Very Dental: Meeting the Patient Where They Are with Dr. Mike Melkers

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[00:01:06] [SPEAKER_03]: This is a production of the Very Dental Podcast Network. This is the Very Dental Podcast.

[00:01:21] [SPEAKER_03]: Welcome to the Very Dental Podcast where you'll find entertaining and relevant

[00:01:26] [SPEAKER_03]: conversations with visionaries, clinicians and your friends in the dental space. Now here's your

[00:01:32] [SPEAKER_03]: host Dr. Alan Mead. Very Dental people welcome to another episode of the Very Dental Podcast.

[00:01:39] [SPEAKER_03]: I'm your host Dr. Alan Mead co-hosting with me today a guy he's been on the show before

[00:01:44] [SPEAKER_03]: but it's been a while. Dr. Mike Melkers. Mike how you doing? I'm doing great Alan. How

[00:01:49] [SPEAKER_03]: about yourself? You got your ducks all in a row? I do have my ducks in a row. At least

[00:01:53] [SPEAKER_03]: they started out that way. They never stay that way but so it's kind of funny this this conversation

[00:01:58] [SPEAKER_03]: has been a long time in coming. Months maybe even years because so Mike was originally on the

[00:02:06] [SPEAKER_03]: show when we called it The Dental Hacks and when Jason was here I think you were on once

[00:02:10] [SPEAKER_03]: or twice early on and that means like early on like 10 years ago. That's crazy. I kind of

[00:02:15] [SPEAKER_03]: can't believe it's been that long. No I know. I know it's not. That's insane. But then

[00:02:20] [SPEAKER_03]: also so I've known Mike for a really long time like longer than probably either of us would like

[00:02:26] [SPEAKER_03]: to admit because we kind of met on Dental Town. We were pretty active in Dental Town which

[00:02:32] [SPEAKER_03]: frankly was sort of the first version of dental social media that I really knew of. I know

[00:02:36] [SPEAKER_03]: there are some people that did like other bulletin boards and stuff like that but like

[00:02:40] [SPEAKER_03]: so that was like probably peak Dental Town for me when I was the most active was 2004-2005.

[00:02:47] [SPEAKER_04]: That's 20 years ago. I know. I was just looking back. It's funny I found some of my early bags

[00:02:53] [SPEAKER_04]: and tags and t-shirts not just from you know townie gathering but also townie fiesta and I

[00:03:01] [SPEAKER_04]: think about how many amazing friends we made back then and how many of those friendships are

[00:03:06] [SPEAKER_03]: still going. We're just baby dentists. Yeah it's true. It's true and what's nuts about it

[00:03:11] [SPEAKER_03]: actually the podcast sort of in my brain formed out of a lot if you if anyone looks back a lot

[00:03:18] [SPEAKER_03]: of the people when we did the roundtable every week the brain trust was all basically old Dental

[00:03:24] [SPEAKER_03]: Town friends. It was Frank Clayton and Brent and Rich Rosenblatt and lots of these people

[00:03:30] [SPEAKER_03]: that I knew from dental so it sort of was an evolution that way kind of interesting.

[00:03:35] [SPEAKER_03]: Like you were probably you were there when I got there. I got there in 2002 mid 2002. You

[00:03:43] [SPEAKER_04]: were already there I'm pretty sure. I was there when it rolled. I remember being there the first

[00:03:49] [SPEAKER_04]: time with Howard and a few of us and said you know type something on the screen let's see if

[00:03:54] [SPEAKER_04]: it shows up. Literally I remember those days we're on the telephone on the corded telephone

[00:04:00] [SPEAKER_04]: and we're online going type something. I want to see if the letter show up on the screen.

[00:04:05] [SPEAKER_04]: I mean it was that old. That's hilarious. I love that. I was one of the first I think

[00:04:09] [SPEAKER_04]: 10 members and I was one of the first five administrators. Yeah yeah yeah it's a

[00:04:16] [SPEAKER_03]: I mean it's a it's the way back machine to be sure and I mean it affected the way that I

[00:04:21] [SPEAKER_03]: practiced a lot. I had literally just gotten out of rehab in earlier that year like in

[00:04:26] [SPEAKER_03]: I got out of rehab in May of 2002. That's so funny like I never call it rehab but people

[00:04:31] [SPEAKER_03]: understand what I mean when I say rehab. I usually say treatment but anyhow I was so I was

[00:04:35] [SPEAKER_03]: not only was I relatively new dentist but I was newly sober and another member who was

[00:04:41] [SPEAKER_03]: who is also in the who is who had been sober for a while invited me said you should try

[00:04:46] [SPEAKER_03]: this place and then it you know literally substituted my addiction. It basically it was

[00:04:52] [SPEAKER_03]: a new addiction after that because I was on constantly and like I will say one of the one

[00:04:56] [SPEAKER_03]: of the more amazing things that I remember vividly was the fact that I went to a Vegas

[00:05:02] [SPEAKER_03]: one of the Vegas townie meetings relatively early on and it was crazy to to meet people in

[00:05:09] [SPEAKER_03]: real life that you had this picture of in your head from the bulletin board you know

[00:05:13] [SPEAKER_03]: because it was you didn't have it wasn't a really visual medium at the time. I mean you

[00:05:19] [SPEAKER_03]: could upload pictures it wasn't really easy to versus you know the way social media is now.

[00:05:24] [SPEAKER_03]: It's pictures and video and all that stuff. We you and I were just laughing about

[00:05:27] [SPEAKER_03]: I mean and you you have a an Instagram and and you know social media presence that's very

[00:05:33] [SPEAKER_03]: video. It's you it allows you to sort of do small snippets of teaching and and talking

[00:05:37] [SPEAKER_03]: about concepts and I'm just wouldn't be funny to take the time machine and just kind of

[00:05:43] [SPEAKER_03]: show your 2005 self some of the stuff that you would be doing now with you know the the

[00:05:48] [SPEAKER_03]: technology that we literally take for granted in our pocket even in 2005 it wasn't that long

[00:05:53] [SPEAKER_03]: before we had an iPhone or there's just what what we're doing now is just insane. It's just

[00:05:58] [SPEAKER_04]: it's crazy you know what I still have PTSD I can literally hear it in my head and I

[00:06:03] [SPEAKER_04]: think you know what sound I'm gonna make yeah yeah it's like I was on dial-up until I think

[00:06:12] [SPEAKER_04]: um I don't even want to say what year I can't even remember but I was in dial-up

[00:06:17] [SPEAKER_04]: until probably 2009 yeah yeah and all those pictures I was loading I remember I'd load

[00:06:23] [SPEAKER_04]: them before I went to sleep yeah because it took that long to upload. Oh good the case is almost loaded eight hours later.

[00:06:28] [SPEAKER_03]: Yeah yeah that's that was you know that was the nice thing about uh Dental Town was pretty

[00:06:33] [SPEAKER_03]: text based in a lot of ways. I mean you could upload pictures but it took a long time so the

[00:06:38] [SPEAKER_03]: text was was pretty quick. I do remember that vividly too. Yeah yeah that's really funny that

[00:06:43] [SPEAKER_03]: so we've just established that we're both old um so I mean we have matching goatees. Exactly we do

[00:06:51] [SPEAKER_03]: we have matching graying goatees and it seems like every time I look it's it's getting grayer

[00:06:55] [SPEAKER_03]: so that's that's the way that it is but so one of the things that that's funny also so it's been

[00:07:00] [SPEAKER_03]: you know it's been years in the making but then two years ago you came with Lane to speak

[00:07:06] [SPEAKER_03]: at my study group I say my it's not really I don't really own it or anything but my study

[00:07:11] [SPEAKER_03]: club is the Francis B. Vedder Society which I talk about on the show quite often and it's the fall

[00:07:16] [SPEAKER_03]: the fall meeting up in uh up in Bel Air Michigan which is which is coming next month actually

[00:07:22] [SPEAKER_04]: and I think that's an spectacular meeting and what wonderful hosts and being up at the I think

[00:07:28] [SPEAKER_04]: that year we were at the ski resort. Yep you were it was it was uh it's uh Shani Creek is

[00:07:33] [SPEAKER_04]: what they call it. Shani Creek the views the fall colors and but but honestly the hospitality

[00:07:39] [SPEAKER_04]: of the Vedder members was was without comparison worldwide they are just so welcoming and looking

[00:07:47] [SPEAKER_04]: through the book of who is spoken there yeah yeah oh my god I'm glad I looked at it afterwards

[00:07:53] [SPEAKER_03]: because that is an intimidating lineup to follow. That is I don't quite know exactly how Vedder

[00:07:59] [SPEAKER_03]: does it because it's really I've been I mean basically I started the membership process at the

[00:08:06] [SPEAKER_03]: first meeting that I went to which was 97 uh it was September 1997 and uh one of the speakers

[00:08:12] [SPEAKER_03]: the speaker that was there you may have heard of him his name is Frank Spear

[00:08:16] [SPEAKER_03]: and then and then and then next fall another guy you might have heard of John Coys so like

[00:08:22] [SPEAKER_03]: like I got out of dental school this I saw Frank Spear before before I had my dental

[00:08:27] [SPEAKER_03]: license like it was literally in the mail still and I saw Frank Spear I'm like oh

[00:08:31] [SPEAKER_03]: oh this is how dentistry is supposed to be done like I didn't I didn't realize you know

[00:08:35] [SPEAKER_03]: it was it was a it was sort of a an early version of of uh facially generated treatment planning

[00:08:42] [SPEAKER_03]: essentially I mean it was kind of it was kind of still in its infancy it was like I said it was

[00:08:45] [SPEAKER_03]: 1997 in any case uh so yeah they have them they have amazing so the first CE I ever saw was

[00:08:51] [SPEAKER_03]: Frank Spear at the Vedder Society basically if you can imagine I mean so that kind of sets

[00:08:55] [SPEAKER_03]: the bar kind of high for for a CE and the Vedder always has really good people they but

[00:09:00] [SPEAKER_03]: the bummer of it is like I I don't miss Vedder I never miss Vedder except I've got a kid

[00:09:06] [SPEAKER_03]: I got a kid who marches in the marching band and that's that I've decided that's the other thing

[00:09:11] [SPEAKER_03]: I'm not going to miss is any of his football games and lo and behold he had a football game

[00:09:16] [SPEAKER_04]: that day so like it's a Friday you understood you called you apologize and Wayne and I was

[00:09:21] [SPEAKER_04]: like dude go don't even worry I know I know but I missed a chance to see you guys speak

[00:09:26] [SPEAKER_03]: it's only things where if this is where I do need it yeah it's it's exactly right so now last year

[00:09:33] [SPEAKER_03]: we had uh someone you you know quite well link was there link was there last year and I

[00:09:39] [SPEAKER_03]: I saw most of link I wasn't he didn't have a he hadn't my kids basically every weekend always

[00:09:44] [SPEAKER_03]: have something but it was not something that I felt like I couldn't miss but so I I was

[00:09:49] [SPEAKER_03]: there and gone I never even talked to link while I was there but he was fantastic he did

[00:09:53] [SPEAKER_04]: yeah sorry a good friend mine CEO and founder of ripe global from begara Australia he came quite

[00:10:01] [SPEAKER_03]: away for that and he's been on the show I mean he was on the show early on as well I

[00:10:06] [SPEAKER_03]: feel bad I never had a chance to talk to him but he was uh he was essentially a rock star

[00:10:10] [SPEAKER_03]: at the better society he never had a chance like people and you probably notice this too

[00:10:14] [SPEAKER_03]: when you were done speaking you had people coming and mobbing you like like lots of people

[00:10:18] [SPEAKER_03]: do at ce they want to come and talk to you and ask questions but he was clearly he was

[00:10:22] [SPEAKER_03]: followed there were there were some some ripe people there and it was it was very cool another

[00:10:27] [SPEAKER_03]: one but he didn't get shanny creek he got uh boeing mountain which is actually also really

[00:10:34] [SPEAKER_03]: pretty but I think the bel-air I think shanny creek is a more intimate uh intimate and easy

[00:10:40] [SPEAKER_03]: to listen to I when I think of the better side I think of shanny creek because it's

[00:10:43] [SPEAKER_04]: usually at shanny creek so anyhow it was hey if you don't mind me throwing a plug on this

[00:10:48] [SPEAKER_04]: lay link that is dr lincoln harris and I are actually going to be in Chicago

[00:10:54] [SPEAKER_04]: together speaking at the end of October okay so you know Bob D and his dentistry and general

[00:11:00] [SPEAKER_04]: group yeah so uh Lincoln Arthur Volcker and I are going to be part of a I believe it's a

[00:11:07] [SPEAKER_04]: two or three day meeting just outside Chicago so if you if any of your listeners uh message

[00:11:13] [SPEAKER_04]: you can just look on dentistry in general on Facebook uh come spend some time with us

[00:11:18] [SPEAKER_03]: I'll put a link in the show notes too so I didn't realize arty was gonna be that's even better

[00:11:23] [SPEAKER_03]: I got it already I mean arty and I also go way back he's been on the show a bunch of times

[00:11:27] [SPEAKER_03]: as well but uh like I went to the greater New York not last year the year before

[00:11:32] [SPEAKER_03]: and it's really funny Chicago I've been two million times I'm comfortable and I know

[00:11:36] [SPEAKER_03]: Chicago well enough to get around on my own I don't know New York at all New York City is

[00:11:39] [SPEAKER_03]: intimidating to me and honestly the feel isn't that much different than than Chicago but I just

[00:11:43] [SPEAKER_03]: don't so arty finally said look arty took me around New York and that was really great

[00:11:49] [SPEAKER_03]: that was really cool like going to like New York's a town I think that's pretty great

[00:11:52] [SPEAKER_03]: to go around with someone who knows where that what they're doing and stuff was very fun

[00:11:55] [SPEAKER_04]: so yeah I'm actually doing the greater New York this year for the very first time

[00:11:59] [SPEAKER_04]: I've never attended I've been asked to present loads of time but it's always gonna

[00:12:03] [SPEAKER_04]: you know that's family week oh my gosh it's always it's always that week after

[00:12:09] [SPEAKER_03]: Thanksgiving like like it starts like the day after Thanksgiving it's crazy I still don't I

[00:12:14] [SPEAKER_03]: don't know why they I always figure it since it's a dental meeting they must have gotten a deal

[00:12:17] [SPEAKER_03]: at the Javits Center or something like that because it's like it's a terrible time but

[00:12:22] [SPEAKER_03]: it is a great meeting I'm gonna try and get there because okay and then the last thing I

[00:12:26] [SPEAKER_03]: wanted to do you and I saw each other from across the floor at the midwinter last year

[00:12:31] [SPEAKER_03]: and we were planning on recording and every time you came by I had someone sitting at

[00:12:36] [SPEAKER_03]: the door and I felt awful they had this super cool podcasting studio thing that it was like glass

[00:12:41] [SPEAKER_03]: walls and it was just a little quieter and they had you know place set up for people to it was

[00:12:46] [SPEAKER_03]: fantastic I'm totally I'm gonna be there I'm gonna try and get there every day of the

[00:12:51] [SPEAKER_03]: midwinter this year because it that was such a great way to record content but

[00:12:54] [SPEAKER_03]: so like we're gonna and we never connected because you you know we are both busy at

[00:12:58] [SPEAKER_03]: different times so again lots of apologies this conversation has been a long time in

[00:13:03] [SPEAKER_03]: I should say the apology podcast I know it is yeah that's we should just do an

[00:13:07] [SPEAKER_03]: entire apology podcast and then record a regular one that's not what we're going to do perfect

[00:13:10] [SPEAKER_03]: so one of the things that brought me that had me re-invite you back and it turns out it was

[00:13:15] [SPEAKER_03]: in April you Mike has a really good social media he's good at social media and in a way

[00:13:23] [SPEAKER_03]: that's it's not salesy it's not it's not the the dentist flex where all they ever do is show

[00:13:32] [SPEAKER_03]: the post-op of the of the all-on-four when you know the one where they've got the retractors in

[00:13:37] [SPEAKER_03]: the and they go okay tap tap tap and they go it's perfect conclusion it's freaking gorgeous

[00:13:42] [SPEAKER_03]: and amazing surgery and stuff like that I mean you may have some of that stuff but that's kind

[00:13:45] [SPEAKER_03]: of doesn't it doesn't really interest you to do that you like to actually talk about stuff

[00:13:49] [SPEAKER_03]: that dentists really need to know so he had a video up back in April that made me

[00:13:57] [SPEAKER_03]: have the conversation because I was kind of moved by it and so before we go on any further

[00:14:02] [SPEAKER_03]: I'm just going to go ahead and drop that drop that audio because it's it's good audio

[00:14:06] [SPEAKER_03]: good video we'll put a link in the show notes but it'll be in right here I need you to stop

[00:14:11] [SPEAKER_04]: doing comprehensive examinations and taking comprehensive records it's not helping your

[00:14:16] [SPEAKER_04]: patients and it's killing your case acceptance don't agree with me fine go ahead and do full

[00:14:22] [SPEAKER_04]: periodontal charting that's comprehensive how about charting all of the existing restorations

[00:14:28] [SPEAKER_04]: in their condition that'd be comprehensive how about a full mouse series of radiographs and a

[00:14:33] [SPEAKER_04]: full series of photographs that would be comprehensive let's get a set of study models

[00:14:38] [SPEAKER_04]: how about a face bow a cr record a protrusive that would be comprehensive how about we take

[00:14:45] [SPEAKER_04]: a ct on every single patient that'd be comprehensive how about an mri to evaluate

[00:14:50] [SPEAKER_04]: their joint health that would be comprehensive how about if we draw blood on every single patient

[00:14:57] [SPEAKER_04]: too and that would be go ahead say it you're thinking it that wouldn't be appropriate

[00:15:04] [SPEAKER_04]: how about if we keep the word comprehensive but we change our mindset to appropriate

[00:15:11] [SPEAKER_04]: appropriate records for the appropriate conditions and the appropriate needs of our patient

[00:15:16] [SPEAKER_04]: when we treat all of our patients exactly the same we rubber stamp them saying you are not

[00:15:23] [SPEAKER_04]: unique and you just have to do what we want not what is appropriate for them share follow along

[00:15:31] [SPEAKER_04]: and i'd like to talk more about this in my past mistakes and your future successes all right

[00:15:37] [SPEAKER_03]: so basically the video uh is the caption that i saw on was we need to stop doing

[00:15:44] [SPEAKER_03]: comprehensive exams and start and taking comprehensive records it's killing our case

[00:15:48] [SPEAKER_03]: acceptance and is not helping our patients we need to we need a mind shift from comprehensive

[00:15:53] [SPEAKER_03]: to appropriate by treating all patients the same we ignore and disrespect the individual

[00:15:57] [SPEAKER_03]: so i i was moved by that i thought it was really good uh i have a lot of honestly i have

[00:16:04] [SPEAKER_03]: a lot of uh a lot of hang-ups and shame based on being comprehensive enough if you if

[00:16:12] [SPEAKER_03]: you know what i'm saying like there was a time particularly maybe even back when we were on

[00:16:16] [SPEAKER_03]: delltown where comprehensive was the word and if you weren't comprehensive enough you'd get

[00:16:20] [SPEAKER_03]: you'd get dragged and all that stuff so i'm curious what inspired you to create that particular

[00:16:25] [SPEAKER_03]: video which is funny because i know you haven't thought about it it was back in april might

[00:16:28] [SPEAKER_03]: as well be 10 years ago but it really moved me when i heard it well i'll ask you i'm

[00:16:33] [SPEAKER_04]: gonna throw that one back at you alan why did it hit you so hard for me it's because

[00:16:40] [SPEAKER_03]: i have a i have a uh a practice that i don't get to do a lot of comprehensive stuff i i have

[00:16:49] [SPEAKER_03]: a practice where i kind of have to meet the patients where they are you know i i have the

[00:16:53] [SPEAKER_03]: classic patient that comes in and they're they're real their dentition is kind of bombed i

[00:16:57] [SPEAKER_03]: there's times when it bugs me when i see people that have teeth that i think

[00:17:00] [SPEAKER_03]: should be could be saved and people do this big all-on-four thing but then there's times

[00:17:05] [SPEAKER_03]: you're like yeah this person is dentures are all on four and that's that they're falling apart

[00:17:11] [SPEAKER_03]: and i've i found myself having to meet the patient where they are because i have a lot of

[00:17:15] [SPEAKER_03]: patients that could use a lot of that that big treatment that cannot that can't do it

[00:17:19] [SPEAKER_03]: whether it's their health or their their the dollars or their commitment to that sort

[00:17:22] [SPEAKER_03]: of thing or whatever they just can't do it and i feel ashamed that i'm not the guy that

[00:17:27] [SPEAKER_03]: deliver this big case care sometimes and part of it is the skill set is hard to maintain if

[00:17:35] [SPEAKER_03]: you're not doing that kind of thing you and i've talked about that before we've talked about

[00:17:38] [SPEAKER_03]: the rep but it's also like there's a certain aspect of dentistry that like you're kind of

[00:17:45] [SPEAKER_03]: shamed for not being the big comprehensive dentist i mean if you're doing quadrants or

[00:17:50] [SPEAKER_03]: you know in in your point was it needs to be appropriate and when i hear appropriate i

[00:17:55] [SPEAKER_03]: feel like you need to meet the patient where they are that was i mean you brought up it you brought

[00:18:00] [SPEAKER_04]: up i was really interested in how and why that hit you and while you say that was all the way

[00:18:07] [SPEAKER_04]: back in april it's very front of my head because it is my everyday life and it's uh my my

[00:18:13] [SPEAKER_04]: commitment as an ed as a clinician but it's also my challenge as an educator and the the

[00:18:19] [SPEAKER_04]: thing that you said it more than once meet the patient where they are that is comprehensive

[00:18:23] [SPEAKER_04]: that is where compassionate comprehensive care begins is meeting the patient where they are not

[00:18:29] [SPEAKER_04]: where we are or where we think we should be and i think one of the biggest fallacies

[00:18:36] [SPEAKER_04]: and this takes me all the way back into the 90s and the aesthetic revolution is that if you

[00:18:41] [SPEAKER_04]: weren't spinning down 28 teeth on a regular basis you were not a comprehensive uh caring

[00:18:47] [SPEAKER_04]: uh clinician which which is total total load of beat you know bullshit sorry i know you beep

[00:18:53] [SPEAKER_04]: things out or don't but that's fine but the but the second word that goes along with that is

[00:18:58] [SPEAKER_04]: shame and that is why that is so much at the forefront is how many times i have clinicians

[00:19:05] [SPEAKER_04]: either call me or come up to me after i've been speaking in a meeting or patients even

[00:19:10] [SPEAKER_04]: and they have the shame because they haven't been turned into a perio prost textbook yes

[00:19:18] [SPEAKER_04]: yes yes which is you know nobody's gonna die from not doing um quote unquote comprehensive

[00:19:25] [SPEAKER_04]: dentistry yep and by that i mean quote unquote i mean by doing this

[00:19:30] [SPEAKER_04]: and i don't want to name any associations that have to do with cosmetics or anything

[00:19:34] [SPEAKER_04]: but but the whole fallacy that we have to drill down every tooth to be comprehensive

[00:19:41] [SPEAKER_04]: is is ludicrous and the whole point of appropriate is meeting the patients where they are for what

[00:19:52] [SPEAKER_04]: their goals are and moving them not to health but towards health and that journey may happen

[00:19:59] [SPEAKER_04]: slowly and sometimes our skills are there and sometimes the patients aren't ready sometimes

[00:20:05] [SPEAKER_04]: we're not ready sometimes they aren't but it's a the whole thing is just a journey yep

[00:20:10] [SPEAKER_04]: and stuffing the traditional rubber stamp of comprehensive down patient and clinicians throat

[00:20:17] [SPEAKER_04]: i just i just don't think is fair to anyone yeah i it is frustrating because

[00:20:23] [SPEAKER_03]: there's a couple different ends but first off like i said you know dentaltown back

[00:20:28] [SPEAKER_03]: in the early 2000s um the the people they got the most respect were the ones that showed the

[00:20:34] [SPEAKER_03]: giant befores and afters of of you know full mouth rehab and i think you know on some level

[00:20:39] [SPEAKER_03]: i think full mouth rehab is a really cool concept maybe to strive for or at least to

[00:20:44] [SPEAKER_03]: have an understanding of um people forget that actually you know complete upper and lower is

[00:20:49] [SPEAKER_03]: also a full mouth rehab when you think about it you know it's like and i mean on some level

[00:20:55] [SPEAKER_03]: spear always talks about you know the the basis of all of his his aesthetic rules come from denture

[00:21:00] [SPEAKER_03]: setup you know so the story is like i mean that's comprehensive and they have no teeth so it's

[00:21:05] [SPEAKER_03]: kind of i will say that the word comprehensive was always like thrown around as like this as

[00:21:12] [SPEAKER_03]: a flex a little bit when i'm that's where the shame kind of came from because you know what

[00:21:16] [SPEAKER_03]: if i have a patient that that i'm you know i'm treating for disease control because they

[00:21:21] [SPEAKER_03]: have teeth their gums are probably inflamed they have a bunch of cavities

[00:21:26] [SPEAKER_03]: but i'm but you know what i'm really needing to do is trying to help them not get so many

[00:21:30] [SPEAKER_03]: cavities you know and this is you know a young adult i see plenty of those things well what's

[00:21:34] [SPEAKER_03]: comprehend what what does comprehensive mean on that like every patient there's so many different

[00:21:39] [SPEAKER_03]: patient types that walk into your office unless you're a specialty office where you're doing

[00:21:44] [SPEAKER_03]: you know i mean and on some level i sort of am a little jealous of the specialist because

[00:21:49] [SPEAKER_03]: in a lot of cases they're they're okay when you go to an endodontist office you figure

[00:21:55] [SPEAKER_03]: you're getting a root canal or figuring out if you need a root canal but the reality is

[00:22:00] [SPEAKER_03]: is that endodontist doesn't have to worry about your smile you know you're that endodontist

[00:22:04] [SPEAKER_03]: doesn't have to worry about there's there's i don't know it's a complicated thing and

[00:22:08] [SPEAKER_03]: i and it and the idea of being a comprehensive dentist is a little bit uh it's a it's a loaded

[00:22:15] [SPEAKER_03]: term on some level i you told the story i wish you'd tell it again i because here's the other

[00:22:21] [SPEAKER_03]: thing so so i took a course from mike probably back in in 2005 2006 we did it in rich rosanblatt's

[00:22:28] [SPEAKER_03]: office oh god that was way back it was it was and then we did another one in canada uh yeah

[00:22:33] [SPEAKER_04]: you came up i remember a water line broke at the house yeah yeah and you dropped everything

[00:22:37] [SPEAKER_04]: and actually came up and helped me teach that one in toronto yeah yeah that's yeah it was

[00:22:41] [SPEAKER_03]: it was kind of crazy so like we we'd i'd taken the course and it was it was nuts and bolts of

[00:22:46] [SPEAKER_03]: occlusion and there were a lot it's a lot of a lot of hands-on uh nti fabrication that sort

[00:22:52] [SPEAKER_03]: of thing i mean it's good courses long time ago and but i do remember you talking about

[00:22:59] [SPEAKER_03]: at one point you after you were really involved with pankey you were you were in

[00:23:03] [SPEAKER_03]: a position where you felt like it was study models in full photos and full full

[00:23:07] [SPEAKER_03]: you know if a patient walks in your office that's what you have to do

[00:23:10] [SPEAKER_03]: and you talked about i mean what happens with that there's there's some patients that are

[00:23:15] [SPEAKER_03]: receptive to that there's some patients that are not and i mean on some level if if that's

[00:23:21] [SPEAKER_03]: all you have to offer you don't know if you don't know who the receptive patients

[00:23:24] [SPEAKER_04]: are going to be for that is that right yeah i mean back then i was so dogmatic i mean

[00:23:29] [SPEAKER_04]: aside from full mouth x-rays full mouth charting period charting photos muscle exam

[00:23:35] [SPEAKER_04]: joint exam aesthetic evaluation oral hygiene you know you know i think i did tarot card reading

[00:23:42] [SPEAKER_04]: and zodiac i feel like you didn't you probably weren't no jokes aside i was you know i was

[00:23:47] [SPEAKER_04]: doing like two sets of study two sets of study model impressions face both cr

[00:23:52] [SPEAKER_04]: regardless of what the patient wanted and i had i had people pounding down my door to get out

[00:23:59] [SPEAKER_04]: they did not want to be there and i and i think the big the big change for me was was a phrase

[00:24:05] [SPEAKER_04]: i learned from dr gary to wood gary and i are actually doing a program at greater new york this

[00:24:10] [SPEAKER_04]: year oh good lecturing i'm really excited i've never had that opportunity to teach like that

[00:24:16] [SPEAKER_04]: with gary but he gave me a phrase and the phrase was based on your goals as i understand

[00:24:21] [SPEAKER_04]: them what i recommend is and if i can't finish that sentence i haven't talked to the patient

[00:24:27] [SPEAKER_04]: right and if i've talked to the patient then the recommendations even if they're those same thing

[00:24:32] [SPEAKER_04]: of the face both the study miles of cr record then it becomes appropriate not not rubber stamped

[00:24:39] [SPEAKER_04]: as comprehensive yeah and some of the things that you said alan i i gotta rewind you a little

[00:24:45] [SPEAKER_04]: bit you talk about dentaltown and all the all the compliments and sunshine that would be

[00:24:50] [SPEAKER_04]: thrown on these comprehensive all in four cases yeah i will tell you there were just as many

[00:24:55] [SPEAKER_04]: private comments of shame that said oh my god i feel like a horrible person because i don't do

[00:25:00] [SPEAKER_04]: that yeah and and but those are the people that aren't aren't going to speak up yep and

[00:25:07] [SPEAKER_04]: when we look at i was just talking about this last week with some clinicians when we look at

[00:25:13] [SPEAKER_04]: that i in a lecture i'll put up a case and it's the same it doesn't even matter what the

[00:25:19] [SPEAKER_04]: the cases has the potential to save teeth you know root canal crown lengthening and crowns

[00:25:26] [SPEAKER_04]: or extract and do implants and i throw this up on a screen i've been doing the same case

[00:25:31] [SPEAKER_04]: for i think about 16 years and without fail it is usually a 60 40 split of who would save

[00:25:39] [SPEAKER_04]: them and who would implant them and sometimes it's 40 percent who would save them and 60

[00:25:44] [SPEAKER_04]: percent who would implant them and when we have that variance in personal preference of how we

[00:25:51] [SPEAKER_04]: would treat and we confuse values with ethics we confuse values with ethics that is our

[00:26:01] [SPEAKER_04]: personal values of what we would do for ourselves affects what we recommend for our

[00:26:07] [SPEAKER_04]: patients and when a patient asked me said what would you do you're the doctor i used

[00:26:12] [SPEAKER_04]: hate that question now i love it but i would say i'll tell you let me i'll tell you what i would do

[00:26:16] [SPEAKER_04]: but first let me tell you why and that y might be aesthetics that might y might be embarrassment

[00:26:23] [SPEAKER_04]: or function or measure of health or or a variety of reasons but if that value isn't the same

[00:26:31] [SPEAKER_04]: as the patient i'm imposing my values and i think the challenge in the in the pitfall

[00:26:36] [SPEAKER_04]: is that when we have people that pick and i mean clinicians pick different treatment choices than

[00:26:44] [SPEAKER_04]: our values we think they're compromising their ethics and we take it personally and we think

[00:26:50] [SPEAKER_04]: they're bad people yeah and that's that goes back to that whole shame thing that you're

[00:26:54] [SPEAKER_03]: talking about more than worse than that we don't say it explicitly but we we we kind

[00:26:59] [SPEAKER_03]: of dance around the fact that we think that they're we think that they're bad because

[00:27:03] [SPEAKER_03]: it isn't that no one's going to say oh you're horrible for doing this but i think it's more

[00:27:07] [SPEAKER_03]: that they believe that they they live on social media depending depending on this

[00:27:12] [SPEAKER_03]: depending on a situation some of them do but the reality is is like even if it's not said

[00:27:17] [SPEAKER_03]: it's thought and that might even be worse at times like because i don't know i just feel

[00:27:21] [SPEAKER_03]: like you can pick up on so much i don't know if you you hung around long enough the what you

[00:27:29] [SPEAKER_03]: on social media or whatever is assumed to be the right thing and why would that be it doesn't i

[00:27:33] [SPEAKER_03]: mean it doesn't make any sense but that's kind of because that's that's what everyone's going

[00:27:36] [SPEAKER_03]: they're portraying their their highlight reel you know they're putting their highlight

[00:27:40] [SPEAKER_03]: reel out they're not putting that you know they're not putting the one out where they

[00:27:43] [SPEAKER_03]: they couldn't get a root tip out or something like that it doesn't happen so now i get it

[00:27:47] [SPEAKER_03]: i didn't mean to derail you but yes exactly i don't think it derailed me at all i think

[00:27:51] [SPEAKER_04]: this this is the this is the conversation that needs to happen and it's actually been my

[00:27:56] [SPEAKER_04]: you know you've known me all my career as the occlusion guy and you know then molding into the

[00:28:02] [SPEAKER_04]: communication guy but the the my big focus right now is value-based bias in in treatment planning

[00:28:10] [SPEAKER_04]: and even my sister and i have been doing some initial research because you know julian i did

[00:28:17] [SPEAKER_04]: that nih grant a few years ago where we actually looked into social media uh got the

[00:28:26] [SPEAKER_04]: how fast does knowledge move in social media compared to peer review and we're actually looking

[00:28:31] [SPEAKER_04]: at how clinicians base their decisions and who they go to when they have knowledge disruptions

[00:28:39] [SPEAKER_04]: based on their age their gender their their nationality their schooling their specialty

[00:28:46] [SPEAKER_04]: training their advanced degree be it master ship fellowship or diplomat and it is absolutely

[00:28:52] [SPEAKER_04]: fascinating the wide variance in case planning even based on the same diagnosis

[00:28:59] [SPEAKER_04]: and that doesn't mean the treatment treatment is wrong it means it's just different they and

[00:29:05] [SPEAKER_04]: you brought it up before kind of again with that shame word is well i guess you know full

[00:29:10] [SPEAKER_04]: dentures or full mouth rehab of course there if someone wants a smile makeover you could

[00:29:14] [SPEAKER_04]: you could straighten their teeth with ortho and white and that's a full mouth rehab

[00:29:19] [SPEAKER_04]: that's comprehensive you could pull all the teeth and do an all on four or all on none

[00:29:23] [SPEAKER_04]: or you could porcelain veneer you could composite veneer and all of those things will give that

[00:29:29] [SPEAKER_04]: patient a beautiful smile when i think about any treatment that i recommend first and foremost

[00:29:36] [SPEAKER_04]: i want to think about the why why does what does what and why does the patient want to

[00:29:40] [SPEAKER_04]: accomplish something and when i think about a process of how we get there that is the

[00:29:46] [SPEAKER_04]: dentistry i'm only gonna i only want two questions after that what are the benefits of this approach

[00:29:51] [SPEAKER_04]: and what are the considerations and i don't want to call them consequences because if you call

[00:29:56] [SPEAKER_04]: them consequences that choice then becomes a negative yeah it does and somebody's somebody

[00:30:01] [SPEAKER_04]: has to be shamed benefits considerations then the first benefit of any treatment plan

[00:30:08] [SPEAKER_04]: has to fit the patient's why yeah is if it doesn't fit their why before it fits our

[00:30:15] [SPEAKER_03]: recommendation goes in the trash okay i got i got something i want to i want to roll back first off

[00:30:19] [SPEAKER_03]: if you and gary are presenting it at greater new york i'm gonna have to get there because

[00:30:23] [SPEAKER_03]: i would i would kill or die to sit down and podcast with both of you at the same time that

[00:30:27] [SPEAKER_03]: would be oh we would that would be amazing and i mean gary's been on the show a bunch of

[00:30:30] [SPEAKER_03]: times and he is he is just good pod period the guy opens his mouth and and he's exactly

[00:30:36] [SPEAKER_03]: what you need to hear but uh one of the things that i do i do a pretty good gary do

[00:30:40] [SPEAKER_04]: by the way but i'm not doing one on tape because i don't want to yeah yeah that's right so

[00:30:44] [SPEAKER_03]: i like that so one of the things that i i always found cheesy except i understand it now is when

[00:30:51] [SPEAKER_03]: you and gary and others would talk about patient goals and it's a little interesting

[00:30:56] [SPEAKER_03]: because first off a lot of patients i think go to the dentist office because they've always

[00:31:02] [SPEAKER_03]: gone to the dental office and they get their teeth polished and then the dentist drops in

[00:31:07] [SPEAKER_03]: hey you're looking good and you know maybe feels around under their tongue to make sure

[00:31:11] [SPEAKER_03]: there's no cancer there or something like that and walk and i think in a lot of cases that

[00:31:14] [SPEAKER_03]: patient doesn't think about what their goals are but but the reality is that's oftentimes

[00:31:20] [SPEAKER_03]: a healthy patient where probably whatever goals they may have are kind of met because they're

[00:31:24] [SPEAKER_03]: pretty happy with their teeth their teeth are in good shape the type of patient that

[00:31:28] [SPEAKER_03]: actually understands that they have goals they're walking in your office and they know what they

[00:31:37] [SPEAKER_03]: are going to the dentist because they go to the dentist but the reality is there are a lot of

[00:31:40] [SPEAKER_03]: patients that probably specifically have goals and and know the goals on the other hand

[00:31:45] [SPEAKER_03]: probably you can explain by asking i don't know that i've ever asked a patient what are your

[00:31:51] [SPEAKER_03]: goals with your teeth because i don't know that they think about them as goals in the way that

[00:31:55] [SPEAKER_03]: but but i think a lot of times how do you how do you draw out the patient's goals when

[00:32:00] [SPEAKER_03]: you're communicating what's what are what are some questions you might ask them that don't

[00:32:05] [SPEAKER_03]: because when you i don't know that patients consciously think of having goals for their

[00:32:11] [SPEAKER_04]: oral health and until a dentist asks that when a patient comes in for a new patient exam a

[00:32:17] [SPEAKER_04]: you know a little chit chat you know about the area or whatever and i always start with the

[00:32:21] [SPEAKER_04]: same intro i'm not a scripting guy but i pretty much start with this one every time

[00:32:25] [SPEAKER_04]: and my assistant's name is ali and i say well alan you know ali and i always start

[00:32:30] [SPEAKER_04]: with just a simple question what brings in today what can i help you with and that's

[00:32:34] [SPEAKER_04]: specific and i shut up them because i don't make any assumption about what they know what

[00:32:38] [SPEAKER_04]: they don't know and getting into goals and you know they might tell me a goal right there

[00:32:45] [SPEAKER_04]: and i don't have to pull one out of them but another one and this was a really uncomfort as

[00:32:52] [SPEAKER_04]: comfortable as i am in communication this one threw me kevin quieson gave me this one

[00:32:57] [SPEAKER_04]: and let's say you know patient comes in and they're 35 and say you know what are

[00:33:02] [SPEAKER_04]: your goals for your teeth when what are your goals or expectations of your teeth when you're 50

[00:33:09] [SPEAKER_04]: and they'll say i never thought about that and i'm like yeah yeah i bet it's kind of weird

[00:33:15] [SPEAKER_04]: question is it yeah i go yeah it's a weird question i'll say yeah but what are your

[00:33:18] [SPEAKER_04]: expectations of your teeth when you're 50 and they might say i don't know i'm like that

[00:33:25] [SPEAKER_04]: might be something you want to think about because that'll help me get you there

[00:33:29] [SPEAKER_04]: and sometimes you don't have to win that answer that day but i'll tell you the other one that

[00:33:35] [SPEAKER_04]: uh that you brought up i wish you also call this the apology and rewind exactly we are

[00:33:41] [SPEAKER_03]: rewinding a lot that's the i've thought about this conversation for some months now so i'm just

[00:33:45] [SPEAKER_04]: i'm hitting all the highlights here that's okay so when you said someone comes in and likes

[00:33:50] [SPEAKER_04]: their teeth and doesn't want to do anything that's actually a goal yeah actually that's a

[00:33:56] [SPEAKER_04]: it's a goal that's a really good yeah yeah and i tell patients that and i said what brings in

[00:34:01] [SPEAKER_04]: they said nothing i said well you came in for a reason didn't you like well yeah i just need

[00:34:07] [SPEAKER_04]: wanted to get checked out established care and get my teeth clean that's that's like the standard

[00:34:11] [SPEAKER_04]: like that's like throwing garlic and holy water at a dentist and i just run away i'm

[00:34:16] [SPEAKER_04]: in terror exactly because i don't know what to say yeah i'll say well can i make this

[00:34:19] [SPEAKER_04]: i said do you like your smile like yeah i like my smile any pain nope i said you okay

[00:34:25] [SPEAKER_04]: chewing so i'm covering pain aesthetics and function yeah and uh and i'll say can i make

[00:34:30] [SPEAKER_04]: the assumption that you'd like to keep things that way yeah i don't want to do anything okay

[00:34:34] [SPEAKER_04]: well how about our goal is to help you avoid doing anything yeah yeah and they'll say what do

[00:34:40] [SPEAKER_04]: you mean and said well you're not you don't feel like you need any dentistry and you're

[00:34:44] [SPEAKER_04]: happy with everything how about if we take a look at your teeth and figure out how to keep

[00:34:49] [SPEAKER_04]: right where you are right now yeah and they'll and i will they'll frequently look at me funny

[00:34:55] [SPEAKER_04]: and say i never thought about that i'm like yeah but you're doing it every day right you're

[00:34:59] [SPEAKER_04]: taking good care of your stuff your teeth your gums i said how about i take a look

[00:35:04] [SPEAKER_04]: and see see what you've been doing and tell me about what what you've been doing to keep

[00:35:07] [SPEAKER_04]: it up like that yeah and i throw it back on them and i never knew how to talk about

[00:35:11] [SPEAKER_04]: brushing or flossing except for it being a checkbox question yeah yeah but when it becomes

[00:35:15] [SPEAKER_04]: maintenance of you know what are you doing to make things go so well and then with the finish

[00:35:22] [SPEAKER_03]: of that excellent question that i've never asked someone before because let's be perfectly

[00:35:27] [SPEAKER_03]: honest in my practice i have plenty of really healthy patients like like the line i use is

[00:35:32] [SPEAKER_03]: like when i grow up i want teeth like yours and and and that's it that would be a great

[00:35:37] [SPEAKER_03]: time to say so what is what are you doing to to keep it keep it so good because i mean i

[00:35:42] [SPEAKER_03]: have plenty of healthy patients and let's be perfectly honest i'd love to take credit for that

[00:35:47] [SPEAKER_03]: but but but you can't they've never really needed anything what is it that they're doing

[00:35:51] [SPEAKER_03]: so well and that is a that's a great question thanks it's it's uh you know i still paper

[00:35:57] [SPEAKER_04]: chart um we can put it in electronic but a couple of questions are on the front sheet is

[00:36:01] [SPEAKER_04]: what are your expectations of your teeth how did you end up here

[00:36:06] [SPEAKER_04]: what you know what made today the right day to to have this exam and then i want to know

[00:36:11] [SPEAKER_04]: what's your home care regimen and they'll get into their brushing their flossing

[00:36:16] [SPEAKER_04]: and all of that stuff and i and i compliment and celebrate with them and so the the end of

[00:36:22] [SPEAKER_04]: that appointment is well alan based on your goals as i understand them of wanting to you

[00:36:28] [SPEAKER_04]: know keep things the way they are what i would recommend is and that is basically my my

[00:36:34] [SPEAKER_04]: treatment planning sheet of purpose process and presentation why they want something what they

[00:36:39] [SPEAKER_04]: what i need to deliver to keep or get them there and then the benefits and considerations

[00:36:44] [SPEAKER_04]: and whether it's on my paper form and i think i think back then you were probably one of the

[00:36:50] [SPEAKER_04]: first classes to see the three p sheet purpose process and presentation whether it's on paper

[00:36:56] [SPEAKER_04]: just between my ears that that's deep in my tissues and it's the way i think about every

[00:37:01] [SPEAKER_04]: case and it also helps keep me from going down rabbit holes yeah and it's so easy to do

[00:37:06] [SPEAKER_03]: i thought of something too you know you ask the patient going back to you say you ask the patient

[00:37:11] [SPEAKER_03]: what do you think your smile you know do you chew well on that you realize i was such a variety

[00:37:17] [SPEAKER_03]: of patients will answer that they're perfectly happy with all that i mean that you've got the

[00:37:22] [SPEAKER_03]: really healthy ones that have great looking teeth and function and then you've got people

[00:37:25] [SPEAKER_03]: that are that that are missing a bunch of teeth or have broken teeth and they're they're

[00:37:29] [SPEAKER_03]: also perfectly happy with everything and it always sort of blows my mind like again that's

[00:37:34] [SPEAKER_03]: my values like how could you you know how could you want this looking at or how could you stay on

[00:37:39] [SPEAKER_03]: the but the reality is is like if you ask that question you got to put your values on a shelf

[00:37:43] [SPEAKER_03]: and just listen because like you're meeting them where they are in a lot of these i mean i have

[00:37:49] [SPEAKER_03]: plenty of patients that probably i could i could list the pathology if i wanted to and they're

[00:37:53] [SPEAKER_03]: perfectly okay with that so then how do when you run into that when you're you're like oh

[00:37:58] [SPEAKER_03]: this i'm seeing some stuff and but they don't really want to do anything how do you how do you

[00:38:05] [SPEAKER_03]: present that to them in a i mean i hate to say it but in sort of a non-judgmental way right

[00:38:10] [SPEAKER_03]: because on some level they've just telegraphed to you that they they don't think they have

[00:38:15] [SPEAKER_03]: any problems and then you're the guy who has to come tell them what you're seeing

[00:38:19] [SPEAKER_04]: i guess it depends on on what it is so my lines in the sand are like oral cancer

[00:38:25] [SPEAKER_04]: or you know things that are going to lead to facial swelling and the triangle of death you know

[00:38:30] [SPEAKER_04]: basically those two things i get very i will get very aggressive in my sure recommendations but

[00:38:37] [SPEAKER_04]: aside from that what first thing i want to know is if they're even aware yeah and and you said

[00:38:43] [SPEAKER_04]: blows your mind i said i might say you're missing a tooth on the upper left or might say

[00:38:47] [SPEAKER_04]: are you aware that you're missing a tooth on the upper left no am i and it's funny that

[00:38:53] [SPEAKER_04]: is awesome they don't even know that they're missing something right that is an assumption

[00:38:57] [SPEAKER_04]: that i might that's an assumption that i think are you chewing okay on that side it's like well

[00:39:01] [SPEAKER_04]: i do most of my chewing on the other side i said is that because of you know that's where

[00:39:05] [SPEAKER_04]: you chew or is it because of that space and and their answer is going to lead me to

[00:39:11] [SPEAKER_04]: where i go next yeah because i know i've always chewed on my left side even when i had teeth

[00:39:14] [SPEAKER_04]: on the right yeah okay a little different conversation but the the whole thing of

[00:39:21] [SPEAKER_04]: the purpose process and presentation of their why and the benefits and considerations i i

[00:39:28] [SPEAKER_04]: i picked this up from from frank spear years ago you tell them what you see you tell them

[00:39:33] [SPEAKER_04]: the benefits of addressing it you tell them the considerations of not addressing it but

[00:39:38] [SPEAKER_04]: you don't actually tell them what they need to do to address it yeah because until they see

[00:39:43] [SPEAKER_04]: what you see and until they understand what the benefit of actually addressing it or not

[00:39:49] [SPEAKER_04]: addressing it is all they're going to hear is money and how long it's going to take yep

[00:39:56] [SPEAKER_04]: and nothing to do with them and how it benefits them yeah so when i look at people like that

[00:40:01] [SPEAKER_04]: i'll say i said is that upper left side you know are you able does that affect your smile

[00:40:06] [SPEAKER_04]: no okay is it hurting or is it is it affecting your chewing no okay the reason i ask is

[00:40:13] [SPEAKER_04]: some people it does affect their smile and they care you don't that's fine i said but what i

[00:40:17] [SPEAKER_04]: am concerned about is even though it's not hurting or affecting your function right now

[00:40:23] [SPEAKER_04]: it has the potential to do that in the future and somebody will go okay and then they might

[00:40:31] [SPEAKER_04]: come back to me at six months ago what did you mean by that six months ago yeah or maybe

[00:40:35] [SPEAKER_04]: that day they say what do you mean it could start hurting and i brought up aesthetics function

[00:40:40] [SPEAKER_04]: and and pain yeah so it's like three fishing lures you throw out there and the one that goes

[00:40:46] [SPEAKER_04]: into their ears is the one they respond to and they are what do you mean it'll affect my function

[00:40:50] [SPEAKER_04]: and it's like well you know if if you have you know wear and large restorations like that

[00:40:55] [SPEAKER_04]: at some point they that yeah i remember this because you know john was just in last week

[00:41:01] [SPEAKER_04]: and he had some teeth that were a third person removal is very strong yeah because

[00:41:06] [SPEAKER_04]: then you don't have to battle that person so poor john over there but john was in last

[00:41:11] [SPEAKER_04]: week and he had a feeling very much like yours i remember him coming in because we had

[00:41:15] [SPEAKER_04]: to fit him into the schedule because he was in so much pain and he couldn't chew on that side

[00:41:20] [SPEAKER_04]: yeah so i bet i threw back two lures because pain is pain is you know almost everybody is

[00:41:25] [SPEAKER_04]: worried about that but function i threw those back and they might say well what did you do

[00:41:30] [SPEAKER_04]: about it and i said well we actually ended up taking the tooth out because he had waited so

[00:41:36] [SPEAKER_04]: long and it wasn't restorable and then you go to consider and what that falls into is

[00:41:42] [SPEAKER_04]: yeah so everything frames around that and it keeps me from feeling defensive or offensive

[00:41:50] [SPEAKER_04]: and the third person removal is a little passive aggressive but it makes it comfortable for the

[00:41:55] [SPEAKER_04]: for the patient and i to talk about hypotheticals without saying you have to do this you you you

[00:42:02] [SPEAKER_04]: you especially with a finger pointing and wagging you have to waggle your finger a lot

[00:42:07] [SPEAKER_03]: yeah and even even if you're not actually doing that you have to be aware that the patient might

[00:42:14] [SPEAKER_03]: depending on how you're approaching it the patient might actually kind of feel that finger

[00:42:17] [SPEAKER_04]: wagging oh yeah we got we got the mental we do it's like dr strange we have the mental

[00:42:22] [SPEAKER_03]: finger we do we do and it's it's it is it's hard not to be so this was i mean this is all

[00:42:27] [SPEAKER_03]: really good stuff we i should probably go back and listen to this and then do another podcast

[00:42:32] [SPEAKER_03]: with all the questions that i have from this one but the um this is really cool i think i

[00:42:37] [SPEAKER_03]: let's kind of leave this conversation we could maybe lead into another one but i want to you're

[00:42:42] [SPEAKER_03]: going to be in chicago in october with arty and link is that right correct so i'm going to be

[00:42:49] [SPEAKER_04]: at bob d's meeting and just let me let me pull up my date here so i believe that is the 25th

[00:42:56] [SPEAKER_04]: and the 26th of october okay and bob's hosting that uh in chicagoland it's a little outside

[00:43:03] [SPEAKER_04]: downtown i believe and lincoln's coming up from australia arty's coming over from

[00:43:08] [SPEAKER_04]: new york city and i'm coming from handover we'll also so lincoln's going to be talking about

[00:43:13] [SPEAKER_04]: comprehensive care and also the fast efficient crown props okay arty's you know arty's

[00:43:20] [SPEAKER_04]: sandbox is always you know efficient predictable practical composite or composite restorations

[00:43:28] [SPEAKER_04]: depending on our listeners sure and then i'm going to be i'm going to be talking about kind of my

[00:43:33] [SPEAKER_04]: my my wheelhouse of uh pace planning communication and occlusion is how do you

[00:43:40] [SPEAKER_04]: want it to look how do you make it fit how do you mitigate threats so that's that's the

[00:43:44] [SPEAKER_04]: melkers mantra and i'm just going to be going over lots of cases from single tooth dentistry

[00:43:48] [SPEAKER_03]: to uh full mouth rehabilitation okay and then also the greater new york with with gary that's

[00:43:53] [SPEAKER_03]: these are these are places where a lot of listeners may be able to just you know if they're in the

[00:43:59] [SPEAKER_03]: area whatever maybe make it easy so i'll make sure to put all those dates in there too

[00:44:03] [SPEAKER_04]: gary and i will be at the midwinter we're speaking all day on saturday okay and so i'm

[00:44:08] [SPEAKER_04]: going to be kicking off the program with something called all about the why and it's

[00:44:13] [SPEAKER_04]: going to be about patient motivation and value-based treatment planning and gary's going to

[00:44:21] [SPEAKER_04]: play off on that on how to actually plan the cases and failure mitigation then the afternoon

[00:44:26] [SPEAKER_04]: he and i are going to be sharing a case after case kind of just tennis match back and forth

[00:44:32] [SPEAKER_04]: and different things based on some of the attendees questions gary and i are actually

[00:44:37] [SPEAKER_04]: meeting in a couple weeks and we're going to have a lot of cases on the sidelines depending

[00:44:42] [SPEAKER_04]: on what people want to hear that day that's awesome that's fantastic i'm looking forward

[00:44:46] [SPEAKER_03]: to it dr melkers i appreciate you being on again we'll do this again soon and like i said

[00:44:50] [SPEAKER_03]: i'm hoping if you're gonna be at midwinter for sure i'll see you guys there and i'm gonna try

[00:44:54] [SPEAKER_03]: and get to greater new york too so this was good it's good to see you as always i feel like

[00:44:58] [SPEAKER_03]: the conversation never really ends with you that's sort of that's that's that's a good

[00:45:03] [SPEAKER_03]: thing it's a really good thing and i'll actually put a show on the show notes the links to

[00:45:07] [SPEAKER_03]: the old episodes that we did a hundred years ago and and for comparison sake but this was

[00:45:11] [SPEAKER_04]: awesome i'm glad you're doing so well it was a pleasure being on alan and as i've told

[00:45:16] [SPEAKER_04]: you we're never finished that's right we never know we're nowhere near done nowhere

[00:45:20] [SPEAKER_03]: near done that's right hey we'll talk to you again soon take care everyone