ETHICS CASE

 

Professionalism

 

 

S Naidoo

BDS (Lon), LDS.RCS (Eng), MDPH (Lon), DDPH.RCS (Eng), MChD (Comm Dent), PhD (US), PG Dipl Int Research Ethics (UCT), DSc (UWC). Senior Professor and Principal Specialist, Faculty of Dentistry, University of the Western Cape, Department of Community Dentistry, Private Bag X1, Tygerberg 7505. E-mail: suenaidoo@uwc.ac.za

 

 

A profession has been defined as an occupation that involves a long and specialised training at a level of higher education and one that is governed by a special code of ethics. A profession has an important and exclusive expertise; possesses an internal and external structure, including experts that mutually recognise each other's expertise, has autonomy in practice of the profession, and is largely self-regulating. Members of the profession accept a set of norms of professional practice or professional obligations. A dental professional as a member of a profession should have respect for human beings, be competent, have integrity and the primary concern should be doing good and acting in the patient's best interests, not for prestige or profit.¹

Professionalism is a broad term used to include the conduct, aims, and qualities that characterise a professional or a profession and relates to the behaviour expected of one in a learned profession. It embodies positive habits of conduct, judgement, and perception on the part of both individual professionals and professional organizations. Professionalism has been viewed as that quality of conduct and character that accompanies the use of superior knowledge, skill, and judgment, to the benefit of another, prior to any consideration of self-interest.¹ There has been much published on professionalism in the past decade, however, it is not a new concept and different disciplines and diverse opinions have been shaping the concept of professionalism and expanding the term to cover a broad set of ideas. Three broad domains have been categorised by Huber (2002) who defined them as habits of practice, habits of group maintenance, and habits of mind.²

Habits of practice or activity include the attributes of cleanliness and personal hygiene, appropriate dress and appearance, decorum, and etiquette. In addition, a dental professional will be honest, decent, fair, trustworthy, law-abiding and of good character.³ These are the ways in which physicians behave toward members of the public, patients and their professional colleagues. Habits of practice involve "behaving like a doctor," and can be taught by the Aristotelian example "teach virtue by being virtuous", since an internalisation of reasons and justifications is unnecessary, but this does not diminish their importance.³

Habits of group maintenance are activities and values that work toward maintaining the highly respected position, trust, and the many privileges of the social status of the dental profession. These powers are informed by an elusive and tacit social contract between dental professionals and the general public, and include among others, self-regulation, exclusivity of practice and financial compensation. The presumption on the part of the patient that they will benefit from, rather than be harmed, by the care provided for them is natural. The comfort and security derived from dealing with dental professionals stems from a confidence that commitments and undertakings will be honoured. Patients, the general public and third parties all place their trust in professional people, and their expectation is that this trust is well founded.⁴ A professional person will take pride in the profession and pay attention to detail; will seek to improve and develop skills; will not be satisfied with substandard work and will seek to do good; will be prepared to acknowledge mistakes, learn from them and take appropriate steps to prevent it from happening again and finally will show respect for those who consult him/her in his/her professional capacity.⁴

Dental professionals are expected to demonstrate high regard for the welfare of the public and some of their social responsibilities are derived from the social contract, or serve to maintain it. Charity, care, public health and hygiene, health education, and political action are examples of habits of group maintenance. Dental alliances at local, national, subspecialty and hospital levels have allowed responsibility for some of these habits to become institutionalised or spread over a collective group of practitioners. Maintaining the social power of the profession is an important endeavour as social prestige, financial reward, professional autonomy, and public legitimacy once lost, are not easily regained.²

Habits of mind are the reflective, cognitive, and philosophical frameworks that inform dental practice and dental behaviour. They are characteristic patterns of thinking that help dentists move from clinical information to clinical decision making and allow others to distinguish a professional from a quack.² Self-care strategies that enhance the habits of mind are critical to dental practice and include the cultivating of clinical mindfulness, reflection in daily practice, education and teaching and emotional intelligence. Studies have found a relationship between connection between effective practitioner-patient communication and patient outcomes (i.e., emotional health, symptom resolution, functional status, and pain control). However, for optimal practitioner-patient communication, practitioners must be ''mindful'' of themselves, the patient, and the context in which they work.⁵ In both ethics and professionalism, it is not enough to use intuition alone when taking and making decisions for one's actions. The traditional standards, values, and goals of the profession must be taken into account.² Habits of mind can be taught only by practice but may not be immediately recognisable because they may be subtly employed or seamlessly integrated into a dentist's behaviour.

Professionalism can be viewed as an activity and not purely a set of rules and as such the use of ethical principles and values to meet today's challenges is a necessarily dynamic process. It requires a reflective equilibrium between principles and dynamic action. Professionalism is a vibrant and a daily part of dental practice. Personal virtue is often cited as being key to professionalism. However, contemporary professionalism in a culturally diverse society has moved beyond personal virtue to a collective commitment to patients, the public, and their health. Contemporary professionalism is a group activity, one practiced in the company of others. It is about demonstrating the values of the profession. A professional person must have a sense of responsibility and a degree of self-control regarding personal behaviour. Doing what is right - when the law requires it, as well as for ethical or moral reasons - should be a matter of personal pride for the professional person.

 

CONCLUDING REMARKS

Professionalism includes practice, education, reflective and applied ethics and demonstrating the values of the profession in all healthcare relationships. Professionalism is a trait that drives dental practitioners to deliver high standards of care and preserve the relationship of trust that exists between patients and the dental team. Excellence in the profession cannot be driven only by following guidelines, standards and rules. Self-regulation and mindfulness, where individual dentists develop and internalise their own guiding principles and values, is essential. True self-regulation occurs at a personal level where dentists take responsibility for their own performance and the performance of their colleagues.⁶

 

References

1. American College of Dentists. Ethics Handbook for Dentists. An Introduction to Ethics, Professionalism and Ethical Decision-making. Maryland, USA, 2012.         [ Links ]

2. Huber S. Haircuts, Neckties, Boy Scouts, and "Mama Said": What is Professionalism? Virtual Mentor 2002; 4(9) 159-61.         [ Links ]

3. Rowley BD, Baldwin Jr. DC, Bay RC, Cannula M. Can professional values be taught? A look at residency training. Clinical Orthopaedics and Related Research 2000; 378:110-4.         [ Links ]

4. Ethics, Values and the Llaw. Dental Ethics Module 3: Professionalism and Integrity. DPL, 2009.         [ Links ]

5. Stewart M. Effective physician-patient communication and health outcomes: a review. Canadian Medical Association Journal 1995; 152:1423-33.         [ Links ]

6. Moodley K, Naidoo S. Ethics and the Dental Team. Van Schaik Publishers, Pretoria, 2010.         [ Links ]