 This video is presented with the intent of further developing your understanding and application of ethical principles, legal obligations, and the relationship between healthcare professionals and their patients. Watch as we present a relatively common scenario involving a patient request. Dr. Everett Cruz has an appointment with Argus Evans, a retiree who has been his patient for about 18 months. Dr. Cruz completed a fair amount of dental work, including a root canal and crown, the replacement of several fillings, as well as referral to a specialist for some much needed periodontal work on his gum tissues. There are several concerns, however, one having to do with a failed restoration on a molar. The other concern is the balance of Mr. Evans' unpaid bill. As Dr. Cruz discusses these matters, put yourself in the dentist's position and consider how you might deal with a similar situation in your practice. Well, Argus, I can see that you have been taking good care of your teeth and gums. There is an issue there with that molar retreated. That tooth that we filled has a fracture in it that goes below the gum line, and even though you may feel no pain there, it's just a matter of time before that tooth is lost. You may remember we considered putting a crown in that space and your decision was to go with the less expensive alternative, the filling, which seems now to have failedness. So now it looks like we will have to consider putting in a bridge or possibly an implant. I see. Also, I hate to bring this up right now. It shows in your file that you have not been following the payment arrangement that we agreed upon. It seems as if the original balance of $6,000 is less than half paid as of last month. I was wondering if you were having some sort of situation that I need to know. I'll tell you, Doc. My feeling is that with what you charged me for the work you did, I should get a lifetime guarantee on it. I think I'm worse off than I was when I first came in to see you. Certainly, this broken tooth is. I was right not to trust you to hold back on my payments a little bit to protect myself from this kind of malpractice. It's your obligation to fix the mistakes you made and you should be responsible for the implant and then write off the rest of what I owe you. But since you've proven yourself to be somewhat incompetent, it might be best if I got another dentist to do the work and you paid for it. What do you think? Well, how might Dr. Cruz 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 disagreeing. You may pause the video after each possible solution to consider the implications of each option. Should Dr. Cruz agree to Mr. Evans' demands? Dismiss Mr. Evans as a patient through a formal process and write off the bad debt. Refer Mr. Evans to the County Dental Society Peer Review Panel for adjudication of the disagreement. Negotiate a compromise treatment with partial payment and further extended payments. 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, Importance, Or Irrelevant. These contributing factors are as follows. Concern for the dentist's reputation in his town. Getting the patient to accept responsibility for both financial and health issues. Complete chart notes of what options were presented and agreed upon financial arrangements. The potential for a protracted dispute and lost time in the office. Addressing the patient's compromised dental condition. What other dentists might do in a similar situation? 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.