Ethics, Jurisprudence, and Practice Management
Ethics, jurisprudence, and practice management: document the decision
Ethics questions test principles: autonomy, beneficence, nonmaleficence, justice, and confidentiality. Informed consent requires capacity, disclosure of material risks and alternatives, understanding, and voluntariness; a signature alone is not consent. Minors generally need a parent or guardian, with exceptions for emancipated minors and emergency care. Maintain confidentiality under HIPAA and state law, and know mandatory reporting for abuse, communicable disease, and impaired colleagues.
Malpractice is negligence: duty, breach of the standard of care, causation, and damages. Abandonment occurs when a dentist unilaterally terminates care without notice or an opportunity to transfer. When a patient leaves against advice, document the advice and the warnings given. Refer when care is beyond your competence. Keep records that are contemporaneous, objective, and complete; alterations are discoverable.
Practice management covers scheduling, billing, insurance, employment, and risk management. Supervision and delegation rules vary by state; know which tasks may be delegated to hygienists and assistants. Advertising must be truthful and not misleading. Traps: guaranteeing results; fee-splitting; treating without consent; discussing a patient’s care in public; and failing to document a refusal or referral.
Rule of thumb: if it is not in the record, it did not happen. Example: a patient refuses a recommended biopsy; document the recommendation, the risks explained, the patient’s questions, and the refusal in the chart.