Doctor, What Are You Ashamed Of?

Years ago, in Dallas (or maybe it was St. Louis, Rochester, or Waukesha), I kicked off a dental CE presentation by asking everyone to “Raise your hands if you screen all your patients for oral cancer.”

Each hand went up. Every one of them.

“How many of you with your hands up have detected a lesion in the last 12 months?” Almost every hand went down. In a room full of 30 dentists, two hands were still up.

My next question. “Of you two with your hands up, have you detected more than one squamous cell carcinoma in the past year?” Both hands went down.

Then I inquired about why they screened every single one of their adult patients for something that affected just .0001% of adult Americans. Several people rapidly responded like there was a free trip to Fiji on the line, “Because we’re in the oral cavity already. We care for our patients, and this could save their lives. And it’s the standard of care in our practice.”

Continuing the role of interlocutor I asked, “Show of hands one more time. How many of you screen all your adult patients for sleep disordered breathing?” Only three hands went up this time. That was more than usual. 

Similar line of questioning. “How many of you with your hands up have detected at least one patient with SDB in the past year?” All three hands remained up. 

“How many of you have seen at least five in the last year?” They chuckled. “I saw five just yesterday. Big tongue on one. Another that doesn’t like her CPAP!”, one dentist exclaimed. The other two collegially chimed in with similar observations.

The crowd participation portion continued when I asked why they screen their patients for SDB. Like the answer was glaringly obvious, Dr. Five scoffed, “Just like oral cancer screenings, we’re in the mouth already. We care about our patients, and it can be deadly. We can do something about it. It’s the standard of care in our practice.”

I could see the lightbulbs going off. The room was aglow now. Heads nodded. To drive the crucial nail home, I remarked, “Admirably, everyone in here is screening their patients for a potentially deadly disease that impacts far less than 1% of the population. You’re doing this because you’re altruistic. You care about your patients. You’re in their mouths already and it’s the standard of care. Discovering something and referring a patient for a biopsy could save their lives. Is that correct?”

Heads nodded. Absolutely. Amen. Preach, Brother Jason.

“There’s another disease that affects 25% of the population. You can easily screen for it and identify signs in the oral cavity. You care about your patients and could save their lives. According to the ADA, it is the standard of care. So why aren’t you doing it?”

Silence. The silence of processing information, chewing on it, and preparing to take action.

“One more question for the three of you that are screening all your patients for sleep disordered breathing. Are there any other reasons you screen those patients?”

Silence. But this is a silence of a different kind. This is sheepishness. Uncertainty. Trepidation about giving the wrong answer. They were in 2nd grade all over again. 

Like the sadistic teacher we all dreaded, I singled out one of the three whose hands remained up. “Any other reasons, Doctor? You care about your patients. It’s the standard of care. You’re in the oral cavity so this is in your scope of practice. What else?”

One dentist muttered something. Maybe it wasn’t a dentist at all. It sounded more like a mime, it was so quiet. 

“What was that?” I asked like I was trying to hear the strange intermittent sound the car isn’t supposed to be making.

“Mooblysh”, she stammered. At least that’s what it sounded like. 

“Can you repeat that, Doctor?”

With trembling hands, she said, “Money. It can be very profitable.” She was opening up and her confidence increased as she spoke, “It really requires little of my time, we get paid really well for it, and I actually enjoy doing it. The response from patients is unlike anything else. And like I said, we get reimbursed really well in some cases.”

That’s what I was looking for. 

In no other business, are people ashamed to make money. Athletes aren’t. Rappers certainly aren’t. Religious institutions aren’t either. You certainly shouldn’t be.

Dental Sleep Medicine is about caring for patients. But it is a business. Done the right way, it can be a very profitable business. This is a vocation. Commit to it. Or else you’re just an amateur. A dabbler.

Maybe this isn’t for you. I guess that’s OK (not really – patients need you!), but it is consequential that you be honest with yourself now. Consider why you’re involved in Dental Sleep Medicine. It’s just you and your reflection in the mirror. You can tell the world whatever tale you want but be totally honest with yourself. Why are you doing this? 

Let’s run through an exercise that might help you. Force rank the following reasons for DSM in your practice. 1 is most important. 7 is least important. 

_____ Help my patients

_____ Should be the standard of care

_____ Seems interesting

_____ Increase revenue

_____ Have a personal story or know someone who does

_____ Differentiate the practice

_____ Other

If you ranked “Increase revenue” 1 or 2, you will probably flounder, flail, fail, and bail. Don’t waste your time, energy, or money going along for the ride. Go get on the clear aligner bus.

In the brilliant War of Art, Steven Pressfield writes, “Technically the professional takes money. Technically the professional plays for pay. But in the end, he does it for love.”

That’s you. You’re a professional. Keep screening your patients. Keep meeting with physicians. Continue developing your team.

Generate a vision. Outline the path. Delegate appropriately. Execute. Evaluate what’s working and what isn’t. Pivot as necessary.

You just might save lots of lives and make lots of money. 

If that last sentence bothered you, read it again. You have to get comfortable with it.

To learn more about how you can improve your Dental Sleep Medicine practice whether you’re new to the field or a seasoned vet, please subscribe to my free newsletter and pre-order a copy of my new book that will be available in hardcover, paperback, and ebook on January 24, 2023. I appreciate you.