About a month ago there was a blog post that got a lot of attention. It was titled 10 Reasons Your Dentist Probably Hates You Too. It created quite a stir and wrote a post that I called 10 Reasons Why My Patients Love Me, in response. The author of the first post wrote it with her tongue firmly planted in her cheek, and I wrote my response to sho
Wild Wild West Dentistry
w that our profession needs more relationship building in an age where the professions have tipped toward business rather than health car
What is the truth about dentistry these days?
There are many ways to practice dentistry. Every dentist is faced with the problem of balancing the paradox between duty and desire...the desire to live a great life and the duty to be a great dentist. We live in a material world and as much as we claim that less is more…so many of us still want more. Yet I truly believe we also want to to find meaning in our dentistry.
It gets confusing for the dentist as he tries to earn his daily bread in an age where the business of dentistry is like the Wild Wild West.
I try to practice in a manner that helps balance the paradox…some might call it “business ethics.” I am truly bothered when I see the breakdown of ethics in our profession…so I give you these things that I see some of our colleagues doing on a fairly regular basis…that I think patients, and the powers that be should know about.
- Your dentist sees you as a profit center rather than a patient. Everyone gets the business thing. Football players tell us this all the time…but this is health care and an ethical dentist MUST put the patient first. That is the real definition of professional. Dentists who do this usually relate everything to the “time is money” philosophy. They usually run behind and are over-scheduled.
- Your dentist just took a weekend course in an advanced surgical technique—-and you are his Monday morning experiment. Yes, it’s true…we call these dentists gunslingers. Many procedures dentists do are fairly safe and reversible, but others are way beyond the skill level necessary for performance. When dentistry is a business and new “profit centers” are available…some dentists go beyond their limitations.
- Many dentists are nothing more than tooth jockeys. That means that they don’t look at the whole patient. Granted, some patients may be satisfied with this standard, but most people go to the dentist for a long-term result. If a practice is set up to treat single teeth, it’s unlikely that the patient will accomplish anything worthwhile. You know if your dentist is committed to your comprehensive care and long-term results if he does a comprehensive examination which includes the teeth, the gums, the bite and an oral cancer examination.
- The dentist uses the cheapest materials available and charges you for “the best.” Dentistry is a blind service. Look, every business tries to cut down on expenses but at least it should be disclosed. When the patient goes to a dentist because of price…duh, how do people really think that works.
- They use cheap labs. Just like number 4…this is an area where the dentists can save a lot of money. These days a dentist can send lab work overseas to China or Thailand. Google those prices. Yes…he can pay as low as $50 for a crown and charge the patient or the insurance company up the wazoo. If you really want to get nervous check out the labor standards in some of those countries. (Lead in crowns?)
- The dentist charges patients one fee and charges the insurance company another, or plan patients get a lower fee. There seems to be a war between insurance companies and dentists on this issue. C’mon, is insurance fraud something new? The problem is that the public accepts a lot of these practices. But what about the patient who REALLY wants the best and is willing to pay for it. Sorry…”let the buyer be aware” doesn’t work for me.
- Your dentist hasn’t taken a legitimate continuing education course since he graduated dental school. Many dentists these days spend a lot of time and money trying to be better. There are many great lecturers and courses available. But too many dentists only go to courses that are free or are sponsored by manufacturers that are selling the next new thing (profit centers?)
- His sterilization techniques are outdated. Dentistry has changed for the better with the preponderance of disposable supplies, but still plenty of tools need to be sterilized. This was a hot topic some years ago when OSHA put their foot down hard. But if you are seeing a trend here about ethics and business, maybe it’s a good time to rethink how patients choose their dentist.
- They let the dental assistant perform tasks they are not licensed to perform. Lots of controversy here. Certain states allow assistants to do more than others. Making temporaries, taking impressions and even giving injections. Some dentists however really push the envelope on this one though…
- They just don’t like their patients. Okay, this is where we started with Lolabees blog post. The truth is the dentist (and his staff) don’t even like some of their patients. This is what got dentists all over that post. It’s true! Unprofessional, but hey, that’s human nature. The real truth is that the dentist should not treat people he doesn’t like. Jerome Groopman, author of How Doctors Think, tells us that mistakes in diagnosis are more likely to occur when doctors treat people they don’t like.
I try to avoid writing anything that is cynical or pessimistic about the dental profession. The last thing we need is someone giving the profession bad press. When Lolabees blog post came ou and I read the comments, I was once again reminded of the elephant in the room. Just like the Readers Digest article of the nineties…Is Your Dentist Ripping You Off? or the 1970 book, Dentistry and its Victims, these thoughts are out there and they should be addressed….hopefully the guilty dentists will stop their ways, ethics will be restored to the profession and maybe patients will start to apply better guidelines when choosing a dentist or a dental plan.
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I am the office manager of a dental office in Texas. I have a comment regarding #'s 5 and 6. You are correct in stating an office may choose a "cheap" lab to make their fixed and removable pieces...but an office cannot charge an insurance company " out the wazoo". Insurance companies set their own fees. A dentist IN network must use these fees, meaning- if an office charges $1000 for a crown but is in network for ABC dental insurance, the insurance company gets to say " you can only charge $600 for a crown." if the patient is lucky, insurance will pay half and they pay half. But most of the time insurance only covers 20% and the patient pays 80%...(once they've met their deductible, and hoping they haven't used their maximum payout for the year-usually $1000-$1500) I don't think it's the insurance company getting anything up the wazoo. Now, for out of network doctors, they get to charge their fee, and the insurance company still only has to pay 20-50% of their OWN fee! Meaning -crown is $1000, insurance pays $120, patient pays the$880 difference. In both cases the insurance company is NOT the one taking a hit. Insurance companies aren't stupid...offices filing claims have to submit a yearly fee list, so it's not as if a dentist can change his fees per patient. Furthermore...a crown can cost cost the doctor upwards of $500-700 out of pocket, from labs bills that can cost $300-$400, materials for the build up and the temporary, paying his assistant and office overhead for a 2-3 hour appointment, and one more appointment to place the crown. And this all before the doctor is compensated for his time and work. So a doctor choosing to be in network with an insurance is more than likely going to make very little to nothing on all that work. But many understand that if they didn't, SO many would choose NOT to seek dental care. It's sad that some dentists choose to go the cheap lab route because in the end it's the patient that loses...but the one constant I see day in and day out, is that the insurance company never loses! AND I can tell you there are some great quality labs overseas that abide by our guidelines, and some horrible, cheap ones right here in the U.S. In summation...patients should do their research before they choose a dentist. Don't just pick one because they accept your insurance. If you "REALLY want the best, and are willing to pay for it"...ask around, read reviews, and contact your state dental association for public records on disciplinary actions against a dentist. MOST dentists are good and honest! The ADA and state dental associations DO have tight controls on how it's practiced, but any human can make bad choices...I mean, it wasn't Michael Jackson's DENTIST sedating him every night...I'm just saying...
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