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This study investigates the attributes of a ‘good dentist’ with respect to the opinions of dental patients, dental students and qualified dentists and determines whether the dental profession and its patients are in agreement with the standards published by the General Dental Council (GDC) in 2005. A questionnaire was circulated amongst the above groups at the University Of Birmingham, School of Dentistry. Each participant was asked to rank 14 attributes for a dentist in order of their importance. The results indicated that generally there was no consensus between individual participants. There was, however, significant overlap between the top six attributes chosen by dental care professionals and the GDC standards. Patients tended to rank other non-GDC mentioned attributes more frequently. Attributes which were considered important by all were ‘putting patient interests first and acting to protect them, respecting a patient's dignity and choices and having good technical ability.’
Clinical Relevance: It is important to gain an insight into patient attitudes and to be knowledgeable of the GDC professional standards, in order to improve overall conduct and performance as a dental practitioner.
Article
The General Dental Council was established in 1956 and, since then, has played a fundamental role in training and regulating the dental care profession. It provides a framework for teaching the undergraduate students in dental schools and regulates dentists during their careers. In 2005, the GDC published six ‘Standards for dental professionals’.1 These were designed to underpin daily decisions made by licensed dental surgeons to ensure that they upheld their code of professionalism. Every registrant must endeavour to follow these standards, which are:
Put patients' interests first and act to protect them;
Respect patients' dignity and choices;
Protect the confidentiality of patients' information;
Co-operate with other members of the dental team and other healthcare colleagues in the interests of patients;
Maintain your professional knowledge and competence;
Each standard is defined by principles, 28 in total, which should be applied at all times to adhere to current best practice guidelines. Although few data have been published around the credibility of these standards, some research has been conducted around the desirable traits of a dentist. In 2011, the GDC commissioned a patient and registrant survey which analysed the attributes that are thought to encourage trust and confidence in dental care professionals. Attributes prioritized by patients alone were:
Knowledge;
Technical skills; and
Cleanliness of the surgery.
Both patients and registrants agreed that communication and respecting patients' dignity were also important qualities.2 This research has reinforced what has already been documented in previous literature.3,4 Earlier work has revealed that a patient's satisfaction with treatment was largely based on the personality of the dentist and the quality of consumer care provided.3 Some of the previous studies conducted have been from a patient perspective, as dentistry is a patient-centred service.2,3,4 However, there is also a need to evaluate the opinions of dentists and the guidelines they should be striving towards as these define the care that they provide. This paper will address the views of a comprehensive sample of dental patients, dental students and qualified dentists with respect to the attributes of a ‘good dentist’ and determine whether the dental profession and his/her patients are in agreement with the standards set by the GDC.
Methods
A group of dental patients, dental students and dentists were invited to participate in a focus group in October 2011 to gather their views about the key attributes expected of all dental professionals. Standard qualitative analysis was conducted on the data to help design a short questionnaire. NHS R&D approval was granted prior to undertaking this investigation.
Two pilots were conducted independently of each other in November 2011 to assess the accuracy of the questionnaire. The first indicated that instructions needed to be made clearer to avoid equal ranking and attributes needed to be better defined. The second confirmed that these problems had been rectified.
The definitive study took place at the University Of Birmingham, School of Dentistry between December 2011 and June 2012. One hundred and eighty questionnaires were distributed across the hospital to a selection of patients, dental students (years 3–5) and a range of qualified dentists, all of whom were employed either by the NHS working within specialty posts or by the University as teaching staff. The data were collected by opportunity sampling. The purpose of the study was explained to each participant and his/her full consent for participation was obtained.
The questionnaire comprised 14 attributes of a dentist, six of which were reproduced from the standards set by the GDC and the remaining eight were generated during the focus group (listed in Table 1). Each participant was asked to rank the attributes of a dentist individually in order of their importance, 1 being the most important while 14 was the least, without awarding equal ranking. Participants had the option to make open comments and rank other attributes which they found relevant.
Attribute
Percentage of qualified dentists who ranked each attribute in their top 6 (%)
Putting patients' interests first and acting to protect them
94
Being trustworthy
76
Respecting patients' dignity and choices
66
Having good technical ability/manual dexterity
62
Recognizing your limitations
54
Maintaining your professional knowledge and competence
48
Ability to deal with a dental emergency safely and quickly
44
Providing patients with detailed information of risks and benefits before commencing any treatment
40
Maintaining a good patient relationship and communicating effectively with patients
38
Protecting the confidentiality of patients' information
30
Co-operating with other members of the dental team and other healthcare colleagues in the interests of patients
22
Writing up patient notes precisely and clearly
14
Showing leadership
8
Keeping involved with research and new technology
4
Results
Of the initial 180 questionnaires circulated, 172 responses were returned. On inspection, 22 out of the 172 questionnaires collected were identified as ‘incorrectly completed’ and thus were deemed invalid for the purpose of this study, leaving a final sample of 150 (83%). This was divided equally between all three categories so that 50 questionnaires were collected from each.
Individual responses varied considerably and there was no real consensus between them. The most popular attributes selected by each participant were tabulated and any interrelationships forming between the three categories were analysed (Tables 1 and 2).
Were the GDC standards the top six chosen attributes?
There was some unanimity between the GDC standards and the dental care professionals surveyed. Four of the top six ranked attributes selected by dentists were standards which were documented by the GDC (Putting patients' interests first and acting to protect them; Being trustworthy; Respecting patients' dignity and choices; Maintaining your professional knowledge and competence (Tables 1 and 2). This was the same for dental students, who also ranked the same four GDC guidelines within their top six attributes. However, when assessing patient responses, discrepancies were noted. Patients only ranked two out of the six GDC standards within their chosen top six attributes (Putting patients' interests first and acting to protect them; Respecting patients' dignity and choices) (Table 2).
Qualified dentists
Dental students
Patients
First
Putting patients' interests first and acting to protect them
Having good technical ability/manual dexterity
Having good technical ability/manual dexterity
Second
Being trustworthy
Putting patients' interests first and acting to protect them
Ability to deal with a dental emergency safely and quickly
Third
Respecting patients' dignity and choices
Maintaining a good patient relationship and communicating effectively with patients
Putting patients' interests first and acting to protect them
Fourth
Having good technical ability/manual dexterity
Respecting patients' dignity and choices
Providing patients with detailed information of risks and benefits before commencing any treatment
Fifth
Recognizing your limitations
Being trustworthy
Maintaining a good patient relationship and communicating effectively with patients
Sixth
Maintaining your professional knowledge and competence
Maintaining your professional knowledge and competence
Respecting patients' dignity and choices
Discussion
The other attributes ranked within the top six choices of all three categories but which fell outside the GDC standards are analysed below. These attributes will be considered and an assessment made to establish why they were ranked highly.
Manual dexterity
Predominantly all the work undertaken by a dentist requires good hand/eye co-ordination from adjusting simple fillings to preparing teeth for complex crown and bridgework. This is a vital skill to ensure that patients are not receiving less than optimal results and to minimize the risks of complications during treatment.
Recognizing your limitations
Recognizing your limits is important as you should be able to identify when to ask for a second opinion. This is crucial to avoid putting patients in ‘at risk’ situations and prioritize patient safety. Knowing when to seek assistance conveys an operator who has the ability to judge his/her own clinical knowledge accurately.
Maintaining a good patient relationship and communicating effectively with patients
Good communication is a skill which is essential to forge a relationship between the dentist and the patient. Freeman5 suggests that effective communication breaks down barriers in the dentist-patient relationship and can lead to an improvement in a patient's oral health. Communication is vital to ensure that an empathetic setting is in place so that patients can feel comfortable with parting with their fears and concerns related to treatment. Effective communication also entails patients having a full understanding of what they are being told.5
Ability to deal with a dental emergency safely and quickly
Dental pain can be so severe that it can impinge on daily activities from eating to sleeping. Being able to deal with dental emergencies efficiently facilitates a good relationship between the patient and dentist and encourages the patient to return, when in need, for further treatment.
Providing patients with detailed information of risks and benefits before commencing any treatment
Patients want to be treated by professional, honest members of the community and be provided with the correct information and advice before beginning any invasive treatment. Patients want to understand their conditions and actively participate in treatment planning. Most have limited dental knowledge and expect the dentist to aid the decision-making process by presenting all the facts to enable an autonomous decision.
General comments
Over 10% of questionnaires returned were not deemed satisfactory for use in this study as participants had frequently mis-ranked the statements, so that two or more statements were ranked equally. This reduced the final sample size. Overall, the sample was limited as it only considered the views across Birmingham Dental Hospital; however, a more representative sample would include a mix of dentists from all areas of the country, students across all UK dental schools and a cross-section of the general population.
Many commented that the attributes were ‘all as important as each other’ and found it difficult to distinguish between them. However, when the same question was posed to patients, they were more decisive when considering the ideal attributes they would like to see from their dentist. Although opinions were divided amongst individuals, there was some agreement between the different groups who participated with this survey. The most popular chosen attribute was ‘putting patients’ interests first and acting to protect them' closely followed by ‘having good technical ability/manual dexterity’, which was ranked highly by all three categories.
While there was some overlap between the dental care professionals surveyed and the attributes highlighted within the GDC publication (Figure 1), many of the attributes ranked highly were those which were generated during the focus groups. This was especially true for patients, who placed greater value on the attributes which fell outside the GDC guidelines. Perhaps this is because the attributes outlined by the GDC are generic and what is expected of all dental professionals. Or perhaps it is because the attributes not mentioned by the GDC are harder to portray and have to be learned, thus deemed more significant. Whatever the reason, it would be helpful if these attributes are given more recognition. For example, manual dexterity is examined during dental training by means of professional competence exams and keeping up-to-date is tested later when it is mandatory for dentists to perform 250 hours of CPD at five-yearly intervals. These assessments provide an indication of the practitioner's clinical knowledge and must be successfully completed to ensure that the dentist can continue to practise.
Figure 1. A comparison between number of students, dentists and patients who recorded any of the named GDC guidelines within their top six ranks. (Each category is out of 50 responses).
However, as some non-technical attributes were also ranked high in importance, it could be argued that more emphasis should be placed on examining these during dental school. Examples include patient role play exercises to examine skills such as communication with difficult yet realistic scenarios, such as breaking bad news, admitting to mistakes, or coping with patient resistance. Attributes, such as showing leadership and teamwork, can be examined via the use of high fidelity simulation exercises, designed to mock real life settings. Work by Bond and Spillane6 indicated that it was a valuable tool when testing competence in the above skills. However, there is a lack of evidence for the use of these systems in credible assessments. Other limitations with these methods are that they can never fully mimic real life situations or recreate individual patient reactions. Thus they can be more readily used in teaching and learning exercises as a method of enhancing these skills.
Recent developments
As of 30th September 2013, the standards were reviewed by the GDC and new up-to-date regulations have been published. Nine principles were introduced, some similar to the previous standards and some new. What is evident from the results of this study is that the GDC is providing clear guidance to the dentists who they are regulating and practising dentists appear to be aware of these.
Conclusion
Within the limitations of the study, only two out of the six attributes ranked by patients were similar to the GDC standards. Although the sample size of patients was relatively small, the present work does indicate a need to research the views of a larger sample of patients and even extend this question to the general public. The same is probably not necessary for dentists or dental students as their views were very similar to that of the GDC.
