Principles of an Ethical Dental Practice
As quoted from the California Dental Association code of ethics: “As healthcare professionals, dentists assume publicly-entrusted responsibilities founded on the principle of non-malfeasance - first do no harm. The American College of Dentists Core Values presents the many characteristics of being an ethical dental professional and has thus been adopted by the California Dental Association as its’ core ethical principles."
State to state variances may change the code somewhat, so to simplify things we will look at some of the main ideologies of the CDA’s principles of ethical behavior.
Often the question comes up as to how much information in the form of a treatment plan should be presented to a patient on their first visit to your practice. A long list of diagnosed procedures and their corresponding fees has a shock effect on some patients, and may cause them to leave the practice before they have any service performed. It is an ethical dilemma because the patient needs treatment and it is the dentists’ duty to give the total picture. What good is it when the patient says, “That’s really expensive, let me think about it and I will call you back.” They seldom call back and often go into a state of limbo, seeing no dentist for a long time.
The principle of autonomy states: “Patients have the right to determine what should be done with their own bodies. Because patients are moral entities, they are capable of autonomous decision making. Respect for patient autonomy affirms this dynamic in the doctor-patient relationship and forms the foundation for informed consent. The dentist’s responsibility to inform the patient of contemporary standards of oral health care, the benefits and the possible harms is paramount to achieving informed consent.”
If, after all of that, the patient decides not to start or continue care, the decision should be considered with compassion. Diagnosing the pocket book of the patient and questioning their ability to pay for services is contrary to respecting a patient’s privacy and autonomy. Though money is always a factor, it is not always the deciding factor. Identifying the first areas of concern and addressing them as priority or Phase One, with the understanding that the patient plays an important role in the result, helps the patient understand their role in their total well-being.
“Compassion requires a consideration for the total well-being of the patient.” Relieving pain and suffering is a common attribute of dental practice, but further acknowledgment of a patient’s future needs is also a compassionate act.
Another area of the code of ethics that is brought up regularly concerns billing practices. In Section 7: Billing Practices, it states that “a dentist has the obligation to submit any billing for services rendered or to be rendered in a manner which is not fraudulent, deceitful or misleading.”
7.A.1. Third Party Benefits: A dentist shall avoid any representation that causes patients to believe the dentist is a provider for the patients third party payer if, in fact the dentist is not.
You cannot “have your cake and eat it too” in this situation. It has been asked, if when a patient inquires whether you “take their insurance” that they are asking whether you are a provider on their network or not. Some offices say, “Yes, we take your insurance” when in fact they don’t. Many people don’t understand that with a PPO they can go to any provider, but the payout will be as an “out of network” versus an “in network” provider. Whether there is any difference in the percentage payout or difference in the fee falls on the dental office to gather that information if they want the patient to appoint.
If the dentist is not a “network provider” then the script would be this: “Yes Mrs. Brown, we do accept assignment of benefits from your plan and from any PPO plan. That means we will bill them and wait for payment except for the deductible and any applicable co-payments. We would be reimbursed as an “out of network provider” because we are not a contracted provider on your plan. If you would like me to, I can find out if there is any ‘out of pocket’ expense for you on your first visit and any subsequent visits.”
With more pressure placed on production in practices, it behooves us to not lose sight of the ethical way we are treating our patients and what our true Mission Values are toward their care.
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