The Loss of Dentistry

So I wrote that last post because of a scenario I experienced a few months ago....

Owner brings her dog in for a swelling under the eye.  As soon as I look at the dog's mouth, I realize it's most likely a carnassial tooth root abscess.  I discussed this with the owner, and also informed her that the rest of the dog's mouth is in really bad shape and he needs multiple tooth extractions.  I also told her that the dog needs to have the mouth radiographed (xrays) because sometimes what we think is a simple abscess can actually be something a lot worse, like cancer.  (two of my most recent carnassial tooth extractions actually ended up being sarcoma in the mouth, not just an abscessed tooth - had I not done xrays before pulling the teeth, we would not have known that)

Owner said this to me:  "Oh no, I only brought him here for you to diagnose him.  I'll be taking him to the low cost facility because they are soooo much cheaper than you.  We will only come here for the real problems." 

WTF?

I was flabbergasted, insulted and angry.

I told her the reason it was so cheap there was because I did such a better job than they do.  It didn't matter.  She just wanted "cheap."   Okay, I get that.    You have 3 kids and 5 dogs.  Maybe you should look at that.  However,  I digress....

But let me do a comparison for the difference between what would occur at my place vs. what will occur at the low cost place.

The removal of a carnassial tooth involves splitting the tooth and pulling out 3 roots.  It involves equipment that can cost $5000.  We also do what's called a mucosal flap with the gum tissue so that we can then close the open socket/defect.  The animal is much more comfortable after surgery and heals so much better.  We also do nerve blocks so that when the pet wakes up, they aren't feeling the pain of that extraction.

We would take dental xrays of the mouth so that we can see the roots of the rest of the teeth, and make recommendations on what else might be abscessing and needing removal.  We also look for things like...  cancer.

All of our anesthesia patients, especially those having dental work, are intubated (have a breathing tube) and have an IV catheter in place and are on IV fluids.  This is for safety and their comfort.

The only ones who do dentistry in my hospital are myself and my registered, licensed techs.  And let me add - that is per my state's LAW.  Unlicensed techs are NOT supposed to be doing dentals.  Period.

Now let me tell you what will happen at the low cost place:  they don't even have RVTs.  They don't have dental xray.  They do not intubate the dentals (there is no breathing tube inserted into the trachea) and they definitely do not place IV catheters or administer IV fluids.   They yank teeth without splitting them, they do NOT do mucosal flapping and I'm pretty sure that local nerve blocks aren't even in their vocabulary.  I can only imagine how many tooth roots are left in those sockets.  How would they know?   They don't use dental xray.

I know of a low cost vet who doesn't use a high speed drill.  He used a pair of pliers to "break" a tooth so he could get it out.  I wish I was making this up, but I am not. 

That's not how I do things.

So what is this client getting?  A very, very poor service, yet she thinks that I'm ripping her off because I charge more for what I do at my practice.  Hmmpf. 

She then had the nerve to ask me for an estimate, so she could compare it to the low cost place.  I refused.  I mean, why should I bother wasting my tech's time working up an estimate for this woman?  I politely asked her to leave.

She deserves the medical care she gets.  And when she does come back to me for something like...  a major abdominal surgery, it's gonna cost twice as much because I now have to make up for the loss of my dentistry services - another bread and butter income - to the low cost facility.

It is a vicious cycle, American Public.  Please hear our cries and believe us when we say we aren't doing it because we want to gouge you;  most of us really do want to provide quality care.  But if you can't support us on the little stuff, then don't expect us to be around when the big stuff comes up.

You will get what you pay for, in the end.