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

Sales in Dentistry

I’m losing faith in dentists.

Aside from never being able to get my patients with crummy insurance to in to see dentists, my growing distrust was heightened the other day when I myself went to my local toother-dude for a cleaning. It would be better described as a sales seminar.

The hygienist tells me she is going to poke my gum line in three places, giving a number to denote the health of the gum as she goes.  “Anything 4 or above we’ll have to talk about. N’kay?”  She says briskly and a little too brightly.

hookShe then proceeds to take her hook needle-thing and poke the gum at one edge of the tooth, then the middle, then at the other edge of the tooth.  If you like the idea of being nailed to a wall with thumbtacks, then I can say with some confidence that you’ll appreciate this exam.

Just before the spearing commences, I’m thinking, “I got this.  No problem.  We’re good if there’s 1’s, 2’s and even 3’s.  C’mon, gums, step it up.  Do me proud.  I brush you almost every night.”

The hygenist perkily launches in, “four, four, five, five, two, four, six, six, four, five, five, four, five, five, six, SIX!, SIX….”

My “gum” score, clearly, wasn’t going to win any golf tournaments.

sonicare-toothbrushHere’s my problem:  From my dismal performance under the spear-hook, the hygienist pivots deftly into a winning performance about the Sonicare toothbrush, available around town, she guesses, but ALSO RIGHT HERE IN OUR OFFICE.

This phenomenal testament to tool-using, opposable-thumb evolutionary Homo Sapien wonder will put those 4’s and 5’s (and SIXES, Good LORD!) right back into the respectable realms of 2’s and 3’s well before you’re evicted from your Homeowner’s Association.

Somehow, this lady’s urgency was a bit too cloying to feel genuine.

Suddenly, I was not only feeling rather sardonic about the “quick trip” speed mode (for those running-out-the-door moments) of the latest Sonicare – the Nimbus 2000 of toothbrushes – but I was starting to doubt all those 4’s, 5’s and 6’s too.

Judging by her elated demonstration of her toothbrush to solve all my ills – her solution to our global financial crisis would probably involve the electronic toothbrush – I’m pretty sure my high score would directly benefit our illustrious dental hygienist and her employer.  Said employer, by the way, was El Dentisto, who used part of his 2.75 minutes with me to also promote the freaking Brush of the Millenium.

I don’t need to spend the average yearly income of a native Paupan on an electronic toothbrush, of course.  It’s really just a question of whether or not I want my face to rot off.  My choice.  Entirely.  Total freedom.

I’ve occasionally lamented the No Free Lunch movement, which insists that drug reps quit bringing me free lunches and coffees from cool restaurants all over town.  I’ve at times accused the whole movement of arm-chair ethics.  I would never prescribe certain more expensive drugs just because I’m getting a MoooLatte out of the deal, right?

And anyway, I like free coffee, dammit.  Why’d they get rid of all the perks (no pun intended) just as I’m arriving on the scene?

But the problem was pretty stark as I sat in that dental chair, thinking about my 3 patients who currently need very basic dental care and aren’t getting any.  They go months or years with festering abscesses, and here I am being told in authoritarian low-register voice tones that my mouth was turning into a cesspool of decay.  Lucky for me, one really really really good way to halt the horror was a toothbrush conveniently sitting in full view on a counter behind my earnest and – was it gleeful? – dental professional.

If the process isn’t outright coercive, it’s certainly manipulative.

swaggertTruth is, health care providers really shouldn’t sell stuff out of their offices.  They just shouldn’t.  It’s impossible to exercise unbiased judgment when certain decisions about a person’s health directly benefits the provider.

These Wal-Mart doctors are no different than corrupt televangelists sweating into powerful sound systems and using Biblical authority to make money.  The white coat carries similar clout.  “Buy this, or you’ll die,” is the implicit message, and it isn’t just wrong, it’s evil.

Doctors make enough money.  Lord knows, so do dentists.

I did manage to claw myself out of there without Toothbrush Extraordinaire.  Somehow, standing my ground was worth the black hole of pus I’ll one day have for a face.  We all make our choices.