I’ve been told the story that when my older brother was just a toddler, he was admonished never to step foot off the curb unless he was holding an adult’s hand. As long as an adult was nearby, he was obedient. But, when nobody was looking (or so he thought), he went directly to the curb and gingerly placed one foot onto the asphalt even though he knew it was the wrong thing to do. This behavior came to a swift end when our mother properly punished him. In those days, it was an open hand on the bare bottom. By the time my brother and I had flown the nest, I am sure my punishments for similar offenses far outnumbered his. It took me the better part of my first 20 years to learn that it’s what you do when nobody’s looking that counts.
These days, I have a new perspective on the subject of behavior. I am in a profession that holds ethical conduct in high regard. We have ethics classes, codes of ethics, even professional organizations dedicated to advancing ethics in our profession. Why is it, then, that so many members of the profession are up in arms over the current state of ethical behavior in dentistry? It seems as though every dentist I talk to has witnessed or experienced some form of unethical conduct amongst his or her peers.
During my time in dental school and as a practicing dentist. I have witnessed dental students cheating by various means: copies of tests had been removed from instructors’ offices, answers had been shared during exams, preclinical projects had been done by upper classmates or outside dental laboratories and passed off as the students’ own. I have seen students who were caught cheating receive light reprimands. a failing grade. or class demotion rather than expulsion. I have witnessed employer dentists callously take advantage of their associates, employees, third-party payers, and patients in the name of increasing their bottom lines. I have both seen and heard stories of employees-dentists and non-dentists alike-stealing not only money but also confidential patient information with the sole intent of advancing their own careers, status. or income. I have witnessed. first hand. the theft of dental association handpieces and continuing education forms at our own CDA Scientific Session.
In spite of the fact that these offenders are a minority in a profession filled with caring, selfless, and giving individuals, they nevertheless leave a bad mark on dentistry. Just as individuals are often judged by their last worst deed, so too are professions such as ours often judged by their worst members’ actions. We have become aware of the fact that as dentistry’s leaders seek to protect and advance the profession, our public image becomes of paramount importance.
We can ill afford to have the collective reputation of dentists everywhere besmirched by the unprofessional behavior of a few.
Like so many of you, I take such intentional deviations from moral and professional conduct as a personal affront, and with this in mind, I offer a three-pronged attack to combat this decline in ethics many of us have witnessed.
Education. Educating dental professionals about ethics must occur at all levels of the profession. It, of course, begins at our dental schools. In fact, it should begin before dental school. Acceptance into dental school constitutes an individual’s entrance into the profession and thus acceptance should be contingent upon both an understanding of ethics and an oath to uphold the ethical standards that have been established for the profession. It is incumbent upon dental schools to continue teaching ethics throughout the entire curriculum. It is further incumbent upon our profession to offer, even demand, continued learning experience on the subject of ethical and professional conduct and decision making throughout our careers.
Discipline. When violations of ethics occur, the body responsible for the individual must take appropriate, yet decisive disciplinary action. Dental school leadership must be unwavering in the fair and uniform application of their rules of ethical conduct. Furthermore, they must have the courage to put their foot down and expel repeat or incorrigible violators, even at the risk of loss of tuition revenues or retaliatory legal action by the offenders. Our state licensing boards must similarly be vigilant over those who breach their moral obligations as dentists. Where gaps exist between law and ethics, we should seek to close them. Until we establish a zero-tolerance policy for ethical violations, we will allow those seeking to compromise ethical behavior in favor of personal gain to flourish.
Commitment. Relegating responsibility for an individual’s behavior to a school, professional organization, or a state dental board is merely shifting that responsibility from where it truly belongs: with the individual. Therefore, a strong commitment to ethical conduct from all dental professionals must exist in order to preserve the high level of public trust and respect the profession wholly deserves. Demanding that individuals adhere to our CDA and ADA codes of ethics is a good start, however, these codes do not cover all areas where lapses in ethical behavior exist. I have found a more inclusive moral compass to be the Six Pillars of Character. These six pillars are trustworthiness, respect, responsibility, fairness, caring and citizenship. Clearly, it is possible to devote much time and space to the discussion of each. Suffice it to say that these principles can provide a sound basis for ethical decision-making in dentistry and in all aspects of life.
Decision making is easy when we have someone. such as a loving parent. telling us what is right and what is wrong. It becomes much more difficult as we gain the freedom and independence we seek in our personal and professional lives as adults. Nevertheless, it is these decisions we make, when nobody’s looking, that have a profound influence on us as individuals and on the profession of dentistry as a whole.
Dr. Gold practices in Santa Monica, CA, and is the associate editor of the CDA Journal.
This paper received the 2004 Award for Excellence, Ethics, and Professionalism in Dentistry sponsored by the American College of Dentists and the American Association of Dental Editors. Reprinted with permission, CDA Journal, 2003, 31 (11), 492-494.
