Imagine a medical doctor who diagnoses a patient with a life-altering (although not life-threatening) condition. It is 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 he decides not to tell the patient about it. Why not? Because he knows the patient's insurance will not cover the procedure, and he is convinced the patient could not afford it.

This is one of those instances where we can see the significance of our actions more clearly when they are projected onto someone else. Just about any reasonable person would say that 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 that they are 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 they 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 are real health implications at stake, including systemic and social health issues. Just importantly, there is 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 is your professional obligation to speak that truth.


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