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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 10  |  Issue : 3  |  Page : 61-63

A study to assess patient’s perspective of health-care ethical challenges in a dental health-care setting


Department of Public Health Dentistry, Jaipur Dental College and Hospital, Jaipur, Rajasthan, India

Date of Submission28-Aug-2022
Date of Acceptance03-Sep-2022
Date of Web Publication29-Sep-2022

Correspondence Address:
Dr. Kirti Vats
Department of Public Health Dentistry, Jaipur Dental College and Hospital, Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_21_22

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  Abstract 

Introduction: Ethical practice in health care is defined as consisting of informed consent, respect for integrity, and patient autonomy. Ethical practice in health care is defined as consisting of informed consent, respect for integrity, and patient’s autonomy. In the past few years, there has been an increase in the number of disputes ranging from inadequate and inappropriate treatments to serious problems of medical malpractice and negligence. There is thus a growing need to identify whether or not patients are satisfied with services provided and which ethical challenges, if any, patients value most in a health-care setting. This is not only to elevate the quality of treatment but also to potentially avoid unnecessary legal complications. Aim: The aim of this study was to evaluate the opinion of patients at a dental hospital about some commonly encountered ethical challenges and to investigate the ethical challenges which patients feel most important to them. Materials and Methods: A total of 100 participants were recruited for this cross-sectional study among patients who have visited the dental hospital more than twice. Each participant completed a self-administered questionnaire on some common ethical challenges. The results were considered as statistically significant when P < 0.05. Results: Approximately 79% of the participants felt that doctors were competent in completing procedure in the time frame, and 84% felt that doctors followed the personal hygiene protocol. Only 47% of the participants felt that doctors accommodated missed appointments/lateness. Conclusion: Participants were satisfied with a majority of the clinical services provided. The majority of the patients considered doctor competence and infection control as important issues. There is, however, a general lack of awareness regarding ethical issues in the dental field.

Keywords: Dental, dental care, dental survey, ethics, patient satisfaction


How to cite this article:
Vats K. A study to assess patient’s perspective of health-care ethical challenges in a dental health-care setting. Int J Oral Care Res 2022;10:61-3

How to cite this URL:
Vats K. A study to assess patient’s perspective of health-care ethical challenges in a dental health-care setting. Int J Oral Care Res [serial online] 2022 [cited 2022 Dec 6];10:61-3. Available from: https://www.ijocr.org/text.asp?2022/10/3/61/357316




  Introduction Top


Ethical practice in health care is defined as consisting of informed consent, respect for integrity and patient autonomy.[1],[2],[3],[4],[5] In the past few decades, the balance of decision-making in determining what is the “best” treatment has shifted from professional paternalism toward respecting the informed and autonomous decision of the patient. In the past two decades, India has witnessed significant raise in the number of dentists, dental practices, and dental negligence cases; on the contrary, there is an increased demand for quality care by the patient, and also the advancement of dental technology in terms of diagnosis and treatment has created the new areas of ethical ambiguity and uncertainty, thus placing the dental practitioners in a challenging situation in patient care. Taking in the opinions and views of patients is regarded as an essential component of the quality of health care. It helps in locating the strength and weakness aspects, elevating the quality of treatment planning, and thus also potentially avoiding unnecessary legal complications.[6],[7],[8],[9],[10] Studies have reported limited formal training in health-care ethics for dentists and they rely only on the experience and the outline of ethical principles studied during under graduation and constantly struggling between right and wrong which has a significant impact on the patient and society at large. As a result, this study aimed to evaluate the opinion of patients at a dental hospital about some commonly encountered ethical challenges and to investigate the ethical challenge considered most important by patients.


  Materials and Methods Top


A cross-sectional study was performed with patients from the outpatient department of a dental hospital in Jaipur, Rajasthan. Outpatients reporting to the dental hospital constituted the study population were included in the study. Patients who are not willing to participate in the study and were unable to give informed consent were excluded from the study. All procedures performed in the study were conducted in accordance with the ethics standards given in 1964 Declaration of Helsinki, as revised in 2013. The study proposal was submitted for approval and clearance was obtained from the ethical committee of our institution. A written informed consent was obtained from each participant. A self-administered questionnaire was used to measure the patient satisfaction with the dental services provided by a dental hospital. A total of 25 closed-ended questions were used in the regional language. The questionnaire was face validated by a group of researchers. Reliability test was performed, and reliability coefficient calculated was 0.85. After a brief introduction on the purpose and intent of the study, informed consent was obtained from the participants and questionnaires were distributed to the patients and filled questionnaires were collected. The questionnaire used a three-point Likert scale, ranging from “agree” to “disagree.” If participants were unsure, unaware, or had never experienced any of the questions, they were encouraged to select “neither.” Any confusion regarding any of the questions was clarified by personnel fluent in the regional language. Only completely filled questionnaires were considered for analysis.

Statistical analysis

Data were entered in Microsoft Excel 2016 spreadsheet (Microsoft, Redmond, WA), and chi-square test was performed using SPSS (IBM, New York, NY) software (version 23.0), to see if any correlation existed between age, sex, and education and the responses to questions. The results were considered as statistically significant at P < 0.05.


  Results Top


Among the 100 patients taken up for the study, 50 were male and 50 were female. The average group of the participants was 79% of the patients felt that doctors were competent in completing a given procedure within the specified time, were committed to being on time, and encouraged asking questions/doubts. Approximately 62% percent of the patients felt that doctors were easily available in case of post visit doubts and that emergencies were handled promptly and effectively. Approximately 85% percent of the patients felt that doctors give adequate post-treatment instructions. Interestingly, only 48% of the patients felt that doctors use modern instruments/devices which an even lesser proportion of 51% felt that it was not difficult to attain an appointment. Finally, only 42% of the participants felt that doctors accommodated lateness/missed appointments. Only 55% of the patients felt that they were given a treatment change which does not change. Here also, relatively high proportions responded with “neither” (22%) and “disagree” (23%) as shown in [Figure 1]. Approximately 80% agreed that the importance of following the prescribed treatment plan is explained in case of disagreement between doctor and patient. Similarly, 72% felt that alternatives are offered in case of such disagreement. Approximately 56% of the participants felt that doctors act in accordance with the law whereas only 56% felt that doctors are truthful in case of any untoward incident. Interestingly, 15% of the patients felt that doctors do not take steps to rectify mistakes, if any. A proportion of 84% of the participants found doctors’ personal hygiene satisfactory, and 70% were satisfied with the cleanliness of the dental setup. Contrastingly, only 53% expressed satisfaction with patient protections such as gowns and laser protection goggles, with 29% not satisfied with this particular facility.
Figure 1: Dentist that given a treatment plan that does not change

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  Discussion Top


This qualitative study was conducted to explore health-care ethical challenges in current dental practice and patient’s opinion in Indian Scenario. Qualitative study provided some degrees of flexibility in data collection, statistical analysis and helped in generalizability of the study result since it uses the general inductive approach. The participants who participated in the present study were selected based on the assumption that they will be in a position to understand and provide a rich source of data. This study was conducted with the aim of gauging patient’s opinions regarding various ethical issues in a dental hospital. There were multiple themes which were explored in this questionnaire.[7],[8],[9],[10],[11],[12],[13],[14] The ethical issue/category of primary importance to each participant was also noted. Self-administered questionnaire was used to collect said information. A study conducted by Nagappan and John in a study conducted in Chennai in 2014.[6] For example, a similar proportion of patients found the doctors polite and courteous and encouraging of asking questions. A study conducted by Kemparaj et al. indicated that the issues of primary concern are that of doctor competence and infection control. The individual question most selected was “doctors are truthful in case of any untoward incident.” The fact that “informed consent” and “medical record maintenance” ranked second last and last, respectively, indicates the lack of knowledge and awareness of one’s own rights in the medical field in general in India. Statistical analysis revealed that female patients are more likely to be satisfied with the explanation of the procedure given by the treating dentist. Newsome and Wright suggested that this finding might be because of females’ greater exposure to dental services, likely moderating their expectations.[7] It was also found that the age group 21–30 was more likely to mark “neither” for questions 15 and 23.


  Conclusion Top


The results of this survey concluded that the majority of the patients considered doctor competence and infection control as important issues. It was seen that females are more likely to be satisfied with the explanations given about the procedure by the doctor to the patient. There is, however, a general lack of awareness regarding ethical issues in the medical field, which can only be alleviated by proper education and development.

Financial support and sponsorship

Not applicable.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dunning JM Principles of Dental Public Health. 4th ed. Cambridge, MA: Harvard University Press; 1986. p. 10-11.  Back to cited text no. 1
    
2.
Kemparaj VM, Panchmal GS, Kadalur UG The top 10 ethical challenges in dental practice in Indian scenario: Dentist perspective. Contemp Clin Dent 2018;9:97-104.  Back to cited text no. 2
    
3.
Bhadauria US, Dasar PL, Sandesh N, Mishra P, Godha S Medico-legal aspect of dental practice. Clujul Med 2018;91:255-8.  Back to cited text no. 3
    
4.
Vashist A, Parhar S, Gambhir RS, Sohi RK, Talwar PP Legal modalities in dental patient management and professional misconduct. SRM J Res Dent Sci 2014;5:91.  Back to cited text no. 4
    
5.
Ali DA Patient satisfaction in dental healthcare centers. Eur J Dent 2016;10:309-14.  Back to cited text no. 5
    
6.
Nagappan N, John J Patient satisfaction with the dental services offered by a dental Hospital in India. J Indian Assoc Public Health Dent 2014;12:297.  Back to cited text no. 6
    
7.
Reifel NM, Rana H, Marcus M Consumer satisfaction. Adv Dent Res 1997;11:281-90.  Back to cited text no. 7
    
8.
Sbaraini A, Carter SM, Evans RW, Blinkhorn A How to do a grounded theory study: A worked example of a study of dental practices. BMC Med Res Methodol 2011;11:128.  Back to cited text no. 8
    
9.
Scarlett MI, Grant LE Ethical oral health care and infection control. J Dent Educ 2015;79:S45-7.  Back to cited text no. 9
    
10.
Sudhakar V, Chandrashekar J Dental health care waste disposal among private dental practices in Bangalore city, India. Int Dent J 2008;58:51-4.  Back to cited text no. 10
    
11.
Sanjeev R Knowledge, attitude, and practices about biomedical waste management among dental healthcare personnel in dental colleges in Kothamangalam: A cross-sectional study. Health Sci 2014;1:JS001I.  Back to cited text no. 11
    
12.
Charania ZK Awarness and practices of dental care waste management among dental practitioners in Chennai City. J Contemp Dent 2011;1:15-21.  Back to cited text no. 12
    
13.
Cederberg RA, Valenza JA Ethics and the electronic health record in dental school clinics. J Dent Educ 2012;76:584-9.  Back to cited text no. 13
    
14.
Kress GC, Hasegawa TK Jr, Guo IY A survey of ethical dilemmas and practical problems encountered by practicing dentists. J Am Dent Assoc 1995;126:1554-62.  Back to cited text no. 14
    


    Figures

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   Materials and Me...
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