Is There Pressure On Aussie Dentists To Trump Up Treatments And Over-Service?
Psychologically, it’s been proven for decades that we harshly judge the negative actions of other people. In preference to praise, we like to assign fault and blame; emotions that processed differently, by different parts of the brain.
Essentially, blame is processed by the amygdala, which has a prominent role in memory, learning and emotions – particularly fear. In neuroscience, praise is perceived as a social reward that activates dopamine-sensitive neurons located in the frontal lobe.
In a landmark study, brain scans showed that the response to this type of positivity set off areas dealing with reason and fact, without lighting up the amygdala at all. Not only do we have a stronger response to negative experiences than positive ones, our memory retains them for longer.
An aspect of human evolution and species survival was the capacity to cooperate, part of which requires the ability to enforce social standards. Harvard University research shows that in both the placing of blame, and the consequences for those in violation of the accepted paradigm, there are similar selective and causal neurological firings.
Interestingly, being criticised and held responsible is interpreted by the brain in precisely the same way it does being physically attacked. Prefrontal cortices effectively shut down so that all our energy can be directed to defending ourselves.
Ironically, it’s a process that sabotages the ability to solve the issue for which blame is attributed.
Overall, there’s not a lot of logic involved when we start pointing the finger. We do it more than we give compliments, and we love for things to not be our fault.
We practically demand it. A three-year-old knows that. Literally.
The interesting thing is that we like to project negative information. We don’t like receiving it, but we sure like puttin’ it out there.
So are we making it up, or are Aussie dentists under pressure?
You bet they are.
Running a practice involves overheads and staffing costs. There are the expenses of materials, equipment, specialist machinery and IT that dental fees also have to cover. As well as that, the profession requires dentists to pay for ongoing development in order to stay up-to-date with innovations and techniques.
Until there are changes to Australia’s fragmented public dental and oral healthcare system, it will remain under-resourced and overstretched. It’s an inadequate system that makes dental care cost more than it does in many other countries.
Adopting universal dental care seems the simple answer to the deeply inequitable structure that presently exists.
The Lucky Country has dismayingly poor outcomes where dental health is concerned.
And it has these caring professionals alarmed.
On average, in one year, there are about 83,000 hospitalisations for dental conditions potentially preventable with earlier treatment.
Dentists are more than aware that maintaining oral health is expensive. Increases in the cost of living and long waiting lists for government-funded care, means treatment are delayed – and that create a backlog of issues.
The Australian Dental Association recently surveyed 25,000 people.
It revealed that more than 68% of Australian adults have not been to a dentist in two years.
Of those, 1-in-4 have not had any dental treatment for five years.
16,750 respondents said they had postponed professional treatment for cracked teeth, suspected cavities, or bleeding gums in the year prior to the survey.
For more than 9,000 of these people, it was because they couldn’t afford to.
Not seeing a dentist for two years is enough time for gum diseases to develop. Often there is no discomfort or pain until there’s a problem – and by then it can be too late for simple, cost effective therapies.
More and more dentists are dealing with “last resort” cases.
Increasingly, they’re just taking out teeth, which is distressing and upsetting.
Not only for the patient but for the clinician too – their focus is on maintaining good oral health. To have to often deliver the news that nobody wants to hear about the impossibility of saving a tooth, or their acute gum disease and the disintegration of jawbone is an emotional burden. It can lead to burnout and other mental health conditions: found to be significantly high in this profession with its demands for perfection, and the complexities of meeting the (sometimes unrealistic) expectations of patients.
Do dentists in Australia over-service their patients to increase practice revenue?
A code of ethics governs dentistry to protect the wellbeing of patients. It upholds the highest professional standards of safety and sterilisation, as well as moral restraint from any professional activity that exploits the trust of the patient.
Which includes performing any unnecessary procedures.
A huge part of wanting to become a dentist is the desire to provide the best possible patient care, and it serves as an integral motivator for principled behaviour.
There’s a proven association between not trusting your dentist, and unfavourable treatment outcomes. Dental pain, discomfort, and dental anxiety are elevated. Appointments are constantly delayed or cancelled. Lack of trust is neither helpful to the patient, or the dentist.
So over charging through over-servicing serves nobody; which is not to say it doesn’t happen.
It can occur across many types of healthcare. In dentistry it’s defined as treatments that are above and beyond the clinically justifiable. In comparison with other health professions, research has found dental practitioners at higher risk of complaint.
A national dataset from 2011 to 2016 showed that dental practitioners made up 3.5% of health professions, yet accounted for approximately 10% of complaints. There were higher rates of dissatisfaction among dentists and dental prosthetists than allied practitioners, with 59% of complaints relating to treatments and procedures.
Approximately 4% of dentists received more than one complaint and in 60% of closed cases, no regulatory action was required.
The most common issue (at 5.8%) concerned fees and over charging.
Almost 13% of complaints resulted in restrictive conditions on practice.
Certainly, there are consequences.
In 2012 a dentist was found to have performed more than $75,000 worth of treatments on a patient, knowing that they were completely unrequired and ultimately ineffective. The Supreme Court ordered payment of $1.8 million in damages, and found him guilty of professional misconduct.
Undoubtedly it’s an extreme case, and in 2020 the University of Sydney interviewed twenty dentists and analysing their notes in the first study of its kind that included their perspective on over-servicing.
With earnings linked to a fee-for-service model, many felt pressured by practice owners or their own financial commitments to provide unwarranted procedures.
One participant commented, “I quit my first job because they were overly commercial and I figured that out about two weeks in because there it was very much a matter of, “how many crowns are you doing per week? We expect our clinicians to be doing at least a crown a day…”
As much as we might like to believe it, over-servicing isn’t inevitable.
Their professional identity as a dentist greatly assisted in putting patients before profit.
During interview one respondent said, “Look, I’d always put my professionalism first. There’s been a couple of times when I’ve recommended a crown and I sort of thought “OK, am I doing this because the crown is a high-end item or because I really believe it’s the best thing for the patient?” I always go with what I believe is the best thing for the patient.”
The Australian dental care system is not ideal. Within it, are thousands of highly skilled, highly talented professionals doing their very best for their patients. Patients who are also not in an ideal situation, which impacts the way they’re able to have needed treatments, and properly managing their own oral health.
We can blame the system, we can blame the fee-for-service model, we can blame the cost of living. That all might make our brain feel better, but it’s not healthy for our teeth and gums.
We have to take personal responsibility. Make the appointment, get a second opinion if you’re unsure and spend the money. We’d spend it if it was a holiday, and there is no better, longer lasting freedom than having beautiful teeth.
If we all did that, maybe it could shift the fee-for-service model. The UK is trialling practices being paid a monthly fee for registered patients, alleviating the pressure for dentists to over-service.
With 6-monthly appointments, instead of having to be treated for advanced issues of decay or gum disease, it would be a clean bill of dental health.
We’d all happily take the blame for that.
Coming in February 2024
Disclaimer: The material posted is for informational purposes only and is not intended to substitute for professional medical advice, diagnosis or treatment. Results vary with each patient. Any dental procedure carries risks and benefits. If you have any specific questions about any dental and/or medical matter, you should consult your dentist, physician or other professional healthcare providers.
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