Gary was your favorite classmate. He and his wife spent countless hours with you during your residency. Gary eventually established a practice a few miles from yours, facilitating your decades-long camaraderie. When he was diagnosed with ALS and he asked you to support his son’s application to an orthodontic residency, you had no choice but to oblige him. You didn’t know his son Chet well. But given your relationship with Gary, you planned to do anything you could to support Chet’s application so that he could eventually assume his father’s practice.

That was almost 5 years ago. Gary has since passed away. Chet has graduated from his residency and inherited his dad’s practice. The problem is that you have learned that Chet has provided 2 second-opinion consultations over the past few months for patients who originated in your practice. In both cases, the parents subsequently called you in a state of confusion. The first told you that her son saw Chet after you advised the family that the boy needed palatal expansion. Chet disagreed, telling the mom that “palatal expansion is barbaric and primitive. You don’t want to put your kid through that!” At the second evaluation, he scoffed at your suggestion to deliver maxillary protraction headgear to resolve maxillary deficiency. In both cases, Chet was unaware that you were the orthodontist who had initially seen these patients. His comments seemed to amount to unjustified criticism. But you weakly reconciled both incidents in your mind by rationalizing that Chet did not know you were the initial orthodontist. Should you let the issue rest there? Does that type of rhetoric elevate the image of our specialty?

The British-based Institute of Business Ethics is an organization committed to the encouragement of ethical business practices. A 2015 survey conducted by the institute showed that 20% of polled employees thought that unethical activities pervaded business, yet only half of that number made any attempt to correct or report the misconduct. Reasons for such inactivity included fear of job loss (30%) or that formal objections would be ignored (25%). Retaliation in orthodontics could range from unflattering Internet reviews or at least poor press from word-of-mouth communications. Either could result in loss of referrals or damage to one’s reputation. Yet knowledge of ethics and concern for the welfare of the patient should trump concerns of retribution when an ethical violation is encountered.

To complicate matters, sometimes the most perplexing ethical dilemmas emanate from situations in which morals collide with personal relationships. We tend to be more forgiving when the alleged perpetrators are those with whom we are close.

How can these situations be mitigated? One of the first steps in intervening is to consider the perspective of the accused. The alleged perpetrator should then be approached directly with a well-rehearsed script before engaging an outside arbitrator in the issue.

As the U. S. Department of Homeland Security admonishes, “If you see something, say something,” with regard to public safety. Potential ethical transgressions should be treated likewise. Unjustified criticism of a colleague is inappropriate. And vilification of those who identify ethical transgressions is equally unjustified. Someone who discloses unethical behavior should be hailed as courageous rather than tattling.

You are obligated to approach Chet directly and explain that his denigrating approach to second-opinion consultations is not only unprofessional but also unethical. Better it comes from you than from a stranger who might be less forgiving.

As Oscar Wilde (1854-1900) said, “No good deed goes unpunished.” Indeed. Many positive actions are unappreciated or burden the good-doer with even more baggage.

Some things never change.