Taking responsibility

With the pressure on DCPs to register still very much evident in dental professionals' minds, it is easy to lose sight of what registration actually means for the DCP. For the first time since different classes of DCP were introduced in the mid-twentieth century, DCPs are now accountable for their own actions and omissions.

DCP tutors across the UK must now emphasise the importance of GDC standards guidance documents to their students (Fig. 1), and find ways to relate the theory to everyday clinical practice.

Figure 1
figure 1

GDC Standards Guidance documents

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‘A professional person is subject to both the law and a professional code of ethical conduct,’ say Brennan and Oliver in their book Ethics and law for the dental team.1

The GDC states that as a dental professional, the ethical principles you should follow are:2

  1. 1

    Putting patients' interests first and acting to protect them

  2. 2

    Respecting patients' dignity and choices

  3. 3

    Protecting the confidentiality of patients' information

  4. 4

    Co-operating with other members of the dental team and other healthcare colleagues in the interests of patients

  5. 5

    Maintaining your professional knowledge and competence

  6. 6

    Being trustworthy.

Dilemmas in practice

With my dental hygiene and dental therapy students at Leeds Dental Institute, I looked for ways to integrate the theory and practice of ethical patient care.

Dental therapists and dental hygienists working for dentists may come across certain methods of patient advice which differ from what they were taught as students. Conflicting advice may confuse the newly-qualified DCP and potentially put patient care and the DCP's registration at risk. With these potential dilemmas in mind, I began to develop case scenarios around actual events that could challenge the DCP in the clinical and non-clinical setting.

Decision-making pathway

I introduced my students to Beemsterboer and adapted her decision-making pathway as follows:2

Step 1: identify the ethical dilemma

Step 2: collect the relevant information

Step 3: state the options

Step 4: apply the ethical principles (see above)

Step 5: make the decision

Step 6: implement the decision.

This decision-making pathway provides students with a clear process to follow when challenged with a dilemma or ethical problem in patient care. When faced with Ethical scenario 1, the DCP can use this pathway to explain to their colleagues why it is not in the patient's best interests to continue with treatment. So for example:

Step 1: is there an immediate risk to the patient?

Step 2: list all the information and propose an action

Step 3: propose the action; raise your concern and approach team members

Step 4: consider what might happen in the short or longer term if you don't raise your concern and whether your registration is at risk

Steps 5 and 6: take action: provide the dentist with INR policy; refer to the relevant Principles document, and implement the action immediately.

The scenarios that I have developed for my students focus on all DCP groups, including members of the team that aren't registered, such as the dental practice manager and the dental receptionist – as in Ethical scenario 2.

How can this situation be avoided or managed using the GDC Standards Guidance on patient confidentiality?

Ethical problems can affect teamworking relationships so it is important that all members of the team have some training in this area.

Principles of raising concerns (Fig. 1) is of specific importance to all DCPs who may experience patient care that falls below the standard expected. For example, a dental nurse might be advised to use a certain method of sterilisation by a dental practice manager because it is appropriate and cost-effective, even though the dental practice manager is not qualified in clinical procedures.

Success on location

As a tutor I have aimed to prepare my DCP students to face the challenges of potential ethical dilemmas and equip them with the appropriate materials to reach a solution. The feedback I have received from my students indicates that they have applied the GDC Standards Guidance to their everyday work, in both clinical and non-clinical settings in dental practice.