I am currently doing my externship at a private dental
practice. During my lunch break, I was exploring potential blog topics
regarding ethics and the dentist I am working for stopped me to tell me an
interesting story.
Long story short:
Patient A was involved in a car accident. He sustained
injuries to his face that required a combined treatment from an oral surgeon
(Dr. OS), an orthodontist (Dr. O), and a prosthodontist (Dr. P). A had dental insurance and began his treatment
process.
1.
Dr. OS successfully treated the broken jaw.
2.
Dr. O successfully realigned the teeth.
3.
Dr. P failed to begin the restorative process
because A’s insurance had “maxed out”.
When Dr. P asked A how much he had been charged for each of
the medical services, Dr. P was surprised to hear how much Dr. O had
overcharged for his services. This amount was clearly more than any orthodontist
would charge for the same procedure. Enraged by the amount, Dr. P decided to
complete the restoration for free and later confronted Dr. O about his unethical
behavior. Dr. O referred this patient to Dr. P and they are friends. When
confronted, Dr. O explained:
1.
I provide the best care for my patients and I am
confident that my services are worth the amount I charge.
2.
I am not doing anything illegal since the
patient gave his informed consent.
3.
I charge for every little thing so that the
insurance company can pay the maximum amount possible. If the patient is paying
for dental insurance, they should be allowed to maximize their benefits.
When I heard this story in full, I was flabbergasted.
Dr. O tried to justify his greed by emphasizing patient care and making it seem
as if he was doing the patient a favor. To my understanding, he believed that
he provided the best care that the patient needed without putting a direct
financial burden on the patient. To top it all off, the patient agreed to the
amount so there’s no problem right? What Dr. O failed to understand was that a
full comprehensive treatment was needed for the patient.
I personally believe that Dr. O was justifying his actions
based on his crooked understanding of beneficence, non-maleficence, and
autonomy. I think this is a clear example of when ethical principles are
wrongly applied as justifications for when a healthcare provider puts their
selfish interest over the patient’s needs.
Studies note that over 10% of the yearly total health care expenditures are that of fraudulent claims (Wang et al., 2017). I can only assume that all the healthcare providers contributing to this number are wrongly justifying their actions by incorrectly applying ethical principles to their needs. What’s your opinion on this?
Reference:
Wang, S.-L., Pai, H.-T., Wu, M.-F., Wu, F., & Li,
C.-L. (2017). The evaluation of trustworthiness to identify health insurance
fraud in dentistry. Artificial Intelligence in Medicine, 75, 40-50.
This was a really interesting read Ji! I really enjoyed analyzing this ethical dilemma. As I was reading this, it reminded me of my mom's cynical viewpoint on dentists. Growing up, my mom was always distrustful of dentists. She believed that because the general public did not know a lot about their dental health, it was hard to know when a dentist was ethical and doing the right thing versus when they weren't. For this reason, my family went years without going to a dentist (probably not the best thing). However this got me wondering if other people were distrustful of dentists too and whether this kept them from going to see a dentist. It just takes a couple of bad dentists to ruin it for others. Obviously, as aspiring medical professionals, we want people to trust us and to believe we have their best interest in mind. How do we ensure that one bad dentist doesn't ruin this goal for all of us? Perhaps, state and federal governments should enforce stricter regulations on dentists? What are your thought on this as an aspiring dentist.
ReplyDeleteI forgot to mention an NPR interview I heard not too long ago about this same topic. The journalists of NPR interviewed behavioral economists, Dan Ariely about his viewpoints on dentists. One fact he mentioned that stood out to me was that if two dentists were asked to identify cavities from the same X-ray of the same tooth, they would agree only 50 percent of the time. When Dr. Ariely was asked why he thought this happened, he replied, "It's not that one dentist finds cavities and one doesn't. They both find cavities, just find them in different teeth" insinuating that dentists can be dishonest. Knowing this, I would probably advocate that more regulations should be placed on dentists.
DeleteShepard, A. C. (2010, November 8). Should You Be Suspicious Of Your Dentist Or NPR's Source? Retrieved from https://www.npr.org/sections/publiceditor/2010/11/08/131079116/should-you-be-suspicious-of-your-dentist-or-nprs-source.