FEATURES
ETHICAL MOMENT
How to appropriately use dental auxiliaries Kennedy W. Merritt, DDS
Q
After years in private general practice of dentistry, the complexities of developing successful practices are ever increasing. Many questions arise concerning the use of dental auxiliaries that keep the best interest of the patient in mind. In addition to the ethical issues, different state dental practice acts affect how we use auxiliaries. From an ethical perspective, how can a dentist effectively use dental auxiliary personnel in practice?
A
The American Dental Association Principles of Ethics and Code of Professional Conduct1 (ADA Code) can help with the ethical dilemma you have posed and, in fact, speaks directly to the issue. Section 2, Nonmaleficence (“do no harm”), states that “[t]he dentist has a duty to refrain from harming the patient.”1 Specifically, section 2.A acknowledges that dentists’ “professional status rests primarily in the knowledge, skill and experience with which they serve their patients and society.”1 Although auxiliaries certainly do have their own skill set and knowledge base, the dentist has specialized education and training to provide appropriate patient care. With the dentist’s specialized knowledge comes the ability to “know when and under what circumstances delegation of patient care to auxiliaries is appropriate.”1 Section 2.C, Use of Auxiliary Personnel, states that: Dentists shall be obliged to protect the health of their patients by only
assigning to qualified auxiliaries those duties which can be legally delegated. Dentists shall be further obliged to prescribe and supervise the patient care provided by all auxiliary personnel working under their direction.1
The challenge is for the dentist to be acutely aware of the legal requirements in his or her state that delineate the specific privileges afforded auxiliaries in that jurisdiction. The old adage “ignorance of the the law is no excuse” is applicable here. Every state allows for auxiliaries to perform duties according to their knowledge and training, and the dentist must be familiar with these privileges as well as levels of supervision required for the auxiliary to perform his or her duties. Being familiar with your state’s laws regarding delegation of duties to auxiliaries is a key component to your ethical use of auxiliary personnel in your practice. Another applicable part of the ADA Code is found in Section 3, Beneficence (“do good”), which obligates the dentist to “promote the patient’s welfare.”1 Section 3.F has particular relevance to the question you have posed as it deals with the workplace environment, requiring that dentists “provide a workplace environment that supports respectful and collaborative relationships for all those involved in oral health care.”1 The behavior of the dentist in the workplace that relates to auxiliaries is critical in establishing and maintaining a practice environment that supports the mutual respect, good communication, and high
levels of collaboration among team members required to optimize the quality of patient care provided. Dentists who engage in disruptive behavior in the workplace risk interfering with professional relationships among team members, decreasing the quality of patient care provided, and undermining the public’s trust and confidence in the profession. By asking, assigning, or requesting an auxiliary to perform a duty that is outside his or her level of training or knowledge, the dentist is arguably creating a workplace that does not support “respectful and collaborative relationships for all those involved in oral health care.”1 Such a work environment runs counter to the overarching goal of the ADA Code, which is to help dentists strive “to do that which is right and good.”1 The practice of dentistry requires not only technical skills but also management skills. Every dentist has the opportunity to train staff members to provide care to his or her patients. The task of the professional is to make this happen ethically for the betterment of patients. n http://dx.doi.org/10.1016/j.adaj.2015.01.001 Copyright ª 2015 American Dental Association. All rights reserved.
Dr. Merritt practices general dentistry in Clovis, NM, and is a member of the American Dental Association Council on Ethics, Bylaws and Judicial Affairs. Address correspondence to the American Dental Association Council on Ethics, Bylaws and Judicial Affairs, 211 E. Chicago Ave., Chicago, IL 60611. Disclosure. Dr. Merritt did not report any disclosures. Ethical Moment is prepared by individual members of the American Dental Association
Continued on page 216. 214 JADA 146(3) http://jada.ada.org
March 2015
FEATURES
Council on Ethics, Bylaws and Judicial Affairs (CEBJA), in cooperation with The Journal of the American Dental Association. Its purpose is to promote awareness of the American Dental Association Principles of Ethics and Code of Professional Conduct. Readers are invited to submit questions to CEBJA at 211 E. Chicago Ave.,
216 JADA 146(3) http://jada.ada.org
Chicago, IL 60611, e-mail [email protected] or call the ethics hotline at 1-800-621-8099. The views expressed are those of the author and do not necessarily reflect the opinions of the American Dental Association Council on Ethics, Bylaws and Judicial Affairs or official policy of the ADA.
March 2015
1. American Dental Association. American Dental Association Principles of Ethics and Code of Professional Conduct, with official advisory opinions revised to April 2012. Available at: www.ada.org/w/media/ADA/ About%20the%20ADA/Files/code_of_ethics_ 2012.ashx. Accessed October 30, 2014.
ETHICAL MOMENT
How to appropriately use dental auxiliaries Kennedy W. Merritt, DDS
Q
After years in private general practice of dentistry, the complexities of developing successful practices are ever increasing. Many questions arise concerning the use of dental auxiliaries that keep the best interest of the patient in mind. In addition to the ethical issues, different state dental practice acts affect how we use auxiliaries. From an ethical perspective, how can a dentist effectively use dental auxiliary personnel in practice?
A
The American Dental Association Principles of Ethics and Code of Professional Conduct1 (ADA Code) can help with the ethical dilemma you have posed and, in fact, speaks directly to the issue. Section 2, Nonmaleficence (“do no harm”), states that “[t]he dentist has a duty to refrain from harming the patient.”1 Specifically, section 2.A acknowledges that dentists’ “professional status rests primarily in the knowledge, skill and experience with which they serve their patients and society.”1 Although auxiliaries certainly do have their own skill set and knowledge base, the dentist has specialized education and training to provide appropriate patient care. With the dentist’s specialized knowledge comes the ability to “know when and under what circumstances delegation of patient care to auxiliaries is appropriate.”1 Section 2.C, Use of Auxiliary Personnel, states that: Dentists shall be obliged to protect the health of their patients by only
assigning to qualified auxiliaries those duties which can be legally delegated. Dentists shall be further obliged to prescribe and supervise the patient care provided by all auxiliary personnel working under their direction.1
The challenge is for the dentist to be acutely aware of the legal requirements in his or her state that delineate the specific privileges afforded auxiliaries in that jurisdiction. The old adage “ignorance of the the law is no excuse” is applicable here. Every state allows for auxiliaries to perform duties according to their knowledge and training, and the dentist must be familiar with these privileges as well as levels of supervision required for the auxiliary to perform his or her duties. Being familiar with your state’s laws regarding delegation of duties to auxiliaries is a key component to your ethical use of auxiliary personnel in your practice. Another applicable part of the ADA Code is found in Section 3, Beneficence (“do good”), which obligates the dentist to “promote the patient’s welfare.”1 Section 3.F has particular relevance to the question you have posed as it deals with the workplace environment, requiring that dentists “provide a workplace environment that supports respectful and collaborative relationships for all those involved in oral health care.”1 The behavior of the dentist in the workplace that relates to auxiliaries is critical in establishing and maintaining a practice environment that supports the mutual respect, good communication, and high
levels of collaboration among team members required to optimize the quality of patient care provided. Dentists who engage in disruptive behavior in the workplace risk interfering with professional relationships among team members, decreasing the quality of patient care provided, and undermining the public’s trust and confidence in the profession. By asking, assigning, or requesting an auxiliary to perform a duty that is outside his or her level of training or knowledge, the dentist is arguably creating a workplace that does not support “respectful and collaborative relationships for all those involved in oral health care.”1 Such a work environment runs counter to the overarching goal of the ADA Code, which is to help dentists strive “to do that which is right and good.”1 The practice of dentistry requires not only technical skills but also management skills. Every dentist has the opportunity to train staff members to provide care to his or her patients. The task of the professional is to make this happen ethically for the betterment of patients. n http://dx.doi.org/10.1016/j.adaj.2015.01.001 Copyright ª 2015 American Dental Association. All rights reserved.
Dr. Merritt practices general dentistry in Clovis, NM, and is a member of the American Dental Association Council on Ethics, Bylaws and Judicial Affairs. Address correspondence to the American Dental Association Council on Ethics, Bylaws and Judicial Affairs, 211 E. Chicago Ave., Chicago, IL 60611. Disclosure. Dr. Merritt did not report any disclosures. Ethical Moment is prepared by individual members of the American Dental Association
Continued on page 216. 214 JADA 146(3) http://jada.ada.org
March 2015
FEATURES
Council on Ethics, Bylaws and Judicial Affairs (CEBJA), in cooperation with The Journal of the American Dental Association. Its purpose is to promote awareness of the American Dental Association Principles of Ethics and Code of Professional Conduct. Readers are invited to submit questions to CEBJA at 211 E. Chicago Ave.,
216 JADA 146(3) http://jada.ada.org
Chicago, IL 60611, e-mail [email protected] or call the ethics hotline at 1-800-621-8099. The views expressed are those of the author and do not necessarily reflect the opinions of the American Dental Association Council on Ethics, Bylaws and Judicial Affairs or official policy of the ADA.
March 2015
1. American Dental Association. American Dental Association Principles of Ethics and Code of Professional Conduct, with official advisory opinions revised to April 2012. Available at: www.ada.org/w/media/ADA/ About%20the%20ADA/Files/code_of_ethics_ 2012.ashx. Accessed October 30, 2014.
