Treatment Planning Process cont.

Question 1

4 Aspects of Health Belief Model:

Answer 1

1. Perceived susceptibility
   - px should understand and accept diagnosis of dentist
   - dentist must be competent during the oral examination
2. Perceived severity
   - significant for px who is asymptomatic and unaware of dental problems
   - px should acknowledge level of severity in their oral condition
   - dentist must explain possible consequences if px chooses not to be treated
3. Perceived benefits
   - px should believe that proposed tx plan will solve their dental problem
   - photographs of completed case can be a helpful adjunct
4. Perceived barriers
   - vital to convince px that accepting tx is better than living with dental problem
   - most common barrier: cost, time, fear of pain

Question 2

4 Components of Informed Consent:
3CD

Answer 2

1. Capacity or ability to make a decision
2. Comprehension of the relevant information by the px
3. Consent must be given voluntarily without coercion or duress
4. Disclosure of all relevant information about the procedure by the health care provider

Question 3

Informed consent cannot be acquired in the ff. instances:

Answer 3

1. Px is in acute pain - unable to voice out concerns or ask questions
2. Px is highly anxious - incapable of grasping the proposed choices
3. After px has been sedated for injury - cannot use clear reasoning to make a decision at that time

Question 4

Changes in cognitive capacity may be related with:

Answer 4

1. Injury
2. Medication
3. Anxiety
4. Illness
5. Degenerative conditions

Question 5

Relevant Information:

Answer 5

1. Nature of the condition or disease being treated
2. Proposed treatment
3. Purpose and benefits of proposed treatment
4. Risks involved in undergoing the proposed treatment
5. Potential complication of the proposed treatment
6. Anticipated consequences of not undergoing the proposed treatment
7. Alternative procedures
8. Prognosis of the treatment

Question 6

Documentation of Treatment Plan:

Answer 6

1. Simple documents - pxs who only need 1-2 procedures wherein short entry in the record can convey adequate info
2. Complex documents - pxs with several tx options wherein dentist may choose to provide hard copies of multiple tx plan which can be reviewed later

Question 7

Types of Treatment Plans:

Answer 7

1. Active treatment plan - a list of disease control and definitive procedures that are sequenced in order with which they will be provided
2. Perpetual treatment plan - deals with px’s needs, concerns, and issues; includes systemic and maintenance procedures

Question 8

Principles of Bioethics:
- duty to treat px according to their desires (within the bounds of accepted tx and to protect px’s confidentiality)
- basis for the practice of “informed consent”

Answer 8

PRINCIPLE OF AUTONOMY

Question 9

Principles of Bioethics:
- denotes the obligation to not intentionally inflict harm (pertaining to the acts of commission of omission)
- asserts the need for professional competence
- remains constant

Answer 9

PRINCIPLE OF NONMALEFICENCE

Question 10

Principles of Bioethics:
- implies the duty to maximize the px’s welfare at all times
- acting in px’s best interest or welfare
- beneficence is a limited duty (since practitioners cannot treat two patients at a time)

Answer 10

PRINCIPLE OF BENEFICENCE

Question 11

Principles of Bioethics:
- signifies the obligation to be fair in dealing with pxs, colleagues, and the society
- forbids discrimination against an individual or group
- stresses that all members of society must have access to health services

Answer 11

PRINCIPLE OF JUSTICE

Question 12

Principles of Bioethics:
- involves maintaining honesty and truthfulness in all professional interactions
- basis of trust in the professional-patient relationship

Answer 12

PRINCIPLE OF VERACITY

Question 13

5 Exceptions to the Duty of Confidentiality:
5Cs

Answer 13

1. Consent - px agrees to the disclosure of info
2. Court order - release of info is required upon the receipt of an order by a court of competent jurisdiction which must be issued by a judge
3. Continued treatment - for the continued treatment of the patient
4. Comply with the law - mandatory reporting statutes such as child abuse, law enforcement, administrative agencies, and other lawful purposes
5. Communicate a threat - involves the duty to protect others from violence by a patient

Question 14

How to DEAL with Potential Confidentiality Issues:

Answer 14

Duty - determine if there is a duty to maintain confidentiality in the context of a tx relationship or other reasons
Exception - utilizing the 5Cs as a guide
Ask - consider asking for help from a colleague, risk manager, or lawyer
Law - be familiar with the law of jurisdiction and the confidentiality policy of the health care facility or organization

Question 15

Accepting Patients into Dental Practice:

Answer 15

1. Consider the principle of justice
   - emphasizes that dentists’ primary obligations include justly dealing with all individuals and rendering dental service without prejudice
2. Denying treatment to new pxs is a common form of human rights violation

Question 16

Can decline treatment for the following pxs:

Answer 16

1. Pxs who are extremely litigious
2. Pxs with unrealistic and/or impossible expectations
3. Pxs who require treatment that is beyond the dentist’s skill or training

Question 17

Dentist’s consultation with the px should include the following:

Answer 17

1. Discussion of proposed treatment
2. Discussion of overall prognosis
3. One’s ability to provide patient care

Question 18

When dentist-patient relationships are limited:

Answer 18

1. For cases when oral examination are performed to give a second opinion
2. For cases when a specialist accepts a referral for a specific procedure

Question 19

Documentation of termination of dentist-patient relationship:

Answer 19

1. Cause/problem that led to the cessation of the dentist-patient relationship
   e.g.: failure to keep scheduled appointments, inability to fulfill financial agreements, px’s failure to follow previously agreed-on instructions (persistent non-compliance)
2. Any attempt/s that may have been made to resolve the situation

Question 20

For cases when tx is suspended or interrupted, letter should be mailed to the px including:

Answer 20

1. Intent to terminate the dentist-px relationship
2. Facts and any related practice policies
3. Access to his/her records
4. List of other equally qualified dentists
5. Options for the continuity of care