CASE 1: MY PATIENT REALLY “LIKES” ME
Jane, a 23-year-old dental hygienist fresh out of school, had just got her first job in the office of Dr. Jay, a 29-year-old dentist. The office was a general dental practice, and Jane became very busy immediately. The young dentist’s practice was growing, but he still was not comfortable with his patient base. He never turned a patient away and often worked through lunch to accommodate emergency patients. One day Jane received a new patient named Elsa. Elsa was Jane’s age, and they seemed to hit it off immediately. They made a lot of small talk during the visit and in the process realized they had a few mutual friends.
When Jane went on Facebook that night after work, she saw a “friend” request from Elsa. Without thinking, Jane accepted it. Before long, it seemed that Elsa was constantly commenting on and “liking” Jane’s posts. Elsa seemed to be everywhere on Facebook, and it did not take long before Jane became annoyed. She was afraid to “unfriend” Elsa, however, because she did not want to make Elsa mad or upset Dr. Jay if Elsa should decide to leave the practice. Besides, if she did unfriend her, Elsa could possibly make a big deal about it and start a negative campaign against Jane, and even worse, Dr. Jay’s practice. What should Jane do now (see Table 7)?
Table 7: Case 1 Solution Step Procedure
Working up the Case (fill in below)
1 • Identify the problem and the professional relationship(s) affected . • Gather all relevant facts: ○ Dental. ○ Medical. ○ Social. ○ Identify stakeholders.
○ Examine potential personal biases. ○ Additional necessary information.
2 • Identify the ethical principles and central values involved: ○ Identify those that conflict. ○ Identify those that should take priority. • Identify any professional obligations involved:
○ Refer to relevant professional codes of ethics (ADA, ADHA) as necessary. • Identify legal issues (civil, criminal, and administrative). 3 • List the possible courses of action available. • Answer the question, “What action could be taken?” • Rank the courses of action in light of information gathered in steps 1 and 2. 4 • Select the best solution from the list of possible actions and be willing to act on it. ○ Answer the question, “What action should be taken?" 5 • Prepare a defense for the chosen course of action: ○ Complete the sentence, “I chose this course of action because …” Note . Adapted from American College of Dentists. (2016). Ethics handbook for dentists . Gaithersburg, MD: Author. Retrieved from https://www. dentalethics.org/ethicshandbook.htm Discussion
● Inform Elsa that the relationship is becoming inappropriate and then unfriend her.
The primary conflict is occurring between the professional, Jane (the dental hygienist), and Elsa (the patient). A dual relationship has developed between the two of them since they became Facebook friends. Jane wants to unfriend Elsa but is afraid that if she does, Elsa may become upset and leave the practice, thus angering Dr. Jay. The stakeholders include Elsa, Jane, and Dr. Jay. The most relevant ethical principles in this case are veracity, autonomy, and nonmaleficence. The central values involved are the patient’s autonomy and the dentist’s preferred patterns of practice. There are no legal issues in this case. This is mainly a matter of setting boundaries and respecting an appropriate provider-patient relationship. The relationship is unprofessional and becoming a distraction and potential barrier to appropriate care. Jane has three primary courses of action to choose from: Gabby cannot recall how many times she had to visit Dr. Talbot on an emergency basis for issues related to a childhood accident that left her with several severely damaged teeth. She is grateful for every time Dr. Talbot was able to accommodate her into his busy schedule to provide necessary treatment. Fortunately, Gabby has always had the financial resources to pay for her treatment. Her parents’ insurance initially covered the costs. Now she has a good job and pays for her own treatment. Last spring a new problem occurred. Gabby developed a large and very painful sore on her gum tissue in the upper right posterior region. It was the Friday before Memorial Day at 5:00 p.m., and Dr. Talbot had closed his office for the holiday weekend. Because of his good nature and dedication to his
● Unfriend Elsa and do not discuss it with her. ● Do nothing and continue the relationship.
Although it may be uncomfortable, and Elsa might choose to leave the practice, informing her that the relationship is becoming inappropriate and then unfriending her is an ethically appropriate course of action. Jane should also learn from this experience and reconsider “friending” patients in the future. An important recommendation for Dr. Jay would be to have a social media policy that clearly outlines appropriate and permissible online interactions for all members of the practice.
CASE 2: GRATEFUL GABBY
patients, Dr. Talbot came in later that evening to examine Gabby and treat the problem. It was an easy fix. Gabby had lodged a large popcorn kernel sheath into the gingival sulcus of tooth #3, and the area had a small abscess. Dr. Talbot removed the kernel, drained the abscess, and assured Gabby that she should be fine in a day or two. Gabby was not only embarrassed but also upset for making Dr. Talbot come in on the holiday for something so trivial. She paid her bill and as she left the office, she decided she would do something nice for him in return. In mid-July, Gabby arrived at Dr. Talbot’s office with a gift of appreciation for all he had done for her over the years, especially during the latest incident. She had thought long and hard about the gift. She wanted to give Dr. Talbot something he
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