Dental Practice Heroes
Where dentists learn how to cut clinical days while increasing profits - without sacrificing patient care, cutting corners, or cranking volume. We teach you how to grow a scalable practice through communication, leadership, and effective management.
Hosted by Dr. Paul Etchison, author of two books on dental practice management, dental coach, and owner of a $6M collections group practice in the south suburbs of Chicago, we provide actionable advice for practice owners who want to intentionally create more time to enjoy their families, wealth, and deep personal fulfillment.
If you want to build a scalable practice framework that no longer stresses, drains, or relies on you for every little thing, we will teach you how and share stories of other dentists who have done it!
Dental Practice Heroes
How to Stay In Control When Things Go Wrong w/ Dr. Taher Dhoon
Nothing throws off your day like a surprise complication. When a surgical or dental emergency hits, how you respond is what matters most. In this episode, Dr. Taher Dhoon joins me to share how we approach emergencies to keep our cool, make smart decisions, and lead our teams.
We dive into emergency protocols, critical mindset shifts, and how to avoid unnecessary risk. Discover new ways to reset in high-stress situations and grow through the tough cases—not just get through them!
Topics discussed in this episode:
- Mastering your mind during emergencies
- The Dunning-Kruger effect in dentistry
- Leveraging mentors and learning opportunities
- Crisis recovery and surgical timeouts
- Knowing when to pass on difficult cases
Explore hands-on training programs and mentorship opportunities at Colorado Surgical Institute: https://www.coloradosurgicalinstitute.com/
You can also contact Chris Richards at (970) 410-6148 or chris@legacydentalinc.com for more information.
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Check out www.relevanceonlinemarketing.com if you want to get the same great marketing results as Dr. Etch. Mention DPH and get your first month FREE!
Take Control of Your Practice and Your Life
I help dentists take more time off while making more money through systematization, team empowerment, and creating leadership teams.
Join the DPH Hero Collective and get the tools, training, and support you need to transform your practice:
- Team and Doctor Training for every aspect of Practice Management
- Comprehensive Training: Boost profit, efficiency, and team engagement.
- Live Q&A Sessions: Get personalized help when you need it most.
- Supportive Community: Connect with practice owners on the same journey.
- Editable Systems & Protocols: Standardize your operations effortlessly.
Ready to build a practice that works for you? Visit www.DentalPracticeHeroes.com to learn more.
You are a dentist and, because of that, unexpected complications and unforeseen emergencies are bound to happen. The question is, how prepared are you to lead your team through them? Today, dr Tahir Dune is back again and he's sharing more real-life insights on handling dental emergencies and how to navigate the unexpected outcomes of treatment like a pro. We're talking about surgical timeouts. We're talking mindset shifts and more ways to stay calm under pressure. Plus, you'll get some great tips on preventing complications and knowing when it's time to walk away from a case. This is the episode for every single person who has ever had anything unexpected happen, and I know that's all of you. Let's go.
Speaker 1:You are listening to Dental Practice Heroes, where we help you create and scale your dental practice so that you are no longer tied to the chair. I'm Dr Paul Etcheson, author of two books on dental practice management, dental coach and owner of a $6 million group practice in the suburbs of Chicago. I wanna teach you how to grow and systematize your dental practice so you can spend less time practicing and more time enjoying a life that you love. Let's get started. Hello there, and welcome back to the Dental Practice Heroes podcast.
Speaker 1:I am your host, dr Paul Etchison, and so excited to be joined once again by the Colorado Surgical Institute, dr Tahir Dune just a great surgeon, great person and just a wealth of knowledge on business stuff. So welcome back, tahir. How are you doing today? Doing great man. Doing great man. The last time you were on, we talked a lot about some lawsuits and other stuff, and if you haven't listened to that listeners, go back and listen to that episode. It was a very interesting one and it'll make you think about a few things with the way that you document your patients. But this time we're talking about emergencies and when things happen unexpectedly, and what we can do as the leader of the practice. So before we get into what to do, I mean talk about what it looks like when you don't think about these things and you just show up and something happens.
Speaker 2:Yeah. So, first and foremost, if you are doing surgical procedures or quite frankly, I mean like if you have kids, kids get hurt all the time. If you have anything going on in your world and you actually go out there and live life, I mean you're going to be faced with incidences where something happens unexpectedly. And for a lot of us, we're probably the leaders of our groups. We're the leaders in our practices, but we're the leaders sometimes out in our friend circles too, and so people do look to us for, like, what do you do? Because if we've gone through like ACLS, training or anything, they say, hey, everyone has a role, someone has to call out the shots, everyone has to kind of fall into their role to get to the other end of this emergency. So back in the day, when we were recording for Colorado Surgical stuff and I get a call from my wife and she's like I need you to listen right now and I was like holy shit, okay, she's only done that like two other times and it wasn't good. And I hear my six-month-old he's three now, but my six-month-old screaming like a scary, fear-based yell, not like a normal kid's cry. She's like Jonathan fell his eyes bleeding and shut. He's bleeding out of his ear, he's bleeding out of his nose oh my God, like. And he's six months old. So you know those little rocker things that they put babies in, you know, just to kind of like have them chill. My brother-in-law was visiting and he's a great guy, but at the same time he had him up on the counter and took his eyes off of him and then my kid bounces and falls off the counter straight on his face, and then she's calling me and I'm in Arizona, she's in Colorado driving to the ER.
Speaker 2:This ability to compartmentalize your emotions, so what they teach in like, sometimes, in like meditation or when you're physiologically like getting stressed out, it's breaking apart what's happening into three categories. So it's like okay, well, what's actually happening? What physiologically is happening to me? Like, my pulse is elevating, my blood pressure is going up, I'm sweating a little bit, my hand is shaking a little bit, and then what's the story that I'm telling myself? Okay, my kid's going to have neurologic issues. My hand is shaking a little bit, and then what's the story that I'm telling myself? Okay, my kid's going to have neurologic issues. My kid's going to be really, really hurt. Okay, what's the story? Kids are very plastic, they're very resilient, they're very strong, they can bounce back from these things. So okay.
Speaker 2:So it's like all these things are happening and in the moment, what do people really need? They just need you to pave a way for them. They need someone to shine a light and say, hey, here's the path through this. And so you got to compartmentalize this stuff. So I go inside, I put my wife on mute, I'm hitting the road for my two-hour drive in the middle of the night to get to the airport, to get to the red eye, to get to Denver, and so I get to the hospital right when he's getting out of the ophthalmology exam and everything is great. You know, like I mean, he's fine, there's no neurologic issues. He broke his orbit in a couple of places and they're like, okay, worst case scenario, he might have like a cosmetic surgery if his eyes are different sizes when he's done with growth and development.
Speaker 2:And so it was a very scary moment for the family. I say kind of easily right now, but it was like very scary moment for the family when it happened. But I take those things, I remember how I showed up in that moment and then I take it to like complications I have in surgery. I'm like, dude, I do the same thing. I do the same thing. Like we come up with a game plan. Someone has to assume leadership, someone has to be the beta and it's not really a beta but someone has to be that ancillary player to just, like you know, do certain things, and that's how you get through some of these complex things.
Speaker 1:It's just a very good skill set to have and I'm thinking of some times where we've had some medical emergencies at my office, when I've had doctors come get me and say what do I do?
Speaker 1:And I want to be like you're a doctor too, like I don't know you do it, but it's like they just people, just need to be, I don't need to be told. But yeah, they need someone to lead, someone to lead, and it's hard to. I've gotten myself in a number of positions with patients and usually it's difficult extractions for me and just stuff that I can't get out, and it's like me cutting bone and then it starts bleeding a whole bunch and I don't like that and I'm just like, oh God, what's happening? Are they going to die? Like I don't know. It's just, it's probably me getting inside my head, but I besides things to my assistants and I've been not so nice to people and then you look back and you're like man, I was just, the emotions just took over and it's like you can't control it. But it helps to be aware of it, yeah.
Speaker 2:And the more and more you put yourself in these situations, the more and more you get acclimated to it, and that's one of the reasons why I went to a zygomatic implant training course way before I was ready to play zygos. But what it did for me is it showed me some crazy ass shit that these oral surgeons were doing. We're reflecting out to orbit. You can see the infraorbital nerve coming out. You're going all the way back up to the cheekbone. Massive bleeds were just clamping them and burning them, closed and huge holes into the sinus, and that was like five years ago or so. Now I'm placing zygos and feeling pretty comfortable about it. I came back from the course. I was like you know what? This other thing that used to bug me doesn't bother me anymore because I saw someone just do it to the 10th degree and just go like ape shit on this thing and they were just keeping their cool and I got to see how they handle that stuff. So that's. Another good thing about these live patient courses is just you get to see stuff and to put your mind at ease because you've seen more complex things than you're going to do at home. There's something called the Dunning-Kruger effect. It's like a just ubiquitous type of business thing where, essentially what it is, it's a curve that shows that there's a point where you think you're really, really good. And this was me too.
Speaker 2:I graduated as a cocky dentist. Oh, me too, I had awesome case acceptance. I was crushing it. I was, like you know, like slinging bridges and partials everywhere. I thought I was the shit. And then I was having all these video problems and I was having all these broken, like I was having inadequate space for the teeth and the partials.
Speaker 2:And so what happens is you hit this thing where you actually think you're really really good, but this is actually where you're the most dangerous, because you've only done enough cases to have successes, you haven't been in the game long enough to have failures and then navigate through your failures. So then what happens is you go down and you have all these complications and then all of a sudden you start coming back up because as you start to manage your own complications, you start to get this real world experience, like this internal knowing of what's happening versus theoretical knowledge. You have this like experiential knowledge. Then you start to move into the masterships part of the Dunning-Kruger effect and really, at the end of the day, everyone's going to be in the Dunning-Kruger.
Speaker 2:Everyone is going to have this point where you think you're better than you are. You get humbled and then you find your way through it. It just really depends how long you stay in. The hard part of the curve and that's what good mentors are there to help you with, and that's what good programs are there to help you with is to shorten the learning curve. For you To start any procedure for the first time and expect that you're not going to have problems, I think is a fallacy, unless you're a unicorn and some of you guys exist out there, it's not me, yeah.
Speaker 1:I mean, I think about when I graduated and I first learned how to place implants and I was doing surgery and just surgical extractions and I felt comfortable over it. Man, I thought I was the shit, I was just awesome. And then now I look at some stuff. I did those first, like first two years of practice ownership. Maybe my second, third, fourth year out. I'm just like I don't even want to try that anymore.
Speaker 1:And I remember one thing that I used to do and this would be a great tip for new dentists If you don't have a mentor to reach out to is I would just make a little note in my phone. I would put the patient's name, the case and if I had an x-ray or something or whatever I need, I would put that there and I'd be like oh, I'm going to this endo course in a few months. In between, or at lunch, I'm going to go up there and I'm going to show this person all these cases and I'm not going to let anything be a misunderstanding and just keep working on it. I think that helped me get a lot better.
Speaker 2:That's absolutely a pro tip. A hundred percent, pro tip, 100%. I feel like everyone should rewind that and listen to that again and do that. I have a lot of attendees that come up and do that with me and we go through all their cases. We go through all their cases. It's amazing. So, yeah, do that, have it for every procedure mix and if you come into contact with someone who's really an expert on that, definitely reach out to that person because you're going to want to ask those really specific questions to those doctors. So I love that idea, man, that's great.
Speaker 1:You know, one thing that I remembered over my career that I think has also been helpful is when you're really deep into like a surgical procedure, like an extraction, and you're just struggling is just saying let's take an x-ray and just get out of that room and for some reason just resetting Like have you ever felt like anything like that has been helpful for you, doing the amount of surgeries you do?
Speaker 2:Yeah, I do the exact same thing. I don't call it a reset, I call it a surgical timeout. So you have a couple of options. If it's not an emergency and you're just stuck, dude, it's totally fine. Leave the room, walk around the block. I literally like walk out of the office and I'll go get some sunshine, I'll pour like a cup of coffee. I have this one lap I do around the entire complex and I come back in. It takes about three minutes and I go back in and I tackle it.
Speaker 2:I liked your idea about hey, let's get an x-ray, so like it keeps the wheels turning a little bit. It's not like you know, you're upset and walking out of the room. And I had a mentor say that back in dental school and I was like, ah, I don't know what you're talking about, old timer. And then now fast forward a couple of years. I'm like you know, there's a lot of wisdom Dunning-Kruger effect. It comes full circle, man. So at a surgical timeout, let's say it's an emergency, right? So one time I had this like petite 16-year-old we're doing wisdom teeth on, my associate's doing wisdom teeth, my associate's doing the sedation. He calls me and he's like I can't keep her sedated. Her numbers are kind of all over the place. She's kind of freaking out and I'm midway, I'm halfway across the highway, Can you get me all the way across? I'm like all right, cool, I'm the shit, let's fucking go, type of thing.
Speaker 2:So I get in there and I did not do my evaluation properly. I kind of skipped my own steps, I kind of skipped my own protocols. Sure, her heart rate was high, but her blood pressure was very low. It was an end of the day sedation. She must have been completely dehydrated and she was like scared. And so I was like, okay, I'll push some meds. But also, what's happening is I'm running an administrative day that day. So I'm in the operatory fixing this case and helping my doc with this case, but I'm having other people come in the room and ask me questions and so he's using a different IV setup than I'm used to. So the IV port is closer to the arm versus, like the tubing being really really far away.
Speaker 2:So I'm pushing meds and this one I really hate, you know, and I wish I had back, but I don't. So this one I really hate, you know, and I wish I had back, but I don't. So I'm pushing meds and someone's talking to me about some other shit and I'm not paying attention. I look down and I administer three times as much as I should have, because I just took my eye off of it and her blood pressure was already low. And so in that moment I know the pharmacokinetics of the medication and I know what it's going to do to her and I know her numbers and I have an idea of what's going to happen in the next 120 seconds. So in that moment it's like all right, surgical timeout.
Speaker 2:Everyone stops, I clear the room of all non-essential personnel and I tell everyone what's going on. And I get on the phone and I start to look up the medications and the reversal agents and I get to have them grab the bag. And I have them grab the emergency meds and I'm getting everything drawn up because I know I have two minutes to really get this going before she starts bottoming out. And so at the end of the day it all worked out fine. I had to sit there for like three extra hours and just keep her numbers up because the medication lasted longer than the reversal agent lasts.
Speaker 2:So you feel like you fixed someone, but then they start to desaturate again because you have to keep administering the reversal. But these are the surgical timeouts you stop, you get everyone out of the room and maybe it's an inventory thing. So you go through your inventory, you make sure you have everything you need, Whatever's happening in that moment. You just need to take a break and gather your thoughts and solve the problem and know what's going to happen. And this one I had never been through. I've never done that before. I have systems in place where I'm never going to do it again. I'm glad it worked out.
Speaker 1:Well, okay, I mean, I think otherwise we probably wouldn't talk about it. You know, it reminds me of I wish I had like a more life-threatening, relatable story. But I was doing a lip flip on one of my hygienists and if we do upper lip, it's four different injections and you put the same amount on one side and just put it on the other side. And somebody came and asked me a question when I was doing the second injection and I was talking and I pushed the whole rest of the syringe in one of the injection things and then I looked up like I was gonna get another syringe. I'm like, oh crap, I was supposed to use that for all four. And then we went, we're just going to balance it out.
Speaker 1:It looked horrible. When she smiled. It was like it just was too much, it was just dead. It just didn't look right for like probably a good six weeks and I felt so bad for her. But she forgave me and I learned something. So now we do I get two syringes, one for the right and one for the left, because I don't ever want to do that again. But it's amazing and my team knows this too when I'm typing, don't ask me a question Like I hate that's like something they know, but this it's probably something I imagine you'd made a rule, like hey, when I'm pushing sedation do not ask me a question I don't know.
Speaker 2:I mean, what would you change After that? It's like hey, not doing anything that's going to cause harm. To come back to the two syringe thing, my mom's a pediatric oncology nurse, so she's always been like sedating children. I told her about the story and she got so mad at me. She was like you need to draw up what you're going to administer. Don't draw up more than you're going to administer. Draw up what you're going to administer. This is a common problem, yeah, when.
Speaker 2:I have a really young patient or a patient who's like, really like, a higher complexity of a sedation. I only draw up what I'm going to administer, so God forbid I make a mistake.
Speaker 1:No-transcript, yeah, that's a good point to make.
Speaker 2:One of the things I found is it's easier to stay out of trouble than it is to really get yourself out of trouble. So what does that mean? That means knowing what cases to do and knowing what cases not to do. Well, how do you know? Because in the very beginning, you're so excited that just someone's willing to pay that much money for this procedure. You just learned. You're like okay cool, I want to get my reps, I. You just learned, you're like okay cool, I want to get my reps. I want to get good at this stuff, I want to do this for my career.
Speaker 2:You start saying yes to a lot of people, but also having a good mentor in your corner where you can send them the case. You can send them the med history, you can send them the cosmetic pictures, you can send them a video of the CBCT and the panel and whatever, and they can look at it and they can say you know, this is actually a pretty hard case. I think you should maybe pass on it because they know where you're at from a skill level perspective. I can't tell you how many times I've said that to one of our alumni or anyone from the DSI family where it's like, hey, refer this case. I think that these are like five different reasons why you want to.
Speaker 2:And also, on the flip side of that, there's so many cases that dentists will send me where I'm like, man, you can do this, like go, go, go, and they're like they're so afraid to do it and they're so concerned because they just want to do like the best job they can.
Speaker 2:So it's nice to have someone in your corner who reviews the case and is like, have no fear, this one is green light, sprint at this one type of deal, and you do that for a lot of your people that come through CSI, right, yeah, and actually one thing I'm doing is I'm going around on random Fridays and doing philanthropy surgeries. So I'm just doing like free surgeries for different offices in Colorado, and so these dentists who like really don't have surgical practices are starting to send me their cases. And I'm getting to these dialogues more and more and it's really fun to see the way that different dentists with different trainings like a cosmetic dentist who does no surgery, how he conveys the message to me versus the GP dentist, versus the ortho dentist. So it's just a fun little passion project I'm doing here for right now I have a lot of people sending me cases and then it's interesting to see the way each different person's mind kind of puts it together.
Speaker 1:I think about, like every case that I've lost sleep over. There was one point during the consultation where, even if it was just a glimpse, where it was like don't do this, don't do this dumbass, you're not that good. And I'm like yeah, I am, you know. And then I was like yeah, yeah, yeah, a hundred percent. The ego, it's the ego. It always crosses your mind.
Speaker 2:Yeah, so there was this one article that came out, but they're actually proving that there's like a neurologic connection between the gut and the brain. So that's why, when I have this like gut feeling, it's your body actually signaling like hey, something is going on. And then you have the intuition that's like in the mind and then you're like, oh, I have this, like you know, heart-based based feeling. There's different ways your body is speaking to you in the consultation room and if you just kind of quiet down a little bit and you just listen to your own intuition, like you know what's right and wrong, you know when you're pushing the limits a little bit, you know when that patient's a little freaking crazy, you know when to pull the ripcord on it. So just trust yourself. When you feel that way, trust yourself, say no to it. The money will come later.
Speaker 1:Yeah, so true, I'm about to deliver 10 units next week and we'll see. I've had this feeling the whole time and I got a bad feeling. I got a bad feeling that keeps pushing me along and we're going to see how it goes. But yeah, man, so if anyone wants to reach out to you or check out what Colorado Surgical Institute offers, where do they go?
Speaker 2:If you want to call Chris Richards, it's 970-410-6148. Or you can email him at chris at legacydentalinccom. Or just check out the Colorado Surgical Institute page or socials or what have you, or look me up on Instagram. We have programs really that cover everything surgical. We even have a Brazil program coming up and we started a digital workflow program. That's like really hands on. So, at the end of the day, anything that really exists within this educational forum, we're creating content for us. If you really want to learn it, I have a way for you to learn it and we're truly here to help.
Speaker 1:Dude, thanks so much for coming on. Always a pleasure, and we'll get you back on maybe next month sometime, because every time you're here I think you just give us so many good things. So thanks so much, de'hare. Yeah, thank you, brother.
