Attitude of Dental Practitioners Towards their Colleagues: A Justifiable Criticism
Ravishankar T.L.1, Tasneem S. Ain2, Vaibhav Tandon3, Owais Gowhar4
1 Associate Professor, Public Health Dentistry, Kothiwal Dental College and Research Centre, Moradabad, India.
2 Postgraduate Student, Public Health Dentistry, Kothiwal Dental College and Research Centre, Moradabad, India.
3 Postgraduate Student, Public Health Dentistry, Kothiwal Dental College and Research Centre, Moradabad, India.
4 Postgraduate Student, Oral and Maxillofacial Pathology, Kothiwal Dental College and Research Centre, Moradabad, India.
NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Dr. Tasneem S. Associate Professor, Public Health Dentistry, Kothiwal Dental College and Research Centre, Moradabad, India.
Phone: 08171621079,
E-mail: khantasneemdr@gmail.com
Aim: A cross-divtional, questionnaire based study was conducted in Moradabad, U.P., India to assess the attitude of dental practitioners towards their colleagues.
Materials and Methods : Eleven-item, close-ended, validated questionnaire was formulated. The responses of 60 registered dental practitioners were recorded.
Results: Majority of the respondents were well versed with ethical obligations towards their colleagues but only few of them were aware of all the principles mentioned in Codes of dental ethics, DCI, India.
Conclusion: Dentists face ethical problems/dilemmas while dealing with their duties towards colleagues and their patients. Adopting of ethical ways in practice was independent of gender, qualification and experience of practice. It is recommended that dental ethics should be emphasized upon during the formative years of dental education.
Introduction
Every Profession that deals with human rights and liberties eventually develops a professional code of ethics to guide the responsible behavior of its members. In dentistry, many Principles of Ethics and Code of Professional conduct have been developed by the Dental Councils to express the obligations and duties of dentists towards patients, their colleagues and society as a whole.
Until 1970s, dental codes of ethics precluded criticism of another dentist’s treatment publicly or to the patient. From about that time the term ‘Justifiable criticism’ or notification of gross and continual faulty treatment were introduced by American Dental Association (ADA) in 1975 [1]. Contemporary codes of practice, direct dentists to provide all necessary information but to refrain from disparaging other dentists publicly or to the patient [2].
Inspite of the set codes of ethics, the dentists face the dilemmas in fulfilling their duties and obligations. Hence they tend to flout all norms and guidelines due to which the entire profession may suffer.
A very few studies have been conducted in India regarding this issue, so a questionnaire based study was conducted in Moradabad, India, to analyze the attitude of dental practitioners towards their colleagues.
Materials and Methods
A cross-sectional questionnaire based study was conducted in Moradabad, U.P., India to assess the attitude of dental practitioners towards their colleagues and profession. The response to the 11-item questionnaire was assessed on a five point Likert scale. The Cronbach’s Alpha was used to assess internal reliability of questionnaire. Out of 93 registered dentists, 60 willing participants were given the questionnaire. The duly filled self- administered questionnaires were collected from the participants the next day.
Results
Descriptive statistics was conducted for all the responses to the questionnaire [Table/Fig-1]. The comparative analysis of responses based on gender, qualification and experience of practice, was done using Chi-square test after dichotomizing the responses [Table/Fig-2]. Statistical significance was set at p-value ≥ 0.05.
Percentage of Dentist According to 5 Responses (5-Point Likert Scale) to Questions
| Strongly disagree | Disagree | Neither agree nor disagree | Agree | Strongly agree |
---|
Comment on the treatment procedure of other dentists, unnecessarily | 3 (5%) | 4 (6.66%) | 2 (3.33%) | 16 (26.66%) | 35 (58.33%) |
Criticizing others dentists on personal grounds | 0 (0%) | 0 (0%) | 1 (1.66%) | 16 (26.66%) | 43 (71.66%) |
Reporting to the judicial body, the excessive faulty works done by colleagues. | 12 (20%) | 18 (30%) | 14 (23.33%) | 13 (21.66%) | 3 (5%) |
The financial dealings of the dentist should not be disclosed to the patients. | 1 (1.66%) | 2 (3.33%) | 4 (6.66%) | 25 (41.66%) | 28 (46.66%) |
A dentist should give more importance to his obligations towards patients or maintain cordial relations with his colleagues | 3 (5%) | 6 (10%) | 11 (18.33%) | 25 (41.66%) | 15 (25%) |
Are you aware of the dental code of Ethics, DCI ? | 0 | 30 (50%) | 12 (20%) | 18 (30%) | 0 |
Comparison between Responses among Gender, Experience of Practice and Qualification
Chi-square test at p ≥ 0.05
| Gender | Experience | Qualification |
---|
Male | Female | Practicing ≥ 5 Years | Practicing >5 Years | Master’s Degree | Bachelor’s Degree |
---|
The last option for a dentist receiving excessive faulty works done by his/her colleague is to report to a judicial body, about the same. | Agree | 12 (24%) | 4 (40%) | 8 (22.85%) | 10 (34.48%) | 10 (30.30%) | 6 (22.22%) |
Disagree | 29 (58%) | 1 (10) | 16 (45.71%) | 17 (58.62%) | 14 (42.42%) | 16 (59.25%) |
p-Value | 0.024 (SS) | 0.782 (NS) | 0.305 (NS) |
A dentist should give more importance to his obligations towards patients than maintaining cordial relation with his colleagues. | Agree | 35 (70%) | 5 (50%) | 23 (65.71%) | 20 (68.96%) | 18 (54.54%) | 22 (81.48%) |
Disagree | 8 (16%) | 1 (10%) | 5 (14.28%) | 3 (10.34%) | 7 (21.21%) | 27(40%) |
P-Value | 0.908(NS) | 0.638 (NS) | 0.075(NS) |
A dental practitioner should tactfully discuss with the patient work done by his/her colleague without criticizing the other dentist. | Agree | 44 (88%) | 7 (70%) | 29 (82.85%) | 26 (89.65%) | 29 (87.87%) | 22 (81.48%) |
Disagree | 2 (4%) | 1 (10%) | 2 (5.71%) | 2 (6.89%) | 1 (3.03%) | 2 (7.40%) |
P-value | 0.35 (NS) | 0.91 (NS) | 0.42 (NS) |
Discussion
Ethics is a fundamental part of dental practice and is generally applicable across national boundaries in similar ways. According to the FDI International Principles of Ethics for dental profession, the dentists should act in a manner which will enhance the prestige and reputation of the profession [3].
Majority of the respondents agreed that a dentist should not comment unnecessarily on the treatment procedures of other dentists or on personal grounds. These responses are in agreement with the Code of Ethics, Regulations,1976; DCI, India, wherein it is mentioned clearly that ‘every dentist shall cherish a proper pride in his colleagues and shall not disparage them either by actions, deeds or words’ [4]. Similar code is mentioned in ‘Handbook of New Zealand’, under section ‘Responsibilities to colleagues’ [5].
About 26% of the respondents feel that the last option for a dentist receiving faulty works done by his/her colleague is to report to a judicial body about the same. This response corroborates with the General Guidelines; ADA, Council on Dental Practice, Revised June 2007, under section ‘Justifiable Criticism’; wherein it is mentioned that “dentists shall be obliged to report to the appropriate reviewing agency as determined by the local component or constituent society, instances of gross or continual faulty treatment by other dentists” [6]. Similar statement is mentioned in ‘Alberta Dental Association and College’, code of ethics, Article 3, under section; ‘Unprofessional Conduct’ [7].
Majority of the respondents believe that dentists should not disclose their financial dealings to the patients. This is in contrary to the Code of Ethics (Alberta Dental Association and College); wherein it is mentioned that “a dentist who refers patients to laboratory, radiologist, diagnostic or other professional service facilities, separate and apart from dentist’s office, who has direct or indirect financial interest in such facilities, shall disclose that interest to their patients in advance of such referral” [7]. This issue about the referral and financial understanding has been least addressed in other codes of ethics.
18.3% of respondents are in a dilemma whether a dentist should give more importance to his obligations towards patients or maintain cordial relations with his colleagues. Actually the response to such situations depends upon the severity of the problem. Making mistakes is inevitable in dentistry, but dentists should try to rectify their mistakes rather than continuously repeating the same (wrong/unethical procedure). If the dentist is continuously doing the faulty procedures then it falls under ADA’s Code of ‘Do no harm’ and also under many other ethical codes; wherein it is mentioned that the rating of such dentists is essential in order to safeguard the patients health benefits [8]. But, professional associations believe that it is preferable to deal internally with substandard work [3].
Majority of the dentists agreed that a dentist should tactfully discuss the work done by his/her colleague with patients. This attitude of the dentists is in line with the General Guidelines for referring dental patients, ADA council on dental practice, Revised June 2007; section ‘Advisory Opinion’ wherein it is mentioned that “a difference of opinion as to preferred treatment should not be communicated to the patient in a manner which would unjustly imply mistreatment”.6
When responses of the dental practitioners was compared based on gender, qualification and experience of practice, it was found that the difference between the responses was not statistically significant which indicated that the adopting of ethical ways in practice was independent of the variables.
Only 30% of the dentists were aware of the code of the dental ethics (DCI,India) This might be due to less emphasis given for ethics during formative years of professional learning.
Conclusion
Few practitioners are unaware of the ethical obligations in their day to day practice, so it is recommended that dental ethics should be included and emphasized upon, in curriculum. CDE programs on ethical practice should be regularly conducted for dental practitioners by the respective associations. Moreover, the regulatory bodies should be stringent during their monitoring processes and take strict actions over the unethical practices.
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