Ss3 Economics Note

[Young Vadlapatla]

Thispaper provides an introduction to some of the fundamental principles and approaches in environmental economics which are of significance to achieving an integrated sustainability science. The concept of a circular economy, introduced by the late David Pearce in 1990, addresses the interlinkages of the four economic functions of the environment. The environment not only provides amenity values, in addition to being a resource base and a sink for economic activities, it is also a fundamental life-support system. Environmental economists have suggested that, taking these four functions as an analytical starting point, unpriced or underpriced services should be internalised in the economy. In Europe significant advances have been achieved in the pricing of externalities by means of truly interdisciplinary analysis which accounts in detail for the environmental consequences. The monetary estimates reached as a result of such interdisciplinary research are gradually being applied to the economic analysis of environmental policy priorities. Although such figures provide only a partial and incomplete picture of the environmental costs at stake, they support and inform the analysis of the virtues of a circular economy for individual resources as well as for sustainability as a future trajectory.

The case note is arguably the most important component of a complete dental treatment record. If drafted correctly, case notes are your best evidence that you have complied with standards of care. Conversely, poorly written or incomplete case notes can be a source of legal jeopardy and embarrassment.

The case note, also known as the progress note, serves to chronologically document patient encounters, communications, and dental procedures. Along with the other components of a complete dental record, the properly written case note serves as a legal, business, administrative, and medical entry that documents and justifies treatment decisions that defend the provider from litigious patients or disciplinary action from state dental boards.

Good sources and examples of properly written case notes can be found at risk management departments of professional liability insurance carriers, the American Dental Association, and in various texts and journal articles.

While reviewing these resources, I have found that there are 12 essential components (sidebar) that many sources have in common. If you wish to maximize your legal protection, include these 12 components in each case note, and your documentation will be in compliance wherever you practice.

Next, detail your objective findings in your record of examination, including caries, tooth fracture, swelling, bleeding gums, periodontal pocket depths, radiographic findings, mobility, oral cancer screening, etc.

If the patient is presenting for a previously treatment-planned procedure, have there been any changes since your original diagnosis? Has the tooth fractured? Has it become symptomatic? If so, you will want to enter your new findings, which may or may not require a modification of your existing plan.

Informed consent/informed refusal requirements vary depending on the nature of the procedure you recommend or perform. All major procedures involving surgery, removal of significant amounts of tooth structure, endodontics, or prosthetics should have a separately signed informed consent in the patient record.

Even if the patient has signed the informed consent form previously, I recommend an entry into the case note that you reviewed the informed consent. Include all noncompliance issues including refusal of treatment and potential consequences. Simple restorations, examinations, and x-rays generally do not require a separate informed consent; an entry into the case note that informed consent has been obtained will suffice.

Medication prescribed: Accurately document the exact number of carpules and type of local anesthetic administered. Be specific as to the name and dosage of local anesthetic and epinephrine and route of administration. All medications prescribed, prescription and nonprescription, should be documented with dosages, frequency, and duration.

Note the patient reaction to the procedure. Did your patient tolerate the procedure well? Did you have difficulty obtaining local anesthesia? Was there a miscommunication with the patient, and how was it resolved? Hopefully most of your entries will state that the patient tolerated the procedure well, but we all have experienced unexpected results during patient visits. Document patient compliance issues such as failure to follow instructions or keep appointments.

Patient instructions include your pre- and postprocedure instructions with follow-up plans. If you provide written instructions, it is sufficient to indicate that you have provided and reviewed these with your patient. Patient instructions also refer to recommendations you have made to your patient such as new treatment recommendations and referrals to specialists.

Although my recommendations will result in some duplication of effort between your case note and the body of your patient record, a thorough stand-alone case note goes a long way in defending you against claims. Keep your comments objective in tone and factual. Never enter disparaging or personal comments into your notes as such remarks may be viewed by juries, judges, dental board members, your patients, or their legal representatives.

Editor's note: This article appeared in the February 2023 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.

Richard S. Harold, DMD, JD, is an adjunct professor at Tufts University School of Dental Medicine in Boston. Dr. Harold received his DMD degree from Tufts University, his JD from New England School of Law, and his BS in pharmacy from Massachusetts College of Pharmacy. Prior to joining the faculty at Tufts University, Dr. Harold owned and operated a general dentistry practice. Dr. Harold has a specific interest in dental-legal issues and has lectured locally and nationally.

The mathematical method, like so many other fallacies, has entered and dominated present-day economic thought because of the pervading epistemology of positivism. Positivism is essentially an interpretation of the methodology of physics ballooned into a general theory of knowledge for all fields.

In physics, the facts of nature are given to us. They may be broken down into their simple elements in the laboratory and their movements observed. On the other hand, we do not know the laws explaining the movements of physical particles; they are unmotivated.

Thus, the equation of the law of gravitation is in itself meaningless; it is only meaningful to us in relation to the facts that we humans observe and that the law can explain. Consequently, mathematics, which performs deductive operations on meaningless symbols, is perfectly suited for the methods of physics.

I have tried in this paper to consider mathematical economics only in its best possible light. Actually, mathematical methods necessarily introduce many errors and inanities which cannot be developed here.

The use of the calculus, for example, that has been endemic in mathematical economics assumes infinitely small steps. Infinitely small steps may be fine in physics where particles travel along a certain path; but they are completely inappropriate in a science of human action, where individuals only consider matter precisely when it becomes large enough to be visible and important. Human action takes place in discrete steps, not in infinitely small ones.

The mathematical economists are therefore framing assumptions which are admittedly false or partly false, but which they hope can serve as useful approximations, as they would in physics. The important thing is not to be intimidated by the mathematical trappings.

The Mises Institute is a non-profit organization that exists to promote teaching and research in the Austrian School of economics, individual freedom, honest history, and international peace, in the tradition of Ludwig von Mises and Murray N. Rothbard.

Non-political, non-partisan, and non-PC, we advocate a radical shift in the intellectual climate, away from statism and toward a private property order. We believe that our foundational ideas are of permanent value, and oppose all efforts at compromise, sellout, and amalgamation of these ideas with fashionable political, cultural, and social doctrines inimical to their spirit.

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Economics is the study of scarcity and its implications for the use of resources, production of goods and services, growth of production and welfare over time, and a great variety of other complex issues of vital concern to society.

Economics is a social science with stakes in many other fields, including political science, geography, mathematics, sociology, psychology, engineering, law, medicine and business. The central quest of economics is to determine the most logical and effective use of resources to meet private and social goals. Production and employment, investment and savings, health, money and the banking system, government policies on taxation and spending, international trade, industrial organization and regulation, urbanization, environmental issues and legal matters (such as the design and enforcement of property rights), are just a sampling of the concerns at the heart of the science of economics.

If you want to understand wealth, poverty, growth, trade, money, jobs, income, depression, recession, prices and monopolies, and study what makes the world work from day to day, you will be fascinated by the complex field of economics!

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