Chapter

9

Patient’s Perspective on Medical Ethics

Rocco Gemma

Keep your words soft and sweet, for someday you may need to eat them.

Johan Reyneke, BChD, MChD, FCMFPS(SA), PhD, White River, South Africa

Ethics

Latin: Mores/Cognate: Mor.es- ium mpl

Ethics

Modern: More $ / Cognate: Do only what is right / Do what it takes to make money.

– ium/I understand money

Ethical

A fine line between being imbued with ethics…

…the honesty of ourselves to ourselves, or

…having a good deal more money.

I’ve always held to the image (my criteria only) that whether one chooses to be a dentist, a dental specialist, or right on up to a maxillofacial surgeon; they are all first and foremost health-care providers. Trained in their field? Yes. Specialized in their field? Yes. Having the ability to take care of, maintain, and promote my dental and attendant overall health? Most certainly, Yes.

Does it behoove me to seek you out when I have a dental problem, an image malfunction, or because the pain is so debilitating that even though one may dread it, an appointment is made to go see the dentist? Again, yes.

I make that leap to voluntarily allow you to enter into the realm of my health, trusting you to do good, to fix right what is wrong, and because of who you are and what you represent, and my being on the outside of your knowledge and expertise, I have to implicitly trust you, to give myself over to you so that again whatever is wrong is righted, and I can heal and continue to be healthy again, mentally, emotionally, and physically.

I do not like pain, especially in my mouth, as that is the source of comfort for me in all of its sensory applications such as eating, speaking, breathing, intimacy, or just the calm comfort and warmth of an easy smile. Yes, pain takes some of that away in its restrictive presence within the confines of my mouth. And you, you are the arbiter of what should and can be done to alleviate it. I have come to you for a yearly examination, as I am assiduous in my dental hygiene, cavity-free because I do not like or want to go to a dentist’s office and have someone probing into my mouth, picking away my teeth, and I absolutely cannot handle the sound of a drill grinding away a tooth. And then, as will be described shortly, I am informed by you, whom I have known in a professional capacity for a long time, that I have a cracked filling, and in all of the unbeknownst attending and upcoming procedures (crown, root canal, apicoectomy), is there one word uttered about reparative dentin or an anti-inflammatory regimen? Pain killers, sure, let’s mask it, only knowing that it’s going to be still there at the end of the day, at the end of the prescription cycle. And the inherent concern and the utter ease of conversation between you, the doctor, and me, the patient at the possibility of another procedure that may have to be performed. Oh yes, and there will be yet another pain scrip. For as the entire scenario unfolds, there will be another procedure, and another. More procedures entail more money. Reparative dentin? What? How about, or maybe, or possibly the taking of an anti-inflammatory before and after each proscribed procedure? Never mentioned. Didn’t happen. An alternative for the pain and discomfort? The patient never knew, even after handing over all of that raw trust. Ethics? Hmmmmm.

“My responsibility is to promote the health of the community and those I serve…”

At what point in one’s career does one begin listening to an inner voice or grasp onto the choice of no longer rendering one’s undiluted oath to their patients? Why would they no longer desire to be in that ethical embrace of “the honesty of ourselves to ourselves”? What story do they concoct? When do people (the dentist) start telling themselves such stories, and why? Possibly, and for a myriad of reasons, their new embrace became one of the desperation? But as it can be fraught and oftentimes overly burdened with selfishness, and like a fractured mirror, the endless attendant excuses that could and would be used to give it a sense of rationale, there can be no desperation here.

Ethics aren’t about desperation, they are about choice. Doing the right thing. Character is what you are in the dark. At the end of the day, when all is said and done and the patient list possibly scrolls through one’s head one last time before tossing it aside before entering into the innocence of sleep, do we question our motives, choices, and actions? The character that makes us who we are and the foundation that we stand on are the stanchions of our own individual morality that support the foundation of our character. Are they hewn from the unmistakable, clean, clear line and depth of ethics, or are they just self-constructed props whose justification is built on money accrued, where the end is not true patient satisfaction, but maybe she or he is a satisfied patient after we have seen and treated them through the prism of “This one is good for two procedures, this one three, possibly four, etcetera.” If that is justification as the means to a money-driven end, then that is the polar opposite of you being helpful. I am being treated as if I, as your patient, and my trust on you are flagrantly immaterial. Without your ethics, I am being misled, and that misdirection is ultimately false.

Let us begin from the beginning. I’ve called your office for an appointment, and always remember that that person answering your telephone is the voice that represents your business. It is the individual who deals with me in a warm, friendly, and professional manner. A little lightheartedness and humor can go a long way in reassuring me that I am going to be taken care of in a way that from the jump street makes me feel comfortable.

That day has arrived, and, with trepidation duly clutched in my psyche (after all, I know

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