Defensive dentistry: perceptions and experiences among GDPs
Study says participants reported stress, low morale and de-skilling.
Although the term ‘defensive dentistry’ is documented, with a range of opinions among practising dentists, little is understood about the perception and the lived experiences of general dental practitioners (GDPs) practising in a defensive way.
The concept of ‘defensive medicine’ was developed in America in the early seventies and has been defined as “medical treatment that may involve more tests, operations, etc., than a person really needs because a doctor is worried that a claim or complaint may be made against them”.
This is also echoed in dentistry, where Stephen Hancocks, a former editor-in-chief of the British Dental Journal (BDJ), described it as “providing dentistry which presents as few risks as possible to the practitioner from a patient complaining, or more seriously taking up a legal case as a result of an action or omission by the practitioner”.
A study published in the BDJ aims to explore how defensive dentistry is understood and experienced by GDPs working in primary care.
An interpretive mixed-methods approach was adopted using an online questionnaire followed by semi-structured interviews. In total, 25 participants completed the questionnaire and six follow-up interviews were completed.
Three main themes were identified: the sense of fear; practising the ‘act of avoidance’ with certain patients and/or procedures; and the overall impact on the profession.
GDPs unanimously identified the negative aspects of defensive practice as actions carried out for self-protection rather than the interests of patients.
The reasoning for such practices included fear of litigation and/or investigation by the General Dental Council, heightening in recent years due to increased public awareness of litigation, and loss of public trust.
Participants reported stress, low morale and de-skilling as outcomes for practising defensively.
The researchers said that the study was inconclusive when exploring what actions could be taken to improve support for dentists and reduce the level of defensive dental practice. “Clearly, an approach to this issue is complex, and further research is recommended to explore systemic improvement strategies in the framework of dentistry within the UK,” they said.
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