dental ethics question...

[toofache32]

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Health care is like a bungee cord.....if you use cheap materials, you take your life into your own hands.

 

[toofache32]

PS- I don't know about other people but I always seem to find that the patients that can't afford the treatment are the same people that still have a cell phone and designer shoes. Its all about priorities.

Amen to that. I see that all the time.

 

[AhhPuller]

That's an incomplete analysis of the issue. Do you really want free trade? Be careful what you wish for. The fact that dentists have a state protected monopoly over the profession is antithetical to truly free trade.

Stop turning every single thing into some sort of socioeconomic debate. It's annoying already. You seem to be in such favor of laissez faire capitalism that it's clouding reasonable thought. I am a big fan of business, but that attitude will drive everything into slave labor wages OR you'll have the development of a union to counteract the undercutting. Either way, the system will be a terrible failure. I bet you're a huge fan of outsourcing; why not just have the Chinese or Indians do everything since they'll work for a few dollars a day. Get real and stop with the nonsense; you sound like a brick or something similar.

 

[12YearOldKid]

Stop turning every single thing into some sort of socioeconomic debate. It's annoying already.

Yeah, Let's get back to ripping on the girl who was trying to scam her way into some free extractions. 😀

 

[Sprgrover]

I think he defined it pretty well in his prior post. Nonmalificence is one of the bedrock principles of our profession, and by receiving substandard "treatment" from an incompetent clinician, a patient can very easily end up in worse shape after than before. Primum non nocere.

This is all stuff you start learning about once you start dental school. 😉

👍

 

[toofache32]

 

[aphistis]

 

[mdub]

I think he defined it pretty well in his prior post.

It's not defined at all. "Do no harm" means virtually nothing. "Danger" means virtually nothing. First of all, we're not talking about cases in which one intentionally harms another. Second, "competence" and "incompetence" exist of a continuum. They are, I assure you, most certainly not binary concepts. When you draw a line somewhere and say that everything on one side is incompetent and everything on the other side is competent, you shouldn't be surprised when someone challenges you. And the location of that line hasn't been justified anywhere on this thread, that's for sure.

 

[howui3]

It's not defined at all. "Do no harm" means virtually nothing. "Danger" means virtually nothing. First of all, we're not talking about cases in which one intentionally harms another. Second, "competence" and "incompetence" exist of a continuum. They are, I assure you, most certainly not binary concepts. When you draw a line somewhere and say that everything on one side is incompetent and everything on the other side is competent, you shouldn't be surprised when someone challenges you. And the location of that line hasn't been justified anywhere on this thread, that's for sure.

😴 😴 😴 😴 😴 😴 😴 😴 😴

 

[mdub]

Are you sure you're not a former President from Arkansas?

I wish. I'd be rich from all my speaking engagements.

The things we call "dangerous" are varied. Sometimes people even call things with extremely low risks of failure "dangerous" because they perceive a low level of control, a high level of dread, etc. (E.g. living next to a nuclear power plant for a few years is seen as vastly more "dangerous" than driving under common conditions for a few years.)

There's a whole book on this subject called The Perception of Risk by Paul Slovic (ISBN 1853835285) that, at the most basic level, deals with figuring out what people mean when they say something is "dangerous."

So, when I pick a term (like "risk") that's less laden with emotional baggage and line-drawing judgments (as "dangerous" is), I don't feel particularly bad about it.

 

[mdub]

I always tell my patients that if they want cheap dentistry they can always head south to Mexico.

Why not let them have that option in the United States?

I also tell them that after their mouth is messed up by the "dentistas" then I am more than happy to fix it at my originally quoted price (and then some).

That's fine. I don't have a problem with that.

People always have options for dental care, whether it be full mouth reconstruction or palliative care.

The one option they don't have is going to a non-licensed dentist.

To decrease the monetary recompense Dentistry has to offer would only decrease the pool of qualified applicants for the profession.

That's only true if licensing is a binding constraint. An example of a non-binding constraint is the minimum wage in many areas. In those areas it doesn't matter whether the federal government mandates that people get paid at least $5.15/hour because market forces dictate a higher wage anyway. In some areas, dental licensing is probably a non-binding constraint because the market would tend to require it without government intervention. In other areas (and among different demographics) it is a binding constraint.

PPS- I know of many dentists/OS that, rather than lowere their prices, choose to donate their time or perform procedures for free in an effort to give back to the community. So please do not paint the entire profession as money-grubbing and heartless.

I think that's perfectly acceptable. Any profession that's protected by licensing requirements owes a social duty to give back to the community. I'm not saying that the original poster in this thread can or should force a dentist to meet his or her duty by accepting services and defaulting on payment if it was agreed that the service was to be performed by a fee. I'm responding to the notion that a lot of people's first instinct was to essentially appeal to the "morality" of free enterprise, when it's not particularly free in this case and it's not particularly moral.

 

[mdub]

don't forget the cable and telephone companies have a monopoly, sure there is direct tv but not exactly the same, should we have 10-12 cable and telephone wires running down the streets, that would look awesome!

I don't see what that has to do with anything in this thread. But it's incredibly easy to answer: telephone service was deregulated and yet telephone companies routinely (as in hundreds of millions of times per day) share their lines with one another under measures designed precisely to prevent the harms from the natural monopoly problem (e.g. duplicated lines). That's less common with cable companies, but price caps are also more common because of that.

 

[mdub]

Yeah, Let's get back to ripping on the girl who was trying to scam her way into some free extractions. 😀

You guys deserve to be ripped on yourselves because you were being a$$holes. Maybe you should have tried to help more. That would have been helpful to her and, potentially, to other people.

 

[aphistis]

It's not defined at all. "Do no harm" means virtually nothing. "Danger" means virtually nothing. First of all, we're not talking about cases in which one intentionally harms another. Second, "competence" and "incompetence" exist of a continuum. They are, I assure you, most certainly not binary concepts. When you draw a line somewhere and say that everything on one side is incompetent and everything on the other side is competent, you shouldn't be surprised when someone challenges you. And the location of that line hasn't been justified anywhere on this thread, that's for sure.

OK, so anything you disagree with can be dismissed as "means nothing." I can see where any further attempt at discussion will be headed. Have a nice weekend. 🙄

 

[FCIllini]

The one option they don't have is going to a non-licensed dentist.

Good point. By the way, I start dental school this fall and need some practice - you want to be my patient. I have no formal training whatsoever, but that shouldn't matter to you. I have no governing body to oversee the procedures I complete on other human beings, but no big deal.

But what the heck ... my price will be dirt cheap & I got a new dewalt drill I'm dying to try out.

 

[hockeydentist]

Good point. By the way, I start dental school this fall and need some practice - you want to be my patient. I have no formal training whatsoever, but that shouldn't matter to you. I have no governing body to oversee the procedures I complete on other human beings, but no big deal.

But what the heck ... my price will be dirt cheap & I got a new dewalt drill I'm dying to try out.

where do I sign up....... 👍

 

[mdub]

OK, so anything you disagree with can be dismissed as "means nothing." I can see where any further attempt at discussion will be headed. Have a nice weekend. 🙄

No. You're drawing a poor inference. And you're probably doing it intentionally. Think about it for a second: How do you know when something is "dangerous," and how do you communicate the level of danger to others. You do it by talking about risks and rewards. You're ignoring the fact that "dangerousness" doesn't just arise out of the ether. It's a socially constructed entity. I'm saying that it doesn't really matter if you attach the "danger" label. I'm saying that, yes, my suggestion would be riskier, but it would also carry benefits. The balance of those costs and benefits is the issue, not the label "danger." I could be wrong. Maybe the costs don't outweigh the benefits. But saying, "dude, that's dangerous" and "do no harm" most certainly does not demonstrate either that I'm wrong or that such a practice would be unethical. All it means is that you looked at a part of the equation.

If you disagree, fine. But when I say everything is dangerous, you're not going to have a response if you stick to the "ban dangerous stuff" position. Driving is dangerous. Crossing the street is dangerous. Flying is dangerous. Watching TV is dangerous. Eating is dangerous. Of course, you're going to say something like, "well, but some things are dangerous but justifiable," at which point you'll be right back to my point about costs and benefits. So why not just skip the whole labelling process in the first place? Seems pretty reasonable to me.

 

[mdub]

Good point. By the way, I start dental school this fall and need some practice - you want to be my patient. I have no formal training whatsoever, but that shouldn't matter to you. I have no governing body to oversee the procedures I complete on other human beings, but no big deal.

I wouldn't sign up to be your patient. I have enough money to get a better dentist. But someone else might want the option. And laws requiring truthful information disclosure (which generally accompany deregulation) would put the patient on notice that you "have to formal training whatsoever." But the issue isn't simply fully trained and licensed dentist versus a laymen. There are intermediary possibilities. Law schools, for instance, often allow students (generally 2nd or 3rd year students) to take on certain limited cases. The justification is that the increased access to the legal system or, in other instances, increased representation in the legal system, outweighs the presumably lower quality of representation.

But, hey, that sounds a lot like what dental students do. Would the world end if there were less trained lawyer-like and dentist-like people running around helping others? I don't think so. As long as they were required to make known their training and experience, their clients/patients would know what they're getting into.

 

[SMW83]

well, the consultation for my wisdom teeth removal is tomorrow May 16, at 11:15AM with Dr John Winfield. Wish me luck that the wisdom teeth won't be difficult to extract and I will tell y'all how it goes tomorrow and then I can quote what the prices would be (general anesthesia, conscious sedation, lical anesthetic, NOS, etc.) and how complex or simple itd be. All I know is that their cheapest extraction, not including anesthesia, is only $85 per tooth. Most expensive is over $400 per tooth. I sure hope it all goes well.....