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?
- Did Gertrude Schmidt, the dental hygienist, respect the patient’s dignity, privacy, and confidentiality in this case? Explain, giving examples.
Gertrude Schmidt appears to have respected the patient’s dignity, privacy, and confidentiality in this case. She observed the patient’s deteriorating oral health and suspected drug abuse, but she did not immediately confront the patient about her suspicions. Instead, she completed her assessment and only shared her concerns with Dr. Melville, the dentist, in a private and confidential conversation. This initial approach showed respect for the patient’s privacy and dignity, as well as adherence to patient confidentiality.
However, the case does not provide information about whether Ms. Schmidt had obtained informed consent from the patient to discuss her case with Dr. Melville. Respecting patient confidentiality would also include obtaining consent before sharing sensitive information with other healthcare professionals.
- How did the dentist and dental hygienist work to maintain a trusting relationship with the patient?
The dentist and dental hygienist took several steps to maintain a trusting relationship with the patient:
a. They decided to meet with the patient after her cleaning was complete, which demonstrates their commitment to addressing her dental health concerns in a caring and patient-centered manner.
b. They planned to discuss their concern about her dental health with empathy and understanding, rather than immediately confronting her about their suspicions of drug use. This approach is likely to foster a more open and non-judgmental communication environment.
c. They aimed to provide education about amphetamine use and its consequences on dental health, which can be seen as a proactive and supportive measure to help the patient make informed decisions about her health.
By taking these steps, the dental team showed a commitment to building trust and rapport with the patient, which is essential for effective healthcare delivery.
- How did team-based care contribute to acting with high ethical standards in this case?
Team-based care in this case contributed to acting with high ethical standards in several ways:
a. Collaboration: The dental hygienist and dentist collaborated to discuss the patient’s case and formulate a plan of care. This collaborative approach allows for a comprehensive assessment and better decision-making.
b. Consultation: By consulting with Dr. Melville, Ms. Schmidt sought guidance and a second opinion, which is a responsible and ethical approach when dealing with a complex case like this.
c. Support: The dental team planned to provide education and dental treatment rather than confront the patient about suspected drug use. This approach is more supportive and patient-centered, aligning with ethical principles of beneficence and non-maleficence.
d. Privacy and confidentiality: The dental team maintained the patient’s privacy by discussing her case in a confidential manner and not sharing their concerns with others who did not have a legitimate need to know.
Overall, team-based care allowed the professionals involved to approach the case ethically and provide the best possible care for the patient.
- Did the professionals in this case act with integrity and high ethical standards? Explain your answer.
The professionals in this case appeared to act with integrity and high ethical standards:
a. Gertrude Schmidt, the dental hygienist, initially handled her suspicions with discretion by not confronting the patient directly but rather seeking consultation with Dr. Melville.
b. Dr. Melville collaborated with Ms. Schmidt, respected patient confidentiality, and planned to address the patient’s dental health issues and potential drug use concerns in a supportive and non-confrontational manner.
c. The decision to provide education and dental treatment rather than immediately accusing the patient of drug use demonstrates a commitment to beneficence, aiming to improve the patient’s overall health and well-being.
However, it’s important to note that respecting patient confidentiality and obtaining informed consent for sharing information with other healthcare professionals are crucial aspects of ethical practice. The case does not provide specific information on these aspects, so it would be important for the dental team to ensure they followed these ethical principles in their actions.
- 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?
The dental team’s decision to provide education and dental treatment rather than immediately confronting the patient with their suspicions of amphetamine use appears to be a reasonable and ethical approach in this case. Here are some reasons to support this decision:
a. Non-judgmental Approach: Confronting the patient directly with suspicions of drug use can be judgmental and may cause the patient to become defensive or uncooperative. By offering education and treatment first, the dental team creates a more supportive and non-confrontational environment.
b. Patient-Centered Care: The focus on educating the patient about the consequences of amphetamine use on dental health and providing necessary dental treatment aligns with a patient-centered approach to care, where the patient’s well-being and understanding are prioritized.
c. Preserving Trust: Building trust with the patient is essential in healthcare. By taking a more compassionate and understanding approach, the dental team is more likely to maintain the patient’s trust and encourage open communication about her health.
d. Comprehensive Care: The dental team’s approach addresses both the patient’s immediate dental health needs and the potential underlying issue of drug abuse. It allows the patient to receive necessary treatment while also receiving information that may help her make informed decisions about her health.
However, it’s important for the dental team to continue monitoring the patient’s progress and be prepared to address the issue of drug abuse if it becomes necessary for her overall well-being. Additionally, they should ensure that they obtain the patient’s consent for discussing her case with other healthcare professionals while respecting her confidentiality.