SPEAASDAFINALIZEDPRESENTATION
- 6. PRINCIPLES OF ETHICS • PATIENT AUTONOMY • NON-MALEFICENCE • BENEFICENCE • JUSTICE • VERACITY
- 7. PATIENT AUTONOMY “SELF GOVERNANCE” • RIGHT TO SELF – DETERMINATION • RIGHT TO CONFIDENTIALITY • PROVIDE REASONABLE ALTERNATIVES • FURNISHING COPIES OF RECORDS
- 8. • 28 YEAR OLD PATIENT PRESENTS WITH PAIN FROM A CARIOUS LESION ON HER RIGHT MAXILLARY CANINE. • YOU PRESENT HER WITH A TREATMENT PLAN TO RESTORE THE TOOTH, BUT SHE ADAMANTLY DENIES THE TREATMENT. • SHE SAYS SHE WOULD RATHER HAVE IT EXTRACTED. SCENARIO
- 9. WE CAN RESTORE IT! • YOU COMPREHENSIVELY EXPLAIN THAT THE TOOTH CAN BE RESTORED, AND THAT THERE IS ABSOLUTELY NO NEED FOR AN EXTRACTION. • YOU INFORM HER OF THE UNNECESSARY NEGATIVE CONSEQUENCES OF THIS EXTRACTION.
- 10. “IF YOU WON’T DO IT, I’LL GO TO SOMEONE WHO WILL!” • MS. JUSTEX TRACT CLAIMS SHE FULLY UNDERSTAND THE SITUATION, AND SAYS SHE NONETHELESS PREFERS THEM TO BE EXTRACTED.
- 11. WHAT WOULD YOU DO? A. CONTINUE EXPLAINING THE BENEFITS OF RESTORATION UNTIL SHE EVENTUALLY AGREES WITH YOU B. REFUSE SERVICE C. EXTRACT #6 D. REFER THE PATIENT ELSEWHERE E. OTHER (SELECT E IF YOU WOULD DO SOMETHING ELSE)
- 12. NON-MALEFICENCE “DO NO HARM” • REFRAIN FROM HARMING THE PATIENT • KEEP SKILLS CURRENT • KNOW WHEN TO REFER TO SPECIALISTS • PERSONAL IMPAIRMENT • POST EXPOSURE/BLOODBORNE PATHOGENS • PATIENT ABANDONMENT • PERSONAL RELATIONSHIPS
- 13. • THE DENTIST HAS A DUTY TO REFRAIN FROM HARMING THE PATIENT. • PROFESSIONALS HAVE A DUTY TO PROTECT THE PATIENT FROM HARM. • “…OBLIGATIONS INCLUDE KEEPING KNOWLEDGE AND SKILLS CURRENT, KNOWING ONE'S OWN LIMITATIONS AND WHEN TO REFER TO A SPECIALIST OR OTHER PROFESSIONAL, AND KNOWING WHEN AND UNDER WHAT CIRCUMSTANCES DELEGATION OF PATIENT CARE TO AUXILIARIES IS APPROPRIATE.” NON-MALEFICENCE
- 14. SCENARIO YOUR PATIENT, TAYLOR, IS A 12 YEAR OLD GIRL WHO COMPETES IN BEAUTY PAGEANTS. HER MOTHER STRONGLY WANTS YOU TO DO FULL VENEERS ON HER DAUGHTER TO COVER UP HER HEALTHY, BUT SLIGHTLY DISCOLORED ANTERIOR TEETH. YOU KNOW THAT THIS IS NOT A MEDICALLY NECESSARY PROCEDURE, AND COULD ACTUALLY BE HARMFUL TO THE CHILD.
- 16. YOU EXPLAIN THIS TO THE MOTHER, BUT SHE RESPONDS THAT SHE IS THE GUARDIAN AND GETS TO DECIDE WHAT GETS DONE TO HER DAUGHTER, AND THAT YOU ARE JUST THE CLINICIAN WHO IS PAID TO DO THE WORK. SCENARIO
- 17. 1) DO THE TREATMENT AS REQUESTED, AFTER ALL IT’S THEIR MOUTH. 2) DO THE REQUESTED TREATMENT ONLY AFTER THE MOTHER SIGNS A WAIVER. 3) REFUSE TO PERFORM TREATMENT ENTIRELY UNDER THESE CONDITIONS. WHAT WOULD YOU DO?
- 18. WHAT WOULD YOU DO? • WHICH ADA PRINCIPLES OF ETHICS ARE AT PLAY IN THIS SITUATION? 1) PATIENT AUTONOMY 2) NON-MALEFICENCE 3) BENEFICENCE 4) JUSTICE 5) VERACITY
- 19. BENEFICENCE “DO GOOD” • PROMOTE THE PATIENT’S WELFARE • COMPETENT DELIVERY OF DENTAL CARE • COMMUNITY SERVICE • GOVERNMENT OF A PROFESSION • RESEARCH & DEVELOPMENT • PATENTS & COPYRIGHTS • ABUSE & NEGLECT • PROFESSIONAL DEMEANOR IN OFFICE
- 20. • THE DENTIST HAS A DUTY TO PROMOTE THE PATIENT'S WELFARE • THE DENTIST'S PRIMARY OBLIGATION IS SERVICE TO THE PATIENT AND THE PUBLIC-AT-LARGE • MOST IMPORTANT ASPECT OF THIS OBLIGATION IS THE COMPETENT AND TIMELY DELIVERY OF DENTAL CARE WITHIN THE BOUNDS OF CLINICAL CIRCUMSTANCES PRESENTED BY THE PATIENT, WITH DUE CONSIDERATION BEING GIVEN TO THE NEEDS, DESIRES AND VALUES OF THE PATIENT • CONTRACT OBLIGATIONS DO NOT EXCUSE DENTISTS FROM THEIR ETHICAL DUTY TO PUT THE PATIENT'S WELFARE FIRST. BENEFICENCE
- 21. SCENARIO KEVIN IS JUST A FEW YEARS OUT OF SCHOOL AND WORKING AS ONE OF SIX DENTISTS IN A MEDIUM-SIZED PRIVATE GROUP PRACTICE.
- 22. RECENTLY, KEVIN LEARNED HIS PRACTICE MANAGER CHANGED HIS TREATMENT PLAN FOR HIS PATIENT FROM A SIMPLE RESTORATION TO A MORE LUCRATIVE FULL CROWN. SCENARIO
- 23. WHAT SHOULD KEVIN DO? 1) ACCEPT THE REASSIGNMENT AND CONTINUE WORK. 2) CONFRONT THE PRACTICE-MANAGER ABOUT THE CHANGE IN TREATMENT PLAN 3) IGNORE THE CHANGE AND CONTINUE WITH HIS ORIGINAL TREATMENT. WHAT WOULD YOU DO?
- 24. KEVIN DECIDES TO CONFRONT THE PRACTICE-MANAGER AND IS TOLD TO NOT WORRY ABOUT IT AND THAT THE PATIENT’S INSURANCE WILL COVER THE CROWN COMPLETELY. IN ADDITION, HE IS TOLD TO CONCENTRATE ON KEEPING HIS PRODUCTION UP AND NOT DISCUSS THE CASE FURTHER. WHAT WOULD YOU DO?
- 25. WHO IS ETHICALLY RESPONSIBLE FOR PATIENT CARE AND PATIENT TREATMENT PLANS? 1) KEVIN – HE IS THE PRACTICING DENTIST. 2) THE OWNER-DENTIST – KEVIN IS SIMPLY AN EMPLOYEE. 3) PATIENTS MUST BE RESPONSIBLE FOR THE TYPE OF HEALTHCARE THEY RECEIVE. WHAT WOULD YOU DO?
- 26. JUSTICE “FAIRNESS” • PATIENT SELECTION • EMERGENCY SERVICES • JUSTIFIABLE CRITICISM • EXPERT TESTIMONY • REBATES & SPLIT FEES
- 27. Mother brings in her 8 year old son, Sami, to your office after he chipped the mesial of #9 from chewing on ice. Sami has no pain, no swelling in the region, but has mild sensitivity. Sami seems to be fine, otherwise. SCENARIO
- 28. SCENARIO The mother is concerned about her son, so you do a patient exam. During the exam you notice a chip mainly in enamel with some dentin exposure.
- 29. SCENARIO Sami is not a patient of record and visits a different general dentist regularly. His mother is requesting immediate treatment.
- 30. A) Treat Sami and refer him to his general dentist for follow-up care B) Treat Sami and schedule 3 month follow-up appointment at your office C) Offer no immediate treatment and recommend follow-up appointment with Sami’s general dentist D) No immediate treatment is required and schedule 3 month follow-up appointment at your office WHAT WOULD YOU DO?
- 31. ADA CODE OF ETHICS 4.B. Emergency Service. Dentists shall be obliged to make reasonable arrangements for the emergency care of their patients of record. Dentists shall be obliged when consulted in an emergency by patients not of record to make reasonable arrangements for emergency care. If treatment is provided, the dentist, upon completion of treatment, is obliged to return the patient to his or her regular dentist unless the patient expressly reveals a different preference.
- 32. The dentist has a duty to treat people fairly. This principle expresses the concept that professionals have a duty to be fair in their dealings with patients, colleagues and society. Under this principle, the dentist's primary obligations include dealing with people justly and delivering dental care without prejudice. In its broadest sense,this principle expresses the concept that the dental profession should actively seek allies throughout society on specific activities that will help. JUSTICE “FAIRNESS”
- 33. 4.A. PATIENT SELECTION. 4.A.1. PATIENTS WITH BLOODBORNE PATHOGENS. 4.B. EMERGENCY SERVICE. 4.C. JUSTIFIABLE CRITICISM. 4.C.1. MEANING OF "JUSTIFIABLE." 4.D. EXPERT TESTIMONY. 4.D.1. CONTINGENT FEES. 4.E. REBATES AND SPLIT FEES. 4.E.1. SPLIT FEES IN ADVERTISING AND MARKETING SERVICES JUSTICE “FAIRNESS”
- 34. VERACITY “TRUTHFULNESS” • DUTY TO BE HONEST & TRUSTWORTHY WHEN DEALING WITH PEOPLE • RESPECTING THE POSITION OF TRUST INHERENT IN THE DENTIST-PATIENT RELATIONSHIP • COMMUNICATE TRUTHFULLY AND WITHOUT DECEPTION • MAINTAINING INTELLECTUAL INTEGRITY
- 35. “TRUTHINESS”
- 36. “IF YOU LIKE YOUR PLAN YOU CAN KEEP IT”
- 37. SCENARIO The fee for a patient without dental benefits shall be considered a dentist's full fee. This is the fee that should be represented to all benefit carries. (ADA) A 35 yo female comes to your office because she has noticed she has a cavity. Upon inspection you determine that #30 is severely broken down and can only be restored with a full coverage crown. Upon hearing this, she becomes very emotional and begins sobbing as she explains that her husband recently lost his job, they are falling behind on their bills already, and she can’t afford to do a crown. Your normal fee for a crown is $1,000 (which is what you bill to the insurance companies as well). Because you have a good relationship with their family and feel bad because of their situation, you tell your pt. that you will do the crown for only $600 to help her out.
- 38. SCENARIO Is the principle of Veracity violated if you are reporting to insurance companies that your crown fee is $1,000 but you lessen that fee for certain patients? A: Yes B: No What if this patient had insurance that covered 50% of the procedure, leaving her a $500 co-pay. Would the principle of veracity be violated if you told the patient you would only collect $100 of their co-pay? A: Yes B: No
- 39. OTHER EXAMPLES • ACCEPTED SCIENTIFIC KNOWLEDGE • WAIVER OF COPAYMENT • OVERBILLING/ FEE DIFFERENTIAL • TREATMENT DATES • DENTAL PROCEDURES • UNNECESSARY SERVICES • MARKETING
Editor's Notes
- #2: Today we are going to be discussing ethics & go over a variety of scenarios in which ethics comes into play. We have to determine whether these issues reallly are unethical or what the circumstances surrounding each one of these issues
- #3: Lines between right & wrong get blurred What is your definition of ethics?
- #4: Ethical Dilemmas Presents in
- #5: What types of jobs encounter ethical scenarios each and every day
- #36: ----- Meeting Notes (1/13/15 15:52) ----- Now let's take at a quick look at an example ----- Meeting Notes (1/13/15 15:52) ----- If you like your insurance you can keep it. Was the principle of veracity upheld in this instance? In the words of Dr. Goldstein..... Not so much Now lets take a look at an intriguing scenerio
- #37: ----- Meeting Notes (1/13/15 15:52) ----- Now let's take at a quick look at an example ----- Meeting Notes (1/13/15 15:52) ----- If you like your insurance you can keep it. Was the principle of veracity upheld in this instance? In the words of Dr. Goldstein..... Not so much Now lets take a look at an intriguing scenerio