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Specialist speaks out
Letters to the Editor
A solution for burnout □ It is not always true that “more than on e chef sp o ils the s o u p .” If your appointm ent book is overscheduled, say 5 or 6 weeks ahead, even w ith a hygienist in the office, a n d you feel stressed, ex h austed , an d g en erally u n h a p p y at the end of the day, m aybe you need another chef in the kitchen to help stir y o u r b ig p o t of so u p . You may be surprised at the results. Because most dentists are enterprising in d iv id u alists—we did, after all, w ant to w ork alone, w ith o u t a “ boss,” and schedule o u r ow n h o u rs and salary — ju st the th o u g h t of an o th er dentist in the office is stressful to most of us. But, should it be? T here is a lot of young ta le n t o u t there, ju s t w a itin g to be productive, with lots of education, lots of school loans to repay, no money to start a practice, lots of am bition, and above all, a lot of energy that you once possessed. . . . Som e p ractices are p erfect for an associate. If your practice is in a large d raw in g lo c a tio n w here you have, or have the p o ten tial for, a large patient flow , a second d e n tis t is m uch m ore practical than a second office location. You sh o u ld use all of the eq u ip m en t and office space you currently occupy for at least 6 days a week and 12 hours a day. Your office is not productive when empty . . . If you have an outgoing and overpow ering “ type A” personality, you obviously w o u ld n o t w an t to h ire a low-key associate. You m ay never get a lo n g p erso n ally or p ro fessio n ally , and the p atien ts w ould not be com fortable. It would help also to find an associate who has the same educational background, although strict adherence is not critical for a good p ro fessio n al re la tio n sh ip . A reasonable am ount of time should be spent in interviewing. When the contract is signed, who works w hen? O b v io u sly the o w n er-d o cto r chooses first. Evening hours are a great way for the associate to build a practice w ith in y our p ractice. T uesd ay an d T h u rsd a y ev en in g s alw ays fill fast. A lternating Saturdays is beneficial for 12 ■ JADA, Vol. 117, Ju ly 1988
both doctors. It is also beneficial to give the associate some space and freedom. T h e associate will capably carry his o r her own w eight, and p a tie n ts w ill appreciate how quickly they can get in for an a p p o in tm e n t. T h e re are m any overworked, unhappy, burned-out prac titioners who could be enjoying dentistry and th eir lives in general m uch m ore fully if they could slow dow n a pace or two and share their pot of soup. JO H N J. SAN FILIPPO, DDS WENTZVILLE, MO
we have a sacred re sp o n sib ility in delivering our highest level of care to our patients . . . A false sense of security exists when we think we are able to perform proce dures that are not commonplace in our practice. We must not minimize the roles of one another. A better sense of judgm ent will keep us from “ taking chances.” The busyness problem w ill alleviate itself as we learn, understand, and respect our various levels of expertise. ROBERT PELLECCHIA, DDS BRONX, NY
Specialist speaks out Alert glove use □ In response to the Em phasis article, “Dentistry in the ’80s: a changing mix of services” (May), I find it distressing, th at as a specialist in oral and m axil lofacial surgery, that the general prac titioners are still unaware when to refer a patient to a specialist. W ith oral and m axillofacial surgery as an exam ple, I find th a t general practitioners are doing surgical proce dures beyond th eir level of expertise. As a result, the patient receives a standard of care that does not meet the level that specialists are accustomed to deliver to their patients. T he p atien t often does not realize that a contemplated surgical procedure requires a level of so p h isti catio n beyond the scope of a general practice. . . . T o circumvent this problem, general practitioners may ask a specialist in one or all of various disciplines of dentistry to come in to their office to provide a service. T h is m ultidisciplined concept or “clin ic” cannot reach the standards of a practice that is solely dedicated to a special discipline of dentistry. Many times it is for economic reasons that a general practitioner keeps a patient w ith in the confines of the general practice. For this reason, the best interest of the p a tie n t sh o u ld alw ays be kept in proper perspective. We m ust realize
□ In the past several years, there has been a tremendous am ount of inform a tion in the literature discussing the need for dentists to wear gloves, liners, and ex am in atio n gloves. I have yet to see any w arn in g s ab o u t possible dangers of gloves used a ro u n d h ig h -sp eed equipment. We in the laboratory in dustry have known for years that gloves used around high-speed equipm ent can cause serious hand and finger twisting injuries. Doctors and their assistants should be w arned to rem ove their gloves w hen they are considering using a high-speed dental lathe to cut or pumice any type of denture, o rth o d o n tic a p p lia n c e , o r p ro sth etic appliance. Rag wheels on dental lathes are especially hazardous, as they have a tendency to grab the latex m aterial, causing the hand and fingers to twist violently . . . I hope this warning will serve to avoid or head off any possible injury to dentists or staff. MARK R. OHLENDORF, PRESIDENT OHLENDO RF CO ST. LOUIS
A shot in the arm □ As an employee health physician, I want to express my appreciation for the many excellent articles regarding hepa titis B vaccine that have appeared and continue to appear in JADA. Because of the excellent work of J ADA, there is an ongoing awareness of the av a il ability, safety, and efficacy of the hepatitis B vaccine. In review ing these articles, I am reminded of the inauguration speech of an articulate young president, John F. Kennedy, who stated: “T he journey of one th o u san d m iles begins w ith a single step. Let us begin . . . ”
A solution for burnout □ It is not always true that “more than on e chef sp o ils the s o u p .” If your appointm ent book is overscheduled, say 5 or 6 weeks ahead, even w ith a hygienist in the office, a n d you feel stressed, ex h austed , an d g en erally u n h a p p y at the end of the day, m aybe you need another chef in the kitchen to help stir y o u r b ig p o t of so u p . You may be surprised at the results. Because most dentists are enterprising in d iv id u alists—we did, after all, w ant to w ork alone, w ith o u t a “ boss,” and schedule o u r ow n h o u rs and salary — ju st the th o u g h t of an o th er dentist in the office is stressful to most of us. But, should it be? T here is a lot of young ta le n t o u t there, ju s t w a itin g to be productive, with lots of education, lots of school loans to repay, no money to start a practice, lots of am bition, and above all, a lot of energy that you once possessed. . . . Som e p ractices are p erfect for an associate. If your practice is in a large d raw in g lo c a tio n w here you have, or have the p o ten tial for, a large patient flow , a second d e n tis t is m uch m ore practical than a second office location. You sh o u ld use all of the eq u ip m en t and office space you currently occupy for at least 6 days a week and 12 hours a day. Your office is not productive when empty . . . If you have an outgoing and overpow ering “ type A” personality, you obviously w o u ld n o t w an t to h ire a low-key associate. You m ay never get a lo n g p erso n ally or p ro fessio n ally , and the p atien ts w ould not be com fortable. It would help also to find an associate who has the same educational background, although strict adherence is not critical for a good p ro fessio n al re la tio n sh ip . A reasonable am ount of time should be spent in interviewing. When the contract is signed, who works w hen? O b v io u sly the o w n er-d o cto r chooses first. Evening hours are a great way for the associate to build a practice w ith in y our p ractice. T uesd ay an d T h u rsd a y ev en in g s alw ays fill fast. A lternating Saturdays is beneficial for 12 ■ JADA, Vol. 117, Ju ly 1988
both doctors. It is also beneficial to give the associate some space and freedom. T h e associate will capably carry his o r her own w eight, and p a tie n ts w ill appreciate how quickly they can get in for an a p p o in tm e n t. T h e re are m any overworked, unhappy, burned-out prac titioners who could be enjoying dentistry and th eir lives in general m uch m ore fully if they could slow dow n a pace or two and share their pot of soup. JO H N J. SAN FILIPPO, DDS WENTZVILLE, MO
we have a sacred re sp o n sib ility in delivering our highest level of care to our patients . . . A false sense of security exists when we think we are able to perform proce dures that are not commonplace in our practice. We must not minimize the roles of one another. A better sense of judgm ent will keep us from “ taking chances.” The busyness problem w ill alleviate itself as we learn, understand, and respect our various levels of expertise. ROBERT PELLECCHIA, DDS BRONX, NY
Specialist speaks out Alert glove use □ In response to the Em phasis article, “Dentistry in the ’80s: a changing mix of services” (May), I find it distressing, th at as a specialist in oral and m axil lofacial surgery, that the general prac titioners are still unaware when to refer a patient to a specialist. W ith oral and m axillofacial surgery as an exam ple, I find th a t general practitioners are doing surgical proce dures beyond th eir level of expertise. As a result, the patient receives a standard of care that does not meet the level that specialists are accustomed to deliver to their patients. T he p atien t often does not realize that a contemplated surgical procedure requires a level of so p h isti catio n beyond the scope of a general practice. . . . T o circumvent this problem, general practitioners may ask a specialist in one or all of various disciplines of dentistry to come in to their office to provide a service. T h is m ultidisciplined concept or “clin ic” cannot reach the standards of a practice that is solely dedicated to a special discipline of dentistry. Many times it is for economic reasons that a general practitioner keeps a patient w ith in the confines of the general practice. For this reason, the best interest of the p a tie n t sh o u ld alw ays be kept in proper perspective. We m ust realize
□ In the past several years, there has been a tremendous am ount of inform a tion in the literature discussing the need for dentists to wear gloves, liners, and ex am in atio n gloves. I have yet to see any w arn in g s ab o u t possible dangers of gloves used a ro u n d h ig h -sp eed equipment. We in the laboratory in dustry have known for years that gloves used around high-speed equipm ent can cause serious hand and finger twisting injuries. Doctors and their assistants should be w arned to rem ove their gloves w hen they are considering using a high-speed dental lathe to cut or pumice any type of denture, o rth o d o n tic a p p lia n c e , o r p ro sth etic appliance. Rag wheels on dental lathes are especially hazardous, as they have a tendency to grab the latex m aterial, causing the hand and fingers to twist violently . . . I hope this warning will serve to avoid or head off any possible injury to dentists or staff. MARK R. OHLENDORF, PRESIDENT OHLENDO RF CO ST. LOUIS
A shot in the arm □ As an employee health physician, I want to express my appreciation for the many excellent articles regarding hepa titis B vaccine that have appeared and continue to appear in JADA. Because of the excellent work of J ADA, there is an ongoing awareness of the av a il ability, safety, and efficacy of the hepatitis B vaccine. In review ing these articles, I am reminded of the inauguration speech of an articulate young president, John F. Kennedy, who stated: “T he journey of one th o u san d m iles begins w ith a single step. Let us begin . . . ”