ETHICS

 

Driving into dentistry

 

 

LM Sykes^I; K Naidu^II

^IBSc, BDS, MDent, IRENSA, Dip Forensic Path, Dip ESMEA, FCD (Pros), Head of Department of Prosthodontics, University of Pretoria, South Africa. ORCID: 0000-0002-2002-6238
^IIBChD, PG Dip (Clin.Mgmt of HIV/AIDS), PG Dip (Int Ortho), MSc in Dentistry (Pros), MChD (Pros), Department of Oral Rehabilitation, School of Oral Health Science, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. ORCID: 0009-0004-6130-8284

Correspondence

 

 

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ABSTRACT

Re-calculating your "dental GPS". This paper uses the analogy of a driver and a journey for a dentist and their career. It uses the driver, the car and the trip as a blueprint against which the clinician can juxtapose themselves, their environment and their path of work. The aim is to raise awareness of the need for regular self-reflection, re-calculation and adaptation if and when it is needed.

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INTRODUCTION

This paper will use the analogy of a vehicle driver to consider how their journey can be used as a blueprint for a dentist's career, and the need for regular self-reflection, re-calculation and adaptations along the way. The two concepts will be juxtaposed throughout the discussion. Begin by considering a young adult wishing to get their driving licence. They first have to learn the basic rules of the road and pass a theoretic test before being allowed to proceed to the practical training. The lessons involve learning about the car, its components, how it works and how to manoeuvre it. This is similar to a dental student in their initial pre-clinical years, where the focus is on theoretic teaching in the basic sciences along with early skills development courses. The driver will then be allowed to get into the car and under the careful guidance of an instructor learn how to control and drive the vehicle in a simulated road setting. Similarly, students in the dental skills laboratories learn how to operate the dental chairs, use handpieces and carry out tooth preparations on phantom heads. Once they have mastered these skills, they may be taken out onto the roads, or clinics, and start to function in a real-life setting. They now have a dual role of performing the task at hand, as well as interacting with other road users, or patients being treated. They also need to function in a variety of settings and environmental conditions and be able to manage any unforeseen and unplanned events. All the while they will be monitored and guided by their tutors. The level of supervision and remediation needed should lessen as they advance in competence and confidence. When the trainer considers them to be proficient enough they will be allowed to take the final examinations and, if successful, will be given a licence to drive. And so their journeys begin.

On day one, each driver will have a specific destination in mind and will set their Global Positioning System (GPS) accordingly. They can specify their preferences such as opting to drive on a straight and direct route, and program in regular stop-overs, planned deviations along side roads or even visiting distant locations en route. The GPS will automatically calculate anticipated time frames, reveal potential obstacles and suggest alternative routes. However, during the journey events may change for a variety of reasons. Drivers will then need to alter their paths and/or destinations accordingly. The GPS will not send them back to the start but merely re-evaluate their current position and recalculate the journey ahead. In the dental world, the GPS may be considered as a DPS or Dental Positioning System. (Note: this paper will focus on individual career paths, but all professionals still need to ensure they maintain standards and perform at the level of global benchmarks).

The letters of the dental positioning system, DPS, will be used to discuss the three main factors that can impact the journey. These are the Driver/Dentist themselves, the Path they follow and the Specific vehicle/practice setting. The driving analogy will be used with the concept of driver and passenger being used as a metaphor for the dentist and patient.

1. The Driver. For a new driver, steering a car alone for the first time can be a daunting experience. It is advisable to venture out slowly and with caution, choose routes that are familiar and that they have travelled before as a learner or passenger, and be guided by cars ahead, but still keep an eye on what those around them are doing. It's also wise to look back in their rearview mirror at times to monitor where they have been and see if others are also taking this route or have deviated onto a better path. With time and experience, it may be tempting to increase speed and cover a greater distance in the same amount of time, or to take shortcuts to get there faster. This is acceptable providing it is still within the law, and that in so doing they don't drive recklessly or put other road users, passengers or pedestrians in danger.

Areas where the terrain is difficult to navigate will necessitate them proceeding with caution, taking advanced driver courses before setting out or, if necessary, advising the passengers to complete the journey with a more skilled driver who has expertise and experience in this field or has a vehicle more suited to that landscape. Considerate and sensible drivers should be aware of the need to pause at regular intervals for self-reflection and to ensure they are still on track with the GPS/DPS. A law-abiding and ethical driver will also be mindful and able to detect when they are suffering from temporary or permanent handicaps that may affect their performance and take appropriate steps to address these. The more obvious issues such as physical injury, failing eyesight or hearing loss are generally easy to detect and manage. However, many drivers ignore the less overt signs of fatigue, mental and/or emotional stress, slowing of reflexes, bodily or cognitive impairment, declining dexterity or any other illness that affects their performance. They should seek help immediately and, if necessary, take a break from driving until they are fit and fully functional again. Failing to take precautions or deal with these drawbacks is unethical as it poses a danger to themselves, their passengers and all other road users. They should also remember that in addition to their moral obligation to their patients, they have a duty to themselves and need to look after their own mental and physical health and general wellbeing. As John Mark Comer stated in his book of the same title, in this day and age there is an increasing need for people to focus on "the ruthless elimination of hurry".¹ A burnt-out clinician is of no use to themselves or the people they set out to serve.²

2. The Path. Before starting on a long journey, the driver will programme their GPS to a set destination. They can add specifications according to their desires and preferences. Some chose to travel on the most direct route with no side roads or deviations and plan to stay on the road alongside the many other general drivers throughout the journey. Others are eager to explore less travelled routes on restricted roads. This will require that they leave the mainstream of drivers for some time to learn about the conditions that they will encounter on the new course. They may only deviate for a short while to gain extra insights, and then go back to their old roads, but will have gained the experience that allows them to offer passengers a better service in the future. Others dedicate themselves to longer structured learning programmes that take some time to complete. During this time they refuel and refresh themselves, update their driving skills and equip their cars with the devices needed for the new driving conditions. Thereafter they could return to their general practices, but most will re-programme their DPS and continue on the road that traverses the new landscape. They are now considered specialist in that field and limit themselves to driving passengers on that road only. They can also increase fares accordingly to compensate for the complexity of the trip, and specialised cars or accessories that may be needed.

Regardless of which path the driver takes, they need to ensure they are always on the best track possible and update their GPS/DPS systems to meet global standards. They can do this by attending refresher courses, talking to colleagues, reading the latest reputable literature, watching videos, attending study club meetings and the like. Thereafter they need to put into practice what they have learned and modify their driving, their cars or their routes as needed. Astute drivers are also cognisant of the fact that no matter how well they plan for each day, the very nature of their profession makes each trip unpredictable. The planned journeys often differ from those anticipated, with unforeseen obstacles, road closures, deviations, speed restrictions or temporary stoppages emerging. A good driver adapts and gets back onto their original path as soon as it is safe and practically possible to do so. However, not all complications are necessarily bad. Life long learners often develop skills that enable them to bypass or cross over hurdles rather than turning to avoidance tactics or being completely halted by them. They may explore different avenues on their own but will benefit more if they can communicate with others, and get advice and second opinions from fellow drivers who have encountered these barriers before. If they are still unsure about the route, it is wise and socially responsible of them to inform the passenger and take a temporary stopover to reset their GPS to calculate a new route that they can navigate. If they encounter a newly built road that is not recognised by their systems, they could venture into this unchartered territory (with passenger consent and judicious caution), knowing they will be driving with little or no guidance and there are risks involved. Alternatively, they could backtrack to roads where they are comfortable driving and end the journey for this passenger at that time. Of course, if the passenger still wants to proceed then it is incumbent on them to arrange a referral to a more skilled driver who would be able to assist.

Passengers also bring with them other problems that cause stress to the driver but yet have to be managed professionally. They may arrive late, need frequent stops, complain, have unrealistic expectations, be difficult to please, have limited funds yet still want to drive in the state of the art car, or want to have a long journey when they can only afford the petrol for a short trip.

Not all drivers like the daily commute: some may have a passion for investigating more about cars and developing new technology in this field, and others may be called to teach and train novice students. These individuals often go back to the beginning of the path and join a group of like-minded educators who dedicate themselves to careers in research and/or training aspiring drivers. It is a privilege to be able to pass on knowledge and expertise and, hopefully, those learners who have been selected to be taught appreciate this opportunity. Successful education depends on both parties' understanding and fulfilling their respective duties to teach and obligations to learn.

3. The Vehicle/Surgery setting. Most new drivers will not yet have their cars. Some hire out vehicles and rent garages from other established drivers. Others may purchase second-hand cars and garages. A few may be able to afford or take loans to purchase new, top of the range vehicles, and house them in custom-built garages. In all cases, the onus is on the driver to ensure that their cars are safe to drive, comfortable and ergonomic for themselves and their passengers, are equipped with all necessary accessories, and will get them to their destinations in a reasonable time and manner. They also need to be aware that the vehicles will undergo wear and tear and must budget for regular servicing, maintenance and repairs. With time, and if they have sufficient paying passengers,they may be able to upgrade and purchase faster and more luxurious cars with bigger engines, more power and speed, and state of the art fittings. Before doing so it is wise to compare their performance to their current equipment, to get advice from colleagues and to read reputable literature that evaluates features such as functioning, costs, service plans, potential for upgrading and capabilities.

Some drivers strive to keep themselves at the forefront of technology and regularly upgrade to the latest models or enhanced performance vehicles such as off-road 4x4 cars. If they choose to drive these, they must be trained on the capabilities and handling before taking anyone for a drive. Many will feel it is not necessary to spend extra cash if their current car still drives well and gets them to the desired destination on time. That is their prerogative; however, they need to remember that passenger safety and comfort are key considerations. They cannot jeopardise either by taking them on a journey in an old, slow vehicle that may be emitting toxic fumes, is uncomfortable to sit in or subjects them to unnecessarily longer rides. They also cannot keep running an engine on old, expired oil and lubricants, or drive them to destinations that are no longer recommended just because they are used to these routes. All drivers have to make sure they offer the passengers the best possible ride, drive in acceptably modern vehicles, travel on safe and recognised roads and reach destinations that are generally agreed on as be^ thebest tinisOtne points.

About the running of their business. They also have legal requirements to only employ registered assistants and maintain professional staff relationships, to have up to date and accurate booking and record-keeping systems, to ensure correct and honest billing, to service equipment and renew licences as needed, to comply with personal continuous professional development requirements and to maintain their registrations with the relevant regulatory bodies.

 

CONCLUSION

It is incumbent on all practicing clinicians to regularly selfreflect and monitor their performance in terms of their own goals, the path they are taking, their skills and capabilities, their working preferences, their levels of education and knowledge of currently accepted literature, materials and techniques, their patient profiles and their physical working environment and facilities. They then need to adapt and implement changes if and when necessary to ensure they continue to practice in an honest, ethical and personally satisfying manner. If we think back to 1891 when GV Black advocated "extension for prevention" as a tooth preparation philosophy we can see how dated this concept is in terms of modern dentistry.³ Perhaps a better adage to adopt would be "prevention for extension" which talks to both prevention of dental disease and destructive or invasive treatment to extend the life of the patient's dentition, as well as prevention of personal mental and physical burnout to extend our longevity and wellbeing.

 

REFERENCES

1. Comer JM. The ruthless elimination of hurry. 2019. ISBN-13: 9780525653097; John Murray Press        [ Links ]

2. Sykes LM, Postma TC. On being self-ish, self-less or well-balanced (other-ish), and how this may relate to practicing dentistry. SADJ; July 2022; 77, 6: 306-309        [ Links ]

3. Joseph R. The father of modern dentistry - Dr Greene Vardiman Black (1836-1915) J Conserv Dent. 2005;8:5-6. Accessed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5483797/ Accessed on 26-01-2024        [ Links ]

 

 

Correspondence:
Name: Leanne Sykes
Email: Leanne.sykes@up.ac.za

 

 

Author's contribution
Leanne M Sykes - primary author (70%)
Kamisha Naidu - secondary author (30%)