Friday afternoon Black Swan. Last patient of the week. An old second molar. A right lower jaw rootcanaled ready for crowning is cracked. Extraction needed. The patient is a 59-year-old man in good health.
I talk to him - if the bone is allright I'm gonna screw an implant in the fresh socket. You skip the second surgery -
The sphygmomanometer scores 180/110 of blood pressure and 120 of pulse. Too much. He worries. I keep quiet and check. My assistant mounted the device in the wrong way. He calms down. The real pressure drops to 140/90. I do anesthesia. The bare minimum.
I start to handle the extraction.
Patient complains - my stomach hurts - he says, and touches his stomach. He is pale like a corpse. He feels sick as I do. He is sweating.
- I have some stomach issue since yesterday maybe it's just that - he says. In the meantime he starts to clench and release his left fist as if to keep off the tingling rising in his left arm.
I studied medicine. I volunteered 1 year in cardiology. I check the ECG. I do not see any S-T modifications or T-wave inversions. Diaphragmatic infarct or acute gastritis - my brain quickly processes informations. He is scared.
I decide to stop my doings. I tell him my diagnostic reasoning. I want him responsible and to control himself.
He calms down. Clinical scenario stabilizes. Blood pressure drops to normal and tachycardia disappears.
I ask him on the way to home for an ECG in hospital. - I'll wait for a phone call in the evening: - I have lost money but not the patient. Later on at 10 PM his wife will call me. Everything ok.
On my desktop the pc blinks. Commercials offer dental marketing courses. Syncronicity would name it Jung. They have epidemically multiplied. The new credo: Dentistry as a premium business.
You are supposed to upgrade to an Ivy League odonto-economist.
An American orthodontist declares to invoice $ 11.000.000 a year. He is ready to share his magic formula for making money. Another from USA but with an aramaic name promises you the 7 figures dental praxis. A dentist of a lost village in the country of north Italy is proud of his 12 chairs and 25 employees. The young sub-urban Cagliostro knows how to shift from a humble dental-office into corporate dentistry providing inexhaustible wealth. Another on-the-verge-of-nobel-price-winning-odonto-economist has put mineral-rich springwater bathing and massage tables in his office. His new brilliant idea: cross-marketing between SPA and dental cleaning.
Deafening memes like "from zero to Empire: all tip & tricks to make easy money with dentistry".
Or "you don't have to work IN your practice but ON your practice."
Not one word about preventing a mishap like above.
Just grow - they say – become bigger, mltiply the number of chairs and employees and hire dentists (poor fools) working only for you – that will save your ass in case of black swans. A simple recipe.
Again I'm figuring out the poor man of today in a huge clinic.
But do they have or at least had sometimes skin in the game before speaking?
They are boasting about a billionair's life posting on socials about the usual crap of happy meals in 3 stars Michelin restaurants, big offices stuffed with any kind of digital technology – but no Microscope of course it would mean a time-wasting habit – scientism in marketing, a big happy family, big cars, country house and nice holidays. No deficiencies. But no efficiency too – hotels and resort are more efficient than a country house you own but you seldom use. Everything pink colored. No scars. No problems. Professionally video-edited stuff promotes beautiful 5 figures incredibly complex never ending (at least 3-4 years) full mouth rehabilitations with greedy surgeries. Indeed dentists are very sensible to surgical skills. It signals a strong attitude to risk-taking i.e. to leadership.
They took classes about neuro-science and NLP. Encoded in their communication symbols of success: youth, technology, digital-addiction, modernism, liberism, determinism, the invisible hand of market, positivism, scientism, darwinism, neuro-science pronism and evidence based bullshit.
They are business generators. They know better than you.
Or maybe not.
The curse of dimensionality (N. Taleb).
"The higher the dimension, the higher the number of possible interactions and the more disproportionally difficult is predictability and the more fragile systems become."
There is no way to predict economy. The behavior of the single unit will not allow us to understand the general behavior of the market (Antifragile – Nassim Taleb).
The single unit of the market: Der Mensch (the human being).
Groups are unit on their own. In any field. Even human's behaviour changes when figures grow. Freud wrote 100 years ago in Group Psychology: "... the greater the number of people the stronger does an automatic compulsion grow. The individual lets himself slip into the common same affect...".
More easy: Menschen (humans) have an attitude to behave like sheeps.
But people have brains.
Neuroscience says we finally got to know the brain and to sequence the DNA : we are ready to fuck brain of customers.
Neuroscience are doomed to failure. Understanding how some area of brain is working (a group of neurons) will never shed light over how the whole brain works.
We are born more or less with the same amount of neurons but what scores better regarding processing power is the number of connections:
the size of the neural network.
Synapses (connections) are increasing by training the brain to learn. The same way they disappear because of inactvity i.e. lack of exercize. Like muscles: if you dead lift they grow if you lie in obliviousness you got atrophia.
Therefore even if you know the functional anatomy of the brain you actually don't know how it works in reality.
By the way, Psychiatry is doomed too trying to decline pathologies of the brain (mind) as a body-organ. Psychology since more than a century has yet explained that our brain-mind is the result of interactions of a continuum of neural networking as memory and experience provide. The physical organ to target with drugs ... is missing.
Science trumpeted huge advances in decoding the human DNA sequence. Nonetheless Epigenetics says we may have changes in gene expression that do not involve changes to the underlying DNA sequence — a change in phenotype without a change in genotype. So we don't know again a damn.
A group of people (Freud) a group of genes (Darwin) and a group of neurons (Kandel) differ from the individual unit (component) because of the interactions. That's real stuff.
Our dental-economist maybe knows better. He is advising you to grow aka to multiply your chairs and employees in your dental office to back off from Black Swans. Because big numbers are the solution to incertainity in life:
the bigger the more predictable.
Holy f... ! I don't know if those people where grown up enough in 2008. Maybe they missed the Hollywood film "Too big to fail". Maybe they don't have scars. Did they never fail in life? I mean some experience of fucking real life. How you dare to advise the poor freshman of dentistry or the middleaged country-dentist exhausted from debts troubled with 3 or more children to raise, that to grow is the only way to survive?
At a certain scale things become different. Mathematically different.
I started really from scratch. No parents to buy me a house. No money to buy an office. Just mortgaging, working and skipping holidays. Got a 4 chairs office in down-town. Something annihilating one's life.
Got a motorbike accident in 2000. Was in a coma for 3 days. Almost died. 3 months of recovery. A One-million-debt pending on my head and 7 souls (children and wife) waiting for food.
I went broken in 2006 because of a fucking scummer. Lost everything in 7 months. I restarted again.
In 2008 made the highest revenue of my life just renting ONE room in a collegue's practice. ONE chair and ONE assistant. Never seen such money again. And it was plain 2008 crisis.
The office you see in the picture is the result of the very long run. I'm a one-man-band as I repeatedly wrote.
The bottom line
The more you have the more fragile you are.
I was little but very robust. I could resist and made even a great revenue.
These are scars. I'm no godness. I'm just human like all of you. I made mistakes. I recovered. I learned something.
Our bless is in our hands. Potentially the highest revenue. They are NOT scalable. Entrepreneurship is a different job.
I prefer to
get as much knowledge as I can
because this is an unlimited-easy-to-handle resourse. No one can steal you. Totally robust to economy's up and downs, bubbles and similarities. The only thing that saved my ass in my life.
My next course: Odonto-Minimalism - The recipe of a Survivor – How to stay Robust until 80 of age and ... patient had gastritis!