David Madow, Author at The Dental Practice Fixers
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David Madow

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!

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.
[music playing]
 
Doctor Gets Paid by the Day

The Doctor Gets Paid by the Day – Is it Fair to Ask Her to do THIS During Downtime?

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We pay our doctor very well by the day and not by production. So since she is getting paid, is it OK to ask her to do other tasks when she has openings? For example, should the doctor get on the phone to call patients? What may we ask her to do and what should we stay away from? Listen to how Dr. Richard Madow and Dr. David Madow answer this one. Then of course we do the call of the week. We call a dental office that is offering a “free dinner” on their website as a marketing technique for getting new patients. Easy, right? Well, not necessarily. Let’s listen in to see how this one was handled! 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!


The Doctor Gets Paid by the Day – Is it Fair to Ask Her to do THIS During Downtime?


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.
 
[Music]
 
Dr. Dave Madow: An associate dentist is guaranteed a certain amount of money per day, whether he or she is busy or not. It can leave us some calls which we’re going to talk about right now. This is The Dental Practice Fixers Episode 10. I am Dr. David Madow along with. 
Dr. Rich Madow: Dr. Richard Madow, great to be here, everyone. 
Dr. Dave Madow: Yeah, it’s great to be back. We really appreciate you and we are the fixers as we say. Let’s get right in to a great question we received and we’re going to go and answer this as best as we can as we always do on these episodes.  
Dr. Rich Madow: This question actually turns out to be multifaceted and even though it’s maybe single-faceted when you hear it. I’ve got it on my phone here. So okay, well, here’s the question and that is, hey guys, we recently hired an associate with a guarantee of $600 per day. But sometimes the schedule falls apart. Question, what can we have the associate dentist do to help out the office? Do you think it is weird to ask her to make phone calls and book her patients since our front office is short-staffed? So, that’s a great question as it is and then it also leads to other questions like should you be paying a guarantee per day to an associate dentist? So, let’s talk about all these issues. What do you think? Where do you want to start?
Dr. Dave Madow: Maybe we should start with why that arrangement in the first place? I think that arrangement in itself can lead to a lot of problems but she sounds like it’s leading to problems already. I mean, so this dentist signed an agreement and he or she is- 
Dr. Rich Madow: She. 
Dr. Dave Madow: She, okay, it’s a she, she’s making [crosstalk] $600 per day. Whether she’s busy or not, she’s guaranteed that amount of money. I mean, why would you want to have an agreement like that? Why wouldn’t you want to have the dentist responsible for his or her production and working hard and knowing the more you, the more you work, the more cases you do, the more you’re going to make. You know, you’re investing in the craft. 
Dr. Rich Madow: Well, I’ll tell you exactly what. I think remember back to our day, I don’t [inaudible 02:22] also [crosstalk]. 
Dr. Dave Madow: A long time ago. 
Dr. Rich Madow: I graduated dental school 84, you graduated in 80. Then we both did our residencies. And then we both… we were looking for associateships before we had our own practices. It was a different time, I think we didn’t have huge student debt, we didn’t have corporate dentistry. In these days, just think of a student graduating, they’ve got a lot of debt and they’re being made an offer by a corporate dental practice. Well, that’s, you know, those practices are all guaranteeing a per day guarantee. So I think all corporate practices are doing [crosstalk]. 
Dr. Dave Madow: I can’t speak for every [crosstalk] it’s very typical. You make x per day [crosstalk]. 
Dr. Rich Madow: Bonuses and chances to earn more but yeah essentially someone will know, well, if I take this job at a crappy corporate dental office, at least now I’ll be able to chip away my loan. If I’d take this job at this other practice where they’re saying, yeah, I got 30, 32, 33%. What if I have a shitty day? I won’t be able to chip away my loan on that day. So, I think we can understand the temptation here where it might be tough to hire someone without a guarantee. 
Dr. Dave Madow: Well, that’s a good question. So okay, if that’s the way that they have to do it, I mean, I don’t agree with it. It’s good but I mean, these are corporate people owning this dental practice. They must know what they’re doing, right? I just can’t [crosstalk] 
Dr. Rich Madow: I don’t like it either. I don’t like it either. I think an associate dentist is different than another team member. It’s different than, you know, someone else and they should be paid on what they collect. It’s the only thing, you know, when you’re an owner dentist, you don’t get paid if the money doesn’t come in. You’re a dentist, you’re in the major leagues now. You get paid on what you… and if you don’t like that arrangement, get a job with, you know, a government agency or a super corporate practice, whatever. You want to be in private practice. There’s a little bit of a chance you got to take. 
Dr. Dave Madow: You know, here’s the way I look at that. I own a dental practice, this is like, you know, if I  own a dental practice right now and I’m hiring somebody, it’s not my problem that you’ve got massive student loan debt. It’s not my problem. I hire you as a dentist, the way we do it here is you get a percentage of the work you do and that’s how you get paid. So okay, but let’s do- 
Dr. Rich Madow: I agree but for some reason [crosstalk] this practice is on a situation with $600 a day guarantee, they work five days, that’s $3,000 a week, that’s a $150,000 a year, guaranteed.
Dr. Dave Madow: $150,000 guaranteed. 
Dr. Rich Madow: It’s a hell of a guarantee for a young dentist.  
Dr. Dave Madow: So I guess we got to answer the question then. So if that dentist has holes in her schedule, I think anything is fair. They can tell her to do anything they want her to do. They can tell her to get on the phone, answer the calls. I mean, I don’t think it’s right, I don’t think it’s right that she gets on the phone and it sounds kind of weird to have like the dentist calling, it’s like vague but again, this is the model that I don’t believe in the first place. 
Dr. Rich Madow: Get her on the phone doing what? What are they doing?
Dr. Dave Madow: They ask if she should be calling patients. Let’s just say going through the “million dollar file cabinet.” People that haven’t been in and people that are overdue to schedule, they haven’t scheduled. For some reason, they got, you know, dropped and they needed to be called. The same thing that the office manager, scheduling manager would be doing. It’s very weird but again it goes back to this whole model, this whole model of the corporate dentist thing is weird as shit. So they’re breaking all the rules. 
Dr. Rich Madow: That’s the reality.  
Dr. Dave Madow: They’re breaking the rules anyway so yeah, it’s the reality. So the dentist might have to go ahead and do some stuff that she… that’s not clinical. 
Dr. Rich Madow: I’ll tell you what I had this dentist do. With our question, I’d say let’s just call her, what’s her name going to be? 
Dr. Dave Madow: Mary Jane. 
Dr. Rich Madow: Mary Jane, last dance for Mary Jane. Say, Mary Jane, see that building down the street, well, that building is the blah, blah, blah corporation. They’ve got great insurance. They have a bunch of patients, I want you to go to that building, meet with the HR Director and tell them why our practice is the best in town and why their patients… setup something, a lunch, a bagel, whatever it is. Do something, some people might call it ground marketing or whatever they want to call it, do something in the community. Don’t just sit there doing nothing. That’s unacceptable. And again, even though this person is being given a guarantee, it’s up to them in a way to grow their little piece of this practice. So let’s come up with some ways to do this.  
Dr. Dave Madow: Yeah, that’s one of the first things I thought of when we got the question that this person should be doing everything possible to grow her part of the practice. 
Dr. Rich Madow: Where it’s like, please call patients. Well, that has gone through the million dollar file cabinet.
Dr. Dave Madow: Yeah, but the ground marketing I think is important too. [crosstalk] Yeah, I mean, she should be doing… I guess she should be doing that anyway like everybody in the community, when she goes to a restaurant, when she goes to get her dry cleaning done, handing the card, getting into a conversation, handing a card saying, “I’m Dr. Mary Jane. I’m [crosstalk] in town with this practice. I’ll take good care of, you know, [crosstalk]” 
Dr. Rich Madow: You’ll see us down the street, you’ll see the chiropractor down as well. I don’t know, we got to draw the line somewhere. You’ll see other health professionals in the area, make yourself known in the community.  
Dr. Dave Madow: Yeah. I mean- 
Dr. Rich Madow: What’s wrong with that? I think that when I first opened my practice and I was the owner, I met everybody, I went to the school and I gave what? Go to the elementary school and give a lecture to the kids and bring little baggies and all this stuff.
Dr. Dave Madow: Yeah. See, you were the owner and you’re incentivized because you knew that when you went to a school and gave a talk, or when you went to a business, or when you did a… you were flipping burgers at the country [crosstalk], you knew that that was going to come back and make you busier, make your practice busier, earning more money. This person is guaranteed $600 a day whether she works or not. I don’t know whether the incentive was there for her to be going crazy to be bringing in more patients. She’d probably rather have holes in the schedule. 
Dr. Rich Madow: Well, that’s the wrong person for your practice because this person is being guaranteed a certain amount of money, they should have to work. And work isn’t always… it’s not always, you know, doing a crown prep to someone who knocks the door and [inaudible 08:13]. Work is grown in the practice. 
Dr. Dave Madow: But okay, if you were guaranteed $600 a day, let’s say you’re a young associate guaranteed $600 a day, would you want your schedule full to the max or would you want some wiggle room and [crosstalk] small things? 
Dr. Rich Madow: My understanding is that the guarantee is different than the potential. So for me, I would usually work, there’s a guarantee but there’s also a percentage. So you cannot more [crosstalk].
Dr. Dave Madow: They won’t insist. [crosstalk] 
Dr. Rich Madow: I’ve never like this some sort if that’s the case. 
Dr. Dave Madow: If that’s the case, if that’s the case, then I’d be out of my… I’d be out doing everything I could to grow the practice. 
Dr. Rich Madow: [Crosstalk] Sitting the back office, they firm up their butts, they don’t know what. That’s just doesn’t work.
Dr. Dave Madow: But there’s something else in the question, I can’t remember the question something else other than should we have her call… I thought there were something else. 
Dr. Rich Madow: Is it weird to ask her to make phone calls and book her patients? 
Dr. Dave Madow: Okay. 
Dr. Rich Madow: No. And I think everything we’ve been talking about, a reason is not to do the guarantee but again I think it’s the reality in today’s world. People… this is just the way it is. These young dentists are getting guarantees.
Dr. Dave Madow: I mean, you can argue that anything that’s done to make the practice better is going to bring in more patients, make her most successful. You would agree with that part, right? 
Dr. Rich Madow: Absolutely. 
Dr. Dave Madow: So let’s say that the bathroom is a mess, should she be in there cleaning the bathroom now to make the practice better? 
Dr. Rich Madow: Well, I’ll go back to this. I did it when I owned my practice. If I walked in there and the place was a mess, I mean, I’m not coming in there like a full cleaning crew but I would straighten up there and I will do whatever it’s up just like you would. A dentist does whatever it takes to make their practice better. Many times it means delegating, many times it means doing things for yourself. But this person accepted the guarantee and to me as crude as it may sound, it means that they do whatever the hell the owner dentist tells them to do whether they like it or not.
Dr. Dave Madow: Yeah and that comes back I guess if it was the right person, the right person and she’s not lazy and she wants to really grow and build that I guess anything is fair game. 
Dr. Rich Madow: Anything goes. 
Dr. Dave Madow: You know, I guess I keep my mindset id still like, hey, you know, you were a dentist, you work on production or collections or whatever it might be. Well, okay, I’ll tell you, well, you remember in the day when I finished my residency and I had associateship in a practice, it was kind of like the original, kind of like the original corporate dental place, it was growing. They had this like business guys coming in once a week and talk to the doctor and tell him what to do basically. So it’s kind of like yeah kind of the original. 
Dr. Rich Madow: Kind of the early days [crosstalk]
Dr. Dave Madow: Right. So I had a guarantee, I wouldn’t tell you what the guarantee was. It was so long ago, it was so low but I also could earn a lot more the more patients I saw. But I don’t remember if I was at… they wouldn’t let me get close to the phone like you call the patients. They wouldn’t let me do that. 
Dr. Rich Madow: Okay, this person let’s say they have a 2-hour hole in their schedule, what’s wrong with them getting on the phone doing confirmation calls? What’s wrong with it? What’s wrong with their patients? Jim, this is, this is Dr. Mary Jane, we’re looking forward to seeing you at your appointment. Do you have any questions for us? That actually can go a long way. I think it’s bright. I don’t see anything wrong with it. 
Dr. Dave Madow: So our answer is basically from this question, our answer is have her do whatever it takes, not clinical, whatever it takes to build the practice. Making calls, ground marketing, whatever. 
Dr. Rich Madow: But I would focus on the doctorish kinds of things like ground marketing, meeting people in the community, go and talk to the elementary school or the senior center, the assisted living facility, whatever you call, we don’t call them [inaudible 11:41] anyway, whatever they call it, doing the doctors things. Then yes, and whatever the doctor says, they got to do because you’re being paid a guarantee. [inaudible 11:50].
Dr. Dave Madow: Okay. I think that’s our answer, right? 
Dr. Rich Madow: I’m with it, man. Let’s do the call of the day. 
Dr. Dave Madow: Sounds great. Let’s get into it. Hey Rich, so before we get to the call real quickly, I was reminded that, you know, we just did a Masterclass a short time ago at our Madow Center and it was a great day. And I just want to remind our listeners and viewers that we offer a Masterclass for dentists. It’s a great day where you come in and it’s a day of learning. But not only a day of learning, they help and show you actually how to build your… how we can help you build your practice. And we’d love to have you come to Baltimore, to The Madow Center for Dental Practice Success for our next Masterclass. Check it out at masterclass.madow.com. It’s for doctors only and it is; there’s no charge. You just get to our Madow Center and we take care of you and it’s a great day. We really give a tremendous amount of info in a short period of time, Masterclass. 
Dr. Rich Madow: No question about it. And if you have to get on a plane to get there, well, how do you get… can you get free airfare? You can because if you use Fattmerchant for your credit card processing, you’re got to be saving more than your airfare amount probably every month, maybe much more. So Fattmerchant is the disruptor in credit card processing. They do not charge an overage percentage, just a flat monthly fee. Instead of telling you every single detail, we got a special site just for you to check it out. It’s bit.ly/fattmad, fat with two t’s, F-A-T-T-M-A-D. So just go to bit.ly/fattmad, F-A-T-T-M-A-D. As a friend of ours, you even get your credit card processing gizmo for free so check it out and start saving money. You’ll have enough money to fly to Baltimore even if you’re coming from Sydney, Australia and we’ll see you in the next Masterclass.
Dr. Dave Madow: We want you to see there. Now, let’s do the call.
Dr. Rich Madow: Let’s do it. 
Dr. Dave Madow: Ready? 
Dr. Rich Madow: Go.
Female Speaker 2: This call maybe recorded for quality assurance.
Male Speaker: To serve you better, this call may be recorded for training and quality purposes.
Dr. Dave Madow: Yeah, okay, I get it. 
Female Speaker 3: Office, how may I help you?
Dr. Rich Madow: Hi, I’ve got a question for you. I’m looking at your website and I’m interested in becoming a new patient and I see the new patient special includes dinner on you. Hello. 
Female Speaker 3: Let me take a look to it. 
Dr. Rich Madow: It says, new patients special, 20% off plus dinner on us.
Female Speaker 3: Okay, let me double check. Okay. I think that’s our new special. Let me pull it up. 
Dr. Rich Madow: Sure. 
Female Speaker 3: Do you mind if I place you on a brief hold to pull it up, okay? 
Dr. Rich Madow: Please. Now, that is horrible hold music. This is like computer-generated. I wouldn’t even call it music.
Female Speaker 3: Oh yes sir. So it is [inaudible 15:16] we’ll give you a gift certificate to PizzaRev. 
Dr. Rich Madow: Where is it to? 
Female Speaker 3: It’s PizzaRev. 
Dr. Rich Madow: PizzaRev.
Female Speaker 3: It’s a pizza place. 
Dr. Rich Madow: Yeah, I don’t really care for pizza. Can I eat somewhere else? 
Female Speaker 3: No sir, that’s all that we have. 
Dr. Rich Madow: A gift certificate to PizzaRev. Now, you don’t come with me, do you? That’s just for me.
Female Speaker 3: Yes, sir. 
Dr. Rich Madow: You do come with us? 
Female Speaker 3: No sir. Just no sir, we just give you the gift certificate.  
Dr. Rich Madow: Wow. What do I have to do to get that? Just come in as a patient?
Female Speaker 3: Yes, sir. We will get you in and schedule you for an exam and x-ray and you’ll see Dr. [Noise] and we’ll go from there. Do you have any issue that we need to discuss at this time? 
Dr. Rich Madow: Not that I know of, just looking for a new dentist. 
Female Speaker 3: All right. Well, very good. We’re glad you gave us a call and that you had an opportunity to look at our website so that’s great as well. Do you have any questions about our office? 
Dr. Rich Madow: I don’t, I don’t have any questions. The free dinner really struck my curiosity so I just wanted to call to find out about that.
Female Speaker 3: Oh right. Well, very good. I’m sorry I had to place you on that brief hold, that is one of our newer advertisements so I just wanted to make sure that I gave you the correct information. 
Dr. Rich Madow: I appreciate it. 
Female Speaker 3: If you have a specific time, would you like to come in and [crosstalk] schedule? 
Dr. Rich Madow: I don’t, I’m still just doing a little research.
Female Speaker 3: Okay. Well, very good. Well, can I take your name and number then and I’ll give you a call. You said, you’re just given… just doing a little research. 
Dr. Rich Madow: Sure. It’s Jim Hinkley. 
Female Speaker 3: Okay. 
Dr. Rich Madow: And it’s 801-242-7727
Female Speaker 3: 777, wait? 
Dr. Rich Madow: 7727. 
Female Speaker 3: I’m sorry. 
Dr. Rich Madow: 7727.
Female Speaker 3: All right. And when you are starting looking for a new dentist, what exactly are you looking for in the new dentist office? 
Dr. Rich Madow: I think they should be licensed. Hey anyway, I really got to run but thank you so much for your time. Thanks. 
Female Speaker 3: All right. Well, thank you so much. Bye. 
Dr. Rich Madow: Thank you. Bye.
Dr. Dave Madow: Okay. Wow, that was incredible on many levels. 
Dr. Rich Madow: That was unique, isn’t it? 
Dr. Dave Madow: On many levels, that was a great call. 
Dr. Rich Madow: Yeah, I got to tell you, I was just, you know, as I think we both do, we do our calls, just put in the name of the town, we put in dentist, so you come up, you go to their website. And this website was really striking the second we got to it and it was a beautiful website. There’s a big ad comes up, free dinner. When you come to see us as a new patient, free dinner, free dinner, free, it was like smacking me in the face. She had no idea about it.
Dr. Dave Madow: Well, so that’s number one. If you’re going to have like an ad, a big ad on your website announcing this free dinner, this promotion, don’t you think at the very least at a morning huddle, the doctor should make everybody aware of this promotion. Everybody should know about it. 
Dr. Rich Madow: There’s always some ads you’re thinking that was on a page off over page off over page in the corner on a sidebar [crosstalk]. 
Dr. Dave Madow: Very, very obvious. So, she should have known everything about it. Put you on hold and say, “Well, I don’t know if I have that promotion.” That wasn’t really good and I wonder what some of the other promotions are. What do they say? What are some of your other promotions? 
Dr. Rich Madow: Free massage [crosstalk].
Dr. Dave Madow: So she should have known everything about it, that’s number one. 
Dr. Rich Madow: Well, okay, let’s do number 0. 
Dr. Dave Madow: Number 0? 
Dr. Rich Madow: Was it really necessary to tell the person twice that the call is being recorded? I was… seriously, I was starting to feel very creepy. I mean, when I call the place, I don’t like it when they say the call is being recorded. I know we’ve come to accepting these days, it’s very normal. But twice, I felt really creepy about it.
Dr. Dave Madow: Yeah, I didn’t like it. I’ll tell you, I agree with that totally. 
Dr. Rich Madow: Awful music. 
Dr. Dave Madow: Awful music. What was it? It was horrible, right?  
Dr. Rich Madow: [Singing] It was like computer-generated. Yeah, I know fake piano music.
Dr. Dave Madow: Get yourself some good on hold messaging. 
Dr. Rich Madow: Absolutely. 
Dr. Dave Madow: Please. Okay. So we killed that one already. Okay, that’s three things there. 
Dr. Rich Madow: This may be cultural. I don’t really like the yes sir, no sir thing but again I thought this is in the South and [crosstalk] maybe it’s the way they all talk to some cultural… we’ll give you a cultural break here.
Dr. Dave Madow: I think it actually [crosstalk]. No, there’s a different reason that… yeah, I think totally acceptable and probably charming. I think that’s fine. 
Dr. Rich Madow: I thought she did a lot of things really well. Speaking of charming, she was an absolute [crosstalk]. I really felt that she cared.  
Dr. Dave Madow: Yeah. 
Dr. Rich Madow: I mean, I thought that she was going to be there at PizzaRev right with me.
Dr. Dave Madow: For a second, I thought she said she comes with you. 
Dr. Rich Madow: She was kind of making a joke, I’m sorry to tell. 
Dr. Dave Madow: Right. I guess she was on the sale, right? 
Dr. Rich Madow: Yup.
Dr. Dave Madow: Now, do you think obviously they’re paying a certain of money for this coupon, for this free dinner? Do you think she should have gone out on the [inaudible 20:03], if you don’t like that, let me see if I can get you another restaurant? Would that have been… you clearly said, I don’t like pizza, would that have been beyond the call of duty if you say, let me see if I can get you somewhere else? 
Dr. Rich Madow: Well, is there a fine line between beyond the call of duty and offering incredible customer service? What if she had said, “Well, everybody seems to love PizzaRev with their pizzas but for you, I’m sure we can work something else out. What kind of food do you like?” I mean, that could be like [crosstalk] conversation. 
Dr. Dave Madow: And even like a Starbucks coupon or something, something but not, you know, it just would take elevated to a higher level for sure. 
Dr. Rich Madow: That’s a great idea and now there’s right next to PizzaRev, there’s [inaudible 20:42] and this [crosstalk]. Do you like that?
Dr. Dave Madow: I’ll take it. 
Dr. Rich Madow: That would have been incredible sales. I think maybe it bothers me, but a great suggestion. And she did say something she said, is there a specific time I would like to come in? I can’t say I like that better than offering two good times because… I mean, again, she did that really well but if you say, is there a specific time and I say, I’d like to come in at 4 PM, you don’t have 4 PM, then you have to backtrack. So even if it was a good effort, I would have preferred fantastic, we can see it’s [inaudible 21:12]. Our start time will be tomorrow at 11 AM, which works best for you? Because once they offer a time and you don’t have that time, then you’re kind of pitching all, I don’t know if pitching all through it, but if you know what I mean. 
Dr. Dave Madow: Okay so we’re on this part of the call where I think we’re both going to agree she was fantastic. First of all, I love the question she asked. It is might not be for data but it was something like, well, what is it that you’re looking for in a new dentist? 
Dr. Rich Madow: Yeah, that was interesting. Those are the variant-
Dr. Dave Madow: Great question, I mean. So she’s in the top 1% because she was asking questions. 
Dr. Rich Madow: I might be disagreeing. 
Dr. Dave Madow: Oh really? Okay let’s hear it, I want to hear it. 
Dr. Rich Madow: Is what are you looking for in a new dentist really a great question? What’s the point? People don’t know what they’re looking for. I’m calling for the free dinner. Her job is to get me off the phone and do an appointment.
Dr. Dave Madow: Right. 
Dr. Rich Madow: Do you think most people when they see it in their respondents with an offer like this really know even any thoughts what they’re looking for in a new dentist? 
Dr. Dave Madow: Yeah, I think they do. I think everybody wants painless. Everybody wants let’s say affordable and somebody that’s caring. So I think if the person… if you or the person calling would have said any of those, yeah, I’m really anxious when I know there’s a dentist. I just want somebody that’s caring. That gives her ammunition to say, well, our doctor is really, really caring and gentle. I think [crosstalk], I don’t think it was bad. 
Dr. Rich Madow: Very well-taken. I think you could see I was maybe excessive like at that point just get the person in. But that might have been also after I may be clear that wasn’t right there to make an appointment. I can’t remember exactly.
Dr. Dave Madow: Maybe it was but I guess one of the reasons I’m saying this also is because she was in that top 1%, 99 point something percent of the dental practices out there would never even gone to that point. They would have said, okay, well, thanks, see you later. So at the very least, she took it to that level when she was engaging in conversation, asking questions, maybe another question but she asked a question and she did everything she could [crosstalk]. 
Dr. Rich Madow: She kept a positive conversation going. No question on that. And then, when I made it very clear I wasn’t going to appoint, at the very least, she got the contact. 
Dr. Dave Madow: She got your contact and that’s the top point 1% probably. 
Dr. Rich Madow: So I’ll tell you what, we cannot blame it on her that she didn’t know about the promotion.
Dr. Dave Madow: That’s a good point. 
Dr. Rich Madow: That’s the dentist or the marketing manager, it’s not her fault. So- 
Dr. Dave Madow: So she did everything right. 
Dr. Rich Madow: She did.
Dr. Dave Madow: That’s a really good point. That was not her fault. She shouldn’t have to come in everyday to the office, get the morning huddle and say, so doctor, are there any more promotions I need to know about? 
Dr. Rich Madow: She called it the advertisement and you really like call that much but she still, you know. 
Dr. Dave Madow: That’s fine.  
Dr. Rich Madow: So what grade are you going to give her?
Dr. Dave Madow: I’m giving her an A. I got to tell you, I’m giving that since we started this podcast when season 2, I think it’s the first A I’ve ever given. I believe. She has an A. 
Dr. Rich Madow: I’m going to give her an A also and I’d love to go share a pizza with her at PizzaRev. 
Dr. Dave Madow: That will be so nice. 
Dr. Rich Madow: I don’t think it’s ever going to happen but it will be fine. Maybe if we’re lecturing in that town, we’ll go to PizzaRev. And I will just see if there’s like a new dental patient sitting somewhere using our [inaudible 24:11]. How can you tell if there’s a new dental patient? I don’t know, they have pizza prime and-
Dr. Dave Madow: Hey, what kind of pizza [inaudible 24:20] or if they say to… they go up to the counter and say, I just got this certificate from my dentist, what can I buy then? How many pizzas can I get?  
Dr. Rich Madow: Have a pizza and a coke. The dentist is highly recommending coke. 
Dr. Dave Madow: Yeah, once slightly, oh you’re from Dr. so and so, you get one slice, yeah, one slice and a coke. 
Dr. Rich Madow: And chips and cake. Yes, sir. All right. Well hey, that is episode 10.
Dr. Dave Madow: Episode 10. 
Dr. Rich Madow: Episode 10, Season 2 of The Dental Practice Fixers Podcast. Thanks for being with us. Go give us a good rating on iTunes. We’d love it and we’d really appreciate you taking time to give us a review. Dr. Richard Madow. 
Dr. Dave Madow: Dr. David Madow, see you next time.
 
 

Doctor Creates a Tough Work Environment But Pays Well – Should Team Stay or Go

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A team member asks what can be done about the doctor. He comes in late every day, after the first patient is seated. He never says hello to anyone and it gets worse from there. Should the team members stay in this environment, even thought the pay is good? Listen to what The Dental Practice Fixers have to say. Then of course we do the call of the week. What happens when an office next to a certain well known landmark is asked to describe their location? Simple, right? Well, listen in to see how this one was handled! 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!


Doctor Creates a Tough Work Environment But Pays Well – Should Team Stay or Go


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 1800-258-0060.
[music playing]
Dr. David Madow: The dentist comes in late every single day. He never says hello, he doesn’t compliment. He’s confrontational, but he pays pretty well. You stay as a team member or do you leave? What do you do in this practice? We’re going to be talking about this Episode 8 of the Dental Practice Fixers Podcast. How are you doing? Dr. David Madow, along with Dr. Richard Madow.
Dr. Richard Madow: Hey, how’s everybody doing? In the old days in the podcasts when we used copyrighted music for each episode, this one would be – oh should I stay or should I go now.
Dr. David Madow: That might be copyrighted, we might not actually use this episode now.
Dr. Richard Madow: If the robotic team of Google can track my singing to the Clash, I’d be so flattered. I would care for…
Dr. David Madow: You always should say you’re a good…
[cross talking - 0:01:20.4].
Dr. David Madow: But this is a crazy situation. It sounds like this doctor is not very friendly or not really good to the team. Nobody likes coming in, but the pay is pretty good. So, what do they do? Do they stay? We’re going to talk about it.
Dr. Richard Madow: We’ll definitely find out.
Dr. David Madow: Along with the letter of this – by the way we have a great idea for a call today which we’re going to do just shortly.
Dr. Richard Madow: It’s going to be a good one.
Dr. David Madow: So welcome back. We’re glad to have you at Dental Practice Fixers Podcast.
Dr. Richard Madow: For those of you who are watching the video, you see two times in a row, we’re together at the studio. So it’s really good to be here. I have feeling the next one is going to be on the split screen. Split screen or something like that.
Dr. David Madow: One of those two. Should we get right into it Rich? Why don’t we read this question that comes from the listener or a viewer, by the way if you have a question, feel free to send it into us and we will get it. If it’s confidential, we’ll withhold your name. I’m not sure if this is going to be withheld or not but we’ll find out.
Dr. Richard Madow: We’ll find out in a second.
Dr. David Madow: But we’d love to help you out with any kind of question or situation or something going on with your dental practice. We are the Dental Practice Fixers. We want to fix so you practice.
Dr. Richard Madow: Well this person didn’t give their name, but they didn’t say anonymous. They gave like a Dear Abby type name.
Dr. David Madow: Oh I know what you mean.
Dr. Richard Madow: You know, like whatever. Lonely in Louisiana.
Dr. David Madow: Sleepless in Seattle.
Dr. Richard Madow: Exactly. Ask Amy, she’s the one, now the advice column in the newspaper.
Dr. David Madow: Oh wait the minute. That’s the Chinese restaurant?
Dr. Richard Madow: It’s a different – totally different Amy. It used to be Ann Landers and Dear Abby. I think there’s some other words now. Now it’s Ask Amy. I always wonder how many of those letters are actually real. Some of them just seem like a little too topical or a little bit too – the way that one piece works over the next to give the next answer. I always suspected that some of them are fake.
Dr. David Madow: I never thought about that. When we’re little kids we – dear letters, Dear Abby…
Dr. Richard Madow: You know, they were twin sisters.
Dr. David Madow: I didn’t know they were twins but I know they were sisters. That’s interesting.
Dr. Richard Madow: They’re both in Chicago.
Dr. David Madow: They both have the same vision to help people in life. That’s pretty cool.
Dr. Richard Madow: We feel it’s like growing up in their household. It’s probably horrendous.
Dr. David Madow: I think all the neighbors will come over like, what’s going on. So I want to give you an answer on paying you on this one.
Dr. Richard Madow: I think Ann Landers was not her real name.
Dr. David Madow: Well if you want to do that – what’s the Spencer…
Dr. Richard Madow: Mary Ann Spencer.
Dr. David Madow: Mary Ann Spencer. That was…
Dr. Richard Madow: Well she was a fictional character. Right?
Dr. David Madow: Yeah we heard there was fictional character. They were owned by like some Jewish company or something like that.
Dr. Richard Madow: Okay now we brought that up, Ann Landers and Dear Abby were Jewish as well.
Dr. David Madow: All these Jews today.
Dr. Richard Madow: I’m telling you man, okay you’ve got two of them right here. Ann Landers, Dear Abby, Mary Ann Spencer. That’s like the least Jewish name.
Dr. David Madow: Bruce Springsteen.
Dr. Richard Madow: Not Jewish. He’s Italian. He’s mom’s maiden name was [inaudible - 0:04:09.4].
Dr. David Madow: I’m glad you know that. I’m really glad you know that.
Dr. Richard Madow: Nobody else cares. Okay let’s get to our question. How did you – with some useless trivia about great musicians and advice columnists. This one said – I love the way she addressed this. Dear Dental Practice Fixers.
Dr. David Madow: Loved it.
Dr. Richard Madow: Please address this as the Dental Practice Fixers from now on. Dear Dental Practice Fixers, everyone in the office has a problem with our doc. He comes in late just about every day, after the first patient has already been seen. He never says hello to us, just expects us to jump to it. We never get thanked or shown any appreciation. He does pay us very well, and if anyone complains, he always points that out. I thought about quitting but I loved the patients too much and do like the pay. What is your advice? Frustrated dental assistant somewhere in Canada.
Dr. David Madow: Oh Canada, I love it.
Dr. Richard Madow: You couldn’t point out your province at least. Canada is a pretty large country.
Dr. David Madow: She didn’t say like “Eh” at all.
Dr. Richard Madow: No she didn’t.
Dr. David Madow: Frustrated.
Dr. Richard Madow: What’s your advice? Eh?
Dr. David Madow: I wonder if all Canadians say that.
Dr. Richard Madow: I thought they did.
Dr. David Madow: It’s like a prerequisite.
Dr. Richard Madow: They all say “about”.
Dr. David Madow: I’m going to go back to my host.
Dr. Richard Madow: What’s your advice about – and to The Dental Practice Fixers down south. I wonder how many Canadian listeners we have.
Dr. David Madow: We’re going to find out because they’re all going to be pissed off now.
Dr. Richard Madow: We love Canada and we’ll send you a looney [inaudible - 0:05:42.1]. So what do you think? What’s your take on this? What’s your advice? Frustrated dental assistant somewhere in Canada. Didn’t Marshall date a frustrated dental assistant somewhere in Canada?
Dr. David Madow: He dated a frustrated troll somewhere in Canada. I don’t know if she was a dental assistant.
Dr. Richard Madow: I think she was a dental assistant. She might have been there.
Dr. David Madow: I wonder if it’s the same one. So I’m going to give you my basic philosophy and this is kind of like very, very broad. It’s at least a head start. Life is short. I prefer to work in a job or business or profession. Whatever it might be, a place that I go to every day, that I really like. And in fact, studies have been done and say like, hey the amount of money you make is – although it might be important, it’s not the most important thing, but fulfillment, job satisfaction are like the most important things, being appreciated. So I would say that if you’re not working in an office that you’ll feel appreciated, you feel like you’re being abused or something. Let’s face it, you got a patient in a chair seated, ready to go. The doc is not even in the office yet. It’s a form of abuse I think. That’s not right.
Dr. Richard Madow: It’s the patient and [inaudible - 0:06:47.4].
Dr. David Madow: Yeah. It’s just not right. So I personally would not want to work in a practice like that. If you’re really good, you can find another practice that’s going to pay you well. Maybe better, many a tiny a bit less, but somewhere in the range I would think. And you being enjoying life every – no. Having said that, there’s nothing wrong with communicating with the doc and letting the doc know your frustration. Because nobody has talked to him or her about this. I think it’s worth the conversation. At least let the doc know that certain things are just not working for you and just not fair that you come in late. Patient’s in the chair, if you come in late every day, it’s not fair to the patients, it’s not fair to us. You never say hello, I don’t feel comfortable working here. Bring it up and see what the doc says.
Dr. Richard Madow: I agree with everything you said, and I think it’s interesting. You pointed out, studies have shown which you know what the heck that means. Studies have shown. We’ve all seen these numerous times. The pay is not at the top of what makes someone happy, and I think you hit the nail on the head as they say, being appreciated is always at the top or near the top of those lists. So obviously, frustrated somewhere in Canada and I don’t know where it could be. [inaudible - 0:07:54.9] maybe. [inaudible - 0:07:56.1]. I’m not sure. I think I mispronounced that. I think Canadians write in with that mispronunciation. Yeah people need to be appreciated and fulfilled at their job. And I think you’re right. It is worth trying to salvage. Don’t just quit. Have a talk with your doctor. I’m going to say maybe even get them a copy of the book “The Happiness Centered Practice” by Dr. Patty Lund. He addressed this. So many – it’s a great book, might a little outdated, but it doesn’t matter, you can pull so much from that great book. But I’m just like, thinking back to my practice. I’m not saying that I was perfect, but I knew from day one to make it a point to always be there. I’d like to be there first. I’ll always be there early. Greet every single team member as they come in. Hello, good morning Therese. It’s great to see you. Say thank you to everybody before they leave. Complement them in fact, throughout the day. Just to say like, hey well, oh my god, horrible.
Dr. David Madow: It may be sick to hear that one.
Dr. Richard Madow: If you do all these things correctly, you won’t have to pay that well.
Dr. David Madow: Because they’re paying half. It would be fun.
Dr. Richard Madow: And in fact, let me make a deal with you. I’ll be nice. I’ll be nice, pay you less. I mean this doc sounds a little bit of too much. And might be tough to cure.
Dr. David Madow: I’m not so sure he or she. I don’t know if it’s indicated as he or she.
Dr. Richard Madow: I think she said he.
Dr. David Madow: Oh he. I’m not so sure if he’s going to be able to change, but it’s worth the try. Because quitting, you know, it’s like anything, like any tremendous change. You’ll always try to make things better before you make a tremendous change. If you can’t make them better, then you got to see it’s on the other side I think.
Dr. Richard Madow: How many times have we heard team members complain that their doc gets in late? That the first patient at 8:30, and the doctor shows up at 8:45.
Dr. David Madow: A lot and it’s totally unacceptable.
Dr. Richard Madow: Horrible.
Dr. David Madow: You can’t run a practice like that.
Dr. Richard Madow: Don’t schedule a patient at 8:30 if you can’t make it there. Maybe you’ve got a reason or good solid reason why you can’t be there till 8:45. Well then don’t schedule an 8:30 patient. Lose that out. So your team member is telling your patients, oh fantastic news. We have early appointments. We have 8:30 but then they’re not seeing it at 8:30.
Dr. David Madow: But the doctor doesn’t show till it’s 8:45.
Dr. Richard Madow: Right. Sounds like they’re a little [inaudible - 0:10:03.8]. I left. And they recommended somebody else because the guy scheduled patients before he even got in. Why would anybody do that? And then you… could you imagine the tension; the doc finally gets in and everybody is all tense already. Then the doctor has no time to relax or do anything or talk to the team or see what’s going on. He has to jump right into the treatment room.
Dr. David Madow: What do you think about huddles every morning? They don’t have one.
Dr. Richard Madow: Non-existent.
Dr. David Madow: I mean, you got to get there early and just go over the day. It’s a business.
Dr. Richard Madow: I would say it’s a rule of thumb which is really not such a great time. But everybody should be there at least 30 minutes before the first patient scheduled.
Dr. David Madow: Absolutely.
Dr. Richard Madow: You know, some people like to wind down, get a cup of coffee, a little socialization. That’s all part of comradery. But you can’t do that if there’s a patient sitting in a chair. It’s ridiculous.
Dr. David Madow: Yeah. So what’s her name again?
Dr. Richard Madow: Let’s see. Most are not watching on the videos [cross talking - 0:11:00.1]. Frustrated dental assistant somewhere in Canada.
Dr. David Madow: Frustrated, and hopefully you can get this straightened out. We’d like you to be able to stay in the practice if your doc can work this out and you want everybody to enjoy their practice. But if not, time to move on I think.
Dr. Richard Madow: We never get thanked or shown any appreciation. We need [inaudible - 0:11:16.7].
Dr. David Madow: Well I’ll tell you what, we’re going to be the first people to thank you. Thank you so much for writing in. We appreciate you. We hope your doc appreciates you as much as we do, because we really do appreciate you.
Dr. Richard Madow: Docs who are listening, even if you think that you’re much better than this doctor in Canada, try to even do better than you’re doing now with your appreciation, with your good morning, with your thanks for coming in today. Say please and thank you all the time. Always being kind. Not gossiping, backstabbing, any of these things. Some nice doctors complain to us that their team is that way. But it always starts from the top. It always starts with great leadership. So please take this to heart and hopefully there won’t be too many frustrated dental assistants around anymore.
Dr. David Madow: Totally agree. Let’s get into the call of the week. But before we do that, we got some things to talk about. It will help you in your practice for sure.
Dr. Richard Madow: Yeah. A frequently asked question. An FAQ that we get is what’s it like to work with you guys with coaching? How does the whole thing work? And it’s a really tough question. It’s tough to explain the whole thing. Everybody wants to know what we do, what our secret mojo is to improve practices through our coaching because we do. That’s why people call us the Dental Practice Fixers. David and I thank you. David and I and our fantastic team of coaches really help practices grow. We really help dentists and team members enjoy their jobs more and what can be better than that? Making more money and enjoying your job more. So if you really want to find, if you’re really serious about finding out what it’s all about, come to our Masterclasses. They are no charge. They’re for docs who own practices who just want to learn a little more about what would it be like to work with us and our team. We have them throughout the year. Usually in Baltimore, at the home office of the Madow Center for Dental Practice Success. So go online, masterclass.madow.com. See what it’s all about, sign up for one, you get to hang with us Meet some of our great coaches, probably meet Sylvia and Whitney from Team Madow. Two of the nicest people you’ll ever get to meet. Along with Ann and Hope of course who are in our office every day. So come join us, we’d love to see you there. It could be the most valuable day you ever spend in dentistry.
Dr. David Madow: Yeah. I’d like to see you there. And while we’re talking about things that are going to help you in your practice, something that you’re doing now that you can be doing much better. There’s no question there. Because every dentist in North America I believe accepts credit cards.
Dr. Richard Madow: I hope so.
Dr. David Madow: We’re not sure. That could be like a whole another topic. But while you’re accepting credit cards, you’re paying fees through the process that are really not necessary. It’s a brand-new way to do this and we’re trying to spread the word all throughout North America. It’s called Fattmerchant. And what they do is there is a monthly fee. Monthly fee for Fattmerchant only and it’s a much easier, much newer way to process your credit cards and to save a lot of money every single month. You’ve got a lot of docs already. A lot of offices all over the country using this. We’re getting fantastic reviews. There’s really no reason to do it the old way and to pay excess fees that you shouldn’t be paying anymore. It’s simple, and the old days, to switch processors, you had to go through a whole regular [inaudible - 0:14:29.2] which is very complex. Now it’s basically a press and a click of a few buttons and maybe a phone call or so. And they get you changed really, really easy. It’s seamless, you don’t even know it’s happening. But you start to save money almost right away. Find out more, simply go to – if you’re watching the video, the link is going to be right below us. It’s BIT.LY/FATTMAD. So I’m going to spell the whole thing out for you in case you’re listening with the audio. BIT.LY/FATTMAD, and you’ll start – as I said, you’ll start saving money right away.
Dr. Richard Madow: Alright. I knew you’re going to use the word [inaudible - 0:15:13.2]. It was way in anticipation and sure enough, boom.
Dr. David Madow: You know, like five years ago, if you wanted to switch credit card processors, it’s a whole – it’s a must. Very difficult. Very very difficult. Now basically, click here, click there, they move you over to Fattmerchant and you’re saving money right away. I’d like to know why anybody wouldn’t do this.
Dr. Richard Madow: It’s a very low [inaudible - 0:15:38.1] factor.
Dr. David Madow: Very low [inaudible - 0:15:39.6].
Dr. Richard Madow: Sounds like [inaudible - 0:15:40.7] doesn’t it? Tonight it’s special [inaudible - 0:15:42.7].
Dr. David Madow: I’ll take it.
Dr. Richard Madow: Alright let’s do our call of the week. Are you ready?
Dr. David Madow: All set.
Voice Recording: This call maybe recorded for quality assurance.
[phone ringing]
Female Speaker: Good afternoon, thank you for calling. This is Kristine. How may I help you?
Dr. Richard Madow: Hi! Are you seeing new patients currently?
Female Speaker: Yes we are.
Dr. Richard Madow: Can you do cleanings and fillings and things like that?
Female Speaker: We do.
Dr. Richard Madow: And cosmetic dentistry too?
Female Speaker: Absolutely.
Dr. Richard Madow: Great. Can you tell me exactly where you’re located?
Female Speaker: Sure. We’re directly next to [inaudible - 0:16:23.8].
Dr. Richard Madow: Okay. Is that a strip center with other businesses, what are you near?
Female Speaker: It’s a strip center. There’s a coffee shop. We are directly across from the field where they have the beach volleyball, the sand.
Dr. Richard Madow: I think I know where that is. Okay. Are you next to that weed shop? I know where you are.
Female Speaker: Yeah.
Dr. Richard Madow: Okay. Now I know. Thank you so much for the information.
Female Speaker: You’re welcome.
Dr. Richard Madow: Okay, bye.
Female Speaker: Thank you.
Dr. Richard Madow: Bye. What do you think?
Dr. David Madow: I’ll tell you something. I loved that call. You know why I love it? it started off innocently like, what kind of dentistry do you do, do you this type of dentistry, do you do cosmetics? And then where are you located, you kind of led her right down and then finally, are you next to the weed shop?
Dr. Richard Madow: I got to tell our listeners; this is right next to my house. Like two blocks from where I live in downtown Baltimore. And there’s this kind of like this little old – it’s really not an area where there are strip centers because it’s very urban with mostly high-rise buildings. There’s this little like old strip center, used to have, I don’t know, like an old dinky real estate business and some neighborhood bank. And you know, the neighborhood bank kind of changed. They went out of business and then there’s really hip coffee shop one in there, and then another business is in there…
Dr. David Madow: I think I know that.
Dr. Richard Madow: Three B. And then another business went in there and then there [inaudible - 0:17:56.1]. This big beautiful medical marijuana store went in there. I mean there’s – you could just tell they put a lot of money into it.
Dr. David Madow: It’s like the Apple Store of marijuana.
Dr. Richard Madow: That’s what it looks like. I’ve never been in. But when you try and buy, you can see that it looks like an Apple store.
Dr. David Madow: I don’t know the part.
Dr. Richard Madow: It just looks beautiful. And then there was this little space still for rent next to the weed shop. A record store or a taco stand.
Dr. David Madow: A yoga studio.
Dr. Richard Madow: Something like that. And then the dentist office goes there which is so funny, but you couldn’t you tell like she was avoiding saying they’re next to the weed shop. We’re across the street from this or two [inaudible - 0:18:40.2] from this.
Dr. David Madow: But you know what I found that’s really funny, when you said, oh wait a minute. I think I know you. You were next to the weed shop. She was going like, yeah. Yeah we are.
Dr. Richard Madow: Like it’s still covert.
Dr. David Madow: It’s a weed shop. It’s legal.
Dr. Richard Madow: Perfectly legal. And honestly, when you drive by there, the largest signs of giving a landmark, you just could have said we’re next to the [inaudible - 0:19:03.1].
Dr. David Madow: But here’s the question. She did not ask for the appointment. I don’t think you said you know but you asked her a lot about the office like you’re going to be a new patient.
Dr. Richard Madow: Do you do cosmetic dentistry?
Dr. David Madow: Obviously you’re looking for a new dentist, but do you think the reason that she didn’t offer you a appointment is because she just generally doesn’t do that anyway or the fact that you mentioned the weed shop. She doesn’t like a stoner patient coming in now. What do you think?
Dr. Richard Madow: I think that they would probably enjoy a patient that was a little bit relaxed than stoned coming in. So I don’t think that’s it.
Dr. David Madow: I need 12 on this, oh yes sign me up right now.
Dr. Richard Madow: It’s legal in Maryland. Certainly nothing illegal that has a medical marijuana card. No I think she just didn’t know how to ask for an appointment. I would say if I said oh I know exactly where you are and you’re close to the beach volleyball…
Dr. David Madow: I think she would say would you like an appointment.
Dr. Richard Madow: Well not certainly.
Dr. David Madow: Well you said that we [inaudible - 0:19:55.6]. We don’t want stone…
Dr. Richard Madow: These volleyball, wholesome, athletic, healthy weed shop.
Dr. David Madow: We don’t know like a bunch of stoners lined up. 
Dr. Richard Madow: Or she should have said we have a 4:20 appointment.
Dr. David Madow: We would have given her A.
Dr. Richard Madow: Or any appointment if she would have said anything like this. Again, it seems to be a very typical pattern. Some of the people on the phone are just horrible. But many like her, super nice, very kind with information. Didn’t ask for the appointment.
Dr. David Madow: Yeah. Next time you’re anywhere near the weed shop, just stop in the dental place and say hey I’m the one that called. Hey man you’re next to the weed shop.
Dr. Richard Madow: We don’t know exactly – they’re like playing Pink Floyd and Bob Marley.
[cross talking - 0:20:40.1]
Dr. Richard Madow: Capitalize on it.
Dr. David Madow: Absolutely. No question.
Dr. Richard Madow: I’ll make a special section for the people coming right from the shop.
Dr. David Madow: The weed shop. It’s a great call. I love the way you just started off gently and let her right and then the last thing was, oh wait a minute, you’re next to the weed shop. It was so good.
Dr. Richard Madow: Nevertheless, she should have asked for the appointment. And you know what, I was very careful not to turn it into an obvious phony phone call and starting asking crazy questions like can I come in stoned or you have a 4:20 appointments. You know that, it’s not what we’re after. So we don’t want to make it into a comedy call or a phony phone call. Those are legit calls from somebody who knew the businesses in the area, and she did not try to get them to come in by offering the appointment. Got to say F.
Dr. David Madow: I agree, F and listen, whoever is watching and listening to us, we say it every time, offer the appointment and you’ll be getting at least a B+ probably.
Dr. Richard Madow: Maybe even an A. So hey we’d love to answer your questions, give it to us. podcast@madow.com or whatever you want to do. Message us on Facebook, call the office, it doesn’t matter. Get us your question however you can. You go onto our website madow.com and click and have a little chat. Hope will – she’ll take care of you. Whatever it takes. Get us your questions. So hey, fantastic Episode 9 Season 2 of the Dental Practice Fixers. Thanks for being with us. I’m Dr. Richard Madow.
Dr. David Madow: Dr. David Madow, we will see you next time. Thanks for being with us.
[music playing]

A Confrontation With a Patient Ends With a Bad Online Review

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A doctor asks what he should do about a bad online review he received from a pissed off patient. It appears as thought the patient did not want radiographs and there ended up being a communication breakdown. After hearing the story, there were definitely some steps that Rich and Dave would have recommended that likely could have mitigated this bad situation. Then of course we do the call of the week. What happens when a potential new patient calls a dental office with a bad tooth to see if it better to have it saved with a root canal or extracted? Not too tough of a question, right? Let’s see how this was handled! 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!


A Confrontation With A Patient Ends With A Bad Online Review

 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: What happens when a new patient comes in, it’s a little bit of a confrontation or disagreement with the dentist that winds up threatening to put a bad review on Yelp. We’re going to find out that exact situation today or Season 2, Episode 8 of the Dental Practice Fixers Podcast. Hey, I’m Dr. Richard Madow: here with my co-host Dr. David Madow. How is it going today Dave?
Dr. David Madow: I’m Dr. David Madow. It feels great man. For once in a while we’re in – a lot of times it’s split screen, but I can touch him. We’re in the same room.
Dr. Richard Madow: Mom he touched me. He started it.
Dr. David Madow: We’re in the same room. Believe it.
Dr. Richard Madow: I’m a little bit uncomfortable actually. We’re very close today. We’ll it is fun being back in the home studio today. Welcome everybody for Season 2, Episode 8. So we’ve got a fantastic listener question today about a really odd situation, but I think it’s the kind of thing that could absolutely happen to any of our listeners out there if it hasn’t yet.
Dr. David Madow: I think we’re going to make a really great phone call at the end like we usually do. Our weekly phone call, this is going to be awesome today.
Dr. Richard Madow: We don’t have a time. It’s going to be awesome. It’s amazing.
Dr. David Madow: When we ask a question like this, it’s going to be awesome. I promise.
Dr. Richard Madow: Yeah. Alright, so I can’t remember what’s been happening since our last episode of the Dental Practice Fixers but what do you say let’s get ready down to it. It’s a really interesting question from the listener and I know we’re going to have fun. Some great comments for us. So Dave why don’t you take it away. I think you got this on some kind of a messaging service. What’s App, I don’t know what it was.
Dr. David Madow: One of our followers, subscribers, messaged us and then also he made it very clear and you’ll see why I withhold the name and so if you ever have a question, if you want something answered on our show and you want to keep it totally confidential, private message us and make sure you make it clear and we can probably tell to withhold your name. We’ll make it confidential.
Dr. Richard Madow: I think there’s a better chance if it’s a really good question if somebody wants their name withheld.
Dr. David Madow: I agree. Totally agree.
Dr. Richard Madow: Well you know, I’ll tell you when they give their names, that might be fake names.
Dr. David Madow: I will warn you though, this question is a little bit messy but I’ve got to read the whole thing because you’re going to see what happens in this – this is a crazy situation. Okay here we go. I’m going to read it slow though so please, well you have to hear every single word of this. It’s amazing. Dear Madow Brothers, I just had a new patient come in to my office. He wanted a cleaning, so we said great. Let’s get some x-rays so we can do an exam. He said, I don’t want x-rays.
Dr. Richard Madow: A little sound effect when he doesn’t want x-rays.
Dr. David Madow: So I gave him a long explanation of why we need them and how we use the most advanced technology to reduce radiation. He said okay so we get four bite wings, and as we’re going over to the panoramic area he said I don’t want to do this anymore. Well you can’t make this stuff up.
Dr. Richard Madow: I quit.
Dr. David Madow: So we haven’t talked about how I can get sued for malpractice if I do a comprehensive exam without either a full mouth series or a pan. He then threats me with a bad online review for making him get x-rays he didn’t need. Then I said, I didn’t hold you down.
Dr. Richard Madow: He actually said that.
Dr. David Madow: I didn’t hold you down. I didn’t bind and gag you. I wasn’t part of it. I explained why I need them and that you elected to get them. You could have left whenever you wanted and I know what you’re trying to do. You’re trying to blackmail me with a bad review. Then he tries to rationalize the bad review saying: So I can’t tell people my experience and I said, are you going to put in the review about how you’re trying to blackmail me with said review to commit malpractice. And he replied, this never happens in California. What? He left and he left a bad review. What can I do? Name withhold by request.
Dr. Richard Madow: They need to be addressed.  Would start with one. When you’re reading that whole convoluted situation.
Dr. David Madow: I know exactly what you think.
Dr. Richard Madow: Whisper to me. You point to it.
Dr. David Madow: Okay I’ll tell you right now. It starts right here.
Dr. Richard Madow: Exactly. I’ll tell you what it is. Those of you watching the video. Why in the hell would a dentist ever utter the word malpractice? When you’re talking to a patient, if I don’t do this, you can sue me for malpractice. That just paints the worst picture. Puts ideas in their head, brings up things that never should be brought up. Why would you ever, ever use the word malpractice or insinuate that you’re doing anything that’s wrong or unethical or could be doing anything that – because you agreed, because you point it to her right away to it.
Dr. David Madow: That’s the thing. There’s so many bad things in the question, but that’s the thing. Why would you ever bring up so you can sue me for malpractice. Yeah put the idea right in there.
Dr. Richard Madow: Why don’t you tell someone to get some cheap ass crazy lawyer that has a billboard on the I10 since we’re in California.
Dr. David Madow: I guess this patient moved somewhere from California so this never had to…
Dr. Richard Madow: Why put any kind of idea like that, you know, patients that – ridiculous. That’s the one thing I want to point out.
Dr. David Madow: The overall total of this, the whole scenario. What’s your thoughts?
Dr. Richard Madow: You know what’s interesting. I think the dentist sent this in trying to get like a sympathetic ear from us, but I think that dentist did so many things wrong. I think they were kind of asking for it. Agreed?
Dr. David Madow: I think the dentist was kind of confrontational – the patient might have been an asshole. There’s no question. I’m getting from this, the dentist was kind of new and inexperienced because I think an experienced dentist would not have done half of these things. First of all, he said he went through a long explanation of why we need it or how we use them. You’re pretty much – let’s make sure it’s simple.
Dr. Richard Madow: There could be interproximal carries that the radiographs…
Dr. David Madow: That’s your dental voice.
Dr. Richard Madow: You heard it before.
Dr. David Madow: There’s so many things. I explained why I need them.
Dr. Richard Madow: Let’s get back to a more basic question maybe. And then we’ll talk a whole bit…
Dr. David Madow: Okay let’s do that.
Dr. Richard Madow: What do you do when a patient refuses x-rays? I think this dentist almost coerced or twisted the patient’s arm into doing something they weren’t comfortable with and it’s never good when you twist the patient’s arm into doing something they’re not comfortable with.
Dr. David Madow: Right. But that opens up a whole another question. We as dentists feel that we need radiographs to make a proper diagnosis, and forget even the malpractice. But we just feel like not doing radiographs, you’re not getting the whole picture. Do we want to see a patient that’s refusing radiographs?
Dr. Richard Madow: I say no. Tell them to walk. Can you imagine if you went to your physician and they said we want to do this image. No. I refuse that. Then you’re out of here. Done. I cannot treat you ethically and in good conscience without a proper diagnosis. I can’t do that without x-rays. I think maybe you should find a dental practice that’s more suited to your philosophy. You don’t have to treat every patient that walks through the door especially one that’s telling you what to do.
Dr. David Madow: Yeah because chances are, a patient is already telling you what to do. I don’t like x-rays, I don’t believe in x-rays. Let’s face it, they’re going to be a kook. All the things that happen, they don’t want this, they don’t want that or questioning every step in a way. Like you just said, you don’t have to treat every patient. Make your life enjoyable. Make your profession enjoyable. Treat the patients that are aligned with you.
Dr. Richard Madow: And then what happens? Patient goes, leave a bad review on Yelp. Now this patient probably would have done the same if you’d kicked them out, but at least you have some ground to stand on that. Could you imagine if your car was like spewing smoke out the back and you took it into the mechanic and they sort of, okay we need to hook it up to this machine and sort of figure it out. [cross talking - 0:09:02.3].
Dr. David Madow: My car is not getting hooked up on that machine. I don’t believe in that machine.
Dr. Richard Madow: I’m telling you to walk, drive, run or be towed the heck out of there.
Dr. David Madow: [inaudible - 0:09:10.4] some of the language.
Dr. Richard Madow: It’s possible.
Dr. David Madow: There’s so many problems with this thing. So let’s talk about for a second. So then he got a bad review on Yelp and this dentist could have prevented it by doing some things differently and from your occasion with this patient, the patient might have been a wacko. I don’t know. But okay, so he got a bad review on Yelp. Now what, what do you do?
Dr. Richard Madow: Well again, speaking of [inaudible - 0:09:36.4], it’s never really you’ll get wacko patients. It’s inevitable that you get a bad review on Yelp or Google or whatever site people are [inaudible - 0:09:43.5]. As we know, the thing you don’t want to do is get into some back and forth with the crazy patient on Yelp. We discussed this before. Some of the strategies going and just kind of in a really nice non-confrontational way, tell your side of the story and say you love to welcome the chance to bring them back to the practice. This person you probably don’t want to come back to the practice.
Dr. David Madow: But say even if you don’t want it. Say it anyway on that to make it look good. And if they call, say I’m going to come back and say no…
Dr. Richard Madow: [inaudible - 0:10:15.1] I’m going back or they don’t want you back and [inaudible - 0:10:18.3].
Dr. David Madow: Yeah. But never get confrontational on Yelp or…
Dr. Richard Madow: Never say this patient was a jerk or anything like that.
Dr. David Madow: And also a lot things lately like whether it’s an automotive service place or hotel or restaurant that gets a bad review. The good ones have somebody that’s – you can tell there’s somebody in charge of it. Always come on and say we’re so sorry you did not have a positive experience then you have to say a few more words and say you’re always welcome back or always trying to make our service better. It’s the best way to go.
Dr. Richard Madow: I don’t know if you use TripAdvisor a lot. I don’t use TripAdvisor.
Dr. David Madow: I’m only a Yelp guy.
Dr. Richard Madow: Yeah. Well I use it for hotels. And no matter how great a hotel is, they screw up, they get bad reviews. And as you said, they’re really well-managed. It’s almost like a script which is fine. The manager of the hotel goes, we’re so sorry you had this experience. They don’t blame it on the hotel guest. They say things like this helps us to improve and we want to have you back to show you what kind of five star experience we can offer. Something on those lines.
Dr. David Madow: If you’re looking for a hotel and you’ll see you zeroed in on a hotel on TripAdvisor and you’ll see two or three bad ones like that, but you see 500 great reviews, you’re probably going to stay there. Right?
Dr. Richard Madow: I think that two or three were probably crackpots.
Dr. David Madow: Yes. But if you go on to a hotel site and you see 50 good reviews but 38 horrible reviews. You’re probably not going to stay there. So our advice to this dentist that wrote in and anybody else that’s listening or watching, hopefully watching us now on YouTube. You’ve got to really make sure your communication skills are up to – I think this dentist needs a little practice and with experience he or she will get better. But if this happens again and again and you continue to get bad reviews on Yelp, that’s going to definitely impact your practice for sure.
Dr. Richard Madow: I didn’t hold you down. You could have left whenever you wanted. I wanted to give this dentist a bad review too. What a jerky think to say.
Dr. David Madow: Well it’s horrible language, I didn’t hold you down. Why ever talk like that? Your communication skills need some improvement. You’re going to continue to get more reviews like this. I hate to say.
Dr. Richard Madow: And possibly soon. So we really appreciate that you wrote in and we don’t, it’s not our goal to start saying that docs who write in are doing all these things incorrectly but hopefully this will be a good learning experience. You please, doc use this as a learning experience. Don’t get confrontational with your patients. You don’t have to treat somebody that’s telling you what to do, but always be kind and gentle when you communicate with patients. There’s no need to use this kind of language, and certainly don’t bring up anything like malpractice.
Dr. David Madow: You and I had practices for a long time. We practiced separately, we both made tons of mistakes, but you learn from it. We’re not knocking you personally. You wrote this in. We’re not making fun of you, but you got to learn from your mistakes. Don’t let this happen again. Make sure your communication skills are getting better every time.
Dr. Richard Madow: Absolutely. Great, great. Thanks so much for writing in. We hope we didn’t skewer you too badly and just stick with us on the Dental Practice Fixers and hopefully you’ll learn.
Dr. David Madow: Should we do the call of the week?
Dr. Richard Madow: Let’s do the call of the week, but before we do the call of the week, I just want to mention I got the most amazing – I think we both got it actually, the dentist, they said they listen to Dental Practice Fixers, they took our advice, they got Fattmerchant for credit card processing in their practice, and they said, it was just like you said, completely seamless. I’m not being charged an overage percentage and I’m saving money each and every month. The patients don’t know the difference. Nobody knows who you’re using for credit card processing. Fattmerchant is the best, and if you’re a friend of ours, they’ll give you a free terminal. So just make it brief, find out why Fattmerchant is the best in credit card processing, why you’ll save money very single month and they’ll give you the free terminal if you’re an FOM. A friend of Madow.
Dr. David Madow: FOM, I like that.
Dr. Richard Madow: Bitly’s B I T. L Y/FATTMAD. Check out Fattmerchant for incredible credit card processing. BIT.LY/FATTMAD and you’ll see us on there wearing much nicer clothes and a little more made up and looking better than this too. That’s your extra bonus.
Dr. David Madow: Yeah on the website we look better.
Dr. Richard Madow: Well they think you look better. I know I’m kind of look back up but maybe a little bit.
Dr. David Madow: I can see it. Like a little face lift.
Dr. Richard Madow: Exactly. Exactly like that.
Dr. David Madow: While we’re helping you with your practice, every episode of the Dental Practice Fixers, we’re trying to – we have a topic, we have somebody that writes in, we try to give the best advice possible, but let’s face it, as great as this is and it’s pretty darn good though. We think it’s probably one of the top podcasts in dentistry these days.
Dr. Richard Madow: It’s in the top 500.
Dr. David Madow: Absolutely in the top 500. But if you really want to crank up in your practice, you want to reach a level of success, you just haven’t been able to do on your own. We recommend checking out our Masterclass for dentists. It’s a full day, we bring you in – generally we bring you into Baltimore where we like to hang, and occasionally we travel a little bit but don’t count on that at all. But it’s a full day of talking, discussing. We have our coaches there and it’s a pretty intense day, and we share with you what it’s actually like and how we can help you by working with one of our coaches. And so, if you want to increase your practice, you just can’t do it on your own. And let’s face it, most dentists can’t do it on their own. We want to share with you how we can help you predictably get to that level that you just haven’t been able to achieve. So, if you want to know more, go to masterclass.madow.com. Check us out. We’d love to have you. We keep Masterclasses very intimate. Somewhere between 8 and 12 docs only. We don’t let these get too big and you do need to own a practice to be able to come to the Masterclass. You’ve got to be a doctor, actually a practice owner.
Dr. Richard Madow: It’s so cool how so many people that have attended have told us it was one of the best days they ever spent in dentistry and really was the day that turned things around for them and upped them on the graph. So yeah, we’d love to see you in Masterclass. Cool, let’s do our call of the week. What do you say?
Dr. David Madow: Let’s get into it. Alright.
[phone ringing]
Female Voice: Thank you for choosing [inaudible - 0:16:36.0] How can I help you?
Dr. David Madow: Hi I’ve got a question for you. I’m kind of new in the area. I’ve got a tooth that is pretty bad. Do you all generally recommend like a root canal or extrapolating the tooth. What is the recommended treatment?
Female Speaker: It’s hard to say what the recommended treatment is, based on the fact that we really don’t know and we don’t have a diagnosis from the doctor. If the tooth is bothering you in a sense that is keeping you up at night, if it’s constantly just dull throbbing pain, that usually is indicative of needing a root canal. However, if it’s just a deep cavity or some decay that has affected the nerve of the tooth, that also could indicate a root canal. It depends on how severe it is, it could also be probably be an extraction. Just depending on how severe, if it’s like a chipped or broken or fractured tooth. Sometimes we can save it with a root canal and crown, sometimes it would need to be extracted.
Dr. David Madow: Do root canals hurt? I’ve heard bad things about them.
Female Speaker: Root canal is used to be kind of traumatic but dentistry honest to god has come so far with just managing all of that. It’s a lot better experience now than it was with say maybe even 10 years ago. Dr. [inaudible - 0:17:58.2] uses the most up to date technology, and honestly, you can even go back to work right after. It’s not a stronger thing.
Dr. David Madow: Gotta find a job. That’s a bad joke. Well thank you. You were really really helpful. I really appreciate that. Thank you so much.
Female speaker: Of course, my pleasure, no problem. Thank you.
Dr. David Madow: Thank you, bye.
Dr. Richard Madow: Wow good call. What do you think?
Dr. David Madow: Well let me tell you something. I was ready to give her an A plus. She was pleasant. I thought she answered the questions great. Yeah, I asked her if root canal hurts, and she didn’t even laugh when I asked her about extrapolation. She’s well with the flow, which is good. I asked her if it hurts, she gave a great explanation how they used to but now with modern technology and the doctor is so great.
Dr. Richard Madow: Doctor who?
Dr. David Madow: Edit that out. But the only problem is – the huge problem is at the very end, she didn’t ask for the appointment. She did everything perfectly.
Dr. Richard Madow: Well I’m not sure I agree with that. Yeah I agree that not asking the appointment is the killer.
Dr. David Madow: What did she do?
Dr. Richard Madow: I thought she went into way… She used the word “indicative” which I didn’t like. I think she wanted to give way too much clinical detail. I mean she was very knowledgeable. She spoke on the level that anybody could understand and that’s really great. So often we see people speak way over the patient’s head. So she did that very well but I think she give way too much information. I think she should have said – she said we can’t tell without the doctor taking a look and giving a diagnosis. So at that point, why not say, why don’t you come on in here for a free consultation. She went into so many – it’s this, it’s that, and the patient is going to remember. You said that if it keeps them up at night… Again, she was really good with the information, but I think you’ve kind go down the rabbit hole and start giving too much information. I think she should have gone for the close much earlier by saying. We really can’t tell what it needs over the phone. Why don’t you come right in for a consultation? But the things she said were great. She was very knowledgeable, very pleasant, spoke on a good patient understanding level. All those were…
Dr. David Madow: Would you agree with thing Rich, would you agree that even though she might have gotten a little too clinical, would you agree if in the end she would have said, we’d love to get you in to take a look at this. I have Monday afternoon at 4:00 or Tuesday morning at 10:00. Would you give her the A?
Dr. Richard Madow: A minus.
Dr. David Madow: A minus. Okay that’s pretty good because most people get an F. I want to share something with you guys. You guys that are listening or watching. If your front desk person simply made it a point to ask every single caller for an appointment and offer 2 good options, basically you’d be getting As.
Dr. Richard Madow: And more new patients.
Dr. David Madow: That’s right. Even if only 20% of that came out with some excuse and the other ones wouldn’t appoint. But 20% by you saying would you like to make an appointment. I have such and such time or such and such time. You’d be so far ahead of the game. It’s not even funny.
Dr. Richard Madow: In this call it’s like, you said I don’t know if it needs an extrapolation or root canal. If at that very point, she would have said, well I’ll tell you what, let’s bring you in to find out.
Dr. David Madow: That would have been best.
Dr. Richard Madow: I mean she was very well-spoken but that would have been best.
Dr. David Madow: She was well-spoken.
Dr. Richard Madow: That would have been better. We’d love to see you as our new patient.
Dr. David Madow: Ask her, boom appointment. Ask for the appointment. How many episodes and how many seasons do we have to do…
Dr. Richard Madow: By the time we get to season 10, every dental practice in the country is going to be asking. That’s our goal. We’re not going to quit until it happens.
Dr. David Madow: And then we have to go on Canada and Mexico. And we’re going to take over the world. Every office in the world is going to ask for an appointment. We’re going to have to know every language.
Dr. Richard Madow: You mean like an office in Papua New Guinea?
Dr. David Madow: Absolutely. No question.
Dr. Richard Madow: Guam?
Dr. David Madow: Oh definitely Guam. Guam is part of the US.
Dr. Richard Madow: My good buddy from dental school, Dr. Andrew [inaudible - 0:22:10.1] practices in Guam. I don’t know if he listens to the Dental Practice Fixers from there but if he does…
Dr. David Madow: Yeah he will be. We’re going to send him this episode.
Dr. Richard Madow: As far as you can get from where we are in the East Coast and in US. I wonder if they recommend … in Guam for their patients.
Dr. David Madow: Oh man I think that wraps episode 8. Thanks for being with us. By the way if you have a question, comment, you know how to get us. Well, podcast@madow.com that’s one easy way. Facebook, you’ll find us, communicate with us. YouTube now is even easier. You just comment on the actual episode. We want to hear from you with The Dental Practice Fixers. We’ll see you next time.
Dr. Richard Madow: Thumbs up on YouTube, good review on ITunes. We really appreciate it. Thanks everyone.
[music playing]
 
 

 

Dentist Whispering to Patient

A Prosthodontist is Humiliating and Degrading the General Dentists in the Community

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Welcome back to The Dental Practice Fixers podcast, dentistry’s most unique show! This week we received information that a prosthodontist in Colorado is spreading information in her community, basically telling the public that general dentists are ill-equipped to do their dentistry and why the only choice is to see a prosthodontist. Rich and Dave look into this situation and reveal what they discover. And it’s not pretty. Then of course we do the call of the week. What happens when a simple call is place to an office by a potential new patient asking for just a little information about the doctor. Easy, right? Well listen in to see how this one was handled! 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!


A Prosthodontist is Humiliating and Degrading the General Dentists in the Community


[Music Playing] 
Dr. David Madow: Hello there and welcome to The Dental Practice Fixers Podcast. This is Episode seven, Season two. I am one of your hosts, Dr. David Madow. I'm going to be bringing in my co-host right there in just a couple seconds, but this is actually our second episode that we're doing a live video so not only can you continue to listen on iTunes and all the other, of course, audio episode apps that are out there but episode audio podcast apps, I should say, but now we have our very own YouTube channel, The Dental Practice Fixers where you can watch us in our studios. By the way, we're on different sides of the planet. I'm in Salt Lake, Rich is in Baltimore, Maryland. But not only can you see us through this live, kind of live but you can interact with us. You can comment, you can like, you can ask questions, and right on the YouTube channel, under each episode, we're going to be... we can interact with you. So, we're, we're really excited. I'll bring my buddy, business partner, brother, Dr. Rich into the, into the episode. What do you... what's going on? [Crosstalk] up to? What's going?
Dr. Richard Madow: It is great to be here for Episode Seven, actually the second video episode. Now, I suspect most people are still listening to audio only and that's fine so [crosstalk].
Dr. David Madow: Oh, I don't know.
Dr. Richard Madow: That way but yeah.
Dr. David Madow: I don't know.
Dr. Richard Madow: And if you're curious what we look like for better or worse, for richer or for poorer, whatever, join us on YouTube, it's fun. You know, I notice and I don't think this is going to happen with The Dental Practice Fixers, I watch music videos, and music instructional videos, and music analysis, all kinds of things like that on YouTube and it seems like the conversations in the comments start off kind of normal and then they degrade into insults and politics and just all this low-level shit. I just don't understand why people do it. So, if you're going to comment about The Dental Practice Fixers even if it's a criticism or critique, please be kind. There's just no reason to be unkind, or personal, or mean, just it doesn't help you, I needed to do that.
Dr. David Madow: It's funny, Rich. I think people like on Facebook for them... now, it is for the most part, people are fairly kind on Facebook but then when you get into YouTube, it starts degrading a little bit and the absolute worst is Twitter people who are just like trolling and saying really, really mean things. It just goes downhill from there. So, hopefully we're kind of in the middle of Facebook and Twitter so hopefully people will be semi-kind.
Dr. Richard Madow: I don't do anything on Twitter. I just don't... I'm just... I'm not saying it's right, it's not wrong, I just don't do Twitter. Twitter, hate Twitter, I just don't do it. And now I'm now I'm even more glad I don't do it when you told me that things get degraded really quickly.
Dr. David Madow: It really, it really does. But YouTube there's definitely some trolls out there that will-
Dr. Richard Madow: Oh God, horrible.
Dr. David Madow: You'd be very mean for some, I don't know for some they like... people would just like hiding behind a keyboard for some reason. I'm not really sure but-
Dr. Richard Madow: I just don't understand why if you don't agree with somebody's opinion, you have to insult them personally.
Dr. David Madow: Right.
Dr. Richard Madow: Just tell them why you think they're, you know, your opinion is different and maybe try to convince them to your opinion but don't attack them personally.
Dr. David Madow: Right. And then if that doesn't work, you can just say, well, you're an asshole but [crosstalk].
Dr. Richard Madow: That might work and maybe it's true but I [laughs]. I see people have been commenting on your post a lot.
Dr. David Madow: Of course, yeah [laughs].
Dr. Richard Madow: All right. Hey again, thanks for that intro. Welcome to The Dental Practice Fixers. Let's get right to this because we've got a... it's kind of a question but you'll see what it is. It's, it's really crazy. It comes from our good friend, Dr. Joanne Rief, and if you've been around us for a while, maybe you've heard her name. She's participated in The Madow Brothers Audio Series many times. You've probably seen her and her fabulous team at TBSE in Las Vegas. She posts on The Dental Place sometimes. She's a really good person, a great dentist, fantastic practice. She takes so much continuing education. Is she ever actually in the office? I know you're her patient. Is she ever there?
Dr. David Madow: She's always taking CE.
Dr. Richard Madow: There's always a sign on the door that says like 'Closed for CE'.
Dr. David Madow: Out for CE. 
Dr. Richard Madow: Right, gone fishing. Anyway, she's very informed, she knows a lot of things, and she keeps me and Dave abreast of a lot of developments in dentistry. And this is one that she sent that I thought was just fascinating. It says, "Saw this," I'm reading this, "Saw this on Mommy Dentists in Business," that's a Facebook group, Mommy Dentists, I don't know, Mommy Dentist in Business.
Dr. David Madow: Mommy.
Dr. Richard Madow: Exactly. Shut up, kid. It's an ad by a Denver prosthodontist that was put on her blog along with other blogs that put down general dentists and touted why patients should go to a prosthodontist. She even stated in her blog that she sued the dentist that she bought the practice from. Then, it goes on to say she was super criticized and wound up taking down the blog. And then, Joanne, I hope you don't mind if I read this but your closing sentence is, "This woman has balls." I don't know if I ever met a woman with balls. But anyway, I think you mean that metaphorically.
Dr. David Madow: Maybe.
Dr. Richard Madow: So, what's Joanne talking about? We decided to check it out. We checked out this prosthodontist blog. She's a prosthodontist in Colorado. We won't give her name or the name of her practice but first on her blog, there's like this big ad comparing prosthodontists to general dentists. The font size is so small, I can hardly read it but it's like this big flow chart saying why prosthodontists are great and why general dentists suck, and it's comparing implants and said says things like, "General and cosmetic dentists have minimal formal training with dental implants. Their knowledge is often from evening and weekend courses." And she goes on to say that, "They make crappy temporaries, they use bad labs, they don't know how to maintain implants," all these things criticizing general dentists, why prosthodontists are better. Then, she's got this next blog called 'Why didn't any dentist refer me to you?' And she's saying that patients complain but why didn't my dentist send me to a prosthodontist? And she says, "Here's why. Number one, they think they can do the work themselves. Number two, they need the revenue. The market saturated with dentists; referring patients can be costly even if it's the right thing to do. Then three, they think the prosthodontist might criticize their work. Then they're saying, she keeps give some crazy example that a general dentist can refer to an endodontist but the root canal specialist knows that your dentist is using cheap labs and they do bad work but they don't tell you because they want to keep the referrals coming." Another blog, "Do you really need that crown? No, you might not need that crown so why did your general dentist tell you, you need a crown? Well, there are a few reasons. One is money. Two is they've had a bad education, and three is they're overzealous to do treatment such as CEREC, which involves removing way too much tooth structure and, and, and charging four times as much." One more blog, "How I first learned about the dark side of dentistry?" [Crosstalk] practice she bought where the dentist was over diagnosing, over treating, overdoing, overcharging, and she wound up suing them, the dark side of dentistry. Wish you were here. What do you think? It's unbelievable.
Dr. David Madow: Unbelievable, does not even halfway describe it. I don't even know what to say other than that first of all I think she's a... she's a bitch. I hate to say it.
Dr. Richard Madow: And she has balls.
Dr. Richard Madow: Unbelievable. Okay, obviously what she said is horrible. It sounds to me like she's like desperate. But I'll take this back to something that Rich you and I learned many, many, I'd say several decades ago. You probably remember this. Back in the old, old, old days when we were very new at our dental conference, TBSE, by the way if you don't know about TBSE, check it out, tbse.com stands for The Best Seminar Ever. But Rich, we were sometimes guilty of instead of like when we had marketing and advertisements and then talking about our seminar, we were sometimes guilty, I will admit this, that maybe trying to knock down other seminars and say maybe bad things about other seminars. But I remember somebody once messaged us and said, "Hey guys, guys listen, you, you guys are the best. You've got the best seminar ever, that's why it's called that. You guys are on top of your game. Why stoop low and not see competition when you guys are already the best?" And both of us thought about that we said, you know something... you're right. And from now on we just talked about the benefits of coming to TBSE and how it can help you and your practice so we never took stabs at other dental seminars. It just wasn't worth it. And this woman if she's that good, if she's that good, all she has to do is prove it by doing great work, being kind to her patients, building a practice that way, and saying good things. You know in these days Rich, we say good things about other dental conferences because they're so really, really good out there, most of them are great, most of them are really good.
Dr. Richard Madow: Yeah. Kind of shooting yourself in the foot too because a prosthodontist wants referrals from general dentists. And some of the things she said anybody with half a brain how do you know my general dentist uses a cheap lab? How do you know my general dentist is overcharging? How do you know they're, they're desperate for revenue? You're making some blanket statements here that are completely false. Well, that was a blanket statement also, making some blanket statements here that are typically false. It's just... it's unbelievable and who is going to... I think maybe this also opens up a broader discussion about the relationship between general dentists and specialists. Maybe these days it's more frustrating than ever being a specialist because with advances in technology and fantastic hands-on CE courses, general dentists are doing more treatment than ever that used to be called specialty treatment. But we're both general dentists, Dave. We know you need fantastic specialists who you trust to refer to. You need fantastic specialists who are going to compliment you when they come in and say, "Oh that root canal looks great. This crown looks cool," whatever it is. You don't need this kind of BS. How can that be good for anyone? 
Dr. David Madow: This is just so disheartening and, you know, like in anything like they're okay, there are great general dentists and there are horrible general dentists just like there are probably great prosthodontists and horrible prosthodontists. I graduated with... there was a guy in my class, Rich you know him, Dr. Tony Lera. He was second in my class. The guy had like hands of gold. I would, I would put him up against any prosthodontist out there and for this woman to say that all general dentists do shoddy work and they don't know what they're doing, I'll put him up against her in a second because it's just simply, simply not true. It's horrible to hear stuff like that.
Dr. Richard Madow: It really is and, you know, back to your earlier comment about TBSE, I think usually when somebody's only way of getting moving forward is to criticize others, that's a big problem. And I'll tell you something else that we both learned early on in our career and that is, no matter how tempting it is, no matter how true it is, don't criticize the work of a colleague, don't criticize the work of a fellow dentist. You know, I think we've all been in a situation where a patient comes in, a lot of times it's an emergency and they just open their mouth and you see like the crappiest work you've ever seen in your life, and you're first, you think you want to do is who did this piece of shit? But you know what, first of all, it never gets you anywhere. They probably love their old dentist and secondly, you weren't there when it was done. You don't know the circumstances. You have no idea how poorly these patients treated this restoration. You have no idea how much they were squirming and screaming and crying while the dentist was trying to do their very best. You just don't know and it doesn't get you anywhere to criticize. Just say, "I can just tell you exactly what we see here today and that is this and this is the way we can treat and it's going to turn out beautifully," instead of saying, "Oh, this thing is horrible. It needs to be redone," it doesn't get you anywhere.
Dr. David Madow: And along another line I will say that when neither of us touched on this one yet Rich but I'm willing to bet that what she's saying because I think it in most states, the Board of Dental Examiners or whatever it might be in your state does not allow you to say that you're superior to another dentist and to tell, tell the public that other dentists are bad. I mean, that's pretty much illegal in every state. If the board gets ahold of this thing, I think she's, she's in big trouble. 
Dr. Richard Madow: That's illegal in 49 States actually. [Laughs] Yeah, I agree. She should be thrown in dental jail.
Dr. David Madow: Yeah.
Dr. Richard Madow: Apparently, she's... I don't know if I'd use the word retracted but she's taking all the stuff down. She's learned her lesson.
Dr. David Madow: Okay. I didn't know that, okay.
Dr. Richard Madow: I just don't think that it looks good for the future. No one's going to refer to her.
Dr. David Madow: Yeah.
Dr. Richard Madow: Maybe they'll refer to her as something but they won't refer to her as a dentist.
Dr. David Madow: Just... doctors if you're listening, doctors, team members, just alwa- always take the high road. Do the best you can, take CE, make sure your treatment is great, take great care of your patients, and talk up the profession. There are a lot of great dentists out there and great team members and talk about... we're all in that... we're all kind of on the same team so to speak. And just… you know, just saying something bad about the profession like that, it doesn't do anybody any good. It's just horrible.
Dr. Richard Madow: A little bit off topic but it's a little bit of a tangent but this, all this talk about general dentists and specialists is reminding me that this... I think sometimes we're in a tough spot when we do need to refer and the patient loves us and they don't want to leave the office and they say, "Well, why do I have to go to this specialist? Can't you do it here?" 
Dr. David Madow: And you say, "Well, I can't do it here because I don't know what the f I'm doing."
Dr. Richard Madow: It's so funny. I remember early in my career, I asked kind of a mentor what are you saying that in that situation? He said, "Well, tell the patient that the specialist has different instruments, that they have just for their specialty." I thought, that is the worst answer, I've heard that many times [crosstalk]. That's the worst answer.
Dr. David Madow: Specialist has different instruments.
Dr. Richard Madow: Yeah, different instruments. They have an oboe. I never liked that one. [crosstalk]. 
Dr. David Madow: What's a good answer for that? Because that happens all the time, the patient is, "Oh Dr. Madow, please can't you do this incredible and difficult procedure in your office? I want you to do it."
Dr. Richard Madow: Well, Sarah, we do root canals in this practice. We... about 90% of the patients that come in needing root canals we do them but every once in a while, there's a tooth that's just very complicated, whether the canals are all curved and twisted or it's a root canal that's already been done and is infected and needs to be redone again and that's why we have specialists to do the most complicated, difficult cases. If I felt that I could do this perfectly which I can with just about every root canal, I'd gladly do it for you here but this is one of those rare cases where I feel like you should be in the hands of a specialist just like sometimes your physician wants to refer you to a specialist because they're just more comfortable with doing that. And as soon as that's finished, you're going to be back in this practice, you're still our patient, you'll be here, you know, it's just something like that.
Dr. David Madow: Yeah.
Dr. Richard Madow: No need to get complicated.
Dr. David Madow: Doctor, you're saying that I'm a rare case, I'm like an anomaly. What's wrong with me?
Dr. Richard Madow: You should take that as a compliment.
Dr. David Madow: No, but I get it, that's a good answer. Who's going to argue that? Look, I think it's most important to look the patient in the eye and say, I want the best for you. I want to make sure and this, you know, this is not a routine root canal. I just want to make sure it's done perfectly that's why there are specialists out there. But as soon as he or she is finished, you're coming back to me, we're going to finish the tooth implant, whatever it might be, you know.
Dr. Richard Madow: And by the way, you know that screaming brat you come in with... that you bring with you every time, they have to go to a specialist too, a special doctor called a pediatric dentist [crosstalk], that brat here.
Dr. David Madow: Very special, special.
Dr. Richard Madow: Very, very special.
Dr. David Madow: Very special. 
Dr. Richard Madow: They're going to use those special gold T-matrix bands on, not the silver ones, the gold one. 
Dr. David Madow: Why the gold ones? Why do you like... why, why are they better? Why do you think?
Dr. Richard Madow: I prefer these.
Dr. David Madow: Okay, that's a good answer, that's as good as any [laughs].
Dr. Richard Madow: Hey, before we get on with the call. I just want to make a quick comment; a bunch of people have been asking us about our Masterclasses. Our Masterclasses are something we do every couple of months, typically in our home office of Baltimore, Maryland. We have a fantastic facility. They are very comfortable and fun where we do our Masterclasses. As you know The Dental Practice Fixers have been doing individual coaching for practices for quite a while now. We have a great success rate and coaching can be a very intimate relationship. It's just... it's different than going to a seminar or reading a journal. It's, you know, we're really there as a part of your practice. And many people want to learn what would that be like to work with you and that's why we do these Masterclasses for people that are interested in growing their practices and want to know what it's like to work with us as their coaches. We do them for free there in Baltimore every couple months. We've got some going on right now. You can sign up, it's masterclass.madow.com.
Dr. David Madow: You got it.
Dr. Richard Madow: You can tell I was struggling to come up with a website there, masterclass.madow.com. Again, it's a great day. We get to know you, you get to know us. Some of our coaching team will be there. We can talk about your practice, about your successes, about your struggles, even maybe brainstorm, offer you some suggestions. But the real purpose is if you think you might want to work with us as your coaches, this is a way in a very safe environment for very little expense, you can come and see what it's all about. So, masterclass.madow.com. We'd love to see you at an upcoming Masterclass.
Dr. David Madow: We hope to see you there. By the way before we get into the call, as Rich and I are trying to help you any way we can in your practice, something else we came across fairly recently that we've been helping a ton of practices with and it's something that every single dental office is doing already. So, we're not asking you to do anything new but you are accepting credit cards for payment, 99.9% of dental offices are accepting credit cards. But here's the thing, there's an old way to do it and there's a new way to do it because the old way basically is there's a processing company that takes a percentage from every single transaction, you do a crown, you do a... you do a bridge, you do implants, and somebody charged it, they take a pretty nice percentage of your production, of your collections there. There's a new way to do it, it's called, Fattmerchant, and there's just, Rich, correct me if I'm wrong but it's only a monthly fee, it's only one fee, small fee per month, and it doesn't matter how much, it doesn't matter if you're collecting a million dollars a month, we hope you are, but it doesn't matter, you're still paying the same monthly fee. So, it's something you're already doing [crosstalk].
Dr. Richard Madow: You still have to pay these are MasterCard, Amex, they have their, their percentage but the processing company, that's when processor takes no percentage. 
Dr. David Madow: The processor takes no percentage, thanks for clarifying that. Changing merchants, changing merchants has been very difficult in the past because it just... it was a whole rigmarole, very complex, now it's pretty much a phone call and or a few clicks on a website and seamlessly you're changed to Fattmerchant. We really believe in them. We've been talking about... talking them up for quite some time. It's never been easier. You're leaving money on the table if you keep your old credit card processing company. So, what we're going to recommend is check out Fattmerchant. I want to make sure I give you the right link and it's too good if you're watching the video, it's going to be below also. It is simply bit.ly, it's B-I-T dot L-Y, bit.ly/fattmad and it's spelled in case you're listening to audio it's F-A-T-T-M-A-D. So, the whole thing together, it's right below if you're watching video, bit.ly/fattmad. Check them out, it's a one-time change that doesn't cost you anything and it's going to save you money every single month in your dental practice. Who doesn't want that? It's a no-brainer.
Dr. Richard Madow: Amen.
Dr. David Madow: Same. 
Dr. Richard Madow: We are in actually, we use it at The Madow Center.
Dr. David Madow:  We use them, sure. We believe in them and we use them as well, of course.
Dr. Richard Madow:  Alright, let's go to our call, it should be fun.
Dr. David Madow: Sounds great.
Female Speaker: Thank you for calling, this is Julie.
Dr. Richard Madow: Hey, quick question for you. I live near your office, I was thinking about making an appointment for a cleaning.
Female Speaker: Sure.
Dr. Richard Madow: But I don't know much about it. Can you tell me a little bit about the doctor?
Female Speaker: She's a female.
Dr. Richard Madow: Excuse me?
Female Speaker: She's female.
Dr. Richard Madow: She's female, okay.
Female Speaker: A female doctor, the only dentist in this office, been practicing... how many years doc? Do you know how long she's been here? 22 years something right? Heck, I don't know.
Dr. Richard Madow: You don't know. 
Female Speaker: 22 years maybe, you know, she takes children, does general dentistry; most surgeries, you know, the extractions, anything like that, things like root canals, implants, big things like that always get referred out to another doctor but everybody seems to love her.
Dr. Richard Madow: Why, why do big things get referred out to another doctor?
Female Speaker: Yeah because she's just general, she doesn't do the root canals and the extractions and stuff.
Dr. Richard Madow: Gotcha, gotcha. Okay. Well, hey, thanks so much for that information. I appreciate it.
Female Speaker: You're welcome.
Dr. Richard Madow: Okay, bye.
Female Speaker: Bye.
Dr. Richard Madow: Wow, what do you think?
Dr. David Madow: Oh my God, what do I think? What do I think about that? I'll tell you what I think. She's a female.
Dr. Richard Madow: She is?
Dr. David Madow: She's a female. Oh okay, sign me up.
Dr. Richard Madow: That's the most you can say about her?
Dr. David Madow: I want to tell you something, Rich, these things like did they just write themselves, I mean, I want to make it clear to all of our listeners and viewers now, these are not scripted, they're not fake, we take, we take a phone number at random and ask a question and in 99.9% of the cases, the calls are like this, it's unbelievable.
Dr. Richard Madow: I'll tell you like 1955 maybe saying the doctor is a woman might have meant something. You know, these days with dental school classes being more than 50% are female thankfully and, and nobody flinches it at what gender their doctor, their accountant, their lawyer. I mean, that's really from the old days, you know, we don't care anymore. To make that the first thing you say and I have to tell you because I looked up this, this person's phone number, the woman's name is on the practice so it's obviously a woman's name. And they answer with her name which you got beeped out so you couldn't hear that.
Dr. David Madow: It wasn't it like Pat, right? It wasn't like Dr. Pat [crosstalk]. It was definitely a female name, right?
Dr. Richard Madow: She's a female, okay great. How long she's been... I don't know how long she's been pra- how long... I don't know.
Dr. David Madow: How long she's been practicing? I think, I think... how long, at 22 years something like that.
Dr. Richard Madow: Something like that. Then, she was like instead of saying how great she was, she started saying negative stuff. She doesn't do root canals, she doesn't do extractions, she doesn't do implants. Perfect, sounds like the offer is for me.
Dr. David Madow: Before she said that I thought it was really fine, she... this is very, very helpful, she treats, she treats people and I think they said like she treats patients and kids or adults and kids or something oh that's, that's a tremendous help. I'll tell you something, she said one thing that if you were to base the call on this one thing and expanded on it, it would've been so great. She said one thing I thought that was very good, you remember what that was? 
Dr. Richard Madow: Everybody loves her.
Dr. David Madow: Exactly, everyone seems to love her which was great. But that's the only good thing she said the entire, otherwise she, she didn't like... she didn't know what to say.
Dr. Richard Madow: Horrible, horrible. It wasn't that tough of a question, tell me a little bit about your doctor.
Dr. David Madow: No, no, not, not tough at all especially if every single person on the team knows the quality and believes in the doc and has been going to the... she, look... she could have said, look, we all... everybody here sees, whatever her name, we're not going to give her name, sees her. We've been seeing her... I've been... my family's been going to her for 10 years. She is great, she's so gentle, her work is beautiful, anything.
Dr. Richard Madow: Okay, let's, let's make a suggestion. Have a team meeting and everybody should have kind of an elevator speech, tell me about your doctor and they... you should be... anybody listening to this should be able to say a 30-second little spiel about how great your doctor is. She's been here for 22 years, she's so gentle, so many people in the community come including us, we come here, our whole family comes here, we all love her, she makes beautiful smiles, and she really makes great personal connections because she takes the time to listen to every single patient. I mean, could you imagine if she just said something like that?
Dr. David Madow: But guess what, Rich, to take it a step further, it's a really good exercise because it's taking a step further, somebody calls an hour later and says how much is a cleaning, you can skirt that question and then go really deeply into how great of an office and how great the doctor is and totally, you know, shield that question and-
Dr. Richard Madow: Let me tell you a little bit about our doctor.
Dr. Richard Madow: Exactly, exactly. Oh, you want to know how much cleaning is, well it sounds like you're looking for a new dentist, is that right? Yeah, we are. Well, let me tell you about our doctor. Oh, I mean, it could be like a home run.
Dr. Richard Madow: And this is also part of our ALASKA system, those of you using our ALASKA system, as kind of a loose phone script when a new patient calls, the K in ALASKA stands for kindness and in 10 seconds of that kindness, you brag about your doctor, you brag about your practice. But again, we're not big believers in like word-for-word scripting but you should be able to boom, use something great about your doctor anytime it's necessary. And if you can't, you're probably in the wrong practice.
Dr. David Madow: This woman was just okay, again, there always are surprises when somebody asks a question or calls the office and like our last episode, you've got to be... you got to think on your feet really quickly. And asking a little bit about the doctor is not that difficult of a question and to say, well, she hesitated, well, she's, she's female, she's female.
Dr. Richard Madow: I just, I just checked she is female [laughs].
Dr. David Madow: Oh my God. Well, I don't know if you-
Dr. Richard Madow: That's the first thing you say, she's female? [laughs]. 
Dr. David Madow: She said it twice too, she had to say it twice. She's female, she's female.
Dr. Richard Madow: Now, what if she were working in a guy's practice and she would say, well, he's a man. I doubt it.
Dr. David Madow: That's a really good point so that's kind, it's kind of sexist right there.
Dr. Richard Madow: Exactly.
Dr. David Madow: I'm telling you. Okay, I'm turning in... I'm voting early on this one. I've got an early vote. I'm turning my vote in.
Dr. Richard Madow: And vote early, vote often. What's your vote?
Dr. David Madow: F, totally F.
Dr. Richard Madow: Well, you're going to be shocked the grade I give but F as well, double F. She got double F. 
Dr. David Madow: I'd say Rich, we should just at some point we hope to get somebody that does a great call, we're able to give somebody an A or A minus or even a B plus. 
Dr. Richard Madow: I'm glad you brought that up. These are not edited, we don't like put the thing on pause and make 20 calls and then come on.
Dr. David Madow: We really don't. [Crosstalk].
Dr. Richard Madow: They, they just are not good every single time. Nobody knows what to say. Hey, if you've got a suggestion for a question, ask for a really cool mystery shopper call of the week, please send it to us at podcast@madow.com or is it podcasts@madow.com?
Dr. David Madow: We ask this every time and we [crosstalk].
Dr. Richard Madow: Maybe it's both by now.
Dr. David Madow: Had the system fixed for sure. I think we prefer podcast, a singular podcast@madow.com but I think Sylvia has worked her magic I believe.
Dr. Richard Madow: Right, unbelievable.
Dr. David Madow: It will go to us.
Dr. Richard Madow: Send us a question for the call of the week, we'd love to do it for you live.
Dr. David Madow: Of course, as you know a lot of people reach out to us on Facebook with questions by Messenger, any way you want to get to us, you know how to get to us. We've been around long enough. And again, if you're watching the video version of this, please comment, like, react, whatever you want to do, and we will, we will ask your question and we'll, we'll try to answer it right there in YouTube, Dental Practice Fixers on YouTube, search for it.
Dr. Richard Madow: Super cool. Thanks so much everyone for being with us, whether it's audio, or video, or all the above. This was Episode Seven, Season Two of The Dental Practice Fixers. I'm Dr. Richard Madow.
Dr. David Madow: Dr. David Madow. We will see you next time. Thanks for being with us.
[Music Playing]
 
 
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The Dentist and Office Manager are Cheating Insurance Companies

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Welcome back to The Dental Practice Fixers podcast, dentistry’s most unique show! Today we have a question from a listener asking if the office manager would be liable for falsifying dental records sent to insurance companies if it’s being done under the dentist’s direction. It appears as though this office is having a difficult time getting insurance to approve scaling and root planning so they are fudging the records that are sent to insurance. Listen to what Dave and Rich have to say about this one. Then of course we do the call of the week. A caller who is a potential new patient asks an office if they are having a “Teeth Cleaning Sweepstakes.” Listen in to see how this one was handled! 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!

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Season Two – Episode 6

The Dentist & Office Manager Are Cheating Insurance Companies

Dr. Richard Madow: Hi, I’m Dr. Richard Madow, and welcome to Episode 6, Season 2 of the Dental Practice Fixers Podcast. And this is a really really big day for those of you in Dental Practice Fixers land which obviously you’re in Dental Practice Fixers land that you’re with us today. Those of you listening on iTunes and Spotify and Sketcher and Diesel and Weasel, whatever you’re still on. You might not know this, but if you’re watching on YouTube or some other video server, you can probably tell that this is our first live video podcast of the Dental Practice Fixers. We’ve been all audio up until now finally, Episode 6, Season 2. We’re coming at you and you can actually see us for better or worse. So I’m not sure if that’s better or not but as you can tell, we’re actually in different locations today. So here I am over here, Dr. Richard Madow and over there is my bro, my main man, my business partner and my co-worker, Dr. David Madow. How is it going today Dave?

Dr. David Madow: What is going on? I’m doing feeling fantastic. Rich this is a monumental day in the Dental Practice Fixers Podcast because we’re… I just want to make sure people understand. We’re keeping… it’s still going to be available on iTunes in all of the audio podcast formats. We’re not going anywhere but we’re adding another dimension. We’re doing… we’ve got a video channel setup. It’s called the Dental Practice Fixers on YouTube and you can actually watch us for better or worse, I guess. Watch us as we’re doing these shows. So feel free to go to the Dental Practice Fixers on YouTube. Just do a search for that, it’ll come right up and subscribe. Subscribe and make sure you enable notifications if you’re watching us on YouTube. So, then every time a new episode comes up with just once a week, you’ll get an extra notification. And please interact with us. I think YouTube is probably more… what’s the word I’m looking for. It’s easier to interact with us.

Dr. Richard Madow: Interactive. Maybe it’s more interactive. Is that the word you’re looking for?

Dr. David Madow: That’s the word I’m looking for. So you can comment, you can like, you can comment back. It will feel definitely more interactive. So we’re looking for this YouTube channel to really grow with some help from you of course.

Dr. Richard Madow: Now Dave before we go any further, I do want to point out that our lawyer [inaudible – 0:02:31.8] Goldberg pointed out that we do need to read some instance we’re going on video and that is that if you are enjoying the podcast while driving, we cannot be responsible for anybody watching the video and getting it to any kind of accident. So this whole disclaimer we have to send, courtesy of [inaudible – 0:02:48.0] Goldberg. So if you’re driving, please do the audio only. But if you’re sitting in your office, your home, you’re on the treadmill, you’re at the movies, wherever you are, you can watch this on your computer or any of your devices.

Dr. David Madow: But they could still… let’s say they’re driving and they’ve got their iPod, iPad, whatever it might be, as long as they’re not… if they got only on YouTube only and as long as they give us their word they’re not watching, I think our lawyer said that might be okay.

Dr. Richard Madow: he only said you cannot utilize YouTube. Well we’ll leave that up to the discretion of the listener.

Dr. David Madow: But what about some of our field insurance guys? Are we insured just in case somebody tries to sue us for watching our…

Dr. Richard Madow: It’s funny that you said that because I contacted them yesterday and told them what we’re doing, and he looked through the policy and he said, guess who doesn’t have insurance. So I guess we’re not. So please be kind, rewind. Well that was quite an intro. So again we’re still on audio if that’s the way you want to enjoy it. But if you’re really a glutton for punishment, you can watch us live. I’m on the east coast today. Dave is in mountain time through the magic of electronic technology, here we are all together. So Dave, I understand that you’re got a really crazy questions today that someone submitted.

Dr. David Madow: It’s unbelievable. So we’ll get into right now because it’s

Dr. Richard Madow: Let’s do it.

Dr. David Madow: It’s an incredible question I think, not only can we give a great answer to. I promised this listener that we will give him a great answer too.

Dr. Richard Madow: Great. That’s subjective.

Dr. David Madow: But we can expand on it. I think everybody is going to love this. So I’m going to go ahead and read the question. It’s a little bit on the long side so bear with me. I actually edited it down a little bit too. So okay, here is how the question goes. Hello Madow Brothers, I just left an office that is practicing insurance fraud. That’s good enough already isn’t it?

Dr. Richard Madow: Right on. Let’s just say congratulations.

Dr. David Madow: It gets better. They’re cooking up a double set of records. One pair of your charts for the insurance company and one for the patient. Granted, the insurance companies are being more and more ridiculous about the perio unless there is calculus visible on x-rays. So I get it, I’m kind of talking at her tone. But there are other cases where they say, well if we add a few more millimeters here and a little mobility there, we can submit another quad or two for scaling and root planing. To make matters worse, the doctor tells the office manager to do whatever you need to do to get those treatment plans accepted. I don’t want her to get in trouble, if caught… here’s my question, if caught, is there any way that just the doc alone would be liable or will the office manager be liable too? Name withheld, I request.

Dr. Richard Madow: Good move withholding your name. Let’s just start with that. Now let me just get this straight.

Dr. David Madow: a double set of books here.

Dr. Richard Madow: We’ve been coaching for 30 years, and just when you thought you’ve heard it all, I’ve never heard this before. This is amazing. They are keeping an accurate record for their patients’ treatment sake, but then submitting a completely falsified record, an exaggerated record in order to get insurance coverage. So it’s pretty much what’s going on here.

Dr. David Madow: Yes.

Dr. Richard Madow: And they add extra pocket depth and mobility. Now they don’t add any extra We’ll give them a little credit for that.

Dr. David Madow: We don’t know for sure. They might be adding [inaudible – 0:06:27.6]. That wasn’t really stated so we don’t know exactly.

Dr. Richard Madow: My first comment is will this doctor be comfortable being the prison dentist one day because that’s where they’re headed. Is this what you have to do to get a job as the prison dentist?

Dr. David Madow: I mean, Rich it’s just an unbelievable story. We can go for so many tangents here but let’s… maybe the first, the quick answer. The first quick answer is the office manager liable also. I’m going to say yes. I mean even though it’s under the doctor’s direction, she is falsifying records. It’s illegal.

Dr. Richard Madow: That’s illegal. We’re not attorneys.

Dr. David Madow: I felt we were.

Dr. Richard Madow: I sleep with an attorney every night so maybe it’s starting to rub off for me a little bit.

Dr. David Madow: Oh I don’t know that. Oh your wife, that’s right.

Dr. Richard Madow: I’m going to say the office manager knows this is illegal. And also, again, from what I’ve learned a little bit in living with an attorney, there’s an exact phrase which I can’t recall but it’s something among the lines of just because you don’t know the law, it doesn’t excuse you if you break the law.

Dr. David Madow: That’s very true.

Dr. Richard Madow: You can’t rob a bank and then go to court and say, well I didn’t know robbing a bank was illegal. And then in this case, I’m not even sure how that applies because the office manager knows this is illegal. They’re complicit in insurance fraud. If I’m prosecuting on behalf of the insurance company, I’m going after everyone especially the office manager who’s making these notes to patients. The office manager is falsely claiming and knowingly falsely claiming these records that are true. What a bad situation. Congrats on quitting.

Dr. David Madow: The writer quit but she’s concerned about the office manager is still there. But Rich we can also go off in a different direction because first of all, we would never ever ever recommend doing anything illegal in dentistry or in our lives. So that goes without saying, falsifying record is illegal. But the other direction we can go on is… the basic problem is they’re having a big issue of getting perio cases, scaling or root planing approved. So there’s a reason for that, and I’ll tell you something. I know for sure that if they just maybe submitted things a little bit differently to the insurance, I mean, totally honestly, but let’s say there’s no real visible calculus on the radiograph, but let’s say if they sent a narrative and said you might not be able to see this on the radiograph but there is a ton of information, there’s calculus that maybe can’t be seen, there’s mobility. This person, this patient definitely needs scaling or root planing. This is what I’m recommending professionally and I would even take it to the point where if the insurance company denied it, send another narrative and say you are denying something that is absolutely and medically necessary if this patient gets upset and comes after somebody. You’re going to be named in the lawsuit. You do not want to deny this claim because this patient needs this treatment. And I’ll tell you something, I think the insurance company would reverse their decision very very quickly.

Dr. Richard Madow: I agree. Unless Sonny Lee is the insurance clerk, then they might not. Denied, but I was going to say a very similar thing. It’s all in the narrative. Numbers are numbers. Narrative is narrative. The insurance person cannot see the case and you’ve got to describe to them in detail and this is the one time I love using dental lingo. I would say, I know you agree. Don’t use dental lingo with patients, but with insurance people I love to use dental lingo and make it sound very complicated. So I would describe as complex ways as you can, and have about some photographs. You’re saying that the calculus is not visible in the radiographs. Send some photographs. Send some photographs of perio probably around it. I mean just do whatever it takes to let them know that yes there is perio disease here, and as you said I think it’s great to say and you’re going to deny this patient’s treatment that’s going to save her teeth? Are you willing to be responsible for that? Won’t always work but I love a good narrative.

Dr. David Madow: Yeah. So I think the dental office is going about this totally the wrong way. Trying to make things up and fudge things with a different set of records as opposed to just telling the truth and saying this patient… look, I’m a doctor. You’re an insurance person, I’m a doctor. I’m telling you this patient needs this treatment. If you’re ready to deny this, you’re going to face the consequences if that comes back on. And I’d say 99% of the time the insurance company say okay you got me.

Dr. Richard Madow: I give. You know what’s weird Dave? Is that so frequently we see practices through our coaching that are under diagnosing and under treating periodontal disease. I wonder if this office is actually over diagnosing and over treating periodontal disease. Dental perio claims approved if you really do it right, it’s not all that difficult.

Dr. David Madow: Yeah agree.

Dr. Richard Madow: My gut feeling is they may be pushing their perio cases for a little more than they actually are. Maybe not but it’s possible.

Dr. David Madow: I mean I didn’t think of that but it’s possible because if they’re trying to do scaling or root planing on a ton of patients that have twos and threes, maybe they are. That’s a good point too. But if the patient… if they’re diagnosing the patient who truly needs it, it’s up to the doc and the team there to make the insurance company realize that this treatment has to be done. So we’re going full back to that office. They’re doing something wrong and certainly, falsifying records is really wrong, really not good.

Dr. Richard Madow: Do you remember back in the day when we were in dental school? We weren’t there together. You’re 4 years ahead of me school wise, but…

Dr. David Madow: Oh watch it. Don’t tell anybody that.

Dr. Richard Madow: When we took the Northeast Regional Boards, you had to have like a perfect class two lesion because you wanted to do a gold… in-layer gold foil and I think they have to do it on an amalgam on a class two as well back in the day.

Dr. David Madow: We did.

Dr. Richard Madow: And it was tough to find a perfect one and some people would actually take a graphite pencil and draw a little [inaudible – 0:12:31.2] area in the inner proximal and duplicate the x-ray. I’m thinking, geez this is just… it’s complete fraud. It’s unbelievable. And those are probably the same people that are doing this.

Dr. David Madow: I was ready… the things that you had to get done to get your license.

Dr. Richard Madow: I want to make another comment too. Back when I was in my practice, I remember early on I have a patient pay for… it’s fairly large case. It was large to me in those days. Probably would seem like nothing now in cash. And they handed my office manager Carol cash and said I bet Dr. Madow is going to like this. And then she came to me at the end of the day and totally innocently said, Mr. so and so who paid in cash, do you want to just pocket this? And I said absolutely not. We have to report this income just like everything else. And it’s one of those things where if your team knows that you’re willing to bend the rules, especially rules like that. Tax fraud, pocketing cash. If they know you’re willing to do that, that where you draw the line and where do they draw the line. If you’re willing to do that, well what’s wrong with them taking home a couple of paper clips which leads to them taking home some more office supplies which we…

Dr. David Madow: Toilet paper.

Dr. Richard Madow: Toilet paper, of course. They can wipe you out with toilet paper. And then was that going to lead…well we don’t really need all this …. I’m going to sell some on eBay. Little dishonesties can turn into some big dishonesties especially if they think you’re dishonest or if they think they have something on you so to speak.

Dr. David Madow: Yeah. And let’s close this little segment and I’ll give you my opinion on how I live my life. Rich I’m pretty sure you live your life the same way. We’ve known each other for quite some time. But I just don’t do anything in life that is going to come back and haunt me that I’m going to get a knock on the door from the IRS or anything. It’s easy to cheat a little bit here now on your taxes but why do it. If you do things right, if you follow the rules, nothing is going to… it’s just not going to come back and haunt you and that I think is a great way to live your life.

Dr. Richard Madow: I totally agree. And that doesn’t mean that we’re like total dorks and do things that are crazy and fun and outrageous and pushing boundaries. When it comes to breaking the law of cheating on taxes or committing insurance fraud, you got to be crazy to do stuff like that.

Dr. David Madow: Yup. Don’t do it.

Dr. Richard Madow: Don’t you break my heart.

Dr. David Madow: Are you ready for the call? We got a great… we’re going to do a great call…

Dr. Richard Madow: Before we do the call, I just want to mention something.

Dr. David Madow: Sure.

Dr. Richard Madow: The last podcast, I was talking about Fattmerchant and talking about how it’s the most incredible way to save on your credit card processing. Because they don’t take an overage percentage. They just charge a low monthly fee. No percentage at all. And I said there’s a special page we have. If you want to check out Fattmerchant, start saving money right away. We use it in our office. You should use it in yours. Go to this website and then guess what, I gave the wrong website.

Dr. David Madow: Oh no, ouch.

Dr. Richard Madow: So I think a bunch of people might have been stranded in like some under construction sites. The website still has under construction signs. It seems to be a little anachronistic.

Dr. David Madow: I think it probably depends on the website and the host I’m guessing.

Dr. David Madow: Okay. Well this is a very nice host. So here’s the correct website. If you want to find out how to save money, get the best credit card processor with Fattmerchant. It’s B I T.LY/FATTMAD. So Fattmerchant is spelled with two Ts. Madow is spelled with MAD, so we kind of combined little shorten versions and I somehow screwed it up. So again it’s BIT.LY/FATTMAD, that’s it.

Dr. David Madow: And if you’re watching the video version of this on YouTube, if you’re watching this on video, right below we are putting the… any time we give a link or something, it’s going to be written below. So there’s no mistake now. Of course, last episode, when you gave the wrong one, our video editor guy of course took it from the script and he put the wrong one.

Dr. Richard Madow: How dare he.

Dr. David Madow: I know. Can you believe it?

Dr. Richard Madow: It’s almost as bad as committing insurance fraud by exaggerating perio pockets but how it seems to know.

Dr. David Madow: I know. Right?

Dr. Richard Madow: That’s no excuse if they didn’t know though. Right? And there’s no www, there’s no .com. It’s just a cool little shortened thing. BIT.LY/FATTMAD.

Dr. David Madow: And while we’re talking about some really cool things that we are helping you within your practice, really quickly, our mastermind… sorry, our Masterclasses are really doing great. It’s a very small group of people that we invite to a location generally in Baltimore. Occasionally you have to check the website which will be below in one second. We might travel to another city but it’s pretty much we like to do it in our hometown of course of Baltimore. Let’s face it, it’s comfortable, it’s easy for us so that’s what we’re doing. And let’s face the fact that we generally have a group of great docs that come in somewhere between… we have only between 8 and 12 per Masterclass. And it’s way that… one of very intimate basis we can show you exactly from start to finish how we could help you and your practice through dental coaching and we’ve been helping a lot of practices over the last few years. Really go from here to here very very easy. And love when you do so much more. So check out. I’m going to make sure I get this right, and in case I don’t, it’s going to be right here below…

Dr. Richard Madow: Who would ever get a website wrong? You’ve got to be an idiot to do that. Come on.

Dr. David Madow: But this is an easy one. It’s simply Masterclass.madow.com. And it’s written right there. If you’re watching the video version but if you’re still listening on ITunes which is very cool, masterclass.madow.com.

Dr. Richard Madow: Fantastic. Let’s do our call of the week. I don’t know about you. I think these are always the most fun part of the podcast.

Dr. David Madow: Let’s dial up a real good one today Rich. Okay? I’ve got a great concept so hang on one second.

[phone ringing]

[foreign language]

[machine recording]

Female Speaker: Hi, how can I make you smile today?

Dr. David Madow: Hi, how are you? I have a question for you. I’m kind of new in town and I know I probably need some work and a neighbor of mine told me… I hope I got the right place so you’ve got some kind of a cleaning sweep space contest going or something like that.

Female Speaker: I don’t think so. I haven’t heard about that. Was it our office?

Dr. David Madow: Maybe, I might be mistaken. It could be my fault. I’m not sure. You don’t have any kind of like contest going for cleanings?

Female Speaker: No we do not. I’m sorry.

Dr. David Madow: Okay. I guess I got to find out who’s doing that contest. I know I need a lot of stuff going. Okay well thank you very much.

Female Speaker: You’re welcome. Have a good one okay?

Dr. David Madow: Same to you. Bye.

Female Speaker: Bye.

Dr. Richard Madow: Wow, what kind of contest? She was a little surprised. You caught her by surprise there.

Dr. David Madow: You didn’t hear about the cleaning sweepstakes in the nation? You didn’t hear about that?

Dr. Richard Madow: We’ve been in… okay let’s back up for a second.

Dr. David Madow: Back, yes I know…

Dr. Richard Madow: I know you’re going to agree. I cannot stand the automated menu stuff. It just screams corporate dentistry; we don’t care. You’re just a number.

Dr. David Madow: That is ridiculous. I mean how large… it’s probably, okay if you’re a new patient press 1, if you’re something press 2, if you have a billing inquiry. I mean how large… I mean it’s going to the same person.

Dr. Richard Madow: If you’re an old patient press 2, if you’re a middle age patient… yeah I agree.

Dr. David Madow: That was ridiculous.

Dr. Richard Madow: Really bad. If you’re so short staffed that you need to have some kind of menu for people to call.

Dr. David Madow: So that part was totally ridiculous and I think most people are going to hang up on those things.

Dr. Richard Madow: I agree. Okay I have something positive to say.

Dr. David Madow: You do?

Dr. Richard Madow: I like the way she answered the phone and just gave her name and said how can I make you smile today. Something like that.

Dr. David Madow: Oh I loved that. I thought she was going to be totally great because when she said that I felt that was fantastic.

Dr. Richard Madow: I agree. Again it’s a different entry. Differentiate or just like we teach practices to say how can I help you. How can I make you smile today? It’s great. She might get some weird answers but still great.

Dr. David Madow: Okay look. I don’t know what else I could have done. I told her I’m new in town. I think I need a lot of work. It’s been a while since I’ve had a cleaning and of course this bogus thing about some kind of sweepstakes contest for cleaning. But oh my god she didn’t take the bait. She just said I don’t think we’re doing that, goodbye. She could have said, well let me tell you something, we’re not having an actual contest going but certainly come on in to our office and here are the reasons why we would take great care of you. Done, game, that’s it.

Dr. Richard Madow: Yeah I’ll say it was a kind of a funny/crazy thing to say which was great and it really caught her by surprise. And you could say well she was so caught by surprise, she was a little bit off her game, but as the call went on after the contest sweepstakes thing. It was already settled that’s not them, she made no effort to get to know you and ask you any questions, say welcome to the neighborhood or we’re not doing a contest but we think you’ll love Dr. [inaudible – 0:22:32.3], whatever it is, something rather than you called the wrong office, bye.

Dr. David Madow: And I know that this was meant to take her by surprise because she probably never got a call like that before saying are you having a cleaning sweepstakes but my point is though that all day long, people that answer the phone at a dental office, they might be taken by surprise. It might not be that question but it might be something else that they got to be quick at thinking on their feet and she was not quick and she lost a possible patient because of that.

Dr. Richard Madow: Agree. It’s kind of like our old lesson. Anybody that calls your office as a potential new patient, they might say a hundred different things, but it’s the same thing they’re saying and that is out of all the dental practices in your town or your city, I picked your office, I called you, I’m trying to become a patient of your practice, please let me do it.

Dr. David Madow: You forgot to say one thing.

Dr. Richard Madow: I want you to be my dentist.

Dr. David Madow: Agree. That’s basically what they’re saying. What can I do to help you? I want you to be my dentist.

Dr. Richard Madow: Every darn one of them. So why not get that person? Okay so they thought they was some [inaudible – 0:23:39.4] cleaning contest, let’s get them on the appointment book and show them our dental practice is the best.

Dr. David Madow: So since we grade this at the end of every call, I’m going to have to give an F because she had all the ammunition right there. I’m new in town, I need to lot of work. I think I need a lot of work. No effort was made whatsoever. I give her an F. I’m sorry.

Dr. Richard Madow: I’m going to say it wasn’t her fault if they had that crazy voicemail pick a number menu. I love the way she answered. She was at least somewhat friendly. She completely dropped the ball where it can which she did not even attempt to get to know you or get you to get you in the appointment book. But just because I’m feeling a little warm-hearted today I’m going to give her a D- because I think she’s trainable.

Dr. David Madow: Okay fair enough.

Dr. Richard Madow: Well there you have it. Our very very first video episode of the Dental Practice Fixers Podcast. It happens to be Episode 6, Season 2. But for those of you who are listening to audio only, we still love you just as much. If not more. So wherever you’re listening, go ahead and give us a five star. If you’re on YouTube give us a thumbs up, make some comments and we’re going to be back with another episode really soon. What do you say Dave? Where are you? Can you adjust that? I think the…

Dr. David Madow: What am I adjusting?

Dr. Richard Madow: The little fader or on channel 16 I think should be 15,000 mhz.

Dr. David Madow: Hold on, let me move that up.

Dr. Richard Madow: Perfect, you got it.

Dr. David Madow: Is that better? Does it sound a little better?

Dr. Richard Madow: Much much better, perfect.

Dr. David Madow: Hey guys until next time. I’m Dr. Dave.

Dr. Richard Madow: Dr. Rich. We’re the Madow Brothers.

Dr. David Madow: The Dental Practice Fixers. We fix all through your practice. See you next time.

[music playing]

 

 

 

 

Dental Consultant Recommended Dropping Two PPOs and Now Practice is Declining

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Welcome back to The Dental Practice Fixers podcast, dentistry’s most unique show! Today we have a question from a listener asking for help. He hired a consultant and she immediately recommended that he drop two PPOs. Upon doing so, he noticed that he is now not nearly as busy as he used to be. Was it a good idea to drop these insurance plans even though they were PPOs? What is the next step to becoming more productive? Listen to what Dave and Rich have to say. Then of course we do the call of the week. An office in Delaware claims that they were voted one of the state’s top dentists. But when questioned about it, things all of a sudden begin to fall apart. Listen in to see how this one was handled! 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!


Dental Consultant Recommended Dropping Two PPOs and Now Practice is Declining

Female Speaker: 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: Hello there and welcome to the Dental Practice Fixers Podcast. I’m Dr. David Madow, and Rich and I really appreciate you being here. I’ll bring Rich here in one second. But before I do, I just want to thank you so much for being a friend and a listener. If you have a second, we will would appreciate some help from you. Simply if you like what you’re hearing, we’d love to have you go to iTunes and give us a nice honest review. If you give us five stars on that, it’ll be great, but just if you want to give us a comment, like, a review or whatever what you want to do, it helps to show a message. So, we appreciate whatever you do. And without further ado, I’m going to go ahead and bring my co-host Richard Madow. That’s Dr. Richard Madow into the show. Rich how are you doing today? 
 Dr. Richard Madow: I am doing great, and you don’t have to doctor me but I’ll take it. So this is Dr. Richard Madow…
 Dr. David Madow: Oh you told me to always call you doctor. That’s what you’ve always said in the past.
 Dr. Richard Madow: Yeah okay.
 Dr. David Madow: Even when we were little kids. I had to call you doctor for some reason. I don’t know, I certainly don’t understand that.
 Dr. Richard Madow: Yeah I want to be called maestro now. 
 Dr. David Madow: As long as your nickname is Downtown.
 Dr. Richard Madow: I have a lot of nicknames. 
 Dr. David Madow: You really do. But anyway, same thing with the last episode. Rich and I are in different locations right now. Rich is in beautiful downtown Baltimore, Maryland. Right?
 Dr. Richard Madow: I am. Still in my home studio. 
 Dr. David Madow: Beautiful, and I’m here in Salt Lake City, Utah and we are probably roughly 2,000 or 2,500 miles apart. We sound like we are in the same room due to modern technology here. 
 Dr. Richard Madow: I’ll tell you something else. I could just drive about from home, in about less than 20 minutes. I can be right at the very beginning of I70, and they just take I70 all the way out to Utah but it doesn’t go to Salt Lake City but it goes somewhere where I can just take maybe I15 to Salt Lake City.
 Dr. David Madow: I believe that would be right.
 Dr. Richard Madow: In my two terms could be wherever the heck you are.
 Dr. David Madow: I’ll tell you something, Rich come at me. 
 Dr. Richard Madow: I’m not doing it. I’d rather fly out there. Hey can I just go on a tiny rant here?
 Dr. David Madow: Please.
 Dr. Richard Madow: I cannot stand dealing with irresponsible people. 
 Dr. David Madow: Oh I love it.
 Dr. Richard Madow: Here’s an example; let’s just say that… I’ll just make a situation up because this happens all the time. You get like a little dent in your car, you take it to the body shop, they look it over, they say okay I’m going to send you an email this afternoon with your estimate. Does that email ever show up? No. And then like a day or two you don’t want to be the pain in the ass because that’s the worst thing to be. And then you have to start hocking the person then you feel you’re being annoying to them, when meanwhile they’ve been irresponsible in the first place, you wouldn’t have had to go through this.
 Dr. David Madow: Well that’s quite a rant. Tell me what happened. What’s the story? Did you bash your car for some reason?
 Dr. Richard Madow: I’m not commenting.
 Dr. David Madow: What did you do? You didn’t tell me you hit your car again.
 Dr. Richard Madow: I’m just saying this is a rant. I’m not saying I did it.
 Dr. David Madow: Oh you made it. I’m going to guess. You were in your parking garage at your home, and you backed into a pole. That’s my guess.
 Dr. Richard Madow: I’m not commenting on that. I’m just fed out with irresponsible people. 
 Dr. David Madow: And I’m going to say one more thing. If that is true, which I’m not sure because you’re not commenting. It’s not the first time. Why don’t you have them remove that damn pole or relocate the pole or give you a new spot or something.
 Dr. Richard Madow: It’s so funny. In my parking garage, the poles and the walls all have like a million dents like black spots on them where you can see people rub up against them. it’s a disaster down there.
 Dr. David Madow: What’s the story? Why do you keep hitting walls and poles?
 Dr. Richard Madow: I didn’t hit a wall and pole. I’m just ranting on irresponsible people. 
 Dr. David Madow: Okay got you. We won’t take this any further.
 Dr. Richard Madow: Let’s put it this way. When you tell a car insurance company that you live in my building, they won’t give you insurance. That’s how bad it is here. 
 Dr. David Madow: Or they double the premiums on travel. Maybe triple them.
 Dr. Richard Madow: There’s like a pole clause. 
 Dr. David Madow: Oh my god. Well you tell me more of the story offline. 
 Dr. Richard Madow: I am not commenting. 
 Dr. David Madow: Okay.
 Dr. Richard Madow: So hey, we have a great question here today. Thanks so much for sending this in. Just like the last time, we’re not going tell this doctor’s name because they asked us not to. So, if you want to send in a question and you’re fearful that we’re going to out you in front of all of our listeners across the world, just put your name with how or if we’re not sure where to withhold your name, we want to protect everybody’s privacy. But as usual, I think a lot of these questions are so universal that they could apply it to anyone anywhere. So, what do you say? Get down to it.
 Dr. David Madow: I can’t wait to hear it.
 Dr. Richard Madow: Okay. Did we say that this is Episode 5? I can’t remember if we established…
 Dr. David Madow: Well we didn’t say it. I say it.
 Dr. Richard Madow: Okay good. Well I’m going to say it now too. This is Episode 5 of Season 2. Just look in my notes. I want to make sure everything is in place here.
 Dr. David Madow: Yeah we said it. I might not have said Season 2 so to be clear, to be very clear, it’s Season 2, Episode 5.
 Dr. Richard Madow: We’re just doing a little housekeeping here. 
 Dr. David Madow: Bathroom is into the right.
 Dr. Richard Madow: I'll tell you something. When we speak at seminars all over the place, I don’t like it when the person introducing comes up and said we have a little housekeeping first. Well let me just say this is how you get your credits, there’s not going to be a break. Why do they have to say we have a little housekeeping? 
 Dr. David Madow: Yeah. Turn off all cell phones. 
 Dr. Richard Madow: Exactly.
 Dr. David Madow: I know.
 Dr. Richard Madow: It’s kind of an insider’s term, housekeeping. 
 Dr. David Madow: We’re going to put that to rest. At TBSE, if somebody does it, we’re going to kick him off stage.
 Dr. Richard Madow: Right off stage. Okay here’s our question. Here’s our question for today. It says, “I hired a dental consultant”, then in parenthesis “(not you guys).” I love it when there’s some parenthesis in their question. Last episode’s question had some parenthesis too, I think. “I hired a dental consultant (not you guys), and she”… well shouldn’t “she” be a giveaway of whatever? Actually, most of our coaches are she. “So, I hired a dental consultant (not you guys) and she suggested that my cash flow would improve and overhead would go down if I drop two of my PPOs. So, I listened and now have lost many patients. We are not busy anymore. What should I do? And what do we tell people who call and ask if we are in their network?” Signed, name withheld.
 Dr. David Madow: When you were reading the question and the parenthesis and little inside jokes, why did I feel like we’re like drive-time DJs? 
 Dr. Richard Madow: I’m not sure if that’s a compliment or an insult.
 Dr. David Madow: Maybe another complement. We’re just killing this one. It’s a great question. I’m going to say that number one, I don’t think enough information was given on this either. 
 Dr. Richard Madow: Well okay, but let’s take it for what it is. Okay so I know where you’re getting. Like did the consultant actually do an analysis and say I’ve determined that you should drop this two PPOs or they just come in and say, hey let’s drop a few PPOs.
 Dr. David Madow: The later is my guess. But what I meant was this doctor is saying… was the doctor he or she? Did you indicate that? I can’t remember.
 Dr. Richard Madow: I did indicate them. The doctor was a she. We’ll say that.
 Dr. David Madow: Okay so doctor was a she.
 Dr. Richard Madow: I’m assuming by name. I mean you’ll never know.
 Dr. David Madow: Yeah okay. So, she could be not as busy, but still here bottom line could be better because last thing I would want is to be seeing patients all day long working my butt off and actually draining the practice and calls in a negative cash or not making any money. So she might have a feeling of not being as busy, but maybe it’s… I don’t know the answer to this but maybe it’s better for the practice. That’s why I’m saying there’s really not enough information here.
 Dr. Richard Madow: I’m going to interpret and say if that were the case, she probably wouldn’t have written in. I think if she were less busy and more profitable, then she wouldn’t have had the need to ask this question. Just kind of an assumption but I think that’s true. 
 Dr. David Madow: You know I think unfortunately, from my experience also, a lot of doctors feel that the busier they are, the more patients, the more hustle bustle during the day, the more successful they are even if they’re not. Even if they’re not making money from the patients. So, I’m not sure. I don’t know the answer but let’s assume that maybe she’s not as busy and she’s not making as much money. Let’s go under that assumption. 
 Dr. Richard Madow: Right. I think it’s kind of those things. Nobody likes PPOs and so they drop them and then their practice goes downhill. So, it’s not something you can just do randomly. You’ve got to really figure out if that’s the best move for you. And I’m also thinking, again just reading into the question that sure you can drop PPOs but it has to be done carefully and cautiously and correctly. For example; let’s say that you decided to drop your worst PPO, you don’t just drop it and say I’m not longer in this PPO. You do it over a period of time say maybe in 9 months I’m going to drop this PPO and then as each patient on the PPO comes in, talk to them and let them know what’s going on and let them know that they’re welcome to stay in your practice and that we figured out that you can join our membership plan or this is a good way that we can help you if you no longer have this crappy… I hesitate to call it an insurance because it’s crappy insurance. But if you no longer have insurance, they’ll just drop it and hope for the best. Do it strategically and start with your worst one, and then do it at a time where you would be able to at least speak to each patient personally and let them know what’s going on and let them know if they go to some crap office that they’re not going to get the same level of care. Don’t just drop it and hope for the best.
 Dr. David Madow: And not only that. Have a plan to fill the void. I mean you can’t just drop a whole bunch of stuff and then not have a plan. So in other words as you’re dropping this PPO, you’ve got to have a marketing plan in place. How are we going to replace these patients? Well you better have a great marketing plan in placed that you start right away, and you’re getting more new patients. There are cash paying patients or better endemic insurance patients or something like that.
 Dr. Richard Madow: It’s a fantastic point. We’re dropping it, we’ve been super busy, we’re dropping this PPO, we anticipate and we won’t be quite as busy. What can we do now to fill the schedule that we haven’t been doing? Really good point. 
 Dr. David Madow: And the worst thing somebody could do is we’re going to start doing some marketing and they just start has or different marketing things without really having a plan, and we see this so often Rich. I don’t know, typically what will happen, they’ll go to a dental conference so they’ll walk around an exhibit hall or talk to some kind of rep that comes in or something like that. And they’re just kind of it’s a hit or miss marketing campaign. That is ridiculous, it could be expensive, it can fail. You’ve got to make sure if you’re going to be doing marketing, do it right. Have a plan, have a budget, know what you’re doing, know what you’re… anticipate what the ROI is going to be and do it the right way. Not to put it in a shameless plug for what we do, but the Total New Patient Plan. We’ve got this total… it’s a total plan all together we do everything for you. You might want to look into that. It’s on our website somewhere, madow.com, check it out. And again, we didn’t even mean to plug it but why not plug something that totally works and it’s totally well-thought out.
 Dr. Richard Madow: I don’t know that there’s a shameless plug at all. It was kind of a shameful plug. 
 Dr. David Madow: Well I think the most important thing is what we see is all the time, docs are mainly doing a hit or miss marketing and that just does not work in the long run at all. Yeah you’re getting a few patients, it’s a start but it’s not going to work long term.
 Dr. Richard Madow: Totally agreed. And also, as we reinforce on every episode when we do our call of the week, you better make sure that your front desk team is incredibly good at turning every potential new patient on the phone into an actual patient in the practice. And maybe just homing that skill will get that schedule full again. 
 Dr. David Madow: I’ll tell you something, that was a really important comment. It bears talking about for a couple of seconds because so many doctors out there are complaining of how they need more income. They need to be more successful, they need more new patients. And Rich, when we do these calls and I want to make it very clear. We don’t do 20 calls and the take the best of the best. We generally… every time we do a call, unfortunately it’s a bad call on the dental office’s end. What I’m trying to say is most doctors think that the person answering the phone in their office is an exception to the rule, and they’re doing a great job. But I’m here to tell you, statistics really don’t lie and most front desk people need a lot of work because just listen to our calls every week. You’ll see what’s happening in most dental office across the United States.
 Dr. Richard Madow: Yup. And it’s kind of circling back to what you called your shameless plug. And whether you use us for your marketing or someone else, whatever you’re doing, there’s so many great avenues in there. You can do all the marketing in the world and it stops at the front desk. You can have 50 incredibly qualified cash paying potential patients calling and if they never get on the schedule, it doesn’t do you any good. 
 Dr. David Madow: Yeah so let’s just circle back to this, kind of like summarize the answer to this question. Do we know that the dental consultant did the right thing? Do we know that the dental consultant ran reports and really understood the mathematics behind that suggesting dropping two PPOs? We don’t know the answer but you did drop them, let’s move on and do the right thing to get better patients and by marketing, by training your front desk. Again, it just comes down to basics. We’re not reinventing the wheel. It comes down to these basic things that you need to be doing in your dental practice to be successful. Are you doing them? 
 Dr. Richard Madow. Totally agree. And also, let’s make another point. People that are not… if people have a PPO that you don’t accept, let’s face it, most of them will not come to you but some will. And the ones that do come to you for a reason and they can be some of your best patients. So, if you’re about to drop a PPO and you’re having a discussion with the patient about it, make it very clear. They are welcome in your practice at any time. And should they leave your practice, still it make it clear. They didn’t burn the bridge. They are absolutely… if they don’t care for the practice they went to, they’re absolutely welcome to come to your practice. You can work on financing, you can offer them a membership plan. There are so many great things that you can do. And same when somebody calls and says are you on my plan? You don’t just say no and hang up on them. You let them know that we’re not technically on your plan but you can still come here and this is how it will work if you do. And we’d love to have you and we think you’ll really see the difference. So again, most won’t do it but some will, and some will go to an office and get burned and then come back thankfully. So just don’t count them out automatically. 
 Dr. David Madow: Right. And if you’re listening to this and you’re at a place where you can actually take notes. We’ve talked about this before, write down the term “you are a non-restricted provider” which means again, you’re not technically on the list but you can work with the company and get some benefits. So yeah always use that. We are non-restricted providers. You can come to us. You’re welcome to come with us. We’ll do the best we can. 
 Dr. Richard Madow: Fantastic. Great question. Thanks so much for writing in. What do you say, speaking of front desk skills? Let’s do our call of the week. This is not just any call of the week. This is the call of the week to one of the best dentists in the state. How do we know they’re one of the best dentists in the state? We’re going to find out. 
 Dr. David Madow: I’ll tell you, before we do it really quickly, I want to remind you that Rich and I are running this Masterclass for dentists. It’s a small intimate setting. We’d love to have you attend. It’s a way to take your practice into the next level and the best way to find out more about the Masterclass and how the whole thing works is we set up actually a web page for it. It’s masterclass.madow.com. Check it out. We’ve got all the information you would want. If you need more, just get in touch with this. We’d love to see you in a future Madow Masterclass.
 Dr. Richard Madow: I got to say, the Masterclass has been a turnaround. There are so many dentists, the day they made a huge difference in their lives. Don’t you think?
 Dr. David Madow: No question about it. I think we are really helping dentists become more successful and happier in the practice of dentistry. We really are. We’d love to have you join us at one.
 Dr. Richard Madow: Speaking of… there’s things like a Masterclass, they make a huge difference in your life. Other things that you can make difference in your life like saving a few thousand dollars every month on your credit card processing. So please check out Fattmerchant. They will save you money on your credit card processing because they just charge a low monthly fee and no overage percentage. Check them out at bitly/… well I’ll spell it out because who knows how the heck to do that. It’s B I T. L Y/fattmadow. Fatt with two Ts. So it’s F A T T M A D O W. We’ll work out a special deal just for our Madow listeners. You’ll get a free processing terminal, you’ll save money. Your patients won’t know the difference. You won’t know the difference except you’ll lower your overhead. So again, Fattmerchant is the best way to process your credit cards. B I T. L Y/F A T T M A D O W. And now we teach you a little bit…
 Dr. David Madow: Hey Rich!
 Dr. Richard Madow: Go ahead.
 Dr. David Madow: I’m going to make a really really quick comment about Fattmerchant because in the old days, when somebody said hey you got to change your credit card processing company and then it was a real hassle. There was nothing easy about it; it took a long time, there was a ton of paperwork. These days, I’ll tell you something. With Fattmerchant, you pretty much contact them with pressing a few buttons, they can change you over to Fattmerchant and there is just no reason why any dentists should not be using Fattmerchant. What you said Rich in the beginning of that segment, save a few thousand dollars a month. Who wouldn’t want that? I would take a few thousand dollars in my pocket every single month from here till the end of eternity.
 Dr. Richard Madow: And we started using Fattmerchant at the Madow Center. It’s fantastic. It’s cool.
 Dr. David Madow: Absolutely. It’s great stuff.
 Dr. Richard Madow: So, we kind of tease the call because we’ve got the call lined up and we just noticed from this person’s website that said they’re one of the top dentists in the state. We have no idea what’s about to happen but let’s find out. Ready? 
 Felicia: Thank you for calling. This is Felicia. How can I help you? 
 Dr. Richard Madow: Hey Felicia, I saw on your website that you were ranked top dentist by Delaware Today Magazine? 
 Felicia: Um-hmm.
 Dr. Richard Madow: And what that does mean exactly?
 Felicia: Here one moment. 
 Dr. Richard Madow: It certainly doesn’t mean you have the best on-hold messaging. Anyone home? Okay this is literally over one minute of hold time. I’m watching the timer. Tick, tick…
 Felicia: Hi, sorry. I’m sorry I just… it looks like we were just awarded that for being one of the top dentists in the state.
 Dr. Richard Madow: Being one of the top dentists in the state? Like based on… I’m not trying to be a wise guy. I’m just wondering what the criteria was for that. Do you have any idea?
 Felicia: I personally am not sure. Yeah, I’m not sure. I’m sorry. 
 Dr. Richard Madow: Oh, so do you think it’s one of the top dentists in the state?
 Felicia: Yeah, I think so. I think we’re a great dental office.
 Dr. Richard Madow: Fantastic. Thank you so much. 
 Felicia: No problem.
 Dr. Richard Madow: Okay bye. Wow! So many things to say about that but they’re one of the top dentists in the state. They really are. 
 Dr. David Madow: How do you get to be one of the top dentists? 
 Dr. Richard Madow: I think first of all you have to put people on hold for a long time. 
 Dr. David Madow: Let me tell you something. When we were on hold for a like a minute?
 Dr. Richard Madow: Over a minute.
 Dr. David Madow: Over a minute. I was just picturing, what are they doing or did she go to a big huddle and they’re trying to figure out how to answer the question. What was going on? 
 Dr. Richard Madow: It’s funny Dave. I was thinking the same thing like is she getting coached on this, but then she came back and all she can say was yeah I think we’re one of the top dentists in the state. 
 Dr. David Madow: That call was unbelievable. 
 Dr. Richard Madow: Plus, she was getting like five texts during the call. Did you hear that text tone that kept ringing?
 Dr. David Madow: Yes. I was wondering where that thing was coming from too so that maybe  texts that were coming through. She didn’t know what was going on. I’ll tell you something though. I mean I don’t really know much about the award they got but she could have really played that thing up and made themselves sound really good. But she turned it into a call that made us tell us she didn’t know what was going on. And using the term “we’re one of the top dentists,” that didn’t give me a whole lot of confidence in that practice.
 Dr. Richard Madow: But you made a really good point. We always love to teach front desk team members to brag about the office a little bit. Could there have been a better chance to brag? Yeah, we have been voted one of the top dental practices in the state and Dr. Jones is such a fantastic dentist and he’s gentle and the smiles that we produce are just a beautiful, we’re changing people’s lives every day and we’re just so flattered that we won this award. Just anything. 
 Dr. David Madow: Well unless the thing was totally bogus and like you busted and she just doesn’t know what to say because maybe there was really no vote. Who’s voting for this anyway? Where does this vote come from? Other dental practices voting?
 Dr. Richard Madow: Well I know here in Baltimore there’s a magazine called Baltimore Magazine and they have the top dentist issue and it’s actually voting by peers. I’ve been asked many times to vote for top dentists in all the different specialties and GPs for Baltimore Magazine. So of course there’s a lot of politics and who knows, and it seems like the dentists who will throw full page ads in the magazine seem to do a little bit better. 
 Dr. David Madow: They’re always the top dentists. 
 Dr. Richard Madow: Right. Look at those airline magazines. They’ve got top plastic surgeons in the country. And where was that? The person that writes a check, I always thought.
 Dr. David Madow: I think it must be. 
 Dr. Richard Madow: Nevertheless. It looks good for patients if your reception area has plaques showing that you’re the top dentist in the state and on your website it says vote of the top dentists in the state. It looks great. So be able to speak intelligently on it. 
 Dr. David Madow: Yeah I think chances are that shows, I think it sounded like they were in Delaware or somewhere, and if it truly was in some type of Delaware Magazine and they were voted one of the top dentists, all the team member should know about it. She should have been at least been able to say yes we’re so proud. Delaware Magazine voted us one of the top dental offices in the state, and we are so proud of the small… they should at least know it.
 Dr. Richard Madow: She knew nothing. 
 Dr. David Madow: Nothing. Zero.
 Dr. Richard Madow: I just have to keep going back to that she said we’re one of the top dentists. It was just great.
 Dr. David Madow: And insult to injury, did she tried to get an appointment? Nothing happened.
 Dr. Richard Madow: Nothing.
 Dr. David Madow: The call went nowhere. 
 Dr. Richard Madow: Sir if you come in, we’ll show you why we’re one of the top dentists in the state. Let’s get you on the schedule right now. 
 Dr. David Madow: Right now. 
 Dr. Richard Madow: You come right now.
 Dr. David Madow: Oh my god. Again, I just want to reinforce that doctor if you’re listening to this and you think that these are all exceptions to the rule and your front desk people are the… maybe yours are. I don’t know the answer. But again, we just don’t make any calls that make perfectly. It just doesn’t happen. So please, our goal is… we want anybody answering the phone in a dental office to be great and perfect and gets the appointment. We’re working on that, it’s just not happening yet guys. 
 Dr. Richard Madow: At least don’t put somebody on hold for a minute and a half and if you have to put somebody on hold which let’s face it, it happens from time to time. At least have something playing. We’d love having customized messages playing to tell how great your office is but at least some nice soothing music or something so they don’t think you hung up on them.
 Dr. David Madow: Yeah. Maybe breakfast with the Beatles or something. Just something.
 Dr. Richard Madow: That would be perfect. 
 Dr. David Madow: Rich that was a great call.
 Dr. Richard Madow: Alright. We’ll keep them coming. So that will give us something to look forward to on Episode 6, but this was Episode 5 Season 2 of the Dental Practice Fixers Podcast. Thanks everybody for listening. I’m Dr. Richard Madow with my co-host, business partner and co-worker, Dr. David Madow. Thanks so much everybody and we will see you next time.
 Dr. David Madow: See you later.
 [Music playing] 

 

Associate Dentist Deep in Debt With Poor Treatment Planning Skills

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Welcome back to The Dental Practice Fixers podcast, dentistry’s most unique show! Today we have a question from a listener asking what he should do with his associate. The associate is a decent clinician but has very poor treatment planning skills. Add to that, he is $300,000 in debt, which is causing him to be extremely aggressive when it comes to recommending treatment. Listen to the advice that Rich and Dave give to this great question. Then of course we do the call of the week. Today we are going to a wedding and need our teeth super white. Is it better to have a cleaning or a whitening procedure? Find out how the woman at the front desk handles 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!


Associate Dentist Deep in Debt With Poor Treatment Planning Skills

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: Hello everyone and welcome to season two, episode four of the Dental Practice Fixers Podcast. First of all, thanks so much for everybody for your great support of season 2. We've gotten so many nice comments so far and we really, really love it. If you want to take it a step further and help out the Dental Practice Fixers, please go on iTunes and rate the podcast. Give us a five star, give us a nice review, an honest review. If your honest review is a five star, you'll really, really be doing us a favor and helping us out. So again, thanks for all your great listenership today. It's a little unusual because, uh, Dave and I are in different locations. This is the first time in the history of the podcast that we've been doing it remotely. So, this is Rich speaking to you right now. I'm in my home office in Baltimore, Maryland and Dave is out in some undisclosed location. I'll just tell he's in the mountain time zone and I think maybe through all those mountains and the fog and the snow and the rain and the sunshine. Let's see if we can hear him. Dave, are you there?
 Dr. David Madow: I am here. Can you see my green screen? I greenscreen the mountains in the background here, right? Oh, it's only you, oh darn. 
 Dr. Rich Madow: It looks good though. I can see it. It looks really nice.
 Dr. David Madow: I have to admit Rich, I was trying to be quiet during the intro and let you do the intro, but when you give us, give us a five-star, honest review, I was just, it just hit me as funny. 
 Dr. Rich Madow: Is there any other kind of review? 
 Dr. David Madow: Well, we deserve it. This is the best podcast in dentistry. There's, there's no questions about it. 
 Dr. Rich Madow: Or so, or so, we've been told. 
 Dr. David Madow: Exactly, exactly. 
 Dr. Rich Madow: There are a lot of podcasts in dentistry. Some are really good. I mean we, we listened to other people's podcasts. Some of them, you just wonder why people think they should be doing about this. 
 Dr. David Madow: Yeah exactly right. 
 Dr. Rich Madow: Lot of great ways to get information out there. We've really enjoyed the podcast, Again, your fantastic comments. So, Hey, what do you say man? What's going on today? 
 Dr. David Madow: I'll tell you something, Rich. Uh, I'm feeling great. Ready for a fantastic episode. How are you doing there? Are you good? 
 Dr. Rich Madow: Doing good. Love it. Loving life in downtown Baltimore. I'm overlooking the beautiful harbor. They're not, they're not dragging any bodies out today, so it's a good day. 
 Dr. David Madow: Oh my God. Okay. Hopefully they won't be any time today or anytime in the near future. 
 Dr. Rich Madow: You know, it's funny, one of the things we really enjoy, we've been, you know, writing, publishing, teaching for so many years and we get, when we do our emails, we get nice replies. It seems like we just started getting comments to the podcast, so I'm keeping it up. We really love hearing your opinions. If there's something you like, something you don't like, if you want to ask a question, make a comment, please feel free to write in. But I can never remember if the email addressed as podcast or podcasts @madow.com, but I think it's singular podcast.
 Dr. David Madow: Yes. 
 Dr. Rich Madow: Is that correct? 
 Dr. David Madow: It is. And I'll tell you something, Rich, every episode we talk about having Sylvia fixed the thing, so any either of them will work, but we, I think we haven't done it yet. 
 Dr. Rich Madow: Okay, well we've got too many other things to do here in podcast land. If you're listening, Sylvia, make it, so podcast@madow.com or podcasts@madow.com, come to our direct inbox. Not some bogus inbox, but our direct inbox.
 Dr. David Madow: Can't be bogus, can never be bogus. And before we start with, we got, Rich, we’ve got a great question here. I'm going to, I'm going to share it in a second, but I've got to tell you, I don't know if you've ever done this. I'm just, I'm working on like a blend. I made this, I made this dark coffee this morning, very dark roast coffee, but I added a tiny bit of French vanilla to the mix as well. It is just awesome. I'm just, I'm just feeling great. 
 Dr. Rich Madow: Well, I am not a flavored coffee guy. I like my coffee hot and black. I'm straight up. No cream, no sugar, no flavor. But I got it too since you brought up coffee. I got to tell you, our coffee maker, we've had the same um, Cuisinart coffee maker for about 10 years. Candy and I got it when we moved downtown. So, we've had it for 10 years and finally, finally gave up the ghost as they say. Um, and-\
 Dr. David Madow: It went up. 
 Dr. Rich Madow: It went up as they say in Baltimore, our coffee maker went up. So, we got this Ninja coffee maker. Ninja is known for making like juicers and juice extractors, I don't know if you're familiar with the brand. So, we've got this Ninja coffee maker and it is fantastic and the coffee is strong and most of all it's really hot. Like it hot like so it almost burns your mouth.
 Dr. David Madow: It's the only way to, yeah. And I like, and like you said, I like it black too but, but hot of course. I'm going to. Rich, I'm going to write this down because I might end up getting one of those and maybe, maybe we can set up an affiliate links. So, and our listeners could get this Ninja coffee maker, we can make a few pennies per coffee maker. 
 
 Dr. Rich Madow: Now that's a great idea. The coffee maker that pays for itself. 
 Dr. David Madow: So, let's get into the question because we have a good one. Richard, we're going to want to talk about this one for a few minutes. 
 Dr. Rich Madow: I know you've got it all primed and ready to go. So, let's do it. 
 Dr. David Madow: So here is the question from a doctor and I will tell you we're going to keep this doctor’s name anonymous as he requested it for obvious reasons. You'll see as we as, as we ask this question, but here's what he says. He says, I have a young dentist just out of residency working with us. His skills are good, but he has no treatment planning skills. He's also- 
 Dr. Rich Madow: I'm cracked up already, he's a good dentist and he has no treatment planning skills, none. 
 Dr. David Madow: His skills are but he has no treatment plan. 
 Dr. Rich Madow: Okay. So, so in other words, his clinical skills are good. 
 Dr. David Madow: Yeah, I think that's what he meant by that. And he's also $300,000 in debt and he needs money. In parentheses, he has three young kids. I liked the fact that it's in parentheses. I feel he is doing treatment just to generate income such as crowns instead of fillings, etc. He wanted to do an extraction last Friday afternoon at 2:00 PM on a 92-year old woman. She was not in pain. He just wanted to produce. I stopped him. I found out today she is taking Prolia, which could cause, which could have caused a real problem at her age. What do you think? Name withheld. Keeping it confidential.
 Dr. Rich Madow: Wow.
 Dr. David Madow: I mean. What can we say about that? There's so many routes we could take on answering this question is just, it's unbelievable.
 Dr. Rich Madow: Yeah. Well I'll say it's kind of a modern take on the age-old question in dentistry, you know, we're here to make a living. We deserve to make a living. There's nothing wrong with making a lot of money if you do it ethically and if you treat your patients correctly and do the right treatment. So, this guy's got kind of a double dilemma because he's under a lot of financial pressure, but is a poor treatment planner, maybe a poor diagnostician, and it sounds like maybe a little bit lacking in ethics, don't you think?
 Dr. David Madow: Oh, absolutely. From what it sounds yes. And you know that this problem has always been around even before this tremendous, I'm going to say tremendous student debt crisis. Back, you know, back in our day when people didn't have this kind of student debt, there's debt for, you know, for paying for dental school and practices and whatever, um, there were other reasons people were over-producing. And Rich, you and I saw it all the time, you know, I'd like to think we didn't do it, but, um, I guess there are always going to be people that just want to produce, produce and be unethical and make more and more and more money. And that's, in my mind is it's just not cool. I think you have to look at the patient as the kind of, suppose this was you or somebody in your family, how would you want to be treated? I think you always have to look at it like that.
 Dr. Rich Madow: I don't understand the little dichotomy in this question because it sounds like this associate has poor treatment planning skills, yet they're always trying to get patients to do unnecessary treatment. It seems like the kind of person that does that will be like a real slickster. They can talk anybody into anything. So, the whole thing is just bizarre.
 Dr. David Madow: It's a mess. But what do you do if you've got, again, like I said, this can go in so many directions because as I've talked about in previous episodes, this student debt crisis thing for, especially for dentists, which just really, really worries me. I mean Rich, we spoke to somebody, we were speaking in a city, which we'll, we'll, um, we won't even, we don't have to name the city just a week ago, and we spoke to a dental student there. So, he's in his fourth year of dental school and he already has $600,000 of student debt, where, where does he go from here?
 Dr. Rich Madow: Well that's another story all together. I remember that guy, super nice guy, the D-force, they call them. And he also, he also didn't like doing crowns and was under pressure from his father who thinks his rich dentist son is going to support him when he graduates. What a disaster.
 Dr. David Madow: It's a, it's a huge problem. But I think, so my point is a lot of these docs who are accumulating massive debt, they're in trouble because what can they do? That's why I think that's why there is going to be, there already is, and there's going to be a lot more overtreating to see, to get out of this debt, sooner rather than later. But it's, it's horrible.
 Dr. Rich Madow: Okay, so what can they do? Well, first of all, what can't they do? They cannot get unethical. You cannot intentionally overtreat a patient just because you're under financial pressure. So, let's start with that. But, but secondly, I think it was interesting that the writer of this question, um, remarked on this associate dentist poor treatment planning skills because you know, it, it seems like if the practice is fairly busy and they must be fairly busy, if they hired an associate, there's enough ethical dental treatment to be done that this dentist should be able to make a good living. Don't you think?
 Dr. David Madow: Yeah. But maybe in this doc's mind, maybe not fast enough. Like he's got three kids, $300,000 in debt. Maybe he just feels I need money. And you know, it just seems like a lot of people these days especially, want things sooner, rather than later, they're not willing to do the right thing and take a little bit of time. They just, they want it to happen like now or yesterday. That's a problem. 
 Dr. Rich Madow: Okay. Well for, okay, let's, so let's go back to this, this exact situation. The letter was written by an experienced dentist, I'm assuming, who's been around, actually you withheld the name, but I know this dentist and so do you, at least enough to say that this person is an experienced dentist with great skills that he's honed over many years. Agree?
 Dr. David Madow: And ethical.
 Dr. Rich Madow: Right, ethical. So why doesn't the dentist become a mentor of sorts and work with this young dentist on their treatment planning skills and work with them on their diagnostic skills, so they can diagnose optimum treatment, which let's face it, many times the right treatment for the patient is the most expensive treatment. And if it's the right treatment, then that's great. And work on them to diagnose proper treatment and present it properly and carefully to the patient. It's a long-term plan. It won't put money in your pocket tomorrow, which is why this dentist must be so anxious, but long-term it will be good for the dentist, good for the practice, good for everyone.
 Dr. David Madow: Yeah. I, I would agree with that 100%. I don't know of another answer. Well, again, we can get back to the root of the problem and then let's take care of these student loans, which I think are just crazy, but it's too late for this guy. If I were him, I would not get into any more debt. I wouldn't go out and buy a house now. I wouldn't like buy into a practice. I wouldn't incur more debt. I would work on his treatment planning skills, be the best dentist he can and start chipping away at this $300,000 a day. And I think maybe they'll start to feel better about themselves.
 Dr. Rich Madow: You kind of starting to peel open a can of worms there because you know, one of the things you'd have to ask is, okay, this dentist has three kids. Do the husband and wife think that they deserve the dentist's lifestyle or are they sending the kids to private school and buying them shirts with little horses on them and you know, living in an expensive house, are they doing all those things? Well, Jeez, that that's going to multiply the financial pressure.
 Dr. David Madow: Yup. I would agree. I think you need to live on, live a life way, way, way, I don't care how many kids you have, live a life way below your means to chip away at this debt and then maybe never live the doctor lifestyle. Just live a regular life.
 Dr. Rich Madow: And I think it's also really important, you know, when we're talking about treatment planning skills, the patients, whether consciously or subconsciously can see the financial pressure that this doctor's under and it just kind of comes out of your pores, you know? And they're trying to talk somebody into something, it just as a horrible short- and long-term plan. So, I think this young dentist needs to work on ethically building up the trust of the patient, becoming their trusted advisor, discussing their treatment needs, maybe giving them options and just being totally honest. And yeah, and I like your approach too, do the treatment that you would recommend on your family member and tell the patient that's what you are doing to your family member. Be honest about it. And that's the way that you can hone your skills, but it's not going to happen overnight. And none of us knew what we were doing when we first got out of school. It's just natural law.
 Dr. David Madow: I think you hit the nail right on the head, Rich. Sometimes the answers are really just the simplest answers, and the simplest answer here is do the right thing, to do it right. Treat people like they're you or like they’re somebody in your family and it's really not that much more complex than that. But yeah, hone your skills of course and do it right. Don't rip people off. 
 Dr. Rich Madow: Yeah. Listen to Spike Lee. Do the right thing. You know, it's funny, Dave, when we had our practices, as many of you listeners know, Dave and I both, um, had really nice practices but we never practiced together. But at one time we were using the same consultant or consultancy as they might say in the UK and this company, part of their teaching was anytime a patient has a somewhat large restoration, two or three surface amalgam or composite, treatment plan them for a crown and that's just not right. In the short term, yeah, you might get a few more bucks in your pocket, but that stuff just comes back to haunt you.
 Dr. David Madow: Well, I think the most ironic thing from that whole, from that philosophy, Rich, is that these people that were teaching us this or sharing this great knowledge with us, were not dentists. They were, they were business people who were, who were like pretty much telling dentists when to do crowns. That that was the most ironic thing. That was weird.
 Dr. Rich Madow: That's, that's another can of worms. The dental consultants who never, never owned or worked in a dental practice, who never, you know, how do they know? How do they tell him, you, you're on, how do they teach you how to diagnose and treatment plan? 
 Dr. David Madow: Yeah. I mean a consultant that does not have a dental degree is telling a dentist when to do a crown. I mean it just does not make any sense at all. It's actually unbelievable. We never really talked about in that level, but think about that. It's true. 
 Dr. Rich Madow: That's pretty funny. 
 Dr. David Madow: Oh my God. Okay. Well I think we, I think, um, I hope doctor that wrote in, I hope, I hope this really helps you. Yeah, take this, take this guy aside and help him out because maybe, maybe he's got potential, but I don't know. I've got kind of bad feelings about it.
 Dr. Rich Madow: I do too. I have bad feelings too and I don't think it's going to be fine right away. I think it's a long-term project. And again, if you were his doctor, Dave, would you consider, if things don't shape up quickly, getting rid of this person because this person can bring your whole practice down. Getting horrible reviews on Yelp and just, you don't want that.
 Dr. David Madow: 100%. I'm going to go back to a word that you used earlier to answer the question. He sounds like he might be a slickster and that's the last thing I would want in my practice. Some slick guy who's, you know, who's known in the community for overtreating. It's gonna, you know, with Facebook and all these groups these days, the word's going to get out so quickly. I'd be very, very careful. 
 Dr. Rich Madow: patients think, a lot of patients think you're over treating even when you're not overtreating. 
 Dr. David Madow: Exactly. That's it. It's exactly right. 
 Dr. Rich Madow: Too much. Oh, Hey, let's, let's move on and get to our call for the day. But before we do that, just a couple quick really cool announcements for all our listeners. Dave, do you want to go first here?
 Dr. David Madow: Sure. I'd be happy to. So, one thing I wanted to share with you is that Rich and I have been doing these Masterclasses, and they have been some of the most, I'm just gonna say one of the coolest things we've done in our 30 years of helping dentists reach success. We get about somewhere but we keep it very small, 8 to 10 docs in a room. We'd been doing them mainly in Baltimore, sometimes we may choose another city. But we invite you to come attend the Masterclass and the main reason we're doing these Masterclasses, we want to share with you along and we have our coaching staff there and our Madow Center staff, we want to share with you how we can help you become more successful, happier, and just have a greater life in dentistry than you are right now through our coaching.
 And it's, it's, the reason we do a Masterclass is just simply because in an email or in a phone call, we just can't really maybe share all the details or how great this relationship can be. So, we bring you in, spend a full day with you and maybe about 8 to 10 of like-minded docs and in one day we just share with you how we can work with you and how we can help your practice. So, the best way to check it out, and by the way these are free, we don't charge, we don't charge, but you have to at least have an interest in becoming more successful through coaching. The best way to find out where our next Masterclass or Masterclasses will be is go to masterclass.madow.com; we would love to share the day with you, so come see us.
 Dr. Rich Madow: Fantastic. We've also been getting great comments from people who are using Fattmerchant for their credit card processing. Fattmerchant is the disruptor in credit card processing and they do not charge you an overage percentage. It's just a low flat monthly fee and they've got great technology and dashboards so you can see exactly what's going on with your credit card charges and patients and all those things. But the main thing you need to know is it's a seamless switch. Use Fattmerchant, you'll save money every month and then hey, something else will pay for itself, maybe even this podcast. So, check them out. Um, of course we, we established a special deal for our podcast listeners and for Madow members. They'll give you your terminal for free so there's no expense in doing the switch. They'll do the whole thing for you, your patients just hand charge cards to you, like usual and you save money.
 So, we've set up a special website so you can learn more about it. It's bit.ly/fattmadow, but fat is with two t's, and it's a bit.ly, if you're familiar with that. So, there's no www or http or anything like that. So, I'll just spell it out for you. It's bit.ly/fattmadow, checkout Fattmerchant. You will definitely be glad you did and you'll save some money. 
 Dr. Rich Madow: Fantastic. Dave, ready to do the call of the day? Let's do the call of the day. I am excited. Okay, here it is.
 Dr. David Madow: Yes. Hi. How much would it cost for a good, for good teeth cleaning?
 Caller: So, you will need an exam and x-rays too, in order to get a cleaning, that'll be $161.
 Dr. David Madow: $161?
 Caller: Yes. That includes the exam, x-rays and a cleaning.
 Dr. David Madow: Okay, great. And one more question. If I want to have my teeth really nice and clean for a wedding I've got coming up, is it more important to have a cleaning or, or like a whitening or whitening procedure?
 Caller: We do have, we do whitening in the office. We have a special going for $175, which you get a tray and 2 syringes and they're reusable. But the hygienist recommends whitening after cleaning.
 Dr. David Madow: Oh, I see. Okay. That makes sense. So, doing both, maybe doing both of them is best, right?
 Caller: Correct. Yes.
 Dr. David Madow: Okay, great. Thank you so much for the information. I really appreciate it. Bye, Bye. Oh my God. I mean, could there have been a better set up for this one? I mean, okay, so the caller said I, I was the caller obviously, but okay. I want my teeth really white. I need a cleaning. I'm going to a wedding, I want, so in other words, I'm going to a wedding. I want nice teeth. And I mean, she didn't do anything. She, she gets, yeah, she gave a couple of fees, but she certainly didn't go, didn't go beyond that whatsoever. Could there had been a better setup?
 Dr. Rich Madow: It was a great setup. I mean, I think somebody really good would have had the entire wedding party in there for whitening.
 Dr. David Madow: Exactly. I mean, that's a really good point. But at least the caller, I mean, how do you know, okay, she could've said something like, well, you're going to a wedding. Let's get you in and make sure your teeth look really good. You're going to be in pictures. You want to look great. It was like a such a great opportunity. She did not take the bait at all.
 Dr. Rich Madow: Well, let's, let's go back. Let's back up a little bit because this is something that we teach in our courses a lot, that we get asked a lot, and that is when you asked how much is a cleaning, she just gave a number. Just said $161 or something like that. 
 Dr. David Madow: Right. Something like that. 
 Dr. Rich Madow: Yeah. That's kind of a loser right there. Sometimes with people push, push, push, push, push, you have to give a fee. But as we teach in our courses too, this is time for the person on the phone to take control of the call by saying something like, "Oh, you're interested in a cleaning, it sounds like you're looking for a new dentist, is that true?" And then take that opportunity to tell them how great your practice is, and tell them that, you know, there are different types of cleanings and the best thing to do is to come in for a full checkup and you know, meet the doctor, they'll even do a free consultation, whatever it is. Instead of just saying $161 and again, and we hate answering insurance questions, but let's face it, if you have good insurance, the cleaning is free. So, it's such a loaded question. She could've gotten around by saying, "Oh, it sounds like you're looking for a new dentist. Come on in and you’ll meet everybody." Just anything but just saying $161 and then nothing. And then she left it to you to ask the next question, which she got even worse, right?
 Dr. David Madow: Yeah. And see now if I would, if I would have been her, I would've used the wedding a little bit more. I would've said something like, oh, that's great. When's the wedding? And the wedding is in two weeks, that's a little bit more of an issue, but it's the wedding is like a month or two. We've got some time. Let's get an appointment, get you in and let's check everything over and let's make sure your teeth are beautiful for this wedding and you're going to look great in the pictures. I would've, I would've really gone with that one. But she really did nothing. And the scariest thing, Rich, as we see almost every time, some poor doctor that owns that practice thinks that his front desk person is doing a great job. 
 Dr. Rich Madow: And let's take it a step further. Let's, she knows nothing about you. You could be the groom, you can be the best man, you can be whatever. But take it even further, you could have, really, you know, you could have ugly composites hanging out of your anterior teeth and you know, bad shades, all kinds of crazy stuff. You could be a candidate for eight veneers. I mean, and you know, if the wedding's in a month, they can complete a multi thousand-dollar case that you've been looking for and this is the thing that pushes you over the edge because you have a wedding coming up. Who knows what could have happened with this great patient? 
 Dr. David Madow: Bingo. That's it. 
 Dr. Rich Madow: She just did not, she never, ever, ever asked for the appointment. She never made you feel welcome. As you said, you know, it's always good to have a little chit chat, good conversation. You gave her such great bait saying that there's a wedding coming up and she just wouldn't take it. 
 Dr. David Madow: Would you say She muffed it? 
 Dr. Rich Madow: She muffed it. A total muffed job. 
 Dr. David Madow: I'm giving her an F man. 
 Dr. Rich Madow: I'll give her an F plus. 
 Dr. David Madow: Hey everybody, thanks so much for being here. This was episode four of the Dental Practice Fixers and we will see you next time. Thanks so much for being a listener and a friend. 
 Dr. Rich Madow: Bye.