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THE BUINESS OF MEDICINE
(2026/08/16)
 

“But doctor, you pulled the wrong tooth. You pulled a perfectly good tooth for nothing.”

“No I didn’t. I’m going to charge you for it.”

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Profit should not be the prime motivator in the health-care professions, however, there is nothing wrong with selling medicine as long as the health and welfare of the patient is placed above all else. While we think of the plastic surgeon or the cosmetic dentist as the salesmen of the health-care industry, every doctor is really selling something to someone as ignoble as that sounds. Even the oncologist and cancer surgeon are selling their particular protocol and service. After all, who doesn’t go for the second opinion? Most patients don’t understand the medicine, even after you explain it well. What they do understand are the components of bedside manner. If you are the doctor with the great bedside manner, they come back to you. When you have it, you’ve essentially sold them on you as much as, if not more than, the protocol.

Once the student graduates from one professional school or another, they are exposed to an onslaught of programs and lectures explaining how to make more money, spend less time in the office, and do better quality service. The problem with these promises is that the only one accomplishing these noble goals is the person on the lecture circuit who is spending less time in the office, making a lot of money from all the attendees, and providing better quality in that they are not in the office performing iatrogenics.

The big business of medicine is not all bad. Wherever there is a lot of money, innovation and technology flourish. Once dentists realized that they could sell cosmetics and advertise the procedures, money poured into new materials that never might have been developed without the promise of big profits.

In medicine, there are many technologies that may have never come to pass, and new and exciting drugs could never be developed without the extensive research dollars generated by the pharmaceutical companies. The promise of vast riches will make an artificial heart and the cure of cancer realities.

When you develop your selling philosophies and protocols for elective treatment, it is imperative to make sure you are not pushing unnecessary procedures, or procedures your patients cannot afford. There are many lecturers out there telling you how to help patients find the money for procedures that you convince them they need. You have to ask yourself if they need the service or if you are just pushing it past many other things they may now have to do without because you sold them a bill of goods.

Finding patients easy credit for elective procedures may put them in debt for years. You have to be a compassionate practitioner and make sure you aren’t part of the vehicle that takes the patient to bankruptcy.

Before advertising in the health-care professions, patients and doctors had a different mindset. Patients came in when they had a problem and doctors addressed the problem. Prevention and lifestyle was encouraged, but there was little, if any, selling. Now gurus teach you how to advertise effectively, literally chart monthly production, increase sales of the most lucrative procedures, offer financing for better case acceptance, and encourage staff to sell in order to participate in production goals that have to continually go up. This sounds a lot more like corporate America than the medical profession.

You have to ask yourself what distinguishes you as a professional. Patients aren’t stupid. They can often see through all the hype and recognize a pitchman. Your credibility rapidly fades when the patient perceives you as a salesman. It’s imperative to learn that a big part of being compassionate is not selling your patients things they don’t need and can’t afford.

We have gone from an era where doctors weren’t allowed to make claims of superiority to daily advertising that makes claims, direct or implied, that one hospital and their doctors are better than all others. How does that make a patient feel if he just had a prostate operation at one hospital and hears that another hospital has the best technique and way of treating his problem? Maybe it’s time to rethink professionalism.

 



 

 

Comments
• Hannah Eden (2026/10/05 18:47)
This article highlights the difficult balance between running a successful healthcare practice and maintaining our primary responsibility to our patients. While financial incentives can promote innovation and improve access to new technologies, treatment recommendations should always be based on what is clinically appropriate rather than what is most profitable. As healthcare professionals, maintaining patients’ trust requires putting their health, individual circumstances, and financial well-being ahead of production goals or financial gain.
• Elise DeDominicis (2026/10/05 14:16)
It can be tough to balance the business side of running a practice with keeping your integrity. The constant push to hit production goals can wreck patient trust if you aren't careful. Real care isn't just about using a good bedside manner to close a deal—it’s about having the empathy to say no to unnecessary or unaffordable treatments, even when the office tells you to produce more.
• Lawrence Wang (2026/10/05 13:16)
What stood out to me most from this post is the difference between selling treatment and educating a patient. I understand dentistry is also a business and a practice has to make money to survive. But I think once production becomes the main focus, it can become easy to cross the line between recommending treatment and trying to sell it. That is one reason I like endodontics. In most cases, there really is not much to “sell.” A patient either has an endodontic problem or they do not. Our job is to diagnose it, explain the options, and hopefully get them out of pain. My military experience also shaped how I look at this. In the military, we basically just did the dentistry that was needed. There were no production goals. So working later in a civilian DSO was definitely an adjustment for me. When I recommended treatment, I always tried to educate the patient rather than sell something. For example, if a tooth had a crack, I would show the patient an intraoral photo and explain what I was seeing. My usual line was, “If this were my mouth, this is what I would do.” After that, I left the decision up to them. I also think something as simple as sitting down with a patient matters. Swayden et al. studied 120 postoperative patients and found that when the physician sat instead of stood, patients viewed the interaction more positively and had a better understanding of their condition, even though the actual time spent with them was about the same. For me, good bedside manner and good business should go together. Sit down, explain what you see, give the patient an honest recommendation, and let them decide. Swayden KJ, et al. Effect of sitting vs. standing on perception of provider time at bedside: a pilot study. Patient Education and Counseling. 2012;86(2):166–171.
• Raymond Fahrenbach (2026/09/08 15:14)
This article made me think about how different dentistry can feel depending on the environment you practice in. When I was in the military, healthcare and dental care were free for the patients, so I never really had to think about the financial side of treatment. I could diagnose the problem, explain the options, and recommend what I thought was best for the patient without worrying about whether they could afford it. Looking back, I think I took that for granted. When I left the military and worked in private practice, my perspective changed pretty quickly. I was compensated based on production, so there was definitely pressure to produce. I went from simply recommending treatment to feeling like I had to sell the treatment as well. That was a pretty drastic change for me and honestly one of the more stressful parts of private practice. A lot of the time, patients couldn't afford the treatment and would have to finance it, which was difficult to see. I don't think there is anything wrong with dentistry being a business, and I certainly don't feel bad about wanting to make a living. I just think there is an uncomfortable line between educating a patient about what they need and feeling like you are trying to sell them something. As a first-year endodontic resident, I want to make sure I never lose sight of that distinction. I want my patients to trust that when I recommend a root canal, it is because I genuinely believe it is the best option for them, not because I am trying to increase my production. I think that is what I took away most from the article. I understand the financial realities of private practice much better now, but I still wish there were an easier way to balance those realities with simply doing what is best for the patient.
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