January 2009 | Modern Hygienist
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Let’s get ethical

If you see something happening in your practice that just isn’t right, there are ways to address the situation and raise the ethical bar.

by Renee Knight

It’s that uneasy feeling something isn’t quite right. It’s overhearing the dentist charge someone too much for a procedure, or seeing him grab another hygienist somewhere his hands certainly don’t belong. It’s knowing that a line has been crossed and if you act, there may be some serious repercussions.

Hygienists face ethical dilemmas in the office all too often, and in today’s tough economic times, it’s even more difficult to find the courage to speak up or the gumption to walk away from a practice that doesn’t live up to your ethical standards. But there are ways to address ethical concerns that come up, whether it’s an office manager who finds creative ways to file insurance claims or another hygienist who knows she can get an extra bonus if the skirt she wears to the holiday party is just a little shorter than it really should be.

Assess the situation

Whenever your feel something has happened that is just plain wrong, there are ethical decision-making models that you can follow to help you determine what you’re going to do about it, says Pamela Zarkowski, JD, MPH, Interim Academic Vice President and Provost for the University of Detroit Mercy. Identify the problem, gather information and come up with alternatives. If you think a patient should be referred to an oral surgeon or have a biopsy and the dentist doesn’t agree, take a step back and really look at the situation. Do some research on oral lesions. Talk to someone else in the practice and take a closer look at the patient’s chart. From there, figure out all your alternatives.

Remember, many of these situations aren’t as black and white as saying something or keeping quiet. There are more options than A or B.

“You have to try to resolve and come up with alternatives that are ethically based instead of saying ‘I can’t do something about this’ or ‘this is the only thing I can do,’” Zarkowski says. “Hygienists do tell me sometimes things are done when they bring something up. Some things are resolved, so it is doable. But if you call someone out on something there is a risk, and you have to weigh all that.”

Have a plan
It’s also important to think about what you’re going to do in certain situations before they actually happen, says Pamela Overman, EdD, Associate Dean for Academic Affairs at the University of Missouri-Kansas City School of Dentistry. Think about what your values are and how you would handle common situations. But don’t stop there—talk with other staff members, other hygienists, patients and even family members. Become involved with professional organizations and find out their stance on certain issues. Contact dental hygiene schools and think back to what you learned when you were still a student. You’ll come up with a whole new set of options that you might have overlooked on your own.

Whether it’s before or after something happens, it’s also a good idea to talk about ethical concerns in staff meetings, Zarkowski says. Bring up a situation and talk about how it should be handled, and have other staff members talk about problems they’re having or situations they’ve encountered and how they were resolved.

If something at work is making you uncomfortable, take the lead in making change, says Anika Ball, Executive Director of the American Society for Dental Ethics. It’s a difficult thing to do, but employers often respect you for defining your ethical standards and standing behind them.

“It’s important to be the one to try to seek change and never take the attitude of passive agreement,” Ball, RDH, says. “You don’t have to leave, but rather you can work to facilitate acknowledgement that something is happening in the practice and work to change that.”

Know your codes
When you do decide it’s time to make your concerns known, it’s helpful to have the industry’s ethical codes to back you up, Zarkowski says. Both the ADA and the ADHA have such codes, and they can be powerful tools when you’re trying to convince the dentist that he or she does have to give patients a copy of their chart, even if they’re behind on payments. Both dentists and hygienists have ethical, and in some cases legal, obligations that these codes clearly outline.

“If you can show what the code of ethics say, that’s very powerful,” Zarkowski says.

“Being familiar with that is a great tool. Educating everyone about what ethics are and what professional groups say about them might be a good first step.”

Take time to reflect
After you’ve made a decision and taken action, think about the process and the eventual outcome, Overman says. Sometimes you might not be happy with the decision you made, but maybe your financial situation took precedence over your moral code. If you do regret the way you handled a particular situation, use that as a learning experience to help you grow as a person and a hygienist. Know you’re not the only one who has faced this type of situation or made a decision you wish you could have back. 

“It’s often a choice between two right things. It’s right for me to keep my position and put food on the table, and it’s right for me to try to change things for this practice,” Overman says. “So I have to ethically choose between two right pathways. Those are the tough ethical situations where it’s not clearly right vs. wrong but it’s right vs. right.”

It’s not easy

Hygienists see and hear things in their day-to-day work lives that they may question ethically—that’s just the nature of the job, Overman says. Patients confide in them, they overhear conversations or they see things happening that they know aren’t right.

Maybe dentists or staff members don’t even realize they’ve done something unethical; maybe the office culture is to say he’s always been like that, it’s not a big deal if he calls us Babe or Honey. It could be you were hit with the unexpected when you first walked into the practice; the ideas you learned in school aren’t played out there, and it makes you a bit uncomfortable. Any number of actions or inactions could lead to an ethical dilemma—it’s just part of the job. You have to decide where your line is and how you’re going to react when your ethics come into question, knowing it could cost you, or even a co-worker, that all-important steady paycheck.

“Each of us has to make our own ethical decisions,” Ball says. “We’re talking about virtues and morals. All of those things make up ethics, and is what defines you as the practitioner. It’s important for each of us to reflect upon what that means and to carry that out in practice each day.”

Renee Knight is an associate editor for Modern Hygienist.

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