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Coaching the Professions


'Dentistry is an ethical issue' Dr. Harold Wirth

This is a big-E. What is ethics? Is it merely doing the right thing? What is the right thing? Can ethics be taught? Is it learned throughout life? Does it change according to the circumstances?

There is no doubt that any attempt to discuss ethics is an ambitious and daunting task. Even an attempt to define ethics can be lead us into a labyrinth of philosophies of historic proportions. Most would agree ethics centers on a certain commitment to standards. Therefore, for the sake of time and space, our discussion of ethics will center on three areas of commitment:

  • Commitment to others.

  • Commitment to personal growth and education.

  • Commitment to be financially sound.

Commitment to others.

The Storytellers of ancient Greece would gather their fellow travelers around the hearth and tell the tale of the infamous bed of Procrustes. When the thief, Procrustes, captured unwary travelers, they would soon experience his unusual hospitality. He was obsessed with making his 'guests' fit in. If one was too short for his bed he would stretch his captive until they fit his expectations. If they were too long, he would literally cut them down to size.

How many times do we find ourselves fitting others into our own Procrustean bed?

The study of ethics is the study of how we treat others. Ethics would be a non-issue if we lived without contact with other beings. Our ethics determine how we interact with those outside of ourselves.

According to Tom Hanlon a successful CEO and lecturer, ethics can be defined and described in one phrase.

Being kind to others.

This may seem simplistic, but it does stand the test of most examples that come to mind:

  • The business leaders, past and present, that manipulated the books were exhibiting no regard or kindness for the millions of people that they hurt in lost savings and jobs.

  • The student that cheats on the test is not just compromising their own character but is acting out of total disregard for their school and classmates.

  • The dentist that does not consider patient's individual temperament, circumstances and objectives, or does not routinely practice at their optimum level of care, skill and judgment, may be tempted to 'fit' the patient into what is convenient

Exhibiting kindness to others is difficult when we are not comfortable with ourselves or who we are. Knowing ourselves, as discussed in the chapter Ethos, is many times not an easy road. As we increase our self-knowledge we must be mindful not to become quite enamored of who we are and, in turn, judgmental of others. The others' only sin being; they are not like us.

In Robert Burn's poem To a Louse, we observe a pompous woman that has her nose in air along with her hair. She is quite active in judging those that are seated in the pews ahead of her. Little does she know or feel that there are wee beasties cavorting in her bonnet.

O wad some Power the giftie gie us
To see oursels as ithers see us!

Robert Burns

Getting to truly know those people that enter our lives is the greatest form of kindness. In a non-judgmental way, we accept them for who they are and where they are at that time. Dr. Pankey spoke of pathos, or that which deals with the other. Pathos is the Greek root word found in empathy and sympathy. Building healthy and growth oriented relationships is not about making people fit our comfortable bed. It is meeting people on their own ground, honoring their beliefs, and being sensitive to their present circumstances. This commitment to kindness allows us to treat appropriately with a service that is centered on what is in the patient's best, long term interest.

Commitment to personal growth and education.

Dr. Pankey had very firm thoughts on this subject. When there was a lapse in ethics he refined it down to two basic areas. What he called; sins of omission and the sins of commission.

Sins of omission are exhibited when the dentist performs at the level of their current knowledge. Although they are practicing to the best of their ability and understanding of dentistry, an ethical dilemma develops when the dentist ceases to expand their knowledge. Their dental chair becomes a Procrustean bed as they practice in their comfort zone. As their practice stagnates, patients are made to fit the treatment plan rather being offered appropriate treatment options. This is the common story of a dentist having twenty years of experience, which translates into one year of experience repeated for twenty years.

But what if a decision is consciously made not to incorporate this knowledge into their practice? This presents a case of a sin of commission, where the newly acquired knowledge is not made available for the benefit of the patients. Some dentists defend what they do to a point of not changing, because to change would be to admit that they were not doing something right before. This is very destructive to the evolution of a practice and the growth of the dentist, staff and their patient community.

Dr. Pankey's sin of commission can be reversed by the powerful concept of the commitment to become a life long dental student. However, this commitment must be tempered by a high level of discernment, to insure that new information and techniques are based on firm scientific principles and proven concepts. This is a commitment not only to do the right thing but to know what the right thing is.

Commitment to be financially sound.

In Victor Hugo's classic novel, Les Miserable, We are introduced to Jean Valjean. The story takes place during the desperate times 18th century France. Because of severe financial pressure and the impending starvation of his family, Jean Valjean is forced to deny his high ethical standards, and steal a loaf of bread. He is caught and imprisoned for many years. However, from the moment of his capture, he leads a good and virtuous life both in and out of prison, punctuated with incredible self sacrifice. This is an example of how good people when placed under financial strain can literally not be themselves.

Many times the financial condition of the dentist can be a strong influence on the day to day decision making in a practice. If there is financial instability in a dentist's life, it can affect scheduling, treatment planning, quality of dentistry, well being of the staff, educational opportunities and so on. The proper management of money is critical to your living within your character and ethics.

Although ethics is a personal matter it affects all those around us. If we are committed to be kind to others and committed to personal growth, knowledge and financial soundness, our ethical dilemmas will be few.

No man is an island, entire of itself; every man is piece of the continent, a part of the main.
John Donne

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