I told the receptionist that the child was still our patient
since we had not dismissed him from the practice. We could
have acted on that opportunity at any time over the past
year by notifying the family in writing and offering to provide
a month of emergency coverage, allowing them this reasonable
time to find a new dentist. But we did not do that. It was now
our obligation to see the patient, regardless of financial
history. It would be abandonment to refuse treatment now. . One of the points that these two examples illustrate is
that ethical dilemmas occur with almost daily frequency in
the dental setting. Most of the time they are subtle. It is easy
to make an improper decision. It does not make any of us a
scoundrel. But by adhering to our principles with all of the
minor difficulties that challenge us everyday, we will have
built the strength of character to overcome the greater
temptations that unexpectedly knock at our door.
All this got me to thinking about another frequently
misunderstood area of professional conduct: the transference
of patient records. How many times have you heard the story
of a fellow dentist, perhaps a colleague and respected member
of the dental community, refusing to forward radiographs
because “the patient hasn’t paid his balance?” I have heard
it many times and as recently as a month ago. Well, this is
where “sound fiscal policy” comes up against the “welfare of
the patient.” It may be frustrating. It may be galling. But just
as function takes priority over esthetics, the patient’s welfare
must take precedence over business considerations.
The feelings that these circumstances can generate are
quite upsetting and it is easy to understand how some
practitioners might make an improper decision. When a
patient requests that records be forwarded, there is really
no excuse not to promptly comply. For our protection, we
should always obtain written permission from the patient or
parent prior to forwarding radiographs and records, especially
if the records contain information of a personal nature,
such as sexual preference, chemical dependency or HIV
seropositivity. The records should be copied and forwarded
at no cost, or for a nominal fee. A delay in transferring the
patient’s records could adversely affect the oral health of the
patient, and further, compelling the new dentist to take new
radiographs will result in unnecessary radiation exposure to
the patient and additional cost. It is also our responsibility to
protect the privacy of the patient during the transference An additional point that surfaces is the fact that the dental
staff has a lot to do with many of these situations.
Communication with staff about our feelings and obligations
would reduce misunderstanding and eliminate many
problems. The time for discussion is before problems occur
so as to spare the embarrassment of an individual. It might
be the topic of a staff meeting.
As members of the American Dental Association we have
all agreed to be guided in our professional capacity by the
ADA’s Principles of Ethics. These principles or standards are
written with the welfare of the patient given the highest
priority. In return for agreeing to abide by these principles
society grants special favors upon the dental profession,
such as self-regulation.
One of the most telling statements of how the leaders of
the American Dental Association feel about the membership
of the dental profession would make the member of any
profession proud were it applied to them: “The Association
believes that dentists should possess not only knowledge,
skill and technical competence but also those traits of
character that foster adherence to ethical principles.
Qualities of compassion, kindness, integrity, fairness and
charity complement the ethical practice of dentistry and
help define the true professional. The ethical dentist strives
to do that which is right and good.”
—R.J.G.
Dr. Richard Galeone of Lansdale served as editor of the
Pennsylvania Dental Journal from 2000-2008.
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