Dispelling Disinformation in Dentistry
Proper informed consent requires maintenance of veracity, other principles of ethics
According to the American Dental Association's Principles of Ethics and Code of Professional Conduct, dental professionals hold a special position of trust and privilege within society and are thus bound to adhere to the highest standards. This code of professional conduct defines key ethical principles, including veracity, nonmaleficence, beneficence, patient autonomy, and justice. Maintaining these principles goes beyond the competent delivery of operative care and requires up-to-date, evidence-based knowledge and practices.
In maintaining veracity, or truthfulness, providers must possess relevant scientific knowledge as well as the skills to seek out, distill, and digest the constantly evolving body of scientific literature. In addition, the selection of high-quality and unbiased continuing education provides a means to both fulfill learning requirements and remain current on topics of relevance to dental clinical practice. Relying on hearing about the scientific literature secondhand can become like a game of Whisper Down the Lane or Telephone in which the initial point or relevancy is lost. All providers should be willing and able to consult primary literature sources to ensure that they have an accurate understanding of novel concepts, and they should possess the ability to discriminate between the highest quality evidence and evidence from questionable sources on any given topic. When considering whether to apply the findings of new research, providers should always follow the ethical principles of nonmaleficence, or "to do no harm," along with beneficence, which refers to acting for the benefit of the patient.
Beyond provider knowledge, disinformation from other sources and patients' own misconceptions can also interfere with the delivery of ethical care. Furthermore, patients may lack the foundational scientific knowledge necessary to fully appreciate the benefits of proposed treatments. Although challenging, effective communication can help to ensure the ethical delivery of care for all patients, regardless of their grasp of dental concepts.
The maintenance of patient autonomy is integral to the process of informed consent, in which patients should be educated until they fully understand the benefits and risks associated with any treatment before granting permission. The patient interview can offer insight into each patient's baseline dental knowledge and perceptions of his or her condition. During these discussions, the compassionate ear of an engaged provider can help to build the trust foundational to the doctor-patient relationship, facilitating an open and accepting dialogue as the conversation moves along to the examination, diagnosis, and treatment.
Unfortunately, particularly challenging patients exist who will question the validity of the science behind recommendations. These are patients who subscribe to ideologies and practices outside of mainstream healthcare, which are often considered "pseudoscience." Oftentimes, these patients are simply exploring the periphery of mainstream science, or they may have become disenchanted by prior healthcare experiences. In other cases, patients have developed contrarian mindsets and exhibit the tendency to shun anything mainstream. When addressing these sources of disinformation, providers should lead with empathy, actively listen, and, stopping short of collusion, praise patients for their engagement and critical thinking. Providers can then reflect the patient's perceptions and acknowledge that the many sources of information available today can challenge those of us who are aiming to distill the truth. By following this approach, a respectful and thoughtful discussion can begin in which the provider shares the evidence-based process of clinical decision-making and explains how this may be counter to the patient's preconceptions. Personal connections formed during an encounter with a trusted provider in the context of a dental exam can help many patients to adapt to new information.
Despite all efforts, certain patients may remain unwilling to follow sound advice. If patients push back against necessary care or insist on pursuing treatment guided by disinformation, providers must be willing to establish firm boundaries in order to protect them from harm and adhere to the principles of ethical dental practice.
About the Author
Brooke Blicher, DMD, is an assistant clinical professor in the Department of Endodontics at the Tufts University School of Dental Medicine, a clinical instructor at Harvard School of Dental Medicine, and an instructor in surgery at Dartmouth Medical School. She maintains a private practice limited to endodontics in White River Junction, Vermont.