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Daniel Sokol’s book ‘Tough Choices’ is something I’ve written about here before.

I haven’t even finished it yet, and I’m writing about it again, (I’m not getting through books as quickly as I usually do at the moment, and it doesn’t help that I have 4 on the go)

It’s a wonderful book, an exploration in to the front line of medical ethics which applies to all of us who work in any aspect of health care.

It should become essential reading for students of all aspects of health care courses and there should be a test at the end and they shouldn’t be able to go on unless they pass it (and mean it). The chapters are very short so you can get through one in your bed each night before you fall asleep (if you’re me).

In his short chapter on surgical ethics, Sokol explains how almost never sees surgeons coming to ethics courses and it’s always physicians.

He describes surgeons almost like a black swan, something so rare that’s worthy of note, because they really don’t feel that ethics falls into their practice and that is a job for somebody else to look at after.

In his chapter though, he lists just some of the areas of medical ethics that apply directly to surgery and some areas that you may not have been considered or thought about, these include the following:

1. Consent
2. Limited information about the skill of the operator
3. Trying a new technique that is lacking in evidence
4. Adding your name to publications that are not directly part of your work
5. Being economical with the “truth” to patients
6. Being physically unable to carry out the work due to the eyesight, tremor etc and not telling anyone
7. Overtreating patients for your own benefits
8. Poor bedside manner
9. Still being a trainee who is unaware of your limitations

This is just a fraction of the list that described by Sokol, something with which we should be considering in our practices on a day to day basis, particularly those of us who provide surgery.

I was laughing with one of my patients this week, who has been in charge of a large number of operating theatres at a major teaching hospital but who now works in clinical governments.

She’s a nurse, highly trained, who is now someone’s subject to the surgeons knife (literally) we were discussing the caricature of an orthopaedic surgeon, the classic rugby playing medical graduate who thinks nothing of the procedures that they carry out – this is a pure caricature and in fact completely at odds with many modern orthopaedic surgeons, but it was one that was still in place when I was a trainee.

I wonder how much of this would apply to many of the people in implant dentistry in my own small world of health care. If we were to be able to make dentistry better, we would have to pay more attention to these things and have to been seen to be doing so.

A place to start would be at dental school, making sure that the ethical component of teaching was robust, consistent across different dental schools and measurable in some way.

But how to check it as we go on through the profession and through our professional lives? It seems like the ethical standing or the dental profession has fallen in the last 10 years under the enormous pressure of becoming a consumer serviced provider and this is one of the contributory factors to an over burdening regulatory system.

For anybody wishing to remain in the profession for anything other than a few short years, making a contribution to the re-design of the fabric of the profession and working ethics back up the agenda of discussion, will be essential.

Blog Post Number: 1976