It is 3:30 on Wednesday afternoon, and you are in the midst of the typically brisk after-school pace. Even though your reception room is full, you decide to take a call from one of your referring dentists. He says that he has just voted for you as the city’s “best orthodontist” in the poll of the local Health Weekly Magazine . In return, he would like you to vote for him as the top restorative dentist. “Good marketing!” he says. Health Weekly is an avant-garde magazine that advertises your city’s best in restaurants, theater productions, and health care. All entries are compiled subjectively, but listing your name could have a substantial impact on new patient flow, since the magazine is widely read. Those elected as “best” can buy expanded space in the magazine to elaborate on their credentials and a framed copy of the magazine’s announcement for a “nominal” fee of $375. You politely thank the caller and excuse yourself to get back to your waiting patients.

Excellence in health care, especially in dentistry, is difficult to quantify. Many indicators used by the medical specialties, such as length of hospital stays and mortality ratios, are inapplicable to our profession. Even top-level athletes can be identified with more reliability and validity than in dentistry. Consider the sprinter with consistently top times for the 100-yard dash or the baseball player with a top batting average. These are objective measures of quality. Since the level of treatment quality in orthodontics can be subjective, one must wonder what qualifies a clinician as “the best.”

Printed statements such as a top-quality listing can be persuasive. If the publisher can boost its sales and increase revenue by selling framed replicas of its publications, the winner of the top-doctor nomination and the magazine publishers increase their public exposure. “Good marketing,” as your referring dentist observed.

The problem, however, is in the public’s perception. Is the “top doctor” ranking an authentic assessment of a practitioner’s level of care? Consequently, might potential patients be incorrectly influenced in their selection of an orthodontist?

The American Dental Association’s Principles of Ethics and Code of Professional Conduct states: “If a dental health article, message, or newsletter . . . is designed to give questionable expectations for the purpose of inducing the public to utilize the service of the sponsoring dentist, the dentist is engaged in making false or misleading representation to the public in a material aspect.” The code further states that “statements should be avoided which . . . [suggest] that the advertised services are superior in quality to those of other dentists, if that representation is not subject to reasonable substantiation.” The AAO’s Principles of Ethics and Code of Professional Conduct declares: “Statements should be avoided that contain a representation or implication regarding the quality of orthodontic or other health care services . . . [that] are not susceptible to reasonable verification by the public, and/or are intended or likely to create an unjustified expectation about results that can be achieved.” The Code of Ethics of the American Board of Orthodontics echoes the same sentiment.

The key to this ethical issue is veracity: telling the truth. Classical ethicists’ support of truth telling is based on the notion that lying is wrong because it violates the respect of the person. But more basically, deception is wrong in our scenario because it can encourage a patient to enroll for treatment in a specific office based on a false sense of security—the patient’s perception that he or she is in the care of the area’s best clinician. This might be misleading.

Quality in specialty care is not determined by an election or by a public-opinion poll. Quality is an attribute that is developed over time, comprising clinical expertise, effective practice management, and old-fashioned compassion for every patient.

Now that’s “good marketing” for sure.