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Best issue ever
LETTERS TO THE EDITOR
THE JOURNAL devotes th is section to com m ent by readers on top ics of current interest to den tistry. The e d ito r reserves the rig h t to edit all com m unications to fit available space and requires that all letters be signed. P rinted com m unications do not necessarily reflect the opinion or o f ficial po licy of the A ssociation. Y our participation in th is section is invited.
A ‘seco n d ’ diagnosis i T w ice in the same day I had an experience that made my hair stand on end. The first was a long distance call from an insurance com pany’s home office to inform me that, unless I sub mitted radiographs of an insured’s teeth to a John D oe, claims analyst, for his review, the replacement crowns I had diagnosed would not be approved on the preauthorization schedule. The second was a phone call from a nationwide insurance firm with a local claims office. I talked to a Miss X from the X Y Z insurance company. Miss X , who is the claims analyst for dental insurance, also requested my radiographs with my prior authoriza tion form. I asked her why she wanted the radiographs, and was very firmly told that she had to have the radio graphs to properly diagnose whether in fact the teeth I had diagnosed on the preauthorization form did indeed need such treatment. When I asked her how she could make such a diagnosis, she very curtly told me that she had been a dental assistant for 20 years and could read radiographs as well as any dentist, thank you. And besides, that was her job and she went on to inform me that she did a good job. Her last statement came as no sur prise; she wanted to know why I was
being so reluctant to send her the ra diographs since no other dentists in the state had objected to having her review their diagnoses from their radiographs. After these revelations, I called our local ethics committee chairman to see if sending radiographs to a lay per son was unethical. H e informed me that there was no matter of ethics in volved and even though he personal ly didn’t approve o f the procedure, he simply sent in radiographs as per the claims analysts’ requests because he didn’t like to hassle with them. This matter of a lay person making a diagnosis and consequently deter mining the treatment plan for a patient evidently is “ not worth the hassle” to the majority of dentists, or perhaps they don’t have the intestinal fortitude to speak up for what they believe in. There is a matter that had better receive their undivided attention and that is the matter o f a peer review committee. I have heard eloquent speeches from many o f our elected leaders of dentistry that peer review must remain in the complete control of dentists, and I fully agree with this. However, how can the dental profession allow lay people to diagnose from radio graphs and thus determine the treat ment, and then make the asinine state ment that only dentists possess the expertise and knowledge to make judgments on peer review? I cannot envision the day that phy
sicians would send a radiograph of a gall bladder to a lay claims clerk for her diagnosis and treatment approval, yet dentists do this regularly without another thought as to what they are doing. Therefore, if dentists are to be in com plete control o f dentistry, our leadership must wake up and act now because we are losing the war by de fault. The time for our leadership to act was yesterday, and since that has passed, it had better be today. Realistically, I predict that the screams of hurt will com e from our leadership only after the game has been lost. There seem s to be an atti tude o f “ don’t rock the boat and make w a v es.” H ow ever, I submit that it is not always possible to arbitrate and negotiate all things, and our leader ship at both the local and national level would be better off going down fight ing than abdicating principles. RONALD G. STROUSE, DDS E N G LE W O O D , COLO
B est issue ever m The N ovem ber issue o f D en ta l A b stracts is the best issue I ever have read. Keep up the good work. W IL L IA M J. T O N N E , DDS HANOV ER, IL L
A d va n ces in periodontics ■ . . . The point I would like to make is that a review o f literature pertaining to prevention o f periodontal disease and including a discussion o f nutrition is grossly incomplete without refer ence to Cheraskin’s work. Whether Cheraskin is right or wrong, he should not be ignored. ANATOL T . C H A RI, DDS NEW PO RT BEACH, CA LIF
■ E d ito r’s note: Dr. Chari refers to a review article entitled “ A critical review o f the present state o f the art of periodontal disease prevention,” written by Paul N . Baer and Robert K. D avis for the 1974 A d va n c es in JADA, Vol. 90, January 1975 ■ 33
THE JOURNAL devotes th is section to com m ent by readers on top ics of current interest to den tistry. The e d ito r reserves the rig h t to edit all com m unications to fit available space and requires that all letters be signed. P rinted com m unications do not necessarily reflect the opinion or o f ficial po licy of the A ssociation. Y our participation in th is section is invited.
A ‘seco n d ’ diagnosis i T w ice in the same day I had an experience that made my hair stand on end. The first was a long distance call from an insurance com pany’s home office to inform me that, unless I sub mitted radiographs of an insured’s teeth to a John D oe, claims analyst, for his review, the replacement crowns I had diagnosed would not be approved on the preauthorization schedule. The second was a phone call from a nationwide insurance firm with a local claims office. I talked to a Miss X from the X Y Z insurance company. Miss X , who is the claims analyst for dental insurance, also requested my radiographs with my prior authoriza tion form. I asked her why she wanted the radiographs, and was very firmly told that she had to have the radio graphs to properly diagnose whether in fact the teeth I had diagnosed on the preauthorization form did indeed need such treatment. When I asked her how she could make such a diagnosis, she very curtly told me that she had been a dental assistant for 20 years and could read radiographs as well as any dentist, thank you. And besides, that was her job and she went on to inform me that she did a good job. Her last statement came as no sur prise; she wanted to know why I was
being so reluctant to send her the ra diographs since no other dentists in the state had objected to having her review their diagnoses from their radiographs. After these revelations, I called our local ethics committee chairman to see if sending radiographs to a lay per son was unethical. H e informed me that there was no matter of ethics in volved and even though he personal ly didn’t approve o f the procedure, he simply sent in radiographs as per the claims analysts’ requests because he didn’t like to hassle with them. This matter of a lay person making a diagnosis and consequently deter mining the treatment plan for a patient evidently is “ not worth the hassle” to the majority of dentists, or perhaps they don’t have the intestinal fortitude to speak up for what they believe in. There is a matter that had better receive their undivided attention and that is the matter o f a peer review committee. I have heard eloquent speeches from many o f our elected leaders of dentistry that peer review must remain in the complete control of dentists, and I fully agree with this. However, how can the dental profession allow lay people to diagnose from radio graphs and thus determine the treat ment, and then make the asinine state ment that only dentists possess the expertise and knowledge to make judgments on peer review? I cannot envision the day that phy
sicians would send a radiograph of a gall bladder to a lay claims clerk for her diagnosis and treatment approval, yet dentists do this regularly without another thought as to what they are doing. Therefore, if dentists are to be in com plete control o f dentistry, our leadership must wake up and act now because we are losing the war by de fault. The time for our leadership to act was yesterday, and since that has passed, it had better be today. Realistically, I predict that the screams of hurt will com e from our leadership only after the game has been lost. There seem s to be an atti tude o f “ don’t rock the boat and make w a v es.” H ow ever, I submit that it is not always possible to arbitrate and negotiate all things, and our leader ship at both the local and national level would be better off going down fight ing than abdicating principles. RONALD G. STROUSE, DDS E N G LE W O O D , COLO
B est issue ever m The N ovem ber issue o f D en ta l A b stracts is the best issue I ever have read. Keep up the good work. W IL L IA M J. T O N N E , DDS HANOV ER, IL L
A d va n ces in periodontics ■ . . . The point I would like to make is that a review o f literature pertaining to prevention o f periodontal disease and including a discussion o f nutrition is grossly incomplete without refer ence to Cheraskin’s work. Whether Cheraskin is right or wrong, he should not be ignored. ANATOL T . C H A RI, DDS NEW PO RT BEACH, CA LIF
■ E d ito r’s note: Dr. Chari refers to a review article entitled “ A critical review o f the present state o f the art of periodontal disease prevention,” written by Paul N . Baer and Robert K. D avis for the 1974 A d va n c es in JADA, Vol. 90, January 1975 ■ 33