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Interview with Sandra Miles, April 4, 2005 | UNCW Archives and Special Collections Online Database

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Title:
Interview with Sandra Miles, April 4, 2005
Date:
April 4, 2005
Description:
In this interview, Dr. Sandra Miles discusses her profession of dentistry, including technological advancements in tools and procedures, HIPAA regulations, and patient care.
Phys. Desc:

Interviewee: Miles, Sandra Interviewer: Zarbock, Paul Date of Interview: 4/4/2005 Series: SENC Health Services (Dentistry) Length 43:40

Zarbock: Good afternoon. My name is Paul Zarbock, a staff person with the University of North Carolina at Wilmington's Randall Library. This videotape is part of the professional personnel in the healthcare delivery system. Today is the 4th of April in the year 2005 and we're interviewing Dr. Sandra Miles. Dr. Miles is a dentist in private practice here in Wilmington, North Carolina. Good afternoon, Dr. Miles.

Sandra Miles: Good afternoon.

Zarbock: I'm going to say on the tape it's now 5:00 p.m. What time did you start your clinical practice today?

Sandra Miles: I started seeing patients at 8:00 a.m.

Zarbock: How many have you seen today?

Sandra Miles: Probably 30 patients.

Zarbock: Would that be a normal day?

Sandra Miles: Normal when only one hygienist is working. You could add about eight to that with another hygienist.

Zarbock: Well all of that is an oblique way of saying thank you very much for making the time to do this.

Sandra Miles: (laughs) You're welcome.

Zarbock: Okay, what individual, series of individuals, or event or series of events led you into the selection of dentistry as your profession?

Sandra Miles: As a youngster, I was very interested in math and science. Obviously, it's a very science-oriented career, but I was also very interested in people. And with that said uhm... I knew I wanted a career that was people-oriented, that I could have my own business, be my own self, yet be around people. And with a career-- with a study in- in chemistry, I graduated with a BS in chemistry, a major in chemistry, minor in biology.

Zarbock: From where?

Sandra Miles: Indiana University, and then I uhm... worked as a biochemist, actually, for a few years as I was still trying to find my way. (laughs) That was another life. And all of a sudden, it did dawn on me exactly what I wanted to do and it was dentistry. It fit. It fits well for a woman's life. I wanted children. I wanted a family. I didn't want a full-time hospital or clinical situation and this fits really well.

Zarbock: And where did you apply?

Sandra Miles: For dental school?

Zarbock: Yes.

Sandra Miles: Only- only Indiana Uni- University. I was working at the time at IUPY, which is Indiana University/Purdue University at Indianapolis and the university is right there. And I applied there and, of course, got in. They didn't like the idea that I only applied to one place. They like it when you apply to anywhere from four to ten dentist-- dental schools.

Zarbock: On what motive?

Sandra Miles: Because you have a better chance of getting in, so they want you to apply to more than one.

Zarbock: And who are they?

Sandra Miles: They being any of the instructors of all the schools. They want you to have that motive, that- that incentive to say, "This is what I really want to do, so I'm going to apply."

Zarbock: "World get out of my way," huh?

Sandra Miles: Right.

Zarbock: "I'm going to get in there no matter what."

Sandra Miles: Well, they asked me. They said, "Where else have you applied?" I said, "Nowhere. My husband works here. This is where I'm-- this is where I live. This is where I want to go to school." They said, "What if you don't get in?" I said, "I'll work for another year and I'll reapply next year." (laughs) And of course, I got in.

Zarbock: What was the curriculum like? It's four years, isn't it?

Sandra Miles: Its four years. Its four years. The first two are mostly bookwork. The last two are a lot of clinicals, a lot of patients, a lot of clinical work, yet you've still go the bookwork involved in it, too.

Zarbock: You had a degree in chemistry. What were the first two years of bookwork?

Sandra Miles: Uhm... anatomy, physiology, uh... dental anatomy, uhm... learning more of what dentistry is all about, dental history, that type of thing, uhm... and some more chemistry. Just that type of thing, and dental- dental materials, so you just really learn a lot about the dentistry aspect of the chemistry.

Zarbock: Did the curriculum really convince you, you had made a wise selection, or did you get a little discouraged?

Sandra Miles: Uhm... I didn't get discouraged. What really happened was when we started the lab work and we sat down and started working on even just the models, and I was there-- the bookwork was nothing. I mean that was-- that was okay. It was not- not nothing, like it was a breeze, but of course, if you're accepted and you've got the brains, you can do it. But when you start to do the lab work and you start to do the model work, you're just there. You realize this is exactly what you want to do, so I loved it. I loved it.

Zarbock: What was the size of your class?

Sandra Miles: There were 82 to begin with.

Zarbock: How many women?

Sandra Miles: Forty percent, approximately 40 percent. And this was in 19-- we graduated in '92, so '88, 1988.

Zarbock: Did you notice any differences, subtle or overt, with the faculty vis-a-vis male students, vis-a-vis female students?

Sandra Miles: Probably the faculty were more male, but there were some female, predominantly then.

Zarbock: And is it true they gave you a piece of chalk or some equivalent and told you to carve a tooth?

Sandra Miles: They used to do soap. They used to do soap, uhm... not so much anymore.

Zarbock: Is that a thing that's passing into history?

Sandra Miles: Not so much. I think that they still love the hands-on. They still want to see what kind of a-- what kind of skills you have. They need to see dexterity. They need to see skill. They need to see motive, uhm... but certainly, you need to know your dental anatomy. That's the-- that's the first thing, because anytime you're sitting there and you're working on a patient, you're recreating what was there and you need to know the anatomy.

Zarbock: This is what seems to be almost a lightheaded question, but I'm going to ask it, anyway. Had you ever given anybody a shot, an inoculation before you went into dentistry?

Sandra Miles: (laughs) Absolutely not, although I have received a number of them myself up to that point. And the uhm... classmate of mine that I'd given it to-- Hi, Kirk, if you ever see this--(laughs) had never received an injection before in his life.

Zarbock: Really?

Sandra Miles: Right. So bookwork is one thing. Learning how to administer anesthesia and listening to what to do is one thing. Doing it and having it done to yourself is another. So we give it to each other, everything goes fine. Four hours later, when you're still numb and you know you're supposed to be numb, that's fine, because you've had this done before. You know it's going to go away in about another half-an-hour or an hour. Kirk calls me at home (laughs) and he says, "Sandy, I'm still numb. I think you did something wrong!" (laughs) And I said, "Kirk, I'm still numb, too. You're going to be okay."

Zarbock: You were giving each other shots?

Sandra Miles: Yes, we gave each other shots.

Zarbock: There wasn't a procedure that followed. It was just the experience of--

Sandra Miles: No. No, it was just the experience of doing it.

Zarbock: The inoculation.

Sandra Miles: Mm hmm.

Zarbock: Is it possible that something could go awry at the time of an inoculation?

Sandra Miles: Yes, there always is, because any time you give an injection, you are injecting in or around the area of a nerve. And if you inject into the nerve or hit the nerve with the needle, there is a possibility that you can harm that nerve fiber. Most of the time, it is a reversible damage; every once in a while, it can be irreversible. Any time people have dental work done, especially some severe dental work, say for example, oral surgery, they have to be aware of that possibility. But with the procedures, with the smaller needles, with the better anesthesia and with the right technique, that's rare.

Zarbock: I was probing a little bit with the differences, if any, between female dental students and male dental students. What has been your clinical observation between male patients and female patients? How would you, in general, characterize?

Sandra Miles: I-- sometimes I think, overall, male patients are not quite as accepting of treatment as female patients are. But yet, once you get their trust, they're-- they could be your best patients. And I think that-- I think I'm saying that as a female. And it takes- it takes that first step. It takes that first trust level.

Zarbock: So the males are really elliptically, at least, pondering, "How really good are you?"

Sandra Miles: Exactly, exactly. They think, "Okay; here I am at this female dentist. What's she going to do for me? What can she do for me?" Once you get their trust, you're their mother (laughs) at that point and you've got it.

Zarbock: Do you have any anecdotes that you would like to reminisce about, strange things that happened when a patient sat down, or fled or fainted?

Sandra Miles: No one's ever-- one person did faint, actually, nothing severe, but uhm... it wasn't while I was working on them. It was when they sat down, laid them back. They hadn't eaten for three days. Getting ready to do some work, laid him back and he passed out. So fortunately, we had the smelling salts, woke him back up and he was okay. Uhm... gave him some orange juice from the refrigerator and things were all right.

Zarbock: It wasn't diabetes?

Sandra Miles: No. No, he just hadn't eaten, hadn't eaten and then probably has- had a little bit too much alcohol in those three days, versus no food (laughs) and if you'd smelled him... Uh, strange- strange things can happen. Probably off the top of my head, I'm not sure I could think of any right away. Something might come later, but uhm... yeah, just funny things all the time. It's great.

Zarbock: You know you trigger off something else. I cannot remember in my life ever having heard a dental joke.

Sandra Miles: Oh.

Zarbock: There are lawyer jokes, and doctor jokes and lots of minister jokes.

Sandra Miles: Oh, yeah. That's funny.

Zarbock: But I've never heard a dental joke.

Sandra Miles: No. I know. (laughs) I don't think I know any.

Zarbock: Again, back to why are we doing these videotapes. You're part of the collection, Special Collections at UNCW. I should have mentioned to you off-camera that what I'm now giving you is immortality here.

Sandra Miles: You did mention that the other day. It was funny.

Zarbock: You'll be there for ever, and ever and ever. Some years from now, this tape is going to be reviewed, as others will be, by other students, researchers, writers and they're going to say, "Ah, that's the way it was then." In my lifetime, dentistry and the presentation of self by the professional has changed substantially.

Sandra Miles: Incredibly.

Zarbock: What are some of the changes since you got out of dental school and right now, April, 2005?

Sandra Miles: Some of the things that are exciting to me and-- because personally, I love the toys. I love the- the materials that are out there and the things that are out there. Digital radiography, for example, when you can take an x-ray and right there, it shows up on the computer screen, right there at your very eyes. And the diagnostic value of a digital film versus a regular film is incredible.

Zarbock: Incredible in what terms? Accuracy?

Sandra Miles: Accuracy in the sense that-- in the sense that-- swiftness of reproduction, accuracy in the sense that you can look at it large. You can increase the size uhm... versus looking at a small film this big to a 19-inch computer screen, uhm... or uh... you know, an 11x9 printed-out sheet of paper, so it's just incredible. And the things you can do with the program to manipulate that picture to see it in 3D, to see it in reverse, it's just incredible the things it does.

Zarbock: You can see it in 3D?

Sandra Miles: Mm hmm, mm hmm.

Zarbock: Wow!

Sandra Miles: Right.

Zarbock: Well, that's a substantial change.

Sandra Miles: Oh, its- it's-- the diagnostic value is incredible. And then the other things that we all have, also, which we've got available here at the office is a CEREC 3D. And the CEREC 3D is a machine that allows you to do a crown in one visit. It is a porcelain milling machine that's computerized. And you can do the crown preparation, take a picture of the tooth, and- and the machine will actually diagnostic-- diagnostically computerize and design the mach-- design the crown and do it for you while you sit in the chair, and then we try it in and give it to you and you're done. That can be for an on-lay, an inlay, or a crown or a veneer. So, there's so much new technology out there that is fun to play with, that's fun to have and do, that we always get to learn. It's a continual learning experience, because out there in 1992, it had just started. CEREC technology had just started in about '89, uh... so it was not where it is today.

Zarbock: Of the two technologies you've mentioned, what advantages are they for me, as your patient?

Sandra Miles: Well, do you like coming back for a second visit when you have a crown? Do you like wearing a temporary crown for two weeks?

Zarbock: Thank you very much.

Sandra Miles: (laughs) Do you like getting numbed a second time? Uhm... digital radiography, do you like uhm... having all those x-rays taken and then going to a room for 15 minutes while we go off to develop them? Would you rather that I have better diagnostic tools to look at your tooth and- and be able to see it better? So for that, in itself, is better.

Zarbock: What about the anesthetics that you use?

Sandra Miles: There are lots of different types of anesthetics.

Zarbock: Have they changed in the time you've been in practice?

Sandra Miles: No, not really. There are a couple that are out there that are new. And I think what you do in anesthesia and what they've done with anesthesia is, it's all in the pH balance. It's all in the-- in- in how it goes into your body and that's more chemistry. You really have to think of the chemistry of it. But basically, what you have to do is use what works for the patient. Use what gets in there and- and gets them numb. Sometimes I can use one thing on a patient and it works perfect. I can use that on the next person and it doesn't work at all. Why? Uh... maybe he's got some infection. Maybe it just doesn't work on that person. Maybe I need to use a different type. Use that type and he'll get completely numb. And it's just maybe that he needs epinephrine, maybe he needs a different type of anesthesia and then it'll work. But it's just whatever the pH balance is, whatever happens to work in his body. And sometimes it's a combination. And I have-- I have what I call a soup. And honestly, I have not done the research. I haven't been in a lab to do the research. It's just a clinical evaluation on my part. But I've got what I call a soup. For some of my patients that won't get numb, I'll pull out the soup and it works 99 percent of the time.

Zarbock: Is it possible, remotely possible at least, that a patient could be really determined not to be?

Sandra Miles: Sometimes I think so. Sometimes I think they can just be as nervous as anything and decide not to be numb. And one of my favorite sayings is, "Valium is my favorite drug." I've never taken it, but it's my favorite drug, (laughs) because I'll give it to my patients. They'll come in and they'll be sedated and I see two different people. When they're nervous and they're sitting in my chair and they're not with-- they don't have valium, they cannot do the treatment. They come in with valium and they just sit down and they let me do what I have to do and they just let me do it. And it's just incredible, the difference, so I say it's my favorite drug. (laughs) And it works, Paul. It works.

Zarbock: Do they ever use anything-- again, out of my youth-- laughing gas?

Sandra Miles: Well it's still there, yes. And we- we were taught that in dental school, also, in 1992-- between '88 and '92. Uhm... the only time I've ever had laughing gas was the one time we had to administer that to each other. I didn't like it. Now I know a lot of people like it. Uh... it's nitrous oxide. Oral surgeons use it routinely. Some general dentist friends of mine use it. Particularly, I don't like it. If you think about when you exhale nitrous oxide, who inhales it? We do, all day. Do you want to be my last patient during the day if I have been doing this all day long? I wouldn't want to. Uhm... not only that, almost everyone that works here is childbearing age, and do they want to do that all day long every day? Granted, we could work on ventilation and do that if that's what the other people have done in their offices, make sure it's ventilated well, et cetera, et cetera. It's not worth the hassle to me. I would rather use patient control, kindness, valium. (laughs) And it works well here for us. It works real well.

Zarbock: Hypnosis?

Sandra Miles: Uhm... I have-- we were taught that in school and I have used that to some level. Uhm... most of the time, the hypnosis that I use is more of a calming technique. I don't say, "Okay, we're going to use hypnosis now, so here we go." Uhm... but the-- but the calming technique that we use seems to help a lot.

Zarbock: Laughing gas, do you really laugh?

Sandra Miles: They call it laughing gas because it makes you so relaxed that some people actually do laugh. You get to a stage where everything is just so funny.

Zarbock: Euphoria.

Sandra Miles: Yeah. Yeah, that's why it's called laughing gas. But just a little bit too much, it just doesn't make you laugh anymore, so you know, it's a-- it's a drug, also.

Zarbock: What about dental tools, the hand tools?

Sandra Miles: As far as how many have changed recently?

Zarbock: Yeah.

Sandra Miles: It's really funny, because some of the tools are exactly the way they were 150 years ago.

Zarbock: Such as?

Sandra Miles: Such as uhm... an amalgam packer or uhm... the mirror can be the same as it was then, except now they have that the mirror tip will screw off, so you can just put a new mirror tip on. You don't have to buy a whole new handle. You know, maybe that's new. Uhm... but so many of the things that we use are the same. They're diehards. They work. Why change them? If it's not broke, don't fix it. Uhm... but some of the things are nice. Some of them, maybe, there's different scalars that the hygienist would use, and there's certainly different electronic devices. For example, if you're using-- if you're doing a root canal treatment, there are some heating devices that are different for packing in the filling material to do a root canal treatment. Those are new. Uhm... there are electric hand pieces now versus your-- your um... air-driven hand pieces. The air-driven have surpassed the belt driven. You remember the big belt-driven hand pieces. Uh... they're not here anymore. Now they're air-driven. Well now there's one step further; there are electric hand pieces and we have those here, and those are really nice.

Zarbock: What is an electric?

Sandra Miles: An electric hand piece. It's actually run on electricity versus the air that's run through the turbines, you know, run through the system. It's actual electricity. It's just a wonderful hand piece. It's nice and smooth. It's not boom, boom, boom. It's a lot better.

Zarbock: What about light sources? Have they improved?

Sandra Miles: Like the curing lights? Uhm... yes, they've got some plasma arc lights that can work a little bit faster. They give a little bit more heat to the tooth. You have to be careful as far as what you're going to do. And again, you have to understand your materials. You have to understand the chemistry behind what you're using. There's so many materials out there that you have to realize what you're using, what works best in your hands, and then figure out what light you want to use. Whether you want to just use an ultraviolet light, go with the plasma arc light; that depends on what you want.

Zarbock: This may be time to introduce the really dirty word, the "M" word, mercury.

Sandra Miles: Mercury, mercury. Uhm... amalgam has been around forever, forever. That's the silver filling material that contains the mercury. I have not placed a silver filling material for probably seven years. I'm guessing seven years. Uhm... I don't have it in the office. I don't-- I don't even own it anymore. I don't have it. But there are dentists. In fact, I saw a filling material today. Their patient-- a new patient came to me and they had-- there was a new filling in his tooth from two weeks ago that's a silver filling material, and that was just placed here in town by another dentist. Uhm... so there are still dentists out there that do silver filling materials. I'm not one of them and I'm not the only one that doesn't do them.

Zarbock: What do you use?

Sandra Miles: I use composite. It's a resin filling material, or I use porcelain which is, you know, your crowns. Uhm... and those-- that's what does it. That's what does it. Composite is that tooth-colored filling material.

Zarbock: A number of years from now, this is going to be a videotape revealing all sorts of things that have happened way back there in the year 2005. I'd like to just gnaw away a little bit on mercury. Why don't you--

Sandra Miles: Oh, that's a really good question. The reason I don't use it anymore is because of the mercury. Today's world is very concerned about the poisoning of mercury in our waters, in our system, in our bodies. And uhm... one of the things we have to be careful with is- is how we even dispose of the mercury that we remove from your mouth. What we have is a solid waste company that comes and picks up the mercury from our-- from our waste traps so that they can actually take it to the dump, so that it doesn't get into our system, it doesn't get into our water supply.

Zarbock: Are you required by law to dispose of the material in that way?

Sandra Miles: In North Carolina, it is highly recommended at this point. They are not going to come in my office and take away my license if they know-- if they find out I'm not, but they want us to. And if we don't, as a profession, then they'll re-- they'll require it in the very near future. What we are required to do at this point is we are required to have it filtered and we are required to take that filter to a dump. If I had one of my staff members carry that filter to the dump, that'd be fine. But having a company come here and waste-- take care of the waste for us is not required.

Zarbock: What do they do with the material, incinerate it or is it landfill?

Sandra Miles: They actually filter it out and then get rid of it that way. And I'm not sure what the process is completely.

Zarbock: One of the big changes, I think, that I have observed in the clinical practice of dentistry is the increasing demands on you to document-- the increasing opportunities for third-party payment. I assume you don't take chickens and pumpkins and potatoes.

Sandra Miles: No, no. No barter systems anymore. That would be called HIPAA. Everybody knows HIPAA if you're alive between (laughs) 2002 and 2005.

Zarbock: What does HIPAA stand for?

Sandra Miles: Health-- ooh, do you know it?

Zarbock: I think its health insurance portability.

Sandra Miles: Insurance portability act-- something act-- accountability act--. Portability and accountability act, that's what it is. And three years ago, we had to take care of the first portion of it, which was your uhm... security-- no; this- this portion is for security. What was it three years ago? Anyway, it's all privacy. That's what it was, privacy three years ago, security now. And so what we have to do is just make sure that our patients' records are private. When-- it goes as far as, if there are three people sitting in the waiting room and we walk out to get one of our patients for their appointment, we can't come out and say, "Bob Jones, it's your appointment." We say, "Mr. Jones, it's your appointment," or "Bob, it's your appointment," not both names, not both names. (laughs) And- and some places have gone as far-- some places being some dental offices, some doctors offices-- have gone as far as to give the patient a number.

Zarbock: Like Baskin Robbins?

Sandra Miles: Uh huh. They will say, "This is your number," and they come out and call patient number 1232. It's just a little-- it's a little crazy at times, but you have to-- you have to establish a system of privacy, whatever that system works well for you. And uhm... yeah, you have to do it. You don't have a choice.

Zarbock: What comments would you make about third-party payers?

Sandra Miles: Insurance companies are out to take care of insurance companies. They are-- they are contracted with the patient. They have nothing to do with us. They are not dealers with the medical practitioner, the dental practitioner. They are out for themselves, and that's their business. Of course, they're out for themselves. They have certain criteria of what they're going to pay and that's what they'll pay. What happens with a lot of people, and especially for dental work, is they come in and they expect it to work like medical insurance. Medical insurance pays. If they go to the doctor, medical insurance pays for everything except their $10 or $20 co-pay. They walk out, they never hear from them again. They come in here and their dental insurance pays for almost nothing (laughs) and they don't-- they're not used to that. If they have any med-- if they have any dental insurance, they still have so much of their co-pay and they're not used to that. They want to say, "Well do whatever the dental insurance is going to pay." It doesn't happen like that, so we have to do a lot of training on what their insurance really is. Their insurance is truly insurance. It's not coverage. It's not like a medical insurance that's going to help them through a car accident or a hospital stay. It's really just insurance. If they need a crown, it's going to help them out a little bit, but if they need to start from scratch and they haven't been in 20 years, it's not going to cover much today.

Zarbock: But you, as a practicing dentist, have to hire all sorts of people to be in the office with you to handle questions, too.

Sandra Miles: Absolutely, absolutely. The entire staff has to be trained on how to do that. And that's-- you don't learn that in dental school. You have to learn lit-- you have to learn a lot about business management as you go along.

Zarbock: Let me take you back to that, because this is a point that other dentists have made. I'd like to hear your remarks. A clinical practice, the scientific practice and possibly the art is all part of the curriculum, but when you graduate, somebody is going to ask, how much is that going to cost. Really, is it just a trial and error process of learning how to run the business?

Sandra Miles: It really is, and I think some of the time-- they try to touch it a little bit in dental school and they really did. There was a course there that gave us some of that, but not enough, not enough, uhm... but its four years. What are we going to do, make it six? So I really-- I'm- I'm not faulting the school for that. Continuing education is mandatory in all states. It better not go away. (laughs) It better not go away. It needs to be there because that continuing education is critical to keeping up with the changes and the work that needs to be done by us. And that's for the dentists. That's for the hygienists. That's for the assistants. And I have my front office staff go, too, so it's just-- it's just mandatory. Uhm... but when you learn it, you're right, you learn it trial and error. I came out and I worked with another dentist for three years. Uhm... you learn a lot that way, because that-- she had already been out for 12 years, ten or 12 years. And so you get to see how somebody else has done it. It gives you a little bit of an insight. But you learn just by doing it. You learn by doing it. And you do, you've got to get your feet wet and not worry about it, or you're not going to do it, or you're in the wrong job. But I love people and I knew that, so that was just something that came along with the job.

Zarbock: What about lawsuits, malpractice?

Sandra Miles: Okay, that's a good question. Obviously, there's insurance. Obviously, everybody has insurance. That's a given. In fact, I had lunch with come colleagues last-- a couple of weeks ago and they were saying that there are some new dentists coming out that aren't carrying malpractice insurance, that aren't carrying uh... workman's comp. And I thought, "They're crazy!" You know, they're thinking, "Oh, I don't need it yet. I don't need it yet. I can't afford it yet." Well, wait a minute. Wait a minute. You know you just-- this is-- that's number one. You don't take home a paycheck before you don't have that. Well obviously, their business acumen (laughs) is a little different than mine.

Zarbock: That's very thin ice.

Sandra Miles: Uh huh, it sure is. Your patient has every right to do that if- if something goes wrong. And hopefully, that something will never go wrong. But there are patients out there that can get hot about anything, because they can just decide to get hot about anything. I had-- when I first came here-- and I've been in this office for nine years. I've been a dentist for 13. I've been in this office for nine years. And I probably wasn't in this office for four months, and I had a dad come into this office and just chew me up on this side and chew me down on this side about his daughter's tooth that didn't hurt her when she came in here. She had a filling done. She had a cavity in a tooth. And once the filling got done, it was sensitive. She ended up needing a root canal treatment done on that tooth. Well, any time you've got decaying of tooth, any time you have a filling in a tooth and you remove that decay and place the filling, you are upsetting that structure. Obviously, the decay was deep enough, the pulp chamber, the nerve chamber was deep enough, big enough that it traumatized it. Well, the decay was what did it, you know, and try to tell that to an upset dad that has to spend the money on a root canal and you can't do that. Uhm... but he came in and just very upset. He's going to talk to his lawyer and he's going to sue me. I probably lost three night's sleep over this. I knew I didn't do anything wrong, but you know, just upset, just knew on-- out on my own, you know, thinking, oh, what am-- what am I going to do? Well I never heard from him again, you know. So now, I think it's happened maybe once or twice since, where some people get upset about something like that happening. Okay. It's okay. And I realize they're just mad. (laughs) They're just angry. You can't help it. When you spend that kind of money on dental work, when you know you have to have a root canal and it's expensive. It's expensive. And you just-- you just kind of have to wait for them to get their anger out and then they're better and it's done.

Zarbock: And there is the phenomena called scapegoating.

Sandra Miles: Oh yeah, there's somebody else to be at blame, mm hmm, mm hmm.

Zarbock: "And I'm mad as hell at my boss and my wife, and the kids are terrible, and the car is broken, and my foot hurts, and now I've got you, doctor."

Sandra Miles: Uh huh, uh huh.

Zarbock: What do you like about dentistry?

Sandra Miles: I really like the-- like I said, all the technology. I like the fact that I can help people out with all the stuff that they need to have done. I like being around people. Sometimes I don't like being a boss. Uhm... I think I'm a good person to work for, but I think sometimes, I'm not a good boss. In what sense, just that-- just that whole management thing we talked about. It's tough sometimes to have six women working for you and expect them to all be adults, and sometimes they're not, uhm... and then I have to come in and be the bad guy, you know. So to be honest, it's- it's tough sometimes to be the boss.

Zarbock: I think you've just enunciated a remark that is universal among bosses.

Sandra Miles: Uh huh. I'm sure I have. I'm sure I have.

Zarbock: But on the other hand, if you didn't like it.

Sandra Miles: I wouldn't have done it and still be doing it, mm hmm. But just do-- being around people, meeting new people, it's a lot of fun. It's a lot of fun.

Zarbock: This is going to be kind of a curveball. How wide of a spread is there in competency of the dentists known to you in this part of the world?

Sandra Miles: (extends arms out-of-frame) You can't see my whole spread, can you?

Zarbock: Really?

Sandra Miles: Mm hmm.

Zarbock: Is that different from any other profession? No.

Sandra Miles: I don't think so.

Zarbock: No.

Sandra Miles: I don't think so. And I don't think it's the schooling. I don't think it's the training. I think it's the desire to want to do what you want to do. I think that's what it is.

Zarbock: I think the training in any professional school is homogenizing.

Sandra Miles: Is rigid, you know, right.

Zarbock: You're going to end up looking pretty much alike.

Sandra Miles: Mm hmm.

Zarbock: But once out into this thing called the real world, you begin to become idiosyncratic.

Sandra Miles: Right.

Zarbock: Pursue other thoughts and ideas. Would you do it again, Dr. Miles?

Sandra Miles: Absolutely.

Zarbock: Would you recommend it?

Sandra Miles: Yes. It's funny, because uhm... I have 14-year-old twins at home, a boy and a girl, and uhm... I would love to see one of-- one or both go to dental school. I don't think either one will, but that's okay. But I'd love to see one- one of them go.

Zarbock: Do your children have the interests that you had as a youngster?

Sandra Miles: Oh, my goodness, yes, yes.

Zarbock: Interest in math, interest in science?

Sandra Miles: Math, science. They both bring home straight A's. They're both just great kids. I'm-- I am very fortunate.

Zarbock: Yes, indeed.

Sandra Miles: Mm hmm, mm hmm.

Zarbock: Yes, indeed. Well I can't leave then, without asking. What are their names?

Sandra Miles: His name is Jonathon Alexander and her name is Jamie Ann.

Zarbock: Isn't that funny? I've never read a study on apples falling far from the trees. I never have read a study. I know that experientially, it seems to me that most children do not follow in the professional footsteps of their parents, most.

Sandra Miles: That's true. That's true.

Zarbock: Most.

Sandra Miles: Mm hmm. And when I- I knew that they probably wouldn't. Like I said, I wouldn't mind if they did, (laughs) but I knew they probably wouldn't.

Zarbock: And of course, forcing them or trying to force them into it is one of the biggest fool's errands that you can make. What about the stuff in your operatory, the chairs, the stuff that goes whiz and whoosh and gurgle?

Sandra Miles: Oh, yes. Once again, the amount- the- the choices out there are just numerous. Uh... your- your personal option is just that. You can open up the catalog or talk to your sales rep from whatever company you want to talk to, and choose what you want it to look like and uhm... they're there. Do you want-- do you want this one to have the buttons on the floor? Do you want this one to have the buttons on the chair or do you want a remote control? (laughs) Whatever you want to have, you- you get the option of.

Zarbock: Is there a price spread or is it pretty tight?

Sandra Miles: Oh, yeah. There can be a price spread, uhm... but not so much if you're talking about just setting up a chair. You know, if you want to get into putting extra equipment onto the-- onto the arm itself, onto the unit itself, then yes, you're talking about more money, but just the chair or just the unit, not too much of a difference.

Zarbock: When you got out of school after four years of undergraduate, four years of dental, a few years in between, and there you are a newly-minted dentist and you'd like to be your own captain of your own ship, where do you get the money to start a practice? It must be very, very expensive.

Sandra Miles: Mm hmm, which is one of the reasons I went ahead and did an associateship for a little while. I did work with another dentist, and I was fortunate enough to work with another dentist here in town, who is just great. And I worked with her, like I said, for almost four years, uhm... gave me the chance to get my feet wet and get uh... get some experience. But even when I first came out on my own, buying this building, uhm... starting my own practice here, it had a dental office here to begin with, but the two dentists that were here built and moved and sold me the office, and so I just moved into an empty building. I didn't buy their practice. I moved into an empty building. Uhm... and so yeah, it's-- the banks talk to you, but you just have to do a lot of legwork.

Zarbock: For posterity sake, when you say "bought somebody's practice", would you interpret that?

Sandra Miles: Sure. There are some times that you could actually buy someone's practice. Uhm... for example, this has been a dental office for 40 years. And when it was originally Dr. Sider's[ph?] office, Dr. Sider had Dr. Blake move in. Dr. Blake actually bought the practice from Dr. Sider, the practice, meaning that he bought his patients. He bought the charts. He bought the practice. He didn't buy the building. He- he rented the building, but he bought the practice. That's what I mean when I say buying a practice. Uhm... well he took that practice and built it along with Dr. Blake-- or Dr. Plage[ph?] and the two of the them moved and took their practice. Well then here's this empty building. They asked me if I'd like to buy it. Knowing it was a dental office already, I bought the building. I didn't buy the practice. There were no-- there was no equipment in it at the time, a couple of things that they didn't take with them, uhm... but I had to buy everything else of my own.

Zarbock: Well what prohibits you, for example, if I bought your practice, what would prevent you from moving down the road a few miles?

Sandra Miles: If you want my prac-- let's say, for example, you're a dentist and you bought this practice?

Zarbock: Yes.

Sandra Miles: Uhm... we would have- have to have an agreement. If you were to buy my practice and you did not want me to do that that would be part of the bar-- the purchasing agreement.

Zarbock: How can you prevent?

Sandra Miles: There's-- that-- that's done a lot. That's done a lot. That's usually part of the agreement is there's a 50-mile radius of, you know, 25 or 50 miles.

Zarbock: You've got to get out of Dodge.

Sandra Miles: You've got to get out of Dodge.

Zarbock: There's nothing that would--

Sandra Miles: But most of the time, when you're selling your practice, you're either moving or you're retiring, anyway, so that's not-- that's not an issue. Uhm... when it's an issue is if-- when you're dissolving a partnership, that's when it's an issue. So you're buying that person's part of your practice, then that's an issue of: there's a 50-mile radius.

Zarbock: Have you had any experience with foreign dentists, either seen their work or some sort of meeting?

Sandra Miles: A couple of times, a couple of times. Uhm... I've got a couple of Russian patients and a couple of uhm... friends that-- from foreign countries, uhm... so yes, some, and- and it hasn't been bad. The quality is not bad. They do different things. For example, the materials that they use are a little bit different. Uhm... they use a less-- when we call them noble metals, we mean that it has gold in it, like a high noble means it has more gold. They would use like a low noble metal. It has a-- it's real-- it's silver. It looks more silver. It doesn't have as much gold in it. Uhm... so they use different materials. And, you know, they would rather go with that lower quality or lower priced metal than use porcelain. They're not really worried about what it looks like, like we are. We're- we're really interested in aesthetics here and they aren't so much. But it was good quality work, overall.

Zarbock: Well I've enjoyed this.

Sandra Miles: So have I. Thank you.

Zarbock: What sort of summary statement would you like to make? A summary statement can go on for five minutes.

Sandra Miles: That's right. Well like I said, I would recommend dentistry to anybody, uhm... now. I- I think ten years from now; I think I still am going to feel that way. Uhm... it's a great career. It's not 24/7. It's a job that you can have and still have a family. Uhm... its independence and uhm... it's still fun. But you get to be a boss. If you don't want to be a boss, (laughs) then don't do it.

Zarbock: You have this amorphous thing called community respect.

Sandra Miles: Absolutely, except you have to have a little bit of a backbone. Don't forget that every time somebody walks into your practice, they're going to say, "I hate dentists." They don't mean that to you. And they'll tell you, "I don't mean you." But nobody walks into a chiropractor's office and says, "I hate chiropractors," (laughs) nobody. They always say, "I love-- thank you. I love you. Thank you for being here." They're going to say it every time. But you know what? Once you help them, they're better. They're better. They don't hate you. And so if you can earn that respect from people, that's just going to make you feel better, anyway. But they say it every time. It's funny, but uhm... I would recommend it. I still love it and it's just a practice that keeps on growing. And it's not just the practice that's growing, but the whole process of what I do every day is a lot of fun.

Zarbock: Dr. Miles?

Sandra Miles: Yes.

Zarbock: Thank you for making the time.

Sandra Miles: Thanks, Paul.

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