Medical Professionals and Assumptions of Power

This post requires some back story: About three months ago, I was eating dinner, and I must have been really enjoying my food because I bit down very fast, and very hard, on the inside of my right cheek. It hurt like a mofo, and there was a fair bit of blood. Within a few minutes, I had a swollen spot of tissue about the size of very large pea. Over the next couple of weeks, I tried chewing on the left side of my mouth, but invariably I’d forget and chew on the right side and bite the swollen tissue again…and again. I was biting it every few days, so it just wasn’t healing. I went to see my dentist for a cleaning, and talked to him about it. He said to give it six to eight weeks to heal, and if it hadn’t healed (or I kept biting it) he’d laser it off. I, ignorant of such things, asked it the laser cauterized the tissue. He said no, that would require 400 degrees of heat and burn my entire mouth – the laser super-heats the cells in the swollen tissue and causes them to evaporate. Cool! The dentist was very nice, the office was clean, he had shiny new gear, and it was only three minutes away from my house. Seemed like the perfect new dental professional. The receptionist told me when I was booking the appointment that it would cost $149 if it wasn’t covered by insurance – not too expensive, and certainly worth it.

A little over a month after my first appointment, I was back in the chair to get the swollen tissue blasted away – a least a few times a week I’d chomp down on it, so it wasn’t healing. When I arrived at 7 AM (ouch!) after not getting enough sleep the night before, he started the procedure. It was pretty interesting, because the laser machine was quite small – about the size of a breadbox (who even knows what that is anymore?). First, a bit of topical gel for freezing. Then a needle into my the inside of my cheek – don’t worry, I didn’t feel it. While the dentist was using the laser to blast away the tissue, his assistant was holding the suction straw, removing the smoke from my mouth – yes, smoke. Thankfully, I didn’t smell burning flesh, so the laser must do something else other than just burn (do boiling cells smoke?). I left with a slight indent on the inside of my cheek – the dentist said that he was going to send off the tissue (I guess there was some left after all) for a biopsy. He must have saw me look dubious, because the tissue was swollen from constant trauma, not because I contracted spontaneous mouth cancer that grew a tumour in 30 seconds. He explained that sending it for a biopsy was “standard procedure” and something they did “just to make sure” even though he acknowledged that he was quite certain there was nothing wrong with the tissue. I shrugged and figured “Ok, whatever, their call.” I assumed (oh boy, here we go) that the biopsy was part of the original fee for the procedure. I left the office and they were going to submit the procedure to my insurance company to see how much would be covered.

I received an email today from the dentist’s office telling me that Blue Cross (my incredibly useless and lame “health insurance” company) wasn’t going to cover any of the procedure. I wasn’t terribly surprised – if I were to be attacked by a chainsaw-wielding psycho, and lost all four limbs, Blue Cross would likely only cover the cost of sewing my legs back on, claiming that re-attaching my arms would be purely cosmetic. Yes, they’re that bad – I’m slowly obliterating my teeth by grinding at night, and Blue Cross won’t cover a new appliance. At any rate, I digress – I’ll rant about insurance companies another day. The dentist office told me that the cost was $265. Pardon? I emailed back and asked why it wasn’t the $149 I was told it would be They replied back that the $265 covered the laser excision (read: laser slice ‘n dice) and the biopsy. The biopsy? The thing that I didn’t think I needed but the dentist wanted to do anyway just to be sure, even though it was pretty ridiculous? Yeah, that biopsy.

What bothers me is how the dentist didn’t discuss it with me – he made the decision for me, didn’t tell me what it would cost, and didn’t offer me the choice. I believe medical professionals should give patients information, but allow them to make the choice. Especially when it comes to dental work, which can be quite expensive, I find it frustrating that a dentist wouldn’t be up front about the cost of the work. As I’ve grown older I’ve realized that medical professionals are like everyone else: they have to make a living, and some are more aggressive about making money than others. While I’m sure some dentists are up-front about the charges for their work, so far every dentist I’ve dealt with hasn’t been. We assume, as patients, that the medical professionals we deal with have the best interests of our health in mind, and are only going to recommend procedures that are absolutely necessary. I’m sure that some medical professionals act that way, but certainly not all. I don’t think my dentist is a bad guy – maybe he assumed I had great insurance and some big corporation was going to be paying for the whole thing, so it didn’t matter. Maybe there’s no profit in the biopsy for him (it goes out to a lab), and he really did only have my best interests at heart. But when it’s all said and done, I’m having a procedure that isn’t medically necessary (or logical), and it’s coming out of my pocket. I have better things to spend my money on.
Of course, if the biopsy comes back and something was wrong, I’ll feel like a complete idiot. Won’t be the first time!