Howard: It is just a huge, huge honor for me today to be podcast interviewing hygienist Deborah Carrier who is the founder of twiceasniceuniforms.com, co-founder of The CPR Sisters, a practicing dental hygienist, and fashion model. Debora has thirty eight years’ experience as a clinical dental hygienist. Her clinical settings range from large group practices to smaller office, specializing in the care and treatment of adults with mild to severe disabilities. The CPR Sisters was co- founded in 2001 by Debora and her sister Darla. They had worked hand in hand with the community to raise awareness of sudden cardiac arrest in children, the importance of early CPR, and the placement of AEDs in public areas. They also partnered with AHA (American Heart Association), through a grant, to train as many lay people as possible in their community and worked extensively with the Nader Parman Memorial Foundation to pass legislation to place at least one AED in all Georgia public schools with that Nader Parman? In 2014, Debora developed and patented a temperature regulating, moisture wicking, antimicrobial uniform and founded Twice as Nice Uniforms. In addition to her many years working as a dental hygienist she was also a high fashion model. She took her experience and love of fashion in New York City where she worked with and learned from industry experts about fabrics, fit, and manufacturing before setting out to create a new stylish, technologically advanced approach to medical and dental apparel. Debora has been featured in RDH magazine, Dentistry Today, Dental Explorer, Dental IQ, Atlanta’s Best Self, and winner of Apparel Magazines Most Innovative Company of 2015. She is member of the Crest Smile Council, partnered with AACD, NCN, Mr. RDH, Smiles at Sea and has participated in various podcasts, seminars, and fashion shows over the past two years. She has also partnered with Crest/Oral B and Atlanta Dental Supply to offer continuing education/fashion shows to the dental community. She is a member of American Dental Hygiene Association, OSAP, NCN, and Launchpad. A percentage of Twice as Nice Uniforms sales go to support the National Cancer Network Foundation. You are a busy, busy person, my god. Do you ever sleep?
Debora: No, a little bit but yes, I’m always on the go and I like it that way.
Howard: Wow. So, tell us when I think of you, I think of five people in the office fighting over the thermostat. I mean there's always someone that's freezing, there’s someone too hot, and in some offices, go to the point where they lock up the thermostat box I'm like, my god.
Howard: There’s got to be a better solution than locking up the thermostat box. So, what's the answer? Is the office too hot or is it too cold?
Debora: It depends on who you are and where you’re working. But yes, that is exactly why I started this. That story is in every single office out there. Every office I walk into, they have to tell me that story. So, I'm a problem solver. So, a couple years ago I started thinking about this issue because in my office I was the one who was always freezing and I'd literally have to go outside at lunch to thaw out because I was so cold and I felt uncomfortable being bundled up. I didn't feel like I look professional and so that's why I decided to start down that road and I knew there were technology in fabrics and I knew we could solve the issue. So that's what I did.
Howard: Seriously in my little walnut brain I had no idea there was any technology in fabrics but talk about that. I mean, I just thought it started off with the Chinese making silk and only the kings and queens could afford it and then wool came along and then cotton. When it came out it was called the poor man's wool. So, the rich wore wool –
Howard: -which I think is scratchy and not very… but the poor man wore cotton. So, are we gone be past silk, wool and cotton? Where are we at now?
Debora: Absolutely. I mean there's all different types of blends that help you breathe but there's also actually technology that's embedded in the fabric. Basically, like under-armor fabric or dry fit where it does regulate your temperature, helps your body to breathe, helps your body to regulate, there's also antimicrobial finishes.
Howard: Really? There's antimicrobial stuff in fabrics?
Debora: Oh, yeah. It's a silver that's embedded. It’s either sewn into it or it’s embedded in the fabric and it’s good for so many washes, usually 50 washes. Ours are good for a hundred washes. There’s also technology for moisture wicking and actually moisture repellent. There's some fabrics you can literally spray a hose at you and it'll just brush right off of you. So, it worked. It's very interesting what's happening with technology and fabric now, is we’re going down a road where eventually our clothes will be able to tell us our heart rate, our temperature, all kinds of interesting things.
Howard: The last couple times I was – I have four boys and we’re all the same size so underwear and socks disappear fast in this house. A lot of those things I get wearing socks, you can't even hardly find cotton anymore. It’s like all the choices are just some type of nylon.
Debora: Cotton has gone to the wayside for a lot of reasons and in the medical uniforms it has, because it stains very easily, it wrinkles, it's hard to take care of.
Howard: So, I always go straight to cost. I just always figured nylon was cheaper than cotton but there’s other reasons than just price.
Debora: Exactly, yeah.
Howard: I love your YouTube video and we were talking before the show that I feel like I already know you. I feel like I've already podcast you. I mean you look at these dental office websites. If they don't have a picture, a hundred people could land on the website. No one would call the office. If they have a picture maybe ten people have to land to go to your website but if you have a video and when I watched your video I mean like, kudos you, I thought like I already know you. Your YouTube video explains it so well. I'm gonna add it at the end of the show ‘cuz it's very well done but why don't you explain it more because it's hard for me to explain here. Well, it's kind of like a two-part system.
Debora: On my uniforms?
Debora: Yeah, so the way it works is there is a removable liner that snaps into the scrubs and into the lab coats and the removable liner is the part that has the temperature regulating in it. I made it removable because I thought people might want the option but honestly, I talked to very few people who actually take the liner out. I mean you may even wash it with the liner in so but it's in everything. It's in the tops, it's in the pants, and it’s in the lab coats. Now, what I do hear a lot is especially for the people who are hot, you're like, “why is an extra layer going to cool me off?” And it is due to the technology, it's in the fabric, and all I can tell you is you just have to try it and if you don't like it you can return them but I have very few people return them and say they don't work. So that's the way it works. It’s just a removable liner that comes in and out. And then my outer fabrics also have the moisture wicking. They don't stain very easily. They don't fade. So, they stay looking nice a long time because these are more expensive uniforms but it's an investment. They're gonna last you a lot longer.
Howard: You have done hygiene for thirty-eight years. Kudos to you. And podcasters are usually millennials. Not baby boomers like us.
Howard: And they have a big soul-searching thing about the uniform. I’m gonna back up and dress up first. You've done it thirty years. You’re a fashion model. I was gonna be a fashion model but I was just too busy at the very end and I couldn't work in the cover of GQ at the time. A lot of them think I'm only twenty-five. Yeah, you got it. Just lay confidence and you got to be the doctor. So, some women think I should be in a full dress with high heels. A lot of the them think I should be in a suit and tie and then there's guys like me I want to be in scrubs.
Howard: But when you do a lecture or you do stand-up comedy or you go in there to meet a patient, you've only got five or ten seconds to establish likability and trust and confidence. So, first way on to the girls. Should the girls be in dresses and the boys be in ties or are scrubs the way?
Debora: I believe scrubs are the way. I understand what they're saying but if the doctor puts on a lab coat and has on a different lab coat than the rest of the staff. Even if you have let's say, a young female dentist who doesn't look like she's the dentist and I've run into a lot that may have this problem. But if they have on a nice starched, nice lab coat that the studies show that people bring respect to someone that's in a white coat so I highly recommend it. I mean number one, why ruin your clothes but it's against infection control guidelines and you need to be protected and you need to be comfortable and you need to be professional. I mean the studies are showing that the patients give you sixty seconds when they walk in your office and in those sixty seconds they’re gonna look at what you look like and how you act and how you carry yourself and in those sixty seconds, they decide whether you're a good healthcare professional or not.
Howard: I know. I can't even believe it sixty seconds. If they redo those things down the road it might even be forty-five or thirty. You see it, you see the same pattern like saying like you see it in commercials. I mean why do they go with Samuel Jackson or these guys? Why do they pay those big bucks? Because they only got thirty to sixty seconds and you already have your belief in him. My, gosh. I've done stand-up in hundred comedy places, you get booed on your first three jokes. You're off the stage and then they're in the back in the green room crying.
Howard: And the same thing with doing a hygiene check. I mean you walk in there. It all takes place in seconds and also heard another interesting thing about the brain that the way our brain evolved is that when you're walking through the grasses and all of a sudden you saw a cheetah. You don't have time to sit and think well. He's bigger than me and he has long pointy teeth and he might not eat grass. You’d be dead if that's how your brain worked. Your brain rips through all that stuff instantly.
Howard: It tells you fight or flight and he also saw it in school. I mean when you and I are in school year. You’d read the questions and say, “Oh, it's B”. But then you start over thinking and over thinking then you erase B and then you put C and then after all these sessions. Oh! damn it. I had B. I put B. Look I erased it.
Howard: And so that's how the brain works. That’s likability. So, you're saying, I agree very importantly. The doctor should look different than the assistant –
Debora: Absolutely, yeah.
Howard: And the assistant should look different than the front office.
Debora: Right. And scrubs are not scrubs, are not scrubs are not scrubs. I mean there's different levels of scrubs and that's what you really need to look at. If you wear the big baggy unisex, horrible wrinkled scrubs, that's how you're gonna carry yourself and that's how you're gonna be perceived. But if you buy scrubs and lab coats that are fitted and more professional-looking and nice starch colors, that's how your patients are gonna see you. Now, as far as the whole office, I think everybody should be in the same color or complementary colors and as far as the people that work in the front. They’re the business people. They don't necessarily have to be in a uniform but they should be matching like the rest of the office. Same fabric.
Howard: You sew clothes for the girls up front too?
Debora: I'm in the process of – Yeah, I just developed some blouses for the ladies up front.
Howard: And by the way. We can't even say ladies anymore because from 1980 to 2015. We lost fifty million manufacturing jobs and boys are pouring into healthcare, I got two assistants right now that are boys. My office manager is a boy.
Howard: It's a changing face from hospitals to dental offices.
Debora: You're exactly right. We do have two different styles of scrubs for the men and we have two different styles of lab coats for the men also.
Howard: So, you have two styles of lab coats and scrubs.
Debora: For the guys and -
Howard: The boys -
Debora: Four different styles for the ladies.
Howard: So, you are a sexist then? So, the men get two and the women get four. Now tell me. How that flew with your conscience?
Debora: No, why? Because the guys are easier. That's what they want. My scrubs are different than most scrubs for men because they're not unisex and they look more, especially my pants, look more like dress pants than like cargo pants.
Howard: Cargo pants?
Debora: Yeah, that's what most scrub pants for men are. The ones with pockets on the side and they look more like hunting pants, cargo pants.
Howard: Cargo. Oh! I never heard that term.
Debora: Mine look more like dress pants and that's what the guys like. So, they don't need a whole lot of variety in what they wear versus the female, she wants a lot more variety.
Howard: But is it sexist for me to say, I mean don't you think women care a lot more what they look like than guys just on a general basis, or is that not true?
Debora: No. No.
Howard: So, you're saying basically I'm just a pig. But no, I mean I grew up with five sisters. I mean they took an hour to get ready in the morning. The most bizarre thing, my dad and I both ever saw in our life, in our entire life, is my sister's eating breakfast. Me and my dad we’re all eating breakfast. My other sister comes down to eat breakfast. Now, remember both of these girls would become nuns.
Howard: She came down, sat down. Saw that my sister was wearing her outfit or clothes or whatever. She dove across the table and stripped her and took her clothes back through and my dad are just like holy moly. Then I raised four boys and sometimes I'd have to hide their shirt because they'd wear the same Raiders t-shirt four days in a row like, “Dude, you can't wear the same shirt four days in a row”. “But I want to wear that shirt”. So, I'd have to hide it. But you're saying the boys and the girls are both really -
Debora: I’m saying that in the professional world. In everyday life, absolutely I agree with you and I was guilty of doing the same thing with my sister when I saw her in my clothes but -
Howard: You dive over the table though? Did you go over the breakfast table?
Debora: (inaudible 14:50) off the table but I got pretty upset. But as far as professional like a lot, especially the younger dentist that I talked to, males, that is very important for them to look… and hygienist to the male hygienists too. They are very- they want better stuff to wear and it's hard for them to find.
Howard: But to answer your question, they don't need to wear a dress, they don't need to wear a shirt and tie, they just need to have a nice lab coat.
Debora: Yeah, not to be if they really want to wear street clothes, they can wear it with the lab coat but honestly, I think it's better just for infection control and protecting yourself.
Howard: Well, it's tough because it's really easy for me to sit and say, I'm a boy and you're a girl. The hardest thing it is in business draw is that the silent generation thinks different than the baby boomers thinks different than the millennials and so you're trying to have a look not to have one person, Debora Carrier grade me. I mean, I'm trying to sell an implant to a seventy-year-old man with a liver spot and I'm trying to sell bleaching to a young millennial, so, you have to have a look that fits the biggest percentage. So, what would the bell curve be? What would the majority find the most respected? You showing up in a dress or shirt and tie or you showing up with scrubs and a lab coat?
Debora: What I believe is no matter what you wear as long as you look professional and polished and your whole office has the same feel going on. I think that's what is important. Not so much hanging up on who's got what on but everybody that works in there should have on the same color each day. There's a lot of studies that show that the patients perceive they're getting better treatment when everybody's in the same color. I don't know why that is but they feel more comfortable, I think. So, at the end of the day –
Howard: ‘coz it looks more professional.
Debora: (inaudible 15:56) so much whether the doctor wears street clothes with the lab coat or scrubs with a lab coat but I think it's that everybody in the office needs to be impeccably dressed so your patient is confident that the office is clean and they have confidence in your knowledge and your skill.
Howard: Sorry to ask you these questions that aren't really related but they are kind related. I can't think anywhere else to ask this. On Dentaltown, because this is Dentistry Uncensored, unfiltered, raw. There's a lot of threads on dental school where dentists don't know what to do because they hired this hygienist and they interviewed him and she hide up but when she interviewed, she didn't have a gold pin in her nose. But when she showed up to work she had a gold pin in her nose or you have your favorite dental assistant for years and she comes back on Thursday sleeved and you're like, oh what?
Howard: And then they don't really want to talk about it because it might sound racist, sexist, whatever but just to dress up because again it's not just how do you look like with your homies while you're at the club. You got to have grandma and grandpa feel comfortable. You got make the boomers feel comfortable, millennials feel comfortable.
Howard: What do you say then at the dental office, when he says I hired my hygienist, now she shows up with a bone in her nose or visible tattoo. What is your thoughts on that?
Debora: I hear that all the time. In fact, I was at a conference this weekend and I heard it this weekend and he said, “my hygienist, when I see her out places, she looks amazing and she comes to work and she just looks like she got up and threw the first thing on, that she could find. My suggestion from that is from the get-go, the minute they're hired, there is a dress code policy that they have to sign and then that way you can go back to that because yes, I mean everybody should look neat and clean and as far as tattoos and piercings and all that kind of stuff, that's everybody's prerogative. It doesn't matter to me, but it's how your patients perceive you and there's patients that are gonna get upset about that so those things need to be covered up and not there, while you’re at work.
Howard: So, do you think some people are upset by nose, nasal piercings and visible tattoos?
Debora: Probably they are. Yeah. So, you have to think about the respect that you need to give to your patient.
Howard: I got fifty patients, my first ten years, because this guy across the street decided he was gonna just grow a beard and he was the best dentist. I'd let him work on me any day. Nice guy, unbelievable and it was always the same person. There was always an old grandpa who said, “I didn't want something falling out of his beard into my mouth”.
Debora: I know.
Howard: My dad, I'll tell you his deep, dark secrets. He thought anybody that grew facial hair was a lazy, just a lazy slob. I mean they're too lazy to get up and shave. I don't even want to talk to you.
Howard: I mean I'm like, “Dad, it's a mustache. Dude, get over it. It's a beard”. So, people are gonna have these thoughts and it's a lot easier. You're not gonna change the world. So, you got to change your policy.
Debora: Exactly. I mean it's a shame that we have to think that way but you do need to. I'm very open-minded and I'm not judgmental towards anybody but I can't think that way when I'm in my dental office. I have to think like I'm a dental professional and I have to dress and act like one, when in here.
Howard: Yeah. I don't want to be that way either, but it is obviously true that the smartest dentists in the world are all bald. It's always the case. I've never seen difference. I’m gonna go another thing. This might be weird or whatever but what about colors? I remember when Ronald Reagan his wife Nancy. It was always a red dress. I don't think I've ever seen a picture of her in a dress that wasn't red. Are there better colors? Are there power colors? Are there more- Are you trying to make them feel like I'm not gonna hurt you or they're more subtle, softer? Talk about color.
Debora: So, yeah. There are studies that certain colors calm people down. I think the colors need to be very complementary to what your offices which tend to be more muted, more complementary colors. However, I have to tell you that I started making red scrub in my scrub line and when I wear it to work my patients absolutely love it and I've sold a bunch of them. So, it's kind of… just a lot of it depends on where you live, like I think probably the more tropical states can get away with some brighter colors than some of the other states. But more importantly to everybody there just has to be a common theme through the office.
Howard: Yeah, the states though. I remember when the OSHA came out. Everybody in Arizona was so - like today, it's a hundred and eighteen degrees. The first couple years I practice, every assistant and hygienist, everybody wore white shorts and white tennis shoes. I mean, my god. Just to walk out and drive home your car, you need to bring those two mittens from your kitchen. I mean really, you'd have to get in your car and start the air conditioner for couple of minutes before you even touch your wheel.
Howard: And then OSHA comes along and says well because it was back because of HIV, right?
Howard: And that's was what it’s more like. Okay, so someone in the government thinks that I'm gonna get AIDS by you coughing on my knee, my calf, my thigh, really? How does that work?
Howard: But that is the law of the land, isn't it?
Debora: Yes, yes. You must follow infection control and it's not just for HIV, it's for a lot of different reasons to protect you..
Howard: But explain that. It’s because -
Debora: It protects your - anybody you come in contact with. Your patient, you and anybody else you come in contact with. That’s why I see this all the time. You’re supposed to wear your lab coat in your treatment room and leave it in your treatment room and it doesn't happen. Or they don't wear a lab coat and then they leave the office for the day in their scrubs and think about what's on your scrubs and you're going home and hugging your kids and making dinner. You don't need to ignore it.
Howard: And that's true. That’s why I stopped hugging my kids the minute I became a dentist. I never hugged them again - was for your own good Ryan. I didn’t want you to get hepatitis. So, do you have a dress code like that, if one of my homies is listening. Could you post? Do you have a dress code you could post on the message boards on DentalTown?
Debora: I absolutely can post that for you.
Howard: Well, we got a quarter million people in DentalTown. Fifty thousand have downloaded the app. There's fifty-eight categories. I'm wondering what category it would be under. Would it be under, let’s see? Would be under endo? No. Finance. Insurance, office oral path, ortho... I think it’d go best under practice management.
Howard: And then ask a dental consultant, dental phobia, front office discussion, ideas make your price go, practice management administration forums, staff management issues. That’s what I wish you'd go to. I wish you'd go to category practice management. Under staff management, you'd say, “Hey, just in a podcast with this guy from GQ magazine, co-professional model of mine from New York and he wanted me and then Ryan when we post the video, we’ll drop it where she does that but say, Howard wanted you to post this question that everybody's getting a lot about tattoos and earrings and things like that and it's tough because I had a dental assistant. I want to hire him so bad but he had a snake coming up the side of his neck and it's like - I love him. I think he's cool. I'm good with it but I don't know what percent. I mean, Phoenix has a lot of retired people in there and some of those sixty, seventy, eighty-year-old people come from a different generation where if you have a snake tattooed on your neck.
Howard: You must have been in prison or you did drugs or you worship some other deity but, yeah, I wish you would post underneath it because it's a very prominent question on DentalTown.
Debora: To handle that issue too, is for the doctor to buy the uniforms for the office and then that way you have total control over who's coming to work and what.
Howard: Yeah. And I got something else to say about that. Nothing irks me more when the dentist is wearing loupes and the hygienist and his assistant aren’t.
Debora: Oh, I know.
Howard: And then the same idiot will say, “Sometimes I'll go through to hygiene check or she seemed out of temper and she left the big speculum cement”. Like, “Dude, you’re wearing three point eight and she's got a naked monkey eye going on”. So, yeah, we buy the uniforms and we buy loupes for everybody with wet hands. You're saying the doctor should control the uniform policy by, I'm gonna buy it. This is what you wear. So, most dental offices work Monday, Tuesday, Wednesday, Thursday. Four days a week, sixteen days a month. So, what you just do, buy four different colors for four different days and that's just so they just know what day you're wearing what.
Debora: (inaudible 26:08)
Howard: And then do you wash that?
Debora: Go ahead. I’m sorry. What?
Howard: And then do you leave the uniform there and then the dental office washes them there, coz that's what we do. We got our own washer and dryer.
Debora: That's exactly how it should work. Most offices that buy from us, they'll buy four sets of scrubs and two jackets for each employee and they leave them at the office. They wash them at the office and everything stays there. And also having them embroidered. I think that’s very important with your logo and have a nametag for your name but to put your company logo on your uniforms.
Howard: And I'll never forget (inaudible 26:48) What’s that again?
Debora: I said in that way then they won't walk away. They'll stay there too, the uniforms.
Howard: Oh, if you put your office name on there.
Howard: Oh, nice. I didn't think about that but I do remember. I figured this out with one of my first associates back in the 80s and she went to numb up the patient and an old senile grandpa grabbed her wrist and said, “Shouldn't the doctor be doing that?” And she was a doctor. And I thought to myself, “Well, okay we can't blame Grandpa for being stupid. There’s seven and a half billion people on the earth. We can't blame him and that's when I decided doctors have to look different than the rest. And so, the dentists are the only ones wearing the lab coats and then their embroidery name should say doctor.
Debora: Well either I mean, anybody that's working with a patient should have some kind of lab coat or protective disposable coat or something on but what I like to see is the doctor in one color coat and the staff in a different color coat. Like I sell three different colors of coats and we're going to be adding more colors. And have the doctor in white and have the rest of the team in the gray or black or navy something like that. They do stand out.
Howard: Yeah. Make sense I mean imagine if you were in the hospital and some guy walked in. He had a tool belt on with the pliers all that stuff and then he walked over to you and started to start IV. You'd be thinking, “Dude, are you the television repairman?”
Howard: I also noticed that every franchise in America from a Hilton to a Hyatt to a Hertz Rent-A-Car, all the way down to In-and-Out burger, everyone's in a uniform.
Howard: And then you go into a place that's gonna treat you for cancer and you have to say, “Excuse me, what is your name?” Dude if you go to Burger King -
Howard: You know what their name is. It says Adrian right there.
Howard: And then you go into a place that’s gonna treat a life and death. Then you say, “I'm sorry, what is your name? I'm sorry what do you do? Are you the doctor?” “No, I'm not the doctor”.
Howard: I'm the insurance coordinator.
Debora: I belong to the Uniform Retailers Association. I go to their meetings and it's interesting to hear especially in the hospital where they're coming from. There is a big trend for all hospitals to go to color coding. And what I mean by that is all the radiologists wear one color and all the PIAs wear one color and then that way when you are a patient there, you're gonna know, my RN’s in navy, my radiologist is in red. So, you will know when somebody comes walking in your room who you're dealing with and I think that's a fantastic idea.
Howard: That is really nice. I just thought if you put in Twice As Nice Uniforms in the search bar. They’re already talking about you. You put in uniforms, the list goes on forever. I wish you'd go in there someday and address all this and it's good marketing for you because you can't go in there and say, “Oh, all the answer is buy my uniform”. That's spam.
Howard: You can. Everybody can start one thread for their speaking. There’s some in there. So, if you start a thread, you get to have one thread that shows uniforms, talk, discussion, whatever. But in the other threads like if you did a search like uniforms, your answer that, you can answer that but in your signature, there's your name, your picture, your logo uniforms. I think you will command a lot of respect because you're already a hygienist of thirty-eight years and you're talking to a lot of people under 30, you know what I mean?
Debora: Yes, yeah.
Howard: How does it feel like you have done hygiene longer than most of your colleagues that have been alive?
Debora: Yeah. You know doesn't feel like it. I've been at the same office now for like twenty-eight years but it feels like ten years. I mean, I still love it. I love my patients. I've been fortunate that it hasn't taken its toll on my body like it has on a lot of people. That was another reason with my scrubs I wanted to make them nice and comfortable because we have hard jobs. There's no doubt about it. We have hard jobs and by what you wear to work can make your job a little bit easier every day. That was one of my goals.
Howard: So, you think it even… leads to a healthier body over the long –
Howard: Like explain that way.
Debora: As far as what leads to healthier body?
Howard: Like back pain, neck pain.
Debora: Oh, how did I?
Howard: I mean it's a hard job, but do you think uniforms can help or hurt that? Because –
Debora: Yeah. I know it did in my case. I know the first day that I wore my uniforms to work, I was amazed that when I'm reaching over to get something across the room I couldn't move, because before I was like moving my entire body. I mean it's whether you're sitting on a good stool or a bad stool you know how you feel and you don't feel like you can move as much, absolutely makes all the difference in the world. And then of course the temperature thing is huge.
Howard: I’ve been a dentist in all thirty-three years and honestly for me, there's a podiatrist. He’s been in thirty years and saw him at lunch yesterday. We both went in the Burrito Company and he was in there and he told me for thirty years that the majority of his clients are what? They're women wearing high-heeled shoes. And he doesn't even think even this should be legal. And you're go in to his office and you see some of these women dentists and front office ladies and they're almost wobbling just to get to the copier machine and I just think you can't do that for thirty, forty, fifty years.
Debora: No, you can't. You have to be smart. You have to think about what toll this is gonna take on my body. If you talk to the people in dentistry who are injured now, that's exactly what they say. I wish I would have paid attention to it. And the wonderful thing is now that we have the technology to help us, we have loupes, we have saddle stools, we have those kinds of things to help us in our daily jobs that we didn't have thirty years ago.
Howard: And what do you wear on your feet? Is that summer shoes, dress shoes, high-heeled shoes?
Debora: I wear nurse’s shoes ‘coz they have support and there's cute ones, you don’t have to wear –
Howard: Nurse’s shoes. I never heard of cargo pants or nurse’s shoes. I'm learning all kinds of vocabulary words. What the hell is a nurse's shoe?
Debora: It's just more comfortable. They kinda look like clogs, some of them look like clogs but there's all different brands and they're made for being on your feet. And then they're cute, they’re not really –
Howard: I've ever heard of cloggers.
Debora: Cloggers? Oh, yeah. Yeah –
Howard: Are they the dancers? No, you can’t make this up. So, this little sweet lady the other night she said to me – been patient with whatever - she said, “Well, I'm in a group, the cloggers and we're having a performance at the high school, I really wish you'd come”. I said, “I'll go”. It’s a bunch of seventy, eighty-year-old ladies. It's kind of like a tap dancing but they wear these shoes that made a percussion and they were all seventy, eighty-year-old women and god dang, they were in good shape and that looks so cool. But as I got older and older and older I figured- I finally, -through trial and error, the only thing that I can stand on my feet on all day long and not even ever once think about my feet are ASICS tennis shoes. And one of the problems they say tennis shoes they all look like, whoever designed them, was on a peyote trip in some desert. It stands out. Your shoes like could be orange, black, green, red, mixture, and then when you go to order a new pair, of course that color is gone and no longer exist anymore. So, now when I ever order ASICS I order two pairs at a time. It's hard to even get them if they're not orange, red, green.
Debora: I know. I do wish that they would make those in just basic white or gray or something like that.
Howard: Do you like ASICS?
Debora: Yeah. I don't personally wear them but yeah, I like the look. But you’re right, they’re looking so loud if you're wearing them with your uniform.
Howard: I know one thing though, every single one of my podiatrists, friends, or patients, they want you wearing New Balance, ASICS. They want you to invest in a high dollar, healthy shoe. And they always say if you don't believe them just go to the American Association of Podiatric whatever but these women, these millennial girls who are looking like they're all that in a bag of chips. They don't realize they were that deformed, crazy-looking silly thing and they're gonna be having foot surgery when they're sixty.
Debora: And they pay for it, yeah. But just live and learn. You can only tell people so many times and they’re like –
Howard: Now you're in Georgia so I assume most people are barefoot that works there?
Debora: Yeah. We don't own shoes in Georgia.
Howard: And I wanted to know why you live in Roswell, Georgia. Roswell, there are Mexican man you'd get to work on UFOs.
Debora: Well, yeah that would be fine but Roswell, it's pretty interesting around here. Alana's pretty eclectic.
Howard: And where was my favorite band REM. Were they from Roswell?
Howard: Oh, Athens.
Howard: Did you like that band?
Debora: Yeah, I like that band.
Howard: Was that the most proud thing that ever came out of Georgia in your mind or was it the Atlanta Falcons going to the Super Bowl?
Debora: We have a lot of good musicians here, I'll take that, yeah. I'm originally from Chicago so answering thing about the Falcons is hard for me because I'm a Bear fan and a Cup fan.
Howard: Yeah. Chicago, they have the most hardcore fans.
Debora: Yes, we do.
Howard: Because I think it's tied directly to alcoholism.
Debora: Well, that's very true. That is a lot –
Howard: That the harder the core the fan they are, I think they just want to go to the bar and drink and watch the game or anything but –
Debora: No. You know, they have cold weather to deal with so they have to drink, stay warm.
Howard: I wanted to talk about something else that's amazing. So, you've been a hygienist thirty years where you work your current job twenty.
Debora: I've been off as I'm at right now twenty-eight years 20, yeah.
Howard: Twenty years. And all these dentists, they're so afraid that corporate dentistry is taking over dentistry and all the pace is gonna go to corporate dentistry but do you think corporate dentistry is keeping their hygienist twenty-eight years?
Howard: Do you see the staff turnover?
Debora: Yeah. Yes, from the hygienist that I know that work in corporate dentistry, they're not happy.
Howard: And wait, do you think that you being there twenty-eight years adds immense value to retaining customers for life?
Debora: Huge. Huge.
Howard: It's everything.
Howard: And all these young millennials that I wanna talk about, the thirty and under just drives me crazy like, well you need to have twenty-eight Yelp reviews. You need to have seventeen Google reviews and you need to get on Twitter and not as like – Dude, no. You can't have all your staff quit every two years.
Howard: I mean, I've been here thirty years. People ask me in 2008, “So, what are you doing during the crash?” Dude, I'm working on my patient’s children's children now.
Debora: Exactly. That's me too and that's so important. They feel they have trust in you and they feel comfortable with you and they just keep coming back. And I have patients that travel from China and London and Canada, New York, and from all over the place. They've moved away but they just keep coming back because they have that comfort level. Everyone in my office has been there a very long time and that's important.
Howard: So, what do you think the owner - is it a group practice, one owner?
Debora: No. One doctor.
Howard: One doctor. So, what do you think is in his leadership bag of karma that's able to keep a bunch of people in that office for twenty plus years?
Debora: He’s one of the most laid-back dentist I’ve ever met in my life. He’s just very laid-back but you know, he's the boss, but, we all respect each other and he respects us and we just had a very family environment in our office. Now I've worked in other office. Actually, the first office I worked at when I got out of hygiene school was a big group office, but it wasn't run like a corporation. It was run like a smaller office and I think that has a lot to do with what happens with turnover and employee satisfaction and you can't treat somebody like a factory worker and expect them to be a professional hygienist.
Howard: Yeah, and yes respect you and so many of these doctors have the god complex. Like when I get on a plane I always start turning to the first text, saying and I'm just curious you know if you have this guy, not a lawyer, not a physician, let's go the dentist. Give me three words to describe a dentist. It's never laid back, it's never cool, it’s never a great guy. It's always arrogant, talking down, know-it-all. I bet grandma say, “No, when that doctor was telling me I had gum disease I wanted to punch him”. Because he was explaining it making her feel bad so she wasn't releasing serotonin, dopamine, oxytocin. She was releasing adrenaline, noradrenaline fight-or-flight. When grandma wants to punch you –
Howard: You're not gonna keep your staff and your patients for twenty years.
Debora: Exactly. In our office, we give the patients all the information and we give them you know everything they need to do, but we don't talk down to them as we're showing it to them. They're adults, we're adults. We lay out the information for you. We lay out our knowledge to you and then you choose to do what you want with it. But being this higher being whatever you want to look at it that way, that's not the way to treat another human being.
Howard: And the dental schools are changing. I mean thirty years ago, they all had this Marine Corps boot camp mentality that the meaner they were to you they were doing it just because it was best for you. And now the dental schools are like, “Yeah, that's why none of your graduates give you money each year”. What schools have the biggest dowry then they start studying the Notre Dame's and the Harvard's and realize. You know what they do differently? They respect their students and they treat them like family and these guys, I mean Notre Dame, if their head priest sends out a letter, I mean the worst that could do is ten or twenty million dollars and if it’s really a good letter? It'll be fifty million.
Debora: Sure. Yeah.
Howard: Same with Harvard.
Debora: (inaudible 41:36) we have that connection and it's very important to have a human connection, very.
Howard: Yeah, and it's gotta be respect. I wanna see how laid back he is. I'm gonna ask you some pointing question. I'm probably gonna get you fired, that's my goal. I'm gonna get you to say something on podcast or he sent you an email tonight. So, how laid-back is he? What happens when that patient come in and says, “I want a cleaning and I don't want x-rays”. Is he like, “Well, let's do a cleaning. Let's build trust”. We'll get x-rays out of them someday or is that like a hard ball she liked and hit the door jack?
Debora: No, it isn't gonna hit the door but these are the reasons why you need the x-rays and you know we respect your opinion but you need to respect the knowledge that we have and this is why you need them blah blah blah. Nine times out of ten they take the x-rays.
Howard: Okay and what about that one out of ten, no x-rays.
Debora: Well, we have a –
Howard: I’m not right in the head. I'm sure my mom dropped me.
Debora: We have a policy we let him skip it once if it’s all faded in the chart and that’s it.
Howard: I know. Yeah. And these dentists, yeah. So, you let it go once. That's what I do too. It’s like, “I am your dentist. I'm trying to help you and if you're not helping yourself I don't see why”. The dentist says, “Well, then I can't help them all”. No cares better than a little substandard care and then they always say, “Well it's because you're in your suit”. And I always go back and say, “Okay, well I have major disability or malpractice companies that will send me all the claims they did last week”. It's never all these little details. It's always something really bad happened, you know I mean? It's an anesthesia death, it's a major implant case, peri-implantitis, you did a root canal and nine times out of ten I want to say this, if a person - I'm trying to figure out your doc because he's obviously got an A-plus in HR keeping you twenty-eight years, what if he does a denture on grandma and she comes back she says, “The old ones fits better. I'm putting my old ones back in. Here's the ones you made me and I want my money back”. And she lays them right on the counter.
Debora: Right. We’ve had that happen. It happened to my grandma actually.
Debora: Yeah, well we work with them. He adjusted a few times and they keep coming back and it all is a individual basis. What kind of patient they are, how they've worked with us through the years.
Howard: But my malpractice attorneys tell me so much of this noise would have been prevented if you didn't give their money back, or refer them to someone that can fix it and the doctor’s ego won't do it. Walmart, I mean, if you go buy a sleeping bag at Walmart and then you go sit there and camp out all weekend at the river and then bring it back on Monday with dirt, rock, mud on it and show them a scratch and say you want your money back, what does Walmart do?
Debora: They’re gonna take back.
Howard: Yeah and someone said I'm not gonna argue with it and it's 1%.
Howard: And you can't let 1% of the crazy people cause you all this grief. Then next thing you know now the dentist has got to cancel a whole day's production because you got to go down to the board and he doesn't want to go down the board without an attorney and then they have to wait there three hours. I was like, “Okay, so you just lost a $5,000 day of production because you wouldn't give grandma back her thousand dollars for the denture?”
Debora: Right, I know. You have to have common sense in this.
Howard: But common sense is not common in dentistry.
Debora: True. Yeah, it’s not just common at all. A lot people out there have not much common sense.
Howard: So, I'm just starting to think I’ve had you for 48 minutes. You just had the millennials, the podcasters are millennials they're not boomers like us. What advice would you give these young dentists as they work with the hygienists? What advice would you give a lot of hygienists on the show? What advice would you give the hygienist where - it sounds like you and your dentists have a great relationship. What advice would you give them to get along? Can we all just get along?
Debora: I would recommend that they really listen to the hygienist and take care of the hygienist. I was saying with like you were bringing up with the loops or a saddle stool or whatever they can make her day-to-day easier. It's gonna make her happier which results in the patient being happier which at the end reflects your bottom line and it keeps everybody in the office happy. In my case with my doctor, he was very understanding about if I had a family, if I had to do something with my son one day and I needed to reschedule a patient or something like that. We’re all people. We all have families and I think that's really important to pay attention to the person, not to the job and how much she's got to produce on a daily basis because she'll produce a ton for you if you treat her right or not. [46:51 unclear] the hygienist. Pardon me?
Howard: How many children did you have?
Howard: One son? And I have four sons. Do you think that's why you look four times better than me? Because I have four boys? Gosh, Ryan. Look how much stress you've done to me. And I'm looking at you think I should have stopped at Eric. And it was Ryan, Zack, and Greg that killed me. Another thing, the code diagnosing thing. I mean some dentists won't let their hygienist talk and I’m like okay well, we're selling the invisible you didn't pull up in a Mercedes. You're not the rich doctor owner. You work here. They know that everybody in the – they know who's an employee and who's an owner. What do you think of the code diagnosing?
Debora: You have to think about how long that patient is with the hygienist. They were with that hygienist forty-five minutes to an hour and they’re with the doctor for a minute or two? So, I think that collaborating is very important. I've gotten to with my doctor where we can like communicate without even talking and we're on the same wavelength with how we're gonna treat the patient. But again, that has to be very open and really get to know your employees and be comfortable.
Howard: I wouldn’t even tolerate. I mean I want them to be in there, telling them everything they know in an honest and transparent way and I want her to say, yeah, this is the cavity, it's into the nerve. Look how the infection’s going at the bottom, that’s an abscess. You need a root canal and then a root canal need a crown and then I go to another one, it says, “well, you know, I can't say anything”. And it’s like, you can’t say anything? That’s a control freak weirdo who always has massive staff turnover and very low [48:39 unclear] then you'll go to another office who’re in the middle. They don't know where they are. They're like, well, you know, I can't say I'm not the doctor, but, I think you have something going on there. It’s like going on there? Is there one registered nurse in a hospital that would say, I think we have something going on here. I mean there it's all about communication. I go to the hospital about every 10 years. I have the same ailment every 10 years. A kidney stone and it's gotten better the three times I've gone there from age twenty-five, thirty-five, forty-five, to my last one fifty-five and you know they have a greased board in, there the nurse will come in there. Well, what questions you have? And as I remember questions, you'll write it down and then, she'll answer the whole thing. And then she’ll write on the second and the third and then when there's a shift change and a different nurse or when the doctor comes in, they look at the grease board and then the doctor just say, “So, do you understand all this? I mean are we good here?” I mean it's all communication. It's all keeping staff reliable.
Debora: You have to have huge open communication and your patient will pick up on that. They'll totally get and have trust for everybody in the office.
Howard: And then I want to talk about something in the news yesterday, Georgia just passed a law, did you hear about that law for a dental hygienist the other day?
Debora: Yeah. The one where we have – oh my gosh, I forget the name of it but where we can go out into the long-term nursing facilities and that type of stuff.
Howard: Yeah. I’ve always thought that the best thing for any industry was competition and I have always been very against all the dentists fighting the hygienists with unsupervised hygiene. So, when I was growing up, I'm fifty-four. When I grew up in Kansas, on every Saturday and Sunday if I walk down my street every third garage, all the boys are there trying to get this car to work again, playing a baseball ordeal, all the cars were horrible and it wasn't until Japan and Germany start selling cars that actually worked. Chevy, Chrysler and Ford. So, I think corporate dentistry is very good for dentistry. They got better hours, they got marketing, they got uniforms and nametags and it's gonna raise the level of all the dentistry and that's good for dentistry; between the dentists and the patients. And I think that it is a crime, I don't know how you could say that you're really a dentist, you're really there for the patients by not letting a hygienist going the street in some town of 1,000 and she lives out there and she gets rid of her dining room table and her china closet. I never understood the china closet anyway because every woman I know that has a big china closet hasn't cooked anything in the last four years and they throw all that away and they put in operatory and they start doing hygiene out of their home and then if they see something they write a referral slip and then they drive from the one thousandth town to the five thousandth town and every dentist I know that lives up the street thinks that girl is the greatest girl in the world and they send her cookies and gifts and muffins. So, I think any form of faulting competition is pathetic. So, what it was, it was in the daily Democrat, what was it? Where was that article? I thought I – no, I can't find it. But, anyway, yeah. So, it was a lot of place that they could work and a hygienist could work unsupervised in domestic violence, nursing homes, and gosh, I wish I could find that list. I posted it.
Debora: What it… is it just gives a lot more patients access to care that were never gonna get that care. And that's what was frustrating about it. Here's these people who need care and there weren't any dentists to go give them care and there were hygienists wanting to. It was sad so yeah, I'm excited about that.
Howard: But you know the most opportunity is during a disruption. If you're sitting there and they tell you you're playing checkers and then all of a sudden, the law is passed and they say okay this is no longer checkers, it’s chess. It's still the same board, the same number of pieces but everything changes. And I mean there's hygienists out there working in a job they hate for a boss that doesn't respect them and just being able to go into a nursing home unsupervised bada bing bada bing bada bing. I mean, I don't know about the domestic violence shelters. I think a lot of them are very hidden. I think I hear that most people who go to a domestic violence shelter, a lot of them say the neighbors didn't even know that's what it was. But man, how many nursing homes are in Georgia?
Debora: Well here's a good example. I have a lot of patients in my practice that are both physically and mentally challenged and some of them, it's hard for them to get to the office. And a lot of them they live in group homes, so, a lot of them I wanted to be able to teach their caregivers how to help them with their home care. But legally, in Georgia I wasn't allowed to go to their home and teach their caregivers how to help them.
Howard: And who made that rule? Who made that rule? Was it the Congress? Was it the – I mean who made that rule? Like Dental Association.
Howard: I feel like that's a bunch of dentist who walk in there. I mean they do it in Arizona all the time and they always think they're good people. They have the Bible in one hand, they’re wearing a crucifix and then the other - they're just really, really, really good people and then when they get done signing the bill, it's like, “I don't think that's anything that's good”. I mean you just took away access to care, availability, competition and your walnut brain rationalize it because you did it because you're all that and this is what's best for the patient. And what ends up being best for the patient every time is that no care is better than some care.
Debora: Yeah. Yup, I know. It's sad. I didn't know you’re from Kansas. I'm from Kansas.
Howard: Really? Where you from?
Debora: Topeka. I was born in Manhattan.
Howard: Really? K-state.
Howard: Wow. And Topeka is the capital.
Debora: Yeah. Where are you from?
Debora: Oh, okay. Yeah.
Howard: And my mom, dad, I don't like to say where they're from. It's Parsons, Kansas. So, now you know they were born in a barn. I mean just everything you would think of anyone born in a barn in Parsons, Kansas is all true. A Farran family reunion looks like the CDC should be there taking DNA swabs to find out what the hell went wrong. But yeah, they were just good people there. That's what I liked about Kansas. I can say the same thing for Phoenix. A lot of people say they live in a town and everybody's this. I mean I feel in Phoenix like Kansas, I think any neighbor here give me the shirt off his back.
Debora: That's wonderful.
Howard: Yeah, I really do like that home deal. So, that was the hour. Hell, we went into overtime so I just wanna end with one thing. Six thousand little boys and girls just got out of that dental school last month and they're entering the workforce. If you had to give them, you only have two minutes left, if you had to give them a two-minute commencement speech as they come out of dental kindergarten and are about to go on and do dentistry for forty years, what advice would you part with them?
Debora: Look and dress and act like the professional that you are. You just spent a bazillion dollars and a bunch of years in dental school and you're intelligent, you're skilled and go out there and be that person. I mean, carry yourself the way you need to be and I worked for a doctor years ago that dressed impeccably and carried himself amazingly well. And he was a horrible dentist but the patient's thought he was a good dentist by the way that he carried himself. And I know as a young new hygienist, you're afraid you don't understand at all. You got to get out there and learn. That's why we're practicing and just dress the part, act the part, and you will be the part.
Howard: Do you think he knew he was a horrible dentist?
Debora: I don't know.
Howard: Sometimes I’m always wondering. I mean, dude do you know that dentistry sucks? It’s hard to say.
Debora: I don't think he did.
Howard: You don't think he knew he was?
Debora: I always think the best of people but I don't know. I don't think so.
Howard: And I'll tell you one other thing after doing this for three decades, they never remember who worked on any tooth. I mean sometimes you'll do a filling on a tooth. “That tooth you did it's completely - It's waking me up in the middle of the night”. “Okay, well I did the tooth behind it I didn't do that one”. But the thing is they never remember. I mean even if they only have like one gold crown.
Howard: I'm like, “Larry, somebody got in your mouth and made your tooth turn gold and you have no idea who did it?” I mean, do you ever remember like waking up on a sidewalk and your mouth felt violated and there's a man running down. Could it have been that guy? And I’m like, “how?” So, the point is they only remember how you made them feel.
Debora: Exactly. Absolutely, you hit it right there. That's exactly it.
Howard: And they never know good dentistry. You listen to anybody in your whole pedigree talk. “Oh, go to my doctor. She's the best OBGYN in the world”. And I'll just say, “Well, half the MDs are board-certified and half aren’t. Is this one board-certified?” “Oh, I have no idea”. All right, can you give me any empirical data? I mean ask me one short think question, if this OBGYN is good? They can't answer anything. They just know she's the greatest OBGYN in the world. So, concentrate and I had you on the show, I called you, you did not call me, this was not a commercial, because you've only got - you say sixty seconds to establish that first impression. If they trust you and want to be my doctor, I'm gonna cut that down to six. Because I came from comedy and stand-up comedy, I mean that's a science and of itself. I mean you go to YouTube and listen to – who’s that four great comedian sitting there talking? It’s Chris Rock, Bob Saget, Louis CK. No, it’s that guy from New York. The guy had a movie series the New York Apartment. What's his name? The comedian they had? Steinberg? Seinfeld.
Debora: Jerry Seinfeld. Yeah.
Howard: Those four guys talk for like two hours on this deal and I mean just the science of it like Seinfeld. Let's say Monday, I write the joke but it's twelve words. I'll spend the next three days; every day, my job is to take one word out of that joke. I mean tighter, more succinct and then here's a dentist response. Seven-minute explanation of a root canal. Are you out of your mind? I mean every comedian that has a hundred million to a billion dollar says the community he's getting a tighter, succinct, tighter, tighter, tighter, tighter, tighter and then there's a doctor rambling on grandma's. You know she's at the point like is there any way you could just put me down? Should I go to the vet? So, shorter, tighter communication measure the response. You say your hygienists is great, well, how many of her patients come back? And then, when your hygienists didn't come back how many of her patients didn't come back?
Howard: Just learn this off stuff. I think this conversation was so amazing because I think they got six seconds to walk in there and look the part, build likability, like trust ability, and if you can kill it on the chair side manner, if you can kill it on attracting retaining staff you can be the shittiest dentist in Phoenix and be financially set the rest of your life.
Debora: Exactly right.
Howard: Well, start that one thread, post pictures of your stuff. I hope this show help you sell some uniforms.
Debora: Thank you. I really appreciate it.
Howard: And I'll see you at the GQ model convention coming up this year on a next project. Bye bye.
Debora: Bye bye.
Debora: Hi. My name is Debora Carrier and I'm the founder of Twice as Nice Uniforms. For thirty-five years of my life I've been a dental hygienist and fourteen of those years have been a CPR instructor. I also on and off through all those years I was a fashion model. Many health care providers work in cold environments. Often, they wear bulky layers over or under their scrubs in order to stay comfortable. This is not a practical or professional solution. I decided to solve this common problem by developing Twice As Nice Uniforms.
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