Sales in Dentistry

I’m losing faith in dentists.

Aside from never being able to get my patients with crummy insurance to in to see dentists, my growing distrust was heightened the other day when I myself went to my local toother-dude for a cleaning. It would be better described as a sales seminar.

The hygienist tells me she is going to poke my gum line in three places, giving a number to denote the health of the gum as she goes.  “Anything 4 or above we’ll have to talk about. N’kay?”  She says briskly and a little too brightly.

hookShe then proceeds to take her hook needle-thing and poke the gum at one edge of the tooth, then the middle, then at the other edge of the tooth.  If you like the idea of being nailed to a wall with thumbtacks, then I can say with some confidence that you’ll appreciate this exam.

Just before the spearing commences, I’m thinking, “I got this.  No problem.  We’re good if there’s 1’s, 2’s and even 3’s.  C’mon, gums, step it up.  Do me proud.  I brush you almost every night.”

The hygenist perkily launches in, “four, four, five, five, two, four, six, six, four, five, five, four, five, five, six, SIX!, SIX….”

My “gum” score, clearly, wasn’t going to win any golf tournaments.

sonicare-toothbrushHere’s my problem:  From my dismal performance under the spear-hook, the hygienist pivots deftly into a winning performance about the Sonicare toothbrush, available around town, she guesses, but ALSO RIGHT HERE IN OUR OFFICE.

This phenomenal testament to tool-using, opposable-thumb evolutionary Homo Sapien wonder will put those 4’s and 5’s (and SIXES, Good LORD!) right back into the respectable realms of 2’s and 3’s well before you’re evicted from your Homeowner’s Association.

Somehow, this lady’s urgency was a bit too cloying to feel genuine.

Suddenly, I was not only feeling rather sardonic about the “quick trip” speed mode (for those running-out-the-door moments) of the latest Sonicare – the Nimbus 2000 of toothbrushes – but I was starting to doubt all those 4’s, 5’s and 6’s too.

Judging by her elated demonstration of her toothbrush to solve all my ills – her solution to our global financial crisis would probably involve the electronic toothbrush – I’m pretty sure my high score would directly benefit our illustrious dental hygienist and her employer.  Said employer, by the way, was El Dentisto, who used part of his 2.75 minutes with me to also promote the freaking Brush of the Millenium.

I don’t need to spend the average yearly income of a native Paupan on an electronic toothbrush, of course.  It’s really just a question of whether or not I want my face to rot off.  My choice.  Entirely.  Total freedom.

I’ve occasionally lamented the No Free Lunch movement, which insists that drug reps quit bringing me free lunches and coffees from cool restaurants all over town.  I’ve at times accused the whole movement of arm-chair ethics.  I would never prescribe certain more expensive drugs just because I’m getting a MoooLatte out of the deal, right?

And anyway, I like free coffee, dammit.  Why’d they get rid of all the perks (no pun intended) just as I’m arriving on the scene?

But the problem was pretty stark as I sat in that dental chair, thinking about my 3 patients who currently need very basic dental care and aren’t getting any.  They go months or years with festering abscesses, and here I am being told in authoritarian low-register voice tones that my mouth was turning into a cesspool of decay.  Lucky for me, one really really really good way to halt the horror was a toothbrush conveniently sitting in full view on a counter behind my earnest and – was it gleeful? – dental professional.

If the process isn’t outright coercive, it’s certainly manipulative.

swaggertTruth is, health care providers really shouldn’t sell stuff out of their offices.  They just shouldn’t.  It’s impossible to exercise unbiased judgment when certain decisions about a person’s health directly benefits the provider.

These Wal-Mart doctors are no different than corrupt televangelists sweating into powerful sound systems and using Biblical authority to make money.  The white coat carries similar clout.  “Buy this, or you’ll die,” is the implicit message, and it isn’t just wrong, it’s evil.

Doctors make enough money.  Lord knows, so do dentists.

I did manage to claw myself out of there without Toothbrush Extraordinaire.  Somehow, standing my ground was worth the black hole of pus I’ll one day have for a face.  We all make our choices.

20 thoughts on “Sales in Dentistry

  1. A few years back, I had to stop seeing an orthopedic surgeon because he was hawking Qigong tapes at every visit. Pamphlets, tapes, workshops. Nevermind that I was an avid Tai Chi practitioner — that was worthless apparently because he could not sell me his wicked wares!
    Just joshing — he was a very nice guy, just weird and obsessed. It got to the point where I didn’t go to postop appointments because of the impending sales pitch.

    Did you know your page is snowing?

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    1. secretwave101

      Festive, isn’t it?

      Here in the PacNW it does, in fact, snow on the beach occasionally. So I guess it’s ok that the snow is falling on my wave.

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  2. Eric

    I know, it’s a sales job.

    Seriously, though, consider it. I was one of the patients in the approval studies for the current-generation Sonicare, like you pictured, and had similar low-grade perio pockets/”normal” low-grade gingivitis, etc. I use a best-selling dentifrice, I bought the latest Oral-B manual toothbrushes, and I admit, I was sloppy about flossing.

    The Sonicare Elite really did an amazing job. In about a month, my scores *did* drop to 1s and 2s, and this was blinded to the investigators (conducted at the University of Washington, in fact).

    So don’t buy it from the dentist, but seriously consider buying one. I’m shocked as to how much it improved my oral health. I’m not sure how much is the Sonicare, and how much is spending precisely 30 seconds on each quad of my mouth, but it’s something, and the $150ish for the Sonicare (at the time) is substantially cheaper than a deep-root scaling and planing (which I’ve been able to delay for several years now).

    E

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    1. secretwave101

      Eric,

      I’m totally with you. I’m willing to buy the brush; it’s a great product. The Sonicare is a poor innocent bystander in this mishmash of ethical compromise.

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  3. Rishi Malla

    Interesting stat: doctors who attest to not being influenced by the free lunches/pens/samples in their prescribing behavior of a certain drug,actually have been shown in a study to increase prescription of drug 17% after the drug rep encounter. This is just horrifying in my mind.

    Check out http://www.pharmedout.org/

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  4. Jes

    I love how you post a well-written commentary about your healthcare provider making you uncomfortable, and the majority of responses are ‘No, seriously Dude, you need to try this toothbrush’. It’s like a Sonicare cult, or something.

    Unfortunately, private practice MD’s, as well as dentists, are faced with the same conflict: balancing best medicine with practice moneymakers. It isn’t only products (toothbrushes, hearing aids) but also elective surgery or having your own in-house CT scans. If you, Dr. A, end up in private practice, it’s a good idea to dwell on the ethical side it of now.

    Well said, Jes. I’m currently considering a private practice with an Xray machine in-office. Am I REALLY going to order the exact same number of films when I can profit from them as I normally would have?

    It’s an ethical thicket, I’ll give you that.

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  5. Kim

    There is this amazing, super-cheap product on the market called “dental floss”. Regular use fixed my (admittedly no worse than 4s) gum pockets right up.

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  6. Chris

    Sounds like you need to choose a better dentist. I have news for you…..dentists make little or no money on items they sell in their office. Often, they lose money on such items. You don’t need a Sonicare. People have been “surviving” without them for thousands of years. With 6’s though, you might want to try flossing.

    You’re telling me dentists provide electronic toothbrushes as a public service?

    If they’re into doing business at a loss, I’d much rather dentists shaft the e-brush public health push and just see some of my medicare patients threatening to go septic from gingival abscesses.

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  7. James

    With 6mm pockets a sonicare sales pitch is the least of your problems. How about having a nest full of bone eating bacteria in your mouth, that is slowly and painlessly eating all of the bone away in your mouth? But you probably aren’t worried about that? You are probably still thinking about the sales pitch.
    Even if you buy the sonicare, it does not mean that if you don’t do your homework (flossing and using the sonicare), you won’t lose your teeth later.
    Do your gums bleed when you brush? If you brushed your fingers and they were bleeding what would you do? Wear gloves? Would you be mad at the sales lady for telling you leather gloves are nicer, if she said it with a smile? Or would you rather have her tell you how to stop those fingers from bleeding?

    James: As I tried to point out, I’m distrustful of the proclamation of 5’s and 6’s because of the profit motive to the dentist to find them. If they lost money for every 4, 5 and 6…would their assessment be the same?

    Doubt it.

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  8. David

    Dear SecretwDrave 101

    I read with great interest your blog about the procedure you went through. It is an unfortunate commentary, and one that I intend to have my team understand today in our team meeting. In my office we are constantly trying to help our patients get what they need, but it is always a challenge to not appear to be selling when one makes the diagnosis and has the solution for the problem at hand. Some people call this convenience and others, like you with a half empty cup world view, look at this type of presentation method as a “selling for profit” conspiracy. To address the facts of your case experience:
    1. You were examined by a licensed hygienist that presented her findings to a licensed dentist that made a professional diagnosis of advanced periodontal disease and suggested a plan for treatment for the diagnosed problem.
    2. You perceived the diagnosis as patronizing because they had a solution to your problem at hand in the office in the form of an expensive tooth brush.
    3. You lost faith because it was “too” convenient a diagnosis and appeared to be in the best interest of the dental office and team.
    4. You did not accept treatment because of your lack of faith in the diagnosis and the apparent “selling atmosphere”.
    5. You posted your experience on line for all, including half empty people like yourself, to commiserate with you and to further cast a negative light on dental profession’s ethics.

    Sounds to me like a lack of faith in yourself, although I agree that it appears to be a conflict of interest to some people when a solution to a problem is proposed by the same person that found the problem. My mother always taught me that unless you have at least a proposed solution to a problem, that you should keep your mouth shut. I agree with this after 47 years of life experience. It is wisdom. By the way the meat hook “periodontal probe” is really a graphic perception and betrays your world view. My team and I will have a great time discussing how we can deal with people like you “Mr. Half empty”. There has been quite a bit of discussion about your blog on at least one dental forum, and I appreciate all the positive comments. It really is about inward and outward focus. I suspect that deep in your psyche you have some severe reservations about your own personal honesty. This is projected to others by you, and you perceive that others are trying to “rip you off”. Hard way to live. Trust is essential to any form of long term communication, and because of your deep seated insecurities, you are unable to trust. I suspect you have significant problems with long term relationships with other creatures including humans. Since you posted this blog and have acknowledged a problem that I also recognize in organized medical and dental services “conflict of interest”, what is your solution? I have spent many hours trying to solve this problem for me. My solution is to be totally honest in all my dealings with my fellow man including my patients. Sometimes it hurts like a meat hook when I present my findings to a patient. My heart pains to help people get what they need but it is hard to help them without appearing to have my self interest in mind since I do get paid to solve their problem. In fact, I have come to believe that it is a good idea for me to prosper by solving others problems, because I can be better prepared to help the next person. As for all your patients that have chronic dental needs without treatment. I believe it is the patients right to choose the happiness they will peruse in life, and if it includes dental care, it is their right to accept or deny themselves that form of happiness. One thing about dentistry and periodontal disease, it is usually a self inflicted disease secondary to poor personal habits and low self worth. Anyway, I will be interested in your response to the following question. How do you propose that medical practitioners help others without helping themselves? I will give you a hint to help in the formulation of your answer if you choose to respond. I believe it is impossible. I believe Napoleon Hill has the best answer I have seen so far; If you help others first, you will naturally benefit. Good luck in formulating an answer if you dare.
    David S. Peterson DDS, FAGD

    Such a challenging and thoughtful comment, I will reply in a separate blog, here.

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  9. Jamie

    Dr. Doctor
    Your right you do have the freedom to have a cespool in your mouth and your patients mouths. You want to blame the insurance companys because they are crummy and now you want to blame dentists for their ethics. Blame Blame Blame!!! No responsibility for my problems, it is everyone elses fault. With every problem there is a solution. Some are just more convient than others. I would hate if you were my doctor because when I go to a doctor or a dentist i go in for a problem and want to come out with a solution. You seem very inexperienced in life and appear to have very low self esteem. Grow up and if you act like an adult you will be treated like an adult.

    Sincerely
    Jamie

    Jamie: Your comment is a bit annoying, but please be assured that if you have an extra $200, I’m happy to still accept you as a patient and provide you with a wonderful, life-saving, ultrasound-assisted, electronic toothbrush!

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  10. Pingback: Reply To ‘Dentist’ Comment «

  11. Tooth pain can be a symptom of many various things. It can be due to inflammation of the gums, an abscess ( an infection that develops in the tooth root or between the tooth and gum ), a cracked tooth, a dislodged filling, or the most typical culprit, a hole. However, sometimes a toothache is caused by something as straightforward as besieged food between the teeth. The food fragments can irritate the gums and the discomfort can radiate into the surrounding teeth.

    Read More from Dentist in Finchley

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  12. David Petersen DDS

    I was looking for a picture of a Sonicare toothbrush to use in my upcoming lecture to the American Behcet’s Disease Association and Google images led me to you. I am recommending the sonicare to this group of people who get terrible painful aphthous ulcers in their mouths many times a year from this rare autoimmune disease because it cleans so well but has less trauma to the gums than a manual toothbrush. I am not making a cent from sonicare or from the ABDA to say this. It is just good advice. You would be wise to not think so much greed or conspiracy theory on this one. And yes, you can clean adequately with a manual toothbrush, but most people don’t, thus dentists have a job.

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  13. David Petersen

    I was just looking for more information for my ABDA conference presentation and your blog came up again.

    I just have to chuckle that you got comments from two dentists with almost the same name on this issue. I am David E. Petersen. Not the same as the David S. Peterson that wrote you the long comment.

    And seriously, was this worth getting so bent out of shape over? I sold Sonicares in my office because I feel it is a good service. When the Phillips corporation was stupid enough to sell them to Costco for less than they sold them to dentists, I stopped selling them and told my patients to go to Costco. They effectively eliminated a huge unpaid sales force that had the most authority and knowledge to recommend their product. When I sold them I made a profit. My practice is a business and there is nothing wrong with making a profit. It was providing a good product that would be a service to my patients. Ophthalmologists sell glasses and contacts. Chiropractors sell nutritional supplements, pillows, exercise stuff. Plastic surgeons sell all kinds of cosmetics, etc etc. My allergist has products available for my allergies. Physical therapists have all kinds of equipment for sale. My pulmonologist sells sleep apnea supplies. Even the famed Mayo Clinic has a myriad of products for sale.

    Yes there may be a profit motivation involved for some. It wouldn’t hurt, however, (in fact it may be very beneficial to you) to consider the side that they are just simply trying to provide a good service to their patients. For me, actually, the paperwork associated with sales taxes, inventory cost on the shelf, etc. made the profit end of selling them really not much of a great deal for me. When Phillips undercut me on the price to Costco and Sam’s Club, it was not a big loss to me to stop selling them. Now I just recommend them similar to writing a prescription.

    David Petersen DDS

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  15. Well I guess many are already doing such practice, offering/recommending something to their patients hoping that they can get some extra from it. Well I don’t really mind it, if it will be helpful for me and I can afford to buy why not, but just don’t scare me or push me to buy such coz that will be another issue. This practice does not only exist in dental industry but in almost all industries? You know people using their authorities to influence others to buy certain products and so on.

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  16. Even if they try to sell you something in their clinic/offices, you still have the freedom to decide whether to buy it or not. But if they are already blackmailing you, pushing you to buy something that you don’t want to, its like an outright hold up already that’s really irritating. I have come across to some people who acts like this, its sad that with that attitude, I think they don’t have the right to be called professional…just an opinion.

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  17. Bec

    Wow, you sound like one of those patients that pisses and moans about the Dentist, yet needs to go the worst. Buy some dental floss at the dollar store and stop worrying about the toothbrush your hygienist is recommending! She was probably pitching it to you since you seem like a lazy brusher….and an electronic toothbrush does the majority of the work.

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    1. Nope. Sorry. Not backing down on this one just because you level some manipulative guilt-inducing drivel about brushing habits. There’s more than one electronic toothbrush. There’s numerous kinds. But pushing one brand – the one with kick-backs – is unethical. Flat-out.

      If you wear a white coat, I say, do your damn job. That job is not commercials.

      Like

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