The Shy Patient

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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 - PowerPoint PPT Presentation

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  • The Shy PatientMarcia Espinoza and Reina LigeraldeDEH 245.30.08

  • The SituationTeresa 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

  • 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

    Teresas 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 Marias office

  • Ethical Decision Making StepsIdentify 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?

  • Ethical Decision Making Steps2. Collect information.3. State the options.Try to get more information out of Teresa alone.Question Teresas 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

  • Ethical Decision Making Steps4. Apply the ethical principles to the options.

    Try to get more information out of Teresa alone.

    Confidentiality VeracitySocietal trustJustice

    Autonomy Nonmaleficence Beneficence

  • Ethical Decision Making Steps4. Apply the ethical principles to the options.

    Question Teresas mother.

    Confidentiality VeracitySocietal trustJusticeAutonomy

  • Ethical Decision Making Steps4. Apply the ethical principles to the options.

    Call the other dental offices for documentation of suspicious child abuse.

    Confidentiality NonmaleficenceBeneficence

    Veracity Justice

  • Ethical Decision Making Steps4. Apply the ethical principles to the options.

    Maria can tell the dentist of her suspicions.

    Confidentiality NonmaleficenceBeneficence Veracity Justice Autonomy

  • Ethical Decision Making Steps4. Apply the ethical principles to the options.

    Report the situation to the child protective services.

    Confidentiality VeracitySocietal trustJusticeAutonomyNonmaleficenceBeneficence

  • Ethical Decision Making Steps5. 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.

  • Ethical Decision Making Steps6. Implement your decision.The steps will be carried out that day while Teresas mother is in the waiting room.

  • Case History QuestionsShould Maria suspect child abuse?

    What professional obligations does Maria have to her patient?

    How should Maria document her observations?

    How should Maria proceed?

  • Case History AnswersYes, 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.

  • Case History AnswersReports 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.

  • Case History Answers3. 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.

  • Questions?