Suspected Drug Abuse

Case Study: Suspected Drug Abuse

Gertrude Schmidt is a dental hygienist in a family outpatient dentistry practice. One of her adult patients has been coming in regularly to have her teeth cleaned since she was a teenager. Ms. Schmidt has noticed a marked deterioration in her patient’s oral hygiene. She is shocked at the number of new dental caries and the worsening of others. The patient also displays symptoms of gum disease, which was not noted on previous visits. Ms. Schmidt also notes that the patient appears to have lost a great deal of weight since her last visit a year ago. The patient is fidgety, speaks rapidly, and has dilated pupils despite the overhead light. Ms. Smith suspects that the patient may be using amphetamines because she displays many symptoms, including the beginnings of “meth mouth,” which is distinguished by severe tooth decay and gum disease (American Dental Association, 2017). Ms. Schmidt completes her assessment of the patient’s dental health and begins to clean the patient’s teeth. As she works, she wonders whether she should ask the patient directly about her suspected amphetamine use. Ms. Schmidt plans to tell the patient to make an appointment with the dentist as soon as possible, to treat the decay and potential gum disease. She decides to take a break from the cleaning to contact Dr. Melville, the dentist, to discuss her suspicions about the patient’s drug use, her concern about the patient’s severely deteriorated dental health, and to create a plan of care to present to the patient before the patient leaves. Together, they decide to meet with the patient after her cleaning is complete, discuss their concern about her dental health, make an appointment with the dentist, and possibly provide education about amphetamine use and its consequences on dental health.

Discussion Questions

1. Did Gertrude Schmidt, the dental hygienist, respect the patient’s dignity, privacy, and confidentiality in this case? Explain, giving examples.
2. How did the dentist and dental hygienist work to maintain a trusting relationship with the patient?
3. How did team-based care contribute to acting with high ethical standards in this case?
4. Did the professionals in this case act with integrity and high ethical standards? Explain your answer.
5. What is your opinion of the dental team’s decision to provide education and dental treatment rather than confront the patient with their suspicions that she was using amphetamines?

1. Gertrude Schmidt’s actions in this case appear to respect the patient’s dignity, privacy, and confidentiality to a reasonable extent. She did not directly confront the patient about her suspected amphetamine use during the cleaning, which would have violated the patient’s privacy. Instead, she took a more cautious approach by discussing her concerns with Dr. Melville before addressing the patient. However, it’s important to note that the patient’s confidentiality may have been compromised when Ms. Schmidt discussed the case with Dr. Melville. Healthcare professionals should always strive to maintain strict patient confidentiality and ensure that sensitive information is shared only with those directly involved in the patient’s care.
2. The dentist and dental hygienist worked to maintain a trusting relationship with the patient by approaching the situation with empathy and concern for her well-being. They did not jump to conclusions or accuse the patient of drug use without concrete evidence. Instead, they decided to meet with the patient after the cleaning to discuss their concerns and offer appropriate dental treatment. This approach helps build trust as it shows that the dental team is focused on the patient’s oral health and overall well-being rather than making judgmental assumptions.
3. Team-based care played a crucial role in acting with high ethical standards in this case. The collaboration between Ms. Schmidt and Dr. Melville allowed them to share their observations, concerns, and expertise to make informed decisions about the patient’s care. This collaborative approach ensures that the patient receives the best possible care and that ethical standards, such as patient confidentiality and respect, are upheld throughout the process.
4. The professionals in this case acted with integrity and high ethical standards to a considerable extent. They did not jump to conclusions or confront the patient directly about her suspected drug use. Instead, they focused on addressing the patient’s deteriorated dental health and offering education about the potential consequences of amphetamine use on oral health. This approach prioritizes the patient’s well-being and respects her dignity, while also addressing the dental issues that are clearly evident.
5. The dental team’s decision to provide education and dental treatment rather than confront the patient with their suspicions about amphetamine use is a reasonable and ethical approach. Confronting the patient directly could lead to defensive reactions and hinder the establishment of trust. By offering education and treatment, the dental team can address the immediate health concerns and create an opportunity for the patient to seek help or information voluntarily. If the patient acknowledges her drug use during the discussion, the dental team can then provide appropriate guidance and referrals for further support and treatment. This approach balances the patient’s autonomy and well-being while still addressing their concerns about potential substance abuse.