YIPPPEEE. I just got HuFriedy Everedge scaler Diamond Apex status! I am excited.
Actually, I am joking. I have received none of that. Imagine though if I did get that?
They are brilliant instruments but I don't solely rely on them.
Or forget periodontics, let's try something else.
Imagine if you got incentives with a certain status for using a certain number of endodontic rotary files. What would happen?
Would you do the endodontic treatment with the most appropriate file system or would you be subconsciously incentivised to do the treatment with the particular file system that lured you with incentives? Would you prefer to wait or tell patients to keep a watch or would you be subconsciously inclined to treat them with the influence of an incentive?
OK not endodontics because the product (files) are just part of it. How about we look at another specialty - orthodontics. What if the product was the mode of treatment? What if the treatment was wholly and soully a product and you were incentivised to use that product? Would you then consider treatment planning independently or would you be biased to using the treatment modality of the product that incentivises you? Would you prefer to think from a problem-ideal solution axis or would you be subconsciously inclined to treat them with the influence of an incentive of the product?
Let me tell you: Incentives matter! The right incentives matter even more.
Don't agree? Let's walk away from dentistry. In fact, let's take a long walk back...to over 100 years ago...to Hanoi in 1902.
Hanoi in 1902 was infested with a rat problem. Not just rats. These were flea-infested rats trawling through the sewers and causing problems.
The then government decided to get a handle on this. They hired rat hunters to go into the sewers and eliminate the rats. They wanted the problem solved. Of course, no one works without an incentive and so the government of the day decided to reward the rat hunters for every rat that they caught. All they had to do was present the rat's tail as evidence.
In April 1902, nearly 8000 rats were killed within a week. Now surely that would have solved the problem?
Instead, the problem worsened and more rats infested the place. What had happened?
Knowing the incentive, the rat hunters decided to benefit themselves, instead of thinking about the greater good. The people of Hanoi had placed their trust in these hunters. Nevertheless, they used the incentive to their benefit.
How? Well some of them simply chopped off the rats' tails and let them go. Others set up rat breeding farms. Whatever the case, the city was now infested with even more rats - most with missing tails.
Like I said, incentives matter!
Incentives influence your behaviour.
Dentistry is a unique healthcare situation where we have to behave in the most uninfluenced way we can. In order to be able to be as objective as possible, we need to think as unbiased as possible. (I say 'as possible' because it is hard to be totally objective).
When a patient presents with a problem, they expect you to provide the best possible care.
The patient places their trust in us. As Charles Feltman said, "trust is when someone is risking making something very valuable to them vulnerable to the action of someone else". In this case, a human being is risking making something very valuable to them vulnerable to our actions.
If our actions are biased by incentives, how will that pan out?
If the incentive is a discount or a Diamond Apex status - how will that influence your decision-making on a conscious or subconscious level?
Granted, we all have to make a living. Healthcare is one of those unique places, where the patient actually pays you as a gesture of gratitude for the care and trust that they have felt. They value the fact that you have acted in their best interest and show their felt gratitude via a payment. This value is not described, it is felt. The gratitude of paying a bill is an emotion.
Yet how would they feel if they were aware that you were being incentivised by a product? What would that do to that trust?
Imagine if you were a patient of a practice and needed dental care. Would you be happy with your physician or surgeon if they were using a product or prescribing a drug not because it was the best evidence based solution for you but because they were getting a financial kick back or incentive to benefit them. What would your initial thoughts be?
Yes, the product company has to make sales, and offering incentives would be their way of doing this. They are not healthcare professionals and do this to increase sales.
Yet, as healthcare professionals, we should be the gatekeepers. We should be putting patient interest above these incentives and making decisions as free from influence as possible.
Instead, we are leaving the gate to follow the carrot that will serve us. We are celebrating receiving these incentives.
Ask yourself:
- What impact does the presence of these incentives have on your decision making?
- is the incentive informing your treatment decision or is your treatment decision being guided independently? (Both on a conscious and subconscious level)
Imagine if the solution is not even dental in certain cases.
Would the dental solution solve a deeper problem?
With the shroud of the incentive influencing you would you be able to see the woods from the apex trees?
Yes, the product may even be superior to others. In which case, you should be making an informed decision about it in the interest of the patient, not the incentive.
In fact, there are marketers and educators actively promoting the art of chasing these incentives as a 'win'. The primary aim of these is to gain these incentives. The self-win is apparently being projected as being more important than the delivery of care.
How does this affect the trust equation?
Healthcare is a unique profession where the provider considers the care of the other first and the reward as a consequence of that.
Incentives matter but the person being influenced by these incentives and their behaviour matters even more.
Nope. I don't want to be a Diamond Apex HuFriedy Everedge Asia and Europe provider. They are awesome instruments and I do use them.
However I am a periodontist first, the patients' care comes first and decisions are guided by as much science as possible. The instruments - these are tools in my armamentarium.
I am not focused on being rewarded for using the tools more. I am focused on my patient and knowing which tools are appropriate in each case.
Because I am aware that incentives matter.