1. Is Professionalism a Contact Sport or a Spectator Sport?
11th IDEALS Congress: Chicago
David W. Chambers
6 August 2015

2. Plan for the presentation
Traditional model of ethics
ACD and the Gies Ethics Project
Nine studies of group morality
Professionalism as a moral community
Four thoughts

3. The Idealized Model

4. A More Realistic Model

5. ADA Membership as a Percentage of Active Dentists

6. A More Realistic Model

7. Percent of US Adults 19-64 with Dental Visit in Past Year

8. The ACD’s Commitment to Ethics
One-day, small-group workshops
Large-group presentations
Three ethics summits; three position papers
Partnerships with ADA, ASDE, and SPEA
Scholarships for dentists interested in ethics
Presentations in dental schools
JACD, including “Issues in Dental Ethics”
Online ethics CE courses
Online digital ethics textbook
Fifty-hour, whole-team office ethics audit and training program
Eight Cases video project
ACD Gies Ethics Project

9. Dentists and Patients Make a Case for Treating Each Other Well

10. “Dentist Is Justified in Overlooking Harassment of Employee by Patient As This Is a Private Matter”

11. What Patients and Dentists See
No connection between behavior and justifications Dignity matters to everyone, but dentists are more open to paternalism Dentists organize their relationship on the technical dimension Patients organize their relationship on oral health outcomes
Chambers, D. W. Do patients and dentists see ethics the same way? Journal of the American College of Dentists, 2015, 82 (2),

12. Do Dentists Say They Support Ethics?

13. “Would You Be Interested in This?” Exercise
Means and (standard deviations) for difference of interest in reading a positive minus a negative article. Technic Financial Ethical Oral health (1.17) (1.39) (1.44) (1.37)

14. What Has Changed in the Professions?
Slight increase in legal
Significant shift toward economic
Mass increase in technical definition of
professions
Declining importance of ethics
William M. Sullivan. Work and Integrity: The Crisis and Promise of Professionalism in America.

15. Ethics Education in the Schools
CODA requirements
Lecture, seminar format
~ 30 hours
Lectures and seminars
Dilemmas
Ethical reflection on principles

16. Survey of Dental Ethics Educators
Absence of full-time dental ethicists
Average part-time commitment ~ 15%
Borrowed from other organizations

17. Survey of Dental Ethics Educators
Absence of full-time dental ethicists
Personal commitment, passion
Self-trained
Loosely connected with groups and
scholarship

18. Survey of Dental Ethics Educators
Absence of full-time dental ethicists
Personal commitment, passion
Isolated
Operate independent of rest of school,
maybe better connected with profession
Little evidence regarding impact
Deans cannot name their ethicists

19. Focus Groups - Patients

20. Some of the Things Patients Say
Dentists contradict each other Suspect “I am being sold” Cost is a barrier Technical competence assumed, pain not a concern

21. Focus Groups - Patients
“I mostly try to avoid dentists. They always find something, even when I just went to someone else. I don’t say anything: I just stay away from them.”

22. Focus Groups - Dentists

23. Some of the Things Dentists Say
Dentist-to-Dentist Issues
Diversity of private standards, protective isolation
Commercialism is becoming more common that service as a motive
Mooching each other patients
Claims to be better than colleagues
Poor interprofessional communication

24. Some of the Things Dentists Say
Dentist-to-Dentist Issues (each own standard)
Dentist-to-patient issues
Inconsistent messages to patients
Commercial motives
Patient as object, potential income
Overtreatment, poor quality treatment

25. Some of the Things Dentists Say
Dentist-to-Dentist Issues (each own standard)
Dentist-to-Patient Issues (patient as objects)
Dentist-to-Organization Issues
Dentists acting independently, not cooperatively
Outside intrusions – insurance, government
Organizations not helping professional dentists
Fragmentation of values and standards
Loss of membership for various reasons

26. Focus Groups - Dentists
“More and more we are looking to those outside the profession for help to advance our individual interests. The profession as a whole is not providing the leadership and the common core of values that I remember from the past.”