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MyView: Was your hygienist sitting next to me in ethics class?

September 16, 2013

By Jeffrey Parrish, D.D.S.

Who goes to "ethics classes" anyhow? For that matter, who goes to "chemically impaired dentists" classes? From the looks of the crowd at the recent ethics offering at Pacific Northwest Dental Conference, I would guess about two-thirds of the audience were not dentists. And many of the situations and questions presented from the audience did not seem like they came from dentists. Why are these staff members so interested in a topic like ethics?

I went because I have gone several times before, and it is always an interesting exchange of ideas and information from both the ethical and legal perspective (and they are NOT the same). I must confess I also go to try to get ideas to share with the readers in this vast audience; thanks to all three of you for commenting at PNDC. But I digress.

But ask yourself, "Why was your hygienist sitting next to me?" And she was. And I can tell you YOUR name because it was on her name tag. But she didn't say much, so she didn't really reveal why she was there. But she didn't look happy and nodded a few times in agreement with concerned comments made. Was her interest purely academic in that ethics is something she reads about regularly in Dental Hygiene Today or People Magazine? Now, I agree that a "chemically impaired dentist" class may attract folks who have a family member or close friend struggling with alcohol or drugs, so they show up for information. But ethics? When was the last time you were at your kid's soccer practice and the soccer mom next to you asked, "Do you think it is ethical that Jenny's mom has her nanny cut up the orange slices when it's the parents who are supposed to do it?" I think many of those staff members are there because they are concerned about what's going on in our offices, not necessarily in their private lives.

So if my premise is correct, what is she concerned about in your office? The questions presented by supposed staff members were of a wide variety, but you can probably guess most of them: treatment and over treatment planning, who's doing what, and is it OK, Groupon and other promotions, or what happens when the doc isn't in but the staff is. And the questions did indicate there are some serious concerns out there.

Now I can quarrel with some ethical nitpicking (Friday, no doc in the office, temp comes off, assistant covering phones re-cements it just like she did five days prior—all of which is illegal, folks—assistants can't touch a patient without you there. And let's not debate whether it is ethical to advertise—that horse left the barn long ago.) But most of the concerns expressed were not nitpicks; they were serious issues—especially in the area of treatment planning and pressures to overtreat—coming from various internal and external forces.

So if a staff person has concerns with the ethical practices of an office, what avenues do they have to express those concerns? If you have established a safe working environment, they should bring it up for a discussion with you and/or your entire staff. But many of us are "my way or the highway," so that doesn't always work. Then what? A Dental Quality Assurance Commission complaint? Pretty drastic, but it probably will work if there is also a provable violation of state law involved; that's a high hurdle to cross in many of these instances: too much "he said, she said," and nothing concrete. How about your local peer review? Well, they might investigate, but the staffer isn't going to stay anonymous, so there is a job in jeopardy notwithstanding all the lawyers ready to sue you for wrongful termination. Quit? Sure, but the employment market isn't as robust for someone working in our field as it once was. So they are mostly stuck. Organized dentistry probably should try to figure out an acceptable avenue for this kind of situation to be explored and remedied, but it doesn't exist at the moment.

But I would suggest that while they may be stuck, you are not. You control the situation and have the absolute moral and LEGAL responsibility to do what is right. And what is right? Start with "Golden Rule"—the original one, not the one with "The one with the gold—yadda, yadda." Would you do this on your blessed mother who suffered through nine long months and diapered you for years and then put up with your being a teenager? I digress again.

When all else fails, read the directions, i.e., the law. Visit the website and click on Title 18, then 18.32 to find laws on dentistry.

Check out what the ADA has to say on ethical matters: here and here.

Talk to your colleagues. Talk to your staff—they probably have a lot of great ideas on how to resolve your situation ethically. Above all, don't assume what you are doing is above reproach. There are lots of times I have had to think awhile about a dilemma raised before coming to what I thought was an ethical decision. But make sure your hygienist isn't sitting next to me next year because she thinks you are an unethical schmuck.

Dr. Parrish is a columnist for the WSDA News, a publication of the Washington State Dental Association. His comments, reprinted here with permission, originally appeared in the July issue of that publication.