Integrity in Prosthodontic Care
Position Statement of the American College of Prosthodontists
When discussing “integrity” within a clinical field, our patients must be the first consideration, as our purpose is to serve them. In prosthodontics, patient concerns can be as varied as the patients themselves, including but not limited to improvements in symptoms, pain, function, esthetics, and cost. Due to the complexity of prosthodontic care, patients may not completely understand the subtleties of their clinical diagnoses, treatment options, or the quality of the prosthodontic care that they receive -- all of which have an impact on the long-term clinical outcomes of the care. This situation means patients must have total trust in the information provided by their prosthodontist.
It is the duty of the prosthodontist to deliver care with the utmost integrity, while adhering closely to the American College of Prosthodontists’ Parameters of Care for the Specialty of Prosthodontics,1 even in the midst of distracting forces related to reimbursement, efficiency, productivity, and profit. These distracting forces can tempt clinicians to rationalize what is best for the patient (e.g., creative diagnosis, unnecessary care, and lack of treatment alternatives) toward their own benefit. Prosthodontists not familiar with the most current evidence are at risk for such rationalization. To provide care with integrity, the prosthodontist is guided by strong ethics,2 is committed to patient-centered care,3 and uses evidence-based principles4 to guide decision-making.
Prosthodontists must rely on professional ethical standards2,5 when providing care for their patients, by adhering to the American Dental Association’s Code of Ethics,2 which has been in existence since 1866. This Code of Ethics marks the moral boundaries within which professional dental care may be ethically provided. Five fundamental principles form the foundation of this Code of Ethics, as detailed below:
- Patient’s autonomy (self-governance): The dentist has the duty to respect the patient’s right to self-determination and confidentiality.
- Non-maleficence (do no harm): The dentist has a duty to refrain from harming the patient.
- Beneficence (do good): The dentist has a duty to promote the patient’s welfare.
- Justice (fairness): The dentist has a duty to treat people fairly.
- Veracity (truthfulness): The dentist has a duty to communicate truthfully.
When an ethical dilemma arises while providing care, prosthodontists are recommended to use the “ACD Test for Ethical Decisions,” proposed by the American College of Dentists5 to help negotiate ethical decisions.
In the test, providers are to consider the following questions:
ACD Test for Ethical Decisions5
- Is it true?
- Is it accurate?
- Is it fair?
- Is it quality?
- Is it legal?
- Have you listened?
- Have you informed the patient?
- Have you explained outcomes?
- Have you presented alternatives?
- Is now the best time?
- Is it within your ability?
- Is it in the best interest of the patient?
- Is it what you would want for yourself?
To support this intended level of integrity, prosthodontists are highly encouraged to adopt the Institute of Medicine’s recommendations on patient-centered care,3 as these recommendations provide a framework for a positive clinical practice environment that promotes not only transparency, but also knowledge transfer to patients and their families. Patient-centered care involves patients and families in decisions regarding health and health care, tailored to fit their preferences. Prosthodontists must ensure their patients and family members are fully engaged and participate in the care decision, which includes information transfer regarding diagnosis, treatment options, and relevant long-term outcomes. Seeking second opinions should also be encouraged. This informed consent process must be documented.
Evidence-based practice is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of the individual patient.”4 Our profession has evolved through evidence-based practice, long before “evidence-based practice” was given a name. Staying abreast of current clinical science and integrating clinical expertise with that science are essential to providing quality care for patients. Because science and research continue to change over time, the prosthodontist who practices with integrity must be committed to life-long learning and synthesis of information.
It is the position of the American College of Prosthodontists that prosthodontists provide clinical diagnosis, treatment planning, and prosthodontic care with the utmost integrity by relying on strong ethics, a commitment to patient-centered care, and the use of evidence-based practice.
1. American College of Prosthodontists: Parameters of Care for the Specialty of Prosthodontics. J Prosthodont 2005;14:1-103
2. ADA, Council on Ethics Bylaws and Judicial Affairs: Principles of Ethics and Codes of Professional Conduct. Chicago, IL, American Dental Association, 2012.
3. Maizes V, Rakel D, Niemiec C: Integrative medicine and patient-centered care. Explore (NY) 2009;5:277- 289.
4. Sackett DL, Rosenberg WM, Gray JA, et al: Evidence based medicine: What it is and what it isn't. BMJ 1996;312:71-72.
5. American College of Dentists: Ethics Handbook for Dentists. Gaithersburg, MD, American College of Dentists Foundation, 2013.
Alvin G. Wee, BDS, DDS, MS, MPH, PhD
Paul E. Scruggs, DDS
Donna L. Dixon, DMD, MA, BS, JD
Approved ACP Board of Directors: March 1, 2015
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