Ethical Practices of Dentists in Raichur City and its Implications in Indian Set-up

Headnote

Abstract

Aim: Ethics is a way to a disciplined practice. Though ethical rales for professional conduct have been in place in India since a long time, not many seem to be aware of the importance it holds and there is no adherence to the rales by and large. The present article was aimed to study the unethical practices by dentists of Raichur City.

Material and methods: A cross-sectional study was conducted in 38 functioning dental clinics in Raichur city, to assess the violation of ethical norms by the practitioners.

Results: It was observed that 37 (97.37%) of the dental clinics had violated the rales set by DCI. An overall 89.47% and 86.84% of the dental clinics had large and coloured signboards respectively, while 52.63% had attractive pictures on their signboards. A total of 13.16% of the dentists had mentioned additional qualifications apart from their academic qualifications and 26.32% of the dentists had mentioned additional captions on their sign board.

Conclusion: This paper enumerates the background on the ethical rales of dental practice put forth by the DCI and the practical implications of it. Also there is a need felt, to amend old rales and help in adaptation and adherence to the newer changes as per the need of the hour.

Keywords: Code of conduct; dental clinics; practitioners; unethical practices; DCI.

Introduction

The dental profession holds a special position of trust within society.1 Ethics is a way to a disciplined practice.2 Ethics is defined as the moral principles that govern a person's behaviour or the conducting of an activity.3 The word moral is concerned with or derived from the code of behaviour that is considered right or acceptable in a particular society.4 Ethics is primarily a matter of knowing, while morality is a matter of doing.2

The codes of ethics are a set of principles of professional conduct, a bench mark to which the dentist must aspire when fulfilling their duties to their patients, public, profession and colleges. It promotes ethical conduct, professional responsibility and facilitates dialogue on common problems on dental practice.5

In India, in exercise of the powers conferred by section 17 Aofthe Dentist Act, 1948 (16 of 1948), the Dental Council of India (DCI) made regulations for laying down standards of professional conduct and etiquette or the code of ethics for dentist.6 There is a significant geographic imbalance among dental colleges and a great variation in the dentist to population ratio in rural and urban areas.7 The dentist population ratio in India is 1:12948.8

Crowding of dentists in cities leads to unhealthy competitions and commercialization leading to the violation of code of conduct put forth by each state dental councils.9 Many dentists complain that industry competition has allowed a degree of commercialization to enter dentistry, which risks undermining the ethical standing of the profession. In a questionnaire study conducted by Dable et ah, throughout 8 metropolitan cities in India, 423(56.02%) out of 1500 dentists were in favour of advertising their services.10

With passing time there has been a gradual decline in the moral values of workforce, with the majority of the work force concentrating on making money.7 If ever any dentist commits a breach of these norms, the Registrar of the State Dental Council could initiate an action under section 44 of the Dentist's act 1948.6 Since 1976 these ethical rales have not seen any change.

Raichur city is a municipal council and district administrative head quarter of Raichur district with a population of 2,34,073 as per the 2011 census.11 There are 38 functioning dental clinics in Raichur city ran by either BDS or MDS practitioners and 2 dental colleges.

The objectives of the present study was to assess the amount of violation of the code of conduct by the dental clinics with respect to the certain clause of unethical practices as laid down by the Dental Council of India.

Material and methods

A cross-sectional study was conducted on 38 functioning dental clinics in Raichur city. The data was collected by means of survey of the dental clinics with respect to the size and colour of the signboard, additional qualifications other than academic qualifications mentioned by the dentist, additional captions and pictures on the board as per the clause k, 1, p and q of the DCI code of unethical practices respectively.6 An informed consent was obtained from the dentists ofthese 3 8 functional clinics.

As per the DCI, the following clauses shall be the unethical practices for a dentist, namely:6

Clause a: Employment of a dentist in his professional practice of any professional assistance (not being a registered dental hygienist or a registered dental mechanic) whose name is not registered in the State Dentists Register, to practice dentistry as defined by clause (d) of section 2 of the Act.

Clause b: Styling by any dentist or a group of dentists his/ their 'Dental Clinic' or Chamber/s by the name of "Dental Hospital/s".

Clause c: Any contravention of the Drags and Cosmetics Act, 1940(23 of 1940), and the rales made there under as amended from time to time, involving an abuse of privileges conferred there under upon a dentist, whether such contravention has been the subject of criminal proceedings or not.

Clause d: Signing under his name and authority any certificate which is untrue, misleading or improper, or giving false certificates or testimonials directly or indirectly concerning the supposed virtues of secrete therapeutic agents or medicines.

Clause e: Immorality involving abuse of professional relationship.

Clause f: Convincing at or adding in any kind of illegal practice.

Clause g: Promise of radical cure by the employment of secret methods oftreatments.

Clause h: Advertising, whether directly or indirectly, for the purpose of obtaining patients or promoting his own professional advantage.

Clause i: Acquiescing in the publication of notice commending or directing attention to the practitioner's skills, knowledge, service or qualifications, or of being associated with or employed by those who procure or sanction such advertising or publication through press reports.

Clause j: Employing any agent or canvasser for the purpose of obtaining patients; or being associated with or employed by those who procure or sanction such employment.

Clause k: Using or exhibition of any sign, other than a sign which in its character, position, size and wording is merely such as may reasonably be required to indicate to persons seeking them the exact location of, and entrance to, the premises at which the dental practice is carried on.

Clause l: Using of sign-board larger than 0.9 m by 0.6 m and the use of such words as 'Teeth', painless Extraction' or the like, or notices in regard to practice on premises other than those in which a practice is actually carried on, or show cases, or flickering light signs and the use of any sign showing any matter other than his name and qualifications as defined under clause (j) of section 2 ofthe Act.

Clause m: Affixing a sign-board on a Chemist's shop or in places where the dentist does not reside or work.

Clause n: Insertion of any paragraphs and notice in the press and also the announcement of names in the trading lists and the display of their names or announcements at places of public entertainments; other than the change of his address.

Clause o: Allowing the dentists name to be used to designate commercial articles such as tooth paste, tooth brush, tooth powder, liquid cleaners, or the like or on circulars for such items, or permitting publication of his opinion on any such items in the general or lay papers or lay journals.

Clause p: Mentioning after the dentist's name any other abbreviations except those indicating dental qualifications as earned by him during his academic career in dentistry and which conform to the definition of 'recognized dental qualification' as defined in clause (j) of section 2 ofthe Act, or any other recognized academic qualifications.

Clause q: Using of abbreviations like (i) R.D.P. for Registered Dental Practitioner, (ii) M.I.D.A. for Member, Indian Dental Association, (iii) F.I.C.D. for Fellow of International College of Dentists, (iv) M.I.C.D for Master of International College of Dentists, (v) F.A.C.D for Fellow or American College of Dentists, (vi) M.R.S.H for Member of Royal society of Hygiene, etc., and the like, which are not academic qualifications.

Results

Of the 38 dental clinics, 11 (28.95) were mn by BDS (Bachelor of Dental Surgery) degree holders, while 27 (71.05%) were owned by MDS (Master of Dental Surgery) degree holders (Graph 1). An overall 37 (97.37%) ofthe dental clinics had violated the rales set by DCI (Table 1), with 34 (89.47%) of the dentists having a large sign board measuring greater than 0.6 m by 0.9 m, 33 (86.84%) ofthe dentists had a coloured board in their clinic, which is in clear violation of rales of DCI which state that the sign boards should not be more than 0.6 m by 0.9 m and should not be coloured. A total of 5 (13.16%) ofthe dentists had mentioned additional qualifications apart from their academic qualifications, 10 (26.32%) ofthe dentists had mentioned additional captions like, "Your partner in Oral Health", "Dentistry at its Best", "Family Dentist" and "Gold medallist" in examination and 20 (52.63%) of the practitioners had pictures on sign boards like smiling face, orthodontic brackets, root canal procedures and dentures. An overall 35 (92.1%) of the dental clinics had attractive symbols, pictures or wordings on the board.

Among the 11 BDS practitioners, 9 (81.82%) clinics had a large sign board and 8 (72.73%) clinics had a coloured board. 3 (27.27%) ofthe dentists had mentioned additional qualifications and 4 (36.36%) dentists had additional captions. 5 (45.45%) ofthe dentists had pictures on the sign boards. Only one (9.09%) dentist did not violate any of these rales.

Out ofthe 27 MDS practitioners, 25 (92.59%) clinics had large and coloured sign board. Only 2 (7.41%) MDS practitioners had mentioned additional qualification. Only 6 (22.2%) MDS practitioners had additional captions on their boards. 15 (55.56%) had pictures on the sign boards. There was no qualified MDS practitioners who did not violate the DCI rales for ethical practice (Table 2).

Discussion

Adhering to the rales is a sign of a disciplined professional attitude. A total of 97.37% of the dentists had violated the rales set by DCI in one way or the other and 89.47% of the dental clinics violated the rale with respect to the size ofthe board, which is higher than the findings of the study conducted by Sabarinath B et ah, in the Chennai city, who reported 69% ofthe signboards were large in size.9 A total of 35 (92.1%) ofthe dental clinics had attractive symbols, pictures or wordings on the board, greater than the findings of Sabarinath B et al., wherein 68% ofthe clinics had attractive symbols, pictures or wordings.9 It is possible that the rising competition could have been the compulsion that has led to the violation of the DCI rales. But on the other hand it is equally important for the service provider to make the public aware of the services being provided.9 A total of 13.1% of the clinicians had used other than academic qualifications on their signboards.

Since we covered only the Raichur city, the available numbers of practitioners were just 38. With this small number we cannot extrapolate our findings to all the regions. Such similar surveys need to be carried out to further evaluate the number of dentists who do not adhere to the code of professional conduct.

These codes of ethics were laid down four decades back. Since the profession as well as the marketing of the service providers to reach out to the masses has undergone a lot of changes, it is equally essential to modify certain codes. Also the DCI needs to keep a tab on such clinicians, since it could entice patients from other dentists, like cosmetic procedures, which may not at all be important to the individuals. In view of the same, the DCI, has directed for an amendment in the Code of Ethics Regulations, 1976.12

Conclusion

The study highlighted the violation of the dental code of ethics by majority of practitioners in Raichur. Ethical practice has been missing and a strong shift from quality to mass practice is being observed. It is upto the governing bodies like the DCI, to take appropriate steps including the earliest revision of its norms and its supervision of strict adherence. It is also the moral responsibility of the dentists to self monitor their activities.

Disclosure : The authors report no conflicts of interest.

References

References

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