AVOIDING OVERT OVERTREATMENT

A couple of years ago, a young college student came to our office, clearly distraught. He never had a cavity in his life. While at college, he decided to go to a corporate chain clinic for the free exam and x-rays advertised on TV. Until then he had been going home to his old family dentist. Thirteen cavities were diagnosed by the corporate clinic, with the recommendation of white plastic fillings for all the teeth. I don’t know why, but he ended up in our office for a second opinion. Since he could not obtain a copy of the x-ray series from the chain clinic, I took a very clear set of my own, and looked over them carefully under magnification. The boy had not one cavity in his mouth! He needed nothing but a routine cleaning.

A while back a patient came to us after visiting a large corporate-owned clinic near Washington DC. He had landed a high-paying contract job in the Middle East, and had to get a dental clearance to secure the job. He brought the corporate clinic’s treatment plan with him. It included a series of deep cleaning appointments, fillings and even a crown or two. I examined his mouth carefully, referring to the x-rays taken at this clinic. The verdict? I could find nothing this man needed except a routine cleaning. I guess the corporate clinic operators thought they really had him over a barrel, since he was under a deadline to get dental clearance for the high-paying job.

Just a couple of weeks ago, a young social worker came to our office after visiting a large Atlanta corporate clinic that advertises a lot via radio. This bright young lady already had a Master’s degree and was starting to work on her doctorate. She had beautiful teeth, and had never had a cavity in her life. Yet the clinic had planned her for four quadrants of root planing and EIGHT white plastic fillings. Fortunately, she was suspicious, and sought our opinion before proceeding with the treatment. We found that she had some tartar under her gums, but really needed only a routine cleaning, and no fillings at all.

Because all three of these patients were skeptical, their teeth were saved from unnecessary, even harmful treatment.

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The sad part about overtreatment is not just the money patients spend needlessly. It is the damage to the teeth. Virgin teeth without fillings are a beautiful thing. They are durable and decay resistant. It is one thing to remove a real cavity and put a long-lasting filling where the decay was. It is quite another thing to drill on a tooth free of decay and place a plastic filling that will leak and require replacement in a few years. Every time a tooth is drilled upon, the pulp inside is irritated. With enough treatment, teeth often need root canals and crowns. It often becomes a merry-go-round of one treatment after the other.

Why is inappropriate treatment so common at clinics owned by corporate investors, instead of licensed dentists? Well, for starters, these clinics are usually staffed by young dentists with outlandish student loan debt- often a quarter to a third of a million dollars. The clinics pay them a fairly low commission, and contract with insurance companies to do dental procedures at low fees. This makes it very difficult for young dentist-employees to honestly make a living supporting their families AND pay back their student loans.

Meanwhile, corporate investors who own the clinics typically seek a 20% return on investment. Overhead for dental offices is quite high and 20% profit is hard to achieve, if all staff is paid market wages. Many times, clinic managers (who are not dentists) badger the providers to churn out more dental treatment. A lot is necessary to be scheduled when clinics cut fees 20-30% for insurance companies! Under this pressure, a lot of needless treatment is recommended to patients. At some corporate clinics, dental assistants and office managers actually add treatment so that they can meet the monthly office revenue goals and receive their bonus!

In my experience, overtreatment of patients is fairly rare by independent dentists who own their practices. Dentists like me depend on referrals of new patients by satisfied existing patients, rather than by expensive advertising on radio and TV. To be sure, there may be differences in treatment options presented between honest dentists. Other dentists are far more apt to cut teeth down teeth for porcelain crowns than I am, because the Navy taught me to do do such good silver fillings. Other dentists might be more apt to do bridges on natural teeth rather than implants. These are legitimate treatment differences between dentists. It is a far cry from the blatant fraud perpetrated on patients who have nothing wrong in their mouths!

It is very difficult for the average patient to process what is truthful and what is not in advertising. A good rule is not to believe any advertisements by health professionals broadcast over the airwaves. The promise of free exams and x-rays in a large clinic with expanded late and weekend hours is very tempting, especially to uninsured patients. But judging from patients we encounter, the ultimate cost of letting corporate-owned clinics treat you is very high. You will pay very dearly for that free or discounted exam. After your insurance money is spent, you might have to pay for the treatment out of pocket when something goes wrong!

Incidentally, did you know that ownership of dental offices by corporate investors who are not dentists is actually illegal in Georgia, as well as most other states? Exactly because regulators were afraid of what is presently happening to patients in corporate clinics. How then do all these corporate clinics exist? Corporate investor-owners scam the state regulators by setting a “fake owner dentist” up with a shell corporation, and claim they just “manage” the clinic for the dentist. When in actuality, the official “owner” dentist cannot even access any checking account where funds are deposited from patient payment! Write your Georgia legislature and demand the Georgia Board of Dentistry develop ownership tests, so corporate investors cannot get away with these scams!

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Please Support Mom & Pop Pharmacies!

The other day a surgical patient needed a prescription filled for an antibiotic and pain reliever we had given her. She went to a big-box chain pharmacy to get it filled. Three hours later, a young voice called us saying the prescription could not be filled without an “attending physician’s” name. Missy repeatedly told the employee that ours was a dental office and all the necessary information was printed on the prescription. I was busy and could not take the call at the time. When we tried to call back, we were placed on hold for 30 minutes, and never could talk to anyone in the pharmacy.

The patient never was able to get the drugs she badly needed that evening. The store manager called us the next day to say that a young, inexperienced pharmacist was on duty that night, and did not know what she was doing.

I wish I could say that occurrences like that were a rarity, but such a fiasco happens nearly every week. Patients don’t realize that I can rarely speak to the pharmacists in big-box stores. They are just too busy and understaffed. I usually can only leave recorded messages on their voice mail systems. Eventually staff listens to most messages and fills the prescriptions, but a good part of the time they never get around to it. Then the patients often blame me, thinking I forgot to phone in the prescription.

Often times big-box stores don’t stock a variety of drugs, or enough of them. They often run out. Then they lie to patients and said I prescribed a rarely-used medication.

Patients always want to save money, but what is your time really worth? Is three hours of waiting worth saving $4?

The difference between dealing with big-box pharmacies and Mom & Pop drug stores is like night and day. I can call and talk to a pharmacist almost immediately. They give me suggestions for drugs that might be alternatives. They cut me slack and let me phone in scheduled drugs, and wait for the written prescription by mail. They work hard for patients’ business, and truly put patients’ interests first. Often the difference in drug costs between big-box and independent pharmacies is little if anything.

There aren’t many Mom & Pop pharmacies left, but they deserve your business. Chapman’s Drugstore in Hapeville has been in business for over 80 years and is only two blocks from my office. You seldom wait more than five minutes for a prescription! Christian’s Pharmacy in Forest Park is owned by one of my patients, and can even compound custom prescriptions for you. Moye’s Pharmacy gives speedy and efficient service to my patients in the McDonough area.

Corporate ownership has been nothing but bad for the dental profession, and I am not sure that it has been any less damaging to pharmacies. Please consider using your helpful independently owned local pharmacy next time you need a prescription filled. You will also support a valuable small business in your community!