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The Shy Patient

The Shy Patient. Marcia Espinoza and Reina Ligeralde DEH 24 5.30.08. The Situation. Teresa Bishop, a new shy, reserved, well-mannered 8-year old patient came in for a dental prophylaxis with RDH, Maria Gomez

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The Shy Patient

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  1. The Shy Patient Marcia Espinoza and Reina Ligeralde DEH 24 5.30.08

  2. The Situation • Teresa Bishop, a new shy, reserved, well-mannered 8-year old patient came in for a dental prophylaxis with RDH, Maria Gomez • Maxillary central incisors were fractured due to Teresa falling off her bike while not wearing a helmet

  3. The Situation (continued) • Recall appointment 6 months later – incisors are restored but now Teresa has bruising around both eyes due to falling down the stairs at home • Teresa’s mother is holding her hand but offers no further explanation. • Record reveals she has previously been seen by 3 different general dentists in the same city prior to her transfer to Maria’s office

  4. Ethical Decision Making Steps • Identify the ethical dilemma. • Should Maria wait to find more evidence before further action? • Should Maria immediately report child abuse to the local Child Protective Services (CPS) agency? • Should Maria do nothing at all so she can keep Teresa as a patient from leaving the practice?

  5. Ethical Decision Making Steps 2. Collect information. 3. State the options. • Try to get more information out of Teresa alone. • Question Teresa’s mother. • Call the other dental offices for documentation of suspicious child abuse. • Maria can tell the dentist of her suspicions. • Report the situation to the child protective services. “All that is necessary for evil to triumph is for good people to do nothing.” – Edmund Burke

  6. Ethical Decision Making Steps 4. Apply the ethical principles to the options. • Try to get more information out of Teresa alone. Confidentiality Veracity Societal trust Justice • Autonomy • Nonmaleficence • Beneficence

  7. Ethical Decision Making Steps 4. Apply the ethical principles to the options. • Question Teresa’s mother. Confidentiality Veracity Societal trust Justice Autonomy

  8. Ethical Decision Making Steps 4. Apply the ethical principles to the options. • Call the other dental offices for documentation of suspicious child abuse. Confidentiality Nonmaleficence Beneficence Veracity Justice

  9. Ethical Decision Making Steps 4. Apply the ethical principles to the options. • Maria can tell the dentist of her suspicions. Confidentiality Nonmaleficence Beneficence Veracity Justice Autonomy

  10. Ethical Decision Making Steps 4. Apply the ethical principles to the options. • Report the situation to the child protective services. Confidentiality Veracity Societal trust Justice Autonomy Nonmaleficence Beneficence

  11. Ethical Decision Making Steps 5. State your decision. • Finish dental treatment. • Check if Teresa says the same story without her mother present. • Find out what the other dental offices have on record. • Document suspicions and findings. • To be courteous to the dentist, let him or her know of the situation. • Call the local CPS agency: 1-800-442-4918.

  12. Ethical Decision Making Steps 6. Implement your decision. • The steps will be carried out that day while Teresa’s mother is in the waiting room.

  13. Case History Questions • Should Maria suspect child abuse? • What professional obligations does Maria have to her patient? • How should Maria document her observations? • How should Maria proceed?

  14. Case History Answers • Yes, Maria should suspect child abuse so she is safe rather than sorry. • 2. As a healthcare provider, Maria has the professional obligation and is mandated to report any suspicious child abuse.

  15. Case History Answers • “Reports must be made when there is a reasonable cause to suspect child abuse or neglect in order • to make state investigative and social services available in a wider range of cases at an earlier point in time, • to make sure that investigations regarding child abuse and neglect are conducted by trained investigators, • and to avoid subjecting a child to multiple interviews about the abuse or neglect.” Beemsterboer, P. L. (2002). Ethics and Law in Dental Hygiene. Philadelphia, PA: Saunders.

  16. Case History Answers 3. Maria should document her observations including all steps of action in the SOAP notes as well as a copy of the report filed with the CPS agency. 4. Please see Step 5 in the ethical decision making steps to find out how Maria should proceed.

  17. Questions?

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