I first posted this on my personal Facebook feed. I expected a lot of negative feedback. But, the opposite happened, for the most part.
I am not fazed. And, this bothers a lot of people.
It seems the new measure of a person is his or her capacity for righteous indignation, pandering for “social justice,” and public virtue-signaling. Keeping up with the Joneses is no longer a material pursuit. It’s an emotional attention-getting pursuit. And, hoo-boy… has this “crisis” provided that opportunity in spades.
I’ve had some friends extremely upset at me for not being as “worried” as they are. I’ve had to “un-friend” some on social media for being rather nasty. One long-time (~20 years) friend and colleague gleefully admonished me for having my practice still open and that I’d be “shut down soon.” He had missed the fact that my state had already shut us down except for emergency patients. But he was apparently happily anticipating the impending shutdown of my business. That’s not cool at all.
I’ve been chastised for being “cavalier” in my posts about this Coronavirus. I’ve been excoriated for not demonstrating the proper amount of fear and dread. I’ve endured the derision and contempt of colleagues even for being open to see emergency patients. Many dentists, incidentally, have run for the hills, ignoring their training and expertise in infectious disease control. They’ve closed their offices and are referring emergency patients to the ER. Or, they’re not even answering the phones at all.
But, I’m the bad guy. According to some… a really bad guy. For seeing emergency patients. My own colleagues are PISSED that any dentist would see patients. Some have accused the dentists who are open, of “stealing” or “scooping up” their patients. You know… the ones who they’ve left in a lurch, refusing to see them.
Perhaps my position and lack of alarm is due to perspective. So, here’s my perspective:
Consider that I came into Dentistry at the time when
HIV / AIDS was the big news. At the time, an HIV infection was 100% fatal. ONE HUNDRED PERCENT. Also consider that dentists were REQUIRED BY LAW to see HIV / AIDS patients. We could not refuse to see them because of their HIV / AIDS status. “Universal Precautions” were implemented, and the conventional wisdom was to treat ALL patients as if they were HIV+. Believe it or not, initially some patients were OFFENDED that we would don gloves, masks, and eye protection. “What’s the matter? You think I have AIDS?” We would explain, “No. We don’t know who does. We are wearing these items for YOUR protection.”
Also consider that dentists and dental auxiliaries knew that if we fucked up and stuck ourselves with an HIV-contaminated instrument, we were quite possibly as good as dead. It was a death sentence… from just ONE “slip-up.” Regardless, BY LAW, we had to see and treat HIV+ patients. The fact that one mistake could kill us with 100% certainty was irrelevant. We had to be very careful. By the way, it was considered “discriminatory” if we double-gloved for known HIV+ patients. Think about THAT.
Now? A respiratory virus is pandemic (worldwide). In the U.S. the mortality rate is currently at 2% (Source: CDC) and likely to decrease as the number of cases increases with full recoveries. Most of the Corona deaths had comorbidities. By way of comparison, HIV was 100% fatal. In the 1980s, AIDS was the LEADING cause of death in young adults. By 1989 (I graduated dental school in 1988), it was the 2nd leading cause of death for men 25-44 years of age, surpassing heart disease, cancer, suicide, and homicide (source: CDC). And, we were legally mandated to see and treat these patients.
Over the years (almost 32 years in practice now), Dentistry and the world have faced a litany of epidemics and pandemics… some of them with very nasty bugs. On a daily basis, dentists have to practice with the assumption that patients may be infectious with a cornucopia of pathogens such as HIV, Hep C, Hep B, Tuberculosis, MRSA, Herpes, HPV, and other flu viruses. Every single day. We have become EXPERTS in sterile protocol and infection control. For over 30 years, we’ve been wildly successful, with virtually ZERO cases of transmission of any of those diseases.
In 1990, I served aboard a combat ship in the Persian Gulf (Desert Shield / Desert Storm). We had Iranian Silkworm anti-ship missile silos targeting us. We were on station for almost 4 months. The Navy made sure we all had our last will and testaments filled out. Serious, deadly business. A few years ago, my daughter was diagnosed with leukemia. We went through 2-1/2 years of chemo treatment. It was fucking hell, and it still affects us to this day.
I’ve faced down accidental death twice. Once, I ran out of air while scuba diving at 80 feet (stupid). Another time, I was in my car (with my wife) and got unexpectedly and suddenly trapped in traffic on a railroad track. “All we need now is a train to come, eh?” Right then, the crossing alarm bells started ringing and the gates came down around us. Traffic wasn’t moving. But, the train was – at full speed. The train’s horn was blaring. I’ll just say some “unconventional driving” got us out of there in the nick of time. Literally.
Perspective? Yeah, I’ve got it. Fazed? Nope.
Now, I’m expected to shut down my practice to ALL patients except “emergencies.” My practice cannot survive on emergencies. Other so-called “non-essential” businesses shut down completely! Why? Hysteria. That’s why.
Yes, Coronavirus is serious. The reaction has been grossly disproportionate. I’ve faced far more serious transmissible diseases without the heinous shutdowns. Because of THIS bug, we have to literally sacrifice our dental practices, and many other small businesses, many of which may not survive the lengthy shutdown? But, we HAD to see the patients with the 100% deadly virus back in the 80s and 90s.
I’m seeing patients almost daily now who cannot contact their dentists or can’t find another office that’s open to see emergencies. Two days ago, I had a patient who called her dentist (part of a local large group practice) and was told to go to the ER (where they can do NOTHING for her). Yesterday, another patient said she called several dental offices, and none even answered the phone. My office was the first and only one that answered the phone. Sad. Pathetic. But, hey… ya’ll stay closed, OK? 😉
Today, I saw an older patient from Austria. He said that the atmosphere here in the U.S. reminds him of Europe in 1944 – 1945, leading up to the end of WW2. That’s some deep shit.
So, you’ll have to pardon me (or not) for failing to join the Chicken Little Club or jockeying to be the most “virtuous” or “woke” person on social media. I don’t care if I piss anyone off. I revel in facts and logic. And, I am always consistent in their application. So far, the majority of people condemning me have resorted to EMOTIONAL arguments, with one even trying to invoke my daughter’s illness as leverage in a debate. Pathetic. It’s not the first time some asshole has done that, by the way.
I will be “careful” and mindful of Corona… just like I am with other diseases every single day. For YEARS, I’ve carried hand sanitizer in the car for use after using gas pumps and grocery carts. For as long as I can remember, after drying my hands in public bathrooms, I’ve used the paper towel as a barrier to open the door when leaving. For many, many years I’ve been doing that. Just now, others are catching on to the concept of hygiene. That may be the faint silver lining in all this. But, at what cost to our economy and livelihoods?
Peace out, my brothas and sistas.
So good and very true! Great perspective. Wish others would see it the same way.
As usual, I fully agree with you. I miss our lunches together. You are one of a very rare group of dentists that I can say that about.
Hi Mike! I hope we can get together for lunch again SOON!
I supported you when your daughter was sick . I even reached out to you one time for advice about web site information. (You never responded) I even bought your book.
You have gone too far in your bravado/ braggadocios posts about this virus.
Condemning your colleagues with your self righteous attitude has gotten to be a little too much.
You have become quite the opposite of a team player.
Please take me off your blog as I no longer wish to support you in your endeavor for greater online presence. Everything isn’t always about the money.
Since I don’t even have a last name, I cannot recall any previous contacts. I appreciate your support with my daughter and my book… and was humbled by the tremendous support I got from so many.
As for “condemning my colleagues,” that is in direct response to the WIDESPREAD condemnations many of us (who are open for emergencies) have received from our colleagues that have shut their offices down completely. I’ve been excoriated on social media for daring to question the new status quo and for seeing patients in need.
Which “team” am I no longer “playing” for? The team that is scared and forgot everything they’ve learned about infection control? The team that has abandoned their patients (I’ve seen several this week)?
The self-righteous are the ones who are on social media threatening and asking where they can “turn in” dentists to the “authorities” for being open.
As for “taking you off” my blog… Not sure what you mean there. Nobody is here by force, including you. You chose to visit and comment here. Don’t like what I write? Don’t read it. Meanwhile 5,000 – 9,000 visits per month. Somebody’s enjoying it. 🙂
I stand firmly by my posts here and elsewhere. I am (not) sorry that I did not meet your standard of “moral outrage” and fear over Corona and, more importantly, blindly glomming onto the nation’s response to it. I will not be coerced or shamed into joining the Chicken Little Club. Your pitchfork and torch brigade will not intimidate me. 😛
In the mean time, I’ll exercise my 1st Amendment Right to speak my mind, among the other Rights protected by the 1st. It’s MY private blog. I get to write whatever I want. I do it mostly for me. 🙂 I’m the HMFIC of this blog. I realize that some will disagree. Some will disagree so strongly that they’ll attack me personally. That’s OK. Bring it.
It is in response to the overwhelming attacks I’ve endured on social media for daring to state the obvious, question “authority,” and to be OPEN to see patients in need.
Fuck the haters Mike! I’m glad to know you and I wish I was seeing patients right now!
Right on, brother!
In 1990 after the David Acer/Kimberly Bergalis HIV transmission controversy, new CDC guidelines were instituted requiring gloves, masks and eye protection for dentists. By then, I had already been practicing 20 years with bare hands, no mask (except when I had a cold) and just my prescription eyeglasses, as every other dentist did at the time. What a change since then! We’ve increasingly become a nation of germophobes and in the well-meaning efforts to make our environment sterile and safe, weakened our collective natural immunity and risk tolerance and become a nation ripe for the media fear mongerers and finger-pointers, of which there are many. There’s a real virus, and
it’s a bad one, but the cure we’ve been forced into is worse than the disease, and
will likely kill more people through economic chaos and hardship than the virus. Meanwhile we need more straight-talking blogs like this and less over-sensationalized reporting. Thanks Mike
Yep. Keep an eye on suicide numbers. Thanks for the comment!
I went in to this field to help people and because I thought I could make a nice living. I am almost at retirement and I have done both… help people and make a nice life. I agree with you that properly done, dental office infection control is top notch. The one caveat, which I remember from every infection control course, is that you can never treat an active TB patient in the office because the bacteria is capable of lingering in the air in an aerosol form for a very long time, and is capable of infecting another person. Now, no one has told me that this is the same as TB, but it seems to me that as you read the stories of it being passed on by totally asymptomatic people to others, it seems somewhat similar. I don’t think have negative pressure filtration systems in my operatories, does anyone?, I am in a high risk group because of my age, and my wife is on immunosuppressant medication. I am seeing emergency patients, and a few select others if I can help someone. I agreed with many of your earlier comments, but as time goes on I think your business as usual attitude may not be the way to go, we don’t know enough about this virus to be cavalier and assume the old infection control works effectively against it. I can’t get regular masks, no less n95’s, I don’t want to put myself, family, staff or other patients at risk. Helping emergencies…. absolutely! Business as usual… not right now.
Thanks for your comments, Michael.
There isn’t a dental operatory on the planet that’s negative pressure. And since most dental offices have drop ceilings and open HVAC systems, it’s impossible to have negative pressure. I’ve heard that the cost of building a single negative pressure room would be in the vicinity of $200,000.
I’m suggesting “business as usual,” (which means the same universal precautions we take for all other pathogens) because the Chicken Littles are only suggesting that we run for the hills and shut down completely. And, that is simply ridiculous and unfounded scientifically or logically.
IME, “business as usual” in a dental office means hygienists who refuse to wear long-sleeve coats and get away with it, DAs who stuff the same gross level 3 mask into their lab coat pocket in between patients all day long, and an office full of people who shove wet instruments into bags, cram an autoclave full to the gills, and then take out still-wet bags and throw them into drawers, perfs and all.
One DA was recently caught cleaning ops with Lysol wipes instead of cavicide.
One hygienist was recently caught dropping “sterile” packs on the floor and simply picking them up and putting them away.
All the DAs I have ever worked with open “sterile” pack as early as THE EVENING BEFORE to save time setting up ops.
I worked with one DMD who told me instruments didn’t need to be sterile because mouths were full of bacteria anyway. He was only a few years out and this was in 2018.
All these people are still employed, or at least they were until the governor of FL shut down offices a few weeks ago.
I have two infection control certifications (and two college degrees but that’s a whole other story) but when I speak up I am told to get my head out of the textbook and live in the real world. I quit working chairside and switched to admin after getting fired from high end office for refusing to simply wipe down a high speed so the DMD could quickly cross over a crown from hygiene.
If I could find an office that actually gave a crap about standard precautions, I’d go back to chairside in a heartbeat. As of now, I’m using my furlough to apply for grocery store jobs, as that seems to be the only guarantee for steady work in a pandemic. And as far as I can tell, Publix cares more about having their employees wear PPE than any dental office I’ve ever worked for.
Are you a dentist? Auxiliary? Sounds like you worked in a bad place. Yes, bad places exist. And, it sounds like you have a knack for finding the few that are. But, speak for “yourself.” Every practice I know, including mine, follows proper sterile protocol. I’ve never seen what you’re describing in 31 years of being in dentistry. It may exist, but it’s certainly not widespread.
And, if you think PUBLIX is cleaner than a dental office, well…. LOL! That’s pretty funny. Good luck with your grocery store career.
Even when the “all clear” is given (if ever), I think the effects of FEAR will linger for a LONG time.
Hi Mike. I’m gonna send you some asbestos britches cause your ass is really taking some heat! I get you though. I go in, just myself, for half days. Lots of administrative, cleaning, and repairing stuff to catch up on. I’ll also see emergencies, which I have already. Where are our patients supposed to go? The hospital? For a tooth? Usually incorrect meds and no proper care, not to mention the added bonus of being in intimate contact with a lot of COVID-19 patients.
This in-fighting is irrelevant. Is there any dental office that would be doing “business as usual” even if we wanted to? In the best of times, it doesn’t take much to keep patients away, and this for sure is the grand-daddy of all reasons. My schedule has automatically mandated virtually complete shutdown – it has dropped off the map.
But what I fear is going to be the real problem is that even when the shelter-in-place orders are eased, business will take a lot longer to get going again. To your point, the media frenzy and public reaction to it have ignited a fire in which we are all going to get burned. Once the virtue-signaling phase is over, many docs will be standing there with their mouths open wondering what the hell happened to their livelihoods. I hope I’m wrong, but my glass is looking half-empty at this point.
Yep… even after the all-clear is given, the newly-minted germ-o-phobes will be VERY slow to peek their heads out into the real world. MANY businesses will go under. Entrepreneurism is officially DEAD. You’d have to be a complete MORON to open a new business… pouring your heart, soul, and fortune into it, ONLY to have the gov’t pull the plug on a WHIM based on HYSTERIA.
Thanks for commenting!
I stayed all afternoon just to see this patient and refer her to an oral surgeon who is also open. She couldn’t find another dentist open. Woke up this morning with facial swelling.
Spot on! The overreaction by many has been a classic example of “the cure killing the patient”. I applaud you for taking a sensible approach to this crisis. I too have been scolded for not being serious enough about this. Serious, yes. Irrational fear, no.
Thank you for providing a level headed approach to things.
Bingo. Serious, yes. Irrational or hysterical, no. Good summary.
Yes. Exactly. I deal with the potential for infectious diseases every single day with every single patient. We assume every patient is infectious and use universal precautions accordingly.
Back with the AIDS scare, if we double-gloved with known HIV+ patients it was considered discrimination. Think about that.
I’m not comparing diseases! You’re inferring the comparison. I can only help what I write. I can’t help what you misinterpret or don’t understand. HIV / AIDS set the standard for infection control, because it was a 100% fatal disease. ONE HUNDRED PERCENT MORTALITY RATE. It set the standard for infection control protocol, WITHOUT stopping the world in its tracks. It didn’t decimate the economy, ruin lives of non-infected people, or take down businesses. They got the job done WITHOUT fucking with everyone’s lives. THAT’S the point. I’m not comparing the diseases themselves. I’m comparing the REACTION to the diseases, with HIV being the EXTREME example of a fatal disease.
Yeah, ok, but no one was getting HIV (and still isn’t) from a shopping cart handle or from aerosols that can potentially linger in the air for half an hour or more . Outside of healthcare, all you had to do to avoid HIV was not have casual sex, a blood transfusion, or share needles. Easy enough for the majority of humans. Grocery shopping does not put me at risk for HIV. It could potentially do so for COVID-19.
Ummm… yeah… That’s not what I was talking about. I was primarily referring to how it relates to the practice of dentistry and comparing THOSE two different reactions.
And, actually, when HIV first happened we didn’t know all the routes of transmission. For example…. saliva. It took a while to get that sorted out. But, we did know it was 100% fatal.
Sigh… missing the point entirely. Oh well… enough of that.
Wow…. missing the point AGAIN… and using a Straw Man argument (that’s not what I said AT ALL).
Oy. We’re done.
We take this course of action, saving 2 million or so lives, which is good to be sure, but then these numbers get swept under the rug: 5+ million dead due to cardiac stress, stroke, and suicide. I’m really not a negative person overall, but this situation seems to be bringing out the worst in me. There will be a huge tidal wave of shit following this mess. Can’t wait to see how the epidemiologists spin that.
Epidemiologists are the “economists” of the health world. Always certain (of their predictions) and virtually never right.
For sure. Kind of like mediocre meteorologists. What a gig, eh? Elevated to B-list celebrity and a cushy 6-figure salary with ZERO repercussions for being wrong. I think it would be hilarious if they had to carry hefty malpractice insurance because if they predicted clear skies and it rained, people with ruined outdoor events could sue them. Sadly, I bet some attorney would take that case.
Yes, exactly. Super easy to avoid HIV out side of healthcare. Easy enough as a healthcare worker.
Per usual I agree with you 100% on this Mike. Regardless, we have been effectively shut down.
I note Sweden is taking a different approach on this whole thing by keeping the sick and elderly compromised quarantined but otherwise going about business as usual in order to build up immunity. It will be interesting to see how they fare when this is all over?
It will be “interesting” in that we will see denial about their success and false claims of “victory” as a result of our shutdown.
In 1987 I worked 6 days (3 Friday /Saturday sets) for a very large dental office in Bellflower, CA. It was sooo gross. One pair of gloves for the whole 6 hour shift. (After 1st day I brought my own). One high speed HP for 2 Ops….. 12 foot hose and the same 557 carbide that may have been wiped with isopropyl alcohol between the right and the left patients! These are the types of places that lead to the hysteria of the disease.
Are you wiping down the reception area, including seats, counter top, door handles, armrests etc?
No doubt the I’m more compliant than you mindset is a significant driver in this.
Thoughts on how assisted living facilities should handle this? Seems that once in the mortality rate is much higher than the average…
Hi Martin, Thanks for your comments.
The saying goes, “The exception proves the rule.” And, your experience is certainly the exception. It’s NOT the rule. I’ve never even seen a place that operates like you describe. I know they exist, but again…. the RARE exception.
The bad (and very few) examples do not negate the majority of offices doing things right. We can’t punish those doing it right for the deeds of the few bad eggs by increasing restrictions and imposing pointless rules on them.
To answer your question… yes… we spray and wipe everything. Our reception area is not used much, even in “normal” times. We literally never have a full, or even 1/4-full, reception area. I have a low-volume practice. The reception area is usually EMPTY, because the scheduled patients are back in the ops, where they’re supposed to be. 🙂 True.
And now the “experts” are rapidly adjusting their models and predictions on the Corona virus. Imagine that???
Will wonders never cease? 😉
I have been echoing words from your post ever since this whole thing started. My office was mandated to close on March 18th. A week or so prior to then my husband asked me “so what are you going to do differently?” Um…..nothing. I explained to him that I treat people every day as if they have EVERYTHING and don’t know it or don’t tell me.
When this all started, instead of paying healthy, non risk individuals to stay at home, we should have been paying the immunocompromised, high risk and elderly to stay home.
Right on, Mary Kay. 🙂