Relationship between dentists &patients  Core issues to construct positive relationship:  Would you like to be a professional & be recognized as one? When receiving a degree in dentistry; you officially become a participant in a profession…BUT…Not necessary being one  A professional: used to refer to one who practices a learned profession with special knowledge & skills to benefit the public regardless of personal gain.

Who is a professional???  Respects patients’ unique needs & values  Places patients’ interests first & foremost  Always considers patients’ values & relevant personal preferences  Has integrity  Is honest  Competent  Strives to improve personally & professionally  Actively supports professional organizations  Concerned about conduct  Ethical

 Key features of a professional:  Must possess an important & exclusive expertise  Must possess an internal & external structure.. Including a community of experts mutually recognizing each other’s expertise & institutionalization of this relationship in a formal organization  Dentistry as a profession is self-regulating (extensive autonomy in practice)  Membership implies the acceptance by the member of a set of norms of professional practice or obligations

 Ethics  Ethics: the moral principals or virtues that govern the character & conduct of an individual or a group… It is the systematic study of what is right with respect to character & conduct  Ethics seek to answer two main questions: o What should we do? o Why should we do it?  The object of ethics is to emphasize spirit (intent) rather than law Why ethics are important?  Ethics affect virtually every decision made in dental office  It includes activities of judging & choosing

 Ethics affect relationships with patients, office staff & other professionals  Ethics are linked to the numerous decisions you have to make as a dentist (straightforward decisions or more difficult ones). when ethics are ignored, you risk making unethical or less ethical decisions… this lead you to unethical conduct… which seriously compromises your service to patients & undermines your ability to function as a professional.  Codes of ethics: Dental organizations usually publish codes of ethical conduct to guide member dentists in their practice… (ex: the American Dental Association, since 1866).. It marks the moral boundaries within which professional services may be provided.

 Codes of ethics & professional guidelines have a quasi- legal force… non compliance can result in sanctions (from censure – losing professional status). Dentists professional characteristics  Dentists possess a distinctive expertise consisting of knowledge & skills for application  Dentists’ expertise is a source of important benefits for those seeking assistance  Due to their expertise; dentists are accorded extensive autonomy in their practice  Dentists have an additional obligation to the larger community so that the profession acts as it ought.

Do dentists have obligations to patients?? By agreeing to take part in the dentist-patient relationship, both accept certain obligations & duties : o Responsibility to disclose information related top this relationship o Dentist is obligated to respect patient’s privacy; maintain patient’s confidence; keep promises’ be truthful’ consider patient’s values & personal preferences in treatment decisions.

Eight categories of professional obligations:  Chief client: person or persons whom members of a profession committed to serve.  Ideal relationship is based on mutual respect & recognizing the other  Secure specific values related to dentistry for clients  Competence: maintain & acquire expertise necessary to undertake professional tasks  Relative priority of patients’ well being  Ideal relationships between co-professionals  Relationship between dentists & the larger community (non-professional groups)  Integrity & education

Business OR/ AND a profession  Chief motive to benefit mankind.. With financial rewards secondary…  As a profession..dentistry usually involves financial compensations for professional services…with some form of business structure to accommodate these transactions.  Both the patient & dentist being considered beneficiary  How to prevent conflict of interest to harm patients???.. Financial gain must NEVER be a consideration in any dental recommendations

What do we mean by “the best interest of patients”??? Professional decisions by dentists must consider patients’ values & personal preferences… This requires careful communication with patients & listing to them.. Involve them in the treatment (inform them about possible complications; alternative treatments; advantages Vs. disadvantages; coasts)

 Access to dental care Care should be provided, within reason, to all seeking treatment..Reasons to refrain from providing treatment: (no expertise or ability to provide competent treatment; injury; patient requests treatment contrary to his best interest)  Advertising Advertising may help people better understand the dental care available & how to obtain it… Should not be misleading  Child Abuse Dentists to detect certain acts of child abuse…& report it to appropriate authorities.. Suspicious incidents require documentation & carful investigation

 Competence & judgment Important: Continue to advance..develop your knowledge & skills…participate in continuing education activities; strengthen your clinical competencies; be familiar with clinical developments; Know the boundaries of your competencies (abilities & limitations).. Even the best clinical abilities are misused if employed with unsound judgment  Confidentiality Nothing to be revealed to anyone else without the patient’s permission.. This is outweighed by the reduction of risk of infection for parties involved

Exceptions may include: other professionals required to provide effective care; relevant personnel (ex: record keepers); relevant facts may be communicated to students for educational purposes.  Emergency care Addressing acute dental conditions by examining, treating Or referring to treatment  Abuse of prescriptions by patients Dentists must be aware of patients’ legitimate needs for prescription drugs…BUT..in case of suspected drug use.. Dentists have a responsibility to refer patients for evaluation & cooperate with appropriate governmental and law enforcement agencies..

 Financial arrangements Fees & payment options should be fair to all patients Dentists should not vary fees solely on the patient’s financial resources… Fees & payment options should be disclosed to patients & agreed upon prior to any treatment  Harassment Dentists must avoid conditions or actions that promote harassment or abuse staff; patients or other related parties

 Dental Decision Elements Assessing medical & social context Good ethics begin with good facts Clarifying ethical problem What type of conflict is present, moral weakness, moral uncertainty or moral dilemma?; what is the nature of choices involved? Who will make the decision? Determining the stakeholders Identifying options & alternatives (some choices involve comprise of some moral principle others may not) Examining the process of decision making: involve collaboration& partnership

Balancing conflicting principles & obligations  Why does communication sometimes fail in the dental practice???  Communication is a complex process.. Patients will be able to respect & trust their dentist only when they get his message without any confusion.  Steps to communicate successfully & effectively with patients: o Wide spectrum of learning styles: when patients use statements such as: ‘’ I see what you mean’’ Or ‘’ I hear what you’re saying’ Or ‘ I know how it feels’.. Then you are on the right track.. You are getting the message across.. Most people are more responsive to images, diagrams & handouts

o Adaptable approach to different personalities: Most patients can be classified into four personalities:  Analytical: take a lot of time to convince.. They will not buy anything until you back it up with sound logic. Not emotion driven, highly organized & focused (Systematic)  Drivers: very assertive. They tell you exactly what they expect from you.  Amiables: warm & genuine personalities. Emotional. Will not get into a confrontation with you, will ask you a lot of questions  Expressives: the most responsive among all groups. They like to form a healthy relationship with the dentist. They like to know you at a personal level.

 Block in communication The basics of communications rest on three things: o The sender of the message o The actual message o the receiver Any block or obstruction in this process can create disharmony in the dentist-patient relationship  Dentists may use the word motivation to describe their patients non-compliance with recommendations.  Motivation refers to lack of understanding; apparent inability to listen or to change their health behaviors.

 The role of the dental health professional to assist patients to attain & maintain their oral health..to do so, they must free themselves from preconceptions or previous experiences.  Most health professionals use the advice form, given usually in the form of knowledge assuming that this will modify attitudes which will result in behavior change. Patients hear the advice as critical & intrusive..patients resist change..dental health professional sensing his words is being ignored feel that his work was a wast of time..

 How dentists enable patients to adopt & maintain preventive health behaviors??? Strategy must incorporate some means of providing information other than advice giving Information must be presented to patients in a way they’ll feel its importance & ownership Rather than a prescription for some dreadful medicine Bringing about lasting & effective changes in health behaviors is not about being prescriptive but is about participation