Patient Mistreatment In The Name Of Quality Care

Why I am finding a new dentist
By Marc Braman, MD
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What am I feeling? Anger? Resentment? Frustration? De-valued? Dehumanized? All of the above?  

They wouldn’t treat me at the dental office where I and my family have gone for years because I wished to exercise some reasonable autonomy regarding my care. So I am out — per their protocol.

It was a lot of work, juggling schedules, back and forth calls, rescheduling my own patients, rescheduling with the dental office. We had finally found that we could mesh schedules today at noon. I had wrapped up my last morning patient’s visit, and dashed to the dental office. I couldn’t help but notice the nice new Mercedes SUV in a premium parking slot, and then a sleek, shiny black Maserati sedan parked even more away from the ordinary cars. Which one belonged to my dentist?, I wondered. I nearly ran up the stairs from the parking garage to the level of the dental office, arriving at 12:02.  

After a short wait I was escorted by the hygienist seeing me today to a treatment room. She welcomed me to make myself comfortable and I placed my laptop bag on the corner chair and slid into the treatment chair. She efficiently verbally walked through what they were going to do for me today: cleaning and x-rays. There was no ask, no discussion, no request for permission. It was statement of fact.

Now, you have to understand. I have been going to this dental office for at least 5 years. It took some doing to convince them to let me do annual dental cleanings instead of every 6 months. But they couldn’t argue when my teeth were doing so well, and the cleanings needed were so minimal, even at one year. (I am a health nut. I eat a whole plant food based diet. My teeth are happy!) Every year they try to twist my arm into getting x-rays, but when I ask to please help me understand the reason these are necessary in my situation, I have never been given anything but a lame “protocol” kind of answer.  I do recall last year, the dentist sounding particularly ominous about x-rays the next time around, despite having just poked around on my teeth and finding nothing for the umpteenth year in a row.

I politely conveyed to the hygienist that I wished to pass on the x-rays. She explained that they would not be able to provide service to me if I did not do the x-rays. I asked if she could help me understand why I couldn’t have my teeth cleaned without x-rays. She said something about the doctor didn’t think they could offer a “quality service” without them. It had been 5 years since my last dental x-rays.  I had never been seen by her before, though she had my chart in her hands. There was no consideration about the state of my dental health, it was pure protocol. And I had hit the limit of their protocol. Wow! All that work and effort to get here, and then this.  

I declined to proceed with care and she politely and very efficiently directed me toward the front desk to “settle up my account”. After waiting for about 5 minutes for the receptionist to finish her phone call and help someone else, she asked what was happening. I let her know that I couldn’t get my teeth cleaned in light of declining x-rays today. She looked things up and verified that I had last had x-rays 5 years prior. She knew the protocol. She asked if I wished to continue care there and I politely declined.

No, I didn’t try to pull the doctor card or talk to the dentist personally. I don’t want any special treatment. I just want quality care as a responsible, thinking human being.

Now, I am not opposed to dental x-rays when they make sense and I choose to do them. But I could see no good clinical indication for them at this point, and I am pinching pennies to get this patient advocacy organization off the ground. I am not an anti-vaxxer, or into conspiracy theories.  And I do understand medical standards, guidelines, and practice issues more than most in healthcare. Bottom line: protocols over patients is wrong. I will not participate in it. I will not support it with my business.

It would be easy, in the midst of feeling so de-humanized, to start speculating about the office not making enough money off of me per protocol so I get the boot. They are obviously doing very well and are very comfortable with the processes that are working for them. But things are more complex than that. And the fundamental problem is that patients have had no voice for so long that this is normal. It is normal that care revolves around protocols and processes that work for those who control them, instead of around patients (who obviously don’t control them).

I had looked at the data — the science — on dental x-rays. I understood the pros and cons. I knew my mouth and health better than they did.  I had taken responsibility for managing my teeth. I was doing so very well. I probably would do x-rays in the next year or two just for good measure. But I was punished for managing my health well and making well informed healthcare decisions that worked for me. And we wonder what is wrong with our paternalistic healthcare non-system. Protocols, managed by those with primary interests other than the patient, will never make for a sustainable, quality healthcare system, no matter how vigorously we in healthcare impose them.

The good news for the moment is that I really don’t need the dentist, or even a teeth cleaning. I can’t find even a speck of tartar with my tongue (I LOVE living well!). I was only doing the cleaning because I was just trying to be a good patient and be responsible with prevention. The bad news is that now my family and I have to try to find another dentist, and one that will treat patients over protocols in a system that is still so profoundly broken, expensive, and grossly ineffective.

The REALLY good news is that we are building an organization to enable patients to take ownership of their health and how healthcare works for them. (And I just saved hundreds of dollars cash for now that will help in that process. No unnecessary protocol payments for Maseratis today. ;) )