Gautam Govitrikar DMD Profile picture
Dentist. Educator. @Penn Ivy League. Cricket. American Football. Pune. Philadelphia. Princeton. Deccan Gymkhana Tennis. Chitale Bakarwadi.Vaishali SPDP.
shahdurgesh Profile picture 1 added to My Authors
16 Apr
#thread on Insurance:

Slowly but surely Medical Insurance is taking over health care.

It is the most misunderstood aspect of health care!

For starters, it’s a privilege not a right!

In returning for paying a premium, you MAY get covered for an amount ranging from ZERO
to your policy limit!

It starts with the room rate limit!

If your policy has that, you will be entitled to a room costing 1% of your yearly limit!

That’s not it.

That decides the “package” you are entitled to! It includes everything.

Hospital fees, medicines, surgeon’s
fees etc!

If you choose to upgrade to a better room, now that total package goes up!

Guess who is responsible for the difference?

You are!

Now let’s look at other cost cutting measures the insurance companies might employ!

Some surgeons prefer to have another
Read 12 tweets
22 Mar
#Thread to discuss medical clearance for dental treatment:

A common misconceptions about dental treatment is that it is not affected by a patient's medical history or vice versa.

"Aho daat tar aahe. Tyacha majhya heart attack/knee replacement/diabetes shi kay ghena"
"Its just teeth. What is the connection with a heart attack/knee replacement/diabetes?"

And then there is the issue of getting medical clearance in writing from their specialist doctor.

I will try to cover most common conditions, associated risks and desired clearance!
1) Diabetes:

Where there is sugar, there are bacteria.

Where there is bacteria, there is infection.

Plain and simple.

So a patient with uncontrolled diabetes is a much increased risk for infection.

What is needed:
1) Current labs. Blood Sugar and HbA1C less than 120 days
Read 38 tweets
28 Dec 20
The first practice I was at in the US was a 2 doctor office. I worked in one half with 2 assistants and the other dentist in the other half.

One of my assistants had been in the business for over 30 years. She knew her s**t. When my colleague relocated, I asked the
office manager to have him assist the new guy because he was very fresh and inexperienced.

One day, I was in the middle of a tough root canal when she came running and said "Dr.G stat" and ran back.

I literally stopped what I was doing, told the assistant to stay with my
patient and ran over to the other side. One look at the patient and I knew he was having a heart attack.

I yelled out "911" which is the emergency helpline, asked them to say "suspected heart attack" which would get the paramedics on their way.

We got the patient on
Read 7 tweets
6 Dec 20
Someone I know will soon become a F1 parent! (F1=student visa in the US).

So I offered to share a few pointers I had put together year ago for students moving to the US for higher studies.

Figured why not share it here.

#F1visa #America #Masters #students #India #Pune
Before you leave:
1.Scan every single certificate (mark sheet degree cert, birth, aadhar, Pan etc) and save in a secure place. Easiest is to open an email address only for documents. Make 4 sets of copies, 2 with your parents 2 with you.
2.Spend AS MUCH time with your parents as possible. It still will feel inadequate once you are there.
3.Buy multiple sweaters, jackets, scarves, wollen caps, gloves, wollen socks etc.
Read 14 tweets
5 Dec 20
One of the main reasons we moved back was the deteriorating health care system in the US.

Everyone needs to understand there is a HUGE difference between "health care system" and "Medical Treatment".

"Medical Treatment" is what doctors do. Be doctors.

Diagnose. Treat. Cure
"Health care system" involves the huge mess surrounding the doctors under which they have to operate.

The layers and layers of bureacracy, third party payments, MBA bosses, pharma companies, medical malpractice, corporate work culture, VC partners etc.
Needless to say, the layers keep on increasing and move the patient further and further away from the doctor.

So now, the diagnosis happens only if the insurance company approves the check up or the tests or imaging.

The diagnosis has to happen within a stipulated time
Read 9 tweets
3 Dec 20

One of the BIGGEST advantages of having studied in the US, specially at an Ivy League school in a city like Philadelphia is the exposure I received to 2 ethnicities:

Judaism and African Americans.
The FIRST thing I was educated on by my friends at Penn Dental was what NOT to say to and about them. And I wish to share that here as I saw a tweet recently break one of the rules.

Judaism: Any one who has studied history knows who Hitler, also known as "The Fuhrer" was.
He basically is responsible for massacre for millions of people purely because they belonged to the Jewish faith.

What he has done, rather had done, is TERRIBLE and almost nothing can come close to it in terms of cruelty, insensitivity, racial bias and inhumanity.
Read 10 tweets
23 Oct 20
#Thread on Calcium defficiency, osteoporosis and dental treatment:

In the last one month, I have treated at least 4 females in their 60's, who have had serious Calcium defficiency. One of them is being treated for osteoporosis while two of them are borderline cases.
"Osteoporosis causes bones to become weak and brittle — so brittle that a fall or even mild stresses such as bending over or coughing can cause a fracture. Osteoporosis-related fractures most commonly occur in the hip, wrist or spine.
Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn't keep up with the loss of old bone."

Read 10 tweets
22 Oct 20
#thread on dentists and X-rays....

Patients often are resistant to dentists taking xrays.

More than anything, they benefit directly from appropriate and adequate X-rays.

For starters, here’s how safe digital dental X-rays are: Image
Next they help reveal a lot of information.

Eg.anytime I take a tooth out, I take an X-ray AFTER to ensure it’s all out.

This patient came in yesterday for an infected tooth. It was so damaged it came out in 6 pieces literally! Image
There was no way to know if it was all out! Except taking an X-ray!

And look what it showed!

A small sliver had lodged itself in the socket!

This would have gotten reinfected and would not have healed for a long time.

It also would have caused a loss of trust. Image
Read 5 tweets
14 Aug 20
Getting a lot of questions about kids and brushing so a quick thread:

Children have 20 primary teeth which start erupting at age 6 months and continue till around the 5 year mark. (see image)

The need for "brushing' starts at birth but is done on the gums initially.
After the baby is fed, either via breast feeding or the bottle, use a clean cotton handkerchief and room temp boiled water to gently clean the gums.

The teeth are forming under the gums and if the milk is left behind it can see through and cause cavities.

The same is done
for teeth when they erupt.

Around the 1 years mark, it is a good idea to start the process of brushing the teeth. There are many wonderful types of infant brushes available which can be used for the same. This is a popular one but can sometimes be too big and hence a challenge.
Read 9 tweets
2 Aug 20
The first Indian commentator I loved and respected was the one and only SMG. Not so much for his skills as one but for his courage to "stand up" to the big boys aka England and Australia on air.

He made his debut in 1990 and while it was expected for ex players to be neutral
on air, it was essential that someone stand up to the double standards going on in world cricket at that time.

His most famous story, which I think occurred while he was captain, was when he refused to allow batsmen to get drinks in between overs on their own. The argument was
that the English and Australian players were not used to the extreme heat and needed additional water to sustain themselves on the field.

His response was that the Indian players were not used to the extreme English cold and so they should also be allowed a heater in the slips
Read 23 tweets
23 Jul 20
One of the biggest cons the western financial system has created is this concept of "good debt".

Basically "Good debt is considered to be debt if it helps you get a job, like a student loan, or helps you earn money, like a business loan.

"Bad debt" is all other debt, but
basically personal loans, credit card debt etc. Home loans can be considered essential, but with care.

The reality is that there is NOTHING like "good debt". I say that because it plays on people's minds to throw caution to the wind and borrow recklessly because apparently you
are going to make money of that and become rich right?


I used to use the terms "Essential debt" and "Criminal debt", again with Home loans being in no man's land.

"Criminal debt" is that debt which you take on for pleasure/addiction etc.
Read 18 tweets
13 Jul 20
If you are a IT professional looking to start his own business, there is a HUGE business opportunity that is being missed by everyone.

It is that of Practice Management Software for Dentists. There was a major player in the market a few years ago. The issue was that they sold
all the data to corporate dental chains.

Suddenly patients who had appointments with their regular dentists started getting calls from chains offering the EXACT same treatment for a reduced cost.

That killed the business. Some folks still use it but overall the trust was

Dentistry as far as I am concerned is at the doorstep of the golden age in terms of technology, patient awareness and motivation and overall parity with Western dentists.

A well made easy to use PMS is worth it's weight in gold!
Read 8 tweets
11 Jul 20

From a very young age, whenever I would lie down, I would get a dry cough. Occasionally on eating butter chicken at Avishkar (Green Park and Raviraj pale in comparison btw) I would get a burning sensation in my throat.

When I joined dental college in Mumbai, I lived
in the hostel. The food was greasy at best! Occasionally I would get a sore throat and head over to the medical college OPD where I would be prescribed an antibiotic usually Azithromycin. Instead of curing the “Sore Throat” it would make it worse!

Btw we never revealed we lived
in the hostel because they would diagnose it as malaria without even a test and start us on HCQ or something similar! 😂

Then I moved to the US, which I describe as the land of soda (Soft drink) and cheese! When I started practice, the schedule was 9-5 with no fixed lunch break
Read 24 tweets
25 Jun 20
There has been enough written about #H1Bvisas and #US2India. I am going to share a few words about how we made the move.

The reason was very clear: We wanted to be closer to family, specifically both sets of parents. We felt we owed it to our children to grow up around
grandparents. We also wanted to be with them as they headed into "old age" thought none of the 4 are anywhere close by any means.

The thinking and planning started a year ago.

The first concrete step was making a concrete decision that this was a one way move. By not giving
ourselves even the option of returning to the US, we ensured all "problems" like traffic, pollution, population etc are mere adjustments and not deterrents to settling down in Pune.

The next step was to make a commitment that we wanted to live close to parents. NOT by
Read 24 tweets
23 Jun 20
Two interesting facts that are not commonly known about H1B visas and GC.

1) You don't HAVE to work for your GC sponsor while it is being processed. You HAVE to work for the sponsor once you get the GC to avoid issues with your citizenship.

The person who has sponsored mine
is someone I never practiced with.

2) You can have multiple part time H1B visas. To gain better experience, I always was in 2 group practices which meant 2 part time visas. When I came for stamping, the lady said "Sorry Sir you need at least one full time visa." Expecting this,
I had printed out the USCIS page which spelt out that multiple part time visas were allowed. She asked to keep the print out to help educate themselves about this better.

Today's ruling is likely to cause a scare among Indians, specially IT folks, and rightly so. How ever, given
Read 7 tweets
20 Jun 20
Anyone who knows me I am a HUGE sports fanatic. Cricket, American Football, Baseball, NBA basketball, March Madness, Tennis, mainly Wimbledon/US Open, Golf, specially the Masters.

#sports #Covid
But I CANNOT for the life of me understand why there is a rush to start competitive sports!

Let's start with NFL: The Dallas Cowboys and the Houston Texans have had players test positive. The star Running Back Ezekiel Elliot is one of them!…
My beloved Philadelphia Phillies had to abandon camp after 8 members of the team, players and staff combined, tested positive. That also resulted in the Toronto Blue Jays having to shut down their camp:…
Read 16 tweets
12 Jun 20
This is something that has been on my mind for a long time. A humble attempt at explaining why the average Pune 4 teenager has no clue who Pu La is, forget reading and listening to his work.

In the 80's and 90's Maharashtrian families in Pune 4 started

#PuLa #Pune #Marathi
getting their kids admitted in English and specifically convent schools than before. This was also the time the US immigration wave really took off and in the mid 90's it was almost impossible to find a house in the zipcode where at least one child was not in the US as an IT
engineer. I have spent time with Indians from all states in the US and for some reason, I found we were pretty much the only people who almost felt ashamed of Marathi and did not see anything wrong with their kids not knowing Marathi. In fact it was almost a matter of pride.
Read 24 tweets
6 Jun 20
I know someone in the US who worked from home for almost 12 years. He was in the sales team and travelled a lot initially. As he rose, his travel went down. His firm did not have a dedicated office space for him and so they let him work from home.

#workfromhome #people #lunch
Slowly he was working 18 days from home and travelled utmost 2 days a week. He is one of the happiest and gregarious individuals I know. As such I thought he would find it tough to not have the social aspect of going to work/travel. I asked him how he handled that.
For starters, he said I sat down and listed the pros and cons of WFH versus going to the office. If I asked for one, I could have had an office space but that would be an irreversible path. Then I could never WFH as much as I could right now.

He made a few key decisions:
Read 18 tweets
31 May 20
"Should I wear gloves?"

The answer is very simple. You don't need to wear gloves for running errands, shopping driving etc. There is no evidence that wearing gloves for such activities actually protects you better.

In fact it can actually

#pune #Corona #Lockdown #Gloves #PPE
spread the germs because people wear the same pair of gloves from one place to another.

What actually will help is being proactive with social distancing, washing hands, not touching your face etc. Wearing a mask is a must. Don't touch it.

#pune #Corona #Lockdown #Gloves #PPE
The one time we do wear gloves is when we are receiving a parcel. Ensure no human to human handling. It is left outside the door and digital payments used. We bought a pair of kitchen gloves which we use. They are washed right after use. This

#pune #Corona #Lockdown #Gloves #PPE
Read 6 tweets
23 May 20
#Thread #Corona #Dentists #Precautions #Pune

There has been a lot of fear generated from the COVD-19 pandemic. Prominent among that has been the notion that "Dentists are at the highest risk of catching and spreading the virus."

This is a thread to discuss what we are doing
in our practice to address those risks and fears.

For starters, we were closed for the last 7 weeks. We were available via our clinic cell phone for emergencies. I don't know if people were just scared or their tolerance ramped up but we barely had to go in.
For starters, we have made 3 major infrastructural changes to our clinic. The first one was a fogger used in the OT of major hospitals. It blasts the disinfectants via micro droplets so there is no need for wiping/mopping. The disinfectant used is Quarternary Ammonium compounds,
Read 33 tweets
13 May 20
If I go a store or a chemist, I spend a few minutes updating them about what precautions they should take to protect themselves and hence their customers and then society as a whole.

Firstly I speak to them about wearing gloves, masks and glasses. Ideally a faceshield.
I speak to them about the need to have some sort of a barrier to ensure the customers keep a safe distance from them. Even a rope will do.

I discuss how the days of handing something to the customer before they purchase it are gone, eg a painting book at the stationary store.
I discuss the need for digital payments to avoid exchange of cash.

I discuss how they need to buy a disinfectant like the one @amitsurg posted yesterday and how they need to spray the counter every other hour or so.

I explain to them how once they go home, they need to
Read 14 tweets