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Word of Mouth Interview
Many professional practices have altered their terms to settlement per appointment. What flexibility does that policy allow patients during hard times? Well, we reluctantly joined that movement some years ago when overdraft rates were 22% plus risk penalties of 2% on top of the 22% - applied if borrowings exceeded the secured overdraft limit. Anybody who has paid banks for long credit lines would realise something had to change. Naturally if a person is "kosher", staging of treatment and regular payment plans are available, merely by asking their treating dentist. What impact did the 80’s recession have on Perth’s dentistry? Competition increased. Shopping on price will occur amongst uninformed consumers and the result will be a corrupting pressure upon standards. Dentists will separate into 2 groups: those committed to excellence and secondly those less competent who can only compete "on price". What standards would drop? The quality and type of equipment made available in the practice, the choice of materials, staffing levels, further education, seeking short-cuts, rorting of health rebates and generally, across the board, a drop in the standard of what is acceptable or more just more of that dreadful conclusive Australian term: "No worries, mate, you should get away with that!" So, your practice competes on excellence, not by being cheapest? Absolutely. Some of our fees may be below average, some above. Each dentist sets their own fees according to their assessment of time, skill, care and judgement. It is more complicated than I thought! What equipment consequences could occur if consumers choose a dentist on the basis of apparently "cheaper"? Since the advent of AIDS, dentistry has had to fund some very expensive new costs. At Aardent we purchased 3 new autoclaves at a cost of some $12,000 in addition to increasing our available handpieces and instrument so to allow those items to be taken out of circulation during the autoclave cycle. All instruments within that sterility process require large amounts of staff time for preparation and restocking. In our practice, that sterilisation occurs for each patient change. Taking small turbines up to 130 degrees shortens the handpiece life dramatically. Last month, I seem to remember a maintenance bill for $2,000 for some handpieces alone! Yet, all dentist are faced with the same increase in their overheads? Some would accept those moral obligations, others might hope that they would go away and other could not afford autoclaves and duplication of all the extra equipment. Even the cost of gloves is high, annually, given that sometimes 6 or 8 gloves might be required for just one patient. The old adage is still true: you do get "what you pay for" and the complexities of infection control may be a force in favour of larger practices which will have the personal available for the task and paradoxically, a large number of staff creates a very questioning and challenging atmosphere. How would a large staff do that? Well, we have regular staff meetings, chaired in rotation amongst all the staff and dentists. Everybody is required to contribute suggestions for improvement. Three dentists and 9 staff can really minutely examine the legitimacy of an issue – whether it be as minor as the band of coffee or as significant as our life support readiness. Is this different to anybody else? Few dentists would carry oxygen ventilation equipment, although we have never required in during an emergency its part of the greater benefit offered by a larger practice. Dental Surgeons are often of an autocratic psychological profile. As our wages bill now exceeds the minimum level, we are now required to spend $3000 on staining. One of our dental therapists had just completed a course on resuscitation. She is a most valuable professional; now, more so. You made mention of health rebates. It seems very complicated and most people never get back what they would expect. How do you feel about rebates? Medicine is in a mess because of rebates. Rebates corrupt both patients and providers. The Senate Select Committee of Inquiry on Medical Fraud and Over-servicing has shown that the immoral and usually less skilful providers will find a way of keeping both the patient and the doctor’s bank manager happy. The two are synonymous. Everything is pitted against the excellent provider. I remember reading a book lying dusty in the upper shelves in the Dental School library, written by an American dentist, under the pseudonym Paul Rievre. He compared Dr. Good to Dr. Bad. Dr. Bad never kept anybody waiting because he didn’t quite remove the decay, he didn’t hurt for he never drilled deep enough and his fees were very low. The author exaggerated to make the point that health providers operate in a tough market, with selection rules for choosing a provider being very different when choosing cars or vegetables. Medicine is certainly going to split into two classes of providers: the cheap and the excellent. Dentistry will surely follow. Rebate levels are a percentage of the "average" fees not the "mode" fee. If most dentists charge $40 for an examination ( one charges $170… and he is worth it!) so the mode fee would be $40 because most dentists do charge that amount. Yet the funds add all the exam fees charged and divide by the number of exams… the average fee then drops to say $20. Why?.. a million people ask! The reduction happens because discounting occurs with families were say 8 children are examined and only 1 or 2 full fees are charged, the remainder at the rebate level,. Good for the family, good for the fund advertising "we rebate half the average fee" but totally misleading for the patient charged the mode or usual fee. The same discounting happens with multiple fillings, extractions etc. Most recently, the increases for the most common items have risen only a few dollars annually and certainly not in line with other indices, let alone actual fees. Yet dentistry can seem never ending, year after year? It certainly is for non-flossers with a high sugar intake, people who will always have plaque on their teeth. Most frustrated are those people born prior to the mid 60’s- prior to fluoridation. We now see those 2 distinct types of patients, pre-fluoriders and post-fluoriders. Our newsletter "research articles" addresses the problems of the pre-fluoriders, many of whom are victims in a war, a war they don’t yet know about. A war in their mouth? Yes, a subtle war waged by their hard diet upon their weakening teeth. Wholegrain bread, muesli bars, liquorice, beef jerky, sugar coated almonds, Minties, Cool Mints etc are like miniature Hiroshima explosions upon the crystalline surface of teeth, especially one belonging to a person over the age of 26 who will certainly sport fillings larger than small. Our forebears would never have eaten those foods as we do because prior to penicillin in 1942, a fractured anything could result in infection and death. A fractured tooth infected and draining into the throat area would have restricted the person’s airway leading to a medical certificate "death by septicemia". So, "We of New Age Food" enjoy these rubbery and stone like fare, pushing our fillings into our teeth like pressing a cricket ball into an ice cream cone. Fracturing of teeth is an epidemic. It would be one of the most important reasons for an emergency visit to our practice, second perhaps to infected wisdom teeth. Is there a sub-classification for the pre-fluoriders? Yes, according to age and the intensity of dentist diagnosis and interception. Most pre-flouriders aged thirty to forty, would today have medium sized fillings. Many of the medium ones would be starting to break, some would have recently been or should be replaced with large to gigantic amalgams. If they floss, they would have little decay. If no sugar, probably no decay. By forty years of age, most patients would have, or should have, at least 4 molars crowned. So really my purpose as a dentist is to anticipate these events, then motivate and educate people about the consequences of inaction" If not, they will lose those teeth by the time they are fifty or, will later have to have a huge amount of dentistry to ‘save their mouth’. By fifty, the patient will be either the proud owner of protective crowns on most of the back teeth or have spaces due to emergency extractions or failed dentistry due to ‘too little (early), then too much (too late)’. With nothing at the back to chew with, the front teeth look like a break knife, chipped and starting to wear and break away to the gum. If at sixty, they win Lotto, it can be too late… but now we have implants. The topic for another newsletter. Suffice to say ‘a Godsend’. So, really my purpose, as a dentist, is to anticipate these slow disastrous and expensive events, to motivate and educate people about the consequences and complexities of not intervening until it is either too late, too numerous or too expensive. Those people, in their 40’s should have a steady program of protecting heavily filled back teeth before they bust them. The prospect of avoiding a surgical extraction at 50- or 60 should motivate even the timid! What is the future for a post-flourider born after mid 60’s? Great. If they floss and avoid sugar and evening ‘grazing’ whilst watching night television eating Toffee Tops – they will need virtually no dentistry other than examinations and cleaning. If they do not do all of the above, the wee beasties will get them and they will suffer the same outcome, with the crossroad (extraction or crowning) at 60 years of age and not 40. Predictably, they will live longer than ‘three score and ten’, so many may require their teeth far longer than either they or MediBank are expecting. |
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