Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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785 Patient-Centered Care with Jasmin Haley, RDH, BSDH, CDA : Dentistry Uncensored with Howard Farran

785 Patient-Centered Care with Jasmin Haley, RDH, BSDH, CDA : Dentistry Uncensored with Howard Farran

7/26/2017 12:25:37 PM   |   Comments: 0   |   Views: 304

785 Patient-Centered Care with Jasmin Haley, RDH, BSDH, CDA : Dentistry Uncensored with Howard Farran

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785 Patient-Centered Care with Jasmin Haley, RDH, BSDH, CDA : Dentistry Uncensored with Howard Farran

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VIDEO - DUwHF #785 - Jasmin Haley
            


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AUDIO - DUwHF #785 - Jasmin Haley
            


Jasmin is the Founder of Beyond the Prophy and Co-founder of MOMgienists. She is an adjunct instructor at Howard Community College and consultant/educator with the Jacques Initiative with the Institute of Human Virology.

 

She has 15 years of experience as a clinician, educator, and dental assistant. Jasmin helps the hygiene community to Think Beyond the Prophy by inspiring and empowering professionals to give the best patient-centered care, reach their greatest potential and explore career options that promote excellence. She regularly writes on her Beyond the Prophy blog and is co-host of the MOMgienists Podcast with fellow colleague and friend Christie Lincoln, RDH. 

 

She is enrolled at the first dental hygiene school in the world, Fones School of Dental Hygiene, in their graduate program with a dual concentration of Public Health and Education. She can be reached at info@beyondtheprophy.com.

www.beyondtheprophy.com

 

Howard Farran: It is just a huge honor for me today to be podcast interviewing Jasmin Haley, RDH, BSDH, CDA. She's coming in today from Baltimore, Maryland where they built the first dental school in the world and had the dental museum. Have you ever gone down there?

Jasmin Haley: Yes I have and I'm taking my children to. They love it.

Howard Farran: How old are your children?

Jasmin Haley: I have an eight year old and a five year old. My eight year old says she's gonna be a dental hygienist, which is ... I'm telling her, "Don't, be a dentist because I want free dental treatment." I'm trying to secure myself when I'm elderly.

Howard Farran: Jasmin is the founder of Beyond The Prophy, and co-founder of MOMgienists. She is an adjunct instructor at Howard Community College, and consultant educator with Jacques Initiative, with the Institute of Human Virology. She has 15 years experience as a clinician, educator and dental assistant.

Jasmin helps the hygiene community to Think Beyond The Prophy by inspiring, empowering professionals to give the best patient centered care, reach their greatest potential and explore career options that promote excellence. She regularly writes on her Beyond The Prophy blog, and is co-host of the MoMgienists podcast with fellow colleague and friend, Christie Lincoln, RDH. She is enrolled at the first dental hygiene school in the world, Fones School of Dental Hygiene in their graduate program with the duel concentration of public health and education. She can be reached as info@beyondtheprophy. 

I'm a huge fan of your podcast. You have 29 episodes. Tell us about your journey where you decided to start a podcast.

Jasmin Haley: Oh my goodness. So, Christie and I have been very, very good friends for a really long time. We have had such and amazing friendship. We have children. We share lots of things. We have a good time, so we wanted to do something together. I came back from an event with ADHA and I had met Elijah Desmond. We had talked about having a business, doing something together. We wanted to do something that was related to being mothers, because that's what was taking most of our life at that time.

We started with vlogs. We started video vlogs and they were horrible. It was very difficult for us to get together. I had to worry about my hair. The kids were walking in as we were trying to film. It was a disaster. We were fit into A Tale of Two Hygienists with Michelle Strange and Andrew Johnston. I said, "You know what, it's really hard for us to get together. Let us try to record it. Just record the audio when the kids are sleeping at night." That was it. We started the podcast and we've taken it from there.

Howard Farran: You have two website. Which one should my homies go to? You mentioned Elijah Desmon. He was on episode 460, Smiles at Sea with Elijah Desmond. That guy's got so much energy. You have two websites. You have Beyond the Prophy and MoMgienists. What's the difference between Beyond The Prophy website or MoMgienists, which is a play on mom hygienist, MoMgienists. I love the name. It's an awesome name and I love what you write on MoMgienists. It says: Meet Christie and Jasmin. Dental hygienists, plus friends, plus moms, pus nine years, plus five kids later equal MOMgienists. Healthcare moms who understand the struggles, the joys, and the self-doubts of raising kids, staying sane, and working. Listen to our regular conversations about everything except the kitchen sink. I love all those pictures on there.

Episode 28, Advocate for Public Health and The underserved. Episode 27, Can Display Incredible Resilience when Overcoming Challenges. The episodes are just amazing. It seems like you have so many passions. Dorothy Ferreira, MOMgienist Who Takes on the International World With Fierceness. 25, Fearless Transit Professional With Rosochaki, RDH. I love this one, episode 24, Take on Professional Bullying Part Two. Are you teaching people to be a better bully or how to defend against a bully? Which side are you on, on the bullying?

Jasmin Haley: How to defend against it. How to deal with it. I'll go back, I'm gonna backtrack. Beyond The Prophy was my first start. I realized I wasn't happy with my career. I wanted to have a little bit more autonomy, be able to control it, be able to speak on what my passion was, so I created Beyond the Prophy. It's a CE company. What I'm focusing on is leading by example, connecting [pureset 00:04:57] leaders as well as education them by helping them to think outside of the box. I started the blog with that and I'm hosting CE events with Beyond the Prophy.

MOMgienists is more of a really fun side where we're building of mothers. We have a few dadgienists who dare to listen to our podcast. We've only had one dadgienist come on and that was Andrew. We actually have another one in an upcoming episode coming up. That's really meant to provide the support that we need in our field. I was finding that in the forums when I was reading, there was so much bitterness about our profession and so many people unhappy and I felt that way. I can relate to that. I wanted to be able to bring what I've learned in my journey of mindfulness, bringing my mindset to another level of excellence and really thinking outside of the box and creating opportunities.

Essentially it's doing that with both. It's connecting, building a relationship with those who are willing to believe in our mission and join us for the fun.

Howard Farran: First of all, do you know how many hygienists are in the United States? 

Jasmin Haley: Around 185,000.

Howard Farran: 185,000?

Jasmin Haley: Yes.

Howard Farran: Is that 185,000, are those who actually work or just people who have an RDH license in America?

Jasmin Haley: I believe it's who has a RDH license in America. That figure comes from the ADHA. I'm not too sure on how they classify that. I'm sure there's a boatload of mothers, grandmothers, dads, those who deal with parenthood. When you ass in the complexity of parenthood and being a professional, it blows your mind. It's one of the hardest things to really create a true work-life balance. I think that's what MOMgienists is bringing, is an outlet for us to be able to talk and have the support that we need. They do it in other industries. It's just not really being done with ours.

Howard Farran: What percent of those 185,000 hygienists do you think are burned out or unsatisfied or don't find being a hygienist professionally rewarding and makes them happy and makes them all that and a bag of chips?

Jasmin Haley: I believe probably over 90%. 

Howard Farran: 90% of what? How would you describe those 90%?

Jasmin Haley: Frustrated, they are feeling unfulfilled. Some of them are leaving the profession and going into becoming RNs or other different fields because they feel like they have no autonomy, they've reached the glass ceiling. I would say from looking at the forms, and this is without doing any type of research, is a lot of hygienists that are dissatisfied with the career, which is why you see so many groups. You have like Beyond The Operatory. I believe the doctor's name is Dr. Stefanou. Then you have Trapped in an OP, which is another community forum for hygienists who are looking to get outside of clinical practice.

Howard Farran: Beyond The OP? O-P? Just Beyond The OP?

Jasmin Haley: Mm-hmm (affirmative)-

Howard Farran: And where's that-

Jasmin Haley: No, Beyond The Operatory.

Howard Farran: Beyond The Operatory? And where's that ... 

(silence)

Jasmin Haley: (silence)

... I understand the complexities of dentistry, when you have 300 plus thousand dollars in loans. It's a business mindset. They have this pressure of all this overhead and all this other things on them. A lot of times they're not making decisions that the hygienist could fully understand.

There's so many things here, and of course I'm loyal to my hygiene friends, but I think there's so much I like to start first at the curriculum. Elevating their thinking and then reshaping the profession.

Howard Farran: I am just loyal to the patients. I'll throw my homies, the dentist, the hygienist. I'll throw everybody under the kitchen sink if it's what's best for the patient. You talked about leadership, communication, entrepreneurship. Under entrepreneurship, do you think independent practice, if that was nationally legal, that would provide for a lot more entrepreneurship? I've always been a very big proponent of independent practice because I just think it promotes competition. I think competition is what's best for the consumer.

I always get frustrated when you go on a cruise and the only things they have is, you get your hair done. I'm bald. You get a mani-pedi, but that really doesn't do anything. I still don't understand why people want sea salt rubbed into their calf. I thought salt causes high blood pressure. I just want to get my teeth cleaned. When I go to a five star resort, I wouldn't mind going to the spa and getting a cleaning or bleaching or something like that, but it's not legal. I always thought why access to care is huge?

Everyone that I've ever seen, I've only seen like seven independent practice hygienists in my entire life, and they are always in a town of like 1,000 in the middle of nowhere. They took out their dining room table and put an operatory, and if they see anything wrong they write a referral slip to the dentist that's 20, 30 miles away and that dentist loves it. He just loves it. Yeah, you're sending him a patient once a day that has a cavity, a broken tooth. They just completely love it. I just think it's a knee-jerk reaction when everybody goes to Washington, DC and says, "I don't want my industry to have competition." I think it's a union mentality. Do you think independent practitioner coast to coast would be a good start for dental hygiene entrepreneurism, or were you thinking other stuff?

Jasmin Haley: I was just recently in Annapolis this year. I didn't have a chance to sit in to hear the dentists actually talk about their opposition to dental therapy, which essentially allow us to get into nursing home facilities and other areas where people are underserved. This is a little bit different from independent practice. I feel like independent practice will never happen in Maryland in my lifetime. We'll just go-

Howard Farran: In your lifetime? You're still just a baby.

Jasmin Haley: I'm 32. I don't think it's gonna happen. With the advanced dental therapists ... When I viewed and listened to those dentists that were in opposition, they're scared. When I think about entrepreneurship, I think about dental hygienists taking their skills and creating a business outside of clinical practice. That's my focus. Now as far as clinical practice, I would love to be able to own a practice and be able to provide care for that but ... I'm trying to be politically correct right now.

Howard Farran: I like what you say because my definition of an entrepreneur is anyone who can make money while they're sleeping. If you can only feed your family by doing live eye-hand surgery or laying bricks or welding or whatever, you're really committed to manual labor. Dentists are just extremely high skilled manual laborers. A cardiovascular surgeon, what's the difference between that and a plumber? When he's taking out a clogged pipe from your heart and replacing it with a cleaner pipe from your leg ... Yeah, it's nice to be able to diversify your income so that if something happened, car wreck, disease, getting older, it is nice to make money while you're sleeping.

Let's go to the hygienists. I have the feeling ... Most all the evidence I have is, most of the people listening to the show are probably dentists under 30. I tell you on the show, if you're a dentist over 30, please email me howard@dentaltown.com. About once a month, it's once a month somebody will email me and say, "Dude I'm as old as you." I had one last month who said, "I'm 64," and what's funny, he's retired. I said, "Why are you listening to the show if you're retired?" He says, "Well, just because you retire, you're still a dentist." He says, "I still love dentistry." 

Let's go back ... Talk to the dentist listening to you right now. What do dentists do that frustrates the hygienists? How could dentists be better employers for their hygienist?

Jasmin Haley: They just need to be able to listen. Take off the hat of a clinician, which is difficult and be able to listen to what their hygienists are saying. We have been trained, where we're not just giving a cleaning. We're providing hygiene services. There's a true ... We're prevention specialists. That is our specialty. It's very difficult to come into practices where you have been trained a certain way in dental hygiene school. You've been trained to provide the best patients centered care, and when you come to practice this, the dentist doesn't acknowledge your training. They don't empower you as a clinician and it is very difficult for many hygienists to swallow that.

An additional thing for that is, some hygienists are in situations where the dentist is not favorable when they are new mothers, if they need to nurse. Supporting them through that. Another aspect that they find is very difficult is when the dentists tell them to clock out when there's no patient that shows up. Oh my goodness, there's a whole lot of things that happen with it. 

I think really what it needs to start with is open communication. The dental hygienist needs to feel comfortable enough to be able to share their concerns and the dentist needs to just lay it out there, especially when it comes to the business aspect. If there's things that you're not able to do, explain that to your particular practice.

Howard Farran: What percent of the hygienists disagree with the diagnosing and treatment plan of their employer dentist? Do you think it is affected by the amount of debt? Do you think a 54 year old, fat dentist, who doesn't have student loans diagnosis more conservative than a 25 year old who's gotta pay $350,000 in student loans, and $750,000 on a brand new practice or is that just too cynical? Do you think the dentist still has their heart in the right place no matter their financial status or do you think that's for people who do desperate things?

Jasmin Haley: I've seen both. I've seen both. I've seen very conservative dentists and I've seen who watch, watch, watch, watch, watch. I've seen dentists who are more aggressive because they have to pay their bills. I've seen all of that. I can't tell you ... When I meet people, I believe initially that they're coming from a good place and they have good intentions. I'm not gonna label the dentists of thinking any particular way including hygienists.

Howard Farran: I think you can label the bold dentists. They always seem to be better batch of dentists. Would you agree that the fat, old, bald dentists are always better? It's a young good-looking ones with hair that you gotta not trust.

I wish we had more insurance because I know dentist who are very successful. They lecture about how successful they are. They don't ever do a filling. So many dentists would do a [DO 00:19:53] or an MOD, they're doing a crown. When some guy says, "Well I do 100 crowns a month," I want to see more data. Does that mean you're also doing 900 fillings a month? It's one thing to say I do 100 crowns a month if you do 900 fillings, but you do 100 crowns a month and do nine fillings, I don't want my children to go to you.

Jasmin Haley: Yeah, I don't get it. I was just recently at a [inaudible 00:20:16] ... I no longer work permanently anywhere. I was recently at a practice and I saw this woman. I provided her assessment. I did her oral cancer screening. I checked her periodontal pocketing. She had mobility in the mandibular anterior. She was using all this occlusal force on the anterior, no posterior teeth. No one discussed replacing the teeth in the posterior. When I mentioned that to the doctor, because she was suffering also from some fractions around her premolar, his suggestion was to do a class five restoration the abfraction on number four. I had spent like maybe 20 minutes talking about her replacing her posterior teeth, and that was his treatment plan. Why, I have no clue. I have no clue at all. 

Howard Farran: Do most dentists let you co-diagnose and explain to the patient and go over the X-Rays and all that? How many of them are free to just let you do your art for an hour verses how many are control freaks, say, "Hey, you're not a doctor. You can't diagnose. Quit saying stuff like that."

Jasmin Haley: You can find both of them. I understand why they could be controlling, because you want to make sure that whoever is providing the co-diagnosis is in alignment with you. I feel that that's okay. I feel like you have to feel each other out and figure out if you guys have the same philosophy. If you don't, then the hygienist needs to leave, if that's the case. I don't know, you find both. You find both.

Howard Farran: I always call it the remote control scenario. Every house I've ever been in in my life, nobody knows how to use all the buttons on a remote control because when they design the remote control, you have all these people come from the VCR, the CD, the cable, the TV and everybody has to get their damn buttons on there. You end up with 80 buttons whereas companies like Apple say, "No, Google it's about the customer." A customer doesn't want 90 buttons and doesn't care about your little [silos 00:22:30] and departments. 

What I've always done in my hygiene department, the patient comes first and I just would always say, "Well, we legally can't diagnose X-Rays." I say, "Okay, well if you can find me one hygienist in prison today serving time for reading an X-Ray, then I'll grant you your excuse." It's just an excuse and I said, "I want you to read the X-Ray." Especially like you, I'm 54, you're 32. I could've made you to age 22 and been your dad. I'm sure you have a better eyeball than me, looking at an X-Ray. I wouldn't want some 80 year old man reading an X-Ray.

I've always been the co-diagnosis. You're in there, you read the X-Rays. You write it down, and then when I come in, and if I disagree with ... Say you say it's a watch on 29 and I say it's a do, then we both zip our lips and we bring in whosever variable, another hygienist, another dentist, someone comes on there and we say ... And everybody knows our culture. It's a democracy. Then that hygienist or dentist will say whatever they say. It's a do, now it's two to one and then you're right. If I feel like it needs to be a learning experience, then I'll get that person back where ... Let's say you said it was a watch and I said it was a do, and then I'm doing a [DO 00:23:54]. Soon as I break through, then I go get you and say, "Come here and look at that X-Ray again, then look in the tooth, and you'll see like oatmeal I'm taking out with a number four [inaudible 00:24:02]."

I always thought the patient comes first, co-diagnosing is everything. I think they believe you 1,000 times more than they believe the dentist because you're an employee and the dentist owns the business. You would have far less financial incentives to be selling anything. I just think-

Jasmin Haley: I definitely think it's a collaborative approach. Also, when the hygienist is very respectful of where the dentist's position is, I think that helps as well. If I find that there's some concern, I may mention it to the patient. I may explain it, but then I tell them that the dentist is the one that makes the final decision. He would be the one that would diagnose that, but you would hear me explain to the dentist that this is an area of concern for me today.

I think having a collaborative approach is always the right course to follow, but you find that there are some dentists that don't prefer that. In fact, my friend Christie explained that when she was first practicing, a dentist felt that, "Oh she's good. She's okay. She'll be a great hygienist one day." Another dentist took that opportunity and shaped her into the amazing clinician that she is.

When I have a question about clinical care, I go to Christie and it's because her dentist took the time to train her specifically for over 10 years and elevated her to a way that clinicians really should be as dental hygienists. I think it should be a collaborative team approach and I don't know how much of that they spend in actually training with that.

It's interesting that now that I'm think thinking about collaboration with the consulting that I'm doing with the Jacques Initiative with the Institute of Human Virology, they've actually taken this program that's centered around persons living with HIV and AIDS and they are focused on interprofessional care. They're actually training dentists, medical students, dental hygiene students, pharmacy students, nursing students, law students, social worker students all together on how to care for persons living with HIV and AIDS. I feel like for the future of dentistry, we're gonna se more collaboration, more interprofessional care compared to what we've seen in the past.

Howard Farran: I think the people who have the most insights are the hygienists who temp because, if I talk to a hygienist that's been I one office for 30 years, she has no idea what's going on in the marketplace unless she has a big social network. How many offices have you temped in?

Jasmin Haley: A ton, a ton.

Howard Farran: Tell these dentists, what do you think better, more fun, rewarding professional offices that are successful do more than the ones that are stressful and unhappy and miserable. What do the successful dental offices do better?

Jasmin Haley: The successful dental offices, they communicate. They have an open dialogue. You know exactly what's going on in the business. You know how much you have to make for that day. You know where you're lacking, what your projected goal is. You're able to give your concerns and they let you be a clinician. They're not micromanaging. There's some liberties that you feel comfortable in doing. When I temp, I actually bring my own instruments. I have my own little kit when I'm there.

Howard Farran: How many kits you have tapped for sterilization?

Jasmin Haley: I have five and I use American Eagle instruments because they're sharp and free. XP Technology, I love that. I was introduced to that just recently this year and I-

Howard Farran: Who introduced you to that?

Jasmin Haley: Lewis, Lewis Meyers and Karen-

Howard Farran: Lewis Meyers.

Jasmin Haley: Karen Siebert. They introduced me to XP Technology and I haven't looked back since. I think-

Howard Farran: Lewis is just ... what a great guy. I like his ambition. When he wanted to be on my podcast, you know what he did? He flew done to Phoenix, Arizona and said, "What's your favorite restaurant," and took me and my boys. We talked about it. I don't remember a thing we said because we were drinking all night, but ... That was a joke. He's the most connected man in dental hygiene. He knows every mover, shaker hygienist out there. I just love his work ethic and all that stuff.

I want to say one thing before I forget. I think the best movie that every hygienist and dental assistant should watch ... Did you ever see the movie 20 Feet From Stardom?

Jasmin Haley: No.

Howard Farran: Oh my God. One of the greatest movies ever. Film maker Morgan Neville shines a long overdue spotlight on hit making contribution and longtime backup singers. A couple of years ago, this woman gets inducted in the Rock and Roll Hall of Fame and everybody's like, "Well, how could you make it into the Rock and Roll Hall of Fame when I've never even heard you on the radio? Who is it?" What the Rock and Roll Hall of Fame figured out is that the greatest musicians of the 70s, allowed their backup singers to just go for it. 

This movie is showing like Mick Jagger ... There was this one backup singer, I wish I would remember her name that whenever she would just start belting it out, Mick would shut up and take three steps back. So would David Bowie. So would all the greats. They were interviewing these backup singers and they said ... Who sang in a lot of one-hit wonders. They'd call them [sheeters 00:29:53]. The lead guy of the band would say, "No these are the words you sang. You're singing too loud and you're drowning me out. I don't want the drum and the guitar in the backup." 

They were control freaks and they said it was their end. He said that the people who were all the legendary bands knew ... That chick's been singing in gospel churches since she was three years old, and her voice is better ... Does Mick Jagger have a voice? Who the hell told Mick Jagger he could sing? You listen to his tracks without his backup singers, you realize Mick ain't a good singer, but he would have the self esteem to find the very best backup singers. Most of them were from the south that grew up in gospel. Mick was Like, "Man if you could take it, take it." It was just a great deal.

That's the same thing with a hygienist and assistant and dentist, that the best dentists are the ones ... Sometimes Jan will get mad at me. I'd be making a temporary and she don't know what I'm thinking or going on or whatever and she'll just say, "Let me do it," and I just back up. I let her do it. If the hygienist wants to present an entire [implan 00:31:07], build up the posterior because there's abfractions and mobile teeth, I'm gonna let her go. 

That's why I predict success for these young kids when they come out of school. If they're humble, they listen to their staff, they listen to their [inaudible 00:31:22], they listen to podcasts, the listen to [inaudible 00:31:24]. They're humble, they're hungry. They're hustlers. They got a big work ethic and they're curious. When something fails, they don't get mad or quit doing it or [inaudible 00:31:34] the rest of their life, they go, "God, I wonder why that failed." 

If you're humble, hungry and curious, you'll crush it in plumbing, welding, anything you go into. You'll crush it. Watch that movie. It is just a lesson on why you should ... That the whole is greater than the sum of its parts, and it's not about you. That's arrogance, concede. It's not about you. It's about your team.

Jasmin Haley: I was watching a video. I just wrote about this in my newsletter. Arnold Schwarzenegger did a keynote for a school. He doesn't believe in the term self-made man because he feels that collectively throughout his journey of his career, he's had all these individuals support him. I feel that when we have that type of mindset and we view it as a team effort, whatever that may be, whatever road you're taking in your journey, I feel that it makes your life more fulfilled. You'll have more success than you realize. I think that team effort is absolutely necessary for dentists.

We value you dentists. We value you hygienists. We value the dental assistants. Each of us have our own expertise, and then collectively, we can build an outstanding-

Howard Farran: Yeah, these self-made men, would they have been a self-made man if they were born alone on an island? And talk about luck, would they have been a self-made man if they were born in Iraq during a war or Afghanistan? So much of what we do is luck. Being in a good country, luck with great mentors. So much of it is luck.

I want to ask you the most serious question of the podcast. What percent of dentists do you think are batshit crazy?

Jasmin Haley: I am not answering that. Oh my goodness. You know what I-

Howard Farran: Come on, at least round up. Is it one in four? Is it a half? Is it three fourths or is it actually all of them?

Jasmin Haley: I think anyone in dentistry in crazy. I think anyone that chooses this profession is a little cray. If anyone can go inside the mouth and provide care, I think we're all a little touched and I think that's what makes us all very special.

Howard Farran: I want to ask another controversial question. You were talking about, this lady had no posterior teeth. She had anterior mobility and there was an abfraction. Docs best idea was to treat an abfraction, probably with a filling. It's still a controversy. It's even a controversy on Wikipedia. Wikipedia says they don't know if it's from improper toothbrushing or if it's from mechanical forcing [inflecture 00:34:09]. What do you think? Maybe the world does know and no one's updated the Wikipedia page. What are they teaching at your school as the cause, the ideology of an abfraction, which is a non-carious lesion on the cervical part of the tooth?

Jasmin Haley: I think that's a little backdated. First thing we teach them to do is never do to Wikipedia. The second thing-

Howard Farran: Seriously? Do you?

Jasmin Haley: Yes.

Howard Farran: Really?

Jasmin Haley: Yes, because Wikipedia, anybody can put in information. That's not a reliable, credible source. The second thing is, we want them ... What I tell my students is that if you see that someone's missing posterior teeth, we're looking at the occlusal forces distributed incorrectly. You obviously can see that with the anterior mobility. 

The first thing is to restore some stability in the mouth by replacing the missing teeth if there's rom for that. That would have been my recommendation for that patient, although I'm not trained as a dentist. I'm just sharing what I've learned over the years with working with different dentists.

Howard Farran: Have you ever stayed in a Holiday Inn Express?

Jasmin Haley: Have I ever stayed in a Holiday ... Probably. You know what Howard, I really wanted to talk a little bit about what I've been speaking about in my CEs, which is about diversity. I think dental professionals should start preparing themselves for changing their thinking because it's evolving.

Historically in your generation and my mother's generations, diversity was considered black and white. Now, we have to include gender identity and sexual orientation. Some of the opportunities I've had in sharing that, some professionals were like, "Well what does this have to do with clinical practice? Why does it matter? Don't we treat everyone the same? What difference does it make?"

I noticed that in your event this year, you had a very, very interesting CE class, Working With [crosstalk 00:36:23].

Howard Farran: I wonder which one that was.

Jasmin Haley: I actually was happy to see that because there's a clinical aspect that you shared. I focus more on the communication. The cross-cultural communication that happens with people and understanding how much culture affects communication with each of us. How important that is, but also for us to realize that now we need to be prepared to look at a different demographic that is being shown to not receive the kind of care that they need.

I've been finding it very interesting seeing how dental professionals are reacting to that from the courses that I give. I wanted to know what the reaction was for your course at your event.

Howard Farran: That was Dr. Kevin Koch. He eventually became Anne Koch. It's a dear issue of mine. I have a couple of dear issues that I grew up with. I grew up in an extremely conservative Republican Kansas family where Communism was evil and blah, blah blah and my little brother was Liberate. Everybody knew when he was five that he was just completely gay. I saw the abuse and the making him feel bad. I saw the literature from the CDC about how young teenage gay boys are one of the highest groups of suicides. 

He eventually moved to Sydney, Australia to get away from it. I told him, I said, "Man if I was born gay in Kansas, I'd have been on the first gay train to San Francisco." I would not live in a state where 90% of all the people thought I was gonna go to hell for eternity, especially when those are two of your older sisters who are Catholic nuns, your own mom ... He just didn't get it.

The other issue that I was dear to was, I had five sisters. My own parents would put me in jeans and put iron patches on the outside. I had no curfew and could swim in the river, and they put them in dresses and they had to be home when the street light on. They could not be within 10 feet of it. It was crazy. I remember swimming out in the middle of the Arkansas River looking at my five sisters standing back from the edge thinking, "If I start to drown, am I supposed to like hang on to my weaner? What does the weaner have to do with me swimming in the river?" I just think it's horrible how much hatred there is in society.

I was watching on Vice News the other night and it was so sad. They said that once this war with ISIS gets over in Iraq, then both the Sunnis and the Shiites say then they're gonna go to war with each other and break up Iraq. The difference in a Sunni and a Shiite is like the difference between a Catholic and a Luther. Just minor, minor details. This is what I believe as a healthcare provider, I'm a dentist and I don't like dentists who ... Well, I'm not saying. It's just not my taste when they try to do their marketing just to cosmetics or just for implants.

I'm the dental office right here in Ahwatukee and if you come through my door, you need a dentist. I don't care if you're gay. I don't care if you're old, young. I don't care if you need me to fix your baby, your grandma, your denture, your ... Imagine you broke your leg and you went to the hospital and they said, "Jasmin, we don't do legs. We only do arms." I'm a doctor for my patients and I'm gonna treat anyone who comes in the door and if anyone thinks that homosexuality is a choice, it's just because they didn't have a little gay brother. Anybody who thinks transgender, transsexual, things like that are bizarre ... How can it not make sense that when 3.6 billion base pairs ... We're not mitosis like a fungi. We're miosis. These pairs pull apart, match someone else, who's to say that you didn't get a girl brain and a boy genital or a boy brain and a girl genital? Who's to say?

Jasmin Haley: I think what professionals are missing are not understanding. I totally hear you, but I feel that hygienists or just dental professionals in general shouldn't be concerned about how they came about with that decision. They need to understand historically, "What disparities they're facing, what's the common terminology that they use and how can I create a safe place for them when I provide them care?"

It doesn't meant that you need to change your personal beliefs. I doesn't mean that you lose your identity by providing more compassionate care. I think that's where they're falling prey to feelings of ... I don't know whether it's fear, because I've gotten from when I'm speaking on my courses ... You expect to get people who are not always gonna like what you have to say. I know that it's not personal, but I've had people completely irate, totally against any type of topic that has to deal with talking about the evolution of diversity and preparing ourselves as professionals to treat every single patient.

It's very interesting to hear you say that. Each of us have our own particular story, but I think it's important that we stay open to whatever changes that do occur as far as cultural changes and be open to that. If you feel like, "Well, I'm not too sure why we even talking about that," then you need to attend a course that's actually speaking about how things are changing and how we can become prepared for that.

Howard Farran: Do you think the Dental chart should be changed from ... Most every chart just says male, female. Do you think there should be a third box, a fourth? What do you think, the chart should be changed?

Jasmin Haley: Yes, yes.

Howard Farran: Would you add a third category? Facebook added like what, 50? 70?

Jasmin Haley: I don't even know. I haven't used any of the things, but yes. I do recommend that. There are some other recommendations that I make in my CE class, making sure that you can allow the person to put a preferred name on there because a lot of times, those who are trans have not changed their legal name. You never want to be in a situation where you actually call someone in your waiting area with their legal name that may be male, but they're living their life as a trans-woman. Those are things that you can add in there. You can even add in there where you have single, married and divorced. You can put partner-

Howard Farran: I never understand single, married, divorced. First of all, divorce is dumb because they never put a plural. It should say, single, married, divorced how many times and plus if you're divorced, you are single. Instead of married, why don't they say married or victim. I don't understand half of this. Look at the health history questions. I understand asking if they're diabetic. I understand asking their medications, but why do you ask if you've ever tested positive for Syphilis, gonorrhea or chlamydia? What does your college days have to do with getting a root canal when you're 40?

Jasmin Haley: You know what, aren't we trying to bridge this gap? Aren't we trying to bridge the gap between the oral-systemic links? [inaudible 00:44:09].

Howard Farran: I took it off my chart clear back in 87 when this retired guy in Phoenix wearing a military hat wanted to see me privately in the office and then he breaks down because I asked him, "Have you ever had gonorrhea?" and he's telling me that he had a two day pass in the Philippines in World War Two. He got it, but he's afraid. He doesn't want his wife to see it on the chart and he never told his wife. 

I'm just sitting there thinking, "Why do I care if you had gonorrhea in World War Two?" Why? If it doesn't affect dentists, that'd be like asking if they live in a three bedroom house or an apartment or a trailer. How does living in a fifth wheel affect my diagnosis? How does having gonorrhea 50 years ago affect my treatment plan? If there's a oral-systemic link connection ... I'd rather you ask finance questions. Have you had your ... No, really. I'm serious because, "Have you had your same job for tow years?" If it costs more than $1,000, 90% of Americans have to finance it. 

If I'm really committed to oral healthcare, I don't want to go in there and say, "Well, your treatment plan is $1,900. Would you like to give me a check or credit card?" I'd rather go in there and say, "Wow, you have outstanding credit. We can do everything the doctor and hygienist talked about for just $145 a month for 36 months." That's a better doctor. I'm gonna understand my patient so that you can get all the treatment you need, not asking if you had gonorrhea.

Jasmin Haley: I disagree with that. I disagree. The reason why is, yes, you don't need to know what they had 50 years ago. You can ask within the last 10 years. If we're trying to look at wholistic care at the whole entire person, if you know that your particular patient is at risk for STDs because of certain types of behavior, then you know that in your ... which they call the dental hygiene of care, in you're assessment, some of the things that your gonna be recommending to them is, "you need to see a routine physician. Here's a possible referral. You nee your physical. When was the last time you had a physical?"

Id they come in and they tell you, "Well, I don't know. I'm eating like this." We're looking at more than just, "Let me take care of your mouth." There's nutritional counseling. There could be counseling made for them if they're high risk for high blood pressure, diabetic, whatever. When we start eliminating that, we're not really seeing ourselves as true professionals that treat the entire system. This is the portal entry of everything else. We need to be prepared to really look at it and see things as interprofessional care. Where can we refer the patient? They may not have immediate dental needs.

Howard Farran: I'm gonna stay with STDs for a minute. I think the most bizarre thing that dental hygienists do in dental offices is that a hygienist has four years of college, a registered nurse has four years of college. 8,000 to 38,000 Americans die each year from the flu. When I look at the CDC research of where those 8,000 to 38,000 people entered the healthcare system the last time, dental offices are the top three. 

Why are we measuring them for periodontal disease when we're not giving grandma a flu shot? How many lives could have been saved if the hygienist [inaudible 00:47:46] a flu shot? Now with HPV and oral cancer, they're saying that you need to be vaccinated before you get the HPV virus. How come I can go into Walgreens and CVC and Farmtech can give me a flu shot and my hygienist with four years of college can't. Why can't that tech give me the HPV vaccine?

The last time I went to the doctor, I needed some booster shot. I think it was tetanus. He said, "Well, just go to Walgreens or CVC." I said, "Well, are you gonna give me a prescription?" He said, "You don't even need a prescription for it." I'm like, "I don't even need a prescription for it but my hygienist can't do it?"

In one progressive state, Tennessee, which didn't surprise me because that's the state that invented Jack Daniels so you know those guys know how to think. Why does America not bring their 185,000 hygienists and 211,000 licensed dentists to the front signs of the flu shot? The one thing I also want to say, everybody always thinks ... About 20% of Americans think the sky is falling. If you go into 100 churches, 20% think the end of the world is coming. ?You go into Wall Street, 20% think the market is gonna crash and you buy gold and then you say to the guy, "Well, let's say every bad thing happens and we do go into depression. What the hell are you gonna do with your gold bars? You gonna eat them? You gonna drink them?" 

They're only good for jewelry and dental fillings. What are you gonna do? "We got no money, we lost our job, we're out of water, we're out of food. I made you a nice gold necklace with matching earrings." 20% of people I believe are just batshit crazy from here to Katmandu. Every century has been better than the century before going back 15,000 years. We're at 2017. 17 years into the last century, we already had the Spanish Influenza, and 5% of the entire planet died. Philadelphia bought their first steam engine because they couldn't build graves fast enough, and here we are, 17 years into the 21st century and no one's talking about, "Hey all you anti-vacs people, can we get a hand because we didn't listen to you and we didn't have 5% of the entire planet die?"

Oh no, but the anti-vacs people are on TV saying vaccines cause all these other diseases and autism and [inaudible 00:50:19]. It looks like no matter what you do, 20% of the planet is still just oblivious to any data. I think the first 17 years of this century are 10 times better. The last century, the great depression, two World Wars, Vietnam, Korea. I think this is gonna be mankind's finest century. 1880, 80% of earthlings could not read or write. Now, half the planet has a smartphone and can get on Wikipedia, even if it's not right on abfractions. It's not good enough for doctors and hygienists I agree, but it's a lot better than my encyclopedias that my mom bought me at a garage sale that were made 10 years before I was born. She bought them for me at age 10. I was reading 20 year old Britannicas-

Jasmin Haley: I had them to at home.

Howard Farran: This is gonna be our finest century, but I think hygienists and dentists need to get our rights to give HPV vaccines and flu shots, but back to the-

Jasmin Haley: I don't if that right there is something that is important that will come down the line, but first there needs to be some evolution happening in the dental hygiene profession first. I'm just thinking about other issues with not having enough time to provide the best care for your patients. How are we supposed to get everything that needs to get done, and provide a flu vaccine and all the assessments and all that stuff that we learned in 30 minutes?

Howard Farran: I think it's at a cleaning off all the tarter and stain, it'd be a lot easier just to take an extra oral photo and then Photoshop it.

Jasmin Haley: Good point.

Howard Farran: That's how you increase your productivity. That's what I do with cavities. A lot of times I'll take an X-Ray and if they have like 12 cavities and I don't want to fix them, I just Photoshop them. It's so much easier and faster.

I want to ask you the most important question. Here's the most important question. If I line up 100 dentists and I say, "What stresses you out the most? What keeps you up at night? What makes you to want to go to work?" It's never, "My fillings are falling out. My root canals are failing." It's never any of that. It's always HR. It's always staff. He's like, "My assistant and my hygienist, they're always going at it but my patients love them. My office manager, she's so moody. She'll come in Monday, Tuesday, Wednesday and be the most adorable lady in the world, then Thursday she'll come in and she's Jekyll and Hyde." 

What they do is, after every procedure, they run back to their office and shut the door because they just can't deal with staff. You've been in so many offices. How come some offices don't have drama and other offices do, and what percent of the office would you say the leadership, the communication, talking about what's the break even point for the day, our goals, concerns? When you talk about communication, they only communicate because they feel safe to talk. Some offices, they feel like "Well, if I say the obvious, the office manager will torture me. The dentist won't talk to me or his wife will fire me." 

What percent of the offices are safe and you can communicate and talk about goals and concerns and everybody is happy and fulfilled versus just living in fear, disfunction, staff drama, all that bullshit. What percent of which?

Jasmin Haley: I'm not a percentage stats type oof person. I like to reach the heart, because you've asked quite a few questions like that and I'm like, "I don't know." I'm going here, this is where I want to reach, here the heart. I would tell the dentist to ... If you haven't had a chance, read Simon Sinek's, Start With Why. Understand your Why because everything starts at the head. You may have all these parts of the body and all of them come together to make this particular, whatever it is, whatever your office, but everything starts with the head.

If you're not clear what your philosophy is, what your why is, what makes you tick, what your passionate about, nobody else would be. If you find that the people that you hire are not in alignment with your why, then you need to get rid of them. Don't think twice because at the end of the day, if the head is not sure about what exactly is important to them, everyone else will be unsure. That's when you get all those different personalities coming in and changing the whole culture and dynamic of an office.

That happens in academia. That happens in corporate. It happens everywhere. Whoever that leader is, they need to understand what's most important to them. What is their why and put their foot down. I think that goes with dentists. It goes with dental hygienists who are looking to do more in their career. It goes with dental assistants as well. Particularly in private practice office, if that doctor is unsure of themselves on what their why is, then you see it throughout the entire practice. 

You don't have to lead on a domineering way. You can lead in a way that could motivate and inspire the other professionals in your particular group to want to seek excellence also.

Howard Farran: I want to be the 400 pound gorilla in my office, but I gotta gain like 30 more pounds first. I'm only at 370. You have a lot of passion for the diversity, the transgender, the transsexual and you also have a lot of passion for HIV AIDS. Where does all that come from? Where does your passion for HIV AIDS, transgender, the poor, where does that come from on your journey?

Jasmin Haley: I'd like correct you and say, I am passionate about cultural sensitivity. It's not particularly with just that group. It's with so many others. I also speak on opioid addiction. My journey began when I discovered how HIV affected people in my personal life. When I discovered that, I was heading on to my baccalaureate degree program. I was devastated in finding out those news because it was hidden from me for some time. 

What I decided to do when I did my degree completion was to mentor, and I'm thankful to the University of Maryland School of Dentistry for allowing me to do that because no one had done it at that time, was to mentor with an HIV AIDS expert. When I had the opportunity to mentor with her, she offered me a job and I delved into the HIV positive community, working with them. 

Having the chance to work with them, I had a large array of patients who identified as LGBTQ. I had my-

Howard Farran: LGB what? LBG-

Jasmin Haley: LGBTQ.

Howard Farran: LBGTQ?

Jasmin Haley: LG ...

Howard Farran: LG ...

Jasmin Haley: ... BTQ.

Howard Farran: The only Q I've ever seen is DQ, that's where I get all my nutrition counseling, at Dairy Queen. What does the Q stand for?

Jasmin Haley: Queer.

Howard Farran: When did they add that?

Jasmin Haley: Well, it's actually 26 letters that make it up all together when you include everything.

Howard Farran: But there's only 26 letters in the alphabet.

Jasmin Haley: I don't know the entire acronym by heart-

Howard Farran: I do, I do.

Jasmin Haley: You do?

Howard Farran: A, B, C, D, E, F, G, H, I, J, K, L, M, N, O, P, Q, R, S, T, U, V, W, X, Y, Z. See, I memorized it, that's how ... By the way, what song do you like more, the A,B,C song or Twinkle Twinkle Little Star? Which song, A, B, C, D-

Jasmin Haley: A, B, C because I can really dance to that beat.

Howard Farran: ... or Twinkle, Twinkle Little Star?

Jasmin Haley: A, B, C because I can dance to A, B, C better.

Howard Farran: You got the moves even when you're in ... Actually that's just a little trivia thing. That is the same some and it was Mozart, and if you ever listen to Mozart's rendition, it's like a three hour rendition. It goes to like aggressive, mean, sad, this, that, but those two nursery rhymes where both the same concert from Mozart.  The Twinkle Twinkle Little Star, but anyway, what is your favorite movie? I lived through that.

Jasmin Haley: Philadelphia is the one that I can think of right now. Philadelphia.

Howard Farran: Denzel Washington, that was an excellent movie. I'd say that wold be my second, but I loved that. And The Band Played On. Did you ever see that movie?

Jasmin Haley: Yes. That's another one. That's another good one.

Howard Farran: In 1981, epidemiologist Don Francis learns of an increased rate of death among gay men in urban areas. The startling information leads him to begin investigating the outbreak, which is ultimately identified as AIDS. I lived through that. That was 1981. I graduated high school in 1980. My boys' mother's best friend when I was in dental school was in law school and died from it. The first person that died in my graduating class of UMKC in 1987 died of AIDS. I lived through this, and again, it's bad now. It's bad now in 2017, but not compared to 1993. If anybody says SIDS is worse today ... See that's my deal, I'm an optimist. It gets better. The first 17 years of this century is twice as better than the last 17 years of the 1900 to 1917. It's horrible, but it's better than 93.

Jasmin Haley: It is, it is to come degree but it's not getting where it needs to be. The HIV infection is still on the rise. When you look at young men of color who are MSM, who are males who have sex with males, there's a 50% chance of getting HIV. That's one out of two. We're talking 2017 when we have antiretroviral medications. We also have something called PrEP, which is pre-exposure prophylaxis. These demographics who are more at risk for HIV, they don't have access to it. 

The people who may not have the highest rick of acquiring, don't have access to it. There's still a lot of growth that needs to happen. There's a break between the continuum of care when it comes to patients who have HIV, which is why the Jacques Initiative is starting this program where they're teaching dentists, they're teaching dental hygienists, and all these different realms of health professionals, how to do HIV testing.

We have dental students and dental hygienists who are learning how to do HIV testing and using interprofessional care so that you get more people tested, then you get more people that are aware of their status and possible more people that are treated.

Howard Farran: I think you're so amazing. The only thing that confuses me about you is, I've been to Maryland 100 times. You weren't born and raised in Maryland, or your mom or dad aren't from Maryland because you don't have the Baltimore, Maryland accent.

Jasmin Haley: I'm from Queens, New Your City.

Howard Farran: Queens?

Jasmin Haley: Yeah, yeah, which is why my-

Howard Farran: So that a Queens accent?

Jasmin Haley: No it's not. It's gone.

Howard Farran: So you sound like someone who is from Queens and started to lose their accent in Baltimore, Maryland?

Jasmin Haley: Yeah, it's gone. Except when I cay coffee or when I say ... I forgot. There's some other word that I say that my sister was saying I dint really say anymore, but that's it. That's the only thing that's lasted. My accent is completely gone.

Howard Farran: I tell you what, I hope you load those podcasts on the Dentaltown app because it'd just be great marketing your podcast MOMgienists on iTunes. Everyone who's put their podcast and load it on Dentaltown, there's now 39, it populates across Dentaltown, Hygienetown, Orthotown. They say that their views on iTunes exploded because of the marketing. So many people on their way to work ... You know, most podcasters have an hour commute to work and they say they get in there and they open up the podcast and they just start scrolling down to what in the mood they're listening to. Sometimes they'll say, "Yeah, I listened to 10 of yours, then I went to that DentistMetrics, and then I started getting into implants or ..." It's just so cool.

I think you are so cool. I hope you do an online CE course for us on ... Dentaltown, Hygienetown is the same online. I hope someday you do an online CE course for us. I hope you write a article. I want you to know that you have a special place with me because Howard Community College where you went, that was named after me.

Jasmin Haley: Oh my gosh, really?

Howard Farran: Did you see my statue when you walked in the front door?

Jasmin Haley: I totally missed it.

Howard Farran: Did you really? Oh my God. Well I'm glad I was able to talk to you so that you know that you went to my community college. Actually, seriously in all seriousness, you remember when they had to take down the Rocky statue in Philly?

Jasmin Haley: Yeah.

Howard Farran: The same day, they took down my statue at Howard Community College. They said, "Both of those statues gotta go." But hey, seriously, love you, love your show, love everything you're doing. I think you're just one of dentistry's thousand points of light. Thank you so much today for giving me an hour of your life and coming on the show. 

Jasmin Haley: Thank you. I appreciate it. Thanks for having me.

Howard Farran: All right, have a rocky hot day.

Category: hygiene, pathology
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