A journalist with Reader's Digest famously visited 50 dentists in 50 states and received WILDLY different diagnoses for... the same mouth, ranging from essentially "you have a single cavity you should get filled" to "you need 21 crowns for $30,000", and this was back in 1997:
I remember in the 90's a Swedish TV consumer rights show did the same thing with the same conclusion. And there was no correlation with if the dentist was a public health or private dentist, it was just a variation in their judgement rather than a "we want to make money" type of scam.
How can you have this widely different amount of cavities based on judgement? How are they not snake oil salesmen, if judgement makes the diagnosis different by magnitudes?
A cavity is just a hole or groove of various depth. It's probably less that one dentist sees a cavity and the other sees nothing and more that one dentist sees a cavity worth addressing the the other sees the beginning of a cavity that they figure will need to be addressed eventually, but there's not a major reason to do it now rather than next year or the year after that.
Also, I imagine some dentists might decide for their patients benefit (as long as there's no pain reported) to let a couple develop to a level is there's a few in various stages of development, so they can do them all at once with a single procedure.
I don't know how likely or accurate those are, but those are some of the obvious ways that came to mind that dentists might be seeing the same thing and suggesting different actions that don't boil down to them wanting to fleece a customer.
My dentist shows me the xray they take once every 5 years. Then they walk me through what a cavity would look like. Then they show me that i have none.
I can understand that the external "poke at it" method requires some judgment, but an xray shouldn't have that much variance.
That's why I also go get a "poke around and look" checkup every year. The X-ray is to spot deeper things, but you can't do that every year without the x-rays becoming a risk factor themselves.
In the United States, it is routine to get your mouth X-Ray’ed every 6 months when you go in for a cleaning. Dental plans include these checkups at no extra charge.
That's what I was led to believe by my dentist when I asked. I just checked danish national guidance, and they say the dose of x-rays is so low the increased risk is incalculable. Instead they say the dentist should only ever use an x-ray if they find it medically necessary out of a principle of minimization.
So it sounds like it's the individual dentists judgment, and their organizing body says that they base it on the occurrence of dental problems in the population the clinics they oversee, with some adjustments based on patient age and risk factors.
So according to Danish authorities, you should be safe getting x-ray'ed every 6 months. They just don't recommend it, since it's a waste.
Yet you are probably in the 90% of developers who cannot estimate properly.
I would like to have a professional judgement closer to how it's done in statics, instead of developers, since you fuck up lives directly with one, and usually not with the other one.
If you ask software development companies, plumbers, builders or lawyers to give an estimate of what some work might cost you'll probably get similar variations?
But that's more a matter of pricing. Not the basic parameters of the job.
Building a wall of known size takes X bricks, Y windows, etc. Contractor 1 might have more markup or estimate different hours to complete the job vs contractor 2 but the parameters of the job are relatively fixed.
The dentist is seeing the same mouth (wall) and telling you there is vastly different numbers of cavities (bricks/windows). And not off by a small margin, but orders of magnitude.
At least software development and laywering has 100s of parameters that can influence some work, even when the requirements are well specified ahead (and those almost always change later, or meet some changed reality).
Tell me you haven't worked in the trades without saying you haven't worked in the trades.
The older the building, the higher the chances stuff will go seriously, sometimes catastrophically with no chance of recovery, wrong. Say for the plumber, according to the plans or the knowledge of the building owner, there should be no more lead pipes left in the building. Lo and behold, you open the wall, and find a lead pipe still under pressure, and next to it a tap to somewhere else that doesn't show up on any plan.
Endboss is if you find asbestos. That turns a jobsite worth a week of work instantly into a hazmat site plus immediate concerns for OSHA aspects.
Or for electricians, the plan was to rip out the entire electrical work in an apartment, and you suddenly find out that half the rooms of the neighbor next to you suddenly don't have lights any more because for some unknown reason half of his apartment actually runs via your client's apartment and no one ever noticed. (In this case it turns out that decades ago, this was one giant apartment that was split as part of a divorce proceeding and then sold off separately)
You're describing the same plumber/electrician changing their estimate after getting more information. That's nearly the opposite of the dentist situation, where it's different dentists giving different estimates with the same information.
> Tell me you haven't worked in the trades without saying you haven't worked in the trades.
Tell me you missed the point without telling me you've missed the point.
Plumbers can give widely different estimates for the SAME job, with the same knowledge (initial or after finding out about all the asbestors, strange piping, and other issues).
Some plan for random bullshit beforehand, some milk you for each and every problem or change request, and some just mark up a "make it worth my time", e.g. if your installation is many decades old and they actually don't want the job or at least get comped very well for their trouble.
> it was just a variation in their judgement rather than a "we want to make money" type of scam.
Sure. I mean, dentists, unlike every other human, are not interested in making money, and would not abuse their position to give incorrect information that is in their benefit. /s
I had a dentist who preferred to see patients each 12 months for a relatively cheap routine check while avoiding doing anything if something was discovered during the check if that could wait. She fixed a minor cavity for me like after 4 years of checks. At some point she stopped accepting new patients because she had too many of them.
That's why I mentioned there was no difference seen with public health dentists. They are on a salary paid by the government and have a huge backlog, they have zero incentive to do more treatment than absolutely necessary.
Parent already covered dentists who are not making money by the widely differing diagoses, because they work for a set salary for non-for-profit government health coverage, and yet still do that.
Call me crazy, but it’s almost like incentives to make money rather than good patient outcomes may just lead to a whole bunch of unnecessary treatments.
As a European, I can assure you we have the same problem. Healthcare providers still get payed by the insurance for the work they do, so there’s both an incentive to bill them for as much as possible and also to upsell special premium services the insurance won’t cover for, like better filling materials, invisible aligners, these kinds of things. As a layman, of course you never know if what they are offering you is really the right way, and asking different doctors for their opinion can also lead to wildly different diagnoses.
Perversely though, there is another incentive for doctors to spend as little time as possible with each patient, because they need to justify all time spent and procedures done to the insurance, which is naturally suspicious of the provider to overbill. Thus, they require tons of documentation the provider has to fill out, and neither that nor just talking to a patient for longer than usual are line items they get paid for, leading to appointments being as short as they can manage - usually rushing in, working through the list a medical assistant prepared, annoyedly answering a question if you can manage to slot it in, and rushing out to the next person.
Having a general sense of ease that a malade won’t ruin me or be a death sentence is a good thing, really, and I cannot imagine living another way. But we haven’t really figured it out yet fully either.
While some of that might be true for some countries with publicly funded dental care, it’s certainly not true for regular healthcare. Doctors are paid fixed salaries, there’s no incentive for them to perform unnecessary procedures. Quite the opposite in fact, departments have strict budgets and so they have a strong pressure to ensure all procedures are medically justifiable, and cheaper / simpler / preventative options have been tried first.
Individual doctors working for a clinic are paid a flat salary, true - but the clinics themselves, or the small doctors running their own office are absolutely dependent on accurate billing to the insurances. They have an incentive to optimise their margins, even if patients are not paying directly, and that means both trying to spend as little on care as possible while getting back as much as possible from the insurance providers.
It sounds like you’re describing a country with a public-private hybrid system. Certainly in the UK and the Nordics, the systems I’m most familiar with, there is no “getting back as much as possible from the insurance providers”, as there are no insurance providers. The hospitals are run by the government, funded by regional governments, and have fixed yearly budgets, not treatment dependent billing. The only exception is some privately run GP clinics that may bill per service rendered.
People say 'Europe', speak as if their experience is the same across the continent, and anyone with a different experience is somehow not in the Europe they mean. It's very annoying.
European healthcare is run very differently across the continent. 'Insurance' can mean a [state] social insurance institute that the doctor must bill. Some countries would employ the doctor directly as part of a nationalised health system. Some places it might be the municipality or city that would then get some subsidy from central government. Some it is a mix of all of this. 'Free' healthcare might actually mean a few hundred Euros, or literally nothing.
This! We went to a pediatric dentist with my kid on Monday, with a referral from another dentist, both private. After small talk, their first proper question was: "Do you have insurance?". Before I could respond, my wife responded affirmatively. Insurance here in Ireland means private insurance. After an x-ray, we were presented with a menu of treatment options ranging from around €2k to €5k.
Later I requested the clinic to share the x-ray with me and consulted with another pediatric dentist from another EU country. His assessment was completely different, and recommended very minimal intervention.
My point was that for the specific critique raised here, the European (or the be exact, the German) healthcare system doesn’t really offer much of an improvement, but suffers from similar problems. The fact that you don’t pay yourself doesn’t change the incentives medical professionals have in terms of getting paid for their work.
The UK has the opposite problem. You don't get overtreated, but you may get undertreated - sometimes it is impossible to find a NHS dentist at all. Indeed, I went private because I literally couldn't find one after my old one sacked me. The private dentists probably have the same problems as described here. But I luckily found a small, nice, ethical one who was recommended by people in town I trust. Literal word-of-mouth still beats any algorithm I know for this kind of question.
Honestly, I think it can happen anywhere - I've had several fillings for very marginal cavities from an NHS dentist that probably weren't necessary.
Part of the reason is that fashions change... that dentist was trained at a time when minor cavities were always treated as soon as they were noticed, but the more recent recommendation is to monitor and treat only if it gets worse.
That sounds like a similar story of taking a car to various places (including the official dealer) and getting wildly different and massively overpriced estimates for totally unnecessary work.
I had my car at a dealer. It was there so I asked for an estimate on a muffler fix. $7000. To be fair they also recommended trying the repair place down the street for that one.
i've told this story on here before but a dear friend of mine is a dental hygenist and worked for a very prominent dentist in ketchum (maybe hailey?), idaho. the hygienists were on a rev-share agreement to push every 'product' imaginable.
https://asset.cdocs.com/uploads/forum/attachments/258722/Rea...
It's a fascinating read that basically confirms all of these anecdotes.