Part 1

Please read the following ethical scenarios and after each one select the statement that applies best to you. All names used throughout the scenarios are fictitious and the information gathered is anonymous. The survey will take approximately 10 minutes to complete. Please stay tuned for CDHBC Ethical Scenarios Survey – Part 2 in the next issue of Access.

Question Title

* 1. Mary is a registered dental hygienist and the dentist she works for, Dr. Smith, has purchased a new laser that he is eager to apply in every possible clinical case. Dr. Smith asked Mary to incorporate the use of the laser into all her adult periodontal cases, regardless of what the disease progression or regression is like. Mary did some research on the efficiency of the laser in treating periodontal cases, and she was not comfortable with incorporating the laser in her treatment plans. When she explained her position to Dr. Smith, he told her she needed to use the laser in order to bill enough to justify the expense of her salary and maintained that she needed to use the laser as much as possible. Dr. Smith implied strongly that Mary’s failure to incorporate the laser into her practice would result in her receiving fewer hours of work and possibly termination of her employment. Mary felt extremely pressured and torn between wanting to secure her employment in a tough job market, and her desire to provide ethical and appropriate dental hygiene treatment to her patients as is her duty.

Reflecting on Mary’s situation above, please select the statement below that is the most applicable to you:

Question Title

* 2. Dennis is a registered dental hygienist and the dentist he works for, Dr. Chan, instructed Dennis to bill for a dental exam, 4BW, PAN, 3 units scaling, prophy, fluoride, and OHI in a 1 hour appointment. Dr. Chan explained that the fee guide is more of a suggestion and she can bill however she wants. Dennis disagreed and explained to Dr. Chan that what the client is billed for needs to align with the amount of time actually spent with the client and for services that were performed. The services Dr. Chan is requesting Dennis to bill for cannot physically be provided in a 1 hour time period. Dr. Chan informed Dennis that if he continued to argue with her about billing or fail to bill as instructed, she would find a different dental hygienist to take his job. Dennis did not feel comfortable billing the way that Dr. Chan had asked him to but he also didn’t want to lose his job.

Reflecting on Dennis’ situation above, please select the statement below that is the most applicable to you:

Question Title

* 3. Rachel, a dental hygienist, recently joined a large practice that includes 3 dentists, 3 dental hygienists, and 4 certified dental assistants. One CDA is responsible for seeing all pediatric clients for their prevention appointments. On multiple occasions, Rachel has overheard the pediatric CDA refer to herself as the pediatric hygienist when speaking to the client’s parents. As well, Rachel has witnessed the CDA using the ultrasonic on several pediatric clients. Rachel thinks this CDA is a very nice person and great to work with otherwise, and she feels awkward bringing this up to the CDA or her employer since she is new and doesn’t want to create any workplace hostility.

Reflecting on Rachel’s situation above, please select the statement below that is the most applicable to you:

Question Title

* 4. Cherrie has been working as a dental hygienist in a dental practice for the past 5 years since graduating. She gets along very well with the other dental hygienist Lucy who has been practicing in the office for the past 11 years. A year ago, Lucy was in a car accident and had to take 3 months off work to recover as she had injuries to her neck and back. She has been back to work part time for the past 9 months, but is dealing with a lot of pain and discomfort. She is a single mom and has to work to pay the bills.  Unfortunately, she is not able to control the pain and suffers greatly during and after work. During lunch last week, Lucy confided in Cherrie, telling her that she has finally been able to control the pain using a type of medical marijuana. She has been using a tiny bit before coming to work, and although it alters her state of mind, she feels she has built up enough tolerance to be able to practice while under the influence. She doesn’t know how to practice without it as the pain is unbearable. Cherrie doesn’t want Lucy to have to stop working but she feels obligated to report her practice under the influence of mind altering substances.

Reflecting on Cherrie’s situation above, please select the statement below that is the most applicable to you:

Question Title

* 5. Kyle, a registered dental hygienist, graduated 2 years ago from a diploma dental hygiene program, and is currently working part time while finishing his dental hygiene degree. He accepted a part time position to cover a 1-year maternity leave for the sole dental hygienist of a dental practice. Kyle has now been in this practice for the past 2 months. The dental practice is in a suburban community and has long term clients. 

At the beginning of each day, Kyle reviews the client charts and notices there is minimal documentation from the previous dental hygienist. Although the other dental hygienist has been probing, there are no other assessments, no dental hygiene diagnosis, and no informed consent. Most commonly all that is documented is “2 units scale, prophy, fluoride, DDS Exam, next apt 6 months”. 

Kyle is used to completing full assessments, developing a dental hygiene diagnosis and care plan, then obtaining and documenting informed consent and using chart documentation to guide follow-up needs at subsequent appointments. He has found that several clients are questioning “all the assessments”, as all they want is a “cleaning” and saying that “the other hygienist did not take this long”. He is finding clients are shocked to hear they have “gum disease”, as no one has ever told them. He has been re-scheduling clients back as the periodontal condition and debridement needs are greater than can be completed in one appointment. For some clients, he is finding that the pocket depths are too deep for him to debride, and looking at past probing depths, there are several areas that are progressing, yet there has never been any referral to a periodontist suggested.

This is the perfect job for Kyle while he finishes school over the next year, and he wants to keep his job and maintain a good working relationship with the office. However, he is concerned that when the maternity leave is over, the clients will no longer be receiving optimal dental hygiene care and the documentation standards will not be met. He is feeling the dilemma of not being able to discuss this with the other hygienist to improve her practice and feels the obligation to report her practice deficiencies.

Reflecting on Kyle’s situation above, please select the statement below that is the most applicable to you:

Question Title

* 6. Peter is a registered dental hygienist and is seeing Bob who is a year overdue for his 6-month dental hygiene appointment. At the previous appointment, Bob presented with generalized moderate chronic periodontitis. At the beginning of today’s appointment, Peter completed a medical/dental history update, an update of the medication list, and took Bob’s blood pressure. Bob indicated that he had recently been diagnosed with diabetes and prescribed a new medication, but could not remember the name. When asked, Bob indicated he has not been taking his blood glucose readings regularly as it was not very convenient for him and also stated that his new medication leaves him feeling "odd" so he doesn’t always take it.

Bob’s blood pressure reading at today’s appointment is 190/96mmHg. When retaken 5 minutes later, the blood pressure remains the same. Peter asked Bob for permission to contact his physician in order to obtain the most recent A1C reading, the name of the medication Bob was prescribed and to consult regarding the elevated blood pressure. Bob angrily said not to bother contacting the physician and that there is no need. Bob told Peter that he would take responsibility for not having the consult and anything bad that might happen and to “please just get on with the appointment”.

Reflecting on Peter’s situation above, please select the statement below that is the most applicable to you:

Question Title

* 7. Please take a moment to describe any additional ethical scenarios not addressed in the survey that you may have encountered in your dental hygiene practice. Again, this information is anonymous and will help us provide information to registrants that is realistic and applicable to dental hygiene practice in BC.