Why Some Patients Think Dentists “Over-diagnose”

I should start this article out with a disclaimer: I have a business background and education. I am not a dentist and therefore don’t have the qualifications to render clinical opinion(s) on how dental problems should or should not be diagnosed.

I have worked with the dental industry for over twenty years, and I’ve seen this issue of “overdiagnosis,” raised regularly throughout the course of my career.  Older folks like me might remember the 1997 Reader’s Digest article “How Honest are Dentists?” or its response by Dr. Levin in Dental Economics.  And for the younger crowd: Reader’s Digest used to be a well-read magazine – not a probiotic.

(Related: Are You Selling Yourself Short to Your Patients?)

In any event, rumblings of this issue can be found in any number of negative online reviews for dentists.  I’ve had the opportunity to read hundreds if not thousands of negative reviews for dentists as research for presentations on the subject at our Internet Marketing Seminar and MGE’s YouTube Channel as well as how to respond to them. Below is a playlist of videos on this topic:

Anecdotally, when I categorize what I’ve found in these reviews, what many find surprising is that issues relating to actual dental treatment rank low on the list of problems cited. Topping the list? A mix of treatment planning/presentation, customer service and financial (insurance) issues.

(Related: How Important is a 5-Star Rating on Google or Yelp?)

Which brings me to the subject of this article.

Like anything, if we discard the negative reviews that give the appearance of authorship by any number of internet “trolls,” we’re left with the real-life complaints of real-life dental patients. And to be clear, I’m not taking sides. Every situation is different, and I have no basis to judge on what actually happened in any of these instances as I was not present. But, if we use these “sensible” negative reviews as a window into the mindset of a disgruntled patient, specifically one lodging a complaint about the treatment planning/presentation process, we start to see a few things.

Generally, these reviews read something like this: “This place/doctor is a (scam, money hungry, etc.) I went in for a cleaning to see Dr. X and he/she told me that I needed $3,000 worth of treatment.”

And in some cases, this comment may be followed by how the patient “went back to my old (or another) dentist who told them that all they needed was a filling, etc.”

(Related: 5 Ways to Improve the Patient Experience)

So, what’s going on here?

While I’m not clinically qualified to weigh in on treatment planning, I can only assume that yes – there are some (a small fraction) of dentists that overdiagnose.  A simple Google search can provide you with real-life examples. And this is obviously not a good thing from any perspective or for the profession as a whole.

On the flip side, if I were to venture a guess based on my experience in the industry, I’d say that fa-a-a-a-a-r-r-r, fewer dentists “over-diagnose” than negative reviews or the various media outlets reporting on the matter would indicate.

The majority of dentists I’ve met are in my opinion:

• honorable people
• with a sincere desire to help others, and
• attempt to do their best in any given situation.

So, with that in mind, let’s circle back around. Why is “Patient A” walking out of “Dr. X’s” dental office and leaving a review that “Dr. X” recommend “$6,000 worth of treatment,” that they “didn’t need?”

(Related: Presenting Treatment with Confidence)

Let’s start with the assumption that Dr. X is a good person (as most dentists I know are) and saw a valid clinical reason that Patient A needed $6,000 in treatment. Well then, what happened?

In many cases – Dr. X failed on one or both of the following points:

1. Orienting the patient to WHY this treatment was a “need.” And
2. Changing the treatment plan in a failed effort to do “some treatment.”

Let’s play it out. And I’m keeping this simple for the sake of brevity.

Dr. X: (after exam) You need six crowns. (Patient discovers the cost).

Note that Dr. X has not in any way oriented the patient as to their mission – i.e. eradicate dental disease, restore health, function or aesthetics, and so on. Explained in a way the patient might have a chance as grasping. The patient just needs “six crowns.” Dr. X may explain the dental issues necessitating the need for six crowns (teeth broken down, decay, etc.), but does not orient the patient as to how this plays into the “big picture.” More on this later.

PATIENT: What will my insurance cover? Will it cover all six?

Dr. X: No, it will cover two this year (with a co-payment, etc.), two next year and so on. So, we can go ahead and get started on the first two crowns.

PATIENT: OK, well let me think about it.

Dr. X: All right, give us a call when you’re ready to schedule.

(Related: 7 Ways to Fill Openings in the Doctor’s Schedule)

Patient leaves. Wonders why they need so much treatment. They just came in to get their teeth cleaned. Discusses it with their spouse who agrees that something is amiss. Goes online and reads stories about dentists “over” diagnosing and leaves a bad review – not necessarily in that order.

And while each situation is different and I’ve “abbreviated” it a bit for the readers sake, I’m sure you’ve seen something like this play out in your office.

Let’s pick up on how this ran off the rails, beginning with the lack of “orientation” by the doctor.

(Related: 3 Ways to Improve New Patient Conversion)

A new patient walking into your office has an agenda. It might be to have their teeth cleaned, get out of pain, improve themselves cosmetically, maintain their dental health, etc. Once they arrive, they need to learn about where they have arrived and what it means. What is your office about? What is your mission as a dentist – specifically with your patient base? And how does the treatment you might recommend connect with this? Obviously, you’d address an emergency patient’s problem first, and then spend some time on this when they come back for their new patient initial exam.

This doesn’t have to be a lecture or even take all that long. But it’s a discussion that should be addressed.

If a patient has a clear-cut idea on the end-result you’re going for, they can then relate to the recommended treatment. If we’re shooting for restored health, function and aesthetic and I (as the patient) agree that this is a good idea, I can then relate to the “six crowns” as a “need” to achieve this end-result.

(Related: The “Right” Words to Use While Presenting Treatment)

And keep in mind when you’re explaining these concepts (health, function and aesthetic) to do so in non-medical terminology that is accessible to a patient. They are accountants, construction workers, executives, sales people, students, etc. Not dentists.

In our example above, Dr X didn’t do this. He/she met the patient, made small talk and recommended treatment. And Patient A could not relate it to a “need,” other than the doctor using the word “need.” Things went further sideways when financial/insurance issues arose.

Specifically, Dr. X told Patient A they “needed” six crowns. Patient A objected based on insurance coverage. Dr. X in an attempt to perform some treatment, quickly backed things down to “two crowns now, two next year, etc.”

(Related: 2 Rules for Improving Treatment Acceptance)

By handling it this way, what is Dr. X telling A? Well, to some degree the four crowns the doctor agreed to put off aren’t all that “important.” They can wait. Even though five minutes earlier the patient was informed they were a “need.” Dr. X shouldn’t be surprised when Patient A wonders how “important” it is to do the two crowns Dr. X proposed doing now.

Not exactly the best way to build a trusting relationship. Is it?

And keep in mind. Patient A is not a doctor. They don’t know why they need the treatment. For that matter, New York Times Personal Health Columnist Jane Brody said it best in her 2007 article “The Importance of Knowing What the Doctor is Talking About,” (emphasis added).

(Related: Big Cases: 10 Rules to Successfully Present Them – Part 1)

“How often have you left a doctor’s office wondering just what you were told about your health, or what exactly you were supposed to be doing to relieve or prevent a problem? If you are a typical patient, you remember less than half of what your doctor tries to explain.”

With these odds – retaining less than 50% of what your doctor tried to explain, you can see where the trouble starts.  So, as a non-dentist, Patient A doesn’t understand the clinical ramifications associated with their treatment plan.

But do you know what Patient A does understand?

Money. We all do.

(Related: How to Turn a Dental Price Shopper into a Keeper)

Unable to associate the need of treatment with cost or any other number of factors, Patient A decides that “Dr. X is after his/her money,” and is “Diagnosing treatment that they don’t need,” leaves a bad review and so on.

Lost in all this? Dr. X recommended treatment that Patient A (from Dr. X’s trained clinical perspective) truly needed.  Only to end up manufacturing the false impression that he/she was “over-diagnosing.”

So, what’s the solution?

1. Make sure ALL of your patients (and staff) are educated on the overall mission of your practice. What’s the goal? What are you attempting to achieve with your patients and how does this play into the treatment you might recommend?
2. Refine your treatment presentation process. This should be a real discussion – not a quick on-off diagnosis and hope the patient accepts. Oral health affects longevity and cardiovascular health. We’re not talking about buying a new TV or car. We’re discussing someone’s health and quality of life. Treat it as such.  You don’t have to badger people. Instead dedicate adequate time answer questions, address concerns and overall – make sure the patient truly understands what it is they need and why – including why it costs what it does.  And there will of course be times where patients don’t accept full treatment – and you’ll have to do it in phases – in these instances make sure the patient understands EVERYTHING including WHY you’re not doing it all now. To make this work, the doctor and whomever does financial arrangements need to be highly skilled communicators.  You may need training on the subject.  That’s why one of the first courses an MGE client will take is the MGE Communication and Sales Seminars for the Professional.  It’s really a class in how to effectively communicate with your patients so that they want what they need.

The upshot of all of this? If I were to commission a thorough survey to find out what “really happened” between doctors and patients leaving “over-diagnosis” reviews, I’d bet my car that “poor communication” would come up as a major culprit.

Don’t take this lightly – you’re in the people business – you need to be good with people! With that said, I highly suggest attending the MGE Communication and Sales Seminars. Fill out the form on this page and an MGE team member will contact you with more information.

Hope this helps! And if you have any feedback or comments feel free to email me at jeff@mgeonline.com.