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How to motivate your dentist

Sitting in the dentist's chair yesterday, and knowing I will return tomorrow (don't worry, it is only root canal work), I realized I had nothing to read.  So I started thinking about the immediate incentives of the dentist, or lack thereof.

I have a very good dentist, but surely there is variation in the willingness of a dentist, across patients, to try harder and do a better job. 

When there is no incentive at all, perhaps the dentist does not try hard enough to alleviate your pain.  Yes there is long-run reputation, but Daniel Kahneman and others find that the duration of a pain has little bearing on your memory of that pain.  So patient reports, as they are filtered into the marketplace, are an imperfect signal.  Furthermore for any given average reputation your dentist seeks, you still want to receive relatively favorable treatment within the distribution of patients.

You might pay a bonus at the end of the visit, if you thought the performance of the dentist was especially good.  But then the dentist might put you though too little pain.  "Fragmented tooth?  Don't worry, you can ignore it."

Last year I stopped going to a dentist who put me through too much unnecessary pain while cleaning my teeth.

Perhaps you should pretend you are a dentist yourself?  (Toward that end, here is a dental dictionary.)  Or a lawyer?  Should you talk about the breadth of your social circle?

With my new dentist, I pretend to have no fear.  And at the end of the visit I said what a great job she did.  I expect better performance by supporting her self-image as a good dentist and I find high-powered incentives difficult to apply.

But might I improve on this approach?  Comments are open...

Posted by Tyler Cowen on April 25, 2006 at 06:57 AM in Economics | Permalink

Comments

By this reasoning, just prior to your session you should also ask your dentist how she likes being in the chair and what her dentist is like.

Posted by: Ed Lopez at Apr 25, 2006 7:21:00 AM

I'm not sure where you got this subject from, but this was the very close to the essay topic on the GRE exam I took this Saturday. Strange. The question asked should a dentist market their less painful, nicer staff to men because men faint more than women at the dentist. I could have used this post a few days ago!

Posted by: Jughead at Apr 25, 2006 8:46:47 AM

Here's a somewhat counterintuitive argument. Acemogolus Kremer and Mian have a working paper in which they suggest that the existence of high powered incentives for teachers can lead to under compensation of teachers in the marketp[lace. They suggest that a solution to this problem is the formation of firms and/or provision of teaching services by the government. In other words dull the incentives. One test for this might be to see if dentists in countries with government run dentistry put their patients through more "optimal" levels of pain. Another approach would be to see if dentists at large practices where people cannot choose their dentists have better pain results. (Aside if you could choose your dentist high powered incentives would still exist).

Posted by: mjw at Apr 25, 2006 9:00:16 AM

I dunno about pain memory and dentistry--some old memories of that type seem very vivid even after decades.

I, too, have a very good dentist--particularly with respect to pain management. At one point, I pointed out that he gave me many more small novacaine pricks and managed to numb only the tooth that needed work rather than the whole side of my face (compared to other dentists I'd had). He said something like, "Yes -- it takes longer and many dentists don't have a fee structure that allows them to take the time."

Posted by: Slocum at Apr 25, 2006 9:05:19 AM

I like your approach of patronizing your dentist by telling her "what a great job she did". That should work! You might try throwing in a treat, like a cookie or even a Ben and Jerry's gift certificate.

Posted by: johnshade at Apr 25, 2006 10:10:55 AM

How about if patients are allowed to hook their dentists up to something like, say, a car battery while the dentist works. Patients would hold the swtich, and they could then provide immediate feedback.... :-) In fact, we could probably use this only as a traning device in dental school. A few years of this would prbably embed a healthy aversion to causing patient pain.

Posted by: bk at Apr 25, 2006 10:51:02 AM

i've never tried with a dentist, but from experience i can say that informing doctors of all kinds that you're a litigator instantly increases the standard of care. it's pretty incredible.

Posted by: none_ at Apr 25, 2006 10:59:29 AM

From a layman non-eco point of view.. when you enter the dentist's room, greet him properly.. smile at him.. ask him how it's goin.. so that he feels relaxed and finds it easier to take his mind off anything he's bothered with, if any. that should help him concentrate and hopefully reciprocate the smile!

Posted by: Me at Apr 25, 2006 11:13:08 AM

Extrapolating from some evidence on hysterectomies might suggest that the best strategy is to pretend you are a dentist who is married to a lawyer (or something along those lines): "Rate of hysterectomy is lower among female doctors and lawyers' wives" http://bmj.bmjjournals.com/cgi/content/full/314/7091/1417/a

Posted by: Diego at Apr 25, 2006 11:39:13 AM

I ended up resorting to biting one dentist. She had been my dentist for about a decade but over a 12 month period just seemed to lose any sense of what she was doing. She started doing dumb stuff, like resting her finger nails on my gums rather than the pad of her finger. She also became an increasingly aggressive advocate of cosmetic dental procedures. I left her practice after she broke a tooth by "cleaning" it (it had an ugly military-dentist crown and I had ignored her repeated suggestion that I let her replace it).

Come to think of it, she'd also been telling me I'd need dental surgery to correct mandibular joint pain. Another dentist spent two minutes with some sanding paper to correct a bite problem in a filling she had put in (he did it for free and wanted to know who she was).

Anyhow, biting her worked.

The events I've described make it sound like my decision about using her should have been easy, but she started out as a great dentist, and it wasn't easy to tell when she stopped being interested in my satisfaction and instead became interested in maximizing her billing (and that this correlated with her apparent disinterest in my lack of pain).

Posted by: Gabe at Apr 25, 2006 11:41:52 AM

Motivating a dentist or lawyer is the same as motivating any worker. Tips and bonuses only motivate in certain scenarios. Gratitude works when it's really genuine and well deserved but, like any compliment, it often comes across as fake or superficial. Big companies motivate workers through bonuses and promotions and status which certainly doesn't apply with a dentist. The best way to motivate a worker is to find work that really interests them or work that has some significant consequence (curing cancer or some dramatic business triumph) or something where lots of people are paying attention (if the dentist's work was televised, he would be much more motivated).

Posted by: giovanni at Apr 25, 2006 1:14:28 PM

I'm sure there's a pun about 'tooth or consequences' in here somewhere.

Posted by: Paul Dietz at Apr 25, 2006 2:16:26 PM

Yes but how do you feel TODAY? Usually they shoot you up with so much novocaine that you don't mind shootin' the breeze with them on the way out. The true test comes when the painkiller wears off...my advice - fill your codeine presciption :)

Posted by: bex at Apr 25, 2006 3:32:58 PM

Before you can figure out how to motivate your dentist you have to decide what you want her to do. As Cowen points out, there could be such a thing as too little pain, at least in the short run.

What are the tradeoffs between pain and sound dentistry, between pain and cost, between pain and time spent in the chair, or, as Slocum mentions, being numb for hours versus only briefly?

I don't know the answer to any of this, but surely there are tradeoffs here.

Posted by: Bernard Yomtov at Apr 25, 2006 3:58:22 PM

To complicate the issue just a little: different patients want different levels of pain relief. One of my sisters refuses novocain because she doesn't like the swelling. I'm a coward, but I'll accept some pain in exchange for speed. My wife wants complete painlessness. Is it odd that dentists don't easily adjust to patient tastes? My sense is that while they differ among themselves, they don't try to adapt to patient preferences.

Posted by: Alan Gunn at Apr 25, 2006 6:11:12 PM

Riffing off bk's idea, what if the dentist gave you a handheld device that would cause a pain meter to rise or fall based on your grip pressure. You could then numerically specify what level of pain you're willing to tolerate.

Posted by: Christopher Rasch at Apr 25, 2006 6:30:44 PM

What about a "ratemydentist" website, like rate my professor

Posted by: jughead at Apr 26, 2006 9:46:41 AM

What about a "ratemydentist" website, like rate my professor

Posted by: jughead at Apr 26, 2006 9:46:53 AM

Incentives matter. But so does selection. This isn't answering the question, but the size and strength of the dentist's hands make a difference. If I was choosing a dentist, gender would be a factor.

Posted by: John B. Chilton at Apr 26, 2006 5:51:05 PM

When I came to my new dentist, I told her how much I hated going to dentists, how miserable the idea of a dentist appointment made me. Then after my first cleaning, I told her what a great job she had done and how she might be turning me around on the idea of dentists. I figured I could appeal to her professional pride, and also make her not want to be lumped in with the other dentists. I had to get a cavity filled recently and it went great, no pain, no suffering, no excessive novocaining. So I guess its working...

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Posted by: levan at Sep 7, 2006 3:49:58 AM

I am writing to say that I am so discouraged with dentists that I may never go back. After enduring the disgustingly filthy offices of Abacus Dental in Victoria BC, and a FOUR month fight, including needing to lodge a complaint to the BC College of Physicians and Surgeons, to have the stupid dentist hand over my files - for which he charged an enormous fee, and sent incomplete, unreadable files, I am at wits end.

What in the world is happening when dentists and their staff can get away with such blatant abuse of patients??

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see her squirt -
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she has a negro problem -
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slap that butt -
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solo videos -
stracy stone -
street blowjobs -
street ranger -
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bare bum mountain -
barefoot maniacs -
be the bitch -
big ass adventure -
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big cock teen addiction -
big league facials -
big mouthfuls -
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big tit patrol -
big tits round asses -
big titty bangers -
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boys first time -
brandi belle -
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Posted by: xcvwet at Aug 2, 2007 11:25:27 PM

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her thick black ass -
horny spanish flies -
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intense penetrations -
internal explosions -
in the vip -
i spy camel toe -
jerk that cock bitch -
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knocked up nina -
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little naughty nymphos -
mandys diary -
mexxxi cunts -
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mike in brazil -
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monsters of cock -
mr big dicks hot chicks -
mr cameltoe -
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my busty girlfriend -
naughty indian girls -
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panties and fannies -
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see her squirt -
servere penetrations -
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swallow for cash -
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team squirt -
teeny bopper club -
the big swallow -
the hoes we choked -
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big mouthfuls -
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big tits round asses -
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fill my pink -
first time auditions -
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flower tucci -
freaks of porn -
gangbang facial -
giants black meat white treat -
her thick black ass -
horny spanish flies -
huge gay pass -
huge movie pass -
in focus girls -
intense penetrations -
internal explosions -
in the vip -
i spy camel toe -
jerk that cock bitch -
kelsey xxx -
knocked up nina -
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little naughty nymphos -
mandys diary -
mexxxi cunts -
midnight lurkers -
mike in brazil -
mikes apartment -
milf hunter -
milf lessons -
milf next door -
money talks -
monsters of cock -
mr big dicks hot chicks -
mr cameltoe -
mr chews asian beaver -
my busty girlfriend -
naughty indian girls -
ox pass -
panties and fannies -
papi -
pimp my black teen -
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pov squirt alert -
public invasion -
pump that ass -
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reality pass plus -
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round mound of ass -
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security cam sex -
see her squirt -
servere penetrations -
she has a negro problem -
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shemale ultra -
slap that butt -
sleep invasion -
smut bus -
solo videos -
stracy stone -
street blowjobs -
street ranger -
suck it you whore -
swallow for cash -
sweet suckers -
team squirt -
teeny bopper club -
the big swallow -
the hoes we choked -
the mother fucker -
tina blaze -
tinys black adventures -
tongues and toys -
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barefoot maniacs -
be the bitch -
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big league facials -
big mouthfuls -
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big tit patrol -
big tits round asses -
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fill my pink -
first time auditions -
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flower tucci -
freaks of porn -
gangbang facial -
giants black meat white treat -
her thick black ass -
horny spanish flies -
huge gay pass -
huge movie pass -
in focus girls -
intense penetrations -
internal explosions -
in the vip -
i spy camel toe -
jerk that cock bitch -
kelsey xxx -
knocked up nina -
latina girl girl -
lesbian teen hunter -
little naughty nymphos -
mandys diary -
mexxxi cunts -
midnight lurkers -
mike in brazil -
mikes apartment -
milf hunter -
milf lessons -
milf next door -
money talks -
monsters of cock -
mr big dicks hot chicks -
mr cameltoe -
mr chews asian beaver -
my busty girlfriend -
naughty indian girls -
ox pass -
panties and fannies -
papi -
pimp my black teen -
please bang my wife -
pov squirt alert -
public invasion -
pump that ass -
real dp dolls -
real hooker videos -
reality kings -
reality pass plus -
real orgasms -
real teens kissing -
round and brown -
round mound of ass -
sammy4u -
sapphic erotica -
security cam chronicles -
security cam sex -
see her squirt -
servere penetrations -
she has a negro problem -
shemale ultra -
slap that butt -
sleep invasion -
smut bus -
solo videos -
stracy stone -
street blowjobs -
street ranger -
suck it you whore -
swallow for cash -
sweet suckers -
team squirt -
teeny bopper club -
the big swallow -
the hoes we choked -
the mother fucker -
tina blaze -
tinys black adventures -
tongues and toys -
tranny surprise -
tug jobs -
vanessa teen -
vip crew -
voyeur intrusion -
we live together -
whore gaggers -
wild party whores -
xxx proposal -
cumfiesta -
8th street latinas -
40 inch plus -
adult friend finder -
all reality pass -
all sites access -
all star porn girls -
amazing footjobs -
anal in the amazon -
angels with dildos -
asian girl girl -
ass army -
ass arsenal -
ass parade -
bait bus -
ball honeys -
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bang bus -
banged babysitters -
bare bum mountain -
barefoot maniacs -
be the bitch -
big ass adventure -
big cock addiction -
big cock teen addiction -
big league facials -
big mouthfuls -
big naturals -
big tit patrol -
big tits round asses -
big titty bangers -
booty catchers -
boys first time -
brandi belle -
brit bangers -
bust that cherry -
busty adventures -
cam crush -
cams -
captain stabbin -
casting couch teens -
cfnm exposed -
cfnm idol -
classics of porn -
coeds need cash -
college teens book bang -
cumfiesta -
cum girls -
cumisha jones -
dangerous dongs -
dirty teachers pet -
drilled and filled -
ebony internal -
erotic spank -
escort trick -
euro sex parties -
fill my pink -
first time auditions -
fling -
flower tucci -
freaks of porn -
gangbang facial -
giants black meat white treat -
her thick black ass -
horny spanish flies -
huge gay pass -
huge movie pass -
in focus girls -
intense penetrations -
internal explosions -
in the vip -
i spy camel toe -
jerk that cock bitch -
kelsey xxx -
knocked up nina -
latina girl girl -
lesbian teen hunter -
little naughty nymphos -
mandys diary -
mexxxi cunts -
midnight lurkers -
mike in brazil -
mikes apartment -
milf hunter -
milf lessons -
milf next door -
money talks -
monsters of cock -
mr big dicks hot chicks -
mr cameltoe -
mr chews asian beaver -
my busty girlfriend -
naughty indian girls -
ox pass -
panties and fannies -
papi -
pimp my black teen -
please bang my wife -
pov squirt alert -
public invasion -
pump that ass -
real dp dolls -
real hooker videos -
reality kings -
reality pass plus -
real orgasms -
real teens kissing -
round and brown -
round mound of ass -
sammy4u -
sapphic erotica -
security cam chronicles -
security cam sex -
see her squirt -
servere penetrations -
she has a negro problem -
shemale ultra -
slap that butt -
sleep invasion -
smut bus -
solo videos -
stracy stone -
street blowjobs -
street ranger -
suck it you whore -
swallow for cash -
sweet suckers -
team squirt -
teeny bopper club -
the big swallow -
the hoes we choked -
the mother fucker -
tina blaze -
tinys black adventures -
tongues and toys -
tranny surprise -
tug jobs -
vanessa teen -
vip crew -
voyeur intrusion -
we live together -
whore gaggers -
wild party whores -
xxx proposal -
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8th street latinas -
40 inch plus -
adult friend finder -
all reality pass -
all sites access -
all star porn girls -
amazing footjobs -
anal in the amazon -
angels with dildos -
asian girl girl -
ass army -
ass arsenal -
ass parade -
bait bus -
ball honeys -
bangbros network -
bang bus -
banged babysitters -
bare bum mountain -
barefoot maniacs -
be the bitch -
big ass adventure -
big cock addiction -
big cock teen addiction -
big league facials -
big mouthfuls -
big naturals -
big tit patrol -
big tits round asses -
big titty bangers -
booty catchers -
boys first time -
brandi belle -
brit bangers -
bust that cherry -

Posted by: zvewt at Aug 2, 2007 11:25:54 PM

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