 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 about differing strategies for interacting with patients doctors Bentley Cruz and Godwin are attending a dental conference in Indiana after a session on restoration Methods is completed the three colleagues start up a conversation about their own restoration preferences You know Patients just don't me my office anymore with metal in their mouths I am over that posterior thing that tooth colored restorations can't withstand biting forces on the back teeth And I'm more likely to fracture the amalgam fellings and I convince 100% of my patients to replace their amalgams Regardless of how much longer they might be serviceable Really when I give my patients a choice Everyone likes composites on the anterior's But there's a pretty even split between amalgam and composite on the posterior's I've never been able to convince myself that sound amalgams need replacing of course I'll talk it over with patients who are convinced that amalgam is bad And I guess I'd replace sound restorations if they absolutely insisted on it But there's just no science that that supports the view that amalgams pose any health risk Look, you're knocking yourselves out trying to appeal to the upscale market or the patient interests Amalgam has its place and so does composite. We're the ones with the training to balance the aesthetic and functional considerations Not the patient. I just decide what the best dentistry is and then I do it You can't just do what you think is best without disclosing to the patient the advantages and disadvantages of all the alternatives Including no treatment at all. Of course I can both amalgam and composite are proven techniques So there's no requirement for informed consent No one's ever complained and most patients would have no idea what treatment is best for their situation I sleep better knowing I've given the best care Uncapable of and I have high efficiency with less talking I agree with part of what you're saying, especially about knowing what's best for the patient But I think you're really missing the point Patients needs be educated on modern dentistry. You have to make them comfortable with newer materials and aesthetic considerations You're gonna be doing more dentistry since composites need to be replaced more often So you really need to explain the advantages to the patient, especially since it's gonna be more expensive I guess you can say that I combine informed consent and patient education into the same presentation Even if I am only stressing the advantages of the two-colored materials If my line that's the quality I'd expect from my family if that doesn't get them Then I tell them my office is amalgam free and then they get the point So what changes would you like to see in the approaches of each dentist? 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 Dr. Bentley is off base in offering only tooth-colored restorations and is suggesting replacement of sound amalgams Dr. Bentley is really selling perhaps unneeded dentistry while calling it patient education Dr. Cruz is off base because he is involving patients in decisions. They are not really qualified to judge Dr. Cruz is carrying informed consent too far. It is not needed in this situation Dr. Godwin is off base in grounding treatment decisions exclusively in terms of his own perception of the situation Dr. Godwin is correct that informed consent is unnecessary in such cases 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 Patient autonomy Patients have the ultimate say over their own care Dentist autonomy Dentists must be allowed to practice as they think best When patients question dentists it damages the professional relationship Dentists should only offer the most aesthetic and expensive care a Dentists comfort level talking about alternatives and costs with patients Whether the patient seems intelligent and to value high-end care The amount of experience a dentist has with the procedures 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