Tribute: Dr. Joe Steven Jr. by Dr. Jasmin Steven Rupp, DDS

Editor's Note: The dental industry lost a respected leader in May of this year when Joseph Steven Jr., DDS, passed away. In this section, we share reflections from his daughter and business partner, Dr. Jasmin Steven Rupp, as well as two articles written by Dr. Steven that were previously published in Dentaltown Magazine. Our journey My dad passed away Friday, May 22, 2015, after a long battle with cancer. Exactly one year before, doctors had removed his bladder due to an aggressive tumor. Fortunately, they were able to reconstruct a new bladder. Then in October 2014, the cancer came back. My dad began his fight with stage IV cancer at that moment. After his first four treatments with chemo and a very strict diet and lifestyle change (led by yours truly), the tumors were almost gone. (Two of the most helpful books were "A Definitive Guide to Cancer" and "How to Prevent and Treat Cancer with Natural Medicine.") When we heard that news, it truly was the happiest, most victorious day of my life. We all cried tears of joy at the office the moment we heard. My dad told me I saved his life, as we cried together for the first time ever. I will never forget that moment. So of course, we continued the same chemo regimen. He started losing weight because he lost his appetite as a side effect of his treatment, so we started letting him eat just whatever sounded good, as he had been feeling deprived. After all, everything was working so we had a little wiggle room, right? About two weeks later, his back started hurting. We were told that it was probably arthritis or the fact that he had lost some muscle mass. After the next four chemo treatments, the back pain got so severe that we did another scan. (So began one of the worst days of my life.) The tumor had done a complete reversal and was bigger than it was when we had begun. Feeling completely defeated, we rushed to MD Anderson. After just one treatment with the strongest chemo regimen that MD Anderson had to offer, the doctors could tell by his blood work that it was not working. We knew at this point that there was no cure and he had only months left. We decided to proceed with radiation to help with the back pain and bleeding that the tumor was causing. Although not a cure, it might—we hoped—buy us a few more months. The radiation absolutely did its job by shrinking the main tumor, but a colon infection took him down for weeks, making him weaker than ever. At this point, around the end of March 2015, we were told that the cancer had spread to his liver and he had less then a month left. The end The months of April and May have been the most invaluable blessings to our family. Yes, we had many irritating moments with each other, as my mom, sister and I were just holding on, and my dad was most certainly not the easiest of patients. Getting him to eat was absolutely the biggest challenge we encountered. It's hard to know what a person dying of cancer is going through, but no one was giving up just yet. And in fact, two to four weeks turned into eight weeks. We did everything in our own power, which unfortunately was trumped by the power of the cancer. However, with cancer, you get the opportunity to say and do everything you need to, leaving the family with a "no regrets" feeling that often is not an option when it comes to death. In that, cancer has an odd way of blessing families. The person, Joe I joined my dad as a dentist back in 2007 and was able to learn his way of practicing dentistry. In fact, he had experienced the pleasure of teaching "his way" to thousands of dentists around the country for more than 30 years. He was a nationally recognized lecturer and consultant through his dental company, KISCO, and his goal was to make others in the profession more efficient and successful. He believed that one could be a successful dentist while doing "bread and butter" dentistry, as he called it. He taught that if you treat your patients like family, as if every one of them were truly important, then you will be successful. His favorite book, the principles of which directed and guided his life, is Dale Carnegie's "How to Win Friends and Influence People." A hard copy remains with him today in his resting place. I always knew that people loved him and appreciated what a funny, kind guy he was. But it wasn't until he passed that I realized the immense effect he'd had on so many people's lives. The outpouring of stories about my dad from other dentists on how he personally helped their careers has been wonderfully overwhelming. His staff at the office adored him and many were with him for 20, 25 or 30 years. My dad believed that his own success was because of his wonderful staff. Going through this process has solidified the relationships I have with these women, as I see the loyalty and love they have had for their boss and friend, which is often rare. I now have some pretty big shoes to fill. And they will be filled…in honor of my great father. What I learned Pick the right doctor. I have so much more respect for our oncologist because he was open to our ideas along the way. He never acted as if his word was gold, even though my dad thought so. He was as caring as anyone can be. We were not just a statistic to him. At the start of our journey, I began learning from the brilliant Dr. Bernie Siegel about all the different aspects that go into treating illness. One of the most inspiring books I have ever read is his "Love, Medicine and Miracles." I learned that the motivation of the patient to be proactive is vital for the survival of stage IV cancer. And I believe it is possible. Bernie Siegel gave me that gift. The glass is still half-full here. My healing The one thing I wish I had done was to really photograph my father at the end, especially with my girls. However, for whatever reason, the timing wasn't right and it didn't happen. Perhaps this is why I chose to create a blog about him. I will always be able to add to it and come to it when I feel the need. One of my favorite cards reads, "There are some who bring a light so great to the world that even after they have gone, the light remains." I am so proud to call him my dad, boss and mentor. Please visit my website, jasminruppphotography.com, for the full blog post with links and to view a special video honoring my dad's life. Dr. Jasmin Steven Rupp is the daughter of Dr. Joe Steven. She attended the University of Kansas as an undergraduate, and then went on to receive her dental degree at the University of Missouri-Kansas City Dental School. She graduated in 2007, after which she joined her father's practice, Riverside Dental, in Wichita, Kansas. She is a member of the ADA, the Kansas Dental Association and the Wichita District Dental Society. She and her husband, John, have two daughters, Harper and Lola.

We're slipping! Yes, our profession is slipping in the polls! Ten years ago, our profession enjoyed the honor of being ranked No. 2 in Gallup, Inc.'s poll for rating the public's respect and trust among various professions. We were right behind pharmacists. Unfortunately, Gallup's 2000 poll showed that we have slipped to eighth place, four places behind medical doctors. I don't know about you, but I enjoyed that well-deserved honor of being #No. 2. Now, I'm a little concerned about the direction our profession is headed.

I have entitled this article, "Maybe We Should Ban Amalgam," because I believe this entire amalgam controversy is driving a huge wedge between members of our profession. It almost appears as if an unhealthy class division has developed. On one side you have the metal-free practitioners, and on the other side the traditional practitioners, who for various reasons, offer their patients amalgam as a restorative option. Dentists who offer amalgam are viciously attacked for supposedly not offering quality dentistry. Dentists who offer composite fillings are often accused of only being concerned about charging and getting higher fees. I believe this dissention is truly weakening our public's perception and trust.

Coming apart
Twenty years ago, a popular trend of providing quadrants of gold inlays and onlays emerged. During that time, I don't recall a distinction being drawn or an attempt to make dentists feel guilty or inferior about the restoration choices for their patients. Offering gold to patients was presented as an upscale alternative for those who wanted longer-lasting, quality restorations. With the amalgam controversies, we seem to have one side accusing the other of cracking teeth and placing fillings that will always get decay under them. Even in my own hometown, a local dentist runs television ads that display schematic illustrations of how amalgam fillings crack teeth. Is this good for our profession when the large majority of people have amalgam restorations in their mouths?

Both groups love to cite particular research studies to prove their points. Let's put the clinical studies aside and look at the most valuable research we have before us—our existing patients. I have to admit, I get offended when I hear dentists make blanket statements that all amalgams crack teeth. My rough calculations indicate that I personally have placed over 20,000 amalgams in my career. So, if the data about amalgams always cracking teeth is true, why do I place only around 50 crowns per month? I should be doing 200 or more if all amalgams crack teeth. Of course I have seen fractured cusps on teeth with amalgams. I've also seen fractured cusps on virgin teeth and those with composite restorations. I've actually had dentists tell me to my face, "Joe, keep placing amalgams and breaking teeth so that I can bond them with onlays later." Does this rhetoric serve our profession well?

So what does this have to do with us slipping in the polls, anyway? As Dr. Paul Belvedere pointed out in a recent article, we are kidding ourselves if we think all this bickering is kept just among dentists.

Some of our patients are attorneys who are well aware of this professional dispute, and this leads to damaging effects on our profession. Maybe we can't stop the legal trappings that are rampant in our country, but we're hurting our profession when we have such openly derisive verbal battles on certain issues within our profession. This leads to lawyers coercing dentists to testify against their colleagues, as we are presently witnessing around the country.

Coming together
Just to put things in perspective, I'd like to share with you an observation made by my brother-in-law, who is a vascular surgeon. Steve and his family travel with us often and I frequently share dental literature and research with him. One day during a long flight, I shared some information on the amalgam controversy. After reading it, he looked over at me, shaking his head, and said, "You guys are just talking about teeth… aren't you?"

Some may consider this article as nothing more than adding fuel to the fire. My intent and desire, however, is that it will at least draw a moment of reflection on the adverse effects to the strength and persona of our profession. There are more serious issues in dentistry that deserve our attention. We should be working to establish acceptance and respect within our profession. With that kind of strength, we could work together towards strengthening our credibility and trust with the American public. I, for one, would certainly like to have that No. 2 position back… wouldn't you?

Editor's Note: This is a reprinted article, originally published in the July 2002 issue of Dentaltown Magazine. Please see the author bio (below) for more information on Dr. Joe Steven Jr.

For years, all my team ever heard from me was "Production! Production! Production!" Twenty-some years ago I had a goal for a million-dollar practice, so we were always striving to efficiently provide the best dental care to as many patients as we could in order to reach that goal. After attaining that goal, I told them that I was not really interested in shooting for higher production numbers because I had another goal in mind. My new primary goal was to be as efficient as possible in all our systems for better peace of mind. By that, I meant I wanted to know that we were doing everything as efficiently as possible to keep our costs down, while providing excellent patient care. I expressed to them that I didn't want our production and collection figures to drop by any means, and that our numbers would gradually increase anyway because of our new endeavor. It's ridiculous to keep going year after year knowing you're losing profit dollars because of inefficiency. Since we had attained higher goals consistently, I wanted to concentrate on the icing on the cake. I wanted us to fine-tune every system. Throughout my career I've been a fanatic on watching the bottom line and being as organized and efficient as possible, but there's always room for improvement. At one of our regular staff meetings, I read the following story, which was the main emphasis of my newfound goal. I would strongly suggest that you read this to your staff at your next meeting. It's not only interesting, but it will help you and your staff to look at the business side of your practice in a whole new light. A little goes a long way For more than a decade, United Airlines has been saving more than $40,000 a year by simply removing one olive from each salad served in First Class. This point is brought out to demonstrate how something as small as an olive, something that easily could be overlooked, could have such an impact on the bottom line. What little olive does your practice have that could be costing you thousands of dollars every year? You might be surprised if you and your staff were to sit down and brainstorm just how many different little olives your practice has. Olives that, if put to a better use, could dramatically change things with your business and maybe even allow for some little perks that before were not available. The staff was just as intrigued with that story as I was. I explained to them that I realized no one is going to receive immediate gratification by not wasting cotton rolls, or not using too much topical anesthetic, or not leaving the nitrous units on accidentally. But it all adds up, and that's money that can be used for a staff trip or for their pension plans. Or it could be used for office improvements that everyone enjoys. It's simply ridiculous to keep wasting money when we all work so hard to produce and collect it. Filling the olive jar Following that meeting, it seemed like just about every other day or so someone pointed out another olive. My hygienists got together right away and found a different brand of fluoride that saved us about 50 cents per bottle. Obviously supply purchases are the best examples of big olives, but there are many others. During one of our meetings, we reviewed our Staff Policy Manual and went over time-clock policies. I pointed out that mistakes with time recordings usually fall at the expense of the practice. I asked our payroll person if this were true, and she admitted that sometimes it can be a pretty big olive. We found another olive while reviewing our uniform policy. Over the years, we drifted away from our daily matching-scrubs policy. As a result, the practice was paying out too much for individual preferences of uniform colors, which resulted in more scrubs than needed. Our policy has a 50-percent uniform allowance that the practice reimburses to the staff members. We reorganized and saved another olive there. We reviewed and revised a few of our checklists that are easily overlooked or forgotten in a busy office. Simple things like turning off the treatment room lights and televisions during lunch might seem insignificant, but really do add up in the end. My pet peeve has always been finding a running nitrous unit with no patient at the other end. Worse yet is leaving a unit on and someone forgetting to turn the main tanks off when leaving the office. We reviewed our policy as to when to remove nitrous from a patient for specific procedures. If a patient receives a mandibular block, it's a waste to leave the nitrous on until they are numb. With many local infiltrations we'll leave the unit on, since we won't have to wait as long for the anesthetic to work. I pointed out to my staff to use their own discretion with each individual patient, but to be aware of this little olive. Olives can also take the form of mistakes within a practice, such as laboratory case inefficiencies on our part. Even though we all experience those busy, chaotic days, we have to take the time to be explicit and thorough on our lab directions for every case. Having to reschedule a patient because a case wasn't back on time—or worse yet, wasn't completed properly—is an easily avoidable olive that costs us valuable chair time and needless negative patient goodwill. Likewise, lab cases sitting in the bins for more than a month need to be reviewed so that these cases can be completed. In our practice, that's a specific duty assigned to a particular assistant. Another seemingly trivial olive that really adds up is the office thermostat. If you don't have one of those programmable thermostats, you're probably spending $100 extra each month in wasted energy, depending on where you practice. There is no reason to have the AC running at the same setting during the evening or on weekends that you do during work hours. During our afternoons off, we manually raise the temperature about six or eight degrees before we leave the office, just to save a few bucks. Finding the jumbo size Of course, it's always great to find some large olives to really reduce your overhead. For years I have been receiving a 10 percent discount at the dental lab I use because I prepay my account with a credit card. Now that's a big olive! Check with your lab today and ask if they provide that courtesy; many labs do. Here's another big one—get a quote on credit card processing fees. There are so many hidden bank fees that we tend to overlook month after month. Between my practice and KISCO, I am saving several hundred dollars per month after evaluating these fees. Nice olive! Want another big olive? About 80 percent of the doctors ask their labs for high noble or semi-precious metal. The lab I use saves many doctors money by suggesting they use non-precious metal, as long as it doesn't contain nickel or beryllium. I've been using non-precious metal for most of my PFMs for years and cannot see one negative thing from using this material. Many olives can be discovered through using a team management approach. Each employee is assigned specific duties and responsibilities. Respective checklists should be used for these assigned duties to guarantee that everything is being done properly. Go ahead and schedule an "olive meeting" with your staff, and get your team's input and suggestions for finding olives in your practice. Many times your team will come up with more ideas than you will for finding olives and improving your bottom line. So where are the olives in your practice? Editor's Note: This is a reprinted article, originally published in the June 2011 issue of Dentaltown Magazine. Please see the author bio (below) for more information on Dr. Joe Steven Jr. Editor's Note: Dr. Joe Steven Jr. passed away on May 22, 2015. A respected leader in the dental industry, Dr. Steven's innovations and insights benefitted his colleagues across the country. In addition to being a member of the American and Kansas dental associations, Steven was a nationally recognized lecturer and consultant whose purpose was to share best practices and efficiencies in the profession, helping to ensure the success of others in the field. Dr. Steven also founded KISCO, a dental-products marketing company. An integral part of KISCO was Dr. Steven's multivolume newsletter—"The Kisco Perspective"—that has become a resource for thousands of dental professionals. A friend of Dr. Howard Farran and someone who clearly shared his passion for helping other doctors achieve success, Dr. Steven was a welcome and prolific contributor to Dentaltown. Dr. Joe Steven Jr. graduated from Creighton Dental School in 1978 and maintained a solo practice in Wichita, Kansas, until June 2007, when his daughter Dr. Jasmin Rupp joined him. Dr. Rupp's tribute to her father starts on page 62.