My office was recently treated to a “lunch and learn “by a rep of a nationally known company. During the “learn” part of the presentation the staff and I were informed that the company’s service could be provided interest free for all of our patients. However, the rep recommended that we tell each patient that only they were getting the service interest free. She said “You know, make them feel special.”
How does being lied to make a patient feel special?
Maybe she thought that it was okay to lie about financing as long as we don’t lie about the need for treatment. I don’t know what she thought. But I do know that lying about anything to a patient is a bad idea, very bad.
What was even scarier to me was that no one else even noticed. We were munching on our complimentary nachos and no one missed a bite.
I sure hope none of the patients who received the free financing start comparing notes in the waiting room. It would be like finding out that the passenger next to you on the plane paid a lower price for their ticket. Or the family at the hotel pool got free breakfasts and a free night. I know that feeling, and it’s not very special.
Monday, May 9, 2011
Thursday, April 7, 2011
Groupon Coupon
I admit it. I am a Groupon subscriber. I have not yet purchased a Groupon, but I do open my daily Groupon email with anticipation and excitement. What new meal, salon service or vacation awaits me today? Will it be a pedicure or a cupcake?
I recently opened my email and found a Groupon coupon for an examination and periodontal evaluation at a periodontist’s office. It was a Groupon for a $375 exam for only $85. That’s quite a discount. It made we wonder, if I was not a dentist, what would I think about a dentist who turns themselves into a coupon? I didn’t have to think that hard because the truth is, I was a Groupon too.
Before I started working for a corporate dental office, the marketing department advertised my services (without stating my name) by Groupon. The Groupon coupon was for an exam and “teeth cleaning” including x-rays, for $45. The patients (I am not sure that’s the correct term for this type of commercial transaction) paid Groupon the fee. Groupon passed $15 on to the practice. The front desk fills my schedule with potential new patients. My “job” according to the practice administrator is to “convert” Groupon patients to regular patients. The theory being that they will then pay for ongoing dental care. That’s not exactly what happened.
Groupon consumers are a clever bunch. I know because some of my friends use Groupons. They don’t eat anywhere without a Groupon. They get their haircut when they have a Groupon. In other words, no Groupon, no deal. This is now a documented phenomenon. ( see www.slate.com/id/2289087). Instead of increasing revenues, the Groupon has the opposite effect. Groupon teaches the consumer that they never have to pay “full price” ever again. Maybe an exam and cleaning is really only worth $45. Maybe an evaluation by a periodontist shouldn’t cost $375. If it really was worth more, why would they offer such a big discount?
This is what actually happened in my office. The majority of the patients using the Groupon had no dental insurance or no current employment. Most had little or no dental needs and they were aware of this because they had, up to the current economic crisis, been regular patients somewhere else. Many patients commented on how nice the office was, presumably because when using a coupon for healthcare there is an assumption that no “nice” office would offer a coupon. Few, if any patients opted for more ongoing dental care. And my guess is that when their recall appointments roll around, they will be at the next Groupon office.
My very first patient on my very first day was a Groupon patient. He turned out not to be a typical Groupon patient. He had not been to the dentist in 12 years. He didn’t need a “teeth cleaning”. However he did need 4 quads of SRP (scaling and root planning or deep cleaning). The practice administrator didn’t know what to do. The patient had prepaid for a teeth cleaning so we”had” to do it. Yes, an ethical dilemma on my first day back in private practice. Actually it was an easy one. I educated the patient about the need for 4 quads of SRP. I explained that that “teeth cleaning” was not indicated for his case. I also told him what the exam would have cost without the Groupon. And I was lucky that he was a nice guy who understood that $45 was not going to clean up 12 years of neglect.
Practicing dentistry is not the same as selling cupcakes. Why are we trying so hard to become cupcake sellers?
I recently opened my email and found a Groupon coupon for an examination and periodontal evaluation at a periodontist’s office. It was a Groupon for a $375 exam for only $85. That’s quite a discount. It made we wonder, if I was not a dentist, what would I think about a dentist who turns themselves into a coupon? I didn’t have to think that hard because the truth is, I was a Groupon too.
Before I started working for a corporate dental office, the marketing department advertised my services (without stating my name) by Groupon. The Groupon coupon was for an exam and “teeth cleaning” including x-rays, for $45. The patients (I am not sure that’s the correct term for this type of commercial transaction) paid Groupon the fee. Groupon passed $15 on to the practice. The front desk fills my schedule with potential new patients. My “job” according to the practice administrator is to “convert” Groupon patients to regular patients. The theory being that they will then pay for ongoing dental care. That’s not exactly what happened.
Groupon consumers are a clever bunch. I know because some of my friends use Groupons. They don’t eat anywhere without a Groupon. They get their haircut when they have a Groupon. In other words, no Groupon, no deal. This is now a documented phenomenon. ( see www.slate.com/id/2289087). Instead of increasing revenues, the Groupon has the opposite effect. Groupon teaches the consumer that they never have to pay “full price” ever again. Maybe an exam and cleaning is really only worth $45. Maybe an evaluation by a periodontist shouldn’t cost $375. If it really was worth more, why would they offer such a big discount?
This is what actually happened in my office. The majority of the patients using the Groupon had no dental insurance or no current employment. Most had little or no dental needs and they were aware of this because they had, up to the current economic crisis, been regular patients somewhere else. Many patients commented on how nice the office was, presumably because when using a coupon for healthcare there is an assumption that no “nice” office would offer a coupon. Few, if any patients opted for more ongoing dental care. And my guess is that when their recall appointments roll around, they will be at the next Groupon office.
My very first patient on my very first day was a Groupon patient. He turned out not to be a typical Groupon patient. He had not been to the dentist in 12 years. He didn’t need a “teeth cleaning”. However he did need 4 quads of SRP (scaling and root planning or deep cleaning). The practice administrator didn’t know what to do. The patient had prepaid for a teeth cleaning so we”had” to do it. Yes, an ethical dilemma on my first day back in private practice. Actually it was an easy one. I educated the patient about the need for 4 quads of SRP. I explained that that “teeth cleaning” was not indicated for his case. I also told him what the exam would have cost without the Groupon. And I was lucky that he was a nice guy who understood that $45 was not going to clean up 12 years of neglect.
Practicing dentistry is not the same as selling cupcakes. Why are we trying so hard to become cupcake sellers?
Monday, March 21, 2011
Is Bleaching the "Botox" of the Dental Profession ?
I used to get angry when I walked by the tooth bleaching kiosk at the mall. I thought I was looking at untrained people practicing dentistry. I even saw a tent for tooth bleaching at an art show. A policeman was there with his girlfriend. I told him that the workers in the tent were practicing dentistry without a license. They were violating OSHA because there was no running water, no infection control procedures, no PPE’s! He laughed. I don’t think he realized that he was part of a crime spree sweeping across the country.
We have lost the battle against non-dentist applied bleaching. It is even less regulated than a hair cut or highlights. And hair grows back. It’s not a dental procedure anymore. And I am okay with that. Because bleaching is not dentistry. It’s the thing we give away to attract patients. And patients know it. They are on to us. Ask the patient who comes to your office for the bleaching special but doesn’t transfer her records to you. She has a dentist. But they don’t have a bleaching special this month. That’s why she is in your office today. She is going back for her cleanings and fillings (her real dental needs). She just wants the bleaching today, thanks all the same.
I am not looking for a lecture on tooth bleaching products here and I am not talking about difficult hard to lighten cases, intrinsic discoloration or drug related discoloration. Just you average patient with teeth of a shade that is still found on the old Vita shade guide.
When patients ask if they can use those strips from the drugstore, tell them the truth. That is your job.
We have lost the battle against non-dentist applied bleaching. It is even less regulated than a hair cut or highlights. And hair grows back. It’s not a dental procedure anymore. And I am okay with that. Because bleaching is not dentistry. It’s the thing we give away to attract patients. And patients know it. They are on to us. Ask the patient who comes to your office for the bleaching special but doesn’t transfer her records to you. She has a dentist. But they don’t have a bleaching special this month. That’s why she is in your office today. She is going back for her cleanings and fillings (her real dental needs). She just wants the bleaching today, thanks all the same.
I am not looking for a lecture on tooth bleaching products here and I am not talking about difficult hard to lighten cases, intrinsic discoloration or drug related discoloration. Just you average patient with teeth of a shade that is still found on the old Vita shade guide.
When patients ask if they can use those strips from the drugstore, tell them the truth. That is your job.
Wednesday, March 16, 2011
Ethical Botox Moment
I don’t know which section of the JADA journal you go to first. I don’t know if you even get the JADA anymore. I used to go straight to the classifieds to see if the University had an ad in for my job. But now that I am back in private practice the first section I go to is the “EthicalMoment”.
I think it’s wonderful that my profession has finally realized we need a forum to find our way through the ethical dilemmas of private practice. I don’t always agree with the solutions offered by the writers (JADA 2006;137:243 free at jada.ada.org). I was excited to open my March JADA and read this month’s ethical dilemma.
This month’s dilemma was delivered via a letter from a dermatologist who wanted to know if it was ethical for a general dentist to administer Botox injections to their patients. It seems the dermatologist feels that the dentist is practicing outside of his scope of practice and thus violating the ADA Code of Ethics. (Hmm…Did he get this idea from the plastic surgeon who wrote a letter to the Journal of Dermatology?)
The responding author does a great job of explaining why it may or may not be unethical. The only problem is that he also assumes that Botox is healthcare and not personal enhancement. And that makes a difference, at least to me.
There is no healthcare benefit to personal enhancement. That means that there is no Beneficence either. I know that Botox may make people feel better about themselves for a short period of time. It may improve their emotional well being or state of mind. But treating the patient’s psyche or emotional state is much farther outside of the dentist’s scope of practice than administering Botox. And yet we use the argument of improving emotional well being or self esteem to justify cosmetic dental treatment that no dermatologist would deem unethical. We bleach teeth that are already whiter than any natural tooth shade. We veneer orthodonically aligned and bleached teeth to make them even straighter and whiter. And we do this because we think it improves self esteem and because…that’s what the patient wants.
“That’s what the patient wants” is not a treatment rationale for dental or medical treatment. But it is a treatment rationale for personal enhancement. When we decided to promote (not offer, but actively promote) non healthcare related personal enhancement procedures we crossed the line from being healthcare providers to something else. The problem is we haven’t yet defined what that something else is. And we haven’t figured out if our ethical obligations to patients change when they become “clients” or “guests”.
I believe that dentists can ethically administer Botox (with appropriate training) because it’s not in any one healthcare professional’s scope of practice. Because Botox is not healthcare. And that may be why so many states have refused to directly control who can administer Botox. Dentists with appropriate training are certainly capable of administering Botox as safely as nurse practioners or gynecologists.
I think it’s wonderful that my profession has finally realized we need a forum to find our way through the ethical dilemmas of private practice. I don’t always agree with the solutions offered by the writers (JADA 2006;137:243 free at jada.ada.org). I was excited to open my March JADA and read this month’s ethical dilemma.
This month’s dilemma was delivered via a letter from a dermatologist who wanted to know if it was ethical for a general dentist to administer Botox injections to their patients. It seems the dermatologist feels that the dentist is practicing outside of his scope of practice and thus violating the ADA Code of Ethics. (Hmm…Did he get this idea from the plastic surgeon who wrote a letter to the Journal of Dermatology?)
The responding author does a great job of explaining why it may or may not be unethical. The only problem is that he also assumes that Botox is healthcare and not personal enhancement. And that makes a difference, at least to me.
There is no healthcare benefit to personal enhancement. That means that there is no Beneficence either. I know that Botox may make people feel better about themselves for a short period of time. It may improve their emotional well being or state of mind. But treating the patient’s psyche or emotional state is much farther outside of the dentist’s scope of practice than administering Botox. And yet we use the argument of improving emotional well being or self esteem to justify cosmetic dental treatment that no dermatologist would deem unethical. We bleach teeth that are already whiter than any natural tooth shade. We veneer orthodonically aligned and bleached teeth to make them even straighter and whiter. And we do this because we think it improves self esteem and because…that’s what the patient wants.
“That’s what the patient wants” is not a treatment rationale for dental or medical treatment. But it is a treatment rationale for personal enhancement. When we decided to promote (not offer, but actively promote) non healthcare related personal enhancement procedures we crossed the line from being healthcare providers to something else. The problem is we haven’t yet defined what that something else is. And we haven’t figured out if our ethical obligations to patients change when they become “clients” or “guests”.
I believe that dentists can ethically administer Botox (with appropriate training) because it’s not in any one healthcare professional’s scope of practice. Because Botox is not healthcare. And that may be why so many states have refused to directly control who can administer Botox. Dentists with appropriate training are certainly capable of administering Botox as safely as nurse practioners or gynecologists.
Sunday, March 13, 2011
Welcome To Ethics with a Bite
Welcome to Ethics with a Bite!
The Ethics with a Bites goal is to become a resource for ethics for the practicing dentist. Practicing dentistry has never been more exciting or more challenging. Technology is changing the way we diagnose and treat patients. Our concepts of ethical treatment must change with technology. But we can’t abandon ethical principles along the way.
New business models are also changing our relationships to patients and staff. These new business models require us to look at ethical relationships with patients and staff in new ways.
The tremendous influence of cosmetic procedures had re-defined dentistry.Our code of ethics must keep pace with the rapid expansion of the types of treatment available to patients from dentists. Where does healthcare end and personal enhancement begin? How does this affect the doctor patient- relationship?
Healthcare law is changing too. How will this affect our ethical relationships with patients? Does the intrusion of the insurance industry create new ethical dilemmas? Do dentists in corporate dental offices have the same obligations and duties to patients as practice owners?
Ethics with a Bite will address these questions and more. I encourage dentists at all phases of their careers to participate in the discussion on how to be an ethical, practicing dentist.
The Ethics with a Bites goal is to become a resource for ethics for the practicing dentist. Practicing dentistry has never been more exciting or more challenging. Technology is changing the way we diagnose and treat patients. Our concepts of ethical treatment must change with technology. But we can’t abandon ethical principles along the way.
New business models are also changing our relationships to patients and staff. These new business models require us to look at ethical relationships with patients and staff in new ways.
The tremendous influence of cosmetic procedures had re-defined dentistry.Our code of ethics must keep pace with the rapid expansion of the types of treatment available to patients from dentists. Where does healthcare end and personal enhancement begin? How does this affect the doctor patient- relationship?
Healthcare law is changing too. How will this affect our ethical relationships with patients? Does the intrusion of the insurance industry create new ethical dilemmas? Do dentists in corporate dental offices have the same obligations and duties to patients as practice owners?
Ethics with a Bite will address these questions and more. I encourage dentists at all phases of their careers to participate in the discussion on how to be an ethical, practicing dentist.
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