Dentists today find themselves in a profession that is increasingly competitive and commercial.
Yet still as healthcare providers, clinicians have an ethical responsibility towards patients to ensure that clinical judgement is primary in all treatment decisions. But how can dental professionals ensure that ethical obligations are met while still providing a service that is profitable?
Modern dentistry gives practitioners huge scope to diversify and offer treatments far beyond ‘core’ services such as relieving patients of dental pain. Indeed, offering ‘optional’ cosmetic treatments can provide a significant boost to practice income, and can even be used as a point of differentiation. However it is essential that any treatment provided is not at odds with long-term oral health outcomes, and that patients fully understand the breadth of options available to them.
The General Dental Council’s recently updated Standards for the Dental Team document reaffirms the need for an ethical approach to dentistry. The GDC advises clinicians to encompass a holistic and preventive approach to patient care that takes into account: the overall health of the patient; their psychological and social needs; their long term health needs; and finally, their desired outcomes. The motivation of a dental professional then is to provide a service that is in patients’ best interests. This means that the clinician will need to provide treatments that balance oral health needs with the patient’s own desired outcomes.
Balancing act
Cosmetic dentistry is an excellent example of the fine balancing act clinicians must be able to perform. It is particularly complicated since patients may wish to undergo treatment that is unnecessary from a purely functional or oral health perspective. They may for instance have other reasons such as improving the way they look, or boosting their self-confidence.
The ethical considerations here are manifold, and each case will be different. One common example might be the decision between long and short-term orthodontics. While longterm orthodontics may be ideal from a clinical perspective, short-term orthodontic systems often produce faster results that are far less expensive. Though the final outcome will always be a compromise, many patients would prefer the short-term option, as they may not be willing to accept a treatment that can take one to two years to complete.
Ethical advertising
One particularly important part of the ethics debate is the need for clear and ethical advertising. The GDC dedicates substantial attention to this in the Principles of Ethical Advertising document that advises that all information or publicity material regarding dental services must be legal, decent, honest and truthful. For although conventional advertising that is seen in other industries uses hyperbole to sell products or services and appeals to consumers by filtering information, the advertisement of dental treatments must be clearly balanced and should only ever stick to the facts.
As healthcare providers, dentists must consider their ethical obligations to patients when drafting advertisements and the first priority of the material should be to provide information to patients that will enable them to make an informed decision about their treatment. This can be a dilemma for practitioners as they may be under pressure to increase the likelihood of patient treatment acceptance. If a dentist thinks that patients will not commit to the most clinically ideal treatment option, they may be pushed to offer an alternative from the perspective of business needs and patient satisfaction.
Ensuring that all dental publicity material is balanced and factual will lead patients to make the most informed decision about their treatment. This is crucial to dental ethics and will help to foster patients’ trust in the dental profession. With clear and objective material, clinicians should also ensure that patients are not confused or uncertain about their treatment options and sound dental advice should be offered with information patients may have achieved from a practice website, leaflets, brochures or other source.
Putting patients first
The essence of all ethical dental practice is to put patients’ interests before financial gain and business needs. If an ethical philosophy underlines all treatment advice and advertising, clinicians will maintain their professional integrity thus ensuring patient trust in the profession as a whole. Acting with integrity means that patient care should follow clinical guidelines relevant to the patient’s situation.
Of course, this could place a practitioner in a difficult situation where a patient’s desired outcome is not achievable or in their best interests. In such a situation, the GDC advises that dental professionals must explain the risks, benefits and likely outcomes of treatment to help patients in their decisions. Where possible, long-term health needs should not be compromised by treatment, and discussing alternative options that suit the patient from an overall health, psychological and social perspective is an example of ethical dentistry that justifies the faith patients and the public invest in their dentist.
References available on request.