By Andrea Shepperson - 5 Aug 2011
- 1 comment
So the champion of consumer rights, Mr Kevin Milne, is suggesting that the public should seek services from a dentist before acknowledging that they don't have the funds and "force a flexible response" from the dentist. Now that was responsible! The suggestion is tantamount to fraud or theft. Remind me to shop at the supermarket this weekend, load my trolley and plead poverty, blocking the checkout and refusing to move until the supermarket offers a "flexible response". We all know where that would lead.
So the media frenzy started, everyone booked their dental
holidays to Thailand (see my earlier blog on this subject) and the
anti-dentist hate mail became venomous.
I loved the comment from one Herald reader called Chris who
wrote ...
"Dentists are a complete
disgrace and a clear indication of where we as a society and (sic)
gone wrong. These people who are responsible for our health should
not be doing it for personal profit, which they do."
So dentists became the whipping board, responsible for the state
of the nation, and we are expected to work for nothing. My
staff would love that - Well guys, no salary this week, sorry.
Chris thinks we shouldn't work for profit, so there is none
and you can't get paid. But you're healthcare workers and
society expects that of you - charity work. Ignore the fact
that you're educated, committed, hard working, skilled individuals
who speak English. Or that you understand the concepts of
infection control. It doesn't matter that we all pay taxes in
New Zealand to subsidize free dentistry for Kiwi kids and publicly
available medicine and hospital care for all.
Chris clearly feels that we are responsible for his dental
health. I agree I am responsible for delivering a high
standard of care and meeting my statutory and ethical obligations
but I don't hold anyone's toothbrush, I don't put food in their
mouth, I don't have control over their decisions to spend in some
areas and not in others, or to prioritise their healthcare
spending. That's abdicating responsibility for your own
health and it really is in the patient's hands.
Dental decay and gum disease are bacterial infections.
Control the infection and you don't get the disease.
Simple. Smoke - expect some problems. Drink soft
drinks and eat acid and sugar - you'll get cavities. But New
Zealanders like Chris don't understand or won't own that
concept and I'm sorry if no one in dentistry has ever passed that
message on. If most patients took ownership of that problem,
they might spend less anually than they do at the hairdresser or
pub.
In the last week I've seen several patients who have visited me
for over 20 years. For quite a number of years I see them
annually, they see our hygienist twice a year and there is nothing
to do apart from reviewing their disease patterns and progress and
scaling their teeth. That gives me an enormous amount of
satisfaction. I don't like destroying their teeth; I would
much rather help to save their teeth. Their annual
maintenance costs would be less than $700 per annum. They're
smart but not necessarily wealthy people who valued their teeth 20
years ago, chose a provider who was wellness-focused and helped
them understand the things they can do for themselves to prevent
dental disease.
Did they have some expenditure over the years? Yes, of
course. They are baby boomers, children of the amalgam
universe, with heavily filled teeth that needed strengthening with
porcelain and gold. We provided that treatment in stages,
often over a period of years and funded tooth by tooth, whilst
maintaining a focus on prevention of disease.
Dentistry is expensive ...compared to what?
Cigarettes, alcohol, X-box, Sky subscriptions, new shoes, cars.
No - it's just that many Kiwis don't prioritise oral health
prevention and don't budget for it as part of necessary
spending.
Preventative dentistry isn't really that expensive. A
visit to the hygienist costs about the same as a cut and colour for
most women at the hairdresser. Reparative dentistry (who
owns the cavity here) is inevitably more costly but think about
that for a minute...a porcelain restoration costs anything from
$1400 - $1850 depending on the type, locality and dentist
delivering the care. Most dentists put that restoration in
with care and dedication, to a high clinical standard and feel
comfortable telling their patients that they could expect it to
last 10 years or longer in a well maintained mouth.
Your tooth is going to drive the equivalent of 400,000 km over
that time as it chews, talks, helps you stay young and healthy
because you can eat good food. What else can you buy for $1500 that
will last you 10 years - not a TV, nor a computer, or a car.
Your car depreciates and needs maintenance, your computer and
TV are out of date in 3 years.
A jug of beer at the local will cost $10. Three of those
each night on a Thursday/Friday/Saturday and you've spent
nearly $100 a week. You've probably got an alcohol problem
with that sort of consumption and hopefully you aren't
driving but add it up - 40 weeks a year and you've spent $4000.
That will buy 2 crowns, 2 hygiene visits and a filling.
And pets.... registration, food, vet bills, vaccinations - more
than a dental hygienist will cost annually.
What about subsidised care - sure...you can have subsidised
dental care if you're prepared to pay more tax. But the
problem with any government funded care is that the benchmark for
standard of care is pretty basic (unless you want to pay lots more
tax). That's likely to attract dentists who are benevolent
sorts but not always the best or most experienced clinicians.
Ask any dentist familiar with models such as the UK's NHS -
the only way to deliver dentistry cheaply is to pay the dentist
very little (you get what you pay for), design a reward
system for dentists that means you push it through fast with a
commensurate drop in standards or deliver the simplest form of care
- usually an extraction ahead of anything more complicated.
We have choices in life....
If you've got a sore tooth I can pull it out - the simple cheap
option for about $300. Expensive! Well.... my
$50,000 receptionist will take your phone call and fit you in
quickly to my spare $80,000 surgery because you're in pain.
I'm assuming you found us on the Internet Yellow Pages after
our $3000 ad placement. I'll take my $400,000 education and
diagnose your problem, talking with you in English and know about
that new medication you're taking as a blood thinner because the
Dental Council requires me to be up to date. I'll use my
$250 forceps. Not to mention my $900 Dental Council Registration
fee just to reassure you I'm a properly licensed dentist, my
$400 xray license and my $50,000 xray machine to check that I'm not
going to leave you permanently numb after tearing your nerve
because your tooth root is wrapped around it. And it would be
good to have a $50,000 dental assistant to help out so you don't
have to suction your own blood because I've only got 2 hands.
Remember she's trained to sterilise those forceps in a
$10,000 autoclave so you don't contract hepatitis from inadequately
sterilised instruments. How much would you like to pay?
Oh, but you want me to save it with my high tech root canal
equipment, my nickel titanium files in my $3000 handpiece (this is
not a $200 Dremmel from Bunnings afterall), my modern resin sealers
and then use my $200,000 camera and CAD milling equipment to make
you a nice white crown that looks like a real tooth. Sure.
Expect to pay a little more.
And you want me to provide assurances that it will last -
absolutely happy to. Expect to pay a little more again
because I have just spent $200,000 gaining advanced continuing
education from one of the worlds best teachers in America, read
dental articles in my spare time to stay right up to date, bring
the latest research and developments to you for your health benefit
so you can protect your teeth and spend less on them. And
probably avoid anymore root canals if you implement our recommended
prevention programme. I will, in fact, save you money over
your lifetime.
Remember you don't have to come to me. You have a
choice!
I agree that if you're a family on one income it's tough in New
Zealand purchasing anything, even essential items. My advice
is to find out the best way to care for your teeth, the best
products to use and ask your dentist how to stagger care to manage
reparative work in a cost effective way. Dentistry offers a
wide range of materials these days - quick, cost effective
solutions to get you out of trouble in the short term so that you
can budget for better dentistry when your circumstances change.
These days most dentists are flexible in timing, funding and
prioritising of care but we'd like to be advised of your need for
that before we do the treatment please! My own office, part
of the Lumino Group of nationwide practices, offers 18 months
interest free terms periodically to help patients purchase needed
reconstruction. Hospitals provide basic relief of pain for
little cost and the community trusts often employ dentists in rural
communities to provide basic services. WINZ will provide
advances for urgent care that can be repaid over time and ACC will
co-fund repairs from accidents.
Yes, this has been a somewhat cynical diatribe in response to Mr
Milnes comments. I'm a passionate believer in the
standard of dentistry that NZ offers, I'm a self-confessed dental
geek and I love my work and my patients. Nothing gives
me more pleasure than doing no reparative dentistry in a disease
free mouth and knowing that I have helped my patients get
there.
There's not a week that goes by that we (the dentists of NZ)
don't get emails from Australia offering us jobs with pot loads
(and I mean potloads more than we earn here) of money. Most
NZ dentists are talented, hard working, caring, reasonable health
professionals who stay passionately in touch with the things that
can help you - the patient.
Talk to them, seek their advice and expertise and keep their
skill in New Zealand. Asian dental holidays - all I can say
is buyer beware.