Beyond your comfort zone.

Abstract

Drew is a 28-year-old engineering student with protruded maxillary incisors and an impinging deep-bite malocclusion. He was referred to you by a senior dentist in the multispecialty practice in which you are employed. His treatment plan called for the extraction of 2 maxillary premolars, followed by retraction of the anterior teeth using bilateral temporary anchorage. Treatment progressed nicely for about 8 months until he began to act oddly. He became flirtatious with you, and even your most mundane comments seemed to be transformed into replies with sexual innuendos. It was soon clear that Drew was attempting to convert a professional relationship into a romantic one. You initially ignored his comments, until he bluntly asked you if you'd join him for dinner that evening. You refused his advances, telling him that you are already committed to a relationship with someone else. You politely asserted that you want to maintain solely a professional relationship with him. You felt uncomfortable about the incident, so you discussed it with a senior partner who is also your employer. A week later, the senior partner tells you that he received a call from Drew that required an emergency visit to address his dental pain. Although the pain appeared to be limited to transient thermal sensitivity caused by tooth movement, there was evidence of mild root resorption at the maxillary anterior teeth. Once the partner advised Drew of his findings, Drew immediately became accusatory, stating that his “orthodontist must have created the problem.” Comparison of the initial radiograph and the recent film disclosed some root remodeling, but the changes were insignificant. Nonetheless, Drew was insistent at blaming you for the change in root length. Although your senior partner conceded that these were probably retaliatory remarks, you no longer feel comfortable treating Drew. Is this a justifiable reason to cease your treatment of him, and what are your employer's responsibilities in this instance? Hostile-environment sexual harassment involves an employee's discomfort in the workplace due to inappropriate sexual advances, innuendos, or references. Examples include display of erotic photographs, inappropriate touching, suggestive language, implicit or explicit jokes, and unwelcome romantic gestures.1Harassment: U.S. Equal Employment Opportunity Commission. Available at: www.ecoc.gov/laws/types/harrassment.cfm. Accessed on August 25, 2016.Google Scholar An isolated incident is not considered illegal but is ethically inappropriate. The harasser need not be the victim's employer, but can be an agent of the employer, a coworker, or someone other than an employee. The victim of the harassment can be male or female. The key aspect of the harassment is that the targeted person objects to the behavior and seeks to avoid it. Once an employer is aware of the harassment, the employer has the legal obligation to attempt to prevent further harassment. The employer can face legal action for failing to protect the harassed employee but is not liable if the employee declines the employer's recommendations.1Harassment: U.S. Equal Employment Opportunity Commission. Available at: www.ecoc.gov/laws/types/harrassment.cfm. Accessed on August 25, 2016.Google Scholar There are 2 issues to consider in this authentic scenario. Drew could be excused from the practice, but there is a risk that he will behave similarly toward the staff in another office. Your employer or a representative of the multispecialty practice is obligated to attempt to protect you from harassment, possibly simply by conducting a frank discussion with Drew.2Rule J. Veatch R.M. Fidelity: obligations of trust and confidentiality.in: Bywaters L. Harmon L. Ethical questions in dentistry. 2nd ed. Quintessence, Chicago2004: 136Google Scholar If you still feel uncomfortable treating Drew, referral to another provider would be in order. The incidents and attempts at remediation must be documented in writing. If you decide to discharge this patient from the practice, he must receive a letter of termination of care from your service. You, or the senior partner, must remain available for Drew's emergency treatment needs thereafter for a reasonable period of time.3Owsiany D. The intersection of dental ethics and law.J Am Coll Dent. 2008; 75: 47-54Google Scholar And the existence of frequently inevitable root resorption should be rediscussed with Drew. Documentation of the original properly executed informed consent in his file to address this issue is important—even if his true objection to you is a failed attempt at romance.