Your last new patient of the day is wearing a full set of ceramic appliances to address a crowded malocclusion. She began treatment at another local practice but became suspicious of the new junior associate’s intent when he began to stroke her hair during the appliance placement appointment. You are taken aback, since you have known the senior partner of that practice as a gentleman and a long-time member of your study club. The patient then reports that the junior associate asked her to join him for dinner over the weekend. She declined, but later that night, she received a phone call from him, again soliciting her company. She became incensed and felt so uncomfortable that she decided to transfer treatment as soon as possible.
You are now faced with several dilemmas. Do you accept her as your patient? Should you contact the senior or the junior associate to explain your concern with this behavior? Should you report the junior associate’s behavior to the state dental board?
Hippocrates (about 460-377 bc ) is considered the father of medicine. Although he did not write the Hippocratic oath, his name is associated with this enduring pledge often required of graduating physicians. The oath states: “Whatever houses I may visit, I will come for the benefit of the sick, remain free of all intentional injustice, of all mischief and in particular sexual relations with both female and male persons, be they free or slaves.” The Principles of Ethics and Code of Professional Conduct of the American Association of Orthodontists (AAO) echoes this admonition. The section entitled, “Principles and Advisory Opinions,” Section I, Item H, reads, “Members should avoid interpersonal relationships with their patients that could impact their professional judgment or risk the possibility of exploiting the confidence placed in them by a patient.”
A doctor’s position of authority can be used to gain an advantage in personal relationships with patients. The abuse of such authority could be perceived as a breach of trust, actions that represent an ethical violation and reflect poorly on the specialty as a whole.
Do you have an obligation to report such behavior to the authorities? According to the AAO’s Principles of Ethics and Code of Professional Conduct , “Principles and Advisory Opinions,” Section III, Item F, “Members with firsthand knowledge that a colleague rendered faulty treatment or is engaged in illegal actions must report such matters to the appropriate agency as required by law” (emphasis added). Although distasteful and unethical, the young associate’s actions might not be illegal. Even so, some form of action could avert a recurrence of the problem.
You are concerned about the patient’s account. The only thing you think that you should do—difficult though it may be—is to discuss the problem with the junior associate. You had originally considered involving the senior partner, either alone or with the junior associate. After all, he is a friend, and you have both a personal and professional allegiance to him. But you realize that a solo conversation with the junior associate offers him the best chance to professionalize his interactions with female patients without a career-threatening action by the senior partner. Finally, even though you are convinced that the patient was telling the truth, you cannot actually prove it.
Since the matter involves disclosure of sensitive issues, you obtain the patient’s consent before opening a dialog with the orthodontist. You then discuss the problem in a forthright manner with the junior associate, emphasizing that he should know that his behavior was ill-received, and his future in the area could be at risk. He also needs to know that your sincere intention is to preserve his reputation and that of your friend, the senior associate, who will not be told of the incident. As long as the junior associate demonstrates professionalism, the state board would not be notified.
This frank dialog will also permit transparency of your acceptance of this patient to your practice.
