AME: Dr. Brian Schweers Contains Multitudes

[00:00:01] This is a production of The Very Dental Podcast Network

[00:00:10] Alan Mead is a dentist with too much time on his hands and too much recording equipment in his basement

[00:00:16] Armed with an obsession to bring entertaining and informative content to the dental world in a way that's never been done before

[00:00:24] I give you the Alan Mead experience

[00:00:27] Well hello and welcome to another episode of the Alan Mead experience. I'm your host Dr. Alan Mead

[00:00:34] I'm a dentist, a podcaster, and an occasional snow shoveler

[00:00:38] And today I have a guest with me today, which is lately for the Alan Mead experience

[00:00:42] I haven't had guests but back in the day, I always had a guest so joining me to co-host Dr. Brian Schwerz

[00:00:49] Brian how you doing? I'm doing great today long time listener

[00:00:52] So happy to be here. He approached me. We have a really interesting topic to talk about but first thing

[00:00:58] I want to say is that so we got snowed like crazy. I'm in Michigan Brian where you're in, Texas, right?

[00:01:04] Texas okay, you probably didn't get snow today. I'm guessing no once every couple years

[00:01:09] We okay, so we got snow today. We get snow all the time, but we've had a I've had a relatively snow free couple weeks

[00:01:15] I

[00:01:16] Had myself believing that I'd be able to mountain bike like a normal person and now we got we got like we got like four

[00:01:23] Or five inches just since I got to work here at seven o'clock this morning

[00:01:26] So we've gotten a bunch in the parking lot, and here's how I do this I pay

[00:01:31] like I

[00:01:33] have someone that does the driveway of the building and I split that with the guy next door who's a dental lab and

[00:01:39] The guy came in and said well

[00:01:42] You know, it's probably a better deal if you it's like 250 bucks per time when they come plow

[00:01:47] Which is highway robbery in and of itself

[00:01:49] But but if if you get a lot of snow

[00:01:51] You're gonna pay but or it's a thousand bucks a month

[00:01:54] For all you can eat and I said, let's just do the thousand bucks a month and in January

[00:02:00] We had like no snow at all. I'm just like really I played the odds and I lost on this deal

[00:02:05] So and it snowed like crazy here today

[00:02:08] It's really I mean, like I said, we got like four or five inches just since I got I got to work in my parking lot

[00:02:13] It's been a mess. I'm like, okay, so we paid in advance

[00:02:16] So do we get do we come serve us first? So we had to shovel they didn't I mean they came after lunch actually

[00:02:22] They they we had to shovel our walk

[00:02:24] I feel like I'm gonna send them an invoice for you know

[00:02:26] $250 because I had to shovel my own walk being that I paid them a thousand dollars a month to do this

[00:02:30] Anyhow, so I'm they literally are probably still out there right now plowing for the first time for today

[00:02:36] so I can't complain too hard, but I don't know man, it's like at the time the

[00:02:41] Thousand bucks not worrying about anything sounded great, but I've lost money every month so far. So yeah, that's

[00:02:48] Even know how to approach that. I don't know if there's anything

[00:02:52] Corresponding in Texas like like everything just shuts down. Yeah, we got a little bit of snow for 24 hours

[00:03:00] Maybe two weeks ago and I mean the whole whole city such shuts down the offices shut down my wife's in her

[00:03:06] She works in downtown Dallas and if her office is closed, they follow the school districts. Yeah down here

[00:03:12] Nobody drives well in anything. And so everybody just takes off my office is a mess. I

[00:03:17] You know, I'll still make it in but it's more for patients that you know

[00:03:22] Half the people sometimes show up some of them don't let stab. I mean

[00:03:26] I've lived in Michigan or Minnesota or Ohio my entire life or Maine. I was in Maine for a summer

[00:03:32] I didn't see any snow there

[00:03:33] but the reality is snow has kind of been relatively normal for me and as a dentist in the same place in Saginaw, Michigan since

[00:03:40] 1998 and every day that it snows like this. I'm fooled by it

[00:03:44] I think okay this it seemed like for a long time

[00:03:47] People would go out of their way to show up just to prove how tough they were and then lately man

[00:03:52] We just our hygiene schedule was decimated today. We lost a bunch of people. So I don't know. I'm not sure

[00:03:57] I I never quite every time I think i've got it figured out. I don't but yeah, I in next year I

[00:04:03] If I go the 250 bucks per

[00:04:05] Plowing deal, you know that we'll just have constant snow, you know, i'll lose i'll lose money either way

[00:04:10] I don't know. I just feel like I used to bring my own plow and plow my own driveway

[00:04:14] Which is a the worst idea ever because you're driving a big plow on a giant dually

[00:04:20] For you know an hour to come

[00:04:24] Are you able to keep that near your office or did you

[00:04:27] No

[00:04:28] I mean

[00:04:29] Yeah, we're we're 40 minutes away and with the dually it was probably even longer and we we keep it

[00:04:34] We keep the dually inside. We have outbuildings at the house, but it I thought hey, well, I have a plow I can do this

[00:04:40] It was dumb. It was stupid to do that. It was like

[00:04:43] It was the classic thing. It's like

[00:04:45] As i'm doing it i'm thinking to myself 250 bucks doesn't seem like that big of a deal

[00:04:50] I'm having to do this myself. Yeah, so yeah. Anyhow, that's that's the that's the thing with snow I guess in

[00:04:56] You probably have to pay to have your your yard taken care of though all year round in texas. See we don't really have

[00:05:02] Yeah

[00:05:03] Come november you're not mowing your lawn anymore because your lawn's dead, you know

[00:05:06] So it's you just have to worry about the snow is what it comes down to

[00:05:10] That that is correct. So but yeah

[00:05:12] I don't know

[00:05:13] We'll get into it a little bit later, but the other mobile dentistry unit that I I work with

[00:05:17] I mean they were in the panhandle and stuff. They get a lot more snow and ice up there

[00:05:21] And even okay a little bit towards the mountains in el paso

[00:05:24] And they pull like a 30 foot trailer and so like if that guy could if that guy could make it

[00:05:29] I can make it in my you know jeep or whatever I was driving

[00:05:32] So yeah

[00:05:33] Was if he's if he's pulling a truck with a generator and all this other stuff and I can't make it from you know

[00:05:40] My you know hotel the 20, you know 20 miles away. So anyways, that's a good point. It's a very good point. So

[00:05:48] All right. So brian, uh, I need to find out a little bit about you brian

[00:05:51] You told me you graduated in 2016. Tell me your dental history. Where'd you go to school?

[00:05:55] So I went to university of texas down in san antonio

[00:05:58] Graduated in 16

[00:06:00] I was a hygienist for two years before that. Uh, I went to baylor college dentistry for that back in 08 to 2010

[00:06:09] Uh practice for a couple years knew I wanted to go back dental school

[00:06:12] Um went to dental school. How did that how did that happen?

[00:06:15] How did you know did you know you want wanted to go back to school after you started practicing dental hygiene or was?

[00:06:20] the plan to be dental hygiene first and

[00:06:22] So in undergrad, I wanted a backup plan. I'm a planner

[00:06:25] I'm a planner and then a backup planner

[00:06:27] And so my backup plan would say if I couldn't get in dental school

[00:06:30] I'd be happy doing dentistry being a dental hygienist. They seemed like they had good income good hours things like that

[00:06:36] um

[00:06:37] And then about six months into hygiene school

[00:06:40] It was a two-year program with you end up with a bachelor's but um, you know six months in I knew I wanted to go

[00:06:45] To dental school, but still didn't know

[00:06:47] If I was going to get it or not

[00:06:49] so I finished that and then just worked on my other prereqs to get into dental school and you know,

[00:06:53] My backup plan was to still do dentistry as a hygienist if I didn't get in for whatever reason got waitlisted one year

[00:07:00] And then got accepted to one school in 12 and then went down there. So it was my only choice. It was good. Okay

[00:07:06] That's interesting. I mean like I didn't know that that's an interesting thing

[00:07:09] I mean like if you ever want to dive down that of being a male hygienist

[00:07:12] I know you've had a couple on the podcast too. It was it's interesting. It was fine

[00:07:16] It was it was good, you know, I can do cleanings maybe a little bit better than most general dentists

[00:07:20] But yeah, other than that, I don't think it makes me an exceptional person by any means when I was in

[00:07:25] When I was in dental school, we had a few hygienists in my class too

[00:07:29] And what you noticed about them is they were much more comfortable with patient interactions because they'd had you know

[00:07:34] They'd been seeing patients forever and they were all brand new at it

[00:07:38] So like there's there's some advantages and you're used to working in the mouth and you already know how to take x-rays

[00:07:42] You know how to do all that. I bet oral radiology was a piece of cake for you

[00:07:46] Yeah

[00:07:47] Perio was actually easier in dental school. I think and

[00:07:51] Hygiene school was so yeah, that was a benefit

[00:07:54] I believe that but I also think that their expectations of their dental students in perio for third year

[00:08:00] Are relatively low being that they haven't worked in the mouth and they get someone like you who's like a who's like a seasoned pro

[00:08:06] At perio, you probably made everyone else look bad. That was sort of the thing

[00:08:10] certainly and then

[00:08:12] Uh, but you know, it was nice. I really enjoyed my classmates and stuff santoy. It was an excellent program

[00:08:17] um, just got a really good experience really well balanced and uh

[00:08:20] Got out practicing a rural town, uh in the panhandle for about a year and okay, iwana, texas. Okay

[00:08:27] um and then

[00:08:29] I had a kid moved back to

[00:08:32] The dallas area where i'm originally from in mesquite

[00:08:35] And uh open up, uh planned to open up an office but worked at a couple associateships around the dfw area

[00:08:41] Okay, and then I got hooked up with a mobile dental company

[00:08:46] in

[00:08:47] 2019

[00:08:48] Okay, uh from a friend of a friend. She worked in the medical billing department

[00:08:52] I didn't even know how many nursing homes or even in texas much less nationwide. It's astounding. Yeah

[00:08:59] Especially with our population, but so you're you're around the dallas fort worth area now, is that right? Yeah, okay there have to be

[00:09:06] There have to be like I don't know i'll bet there's more than a thousand around you around dallas fort worth

[00:09:13] For are you talking about like nursing home? Yeah, i'll bet there's got to be more than a thousand. I swear

[00:09:16] Oh, yeah, I mean there's a mess of them here and in dallas fort worth is huge if you don't know

[00:09:22] if people don't know how big of a metropolitan area like like

[00:09:26] It flies under the radar for people who think of new york and los angeles, but dallas is freaking huge

[00:09:32] It's really that's a big area. So I don't know who actually runs the contracts for that

[00:09:36] um, and if however deep you want to dig into some of the logistics of some of that, but the company I work for and with

[00:09:42] The um, they're based out tennessee. And so they work out they were working out of california

[00:09:47] louisiana, texas florida south carolina

[00:09:50] And

[00:09:52] They were trying to get into mississippi and alabama, okay, um, so they have probably

[00:09:58] I think close to

[00:10:00] 4600

[00:10:01] Nurturing homes that they service. Yeah

[00:10:03] And those I think are just the ones that are in their their states and yeah

[00:10:07] And there's none of those or even honestly within like an hour of dallas

[00:10:11] Yeah, when I first started with them most of my routes were

[00:10:15] you know

[00:10:16] I mean texas a huge I was putting 40 000 miles a year on the car

[00:10:20] Uh, just texas is texas is huge and it's if you haven't spent any time in the car

[00:10:25] Okay, so I got a great story. I went to I went to a uh

[00:10:28] There was a podcasting. Um

[00:10:31] Meeting called the podcast movement. I don't know. It's probably still going on

[00:10:34] It's it was like the first podcast meeting in literally in 2014

[00:10:38] Which is like a month and a half after jason

[00:10:39] I started the dental hacks first

[00:10:41] I went down to dallas to to go to this meeting and I had no idea what to expect and it was

[00:10:47] There were there were some technical things that I learned. There's some good people that I met a lot of it was

[00:10:52] Was howdy market and it was it was sort of cheesy marketing stuff

[00:10:56] And so I I took what I need and left the rest

[00:10:59] Let's just say that but it was good, but it was in dallas and it was in august and it was hotter than hell

[00:11:04] What were your thoughts? What were your thoughts about dallas? I mean, what would you stay at?

[00:11:08] Where'd you I mean, were you impressed? Were you were you I liked it. I liked it

[00:11:11] But we we were in a nice it was a nice hotel

[00:11:13] It was a convention center and I rented a car and you know what I did

[00:11:18] I went down what what town is what like part of dallas is baylor in no, no, not baylor southern methodist

[00:11:25] So then what what town would that be?

[00:11:28] Uh, I think it's a little bit north southern methodist. Okay. I don't know exactly where I went

[00:11:33] I decided

[00:11:35] The craziest thing is I should figure out if I can find the restaurant

[00:11:37] This was right when I was first getting into ramen

[00:11:39] Like when I go to big cities, I go to ramen joints because they don't have any around here and I love that stuff

[00:11:44] So there was one

[00:11:45] In it was a college town and dallas is just I mean saying a college town in dallas

[00:11:50] How many how many big universities are there? I want to say it was

[00:11:54] It was either baylor or southern methodist campus area and there was a a ramen joint and I I rented a car

[00:12:01] Uh because I didn't honestly like everything I didn't want to hang out with my podcasting people

[00:12:05] I you know, I I go to these things and I should be more social than I was

[00:12:08] I want to go to the ramen joint

[00:12:09] So I drove to the ramen joint alone and it was so good

[00:12:11] I went to the same place twice and it was not it was not close

[00:12:15] It was it was like a 40 minute drive to get there. It was like a uh in in so in driving around

[00:12:20] It's just huge like the the classic thing where you're it was and of course there was construction around our hotel

[00:12:25] so so like I was driving all over the place to get you know, it was

[00:12:29] Dallas and then they had it in fort worth the next year. I went in fort worth same story just

[00:12:33] Huge just to me. It's such a big area

[00:12:36] And I mean like I didn't realize that dallas had big skyscrapers in a downtown and all that stuff

[00:12:41] I didn't know that like i'm what I was familiar with in big cities was chicago. That's kind of what I knew

[00:12:46] so I

[00:12:47] Like I said, it flies under the radar. It's no it's a very it's a big very metropolitan very modern

[00:12:53] My wife works downtown at baylor scott and white

[00:12:56] But I don't make it down there very often. We live probably about 20 miles northeast of the dfw area

[00:13:02] But it's so big like I just say dallas is where we live at. Yeah, I know

[00:13:05] I know it's and that is so big. Well, the other great story is I I uh

[00:13:09] I got I was geocaching back into the g if anyone knows what geocaching was

[00:13:14] It's it's i'm sure that it's it's like pokemon go but for grown-ups a little bit. It's it's like a

[00:13:20] A gps use your gps to find a cache that someone's hidden somewhere and and I wanted to get

[00:13:26] I wanted to get a cache in texas and I wanted to get a cache in oklahoma

[00:13:30] So I rented a car and as it turned out in in a very texas way

[00:13:33] Uh, I had like a an economy car and they gave me a pickup truck a big huge pickup truck

[00:13:38] Which is like the most texas thing ever right? It's great

[00:13:41] And so I drove up I drove up

[00:13:44] basically from wherever I was in in

[00:13:47] Fort worth

[00:13:48] I drove is to the closest border of oklahoma and I found a cache in the closest and what I remember is

[00:13:55] I went past a huge casino and then it was like the next exit

[00:13:59] And there was a cache in the middle of nowhere and it was underneath like a rock or something. I got poison sumac

[00:14:06] I got poison sumac from my friggin

[00:14:08] Geocaching experience like my arms were covered with this stuff

[00:14:11] It was horrible and I like and I I could feel it immediately. It was almost like something attacked me. I'm like, yeah

[00:14:16] Going to oklahoma. It's amazing. I get bitten by some kind of snake or something like that

[00:14:19] But uh, but I did get the cache

[00:14:21] I really haven't geocached much since then the same thing when I went to louisiana when I was going for ce

[00:14:25] I was too afraid to look for him because I was afraid I was gonna find a water moccasin or something like that

[00:14:29] Yeah, that's we don't have a lot of uh venomous snakes in michigan

[00:14:33] In fact almost none, but yeah, I figured the further south I go the more likely i'm going to run into that

[00:14:38] So I was a little worried about that. You could you could are you gonna and on a uh piggybacking podcast?

[00:14:43] Anywhere in the south for it? I know

[00:14:46] Voice of the dentistry has kind of

[00:14:48] Taken a uh sabbatical, but it is a sabbatical if we likely if we do it again, it will likely be wow

[00:14:54] This is inside baseball. Sorry. There's no no, no, no, no, no

[00:14:58] I'm i'm for anyone who's listening and interested their voice dentistry may be coming back

[00:15:02] it'll probably be in in arizona again anyhow, but

[00:15:05] Excellent, you get me excited. I've been to one of them. Okay

[00:15:08] Which which one which where where was it when you went? It wasn't tennessee, was it? No, it was it was arizona

[00:15:13] It was it was 2017 or 18. Okay, so it's probably the double tree. It's probably the double tree. Yeah. Okay, that's cool

[00:15:19] It's a it's still it's still the funnest meeting ever

[00:15:21] You know

[00:15:21] It's one of those things where and like I said it we it we may be bringing it back in some form or another

[00:15:26] We're we're we're in talks

[00:15:28] once

[00:15:31] Well, you know it's if anyone wants to bug moody about it that's he's he it's it's in his very capable hands

[00:15:36] So once once I know more we'll spread the word

[00:15:38] We're still we're still working things out

[00:15:40] But the four of us would like to do it again

[00:15:42] So I totally missed the podcast where it wasn't a thing anymore and I was like every year I get kind of psyched up

[00:15:47] Am I? Yeah. Yeah, I tell my wife that i'm going to a podcast convention. She's like what what what what do you do it?

[00:15:52] What yeah, no, you stay home with the kids. Yeah, and uh, so anyways, I I it's always on my mind

[00:15:57] But I only actually committed to it one year, but it was it was a blast really. Yeah, it's a good good meeting and it's it's it's uh

[00:16:04] We're gonna fix it in such a way that if we do it

[00:16:07] We're gonna do it in a way that's more sustainable because it's not

[00:16:11] We never charge very much for it. It's not a huge money maker. So we have to figure out a way to

[00:16:16] Uh to get over to be perfectly frank. I don't know if you ever run a meeting before but if you run a meeting at a hotel

[00:16:22] The hotel makes a lot of money off the meeting and the people running the meeting make nothing

[00:16:27] Or negative they make negative dollars in a lot of cases. I can say that from experience

[00:16:31] So we're trying to figure out a way

[00:16:33] To cut the hotels out of it like the hotels and catering because boy. Oh boy, they soak everything up

[00:16:38] Not that it's about making money

[00:16:39] But at this point, you know, you don't you'd rather not charge a bunch of money for this kind of meeting

[00:16:43] It's just a but you also want it to be a quality meat

[00:16:45] I mean obviously there's like special magic sauce that goes along with the vod just in general

[00:16:50] But you also want good good accommodations a good. Yeah, you know decent environment to socialize

[00:16:55] We always got great speakers and the secret to that was not paying anyone anything to speak

[00:17:01] We basically gave them a ticket in and fed them. Well, you know, it was kind of the and they all enjoyed it

[00:17:06] It was like, you know, you're you're probably supposed to pay your speakers, but we never did

[00:17:10] This is how it worked out

[00:17:12] And we got great speakers because they kind of enjoyed coming over for the party, you know

[00:17:15] And I suspect that will probably keep us afloat if we keep doing it. So that's that's inside baseball

[00:17:20] you guys can bug me about that as we and or buck moody at moody about it too because he and I are the

[00:17:24] ones who are kind of

[00:17:25] Good doing. I mean we both missed it a lot this january

[00:17:29] Frankly being in michigan going to arizona in january has never been a tough sell for me

[00:17:33] So it's a I mean maybe dallas is where I should be going. I don't know maybe i'd love to arizona

[00:17:38] I mean, that's it's short for us to get over there. Yeah, where it's great stuff. So

[00:17:43] Okay, so I got a dig in we got a dig in you you

[00:17:46] ended up working in

[00:17:49] Nursing homes, is that right like in in on one of the one of the gigs that you have

[00:17:53] I know that you you have a startup practice. It sounds like as well

[00:17:56] Maybe we'd go into that sometime, but I really want to dig into the nursing home thing

[00:17:59] How does tell me about that gig?

[00:18:01] So I started with them in 2019

[00:18:03] I was opening up my own practice and I wanted a part-time job

[00:18:07] A friend of a friend worked in their billing department at a nursing home facility and she was like hey, we're

[00:18:13] You're you're a dentist. We're looking for um

[00:18:17] um

[00:18:18] We're looking for just honest dentists to do honest work treat them like family and and go from there

[00:18:23] I'm, like well, that's that's easy. That's the easiest thing ever. So I said sure

[00:18:27] um signed a contract met with one of the owners and partners and he said all right, you'll be in houston

[00:18:33] You know three weeks on wednesday. The trailer will be there

[00:18:36] Okay, so I show up i'm ready. I've got about two years of experience under my belt. I'm okay with dentures

[00:18:42] I'm not great, you know, i'm okay with most extractions and all right

[00:18:46] Just hit the ground running show up guy shakes my hand and we just start working out of a trailer

[00:18:51] Uh, it's got a it's a pickup truck with a generator in the back. They run power through that

[00:18:56] It's like a military grade generator

[00:18:58] and diesel and then that connects to the

[00:19:02] Anywhere 25 to 30 foot trailer. They've got a few of them and then inside these

[00:19:06] uh, kind of think of like a

[00:19:08] uh

[00:19:10] It has a ramp in the back so you can actually like wheelchair patients

[00:19:13] Sure, they don't actually have to step up anything and it's got two

[00:19:18] Uh dental units no chairs, but uh water high speed suction

[00:19:24] Are they like the self-contained ones the uh

[00:19:28] Or is it is it built into the trailer or is it just sort of like a self-contained on the side? Okay

[00:19:34] And uh, I may send you a picture of it because it is kind of hard to describe

[00:19:37] So those two are at the middle of the trailer the back of it's a denture station as your traditional wax rims

[00:19:43] we don't really do those anymore of a scanner, but

[00:19:45] um bite trays things like that at the very front is where all the technology is

[00:19:51] autoclave

[00:19:52] Cold sterile things like that. So it's divided up into a few different sections. So it's a pretty fully functional trailer

[00:19:58] So it doesn't have dental chairs per se. How do you where do the patients sit?

[00:20:02] Do they just is there a most most of them are in wheelchairs? Okay. Okay. Okay. Okay. Got it

[00:20:07] And we do have one jerry chair. That's like a manual like it can lean back. Got it. Okay

[00:20:12] But even that is it's really challenging some of these

[00:20:15] residents are so

[00:20:17] Critically compromised like yeah

[00:20:19] I don't know how to I don't know how they sleep because some of them were in literally I could see shape and you can

[00:20:24] Imagine trying to extract number three. Yeah on a 91 year old

[00:20:28] Has its challenges? Um, but uh, yeah

[00:20:30] So anyway, so working with them for about four or five years and I still work with them

[00:20:34] About two or three times a month just doing part-time work on like fridays

[00:20:38] They seem to like me enough to keep me around

[00:20:40] And i'm competent enough to kind of serve their needs for what they need and and not, you know, ruffle too many feathers. So

[00:20:48] so what's interesting about this is is you actually approached me after I recorded an episode where I was

[00:20:55] My contention is that informed consent in dentistry and frankly informed consent in medicine as well is a complete joke

[00:21:01] We talk we talk about it as if we really know what's going on

[00:21:04] But the reality is and and i'll post the link in the show notes if you haven't heard it

[00:21:08] I'm convinced that you can do all the informed consent work that you would like to do. Um,

[00:21:14] But it's much better to work on patients that like you

[00:21:17] uh, they're patients that are rooting for you and and if if you don't have a relationship where you think the patient is in your

[00:21:22] in your uh

[00:21:24] Really wants you to do well and wants you to do

[00:21:26] You need to reevaluate that because there's no amount of informed consent or no amount of of signed forms

[00:21:32] Uh, that's going to save you if the patient is mad at you and something goes badly

[00:21:36] Whereas if they're rooting for you if they like you if they if they think they trust you and think you know

[00:21:41] What what's in their best even when stuff goes poorly?

[00:21:44] You can you can work with them and I and and I so I I don't remember exactly what the episode was called

[00:21:49] But and then you you messaged me I think after I released that episode because you have a particular

[00:21:54] Situation with with these nursing home patients that where informed consent is really difficult because for a lot of reasons

[00:22:00] So I want you to dig into that for me. Sure

[00:22:02] So the financial part luckily for us kind of gets taken out of the equation

[00:22:06] There's people when they're enrolled in this program

[00:22:08] It's all kind of state funded so for residents to qualify to be in a long-term care facility for the most part

[00:22:14] They have to meet three out of five requirements like they can't get dressed in the morning. They can't bathe themselves. They can't

[00:22:20] Buy their food. There's certain requirements. I don't know exactly what they are

[00:22:23] Yeah, but that qualifies them to be a resident once they're there for so long they have funding

[00:22:28] Yeah, it's called an incurred medical expense and IME

[00:22:31] So that covers vision wheelchairs things like that. Well part of that coverage is dental so it's all state funded

[00:22:37] So the residents don't actually pay us anything

[00:22:40] We have contracts with the owners of the nursing homes and this is well above me

[00:22:44] So I don't really know all the details about it. Sure. Sure

[00:22:46] They basically say hey

[00:22:48] We all come in and service our dental needs because legally if a resident reports pain or condition

[00:22:53] The nursing home if they accept them as a resident they have to provide care within a certain amount of time

[00:22:59] Usually it's a couple of days. Um, and so you can imagine. Hey, i've got a toothache

[00:23:03] Okay, trying to get a resident out transported to a local facility that can even accommodate them can be

[00:23:09] A whole day ordeal. So a lot of our partnerships are based on us meeting the needs of their what they need

[00:23:16] um, so in general the I got off a little bit off track, sorry the

[00:23:20] Financial aspect is taken out which can be a burden in private practice. Yeah

[00:23:24] When money's involved people tend to throw around the words the lawsuits and stuff a lot more

[00:23:30] So that that parts out of it, which is not also also let's be perfectly honest

[00:23:33] It's not supposed to work this way

[00:23:35] But treatment planning is affected when when you're not worried about or when you're worried about what what stuff costs and what people you know

[00:23:41] Like clearly, uh, I do more removal than I would like because fixed is more expensive

[00:23:46] Let's just say that you know like and so on some level if if the financial stuff is not

[00:23:51] In your lap all of a sudden that gets simpler now i'm assuming that also

[00:23:55] Affects the way that you treat and plan for people correct

[00:23:57] And so since we're a mobile unit, we don't do crown and bridge

[00:24:00] We don't we can re-cement something if they have it, but that's about the limitation of crown and bridge

[00:24:04] um, we can do some fillings obviously you can imagine the bonding protocol is not as ideal as a

[00:24:11] A brick and mortar place, but we can do most fillings a lot of glass on them or a lot of silver diamine

[00:24:16] fluoride stuff

[00:24:18] Thank god for that stuff, by the way. Oh, I painted on everybody. Yeah

[00:24:22] but uh, and then obviously prevent it so main focus are unfortunately kind of the extremes of

[00:24:28] Preventative and then it gets to palliative care where yeah, we'll pull teeth and replace them with dentures

[00:24:33] There are a lot of printed dentures. So they're not as

[00:24:36] They're not as fine-tuned and they're not as

[00:24:39] Great as traditional like pressed dentures. Sure. Well, sure it still meets their needs. So anyways, um the

[00:24:47] The the financial part is taken out of it, but that's kind of the limitation of our treatment planning

[00:24:51] It's like all right, I can take out the tooth or do you want to keep it?

[00:24:54] Hey, is it bugging you, you know and kind of go from there

[00:24:57] But then even when you get to that point of who wants to get a tooth taken out

[00:25:00] Well, nobody some of these residents have dementia. Yeah, um, you know and you try to let them know

[00:25:05] Hey that mrs. Jones the tooth's infected it could swell up on you unexpectedly, especially lower ones

[00:25:11] You know how it is and all the people listening, you know

[00:25:14] Sometimes it happens but it's one out of 20 and you never know who it's going to happen to

[00:25:19] Um, and so we try to encourage I always and it always happens the day after you saw them too

[00:25:23] That's the other thing like literally it happens the day

[00:25:26] You saw them that their their kids brought them in for a for a cleaning

[00:25:29] You did it you did a recall on them and everything like that looks great

[00:25:32] And then they call the next day and they've got a swollen tooth that you didn't catch and you look like an idiot

[00:25:36] That's that's essentially what it always happens

[00:25:39] So I always try to encourage the residents to get stuff out before it becomes a problem because the nursing homes will call us too

[00:25:44] and say hey mrs. Jones is

[00:25:47] Having an issue we need you here now and it's like yeah

[00:25:49] We're a mobile service or just not an on-call service. Like we go we we travel we could be five hours away

[00:25:55] Yeah, I mean and so logistically sometimes we have to rely on that but back to the consent thing

[00:26:01] You know some of these residents are

[00:26:04] They don't have the power of attorney of their finances, but the way that it works is they can always accept care

[00:26:09] I don't know how much you know about that like

[00:26:11] obviously like end-of-life support stuff you can have like a

[00:26:15] Medical power of attorney and they can decline services, but everybody always has the right to accept services

[00:26:21] so if you say yes, I would like to accept services whether

[00:26:25] They're there or not

[00:26:27] Technically they can always accept services. Yeah, so that's what I always ask them. Hey, you know, mr

[00:26:31] Smith you got a broken tooth. It's not working for you. It could become affected. Would you like to get it out?

[00:26:35] Um, so, you know, it doesn't lead to something that's kind of the way I approach those

[00:26:39] Obviously some residents just like patients are no

[00:26:42] There's no way you're you're pulling a tooth on me

[00:26:44] And if you're combative like obviously I can't make you get it done. I can just encourage it and if you get it done

[00:26:48] Perfect. Mm-hmm. But you know then what happens when there's a complication obviously, there's they're on

[00:26:55] 50 every medication their med list is outrageous. Yep blood thinners out, you know

[00:27:01] how many how many of the women in these these places are on some kind of a

[00:27:05] Some kind of a bone density medication that that makes you sweaty about surgery surprisingly enough. I haven't ran into a ton of that

[00:27:12] Interesting luckily the nursing homes are pretty good at records in the sense of like obviously private practice patients when they come in

[00:27:18] You're relying on their verbal history. Yeah, these have a very well-documented

[00:27:22] Medical history so that works positive. Yeah, um, but I mean whenever we've had patients come in from those places

[00:27:28] uh, they

[00:27:30] They come in with a big package of of whatever was in the chart last printed out and there's like 30 pages and it's got

[00:27:36] Meds like literally the time they were delivered

[00:27:38] You're right the record keeping there and that's actually half of the business

[00:27:41] There is record keeping on some level just making sure that part of that makes me feel better that they're with somebody that night

[00:27:46] So that even like if there's a complication at least to have some aids around them. They're not going home alone

[00:27:51] Not a good point. Very good point. Yeah

[00:27:52] yeah, so there are some really good positives about working with that population, but it has definitely a lot more challenges and struggles than

[00:27:59] sometimes the benefits but

[00:28:01] um

[00:28:02] As far as consent goes, you know, I always ask them but we don't we don't really even get we don't get assigned consent

[00:28:06] That's always kind of been a sticking point like in texas

[00:28:09] You're supposed to always have a signed treatment plan blah blah blah, but you know, do I lose a sleep at night?

[00:28:14] No, I do honest work. I I ask them, you know if it's something they don't seem interested and i'm not going to do it

[00:28:19] And so I don't have any trouble sleeping

[00:28:22] but i'm sure if

[00:28:24] You know the records came to paper like there'd probably be some holes in it, unfortunately

[00:28:28] But if if you're worried about that understand that uh, okay

[00:28:31] So anything that goes in front of the board if there's something that if they're looking for something the board will find it

[00:28:38] Well for sure that's it doesn't matter how good your records are

[00:28:41] I i'm not trying to say do do excellent records, but understand that even excellent records

[00:28:45] They'll find something because they're going to find something but also informed consent

[00:28:49] Just because a person has signed a piece of paper saying they understand doesn't I mean you can have the entire informed consent

[00:28:55] And then you know, literally walk back in the room and the patient's so what are we doing?

[00:28:58] That's that's the classic one. You're like wait a second. So again, uh,

[00:29:02] And it's tough because these these patients you you this might be the first time you've ever seen them

[00:29:06] You don't you haven't had a chance to form a relationship a trusting relationship and mind you being really friendly and nice helps a lot

[00:29:13] Like but but I mean like this is tough because this isn't a this isn't a long-term patient

[00:29:17] You've seen over a period of time. So we have uh pressures put on us too by the facility the facility

[00:29:22] You know not that they verbalize it. It's not anything like hey, you have to do this

[00:29:26] But they're like hey, we need our residents taken care of because if you don't it's going to be an emergency and i'm like, okay

[00:29:31] I get that point sometimes family members put pressure on us or like hey

[00:29:34] My mom needs dentures and you're like this isn't a good candidate. She's gonna hate them

[00:29:38] They're gonna be terrible but from the daughter she's like well, no my mom needs denture. She's losing weight

[00:29:43] I'm like she's losing weight for other reasons dentures suck. Yeah, so please don't go that right

[00:29:49] I always felt like that that you know doing this to someone who's 85 years old and not functioning that well anyhow

[00:29:55] like like

[00:29:58] I mean

[00:29:59] I feel like that adds a lot of complication like literally there are a lot of people who do very well with dentures and never

[00:30:04] Have any trouble with them, but there's plenty of them that don't adapt very well

[00:30:07] And the last thing i'd want to do is try and throw this to someone who's already in a nursing home

[00:30:11] Maybe is dealing with some dementia trying to figure out how to use dentures how to eat with dentures and live with dentures

[00:30:16] Yeah, and even on another side sometimes we can talk about lost dentures and all kinds of other craziness that happens when they go to hospital

[00:30:22] Stays and they oh, yeah. Oh, yeah, they lose them

[00:30:25] Luckily, we keep backup records of them so we can just reprint another one. Yeah, that's huge that part's nice

[00:30:30] Yeah, um, and that is a great service we offer. Uh, there's like duplicate denture

[00:30:34] So even if they have a set we'll scan them they lose them. We just duplicate them send them to them

[00:30:38] Yeah, that's great

[00:30:40] but the uh

[00:30:40] But yeah

[00:30:41] So I get pressures from consent and and the family members put pressure on us to

[00:30:45] To to do certain things because they think it's gonna you know, they ask about implants all the time

[00:30:49] I say, you know, unfortunately, we don't provide that service

[00:30:51] Um, and a lot of them wouldn't be eligible just from a medical standpoint. Sure

[00:30:55] So yeah that part's always challenging. But yeah the consent on some of them. They also change their mood

[00:31:01] I mean i've i've seen some residents in the morning that are fine

[00:31:05] And I mean i've been doing it for about five years now, so sometimes i've seen residents have such as

[00:31:09] such a

[00:31:10] steep decline in the few years i've seen them that they went from fully competent to

[00:31:16] Almost not able to even lift their head up. I mean it's that

[00:31:19] um

[00:31:20] It's it's it's heartbreaking sometimes but then it's also

[00:31:23] You know

[00:31:23] you kind of take that in consideration when they are able and they're alert it's like man

[00:31:27] I really need to get some of these teeth out so that as much as we can today

[00:31:31] Yeah while you're doing well exactly and and I really limited to like one quad a couple car fuels like that's a limit of mine

[00:31:37] Because they're so medically compromised like i'm not overwhelming them. I'm not doing full mouth extractions. Um, i'm

[00:31:43] Sequentially treating them and that's again my kind of personal preference

[00:31:46] We've had some providers that do a little bit more stuff

[00:31:49] But I mean we've had residents like go to the hospital afterwards because they didn't stop bleeding after you know

[00:31:54] So many extractions and you know, luckily those are few and far in between but those those always stick in your mind

[00:32:00] Yeah, they do. I would be I would be the conservative guy that like I I I don't

[00:32:05] Working on fragile people makes me nervous as it is like much less on someone who's already in a nerd

[00:32:09] I mean, that's a whole level a whole different level. I mean some of them i'm sure are quite

[00:32:14] With it mentally and but physically are in trouble some of them the other way where where they're they're physically in okay shape

[00:32:19] But mentally not with it and you know, each one has its own set of problems

[00:32:23] Really? It's kind of you have to you have to go with the flow I suspect for sure and the uh,

[00:32:29] Some of them I don't even know why they're in the homes. I mean, they're fully capable competent

[00:32:33] They they walk around they talk. They're they're lucid. They're younger

[00:32:37] They're in their 40s and 50s. And so that you know, that's maybe five percent of the residents or so interesting

[00:32:43] some of them some of them are on hospice some of them are in hospice because they're

[00:32:47] um, they refuse their medications, but i've seen them for like three years now and i'm like this resident was on hospice like three years

[00:32:54] Ago and they're like, yeah, they're on it because they're refusing their blood pressure med and we have to note it that way and i'm like

[00:33:00] That's interesting. Yeah, so many interesting things. That's dark is what that is. That's the wow. I mean

[00:33:06] God only knows like okay. So here's something that's interesting you you as a uh as a practitioner

[00:33:12] Uh, you've had to you deal with medical stuff. I'm curious. Do you have someone?

[00:33:18] How many people do you work with like like is it just you and an assistant or you and multiple people

[00:33:22] What how does it work? So so that's a great point. Uh pre-covid. It was a unit manager

[00:33:27] Who's responsible for driving the truck trailer maintenance?

[00:33:30] Inputting the dental notes communicating with our main point of contact which is usually a social care worker in these facilities

[00:33:38] And they run the logistics

[00:33:40] um

[00:33:41] Then I have a dental assistant myself and then a patient transporter that coordinates because we have two dental units

[00:33:48] We can somewhat make it more efficient if you know, my assistant is taking x-rays

[00:33:53] Yeah, and then i'm treating, you know kind of going back and forth that way sure

[00:33:57] After covid it totally shut down if you ever want to jump on a podcast for nursing homes during cobit

[00:34:03] That's all that could that could easily be an hour. Yeah, we should do that for sure. That's that's really interesting

[00:34:08] Oh my god, that's really interesting. But the uh, yeah, it was nuts

[00:34:12] How often how many patients do you like when you go to a facility?

[00:34:15] Do you try and line them up and see as many as you can while you're there or is it?

[00:34:19] Or are you typically there because someone's having a specific problem or what?

[00:34:23] Most of the time they're planned visits because obviously the logistics of the the trailer and stuff

[00:34:27] yeah, but usually there's a list of residents anywhere from

[00:34:31] 15 to 55. I mean el paso facilities would have 80 people any residents on the the list obviously

[00:34:38] Even at a quick pace, maybe i'm seeing three or four residents an hour sometimes like quick denture checks things like that

[00:34:45] But i'm not kind of booking it an ideal so you can imagine eight hour workday on my feet

[00:34:50] Okay, maybe ideally we see 24 residents. Yeah, but you know if it's an extraction that takes me an hour

[00:34:57] Okay, that that's one patient I can see in an hour

[00:34:59] So it varies but i'd say on average probably somewhere between we physically see probably 10 to

[00:35:05] 25 residents a visit is kind of our goal

[00:35:08] Um because some of them are in dallas's some of them leave

[00:35:11] One word I learned in a nursing home, which is super sad

[00:35:14] Uh, they refer to residents when they pass away as expired

[00:35:19] and I heard it at one facility I was like

[00:35:22] The social care worker really say that because obviously they have to build some walls because it can be emotionally draining

[00:35:27] to

[00:35:28] To have residents pass away

[00:35:29] but

[00:35:30] And then I went to another facility that was several hundred miles away

[00:35:33] And then they they use the same term and then next month they use the same term

[00:35:36] They're like, oh mrs. Smith expired and i'm like, I just feel so dirty using that word. Yeah

[00:35:41] Yeah, like I like I don't know anyways it it apparently is a very common term in nursing homes which I was very

[00:35:48] shocked by but anyways, um that um,

[00:35:52] But we usually see about 20, you know anywhere from 10 to 25 residents, uh, a visit is a goal

[00:35:58] Okay, um and then kind of do what they need obviously priority patients if they're in pain if something changed we prioritize them

[00:36:05] Preventative visits. We actually have hygienists at work with us now

[00:36:08] Okay, uh, and so they can keep up more on the cleaning side of stuff. Yeah. Yeah

[00:36:13] But it's different. I mean the level of care not to say that it's substandard, but it's different

[00:36:18] It's not it's it's it's they're they're not in the same physical condition and we're not in the same environment

[00:36:24] As we are in private practice and so that I got a couple questions that we'll have to talk about another

[00:36:28] Another episode sometime but sure but one one of them you can probably address now

[00:36:32] Do you typically go to one facility per day or are there are days where you're scheduled at multiple facilities?

[00:36:38] So this past friday, I worked at two different facilities and had residents from three facilities

[00:36:43] Okay

[00:36:44] so sometimes it is if they're in the same town or

[00:36:46] Is that one trailer or two trailers and you move in between trailers?

[00:36:50] One trailer and they got to pack it all up and move it

[00:36:53] Sometimes they can be like 45 minutes away too

[00:36:56] And some of the facilities like they expect us to see a list of 30 people at two facilities

[00:37:01] I'm stressed out just listening to this by the way. I really am. Yeah

[00:37:04] That's that's that's a different that's a whole different level and plus you got you got so much record keeping requirement

[00:37:10] That's wild. That's wild. There's more there. But the other question I want to ask you and it's and I want you to think about this

[00:37:15] We'll do it another time. Sure. I want

[00:37:17] to learn how you

[00:37:20] Screen medical histories efficiently because guess what you guys have to be really efficient

[00:37:26] You have to hit the high spots because you've got patients there that are see that have a lot of stuff

[00:37:32] A lot of stuff so you got to know

[00:37:34] What stuff is going to keep you from doing things on them?

[00:37:37] what stuff is not important because the reality is

[00:37:40] I I mean I see I see plenty of people where I feel like they have a lot of medications, but i'll

[00:37:45] Bet I see nothing compared to what you see at those these nursing homes

[00:37:48] So what a question kind of to ask you what what would keep you?

[00:37:53] What medications or what conditions would keep you from say just doing a preventative prophy apply fluoride screening on a patient not much

[00:38:02] super high blood pressure, uh is questionable mostly because

[00:38:05] Are they not are they on medication?

[00:38:07] They're not taking it or or have they not ever had medication because we take blood pressures on everyone and frankly

[00:38:14] You know if I was a betting man

[00:38:16] 50 or more of the patients will walk in the door if their adults have high blood pressure

[00:38:20] So the question is are they treating it or not?

[00:38:22] And that's not necessarily that doesn't necessarily keep us from doing a prophy per se

[00:38:26] But so there's a lot of that we're screening for blood pressure almost constantly

[00:38:30] We have we I bet you we refer to a doctor three four times a week

[00:38:34] For people with blood pressure and if you know for surgery

[00:38:37] Uh, you know, there's limits what's amazing is I I wouldn't have thought my limit was all that low

[00:38:42] But we've had times in the last year where I wouldn't do an extraction because their blood pressure was so high, you know

[00:38:48] Yeah, and if it's like an invasive treatment

[00:38:50] We obviously don't do and then luckily the nursing home facilities keep really good records of all their bps so we can

[00:38:55] Get accurate vitals. We have our wrist cuffs and stuff. Yeah on the um

[00:38:59] Trailer to get it like right but you know how those vary they're garbage

[00:39:03] They're garbage, but the reality is I I had a guy who's whose blood pressure was so high yesterday with the wrist cuff

[00:39:09] I was ready to send him to the er and he's like, you know, I took my medicine this morning

[00:39:12] It's normally so I got an arm cuff

[00:39:14] He's a bigger guy got an arm cuff and he was fine. Like I could hear it like I get it

[00:39:18] So i'm thinking to myself. Okay. I don't know if I I don't know if the wrist cuffs are you know on on a healthy person

[00:39:23] Maybe that's fine. I don't know. It's very weird

[00:39:25] It's a yeah, but then the other stuff I think of that

[00:39:27] I think of um

[00:39:28] If they're on blood thinners depending on the blood thinner and depending on the person and and I do a lot more

[00:39:34] Work on people that are on blood thinners now than I used to

[00:39:38] I used to punt that over the doctor just because I didn't want to touch

[00:39:41] Well now I have a better handle on it

[00:39:43] So I feel like I feel like in most cases if we can get

[00:39:46] Have you seen some of the updates from even like the american heart association and stuff that now they're trying to

[00:39:52] Get away from drug holidays, especially. Yeah. Yeah simple i'm putting an air quote simple

[00:39:58] Extractions. Yeah, you know, it's simple but yeah, like if it's less than three t they're they're really trying to get away from drug holidays

[00:40:05] Well, they're saying for for particularly for the newer blood thinners

[00:40:08] Apparently the the rebound effect from going off and coming back on is like way more dangerous than the bleeding stuff

[00:40:14] Because the bottom line is we can still we can keep them

[00:40:16] We can get someone to stop bleeding just as long as we as long as we realize that they're bleeding like crazy for the most

[00:40:22] part

[00:40:23] Sometimes i've had a couple in these same situations

[00:40:26] That makes me feel a little bit more comfortable at nursing staff is there and one of the facilities in general

[00:40:31] It was actually the resident's daughter was a staff member at a facility

[00:40:36] It was like 23 or 24 was pretty mobile loose. Her daughter was worried. She was going to swallow but she's yeah

[00:40:41] Yeah, I think it was direlto. Yeah, and it was a soft tissue bleeding and I I mean the extraction took five minutes

[00:40:47] It took me an hour and a half to get her bleeding to stop. Wow

[00:40:51] And it was still okay

[00:40:53] By the end and it did feel make me feel more comfortable that hey, her daughter is actively watching her. She knows what's going on

[00:40:58] It is yeah and she was going to be with her but without her

[00:41:01] And even her daughter being there like that was one that I would have easily pun it and I mean it makes me nervous

[00:41:07] Yeah, I mean that that part is is is very challenging. Um, but the other pressure that I get a lot is

[00:41:14] These residents for the most part they can't drive themselves out to get care. Yeah

[00:41:19] Yeah, they can request it

[00:41:20] But in all reality a lot of these facilities not that they're bad and they're not trying to avoid it

[00:41:24] They're not gonna they're not gonna put them as a priority to have them transported for a single tooth extraction

[00:41:31] Unfortunately, and so it's somewhat

[00:41:33] Implied pressure of if I don't do it is this resident gonna get done? Yeah. Yeah. I totally got that's wild challenging

[00:41:40] This is this is a this topic is is there's a lot here and I suspect there's a lot of people that that haven't really

[00:41:46] Even thought about it

[00:41:47] but I love the fact that my my comments on informed consent were what had you reach out because that like

[00:41:53] This is what real

[00:41:55] Clinical dentistry looks like, you know, the stuff on instagram is great. But like

[00:42:00] The unexpected bleeder that's the real stuff

[00:42:04] that's the stuff that

[00:42:06] And and I know I practice probably 20 minutes away from uh, mr. Uh pizza kenny himself. Okay. Sure

[00:42:12] Yeah, okay. Okay. If you ever want to jump on a podcast my assistant knows some people at work for him still and it's not

[00:42:18] Where's he? He went to rehab recently. Yeah

[00:42:21] Uh for for sexual misconduct. So anyways, that's gonna be a fun one

[00:42:25] uh, he's but I mean I he never slowed down on instagram wanting to I don't know that I follow him but I've

[00:42:31] There's a lot of people that make it their their mission life to follow him

[00:42:35] He never really slowed down on instagram. It doesn't seem like he got beat up too bad if he's still practicing. There's very little. Um

[00:42:41] Worried about yeah from like an informant

[00:42:44] Yeah, I think the texas the texas board might might have some issues. I don't know. I'm just gonna put it out there

[00:42:49] But whatever. Yeah

[00:42:51] As a michigan guy, I can I can look from a distance and smile. So yeah, but no this you know

[00:42:56] That part's nuts. So yeah as far as your informed consent

[00:42:58] I 100 agree with you and I don't i'm not nervous if ding dong is practicing down the street for me

[00:43:03] But as an ethical provider, it's something that we should be thinking about it is not something that i'm worried about

[00:43:09] but it is something we should be thinking about because I

[00:43:12] I do believe there are people out there that think a signed piece of paper

[00:43:15] Is going to make a bit of difference with with it, you know

[00:43:18] Like can you imagine a bad outcome and you looking at a patient go? Well, you signed the piece of paper, you know, like

[00:43:24] All right

[00:43:24] And are you familiar with like even though if you have signed consent

[00:43:27] It doesn't even like medical consults and I think those are the silliest thing in the world too

[00:43:31] Yeah

[00:43:31] They're not silly in the fact that they're not important and you shouldn't collaborate with colleagues

[00:43:35] But they're silly in the fact that even if I get a signed medical consult from a cardiologist

[00:43:40] The patient has a complication that's related to that in my chair i'm still held responsible regardless of what that piece of paper says

[00:43:46] So i'm kind of like what's the point of the piece of paper if i'm still liable for my own adult actions and provider

[00:43:52] You know professional actions. Yeah, i'm just not going to get it like i'm going to use my best judgment

[00:43:56] I'll consult them if I need it and be put on my big boy pants and take my responsibility and we can't

[00:44:04] We can't

[00:44:05] Guarantee outcomes we can do our best to to prevent

[00:44:10] Stuff like well, I mean I have a colleague. He doesn't practice in town anymore

[00:44:13] I had a colleague that had someone die in his chair

[00:44:16] It was completely separate from dentistry, but but she died in his chair and you know what?

[00:44:20] You know wasn't his fault. It was not he didn't get in trouble per se

[00:44:23] But you know what that wrecks a person that person can you imagine?

[00:44:27] Like and how many how many times have I seen a patient come in?

[00:44:30] It's been they've spent a while they're in and their health has gone much worse and you're like god

[00:44:35] I want to help you, but I

[00:44:36] Just don't don't have a stroke in my chair, please

[00:44:39] You know, you're just like yeah because because the thing is is that the risk is there right?

[00:44:43] Like it's it's it's rough. I always feel like you know

[00:44:47] And and it's because I care about the people and it's because I I understand what we're having to deal with and in

[00:44:52] You want them out of your chair as quickly as they can so kinda kinda. Yeah, kinda. I don't know this

[00:44:57] It's it's I appreciate you being willing to talk about this stuff because this is the real this is the real stuff

[00:45:02] This is this is not the instagram stuff

[00:45:04] This is the real stuff and and yeah

[00:45:05] You're seeing people that a lot of other people don't want to see or can't see

[00:45:09] Or or they can't even get out to see someone. So yeah, it's it's it's super valuable

[00:45:12] We appreciate what you're doing. But also you're you're running a private practice as well and you're a freaking hygienist

[00:45:18] Yeah, you're you just

[00:45:20] hold multitudes

[00:45:22] But dr. Swears holds multitudes, I think that might be the title of this episode, but this is awesome

[00:45:27] I appreciate you being on for sure

[00:45:29] I'd love to come back and if you have any other tangents or you ever think of something that you ever want to go down

[00:45:34] Let me know. I mean I could talk about nursing home facilities for

[00:45:37] Multiple episodes I could talk about what it is, you know getting from hygiene to dentistry

[00:45:41] I really want to talk about the hygiene all that man

[00:45:43] I really want to talk about that because i've had people that I wanted to ask and they never really wanted to talk about it

[00:45:47] So maybe I should have you on and pam pam marigliano. She because she was a hygienist. She's a freaking prosthodontist

[00:45:53] I should have like do a round table with these people. I'm sure I loved your round tables

[00:45:57] That was my favorite thing about yeah, they are the best. They are the best logistically. They're harder, but they are the best

[00:46:02] So yeah. All right, bryan. Thanks a ton for being on this was fantastic. Certainly at any time

[00:46:07] Always reach out and uh, yeah, even if you want to talk about kenny down the street

[00:46:11] Let me know I can give you some dirt on him too. All right, very good. We'll talk to you soon

[00:46:15] Okay