KDA Today

KDA Today

For Immediate Release

Date: Oct 21st, 2014
Contact: Bruce S. Haskell, DMD, PhD, FACD
Phone: 800-292-1855
Email: info@kyda.org

“…and he did what?!”: Giving a Professional Second Opinion

Our profession is to heal our patients. As a licensed dental professional, our actions are formed by scientific and clinical evidence, taking into account our patient's values and preferences together with one's own clinical judgment. We are trained in decision making consistent with oral diagnosis, planning and treatment.

Professionalism, however, is more than mere competence as a dentist. This notion is often not an easy one. Our behaviors and actions related to this role are rather "involved", especially our relationships with our colleagues.

The Problem:
Dental professionalism requires ethics, honor, and integrity. Honest differences of opinion are expected in any developing and growing field of clinical practice. A serious concern is with negative doctor- doctor relationships, or "doctor-bashing." This is the professional criticism of one’s colleagues, a practice which damages the profession and its reputation in our community. In dental practice, we are often exposed to power struggles due to differing schools of thought and "methodologies". This may apply to restorative techniques, TMD therapy, periodontal and endodontic treatment, orthognathic surgery or perhaps different philosophies in orthodontic care. As a result, doctors may unknowingly behave in a manner that detrimentally affects the position of their colleagues through ridicule and denigration of a service provided. A negative comment is all too easy to make and can be taken by a patient to precipitate a lawsuit; something we all wish to avoid! Fault finding serves no other purpose than to express ill will and smear the image of one’s colleagues. The purpose of expressing one’s opinion is to help correct a problem, not to make "hard feelings" within dentistry.

Properly constructed positive commentary can be made in a professional environment which invites criticism, such as at scientific meetings or when doctors seek peer review. Your dental society may appoint ombudsmen in the peer review process with the intention of analyzing current dental practice with suggestions for self-improvement if warranted. This is the proper role of an informed dental society. We are here to help!

Suggestions:
If a patient comes to you for a second opinion or specialist advice or for an alternative to suggested treatment, try not to vent personal bias about the competence of other practitioners or "schools/ methods" of treatment. The patient has come to you to get the best advice possible. Do not give him the worst of us — the habit of criticizing others so that the patient loses faith in dentistry. If there is a difference of opinion over the diagnosis, do not attack to establish your own superior knowledge or boost your own ego.

An honest comment offered in good faith, to promote the patient’s best interests may be justifiable. However, even this can often be construed as inappropriate criticism. I know I personally have had to learn to think more before speaking out loud. If we reflect, I'm certain that all of us have said something improper while simply meaning to be honest and helpful. Playing "telephone" as a party game, we realize how easy it is to jump to conclusions and pass judgments based on garbled communication, a "one-sided" version of a story, or perhaps speaking when not understanding how complicated the original clinical situation actually was. It may also have been impossible to provide ideal treatment because of unforeseen circumstances; pain control, behavioral problems, cooperation, material failure, hidden medical issues, or perhaps simple inadvertent omission. It is important to walk that mile in another's shoes to understand the situation presented at hand. Your professional obligation is certainly to inform the appropriate authority about a colleague whose professional conduct, fitness to practice and professional performance appears deficient. My suggestion is to call your colleague first and do your best to determine what the facts are before believing the worst. It may not be easy or comfortable, but it is warranted. "Doctor-bashing" is self-aggrandizing, often un-provable and results in reducing the trust in a colleague’s knowledge or skill. It is unprofessional.

Obligation:
Do not get caught in the legal web of another doctor’s "presumed" negligence. Few of us are trained in medico-legal issues as lawyers are. If approached with such an issue, I recommend you tell the patient to first approach a voluntary group such as your own Society's Peer Review Committee, or a medico-legal expert for proper advice and guidance.

All of us have our own difficult patients. As we would want to be treated fairly by our colleagues, so should we be respectful and fair to them in return!

References:
James Adams, MD SAEM Board of Directors, Northwestern University Medical School News and Information for
An Argument for Professionalism
Residents Interested in Academic Emergency Medicine. Edited by the SAEM GME Committee http://www.saem.org/docs/residents/an-argument-for-professionalism.pdf?sfvrsn=2

Vijay Thawani The doctor- doctor relationship: professional criticism. The Indian Medical Journal 2000
http://ijme.in/~ijmein/index.php/ijme/article/view/1394/3062

Kevin Campbell, MD Throwing the Doc Under the Bus: Undermining Trust and the Doctor-Patient Relationship 2013 http://www.wncn.com/story/22818354/dr-kevin-campbell

Press Releases