DENTISTS AND PATIENTS

Whats special about dentist-patient relationship ? It is the corner stone of dental practice therefore dental ethics International Principles of Ethics for the Dental Profession The needs of the patient are the overriding concern So for you to establish this concern you need to build a relation with your patient , have a good communication with him in order to know his needs and expectations

Paternalistic relationship (dentist autonomy ): it is the traditional one , where the dentist made his decision and the patient submitted to them , but recently it has been rejected . Equal relationship (patient autonomy ) : the other scenario is when the patient's needs and concern are the ones which control and the dentist needs to accomplish them . but since many patients are unable or unwilling to make decisions about their dental care ,patient's autonomy is often very problematic .

We'll discuss six main problems facing dentists in their daily llife : Respect and equal treatment communication and consent decision-making for incompetent patients Confidentiality uncooperative patients Financial restraints on treatment

1- Respect and equal treatment :

The believe that all human beings deserve equal treatment is recent , in many societies disrespectful and unequal treatment of individuals and groups may be considered as normal For example : Slavery : is one such practice esp. in the 19th century , still exist nowadays but of course illegally Women : still experience lack of respect and equal treatment in many countries . Also discrimination on the basis of race , age , disability or sexual orientation are wide spread .

There are conflicting views on patient equality and rights in dental profession , for example : American dental Association dentists have been told not to refuse to accept patients into their practice or deny dental service to patients because of the patients ra ce, creed, color, sex or national origin FDI international principles : asserts the dentists right to decline to treat a patient, except for the provision of emergency care, for humanitarian reasons, or where the laws of the country dictate otherwise.

But if dentist do not have to give any reason for refusing a patient , he is practicing discrimination "" " without being held accountable . so a dentist's conscience is the only means of preventing abuses of human rights in this regard not the law nor any other authorities .

TRUST :

American Dental Associations Principles of Ethics and Code of Professional Conduct : Once a dentist has undertaken a course of treatment, the dentist should not discontinue that treatment without giving the patient adequate notice and the opportunity to obtain the services of another dentist. Care should be taken that the patients oral health is not jeopardised in the process.

So in order to save this trust which is essential to the dentist patient relation , dentist should not abandon patients under care .

Why a dentist want to terminate a relationship with a patient ?? Dentist moving or stop practicing Refusal or inability to pay for the dental services Dislike of the patient and the dentist for each other Patient refusal to comply with the dentist's recommendations So if you want to stop treating a patient for a reason or another there are some responsibilities you are expected to do , such as : Dentist should consult his\her code of ethics and other relevant guidance documents Examine his\her motives Justify his\her decision to the patient and a third party if appropriate Motives could be legitimate" "or unethical

if the motives are legitimate , dentist should : help the patient to find another suitable dentists If not possible , you should give the patient adequate notice of withdrawal of services so he can find alternative dental care . if the motives is not legitimate , dentist should : Take steps to deal with this defect

Many dentists especially those working in the public sector often have no choice with the patients they treat.

Some patients may be violent and pose a threat to the safety of the dentist and his staff , others can only be described as obnoxious because of their attitudes and behavior . With such patients : These patients forsaken their right to respect and equal treatment Or dentist should make an extra work even heroic efforts to establish and ,maintain therapeutic relationship with them .

And dont forget Its your responsibility to balance between you and your staff safety and well-being AND promoting the well-being of the patient If it is not possible You should try to make alternative arrangements for the care of the patients .

Another challenge to the principle of respect and equal treatment arises when dealing with infectious patients specially AIDS patients , because it is life threatening disease and it is associated with social prejudices . With such patients some dentists hesitate to perform invasive procedures because the possibility of being infected However dental codes of ethics make no exception for infectious concerning dentist's duty to treat them equally .

Policy statements on human immunodeficiency virus infection and other blood borne infections : - Patients with HIV and other blood borne infections should not be denied oral health care solely because of their infections. - universal infection control procedures should be employed for all patients irrespective of their health status

The intimate nature of dentist-patient relationship can give rise to sexual attraction . a fundamental rule of traditional medical ethics which also applies for dentistry that such attraction should be resisted .

Oath of Hippocrates includes the following promise:

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons.

2- Communication and consent

Informed consent : the approval of the patient to receive treatment or the right of the patient to make decision about their health care . It is a general legal and ethical principle that you must get valid consent before starting treatment or physical investigation, or providing personal care, for a patient. This principle reflects the right of patients to determine what happens to their own bodies, and is a fundamental part of good practice. Good communication is a necessary condition for informed consent When dental Paternalism relationship was normal , communication was simple , it consist of dentists telling their patients what treatment they were going to perform Nowadays with Equal relationship communication requires much more from the dentist , you must provide all the information patients need to make their decisions , including : Explaining complex dental diagnoses Prognosis and treatment in simple language Confirming or correcting information that the patient may have The cost Advantages and disadvantages Answering any question that they may have Good communication skills do not come naturally to most people , you must develop it by continues effort and working .

 Major obstacles to good dentist-patient communication are : differences in language : if the dentist and the pt do not speak the same language , an interpreter will be required . in many situations there are no qualified interpreters and the dentist must rely on family members or seek someone else for the task .

Differences in culture : because of different cultural understandings of the nature and cause of illness , pts may not understand diagnosis and treatment options provided by dentists . also what is considered to be disfigurement in one culture may be considered as a sign of beauty in another .

Patient speech impairment during treatment : of course pt can't speak while your hands in their mouth , and this will affect him making decisions , for this reason pts should be fully informed in advance of all information about the treatment , and the dentist must provide a two way communication during treatment like providing a writing table for pt to ask and answer Qs . If the dentist has successfully communicate with the pt , all the information the pt needs and wants to know about his/her diagnosis , prognosis and treatment options will be clarified , then the patient will be in a position to make an informed decision about how to proceed . Competent patients have the right to refuse treatment, even when the refusal will result in pain or disability . evidence of consent can be explicit or implicit (implied) Explicit consent is given orally or in writing Implicit consent is given when the patient indicates a willingness to undergo a certain procedure or treatment by his or her behavior , eg : open his mouth it is preferable to obtain explicit rather than implied consent.

There are two exceptions to the requirement for informed consent by competent patients: Situations where patients voluntarily give over their decision-making authority to the dentist or to a third party: Because of the complexity of the matter or because the pt has complete confidence in your judgment . pt may tell you " do whatever you think is the best " but you should not be egar to act on such requests , you should provide pts the basic information about the treatment options and encourage him to make his own decision . if after such encouragement the pt still wants you to decide ,you should do so according to the best interest of the pt .

Instances where the disclosure of information would cause harm to the patient . in these cases you are allowed to withhold dental information if disclosure of such information would be likely to result in a serious physical, psychological or emotional harm . eg :if pt would be likely to forgo needed treatment if it'll be painful Outright lying is never justified since it does serious harm to the trust relationship of patient and dentist. So be careful when doing this .

3- decision-making for incompetent patients

who are incompetent pts ? pt who are unable to make decisions for themselves - children - Individuals affected by certain psychiatric or neurological conditions These patients require substitute decision makers either the dentist or another member when dental paternalism was ok ,,, dentists were considered to be the appropriate decision makers for incompetent patients

and they may consult patients parents but still the final decision was theirs dentists have been gradually loosing this authority in many countries as patients are given the opportunity to name their own substitute decision maker to act for them when they become incompetent in such cases dentists make decisions for patients only when the designated substitute cannot be found

Problems with substitute decision makers : those who cannot agree among themselves , eg : divorced parents Those whose decision is in the dentists opinion not in the patient best interest What to do then ??? if they were not agree among themselves , dentist can try to mediate between parties . if it fails , or if their decision was not for the best of the patient , dentist may have to challenge them in the relevant legal

the principle criteria to be used for treatment decisions for children and mentally disabled adults are their best interests , although their expressed preferences should be honored to the greatest extent possible compatible with their best interests for adult patients who have become incompetent , the principal criteria are their preference , if these are known . If these are not known , treatment decisions should be based on the patient's best interest .

Keep in mind patient's refusal of a recommended treatment does not mean that the patient is incompetent ; it may be that the patient has failed fully to understand the dentists recommendation and reasons for it

 Patients are not necessarily competent because they readily agree to the dentists proposed treatment Refusing patients may be competent whereas agreeing patients may be incompetent , thus making their agreement invalid

4- Confidentiality :
It is your duty to keep patient information privacy . The Hippocratic Oath states : what I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men , which on no account one must spread abroad , I will keep to myself holding such things shameful to be spoken about

The high value that is placed on confidentiality has three sources o autonomy : personal information about an individual belongs to him and should not be known to others without his consent . "pt decides if he wants to tell his secrets or not " o respect : one important way of showing pt respect is by preserving their secrets and privacy .

trust : in order to receive dental treatment a pt must reveal personal information to the dentist . so pt must has a good reason to trust you.

The U.K. General Dental Councils Principles of Patient Confidentiality summarises the dentists responsibilities for respecting confidentiality as follows Treat information about patients as confidential and only use it for the purposes for which it is given

Prevent information from being accidentally revealed and prevent unauthorised access by keeping information secure at all times

some breaches of confidentiality occur frequently in health care settings . dental assistance , dental hygienists , nurses and dental radiographer require access to a pt health records in order to provide adequate health care .

Where patients speak a different language than their dentists . there is a need for interpreters to facilitate communication . In cases of patients who are not competent to make their own dental decision . here other individuals have to be given information about the pt in order to make decisions on their behalf . comply with legal requirements .for example when you suspect a child abuse or something

HIV positive patients . discloser to his\her sexual partner may not be unethical , esp. when your pt is unwilling to tell his partner which will put his partner in risk . these breaches of confidentiality are usually justified .

5- Dealing with uncooperative patients

Some people are very difficult to treat because of their attitudes and behavior . The two categories of such patients are : Fearful children - Irrational child : who believe that any dental treatment will include pain - completely rational child : a dentist may have told him that this procedure will not cause pain , when in fact he did cause him pain .

good communication is the key to overcome resistance in some cases , referral to a pediatric may be advisable .

Noncompliant adults : - Pts who are not compliant with the recommendation of their dentist for self-care ,or they dismiss their appointments - Dental ethics does allow for such termination under certain conditions . - You should have made efforts to encourage the pt to change his behavior , maybe a little warning that if there is no change in his attitude he'll have to find someone else to treat him - If you try with the patient and he still show no interest you can leave him but first you : should be prepared to justify his/her decision to the patient and to a third party if appropriate . the dentist should help the patient find another suitable dentist . If this is not possible , should give the patient adequate notice of withdrawal of services so that the patient can find alternative dental care

6- Financial restrains on treatment

The cost of dental services is considered as a problem for a lot of pts In most countries , the vast majority of dentists are private practitioners . They have to ensure the financial viability of their practice while remaining faithful to the ethical foundations of their profession . Dentists are generally not required , either by law or by professional regulations , to provide care to those who cannot afford it , except in an emergency

So how to act ??

 Accepting patients covered by insurance that provides compensation below the rate usually charged by the dentist Allowing patients to pay over an extended period Reducing or eliminating fees for some patients Lobbying for better oral health insurance coverage for those in need Consider how they can make their services available to people who cannot afford them

The End . Done by : Rmz .H. Rabadi

There is no need to refer to the book since every single detail is included here