Ethics — Food for Thought

Henrik Hansen, DDS

Now that I’m in my 42nd year of practice and my hair has lost most of its color, I’m asked a lot when I’m going to retire. My answer is: God willing, not anytime soon. A few months ago, an 80-year-old patient said after I told him that he looked great, “I’m going to be around another 50 years, and you’ll be my dentist.” My comment was, “Leo, do you really want a 121-year-old dentist in your mouth?” Whereupon he said that at 130, he pretty much would not care.

I enjoy my patients and would miss them. I still get excited when things go well, and the math major in me loves the problem-solving challenges. However, it’s got me thinking about when it will be time to hang it up. Most of my local contemporaries have already retired, some to travel and pursue other activities while they’re still vertical, some due to physical issues and some because they’re tired of the strain of practice. However, when is it time to retire because you just can’t provide the same level of care as you once did?

Many years ago, a patient of one of the local pillars of the dental community came in to get a second opinion. It seems this elderly dentist had placed a crown on a lower molar and the patient could feel a sharp point next to the tooth. I noticed a massive “J” margin on the lingual where the point of the J was about 2 mm from the lingual wall of the crown and poking above the gums.

I called the dentist and gently explained the situation. He told me it’s getting harder and harder to do the work due to poorer vision and trembling in his hands. I said that as the years go by, there are going to be changes and most not for the better. The rational thing to do is to recognize when it’s time to stop practicing – for the patients’ sake, as well as yours. He thanked me and shortly thereafter retired. Dentistry is very often hard to do well and takes its toll on us physically, mentally and emotionally.

Two years ago, when I turned 70, the DMV gave me the written test to check that dementia hadn’t gone too far and the eye test to make sure I could still see. In order to graduate from dental school and get a license to practice, we must demonstrate certain core competencies. However, unless you run afoul of the dental board, that’s the last you’ll be looked at. So, it’s up to the individual to gauge when it’s time to stop. This decision is not always an easy one, but one filled with ethical considerations. There is beneficence (do no harm), veracity (truthfulness), professionalism, compassion, competence, integrity and justice. That’s just about the whole list. So how do you judge? My personal retirement test is when I can do an acceptable crown prep after chasing decay subgingival down the root on an endodontically treated tooth with the patient comfortable and not numb. If my eyes and hands can pull that off, I’m OK. So, it begs the question, “What’s your retirement test?”

Henrik Hansen, DDS, is a general dentist practicing in Fairfield, Calif. He served on the CDA Judicial Council and is past chair of the Council on Peer Review as well as a past member of the ADA Council on Dental Benefit Programs.