Professionalism, Ethics, and Practice Management
The ethical framework
The five principles to know are patient autonomy, nonmaleficence, beneficence, justice, and veracity. Most exam vignettes resolve to autonomy plus veracity: the competent patient decides, and the dentist must tell the truth about diagnosis, prognosis, and options.
Informed consent and refusal
Valid consent requires decision-making capacity, disclosure of the diagnosis, the nature of the proposed treatment, material risks and benefits, reasonable alternatives including no treatment, and the likely consequences of refusal - then a voluntary decision, documented. The patient may refuse; refusal is not grounds for abandonment. Document the discussion, offer alternatives, and continue to provide available care or transfer appropriately with notice and records.
Confidentiality and records
Protected health information is shared only with consent or as legally required - for example, reporting suspected abuse, or responding to a valid court order. Well-written records are contemporaneous, objective, and specific; they are simultaneously the clinical tool and the legal defense.
Competence and boundaries
Practice within your scope and refer when the case exceeds your training or the patient's needs. The four elements of a malpractice claim are duty, breach of the standard of care, causation, and damages - all four must be present. Conflicts of interest, fee splitting for referrals, guarantees of results, and billing for undocumented services are ethical as well as legal hazards.
Practice operations
Understand infection control and OSHA requirements, team delegation rules for expanded-function personnel, scheduling and recall systems, and how insurance participation affects case acceptance.
Traps
Discussing a patient's care with a family member who calls without authorization. Treating a minor or an incapacitated adult without proper consent. Promising a guaranteed outcome. Dismissing a patient abruptly without notice or records.
Rule of thumb: if it is not in the record, it did not happen - document the consent conversation, the risks named, and the alternatives offered, including no treatment.