Illustrative Cases

Illustrative cases:

These cases are intended to start conversations about professionalism in the workplace, classroom, or clinical space. They are examples of situations that many of us may find ourselves in, or identify with, in some way. They can be used as stems for educational conversations about professionalism, in one-on-one sessions or group settings. The goal is not to find the ‘perfect solution’, but rather, to be aware of the nuances at play, and to become aware of each person’s perspective, in order to make the best decision, for that moment in time.

1A. Commitment to Patients: Student

“I was so startled by this case. I just want to talk to someone about it...”

The morning clinic in Kaye Edmonton Clinic finished early because of patient cancellations. The instructor decides to take the team (including the keen first year dental student who is in the clinic to observe) to Starbucks for coffee. While standing in the usual 20-person deep line, the first year dental student tells your team about the HIV, Hepatitis C positive former drug addicted lady who was brutally assaulted, and that he saw in the emergency dental clinic the day before. He was helping the dental resident treat the patient for a maxillary alveolar fracture.

Guiding Questions:
How is the confidentiality of the patients threatened?
What sort of support can peers provide in this situation?
How do time and place affect the appropriateness of this student’s storytelling?
What is the role of storytelling in gaining social support in the workplace?
How could the student cope with this terrible story in a more professional manner?

1B. Commitment to the Patients: Faculty

“I am so tired. And he needs the money....”

A young dentist is overwhelmed by the demands of clinical practice, teaching, home and family. He is in desperate need for help with yard work and other chores around the house. During a routine clinic visit, his patient’s father (who he knows quite well) tells him that he is looking for work as a groundskeeper and handyman. The young dentist thanks his lucky stars, and makes arrangements to hire the parent.

Guiding Questions:
Discuss any conflicts of interest in this scenario.
How might this arrangement affect the dentist’s relationship with his patient?
Does the size of the community they live in affect your perspective? How?

2A. Commitment to Society: (Student)

“I saved him a trip to the emergency department…”

It is Saturday night, and you finally have the weekend off from the emergency hospital dentistry rotation that you are currently assigned to. After a night of partying, you, as the designated driver, are taking people home. One of your friends, a fellow dental student, is very drunk, and has been vomiting. He needs fluids and rest. He can’t keep anything down, and you suggest a trip to the emergency. He begs you not to take him, because he is worried that the hospital dental staff will find out (its’s a small place) and judge him when he returns to work on Monday. You have just completed the IV sedation course and your friend asks if you would start an IV on him, and give him some fluids, at home.

Guiding Questions:
Describe any conflicts/issues that might arise from treating a colleague/friend?
Describe any conflicts/issues that might arise from treating someone outside of your professional setting/hospital?
Is it ‘okay’ to take medical supplies from the hospital, IF it spares ‘the system’ the cost of a medical visit?

2B. Commitment to Society: (Faculty)

“But if she can’t go to school, it is bad for her future…”

You are a maxillofacial surgeon. Your good friend, a practitioner, who refers you a large number of patients who require orthognathic surgery, calls you about his daughter who needs a bone graft prior to placement of an implant. This is not an urgent procedure but, because of a concern that she would miss school, he asks that she be booked during the summer holidays. You already have a long list of patients waiting for surgery and your first opening is not until October. Booking his daughter will mean cancelling a patient who has waited more than 8 months for surgery. You recognize that the dentist is a very good referral source and you would like to help him. The economy is down in the province and you start to think about how important this practitioner’s referrals are to your practice. Over lunch the practitioner mentions that his daughter has an excellent chance of winning a scholarship in her final year of school and the impact that missing school in October will have on this opportunity. You start to think, “Maybe I can move her up on the operating list…after all success in education is very important and I want to help out this practitioner.

Guiding Questions:
Is it ‘alright’ to bump up someone’s appointment, like this? What circumstances might make it okay? Is it never okay?
What might be the impact on others (eg patients, other office staff, yourself) of such an action?
Do you have any strategies for managing/addressing the expectations of family and friends?

3A. Commitment to the Profession: Student

“Wow. That was so inappropriate. I’m just a student – what can I do?”

It is the end of yet another LONG simulation lab! As is often the case, dental student ‘Jones’ has left 30 minutes early…leaving you feeling a little envious! As the remaining students exit, you, Dr. ‘Smith’ (one of the instructors), and the laboratory assistant are left in the room.
True to form, Dr. ‘Smith’ launches into a 5 minute monologue, directed at you, about how inappropriate dental student Jones’ behaviour is, and how unfair it is that he routinely arrives late and leaves early. He then turns to the laboratory assistant and says “Isn’t that a lot of BS? I mean, seriously, we all have to stay.”

Guiding Questions:
What questions might you want to ask Jones?
How might you express your discomfort to the preceptor? Would you express it, at all?

3B. Commitment to Profession: Faculty

“I have so much to do. If I don’t delegate, I’ll never get through it.”

During an extremely busy clinic, a clinical instructor asks a second year dental student (who is just starting in clinic) to obtain consent for a patient’s procedure. The student has never seen or performed this procedure before.
The instructor explains the ‘gist of it’, and then tells the student to quickly go and get the consent signed so that he can attend to the other patients.

Guiding Questions:
Have you been in a situation like this before? How did you respond then?
What are the risks to you, the patient, the clinical instructor, the hospital? What are the benefits for the same people?

4A. Commitment to Self: Student

“I really want to stay and support my scared patient, but my family and friends miss me....”

You are working in the U of A hospital dental clinic, helping the general practice resident with a patient who has developed a serious abscess. The patient is a young and challenged man that you have been following in the Kaye Edmonton Clinic over the past few months. He is quite terrified about having dental treatment and easily becomes agitated. During the time in clinic you have developed a good rapport with the patient to the point that he depends on you being there to help him get through his treatment. For a number of personal and professional reasons you have developed a deep sense of concern and responsibility for this young man. The patient needs a tooth extracted and the abscess drained and he begs you to stay with him during the procedure. However, you have promised your boyfriend that you will attend his hockey game tonight, as he feels he ‘never’ gets to see since you since you started third year dentistry.

Guiding Questions:
How would you want to respond in this situation?
What do you consider healthy professional boundaries?
What might the impact be to the patient if you choose not stay late?
What is your opinion on the value of work-life harmony? How do you achieve it?

4B. Commitment to Self: Faculty

“It’s just dinner. What’s the big deal?”

You are a newly minted staff-person, and have recently moved to Edmonton. At the end of a long OR day, followed by 2 facial fractures, you are finally ready to leave. Your dental resident has worked admirably alongside you, and is equally exhausted.
You want to acknowledge this individual’s work and you are hungry! You text them and invite them to dinner…your treat.

Guiding Questions:
What considerations are there for determining if this is an appropriate social encounter?
How important do you perceive professional reputation to be?
How could this situation be perceived from an outside view?