Money and Ethics: A Potential for Conflict

Gary Herman, DDS

Ihave an old-school family practice. A colleague nearby has recently opened a very different style of office. He is aggressively marketing, offering discounts, doing free exams and “upselling.” To me, he is violating his ethical duties, but I do not know that for sure. What should I do?

Dentistry is not a charity. Dentists are allowed, even encouraged, to be successful. Making money is necessary, especially as the costs of education and establishing and running a practice grow and payments are being restrained by outside forces, such as third-party payers and nontraditional practice models. However, dentistry is both a business and a profession. Conflicts can occur when trying to function in both of these arenas.

In the scenario described above, marketing, discounting and discussing the results of an examination and proposal of treatment could all be appropriately ethical. Even providing free care can be done within dentistry’s ethical framework. However, each of the situations described, depending on exactly how these subjects are addressed by the dentist, could be flagrantly unethical.

Section 6 of the CDA Code of Ethics concerns false claims and representations in advertising and is based on the Ethical Principle of Veracity. Intentionally misleading the public with false statements and/or partial disclosure of facts could lead to a false or unjustified expectation of results and would be unethical. If the advertising is factual and intended to educate potential patients of services provided, it is very likely acceptable.

Similarly, promoting discounts to specific groups of patients is acceptable as long as the discount is applied appropriately. Providing free care as a charitable gesture is completely professional; however, luring patients to the practice by offering free exams only to propose an expensive list of treatments (that may be only elective or even unwarranted without discussing lower cost options) or not presenting the patient with information as to what could result from no treatment would be ethically wrong under Section 1D of the CDA Code of Ethics and is based on the Ethical Principle of Patient Autonomy.

Yes, money is important, and you should be able to provide dentistry at a fee level that is fair to the patient as well as to your practice. We should all strive to make patients understand all that we are providing within the scope of the treatment they have received; hopefully, you have helped your patients realize they have received a good value for the money they have spent.

The conflict between money and ethics occurs primarily when money is valued by the practice more than ethics are valued. Wouldn’t it be nice to see your practice grow not from spending a lot of that money on advertising, but rather by spending time establishing trust and respect from your patients and letting them be your investment in word-of-mouth advertising? n

Gary Herman, DDS, teaches at the University of California, Los Angeles, School of Dentistry and lectures on ethics, dental law and patient management. He is past chair of the ADA Council on Ethics, Bylaws and Judicial Affairs and is a member of the CDA Judicial Council.

Have an ethical question you’d like to have addressed by the Judicial Council? Email lori.alvi@cda.org.