When you buy a car, you can count on the salesperson to try and upsell you, whether it’s for a more expensive option package or rustproofing the undercarriage. And you can’t buy any type of electronics or appliance these days without being offered an extended warranty.
I get it—that’s how folks in retail make more money. Knowing this, we can gird our loins, set our limits and make the transaction on our terms.
But what I’ve observed as I’ve gotten older is that upselling is creeping into the medical field. And navigating these waters is a bit trickier—not to mention distasteful. Or downright unethical.
I first noticed it when we lived in California, where some doctors were selling vitamins and other nutritional supplements in their offices and—guess what—they had a product (or five) that they strongly recommended for what ailed you (or could befall you).
Unlike most prescription medications, these products weren’t covered by health insurance, and all profit went directly into the doctor’s pocket. So what’s motivating the doctor’s recommendation—financial gain or my good health?
There’s a federal law (the Stark Law, named after former California Congressman Pete Stark) that prohibits doctors from referring Medicare patients to an entity with which they have a financial relationship (like a diagnostic imaging center). Its intent was to remove monetary incentives for doctors to order more services than necessary.
Hawking products like nutritional supplements—the more the doctor sells, the more money he makes—smacks of the same conflict.
I mean, your doctor is the person you’re entrusting with your health and, by extension, your life. So it’s more than a little disconcerting to have to suss out his motives when he recommends products that he just happens to sell. I’d be more inclined to believe a doctor had my best interests at heart if he or she simply made a recommendation—and left it up to me to purchase the products wherever I chose.
Here are some other medical upselling experiences that I—or people I know—have had that stick in my craw:
The first time I saw a dentist in California, he wanted to replace all the amalgam (silver) fillings in my mouth, claiming that the mercury in them was poisoning me. Actually, the greatest amount of mercury exposure from amalgam fillings happens when they’re “installed” and when they’re removed from our teeth, so if he was so concerned about my health, why take them all out? As long as the fillings are intact, any health risk is extremely low, so I opted to keep mine—and find another dentist.
For a couple of years, every time I visited my vet’s office, the vet tech would suggest I buy flea and tick protection for my two cats—to the tune of about $30 per month, per cat. And I repeatedly told her that my cats never go outside, so their risk of getting fleas or ticks is practically nil. Thankfully, the suggestions have stopped.
The piece d’resistance, however, was a Colorado dentist encouraging my then-83-year-old aunt to get $18,000 worth of dental implants instead of new dentures, which inspired this:
eighteen grand worth of implants.
My reply? Bite me.
My aunt declined his proposed investment more tactfully, but c’mon—what ethical provider does this sort of thing?
As we boomers age, we’re interacting with doctors and dentists more than ever. And many of us will be facing decisions about joint replacement, for example, or whether surgery makes sense for back pain.
Whatever the reason for seeing a surgeon, just remember the old saw about how when you’re a hammer, everything looks like a nail. Surgeons get paid to cut. But unless you’re in intractable pain, your quality of life is severely compromised or your life itself is at risk, it usually makes sense to try more conservative measures before going under the knife. And ethical surgeons will agree.
A couple of years ago, my husband was referred to a surgeon to determine if the intermittent groin pain he’d been experiencing was related to a hernia. After pushing and poking Donald’s abdomen for an inordinately long time, the surgeon finally announced that he thought he’d found something that could be a hernia, and when would my husband like to schedule surgery to take care of it?
Donald said he’d think about it. And a subsequent visit to another specialist revealed that the problem was really referred pain from a deteriorating vertebra—and surgery wouldn’t fix it anymore than it would have his supposed hernia. That was the doctor we trusted.
It all underscores how medicine is changing, and how important it is to be an educated, engaged and empowered patient, willing to advocate on our own behalf and for our loved ones. In our parents’ generation, doctors were virtual gods whose advice was to be dutifully followed, no questions asked. Given the inherent conflicts that exist in today’s healthcare reimbursement system, we can’t afford NOT to ask questions.
And feel empowered to say no when someone asks if we want fries with that.
Okay, I’m getting off my soapbox now.
So what about you—have you ever felt as if a healthcare provider was upselling you or a loved one? How have you handled it? Please share!