Year : 2013 | Volume
: 31 | Issue : 2 | Page : 61--62
Professionalism in changing times
Editor, Dean, People's College of Dental Sciences, Bhopal, India
N D Shashikiran
Editor, Dean, People«SQ»s College of Dental Sciences, Bhopal
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Shashikiran N D. Professionalism in changing times.J Indian Soc Pedod Prev Dent 2013;31:61-62
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Shashikiran N D. Professionalism in changing times. J Indian Soc Pedod Prev Dent [serial online] 2013 [cited 2020 Oct 21 ];31:61-62
Available from: https://www.jisppd.com/text.asp?2013/31/2/61/115695
The Dental council of India calls upon dentists to follow high ethical standards which have the benefit of the patient as their primary goal.
Ethics and professionalism are cut from the same cloth, a seamless garment. Both components are vital to give the dental profession guidance, and although both of them influence many decisions we take, they do have differing roles. Within the context of dentistry, the "must" represents a decision taken on minimum standards that dentists are expected to achieve for the safety of their patients, staff, and themselves. The "ought" represents the constant attempt to achieve more than is required: To realize our potentials. This is a concept which gets to the heart of professionalism - striving for the best when there are no external forces compelling you to do so. It follows from this that we can expect "must"-type regulations to be easy to formalize, rules that can be agreed upon and enforced. The "ought" is far harder to formalize in this way as it is dependent upon the individual. We can thus see, perhaps, why professionalism is not an easy word to define. When hearing the term "professional," we think of such terms as experienced, qualified, licensed, official, expert, masterful, polished, thorough, authoritative, and businesslike. It would seem that we qualify as professionals from that list, but why then are we losing the respect of public opinion?
There are undoubtedly numerous factors contributing to our decline in ranking, not the least of which is the explosion of advertising in the dental field. The obnoxious practice of drug companies giving costly gifts such as gold chains, cars, and foreign junkets to doctors causes further erosion of our self-preservation efforts, self-efficacy, and our ability to improve or even maintain our professional stature with the public we serve.
The Department of Pharmaceuticals has in place a code of conduct for drug companies to restrict such unethical practices, but it is voluntary in nature. Despite such codes, "the pharma companies continue to sponsor foreign trips of many doctors and shower them with high value gifts to oblige prescribers who then prescribe costlier drugs as quid pro quo." The voluntary nature of Uniform Code of Pharmaceutical Marketing Practices of the Department of Pharmaceuticals has failed to curb unethical practices and illegal promotion of drugs. Henceforth, the parliamentary standing committee on health has recommended that the health ministry should be involved in enforcing the code, along with the Department of Pharmaceuticals. It seems the pharma companies are worried about the new Medical Council of India (MCI) guidelines that restrict sponsorship for conferences and freebies to individual doctors. They think it is a big setback as it may interfere with doctors' education and knowledge! They have proposed new amendments and have asked the health ministry to advice the MCI accordingly.
The obvious difficulty with such a nebulous concept as professionalism is that if there is no obligation to strive for professional ideals, there will always be a minority who flout these ideals to such an extent that they may place patients and colleagues at risk of harm. Leaving professions to be fully self-regulated in the past has led to spectacular professional failures, and the changing demands of the public bring into focus the need to both strengthen the "must" in professional practice and discourage individuals lacking the "ought" from entering the profession to begin with.
Does it mean that we have to go back to the days of white coats and ties instead of the more practical and comfortable scrubs when we treat our patients? Give up the use of credit cards and financing options that are so necessary today? Stop the expanded use of auxiliaries and practicing under "General Supervision"? Hardly! What we must do is bring back the aura of care and professionalism that dominated our offices not that long ago.
There exist two models of dentistry, one as a profession and the other as a business. These two paradigms are incommensurate and decisions should be made as to which we are. Currently, the increased demand for improved aesthetics is pushing the dental profession further toward the business model, less helping those in need but more serving those who demand and can pay. There is a view, acknowledged within the profession, that the concept of the professional as guardian of a social contract is being displaced by "the notion of the professional as a purveyor of expert services." This is not to say that pursuit of business precludes acting in an unethical manner. Business ethics is a discipline in its own right. Given that almost 90% of the dental profession works in general dental practice, are dentists resigned to be no more than ethical business people? If a dentist wishes to do good for people, not much will be done if the practice becomes bankrupt. We cannot escape the fact that if business mentalities were to be ignored totally. It would be unethical if the dental profession did not make an appropriate use of resources, both human and financial. It will otherwise cease to exist. We can also defend a dentist who is both a professional and a business person on the grounds that keeping the business working well is part of the social corporate responsibility to the benefit of all the patients treated there. But at precisely what stage does this argument stop working? As soon as the dentist earns more than a subsistence income? The answer is not easy, but it can perhaps be summed up by which we value more: Money or patients.
Thus, it is our contention that a debate in dentistry as to the meaning and use of professionalism is needed, as already recognized by the medical profession. The framework in which our debate should occur is one in which we put patient interests at the heart of the practice of dentistry, define roles and standards more clearly, strengthen leadership, and explore relationships within and without healthcare. It will allow us to maintain integrity, striking the correct balance between the multiple and, sometimes, conflicting ends we seek, assess the professional potential of new applicants to dentistry, and train accordingly.