Wednesday, August 17, 2011

The Dentist Down the Street

Happy Wednesday,

Summer is officially over. We treat three counties at our office. One of the counties went back to school on Monday. And the other two counties go back to school next Monday.

I finished Through My Eyes by Tim Tebow. It was okay. It was, for me, reliving the glory days. I would think that if you are not a Gator fan, this book wouldn't be any good.

My wife and I watched "No Strings Attached." I thought it would be a good romantic comedy. Well, it turned out to be an okay movie, but it offended my wife about 15 times before we could even settle down. I am starting to think most directors are making movies to please the 18 to 25 age group. I guess they are the ones going to the theater. Me? I am just paying $1 to see it on Netflix, so they don't care if I am offended or not.

Okay topic,

I work in a pretty small town. There are about eight dentists in my town. I think regardless of the size of your town, there dynamics in a city that are the same. There are the Esthetic guys. There is the "good, more expensive dentist"; there are the "good, but don't take all insurances" dentists; then there are the offices that "take all the insurances and run like a factory."

So we have that in our little town. We have the super expensive cosmetic dentists. We have the established, a little more expensive guy, the family dentist (that's me), and we have the dentist that takes a lot of plans and he/she is kind of not as good, but also not as expensive as others. And we have the new dentist that is pretty good at taking lots of plans to get established. Then, of course, the dentist office that has a super high volume of patients and staff (and dentists).

I get patients from all of them. I get second opinions, I get "I don't like that guy (or gal)". I get "I just had this tooth worked on and it still hurts".

You know all the reasons.

On a side note....what gets me the most is the ones that say stuff like, "I never really liked that dentist. I went to him/her for 12 years, but never felt comfortable there".

I got people that leave my office for a $12 bill, and this other dentist has people staying there and they don't even like them.

As you know I am very conservative in my dentistry. And my biggest issue with all these guys/gals is obviously over-treatment. Yesterday, I had a new patient and you wouldn't believe the stories she was telling me. Now, I understand sometimes that patients don't hear what the dentist is saying, and when they try to reiterate it, it sounds all crazy.

But this patient had a front tooth (#8) crown that she wasn't happy with. I took a look and WOW. She was a 70-year-old woman and her teeth were dark. This crown was not. The crown was at least 2 shades too light. After a couple of years, it started to move mesially and overlap on #9. So the woman went back and this dentist told the woman she had a crack in the tooth, it needed to be removed, and she needed a...you guessed it....a bridge.

Hmmm.

Then he/she told her that a bridge in the back needed to be replaced because of decay. This dentist showed her some phantom decay on some x-ray. I took a full mouth series and did a full work up on this patient and she needed a grand total of NOTHING. There was no crack in her tooth. There was no decay under her bridge.

This kind of thing just drives me bananas. Either this dentist is a complete shyster and a crook or a terrible diagnostician. Either way, I think money is fogging their judgement. My gut is this dentist is a shyster. Man, do I hate this. I hate this because of all the patients that are out there going to them. People in MY community.

I got another dentist down the street that has a diagnodent. Don't even get me started. Do you know how many people have come to me asking me if this dentist's treatment plan was fair. Twelve occlusal fillings. I found a grand total of none on over 90 percent of them. I want to picket outside the office. Put fliers on all their cars. "Don't go to this shyster. Come to me. I am a tad bit more expensive, but I am honest and fair!"

How would that look if I was in front of their office?

Now after talking to this patient for awhile, I found out that her brother and sister-in-law come here and they have been trying to get her here for a long time. She claimed she didn't want to come here because I was too expensive. I think she called here about #8 before she had it done and I was $300 to $400 more than the other dentist. She kept saying, "I should have come here."

Am I too expensive? Everything this dentist did has to be replaced, and they are telling you that you need something that you don't....who is too expensive?

When will people stop thinking that a $1,200 crown is the same as a $800 crown. I, as a small business owner and perfectionist, would not rest until my patient was completely satisfied. So if I put in a crown that is wrong or the patient doesn't like it, I will do it again. And if I feel like I can't please them, I chalk it up to a business expense and give them their money back. How many times have you heard, "I have hated these crowns since the day my last dentist put them in"?

A Cooper tire is a Cooper tire. One place charges $175 for the Roadmaster and another place charges $215. I get that. I price check.

But dentistry at one place is not the same as it is at another place. How can we get more people to know that? I have my picket ready....just tell me what to write on it.

Do you guys have this issue? Am I the only one?

Have a great Wednesday!

john













13 comments:

Anonymous said...

I am dealing with exactly the same thing! We have a large dental group here that over diagnose. Personally I think it's malpractice, but try to get anyone to do anything about it! I had a new patient come in one time that had just had 14 cavities filled, after never having had a cavity before! I asked her, "Didn't you question the fact that all of a sudden you needed 14 fillings?" She said- "well I figured he was the dentist ans he would know better than me!" She trusted him! These people are trained very well with the proper- or improper- verbal skills, and seem to be able to convince patients they need work that they really don't!! At least I can sleep at night. I was on our Board of Dentistry for several years and have seen the ethics in dentistry steadily dwindling away!!
I love your blog!

Anonymous said...

This is the first time I've commented on here, but this post hit so close to home that I had to say something. The problem is that I recently went to work at a place like the one you described. I was thinking that I might be able to turn things around. Well, I had no idea how bad it was or how hard that could be until the last few months- and you better believe that I am taking the first opportunity that comes along to jump ship.

It is sad that there are a few people who's ethics are totally dictated by the almighty dollar. And worse, it is sad that these people reflect an ugly picture of dentistry that causes patients to totally lose faith in the profession as a whole.

When you decide what to do with your picket, give me a call- I'll be standing there right next to you.

Anonymous said...

This is the first time I've commented on here, but this post hit so close to home that I had to say something. The problem is that I recently went to work at a place like the one you described. I was thinking that I might be able to turn things around. Well, I had no idea how bad it was or how hard that could be until the last few months- and you better believe that I am taking the first opportunity that comes along to jump ship.

It is sad that there are a few people who's ethics are totally dictated by the almighty dollar. And worse, it is sad that these people reflect an ugly picture of dentistry that causes patients to totally lose faith in the profession as a whole.

When you decide what to do with your picket, give me a call- I'll be standing there right next to you.

Anonymous said...

To play devils advocate. You should always take what the patients says with a grain of salt and verify the truth before passing judgement. Now if you see it printed in black and white on a treatment plan then you have your proof.

navygatordmd said...

John,

We have the same issues here in our town, same grouping of practices. There is one local dentist that actually lost his lisc. for doing this stuff but that is a rarity. One dentist told me the office manager at one of these corporate offices told them studies showed that the average patient has 8 cavities so is he was not diagnoising that many on every new pt he is not looking hard enough. I drives me crazy!

Anonymous said...

Let's call a spade a spade...someone is not playing by the rules and causing people to undergo procedures they don't need or has poor results. Get those records, get the proof, and turn them in. Give your patients the proof they need to file a malpractice suit, offer to call their old dentist and tell them they did wrong and need to fix their errors or allow you to fix them at their expense, turn them in to your state dental society, etc.

What, you say? I've got to protect myself, so I'll keep saying nothing, except blogging about it all in a manner that no other dentist will get caught, and no fingers will be pointed my way.

You know the right thing to do. But you aren't doing it. You are part of the problem.

I am sick to death of "professionals" who cover for each other. I am dealing with a situation right now that shouldn't have happened and every dentist I've seen is silent. It took a friend who is a doctor who quietly told me to "see an attorney". Imagine that---a doctor who tells you to see an attorney!

Dentists need to ante up. They need to clean up their profession. NOW.

Anonymous said...

In every profession there is good and bad. DOCTORS need to clean up there own act too. You get prescribed a pill based on what the drug rep has given to doctor. Then that pill either doesn't work and they tell you to take it anyway or they give you another pill to cover up any side effects or short comings of the first pill.

Anonymous said...

Yes, every profession DOES have good and bad. But this is a blog about DENTISTS. If you don't start by cleaning up your own backyard, it does little good to complain about anyone else's.

Anonymous said...

In response to the second-to-last writer, anyone has to be very certain that gross negligence has taken place in order to even attempt a libelous investigation against another practitioner. You can be countersued quite easily for denigrating somebody's reputation and that is going to be expensive. Even to defeat a frivolous case will be a couple of years and 10K if you're lucky. The US economic woes are going to create moral hazard in some people and I am betting that many are ethically challenged when they have a hard time paying the bills. Its a very tough call, whether to enact our duty to society, or to fall on our sword and end up very much worse off. If you are serious about reporting someone, a call to your local dental board will be the first step.

Anonymous said...

A couple of years and 10K? That is nothing compared to the pain, suffering, and medical costs I've had to go through. If you don't want to help clean things up in the dentistry world, prepare for the patients and their lawyers to do so.

A funny thing is happening with doctors and hospitals in our community. When an error occurs, they go to the patient and family immediately and admit it. Guess what? Malpractice cases have dropped to almost nonexistent. Perhaps dentists need to learn that lesson, instead of remaining silent.

drjudd said...

Any patients that think they have recieved inapropriate care can go to the local dental board and file a complaint. They in turn will review the case and make suggestions to remedy a situation. If there is no resove the courts would be the next step. I found that being upfront and honest about your treatment recomendations and if things dont go as expected to do my best to make it good. If you show you care and have a trusting relationship with your patients they will be very forging if things don't go well.

I too have a diagnodent but it is just a tool to be used with the other diagnostic tools that you have. I sometimes will get a false positive. I will start to clean out the suspected area and if there is no decay I will stop, clean out the organic gunk out the other groves and place a nice sealant It is then called a sealant and not a filling.

Anonymous said...

I just want to chime in as an advocate for the large group practices. I work for one and I really like it. I think that all too often they are cast in the same stereotype (overdiagnosing/overtreatment planning dental mills). Yes, I see a lot of patients and I am very busy. But, I have a highly trained and highly skilled staff that allows me to spread the load amongst my team. With the patient flow that we have, there is no need to overdiagnose. Yes I am seeing lots of PPO patients and yes some of their plans are extremely poor as far as reimbursement. But, I am able to provide excellent service and excellent dentistry to a large segment of the population that otherwise would not have the means because I work for a large group. And guess what, most of them are very appreciative. I can sleep at night and I sleep very well. I take it slightly personal when people cast dental groups as overdiagnosing and money craving. Comments about high patient/staff/dentist turnover I do think are warranted however. But, I think that is due mosttly to bad groups/management.

gatordmd said...

I absolutely believe that patients can get excellent care at a group practice and I am sorry if I made it seem like they couldn't.
I think that it has everything to do with the dentist.
Big practice, boutique practice, PPO practice, CEREC practice...I don't think it matters what kind of practice it is.
When a dentist lets money cloud his/her judgement at that point it doesn't matter where they are at. Or what age they are or their patient population...it is just bad.

Thanks for sticking up for large group practices. Keep up the good work.
john

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