren't that familiar with it. It's not a narcotic in any way, it's not classified and it's not psychoactive or changes your frame of mind. You're not going to see triangles when you taste, nothing like that.  
  
 Dr. Dave Madow: But just to make sure our viewers and listeners know this, it is part of the hemp plant but it's... they're different like I guess varieties and the hybrid may not be the right word but they're different in varieties and it's a variety that is very, very high in CBD and extremely low in THC so there's no, again, no psychoactive component.  
  
 Dr. Rich Madow: Correct, correct. So what's your opinion?
  
 Dr. Dave Madow: So my opinion is I've been using CBD oil for the past, over a year. It really helps, it's a great calming effect that if I ever have... if I'm like anxious for a day or if I have trouble getting to sleep or anything like that or I want to have like a really good night’s sleep, I find that it really, really does work. Now again, I know it's anecdotal on one person. I really do believe that it works. I won't take something to be so popular and have no effect at all. I've been reading and watching a tremendous number of videos about it. I mean, I think it's actually even better than [inaudible 07:42]. I think it's a lot better than [crosstalk]. But it's old Rich and I have talked about an [inaudible 07:49] product that.  
  
 Dr. Rich Madow: It's funny that you said because I was going to bring that [crosstalk].  
  
 Dr. Dave Madow: I did that on purpose.  
  
 Dr. Rich Madow: I was going to bring [crosstalk]. Oh really, okay, because you know my opinion?
  
 Dr. Dave Madow: Well, I really don't know. I have a feeling I know your opinion but I don't know your opinion for sure. And of course, you can always say there's a placebo effect, you always say if somebody tells you this is going to calm you down and it will. I don't know, I mean, I definitely found it to help me and while I'm sleeping, my body doesn't know if it's a placebo or not and it really does help me get a better night’s sleep. I really found that.  
  
 Dr. Rich Madow: I disagree with that. I feel your body totally knows it's a placebo. I got to say first of all, just, you know, in general I know we're here to give our opinions. I have nothing against CBD oil, I have nothing against, you know, responsible use of medicinal or recreational marijuana or alcohol or anything like that. I think that, you know, things used by responsible people that do things the way you're supposed to do it and don't go driving on it. I've no problem with any of that stuff. But I do have a feeling that... I just feel like every few years, something else comes along. This is the big thing that when you look at CBD oil, if you look it up, there are people claiming that it cures everything. I mean, yeah, anxiety, insomnia, herpes, diabetes, heart problems, cancer, the list goes on and on and on and I just felt like it's the same kind of thing when some... there's some high top MLM and they've developed this proprietary formula of only the small, you know, grain that's in the rice paddies, they're only in a certain area of Thailand and that they've distilled in a certain way, and it cures everything. I am putting CBD oil in this category. I get very skeptical when there are claims that something does too much. And honestly, and I don't want to offend anyone here, I feel the same way about chiropractic. You know, I'm sure there's some fantastic knowledgeable chiropractors out there but if you talk to many chiropractors, oh yeah, chiropractic cures this, this, this, heart disease, diabetes, hypertension, all kinds of aches and pains, fibromyalgia, Lyme disease and all these, just come and we crack your back and it actually cures everything. Not so sure I'm a believer. The chiropractor has its place for certain, you know, the care of the spine. Well, I certainly hope so but, you know, you talk to chiropractors and they say it takes care of everything. And I'm a big believer in the placebo effect. I think it's the same with so many medications. I think, you know, … over the counter in some medications. You know, I've heard people say that you take a tiny sliver of one and they slept through the night. Well, hey, I get very skeptical when there are too many claims for one product. 
  
 Dr. Dave Madow: Well, you know, Rich, when I first started talking about CBD oil today though, I only talked about pain and anxiety. I don't know about anything else, about diabetes, high blood pressure, heart disease, I don't know and I won't even comment on that. I don't know but I found having some ski injuries and sometimes some, you know, I like to be calmer, I found that it definitely works for me. Now, it's been... this is a fact, this is not... it's a fact that we do have receptors in the human body, receptors that the CBD of the cannabidiol binds to. We have receptors and, you know, I think believe it or not, I think it's absolutely been proven that marijuana, THC, can help with anxiety and pain. I mean, I think that it's documented in many studies. And as CBD is very similar except it doesn't get you high, that's the main difference actually.  
  
 Dr. Rich Madow: Well, what the hell good is it? 
  
 Dr. Dave Madow: Honestly, I'm going to tell you there's another little side-story, it's a little personal but it's something that's really weird and it might not be related at all, but it's a very interesting story. A couple years ago, I noticed some weird things. I thought it was like just [inaudible 11:46] on the bottom of one of my feet. It turned out it was like I think there's warts and I don't know, I mean, it's not uncommon but I went to my dermatologist and she applied all these different things for like over a period of a year and like nothing got better and there's definitely not, it doesn't hurt or anything except, you know, other people can catch them if I'm like at a public bath or showers, something like that.  
  
 Dr. Rich Madow: [Crosstalk] Public baths and showers to begin with.  
  
 Dr. Dave Madow: Tell me about it. Now that I know all that stuff, it's true, you're right. But I am... I tried all this different stuff my dermatologist recommend, not only topical stuff but stuff by mouth and like nothing did it, nothing helped and I was trying all this crazy BS. Coincidentally, that's how I started using CBD oil like I'm going to say I don't even have a good feel for this one but I'm going to say like six months later roughly. I touched the bottom of my foot that had the warts and it's like everything is totally gone. Now, I'm not saying it was CBD, trust me, I know it's not scientific as anecdotal but all I'm saying is it's the only thing I changed in my life. [Crosstalk].  
  
 Dr. Rich Madow: Okay. So here we go, now, you're talking about exactly what I was saying. Okay, yeah, it's good for anxiety and restlessness but now it also cures foot warts. 
  
 Dr. Dave Madow: I didn’t say that. You're putting words on my mouth.  
  
 Dr. Rich Madow: You're saying there might be a connection between you using CBD and your foot warts going away.  
  
 Dr. Dave Madow: I said, they may or they may not. If you rewind this, you rewind this and you watch where I said it, this maybe had nothing to do with the story. I said, it may have nothing but coincidentally that's when my foot warts went away. I don't know what to say.  
  
 Dr. Rich Madow: If it's coincidentally, then it had nothing to do with it. [Crosstalk].
  
 Dr. Dave Madow: All I'm saying is I don't know the answer. I don't know... I can't take a stand because I don't know the answer  
  
 Dr. Rich Madow: You're saying, it's possible that CBD oil cures foot warts?  
  
 Dr. Dave Madow: I'll say it's possible.  
  
 Dr. Rich Madow: Okay.
  
 Dr. Dave Madow: It is possible.  
  
 Dr. Rich Madow: Okay, exactly my point. And you talk to somebody else and they had, you know, nasal palate cured. You talked to somebody else there [crosstalk].  
  
 Dr. Dave Madow: I've totally forgot to tell you about that too.  
  
 Dr. Rich Madow: You talked to somebody else, they had a French accent and all the sudden, they don't anymore. And it's also possible. I mean-
  
 Dr. Dave Madow: You are sick, you're sick.  
  
 Dr. Rich Madow: Okay, here's what I'm going to say and maybe we should move on to the call. So yeah, of course, I feel like it's kind of on point so please get your final say. I know the famous article in the Atlantic which we all thought was total bullshit. Really it takes a dentist to task for not really being resource-based, evidence-based, using scientific studies a lot and let's face it, I don't think there are totally legit research-based, evidence-based scientific studies on CBD oil but it showed it does all these things including insomnia, anxiety, all these things. I think it is pretty much anecdotal at this point. So, if you recommend that to your patient, are you going down that rabbit hole of being non-scientific, being that non-scientific dentist who just, you know, is recommending things that are not evidence-based. I'm not so sure. I think if I were to talk about it to a patient, I might want to say I've nothing against it. If you feel it works well for you, feel free to use CBD oil before your dental appointments. When it comes to dentists recommending it to anxious patients as a proactive measure, I'm not so sure I'm buying it.  
  
 Dr. Dave Madow: Well, we got the same opinion there because I think part two of the question was this dentist, she's asking if she should use it in her office for anxious patients? My answer would be the same as yours. I'm not so sure; first of all, it will be totally legal because you can get it over the counter anywhere, you will be saying like to a patient, "take this Advil before treatment to help this pain," over the counter. But I do agree [crosstalk].  
  
 Dr. Rich Madow: Proven to work.
  
 Dr. Dave Madow: Okay, but Rich, I'm agreeing with you. I'm agreeing with you, remember. I'm not so sure, only on part two, part one, totally that’s great. But I'm not so sure dentists should be giving out CBD in their offices. By the way, this dentist, kind of a side note that wrote those questions is totally into some type of... again, I wish we had more time to talk about this but there's some type of multi-level marketing thing in dentistry for dentists with CBD oil and they're recommending, you know, you get this and give this to all your patients and get your patients on that. I don’t agree with any multi-level at all.  
  
 Dr. Rich Madow: I'm not surprised, I'm so not surprised. Multi-level, maybe there's a topic for a different episode but multi-level deals in snake oil in my opinion and just about it, not all but maybe.  
  
 Dr. Dave Madow: Well, not all but here's the thing Rich. In the beginning of the show, you said that this is kind of like the flavor of the week or every couple of years, there's something new that comes out. This is 2019 and we're recording this in mid-2019. CBD oil has been around for a while, it's not new. I'm willing to bet that we look at this five years from now, somebody pulls out this podcast in five years. I think CBD oil is going to be totally around, very popular and it's not going anywhere. That's my opinion, it's my bet, it's not going away at all.  
  
 Dr. Rich Madow: Okay, I disagree. I think they have a …but I think its stature as this cure-all, do all everywhere. I think it's going to be not as popular but what can we say [crosstalk]. Gone now will be gone but, you know, most [crosstalk] are gone but I think-
  
 Dr. Dave Madow: I think it also kind of parallels Canada's culture like, you know, cannabis is becoming legal in more and more states. As that becomes more legal for medical or recreational, the cannabis may still be like CBD but CBD is sold everywhere. I don't think it's going anywhere, man. I think it's going to be like [crosstalk].  
  
 Dr. Rich Madow: Hey, man.  
  
 Dr. Dave Madow: You won't get into like probably get convenience stores and they sell it and I would never use this stuff, never. But like the tablets that keep you awake, you know, all that stuff. I think, you know, especially with [inaudible 18:02] everywhere. I think CBD is going to be one of those things that it's everywhere and it's not going away.  
  
 Dr. Rich Madow: I totally agree with that. I totally agree but I think, you know, I'm not sure if this is a good analogy but let's say for example, 10 years ago, everybody was recommending fish oil supplements and you can still get them anywhere but I don't think they're nearly as popular because I think it’s shown that it wasn't the cure all for everything, for inflammation, for heart disease that it was once found to be. And I think everybody seems to recognize now that it's better to eat it as part of eating fish; that does more than taking fish oil supplements and it was kind of overhyped and overrated. It still has its place among some people and I feel that's kind of the same with CBD.
  
 Dr. Dave Madow: So fish oil supplements are still very popular.   
  
 Dr. Rich Madow: They kind of had... I think they're not what they once were. They were the cure all 10 years ago. Every fish oil supplements do everything.  
  
 Dr. Dave Madow: Okay, let's leave it on that Rich.  
  
 Dr. Rich Madow: I think we're going to have to meet... we're going to make a plan to meet up 5 years from now. I'm proposing 3PM, March 18th, 5 years from now, we'll meet at the equator.
  
 Dr. Dave Madow: Okay, let's do that and I'll tell you something. Let's also put some money on the CBD oil. I'm going to put a lot of money on my bet that it's going to still be tremendous.  
  
 Dr. Rich Madow: Oh that's kind of an opinion what tremendous is.  
  
 Dr. Dave Madow: I know. So we deliver that then?  
  
 Dr. Rich Madow: Yeah, we'll check back in a few years. I think when they came to the end now as far as dentists actually recommending it in their practice, our opinion is kind of [inaudible 19:38] and together a bit and get closer to one another. So great question from Dr., what was that? heranomous? No, Anonymous. It's heranomous splash in Maryland. Keep your questions coming, podcast.madow.com. We'd love to hear from you.
  
 Dr. Dave Madow: So Rich before we get into today's call, we've got a couple special, really special announcements, right?  
  
 Dr. Rich Madow: Yeah, sure, go ahead. I've got one too, you go first. You go first.  
  
 Dr. Dave Madow: Oh you want me to start? I know you have a real special one so I'm going to go really, really quickly because Rich and I mentioned this during every episode, we both believe in both of these things I'm going to mention really quickly. Our Masterclass which we get people into our Center For Dental Practice Success in Baltimore. We do a full day with you. We limit it to dentists, a small group of dentists. By the end of the day, we have shared with you a lot but in particular how we can help you to grow your dental practice. So check it out more, just go to masterclass.madow.com. If you're watching the video, it's right down there. If you're not watching the video, it's masterclass.madow, M-A-D-O-W.com. Secondly, if you are still doing your credit card processing, one of it in prehistoric ways. In other words, if you're not using Fattmerchant yet, get using Fattmerchant. Quickly, it's going to save you money every single month, which is simple. We guarantee, it will save you money every month. Why not do it? Go to... the link is right there. But if you're listening, bit.ly/fattmad, that's F-A-T-T-M-A-D. It's bit.ly/fattmad. Rich, take it away.  
  
 Dr. Rich Madow: Thanks for saying really quickly. We know that a lot of our podcast listeners and watchers really don't know that much about us like who are we, who are these two guys? They've been coaching dentists for 30 years, they are dentists and blah, blah, blah. Well, what else have they done? One thing that amongst people that have been with us for a long time, we're really known for is TBSE, it stands for The Best Seminar Ever. It's the original Vegas multi-day, multi-speaker seminar. We didn’t name it The Best Seminar Ever, that would be kind of egotistical, I don't know what it will be but it used to be called The Super Fall Seminar when we started way back in 1995. People who attended year after year said we need to start calling this thing The Best Seminar Ever. How can we say no? So check it out, it's in Las Vegas, at the beautiful Tropicana Resort. It’s this November. It's two days, Friday and Saturday. And one thing different about TBSE is there are no breakout sessions. Everybody, docs and teams are in the same room the whole time. So check out tbse.com, The Best Seminar Ever. We've got some amazing speakers this year. Of course, I'll be there, Dave will be there. Maybe we will even do a live podcast from there. Who the heck knows, check out tbse.com. Got some fantastic speakers this year. Somebody who will be at TBSE for the first time and we just met, PeyRay, Dr. PeyRay, the guy is an amazing young clinician and kind of a teacher, a key opinion leader. We're excited about all our speakers but for some of you younger folks as they say, you might really be excited about him. So go to tbse.com. We'll see you in Vegas this November. Let's do our call.
  
 Female Speaker 2: For calling Dr. [Noise], Shirley speaking, may I help you?
  
 Dr. Dave Madow: Yeah, hi Shirley. Can you tell me if you take CareCredit there?  
  
 Female Speaker 2: If we take what?  
  
 Dr. Dave Madow: CareCredit, CareCredit, I think it's a way to finance my dental work because I think I got a lot of dental work that needs to be done.  
  
 Female Speaker 2: Okay. Can you hold while I check?
  
 Dr. Dave Madow: Sure.  
  
 Female Speaker 2: All right then.  
  
 Dr. Dave Madow: Sure, thank you.  
  
 Female Speaker 2: Hello, no sir, we do not.
  
 Dr. Dave Madow: You don't take CareCredit. Okay, because I just know like I got a lot of stuff that needs to be done and I'm just trying to figure out how I can pay for it. But okay if you don't take it, thank you, thank you so much.  
  
 Female Speaker 2: What is your name?  
  
 Dr. Dave Madow: My name is David.  
  
 Female Speaker 2: David and your last name?
  
 Dr. Dave Madow: Michaels.  
  
 Female Speaker 2: Okay. All right. Well, did you need a lot of care from... did they tell you you need a lot of care here?  
  
 Dr. Dave Madow: No, no, I'm just kind of new in town now. I haven't been to your office yet.  
  
 Female Speaker 2: Oh okay. All right. Okay. All right. Well, all right thank you for calling, David.
  
 Dr. Dave Madow: Well, thank you so much. I appreciate all that.  
  
 Female Speaker 2: You're very welcome.  
  
 Dr. Dave Madow: Okay sure. Bye.  
  
 Female Speaker 2: All right. Bye.
  
 Dr. Dave Madow: Okay. Can you believe that?   
  
 Dr. Rich Madow: I just put some question like what is it like to have a job and be so bad at that job? So bad.
  
 Dr. Dave Madow: You know, I thought she was going in the right direction, what's your name [crosstalk], somebody told you need a lot of work. What's that?  
  
 Dr. Rich Madow: Yes, she took a little pivot there at the end where she was about to redeem herself.
  
 Dr. Dave Madow: I know. She knows I needed a lot of work. What's your name? I thought she was going to take, have some, come on in and let's... but she said, okay, well, thank you very much.  
  
 Dr. Rich Madow: Okay. Let's back up for a second. Who the hell doesn’t take CareCredit? Geez. It's like a requirement for the dental practice.  
  
 Dr. Dave Madow: That is a good point. I mean, not to sound like [inaudible 25:12] that's been on the dental care well for a long time but that is a good point. It's a really good point.  
  
 Dr. Rich Madow: Yeah, unbelievable and she had no idea what it was. So this office is, you know, not really well-informed. Put you on hold for a long time, no on-hold music or messaging at all which is always disconcerting because you're not sure if they hung up or not. 
  
 Dr. Dave Madow: Right.  
  
 Dr. Rich Madow: And she kind of said, we do not and she was ready to let you go. But then as we said, she took that little pivot and asked for your name. But then, she thought well, you were diagnosed at her office and you needed a lot of treatment and since that wasn't the case, well, screw you, see you later. Wow, that was pretty unbelievable.  
  
 Dr. Dave Madow: I don't know what else to say. I mean, I’m ready to give her my grade because I don't know what else I can say about it, other than the fact Rich... well, I'll go back to the question we always ask, do you think her dentist is somewhere in the back office treating patients, really proudly saying, my team member at the front desk is great. She's so nice, everybody loves her, she's doing a great job. I'm going to say yes, she thinks that.  
  
 Dr. Rich Madow: I think it's very possible that everybody loves her. There's no question about that. And then, I'm going to say yes also man, what would happen if the dentist were to walk in, some patient called, they're new in town, they needed a lot of treatment, they asked if we took CareCredit and I just hang up on them. I mean, geez, she should at least offer some other… say we do have other options available for you. Come in, let's talk. Let's meet the doctor. Let's do something here. It's hard to believe they don't have some kind of financial options even that option that we never recommend which is we do all this treatment and we hope that you pay by the month, you know, play and pray. Whatever, that's an option. I don't do that one but at least [crosstalk].
  
 Dr. Dave Madow: Okay, I'm ready with my grade. My grade is an F, totally F. No question, final answer.  
  
 Dr. Rich Madow: I think that's a little harsh. I know now. Okay. Here's my grade. I'm going to hold it up for you watching on video. F, she totally failed. It's just a shame because she seemed really nice.  
  
 Dr. Dave Madow: I have nothing else to say.  
  
 Dr. Rich Madow: Episode 13, Season 2 of The Dental Practice Fixers. Thank you so much everybody for listening. I'm Dr. Richard Madow.
  
 Dr. Dave Madow: Dr. David Madow, we'll see you next time for sure.
  
 [Music]
  
   

Do All New Dental Patients Need X-Rays What if Your Patient Refuses

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A new patient comes into your office and one of the first things she says is “I don’t want x-rays!” When questioned why not, the reason is that she simply feels that she does not need them, nor does she want the radiation. What would YOU do?  This is a question that we received, so please listen in to what Dr. Richard Madow and Dr. David Madow have to say. Then of course we do the call of the week. Since we are on this topic, we call an office asking if we could come in as a new patient and not have any radiographs taken. Listen in to see how they handle it! If you have a question that you would like answered on our podcast, please send it in to podcast@madow.com. We will do our best to get yours answered!


Do All New Dental Patients Need X-Rays What if Your Patient Refuses

Female Voice: The Dental Practice Fixers Podcast is brought to you by the Madow Center for Dental Practice Success. To find out how we can help increase the success of your practice, check out madow.com or call us at 1-800-258-0060.
 [music playing]
 Dr. David Madow: A new patient is in your chair. Everything seems great, although they say I do not want any x-rays. What do you do? We’re going to answer that in Episode 12 of the Dental Practice Fixers. Welcome, welcome, welcome. I am Dr. David Madow, along with…
 Dr. Richard Madow: Dr. Richard Madow, your co-host and fellow Dental Practice Fixer. Thanks so much everybody for being with us today. And thanks most of all for all your great comments about the Dental Practice Fixers, and going on iTunes and giving us a good rating. Feel free to do that all you like and tell your friends. Most of all, send us your questions. It may just wind up on an episode of the Dental Practice Fixers. We’ve got a great question for Episode 12. I’m just going to get right down to it. And here’s our question for today. It says, Dental Practice Fixers, I had a new patient recently. A young woman who absolutely refused to have radiographs taken. She assured me that she was not pregnant. No way in hell was her exact phrase. No way in hell. She didn’t believe in x-rays. She felt they could be dangerous and didn’t want them; she wasn’t having any problems. If her dental condition was 100% immaculate, I could maybe have let it slide. But she did have two crowns, a few restorations and mild gingivitis. I loved that. Mild.
 Dr. David Madow: Little mild gingivitis. Very mild.
 Dr. Richard Madow: Garden variety gingivitis. I told her I could not see her as a patient without x-rays, and she raised a big fuss and walked out. Loved that. Could this have been handled differently? From Dr. Amy in Aurora. Dr. Amy in Aurora, we don’t know if that’s Aurora, Illinois, Aurora, Colorado. Maybe there’s some other Auroras out there, but it doesn’t matter Dr. Amy. Great question. So after that whole scenario, let’s start by her main question and see where it goes. And that is could this have been handled differently? What do you think?
 Dr. David Madow: I’ll tell you something, from what Dr. Amy in Aurora…
 Dr. Richard Madow: Dr. Amy in Aurora or is it Dr. Aurora in Amy.
 Dr. David Madow: It could be Aurora – maybe Aurora Borealis?
 Dr. Richard Madow: Maybe Aurora Miracle. 
 Dr. David Madow: Maybe. I know it’s always limited because when somebody’s writing in a question, they don’t write a whole dissertation. They don’t know everything. But from what I heard in the questions; Rich I think she handled it right. I mean could she have tweaked the language a little bit, could she have done something? Maybe. But here’s what I’m going to say, and maybe we’re not this deep into it yet. But I’ve got a general feeling and I’ve got to let this out. I’ve got to let it out. 
 Dr. Richard Madow: Hold on, go ahead. 
 Dr. David Madow: Generally, generally speaking, a patient like this that just refuses x-rays because they say they’re dangerous. I think a patient like that is going to be trouble all along, I think, and she absolutely refused even after some education, you’re going to keep them in the practice. I’m not so sure.
 Dr. Richard Madow: Well I think that’s a really good point. And that’s the main point in this as well. And that is if a patient is trying to tell you what to do, they’re dictating how you do your diagnosis, how you treat them or whatever. Is this patient right for your practice? We’ll get to that. But I think the sidebar is, did Dr. Amy do anything to try to inform this patient? Some would say educate, that these days x-rays are incredibly not harmful. If she didn’t, she should say we use digital x-rays. It’s not like the old days. The amount of radiation is insignificant and without them, there could be cavities under that crown you have and if we don’t find those cavities, that can lead to much worse problems including a root canal or an extraction. And that’s why we like to do x-rays. That’s why we require x-rays, whatever. Could Amy have done a little more? We’re not sure about that because she’s not on the show with us today. But the way this question is phrased, it seemed like she just said, okay you don’t want x-rays, get the hell out of here. So I’m not so sure I’m a big fan of… 
 Dr. David Madow: Well again, yeah we’re not sure to the extent of what Dr. Amy did. But I think when we read a question like this and we’re only limited to the information, a lot of times we just have to go on our gut feeling. And my gut feeling, again just from what you said, is that this patient is a nutcase. And even if Dr. Amy would have explained more and more. Like, okay there’s not as much – there’s not nearly as much radiation with digital radiographs as it was in the past. I think this patient; she comes in as she’s dictating how Dr. Amy needs to do her treatment or diagnosis and treatment. I say get rid of her. If you’re a busy practice, you don’t even need to take every patient. And why deal with a nutcase that’s going to be probably problems all along when you’ve got so many good patients that are going listen to you and do what you recommend. That’s my feeling. 
 Dr. Richard Madow: A nutcase.
 Dr. David Madow: Yeah I’m going out on a limb saying this patient sounds like a nutcase. 
 Dr. Richard Madow: And so she’s an antivaxxer or a flat Earther or something.
 Dr. David Madow: So get rid of her. Get rid of her. Now look, there might be people listening to this show that don’t care if they take radiographs on a patient or not. I’m not saying that’s good, but if you don’t care and if you want to set yourself up for potential problems, then see her. But if you’ve got a good practice and you really try to diagnose properly and do the right thing. And you got somebody that comes in and telling you what to do, then what else is she going to want? There’s probably some material or some kind of impression or something that you – I don’t want that either. I think get rid of her. 
 Dr. Richard Madow: Okay that leads to two questions now. So I hope I remember both. One is I know some practices have the refusal to have x-rays for them and they say, okay well we really recommend them. If you don’t want them, you need to sign this and then we’ll go ahead and treat you. I am not a fan of that. I think that can come back to haunt you in so many ways. First of all, I think that you would get killed in court if you treat a patient…
 Dr. David Madow: Absolutely.
 Dr. Richard Madow: They’re going to have – a fantastic lawyer. I think that’s a mistake. It’s almost like saying I give you permission not to do what you need to do. Does that really count? I don’t think it counts. In a court of law, I think you’re really hanging on iffy ground there. So, now that leads to some more issues. What if you recommend treatment for patient if they say, well I don’t like that. Is there any other way to do it differently? Can you do that more cheaply? Can you only do what my insurance covers? Now we’re still talking about a patient dictating treatment here. 
 Dr. David Madow: I agree. That’s why I said, I don’t have a good feeling about this patient at all. And I still go back to what I said originally. If you’ve got a decent practice and you’ve got other patients coming in that are going to listen to you and agree and be reasonable, then those are the kind of patients you want to see all day long. And these patients that are refusing this and that and making you change your philosophy; we don’t need patients like that. I mean, Rich you and I have been preaching for a long time about how to have a more successful, a busier practice, yeah teaching, preaching, whatever. Forget the semantics, you know what I mean. I think dentists for some reason, feel that they need – a lot of dentists feel that they need to take everybody that walks in that door. I don’t feel that way.
 Dr. Richard Madow: Well I don’t either. I think that’s one of the big lessons as well. I feel like I’m saying this all the time. So maybe this is preaching: we are not obligated to see every single patient. Unless somebody is bleeding, swollen and in severe pain. That’s our debt to society, to take care of these people. In my opinion, I think you agree, whether they can pay or not. If somebody comes in and they’re bleeding or in horrible pain. It’s great to be able to help someone like that. But what about some grey areas? What if a patient has got a really destroyed tooth, missing a lot of structures? It’s just a mess. We’ve seen all these before, and we want to do a crown and we recommend a crown and the patient said can you just do a filling? Well, we could do a large filling. It might not last, it might not be a good restoration, it could cause bigger problems in the future. It’s than better than nothing. Is this patient now dictating treatment?
 Dr. David Madow: That’s a great question. I would feel better with something like that as long as if it’s a purely financial thing and they just can’t afford a crown but something needs to be done. And they’ve realized it’s not ideal treatment and you’re telling them, you’re educating; you’re documenting everything. I feel better with that because that patient is really not trying to – the way I look at it they’re not really dictating treatment. They’re just saying, hey I can’t afford the Cadillac, give me the Buick or something like that. 
 Dr. Richard Madow: But a filling is not a Buick, Tom.
 Dr. David Madow: It’s not a Buick, okay give me the Chevrolet Chevette.
 Dr. Richard Madow: Ford Pinto, is that where we’re going here? 
 Dr. David Madow: Hey I loved those Pintos, they’re great. 
 Dr. Richard Madow: Yeah I loved those Pinto Station Wagons. I know in California it seems to be very in to restore some of those cars like a beautifully restored Ford Maverick or a Pinto Wagon.
 Dr. David Madow: How about the Mavericks with like the real big bumpers? That was…
 Dr. Richard Madow: Oh yeah the JS model. 
 Dr. David Madow: It’s 1974 JS. 
 Dr. Richard Madow: They must be maintenance nightmares though and they don’t have the safety features of modern cars, but they look cool.
 Dr. David Madow: They look cool. But I feel that it was somewhere like that and they’re going into it. No, okay. I mean, you’re not doing anything – okay let’s face it. I don’t think there’s anything – there’s no malpractice there if you’re telling your patient they need a crown but you’re going to attempt the large filling. I don’t think it’s malpractice. 
 Dr. Richard Madow: I think if it leads to a root fracture, they lose they the tooth. 
 Dr. David Madow: I don’t think it’s in the same league as just saying, okay we won’t do radiographs. I don’t think it’s in the same league. 
 Dr. Richard Madow: Well I think one of the big differences is treatment versus diagnosis. And if somebody refuses radiographs, you can’t even do your proper diagnosis. So maybe that’s a line that could be drawn, kind of a demarcation there. Treatment – if you inform the patient of the best treatment they can get and they want some compromise, maybe you can learn to make that choice. I’m not a big fan of it, but maybe you can do that. When it comes to diagnosis, draw the line.
 Dr. David Madow: Agree. I would. And bottom line, I’d kick that woman out of the practice so fast. It wouldn’t be funny. 
 Dr. Richard Madow: Okay well let’s have that nutcases then. You use that phrase, that extremely derogatory phrase.
 Dr. David Madow: Nutcase. Total nutcase. I’m not PC. I don’t care. I’m not PC.
 Dr. Richard Madow: How about other nutcases?
 Dr. David Madow: Get rid of all nutcases. Give me an example. Give me example of a nutcase.
 Dr. Richard Madow: A patient that’s – okay, I don’t know if you call this a nutcase. I think we’ve all had these patients. I had them in my past practice. Patient has said I don’t want any anesthetic. Just treat me. I remember one guy who specifically – he happened to be a relative. The guy was flailing around like he was in a torture chamber. It took me five times as long. I was totally stressed out. He was totally stressed out. I don’t think I did my best work and then to make it worse I didn’t even charge them because he was a relative. If you’re watching, I doubt you are, but you know who you are. In retrospect I should have said no. I insist on treating patients who are numb and comfortable and comfortably numb. Is that a nutcase? Somebody said I don’t want any anesthetic.
 Dr. David Madow: Not necessarily. However, I would treat them up to the point where if they don’t want no anesthetic and they’re comfortable and they’re sitting back, no problem. Once they start flailing around like you just described and you can’t do your best work, I’d say it’s either anesthetic or you’re out of here buddy. I don’t care if you’re my relative or not. Get the hell out of here.
 Dr. Richard Madow: That’s not a nutcase. 
 Dr. David Madow: Not it’s not necessarily a nutcase. It’s somebody who just doesn’t want anesthesia. 
 Dr. Richard Madow: I think some people would say that 90% of TMJ and facial pain patients are nutcases. 
 Dr. David Madow: Yeah. And then what’s the other malady that people have? I think a lot of people – I’m not saying this isn’t true but a lot of people would say – what’s that…
 Dr. Richard Madow: Fibromyalgia?
 Dr. David Madow: Fibromyalgia. Is that a nutcase patient? I don’t know. I don’t know the answer.
 Dr. Richard Madow: I think before judging that, we might say a fibromyalgia patient would have inherent difficulties in treating them that’s for sure.
 Dr. David Madow: So you’re saying our practice does not accept fibromyalgia patients or TMJ patients, or any of those. 
 Dr. Richard Madow: Wow. Kind of like that sushi bar that had a big sign on the door that said no California roll, no spicy tuna roll. It’s like eliminating people that they don’t want, right from the get go.
 Dr. David Madow: Well are you going to treat somebody with many year syndrome
 Dr. Richard Madow: I don’t even know what it is. So I guess I’ll say yes. 
 Dr. David Madow: Here’s where I limit it. I would absolutely not treat somebody that came into my office that had groats disease. They’re gone. You just can’t treat groats. 
 Dr. Richard Madow: Okay. But that’s a management issue. I think more than anything else. 
 Dr. David Madow: Anyway, I’m going to say…
 Dr. Richard Madow: Before long, you won’t have any patients. 
 Dr. David Madow: I’m just not going to accept a nutcase. That’s all.
 Dr. Richard Madow: Okay, well with that said…
 Dr. David Madow: That’s the conclusion.
 Dr. Richard Madow: We’ve reached the logical conclusion, but again, I think that maybe Dr. Amy didn’t try hard enough to let this patient know how safe and important radiographs are. But at that point, if you like to use all those opportunities and your patient said no, I agree. I don’t like signing the little things like I refuse x-rays. I think you can come back and [inaudible - 0:14:08.9] big time. 
 Dr. David Madow: I’d say 30 seconds. If she can’t explain in 30 seconds, you don’t have to go into like a 5 minute…
 Dr. Richard Madow: Oh no no. No scientific. You don’t have to talk about Dr. Redken. 
 Dr. David Madow: 15 or 30 seconds if this patient still said I don’t care, I don’t want them. You’re out of here buddy. Next.
 Dr. Richard Madow: Why can’t it be any different than a patient saying I don’t want you to use the periodontal probe on me. Would you have that patient in your practice? Absolutely not. 
 Dr. David Madow: No way. Zero chance. 
 Dr. Richard Madow: Especially that you come in knowing the term periodontal probe. That’s asking for trouble. 
 Dr. David Madow: How about if patients said I don’t want you checking for fremitus? I do not want anybody here checking my mouth for fremitus. 
 Dr. Richard Madow: I think I’d want that patient in my practice. 
 Dr. David Madow. Let’s do a phone call man. 
 Dr. Richard Madow: Before we do the phone call, hey we’ve got a Masterclass coming up. It’s going to be in Baltimore. We are doing one for the first time on a Saturday. I know some people kind of complain. I can’t come to the Masterclass. I can’t take off too much work. It’s totally worth it but for you or for anyone else, go to masterclass.madow.com to see what the whole thing is about. This is no exaggeration. It really could be the most important day you’ve ever had in your years of practicing dentistry. Masterclass is for docs only, for practice owners only, looking to make some major improvements, kind of turn that corner. Maybe take your practice from good to great or mediocre to good or from downright shitty to fantastic, whatever it is. If you’re really looking for some positive changes in your practice, check it out, masterclass.madow.com. It’s a small intimate group and really, really good things happen. We’d love to see you there.
 Dr. David Madow: There you go. While we’re giving tips. Rich and I love – even the small tips are good and here’s one that’s going to change the way you’re doing credit card processing in your office and save you some money every single month. It’s very simple math. It’s very simple. We believe in our partners at Fattmerchant. Just a modern cool way – I don’t even have to go into the detail because we promise you you will save money every single month and it’s simple to switch over. We have a lot of our friends and followers and doctors that have switched over to Fattmerchant already. Check them out, we’ve set up very simple link, and I want to make sure I get it raise this time. It’s BIT.LY and if you’re watching the video, we’re going to have it right below us. BIT.LY/FATTMAD and fattmad is spelled FATTMAD. Check them out, the link right there. BIT.LY/FATTMAD. You will change your credit card processing forever in your practice and make money every month. We promise.
 Dr. Richard Madow: Alright. 
 Dr. David Madow: Do the call.
 Dr. Richard Madow: Let’s do the phone call. It happens to be thematically linked to Dr. Amy’s question. So let’s see what happens.
 Voice Recording: To serve you better, this call maybe recorded for training and quality purposes.
 [phone ringing]
 Female Speaker: Good morning. This is Amy.
 Dr. Richard Madow: Hi, I’ve got a quick question for you. I want to come in as a dental patient but I’m not sure about dental x-rays. I know that dentists usually insist on taking x-rays. Is that the way at your office? 
 Female Speaker: Have you had them anywhere else that could we kind of get emailed here so we at least have a baseline? 
 Dr. Richard Madow: Yeah I haven’t had x-rays for a while. 
 Female Speaker: What we could do is kind of take the minimum of just the T18 side and that will help him just to make it for him to do the exam. He wouldn’t want to miss any cavities. So that will help him see between the teeth. And then the rest [inaudible - 0:17:42.8] to see from looking in there. 
 Dr. Richard Madow: Yeah. Are those safe? 
 Female Speaker: Excuse me?
 Dr. Richard Madow: Is that safe? I’m just really concerned about radiation and x-rays.
 Female Speaker: Yeah. So the thing is actually digital. So when it’s a digital x-ray, it takes a lot less radiation. You can get more radiation from being outside or if you’re on a plane. So especially if you’re just taking the T18 side, you wouldn’t have any issues at all with that. Back when they were film, it took a little more radiation to expose it. But now that’s everything is digital, it’s very very minimal. 
 Dr. Richard Madow: Oh cool. What if I decide I just don’t want them at all. Is that still okay? 
 Female Speaker: It’s just – I’m pretty sure that legally you’d have to have them to do an exam, but hold on one second. 
 Voice Recording: Without metal wires or brackets. Invisalign is removable so you can eat and drink what you want while in treatment. Plus brushing and flossing are no problem. Invisalign is comfortable because it has no metal to cause mouth abrasions during treatment. And no metal and wires usually means you spend less time in our office getting adjustments. Find out if you’re a candidate. Ask about Invisalign today. We’d be happy to tell you more. 
 Female Voice: So yes he would have to have them just for legal reasons. He wouldn’t be able to do an exam and then we also wouldn’t be able do a cleaning without an exam. 
 Dr. Richard Madow: Okay. So I don’t want them maybe I’d probably – maybe she’d find another office. 
 Female Speaker: Thing is I don’t know if there would be one since that is the law in South Carolina under standard care, but yeah that’s it.
 Dr. Richard Madow: It’s actually a law. Wow, interesting. 
 Female Speaker: Yes. So what the American Dental Association requires is an exam by the dentist once a year, and you must have that before you could even have any cleaning or anything from us. And to do a proper exam, you have to have x-rays or in other words to do an exam where you’re not able to diagnose so you kind of – it’s kind of a little bit of fraud because they’re saying you’re doing an exam but you can’t really do an exam. 
 Dr. Richard Madow: Wow it’s fraud. That’s really – I mean the American Dental Association requires that? Wow, interesting.
 Female Speaker: And they actually have a website which shows all the different ones that they recommend and then also, it has a little chart on the radiation to where actually explains what x-rays are equal to, kind of like just eating a banana you get radiation from just one x-ray at a dental office. And then it’s a nice chart to take a look at.
 Dr. Richard Madow: You get radiations from eating a banana?
 Female Speaker: Yes. And then airplane…
 Dr. Richard Madow: How do you get radiations from eating a banana?
 Female Speaker: I have no clue. It’s just like a pretty chart that says…
 Dr. Richard Madow: So it’s not like a microwave banana. It’s just a regular banana. 
 Female Speaker: Yeah and I don’t know what it is, but apparently, you can get radiation from that. Just one plane ride is equal to like a full series of dental x-rays.
 Dr. Richard Madow: Yeah that makes sense. 
 Female Speaker: Yeah. So at times that shows the different – just a pretty cool chart. But now it just takes very little radiation to get an image.
 Dr. Richard Madow: Well very informative. Maybe I’ll find a dentist that’s not a member of the American Dental Association.
 Female Speaker: Alright. Thank you.
 Dr. Richard Madow: Thank you, bye.
 Female Speaker: Bye.
 Dr. David Madow: You know, I think I always say this after a call – oh my god…
 Dr. Richard Madow: But it had some twists and turns too. That’s for sure.
 Dr. David Madow: What is the story with that thing? 
 Dr. Richard Madow: I have a few comments. I like the on-hold message for Invisalign. That’s a nice touch.
 Dr. David Madow: Very nice.
 Dr. Richard Madow: Yeah. I mean, how frequently do we actually hear a good on-hold message when we do these calls? 
 Dr. David Madow: Almost never. So yeah that’s good, that’s good.
 Dr. Richard Madow: Okay she was very nice, she was pretty knowledgeable.
 Dr. David Madow: She was nice, she was cute.
 Dr. Richard Madow: She was knowledgeable. She knew what she was talking about.
 Dr. David Madow: Kind of.
 Dr. Richard Madow: I think that puts her ahead of many many people. But then she kind of started going off the deep end when she brought up that this is the law, and the American Dental Association requires that you do this, and that it’s fraud if you don’t. I’m not so sure about that.
 Dr. David Madow: Right. Let’s take it back to the beginning. What would you like to have – how should she have handled this? She got a potential new patient on the phone who wants to come to the practice but is stating that he doesn’t really want radiographs. What do you do? Do you try to explain everything on the phone or do you try to just get them into the office and do the explanation there?
 Dr. Richard Madow: Okay great question. I’m going to go back to your term of nutcase earlier. I think even you can even tell on the phone the patient is just a wacko and they’re not going to fit in your practice and just cut your losses. But I think if the patient’s really – and I sounded pretty reasonable. I just got some questions about x-rays. I think if the patient sounds reasonable, you think they might be a good fit for your practice? I agree. Let’s get them in, have them meet the doctor. The doctor can just explain a little bit about x-rays/radiographs, whatever you want to call them. It might be worth a shot. Do you agree?
 Dr. David Madow: Yeah. Because once they’re in the practice, I think there’s a better chance of a true connection. Let’s face it, when we’re on the phone, there’s not really like a true connection yet. Once you’re there, and you see these people are good and they really care and they explain a little bit about this minimal radiation. I think there’s a much better chance of somebody saying, okay I get it, let’s do it. As opposed to on the phone which she talked about bananas and fraud and the ADA. Not just it’s ridiculous. You can’t do that on the phone.
 Dr. Richard Madow: Yeah I totally agree. Again, I’m not a lawyer, you’re not a lawyer. But I think when you start to say things like this is fraud and the ADA requires that it’s done this way. I think that it’s kind of combative type talk. I didn’t care for that at all. I don’t think it’s accurate. I remember a few episodes ago somebody was saying, I can get sued if I do this. Why are you going to bring up things like fraud and the ADA requires? I just don’t – I don’t think anything good can come up with that conversation. 
 Dr. David Madow: Well you had the best comeback ever. It was hilarious. I think I’m going to find a dentist who’s not a member of the ADA.
 Dr. Richard Madow: I know, and then she said okay bye. We can’t let this go without talking about the banana thing. 
 Dr. David Madow: Right. What’s the story on the banana? I mean come on.
 Dr. Richard Madow: She said you’ll get more radiation eating a banana. I said, like a microwave banana? But I’ve never heard of that before. Have you ever heard of that before?
 Dr. David Madow: No. I’m a little bit worried because I had a banana just a little while ago. I’m a little concerned. 
 Dr. Richard Madow: I had two bananas today already. It’s one of my favorite foods. Favorite of all time. I googled it and there are people claiming and maybe this is on the ADA website. I didn’t check that out. But a small percentage of the potassium in bananas are like ionized potassium molecules. Technically they are radioactive and they enter your body when you eat a banana. But if you read a little further, you’ll see there’s no scientific basis for that because your body has a way of keeping the amount of radiation – and again I’m getting all this wrong. But essentially, the bottom line is you don’t get radiation from eating a banana. Your body has a way of regulating that.
 Dr. David Madow: I feel better now.
 Dr. Richard Madow: I know. Actually, you’re glowing a little bit. 
 Dr. David Madow: I didn’t tell you what I had a little while before we started recording. I had one banana; it might have been radioactive and I had a nice big glass of heavy water. 
 Dr. Richard Madow: Wow. How heavy was it?
 Dr. David Madow: It was pretty heavy.
 Dr. Richard Madow: You do a – I actually had a couple of isotopes. 
 Dr. David Madow: Do you know where that new restaurant called Teledyne Isotopes?
 Dr. Richard Madow: Yeah I have a friend of mine who works at Teledyne Isotopes. I ordered a few to go, Grubhub just delivered them. 
 Dr. David Madow: Sir here are your isotopes. 
 Dr. Richard Madow: Thank you.
 Dr. David Madow: Tip the driver please. 
 Dr. Richard Madow: So bottom line, I said I’m going to find a dentist that’s not a member of the American Dental Association. She just kind of chuckled. At that point, I think she probably did the right thing. 
 Dr. David Madow: I think it turned out that you were perceived as a nutcase. Let’s face it.
 Dr. Richard Madow: Exactly. 
 Dr. David Madow: She did the right thing. 
 Dr. Richard Madow: I’m not sure I want to even give her a grade. 
 Dr. David Madow: Yeah I think grading her might be difficult because there’s so many twists and turns, and then at the end you said I’m going to find a dentist that’s not a member. And so, she had to just say okay bye. So maybe she should get an A for that part. For that part at least.
 Dr. Richard Madow: Yeah I’m going to give her not bad. I didn’t like the whole fraud thing. That was kind of biased. 
 Dr. David Madow: Okay so just to summarize, I think we can both agree that she should have done everything possible. Be kind, invite you in to the office for your initial exam, even for a consultation to talk about it. And then once you’re there, that’s when they handle the whole thing. Not on the phone. 
 Dr. Richard Madow: Right. So I’m never sure if it got into the phase of maybe you should find – I want to find a dentist that’s not a member of the ADA or eating a banana, or that biased. So again, I’m going to lower her grade now to a B, maybe a radioactive B. I’ll give her a B+. But maybe it’s like a charge Ion on a B-, I don’t know. Whatever it is. Not bad though. Certainly not bad.
 Dr. David Madow: That was a fine grade because she probably did – I’m not going to give her a good grade because if she did it right, she would have gotten you in for some type of consultation or first visit to discuss in the office. I think she didn’t do it right so I’m going to have to go with a D. I’m sorry.
 Dr. Richard Madow: Okay. I think she said our office is right next to the tanning center. That maybe would have been good. Okay, well hey. Interesting stuff today. That wraps up Episode 12 of Season 2 of the Dental Practice Fixers. Thanks so much everybody for all your kind comments and ratings and all those great things. We really really love it and we hope this show is informative to you and helps your practice. So hey, I’m Dr. Richard Madow.
 Dr. David Madow: Dr. David Madow, we will see you next time. 
 [music playing]
  
   

For How Long Should Dentists Guarantee Their Work? Should They Guarantee it at All?

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For some reason in dentistry we have been accustomed to not charging patients if they come in with something that broke that we did, no matter how long ago the work may have been done. Why is this? Patients have been expecting this and we have obliged for the most part for decades. Would a heart surgeon say “no charge” to a family if a patient passes away during bypass surgery? Would a knee procedure be redone for free if it failed a year later? We think you know the answers. So why is dentistry different and what can we do about it?  Listen to what Dr. Richard Madow and Dr. David Madow have to say. Then of course we do the call of the week. We call an office asking a fairly simple question – we just moved into the area and the wife needs a LOT of work. Is it ok if she brings her comfort animal to help relax her? You will NOT believe this one in a million years! If you have a question that you would like answered on our podcast, please send it in to podcast@madow.com. We will do our best to get yours answered!


For How Long Should Dentists Guarantee Their Work? Should They Guarantee it at All?

 


Voice Recording: The Dental Practice Fixers Podcast is brought to you by the Madow Center for Dental Practice Success. To find out how we can help increase the success of your practice, check out madow.com or call us at 1-800-258-0060.
[music playing]
Dr. Richard Madow: Hey doc! How long is this crown going to last? What do you mean you don’t warranty your work? What are you talking about? Don’t you hate it when patients try to pull that bullshit? Why is it that they think that dental treatment should last forever? Do they ask the same thing about the surgeon, about a veterinarian, about a plumber? We’re going to find out on today’s episode of the Dental Practice Fixers. I’m Dr. Richard Madow. Welcome to the Dental Practice Fixers Season 2, Episode 11. And I’m here with my co-host and I’ll let you introduce yourself.
Dr. David Madow: Hey there Rich, glad to be here. I am Rich’s brother Dr. David Madow. How is it going? We are so happy to be here with you on the Dental Practice Fixers. You know why? Because we are going to fix your practice today. We’ve got a great question and not only that, we’re going to be doing a call later in the show. To tell you something, this is the first time asking this question ever. It’s going to be unbelievable. So stay with us, the all-time…
Dr. Richard Madow: Or older calls I believe.
Dr. David Madow: I have a feeling this one is going to be like the cold call. I just have a feeling.
Dr. Richard Madow: It’s just incredible.
Dr. David Madow: We don’t know which direction it’s going to go in.
Dr. Richard Madow: Hey anyway. Let’s get started. Dave, I think you’ve got a really good listener question that you pulled off of the Dental Place Facebook group. Dave, do you have another chance to check that out? Go on Facebook, search for the Dental Place. We’ve got some great private group discussions there. We’d love to see you there. It’s so nice we get Dental Practice Fixers from the group and that’s the case this time.
Dr. David Madow: It’s funny Rich, because this question starts with a headline.
Dr. Richard Madow: A headline.
Dr. David Madow: It’s like a headline, so I’m going to read the whole thing. It’s a little bit on long side but bear with us because it’s a great question, and it’s one that Rich and I are going to get this detail with here on the Dental Practice Fixers Podcast. So the headline is just picture this like big bold letters, this dental work better last forever. Then he goes, hello Brothers, isn’t that the mentality of patients now with dental work? Why is this and how did that mentality come to be? I know two people who have had a knee replaced, where something went wrong. One was laid up for an additional year and three months. [cross talking - 0:02:35.0].
Dr. Richard Madow: So 15 months.
Dr. David Madow: A year and three months. And the knee had to be replaced, in both cases, the additional surgery was charged at full price, and both people said while they were a little disappointed the first surgery failed, they had no issue with the additional charges as they understood working on a human body is a risk. It’s unpredictable. Likewise, this stole the question, I have a patient that is a heart surgeon; unfortunately he occasionally has folks he works on who don’t make it. And he’s a good friend of mine so I was comfortable asking him if he charges for his surgery where the patient does not make it or passes away soon afterwards.
Dr. Richard Madow: They don’t make it or they passed away. One or the other.
Dr. David Madow: They don’t make it or they passed away. Sooner or later they billed…
Dr. Richard Madow: They know they’re down on the table.
Dr. David Madow: Like a month or two later they passed away. So he was asking that question. The surgeon was asking that question, you still charge. And so, he looked at me like I was crazy or something and confirmed it. Of course, I charge for those cases. Like what do you mean, do I charge? I charge. So here is the dentist asking this question. How many people when a filling breaks, five, ten or more years, they rush right back in and say that filling YOU did broke. Of course, with the unstated or stated, believe it. You should fix this for free and somehow, you’re at fault that it broke. Even when teeth you never touched bridge or have a problem. But the patient often gets confused and comes in believing that it was something that you did wrong. So the overall question is how did this mentality ever come to be? Seems like this is a common happening for most dentists and some common topic for discussion on various dental sites. Better question might be how do we reverse this seemingly ingrained mindset in the general population? Signed, Dr. Ken Henley. Dr. Henley thank you so much for that question. This is definitely an age old question in dentistry for decades and decades I think.
Dr. Richard Madow: I agree. First of all Ken, I’m a big fan of your brother Don Henley. Drummer for the Eagles, lead singer, great musician. They say somewhat of an A-hole but I can forget back some music and so…
Dr. David Madow: Can you say that? They say that…
Dr. Richard Madow: He does not have the best reputation. It was always like Glenn Frey was the good guy and Henley was the A -hole, but Glen unfortunately is no longer with us. Those were the two main guys.
Dr. David Madow: What kind of rep?
Dr. Richard Madow: Wasn’t they own the band?
Dr. David Madow: Who was the guy that was – wasn’t there was somebody else was pretty well…
Dr. Richard Madow: Joe Walsh.
Dr. David Madow: Joe Walsh. That’s what I’m thinking. I’m thinking Joe Walsh.
Dr. Richard Madow: He’s not really one of the principals of the band. He’s still to this day kind of a hired gun.  I think very well-paid hired gun.
[cross talking - 0:05:26.4]
Dr. Richard Madow: Okay we got off topic way too quickly. I’ll tell you something.
Dr. David Madow: Well this question is incredible.
Dr. Richard Madow: I remember one time I heard a very learned rabbi who was asked one of those religious philosophical way of how could god let this happen type question. And he just said, I don’t know. And I think sometimes that’s the wise answer. Right? I say speaking for myself. I have no idea why dentistry is segmented from medicine and both of us, I mean Dave speaking for you, totally agree that this is true. This has happened constantly. We both saw it in our own practices. Why does it happen to dentists and not physicians? I have no idea. Is it our fault? Do you think we’re to blame?
Dr. David Madow: Like me and you or just…
Dr. Richard Madow: No, no. Dentistry in general.
Dr. David Madow: Yes. Dentistry – dentists are to blame. But here’s the caveat to that. Dentists are to blame, but I think this is so ingrained and it goes back so many decades. This is not something that started five years ago. So many decades that I think it’s going to be very difficult to change or reverse. I think we pretty much, this is the way we’re doing things now.
Dr. Richard Madow: Okay let’s back up too. Are we sure that if someone had a knee replacement that failed in a month, that they will fully expect to pay full fee for their new knees? I don’t know the insurance they need for…
Dr. David Madow: Said right here in the question.
Dr. Richard Madow: Well that one reason. That’s one purpose. I don’t know and I don’t also the insurance restrictions over that. And I used to say this to patients sometimes when they say how long will it last. I would say, well the insurance companies will pay for a new one in five years. It’s our expectation that it will last way longer than that. The insurance company is based on their data. Feel that it’s acceptable for it to last five years. So it could be a little longer, could be a little shorter. Sure, but on the average. And then, I was kind of setting the expectation though because crowns typically do last more than five years. Now, a tricky restoration with a weakened cusp, that can probably last less than five years. So why do patients think and they all do. Why do you think that the redo is free?
Dr. David Madow: I mean like any redo. Why would there be any redo in dentistry? Anything we did, as long as we’re doing it as best as we can, simply did. You did a [inaudible - 0:07:40.9].
Dr. Richard Madow: What if the best as you can is your shit job.
Dr. David Madow: Then that’s a whole different story. Let’s say you do a class 2 composite and do a composite, making this up. Patient comes in the next day, let’s say two days later.
Dr. Richard Madow: That afternoon.
Dr. David Madow: Let’s say the next week. Okay we’ll go with the next week. Patients comes in the next week and said this filling broke out of here. I think most dentists are going to say, okay I’ll replace it for you.
Dr. Richard Madow: 100%.
Dr. David Madow: But should we be replacing that at no charge? Should we do it?
Dr. Richard Madow: I got to tell you.
Dr. David Madow: It takes up chair time…
Dr. Richard Madow: There’s no dental patient in the world that would be totally accepting of – and then if the insurance won’t cover it, they have to pay for the thing out of their pocket.
Dr. David Madow: I totally agree.
Dr. Richard Madow: They will flip.
Dr. David Madow: So I think that’s maybe how maybe some of this come along because – but that insurance [inaudible - 0:08:31.5] so I’m not sure, but yeah you’re right. If insurance pays for the filling and they got to come in a few days later and have the things replaced. They say, okay it’s going to be $300, they’re going to flip out. But what’s the analogy in medicine?
Dr. Richard Madow: Well I was going to say if the doctor removed some mole and the mole grows back, the patient never said the doctor did a shitty job. They say the mole grew back.
Dr. David Madow: The mole grew back.
Dr. Richard Madow: And your doctor goes, well we got to go a little deeper this time. They never blame the physician.
Dr. David Madow: Well I don’t know. If you have a mole taken off and you felt in your mind that doctor didn’t go deep enough, you’re probably upset.
Dr. Richard Madow: Yeah but we never go too deep and cause like a scar, we’ll take out healthy tissues. So I think we almost like it. Because many – these days with the MOSE procedures, they can tell right away if they’ve gone deep enough or it’s like a cancerous lesion. I think this is a good analogy. I think people don’t blame the physician but they always blame the dentist.
Dr. David Madow: Well the mole might be a better analogy than the knee or the heart. Because let’s face it, you’re dealing with life and death and it’s a known fact that if you’re in for heart surgery, you could die on the table.
Dr. Richard Madow: And you better be sure that you sign a release saying that that could happen. And anytime you get anesthesia, same thing. You’re signing your life.
Dr. David Madow: Right. You’re probably not signing your life away that if this is to be repeated next week. I don’t know if they’re doing that, but I think it’s – with heart surgery, I think it’s understood that this is so risky and you’re saving a life and it might not work, and you might die. And if you die, you still gotta pay, I think that’s kind of implied. I think it’s understood by the general population. But the mole is probably a better example because if you get something taken off and then two months later, it’s something that’s growing back. You go into the dermatologist and say, I’m not happy with this. It’s growing back. You better do this for free. I don’t know the answer to that.
Dr. Richard Madow: Or how about botched plastic surgery? It happens all the time.
Dr. David Madow: I mean look at mine. I need to go back.
Dr. Richard Madow: I was going to say something. Not everybody is renewed unfortunately.
Dr. David Madow: But I think this has been a tremendous problem in dentistry for a long long time. To summarize, we can still talk about it but I don’t think it’s going away.
Dr. Richard Madow: Okay so it’s then, isn’t it up to us to preface our dental treatments to make the patient more aware of the fact that anytime you do work on the human body, that there’s a great chance that it will fail. Will it be in a week? It’s possible. Will it last the rest of your life? That’s possible too. You can say to the patient, look, when I was in dental school, we worked on these fake plastic teeth, they weren’t surrounded by saliva, they weren’t surrounded by thousands of pounds of biting forces all day long. Every filling had a kind of a plaster tooth in dental school but still in perfect shape. Kind of blame it on the patient.
Dr. David Madow: And the ones I did, they all fell out. So yours are just still there?
Dr. Richard Madow: That explains a lot. I mean I don’t know if it’s worth going into a lengthy explanation. I would certainly drive the point home that we’re dealing with your body, your saliva, your biting forces. All those things. Yeah if I did this on a plastic tooth, fake mouth, it will last forever, but it’s not reality. So if a patient said hey doc, how long will this crown last? That gives us the opportunity to make their expectations more accurate. And should we preface every dental procedure by making their expectations accurate? And when we have this problem…
Dr. David Madow: Well you wouldn’t say if somebody said to you that you were doing three crowns on a patient, and the patient said, hey doc long should these crowns last? You’re not going to say, well it could fall out as soon as you walk out the door. If they do, that’s your problem. I’ll charge to redo them again. You’re not going to say that.
Dr. Richard Madow: Yeah. When you do that, is you say, Mr. Jones, I’m going to give you a warranty. As a matter of fact, we call it a taillight warranty. And that means these crowns are warrantied until we see your taillights pulling out of the parking lot. They’re guaranteed with our taillight warranty.
Dr. David Madow: And I realize that’s a joke. But seriously, what would you do if you do a crown on somebody and they come back – let’s be fair. Let’s be really fair. A year later, there’s recurrent carries around the margin.
Dr. Richard Madow: This is serious now. Hard to believe.
Dr. David Madow: Things should be serious. It’s a serious show here.
Dr. Richard Madow: Why not – pretend you’re the patient Dave. You have to call me Dr. Madow.
Dr. David Madow: Dr. Madow.
Dr. Richard Madow: Yes. I’m going to put my hand on your shoulder like I do [cross talking - 0:12:58.8]. I can feel the tightness in that.
Dr. David Madow: It’s a little sore.
Dr. Richard Madow: In other words, we’re going to – what’s the word, not preface. We’re going to anticipate their question. Because they’re thinking of it anyways. Dave I know a question a lot of patients have is how long will this crown last? So they are difficult questions to answer because we’re dealing with a human body, we’re dealing with saliva, we’re dealing with thousands of pounds of biting forces, bacteria. Even healthy people have millions of bacteria in  their mouths. So all kinds of other factors. So we will fully expect and the insurance company expects actually that the crown will last about five years. We’ve put crowns in place that have lasted 10 years. We’ve seen patients from the previous dentist who are in this practice that their crowns have lasted 30 years. We’ve also had crowns placed that only last a year. Even a perfectly done crown, so it’s really impossible to be able to tell how long it will last. Now you have a realistic expectation. Right? And you never mentioned cost…
Dr. David Madow: Dr. Madow, if I get this crown – thinking I might be getting it done. If I get this done and let’s say a year from now it falls out. What do we do?
Dr. Richard Madow: Well hopefully we’ll be able to cement it right back in place. There’s just a very minor charge for that. But if the tooth underneath decays or if there are other circumstances like that, then we’ll have to build a brand-new crown. It’s not our expectation, very well may last for 10 or 20 years. That’s what happens when we’re dealing with a human body. Who could argue with that?
Dr. David Madow: I don’t think anybody can argue with that.
Dr. Richard Madow: Maybe I think dentists are afraid to bring it up?
Dr. David Madow: Yes. Not only afraid to bring it up, but I think most dentists are probably not going to do that thing. Most dentist are going to – okay here’s another. I’ve heard of this going around and a lot of speakers talk about this and I think maybe even because you and I have spoken about this, and I’m not so sure I agree with it, but some dentist will say, hey Jimmy, as long as you come in – if we do these crowns, as long as you come in for your regular cleaning every six months, if anything needs to be done with these crowns, we’ll do it at no charge. Now is that something you want to begin? You’ve heard that too.
Dr. Richard Madow: I used to do it in my practice
Dr. David Madow: Is that something you want to be involved with?
Dr. Richard Madow: I’ll tell you something. I’m not recommending it at this point in time. But I can tell you, when I did that in my practice, I found that when people did come in every six months, their dental restorations lasted. Now, granted I did sell my practice eventually, and I don’t know what happened after all that.
Dr. David Madow: I’ll tell you what happened.
Dr. Richard Madow: And I’m sure whenever anything happened, they blame it on the team.
Dr. David Madow: I’ll tell you exactly what happened. Some sucker that bought your practice, we do a bunch of crowns for free. That’s what happens.
Dr. Richard Madow: Well I don’t know if you took that deal. So again, these days I wouldn’t recommend doing it but it did work well in my practice. I knew I was taking a risk that I wouldn’t have to redo some crowns for free that certainly won’t by far that think that better things happen. I also knew that you encourage the patients to come in every six months. And that was a good thing. And I think that restorations did last longer when they came in for six months.
Dr. David Madow: Not only that, but if they came in every six months, any dental treatment that you saw need to be done will be treatment planned, they would get it done. So it could be argued that that technique is in the long term more profitable for the practice because they’re coming back every six months anyway, they’re getting more treatment than getting all their treatment done.
Dr. Richard Madow: They have pretty much like a warranty. As soon as they went in [inaudible - 0:16:15.3]. And as soon as they leave your practice, that thing is over. So I encourage you to come in.
Dr. David Madow: Somebody could…
Dr. Richard Madow: So somebody could find that idea.
Dr. David Madow: That’s the thing. That’s why we’re talking this out. I think they really don’t know the answer because the bottom-line question was how do we reverse this seemingly great mindset in the general population? I’m not so sure we can.
Dr. Richard Madow: I think if we do that little speech that I just kind of made up here, and answer the patient’s question before they even ask it, it covers that entire topic. So maybe we should all start doing that.
Dr. David Madow: So your job – every single day in the US sees this show because we’ve got the answer to take care of this whole promise. Only going to work if every dentists sees it and does it. Otherwise, our profession is going to be in trouble. So it’s up to you to make sure it’s being passed around. We’re all going to do it.
Dr. Richard Madow: We just saved dentistry. It’s better that to someone to save dentistry.
Dr. David Madow: Is this the summit to save dentistry?
Dr. Richard Madow: I think this is right now the summit to save dentistry. Alright, hey let’s do our call of the week. What do you say?
Dr. David Madow: That sounds fantastic. But before we do it, before we get into the call, you want to just talk about a couple of things first real quick?
Dr. Richard Madow: Sure, real quickly. It’s funny, I just asked Sylvia for some data on our coaching program, because people always want data. Well we heard your coaching program is great. I have a friend that loved it, but what are the statistics? So there are a million statistics. One thing that really struck me as a success which we were so proud of is that the average practice that works with us gets six times more than their coaching fee in collections during the first year. Six to one return or investment. Our coaching fee is very reasonable. What they pay in coaching fees comes back to them in collections. Production over six X for they paid. So that’s one little data point. Want to find out more about working with us? We’d love to work with you and your practice so you can earn more money, and love dentistry even more. We even have an upcoming Masterclass at our Madow Center in Baltimore. It’s free, we even provide breakfast and lunch. You have to get your butt to Baltimore, doctors only, go to masterclass.madow.com to find out more. Masterclass.madow.com and we hope to see you here.
Dr. David Madow: I thought you were – way to store your new website. I really thought you were going to say getyourbutttobalitmore.com.
Dr. Richard Madow: I think we should see if that’s available.
Dr. David Madow: If that’s available we’ll take it. But for now, just for now, go to – make sure you go to masterclass.madow.com.
Dr. Richard Madow: I like that, getyourbutttobaltimore.com. Don’t go to that site yet. Go to masterclass.madow.com
Dr. David Madow: Before we do the call really quickly. That was a great tip. I got a real short little tip for you or from us. But, this is not going to make you or save you as much money as the masterclass, because that is not – but we’ll take every little thing we can get. And right now you are using a credit processing company. So you’re paying certain amount for that every single month. How about if we told you we can save you a ton of money on your credit card processing? No overage fees or anything like that, and it’s very very simple to switch. When you do it, it’s a no brainer. It’s like make a phone call and click a few buttons and you’re done and you’re saving money every single month. Well you can do that. We’re recommending you give our friends at Fattmerchant a call or a click. Click is better, they’ll give you a website to click to right now. It’s BIT.LY/FATTMAD, and fattmad, we’ll get back to that in a second. In case you’re now watching the video, you want to know this for sure. It’s FATTMAD. Okay we’re going to spell it out for you. If you’re driving in your car, please be careful. Don’t write it down. Just go back and rewind later. It is BIT.LY/FATTMAD. Whatever you do, if you wrote it down, check it out. We promise you, you will save money every single month on your credit card processing. Good enough, do it. So let’s make the call.
Dr. Richard Madow: Absolutely.
Dr. David Madow: Hi Michelle, I got a question for you all. My wife and I are kind of new in town, and she is going to be needing a lot of dental treatment and she wanted me to find out if it’s okay when she comes in if she can bring her little comfort animal with her.
Female Voice: What do you mean by little comfort animal?
Dr. Richard Madow: She’s got a little animal she carries around everywhere just to make, you know, to give her a little more peace – she’s a very anxious person. It just kind of helps calm her down, take the edge off and she just feels more comfortable with it with her comfort animal.
Female Voice: My concern is if she needs a lot of dental work, our schedule is booked up until – first of all, I’ll put you on a sixth month schedule. My only concern is we don’t have the schedule to see if she needs the work right away. The next one that we have is not up to the end of June.
Dr. David Madow: End of June, and it’s April right now. So two and a half months.
Female Voice: Yeah. So it might be, like for us, let’s say if you come in now and you went into the end of June, even after at the end of June, it’s going to be many months.
Dr. David Madow: Well she just moved here and she was told she needs I think like 12 crowns and she’s ready to get them done. So you’re saying she have to wait that long?
Female Voice: Oh my goodness, that’s 12 crowns. We thought we won’t have time for that 12 crowns.
Dr. David Madow: Oh you wouldn’t have time for 12 crowns?
Female Speaker: Yeah.
Dr. David Madow: Oh okay. Because 12 crowns and not…
Female Voice: Here’s the thing, one of the crowns, it depends on – some of the crowns if it was next to each other, it means that you have to – in ideal world you have to do it at the same time. So that is – let’s say if you have  four crowns, I’m not sure if you need a crown or that you need a bridge.
Dr. David Madow: Well I know that she needs a bunch and not only that, it makes things a little more complicated for you. The same dentist told me that I need a whole lot of dental treatment. So we’re trying to establish ourselves with a new dentist, but you say you wouldn’t be able to see us anytime soon. Right?
Female Voice: Yeah. I mean with a crown, like for us – let’s say assuming that you have ¾ tooth for the crown next to each other, you have to do it all at once so that [inaudible - 0:22:46.8] and to get that [cross talking - 0:22:50.1]. And that procedure alone is like a whole day by itself. You are not going to be able to do sit in a chair the whole day.
Dr. David Madow: Right. I think between the two of us we probably need like 90 to $100,000 worth of dental treatment. That’s probably way too much. That probably takes a lot of time.
Female Voice: It’s a lot of time and money. I can tell you one crown is 1400 at least. And if you need 10 crowns that’s $15,000.
Dr. David Madow: Well we also need some gum treatment so that’s going to add to that, but okay…
Female Voice: Wait, how do you know – well it is true, you probably need that and if you need a gum treatment and things like that, I can refer you to a gum specialist right now.
Dr. David Madow: Yeah but I’d rather just associate myself with one practice first. That’s probably the best thing and I know we need a lot of crowns, a lot of crowns. We both need it.
Female Voice: Yeah. That’s why I want to be upfront with you. Because I don’t want to get you in and then we don’t have time to – it’s not that we don’t have time. It’s just that you’ll have to wait longer down the road and that’s no good.
Dr. David Madow: Sure. I understand. Let me see if I can find an office that’s maybe not as quite busy. That might be a little better choice. Is that right?
Female Voice: Yeah. And then also, some office that would be able to accommodate a lot of the stuff that you and your wife needs.
Dr. David Madow: Right. Well you’ve been very kind and I appreciate it. Because like I said, we need a lot of work done. You’ve been very kind. It sounds like you guys are a little too busy.
Female Voice: Yeah. I just want to be honest about it. I don’t want to be greedy and get you in and just to get the money and then…
Dr. David Madow: No that’s good. I’m looking for a good, honest dentist and not greedy. So that’s perfect. So thank you very much. I do appreciate your time. Thank you so much.
Female Voice: Alright. Next time.
Dr. David Madow: Bye.
Dr. Richard Madow: Holy shit.
Dr. David Madow: You know, it’s funny, when we made that call, we didn’t even think we would go in that direction. We wanted to find out more if they would accept their comfort animal.
Dr. Richard Madow: It kind of brings right over the comfort animal thing and…
Dr. David Madow: She really took one of the fact that my wife needs a lot of crowns but it’s going to be too long before they fit her in. They’re just too busy for seeing – she needs all these dental works. 12 crowns. I don’t even know what to say.
Dr. Richard Madow: Well another case where I would imagine the dentist has no idea this kind of stuff was going on in their practice. Their front desk person is unilaterally telling the patient that wants 12 crowns to go somewhere else. Go somewhere else.
Dr. David Madow: Now here’s the weird thing. I just thought of this one. Let’s say he’s doing some kind of – assuming he’s the dentist. There were doing some type of marketing and they were spending a lot of money every month at some marketing company and they’re saying we’re not getting any calls. This isn’t working. Meanwhile, she never asked how we found out about them. So, this could have been a hundred thousand dollar case from this marketing company, whoever it is. For a hundred-thousand-dollar case, she said we’re a little too busy, we can’t really take you on.
Dr. Richard Madow: And they’re booked 2 ½ months out. That’s a huge problem. How can your practice grow if you’re booked 2 ½ months – are you really…
Dr. David Madow: I assume that was for hygiene. I assume she meant that for hygiene.
Dr. Richard Madow: Why would she ever think that she has to wait to get his patients for hygiene? That is ridiculous. Get that patient and say, say come over right now. If you’re on your cell phone, let me give you directions right now.
Dr. David Madow: I would send a Lyft over for her. If she needs 12 crowns and her husband needs a whole bunch of dental work also, I would send like a limo.
Dr. Richard Madow: She was really nice, let’s give her that. I also like the way that she was going to refer you to a specialist without doing an exam first. That was really good.
Dr. David Madow: Here’s the deal, this dentist – what’s her name. I can’t remember…
Dr. Richard Madow: Michelle. How can I forget that? She said Michelle.
Dr. David Madow: If you ask this dentist, how is Michelle doing. He’d probably say oh she’s doing great. She’s really great with our patients. Our patients all love her. Meanwhile, she sends hundred thousand dollars out the door just now. A hundred thousand dollars.
Dr. Richard Madow: So okay, that’s a good point though. Two and a half months out, probably it’s a hygiene. This one in the front desk, was like, well when a new patient calls, they get an appointment for a cleaning. So hygiene is booked two and a half months out. This person knew that they needed 12 crowns, 14 crowns, whatever. How many patients are you losing that don’t know they need a tremendous amount of work, but probably do if you’re making them wait two and a half months.
Dr. David Madow: Two and a half months for hygiene.
Dr. Richard Madow: Millions each year you lose. If a new patient calls and they want to come in, and you’ve got to wait two and a half months out for hygiene, you are short a hygienist. You’re going to need a new hygienist, you need to be putting new patient time in the hygienist column, whatever you want to call them, on their schedule. Or you can treat them as you [inaudible - 0:28:01.5]. And then if you sense the patient needs any kind of restoration or a decent amount of – get them in with the doctor right away. Don’t make them wait because you will never see them again.
Dr. David Madow: This was perhaps one of the most unbelievable calls I think we’ve done in the history, seriously.
Dr. Richard Madow: It was unbelievable.
Dr. David Madow: I think last episode we did one and that one did great. I think we both gave her an A.
Dr. Richard Madow: She was the one that had a free pizza dentist.
Dr. David Madow: Right.
Dr. Richard Madow: There’s no way that she would have made this patient wait two and a half months. They would have been getting their crowns and their pizza way before this patient is even coming into the office.
Dr. David Madow: Was this unbelievable?
Dr. Richard Madow: It was pretty unbelievable. That’s why you hear it on the Dental Practice Fixers. We even fix this practice. As a matter of fact, we can just show up with this practice. We’re here to fix your practice.
Dr. David Madow: Not only fixing, we’re busy, we’re booked until June. We don’t need fixing. Well sorry, your front desk person just turned down a $100,000 case.
Dr. Richard Madow: So this is a million-dollar practice which is based on the skills of the front desk person. I doubt it is. So it’s a million-dollar practice. They just turned down a chance to increase by 10%.
Dr. David Madow: If they are 10%. Here what else we’re going to need. That’s when I said we might need a lot.
Dr. Richard Madow: And how many more patient is [inaudible - 0:29:15.9].
Dr. David Madow: I don’t know what to say.
Dr. Richard Madow: So many lessons here, but one main one is if you can’t get a new patient for two and a half months, your practice cannot grow nearly the way it should be growing. So stop complaining. Take some action.
Dr. David Madow: Well I’ll tell you one more lesson and then we’re going to end this episode. But another episode – and we found this out really in one of the most recent Masterclasses that we just did, is the doc that we had there, admitted that he has no idea what his front desk people say on the phone. And I’m not saying we need some micromanaging, need to be there recording every call on this. You need to set up some guidelines and rules and know the exact – you need to know what they’re doing. You need to know what they’re saying.
Dr. Richard Madow: You need to get proper training for your front desk. It is an incredibly important position, and dentists just tend to hire someone, they stick the new girl in the front desk. This person has 10 years’ experience, their office is down the road, so they’re great front desk. If you stick in there, no training, you have no idea what’s going on up there, and it leads to disasters like this or like disasters you hear every week on the Dental Practice Fixers except for last week. Maybe she was actually good. So hey, thanks for listening. Give us a rating on iTunes. Tell all your friends about the Dental Practice Fixers. We’d love to grow on our podcast just like we’re helping you grow your practice. So from the Dental Practice Fixers, I’m Dr. Richard Madow.
Dr. David Madow: Dr. David Madow, we will see you next time.
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