Thursday, March 13, 2014

The kindness of strangers--SFO

I'm at SFO waiting for flight UA-1536 to Vegas.  

At first it's smooth sailings.

At 5:59 PM, I got a call from United airlines warning off possible delays.
I leave for SFO at 7:49 PM (late, I know).
The promised Bart is missing--arrival at 9:00 PM.  No worries...flight at 10 PM.

Then stuff gets messy.  

I get on blue line--wrong way!  At Westfeild, I and a fellow straggler hustle to reverse course: 9:03 PM.  Gate 3 at 9:10.

Meanwhile, UA1536 is noted as on schedule to *leave* at 9:18 PM.

Security check.  Crap!  Nice airplane lady waves me to front--still another row!  9:12 PM.  The couple in front of me graciously lets me pass.  9:14 PM.  Security doesn't body search me (unusual).  9:16 PM.  I barrel to gate 73 and almost knock over a dainty brown haired dude in front of his son.

And the flight is delayed to 10 PM.

Thanks to all the gracious strangers.
I really appreciate your consideration.

I love my job

Some days are awesome--like today.

There's a young lady from LA.  She's a new patient.  It's first time to the dentist by herself.  She says she needs a root canal, and shows me this: 
The dentist in LA lopped off half her tooth.  To their credit, all decay was removed.  Sadly, there was no attempt to temporize things--just a grungy cotton pellet with a spot of dried blood.

So I pray.

The tooth is infected, but the nerve is dead.
The tooth is open.  I file the canal.  The apex locator isn't working, so I pray and feel for the apex.

And God answers.
This is *exactly* what I want.  I finish cleaning and shaping.   Irrigate with my special mix, and fill the canal:
Gracias a Deus!

The rest was fun: build up core with Fuji iiLC.  Reinforce with A2 composite.  Create a layered buildup that looks like God intended:

The tongue side is uglier.  I wanted to make sure that this tooth doesn't get fractured.  (The stain is blood under the composite overlayer--no worries.  It didn't interfere with the core Fuji buildup.

Uurgh.  Ugly.

Anyways, I have to thank God that my patient is out of pain and can smile.

Wednesday, March 5, 2014

FEMA training--aargh!

As part of my job with the San Mateo Medical Center (great team), I am required to have all sorts of non-dental related training.

Some of it is good (emergency codes, first responder protocols), some useful but boring (hospital safety, OSHA, sexual harassment), and some are hard to apply outside the public sector (medical billing fraud compliance remediation as a hospital.)

Recently, the whole dental team was assigned FEMA's NIMMS (national emergency medical management system) training due to a mandate by President Obama.

In short--be prepared, and don't trust your government...or at least FEMA.

In long: the NIMMS training has some good principles (watered down versions of classic military standard operations).  However, these principles are needlessly cloaked in jargon--very wordy, poorly presented jargon.  

The instruction is geared towards bureaucratic cratic self preservation and image control instead of actually helping people.  There are moderately useless diagrams that are informationally empty.  There are pointless videos.  The questions are needlessly obtuse, and test based on key words instead of true knowledge.

Base principles (I'm not making this up)
-do not skip chain of command
-do not take initiative 
+before doing anything, it must pass through at least 4 levels of bureaucracy 
+the PR guy is at top
+the logistics guy (who gets stuff done) is at bottom
+resource acquisition must go through at least 3 levels of bureaucracy--but must be sourced/funded locally--then resubmitted to regional--then state--then interstate--then FEMA--then Gov

What I'll be doing in response to training:
- get fit.
       I don't care about getting a bikini body.  Rather, I want to never need FEMA or any government "help" if possible.  Instead, I'll be a first responder.
-get reserves
      I'll be sure to keep 3 weeks supply of food/water.  At the rate FEMA works, 1 month may be better while they (request authorization to distribute.
      I already have emergency shelter/food in the car.
      Maybe I'll put together a "bug out bag"--no guns mind you--food, first aid, navigation, fire, and possibly dental related supplies for field treatment.
-get equipped
       I really want an Aseptico portable op.
I used an Aseptico taskforce portable unit in the jungles of Cambodia, and I can vouch for it's reliability, portability, and good worksmanship.
       In the event of a major emergency, I want to be there for my patients--not some career bureaucrat from FEMA
-get training
       I hope to become fluent in Cantonese and Spanish by 2015.  As of yesterday, I finally have internet.  I hope to make wise use of YouTube and various podcasts.  I see this as a matter of respect for my patients----sorry, no Arabic, Urdu, Mongolian, Russian, Farsi or Hindi is planned at the moment.
        I may look into basic field survival, foraging, bushcraft, and field medic training in the future.  I thought my friend ( and prebably the best gum surgeon IMHO in the east bay) Dr. Karl Ching was nuts for learning man-tracking and extreme wilderness survival.  Now I think he's wise...

Sheesh!  I sound like an alarmist!

Wednesday, February 26, 2014

CPR training--déjà vu?

Reminds me of a classic transition to the judo scarf hold--Kesa-gatame.

Note: new standard is 30 chest compressions to / breaths--aim for 100 bpm.

Saturday, January 18, 2014

Sonicare. Haight Ashury. Street

Random find.
No, I didn't use it.

Lying on the side of the road near Skates on Haight.

Wednesday, April 24, 2013

Do good vs. look good

For the past three weeks, I've been working for a dentist in Livermore.

At first, it seemed great. He had good systems, well trained staff, and cable TV in every room.

Three weeks later, I've found myself in hot water for doing good instead of looking good.

For example, there was a crown where the buildup came out in the temporary--meaning that the crown would be unsupported. He was furious that I built up a new buildup, took another impression, and reappointed the patient.

He told me that he would have simply cemented it in place.

Wednesday, April 10, 2013

Why I want my own practice

Over the past couple days, I've been thinking why I want a practice.

Why do I want one?

Quality control - I can use good labs, good equipment, and train great people.
I want things at top quality.
Creative control - I can dedicate the practice to the very best dentistry available.
Better tax write offs - my biggest "optional expense" is training and equipment for my patients. My second expense is cool stuff to show my appreciation for people.
It's be nice to deduct this from my overinflated taxes.

Why it's a bother:
Labor costs - wages get higher; benefits cost more, especially health coverage; sick pay. The Bay Area is a very expensive place.
Taxes - Obamacare medical device tax 2.7% on everything we buy. Business tax. Payroll tax. City tax. State tax.
Liability, lawsuits - California has some of the highest number of lawyers. There are hundreds of opportunities to get sued over stuff like a kid slipping in front of your office.
Marketing/Competition - the SF Bay Area is a super saturated market full of tons of dentists. Frankly, it'd be easier to compete anywhere else (except LA).
Staff issues - the new assistant is hungover and the front desk decided to ditch work for a new boyfriend. These issues happen more often than you think.
Paycheck - as boss, I'm the last one paid. Frankly, some days I'll be paying money to keep the place open.

I'm probably crazy, but I still feel that the end goal is worth it.