Ethics of Gaming the System.

Dentists justifiably bridle at having to compromise what they believe, based on evidence, is in the patients' best interests based on reimbursement rules of benefits providers. Benefits providers justifiably bridle at having to pay for services not contracted by those who purchase insurance. A particular case involving performing multiple quadrants of root planing at a single appointment is used as an example of this tension. One alternative is for the profession and the industry to seek to negotiate a win-win joint position. Another is for a few to game the system, which only makes it more difficult to reach ethical common ground.

How much dentists are ethically concerned about overtreatment; a vignette-based survey in Switzerland.

BACKGROUND: Overtreatment (or unnecessary treatment) is when medical or dental services are provided with a higher volume or cost than is appropriate. This study aimed to investigate how a group of dentists in Switzerland, a wealthy country known to have high standards of healthcare including dentistry, evaluated the meaning of unnecessary treatments from an ethical perspective and, assessed the expected frequency of different possible behaviors among their peers. METHODS: A vignette describing a situation that is susceptible for overtreatment of a patient was presented to a group of dentists. The vignette was followed by five options. A questionnaire including the vignette was posted to 2482 dentists in the German-speaking areas of Switzerland. The respondents were asked to rate each option according to their estimation about its prevalence and their judgment about the degree to which the behavior is ethically sound. RESULTS: 732 completed questionnaires were returned. According to the responses, the most ethical and the most unethical options are considered to be the most and the least prevalent behaviors among dentists practicing in Switzerland, respectively. CONCLUSIONS: Suggesting unnecessary treatments to patients seems to be an ethically unacceptable conduct in the eyes of a sample of dentists in Switzerland. Although the respondents believed their colleagues were very likely to behave in an ethical way in response to a situation that is susceptible to overtreatment, they still seemed to be concerned about the prevalence of unethical behaviors in this regard.

Occlusion and temporomandibular disorders: a malpractice case with medical legal considerations.

Occlusion and temporomandibular The issue of temporomandibular disorders (TMD) diagnosis and treatment has become a matter of increasing interest in the medical legal field in recent years. The old-fashioned theories based on the occlusal paradigm was proven to be erroneous, and clinicians who still provide irreversible treatments to TMD patients have to be conscious of the potential legal consequences of their behavior. The present paper described an illustrative case report of a patient to whom extensive and irreversible occlusal therapies were performed with the unique aim to provide relief from TMD symptoms. The treatment was unsuccessful and the dental practitioner was called into cause for a professional liability claim. The clinician was judged guilty of malpractice on the basis of the lack of scientific evidence of the irreversible occlusal approaches to TMD, which were erroneously used and did not give the patient any benefit, thus forcing him to a non necessary financial and biological cost. The failure to satisfy the contract with the patient, which is usually not covered by any insurance company, forced the practitioner to give the money back to the patient. The ethical and legal implications of such case were discussed, with particular focus on the concept that medical legal advices need to satisfy the highest standards of evidence and have to be strictly based on scientific knowledge.

Perceptions about conflicts of interest: an Ontario survey of dentists' opinions.

The purpose of this study was to explore the opinions that general dental practitioners in Ontario have regarding various situations that may be perceived as a conflict of interest. Standard quantitative analyses were employed to assess the association of attitudes and opinions concerning conflict of interest with gender, length of practice, and prior interpersonal communication, ethics, and religious training through a survey of general practice dentists in Ontario. Positive associations were found between the recognition of conflicts of interest and the number of years of dental practice, interpersonal communication training, and the reading of ethics-related articles in journals. Opinions vary on what is and is not a conflict of interest. Dental education has shaped a better understanding of these issues; however, for many dentists, previous education has not been totally adequate to guide them through conflict of interest situations. Age and mode and length of practice appear to have a direct effect on awareness of conflict of interest issues. Dentists need specific instruction and clearer direction regarding conflict of interest issues, so that they can better manage situations deemed to be conflicting and thereby earn and maintain patient trust in the profession.

Overservicing in dental practice--ethical perspectives.

Overservicing or the acceptance of unnecessary, inappropriate, excessive or fraudulent treatment is regarded as sanctioned lying, cheating or stealing and thus constitutes unethical conduct and a breach of the integrity of the profession. During the past year the media have repeatedly reported that the private sector is bloated with overservicing: one of the most important factors contributing to the increasing inflation of health care costs. Overservicing is an ethical problem presenting with a conflict situation among the interests of the patient, the provider and the funder. For example, since dentists are in a position to gain financially from their professional recommendations, they are at risk of having a conflict of interest: by overservicing they collect more fees. Low medical aid tariffs, delayed payment of benefits, oversupply of dentists, decreasing business and the spiralling costs of dental materials and equipment are the primary causes of high practice overheads and low cash-flow levels. Dentists may seek alternatives such as overservicing or unnecessary treatment to generate income and to improve their cash flow and/or profit. The main motives for overservicing are economic survival and financial gain. Some dentists may overtreat unintentionally due to out-dated treatment philosophies or where criteria for diagnosis and effective care are not clear, leading to variation in treatment decisions. Some overservicing may be due to patient-initiated demand. Dentists are largely unregulated as to the appropriateness or necessity of treatment decisions because of their professional status. Society trusts that their professionals will put the benefit of those they serve above their own self-interests. The aim of this review is to provide dentists with some guidance to the process of ethical decision making, the ethical principles involved, moral rules, and guidelines for professional standard of care. Business considerations whether profit, financial gain or economic survival should never justify overservicing by the dentist. If the patients' best interests are always considered, the profession of dentistry can ethically exist within a business structure.