A question of ethics

Some issues that a new dentist might face may include:

It is my first time doing a procedure that I want to incorporate into my practice: how can I do that ethically on my first cases?

When should I refer? Are there ethical considerations if I don’t refer?

At what point should I send the patient to a specialist? When and how do I tell a patient their treatment should continue with a specialist without losing the patient’s confi dence or trust? As an ADA member, what is my ethical obligation to my patients?

Dr. Ishkanian

Dr. Ishkanian

We invited Dr. Emily Ishkanian to share perspectives relevant to clinical experience. is the ADA New Dentist 14th District representative and representative on ADA’s Council Ethics, Bylaws and Judicial Affairs. The ADA Principles of Ethics and Code of Professional Conduct (the ADA Code) can offer guidance to help new dentists answer ethical questions, Dr. Ishkanian said.

“My reputation, my name and my license are too valuable to risk,” Dr. Ishkanian said in describing several real world practice situations she encountered. Dentists are faced with challenging ethical dilemmas in day-to-day practice. However, new dentists are placed in especially precarious positions when faced with what seem to be a choice between acting as defined by the ADA Principles Professional Responsibility and possibly losing their job.

Some ethical situations include the following:

Advanced procedures
When you are asked to complete procedures and your gut tells you this isn’t a treatment you feel comfortable performing, you have the option to refer to another practitioner who is more skilled in the procedure. Not only should this be an option, but it may actually be an ethical obligation. Ultimately, as the dentist, you make that call, because only you know your capabilities and you are responsible for making sure you do no harm to your patients. Recognize that referrals don’t make you a weak clinician, but rather show that you value the patient’s best interests. No one should expect you to do anything you don’t feel comfortable doing.

Ratios
Crown-to-filling ratios may sound absurd, but some new dentists have actually been faced with this expectation. If a dentist hasn’t met the adequate ratio, he or she may have been reprimanded or in some instances his or her employment may actually have been at risk. At the end of the day, as a dentist you have gone to school to gain the clinical knowledge to diagnose, educate and treat your patients. Yes, dentistry is a business, but you and your patients determine the best treatment, not the offi ce manager.

Continuing your education
Upon graduation from dental school, you quickly learn that you are a beginner. Is there a treatment you are looking to incorporate into your practice but you feel you don’t have quite enough experience? Take the proper steps to fulfi ll your ethical obligation to do no harm to your patients. Participate in continuing education, specifi cally hands-on CE; engage in a mentorship with a seasoned dentist by shadowing him or her while he or she is doing the procedure; reference online tutorials, textbooks, dental blogs, message boards; and most importantly know your limitations and when to refer to maintain the standard of care and to do what is best for your patient.

“After the physical, emotional and financial sacrifices I’ve made to reach this point in my career, I’ve realized that my dentistry and my work reflect the person I am and how I choose to care for my patients,” said Dr. Ishkanian.

Dr. Ishkanian suggests that if you are faced with an ethical dilemma, address it with the owner or owners of the practice. If you don’t see change on the horizon or there are too many ethical challenges that appear unlikely to be resolved, then it might be time to move on, maintain your ethics and standards and fi nd a practice that shares your philosophy. Always put your patients first, and remember this is your license and your reputation. Don’t put yourself in a position where you’re defending it.

Available ADA resources to help new dentists facing ethical situations include the ADA Code of Ethics, the Ethics Hotline and the archive of ethical scenarios that can be found at ADA.org.

When professional conduct is the question, the ADA Code may have answers.

The ADA Principles of Ethics and Code of Professional Conduct amplifies Dr. Ishkanian’s advice. “The American Dental Association calls upon dentists to follow high ethical standards which have the benefi t of the patient as their primary goal,” says the preamble to the Code.

“The ethical dentist strives to do that which is right and good. The ADA Code is an instrument to help the dentist in this quest.”

7 comments

  • I’ve always wanted to be a dentist since I was a little kid. Working on teeth just seems like something that I would love to do the rest of my life. These tips on how to be a better dentist are defiantly going to help me be the best dentist I know I can be. Thanks so much for posting this great article.

  • Ethics is important in every industry. There are some sad stories in the news about dentists doing procedures for the money and not to help their patients. It’s good to know that some people truly want what is best for their patients. Thank you for posting!

  • It’s always a smart decision to be real with what you can really do as a practitioner. I’ve faced the same dilemma before and I was thankful I did the same thing because I could have hurt my budding career at that time. This is a practical tip for all beginner dentists out there. Just remember that your purpose of you becoming a dentist is to make people happy with their own smiles.

  • Nice article. Ethics play a huge role in your dental career. Whether you own a practice or work as an associate, you have to make important decisions. It is important to go above and beyond the required continuing education requirements if you want to grow as a dentist. At first, you should work closely with a specialist on procedures you are learning to build your confidence. You should always feel comfortable talking with the patient. You might be surprised how willing patients are to be your first for a new dental procedure. The other reason you want to work closely with the referral is that you may need them to help you out in a bind. Good referrals are not intimidated by you growing your dental skills. You also want to have a close relationship with your accountant. If you are in an associateship that pressures you to produce, you should be looking for a way out – quick! Trust your better judgement. Thanks for posting.
    Dentist in Sarasota, FL

  • This is interesting. I think that ethics is a subject that can never be talked about enough. The situations you present aren’t that out there and something dentists could face everyday. I think that your suggestion to refer to someone who is more proficient at an advanced procedure is a good example of a good ethical situation and response.

  • If you want to grow as a ethical dentist, It is important to go above and beyond the required continuing education requirements. First you need to build your confidence working with specialist.
    Thanks for Posting
    Dr. Jenifer C. Back

  • When I first graduated I had choices to make like do the endo that is on the seclude or refer. You get money for the molar endo and crown but if its too difficult your going to take a lot of time, its going to be frustrating, and you may waste the patients time by having to refer anyway. Its important to think about production goals and the patient. We as dentists are business people and doctors but we also are educated. We have to take it upon ourselves to talk to employers to do the hard procedures we evaluated personally based on criteria we learned. Here is a check list for endo: https://www.aae.org/specialty/wp-content/uploads/sites/2/2017/10/2006casedifficultyassessmentformb_edited2010.pdf You should check a checklist based on evidence and considerations of what cases to refer and what to do. Its personal on what cases you care comfortable doing. Don’t do things you cannot do like calcified canals…if u can’t see the chamber and u haven’t seen those cases, not a good idea to do it. This is just personal advice. Love to here people’s thought on the ethical principles (respect patient autonomy, etc.). Follow my blog TheFlossopher.com a dental ethics blog or email me at drburla@theflossopher.com.

    Dr. Vishnu Burla, DDS, BA Philosophy

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