Introduction of the keynote speaker, Dr. Charles Dwyer, Academic Director of the Aresty Institute's Managing People Program in the Wharton School and Associate Professor in the Graduate School of Education at the University of Pennsylvania was made by Program Facilitator and Subject Matter Expert, David W. Chambers, EdM, Ph.D,MBA, editor of the Journal of the American College of Dentists and Professor and Associate Dean for Academic Affairs, University of Pacific, School of Dentistry.

Dr. Dwyer's opening remarks focused on "Values, Perceptions and Truth". He mentioned that "Ethics provides a better solution than an alternative and when Ethics fail, there are laws and when laws fail, there is war".

Additional comments were made regarding truth in advertising and what leads people to be untruthful. Dr. Chambers made remarks and outlined the expectations and sessions to be held. There were plenary sessions with the general assembly, led by Dr. Chambers which outlined broad topics and specific questions to be discussed in the smaller subgroups which followed the plenary. Subgroups were identified and assembled and led by a Subject Matter Expert (SME). Group Three's SME was Dr. Thomas Hasegawa, Professor and Associate Dean of Clinical Services, Baylor College of Dentistry, and Chairperson of the American College of Dentists Ethics Committee.

Members of Group Three were P.D. Miller, Phil Bonner, Tammy Byrd, Esther Scherb, Larry Farrell, Richard Jones, Ken Follmar, Evelyn Ireland , Robert Klaus and G. Siminovsky. Richard Celko

Dr. Hasegawa made a few comments regarding the format and then the discussion focused on truth in dentistry. Topics included truth in advertising of certain products and how claims are made. The need for standards and program guidelines was discussed. Truth in submission of claims was also mentioned. It was defined that the reason claims are submitted with improper codes tend to be so that additional benefits are obtained. Mentioned in addition, was that approximately 60% of physicians have made statements (untrue) to insurance carriers in an effort to obtain coverage for the patient.

Motivating factors contributing to untruthful or partially truthful behavior were also discussed.

1. money, greed
2. ego, pride, acceptance
3. easy way to avoid conflict,/confrontation/
4. sense of security
5. covers for incompetence

Discussion then focused on whether this translated into just the dental professions, all professions or society as a whole.

It was decided that this was prevalent within the society and that it would be of future initiatives would be necessary to identify all components.

There was discussion about the need for standards within all of the organizations represented. It was mentioned that some organizations have strict measures and educational requirements before allowing participation or membership, as well as passing certain examinations (ex. Board examination for specialty) whereas other may only have a financial requirement which would be limited to paying dues.

Consensus was reached that the need for establishing guidelines and criteria for all associations to be measured was necessary. The purpose would be to gain consistency within the respective profession. An example that was mentioned was the need for standards in advertising with substantial evidence as basis rather than presentations based on testimonials. The need for reliable data and the ability to reproduce results with certainty and validity would lend credibility.

Additional plenary discussion took place with the general assembly and Dr. Chambers asked the SME to provide brief synopsis of each of the subgroup discussions. Dr. Chambers quantified some results and these will be part of a paper for publication for the JACD.

Also discussed was the need to identify and prioritize barriers to truthful behavior.

The five most important behaviors as identified by group three included:

1. Debt burden
2. Lifestyle expectations
3. Incompetence, overtreatment
4. Peer pressure
5. Financial repercussions

Conclusion was reached that some people are untruthful and provide services or due to the need to satisfy financial obligations. Others may not be truthful as a means to cover lack of experience or competence with certain procedures. Some people would choose to state that they may be familiar with how to do something when in reality they may have very limited knowledge or exposure.

The discussion focus then changed and concentrated on the need to identify opportunities for truthful behavior and these included:

1. Full disclosure (example manufacturer and a paid consultant)
2. Peer review (Literature basis), Evidence Based Dentistry
3. Increased communications, raise awareness
4. Establishing and enforcement of credential and standards specific to industry.
5. Education of providers and consumers.

In conclusion, the purpose of this summit was to recap the progress made in the prior summits as well as identify the opportunities and barriers to truth and truthful behavior.

1. There was discussion regarding the need to establish and provide consistency in content of Ethics courses taught within Dental Schools.

2. The establishment on a voluntary basis of credentialing bodies and certification programs for all allied healthcare professions.

A follow up article regarding the data will be published in the JACD (unknown date).

I would be available for discussion if more details or further information is necessary.

Respectfully submitted,

Richard M. Celko, DMD, MBA
National Dental Director of Utilization Management, Aetna
AADC Representative for the 2004 American College of Dentists Ethic Summit Initiative