Since Dr. Arnold is questioning her own assessment of the situation, she should proceed with the first option, but in a timely fashion. It would be appropriate for Dr. Arnold to further investigate and discuss the situation with a colleague before
taking any action that might jeopardize her job. In order to protect patients, the next step will most likely be to have the conversation about her concerns with the owners of the practice.
CASE 4: OH, NO! NOT AGAIN!
extraction. As a result, Mr. Wayne experienced a large oral-antral communication, which a bone and tissue graft repaired. When everything was complete, the surgeon’s fee exceeded $1,500, and Mr. Wayne paid the balance with a check that day. He left the office in stable condition and in a surprisingly jolly mood, taking everything in stride and blaming no one. Dr. Ogilvie knows that unsatisfactory outcomes occur even when dentists follow best practices; however, this is approximately the 10th time that she has received a referral from Dr. Midi under similar circumstances. As in all the other cases, Dr. Ogilvie feels that Dr. Midi should never have attempted the procedure in the first place. Dr. Midi should have referred this case to a specialist immediately. Dr. Ogilvie wonders how many other patients Dr. Midi should also have referred to a specialist. In addition, Dr. Ogilvie thinks that Dr. Midi should take full responsibility and reimburse Mr. Wayne for at least her fees, if not the oral surgery fees as well. She did not tell Mr. Wayne this. In all of Dr. Ogilvie’s 20 years of practice, Dr. Midi is the only referring dentist she has had to “bail out” of an unsatisfactory situation this many times. What, if anything, should Dr. Ogilvie do now (see Table 10)?
Dr. Ogilvie has been practicing in the quiet town of Collinsville for 20 years. As an oral surgeon, she has seen the gamut of cases from her referring dentists. As the only oral surgeon in a tri-county area, she is very busy and has a large referral base. Dr. Midi has also been practicing for 20 years in a nearby blue- collar community of approximately 10,000 people, and she is an occasional referral source for Dr. Ogilvie. As professionals, Dr. Ogilvie and Dr. Midi are cordial acquaintances. They see each other occasionally at the Tri-County Dental Study Club meetings and social events; however, that is the extent of their relationship. One afternoon Dr. Ogilvie received a call from Dr. Midi stating that she needed to refer a patient to her office immediately. Dr. Midi claimed that in the middle of a routine extraction of tooth #2 for her patient, Mr. Wayne, she heard a “crack,” and before she knew it, the entire right posterior side of Mr. Wayne’s palate was “moving with the tooth.” Dr. Ogilvie received Mr. Wayne into her office right away as an emergency patient. She diagnosed a large right maxillary tuberosity fracture and was able, with some difficulty, to surgically dissect the ankylosed tooth from the fractured bone. This was no routine
Table 10: Case 4 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
professional self-regulation. Dentists who suspect a colleague of providing substandard care must take action to protect patients. The possible courses of action in this case include: ● Call Dr. Midi and discuss the concerns. ● Call the state dental board and report Dr. Midi for substandard care. ● Continue to monitor the patient referrals from Dr. Midi and report her to the board if she sends another case like Mr. Wayne’s. The best course of action would be for Dr. Ogilvie to call Dr. Midi to express her concerns and gain more information about the referral cases Dr. Midi is sending her. Patient safety has to come first, but professional courtesy is also prudent. Although
The primary conflict in this scenario is between professional and professional. Dr. Ogilvie is an oral surgeon who receives referrals from Dr. Midi. She feels that Dr. Midi is possibly taking on cases that are too complex, and beyond her skills and training, and thus causing patient’s physical harm and additional expense. The stakeholders in this case are Dr. Ogilvie, Dr. Midi, and patients of Dr. Midi. Principles that apply here are nonmaleficence, beneficence, and justice. The central values include the life and health of the patient, the patient’s oral health, the dentist’s preferred patterns of practice, and efficiency in the use of resources (cost). Professional obligation dictates that dentists refer patients to other providers when the required procedure is beyond their skill level. Failing to do so could result in malpractice or negligence. Professional obligation also dictates
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