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?
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:
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.
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.”