Brisky study by the University of Zurich
On behalf of the ETH Zurich, a young medical student visited exactly 180 dentists' practices in the greater Zurich area. The special thing was: at half of the appointments, he appeared as a well-groomed, success radiating man in a noble suit and equipped with accessories, such as expensive smartphones, which symbolised status. He told the doctors that he was a translator at a bank. During other visits to the doctor's office, he would shuffle up to the treatment chair in jeans and a hooded sweatshirt and pretend to be a translation student on an internship.
A second test criterion of the scientific experiment was: Both as a smart translator and as a casual student, the man said at every second appointment that he had already published an existing X-ray on an internet medical portal - with the request for diagnosis by other users or experts.
Overtreatment is readily recommendedWhat the field test brought to light: almost every third dentist visited (over 32 percent) recommended over-treatment to the test person, i.e. an additional and unnecessary treatment, which of course causes additional costs. This confirms the feeling of many patients that they - as laypeople - are quite helplessly "at the mercy" of a dentist. A circumstance that admittedly also affects other branches of medicine.
To explain: Four reference dentists had examined the test patient before and after the study and found only a superficial caries lesion. Professional tooth cleaning followed by sealing and advice for better oral hygiene with thorough brushing would have been the first choice. The recommendation for one or more fillings, which many of the dentists in the check wanted to implement, is therefore clearly rated as "unnecessary overtreatment" by the authors of the study.
The patient was suggested fillings on 13 different teeth. The average cost of each treatment would have been CHF 535, with a median of CHF 444. One dentist played particularly high poker, wanting to charge for two fillings for 1,750 CHF.
Curiosity: Over-treatment more recommended to the "normal"Interesting question: to whom is the dentist more likely to recommend over-treatment? The suit-wearing guy or the regular guy in the hoodie? If one would expect higher socio-economic status to be combined with more turnover, one would be wrong. In the study, the student was more often advised to have more extensive dental treatment than the professional translator. The study authors can only speculate about this remarkable fact.
Conclusion: The patient with higher socio-economic status and education was less often offered over-treatment (in only 26.67 percent instead of 37.78 percent of the cases). Another interesting observation, however, is that the test dentists who did not offer overtreatment made the patient wait an average of 9.8 days for an appointment - for the others who had the extra turnover in mind, it was only 6.2 days. Thus, a practice's occupancy rate has a noticeable impact on the type of treatment it provides.
Overtreatment is by no means harmlessIt is not a harmless rip-off when patients are recommended unnecessary procedures. Even the first drilling of a tooth can start the so-called death spiral, because a crown margin is almost never "bacteria-proof": caries bacteria eat their way under this first filling, a larger one follows, caries again, drilling again, always more healthy tooth substance is lost. The vicious circle ends - usually after a few years, sometimes only after decades - with dental crowns, root canals and often with tooth loss. With bridges, two neighbouring teeth can be additionally destroyed because they are ground down. The risk of root damage increases to ten percent.
The problem is not newMargrit Kessler, President of the Patient Protection Foundation was not surprised: "It is well known that dentists are far too quick to carry out expensive treatments that are not necessary. The perfidious thing is that many people don't realise it."
How to evaluate your own dentist's diagnosis?Having confidence and believing in something are two sides of the same coin, you don't know. If you want to be sure, the only option is to get a well-founded second opinion from another dentist - which health insurers also demand and pay for.
The discussion paper in the original: "Health Services as Credence Goods: A Field Experiment"
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