Social Values, Regulatory Tensions and Professional Practices with Underprivileged Populations: The Case of Quebec's Oral Healthcare System.

OBJECTIVE Dentists may experience frustration in their practice with people living on welfare, often perceiving them in a negative light. The difficulties encountered are detrimental to the patient-professional relationship and contribute to compromising access to care for this underprivileged population. In order to fully understand patient-professional interactions, we must consider the macroscopic contexts in which they occur. This paper examines the systemic influences of these interpersonal relationships to deepen our understanding of an important access-to-care determinant for people living on welfare. METHODS Two frameworks are applied to the analysis of Quebec's oral healthcare system: the social values framework and the regulatory logics framework. RESULTS Our assessment leads us to posit two phenomena: (1) certain negative stereotypes regarding patients living on welfare allow dentists to manage the inevitable regulatory conflicts (i.e., economic vs. professional) involved in their practice and (2) the behaviours of people living on welfare are frequently judged according to the social values embodied in the organization of Quebec's oral healthcare system, delivery and financing. CONCLUSION Quebec's oral healthcare system fails to provide effective access to care for individuals living in poverty, and the government must significantly augment its involvement in this healthcare sector. Dentists should also understand the impact that systemic influences have on their rapport with people living on welfare. We argue that new orientations for the field of dental professional education should be considered.This paper was originally published in French, in the journal Pratiques et Organisation des Soins 2011 42(3).