A couple of experiences this month led me to consider ethics in dentistry. A relative said she’d had some dental work done, and a dishonest patient gave me a call.
My relative had a few fillings done. She expressed concern that the hygienist had heard the dentist say that he had student loans to pay. She also knew the dentist’s family: that his wife had expensive tastes, and they lived in a large, beautiful home. She wondered: had he given her dental treatment based on her needs, or based on his pocket book?
A few years ago I polled family members on possible dental slogans. One suggestion was the hilariously inappropriate, “Put your money where your mouth is.” Of course I didn’t use it. While a dentist should be paid for the service provided, that shouldn’t be the driving force for treatment recommendations.
In dental school I learned medical and dental terminology. It’s like learning to speak another language. The faculty encouraged me that I not forget how to speak Patient.
This means that I shouldn’t tell a patient, “You need a restoration on the mesio-occlusal of tooth #18.” I should say, “You need a filling between the teeth on your last lower left molar.”
It also means that I have to justify my diagnosis. Can I point out the dark spot on the x-ray that shows the cavity or the abscessed tooth? Can I explain the problems associated with an impacted wisdom tooth well enough that my patients will choose to have them removed? If they understand the problems of their dental health, then they will understand the need for dental treatment. They will not doubt the motives of my recommendations.
I know there are enough true dental problems out there that I don’t have to make up treatment that doesn’t really need to be done. As always, I only recommend treatment I would choose to have done for myself.
I was called by a dishonest patient over the weekend. He told me his name and explained that he was out of town and was having the early symptoms of a tooth abscess. I asked him a few questions about his symptoms, and all his answers matched a tooth abscess. He even knew the tooth numbers. (He was speaking Dentist to me.) I told him I was logging into my office computer remotely so I could see if I had any recent x-rays of the tooth in question, but I couldn’t find his name in my system. *Click.* He hung up immediately.
It seems he was not my patient, despite specifically claiming to be. Almost certainly he was drug seeking, and hung up as soon as he realized he would not get what he wanted. His weekend timing and remote situation of distress fell within drug seeking behavior. His answers were so spot-on that it couldn’t have been the first time he’d tried this ruse.