Your brother’s daughter Elizabeth is now ready for orthodontic treatment. Although the family lives several hours away, you have been the trusted authority in dental health care since you graduated from your orthodontic program. And given your brother’s financial difficulties, any assistance you can provide would be welcome. After you produce diagnostic records, you call your brother and advise him that the best treatment course is a comprehensive, 4-premolar extraction regimen to reduce her Class I bialveolar protrusion. Your brother’s dental insurance will provide a $1500 reimbursement for correction. Although you would never accept a penny from your brother, you figure the insurance allowance would at least reimburse you for the materials and laboratory work required to treat your niece.

Soon after treatment has commenced, your business manager says that your brother called the office to request that the insurance reimbursement be assigned to him rather than you, “to compensate (him) for his lost work time and travel expenses to commute to your office.” Merely from the tone of her voice, you know your manager is hesitant to accept this request. She has always been an upstanding employee with a strong sense of discerning right from wrong. “Doctor,” she says, “I just don’t feel comfortable diverting those insurance funds to your brother. They rightfully should be collected by you, the provider.” You know quite well that she is correct. But you do not want to affront your brother, and he certainly can use the money. But is it appropriate to exert your own influence on your staff to cooperate in an unethical endeavor?

As the most educated and often the most experienced member of your team, you are called upon to make multiple decisions throughout the workday. Whether it is your expertise to address a patient’s clinical question or to resolve an administrative issue that is beyond the realm of your most seasoned employee, or a business decision that has repercussions that could affect your income, “the buck stops” with you. You are ultimately responsible for all that emanates from your actions and your office staff. Your position of authority includes a sense of power—whether you perceive it or not.

The ability and authority to make countless, autonomous choices can be a luxury as well as a liability. Delegating a decision to a trusted employee or overriding an employee’s judgment can involve repercussions that can either bolster or damage interpersonal relationships, financial issues, or your own peace of mind. This burden can be a source of stress for some people. But when you subject an employee, a vulnerable and obligate subordinate, to act in an unethical manner for your direct or secondary gain, an abuse of power has occurred.

One problem with abuse of power is that successful transgressions become repetitive and desensitizing. The more often you remain unchallenged in delegating unethical activity, the more attractive such delegation becomes. One can lose the perspective of what is ethical when one is repeatedly rewarded for inappropriate behavior.

Finally, your leadership role establishes you as an exemplar of proper behavior. Your staff, your patients, and your colleagues form an impression of you from what you do. The abuse of power for personal gain can become a negative talking point for those who view you from near and afar.

Now back to the dilemma your brother has thrust upon you. There are multiple ethical and legal reasons that should challenge your temptation to complicate an insurance reimbursement, not the least of which is to uphold your image.

You need to explain to your brother that the insurance reimbursement must remain with you because you are the expressed benefactor in the plan. After all, your brother chose to seek care with you of his own volition. If the issue of your brother’s commute to your office needs be reconciled for whatever reason, you should do so in a way that is independent of your office staff or your business policy. That’s use—rather than abuse—of power.