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Ethical decision making

March 1, 2018
Dorothy Garlough, RDH, reminds us to don’t let a catastrophe remind you that ethics are an important part of practicing dentistry.
What would you do when ethical misconduct occurs?

Dorothy Garlough, RDH, MPA

Consider this scenario. A large corporation’s profits were declining and shareholders were putting pressure on the board of directors to turn the company around. After all, no one had invested in this company to lose money. The board knew that new leadership was required to right the sinking ship and lead the company in another direction. The mandate was to drive revenue up and keep shareholders happy.

A new CEO needed to be hired to steer the company in a new direction. Candidates were scouted and one candidate, a well-known tycoon with a reputation of righting sinking ships, was interested in the position. His CV was impressive, with competencies and skills that aligned well with the company. More importantly, he had an astounding record of leading companies from an abyss of downward spiraling profits to new heights. His history of strong leadership had repeated itself in multiple companies. To the board of directors, he looked like the perfect candidate. He was hired based on his past performances.

Time passed, new initiatives were put in place, and the company began to right itself. Moods lifted, the corporation gained a forward momentum that it had not experienced in years, and the board of directors was affirmed in their decision to hire this business genius. As stock prices soared, the shareholders were ecstatic. All looked perfect, until a fault line was discovered that led to an earthquake.

It was discovered that the CV of the now head of the organization had inaccuracies and fabrications of his competencies in several areas. He did not have the education that he proclaimed. When approached by the board of directors, he stated that it was an oversight, that he had self-taught himself in the areas of concern, and that he had not been hired on his CV. He said he had been hired on his past corporate record of elevating dying companies. He had clearly done this, so what was the problem, he asked them.

A good question to ask when faced with a struggle is, “Who do I want to become?”

The board of directors had a dilemma. Yes, the company was headed where they wanted it to go, shareholders were happy, and the objectives were being achieved. Their share value was rising rapidly, new markets were opening up to them, and engagement of employees was at an all-time high. But the new leader had not been transparent with information with which he should have been forthcoming. What was the board of directors to do?

From their point of view, they had three choices: Ignore the issues and allow the CEO to remain at the helm; penalize him for his lack of transparency, but retain him as leader; and fire him.

I ask my readers: “What would you do?”

Ethics in dentistry

Everyone is faced with tough choices. Some of the choices are private dilemmas and some are professional. Situations arise where you wonder what you should do. What is the right decision? What is morally correct?

Dentistry is not immune from quandaries where ethical decisions must be made. In fact, they happen all the time. Some seem minor, such as telling the office manager that you found out a coworker actually had other plans on the day she called in sick. Or perhaps you withhold new tools from a coworker to make yourself look superior. Some quandaries are more serious. Maybe you’re asked to falsify a treatment plan to take advantage of a patient’s insurance. You question this but then figure you’re not hurting anyone (the patient pays for the insurance anyway), your boss is ultimately responsible, and it would put you on the A-team with your boss. Or, maybe you’re a dentist tempted to overinflate a minor clinical problem for a patient and convince the person he or she needs the Lexus treatment instead of the Chevrolet treatment because of an urgency that is actually not there.

Aside from the fraudulent implications of the last two examples, there is also discipline from professional associations as a result of unethical actions. Professional conduct stipulates that ethical behavior is adhered to, with a mandate to protect the public and build trust for the dental profession. Associations offer guidelines for professional conduct, but they are not all encompassing. Personal ethics often overlap with professional ethics. A good question to ask when faced with a struggle is, “Who do I want to become?” This question, along with decision-making models, can help steer you in the right direction.

Ethical decision making

There are many decision-making models that professionals can refer to when faced with ethical choices. Defining the problem and thinking through the situation from all sides is key to making the right decision. Personal reflection will help you determine your true intention. What do you hope to accomplish with the decision, and whom can it hurt? One metric that might help you decide if you’re doing the right thing is to speak with the affected party. If you’re unwilling to talk about it, there is a chance (because you want it kept secret) that it could be the wrong ethical decision. Thinking through the consequences both short- and long-term can help you choose.

The story’s finale

What was the decision of the board of directors with their star CEO? They fired him. They felt leaving him at the helm of the corporation was a bad move and would send a message to employees that it is OK to falsify information, manipulate the truth, or omit facts. They could no longer trust the CEO, and this was exacerbated by his lack of remorse and his flippant dismissal of the infraction. He argued that he had been hired for his performance and the numbers showed that he had delivered. The board of directors, however, looked at the bigger picture and the influence he held with employees. The corporation valued a culture of transparency and trust, and the CEO’s infractions had trampled on both values. A “whatever it takes” attitude was not supported in the company if it would promote unethical behavior.

The message was that ethics matter. Radiating ethical behavior throughout any organization, whether a corporation or private dental office, is indicative of the culture within the organization. Are high standards adhered to? Is everyone forthcoming with information that would benefit the office? Do you do what is right, even when you know you won’t get caught? Ethics is the compass that steers people in the right direction. One small infraction can lead to larger infractions, and a culture can spiral into an abyss of mistrust, as well as questionable and even illegal behavior. Guarding a culture of honesty, forthrightness, and transparency is important.

Self-awareness, coupled with self-regulation on both an individual and office level, will help ensure that ethics is understood and adhered to. However, too often there is no discussion of the ethical behavior required to align with the office’s vision. Consequences are discovered only when there is a breach of trust and a crisis occurs. Taking the time to speak about ethics and what they mean to all team members ensures that everyone is on the same page and can help prevent calamities. Statistics reveal that the ultimate bonus of ethical training is not only an elevated team culture, but also elevated care to your patients.

DOROTHY GARLOUGH, RDH, MPA, is an innovation architect, facilitating strategy sessions and forums to orchestrate change within dentistry. As an international speaker and writer, Dorothy trains others to broaden their skill-set to include creativity, collaborative innovation, and forward thinking. She recognizes that engagement is the outcome when the mechanisms are put in place to drive new innovations. Connect with her at [email protected]. or visit