Microsoft

It is fairly late in the evening tonight and I am working on my presentation for our annual HIPAA update for the staff coming up and I was updating our risk assessment for catastrophe recovery under HIPAA. We actually have six backups for our computer. We have mirrored hard drives on our server, we have what is called a NAS which is a solid state drive which backs up our server every minute which is actually 2 hard drives in it, which are also mirrored. We have a remote storage facility at McClellan Air Force base in one of their secured buildings for the old Military base that is backed up every night and then we have encrypted cloud storage making for a total of six back up procedures so that your personal health information is secured and recoverable in case of a catastrophe. As I am working on this it reminded me of an old engineering joke that my father told me a few years back. The story goes that there is an engineering conference and as with most conferences all the engineers are staying at a local hotel and they have to go to the convention center and they are transported there by a convention bus. So these 3 engineers get up in the morning and go down and get on the bus. Before they reach the convention center the bus breaks down and the first engineer jumps up says I am mechanical engineer I know this is a mechanical problem I have my tool bag right here I am going to go out and fix it. The 2^nd engineer jumps up says I think this is an electrical problem I know how to fix it he grabs his tool bag and runs off the bus to go fix it. The 3^rd engineer is a Microsoft certified engineer and he is simply sitting in his chair and yells out at the other engineers don’t go to all the trouble this is a computer problem everyone just gets off the bus and gets back on the bus and starts up and we go on to the convention. Obviously this is meant to be an extreme version of the story but it is part of modern society and the reason that we have six backups for recovery of all of your protected health information which includes obviously all the documentation of all the different procedures that we have done on you. Hopefully we never have to use any of our catastrophe recovery tools and we can just ride on the bus over to the convention center without having to get off. See you at our next blog.

Periodontics

I had the unique experience the other day of having a meeting with the periodontal group that we do most of our referrals with. Capitol Periodontal Group came by the office for a meet and greet. Most of the senior members of that group which I have been working with for the last 40 years have retired. Dr. Angel, Dr. Roberts, Dr. Hogan were some of the original owners. The 2^nd generation,Dr. Lane and Dr. Berrin have retired leading me to the 3^rd generation of seniors in the practice. Dr. Towfighi and Dr. Pretel. I had not had the opportunity to meet several of the younger members of their group (the 4th generation), so Dr. Towfighi said he would bring over some of the members to my office for lunch. I was shocked when everyone came. There was a group of 10 of us all sitting around talking about the differences of the new procedures in Periodontics. One of the topics was the new LANAP procedure which stands for Laser Assisted New Attachment Procedure. They reviewed the procedure with me and as one of the comments that I heard was that it is the “Holy Grail of periodontics” because it actually allows new bone to generate and new gum tissue to generate around infected and periodontally diseased teeth. This puts into question one of my periodontal instructors at UCLA, Dr. Takie, whose favorite phrase was  “you show more or have them no more” which means that you did gum tissue reduction to eliminate periodontal pockets in order to save your teeth. That process can lead to substantial issues associated with post-op sensitivity and additional decay problems. The new LANAP procedure however allows patients to avoid all these issues. This is obviously a new procedure it has only recently received FDA approval in 2015 and so it will be interesting to see how valuable this process is. The reason that I am mentioning all this is we have a large number of patients that I think can benefit from this process and so don’t be surprised if you hear our hygienist mention it. Hopefully it will truly become the “holy grail” and we will be able to save a lot more teeth.

Government Regulations

In my mind, there is no question that government continues to intrude on our lives more and more. Whenever we have a new patient come into the office, because of government rules, we have to electronically sign all the different forms that the government requires us to have. These are primarily part of HIPAA, the Health Insurance Portability and Accountability Act. And although it may seem like a pain in the neck, they are the government's way of protecting us from ourselves. Often times I will have patient's comment to me about the number of forms they have to sign and I relate to them that it is similar to buying a car or buying a house or signing that crazy contract with Apple when they are upgrading our software. These are forms that are drawn up by a team of attorneys you never really want to read, but it is probably better for you if you do. In our particular situation when the patients get a little frustrated in signing the forms my comment to them is usually the same, “the government will protect you from everything ill that will ever happen to you,. All you have to do is sign away all of your rights and give them all your money.” That is meant as a joke, but the way things are going it really seems like there may be a lot of truth in saying that. It certainly will be interesting to see how our next presidential election works out in November.  It will definitely give us some indication as to the direction that we are heading in our country. In my opinion, hopefully government does not get any more intrusive than it already is. By the way, having reached Medicare age I'm wondering how I managed to survive so long.  

Stress Test

One of the best aspects of aging is that you see life in different perspectives over a period of years. After doing dentistry for 40 years I have certainly seen a lot of interesting things that primarily has brought me great joy. However, getting old comes with a cost. One of those costs, interesting enough is having your wife yell at you about getting a cardiac stress test done. You know that when you go to the doctor and they put you on a treadmill and increase the speed and inclination to get your heart rate up to see the overall condition of your heart. I got the pleasure of participating in a stress test a few weeks ago after having my wife yell at me for a number of months about it. I went to the doctor’s office the cardiologist checked my medical vitals before I got started and then she gave me over to the technician to perform the stress test. There are 7 levels to the stress test I did get through 5 of them with my heart rate getting up to over 180. When we were on the 3^rd level I noticed that the inclination was starting to get to me a little bit so I asked the technician if he ever had anyone pass out while taking the stress test. He indicated that very morning he had a patient go into cardiac arrest while doing a similar stress test. Fortunately, with the cardiologist right there the patient did survive but it did certainly make me wonder about my own mortality and perhaps gave me a little bit more desire to perform well on the stress test. Interesting enough the technician came in a couple of days later as a new patient to our office and we were reminiscing about my adventure at his office. I am anticipating that his adventure in our dental office will be as much of a success as mine was at his and not like the other guy's.  Hopefully I'll see you on my next blog.  

Old sayings

It is time to continue my "old sayings" blogs. This time it is 1972 UCLA School of Dentistry's Dr. Jennet. He was my group director and practiced dentistry for years in Portland, Oregon. He retired and I was blessed to have him as my clinical instructor for my 4 years at UCLA. Based on his experiences in private practice and at UCLA he was able to observe dentistry from several different angles. Thus his wealth of old sayings was substantial. How about one of my favorites first “Dentistry is not expensive, Neglect is.” That is even more true in 2016 than it was in 1972. If you want to "feel good" you need to take care of yourself, and that includes your teeth! Don’t ignore your symptoms is what Dr. Jennet was trying to get through, if you do it will cost you time, energy and probably a lot of money to fix a problem that should never of occurred. To that end old saying #2 comes to mind.  “You only have to floss the teeth you want to keep.” What he was saying is also part of his old saying #3, “there is nothing better for you than a little appropriate oral hygiene.” Obviously, Dr. Jennet like myself, lived and breathed dentistry. But I firmly believe he did not like being in the dental chair any more than I do today. Which leads me to his 4th saying “dentistry is like Christmas, it is better to give than to receive,” You have to admit he did have a weird sense of humor. See you at my next blog.

Life's Mission Statement

Almost 15 years ago I came to the conclusion that our government’s efforts to control every aspect of our life was becoming so oppressive that as a small business person it was impossible for me to keep up with all new government regulations.  We opted to hire a staff outsourcing company called Staff Resources who would handle all of our human resources needs and essentially I would be “leasing” my staff from staff resources. Jo, our HR representative from Staff Resources, was in charge of general supervision of our practice. She instilled in me the necessity of equal treatment for everyone in the practice. I could not play favorites with staff members. I had a close working relationship with staff members. We have worked with this concept for many years and it has serviced us well which brings me to the reason for this blog. In contemplating this concept of fairness for all I came up many years ago with my life’s mission statement so I thought I would write it down and it has been in my file ever since and I thought I would now blog it.

 My life’s mission statement reads “I believe that I have a responsibility to be a good person by that I mean fair, honest, hardworking and honorable. If I do that, if I am good to my family, fair to my staff and patients, true to my friends. If I give back to the community, if I am not a liar, a cheat or a thief then I believe that should be good enough. At the end of the day if there is indeed somebody or presence standing there to judge me, I hope that I will be judged on whether I lived that true life and not whether I worshiped a certain “God.”

 Even though I wrote this many years ago, I believe it is as true today as when we first hired on Jo from Staff Resources to verify that we are “fair” to all of our staff. See you on our next blog. 

Digital Radiographs

We at Boulevard Family Dentistry have been using panoramic x-rays for 24 years to help us diagnose an extended range of potential oral conditions.  These were originally done with analog x-ray film which we ran through an x-ray processor.  That was a great process but had certainly many limitations.  We converted our panoramic x-ray in 2002 retrofitting it for digital x-rays that substantially lowered our patients x-ray exposure levels and improving the image quality.  To take that to the next level, we opted to replace our Gendex panoramic x-ray with a brand new state-of-the-art Orthopantomograph OP30 digital panoramic x-ray unit.  It provides us with many upgrades which benefits us as diagnosticians and the patient with increased diagnostic capabilities.  For the patients that means radiation exposure that is half of what it was with the analog machine.  A total of 10 seconds exposure compared to 20 seconds, that is more that 4 times better than the old analog pano.  Our patients with severe gag reflex or large tori or fearful young patients, the new panoramic x-ray offers external bite-wing radiographs for diagnosing cavities with no x-ray film in the mouth.  We can do temporomandibular joint targeted exposures for better TMJ dysfunction diagnostic capabilities and we have state-of-the-art image quality.  This leads us to a win/win situation for the patients, staff and for our diagnostic capabilities.  We will continue to strive to update our office with the latest state-of-the-art techniques and equipment as always trying to give the best possible care to our large family of patients.