What Makes Us Human…The Power of Choice


By Barry F. Polansky, DMD


When Will Dental Patients Wake Up to Their Freedom of Choice?


Harry was in today. He’s been a long time patient who will now leave the practice to go to an HMO—so I invoked my right to take a risk of insulting him to tell him my truth. I don’t know if my truth is the truth—but it certainly is the dentist’s perspective.


I breed and show boxers, so I used the analogy of training dogs. Where dogs follow food, people follow money. Government and corporations see humans as commodities. They manipulate people for their own purposes. They don’t even talk a good game.


Although I must train my dogs to behave, I love them and would never do anything to hurt them. To train them, I manipulate them with food treats. But, people are not dogs, and they shouldn’t be “trained” and “handled” like dogs.


People, unlike dogs, have a shield–a protection. It is called their “freedom of choice.” It’s just amazing how many people forget to use it and follow the money… like so many food treats.


The truth is that it is very difficult to conduct a comprehensive exam, take appropriate records and X-rays and provide all needed treatment for the fee that is provided by the insurer. Dentists decide to either lose money or reduce services and limit treatment options to keep from losing money.


I told Harry, “I won’t be here in fifty years but if I come back, I imagine I will see pastures of sheep that have given up their freedom of choice.” It bothered me that he was allowing his HMO choice to determine his health options. He was giving up his freedom of choice, his dentist of MANY years, and what I KNOW to be better oral health care by “following the money.”


I know it sounds like a hard thing to say to a patient, but in the wake of Jonathan Gruber suggesting that the “stupidity of the American voter” contributed to the passing of the Affordable Care Act and the obvious manipulation of the American people and Congress, can you blame me? I had to take this moment to educate my patient, even if he is leaving me.


Why do people allow themselves to be manipulated? People don’t exercise their freedom of choice because they are busy and because no one explains the issues to them. Double talk can be very confusing to them. (Gruber said the public is stupid. I’m not so sure of that. Maybe people are too busy, too distracted…or, it seems, too trusting in their government and its experts.)


I discussed the incursion of HMO philosophy on dentistry at length in my 2003 book, The Art of the Examination. Insurance companies and managed care companies essentially see all patients alike. They are units of production in a dental insurance factory to be handled cost effectively as they move through various treatments.


What seemed like a good idea at one time has turned into a giant monster that has taken over healthcare in America. I wrote back in 2003 that third parties have helped to “mutate” healthcare in a number of ways. (1) They place a higher premium on technology than listening to patients. (2) They are indifferent to prevention and the promotion of health. (3) They see people as body parts and not whole persons. I’ve said it before, and I’ll say it again, to treat people properly, we must maintain a set of values.


For me, the only thing that counts is the doctor-patient relationship. It’s why I practice dentistry. I enjoy understanding and treating the whole person to prevent oral disease and promote health. I don’t view the mouth as individual teeth to be treated, but rather, an entire complex system of interrelated parts, chemistry, and physical forces that are affected by the health, behaviors, emotions, and thoughts of the patient. An HMO dental plan doesn’t value what I value most.


A recent phone call to a colleague has greatly heightened my awareness of patient migration to what they view as “greener” dentistry. Here’s the fee-for-service dentist’s point of view (although, I figure no one but other dentists are likely to empathize with this story). The bottom line is that my colleague lost more than half of his practice in Washington, D.C. because the World Bank, his main source of patients, went PPO. What’s he to do? He’s spent 25 years building a loyal fan base…what had been a loyal tribe. Now most are gone. Replacing the patients in D.C. is near impossible because most of the population is composed of government employees…people with PPOs. He refuses to join the PPO train and be tied to its limitations and the culture of care it instills.


Most dentists and psychologists can understand this position, regardless of what the lay public believes and corporations prescribe he should do. I empathize…I understand. Work is important. And, when one’s quality of care IS one’s WHY to work…need I say more?


Now let’s turn back to the dogs. If we keep treating people like dogs, we will wind up with puppy mills…factories. That is why our founding fathers protected our freedom of choice.


From the dentist’s perspective, there are three rules we wish every patient would take to heart:


  1. No one cares more about your health than you.


  1. You must be your own advocate for your healthcare.


  1. There is nothing more important in your healthcare than the doctor-patient relationship.


It’s the doctor-patient relationship that ensures the doctor understands the patient’s circumstances well, will become the patient’s co-advocate for healthcare, and will invest everything possible of herself or himself to give the patient the needed time and care. Fortunately for me, over the years, many patients who have “followed the money” and gone to HMO care, have returned after a period of months or years, seeking better dentistry and to reestablish the doctor-patient relationship we had.


The good news is that it has been estimated that 75% of people buy on price and 25% buy on quality. Since only a few dentists are focused on providing comprehensive, optimal dentistry, that leaves a great opportunity for those who do. And so, I suggest patients will wake up to their freedom of choice when we dentists take the time to educate our patients, not only about their health, but also about the economics of health as well. We need to find the words to present the truth and never insinuate they are stupid.


As Harry left me today, I hoped he would be alert to observe the difference between my comprehensive approach and his future HMO experience. My door is always open for his return.




Commentary by Amol Nirgudkar, CEO of Dentist Profit Systems, LLC


Barry is absolutely right about businesses and government engaging in manipulations to “fool” their customers into believing that “you can have your cake and eat it too.” All of us intuitively and empirically know that the idiom is false. Nevertheless, we are tempted by manipulations like discounts and sales, because they trigger the release of dopamine within our brains, and dopamine gives us a temporary high and a feeling of accomplishment.


Price is the ultimate sales manipulation tactic that works like magic, especially during the holiday season. Throngs of customers line up on Black Friday and Cyber Monday to buy things they absolutely do not need, but buying them makes customers feel elated (at least temporarily). The case of a patient choosing HMO dentistry is no different than a crazed shopper looking for the ultimate bargain. Both are “junkies” hunting for a cheap thrill, and the price manipulation makes it an easy decision.


Money, despite its inherent limitations, has immense power to make people temporarily happy. Just do what feels right in the moment and kick the can down the road is a mantra most of us find hard to resist. Our politicians have mastered this art. We are suckered into voting for the wrong candidates because they simply give us what we want to hear. Therein lies the problem.


Healthcare is extremely complex because of the inherent information and knowledge asymmetry between providers and patients. I simply do not know for sure whether my dentist did a great job or not without seeking another dentist’s opinion or waiting to see if problems arise where I need retreatment or new, more expensive treatment.


Most times, human intuition about better and best isn’t strong enough to overcome the temptation for a discount. It takes analytical thinking to move beyond the temptation, and that takes energy. Most humans, given a choice, will choose something easy over something hard, and the HMO discount seems like the obviously easy choice to make—given the complexity of health factors and healthcare choices.


“Healthcare for all” was an easy concept to accept and most of those who didn’t oppose the Affordable Care Act didn’t have the time or the desire to tax their brains in understanding the true long-term cost of the gargantuan law. As a result, patients today are suffering from higher costs and diminished access to care and accepting a new culture of healthcare that isn’t in their personal best interest.


The crisis in decision-making is not restricted to healthcare alone, but since health directly affects our lives, it is important for us to pay attention and wise-up. As Barry says, if we don’t take care of our own health, no one else will, and unfortunately excuses and hindsight will not fix us for the better.


If we, as people — not dogs, could forsake our desire to satisfy our short-term cravings in the interest of long-term benefits, we could make tremendous strides in creating healthy and fruitful lives.