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Dentistry is less scientific and more gratuitous than people think (2019)

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Re: Dentistry is less scientific and more gratuitous than people think (2019)

#271
Disclaimer: Dentist here (and programming enthusiast) The other side of the story, that nobody really talks about, is the psychological abuse that -dentists- are subjected to, by patients. As an introduction: I was above average at my uni in terms of clinical and theoretical skills, bought my own practice from a retiring dentist and always behaved 100% ethically (I'm one of those that don't overtreat at all and I built a reputation and a client base that allows me to have more than enough work without resorting to that).

You should know that our days are basically spent in an almost PTSD status after having undergone years of abuse by patients in the form of dark, frustrating patterns that repeat every week. These are behavioral patterns that typically leave us in a frustrating and infuriating lose-lose situation through no fault of our own, and they seem ingrained in the general population.

A few examples: in my clinic and those of my colleagues about 75% of african immigrants that book an appointment, and confirm it 2 days before, end up no-showing for the appointment, and don't even answer the phone when we call them. this happens several times a week. I haven't found a solution because I can't just say "you're an immigrant and I won't book your appointment", nor can I make them prepay while holding native residents exempt from this rule. No-showing means I lose a sizable amount of revenue while having to pay the staff for nothing. Example 2: a good percentage (20%?) of those with an infection are given antibiotics, I explain they should come back when the pain has subsided, -usually a few days- to perform the root canal / extraction (which will allow me to use anesthesia effectively - it doesnt work when you have an infection) and they also end up no-showing because "it doesnt hurt any more", without bothering to answer their phone when we call them. They call back 2 months later, in pain, demanding to be seen -today-, at which point my blood is boiling. Bear in mind I explain this at least 3 times during the first appointment. Example 3: randomly, a good patient will turn rogue and decide that the crown I'm doing on her canine "looks too big" or "is too rounded" or some other subjective aesthetic bullshit like that. it's typically a middle-class 50-60 woman. This happened today to me, I showed the crown's thickness to the patient with a measurement tool, it was 0.5 -millimeters- and explained it's physically impossible to make it any thinner. Her answer "it's your problem, I'm not a dentist". These patients will typically then refuse to pay for about 1000$ of work, despite the work being first class, because "they are not happy". This happens randomly and is not predictable despite my best efforts, and is peppered with ridiculous episodes like crying in the chair, calling their husband who will typically back their claims and then start guilt-shaming you with gems like "my wife is so distressed by this. we are both deeply hurt." Example 4: a patient will randomly decide he will try to leave a bill unpaid, and they will adopt every kind of trick and dark pattern in the playbook. Lies, asking to delay the payment so they can stiff me out of 4 fillings instead of just one etc..this happens multiple times a year. Example 5: patients taking impressions for, say, a night guard, after being explained the cost and days it takes to make it. We typically deliver then a week later. They will then call a day before their delivery, when the night guard has already been made, saying "doctor I've decided I don't want it any more, I want to cancel the appointment, k thx bye". That is the average message, and I stress the "k thx bye" part where they make it clear they don't even want a reply and it's all said and done (typically because they think they can buy a 20$ nightguard on amazon instead). They will refuse to pay for the nightguard that's already been made and the laboratory has already billed me.

I could go on for hours and cite about 40-50 of these patterns that we see day in and day out, they put you in a very frustrating position where choice 1 is bad and choice 2 is even worse (say, suing the patient for collections as option 1 and taking a direct loss as option 2).

It almost got me burned out and I know several colleagues who either have burned out, or completely changed profession because of the widespread lack of basic respect and fairness from patients.

This happens while, as someone else said, you're in xxx,xxx$ debt, so you can imagine being told unfairly that you have to eat a 1000$ loss for something that's not your fault, tends to make you want to scream. I know I went home shouting in my car more than once asking what I did wrong to be subjected to this bullshit day in and day out.

It's a incredibly abusive profession and it has a very high suicide rate (at like 3x the average for other professions, this is true for most medical professions by the way). And I won't even talk about the physical toll it has on you because I don't mind working 8 hours even in uncomfortable positions, but seeing the way people lie, cheat and try to blame-shame you tends to take away all faith in humanity. So yes, there are bad dentists just as there are bad -anything-, but there are also bad patients. I guess I just wanted to vent and let you see the other side of the coin...we say "no good deed goes unpunished" and it's true indeed

Re: Dentistry is less scientific and more gratuitous than people think (2019)

#272

Well it's only anecdotical of course, but I had a similar experience a couple of years ago that made me very confused about dentistry in general. At the time a had a small tooth ache so I was planning to visit a dentist to check it. I was living in Switzerland, where dentist costs are very high, but I was about to go on holiday to Tenerife, where prices are much lower. So I checked on the Internet and chose the denti…

The "little camera with screen" immediately jumped out as "designed to get the customer to pony up the money right now" - and I've seen similar things with (as others have mentioned) auto maintenance; and if you know something about it the fact that they bring it out unasked for is a huge red flag (the one I've seen is comparing motor oil from the dipstick with new motor oil and saying it clearly needs to be changed, along with the filter and any number of other things they bring up).

Re: Dentistry is less scientific and more gratuitous than people think (2019)

#274
post #250

Earlier quoted context omitted.

0. Something food something. If I eat certain things my teeth feel so much cleaner at the end of the day then other things. I do not believe that is not a very big factor.

Seriously! Grains, sugars, and alcohol are pretty much no-nos if you want to have teeth when you're older. I've had a dentist comment on how he wished he had so few issues. I brush like once a day just for hygiene/bad breath or whatnot, and that's pretty much it. Without the sugars and starches, the bacteria that would cause cavities just don't cause cavities.

> I've had a dentist comment on how he wished he had so few issues.

Ok, but your anecdote doesn’t really say much. I’ve had a dentist tell me that too, and I intake plenty of sugar, grains, and alcohol. Haven’t had a cavity or other major dental issue in 38 years. I brush twice a day and floss once, and only sporadically see a dentist.

Re: Dentistry is less scientific and more gratuitous than people think (2019)

#275
post #91

Throwaway because I run a large dental software company. Dentistry is practiced as a business focused on maximizing revenue. Dentists are routinely coached to deploy sales tactics to increase their treatment acceptance beyond what is needed. If you walk into a dental office, you need to protect yourself from being abused. A second opinion unfortunately puts you in the same position, but now with a new dentist who wil…

I've gone to my current dentist for years and he's always extremely reluctant to even do fillings (last time he gave me a speech about how you can't replace what "God gave you" so you should just monitor it or so.) I think there are some dentists that legitimately care. EDIT: Mine is actually in a very wealthy neighborhood and the lady who runs the practice (I think that's how it works?) has a reputation for buying s…

Ugh, yeah… it’s so frustrating that as a consumer you can’t tell for certain whether your teeth need to be drilled or not. I’d so much rather pay some bullshit dentist-needs-an-audi fee, rather than pay to needlessly destroy the structural integrity of my teeth so they can make a buck.

Re: Dentistry is less scientific and more gratuitous than people think (2019)

#276

Earlier quoted context omitted.

Yup. In fact, a great hack is to go to an inexperienced dentist instead of an experienced one for routine work. The reason is that dentists who are fresh out of school are competent enough to do basic cleanings and checkups. But they haven't yet had time to accrete the expensive habits, and the little business optimizations that feed them, that highly-paid professionals often develop. I generally switch dentists ever…

Here in Germany it is actually the really old dentists that can be trusted. They were not raised to think business oriented. Though most of them have have retired by now. My old childhood dentist used to do the absolutely necessary. He just cared about keeping my teeth healthy and not putting me under unnecessary stress. He did not even remove my wisdom teeth. When he retired the new doc would simply maximize the amo…

My "really old dentist" drilled a whole straight through 2 teeth and didn't tell me after filling it up... It is just an anecdote (as is your account), but I now prefer a university clinic where young students are taught and most of the time keep working for a time there as well. Up to date techniques and they are not out for the big bucks yet.

Re: Dentistry is less scientific and more gratuitous than people think (2019)

#277
post #136

Ah this article put the finger on why I don't trust my 'new dentist': The operation is just too slick from a business POV. As someone familiar with SaaS or in general this kind of recurring business model, you can sense all the little operational policies and procedures designed to increase your LTV. It's a well-oiled machine. Without fail, the hygienist recommends cleaning not once every 12 months or even every 6 mo…

I always visit dental offices with low overhead, poorly decorated, etc.

I had a dentist one time that had a different car for every day of the week. I left them after only a few visits.

Re: Dentistry is less scientific and more gratuitous than people think (2019)

#278

Earlier quoted context omitted.

Here in Germany it is actually the really old dentists that can be trusted. They were not raised to think business oriented. Though most of them have have retired by now. My old childhood dentist used to do the absolutely necessary. He just cared about keeping my teeth healthy and not putting me under unnecessary stress. He did not even remove my wisdom teeth. When he retired the new doc would simply maximize the amo…

The best dentist I ever went to had a picture of his airline pilot wife on the wall - and from how he treated his patients and charged, I got the feeling he worked because he liked to, not because he needed to. However, if you have a "flat fee" dentist/doctor you could be now encouraging the opposite - do the minimum work necessary to get done with the day. It's hard to legislate "be a caring, honest professional" bu…

> However, if you have a "flat fee" dentist/doctor you could be now encouraging the opposite - do the minimum work necessary to get done with the day. It's hard to legislate "be a caring, honest professional" but we can at least remove some of the incentives to not be.

First of all, we know that it does not encourage the opposite, see Germany pre 2007 or any other country where where health care is not run like a business but let's look into it in the abstract:

Humans love helping other humans. The "be a caring, honest professional" part is a product of intrinsic motivation. The idea that it needs to be externally motivated is extremely harmful. That is not how humans work.

Yes, some people get into medicine for the social status, the power or simply money but that is not the majority and we need to a way to filter out those that are full on narcissistic but the vast majority really just wants to help people.

> The best dentist I ever went to had a picture of his airline pilot wife on the wall - and from how he treated his patients and charged, I got the feeling he worked because he liked to, not because he needed to.

You hit the point here. He doesn't need any external drive to do his best, he just needed the opportunity.

It's similar to software developers wanting to write good code. They will strive to do so given the chance and ability even when management discourages and punishes them for that, as is often the case. (Well, "good code" might be subjective but you get the basic idea, humans want to do a good job.)

Re: Dentistry is less scientific and more gratuitous than people think (2019)

#279

Earlier quoted context omitted.

>cost out-of-pocket to address the cavities and they gave a number somewhat north of $200 Sorry for the all caps, but YOU HAVE TO NEGOTIATE PRICES! $200+ per filling is an ASKING PRICE. You counteroffer at $75/per filling. Maybe meet at $90/each. IF YOU DO NOT NEGOTIATE PRICES YOU WILL BE CHEATED!

You have to haggle at the dentist?!

"You need seven cavities filled"

"I'll fill two of them"

"Ok, how about five?"

Yes, I know they're talking about haggling on price, but it's more amusing this way.

Re: Dentistry is less scientific and more gratuitous than people think (2019)

#280

My dad was a dentist in a small, rural town. He cared a great deal about the quality of his work. He died 17 years ago, and my family still runs into his patients who mention how their new dentists rave about the durability of his work. So, there are dentists who aren’t in it just for the money. It is anecdotal, but so is the article. For that matter, the bad dentist was caught by a good dentist. Also, I miss my dad.

I wonder if there's some correlation between rural dentists and quality of care. On one side you'd have the argument that they're probably in less need of money and so can be more honest, because if they wanted more money/patients they'd move to the cities, on the other, if they're the only business around they can do whatever they'd want.

I strongly suspect it leans toward the former though, as even a small town will have multiple dentists, and many of the rural dental offices are basically hereditary.

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