From student to registered professional
Dental undergraduate training teaches many things; knowledge of dentistry and the associated practical skills is central to the ability to treat patients.Unfortunately there can sometimes be a temptation to rely solely on our skills and knowledge to provide the answers to every problem that comes through the surgery door.
After all, dental treatment is by its nature practical, so surely treatment problems and dilemmas have a clear practical solution?
Knowledge, skills, judgement and professionalism
Knowledge and clinical ability are just part of the picture.
Whilst patients undoubtedly value skill, competence and a personable and friendly manner, and these qualities are absolutely essential, they are only part of overall patient care.
Sound professional judgement is also required. Dentistry is not just the 'what and when', or even the 'how', but very much whether the treatment that can be done should be done at all.
Is it in the patient's best interests, and have those interests been prioritised over those of the dental team?
There is much dental (and medical) research evidence, as well as Dental Protection's own case experience, which indicate that a lack of professionalism (often demonstrated through poor communication) can result in legal and ethical problems for the dentist - even if the treatment itself is technically competent.
The ability and motivation to professionally judge a situation, and to act appropriately, very much defines the transition from student to dentist. The ability to make this transition successfully is an empowering experience for the dental graduate.
What makes a real professional?
Whilst knowledge and skill are relatively straightforward to teach, and to learn, professionalism can be more difficult to define and assess.
Professionalism is not simply a record of attendance or attainment as an undergraduate, or even looking smart, but very much an attitude of mind and ethical reasoning.
So what makes a dentist professional? Undergraduate teaching is very clear as to what are the standards of good judgement, and professionalism.
In addition, observing the behaviours and example of the undergraduate clinical teacher demonstrates the values that are expected.
Whilst dental training attempts to teach, and demonstrate, what professionalism looks like, the application of the concept is not always easy. Professionalism may not be popular with every patient; after all it could mean declining to carry out treatment that they want, because it is unsuitable. Being professional can also present problems in the early years of qualification when the graduate faces pressures, especially monetary ones, from patients or employers.
Doing the 'right' thing
Registration as a dentist creates rights and privileges as well as obligations. Those obligations will include handling pressure and demands from patients;
Why can't I have a crown, I've got the money? Why do you have to take that tooth out, isn't there another way?
It may be tempting, clinically and financially, to give in to such pressure in the belief that you are helping. Other colleagues or staff in the practice, may also encourage you to provide the treatment, but they will not have any responsibility if it goes wrong.
So what should be done in these situations? It may seem quite straightforward to simply refuse treatment if the treatment is not appropriate. But it is not always that easy. The dilemma may involve a number of factors. The treatment issues may not be immediately clear. Pressure from patients may indeed be in good faith. They really don't want to lose that tooth; who would?
This type of pressure can be difficult to handle, especially at the start of a career when there may be a strong desire to please people and gain approval. In these situations you should listen to your professional 'voice'.
The knowledge, skill and professionalism have already been taught. Professionalism can be activated by the experiencing your own sense of clinical responsibility. Although your experience may be lacking initially, simple logical decisions based on undergraduate teaching, as well as an ethical attitude of mind, will produce the correct solutions.
The following case illustrates the pressures that can face the dentist, and how to adopt a professional approach.
Being professional
- Distinguish unreasonable from reasonable patient expectations - patients have a whole list of expectations, both clinical and non-clinical. Hopefully they will be reasonable ones, but sometimes they are not. For example, an improvement in the colour or shape of teeth can be made for a patient but it is not necessarily a life changing transformation of appearance. If expectation cannot be achieved, then no matter what the patient's requests, the treatment should not be attempted. To go ahead in such circumstances is not acting professionally.
- Stick to the clinical decision - patients may want a procedure to be carried out, indeed they may be desperate and exert pressure, and offer considerable quantities of money, but that still does not, and cannot, change the clinical circumstances. If the treatment is not needed, or bound to fail, then it should never be carried out. The patient does not have the responsibility, the dentist does.
- Resist pressure from colleagues - colleagues may say, 'we always do those treatments' or 'we will do it if the patients really want it'. But if you as the dentist are unhappy with that view then it must be resisted. This can be just as challenging, sometimes more so, than resisting pressure from patients.
- Seek clinical assistance where necessary; knowing limitations - If the dentistry is clinically too difficult or demanding then refer on to a specialist. This is absolutely in line with General Dental Council guidance.
- Always seek ethical and legal assistance where necessary - even in a large surgery, with many colleagues, the dentist is mostly alone as far as professional responsibility is concerned. If a dilemma arises then seeking objective views and assistance from an indemnity organisation is both prudent and invariably reassuring.
- If in doubt, buy yourself some time - most dental treatment does not require immediate or emergency action. If there is uncertainty, then postponing the procedure so that it can be reflected on and assistance sought where needed, is the smarter option. If it does not seem the right thing to do then that feeling, again the professional voice, is usually correct. Waiting rarely does any harm.
- Use a mentor - many dentists find this helpful. The mentor may be a dental professional, but does not have to be. It can be useful if they come from beyond the immediate surgery environment.
The mentor's role can provide an objective view of problems to help find ways forward when dilemmas arise, but more than that it can assist the dentist to reflect deeply on their experiences.
Conclusion
Dental undergraduate training provides the skills, knowledge, judgement and professionalism to practise dentistry. However, the best patient care requires the clinician to adopt high standards of professional values and judgement, as well as technical expertise. Whilst professionalism is very much part of undergraduate education, the real test lies in applying it to difficult situations.
That ability comes from not just what is taught, but also from continuous self-reflection and listening to the professional voice within each of us. This is both empowering and central to maintaining professional competence. It marks the complete transition from student to dentist.