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Letters: Creative diagnosis and ethics

April 07, 2014

I have been reading the letters regarding what has been termed "creative diagnosis" with great interest. It is obvious that this is a gray area. I would like to voice my opinion on this issue, as I have seen numerous examples of this in my 29 years of practice.

First off, let's address the practice management gurus who tell you that you need to set monthly practice goals and that you should offer bonuses to your employees when these goals are met. My problem with this is that, unless you have an unlimited number of new patients on a monthly basis, how do you achieve these goals? I know of some offices whose goal is "two a days," meaning two crowns every day. Or every adult patient needs scaling and root planing. The only way I can see this happening is by selling unnecessary dentistry to the patient that trusts you and will do as recommended. The staff is rewarded for pushing these things so they get on board and push things even before you see the patient. Are they capable of diagnosis?

My degree is doctor of dental surgery; as such, it is my job to ADVISE patients of necessary dental treatment to achieve a healthy oral environment. I am not a salesman so I do not have to sell anything to my patients. If, after my advisement, the patient chooses to not have the treatment, so be it, I've done my job.

I'm aware that many new dentists come out of school with major debt but does that justify creative diagnosis to make the bills? How about the ones that build million dollar buildings? I think not.

My mantra in my office is, if you wouldn't recommend it to your mother, then don't recommend it to your patients. I have made a very good living practicing in an ethical manner and I sleep well at night. My opinion is that if it ain't broke, don't fix it. I do not think it is ethical to take a camera and magnify a faulty amalgam 10 times to show a patient that it has a slight flaw at the margin and needs replacement when it is functional as is. In my opinion, the only use of cameras is to sell unnecessary dentistry. I am in total disappointment with our profession as we close our eyes on this problem and just allow it to continue. Someone needs to stand up and stop this blatant violation of trust.

Matthew L. Logan, D.D.S.
Brooklyn, Mich.