I thoroughly enjoyed your editorial in May JADA, "The Noble Lie." How scary it is to think that almost half of physicians would lie to get pain medications for their terminally ill patients. Inference tells me that this is something that physicians have to do occasionally in their practices to help their dying patients cope with extreme pain.
In your article, you say that we as dentists are lucky that we do not have to deceive insurance companies yet, but I must say that I feel the pressure to do that almost daily—especially in trying to control what you might lump into a generic category of "occlusal disease," trying to get bite splints approved to save patients’ dentition and for temporomandibular disorders, or TMD.
Only recently have I begun the journey with Dr. Pete Dawson to really understand and treat occlusal problems (I admittedly have a long way to go before I am competent). I can see the future, and I will most likely have to divorce myself from insurance companies to provide almost any restorative treatment if I am to go through the process of finding true centric relation, or CR: taking models and mounting them in CR to determine the exact relationship of their maximum inter-cuspidation with true CR and then doing the necessary occlusal adjustment to make these coincide before restoration even begins. And this is just for those who do not have any joint pathology. Certainly no insurance company is going to pay for all of the diagnostic time needed.
As I see it, and I realize I may be wrong and change my mind later, it will be easier to keep my relationships with my patients intact, keeping only their specific situations and solutions in mind and having that direct me as to what is needed, by not having any insurance company between us breaking down that relationship. That relationship, which really is their confidence in me, has to be as pure as possible to reach the goal of lifetime occlusal (and TMJ and muscle) harmony and absence of pain.
The quote at the top of your article is so disturbing that I cannot fully describe the fear for my own well-being, as well as the disgust I feel for insurance companies in general or the medical profession for climbing into bed with them.
I will be interested in what the survey by the Rand Corp. says about how patients feel about fee for service. My gut feeling is that in the future there will be two levels of dental service available to patients in the United States: those dentists who let the insurance companies call the shots and provide "patch ’em up"-type services, and those who provide comprehensive, lifetime-lasting services.
For me, the second would be more personally rewarding from an emotional and psychological perspective, and that is why after practicing for 22 years, I am becoming a serious student again.
When my practice outlives me, quality of service and the tight personal relationships with patients are the legacy I hope my practice displays as to what kind of man I was. It may be old-fashioned to care for my patients’ well-being and do nothing but individualized services for them, but that is just the way I am.
Thank you for the article and thanks for "listening."
