Ethical Dilemma

[jessUMD]

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Have any of you faced any ethical dilemmas or compromising situations while shadowing or working at a dentist's office? I have heard this question come up so many times and am just wondering what people's experiences have been with this. I haven't been in this situation at my office, luckily, but I'm curious to see if you have, and if you felt like it was easy to deal with.

 

[dexadental]

I wouldn't call this an ethical dilemma, but the dentist I work for is insanely obsessed with money...I won't list his name or anything hehe. He likes to sport gold chains, like 5 gaudy gold bracelets and a nice rolex (hes puerto rican so he can sport the gold, while I'd rather choose silver 😎 ). Anyways, when I become a dentist, I don't think I'll wear all that jewlery to my practice, call me crazy but I like fancy stuff, but don't like to wear my wealth on my sleeve. Other than all that stuff, including having a doggie in the office and being a womanizer, hes an all around excellent dentist and great guy. Note to self: excessive jewlery on a dentist is a turnoff as a patient. Just an opinion, 😀 ...I like these "smilies"...they're alot of fun!

 

[Profchaos]

Same here. The dentist I shadowed in Vegas loved to show off with his wealth, so does his wife. I mean it's not a bad thing to have money, but please don't brag about it.

 

[rocknightmare]

i don't know but can this be an ethical dilemma? if a doctor screws up a patient tooth but doesn't inform them about it?

 

[45540]

I've seen a dentist nick the adjacent tooth when doing a pretty bad class 2 on some malaligned teeth but he buffed it out and told the patient they might be getting decay on the adjacent tooth as well.

But there's a fine line between ethical dilemmas and iatrogenic cases.

 

[aphistis]

Payment issues are big sources of ethical problems. I've worked with dentists who have patients with insurance, but who were personal friends, or lower-income, or something like that. The doc wrote off the patient copayment, but billed the insurance company. That's straight-up insurance fraud.

 

[12YearOldKid]

I've seen a dentist nick the adjacent tooth when doing a pretty bad class 2 on some malaligned teeth but he buffed it out and told the patient they might be getting decay on the adjacent tooth as well.

But there's a fine line between ethical dilemmas and iatrogenic cases.

If nicking adjacent teeth were a problem every dentist in the country would be sued on a monthly basis.

 

[jheidenr]

I was shadowing a dentist in a rural area and it was not uncommon to have drunk patients come in to be treated. There ended up being a big argument between the dentist and his staff because they didn't think a consent form signed by a drunk person should be valid. This dentist felt bad for these people and their situation and wanted to help, but his staff felt threatened. The assistants and front office refused to treat the patient, so I ended up assisting the dentist and helping bill the patient.

 

[DrTacoElf]

Payment issues are big sources of ethical problems. I've worked with dentists who have patients with insurance, but who were personal friends, or lower-income, or something like that. The doc wrote off the patient copayment, but billed the insurance company. That's straight-up insurance fraud.

Yes i've seen this as well but in a different format. If you offer the patient any % discount for whatever reason you have to offer the insurance that same % discount. I.e if the patient copay is $100 and you give them 25% off for whatever reason making their copay $75. You have to give the insurance a 25% discount as well.

 

[toofache32]

Payment issues are big sources of ethical problems. I've worked with dentists who have patients with insurance, but who were personal friends, or lower-income, or something like that. The doc wrote off the patient copayment, but billed the insurance company. That's straight-up insurance fraud.

That's definately insurance fraud. It must be fairly common, because it's specifically addressed in the ADA Code of Ethics literature.

 

[toofache32]

I've seen a dentist nick the adjacent tooth when doing a pretty bad class 2 on some malaligned teeth but he buffed it out and told the patient they might be getting decay on the adjacent tooth as well.

But there's a fine line between ethical dilemmas and iatrogenic cases.

In dental school, I was cutting the lingual surface of a crown prep on #19 and the patient coughed. His tongue flew over into my bur and got all chewed up. He was numb, so he didn't know it. I told him about it and said he should definately take some ibuprofen at home because it would be sore for a day or two.

Now that I think about it, I nicked 2 tongues while in dental school.

 

[aphistis]

I was shadowing a dentist in a rural area and it was not uncommon to have drunk patients come in to be treated. There ended up being a big argument between the dentist and his staff because they didn't think a consent form signed by a drunk person should be valid. This dentist felt bad for these people and their situation and wanted to help, but his staff felt threatened. The assistants and front office refused to treat the patient, so I ended up assisting the dentist and helping bill the patient.

That dentist is really asking for trouble if something ever goes wrong. Even throwing aside the potential medical complications introduced by working on a loaded patient...if a sorority girl is legally unable to consent to having sex at a party, I don't think the doc would have much luck waving the consent forms around in court.

 

[luder98]

Payment issues are big sources of ethical problems. I've worked with dentists who have patients with insurance, but who were personal friends, or lower-income, or something like that. The doc wrote off the patient copayment, but billed the insurance company. That's straight-up insurance fraud.

This is fairly common in my community. I still remember the first few months we were in the US. Due to the lack of English, my uncle took his wife to a dental office where they spoke our language. The dentist told them not to worry about copayment and that he would take good care of them. I think all he did was a fill-up. At the end of the year, they got the statement from the insurance company. It showed that the dentist had max-ed out their anual allowance for just that fill-up!

 

[jessUMD]

I was shadowing a dentist in a rural area and it was not uncommon to have drunk patients come in to be treated. There ended up being a big argument between the dentist and his staff because they didn't think a consent form signed by a drunk person should be valid. This dentist felt bad for these people and their situation and wanted to help, but his staff felt threatened. The assistants and front office refused to treat the patient, so I ended up assisting the dentist and helping bill the patient.

WOW. were these people visibly intoxicated or had they just had a few drinks? I am really surprised the dentist would have risked treating them. Did that put you in an uncomfortable position or did you just end up assisting because you felt it was ok?

 

[toofache32]

This is fairly common in my community. I still remember the first few months we were in the US. Due to the lack of English, my uncle took his wife to a dental office where they spoke our language. The dentist told them not to worry about copayment and that he would take good care of them. I think all he did was a fill-up. At the end of the year, they got the statement from the insurance company. It showed that the dentist had max-ed out their anual allowance for just that fill-up!

I wonder what the whole story is here. Some maximum allowances are only in the $200-500 range, while some of the best are still only $1000 or a little more. It doesn't take much to max that out. That's why dental insurance sucks in general. Many people think it's like medical insurance and that most things are covered.

 

[luder98]

I wonder what the whole story is here. Some maximum allowances are only in the $200-500 range, while some of the best are still only $1000 or a little more. It doesn't take much to max that out. That's why dental insurance sucks in general. Many people think it's like medical insurance and that most things are covered.

They had very good insurance. It was more than 1000 that the dentist charged for the fill-up.

 

[aphistis]

They had very good insurance. It was more than 1000 that the dentist charged for the fill-up.

For your aunt's fill-up, did the dentist use amalgam, resin, or regular unleaded?

😀

I'll be here all week.

 

[toofache32]

For your aunt's fill-up, did the dentist use amalgam, resin, or regular unleaded?

😀

I'll be here all week.

I was thinking the same thing. Diesel is cheapest...

 

[toofache32]

They had very good insurance. It was more than 1000 that the dentist charged for the fill-up.

Did he fill it all the way from the end of the root (a root canal)? That alone can be over $800 before the core is even placed. This whole thing is really none of my business, but I have to assume by your calling it a "fill-up" that you may not have understood what all was done.

Or it could still be insurance fraud.

 

[jheidenr]

WOW. were these people visibly intoxicated or had they just had a few drinks? I am really surprised the dentist would have risked treating them. Did that put you in an uncomfortable position or did you just end up assisting because you felt it was ok?

I shadowed the guy for a week and it happened twice. Both patients were extremely drunk. It was a pretty tense situation, I ended up helping out when I realized that the dentist was going to do the procedure even without the aid of his staff. I felt extremely uncomfortable, especially when the patient left and everyone was really tense.

 

[Sprgrover]

I shadowed the guy for a week and it happened twice. Both patients were extremely drunk. It was a pretty tense situation, I ended up helping out when I realized that the dentist was going to do the procedure even without the aid of his staff. I felt extremely uncomfortable, especially when the patient left and everyone was really tense.

That's just creepy and asking for trouble.

 

[eran76]

The GP I work for is obsessed with doing bridges and full mouth restorations on geriatric patients who REALY don’t need them: like a 86 year old woman with advanced Parkinson’s who got all her uppers capped a few years ago (she’s already dead), and most recently a 89 year old gentleman who had just suffered a stroke and was sobbing with the assistant b/c he knew he was going to die soon and didn’t know how he was going to pay for the dental work.

Screwing the insurance company is illegal and unethical. But ripping off the elderly with thousands in unnecessary (cosmetic) dental work is not only unethical, it’s immoral.

 

[luder98]

Did he fill it all the way from the end of the root (a root canal)? That alone can be over $800 before the core is even placed. This whole thing is really none of my business, but I have to assume by your calling it a "fill-up" that you may not have understood what all was done.

Or it could still be insurance fraud.

Although I don't know those dental terms you two threw at me (this is pre-dental forum btw), I know the difference between a regular fill-up and a root-canal. It should not be more than 300 for what he did. Also, this was 10 years ago.

 

[kes12]

Payment issues are big sources of ethical problems. I've worked with dentists who have patients with insurance, but who were personal friends, or lower-income, or something like that. The doc wrote off the patient copayment, but billed the insurance company. That's straight-up insurance fraud.

I worked insurance in a surgeon's office. The way he wanted to get around this fraudulant situation, for example a professional courtesy write-off PLUS collect their insurance, was to bill them three times, with printed billing having a little code in the corner ("I.O." which meant "insurance only) to alert us to pull it out and not actually mail it, then write it off after three months of billing cycles. Pretty sneaky, huh.

 

[airvent]

I was shadowing a dentist in a rural area and it was not uncommon to have drunk patients come in to be treated. There ended up being a big argument between the dentist and his staff because they didn't think a consent form signed by a drunk person should be valid. This dentist felt bad for these people and their situation and wanted to help, but his staff felt threatened. The assistants and front office refused to treat the patient, so I ended up assisting the dentist and helping bill the patient.

First off, it is the DOCTOR'S decision to make not the staff. I think most dentist would fire thier staff if they compromised or second guess the DOCTOR'S decision.

Yes treating a drunk patient is risky , and he should have asked them to return sober, but maybe he had his reasons to treat them then and there.

 

[toofache32]

It's fraud plain & simple. This is specifically addressed in the ADA Code of Ethics. View this link and scroll down to page 7 and read "waiver of copayment." The reason is that in an 80/20 system, if you waive the patient's 20%, then you have reduced your fee. The insurance is then paying 100% when they are only contracted to pay 80%.


http://www.ada.org/prof/prac/law/code/ada_code.pdf

 

[toofache32]

HOWEVER,If you engage in it as a practice to increase your business then it could be seen as fraud. BUt noone is going to give you grief for not charging friends or family

From http://www.hmeconsultant.com/arpages/ar11.html

"Anyone who routinely waives copayments or deductibles can be criminally prosecuted under 42 U.S.C. 1320a-7b(b), and excluded from participating in Medicare and State health care programs under the anti-kickback statute."

The AMA explains it well:
http://www.ama-assn.org/ama/pub/category/print/4615.html

I don't think the insurance companies will specifically look for copayment waiving, but if they find out you're doing it they can prosecute in some states. If nothing else, you're breaching your contract and they can cancel you as a provider.

 

[dentaldetox]

Um a GP I worked for once asked me to "recycle and cold steril" the evacuator tips after each patient in order to "recycle and help save mother earth" by using them on the next patient. If I remember correctly, under OSHA rules we aren't supposed to disinfect and recycle disposable plastic materials? Anyone know if this is a common $ saving practive in dentistry?