Step-1: Identify the Ethical Principles at Stake

Beneficence

• Caring about and acting to promote the good of another
• The hygienist must always give priority to the best interests of his/her clients
• In this scenario the hygienist must care for and act to promote the health of his/her clients, rather than giving more importance to the monetary interests of the dentist.

Autonomy

• Pertains to the right to make one’s own choice
• By communicating the relevant information openly and truthfully, dental hygienists assist client’s to make informed choices and to participate in achieving and maintaining optimum oral health.
• The hygienist must communicate openly and honestly with the clients about all the treatment options available and their pros and cons to gain optimum oral health rather than promoting the most expensive option recommended by the dentist.

Professionalism

• Professionalism means being competent, honest and fair
• Competence: refers to providing high quality care
• Honesty: being truthful both in your statement and your omission.
• Fairness: appropriately balancing competing interest
• In this scenario the dental hygienist must be completely honest and fair to her clients even when it competes with her personal monetary interests and employer pressure.

Conflict of Interest

• A conflict of interest occurs when a dentist/dental hygienist has a personal interest (monetary, moral or personal belief) that a reasonable person might think could improperly influence his/her professional judgment
• In this situation the hygienist must not allow her personal monetary interests or employment prospects to jeopardize the client’s oral health or influence her professional judgment.

Step-2: identify the various option for action

• Take no action and do as the doctor has mentioned
• Advise the client to research his or her options and decide what is best for them.
• Try again by explaining to the dentist about why you think the policy is not in the best interest of the clients
• Call the regulatory authority and report the dentist and or ask for their recommendations in solving the issue
• Follow the right informed consent way by telling the various options of treatment and advantage and disadvantage of each treatment.
• Leave the office and find another that is suitable to your ethics.

Step-3:Assess Options

• You are misleading the dentist by being silent, and preventing the office from taking appropriate steps to ensure appropriate treatment measures are in place and are failing to look after the best interest of your client. Harm the client loose reputation from your client.
• You may lose clients
• You may lose the dentists trust
• The dentist may agree or disagree with your opinion.
• If you call the regulatory authority to report the dentist, his license may get revoked
• If you leave the present job you will be relieved from the present ethical dilemma

Step-4:Implement the action

• Provide various procedure to correct or remedy his/her  dental issue.
• Provide information about the necessity of performing each procedure on the client.
• Enumerate the benefits of the procedure.
• Enumerate any harmful effects of the procedure according to the medical condition of the client even if those effects are minor or negligible.
• Inform about the cost of each procedure.
• Inform the client about the gain sharing policy of the practice
• Tell the client that his/her choice of procedure will contribute proportionately to the offices gain sharing policy.

Step-5:Evaluate outcomes

• The Dental hygienist will gain the client’s trust for her being honest.
• The Dentist could lose the client’s trust because he/she would think that the office’s primary goal is to optimize its profit margin.
• Client might check the costs of similar procedure at other offices and potentially have/his treatment done at a different office.
• Dentist/Dental hygienist might lose clients.
• Dental hygienist might lose his/her job.

The information is based on CDHO guide updated in 2008

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1-      Prepares the Dental practitioner with necessary information regarding ongoing treatment of the client. Doing so the dental practitioner improves the time management.

2-      Helps the rest of the dental staff with information. (E.g. scheduling or billing purposes).

3-      Helps the dental practitioner not to perform procedures that are contraindicated to that particular patient

4-      Tx notes are useful for report documentation purposes

5-      To be accountable in front of the college for an excellent  conduct and competency ( recordkeeping is a legal requirement)

6-      For legal purposes ( If issues with the clients arise)

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Clients access and correction rights to dental records

All the clients have the right to obtain a coy of their treatment chart.

A client can authorize another person to obtain his own chart E.g parents, relatives, friends etc

For clients that are incapable of decision making his/her decision maker can obtain the clients chart copy at any time.

Reasonable fees an be applied to the client

What should a dental hygienist do when leaving the office?

When leaving a practice its hygienists responsibility to make sure that the client can have access to his/her chart information

We can either make a copy of the client’s records or make sure that the records left behind at the previews office will be maintained for the required period of time and these records will be available to you at any time if needed.

The records are now owned but the dental hygienist at any time. These records belong to the clients.

No matter what solution we find in securing the client records, we have to let the clients know about these arrangements and make possible that they have access of these records at any time.

Acts that protects a client’s personal information in Canada

Personal Health Information Protection Act, 2004

Personal Health Information should be kept for at least 10 years,this includes paper work, electronic records and digital photographs.

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Written consent

It’s a piece of paper unless its read, understood and its appreciated. Written consent form is signed by a witness (dental hygienist and the client or his/her representative). The value of obtaining a written consent is to prove that a consent was obtained if a challenge arise.

A written consent is not a complete defense when problems arise.It is required an informed consent to make sure that the clinician is on the safe side.

Informed consent form

Involves the meeting of minds between client and clinician. Consists in informing the client regarding the findings, and gives the opportunity to the client to make his own decisions regarding the treatment plan suggested by the clinician. It’s the clinicians duty to provide information and make recommendations that will enable the client to make informed choices.

Verbal consent

If a written consent is not obtained from the clinician than a verbal consent is enough as long as it is written in the treatment records in details.

Determination of capacity and substitute decision makers role in treating a dental client

Determination of capacity

All clients are assumed to be capable of decision making therefore capable of signing a written consent. When there are reasons to doubt the capability of the patient then an assessment of a client is made to assure that he is really in able to give a consent.

Substitute decision makers

When a client results incapable from the assessment then a third party is required to .give consent. These third parties are considered substitute decision makers. Substitute decision makers include: relatives or official institutions that deal with this situations like The Public Guardian and Trustee.

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Written consent

It’s a piece of paper unless its read , understood and its appreciated. Written consent form is signed by a witness ( dental hygienist and the client or his/her representative). The value of obtaining a written consent is to prove that a consent was obtained if a challenge arise. A written consent is not a complete defense when problems arise. It is required an informed consent to make sure that the clinician is on the safe side

Informed consent form

Involves the meeting of minds between client and clinician. Consists in informing the client regarding the findings, and gives the opportunity to the client to make his own decisions regarding the treatment plan suggested by the clinician. It’s the clinicians duty to provide information and make recommendations that will enable the client to make informed choices.

Verbal consent

If a written consent is not obtained from the clinician than a verbal consent is enough as long as it is written in the treatment records in details.

Determination of capacity

All clients are assumed to be capable of decision making therefore capable of signing a written consent. When there are reasons to doubt the capability of the patient then an assessment of a client is made to assure that he is really in able to give consent.

Substitute decision makers

When a client results incapable from the assessment then a third party is required to give consent. These third parties are considered substitute decision makers. substitute decision makers include: relatives or official institutions that deal with this situations like The Public Guardian and Trustee.

Patients chart

All the clients have the right to obtain a coy of their treatment chart.

A client can authorize another chart to obtain his chart

For clients that are incapable of decision making his/her decision maker can obtain the clients chart copy at any time. Reasonable fees an be applied to the client

What happens to the clients records when a Dentist or a dental hygienist leaves a dental practice?

When leaving a dental practice its Dentists or Dental Hygienists responsibility to make sure that the client can have access to his/her chart information

They can either make a copy of the clients records or make sure that the records left behind at the previews office will be maintained for the required period of time and these records will be available to you at any time if needed.

Keep in mind that the dentist owns the paper where the information is written, but he/she doesn’t own your actual information.

The personal information and the treatment record that the dental chart includes belong to you and no one else. There are measures that a dental professional has to take when leaving an office in ensuring that the patients chart is secure

and safe. ( Eg: deciding to quite working, leaving the country etc ) No matter what arrangement your dentist or hygienist takes they should by law let the patients know about these arrangements and make possible that they have access of these records at any time.

What’s the act that protects a client’s personal information?

Personal Health Information Protection Act, 2004

How long are your records kept in a dental office by law?

Personal Health Information should be kept for at least 10 years, This includes paper work, electronic records and digital photographs.

This article is copyrighted and originally prepared by Amy RDH. For more info visit our TERMS OF USE

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