“Do you want to be called Mike or Michael?” said the young woman, a third my age, cheerfully, as she led me to the dentist’s chair.  I mumbled, “It doesn’t matter” and sat down.

I wasn’t looking forward to the visit, since it was my first dental exam in a new city.  Being called by my first name by strangers much younger than I, without my permission, wasn’t a good start, either.  I find it a little rude.  I realize my feelings may not be the norm.  Many might say, “Get a life” or “suck it up,” which is why I didn’t tell the woman anything.  I was brought up to be polite to elders, and sometimes being quiet is the best behavior.  I was also in the military, quickly learning to call superiors “Sir”.  Few of the young have had that experience.

I practiced medicine for 20 years, calling very few patients by their first name.  I just didn’t do it.  I didn’t mind when nurses called me by my first name, or if they called me, “Dr. Mike,” which I found endearing, because it simultaneously showed both respect and informality.  I used “Sir” to answer lawyers, and it devastated their ability to get my goat.  It’s difficult to argue with somebody who keeps saying “Sir.”

One needs to develop a sense for whom informality is appropriate. My next door neighbor is 21 years my senior, but I use her first name.  The chief of neurology, when I was a resident, is about her age, but I have never once called him by his first name, nor would I, should I ever see him again.  I don’t think he would mind; I would.

Online, first name basis is the norm, and many take advantage of it, saying things they might not say face to face to an older adult.  Or maybe they would, since today, young is good and old is….well, not so good.  I’m crotchety, I guess, but I think since English doesn’t use the informal second person pronoun, we need to show respect in other ways.

I received a survey after the initial evaluation, since virtually everybody in the service industry surveys these days.  It was not anonymous, making me more reluctant to respond.  Surveys I like have three questions:  Did you like the care?  (Yes/No)  Would you recommend us to a friend?  (Yes/No).  What can we do to be better? These are fundamental questions, easy to answer, and offer a chance to receive good suggestions.  They are neither a census nor randomly generated, so one must still be cautious in interpreting the numbers.

I was going to blow the whole thing off, but the way I had been addressed still grated on me, so I decided to express my thoughts—politely—on the issue.  It is never wrong to call adults “Mr.”, “Ms.”, “Mrs.” or “Dr.”.  It is appreciated, and if the individual feels you are too formal, they will tell you to use their first name.  Unfortunately, the survey required an answer to every question in order to be submitted.  So, I had to give a number of stars to everybody, fill out another box for comments, and…..whether I was on Facebook.  You see, they wanted to post my comments anonymously or with my name on Facebook.  

I must be getting stodgy, because the idea of a dentist, or any physician, using Facebook for posting patient evaluations seems weird, especially given privacy regulations.  When I received the survey, I had only digital X-Rays, gum probing, and an estimate of what I needed, a screen view of every one of my 24 teeth and the itemized bill, visible without leaving the chair.  I was glad to be sitting when I saw the bill, in four figures, double what I have paid for dental work in the last decade, including a root canal.

Because I hadn’t filled out every box, I still had the choice to quit or finish.  I suspected that all the stars I had to put for each individual involved would be averaged, and that bothers me.  I’m a crotchety old guy.  Stars are ordinal data: 1 star and 5 stars should not be averaged to get 3 stars, unless the stars stand for interval data, like temperature, money, or speed.  Love and caring are not interval.  I then added something I had forgotten.  Prior to the appointment, I had received 3 e-mails, a call (6 days earlier), which I had to acknowledge by calling back, and an SMS the day of the appointment.  That is over the line.  In my day, even calling patients to remind them wasn’t done.  I now think that is a good idea:  One call is reasonable, without requiring a call back to acknowledge.  A statement that one may be billed for a no show is entirely appropriate.  Professionals shouldn’t have their time wasted.  Really, an SMS?

Why didn’t I have dental insurance?  Good question.  Three-quarters of people over 65 do not have it.  Twenty-five per cent have lost all their teeth, 40% if poor.  About 60% have significant periodontal disease.  My dental costs per year for the last decade were minor, and I had been doing well.  I had no reason to think matters were suddenly going to change.  Bad decision.  Dental insurance has pre-existing exclusions, and now that I have been examined, I have them.  What I find interesting and disturbing is that AARP, which bombarded me about medical plans, was more silent about dental.  There is a one year waiting period for a crown and periodontal disease, and coverage is about 50% of the cost.  That’s crummy.

More than half of Americans have some sort of dental disease.  For the elderly, it is yet another cost to have insurance, although chronic periodontal disease can cause systemic problems, which increase medical costs.  Since the Affordable Health Care Act is under fire, don’t count on dental coverage in the near future. Many elderly can’t afford four figure costs for dental care, so they do without, dealing with the worst thing first, hoping something else bad doesn’t happen.  This is how many Americans deal with medical issues.  This is how many Americans deal with financial issues.

If you are young and in the service industry, call older people “Mr.” “Ms.” “Sir” or “Ma’am” as a default.  They may not like the bill, but at least they may be addressed appropriately.

Twenty-two days before my next appointment, and I just got an SMS and an e-mail, reminding me.  I’m waiting for Viber and WhatsApp to sound off.  Fortunately, I don’t have Twitter.

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