Thinking like a behavioral economist (dentist edition)

By Razib Khan | July 1, 2012 11:41 am

This clip with Dan Ariely telling off a dentist who tried to sell him on a more expensive item is classic. Would that we all behaved in such a manner, no? The problem when you interact with a particular set of professionals, in particular in healthcare, the information asymmetry is such that it is very difficult for you to make an informed choice as a consumer. I’ve had an experience very similar to Ariely with dentists.

The problem here though that is that dentists are professionals. In other words, they should be motivated by something other than the profit motive. Ergo, we (the public) confer upon the profession licensing for exclusive services. The problem is that professionals are not immune from incentives. On the conscious level it seems that professionals generally do perform services without the profit motive in mind (e.g., dentists and doctors encourage your toward good health).* The problem is that on the unconscious and implicit level is where subtle biases and preferences come to the fore.

Naturally professionals don’t want to admit that they have biases. I’ve listened to Dr. Thomas P. Stossel dismiss the possibility that gifts and perks by pharmaceutical companies might have an effect on their practice. Stossel’s assumption seems to be that as smart and educated professionals of course doctors wouldn’t allow such practices to bias their judgment. First, just because you have a medical degree doesn’t make you the genius of all things. A psychologist or economist he is not. Second, these firms themselves have marketing professionals who likely are aware of some of the literature on influencing people.

The point here is that there are no gods. Professionals are humans as well, and they are providing you services. Unfortunately because of the way medical insurance is designed in the United States we don’t see the price of these services, ergo, one reason for inflation in the health care sector (insurance companies have had difficulties imposing price pressure; they’re less popular than hospitals). Ultimately one thing we can do is behave in a more critically rational manner. I’m going to see a dentist in the next month for a basic check-up, and my consciousness has been raised by Ariely’s points (I probably wouldn’t be as direct as he was, but I’m going to be firm in not being persuaded into something before doing my own research).

Of course one problem with this tack is that turning something into a consumer-monetized transaction changes the interaction. Often not for the better. Ariely himself pointed this out in Predictably Irrational. Right now professionals have some moral and cultural pressure to not behave as financial optimizers. If consumers start to behave like…consumers, then they may change in response.

* I believe that in the modern American context many professional organizations operate as guild which are engaging in rent-seeking, but that is a different discussion.

  • Tom Bri

    I work with dental insurance. A couple of points. One, I often speak with dentists. As you would expect, they run the gamut. Dentists tend to give away a lot of services because patients either cannot pay or will not. And plenty of dentists just give away services, if they find out for example that insurance won’t pay when everyone thought it would, or if their patient’s financial status changes.

    But there are plenty of dentists who go straight to the most expensive procedure, bill the patient and only then submit it to insurance. The insurance company (I speak from experience) will only pay for the least expensive generally accepted procedure for that particular condition. So the patient is stuck paying the difference. Part of my job is fielding questions from irate clients. I do the math and explain it. Funny, it isn’t the stupid people who react the worst, it is the smart ones. Embarrassed?

    My advice, if you are going to have a procedure that is over the normal exam/cleaning/filling, get the dentist to submit it to the insurance company before you have it done. Get the insurance company locked into a $ benefit amount, and the dentist on board. That will also tell you if what the dentist is advising is the routine treatment or the more expensive one.

  • Tom Bri

    Okay, watched the video and had to laugh. The whole resin/vs amalgum thing comes up every single day at work. Some dentists even tell patients no one does amalgum any more. Resin/composite/porcelain is always going to be a lot more expensive than old-fashioned amalgum, which is all your insurance is going to pay for.

  • Brian Schmidt

    Too bad there aren’t more opportunities to comparison shop between professionals. I had one chance – I went to random Dentist 1 who offered free cleaning/exam, and she said I had five teeth with big older fillings that should be replaced with crowns. Dissatisfied, I went to my landlady’s Dentist 2, who said the fillings could lasts another 5-10 years and that crowns don’t last forever either, so don’t replace them. Dentist 2 has now had my business for the last 14 years and I never resist when he says I need work.

    Maybe Yelp will help with this. I’d definitely send business his way if he needed it (he doesn’t).


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About Razib Khan

I have degrees in biology and biochemistry, a passion for genetics, history, and philosophy, and shrimp is my favorite food. In relation to nationality I'm a American Northwesterner, in politics I'm a reactionary, and as for religion I have none (I'm an atheist). If you want to know more, see the links at


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