Guest Editorial: A Clarion Call for Partnership and Communication for Better Patient Health

Editorial:

Today's wide range of health care options for people has intensified the need for partnership with a wide variety of health professionals, along with good communication and collaboration to achieve optimal health outcomes for patients. Increasingly, these new options in technology and technique featured here and in other publications have created an increasing need to collaborate with a wide variety of professionals—oral health team members, head and neck specialists, nurses, paraprofessionals, plastic surgeons, neurologists . . . and the list goes on. This increased collaboration is necessary to achieve the goal of providing the best possible care for patients. For patients, their expectations for care are also increasing and they expect more from us.  
Recently, I spoke on ethical communication to dental editors from around the country as part of the American Association of Dental Editors. In the wake of disciplinary actions to students in at least six dental schools this year, the group discussed the need for ethical communication, including the need for open and trusting communication among various professionals for their patient's care. Dividing into groups of about eight each, they came up with a list of values and definitions for ethical communication.  One of the most basic ethical tenants is the concept of respect for persons. At least two ethical convictions are part of this. One is that individuals should be treated autonomously; another is that people with diminished autonomy (e.g., from a handicapping condition or disability) are entitled to protection. Therefore, this tenant acknowledges that there is both a requirement to acknowledge autonomy and a requirement to protect those who may have diminished autonomy. Another is tenant is beneficence. Not only should persons being treated in an ethical manner be respected in their decisions and protected from harm, but the health professional has an obligation to secure the patient's well-being. Because of the different types of treatment options available from different professionals, coordinated care is necessary, and this requires collaboration and partnership with other professionals. One of the challenges for the busy health practice is to assure that communication and collaboration occur, despite barriers to reimbursement in taking the time to do that. 
Within the Hippocratic oath, do no harm has been a fundamental principle of health care ethics. Another component requires health care professionals to benefit their patients according to their best judgment. This may require learning what will in fact benefit persons, as well as understanding any risks. With an increasing list of health care options, the problem is to decide when it is justifiable to seek certain benefits despite the risks involved. The other option is to determine when the risks outweigh any benefits. The group of editors identified key barriers to achieving ethical communication. These included self-interest, monetary concerns, the influence of electronic media, insufficient scientific information about risks and benefits and self-protection. Other identified barriers were linguistic and cultural, or socioeconomic. More importantly, the groups defined the values for ethical communication that include trust, truth, integrity, and evidence-based communication about procedures. One definition that captured the notion of ethical communication in the context of health care was that as health professionals there was an obligation to be an honest purveyor of useful and objective information, based on science that is easily accessible in a timely, transparent, motivational fashion, and commercially unfettered. While that is a pretty long definition, many agreed that using science-based evidence for treatment options, partnering with a broad array of professionals, and collaborating with patients on health care decisions is simply the right thing to do.
    Margaret Scarlett, D.M.D.
    Scarlett Consulting International
    Atlanta, Georgia
    megscarlett@mindspring.com