Yucky but Useful

Have you ever been in that uncomfortable situation where you feel like you might need to report something to either the state board or even the police? This episode digs into an incredibly yucky topic, but the information provided should make it useful for any listener. Dr. Kuba and Bethany shift through many of the various situations that can come across your plate that might necessitate you filing a complaint or taking some type of action. Dr. Kuba and Bethany remind listeners of other actions that people can take if they determine not to publicly file a complaint. Get your vomit bags ready!! 

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Transcript

00:01
Are you looking for a podcast where you can hear from real people regarding their real dental drama? If so, then you've come to the right place.

00:11
Join hosts Bethany Penny and Dr. Reena Kuba as we dive into the solutions we've created and the mistakes we've made while managing dental drama.

00:22
Let's get started.

What's up, friend?

How are you?

Good. How are you?

00:27
Good. You doing okay with me practically sitting in your lap over there?

00:30
I mean, you can... [laughter] You can say we've grown close through this podcast, but nothing like today.

00:38
Yes, we are having technical issues with our mic, and hopefully sound quality will be, you know, okay. [laughter]

00:46
If not, we're getting some good cuddle time in here.

00:51
Oh, if only we had a picture to show how close we actually are. Anywho, okay, so we've got a yucky topic today. Are you ready?

01:00
I'm ready because I, per usual, I don't have any suggestions.

You do.

Oh, but you do.

01:08
Oh, no. I got the stories. I just don't have the suggestions. And this is where I turn to you and go, "What do I do in this situation?"

01:16
You ready?

I'm ready.

01:18
Okay. So, what do you do if you feel like you...

01:24
...either need to report somebody to the board or, even more, I guess, benign than that...

01:32
...that is, if you don't like the work that you're seeing. So, I think where this is extra...

01:39
...yucky to me is, um, the fact that I've always been like, we...

01:46
...need to be very careful as a profession when we comment about somebody else's work. Like, why would they leave that...

01:54
...margin that way? Or what kind of treatment plan was that? Why would they... whatever, right? So, like, I don't know why...

02:02
...people do that to each other. Even if you're a competitor down the road, to talk bad about somebody's treatment plan or their office or their whatever is...

02:11
...detrimental to the whole profession because somebody's doing it to you about your work and about your treatment plan.

02:16
So, make no mistake. Like, you know, I've always been very, very weary of that...

02:23
...of anybody making a board complaint or how much of that stemmed from colleague to colleague.

Mm-hmm.

02:30
And I think we need to be very careful with that.

Yes.

02:33
Um, but then there are cases where you're like, "Okay, I don't mean to judge so-and-so. Like, I've seen this coming from their...

02:42
...office, and I don't know the circumstance. Was the parent a lunatic and demanding things? Was the kid a little, you know...

02:49
...was it a show getting this work done?

02:52
Um, we struggle getting a cleaning done on the kids. So I can only imagine, you know, how ortho got an expander in it...

02:59
...right? Like, so I... But then there comes a point where it's like you're like, "Okay, this is not just a one-off. This is how...

03:06
...this person treatment plans, or this is how this person, um, how their work is...

03:13
...presenting, and I don't like it. Now, am I going to judge? It's hard not to. And so...

03:22
...for me, I would prefer just to stay in my lane, bury my head, not think about it.

03:27
I think the problem comes when, if you do work where you are cross-referring and you are working...

03:36
...where you're seeing a lot of this, what is my obligation? Can I keep burying my head? Should I keep burying my head?

03:43
Like, what do I do? Um, so do you want me to just jump into examples, or do you...

03:51
Yeah, I think paint an example of what you might be talking about where you're in a position where it's hard to...

04:00
...keep looking away and you're trying to figure out, "What's my responsibility in this?"

04:04
Okay. So, I have two examples, and I think this is, you know... I think both of my examples are, um, you know, from like, oh...

04:13
...as the specialist, you tend to see these things. But I think this is very common in everyday, like even general practice...

04:20
...to general practice. Um, so yeah, I think that's where, to me, it's like it could get tricky, but at the...

04:28
...same time... Anyway, let me just, like you said, jump into this example. [snorts] Um, so in my example, if it is a...

04:38
...um, well, you know, I'm in a very metroplex transient area where offices kind of come and go.

04:47
A lot of people retiring, new people buy their practices, things like that. So what do you do when, in my case, in this...

04:54
...scenario, um, an orthodontist that is in the community and, um, you know...

05:03
...you see one or two where you're like, "Man, that's kind of an odd result. Like, why did they finish the case and consider that case done?"

05:11
Or, "Man, that's a yucky retainer. How do they expect the patient to keep that clean?"

05:19
Or, you know, "This is the third expander now that I've seen that really doesn't look clean."

05:30
Um, so, you know, the first one or two where you're like, "Okay, you know, maybe the kid was really difficult to get this...

05:38
...expander on. I could see that." But now you're like, "Now I'm on the fourth or fifth one, and I know this kid is not...

05:46
...you know, this kid cooperates and doesn't struggle with being a good patient. Why does this expander... Why is there glue everywhere on this expander?"

05:54
And so it does make you start going...

Yeah.

05:58
Okay. Like, to the point where I'm like, "Oh, I can tell who the orthodontist is because this is the quality that you're used to seeing."

06:08
Right. And now I'm like, "Okay, I don't know these other three orthodontists that I've typically worked with. This is not what their work looks like."

06:17
Um, so what do I do? Do I... You know, this practitioner is newer in the community and, you know, you like to...

06:25
...support newer, and they're doing a lot of advertising. So, um, patients are going there and asking my opinion.

06:35
What do I do? Gosh, that's hard. What do I do with this?

06:39
Yeah, because to me, in this particular case, especially you being pediatric, um, that you're working very closely with...

06:47
...the orthodontist. And so you're trying to figure out, for your patients, how do you handle that? Especially if they've seen all this advertisement, you're...

06:56
...saying, "Hey, let's get you set up with an orthodontist." And, um, ultimately, you have to try to figure out how do I...

07:04
...say to this person, "I might not recommend this orthodontist." So you're in a tricky situation just parent-to-doc communication.

07:11
But then also, if this becomes so prevalent that now we've got pretty major issues coming out of subpar...

07:19
...care, then we take it even further and go, at what point, colleague to colleague, do...

07:26
...we bring up clinical concerns? So, to me, it's twofold. How do we talk to a...

07:34
...patient about somebody that we might not recommend? And then also, is there any point where we need to actually take...

07:41
...this further? Like, when do we report somebody to the state board?

07:46
Right. And so, in this case, I'm not seeing anything reportable, but I think, to your point, yes.

07:52
So, with one of the colleagues, um, I did reach out because I saw some appliances...

08:00
...being put on a certain way that I was like, "This is weird. I don't like it."

08:06
To the point where if my hygienist is like, "We can't clean this patient because the brackets are placed oddly."

08:15
Um, how is the patient keeping this clean at home, and why did they approach it this way? To where I finally was like...

08:23
..."Okay, let me ask the provider and be like, 'What is this? What is this?'" And now, if the provider is like, "Oh no, this is a...

08:29
...technique, and it's being used, you know, and taught in these programs, and this is the reason why." So, to me...

08:38
...I'm like, "Okay, so you're not just putting brackets on in this haphazard way to be lazy or whatever."

08:48
There, you have a reason, a rationale, and can go back to evidence-based...

08:55
...rationale why. But at the end of the day, I don't like it. Like, I don't like it. I'm not used to seeing it. I don't...

09:02
...see how it's... I can see how it may help move teeth a certain way, but it's doing no good if this kid comes out of braces...

09:10
...and has 15 facial lesions now because they couldn't keep their teeth clean.

09:15
So now I'm like, okay, is this a philosophy difference? And then do I... am I dictating what he should do?

09:24
Do I say, "Hey, man, I don't like your work anymore. I'm going to quit referring to you." Do I silently quit referring?

09:31
Do I... what am I doing?

09:35
Oh, that's so hard because, again, they have their own reason for whatever they're doing, but you disagree with that reasoning. So it's like, who are you to then go and tell the orthodontist, "Hey, buddy, I don't like it done this way," when you're not the orthodontist? But at the same time, you're seeing it from your vantage point as a pediatric dentist and the issues it's causing your patients.

10:03
Absolutely. That's challenging. Or even, it would almost be like the GP that refers to me and is like...

10:11
..."You keep putting these stainless steel crowns, and I think that's overtreatment." And me going, "Well, the kid is four and has, you know...

10:20
...MODO lesions everywhere, and their hygiene is... you know, there's plaque everywhere. I'm not going to put fillings that I know are going to fail...

10:28
...in a year or two, and then we're going to be back to either crowning at that point or extracting at that point. And this four-year-old is probably going to need...

10:35
...a sedative of some sort to get them through these eight restorations."

10:40
So I'm trying to look at the big picture, and the GP going, "You're full of... You just want to do your crowns because it's easier on you, and I'm not...

10:48
...referring to you anymore." I mean, I guess in that case, yeah, I don't want that person's referrals because they're trying to tell me how to practice.

10:56
Which, so to me, then maybe the answer is I just kind of quietly stop referring patients to this orthodontist. But, you know...

11:04
...is he going to see that there's a drop-off and then come question me? And if he does, is that where I need to say, "Hey, man, I really don't like the way..."

11:12
...these things are. But then am I making an enemy in the community? You know, like, I don't know how to...

11:20
That's so tricky on multiple levels to me, knowing I represent...

11:27
...specialists, and I know they would want to hear the feedback, but it's...

11:35
...it's one thing to give feedback on, like, "By the way, we keep getting complaints about your treatment coordinator."

11:43
So, just wanted to let you know, buddy, that, hey, Barbara keeps running your patients off, and you should know that. That's different, and I feel like that's really...

11:52
...easy, relatively easy feedback to give when you see...

12:00
...okay, by the way, you're trying this new technique, and I hate it. And I know clinically you've got your rationale for...

12:07
...it. To me, that's like... I don't know. That's such a challenging conversation to have because, to me, that's not feedback. That's you challenging their clinical expertise.

12:18
Yes. And so I guess that's my question.

12:20
What do I do? Do I just not challenge it and just quit referring? Is that probably what most of us are going to...

12:28
...tend to do? And if that's what I tend to do, is that wrong to do that?

12:32
I think there needs to be dialogue on it, which is the harder suggestion here. The easier suggestion is there's...

12:40
...especially in your area, there's plenty of referrals. There's plenty of other orthodontists that you can refer...

12:46
...to. So you don't need this orthodontist particularly. At the same time, I feel like, as professionals, we should always...

12:54
...be open to even being clinically challenged. Like, "Hey, why do you pediatric dentists not like this new technique?"

13:03
I want to know about that. Now, your buddy, the orthodontist, may still say, "Hey, no, I'm sticking to it."

Which is what he said.

13:12
That's what he said.

13:13
He's like, "Oh, no. This is..." You know, I was like, "Okay. Well, I just then encourage you to really document all of the conversations you have about...

13:22
...the hygiene." Because he said something like, "Oh, yeah. No, my team, you know, we talk about hygiene at every visit."

And I mean, okay, but I hope you're writing that down.

13:31
Yeah.

Because protect yourself then.

13:33
Yeah. So to me, if you've had that conversation and your buddy's like, "Yeah. No. This is what I'm doing."

13:40
And from your vantage point, that's not advantageous to the patient, then yes, I would say quietly quit referring...

13:49
...because you've brought it to their attention, and they're... So it would be wrong, right, for me to say, "Well, I...

13:57
...don't want that on any of my patients."

Yeah. Like, I can't. If that's their clinical judgment is the best way to proceed, is to proceed that way.

14:08
Um, and I just don't like it. I shouldn't dictate the treatment. It would be like a general dentist telling me I don't want stainless steel crowns...

14:15
...on any of my patients. And me going, "Oh, okay. Well then, in your case, for your patients, I'll do all these fillings that I normally wouldn't do."

Yeah.

14:23
I'd probably just be like, "Well then, don't send me any patients."

I agree completely.

Yeah.

I would say, to me, you can't dictate then.

14:31
Unfortunately, you can't control either.

14:33
Like, your parents are going to choose the orthodontist. You're going to refer them to the ones that you prefer. That doesn't always mean that...

14:41
...they're going to go to the ones that you prefer, which then means you may still be looking at this situation where you're like, "Ah, gosh, I've got one...

14:50
...here that I don't like the way that the orthodontist did it because they chose this orthodontist." So you can control your referrals, but you can't control...

14:58
...where the parent ultimately goes. So you're still going to see these situations that irritate you, but you're not actively referring to that...

15:06
...orthodontist. That, to me, would be, you did the right thing. You brought it to your referral's attention and said, "These...

15:13
...are the issues that I'm seeing with it." Your referral said, "Yeah, there's clinical reasons that I'm doing it that way, so I'm going to do it that way."

15:22
And you tucked away and said, "Okay. Well then, I'm not going to actively refer."

Yeah.

15:29
Okay. That sounds fair.

Which, I mean, I think it'll be a slow enough trickle. It might take a year or two for him to realize that I'm not really referring patients anymore.

15:38
Yeah.

To him.

15:39
So I probably have a year or two buffer before he kind of realizes that.

Yeah.

Yeah.

15:45
Okay. You ready for situation number two?

15:47
Yeah. Ready.

Luckily, this one's not mine, but it's just, you know, when you go to study clubs and whatever, you talk amongst yourselves.

15:56
Funny enough, another orthodontist in the group, so he said...

16:03
...something basically like there's a general dentist in the community, and I think...

16:12
...why people do this to each other, I don't know because it's just tacky.

16:16
It's tacky. But, like, for example, the general dentist that... those of y'all that do Invisalign and do all of that...

16:24
...but then you send your spouse, your sister, your children to the orthodontist.

16:29
I don't like that. I'm just going to say it. I know a lot of you do it. Y'all can be mad at me, but I think that's a shitty thing to do.

Like, or general dentists that ask me to see their kids, but you don't send me any other kids.

16:37
You call yourself family dental, and so you see kids, and you'll do stainless steel crowns and you'll do things on other kids.

16:52
I can see where it's like you're going, "My kid's not going to cooperate with me."

16:56
That I see. Like, fair. But if you've got an associate or two and somebody's taking care of...

17:04
...that kid, then why don't you let the associate see your kid? So for your kid, you want a board-certified pediatric dentist. For your kid, or your...

17:12
...spouse or your sister, you want a board-certified orthodontist. But for your patients, you, with your general degree and your, you know, whatever experiences...

17:19
...isn't... Like, I don't like that. I don't think that that's fair. Now, again, I may be pissing a lot...

17:28
...of people off, but if you see kids and you see your own sister for Invisalign, all that, I'm not talking about you. I'm talking about the...

17:35
...people who are taking on cases that they wouldn't do for their own family members. And I don't agree with that.

Anyway, so we've got a...

17:44
...practitioner in the community. And funny enough, I think that's why this orthodontist came to me because this is a general dentist who lets me see his kids, who has asked to borrow pediatric-specific supplies from me because he doesn't have them in his office.

17:59
So instead of referring the kid to me, he sees those kids himself in the community, borrowing my materials or my equipment.

18:08
Um, and he's done the same to the orthodontist where he does orthodontics in his office, but then his kids...

18:16
...sends to the orthodontist. [snorts] And I guess he has also, um, in a couple of cases that he couldn't...

18:24
...finish out, whatever them... I don't know exactly. I don't know if they were Invisalign cases. I don't know if they were actual ortho, um, brackets...

18:33
...and all of that. I don't know to what degree his orthodontics is, but all I know is he's not an orthodontist. He's a general dentist. Um, and he calls the...

18:42
...orthodontist in town and has had his patients go to the orthodontist to go, like, see what that orthodontist would...

18:50
...do to finish this case the way you want it done. My question is, how do you get to where the patient even comes back to you?

18:59
Yeah. How does that conversation... I'm not that slick to even figure out. Do I tell the patient and say, "Well, go ask the orthodontist what they would do so that...

19:08
...I can..." How would the patient not go, "Wait a minute. Why do you not know how to do this? And the specialist... so you want me to go get the tools and tricks from...

19:16
...the orthodontist and then you carry it out?" I don't even know how he puts the patient under his spell to be able to do that, but he apparently has.

19:24
Um, and I don't know if the patient just really doesn't know. Like, maybe they think the orthodontists only see kids, or maybe they think that there are...

19:34
...special cases that an orthodontist sees that they don't need to go that route necessarily. But, um...

19:41
...wow. Would it be like, I'm the GP and, uh, you know, go see the cardiologist because I can't get your blood pressure...

19:49
...under control, but go see what meds they would do. But you don't need to go to the cardiologist because you don't need surgery, but we just need to know what they would do. Like, how do you even spin that?

19:57
Yeah. Anyway, he's managed to spin it, um, and to where now he's sent this...

20:04
...orthodontist three or four patients where he'll get him to consult and to say, "This is what I would do to finish...

20:12
...out this case and have a better result." And then the patients don't stay with him. They go back to the GP, and then he does whatever. So, I could be getting...

20:22
...some of that wrong, but that's my understanding of the story that was shared with you.

20:28
So, the orthodontist, you know, last time we met at study club or whatever, he's like, "Oh gosh, I've got another one for you."

20:36
He's like, "This patient came in, and, like, for a board-certified orthodontist, it's a very complex case because it's an adult that really needs...

20:43
...orthognathic surgery to get the bite right and to do whatever." And I guess she ended up at this GP's office. Maybe...

20:51
...he's her GP. And, um, she said she basically wanted her teeth straighter.

21:01
And so GP's like, "Yes, we can do that for you." And I think did Invisalign and, you know, finished the case. Took a year...

21:09
...and a half, two years, aligned the teeth, whatever. Well, now I don't know how the patient found the orthodontist, but she ends up at the orthodontist, and...

21:17
...she's like, "My back teeth don't touch together anymore, and my front teeth are getting loose."

21:25
And so the orthodontist is like, "Oh my God."

21:32
And he's like, this case, by just aligning the teeth, the GP has totally ruined her occlusion, and to the point now where all of her...

21:40
...forces are on eight and nine. So no wonder eight and nine are mobile.

Yeah.

21:45
Um, the lady does not have periodontal disease. She's not old. She's like, whatever.

21:51
But she's astute enough to realize that something ain't right. And I guess she's talked to the GP about it, and the GP's like, "No, no, no. You're fine. Everything's...

21:58
...good," like whatever. So the orthodontist is now going, "Okay, at what point do I..."

22:05
...this is like a case that this patient is in harm's way.

Yeah.

22:12
Really needs, like, another two to three years of ortho to undo what the GP did and at least get her back to baseline, which baseline wasn't great, but it's better...

22:21
...than where she is now before she loses eight and nine. Like, talk about aligning teeth...

22:26
...and now you're like, "Okay, well, you know, you spent all this time and money aligning two teeth that are now going to fall out," you know?

22:34
So I'm like... he's like, "I don't know what to do with this."

Yeah.

22:37
I don't know. And I'm like, "Dude, I don't know what to do with that either. Like, do you report this person to the board? Do you suggest the patient report...

22:44
...it to the board? What do you do?"

Oh my gosh.

22:51
And so I didn't have an answer for him. I was like, "I have no idea what to do. Can I go bury my head again? I do not want to deal with this."

And he's like, "Well, what should I do?"

And I'm like, "Dude, I don't know. I don't know what you should do. I'll ask Bethany."

23:00
So here I am asking Bethany, what does he do in this case?

23:04
Oh my gosh. This is, to me, again, where I want to vomit because I...

23:11
...know you're the exact same way. My whole mission in life is to protect dentists, to...

23:18
...try and get them to protect themselves. And so, here you go. You've got this. Unfortunately, in this case...

23:26
...there's so much history with this particular doctor and the fact that he sends his kids to you, he sends his family members, you know, to the...

23:33
...orthodontist, but then does all these things himself that it makes the waters even more murky because if this...

23:40
...were a standalone case and you're like, "There must be something to this case that I'm not seeing or not understanding."

23:49
First of all, the clinical outcome is obviously horrendous, so it's a terrible case and could absolutely be reported to the board regardless.

23:56
But you're like, "Oh, if this is a one-off thing, I want to know more about this before I take this to the next level," which is...

24:03
...what I would typically recommend. If you're seeing this as a one-off, okay.

24:11
If this is a pattern, if you see this guy's patients or you've seen several and they all look clinically not good, then, to me, we have a responsibility to the general public to protect patients.

24:22
I'm going to say I don't think I could... I don't think I would put myself in that line of fire. I don't think you necessarily need to report, but you need to be able to have an honest...

24:31
...conversation with the patient that says, "By the way, here's clinically what I'm seeing. I don't know all the conversations that you and your dentist...

24:39
...had. I want you to go back and dialogue for sure, but just know that right now you're in a very compromised position."

24:47
And you never want to disparage the other doctor, to your earlier point.

24:53
We've got to be careful about that. But you've got to let the patient know. It's your responsibility to let the patient know they're in a very precarious situation.

25:01
I think the orthodontist did that. And at this point, though, he didn't know who the previous provider was.

25:09
Yeah.

25:10
He's like, "Look, from what I can see now, you know, I don't know where you started, but from the way it looks, you probably started where you were here. You probably needed jaw surgery."

25:17
And I think the lady said, "Yes, I think I've been told that when I was younger," whatever.

25:25
And he's like, "So, this is what you need to do now, and you need at least another two to three years, and you need... Were you ever in elastics?"

"No, I wasn't."

"Okay, that's at a bare minimum. You need to do this."

25:33
And so he's like, "I would take that back to your GP, and if they want my help in guiding them through that, I can help with that."

Well, then that's when she said the GP's name.

25:41
And he's like, "Oh, for sake." Like, why am I not surprised that that's who you saw?

25:54
Um, and so I think... and I think he did have a conversation with the GP, and the GP was like, "Well, I don't know why she's...

26:03
...upset. She wanted her teeth aligned, and that's what we gave her."

26:07
So it's almost like... and you know what? I was like, you know, I hear that quite a bit when I do my consulting for different things.

Like, "Well, she knew I wasn't an orthodontist. She knew that I wasn't going to do jaw surgery.

26:17
This is what she wanted. This is what she consented to. This is what I said I could do."

I think it takes me back. Actually, I could get myself in trouble here.

26:26
There was a chain that was on, um, I think everybody probably knows what I'm talking about, where you could...

26:34
...just walk in and get your aligners. And I think that was the crux of all of that, is that from that company's viewpoint, it's like, well, the...

26:43
...patient knows that we are just making aligners. But patients were getting really not good results because...

26:52
...they didn't really know what they were asking for.

26:54
Yeah. [snorts]

And so, um... and patients shouldn't know what they're asking for, ultimately. I mean, not clinically.

27:03
They know the outcome that they're looking for. So this lady wanted straight teeth, which is probably what she communicated to the GP. GP says...

27:11
..."can give you straight teeth." She assumes straight teeth is also going to mean she can chew food.

27:18
Right.

Yes.

And not lose her front teeth.

Correct.

27:21
Right. So, you know, um, so I'm not saying it has to be the orthodontist that reports this guy.

27:30
I just think he has a responsibility to make sure this patient knows the situation that she's in, and then the patient...

27:39
...can decide what she does with that information.

27:41
So, I guess that's what I wanted to know from your side was, I think that's exactly what the orthodontist did. My question was, at what point...

27:53
Yeah.

27:53
...if he never reports to the board, I never report to the board just because I'm just like, what goes around comes around.

28:00
If I report something, is somebody going to report me? Am I opening myself up to this? You know what I mean? Like this world of karmic whatever.

28:07
Um, and I really don't.

28:10
But at the same time, to your point, is the job to protect our patients in the community? But I guess my question is, well, how far do I have to go to do...

28:19
...that? Like, if I promise not to do harm within my walls, is that good enough, or...

Yeah.

28:23
What... what is...

And I think you're exactly hitting the nail on the head because it's a slippery slope. And so the reason that I'm hesitant to say, "Hey, you know, Dr. Kuba, go and file a complaint on this guy..."

28:34
...is I know that there are so many other doctors out there that would take...

28:42
...advantage of that situation. And now you talk about the expense of dentistry. If we're constantly in litigation or in...

28:49
...front of the state board, now I'm time away from the practice. That's expensive. The lawyer I had to pay, that's expensive. And to me, it's like...

28:58
...okay, let's not stab each other in the back. And I feel like there's too many people that are prone to do that. But it...

29:05
...is a patient. The patient deserves to know the full picture. And while this orthodontist can't know what she looked...

29:13
...like before, he can know that she's done with her Invisalign therapy, and this is the state that the doctor left her in.

29:20
And without being like, "That doctor's an idiot," he needs to be able to say, "This has left you in a state that is...

29:28
...not good at all. Here is what's going to happen if you continue to bite this way.

29:34
You have options. Here's the options you can do with me, or you need to go back to the doctor that left you in this position, and you need to have some hard...

29:42
...conversations with him or her, whoever it is. Um, because this is not good." The patient needs to know the state that...

29:49
...they were left in is not good. And that's not us saying that the doctor's an idiot. That's just saying this is not a good place for your mouth to be in.

29:57
You need... and then let the patient take appropriate action if they think it needs to be taken. And if this is coming...

30:06
...up several times that you continue to see the patients from this doctor and they continue to be in this...

30:13
...spot, eventually one of those patients is going to report. That's the way I see it.

30:18
Yeah. Which, again, I... [sighs] I would hope that said provider...

30:26
...would pause and go, "Somebody is trying to tell me something."

30:30
Yeah. So, for example, in the case with me and the orthodontist, there's nothing that I have to get. We're not competitors. We're not whatever. If I'm...

30:37
...trying to bring this to your attention, um, I...

30:45
...if I was him, I would be like, "What is she trying to tell me?" Like, maybe, yes, maybe I've taken these courses or I've read these articles or I've whatever, and this seemed to be a good technique, but...

30:53
...actually now, um, you know...

31:02
...or have been doing this for two decades, and Kuba, you're worrying for no reason. This is just fine. I'm sorry you've never seen this technique before.

31:10
But if you're a younger provider, in this case this gentleman is, I think you need to pause because I'm...

31:13
...not coming from a malicious viewpoint at all.

31:13
Right.

31:22
I'm trying to support you and send you patients, but now I'm seeing some stuff that I'm like... and being that I'm that much senior to you, I would...

31:30
...hope you would kind of pause.

Um, and so same in this case. I think what's harder is when it's general dentist to general dentist.

31:38
Yeah. And, you know, um, so which brings me to... You have two examples of things that I know you have to be careful talking...

31:44
...about, but from a reporting standpoint, if you...

31:52
...say, um, say you saw something that...

31:59
...let's say an auxiliary was doing something that was out of the scope of their license.

32:05
Yeah. So, for example, I'll say in Texas recently, like in the last two years, three years, something like that...

32:10
...Texas has allowed hygienists to, um, give local.

Yeah.

32:17
But it's very specific about this is the coursework you need to have, and you can only give local in these situations, and you can...

32:24
...whatever. So what if the dentist or another hygienist...

32:31
...or another assistant saw the hygienist giving local in a...

32:36
...situation where she did not meet those qualifications?

32:36
[snorts]

32:37
What do you do with that?

32:40
Yeah. To me, um, and it's not like the hygienist didn't know. She knew, right? Obviously.

32:48
But now she's got her friend in the chair, and friend needs certain things, and the hygienist is just like, "Well, I'm going...

32:57
...to do it for you because you're my friend." And technically, yeah.

It makes me think of this a lot with, you know...

33:05
...Botox injections and lip fillers and, um, uh, teeth whitening. This has come up...

33:12
...where, you know, "Oh, it was discovered that this RDA was running a teeth-whitening service out of her home garage..."

33:22
...or something like that. You know, what are the lines of moral, legal...

33:30
Absolutely.

33:32
So this is where I tend to be very much... um, it is a public...

33:39
...safety situation. If somebody is consistently blurring those lines of...

33:46
...using their license appropriately or misusing their license as a license to do things that they shouldn't be doing...

33:54
...to me, that has to be reported by whomever discovers this. And again, unfortunately, most of the time your...

34:02
...name is connected to the report. There's no, at least in Texas, it's different for every state. You know, you can't be anonymous with alerting the...

34:10
...board of the situation. But the board's job in any state is to ensure that it's managing the licensed individuals and...

34:20
...making sure that they're not breaking protocol or going outside the bounds of those licenses. How can they manage that if they don't know that there's an...

34:28
...issue?

So I guess, to me, like, I'm putting myself and wondering if this happened in my office or to me and I...

34:36
...discovered that, you know, my hygienist brought her boyfriend up on the weekend and was, you know...

34:44
...numbing or giving Botox, do whatever, whatever it is, right?

34:47
And to me, I'm like, okay, I could, A, turn my eye to that and just say, "Don't do that again."

Mm-hmm.

34:54
Or I could... I mean, ultimately, if something went wrong, is my name going to be tied to that because you did it in my...

35:02
...premise or you used my filler or you used my Septocaine, like whatever?

35:10
But I guess to me, yeah, watching my own back. But okay, so now next level is, do I turn in a colleague? Like maybe she...

35:18
...really was like, "Well, it's okay. It's just my boyfriend. It's just my sister. She's not going to report us," or whatever.

35:25
Like, how big a deal is it? She's just asking me to, um, you know, help her out here.

35:30
Her tooth was hurting, and I didn't want to bug you. So I was going to just bring her and numb her up so that she could hold off until she could go see the oral surgeon.

35:39
Yeah.

Um, so what do I... Am I okay with that?

35:44
Should I be okay with that? Like... because if I escalate it and now it is a board issue, like not only am I tied to...

35:52
...that because my name's on it, but said hygienist is going to leave my practice. I've got to fire her. Where can you find a hygienist anymore nowadays? Like that whole snowball effect.

36:02
Yeah. Um, but at the same time, if you have decided, you've made the conscious decision to come into my office at a time that you knew I wasn't...

36:12
...going to be here, use my materials, and then do this illegal thing.

36:20
Who wouldn't you do it on or for?

Exactly. That trust is already broken.

36:24
And now you're questioning the line of thought process this person has. If they can't see the multiple boundaries that...

36:31
...they passed to inject her boyfriend with Septocaine, like that to me...

36:39
...shows a miscalculation that is probably always there. This is not like you bring it to their attention and all of a sudden they become wise.

36:48
They made a series of very unwise decisions and will continue to make unwise decisions. It's a risk...

36:54
...factor for the practice anyway, in my opinion. Now, there are some things that are less consequential. For example...

37:04
...I was just in a practice recently where the doctor noticed an assistant placing a sealant, and he was like, "Wait a...

37:12
...second. Is that person... I thought they didn't have their sealant certification." Thankfully, he's paying attention to this, so kudos to that doc.

37:21
But then also, he brought it to the attention of that assistant and was like, "Did I see you place the sealant?" And she was like, "Oh yeah, you know, I...

37:29
...placed a sealant."

He was like, "When did you get your sealant certification?

37:32
I've missed that you did that."

And she was like, "Oh, I haven't done it yet."

And he was like, "No, ma'am. No, no, no...

37:39
...no. You don't do that."

So he approached her about it. And then we had her sign a document saying, "I understand. I'm not sealant certified...

37:47
...blah, blah, blah. I will not, you know, place sealants in this office."

Okay, now did she still go outside...

37:56
...the bounds of her license? Yes. Had she gone through the proper training for that sealant certification? No, she...

38:03
...had not. But the doctor caught it. The doctor corrected it. The assistant was unaware that she couldn't do it without...

38:11
...the certificate. And again, it's like, a sealant's important, but in the grand scheme of things, could she have...

38:20
...harmed this patient with that sealant? Maybe. But, so, I hate to throw gray in here, but...

38:28
...would we have reported that person?

So I think for me in that case, it would depend if she truly didn't know that you...

38:35
...needed that coursework for sealants, which I can see happen. Like, it happens all the time. When we post for an RDA...

38:42
...I'm doing it right now, and every single RDA that I'm asking, "Do you have your certifications for sealants and coronal...

38:50
...polishing?" "I don't. My other doctor never made me get it."

Yeah.

38:55
So yeah, fine, right? But if you truly didn't know... But if you did know and you did a sealant, I think I would still have a problem with you because...

39:03
...that to me says, you know right from wrong and you're choosing wrong.

39:07
Even if it's just a sealant, but where does that line end? And so to me, like, if you can't see the right and wrong in that...

Yeah.

39:15
I'm a rules follower. I'm sorry. Like, for me, I tell everybody on my team, if you come in and I catch you stealing a stamp...

Yeah.

39:24
...you're done. Like, I'm firing you. I don't care if you've worked here for eight years. I'm firing you over a damn stamp because to me, that's a trust factor that's broken.

39:33
True.

39:34
Um, [snorts] so, uh, you know, that varies. But like, yeah, if you're catching a dentist doing something that they're not licensed to do...

39:45
Yeah.

39:47
Yeah. We've got to, you know... What does the airport say? If you see something, say something. And to me, it...

39:54
...applies. This is where we have to hold each other accountable. And it is a public safety issue. If you see something, we've got to say something.

40:02
And oftentimes, and I hate to say this, but I have to say this, it's a state board issue. The state...

40:09
...board needs to manage that. It can't be the practice owner that's then digging into all the nitty-gritty of the legal...

40:17
...ramifications and could I make a case that this person didn't actually do something wrong. Let the state board do...

40:25
...what the state board is meant to do, which is to manage licensed individuals. And we have a responsibility to bring that information to them.

40:33
I'm going to be honest, I think most of us are like, "Yeah, I'm not touching this with a 10-foot pole. I'm just going to stay in my bounds and not stir...

40:41
...trouble up." Um, and I think, you know, but what do you do when you're confronted with the situation where...

40:49
...that's not going to work anymore, I think. So that's why I wanted to bring this up.

40:53
Um, and talk to somebody.

Talk to somebody.

40:55
It's a big decision. It should absolutely be weighed out. It should not just be like you've got state board...

41:02
...you know, memorized into your phone, and you're like, "Yep, another one. Let me call them." I'm not saying we become like that. Talk to somebody. See if it...

41:12
...dialogue with other colleagues to see, is this something that I need to report? And really consider the fact that you may need to.

41:23
Yes. Yucky. Yucky. Um, so, uh, I do want to give a little plug for speaking of yucky. You pointed this out...

41:32
...that this, like, I just had this, you know, I'm kind of wondering, like I said, with this colleague, like, what do I do?

41:36
Do I quit referring, or what am I doing with that? Right. So I wanted to talk through that. And then the other one also happened, you know...

41:44
...within the last six weeks or so. Um, but you pointed out that this kind of fits our June theme and our July digest theme. So I wanted to make sure I tied...

41:52
...that up so that people have resources they need. Can you talk a little bit more about...

Yes. So, we've had this whole month...

41:59
...it's been, um, a lot of content that ties into July, which is going to be protecting yourself. July is all about...

42:06
...protect yourself from... Have your articles about get a good attorney, have that attorney ready to go, which was...

42:14
...great. Um, I talk about get your team ready for these financial conversations, these insurance conversations. So I...

42:21
...think it's really important that as we listen to all the topics from this month, if you need more, this is why we do what we do. There is a resource in...

42:29
...the subscription. You need to subscribe for July because there's a lot of additional information on how to protect yourself. Yucky but useful.

42:38
Couldn't have said it better. That could be the title. Yucky but useful.

42:43
Thanks for joining the conversation today. We hope that you are comforted in knowing that you are not alone. But we also hope that you're walking away with...

42:51
...some really great tips and tricks to try in your practice.

42:56
We value your feedback. So please take a few moments to rate and review the podcast. Finally, we want to make...

43:04
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43:11
...let us know what topics you want us to cover.

43:15
As always, please know that we are rooting for you today as you manage your dental drama.