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Things I wish I knew when I started practicing dentistry

Dr. Anne-Marie Nguyen and family

Dr. Anne-Marie Nguyen, with her family in Houston                               

Photo courtesy Dr. Anne-Marie Nguyen

Wisdom for graduates from Dr. Anne-Marie Nguyen ’90, a Houston periodontist with a thing or two to say about ethics

After more than 20 years as a full-time, private practitioner, Dr. Anne-Marie Nguyen has seen the gamut when it comes to ethical behavior in the dental profession. That includes the good, bad and downright ugly. It’s an issue she feels so strongly about that Nguyen — former president of the Houston Society of Periodontists and founding member of the Houston Asian-American Dental Society — agreed to share her experiences with a Dallas audience in February.

The result: a riveting presentation revolving around what she has coined “Nguyen’s 10 Commandments of Ethics.” It’s a topic she’ll delve into this fall, when she leads an ethics presentation during faculty grand rounds for the UT Health Science Center San Antonio Dental School. In this Q-and-A session, Nguyen opens up about how graduating dentists can do right by their patients and at the same time, avoid some career pitfalls.

BDRO: Tell us about your practice in Houston. What is it called, and how long has it been open?

Nguyen: I have limited my practice to periodontology since 1999. I named it simply “Dental Office of Anne-Marie Nguyen, P.A.” Looking back, I should have named it something else — like “Gum Disease Shop,” “Gum Boil Factory”— you know, something catchy and interesting that better reflects what I do for a living.

BDRO: What are the top three things you wish you knew when you graduated from dental school?

Nguyen: 1. Get a mentor.

My word of advice to the new graduates is to choose your mentor carefully and wisely while in school. After graduation use that person as a source of advice. While in school, I found two mentors who really deserved to be called teacher: Dr. Tommy Gage — pharmacology — and Dr. James Gutmann — endodontics. After graduation, I met a physician named Dr. David Graham while I was training as a general practice resident at the veterans’ affairs medical center in Houston. From my observation, these three mentors all have some things in common: They push the students beyond their limitations, and they want to develop the best abilities in students. These mentors instilled in me the values of hard work, integrity, efficiency and determination, along with a seed of kindness and compassion. Trust me! You will need all of those qualities to be successful in the private practice world. 

Again, choose your mentor wisely. If you find yourself in a practice with an owner who maximizes profits in unethical ways, such as creating services and up-coding procedures, committing insurance fraud, or altering professional records, I suggest that you get out of the contract as fast as you can. If you are desperate and cannot find any other job openings, then learn from it but don’t do it! It’s not worth it!

10 Commandments of Ethics 

From Dr. Anne-Marie Nguyen

  1. Thou shall do no harm.
  2. Thou shall not be so greedy.
  3. Thou shall not perform phantom coding.
  4. Thou shall not lie to your patients.
  5. Thou shall not be cheap.
  6. Thou shall not fake nor alter patients’ records.
  7. Thou shall not deny patient’s request for records.
  8. Thou shall not offer unrealistic expectations.
  9. Thou shall remain up-to-date with current knowledge.
  10. Thou shall refer to specialist(s) if it’s not within your expertise.

2. Know your limitations, and trust your intuition.

Looking back, from the day I donned my white coat, I was given the title “doctor.” I felt I was on top of the world and that I could do everything. For the first several months, I had an arrogant, feisty, overconfident attitude in the office because everyone addressed me as “doctor.”

Well, I was brought back to reality very soon after I was assigned to remove a full bony impacted third molar wisdom tooth in a young patient. Deep down inside, I knew that case needed to be referred to an oral surgeon, but because I was arrogant and had too much ego, I went ahead and performed the surgery. After more than two hours of picking out small tooth fragments, I was exhausted, and the patient was suffering greatly. Finally, by the grace of God, I removed the one and only impacted third molar.

I learned that everyone has limitations, and that there is often someone with better training and more clinical experience. After 22 years in practice, I still refer my patients to other specialists. I realized by doing that, the patients will give you more respect because they’ll know that you are honest and that you really care for their safety as well as their overall health.

I’m afraid the younger clinicians might not know their limitations because of societal pressures, market forces and self-interest in material possessions. I have witnessed many cases with irreversible damage to patients that resulted from lack of referral, limited training and an effort to maximize profits. 

3. Work with a small or group practice to learn the business management skill for a few years before opening your own shop.

This was the best advice given to me by my sister, the accountant. Remember, dental schools only teach students the technical skills and the knowledge to go with it. They do not teach students about dealing with people and the required management skills. Little by little, we all learn the hard way.

While you are working as an associate, start building your own patient pool and meet as many people as you can. By the time you open your own practice, you will have patients ready to be served. Remember, time is money. The mound of bills will be waiting for you. No one will work for you for free … except maybe your mother.