Imagine you are faced with a patient who has a compromised tooth. The options for saving the tooth or extracting it (and replacing it with an implant) are both viable.
The cost will be about the same. Saving the tooth is likely to need a root canal treatment, a core and then a crown. Extracting it and replacing it with an implant will need a delayed placement approach.
What will influence your decision?
if you think purely from the patient interest view - you will give serious though to the option of saving the tooth as we know long term studies on periodontal and endodontic treatments show positive outcomes for tooth retention.
However, you may choose the implant option because:
1. The root canal, core and crown is technically more demanding and your skillsets are more adept to, and you are more comfortable with, placing implants.
2. The return on investment in terms of fee per hour is higher for the implant option.
Either of these two options, influence your decision making. They take away the decision making away from thinking about the patient purely and more towards your interest and biases. Thus your decision making can be influenced without you realising it.
Two recent trends in dentistry are increasing the influence of these factors.
1. First is the rise in implant focused courses and conferences. The implant companies have bigger budgets and are willing to support courses that use their implants. In addition some of the companies are building their own conferences. Some even pay fully for the delegates stay and travel. Of course none of these courses or conferences will say that the particular implant system has deficiencies or even discourage the use of implants in favour of other treatments. On contraire, they will frame the conference as educational. Yet we all know, the focus is placed on their implant and their products. They even place incentives for using and purchasing their products.
2. The second is a rise in discussions and posts that focus on talking about money, high ticket items, conversions and monthly gross. I have even heard a CEO of a corporate boasting how he has built a corporate with a certain valuation. (He barely speaks about what difference he has made in health). On the grapevine, this same corporate has a chart in the staff room measuring how much income each clinician has generated for the day Vs the target. The focus is placed on revenue.
When the focus from the above two factors are on revenue and implants, the brains decision making is influenced by them. The decision making process becomes biased. It is no longer purely in the unbiased interest of the patient.
This is where cause driven leadership steps in. Cause driven leaders focus on the patient centred outcomes. Self driven leaders power up these kind of influences further.
The distinction maybe minute but the long term impact could be mega.
Would this contravene GDC standard 1.1, if a professional is aware about it? I dont know.
The current car finance scandal unravelling in the courts is an indication. Car sales agents did not inform customers that they would get a commission for recommending finance. This will likely result in a global pay out that some consider might reach similar proportions to the PPI scandal.
I do sometimes worry about where dentistry is going