The Two Realities of Patient Care

magine a medical doctor who diagnoses a patient with a life-altering (but not life-threatening) condition. It’s a condition he has seen many times. He knows there is a procedure — one he has performed successfully many times — that will address the issue effectively, but decides not to tell the patient about it because he knows the patient’s insurance won’t cover the procedure and he’s convinced the patient couldn’t afford it.

This is one of those instances where we can see the significance of our actions more clearly when they’re projected onto someone else. Just about any reasonable person would say the doctor in the scenario I’ve described is guilty of withholding important information, if not outright malpractice.

And yet this is something many dentists do all the time. They do it with the best of intentions; they want to believe they’re attuned to their patient’s financial concerns and they want to make acceptance as easy as possible. So they prejudge what they think patients will accept and adjust their case presentations accordingly.

The next time you find yourself doing this — the next time you catch yourself thinking, “They’ll never go for that” and holding back from presenting ideal treatment — remember that doctor. Is that the level of care you want to provide? Is it the level of care you would want for yourself and your loved ones? Sure, nobody ever died from not receiving discretionary dentistry, but there can be real health implications at stake, including systemic and social health issues. Just importantly, there’s the matter of your professional integrity.

A patient’s economic limitations are a reality of dentistry, one that every dentist must recognize and find ways to deal with. But that reality must remain completely distinct and separate from the patient’s clinical reality. You see what you see, you know what you know, and it’s your professional obligation to speak that truth.