Reply To ‘Dentist’ Comment

I recently wrote a blog (Sales In Dentistry) decrying a dentist’s attempt to sell me an expensive toothbrush while I sat helpless and captivated in his chair.  The blog generated quite a backlash from some dentist’s groups.

One of the comments on the blog, however, was so thoughtful and challenging, I decided I would turn it into a second blog.  Below, I’ve pasted parts of the comment and replied to them (in red).

Dear SecretWave 101

I read your blog with great interest.  It is an unfortunate commentary.  In my office we are constantly trying to help our patients get what they need, but it is always a challenge to not appear to be selling when one makes the diagnosis and has the solution for the problem at hand. That’s just it…THE solution is not a branded toothbrush, there are others on the market…my dentist should have pointed out pros and cons to each of them.

Some people call this convenience and others, like you with a half empty cup world view your half empty is my half-real, tomato-tomaghto, brother look at this type of presentation method as a “selling for profit” conspiracy.  To address the facts of your case experience:
1.  You were examined by a licensed hygienist that presented her findings to a licensed dentist that made a professional diagnosis of advanced periodontal disease and suggested a plan for treatment for the diagnosed problem. If they’d dropped the toothbrush infomercial, I’d believe that more easily.
2.  You perceived the diagnosis as patronizing because they had a solution to your problem at hand in the office in the form of an expensive tooth brush. As mentioned…A solution, not THE solution.
3.  You lost faith because it was “too” convenient a diagnosis and appeared to be in the best interest of the dental office and team. The problem wasn’t convenience, it was bias.  There are other options that weren’t presented.
4.  You did not accept treatment because of your lack of faith in the diagnosis and the apparent “selling atmosphere”. I might have given that impression in my blog, but in fact I actually did buy an electronic brush (Oral B – 80 bucks at Costco)…and then went shopping for a dentist I better “connect with” (read: trust)
5.  You posted your experience on line for all, including half empty people like yourself, to commiserate with you and to further cast a negative light on dental profession’s ethics.  True.  And your critique here is fair.  I’m willing to consider that my blog entry didn’t promote collegiality among professionals and potentially denigrates your profession to patients, which really wasn’t my intention.  But for the moment I can only meet you half-way on that point because I do believe my main points are fair criticism. Perhaps I chose the wrong venue.

Sounds to me like a lack of faith in yourself self-doubt is my constant companion…and we’ve become, if not friends, at least good neighbors, although I agree that it appears to be a conflict of interest to some people when a solution to a problem is proposed by the same person that found the problem.  My mother always taught me that unless you have at least a proposed solution to a problem, that you should keep your mouth shut.  I thought I outlined my very simple solution…don’t sell crap in a medical office.  Ever.  It’s available in stores everywhere.  There’s NO reason to do it except to make a profit and in the process eliminates competition between brands.  And this isn’t my solution.  It’s ILLEGAL for doctors to have a pharmacy in their offices for the same reason.

By the way, the meat hook “periodontal probe” is really a graphic perception and betrays your world view.  Fair attack on your part.  Graphic.  Unfair and a bit exaggerated, but I just can’t keep my hands out of the hyperbole cookie jar.

My team and I will have a great time discussing how we can deal with people like you “Mr. Half empty”. That’s doctor Half empty, pal There has been quite a bit of discussion about your blog on at least one dental forum *polishes nails on lapel*, and I appreciate all the positive comments.

I suspect that deep in your psyche you have some severe reservations about your own personal honesty see self-doubt comments above.  This is projected to others by you, and you perceive that others are trying to “rip you off”. Actually, I’m fairly gullible…

Trust is essential to any form of long term communication, and because of your deep seated insecurities, you are unable to trust Let’s see, this is deep seated?  Madoff, World Com, Lehman Brothers, Ted Haggard, Enron, Scooter Libby, Barry Bonds, Roger Clemmons, *sigh, inhale* Richard Nixon, ‘Iah did NOT have sex with that woman’, Bill Richardson, Baron Munchausen…who, exactly, should I trust? I suspect you have significant problems with long term relationships you are free to ask my wife of 11 years or 4 kids about that, or maybe my parents with other creatures actually, I”ve only recently managed to form a lasting relationship with a cat…I’ve consistently dropped a number of them off at the pet shelter in years past.

Since you posted this blog and have acknowledged a problem that I also recognize in organized medical and dental services “conflict of interest”, what is your solution?  Don’t sell stuff in your office.  Just don’t. Be a dentist, not a salesman.

As for all your patients that have chronic dental needs without treatment: dentistry and periodontal disease, it is usually a self inflicted disease secondary to poor personal habits and low self worth.   You are espousing classic conservative ideology, which I don’t always disagree with.  But in the realm of basic health services, I think people with a tooth abscess should be able to see a dentist.

How do you propose that medical practitioners help others without helping themselves?  I don’t.  We all have to make money, and health pros should be well-compensated for their expertise, management of responsibility, and years of sacrifice.  The thing is… they are.  Doctors and dentists salaries are in the top 1% of the nation.  Which is why there’s no reason to overdo it with value-added products that unnecessarily extend profit margins.

Good luck in formulating an answer if you dare.  Thanks.  My answers probably sucked.  But this was my best shot.

See?  There’s that self-doubt that once again keeps me from trusting myself.  You could argue that this dubious companion prevents me from getting too arrogant; that it forces me to carefully examine my motives.  But I suppose that perspective on the value of inner consternation would be far too “half-full” for some people to tolerate.

David S. Peterson DDS, FAGD

The Family’s Doctor

Being a doctor to your family is tough. I didn’t think so, at first, but it gets harder to deal with as time goes on.

When I first became a resident – an actual doctor, in some people’s minds – I was flattered whenever someone from the family wanted to know what I thought. But further in to training, I began to see how much of medical diagnosis is based on the systematic physical and historical evaluation. Family and friends just dropping questions about real problems on me began to feel overwhelming because I knew I couldn’t give them good medical advice. Furthermore, other than saying things were fine…I couldn’t help anyway. “Go to the ER,” or “All good, dude, don’t worry about going to the hospital…just don’t use that hand anymore” were about the only 2 things I could say. Then, they take your word for it because you’re a doctor and you should know about these things and you worry that something will go wrong.

I’ve found that this conundrum is even harder to manage in my immediate family. With 4 kids, things happen all the time that could benefit from a primary care doctor’s evaluation. Additionally, with me working constantly – taking care of other people’s kids, as it were – you can imagine how hard it is for my wife to take one kid in to see their actual doctor rather than just having me check them out. But in the U.S., there’s all kinds of ethical issues with doctors taking care of family members. We’re strictly forbidden to take care of family members whenever they’re in the hospital – bastion of regulation and compulsive ethics that it is. In the clinic, things are a little more relaxed, but not by much. The general thinking is that doctors won’t be able to make objective medical decisions about family members. As if the decisions before us amounted to, “Foul insurrectionist of the imperial realm…OFF with your hea-! *Gulp* Wait a minute, aren’t you my kid? Well, OFF with your pigtails, then!”

jordie.jpgI can say that there’s some truth to this bias thing, although I wish there was some room for practicality. When my 3-year old daughter fell on a display rack at the grocery store and avulsed the tip of her left ring finger – her WEDDING finger, potentially – all I could think about was whether or not a new fingernail was going to grow back. As a doctor, I was worthless in the ER. Never mind distal tarsal functionality. Never mind osteomyletis or tendon rupture. WHAT ABOUT THE FINGERNAIL, YOU IDIOT KNOWNOTHING DOC!? SHE’S GOT 2 SISTER’S, YOU KNOW…FINGERNAILS ARE IMPORTANT AT MY HOUSE! Incidentally, it was around that time that I looked down at her pt. data armband and realized that based on the totally wrong birth date I’d given the front desk, my daughter was now in their system as a two year old male.

I also remember being quite an idiot for the birth of our 4th kid, which was via C-section. Just before the surgery started, I’m sitting in a chair at my wife’s head and a drape separates us from the surgical action about to start below. The doc says to me, “Hey, you recently finished med school, right?  We’re just about to get started here.  You can come down here an help or watch if you want” I about retched. Good GOD, man! Are you some kind of sadist? You’re about to eviscerate my wife! For the love of all that is holy, next time I want to watch someone commit seppuku, I’ll find it on You Tube! “Uhhh. No thanks.” I managed, severely nauseous and dizzy.

Many other countries see this issue differently. The idea that your son or daughter is a doctor means you have someone who you can implicitly trust in the medical field. You also have someone who you know will listen to you and give you the care you want (and won’t be bought off to kill you). Nobody’s going to sideline you or ignore you or mess something up if it’s your own kid who is taking care of you. In many countries, when children become professionals, there is cause for celebration because of how it will help the family, not the child.

I recently was wrestling around with my two oldest kids in our front yard. Just prior to ultimate triumph over both of them at the same time, my crafty 6 year old intertwined her entire body in mine and toppled me to the ground. In the process, I stepped on her wrist, which happened to not be in our yard anymore, but on the sidewalk. She cried, hard. In response, I performed “surgery” – a silly act where I make noises while pretending to be cutting and sewing.  This usually makes the injured tyke laugh while giving me a chance to actually examine the injury, and she seemed ok. No crying about it that night. But I a sliver of concern wedged itself into my comfortable analysis the next day when we noticed her trying to write and color with her non-dominant hand. “What’s wrong with your hand?” Mom asks, concerned. “It hurts where Dad stomped on it.  Better if I don’t move it.”

Great. I just broke my daughter’s wrist. In a perfect world, I could just call the radiologists (most of whom I know…except the contracted film-readers in Bhutan or wherever) and say, “Joohh! Hey, Geoff here. You remember my 6 year old from the BBQ last week? Yeah, need a quick zap of her left wrist. If you would, look for a distal ulnar fracture. Yeah, will send her right over. Thanks so much.” Kid gets zapped, rads reads, says minor fracture, I take kid into my clinic and wrap up her arm in a cast for a few weeks myself. Cost to me = some time and $0. Alternatively, Xray is negative so we skip the casting step and cost to me is less time and still $0.

This isn’t how it would work, though. I have to work, first off, so my wife (all alone) would need to do the following: Take all 3 kids to clinic. Scream at two littlest ones as they expand their imagination in the waiting room.  The youngest is dragging his tongue along every surface he can reach…for some reason Freud described having to do with sex that nobody understands. I pass my family 2 or 3 times, unable to help in any way because I’m busy. Eventually, another doc who knows about as much as me – but “scrubbed” of bias – sees daughter. Youngest has now partially swallowed a reflex hammer. Doc learnedly proclaims, “Daughter needs an XRAY!” Film ordered. Wife stops at hospital financial aid office to explain that said hospital pays dirt and we need assistance. 45 minutes later (youngest now gnawing on some old guy’s cane), cheap(er) Xray is granted. 2 hours later, Xray is positive. Child needs cast. Clinic closed. Not sure what kind of break. Best evaluated by orthopedic doc. Ortho doc (avg income $700,000 per year) does not give financial assistance (“Doesn’t your husband work with me in the OR sometimes? Coool. Here’s your bill, mam.). Normal break, needs cast. Kid heals. All done. Total bill = $3500 because of Dad’s stupid, clumsy feet. Dad now eyed suspiciously by CPS drones who wonder what kind of father figure would initiate non-sexual contact with their child.

In Israel, where I trained, there is a term roughly pronounced “protexia”. It means that if you work at the hospital, you get a break. It’s understood that you’re helping out as many people as you can, and when you need help, the organization pulls together to get you taken care of. Not here. You do it by the book. The book written by Americans with American medical ethics.

So we didn’t take our daughter to the doctor, despite the irony that she lives with one. We decided instead to just sit around biting our nails about the issue, hoping she’s alright. Just like most Americans with crummy or non-existent health insurance who work full-time. But at least the bone doc’s doing alright.