CASE 3: SUPREME DENTAL
In the 5 years since graduating from dental school, Dr. Arnold, a general dentist, has worked in three different dental practices. She left the practices for various reasons. These circumstances frustrate her, and she wants to find a practice she can call home for the long term. Her student loan debt is in excess of $250,000, so she needs a good job. She does not feel that she is ready to open her own practice. Dr. Arnold enjoyed working as an associate at her last practice. The economy took its toll, however, and the senior dentist, Dr. Harold, could no longer employ her. At that practice, Dr. Harold was very old-school in his approach to business; he did not believe in advertising or actively trying to seek new patients. He believed that word of mouth was the best form of advertising since he had made a good living practicing that way. When Dr. Harold hired Dr. Arnold, his intention was to slow down and eventually sell the practice to her. However, his 401(k) retirement plan took a huge hit with the market downturn, and he decided he needed to continue working full-time. He could no longer afford to keep himself and Dr. Arnold on the payroll. He essentially laid her off from work. Regardless, Dr. Arnold had always respected Dr. Harold for his adherence to ethical standards and professionalism. She never worried that the care provided to patients or the practice management style of the office violated ethical principles or fell below the standard of care. Despite her fondness for Dr. Harold’s values, Dr. Arnold would have made some changes had she been able to run the office herself. She believed that to maintain a steady flow of new patients and keep the practice fresh, she would need to be a little more proactive. That is what attracted her to Supreme Dental. A relatively new practice, Supreme Dental has become well known in the community very quickly and is the exact opposite of Dr. Harold’s practice. Supreme Dental’s practice style is cutting edge, and the two dentist owners are extremely business savvy. This appeals to Dr. Arnold very much. Their advertisements on billboards are visible from the major highways surrounding town.
Potential patients can hear their advertisements on the radio and see them in the local newspapers on a regular basis. Patients have mentioned that even the name of the practice elicits a positive feeling. The biggest payoff, however, came from a social media coupon site. This approach was effective; patient flow became phenomenal despite tough economic times. Dr. Arnold was not about to lose another job to the economy. As soon as she got the call, she took a position with Supreme Dental. Dr. Arnold is busier now than she ever imagined. After 6 months, though, she is starting to have some concerns about the marketing strategy of the practice and the work they perform. Patients seem to be happy overall, but Dr. Arnold is having doubts. For example, she knows that to perform a proper dental examination, she needs to take a complete set of radiographs. She constantly has to explain the need for radiographs to her new patients when they present for their “free” examination from the social media coupon site. Another big concern is the “lifetime guarantee” that Supreme Dental offers to patients. She believes that she is an excellent dentist, but feels that she cannot realistically guarantee her work for life. She has also noticed that at local dental society meetings, her colleagues in the community are not especially friendly to her. The owners of Supreme Dental choose not to participate in the local dental society themselves, so they never attend the meetings. As for the same-day denture, implant, and crown procedures she is performing, she is unsure if she is practicing within the standard of care. The owners have taught her these faster techniques, but she learned a very different way of doing things in dental school. Of course she knows that dental school did not always reflect the real world, and she realizes that many things, including materials and techniques, can change in 5 years. The owners of Supreme Dental say they are “mentoring” her to provide state-of-the-art care within a practice model that is “innovative.” Are Dr. Arnold’s concerns valid (see Table 9)?
Table 9: Case 3 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
owners of the business, as well as over the pressure to rush patients through complex procedures. The primary stakeholders are Dr. Arnold, the owners of the practice, and patients. The ethical principles at play in this case are nonmaleficence, justice, veracity, and autonomy. The central values at stake are the life
The primary conflict in this scenario is between professional and professional, Dr. Arnold and the owners of Supreme Dental. The problem is that Dr. Arnold, a relatively new practitioner, has concerns over potentially misleading advertising by the
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