 Dr. David Benzinger has had his pediatric dental practice for almost 20 years. He loves helping families get their kids off to a great start with their dental health and with good habits. He finishes up with one young patient and gets ready for his next appointment with an 11-year-old girl who has been his patient for about four years. Allie Winslow is seeing Dr. Benzinger for a routine recall care visit. Dr. Benzinger is ready for you, Allie. Do you want to just leave that jacket out here with your mom? I think I'll keep it on. Okay. Allie does not seem to be her usual energetic and bubbly self. In the past, Allie has always been carefree and energetic during her visits to the clinic, always happy and full of life. Dr. Benzinger notices this right away and tries to brighten things up a bit. Hey there, Allie. It's good to see you again. Allie, how are you doing today? I'm okay. You've been playing a softball this summer? Now I remember how much you enjoyed it last year. Yeah, I've been playing a little. Okay, that's good to hear. Before Dr. Benzinger gets started with your exam, would you mind removing your jacket so I can place the patient napkin around your neck more easily? Don't you feel better? You were starting to make me feel warm. So, you've been striking out a lot of people this summer? Not really. I see. What happened there? I don't know. I guess I fell down or something. Do you do that playing ball? I haven't really been playing much this year. That's right. You mentioned that already. It looks like it hurts. It's not a big deal. You can put the jacket on if you like. Okay, let's get started. After the appointment, Dr. Benzinger asks Carol if she noticed anything unusual about her interaction with Allie or her mom. Carol confirms that she did. He then asks her to invite Allie's mom to meet with him in his office to discuss today's appointment. Mrs. Winslow? Dr. Benzinger would like to see you for a few minutes to discuss today's findings and some recommendations for her next visit. Allie can wait here with me. I'm so sorry, Carol, but we have to scoot out of here. Allie has an eye doctor appointment across town and we have just enough time to get there. I'm sorry. I hope we can talk next time. So sorry. After Mrs. Winslow leaves, Carol tells Dr. Benzinger what was said. You know those changes we noticed in Allie today? Her mom, she just about flew out of here when I told her you'd like a word with her. He's not at all sure what to think about the matter, but has some concerns. What are the ethical and professional issues raised by this scenario? You may pause the video to consider this question. Consider these possible options for addressing this situation. You may pause the video after each possible solution to consider the implications of each option. Should Dr. Benzinger do nothing at this time and wait until Allie comes in for another appointment to observe her again? Immediately submit a report to Child Protective Services. Call the parent and question directly about the cause of the bruising that was noted on the patient. Consult with the child's pediatrician. Document the examination findings with a chart note entry and photographic records. Prior to releasing Allie, discuss the bruising with her, applying subtle pressure if she is reluctant to say anything. Now let's look at potential contributing factors as you weigh what's important in your decision about an appropriate course of action. Distinguishing injuries from those that are accidentally inflicted or due to an underlying medical condition. The responsibility of the pediatrician or family physician to also notice and report abuse. The requirement by law to report suspected abuse. Having an office protocol to report suspected abuse consistent with state laws. The possibility to put at risk the relationship of trust with the patient and the family. 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 appropriate solutions to the challenges they sometimes must face.