Most doctors don't have as strong a profit motive as a dentist.

Most people see a PCP that doesn't really have the means to recommend you for thousands of dollars of treatments that he'll oversee. Instead he refers you to a specialist, but you still have your PCP to rely on to say "Hey, this specialist says I need surgery for this, is that reasonable or should I get a second opinion".

But when you go to the dentist and he says you have 15 cavities and need two root canals immediately and he can get you an appointment as soon as tomorrow to get started, a lot of people will just do it without seeking a second opinion since there's a lot of friction to finding a new dentist and undergoing a second exam.

When I needed a root canal, I self-referred myself to an endodontist both as a second opinion and for his expertise at doing the procedure. My dentist's dental tech seemed surprised I wanted to go somewhere else for the root canal, she said "Well, most people like Dr Xxxxx do it, he's very good at root canals".

▲

treis 5 hours ago | parent [-]

Most and maybe close to all Drs get paid or a bonus on RVUs (relative value units). A system that seems indistinguishable from a salesman's commission to me.

	▲	Johnny555 4 hours ago \| parent [-]
		That's why I used the PCP as an example, most people start with a PCP, and though the doctors he refers out to may want to do a procedure to maximize their RVU's, the PCP gets no incentive for referring out that patient (and anti-kickback regulations prohibit that kind of compensation even if the PCP and specialist are in the same practice). So the PCP helps keep this in check. Even ignoring RVU's, most specialists will want to treat a problem with their speciality if it would be an effective treatment so a second opinion is almost always a good idea. I shopped around for treatment for a procedure I needed, the robotic surgeon recommended robotic surgery, the laser specialist recommended laser surgery, the general internal medicine doctor gave a few less invasive alternatives. I researched them all, went back to my PCP and picked the procedure I wanted to have done.