The philosopher George Santayana famously once said: “Advertising is the modern substitute for argument; its function is to make the worse appear the better.” This outlook seems to be inconsistent with the obligation for dental professionals to be transparent but in a marketplace in which people are accustomed to information being available at their fingertips, can modern dental services survive without advertising? Indeed some multinational manufacturers and retailers would be quick to point out that advertisements don’t just sell a product or service but also ‘sell’ values and concepts. But it would be a poor indictment of our society if Gillette really was “The best a man can get” and furthermore I must admit that the words “I’m Lovin’ It” do not necessary come to mind when reading the McDonald’s calorie information sheet after consuming copious amounts of French fries.
Television
It was not long ago that many dentists felt the GDC’s approach towards advertising seemed to be stricter than that of other professions. But, as a consequence of considerable pressure from the Office of Fair Trading, the approach towards advertising was relaxed and ever since advertising in dentistry is now considered more acceptable, not only from a regulatory perspective but also a social one. However, notwithstanding the guidance developed by the GDC on ethical advertising, advertising in dentistry is still a contentious issue as demonstrated by a recent national TV advert that ran between January and February, which promoted affordable dental implants to a mass audience.
Consumerism
The Government’s White Paper, Equity and Excellence: Liberating the NHS set out the vision of an NHS that putspatients and the public first, where“no decision about me, without me”is the norm. It included proposals togive everyone more say over their careand treatment with more opportunityto make informed choices, as a meansof securing better care and betteroutcomes. This is a virtue which themajority of dentists surely subscribe to,but is there a risk that consumerism isengulfing the profession? The similaritybetween NHS Choices and Tripadvisoris uncanny, and the platform’s ability foranonymous users to leave potentiallydefamatory online feedback is one stepbeyond the “no decision about me,without me” normality.
Alongside this shift towards patient autonomy, practices also face increasing competition from each other, particularly in inner city areas where two practices can exist within yards of each other, which is where advertising is considered as an essential tool for commercial survival. Opponents of dental advertising contend that dentists should not be ‘touting’ and that it is wrong to regard patients as consumers but rather than as individuals needing help. However proponents assert that we cannot use such a broad brush approach to label patients because some people do in fact regard themselves as consumers since they ‘shop around’ for the best price or treatment package.
Public perceptions
At the heart of this debate is the dual role of practitioners as healthcare professionals and as business owners. It is not generally regarded as unethical for a dental professional to be successful in business, but it would be if this was at the intentional expense of their patient’s interests. The 2010 research report General Dental Council Patient and Public Attitudes to Standards for Dental Professionals, Ethical Guidance and Use of the Term Doctor, revealed that respondents felt dentists were more “businessmen than healthcare professionals” and that an increase in active promotion of expensive (and what are traditionally viewed as unnecessary) cosmetic treatments appears to be fuelling this perception further, albeit respondents recognised the voluntary nature of having cosmetic treatment undertaken.
These perceptions portrait an uncomfortable trend being that the profession has not travelled particularly far from the qualitative research conducted by Helen Finch et al in the 1980s whereby it was revealed that dentists were perceived as only being interested in money. But are we still fuelling this perception? It would seem so, as gone are the days when dentists would leave their sports cars at home, opting instead to drive the trusty old family saloon to work for fear of their patients seeing just how much money they were making. Nowadays images shared by dentists on social media inform patients precisely how ‘their’ money is being spent, and although this may be viewed as cavalier in some quarters, it is can also be regarded as refreshingly transparent.
Ethical advertising
You only have to flip open the Yellow Pages to see local dental practices advertising elective procedures such as tooth whitening. If considered as a cosmetic procedure, should tooth whitening be considered any different to other medical cosmetic procedure? The 2013 Independent Review into the Regulation of Cosmetic Surgery, chaired by NHS medical director Sir Bruce Keogh, made a strong call for the Government to regulate the cosmetic surgery industry, estimated to be worth £3.6bn by 2015, including tackling advertising. However, of course, not all tooth whitening is regarded as cosmetic. Unlike tooth whitening, dental implants are a more functional treatment rather than an elective ‘cosmetic’ one. Is there any harm to promote affordable surgical treatments widely to a mass audience? Opponents may argue that dental implants should not be able to be ‘demanded’ by patients but only provided if clinically necessary, therefore it is inappropriate to widely advertise them. The GDC’s guidance on ethical advertising acknowledges that advertising by dental professionals can be a source of information to help patients make informed choices about their dental care, but the guidance also outlines only recommending products if they are the best way to meet a patient’s needs. Therefore unless the needs of each member of the audience is known, which is unlikely with mass media, it could be argued that specific dental treatments perhaps ought not to be advertised as it is not known whether they actually are ‘the best way to meet a patient’s needs’.
In summary, we cannot escape advertising in dentistry as it is a necessary tool for the modern dental practice. At first glance the professional obligation which dental professionals have seems mutually incompatible with their commercial interests in running a dental practice however they do overlap as demonstrated by the fact that ethical dentists do run successful businesses. Dentistry is a profession rather than a trade therefore there is an obligation placed upon dental professionals not only to place patients’ interests ahead of our own but also not to undermine public confidence in the profession.
Despite the rise of consumerism and the need for practices to commercially compete, the ethical issues which face dental professionals regarding advertising remain unchanged; they must not be false, misleading or have the potential to mislead.
The views expressed in this article are those of the author and do not necessarily reflect the views of, and should not be attributed to, anyorganisation that he works for.