● Third-party payers : How has the Patient Protection and Affordable Care Act changed the insurance industry? ● Millennial mentality : How do expectations for education, practice, and care differ among students, practitioners, and patients? ● Dental education : Do academic pressures lead to academic dishonesty? (Fita, et al., 2020; Beemsterboer, 2018). Although each of these areas poses concrete and pressing ethical challenges for today’s dental practitioners, the focus here will be on the ethical issues specifically related to digital communication and arising from the technology boom of the 21st century. After exploring important definitions related to digital communication, this section will consider the ethical problems most commonly associated with this use of technology. Case studies will illustrate how dental practitioners can prioritize and navigate through these complex issues. or newspapers. The information conveyed should be truthful, accurate, and not misleading in any way. Although websites can be flashy and creative, dentists must work carefully with website designers to ensure that they portray their practices in an appropriate manner, maintaining professional decorum at all times. Because Web designers may also work with other types of businesses that may not be as ethically sensitive to professional standards, it is the dentists’ responsibility to ensure that they uphold ethical principles. A recent electronic advertising trend and a new challenge to the profession, is the selling of group discount coupons for dental services. Daily-deal websites, such as Groupon and LivingSocial, offer professionals the opportunity to mass market their services at a discounted rate. Potential patients buy the discounted services directly through these websites, the websites pay the professional a flat fee, and the website gets a financial cut of the profit. The patient pays the third-party entity, rather than the dentist directly, for these services. Ethical challenges come to light upon closer examination of these transactions. An example of how an electronic coupon broker site might work is as follows: A dentist usually charges $400 per arch for tooth whitening. He contracts with the coupon broker to offer patients the discounted rate of $300 per arch. The coupon company collects the fee from the patients and takes a percentage, such as 25%, off the amount. The dentist receives $300 minus 25% ($75), or $225 per arch from coupon purchasers. The cost of the whitening material and miscellaneous overhead is $75 per arch. This leaves a profit of approximately $150 per arch for the dentist as opposed to $325. The dentist hopes to make up the difference either by volume (the number of patients buying the coupon and coming in for treatment) or by the number of patients buying the coupon and not ever coming in for treatment. This type of promotion poses several problems. The first issue with this sort of advertising via social media is that some may perceive it as unprofessional. The websites may offer dental services next to movie tickets, body massages, hair coloring, and bowling games. Thus, this type of advertising moves the dental profession to a merchant-level occupation. When referring back to what it means to be professional and have professional obligations, this situation raises an “ethical red flag.” In an Advisory Opinion, the ADA Code (2020a) clearly states that the prohibition against a dentist accepting or tendering rebates or split fees extends to a dentist’s dealings with any third party, not just other dentists (Section 4.E.1, p. 10). The Advisory Opinion specifically addresses the use of “social coupons” and explicitly prohibits their use if a third party receives a portion of the fee from the patient. Social coupons may attract new patients to a practice. However, because social coupons are often procedure specific, they may attract prospective patients who are not good candidates for the advertised service. When this happens, the ethical problem
brings new challenges. Some of the major ethical challenges to the dental profession are outlined below: ● Advertising : Has the profession gone too far? ● Scope of practice issues : What defines dental practice in the 21st century? ○ Estgetics. ○ Injectable botulinum toxin products (e.g., Botox, Dysport, and Xeomin). ○ Vaccinations. ● Electronic explosion : What are the good, the bad, and the ugly? ○ Social media and networking telemedicine. ○ Privacy issues and dual relationships. ○ Cyberbullying. ● Student loan debt : Does excessive debt lead to unethical behavior? ● Corporate dentistry : Whose practice is it, anyway? Advertising According to the ADA’s social media posting protocol (ADA, n.d.b), the term social media means “any website, application or other platform that allows end-user interaction, and includes, but is not limited to, blogs, websites, networking websites (such as Twitter, Facebook, LinkedIn, etc.), online forums, podcasts, message boards, chat rooms and interactive web or mobile applications.” There is no doubt that the advent of social media has changed the way dental practices market their businesses. The digital generation wants to shop online for just about everything, including healthcare providers. Web pages can speak volumes about professional offices, and not having one at all may say even more. The advantages of advertising online and having a dynamic Web presence are apparent. The sheer number of people whom dental practices can reach this way is astounding. It is also convenient for patients to be able to peruse practices and compare services when searching for a new dental provider. Advertising by a dentist cannot misrepresent facts or fees, imply specialty certification where there is none, cannot create false expectations and cannot guarantee results (Kaur, 2018). Advertising itself has been a hot topic in dentistry since “Painless Parker” began his marketing campaign near the end of the 19th century. According to Peltier (2007), who wrote on Painless Parker’s legacy, Parker was a dentist with a questionable reputation among his colleagues; some called him a quack and charlatan, and they believed he was a menace to the dignity of the profession. At one point, he owned 30 dental practices and his dubious ethics of practice were a hot topic. He was famously photographed wearing a necklace made of 357 teeth, all of which he extracted in one day. He also did a lot of advertising (Billock, 2016; Peltier, 2007). In that era, there was a strong aversion to advertising dental and other professional services publicly. Some accused professionals who advertised of cheapening their profession. Advertising by professionals, including dentists, was considered beneath the dignity of professionals. It implied that only those with inadequate clinical skills and who lacked an adequate patient volume would need to advertise their services to the public. In the 1970s, the Federal Trade Commission began interpreting bans on advertising by professionals as being unfairly restrictive. Advertising has been legal since then, provided the messaging is truthful, accurate, and not misleading in any way. The ADA Code (2020a), under the principle of veracity, offers extensive guidance on the subject of advertising in dentistry. Basically, the code states that any dentist may advertise but no dentist shall advertise or solicit patients in any form of communication in a manner that is false or misleading. The digital era has once again challenged the boundaries of acceptable advertising. Internet advertising is more abundant and comes in many forms; however, dental professionals must apply the same professional standards they use when advertising by traditional means, such as telephone directories
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