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
- Did Gertrude Schmidt the dental hygienist respect the patient’s dignity, privacy, and confidentiality in this case? Explain, giving examples.
- How did the dentist and dental hygienist work to maintain a trusting relationship with the patient?
- How did team-based care contribute to acting with high ethical standards in this case?
- Did the professionals in this case act with integrity and high ethical standards? Explain your answer.
- 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?
- In this case, Gertrude Schmidt, the dental hygienist, made efforts to respect the patient’s dignity, privacy, and confidentiality to the best of her ability. However, there are some aspects to consider:
a. Respecting Privacy: Ms. Schmidt did not confront the patient about her suspected amphetamine use during the dental cleaning. Instead, she decided to discuss her concerns with Dr. Melville privately, which shows an initial respect for the patient’s privacy.
b. Confidentiality: Ms. Schmidt took the appropriate step of contacting the dentist, Dr. Melville, to discuss her concerns rather than discussing them openly with other staff or patients. This action helps maintain the patient’s confidentiality.
c. Dignity: While Ms. Schmidt had concerns about the patient’s deteriorating oral health and suspected drug use, she did not make any judgmental or accusatory statements to the patient during the cleaning. This demonstrates an effort to uphold the patient’s dignity.
However, it’s essential to note that, in this case, Ms. Schmidt and Dr. Melville eventually plan to discuss their concerns with the patient, which could potentially affect her privacy and dignity. The manner in which they approach this conversation will determine how well they continue to respect these principles.
- The dentist and dental hygienist worked to maintain a trusting relationship with the patient through the following actions:
a. Open Communication: They decided to meet with the patient together after her cleaning to discuss their concerns. This collaborative approach can make the patient feel that their health is a priority, fostering trust.
b. Professionalism: Both professionals refrained from making assumptions or accusations during the initial dental cleaning, maintaining a non-judgmental and professional demeanor.
c. Offering Treatment: Instead of immediately addressing their suspicions about amphetamine use, they prioritized the patient’s oral health by recommending treatment for dental decay and gum disease, which can help establish trust and rapport.
- Team-based care contributed to acting with high ethical standards in this case by ensuring that multiple perspectives and areas of expertise were considered in the patient’s care. This approach allowed for a more comprehensive assessment and treatment plan. It also helped ensure that the patient received both dental treatment and education about the potential consequences of amphetamine use, which aligns with a holistic approach to healthcare.
- The professionals in this case demonstrated integrity and high ethical standards by:
a. Respecting Patient Privacy: They did not confront the patient openly about their suspicions but opted to discuss the matter privately first.
b. Prioritizing Patient Health: Their primary focus was on addressing the patient’s dental health issues and ensuring she received appropriate treatment.
c. Collaborative Decision-Making: They decided to meet with the patient together, showing a commitment to involving the patient in their care plan and addressing her concerns openly.
d. Providing Education: Rather than making assumptions or accusations, they chose to educate the patient about the potential consequences of amphetamine use, which is a proactive and ethical approach to healthcare.
- The dental team’s decision to provide education and dental treatment rather than confront the patient with their suspicions of amphetamine use can be viewed as a reasonable and ethical approach. Here’s why:
a. Patient-Centered Care: The dental team prioritized the patient’s oral health and overall well-being, which is in line with patient-centered care principles.
b. Non-Judgmental Approach: By offering treatment and education rather than accusations, the team maintained a non-judgmental and compassionate attitude, which can be more effective in motivating the patient to address their health issues.
c. Promoting Informed Decision-Making: Educating the patient about the consequences of drug use allows her to make informed decisions about her health without feeling pressured or judged.
d. Encouraging Trust: This approach can help build trust between the patient and the healthcare professionals, making the patient more likely to seek help or advice in the future.
Ultimately, this approach strikes a balance between addressing the patient’s immediate health needs and providing information for her to make better choices in the future, while also respecting her dignity and autonomy.