Mixed perceptions

Two GDC surveys find that patients take a harsher view of professional misconduct than those in the dental profession but are more tolerant when it comes to personal behaviour. Andrew Collier examines the figures

10 August, 2018 / featured

Professional Conduct

Dental patients generally want to see harsher sanctions imposed against members of the profession who are guilty of clinical misconduct than practitioners themselves, according to two comprehensive new studies.

However, in the main, patients tend to seek a more lenient outcome in cases of personal misconduct – in other words, incidents that have nothing to do with their dental care – than dentists feel is appropriate.

The findings come from the Final Report of the General Dental Council’s Registrant Survey 2017-18 and the GDC Public & Patient Survey 2017-18. The registrants survey, issued to a random sample of 36,000 registrants, elicited more than 6,200 responses.

Research was carried out by quantitative means through an online survey as well as using the qualitative methodology of focus groups and in-depth telephone interviews.

Respondents were presented with a series of different potential scenarios involving misconduct by a dentist or dental nurse. They were then asked what sanction should be imposed in that particular situation.

The options were no action; a reprimand, leaving the professional free to practice; conditions such as agreeing to further training or taking steps to improve; suspension for a set period of time; or the ultimate step of being struck off the register.

In the hypothetical scenario of a dentist or dental nurse posting racist comments on their personal Facebook page – a case of personal rather than clinical misconduct – four per cent of dentists felt no action should be taken.

A total of 33 per cent felt there should be a reprimand, 18 per cent conditions imposed, 25 per cent suspension and 14 per cent striking off.

Among patients and the public surveyed, a significantly larger percentage – 13 per cent – felt no action should
be taken.

If a dental nurse were involved, in some categories the figures were slightly, though not dramatically, different.

Five per cent opted for no action, 37 per cent for a reprimand, and 22 per cent for suspension. Exactly as with the dentists, 18 per cent opted for conditions being attached and 22 per cent for suspension. A total of 14 per cent saw striking off as the best remedy.

There was a lower demand from patients than for the professionals (26 per cent and 12 per cent respectively) for a reprimand or the imposition of conditions on dentists, but interestingly a higher figure (28 per cent) felt suspension was appropriate, as was the case with striking off (19 per cent).

All the respondents in the survey have been anonymised, but one dental practitioner commented that he would personally opt for a reprimand, explaining this sort of conduct would not actually endanger patients.

“It’s unprofessional and possibly bringing the profession into disrepute, but if it’s a first offence it should just be [a case of] ‘don’t do that again’”, he added.

“If they’re a repeat offender, that’s different because they haven’t responded to a reprimand, so you need to move onto something else.”

And a dental nurse commented: “I’d personally suggest conditions. There may be more training that’s needed, whether in the sense of the racist comments or in the sense of how to use social media in a positive way without bringing our profession into disrepute.”

The survey findings of registrants’ views and those of patients and the public on the appropriate actions in hypothetical professional scenarios

Varying attitudes

Another question relating to personal rather than clinical misconduct concerned a dentist or dental nurse being charged for drunk and disorderly behaviour on a night out.

In this case, attitudes varied dramatically between patients and registrants, with more members of the public feeling that no action should be taken against a dentist – 42 per cent, compared to 10 per cent among dentists and 13 per cent among dental nurses.

A total of 34 per cent of dentists felt a reprimand would be the most appropriate outcome, compared to 37 per cent of dental nurses.

A smaller percentage of the patient cohort favoured the harsher outcomes compared to dentists – 10 per cent against 19 per cent for a dentist having conditions attached, 13 per cent against 26 per cent for suspension, and six per cent against seven per cent for striking off.

“You’ve got to have a certain level of professionalism,” said one dentist respondent. “If somebody is acting unprofessionally and has been charged, I think they are bringing our profession into disrepute.”

However, another responded: “The only way that drunkenness will affect anyone is if the dentist comes into work [still under the influence] the next day, and that’s a different thing completely.” Another remark was: “Until they’re actually found guilty, there should be no action.”

The responses of the public and patients on personal conduct were starkly different to those of the professionals

Clinical scenarios

Moving on to questions relating to clinical misconduct, one hypothetical scenario in the survey involves the case of a dentist prescribing, or a dental nurse accidentally giving, the wrong medication to a patient, leading to serious side-effects and an admission to hospital.

In this case, two per cent of dentists felt no action should be taken, with a further 13 per cent opting for a reprimand, 45 per cent the attachment of conditions, 26 per cent suspension and nine per cent striking off.

In the case of dental nurses, twice as many – four per cent – felt there should be no action, with 12 per cent favouring a reprimand and 39 per cent conditions. The figure for suspension was slightly lower at 23 per cent, but for striking off, it was substantially higher at 13 per cent.

The public/patient cohort tilted more strongly to the harsher outcomes. Three per cent went for no action, but eight per cent opted for a reprimand, 23 per cent for conditions, 42 per cent for suspension and 21 per cent for striking off.

Some respondents felt that the dentist or dental nurse should not necessarily be judged too harshly, particularly if it was an honest mistake or partly the fault of the patient in some way.

“If it happened, it would be a learning point to know that you can’t just rely on their medical history and you need to ask them every time,” said one dentist.

Another commented: “It’s a mistake … if this person is actively trying to do harm to someone then it’s different … the person may just need more training.”

Another view was that if the error highlighted a more serious failure, such as a practice not updating patients’ medical histories, then more serious action should
be taken.

“If they never took a medical history, it should be a suspension, because they’re dangerous,” said one participant. “If they had a busy day and forgot to ask the patient, then it’s not as serious.”

And a dental nurse commented: “If it was a mistake, then it should be a reprimand, but maybe with some training but not with any restrictions in place. How can you restrict a dentist from writing prescriptions?”

In a different question on potential clinical error, respondents were asked about the case of either a dentist removing the wrong tooth, or a dental nurse reading the notes wrongly and the dentist extracting the wrong tooth as a result. Among patients, three per cent thought no action should be taken; 14 per cent opted for a reprimand; 31 per cent felt conditions should be attached; 36 per cent believed suspension to be the most appropriate outcome; and 13 per cent thought the professional should be struck off.

Dentists veered more towards the softer outcomes, with almost half – 45 per cent – believing the mistake should result in conditions being attached. Four per cent felt no action should be taken and 17 per cent believed a reprimand to be the best solution.

Mitigating factors

There was a notably softer response to the suggestion of harsher penalties within this cohort, with just 21 per cent believing in suspension and eight per cent opting for striking off.

Among dental nurses, a dramatically higher figure – 14 per cent – felt no action should be taken. A reprimand garnered 23 per cent support, while 38 per cent opted for conditions. There was also lower support for the toughest measures among nurses than from dentists, with a figure of 16 per cent favouring suspension and just three per cent opting for striking off. “It’s a training issue, potentially,” said one dentist, while another said: “If they had done it 10 times it’s different, but what if it’s a one-off?”

Yet another comment was: “I can imagine the younger dentists who have just come out of dental school would be quite scared. They would think it’s quite a serious thing to take a wrong tooth out.”

However, some professionals observed there could be mitigating factors, such as clinical decisions concerning extractions sometimes being complex.

It was pointed out that it isn’t always a simple task to determine which tooth should be removed, particularly when it is being taken out to try to ease pain on the basis of information provided by the patient.

“You could take one tooth out and the next day the patient still has pain and says you’ve taken the wrong one out,” said one dentist. “It could be that the pain was coming from both of them.”

And of the potential outcomes of suspension or striking off, one dental nurse remarked: “It’s so harsh!”

Further information is here on the GDC’s website

Tags: conduct / mixed / perceptions / Professional

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