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Moral injury responses in the dental industry


Are you putting your employees in a difficult position?

I received several emails last month in response to my article on moral injury. I unleashed the genie by writing about it, which felt pretty good! But then I started getting the emails. (I suspected this was a problem in the industry, but after hearing from so many of you, I now know it is.) One reader really motivated me to share some of the stories she shared with me.

One hygienist spoke about how blessed she was to work for a phenomenal dentist for 20 years until he passed away. She felt that both the practice and the dentist were her family in many ways. She loved the comradery and respect that was given to her and her colleagues. (Can you say, a healthy work environment?) When you love to get up and go to work, you’re blessed. It says an awful lot about the people who work there. Isn’t that what we’re all looking for when searching for a job or when we try to make changes to fix problems where we work?

Related reading: What is moral injury?

She didn’t have much time to grieve for this dentist before she had to start looking for a new position. Unfortunately, she couldn’t take time off. (Those bills must get paid somehow!) The upsetting thing is that as she started looking for jobs, she noticed that the same ethical issue came up repeatedly. This was discussions about what her “commission” would be and how that would factor into her salary. She was shocked and had stomach pains thinking about upselling the patient on procedures and services that he or she may not need. Learning the term “moral injury” helped her to define what she was feeling inside.

Where are the ethics here? Commissions are used in sales because they motivate employees to sell, sell, sell. When the patient asks you, “What would you do if it were you?” you may subconsciously sway them toward spending the money. Some of you will be emailing me on how that’s not true. I’m not naïve. When you incentivize employees, what do you think happens? Sales go up in every industry across the board.

This is scary. This shouldn’t be occurring in healthcare. I’m not sure what your code of ethics are, but I know that in my social work code of ethics, this goes against the very grain of who we are as professionals. My recommendation is for all of you to look at the code of ethics for your employees and see if you’re putting them in an impossible situation.

Another reader wrote that she was terminated after 25 years of exceptional work because she wasn’t bringing in enough money. She wasn’t upselling. What are we doing to our employees? Are we compromising their ethics for the almighty dollar? Let’s be honest, this is just wrong.

This issue of commissions is impacting whether we’re losing talented, experienced people. One hygienist wrote to me saying “I always thought I would leave the profession because of physical limitations not moral issue injuries.” We’re losing good people in this industry.

More from the author: How to set boundaries in your dental practice

What I want you as dentists, oral surgeons and specialists to think about is at what price are we harming our employees? Yes, I get that this is a business, but to be honest, this is healthcare. Should we really be upselling and giving commissions?

One reader shared with me that patients in her office were having procedures that weren’t necessary. For that reader and others who are dealing with issues like that, my suggestion is to find a practice that follows your philosophy on care. If unethical behavior is practiced, report that dentist to the dental board. I feel strongly, as do many of you, that we can’t tolerate this behavior anymore. Speak up. Make a difference. Try to find a solution, but also protect yourself.

I believe that unethical behavior is something I can’t live with. Being able to go to sleep at night with a clear conscious is my goal. Isn’t “do no harm” the first mantra of medicine? That mantra covers your employees as well as your patients. Can you say you’re doing no harm?

Email me at diana2@discussdirectives.com and share your thoughts on this topic.

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