Professionalism and Ethics

Navigating Cultural and Disability Biases

This presentation taught the participants about bias and cultural differences that may come up in a career in healthcare. It is imperative that these discussions are happening to make patients more comfortable and welcome. 

During the Navigating Cultural and Disability Biases presentation, we learned about the different medical and dental care can be in other cultures. We got to listen to a guest speaker talk about the differences and similarities in American healthcare. She discussed the lack of healthcare and how it made her family members not make an appointment to see a doctor and ignore health conditions they may have. 

People come from different places in the world and not everyone is used to healthcare in America. Some physicians may not want to treat people from other cultures due to language barriers and cultural differences. It is important as health care professionals, to provide the same standard of care to each patient. Accommodations may be needed to provide the same standard of care. Healthcare professionals should also be aware that some treatments might be outside their patient’s beliefs. This has to be respected. This should not be avoided. Hiring a language interpreter, calling a language interpreter service, making sure informed consent is obtained, and providing access to care is imperative for the standard of care all patients should be given. 

Healthcare professionals may have bias, even if they do not know it. People have bias to people or ideas that are out of the norm for them. This could be due to being used to the values, traditions, and beliefs that their community had. It is important that we take an active role in fighting bias. This means we have to be aware of our actions, thoughts, and words that we choose. This will ultimately eliminate bias that we might have. 

As healthcare professionals, we must overcome any bias we may have and treat patients with the standard of care. Having an open mind and realizing that the world is big with many other cultures is important. 

Pharmaceutical Waste

Listening to the Zoom conference about the dangers of pharmaceutical waste was very eye opening. I had never really thought about where all of the population’s leftover prescriptions go after they are done with them. Now, I see the importance of patient education on disposing of unwanted medications. 

There are many reasons why someone needs to dispose of medications. Some of these reasons are no longer needing the medication, an allergy to a medication, a doctor overprescribing medication, and changes in doses of medications. I was surprised that the FDA used to say that flushing all pills was okay. Now, we are seeing our environment suffer from these practices. Pharmaceutical waste also comes from the drugs excreted in the population’s urine. One of the slides in the presentation talked about how frogs and other wildlife are having reproductive issues due to oral contraceptives. This was really surprising to hear but it makes sense. I also learned that CVS and Walgreens have drop boxes where patients can give their prescriptions and it is disposed of correctly. As dental hygienists, we do not handle a lot of prescription drugs, but we do handle local anesthetic and needles which we dispose of in sharps containers. 

We can provide information to patients while doing medical history. Dental hygienists can tell patients where to dispose of prescription medications. Some of these places include drug take back locations, pharmacies, DEA drug take back days, and police stations. A lot of our patients have asthma. In the clinic, albuterol is a popular short acting beta agonist. Albuterol comes in inhalers. I think it would be a good idea to ask the patient how they are disposing of these inhalers. If they are just throwing old inhalers into the trash this causes the medication to leak out and harm the environment. You should tell the patient to call their local waste and recycling facility. You could also tell them that some pharmacies will take back old inhalers, but to call and check first. I think the patients and environment will benefit from this conversation. I think it will also make the patient more mindful of how they are disposing of their other medications. 

Altogether, I think that the pharmaceutical waste zoom presentation was enlightening. The dental field contributes to a lot of waste in the environment. I think it would do the environment a lot of good if we incorporated this into patient education. Patients should be made aware of how to properly dispose of medications.    

The Importance of Ethics 

Throughout my education, I have learned about the importance of ethics in the dental industry. Ethics are the moral principles that govern a person’s behavior or the conducting of an activity. It is also the contract a person makes with society. Ethics are completely essential for self regulation and the dental profession. Ethics can come to help when we are faced with challenges in the workplace. Some of these challenges may be when dental hygienists get paid for commission, or when there is conflict with standard infection control procedures, not diagnosing dental disease, and not referring a patient to a periodontist when needed. 

When dental hygienists get paid partly by commision it might pose an ethical problem. A dental hygienist may recommend certain procedures like getting a night guard made. This is a good idea if the dental hygienist notices the patient has a bruxing habit. The patient might present with attrition and a soreness in their TMJ. If the patient does not present with this it is unethical to recommend a night guard to be made for them. This violates veracity which means the truth. The hygienists would not be truthful. 

A dental hygienist may see standard infection control being violated and this poses an ethical dilemma. Infection control is an important part of being a dental hygienist. It keeps both the patient safe and the dental professionals safe. If a dental hygienist sees a dentist drop a crown on the ground before placing it in a patient’s mouth this is unethical. This might give the patient an infection. It goes against the ethical pillar of non-maleficence. Non-maleficence means to do no harm. Placing the crown would be doing the patient harm. The dental hygienist should not work for a practice that does not practice infection control. 

If a dental hygienist does not diagnose periodontal disease or refer a patient to a periodontist when needed it will pose an ethical dilemma. A patient needs to know that they have periodontal disease to properly manage it at home with home care. They also may need to be referred to a periodontist if the disease is out of control. If the patient is not made aware of their disease it is against the ethical pillar of veracity.

These ethical dilemmas are some of the most common ethical dilemmas a dental hygienist might face (Gaston, 1990). It is essential that a dental hygienist sees the problems with these ethical dilemmas. Ethics are extremely important in the dental field and they protect the patient and the professional. 

Ethics in dentistry are the standard of care. Smith states that ethics can become more complicated when geriatric patients come into the picture. This is due to the evolving dental needs of the older population. Completely understanding informed consent may become an issue for elderly patients (Smith, 2022). A patient has to be totally aware of the outcome and risks of a procedure. If a patient has dementia, it might be difficult for them to fully understand the outcome and risks associated with the procedure. It is also in their best interest to get the procedure done especially if they are in pain. This poses an ethical dilemma. The ethical pillar in question is autonomy. Autonomy is the free will of one’s actions. This is due to the rising number of patients with dementia and declining capacity. This topic relates to one of our program outcomes. The outcome is exploring the complexities of ethical decision-making as it relates to professional expectations and social responsibility. Both of these topics connect because as dental professionals we need to look at the needs of our patients and our responsibility to give them solutions in an ethical way. Our patients need to be a part of the decision process to see what the best option is. The patient must understand what the risks and outcomes of the procedure will be. This poses a problem when the patient can not properly give informed consent. A solution for this could be if the patient has a healthcare proxy or power of attorney. 

References

Carlos S. Smith, Spiro C. Stilianoudakis and Caroline K. Carrico

Journal: Journal of Dental Education, 2023, Volume 87, Number 5, Page 646

DOI: 10.1002/jdd.13159

Gaston MA, Brown DM, Waring MB. Survey of ethical issues in dental hygiene [published correction appears in J Dent Hyg 1990 Sep;64(7):352]. J Dent Hyg. 1990;64(5):217-224.