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lack of trust in medical/dental profession

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  • #16
    Originally posted by Zaphod View Post
    There is unfortunately a certain amount of this in all practices and certainly some are more aggressive than others. The incentives can even grow insidiously over time. Radiation centers, imaging, etc..etc...not hard to find bad examples unfortunately.

    Partner was just complaining about his ortho buddy giving him an xray before a steroid shot, no idea of prior studies. Im always complaining about Moh's as I think its vastly overused, but not always due to pay, often things are overused because you think you're doing good or its simply what you know.
    I think the latter is much more of what goes on in dentistry. Sure there always crooks that recommend truly unnecessary work. But the much larger group are doctors practicing as they think best and as they were trained, which is dentistry is to be aggressive in prevention and treat every cavity, even though there is minimal evidence to support it.

    https://www.theatlantic.com/magazine...tistry/586039/

    Obviously in medicine we are guilty of this as well, as a Urologist at least 1/3 of the prostates we took out for cancer in the 90s/early 00s were for men we now wouldn't recommend surgery on. But for the most part, medicine has at least tried to march forward in obtaining evidence for what we do and prune the practices that aren't supported by evidence, which dentistry lags behind on.

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    • #17
      Everyone, is there really a need for yet another thread like this? My question about radiographs devolved into dentist bashing.

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      • #18
        It's not just dentistry. The money grab is everywhere... from the car mechanic to.. well... just everywhere.

        For example, in my own speciality, ophthalmology, I'm not a fan of multifocal intraocular lenses after cataract surgery and I doubt as many ophthalmologists would recommend them if they weren't paid for out-of-pocket (some ophtho's would disagree, however). And the "co-management" with optometrists is basically just legal kickbacks for referrals.

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        • #19
          Have issues with dentist and ortho too, lol.

          Ortho: Spouse had some wrist pain I said will probably get better with rest but ortho suggested injection which only made it worse and now may now need surgery.

          Dentist: I have periodontal issues. 3 dentists in past 5 yrs (due to moving around) have said everything from it being fine to needing surgery. Who knows.

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          • #20
            Yikes.

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            • #21
              Tried to schedule two outpatient procedures at the same time.
              Doctor said seems reasonable. The office scheduler came back and said needed two different dates, “insurance”.

              Dumb me, I thought it was safety. Two outpatient procedures. Insurance collections. Maybe I missed “collections”.

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              • #22
                Originally posted by Tim View Post
                Tried to schedule two outpatient procedures at the same time.
                Doctor said seems reasonable. The office scheduler came back and said needed two different dates, “insurance”.

                Dumb me, I thought it was safety. Two outpatient procedures. Insurance collections. Maybe I missed “collections”.
                I had a similar issue with a local dermatologist. I had a mole near my axilla that was large, dark, irregularly bordered, etc but also was really irritated from rubbing on my shirts so I wanted it removed. I called one office and told them I had a mole that I needed to have removed and would like an appointment for that. The scheduler asked me how I knew it needed to be removed and I told her because a) it was bothering me, and b) I am a physician and know it has some risky characteristics. She proceeded to tell me they wouldn’t do that and I needed an appointment to see if it needed to be removed before they would schedule me. I told her I wouldn’t be doing that and would find another dermatologist office who would.

                And I did, and the office turned out to be closer to my house. And then my wife and kids went to that office instead. And I’ve since referred anyone who asks about a dermatologist to this office instead of the other one.

                I think everyone needs a good accountant, attorney, mechanic, and dentist. My past few dentists (in two different states) have been people I go to church with. I trust them to do the right thing and make the correct treatment plans, and so far I feel good about my choices.

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                • #23
                  Originally posted by Lordosis View Post

                  They must go quite deep in order for it to cost that much :O
                  It ends up counting as a routine colonoscopy, too.

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                  • #24
                    Dentists I have found for insurance will rec what the insurance will pay. Had a great plan from.kaiser. got routine every 3months offered and x-rays q two years. I'm fine with what insurance pays for routine care. Prerequisites and doing additional...I have an issue.

                    Then again, I have an issue with routine ekgs and routine stress testing

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                    • #25
                      Originally posted by Tim View Post
                      Tried to schedule two outpatient procedures at the same time.
                      Doctor said seems reasonable. The office scheduler came back and said needed two different dates, “insurance”.

                      Dumb me, I thought it was safety. Two outpatient procedures. Insurance collections. Maybe I missed “collections”.
                      I have patients that I see regularly for treatments. Some insurances are now requiring an office visit between for documentation before they will authorize repeat treatment. Costs the patient time and money, gives us extra work, etc. Very infuriating.

                      There are also procedures that I can and cant do "together" at the same visit. Of course each additional procedure gets reimbursed at a 50% discount. That isnt always an issue, but sometimes theres only so much you can do. Sometimes its insurance, sometimes its medical

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                      • #26
                        I'm an endodontist and I had to get a deep cleaning a few years back after maintaining hygiene but not getting my teeth cleaned for about 5 years. It was the right call.

                        The best way to know what dentist to see is to ask a local dental specialist.

                        Patients are notoriously bad at knowing if they received quality dental care. Most referrals are based on pain control and general likability. Quality is unknowable to the patient.

                        Dentistry is the application of art and science. There is a lot of room for interpretation and disagreement between very honorable and educated people. Medicine is similar. Dental radiographs are the best way to examine teeth, but that doesn't make them particularly good.

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                        • #27
                          Originally posted by Bdoc View Post
                          First i will talk about my fellow MDs. Orthos have been the big culprit for myself and my friends. I know multiple experiences where myself and other people have gone to orthos with MRI results already done of either a shoulder or back for chronic pain and without even seeing the doctor, the office demands an xray. This is a complete money grab that even my non MD friends can identify and im honestly appalled. (one payed 300$ out of pocket for it bc he doesnt have insurance).
                          To reiterate what BruinBones said, the above is blatantly false. Xrays (especially weightbearing ones) often show much more clinically relevant info than an MRI does. And yes, you can refuse them if you want. We'll have less useful info to work with to help you. If you're ok with that, then we will be too. Spine flexion/extension xrays may show instability that an MRI would not for example.

                          I think primary care should refer to ortho before ever ordering an extremity MRI, we often don't need them. And the xrays are cheaper than an MRI. . .

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                          • #28
                            Worst IMO is PC sports med, at least in my neck of the woods. Routinely refer advanced arthritic knees in patients over the age of 65 with MRIs for meniscal tears. A referral from a PCP usually is just “knee pain”, with no imaging.

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                            • #29
                              Originally posted by Medstud21 View Post
                              Worst IMO is PC sports med, at least in my neck of the woods. Routinely refer advanced arthritic knees in patients over the age of 65 with MRIs for meniscal tears. A referral from a PCP usually is just “knee pain”, with no imaging.
                              Agreed. It would be more abnormal for a 65 y/o to not have a meniscal tear. But, but, but they also have a Baker’s cyst!!

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                              • #30
                                Originally posted by MaxPower View Post

                                Agreed. It would be more abnormal for a 65 y/o to not have a meniscal tear. But, but, but they also have a Baker’s cyst!!
                                I think my spouse has a torn meniscus. Her daughter an ortho sports med doc thinks so too. Of course, yours truly who knows absolutely nothing about medicine thinks she should get it fixed.

                                The doc says, fix it now, fix it later or fix it never. Those are the 3 options. I don't know if it is actually operative, haven't seen a thing other than you two quibble.
                                Knee surgeries are so cool now.

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