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This problem is the biggest in dentistry. Most dentists are perfectly capable of providing the correct diagnosis. Unfortunately, even if and when they are, the
by tmamic 7y ago
This problem is the biggest in dentistry.
Most dentists are perfectly capable of providing the correct diagnosis. Unfortunately, even if and when they are, there are obstacles:
- Weak incentives to provide an accurate diagnosis
- Strong incentives to provide a particular inaccurate diagnosis
Giving a correct diagnosis often means investing more resources, as well as continuously investing in education and tooling. If the patient doesn’t see the difference between a correct diagnosis and “probably correct diagnosis” then they will react the same in both cases.
This situation where every diagnosis is perceived as the same, an examination is one of the least profitable services provided by dentists and, naturally, falls into the problem of “adverse selection.”
Some dentists recognise the opportunity of giving the wrong diagnosis to get a higher benefit. Be it by keeping or winning over the patient or by leaving room for the ability to recommend costly treatments.
The results of this are:
- Patients on average get a less correct diagnosis
- Dentists earn little to nothing for their diagnostic work
- cptskippy 7y agoIt goes beyond correct diagnosis with Dentistry. Even with a correct diagnosis there are often multiple methods of treatment that vary dramatically in terms of recovery and cost. More often then not the Dentist recommends a costly treatment and doesn't even provide alternatives. I've seen dentist offices that were just cavity filling mills that filled anything remotely resembling a cavity and using three different methods of pain management during the procedure. The dentist literally had rows of chairs in the same room getting cavities filled. I've sat in a dentist's chair and been told I had a cavity that needed and could be filled that day. Unfortunately I was not in a position to pay for the procedure so I deferred. I saved up the $$$ needed and returned at my next appointment prepared to have it filled only to be told I didn't have any cavities. When I was a kid, you didn't get braces until you lost all your baby teeth, now Dentists have started recommending braces for children as young as 4 with the expectation that they'll need braces again as a teen.
- tmamic 7y agoYou are absolutely right. Dentists are able to recommend wrong therapy plans without patients knowing. Even when a patient gets the correct diagnosis, they can be recommended drastically different therapy plans. This happens because there are many ways to solve the same medical problem. Depending on the financial capacity of the patient and the desired quality which is most commonly measured by the length of durability or visual appearance, as well as other factors. Another related issue is the aesthetic dental work paid for by the patient, which can cause the need for more treatments down the line. All these decisions influence the health of the patient in a way they aren’t able to fully comprehend, and they rely on dentists as experts to advise them. Generally, advice and diagnosis are not separate. This creates a venue for unethical behaviour. For example, dentists might resort to recommending "tools from their toolbox.” In your case, it was fillings. When you buy a hammer, suddenly everything looks like a nail. The results of all this are: - Patients get suboptimal/wrong health treatments - Treatments are still performed long after there are better approaches available - Dentists are less able to give the right advice
- yboris 7y agoSpecific example I came across (may have even been a scientific study). Memory is a bit hazy, but roughly: Dentists routinely recommended the more-expensive ceramic teeth replacements for teeth in the back, even though ceramic is less durable than the metal counterparts. Even though you basically can never see the hind teeth, so cosmetic reasons shouldn't have applied as they do for front teeth.
- onlyrealcuzzo 7y agoI've wondered why diagnostics doesn't work differently. Why not have a specialist collect the data needed: pictures, temperatures, blood pressures, basic answers to questions, etc... Then farm this data out to several doctors who make a diagnosis -- until you've reached a statistical significance. Then, use this data to train a machine learning model.
- tmamic 7y agoIt's almost exactly what I am working on.
- loco5niner 7y ago> Even though you basically can never see the hind teeth I notice metal in peoples hind teeth all the time. This is still a cosmetic need. Food for thought. If teeth are constantly grinding against each other, is it good for the opposing teeth to constantly be grinding against a hard material like metal?
- realityking 7y agoI agree with your point about regularly noticing metal crowns but note that dental ceramics are way harder than metal. Dental ceramic is a 7 on the Mohs scale while gold and silver are in the 2.5 to 3 range.
- loco5niner 7y agoInteresting. And tooth enamel apparently ranks a 5.
- pkaye 7y agoMy elderly mother had such a bad experience with a dentist. She had some tooth pain and the dentist she picked wanted to replace ALL her teeth with implants. I went with her to see what is going on and the dentist insisted and expected the work to start the same day. We walked out and scheduled an appt with my dentist. They instead recommended a deep cleaning and fix one tooth. Then 15+ years later her teeth are doing fine.
- suyash 7y agoAbsolutely, every time I've been to a Dentist, they want to do full set of X-Rays etc.
- iends 7y agoThe standard of care in the United States is xrays for diagnosis. Depending on how often you go to the dentist, this doesn’t seem unreasonable.
- mmhsieh 7y agoI wish I could add 100 points to this. Knew a dentist. She told me how her mentor mentored her in the art of billing to the max on everything and pushing every procedure under the sun for financial gain. I fly 3000 miles to see the same dentist I have seen since childhood. Honest guy who has a conservative mind about treatment. It's worth the extra airfare.
- dennis_jeeves 7y agommhsieh, mind tell me who this is? I'd be interested in knowing.
- notyourday 7y ago> Some dentists recognise the opportunity of giving the wrong diagnosis to get a higher benefit. They should be sued out of existence, both criminally for fraud and after that civilly.