To understand the understood

Mr Millon was referred to you by a local prosthodontist to extrude a fractured premolar in preparation for a full-coverage restoration. Apparently, the chemistry between the 2 of you was superb. He immediately enlisted for treatment with the sweetest words you could hear: “How soon can we get started, doctor?” As you arise to shake his hand at the conclusion of the visit, he asks whether you could evaluate his adolescent daughter soon. “She’s been in treatment for more than 3 years,” he said. “We are happy with the result, but the orthodontist won’t take off those braces.”

Early the next week, you have the opportunity to evaluate his daughter. Treatment seems to be progressing nicely. You notice that her overjet is not yet ideal and that a few marginal ridge discrepancies need to be resolved, but these corrections should not take long. And the second molars appear to be emerging in fine position. Without saying a word, you conclude that the case is almost completed, but you refrain from comment. You wonder whether the orthodontist has delayed debanding because of a fee issue, perhaps attempting to collect full insurance remuneration. You hope that he wishes to provide the final details of occlusion and esthetics, many of which parents and patients are not always aware. Without offering any suggestions, you request Mr Millon’s permission to call your colleague to seek, as the great radio commentator Paul Harvey used to say, “the rest of the story.”

Principles and rules are written for the good and order of society. In the health care realm, there are many examples. Maintenance of the confidentiality of patient records (fidelity), honesty in communications with patients (veracity), and refraining from harming a patient by executing procedures in which competence is insufficient (nonmaleficence) are examples of established directives in our organization’s code of ethics and professional conduct. In contrast, there are unwritten rules in all aspects of society. Common courtesy dictates that the first through a doorway should hold the door for the person who follows. People exiting an elevator have the right-of-way over those who are entering. In baseball, stealing a base is shunned when the at-bat team is winning by 10 runs or more. In our specialty, unwritten rules of etiquette similarly apply. It’s courteous to resolve an emergency issue for an out-of-town patient without a fee if it can be resolved swiftly and safely. And a follow-up call to that patient’s orthodontist to inform her of your attention to the patient is a welcome act of courtesy.

We often hear that the new generation of orthodontists is beset with burdens that did not exist for veteran practitioners as they emerged from their residencies. Overbearing educational debt, keen competition in desirable practice locations, and the emergence of corporate dental entities loom larger today than they did for graduates 2 or 3 decades ago. Yet the rules of proper conduct that motivated our forefathers since our specialty was founded—beyond the principles of classical ethics—should endure despite the technological advances and stressors of the modern era.

The effort to communicate with another practitioner when you have encountered a patient in his or her care is 1 such act of courtesy that should endure as long as the specialty exists. It is never stated as a formal rule—but expected—and therefore understood. One does not need to memorize the American Association of Orthodontist’s Principles of Ethics and Code of Professional Conduct to demonstrate such simple respect for our colleagues. It’s as basic as the golden rule.

In your case, your initiative to communicate with the original orthodontist to understand and interpret the full story of Mr Millon’s daughter’s orthodontic history is a noble and appropriate display of courtesy to your colleague. Only then should you attempt to remediate Mr Millon’s concerns.

It has been said that “Honorable men (and women) need no laws ( women added ). They inherently know right or wrong and are naturally considerate of the feelings of their patients and colleagues.”


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Dec 12, 2018 | Posted by in Orthodontics | Comments Off on To understand the understood
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