Dr. Rickland Asai’s January JADA Ethical Moment column, "What Are My Ethical Obligations in Enhancing My Practice Through Marketing?" (
JADA 2007;138[1]:106–7
), muddied more than clarified the ethical waters for me. And I found Dr. Asai’s introductory warning against treatment planning based on a dentist’s need to do dentistry, rather than the patient’s need to have it, a little insulting. Don’t shoplift or cheat on your taxes either. False advertising is certainly unethical, and simply saying you are better than Dr. Jones down the street, without a recognized standard to offer as proof, is part of what makes us professionals, and not simply craftspeople.
The ethical standard regarding "fee splitting" arose to stop doctors from making patients see another doctor they were not planning on seeing, and getting a kickback on the fees. If it is "fee splitting" to pay a marketing service because it steered a patient who was already seeking care, it must also be unethical for me to give flowers or a gift certificate to a patient to thank him or her for a referral. I would be interested to hear the logic that makes it unethical to pay for one referral, but OK to pay a monthly fee for several, which Dr. Asai seems to imply is not a problem.
Pay and hope—OK. Pay based on actual performance—good business decision, but not ethical. Dr. Asai seems to be searching the ADA Code of Ethics like a prosecuting attorney trying to stretch the meaning of the law to ensure a guilty verdict and suitable sentence to fit his ideas of what is correct, not what the intent of the law was.
As to the prewritten newspaper columns, if there are no misleading or false statements, and the opinion expressed within agrees with that of the dentist paying for it, what purpose does such disclosure serve? Do we need to tell patients that we didn’t cast the crown? We are taught to refer areas of dentistry that can be better done by a specialist. Why not here? Having laypeople clearly understand something about dentistry or dental care that might help them improve their own health, because the writer was a professional at what he does, sounds pretty ethical to me.
When we increase competition within our profession, just as increasing competition in businesses making computers, automobiles and dental materials, the quality of the product gets better. That is good for everyone, except the practitioner who doesn’t want to compete or does not want to get better. They should read Dr. Roger P. Levin’s column in the same issue of JADA, "The Passion for Dentistry" (
JADA 2007;138[1]: 104–5
). For those who believe, as Dr. Asai does, that offices experience slow times that "usually are related to factors beyond the dental office," they should skip it and all of Dr. Levin’s future columns.
As a marketing strategy, being nice to our patients is great, but a very high proportion of our population still chooses big-screen televisions instead of dentistry. Helping our members and dental care stand out from the crowd of possible purchases improves both the public lot and our own, and should be a primary consideration for our organization. There is nothing ethical about people not going to the dentist.
