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MyView: Unnecessary for gentlemen

December 09, 2013

By Brian Shue, D.D.S.

Nurses are the most ethical professionals. Members of Congress and car salespeople are the least ethical. Surprised? Those are the findings of the Gallup poll "Honesty/Ethics in Professions" from December 2012.1

Each year, 1,015 randomly sampled adults 18 and older across the U.S. are asked this question: "Please tell me how you would rate the honesty and ethical standards of people in these 22 fields—very high, high, average, low or very low?" There is a ±4 percentage maximum margin sampling error.

Health professionals are the most trusted, capturing four of the top five choices. Nurses received a combined 85 percent of "very high" or "high" marks. Rounding out the top were pharmacists (75 percent), medical doctors and engineers (tied at 70 percent each) and dentists (62 percent). Two other health professions scored slightly above average: psychiatrists (41 percent) and chiropractors (38 percent).

Gallup reports the highest score ever achieved was 90 percent by firefighters—in the poll conducted just after the 9/11 tragedy. This annual poll does not include every profession each year (for instance, telemarketers and funeral directors will have to wait for another year). Gallup has included the dentist category in its recent polls about every three years.

Three out of five believe dentists have high ethical standards, which matches our highest score from 2006. Dentists in the last decade have received a rating of at least 56 percent, which is higher than the usual 50 percent-range that dentists have earned since first being included in the poll in 1981.

On the other hand, two out of five don't regard dentists as highly trustworthy. Gallup polls didn't exist back then, but what would our dental forefathers think? We have come a long way from the 19th century dental charlatans and quacks who roamed the streets plying the trade of dentistry without respect from the general public nor the medical profession. It took great strides, too numerous to mention, to elevate dentistry in the U.S. into the respected profession of today.

Early dental organizations, from the local to the national level, endeavored to bring art, science, professionalism and ethics to prominence in our field. Although not the first or even second national dental organization, the ADA arrived in 1859 and obviously survived the 19th century. It adopted a constitution the next year, which included an article that targeted the nonethical dentist member:

Conduct of Members—Any acts of special immorality or unprofessional conduct committed by a member of this Association, shall be referred to the Committee of Arrangements, whose duty it shall be to thoroughly examine into the case and report at the next meeting, if the charges be sustained. Whereupon, by vote, the offending member may be reprimanded or expelled: a two-thirds vote being required for expulsion, a plurality vote being sufficient for a reprimand.2

But there's more. On Aug. 3, 1866, leaders at the ADA annual meeting debated the merits of a freshly written Code of Ethics. Ethics Committee Member and Immediate Past ADA President John H. McQuillen stated "on general principles (he) was opposed to its adoption, as unnecessary for gentlemen, and its enforcement impracticable upon those who were not." But after much discussion very late into that Friday night, it passed.3

Although it paled in comparison to the scope of our current 6,900-word membership-binding ADA Principles of Ethics and Code of Professional Conduct, the original ADA Code of Ethics clearly captured the essence of doing the right thing—in less than 730 words.

There is much to learn from this original document. In order to push our ethics forward and earn more of the trust of today's public, let's take a step back and learn from the past. Here are major points from the 1866 ADA Code of Ethics in its exact language:

• The dentist should be ever ready to respond to the wants of his patrons, and should fully recognize the obligations involved in the discharge of his duties toward them.

• It is not to be expected that the patient will possess a very extended or a very accurate knowledge of professional matters.

• The dentist should be temperate in all things, keeping both mind and body in the best possible health, that his patients may have the benefit of that clearness of judgment and skill which is their right.

• A member of the dental profession is bound to maintain its honor, and to labor earnestly to extend its sphere of usefulness.

• The person and office arrangements of the dentist should indicate that he is a gentleman; and he should sustain a high-toned moral character.

• When consulted by the patient of another practitioner, the dentist should guard against inquiries or hints disparaging to the family dentist.

• Dental surgery is a specialty in medical science.

• Dentists are frequent witnesses, and, at the same time, the best judges of the impositions perpetrated by quacks; and it is their duty to enlighten and warn the public in regard to them.

Though simply worded, the Code made profound statements almost 150 years ago to advance our profession.

Omitted here are a few points made in the Code that aren't relevant in today's world (such as prohibition of advertising) and no attempts were made to alter the document to make it gender neutral.

Once again, we need to prove ourselves to the public. Our public's image of the honesty of our profession should not continue to register as "average," "low," or "very low" in such large Gallup numbers. There is room for improvement.

It is obviously not going to be easy to change the minds of those who do not hold the dentist to such high esteem, yet it is even easier to betray the trust of those who already believe dentists to be honorable. Much can change with every interaction we have with our patients, either positively or negatively. Harken back to the simpler times, when a basic code of ethics helped guide the members of our profession, even before the time that dentistry became regulated and licensed.

Elevate our profession. As the 1866 ADA Code of Ethics states: "For this, and the many other benefits conferred by the competent and honorable dentist, the profession is entitled to the confidence and respect of the public." Those 19th century dentists did everything possible to accomplish that.

We have two to three years before the next Honesty and Ethics Gallup poll once again includes dentists. There's time to get it right.

Let's be that 19th century dentist.

REFERENCES

1. Gallup Poll, Honesty/Ethics in Professions, December 2012. 

2. American Dental Association. The Dental Cosmos 2(2):97- 98, September 1860.

3. Transactions of the American Dental Association, at its Sixth Annual Session. The Dental Cosmos 8(2):88-90, September 1866.

Dr. Shue is an associate editor for the California Dental Association and has been editor for the San Diego County Dental Society for the past eight years. He participated in the ADA Institute for Diversity in Leadership program in 2004-05. His comments, reprinted here with permission, originally appeared in the May issue of that publication.