Doctor Patient Relationship - The Sacred Cow

I may get into some trouble by writing this blog entry....I am looking for comments from both dentists and non-dentists.

The American Heritage Dictionary defines "Sacred Cow" as: Figuratively, anything that is beyond criticism: "That housing project is a real sacred cow; the city council won't hear of abandoning it."  In India, followers of Hinduism consider cows sacred and do not eat them because they believe the animals contain the souls of their dead ancestors.


In healthcare the sacred cow is the "Doctor - Patient Relationship". Nothing should interfere with this.  Not insurance plans or policies and most certainly, not government.


I recently saw a marketing piece from a large dental insurance company here in Colorado describing various options to prospective clients.  On the back cover there is a heading,

 "Why buy dental insurance?" 

I would like to take this opportunity to give a dentist's perspective on some of the points...

Point #1. "Your overall health could be impacted by your oral health" - true!


Point #2. "Dentists can catch potential problems early when they see you regularly" true!


Point #3. "People with dental insurance have better oral health outcomes" false! People that go to the dentist have better oral health outcomes.  


Less than 50% of people with dental insurance actually go to the dentist.  This implies that you can't go to the dentist without insurance.  People spend more money on their cell phone bill per month than it costs to get a cleaning from the dentist every 6 months.  


Point #4. "Routine exams allow your dentists to get to know you and your health history." true - great point.  


We (dentists) value the relationships that we have with our patients.  The relationships that I foster with my patients are what gives me the most satisfaction in my practice. Through consistent visits over the years we are able to monitor changes in the oral health.  We have detailed notes to compare the present condition with past.  A trusting relationship that is created over time ensures to the patient that the dentist has his/her best interest in mind.  


Point #5. "You could see significant savings" true and false- 


You could if you have no dental problems.  If you have dental problems, you might not. The discounted rates that the participating dentists are required to charge means that the dentist must lower his cost for the work.  Something will have to give from the producer side to make this work for the dentist to stay in business.  Lower cost materials, lower cost lab work, work done by assistants rather than the dentist, etc.  This could affect the outcome and/or quality of the work.   


Point #6. "Subscribers (patients) are protected by discounted rates even for procedures that are not covered under their plan" false!


This statement bothers me.  They just made the point that it is good to have a trusting relationship with your dentist.  This statement creates distrust in the relationship.


Why does the insurance company feel that the patient needs protecting? Just what are they protecting the patients from?


You can buy a Kia or you can by a Lexus - both will reliably get you to places you want to go. The Lexus will have more bells and whistles than the Kia; therefore it costs more.  Is there an entity that is protecting the prospective car buyers so they don't pay more for the car? No.  What people are choosing to pay extra for is the experience and the confidence in the brand.  If the cost of the car was more than the prospective car-buyer values, there will be no sale.  The sale is market driven!


Not all cars are the same.  Not all dentists are the same.  Not all dental procedures are the same.  Dentists that invest in continuing education are constantly raising the care that they provide to their patients.  By doing this, they can provide better dentistry and the patient will have a better experience.  They might charge a little more so that they can make a living and continue on their path towards mastery.


If someone values a different level of care, they should not be penalized for it.  Some people value low cost, some value individualized experience.  Some value life-like esthetics, some value function.  That is their choice and should not be prevented to seek out what is important to them.  If the fee is too high, there will be no sale!


Dental insurance companies are doing this and interfering with the sacred cow.


This self proclaimed protector (dental insurance company) has yearly revenues upwards of $100 million dollars.  I don't know any dentist, anywhere, anytime that has revenues in that galaxy.  


We run small businesses.  


We are artisans and craftsmen, managing personalities while balancing science to make a living.  


We invested at least 8 years in college and dental school.  Some of us have advanced degrees in various aspects of dentistry. We learned in dental school to provide the best care for our patients based on science - not on what the insurance companies cover.  The insurance company has established their own "standard of care" through propaganda such as this.


Dental insurance companies although they may be benevolent in their intent they are skimming money from the patients and interfering with the "Sacred Cow"


7. "Without Network Protection, there is no limit to what providers can charge for non-covered services."  false!


This statement irritates me and just about every other dentist that I know!


The free market that we live in drives the fee.  If a dentist charges too much, the patient won't buy it! This is a non-covered service, why should an insurance company set a fee for a service that it does not cover?  It makes no sense. 


I think that the public needs protection from the propaganda that the insurance companies are feeding them.


Last spring, a few colleagues and I had the opportunity to represent the Colorado Dental Association and the American Dental Association in Washington DC.  We had several legislative experts speak to us as a group before we met with Colorado's legislators.  Every expert was adamant when they told us this truth-


"Dentistry is the last free market health care system that works."



It works because we value the "Doctor - Patient Relationship" as sacred.


You can blow out a candle
But you can't blow out a fire,
Once the flames begin to catch,
The wind will blow it higher.
Peter Gabriel "Biko"


Lets get the flames to catch!

What do you stand for?

My family and I are in Durham, NC. My son Max (9 years old) is attending the Coach K Duke Basketball Camp. As a life-long fan of college basketball, this week has definitely been an amazing experience for me. I am sure Max is having a great time as well. No one epitomizes the game of basketball better than Coach Mike Kryzyzewski. Year after year, he puts out a team that is ranked in the top echelon of the NCAA. To my knowledge, there has never been any questions about NCAA violations or controversy. They have a consistently high graduation rate at one of the finest schools in the country. (There was a problem with the Lacrosse team a few years back, but that was determined to be unfounded.)

How does he (Coach K) do it?

The top rated high school basketball players can join the pro's after one year of college. And believe me, they are going pro!

If I was offered millions of dollars to become a dentist before I graduated, I would have done it in a heartbeat. I most likely would have finished my degree in the evenings, but I would have gone pro...no question.

With this in mind, it is harder to recruit the top players. It is harder to develop the talent. It is harder to have the players gel as a team in this era. But, every year, Coach K is in the running.

I have read several books written by the Coach. He is definitely a man that knows who he is and what he stands for. In fact, it is posted outside Cameron Indoor Stadium (Duke's modest basketball arena)...I was so astounded, I had to photograph them. They not only know who they are and what they stand for, they publicize it!

My friend, and mentor Russ always reminds me, "If you stand for nothing, you will fall for anything." He challenges me to live in integrity. My actions must match my intentions. And my intentions must be in line with my core values.

Bob Frazer, DDS reminds me that "An organization without a clear vision is at the mercy of every changing wind and knows not for what port it is making. Therefore is not likely to achieve greatness, perhaps not even survive long term. Or as proverbs says - "Where there is no vision the people perish."

The Duke Athletic Department stands for Sportsmanship, Loyalty, Diversity, Commitment, Excellence, and Respect. These are what I would refer to as their Core Values.

Core values are your moral compass. When you are actively living your core values, your life is harmonious. You are true to yourself. You are who you are, and that's who you are.

Though my own personal work, I discovered who I am and what I stand for. My core values are courage, family, integrity, humanity and humility.

Core values do not waiver. They will always be there. Even if it puts me at a competitive disadvantage. I am who I am and that's who I am.

Our business also has core values - They are the same as my personal core values. I cannot pretend to be someone else while at work.

On this Fourth of July, I think it would be appropriate to explore the core values of our esteemed country, as written in the Declaration of Independence -

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

This document still inspires millions of people around the world today!

When I was deciding about joining the Colorado Dental Association's (CDA) Executive Board, Bob Frazer, DDS, encouraged me to explore my core values and see if it is in line with the core values of the CDA. That made it an easy decision. I now encourage the board to explore our core values with every decision that we make. As I said, it is the moral compass. This is who we are, this is what we stand for.

Stephen Covey's "7 Habits of Highly Effective People" encourages his readers in habits 1 and 2 to - Be Proactive, and Begin with the end in mind. He is talking about finding out who you are and what you stand for. If you can figure that out, you are well on your way to living a successful and purposeful life.

Who are you and what do you stand for? As Russ says, "if you stand for nothing, you will fall for anything."

On a side note, I don't know if my son will ever be skilled enough to play basketball at Duke. I do want to impart on him the values that forge a successful life. Who better to learn from than Coach K!

And, just in case you are wondering, neither Gina or I went to Duke University...but we are absolutely awestruck by the campus.