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 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 this will not be an easy conversation to have, Dr. Ogilvie needs to acquire more information before considering whether to refer Dr. Midi to the state dental board. By choosing this course of action, Dr. Ogilvie does run the risk of losing Dr. Midi as a referring dentist, but she also has the opportunity to strengthen and clarify her professional relationship with the other dentist. If the conversation goes badly and Dr. Ogilvie feels the situation is serious enough, she could then make the call to the state dental board, reporting Dr. Midi for substandard care.
CASE 5: I’LL TEXT YOU LATER
Dr. Jones is very much into new technologies. He has a state-of- the-art practice, and he owns many new electronic devices. He also has a very interactive website where patients can schedule and cancel appointments, view instructional videos, and so forth. The latest trend that interests Dr. Jones is teledentistry. He believes that using this technology can enhance his communication with his patients, save time, and help build his practice. The teledentistry application that Dr. Jones has chosen to utilize first is simply texting with his patients for postoperative follow-
up. In the past, he called patients personally after extensive surgeries to check on them. By switching to texting for follow- up, he is able to contact all of his patients who have undergone surgical and restorative procedures, to see how they are doing. He has noticed that they do not always respond to him, but at least he has reached out to them. Dr. Jones has had his staff members program all of his patients’ cell phone numbers into an office cell phone dedicated to this use. Since he does not have time to call everyone personally, he thinks this is a great option. Should Dr. Jones continue this practice (see Table 11)?
Table 11: Case 5 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 method of communicating via text messaging with patients is appropriate.
In this case, the relationship in question is between professional and patient. Dr. Jones has begun the practice of texting his patients to check on them after extensive procedures as opposed to calling them and speaking with them directly. The stakeholders are Dr. Jones and all of his patients. The ethical principles involved include autonomy, beneficence, and nonmaleficence. There may be patients who are not tech-savvy and will feel excluded (an issue of justice). The central values at stake include the dentist’s preferred patterns of practice and patient autonomy, although the patient’s overall health and patient’s oral health may also be impacted. Legal implications include the potential for a HIPAA violation. Professional obligations include the duty to respect the patient’s confidentiality. The question posed is whether or not Dr. Jones’s
The choices at hand include: ● Continue this practice. ● Discontinue this practice. ● Use this practice more selectively. Although the practice of reaching out to more patients postoperatively for follow-up is an honorable one, the problem of sending text messages to patients’ cell phones is that it is impossible to know who will retrieve the text message. There is the danger that a message may be read by someone other than the patient if a cell phone is left unattended. A dentist who calls patients directly can be sure he or she is talking to the right person. However, anyone can respond to a text message, and the dentist cannot easily confirm that he or she is communicating
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