 This video is presented with the intent of further developing your understanding and application of ethical principles legal obligations and The relationship between health care professionals and their patients watch as we present a scenario involving a challenging dental care situation Dr. Nate Raulston a general dentist has a long-standing and cordial relationship with the town's periodontists Dr. Bailey and Dr. Charles In the past when Dr. Raulston has referred patients to either specialist They have been referred back to him for general care once their periodontal treatment was completed that pattern seems to have changed and Dr. Raulston has begun to wonder why none of his recently referred patients have been referred back to him by either colleague Now he is receiving a phone call from a patient. He had referred to dr. Bailey. Hello. This is dr. Raulston Mrs. Dean I haven't seen you for a while. How are you? I've been wondering how your treatment with dr. Bailey turned out Oh, dr. Raulston. I'm glad you asked. Hey, I'm on lunch right now, but that's exactly what I wanted to talk to you about I don't know what to do. I am confused about everything and I was hoping you could help me. Well, I'll try Listen, dr. Bailey and his entire staff are truly Wonderful. He said they had the problem that you referred me for under control Course it involves surgery just like you told me. Okay. I hope that went well. It did But the problem is that now he wants me to come in four times a year for these specialty cleanings and evaluations He said I have a high risk for gum disease and that general dentist like you can't handle that Which is why you referred me to him. There's a lot more than you do and in fact, it's a bit more than my insurance will cover I don't think I can afford this optimal specialty care that he says I have to have He also said I could relapse or some such thing And I don't come in regularly and that he can't have that kind of patient in his practice He said he would drop me as a patient if I miss any of these appointments What do you advise me to do dr. Ralston? Well, how should dr. Ralston handle this? You may pause the video here and consider the options or you may continue on to the next section Here are some possibilities that may have occurred to you Perhaps it would be beneficial to rate each possibility as Absolutely, you are entirely in agreement Probably you think it is a good idea 50-50 you are not sure Doubtful you don't think it is a good idea or no way you entirely disagree You may pause the video after each possible solution to consider the implications of each option Should dr. Ralston confine his comments to reinforcing the desirability of optimal care Suggests that the patient make an appointment with him Invite doctors Charles and Bailey to lunch to discuss what appears to be a change in referral patterns Explore with the ethics committee of the component society What might constitute over treatment? Now let us rate the importance of each of these contributing factors as you weigh what is important in your considerations rate each one as decisive important not clear little importance or irrelevant These contributing factors are as follows the patient's financial situation The implication that the generalist is not competent to maintain the patient a Change in the trust level between the patient and dr. Ralston The accuracy of informed consent so the patient understands all choices The patient's freedom to choose the level of care they desire the importance of optimal oral care Many dental practitioners face ethical dilemmas such as this one on any given day Anticipating how you might deliberate to find a suitable resolution to any such dilemma Is good preparation and can aid each practitioner to find their way out of the challenging questions They sometimes must face