Since October I’ve been making the rounds of appointments between a general dentist, oral surgeon, endodontist and periodontist. What started as a simple filling turned into six months of extractions, surgery, root canals, re-treated root canals and more surgery. I’ve discovered how nerve damage can affect ability to pronounce words, cause loss of taste and contribute to TMJ making it painful to chew food. But this post isn’t a tale of woe, nor a complaint against these professions.
I’ve had good care despite complications and, thankfully, I have dental insurance that has covered a major portion of the costs. But the experience has highlighted a health issue I’ve given little thought. How we pay for dental care needs reforming as badly as other segments of health care. But dentistry isn’t mentioned in the wider health care discussion perhaps because it’s not perceived as the cause of life-threatening conditions and, except in acute circumstances, it’s considered optional. But oral health is neither benign nor optional. It’s as important to quality of life as sound heart and lungs, and as directly connected through the circulatory system. Sometimes a toothache isn’t just a toothache.
Sitting in waiting rooms I’ve heard patients talk about health, work and money. They speak of working with pain or missing work. Their untreated problems are costly to businesses in lost productivity and effectiveness. And dental problems are equally costly to individuals. They contribute to other health problems, some of which have significant effects on individual health. They can lead to emotional reactions that affect attitudes on the job. And they are costly in lost wages.
In every waiting room I’ve heard patients negotiating how to pay for services, sometimes unsuccessfully. I’ve wondered about the woman with no dental insurance who needed endodontal services but couldn’t work out a payment plan and the student looking for a referral who would take a small insurance payment. What does one do when the problem doesn’t go away but the cost is prohibitive? Find a dental school clinic? Keep searching for another provider who will deal? Stock up on ibuprophen and self-treat the symptoms?
Probably all of the above, especially if you’re working and can’t spend the time doing this research and can’t get the money together to pay the upfront portion of a large bill. In every office I’ve visited, the first matter dealt with is ability to pay. Then the consulting and diagnosis begin. Receptionists are trained to make clear what the costs will be. It’s done with finesse in some places and heavy-handed clumsiness in others, but in all cases this is the first item of business. (pun intended)
After hearing many variations of the problem, I wonder how many patients dental professionals are carrying and writing off. While I don’t wonder why the receptionists are trained to screen for financial ability, nor why the dentists don’t want to discuss finances after the patient is in the chair, a couple of times I felt as if I were buying a used car.
“If we do option A it will cost $500. Option B will cost $1000. Any questions?”
I say, “No.”
But I’m thinking, “Whatever it takes to end this pain.”
“Sign here for option A, and here for option B.”
Monetizing medical procedures changes the relationship between patient and provider. It frames health and healing as a commercial relationship, which it is of course, but only in part. It is also a relationship of trust and compassion. One hopes for something more than a financial transaction, a modicum of personal touch and humanity, perhaps. I hope the person putting sharp objects in my mouth while I’m drugged is not only technically skilled but also compassionate and sensitive to my fears and concerns. Framing our exchange as a transaction from the outset puts this into question. It changes expectations, trust and, perhaps, results. I suspect it changes attitudes toward healing and followup.
Am I just old-fashioned and out of touch? Should we even attempt to change? And what would we change if we could? Well, that’s for another day. And I haven’t even begun with the time-consuming, wasteful, frustrating, incoherent maze we call insurance–dental insurance, health insurance, prescription drug coverage. But I’ll stop here. Just thinking about it reminds me I’ve got to take a pain pill.