Axed due to mission trip disclosure?

[Garett24]

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Hello,

Last cycle I interviewed at UF. It was my first interview and I was quite nervous and now interviewing multiple schools I realize it was still the most intimidating. Anyway, the conversation on my mission trip to Nicaragua came up. When they asked what I did I told them honestly that I worked under a dentist to provide care for the underserved. I mentioned how I had pulled a tooth and done a shot with the dentist holding my hand. The interviewers looked at me as if I had kicked a sick kitten on the side of the road and quickly scribbled on their notepads. They then asked what moral problems were with that situation. So I told them exactly what I thought: The people were in desperate need of care and although I was not a trained dentist, I was under a trained professional who was directing my tools and hands while being performed, controlling 95% of the procedure. Other than that aspect the interview went fine. My peers had told me not to disclose this information, but it just slipped out. In fact, I am still having a hard time thinking what I did was unethical.

Luckily I have been accepted this cycle (to a different school) and have not heard from UF. They were my #1. What I am wondering: was this a dealbreaker to not be contacted again?

 

[slick15]

probably. Ive heard many times to not do things you wouldnt be able to do in US on those mission trips. Even if you did, to never disclose it. probably a red flag for them.

 

[Advance]

Yeah that was a bad move on your part. I'm glad you got in to a school though.

 

[Garett24]

Yeah that was a bad move on your part. I'm glad you got in to a school though.

The more I ask around the more I am finding it to be a bad move. But don't people who interview students know what is going on during these trips? I feel like such a stupid thing slipped (the truth) and although it is a red flag, I don't agree with it. Those people got medical help and walked out happy, and that encapsulated my interest in dentistry. I guess I should have stuck to the format.

 

[fogorvostan]

That was not a good move IMO. I went to Nicaragua as well on a similar trip but I did not assist. I shadowed dental students instead. They offered to let me help, but I couldn't in good conscience knowing that I am not a trained or legally allowed to do so in the US.

Edited to add: I talked about my trip at one of my interviews and the people interviewing me seemed interested in it. I mentioned how I did not perform anything on anyone, but collected donations before I went (I bought boxes and boxes of toothbrushes + toothpaste), taught children how to brush their teeth, shadowed dental students, etc.

 

[doc toothache]

The more I ask around the more I am finding it to be a bad move. But don't people who interview students know what is going on during these trips? I feel like such a stupid thing slipped (the truth) and although it is a red flag, I don't agree with it. Those people got medical help and walked out happy, and that encapsulated my interest in dentistry. I guess I should have stuck to the format.

They probably would have liked it more had you given them your rationalization for having "kicked a sick kitten on the side of the road" possible something along the line of, what the heck, it would have died anyway or it was the humane thing to do. Sadly, you still appear to remain clueless. During your ds make it a point not to miss the ethics/jurisprudence lectures.
http://forums.studentdoctor.net/threads/mission-trips-the-good-the-bad-the-ugly.945694/

 

[Dentonymous]

In fact, I am still having a hard time thinking what I did was unethical.

Think about it this way. What benefit did those patients get from you performing extractions and administering local anesthetic? You said that the dentist did 95% of the work, but why couldn't he/she just do 100%? Clearly allowing you to help didn't save them them any time and allow them to work on more patients, but on the contrary probably slowed them down. If you were in that persons shoes would you be OK with some random dude without any experience walking in and extracting your tooth? Somehow I doubt it. I bet that if you asked any clear minded adult that if they would be OK with some random person performing a procedure on them they would absolutely say NO. Last time I checked, underprivileged/underserved people are still human and they still have rights. The point of your trip was to help other people NOT yourself. The only person who benefited from this situation was YOU and I'm not even sure if that is true. Dental schools exist for a reason and that is where you should be learning how to perform these procedures.

 

[Garett24]

Think about it this way. What benefit did those patients get from you performing extractions and administering local anesthetic? You said that the dentist did 95% of the work, but why couldn't he/she just do 100%? Clearly allowing you to help didn't save them them any time and allow them to work on more patients, but on the contrary probably slowed them down. If you were in that persons shoes would you be OK with some random dude without any experience walking in and extracting your tooth? Somehow I doubt it. I bet that if you asked any clear minded adult that if they would be OK with some random person performing a procedure on them they would absolutely say NO. Last time I checked, underprivileged/underserved people are still human and they still have rights. The point of your trip was to help other people NOT yourself. The only person who benefited from this situation was YOU and I'm not even sure if that is true. Dental schools exist for a reason and that is where you should be learning how to perform these procedures.

The funds for the clinic that had to be set up/materials were all made available because of the students payment to the trip organization,
otherwise this help would not have happened despite the dentist being a trained professional. So in this way we were responsible.

We were also happy to provide a great deal of dental supplies to the community. As far as slowing down the dentist, I do not believe we did. We took three days to train and find out the right questions to ask to survey the patient's medical history and problems before the clinic was set up. Once it was, the dentist jumped from station to station and was able to dive in because we had all the info ready. So yes the dentist did 95% of the handwork, but she was able to move with great speed and see more patients when tools were laid out, composites were ready, etc.

Look, I know it may not be seen as professional. But looking at the outcome of having the trip vs not having the trip the binary result is that the residents benefited greatly. Yes they have rights, and at the time to be honest I didn't think much of it, I was following orders. If I were in their shoes I would give up my "right" to have some gringo hold an instrument and look close into my mouth vs living with pain. The rules bend when resources are scarce. It surely didn't JUST benefit me, thats not the point of a trip and a daring accusation. I was just seeking whether or not this disclosure was so costly, which I am now learning is.

 

[Incis0r]

I can understand both sides of this. OP, from reading your posts, it seems like you were confident when doing the procedure and made sure to fully understand what you were doing before you did it. Plus these kinds of trips usually have hundreds, if not thousands, of people coming for aid, and a little helping hand can help more patients be seen by the doctor.

Part of the issue is that the standard of care was compromised when you extracted a tooth. Generally, in these global service trips, the objective is to maintain and provide the same standard of care that you would in the United States. That ensures that no ethical lines are crossed. In the U.S., you certainly wouldn't extract a tooth, so from that point of view, it doesn't seem appropriate to do it overseas.

The other thing is- many foreign governments mandate that only licensed and trained professionals provide those kinds of services. It is part of the reason why the global service group gets the visa to enter the country and provide healthcare. I'm not familiar with Nicaraguan law, but if that rule was part of the arrangement, then the group may have violated national law when they gave you permission to extract a tooth.

What's done is done. I know you went there to help out, and that is admirable. Just watch the ethical lines a bit more closely next time, and all will be well.

FWIW, I want to do plenty of these global service trips soon as well, and I'm eager to get my dental school training done so I can do a few each year.

 

[Dentonymous]

The funds for the clinic that had to be set up/materials were all made available because of the students payment to the trip organization,
otherwise this help would not have happened despite the dentist being a trained professional. So in this way we were responsible.

We were also happy to provide a great deal of dental supplies to the community. As far as slowing down the dentist, I do not believe we did. We took three days to train and find out the right questions to ask to survey the patient's medical history and problems before the clinic was set up. Once it was, the dentist jumped from station to station and was able to dive in because we had all the info ready. So yes the dentist did 95% of the handwork, but she was able to move with great speed and see more patients when tools were laid out, composites were ready, etc.

Look, I know it may not be seen as professional. But looking at the outcome of having the trip vs not having the trip the binary result is that the residents benefited greatly. Yes they have rights, and at the time to be honest I didn't think much of it, I was following orders. If I were in their shoes I would give up my "right" to have some gringo hold an instrument and look close into my mouth vs living with pain. The rules bend when resources are scarce. It surely didn't JUST benefit me, thats not the point of a trip and a daring accusation. I was just seeking whether or not this disclosure was so costly, which I am now learning is.

I have no doubt that the mission itself was a great benefit for the people that received care. I realize that you, as volunteer, play a vital role in helping things run smoothly and efficiently. In that regard I completely agree with you. There is nothing unethical about having volunteers help by setting up the clinic, laying out and sterilizing instruments for the providers, etc. What is unethical is when said volunteer begins to participate in the role as a care provider. It sounds like the actual dentist was standing over your shoulder and essentially holding your hand through the procedure which is inevitably going to take longer than if they had just done it themselves. I'm not saying that you were trying to harm the patients or had any sort of malicious intent. However, that situation posed nothing but potential harm to the patient because they weren't receiving care from a trained professional. I'm not trying to come off all preachy or whatever, but you said that you didn't think what you did was unethical and all I'm saying is that you should put yourself in that patients shoes and you might think a little differently. Either way what is done is done, and all you can do is learn from the experience and move on. Congrats on getting into dental school this time around. I wish you nothing but the best.

 

[pgex2t]

To the best of my knowledge, it's a deal breaker. While not on the same magnitude, it's like our version of untrained volunteers assisting with surgeries in impoverished parts of the world. If you're looking at it from a binary perspective, sure it might not seem like a big deal. Unfortunately, ethics and laws don't run on a binary system in the good ol' U S of A

 

[Soleus715]

The more I ask around the more I am finding it to be a bad move. But don't people who interview students know what is going on during these trips? I feel like such a stupid thing slipped (the truth) and although it is a red flag, I don't agree with it. Those people got medical help and walked out happy, and that encapsulated my interest in dentistry. I guess I should have stuck to the format.

I completely agree with doc toothache.

You seem completely fine with having done something so unethical. What's the point in going into dental school if you're just gonna inject people with shots and pull teeth without a degree anyways?
And here I am, being pissed about dental therapists doing irreversible procedures on patients...

There's only a few things that could make me get this riled up on SDN.. ethical issues really tick me off. What if some of those patients overseas you treated were in more pain due to nerve damage after what you did to them?
Could you live with that? With knowing that you can't even confirm if they are ok? I have patients come into the office at my work that had dysaesthesia from nerve damage caused by other dentists.
Who's to say that dental volunteers can avoid this? And the dentist was holding your hand the whole time? Why didn't he just do it then? I'm not really following the logic behind letting volunteers do anything illegal in the U.S. It's illegal for a reason.

 

[Mad Jack]

Terrible move. There's a lot more than you realize going on in the oral cavity, you could do some real damage, and all for what? So you can feel like you had a cool experience?

 

[Incis0r]

I have no doubt that the mission itself was a great benefit for the people that received care. I realize that you, as volunteer, play a vital role in helping things run smoothly and efficiently. In that regard I completely agree with you. There is nothing unethical about having volunteers help by setting up the clinic, laying out and sterilizing instruments for the providers, etc. What is unethical is when said volunteer begins to participate in the role as a care provider. It sounds like the actual dentist was standing over your shoulder and essentially holding your hand through the procedure which is inevitably going to take longer than if they had just done it themselves. I'm not saying that you were trying to harm the patients or had any sort of malicious intent. However, that situation posed nothing but potential harm to the patient because they weren't receiving care from a trained professional. I'm not trying to come off all preachy or whatever, but you said that you didn't think what you did was unethical and all I'm saying is that you should put yourself in that patients shoes and you might think a little differently. Either way what is done is done, and all you can do is learn from the experience and move on. Congrats on getting into dental school this time around. I wish you nothing but the best.

Agreed.

 

[Garett24]

I have no doubt that the mission itself was a great benefit for the people that received care. I realize that you, as volunteer, play a vital role in helping things run smoothly and efficiently. In that regard I completely agree with you. There is nothing unethical about having volunteers help by setting up the clinic, laying out and sterilizing instruments for the providers, etc. What is unethical is when said volunteer begins to participate in the role as a care provider. It sounds like the actual dentist was standing over your shoulder and essentially holding your hand through the procedure which is inevitably going to take longer than if they had just done it themselves. I'm not saying that you were trying to harm the patients or had any sort of malicious intent. However, that situation posed nothing but potential harm to the patient because they weren't receiving care from a trained professional. I'm not trying to come off all preachy or whatever, but you said that you didn't think what you did was unethical and all I'm saying is that you should put yourself in that patients shoes and you might think a little differently. Either way what is done is done, and all you can do is learn from the experience and move on. Congrats on getting into dental school this time around. I wish you nothing but the best.

Thanks for the input