Dr. Henry Botuck, retired restorative dentist and member of the Northern Virginia Dental Society Ethics Committee, was kind enough to forward me an article from the New England Journal of Medicine entitled, “Talking with Patients about Other Clinicians’ Errors.” (http://www.nejm.org/doi/full/10.1056/NEJMsb1303119). After reading this interesting piece, I am reminded that our friends in the medical community experience many of the same ethical dilemmas we do as dentists, and it is interesting to examine the parallels.
The article explores the challenges practitioners face when disclosing to their own patients that they have made a harmful error in treatment. Additionally, the article describes the issues that often arise when one suspects, or when a patient suggests, that a colleague may have made an error in treatment. Our own Code of Ethics, The ADA Principles of Ethics and Code of Professional Conduct, states that “Dentists shall be obliged to report to the appropriate reviewing agency as determined by the local component or constituent society instances of gross or continual faulty treatment by other dentists.” It is rare in dentistry to see gross or continual faulty treatment by other dentists, but more frequent to hear from patients who are angry about their dental condition and who assign blame to their previous dentist. As this article points out, without firsthand knowledge of treatment history, determining if faulty treatment has occurred becomes difficult, if not impossible. The suggestion is made in this article to reach out and talk with the previous physician to get a better understanding of the situation. However, in dentistry, and it appears in medicine, communication among colleagues at this critical juncture often doesn’t happen. “Fear of how a colleague will react…reluctance to risk acquiring an unfavorable reputation with colleagues…interprofessional and other cultural differences….dependence on colleagues for referrals…and time constraints”... can pose obstacles that prevent this important conversation from happening.
Such colleague to colleague conversations can be daunting, especially for dentists, many of whom are non-confrontational. Nevertheless, in my experience, making that call and exploring for more information nearly always leads to a better understanding of the situation, an enhanced outcome for the patient, and a strengthening of the relationship with our fellow dentist. After all, if the shoe were on the other foot, we would want to be contacted.
My wife reminded me today that “Ethics is character in action.” Many of the ethical matters that are reviewed in this insightful article and that we face in dentistry revolve around strength of character, and this article affirms that having the character to communicate with our colleagues at the more difficult times is the key to learning and to improved patient care.
Virginia Dental Journal - Vol 91 #2 April-June 2014