The 'Irrational' Way Humans Interact With Dentists

Even if you show up with a bag full of cash, point right at the car you want, and agree to the sticker price, there is a shocking amount of paper work that needs to be completed. The guy on the lot, the guy sitting at the desk to watch you fill in the paper work, and the guy who knows how to make copies of the paper work are all different. At every step you will be asked a question you had no idea would need deciding.

As soon as financing or insurance come into the game, it gets really ridiculous.

Here's a brilliant article from several years ago that crops up on HN from time to time -- an undercover report on car dealerships. It's long, but it's recommended reading if you are planning to buy a car, or if you have any interest in sales psychology:

http://www.edmunds.com/advice/buying/articles/42962/article....

According to this article, there are two kinds of dealerships -- high-pressure and low-pressure -- and the reporter spends some time working at each. The high-pressure Japanese dealership had an elaborate buying process with many additional costs, delays, and psychological tricks to greatly inflate the final price. "Let me talk with my manager" is used as a weapon.

But online research is a good idea. Some lines from the article:

"Three hundred below invoice," he smugly answered.

I asked how he did it. He said he checked prices on the Internet. He then called the fleet manager and made the deal over the phone.

I had a schizophrenic reaction to this. Part of me admired the fact that he had outfoxed the dealer. But the car salesman side of me was angry that I never "got a shot at him." It seemed like just a matter of time before people who, in the past, walked onto our car lot, would be on the Internet making deals.

I think this is more "the rational way dentists interact with insurance companies". Insurance companies pay well under the usual market rate for treatment, so it makes sense for a dentist that accepts insurance to find a lot of problems that can be fixed in a short amount of time. "Yeah, that's probably a cavity" for 3 teeth on the same side of the mouth requires about as much time-in-chair as 1 cavity, but he gets to bill 3x. And since the insurance company is paying for it, there is no risk of not being paid. (It's bad for the patient, of course, because the fillings have to be redone in 10 years. But that ticking time bomb keeps the insurance payments coming in, and so it's good for everyone. Except the patient.)

My dentist doesn't take insurance and so he probably doesn't do this.

Does anyone actually go to dealerships anymore to 'look' for cars? With websites like Autotrader, you basically have all of your choices listed for you. The last car I bought, I found online, went to the dealership, and it wasn't that bad of a situation. Just like any other major purchase you should do your homework before confronting anyone in sales.

The main areas I evaluate are:

- technique (one of the most important, but generally difficult to interpret without some tuition. However some good indicators are time spent in mouth during procedures, how prepared is the dentist (hunting for tools is worrisome), level of pain, number of times work has had to be fixed)

- hygiene (appropriate glove changing, mask, tool use and sterilization). The most obvious things I notice are whether tools are coming out of sterilization bags and being placed on a sanitized surface. Does the dentist return a tool that's been in your mouth back to the sanitized surface?

- equipment (age of equipment, tech levels (not too high - don't forget, you the patient are paying for it). This is also important as digital x-rays use much less radiation and allow for immediate review with the patient.

- patient manner (attentiveness to pain and mouth discomfort, willingness to answer questions and properly explain procedures, or even minor things like accommodating patient embarrassment of tooth condition)

- upsell (does the dentist try to have you buy an occlusal splint without demonstrating actual tooth wear, sell you on cosmetic surgery, or attempt immediate intervention constantly rather than a wait and see approach)

- preventative methods (often, but not too often periodontal examinations, fluoride treatments, x-rays, etc)