A profession is defined as “a vocation with a body of knowledge and skills put into service for the good of others; the welfare of society” (Van Mook et al., 2009). Medicine and dentistry are recognized by the public as the archetype of professionalism (Bloom, 2002). Professionalism is demonstrated through three key foundational elements: clinical competence, communication skills, and ethical/legal understanding. Building upon these foundations, a professional applies the principles of professionalism: excellence, humanism, accountability, and altruism. A professional aspires to demonstrate these principles in their behaviours and wisely resolves situations in which these values may be in conflict (Arnold &Stern, 2006).
The dental professional strives for excellence and is committed to competence in knowledge and technical skills, communication and ethics. Dental professionals should not be satisfied in providing the minimum standard of care and should place a conscientious effort towards providing care that goes beyond ordinary standards (Arnold & Stern, 2006). Inherent in the principle of excellence is a commitment to lifelong learning and improvement. In an Interview with Dr. Woo (MBBS), he emphasized the importance of continued learning as patients would expect their health care provider to be up to date, providing treatment based on the best available information. He mentioned that excellence in medicine is also expressed through effective collaboration with other health professionals to help improve the quality and delivery of health care. Promotion of scientific knowledge and maintaining the integrity of that knowledge are also professional obligations (Arnold & Stern, 2006). Dr. Woo stated that good practice involves public health advocacy to improve health outcomes of patients and communities, especially those that face significant health disparities.
Humanism emphasizes the sincere concern and value of human beings and it is a core principle that guides the dentist-patient interaction. Humanism encompasses values such as compassion, empathy, respect, and honor and integrity (Arnold & Stern, 2006). Respect is a personal commitment to honor the choices and rights of others regarding themselves and their medical care (ABIM, 1989). Having respect for cultural and societal differences includes a sensitivity towards a person’s age, culture, gender, and disabilities (Beach et al., 2007). A genuine effort should be placed in adapting one’s practice to improve engagements with patients from a variety of backgrounds (Dental Board of Australia). Dentist are obligated to respect patient privacy and confidentiality and provide informed consent. Empathy is the ability to understand the patient’s perspective and feelings (Arnold & Stern, 2006). Empathy is a key factor in the dentist-patient relationship and is positively associated with negotiated treatment plans, treatment adherence, patient satisfaction and reduced dental anxiety (Jones & Huggins, 2014). Communication skills are important in conveying empathy towards the patient. It may often involve the observation and use of non-verbal cues and body language (Arnold & Stern, 2006). Empathy and compassion drive the professional to act in beneficence. However, it is advised to refrain from getting too emotionally involved in order to preserve one’s objectivity and professional responsibility (Arnold & Stern, 2006).
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Accountability refers to reliability, talking responsibility for one’s actions, and a responsibility to answer to those who place trust in the dental professional (Levinson, 2014). Accountability is demonstrated by taking responsibility for one’s mistakes, full disclosure, correcting errors and apologizing to parties involved. Medical professionals are accountable for quality of care, upholding principles, and reporting conflicts of interest (Arnold & Stern, 2006). Conflicts of interests do occur in medicine such as financial arrangements with pharmaceutical companies. While such conflicts are difficult to avoid completely, professional organizations recommend disclosure and management of such arrangements to make sure that patient and peer perceptions are not negatively influenced (Arnold & Stern, 2006). Accountability also involves the protection of confidential information that patients share in trust and is stated in the code of law. However, unintentional breaches of patient confidentiality do occur such as discussing patient information in a crowded area (Levinson, 2014). Dr. Woo stated that professionalism involves abiding by a certain code of ethics in patient care and being someone that patients can trust with their health and confidential information. It is unprofessional to risk a potential breach of confidentiality and it undermines the trust patients have in their health care providers. Dr. Woo emphasized that a professional is a representative of the profession. In relation to his statement, accountability and professional behaviour also extend into online and social media presence as well as personal appearance. Due to the public and potentially permanent nature of the internet, digital unprofessionalism may be significantly damaging to confidentiality, and the patients’ perception of the professional and the profession (Levinson, 2014). Medical associations provide guidelines in forming professional relationships and boundaries with patients. For example, friendships with patients are generally considered as undesirable in order to ensure that the patient’s medical needs remain a priority. However, it is argued that context does matter such as in cases where the individual is the only practicing dentist in a rural town and inevitably forms some friendships with patients (Levinson, 2014).
Altruism incorporates many professional principles including a commitment to providing the best care, selfless behaviour, and avoiding self interest. Altruism is defined as the duty of the medical professional to place patient welfare ahead of one’s own and recommending what is in the best interest of the patient (Arnold & Stern, 2006). Altruism is exercised by providing the best and most appropriate treatment for patients, avoiding highly profitable treatments if they are unjustified, avoiding overtreatment, and abiding to ethical and legal financial/business practices (Dental Board of Australia). Dr. Woo affirms the privileged relationship health care professionals have with their patients. “Doctors are privileged in their ability to have tangible effects on peoples’ health and lives. Patients have the right to expect that their best interests come first”.
Professional dental organizations exist to provide policies and guidelines and help dentists meet their professional obligations. The Australian Dental Association provides support to its members through enhancing their ability to provide high-quality oral health care, public health advocacy and promotion of ethics (ADA). The ADA also holds conferences that discuss the latest knowledge, develop collegial relationships, and refine professional identity. The Dental Board of Australia provides policies and guidelines on a range of issues. Resources are provided in continuing professional development which is required by dental professionals to further their knowledge and professional qualities (Dental Board of Australia). Dr. Woo further develops his skills and professional identity by attending events and tutorials in oral and maxillofacial surgery as well as CPD events such as surgical skills and trauma courses.
Dental professionalism is signified through clinical skills and knowledge, communication skills and ethics that lay the foundation of public trust in the profession. Upon these foundations, the dental professional strives for excellence, humanism, accountability, and altruism. Guidelines for medical professionalism seem to be in continuous discussion and evolution, especially in response to contemporary socio-economic issues and the rise of technology and digital media.
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