Personal conduct

The most important of these is the fact that members of the general public must have confidence and trust in whatever a healthcare professional tells them.

Honesty, integrity and fairness form the cornerstones of accepted professional and personal behaviour.

Personal conduct was defined by Lord Steyn during the course of a medical case over which he was presiding, as 'Performance or behaviour of practitioners due to factors other than those associated with the exercise of medical or dental skills.'

In other words it is those activities beyond the purely clinical task of dealing with the oral tissues. It concerns both personal behaviour and a prevailing state of mind.

We all have to accept responsibility for our actions and the same action can be judged differently according to the degree of innocence or premeditation attaching to it. The person who fires a gun during target practice and accidentally hits a passer by is not subject to the same punishment as the man who knowingly points the gun and fires it at a passer by. The result may have been the same, but the state of mind was not.

What is unacceptable?

It may be easier to visualise the rather nebulous concept that we might call personal conduct, by listing behaviour that would not be considered acceptable rather than creating the much longer list of that which is. Unacceptable conduct is essentially any form of behaviour which would be obvious to almost anyone as being wrong. In other words, 'no reasonable person would expect to be forewarned that the behaviour is wrong'.

Very often a young dentist will take the view that their personal life is just that - personal and not linked to their professional life. It may not always be obvious why something which happens beyond the confines of the surgery and outside surgery hours, should still impact on your professional life. A little clarity emerges if you can accept that the separation between these two worlds can never be mutually exclusive. There is often a degree of overlap, which knows no boundaries, particularly so with communications using email and the Internet. As a result, personal conduct can rapidly affect your credibility as a professional person and also your integrity, in the eyes of colleagues and the general public who may now come to hear about the way that you conduct your life through a variety of different channels.

It would be foolish to ignore the fact that dentists are governed by the ethical code of their regulatory body (Dental Council or Dental Board). Such codes can be considered as the basic principles that will guide behaviour throughout a professional career.

Expectations of statutory bodies

Dental Boards and Councils are particularly concerned about aspects of behaviour which reflect adversely on the profession as a whole; such as dishonesty, indecency, or violence. They would normally take the view that this type of behaviour is inherently disreputable and likely to bring the profession into disrepute or to undermine public confidence in the profession. All registered members of the dental team should always be in a position to justify the trust which has been placed in them. This is a small burden that comes with the many advantages and privileges of having a professional status.

In terms of moral responsibility the healthcare professional is always accountable for their actions both in and out of the surgery. This requirement applies to all manner of behaviour and we have already considered some of them in earlier modules in this series and we will not repeat them here;
Professionalism and integrity (3), Respect and tolerance (7) and Honesty (6).

There are other activities that often start within a social context possibly for amusement or fun, but which are not always easy to distinguish as being unprofessional at the time either because of peer pressure ('don't be such a wimp') or the use of drugs (alcohol as well as substance abuse). It is only with hindsight that you may realise that you have overstepped the mark.

Alcohol

For those who do not drink alcohol, the following comments may seem redundant, although they will undoubtedly have a resonance with situations that they have come across. Indeed small quantities of alcohol have served to lubricate the wheels of social interaction since the earliest civilisations. This drug is freely available and perfectly legal throughout most of the developed world. Its ability to release inhibition can be useful in a social setting but its ability to affect the central nervous system and impair judgement is where the risk lies for the professional person.

"Character is like a tree and reputation like its shadow. The shadow is what we think of it; the tree is the real thing"

Abraham Lincoln (1809-1865)

You may say something inappropriate

• Drunken behaviour can be offensive and lead to violence


• Driving whilst intoxicated can result in accidents


• Working whilst intoxicated can put patients at risk and it suggests a disregard for their well-being.

Whilst this is not a comprehensive list it does demonstrate some of the situations in which the conduct of a professional person would be judged unacceptable by a variety of agencies including the police, employers and any Board or Council with which they are registered.

Substance abuse

'Recreational drugs' is a polite phrase that covers a variety of substances that are proscribed by society. The availability of substances like cocaine, marijuana, ecstasy and heroin and their tacit acceptance in some circles does not make it acceptable behaviour for professional people to adopt.

Students in particular are encouraged to challenge accepted principles. They might experiment with drugs including alcohol, perhaps as an extension of their self-expression and autonomy.

Most students enter dental school around the same time as reaching adulthood, and may be living away from parental supervision for the first time. What is often forgotten is the fact that medical and dental faculties are usually required to provide a good character reference for each student at the time they graduate, before they can register and start practice. Clearly any past history relating to substance abuse or excessive alcohol consumption would make it difficult for the faculty to give such a reference.

"Integrity is telling myself the truth. And honesty is telling the truth to other people"

Spencer Johnson Physician and writer (1938)

Social responsibility

We all have an individual responsibility to society. That responsibility can be 'negative' in that it is a responsibility to refrain from acting, or it can be 'positive', meaning a responsibility to act.

We have already established that alcohol and other drugs can result in behaviour that is irresponsible.
We have mentioned the risks associated with drink/driving which can cause damage to life and limb but the same impaired judgement that might persuade you to get behind the wheel can lead to acts of vandalism and even the temptation to do something criminal. Such activities are unprofessional and naturally something that we refrain from doing. If we forget this, we do so at our own peril. Sometimes this can be hard to remember when tempted by an action that might even seem insignificant (removing a road sign or other souvenirs from a weekend away or smuggling an item through customs). Sometimes the temptation may be misguidedly considered as self-preservation - such as leaving the scene of an accident.

Positive social responsibility

This concept requires the professional person who observes such forms of socially irresponsible behaviour to report it rather than to 'turn a blind eye'. A similar ethical response prompts a 'good Samaritan' act when you come across an individual in distress (eg. collapsed in the street). Not to respond in such circumstance would certainly be selfish and might even be considered socially irresponsible.

Criminal acts

Premeditated criminal acts can be driven by a variety of factors and none of them are compatible with any registered professional standing. Whilst the legal system may impose its own penalties it is then left to the regulatory bodies to decide whether or not to remove your professional status, but by now we have gone well beyond anything that might be recognised as professional conduct. Indeed from an ethical standpoint such behaviour is also immoral.

Morality

Sometimes defined as 'a code of conduct created by society', this definition of morality differs somewhat from the legal definition, in that the Law is more specific about rules and penalties, as well as the way in which those rules and penalties should be applied and by whom. But the Law can only embody some of the ethical values adopted by society. Some ethical concepts only have embodiment within a moral code that is dependent on self control and self regulation.

So how does this fit with the commonly held view, 'Everyone else is doing it - it must be OK.'

Consider the example of an insurance fraud. We can probably all think of individuals who have made an insurance claim for damaged baggage or a lost camera at the end of every holiday. The argument often is: it's not a lot of money, the insurance companies can afford it, everyone else is doing it...

So what's the problem?

Firstly, it is dishonest to claim that a camera has been lost or that baggage has been damaged in transit when it has not! It is also a criminal offence to make a false statement in an attempt to make a financial gain. Secondly, it is immoral that one person's gain is made at the expense of others; future insurance premiums are likely to increase for all the honest insurance policy holders.

Moral complicity

A person is morally complicit if they participate in, or are culpably associated with wrongful acts. In other words, they assist another person in an act which they know to be wrong. This might involve assisting someone to make a false statement or providing a false alibi for another person.

A friend of a dentist was in trouble because he had taken unauthorised absences from his workplace. He then approached the dentist to ask him to provide a fairly elaborate alibi. The dentist was asked to confirm that his friend had been unable to attend work because he had taken the dentist's young child to hospital for emergency treatment following an accident in the home. This of course was a total fabrication.

However, the dentist wanted to help his friend; he knew that he had financial difficulties and could not afford to lose his job. So the dentist provided a false statement to provide an alibi for his friend. This of course was easily disproved and the dentist then found himself facing greater sanctions than his friend. He tried to argue that he had acted in 'good faith' and that no one had been harmed. The Dental Council took a very different view.

If you are ever in doubt about this sort of situation, ask yourself this question - would a reasonable person reviewing the facts of this situation think that I am about to do something dishonest? If the answer is 'yes', don't do it. A professional person should also ensure that they avoid any appearance or suggestion that they might be acting inappropriately.

Public expectation

Behaviour considered acceptable in (say) a footballer or a pop star would often be unacceptable in a dentist. For example a footballer will sometimes commit a 'professional foul' in an attempt to stop an opposing player advancing further towards the goal. A pop star may act drunkenly on a plane and cause the pilot to divert to protect the safety of his passengers. These types of behaviour are often reported in the media along with comments along the lines of, 'What can you expect... that's how they behave'.

Certainly no dentist would be expected to behave in that way. Just imagine the media frenzy if a dentist was to act so inappropriately as to cause a flight to be diverted to protect the safety of the other passengers.

Three examples of poor personal conduct

1) A dentist was frustrated and disillusioned with practising dentistry and felt that there must be a better way. Like many of his colleagues he had obtained an insurance policy which would compensate him if he was physically unable to practice dentistry.

He needed to be sufficiently impaired that he could not practice dentistry - but well enough to enjoy life. He felt that he could spare a finger!

He decided he could justify the claim in two ways;

• claiming that the loss of the finger had occurred in a Road Traffic Accident


• claiming that he could then no longer practice dentistry.

Being a good clinician he was able to administer local anaesthetic before he amputated his own finger with an axe! He then faked a road traffic accident and attempted to convince his insurers that the finger had, in fact, been severed in a car crash. He claimed a significant sum from his insurers.

"Many a man's reputation would not know his character if they met on the street"

The insurers investigated the facts as a matter of routine. Sadly, the dentist had failed to consider the forensic evidence, which showed 'the shape of the cut on his index finger, the level of local anaesthetic in his blood and the absence of skid marks on the road'. In combination these facts indicated that the dentist's statement was false and so was his claim.

The insurers brought legal action against the dentist for making a false claim.
As well as the large fine, the dentist also received a six-month jail sentence. He then faced the sanction of his Dental Council.

2) As is sometimes the case, a government decided to privatise what had been a public utility. This meant that shares in the utility would be offered for sale to the public for the first time. Expecting a good response and wanting to make the system as fair as possible, applications were restricted to one application per person for a maximum of 400 shares.

A dentist was keen to purchase shares but felt that she would need very many more than 400. As she sat in the surgery thinking he decided that she could obtain application forms and make multiple applications in the names of her many patients providing the patient details and her own surgery address. She then made multiple fraudulent applications for shares. Not surprisingly this was very quickly detected and she was found guilty of forgery - of the many signatures - and of fraud.
As in the previous example this dentist received a large fine, a jail sentence, and then faced the sanction of her Dental Council.

3) Dentists are also members of the general public and sometimes subject to the same personal weaknesses. A dentist became obsessed with a female who worked in a local shop. He spoke to her personally, telephoned her and wrote inviting her to seem him socially. Unfortunately his attentions were not at all welcome and his advances were rejected.
However, the dentist did not accept that his attentions were unwanted. He started to wait outside the shop for the lady to leave. He then followed her home, standing outside her house each night until all the lights went off.
This behaviour continued day after day. Eventually the victim contacted the police and the dentist was found guilty of harassment and stalking. The dentist argued that he had no idea that he was harassing the victim.

The question the general public would ask is, 'would a reasonable person feel harassed in a similar situation to that of the victim?'
Add into the mix the earlier definition of personal misconduct, 'no reasonable person would expect to be forewarned that the behaviour is wrong' and you can appreciate the difficulty with this behaviour.

In addition to that, harassment and stalking are criminal offences in some jurisdictions. Regardless of whether the harasser was a dentist or a member of the general public he should have realised his behaviour was wrong.

Is public expectation of a dentist's personal conduct greater than for a member of the general public?

We have already established that all registered professional people are also members of the general public. In the following situation, imagine that the driver of the car was a member of the general public and not a dentist.

It's late at night. A young female borrows her older brother's highpowered sports car. She is not insured to drive it; in fact she's not allowed to drive it! She picks up a friend and drives to a party. They have some drinks. They jump back into the sports car - there's much loud music and laughter and they are driving at great speed!

Suddenly, the young female driver loses control of the car on a bend. There's a horrific crash into a tree. In the force of the collision the friend is projected through the windscreen and lies terribly injured on the ground.

The young female driver looks for her mobile phone and considers calling the emergency services. Then she remembers it's not her car, she has no permission to drive it, and she's not insured. So she runs away, leaving her friend lying injured.

About an hour later, a passing motorist stops and summons the emergency services. The injured friend has unfortunately died of her injuries by then. Of course the young female is later identified as having been the driver of the car when they left the party. During the ensuing court proceedings it becomes clear that the friend had a very high chance of survival had medical assistance been provided at an early stage.

The public view is that this is appalling; abandoning an injured friend and allowing them to die. Morally we are responsible not only for our own actions, but also for any omissions and the consequences thereof.

When the public learns that the young driver in this case is a dentist, then the situation is compounded. A dentist is expected to have a much higher standard of personal conduct by way of general behaviour (not to have put themselves in that position in the first place) and moral behaviour (to do the right thing). A dentist should never place another human being at risk in order to protect himself/herself.

The conclusion is clear; the public expectation of personal conduct is actually much higher if the person has a professional career and particularly if they are a dentist. You always need to ask yourself; would a reasonable person knowing the facts, think that I am acting appropriately?

"Character - the willingness to accept responsibility for ones own life - is the source from which self respect springs"

Joan Didion Author (1934)