Stop Diagnosing the Pocketbook

Cost is a consideration for all of us, which we take into account when deciding whether or not to purchase a wide variety of goods and services. Our responsibility as clinicians is to make recommendations to help patients achieve the best health possible, without letting our preconceived ideas about the patient’s ability to afford treatment get in the way – what I refer to as diagnosing the pocketbook. One of the things we do not know and cannot predict is how much value the patient puts on their oral health. When we fail to recommend salivary testing because we think the patient will not proceed due to the cost, we have taken the decision away from the patient.

How we discuss the information obtained by bacterial testing affects the patient’s understanding of its importance and what it means for them. The verbiage I use is as follows; “Salivary testing is the only way I know specifically what I am fighting. Otherwise I am just guessing.” This reasoning is accurate and succinct and helps with the crucial decision-making of whether they can afford to have us treat their gum disease blindly. As the patient’s healthcare provider, I see the true value of bacterial identification, which helps “tip the balance” in the patient’s favor by actually knowing what we are fighting against; thus enhancing the predictability of a favorable result.

Ultimately each patient will decide for themselves whether or not to proceed with salivary testing. It is our responsibility to present our plan to return the patient to excellent oral health without making assumptions about the patient’s willingness to proceed with our recommendations.

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Richard H. Nagelberg, DDS
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