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HoldenACL.MedHealthCare Philos 2018;10.1007/s11019-018-9834-1

Socrates asked Thrasymachus '.... tell me .... is your physician a moneymaker, an earner of fees or a healer of the sick?' The potential conflict between the provision of healthcare and the running of a profitable business is thousands of years old, but is it relevant today? Dentistry has traditionally been provided by entrepreneurs, setting up practices wherever there is a perceived demand for their services. This paper asks whether the potential conflict between the practitioner's need for profit and the needs of the healthcare consumer is a valid concern.

Increasing normalisation of the term 'health consumer' or 'client' could indicate that the transaction between professional and patient has become a purely commercial one. However, the empowerment of the consumer has given rise to a more equal relationship between clinician and patient, leading to a more collaborative approach to care.

The prime function of a dental business, though, should not be 'business' but to 'empower consumers of healthcare to access treatment that they need'. There is a clear difference, however, between what the patient needs and what the patient wants. For instance, the profile of elective cosmetic treatments available has risen rapidly in recent years. Their provision to benefit patient appearance should not damage the clinical/patient relationship, unless that want is generated and sold purely to the commercial benefit of the practitioner. The risk of over-medicalisation, by sowing seeds of discontent in the patient about their appearance, is high. But it is not for the professional to judge what is, and what is not, appropriate for the greater good of the patient. Here the collaborative approach to care, with understanding the patient's needs and wants, acts as argument against the accusation that selling cosmetic treatments is unethical and driven by the need for profit.

Other commercial considerations threatening the clinician/patient relationship include the increasing availability of whitening (in some jurisdictions) and injectable fillers by non-dentists, and the competition for patients from advertising from other dental practices. Demand for the perfect smile or tooth shade may also be driven by toothpaste and toothbrush manufacturers.

The commercial nature of general dental practice is unlikely to change in the future so practitioners should strive to maintain 'inherent virtue' in the provision of their services, whether wanted or needed by patients. Failure to do so leaves patients in the hands of those who are here today, gone tomorrow, seeking only profit where they may.