JACD 71-4 - American College of Dentists

Issues in Dental Ethics
54
The doctor-patient
relationship is at the heart
of the dentist’s work.
Dentists must nurture this
relationship and protect it.
Even keep it sacred.
We all need guidelines in order to
keep moving in the right direction.
There are many sources from which a
dentist can receive personal and professional
guidance on how to live. What
follows are eight guidelines that are not
only appropriate at the moment when
students begin to practice in the clinic,
but are appropriate throughout a career
in health care. For that reason, they are
offered here as “White Coat Principles,”
with the hope that, whenever dentists
put on the white coat (or whatever
mantel they wear in practice), these
principles will come to mind again.
Principle 1: Patient Care is
the Point
The first principle may seem too obvious
or transparent to mention, but it is
actually important enough to be listed
first. The whole point of doctoring is to
provide excellent and appropriate health
services to other human beings who
cannot do so for themselves. Motivations
such as money, a fine car, convenience of
practice, and a professional’s reputation
among colleagues are secondary to this
overarching responsibility to patients.
When a dentist graduates from dental
school, he or she possesses a very special
set of skills, rare and important. These
are skills that internists, neurologists,
attorneys, astronauts, senators, even
psychologists do not possess, and the
dentist has a duty to share these skills
and the benefits they produce with
others who are in pain, with people who
do not understand their own oral health
or the health of their children, and with
some who do not have much money.
Our community counts on dentists to
take care of those who need dental care.
This principle is not abstract. Not
long ago I returned from a trip to the
East Coast, where I was asked to help
with a dental practice overwhelmed
with patients. The exhausted dentist,
who has been in his community for
twenty-five years, cannot convince even
one of the other fifty local dentists to
take on a Medicaid or indigent patient.
No other dentist in his tri-county area is
even willing to serve on the local hospital
staff to take dental emergencies. This
state of affairs is baffling and heartbreaking.
In my view, real doctors keep
their commitment to patients in need.
Principle 2: The Doctor-Patient
Relationship
A noted professor calls dentistry “a people
business.” He tells the sad story of a
patient who asked him about dental
school, mentioning that her best friend’s
son would be a terrific dental student
and dentist. When the faculty members
asked what it was that led her to think
this, the woman stated, “Oh, he spends
all of his time alone in his room, building
model airplanes.”
I would even go so far as to assert
that dentistry is a “relationship business.”
The doctor-patient relationship is at the
heart of the dentist’s work. Little of value
takes place without that relationship, and
it is the vehicle for dental practice and
especially for dental care. Dentists must
nurture this relationship and protect it.
Keep it sacred, even. This special relationship
has healing qualities which have
been documented by empirical research.
One could easily squander its powers.
Entering the dental profession entails a
commitment to put the relationship to
work and to treat each patient as if he or
she were the most important person in
the world at that moment in time.
Principle 3: Discuss Options
and Possibilities
The days of paternalistic doctoring are
clearly on the wane. Patient autonomy is
a core element of modern ethical and
successful practice in our society.
2005 Volume 71, Number 4