**7. Data and analysis**

*Bioethics in Medicine and Society*

preventative measure should outpatient dental clinics attempt to misrepresent their

In addition to regional regulations limiting the naming of dental clinics, the American Dental Association sets national regulations for dentists [38]. These standards (**Table 3**), as influenced by bioethical principles, state that an orthonym

The Lexeme What lexemes compose the orthonym? What are the possible and perceived definitions

The Significance What significance is assigned through association habits? [22, 36] How does this

What is the socioeconomic composition of the community? How is cultural context reflected within the orthonym? [23] What association habits contextually define this

discourse position itself within the community? How might this discourse influence the

The Illinois Dental Practice Act [37] states that dental clinics may not include titles or specialties in their orthonym that they are not certified to perform, use words that misrepresent or cause the patient to misinterpret services provided in order to gain more patients, practice under a false name, allow another uncertified individual or clinic to practice under their name, and must include disclaimers when appropriate*.*

2

practice with potential consequences on patient health.

that is misleading in any way is considered to be unethical.3

of these lexemes? [20, 35]

discourse? [22–24, 36]

patient and the practitioner? [26, 27]

<sup>2</sup> The full version of the *Illinois Dental Practice Act* can be found at www.ilga.gov.

*Excerpt from the American Dental Association's document on ethical standards.*

**ADA Principles of Ethics & Code of Professional Conduct [Revised 2018]**

<sup>3</sup> The full version of the American Dental Association's *Principles of Ethics & Code of Professional Conduct* 

Since the name under which a dentist conducts his or her practice may be a factor in the selection process of the patient, the use of a trade name or an assumed name that is false or misleading in any material respect is unethical. Use of the name of a dentist no longer actively associated with the practice may be continued for a

*If the answer to any of the above is* "no," *how might the discourse be altered so as to better fit communicative and* 

*A rubric for analysis of communicative value and bioethical compliance within healthcare communication.*

**Principles?**

health?

benefitting the patient?

harm to the patient?

**Does the discourse comply with the Four Bioethical** 

1. Beneficence: Does this communication work toward

2. Nonmaleficence: Does this communication disallow

3. Respect for Autonomy: Does this communication promote the patient's informed involvement in their

4. Justice: Does this communication represent fair distribution of health services in the community?

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**Table 3.**

*\**

**Table 2.**

The Environment

**Table 1.**

*(2018)* can be found at www.ada.org.

*5.G. Name of Practice*

period not to exceed 1 year.

**Does the discourse follow the Four Communicative Maxims?**

relevant to the task at hand?

1. Manner: Is this communication in a manner that is appropriate within a healthcare setting?

*A brief guide for onomastic analysis and discussion.*

2. Relevance: Is this form of communication

3: Quality: Is this communication of quality, that is does it provide false information?

4. Quantity: Is this communication appropriate in amount for which the medium requires?

*ethical standards within healthcare communication?*

In this case study, the analysis of ten medical dental clinic names will be categorized in units for ease of reading. The units include explanations of orthonyms that: (a) list medical credential, (b) describe the ideal patient, (c) focus on the patient experience, (d) refer to health outcomes and (e) appeal to patient identity (**Table 4**). Each section will anecdotally analyze clinic names used in this case study.


#### **Table 4.**

*Regional trends in dental clinic names.*

### **7.1 Orthonyms that list medical credential**

Medical credential is important—it is what determines whether or not someone should be operating on a patient. Whether the proper name uses the word 'doctor' or lists dental degrees such as D.D.S. or D.M.D., or specialties such as periodontics or maxillofacial surgery, these orthonyms are communicating with the patient that the dentist they are seeing is indeed qualified to be practicing dentistry. Due to their nature, the misuse of lexemes in this category would be highly unethical.

*Dr. Joseph Watson, DDS.* This orthonym is simple and direct. It is made up of the doctor's name followed by their medical credential. The words used in the orthonym are obvious in their meanings and do not require the patient's analysis. This language conforms to discursive maxims in that it uses only what is necessary to convey only what information is essential. This dental clinic is located in the South Shore Neighborhood of Chicago on Chicago's Southside, and is 2.8% White, 1.8% Hispanic, 93.3% Black, 0.4% Asian, 1.3% Mixed, and 0.4% other. The median household income in this neighborhood is \$27,900.

This orthonym states medical credential and education level twice. This may be a reinforcement to the patient that the dentist is an expert and qualified to do their job by using "Dr." and "DDS" in the clinic's name. This may also be interpreted as the dentist positioning themselves as of greater education level perhaps serving to increase the gap between the patient and the practitioner. This orthonym adheres to both communicative maxims and bioethical principles: It communicates well and does not appear to cause harm.

*Dr. Louis C Rutland III.* This orthonym takes a similar form as the previous. It is short and direct and does not require interpretation. The words used in this orthonym are orthonyms on their own combined with a marker of education level. This orthonym is short and gives only the necessary information in accordance with discursive maxims [19]. Dr. Rutland's office is located in the East Chatham

neighborhood of Chicago on Chicago's Southside. This neighborhood is 2.7% White, 1.2% Hispanic, 94.4% Black, 0.8% Asian, 0.5% Mixed, and 0.3% Other, and has a median annual income of \$23,800. Furthermore, this orthonym is similar to that of Dr. Joseph Watson, DDS and the socioeconomic composition of the surrounding community is also very similar. As community reflects cultural values, and cultural values are the collection of simultaneously performed identities, this orthonym might be interpreted as influenced by and influencing the neighborhood.

The use of "Dr." could be interpreted as a means of positioning the dentist as doctorally educated as well as informing the patients that they have the proper medical credential. As previously mentioned, communication has the power to influence within medical contexts. This orthonym could be interpreted as building trust with the patient before they even walk into the door. For this reason, it could be interpreted ethically and communicatively satisfactory.

#### **7.2 Orthonyms that describe the ideal patient**

Describing the ideal patient attracts only the patients that a dentist can properly serve. For example, a dental clinic that uses the word "pediatric" is probably not somewhere that maxillofacial surgery is performed. This could be viewed as cutting to the chase, as it were, and prepping patients for what to expect when entering a specific dental clinic. Ethical problems may occur when services are misrepresented in this way causing the patient some level of hurt.

*1st Family Dental of Andersonville.* This orthonym gives a *prima facie* description of the ideal patient through the use of the lexical entry "family." It is made up of patient descriptors as well as an area marker. There is no need for interpretation here. For example, one would not interpret this to be a luxury dental office, but, rather one where parents and children can get the treatment they need. This dental office is located in the Andersonville neighborhood on Chicago's Northside and is 68.4% White, 10.5% Hispanic, 7.4% Black, 10% Asian, 3.6% Mixed, and 0.2% Other. Habitants of Andersonville have a median household income around \$76,500.

The words that make up this orthonym that are of particular note include "1st", "Family", and "Andersonville." By including first in the orthonym, this dental office could be perceived as claiming their territory. The word "family" is also important and could be understood as a marker for the clinic's ideal patient. By using the word family in the orthonym, the creators are designating general services for the whole family and effectively warding off patients who need more specialized procedures such a periodontal surgery. This orthonym could also be interpreted as positioning itself as a family friendly place within the community, one that brings to mind toys in the waiting room and the occasional crying child. While the communicative values are ethical, they could be clearer [19]. Family is culturally defined and a dentist may find ethical dilemmas within. Ethical principles may also be overlooked should this clinic not actually be a family dental practice, whether implicitly or explicitly, which would then flout both communicative and ethical principles.

*Sonrisa Family Dental.* This dental clinic's name, half in Spanish and half in English, yields important information about this clinic. The words in this orthonym include "sonrisa" and family dental. Family dental warrants no explanation, though to some readers "sonrisa" may be an unfamiliar term. Sonrisa means smile in Spanish. This orthonym code switches between Spanish and English to say what may be translated as "Smile Family Dental." For the person in the community in which this clinic is set, it may be viewed as following the norms of effective discourse. It is short and explains its patient base: families. As a perfect example of

**125**

meaning.

*Biomedical Ethics and Communicative Maxims: Case Studies in Outpatient Health*

discourse being shaped by and shaping community, if this dental office was located in a different neighborhood the definition of the word "sonrisa" may go amiss. The Sonrisa Family Dental selected for this study is located in McKinley Park. Sonrisa Family Dental appears to have multiple locations across Chicago yielding slight complication and potential inaccuracy to this research. McKinley Park is located in Chicago's Southwest side and is 16.9% White, 62.7% Hispanic, .9% Black, 19% Asian, 0.7% Mixed, and 0.8% Other. This clinic has a large population of potential Spanish-speaking patients surrounding it, where other neighborhoods where this clinic exists, such as Archer Heights on Chicago's Southwest side has a majority Black population [67%] with Hispanic being the second largest at 23.7%. By using a Spanish word in the orthonym, the potential patient may note that this clinic may be a place they can use the Spanish language. This may also be

observed as serving to frame this medical dental clinic as a safe place for community members who do not know English to seek medical help. As discourse may influence worldview, this orthonym may develop ideas or thoughts in the mind of the patient about the type of treatment they are to receive [bilingual] before they actually walk into the clinic. This orthonym falls in line with bioethical principles that seek to serve the benefit of the patient so long as the orthonym accurately describes

*Montrose Tooth Fairy.* This orthonym is describing the ideal patient in a more abstract way. The words in this orthonym do not explicitly state that it is a dental office at all, nor do they attempt to describe any sort of medical credential. In fact, a child may even interpret this establishment as a place to bring a fallen tooth for a monetary reimbursement. Arguably this discourse, though it requires some extrapolation, may be somewhat effective, once the patient realizes that this dental

Montrose Tooth Fairy is located in the Uptown neighborhood on Chicago's Northside. The population of Uptown is 44.9% White, 12.9% Hispanic, 28% Black, 11.5% Asian, 2.1% Mixed, and 0.6% Other. The median household income in this community is \$37,600 a year. As this orthonym is more metaphorical than literal, the patient's mind may be perceived as subconsciously left to explore the intended

Along with describing the ideal patient, this orthonym could be understood as relaxing the potential patient. For example, a child going to this dental office may have warm feelings about the tooth fairy and may not experience as high of levels of nervousness when visiting for cleanings or other procedures. As with the previously mentioned examples of healthcare communication, this communication hesitantly falls in line with bioethical principles given it is an accurate representation. If, for example, this clinic turned out to be a place where children were not welcomed and pediatrics was not a specialty, this could be viewed as maleficent. A more explicit orthonym that requires less analysis could be more bioethically appropriate.

Orthonyms that are focused on the patient experience are found as taking creative liberties within healthcare communication. For example, a dental clinic using the word "salon" in their orthonym would strike a different image in the perspective patient's imagination than a clinic simply named "dental office." This form of language verges on art and may be beyond the scope of healthcare communication. Ethical concerns may arise for those clinics that use superfluous adjectives that may

*Art of Modern Dentistry.* The name "Art of Modern Dentistry" sets this clinic apart from the previous. By alluding itself to art, the words used in this proper

the practice, and only in the context of a patient who understands Spanish.

*DOI: http://dx.doi.org/10.5772/intechopen.93233*

clinic probably offers pediatric services.

**7.3 Orthonyms that focus on the patient experience**

lead patients to expect something beyond the practitioner's scope.

#### *Biomedical Ethics and Communicative Maxims: Case Studies in Outpatient Health DOI: http://dx.doi.org/10.5772/intechopen.93233*

discourse being shaped by and shaping community, if this dental office was located in a different neighborhood the definition of the word "sonrisa" may go amiss.

The Sonrisa Family Dental selected for this study is located in McKinley Park. Sonrisa Family Dental appears to have multiple locations across Chicago yielding slight complication and potential inaccuracy to this research. McKinley Park is located in Chicago's Southwest side and is 16.9% White, 62.7% Hispanic, .9% Black, 19% Asian, 0.7% Mixed, and 0.8% Other. This clinic has a large population of potential Spanish-speaking patients surrounding it, where other neighborhoods where this clinic exists, such as Archer Heights on Chicago's Southwest side has a majority Black population [67%] with Hispanic being the second largest at 23.7%.

By using a Spanish word in the orthonym, the potential patient may note that this clinic may be a place they can use the Spanish language. This may also be observed as serving to frame this medical dental clinic as a safe place for community members who do not know English to seek medical help. As discourse may influence worldview, this orthonym may develop ideas or thoughts in the mind of the patient about the type of treatment they are to receive [bilingual] before they actually walk into the clinic. This orthonym falls in line with bioethical principles that seek to serve the benefit of the patient so long as the orthonym accurately describes the practice, and only in the context of a patient who understands Spanish.

*Montrose Tooth Fairy.* This orthonym is describing the ideal patient in a more abstract way. The words in this orthonym do not explicitly state that it is a dental office at all, nor do they attempt to describe any sort of medical credential. In fact, a child may even interpret this establishment as a place to bring a fallen tooth for a monetary reimbursement. Arguably this discourse, though it requires some extrapolation, may be somewhat effective, once the patient realizes that this dental clinic probably offers pediatric services.

Montrose Tooth Fairy is located in the Uptown neighborhood on Chicago's Northside. The population of Uptown is 44.9% White, 12.9% Hispanic, 28% Black, 11.5% Asian, 2.1% Mixed, and 0.6% Other. The median household income in this community is \$37,600 a year. As this orthonym is more metaphorical than literal, the patient's mind may be perceived as subconsciously left to explore the intended meaning.

Along with describing the ideal patient, this orthonym could be understood as relaxing the potential patient. For example, a child going to this dental office may have warm feelings about the tooth fairy and may not experience as high of levels of nervousness when visiting for cleanings or other procedures. As with the previously mentioned examples of healthcare communication, this communication hesitantly falls in line with bioethical principles given it is an accurate representation. If, for example, this clinic turned out to be a place where children were not welcomed and pediatrics was not a specialty, this could be viewed as maleficent. A more explicit orthonym that requires less analysis could be more bioethically appropriate.

#### **7.3 Orthonyms that focus on the patient experience**

Orthonyms that are focused on the patient experience are found as taking creative liberties within healthcare communication. For example, a dental clinic using the word "salon" in their orthonym would strike a different image in the perspective patient's imagination than a clinic simply named "dental office." This form of language verges on art and may be beyond the scope of healthcare communication. Ethical concerns may arise for those clinics that use superfluous adjectives that may lead patients to expect something beyond the practitioner's scope.

*Art of Modern Dentistry.* The name "Art of Modern Dentistry" sets this clinic apart from the previous. By alluding itself to art, the words used in this proper

*Bioethics in Medicine and Society*

neighborhood of Chicago on Chicago's Southside. This neighborhood is 2.7% White, 1.2% Hispanic, 94.4% Black, 0.8% Asian, 0.5% Mixed, and 0.3% Other, and has a median annual income of \$23,800. Furthermore, this orthonym is similar to that of Dr. Joseph Watson, DDS and the socioeconomic composition of the surrounding community is also very similar. As community reflects cultural values, and cultural values are the collection of simultaneously performed identities, this orthonym might be interpreted as influenced by and influencing the neighborhood.

The use of "Dr." could be interpreted as a means of positioning the dentist as doctorally educated as well as informing the patients that they have the proper medical credential. As previously mentioned, communication has the power to influence within medical contexts. This orthonym could be interpreted as building trust with the patient before they even walk into the door. For this reason, it could

Describing the ideal patient attracts only the patients that a dentist can properly serve. For example, a dental clinic that uses the word "pediatric" is probably not somewhere that maxillofacial surgery is performed. This could be viewed as cutting to the chase, as it were, and prepping patients for what to expect when entering a specific dental clinic. Ethical problems may occur when services are misrepresented

*1st Family Dental of Andersonville.* This orthonym gives a *prima facie* description of the ideal patient through the use of the lexical entry "family." It is made up of patient descriptors as well as an area marker. There is no need for interpretation here. For example, one would not interpret this to be a luxury dental office, but, rather one where parents and children can get the treatment they need. This dental office is located in the Andersonville neighborhood on Chicago's Northside and is 68.4% White, 10.5% Hispanic, 7.4% Black, 10% Asian, 3.6% Mixed, and 0.2% Other. Habitants of Andersonville have a median household income around

The words that make up this orthonym that are of particular note include "1st", "Family", and "Andersonville." By including first in the orthonym, this dental office could be perceived as claiming their territory. The word "family" is also important and could be understood as a marker for the clinic's ideal patient. By using the word family in the orthonym, the creators are designating general services for the whole family and effectively warding off patients who need more specialized procedures such a periodontal surgery. This orthonym could also be interpreted as positioning itself as a family friendly place within the community, one that brings to mind toys in the waiting room and the occasional crying child. While the communicative values are ethical, they could be clearer [19]. Family is culturally defined and a dentist may find ethical dilemmas within. Ethical principles may also be overlooked should this clinic not actually be a family dental practice, whether implicitly or explicitly, which would then flout both communicative and ethical

*Sonrisa Family Dental.* This dental clinic's name, half in Spanish and half in English, yields important information about this clinic. The words in this orthonym include "sonrisa" and family dental. Family dental warrants no explanation, though to some readers "sonrisa" may be an unfamiliar term. Sonrisa means smile in Spanish. This orthonym code switches between Spanish and English to say what may be translated as "Smile Family Dental." For the person in the community in which this clinic is set, it may be viewed as following the norms of effective discourse. It is short and explains its patient base: families. As a perfect example of

be interpreted ethically and communicatively satisfactory.

**7.2 Orthonyms that describe the ideal patient**

in this way causing the patient some level of hurt.

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\$76,500.

principles.

name are less obvious in what they are referring to. The potential client may be left to imagine various art exhibitions, a beautiful office, or perhaps smiles so brilliant that they are art themselves. As with metaphors, the locutionary act of this dental clinic does more than just identify itself as a place to get teeth cleaned. It speaks to the patients who may wish to have a more luxurious experience [20, 35].

Art of Modern Dentistry is located in the Lakeview neighborhood on Chicago's Northside where the population is 80% White, 8% Hispanic, 3.5% Black, 5.8% Asian, 2.5% Mixed, and 0.2% Other. The average household income is approximately \$106,900. It is no surprise that within this neighborhood the acceptable lexical values to be used in health communication may include "art" and "modern." The cultural context of this community allows this dental clinic to position itself as desirable, or a place of art and beauty [22, 36]. In fact, this descriptive name could be viewed as having the ability to slightly alter the worldview of the patient according to social semiotic theories [25]. The patient upon viewing this orthonym may now believe that going to the dentist does not have to be a routine occurrence, but may be more akin to the museum experience instead.

This clinic may be understood as positioning itself as a place of luxury, and positioning patients as art connoisseurs rather than ordinary persons with cavities [26, 27]. Association habits of capitalistic cultures favor the heavenly over the mundane; the name of this clinic is furthering association habits and using such association habits to its gain [24]. Dentistry is not always a trip to the museum, and using this type of language within healthcare contexts may not be in the best interest of the patient. This orthonym may be creative, but it could be argued that it is on the brink of violating communicative maxims and ethical principles.

*Dental Salon.* This two-word orthonym is simple yet luxurious. The first part of this orthonym, "dental" is defined unambiguously as a that relating to dentistry. The second word in the orthonym is up for interpretation. Thoughts of relaxation could be associated with the word salon. This orthonym is on the edge of communicative effectiveness; it may take a moment to assess whether this is a dental office or perhaps a place where one can get a sort of spa treatment for their mouths. Ineffective communication in healthcare in-and-of itself may be considered to sidestep bioethical principles.

Dental Salon is located in the Ranch Triangle neighborhood on Chicago's Northside. This neighborhood is 86.3% White, 6.7% Hispanic, .6% Black, 5.7% Asian, 3.1% Mixed, and 0.2% Other. The median household income for Ranch Triangle is \$146,600. This orthonym reflects the surrounding community and simultaneously constructs it while placing focus on patient indulgence. Bioethically the question must be asked if outpatient clinics should represent themselves in a manner that may be misleading and out of the scope of healthcare.

*Chicago Smile Design.* This is another example of the clinic being glamorized. Instead of going to get a cleaning, patients may be visiting this dentist to have the feng shui of their mouths rearranged. Design aside, the lexemes making up this proper noun are all rather familiar to the patient. The smile could be defined culturally, though facial tissue and bone are pretty culturally transcendent. However, the word design in this orthonym is where creative choices were made. When thinking of design, one's mind probably does not immediately imagine their dentist.

Chicago Smile Design is located in the Old Town Triangle neighborhood on Chicago's Northside. The population is 77.1% White, 5% Hispanic, 5.3% Black, 8.5% Asian, 3.1% Mixed, and 1% Other with a median household income of \$99,700 per year. This orthonym is framing and positioning this dental office as a place of luxury within the community. This discourse could also be viewed as a reflection of the surrounding community; with a comparatively high median household income it is no revelation that this office is describing itself as luxurious through its

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*Biomedical Ethics and Communicative Maxims: Case Studies in Outpatient Health*

treatments are offered has the potential to lead to maleficence.

orthonym and appealing to the vanity of the surrounding community. Within the communicative maxims it may not be effective; causing the patient to wonder what

In dentistry, health outcomes may vary from more serious, such as a periodontal procedure, to the more superficial whitening procedure. Though whitening may be more of a cosmetic procedure, than anything else, the general public tends to see bigger and brighter smiles as healthier. In this case, these will fall under the category of health outcomes, though representing cosmetic procedures such as teeth whitening as a health outcome may intrinsically be unethical. By implying that perfectly white teeth are health outcomes, more patients may opt for unnecessary

**Perfect Smile Dental Spa.** Generally, the focus of this orthonym directs patients

orthonym the only word that may lend itself to interpretation is "spa." As previously addressed, the potential patient may not immediately realize what is meant by spa,

to two areas: that of having a perfect smile, and that of going to a spa. In this

Perfect Smile Dental Spa is located in the North Center neighborhood on Chicago's Northwest side. North Center has a population that is 77.6% White, 11.7% Hispanic, 2.1% Black, 4.9% Asian, 3.4% Mixed, and 3% Other, with a median household income of \$89,200. Where this orthonym refers to the patient outcome of a "perfect smile" it could also be understood as reflecting the cultural ideal to have said perfect smile, though such things as bleaching or veneering may be cosmetic procedures. Within healthcare communication, part of nonmaleficence and benevolence is to keep patients properly informed and not lead them astray. This instance of communication, along with others in this case study, may be reinforcing the idea that a "perfect smile" is healthier, potentially leading to unnecessary treatments. **Big Smile Dental.** What does one picture when reading the name "Big Smile Dental?" By cultural association, with smiles come feelings of happiness. Not only could this clinic be regarded as providing big smiles, but perhaps a lifestyle of smiles or of happiness. Big Smile Dental is located in the Logan Square neighborhood on Chicago's Westside. Logan Square is 32.4% White, 57.4% Hispanic, 6% Black, 2.4% Asian, 1.6% Mixed, and 0.2% Other, with a median household income of \$54,000. In a sociological analysis of today's culture, big lustrous smiles are sold in every way. Where Big Smile Dental does not use words to portray itself as the most luxurious place in the city, or a place where family is created, it capitalizes on big smiles. This proper name could be taken as influencing people's point of view by associating big smiles with this particular clinic. This communicative value may serve to attract new patients seeking a beautiful smile, however, this may be interpreted as an unethical capitalistic motives in healthcare exploiting the cultural ideal and

rendering this communicative value on the verge of ineffectiveness.

causing patients to seek more treatment than may be necessary.

The identity of the patient is important—it is part of their health and can be part of their treatment. These orthonyms contain lexical values that build rapport with the patient through a focus on the patient's identity. Whereas the identity of the patient is not to be neglected, it can also be understood that it should not be used to increase monetary worth through gathering a larger patient base. Listening to the patient and understanding their culture and backstory may be a more suitable

**7.5 Orthonyms that appeal to patient identity**

manner for connecting with the patient.

*DOI: http://dx.doi.org/10.5772/intechopen.93233*

**7.4 Orthonyms that refer to health outcomes**

treatments.

orthonym and appealing to the vanity of the surrounding community. Within the communicative maxims it may not be effective; causing the patient to wonder what treatments are offered has the potential to lead to maleficence.
