NBDE Professional Ethics and Management Questions and Answers — Questions and Answers
Question 1: A patient with clinically sound amalgam restorations requests that they all be replaced with composite fillings due to a fear of mercury toxicity, despite the dentist's explanation that there is no scientific evidence to support this concern. Which of the following is the most ethical course of action for the dentist?
- Perform the treatment as requested to honor the patient's autonomy.
- Refuse to perform the treatment and immediately dismiss the patient from the practice.
- Educate the patient about the longevity of their current restorations and the risks of unnecessary treatment, and then decline to perform the procedure. (Correct answer)
- Refer the patient to another practitioner who is willing to replace the amalgam restorations.
Correct answer: Educate the patient about the longevity of their current restorations and the risks of unnecessary treatment, and then decline to perform the procedure.
The correct action balances the principle of patient autonomy with the principles of nonmaleficence (do no harm) and beneficence (act in the patient's best interest). Simply performing an unnecessary procedure violates nonmaleficence. The dentist's primary duty is to educate the patient and refuse to provide treatment that is not clinically indicated and could cause iatrogenic harm. Dismissing the patient without due process or referring them for a procedure you believe is unethical are not appropriate actions.
Question 2: According to the Health Insurance Portability and Accountability Act (HIPAA), which of the following actions constitutes a permissible disclosure of Protected Health Information (PHI) without the patient's explicit authorization?
- Reporting suspected child abuse to the appropriate state authorities. (Correct answer)
- Providing a patient's treatment details to a spouse who is concerned about the cost.
- Posting an interesting clinical case with radiographs on a private social media forum for dentists.
- Confirming a patient's presence at the clinic to a caller who identifies as their employer.
Correct answer: Reporting suspected child abuse to the appropriate state authorities.
HIPAA's Privacy Rule permits covered entities to disclose PHI without patient authorization to public health authorities or other appropriate government agencies authorized by law to receive reports of child abuse and neglect. Disclosures to family members, social media, or employers for non-treatment purposes without specific patient consent are generally violations of HIPAA.
Question 3: A new associate dentist observes the senior partner, who is the practice owner, consistently billing insurance for a full mouth debridement on new patients who only require a routine adult prophylaxis. What is the associate's most appropriate initial ethical action?
- Report the senior partner to the state dental board for insurance fraud.
- Adopt the same billing practices to maintain consistency within the office.
- Resign from the position immediately without discussing the reason.
- Privately discuss the observation and concerns with the senior partner, referencing proper ADA coding and billing guidelines. (Correct answer)
Correct answer: Privately discuss the observation and concerns with the senior partner, referencing proper ADA coding and billing guidelines.
The most appropriate initial step is direct, private communication to address the potential issue. This allows for clarification, correction of a possible misunderstanding, or addressing the unethical behavior internally before escalating the matter. Reporting to the state board is a later step if the behavior is confirmed as fraudulent and continues uncorrected. Ignoring the issue or participating in it would be unethical.
Question 4: The ethical principle of Veracity requires a dentist to communicate truthfully with patients. Which of the following actions is a direct violation of this principle?
- Recommending a specialist for a procedure that is outside the dentist's scope of expertise.
- Guaranteeing to a patient that a newly placed porcelain crown will 'last a lifetime'. (Correct answer)
- Charging a higher fee for a complex procedure compared to a simple one.
- Informing a patient about a procedural error, such as a small perforation during an extraction.
Correct answer: Guaranteeing to a patient that a newly placed porcelain crown will 'last a lifetime'.
The principle of Veracity is centered on truthfulness and honesty. Guaranteeing the longevity of any dental treatment is misleading because clinical outcomes can never be certain and are dependent on many factors. Recommending a specialist is an example of nonmaleficence, charging appropriately is a matter of practice management, and disclosing a procedural error is an application of veracity.
Question 5: A dentist decides to terminate the provider-patient relationship with a patient who has been repeatedly non-compliant and verbally abusive to staff. To avoid a charge of patient abandonment, which of the following steps is essential?
- Sending the patient a certified letter providing notice and offering to provide emergency care for a reasonable period. (Correct answer)
- Completing the entire active treatment plan before initiating the termination process.
- Informing the patient of the decision during their next scheduled appointment.
- Ensuring the patient's account has a zero balance before sending any notification.
Correct answer: Sending the patient a certified letter providing notice and offering to provide emergency care for a reasonable period.
To legally and ethically terminate a patient relationship without risking abandonment, the dentist must give the patient written notice, preferably by certified mail. This notice should state the reasons for termination and provide a reasonable period (e.g., 30 days) during which the dentist will be available for emergency care, allowing the patient time to find another provider.
Question 6: A dental hygienist, while performing their duties, negligently causes an injury to a patient. Under the legal doctrine of *respondeat superior*, who is held ultimately liable for the employee's actions?
- The dental hygienist alone, as they are a licensed professional responsible for their own actions.
- The patient, if they exhibited any form of contributory negligence.
- The dental assistant who was also in the room.
- The employing dentist, as the 'master' or employer. (Correct answer)
Correct answer: The employing dentist, as the 'master' or employer.
*Respondeat superior*, Latin for 'let the master answer,' is a legal doctrine holding that an employer is vicariously liable for the actions of an employee when the actions take place within the scope of employment. Therefore, the practice owner or supervising dentist is ultimately responsible for the negligence of their staff, including hygienists and assistants.
