Did anyone read the guest editorial in the September, 2014, issue of JADA (see attached)?

It summarizes the December, 2013, published report of the Presidential Commission for the Study of Bioethical Issues (also attached).

Specifically, the guest editorial addresses the "incidental finding" of carotid plaques found during CBCT imaging for dental implant planning, TMJ evaluation, etc. The authors make the point that we need to discuss the possibility of these findings prior to having the test performed and have the risk in writing that they sign. They then discuss the need for clinicians to allow the patients to tell us whether they want us to tell them of incidental findings or not.

I don't know how other dentists think about this, but I know that if I were having a test done, I would want to know everything that the test turns up and then decide after I know what the findings are whether or not I want to pursue treatment for myself or not. I can't understand how other patients may not want to know the "truth." In my experience as a clinician, my patients have always appreciated the fact that we have found carotid plaques, arthritic changes in the neck, etc., on CBCT scans even though the physicians choose not to treat the findings for one reason or another. I simply interpret the radiology report, the sleep study, or the bloodwork that we receive and make a recommendation to discuss positive findings with their physicians; I have not had one patient in 10 years of doing so complain about my concern, diligence, and honesty about the findings.

I think that the concept of withholding information from our patients, even if they want us to do so, creates all sorts of problems. For example, why does a patient come in for a dental exam? Do they only want us to tell them if they have abscesses, or do they only want us to tell them that they have wonderful healthy teeth? Where do we draw the line? What about doing oral cancer screenings? Should we only tell them if they have obvious cancer, or should we tell them when they have suspicious lesions that should be investigated further? I suppose, based on this report, that we should listen to the patient and not tell them of a leukoplakia or erythroplakia if they only want us to tell them if they have .cancer. (Sarcasm intended.)

Reports like this one, at least to me, seem to be trying to encourage sweeping diagnoses under the rug for some ulterior purpose. In the age of the Affordable Care Act, it makes me question what is driving this type of "ethical" recommendation. Furthermore, I have a hard time believing that if we withheld the finding of a carotid plaque, for example, and the patient had some catastrophic event related to that findings that we would not be held medicolegally liable for failure to disclose or being negligent even though the patient told us they didn't want to know about any unpleasant findings. Who does?

While this article has definitely got me a bit fired up, I am sharing it on this forum because I think that this is an excellent topic for discussion on SpearTalk. Please read the attached articles and give them some thoughts. I would love to hear what others think about this topic, and I really hope that some disagree with me so that I can understand the other point of view better.

We all know people who represent us at the local, regional, and national levels of organized dentistry. I hope that the discussion that ensues on this topic will help guide us in discussions with our delegates to effect positive change for our profession.

Thank you.

Kevin Huff