|Year : 2022 | Volume
| Issue : 1 | Page : 35-39
Knowledge, attitude, and practice of dental practitioners toward the medicolegal system: A cross-sectional questionnaire study
Ruchika Kallianpur, Treville Pereira, Subraj Shetty, Swati Gotmare, Christina Pereira, AK Anjali
Department of Oral and Maxillofacial Pathology and Microbiology, School of Dentistry, D. Y. Patil Deemed to be University, Navi Mumbai, Maharashtra, India
|Date of Submission||11-Mar-2022|
|Date of Acceptance||25-Jul-2022|
|Date of Web Publication||02-Sep-2022|
Dr. Treville Pereira
Department of Oral and Maxillofacial Pathology and Microbiology, School of Dentistry, D. Y. Patil Deemed to be University, Sector 7, Nerul, Navi Mumbai - 400 706, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Every element of human involvement is affected by the law, and dentistry is no exception in this respect. The efficient implementation and development of comprehensive care is halted by a lack of awareness of the medicolegal aspects. Awareness of the medicolegal system is as essential as professional competence in the practice of medicine. It only makes it vital for health practitioners to be informed of medical law and ethics because of heightened understanding among patients about the same. Aim: The aim of this study was to evaluate the knowledge and awareness on medicolegal issues among dental practitioners in Mumbai. Materials and Methods: A self-structured, pretested, close-ended, self-administered questionnaire was conducted on 100 dental graduates and postgraduates across Mumbai compromising 11 questions related to the medicolegal system, Consumer Protection Act, and informed consent. Conclusion: Participants were aware of the various aspects of the medical legal system, but lacked comprehension of the finer points. However, they lacked basic information in regard to the medicolegal programs and courses offered in the country.
Keywords: Dental practitioners, indemnity insurance, informed consent, medicolegal system
|How to cite this article:|
Kallianpur R, Pereira T, Shetty S, Gotmare S, Pereira C, Anjali A K. Knowledge, attitude, and practice of dental practitioners toward the medicolegal system: A cross-sectional questionnaire study. Muller J Med Sci Res 2022;13:35-9
|How to cite this URL:|
Kallianpur R, Pereira T, Shetty S, Gotmare S, Pereira C, Anjali A K. Knowledge, attitude, and practice of dental practitioners toward the medicolegal system: A cross-sectional questionnaire study. Muller J Med Sci Res [serial online] 2022 [cited 2023 Feb 5];13:35-9. Available from: https://www.mjmsr.net/text.asp?2022/13/1/35/355292
| Introduction|| |
No greater opportunity, no greater responsibility, and no greater obligation can fall to any other human being than to become a health-care professional. This also signifies a need for scientific knowledge, technical skill, moral understanding of the profession, and awareness about the relevant laws of the land.
India has undergone significant changes in medical practice, impacting health delivery in both positive and negative directions. As a result, there was an increasing sense of responsibility for medical care, and this led to physicians and dentists being subject to the legal process.
Law influences every aspect of human activity, and dentistry in this regard is no exception. As a career, dentistry has come a long way. This has evolved from being an undifferentiated career to an advanced level of professionalism. While shedding old dogmas and methodologies, dentistry has witnessed changes during this time, embracing new ideas that adhered to ever-changing technology. This transition has also led to a paradigm shift in the patients' attitude toward the doctor and apprehension within the health-care profession regarding increasing trends of complaints and lawsuits today.
Knowledge about medical ethics is as fundamental to the practice of medicine as clinical skills. Implementation and improvement of the conceptual framework for health policy is still in its infancy. In today's times, the dental and medical curriculum in India, prioritizes more on the technical aspects and boosting technical skills, but lacks in ethical aspects.
With medical error as the top 10 killer according to the World Health Organization and India accounting for 26% of the world's global burden of disease, it becomes a requisite for doctors to safeguard themselves against a heap of risks or loss which could arise due to professional negligence cases.
A large number of dentists are being called to court for patient claim resolution, making it highly important that dentists have ample knowledge of the law and the consequences for their profession. This survey was undertaken to assess the knowledge, awareness, and practice of the medicolegal system among dental practitioners in Mumbai.
| Materials and Methods|| |
This present study used self-structured, pretested, close-ended, self-administered questionnaires that were conducted across Mumbai on 100 dental practitioners; 70 were MDS dental practitioners and 30 were BDS dental practitioners. The questionnaire consisted of nine questions pertaining to the legal aspect of medicine, professional indemnity insurance, Consumer Protection Act, and informed consent. The purpose of this study was explained to the participants and they were assured of confidentiality [Table 1].
Ethical clearance was obtained from the Institutional Research and Ethical Board D Y Patil University, School of Dentistry, Navi Mumbai.
Descriptive and inferential statistical analyses were carried out in the present study. Results on continuous measurements were presented on mean ± standard deviation, and results on categorical measurements were presented in number (%). The level of significance was fixed at P = 0.05 and any value ≤0.05 was considered to be statistically significant. Chi-square analysis was used to find the significance of study parameters on a categorical scale. The statistical software IBM SPSS statistics 20.0 (IBM Corporation, Armonk, NY, USA) was used for the analyses of the data, and Microsoft Word and Excel were used to generate graphs, tables, etc.
| Results|| |
A total of 100 dental practitioners participated in the study, out of which 44 were male and 56 were female. On the basis of qualification, 70% of the participants were MDS graduates and 30% of them were BDS graduates. Participants have been divided into two categories to illustrate the expertise of participants on the basis of their age. The first category included the age between 25–45 years. The age of 46 and above was part of the second category. The mean age of the participants was 38.8. Information on the description of the participants in this study according to their gender, qualification, specialization, and age group is shown in [Table 2].
Regarding knowledge of professional indemnity insurance, approximately 62% of the study participants knew about professional indemnity but only 35% of them had taken insurance coverage to protect themselves against claims [Table 3] and [Figure 1].
|Table 3: Awareness of medicolegal programs/courses among dentists and professional indemnity insurance|
Click here to view
Only about 57% of the participants have attended any program concerning medicolegal issues. Just 34% are aware about courses regarding medicolegal aspects. A whopping 86% of the participants felt that in undergraduate dental courses, medicolegal issues should be taught [Table 2].
In respect to the understanding of dentists of informed consent, results revealed that only 56% of dentists take informed consent and case history at their workplace [Figure 2]. Only 42% of the participants were aware that a copy of informed consent should be given to the patient when asked for. Although only 59% of dentists were able to draft an informed consent [Table 4].
|Figure 2: Number of participants who take informed consent and case history at their workplace|
Click here to view
Our study also suggests that senior dental professionals are well informed about the Consumer Protection Act [Table 5]. In total, about 51% of the participants in the study were aware of the Consumer Protection Act and the legal procedures needed to address the same [Table 6] and [Figure 3].
|Figure 3: Percentage of participants aware about Consumer Protection Act|
Click here to view
|Table 6: Awareness of Consumer Protection Act on the basis of age groups|
Click here to view
| Discussion|| |
In the age of consumerism, awareness in developing societies is increasing and people are changing their attitudes toward medical and dental professionals. This increases the probability of suing dental practitioners for their misconduct. Law is universal and is applicable to all, making it the duty of every individual to know the law of the land where he resides. As a result, a dentist should be aware of and updated with the various forms of health-care practice-related legislation.
This questionnaire-based survey was conducted on dental practitioners across Mumbai to understand the awareness of medicolegal issues. A total of 100 dentists participated in the current study. The result of this study provides a clear insight into the understanding, awareness, and the need to strengthen knowledge, attitude, and practices regarding medicolegal issues.
Informed consent is recognized universally as a vital protective measure to ensure that the right of an individual is preserved. It is also a significant device of standard practice in ethical medicine. The current study showed that only 56% of dental practitioners take informed consent and case history at their workplace, comparable to a study conducted by Gupta et al. in Punjab, where 48.7% of the participants obtain consent before the treatment. There is also similarity to a study conducted by Memon et al. among medical practitioners, in which only 45.7% of the participants took informed consent. This could probably be due to the dental professional's urgency, lack of time, or incompetence.
As per the findings of this study, just 42% of the participants were aware that a copy of the informed consent form should be given to the patient when asked for which is close to a study conducted by Khare et al. in Bhopal, wherein only 48.6% of dental professionals were aware of the same. Unawareness of the evolving trends in obtaining patient consent may be the most common explanation for the total lack of knowledge.
In this study, only 36% of dental professionals were aware about the courses regarding the medicolegal system which is similar to a study conducted by Garbin et al., where 48.57% of dental health professionals were aware about the courses available. Another research conducted by Saltstone et al. showed similar findings, of which 48.9% were informed about the courses in medical ethics., These results are comparatively high to a study conducted by Baheti et al., wherein 92% of health professionals, which included dental practitioners, medical professionals, and physiotherapists, were not aware about the courses available.
In an ever-changing world, the role of dental indemnity is to facilitate, support, and safeguard dentists in the numerous challenges and litigations that they encounter throughout their professional careers. In the present study, 62% of the participants were aware about professional indemnity insurance which is very similar to a study by Yashoda et al. in Bangalore, where 63% of the participants had knowledge of indemnity insurance. This is higher than the study conducted in Chennai by Mohandas et al. among dental practitioners.
The current study suggests that 65% of dental practitioners have not taken insurance coverage to protect themselves against claims which are in contrast to a study conducted by Gupta et al. wherein 79.4% of the dental practitioners did not have dental indemnity insurance. The relatively small number of insured dental practitioners may be attributed to the exclusion at undergraduate level of these subjects from the curriculum, leading to a lack of understanding of the same. To counter this unawareness, transdisciplinary courses and programs should be conducted in colleges. Efforts must be taken to make indemnity insurance compulsory, which would help raise awareness and also ensure the maximum number of insured dental practitioners.
Due to the Consumer Protection Act, which was implemented to help protect the interests of the consumer and to correct their concerns, patients today have become more informed and are much more likely to challenge health-care professionals. In the present study, 51% of the participants were aware about the Consumer Protection Act which is similar to a study conducted by Singh et al. in Udaipur, where 49.6% of medical professionals and 50.4% of dental professionals were aware about the same. In contrast with young practitioners, our study also indicates that senior dental practitioners are more knowledgeable about the Consumer Protection Act [Figure 4]. This is in accordance with the study conducted by Haripriya and Haripriya et al. in Bilaspur. This may be attributed to an increase in academic expertise, an increase in the number of seminars attended, programs, conferences, and understanding of the frequency of negligent cases in dental practice related to legal issues.
|Figure 4: Awareness of Consumer Protection Act on the basis of age groups|
Click here to view
The limitations of the study were its limited sample size since it was performed only in one dental college. It is, therefore, difficult to generalize the effects of this research to all dental practitioners. Another downside was that only one or two questions regarding a particular law or legal rule were asked. This alone cannot indicate if, and vice versa, a participant had inadequate knowledge of the same. Many more questions on a particular topic will be necessary to calculate the knowledge reliably, requiring the use of a much longer and more time-consuming survey instrument.
| Conclusion|| |
This study was conducted as a sincere effort to evaluate dental practitioners' knowledge of informed consent, professional indemnity insurance, and the Consumer Protection Act. It also seeks to enhance their comprehension, knowledge, and attitude regarding the same. Participants were familiar with the different facets of the medicolegal system, but lacked knowledge of the finer points, thereby indicating an urgent need to refresh their understanding of this issue. To address this, emphasis should be placed on legal jurisprudence and legal medicine in undergraduate and postgraduate training, as it is essential for dentists to defend themselves from civil lawsuits and even criminal proceedings. This in turn would contribute to greater dental practice and satisfaction. Having said that law should not be a source of fear or an obstruction in the delivery of a professional service, especially a service as important as medicine; on the contrary, it should facilitate as a tool to ensure that there is due diligence done both on the caregiver and caretaker's side in the health-care system. On the contrary, it should facilitate as a tool to ensure that there is due diligence done both on the caregiver and caretaker's side in the health-care system.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Radhika T, Nadeem J, Arthi R, Nithya S. Awareness about medico legal aspects and Consumer Protection Act among dentists. J Forensic Odontostomatol 2017;35:1-8.
Bhadauria US, Dasar PL, Sandesh N, Mishra P, Godha S. Medico-legal aspect of dental practice. Clujul Med 2018;91:255-8.
Hiremath SS. Ethics in dentistry. In: Goswami N, editor. Textbook of Preventive and Community Dentistry. 1st
ed. New Delhi: Elsevier; 2007. p. 248-9.
Singh K, Shetty S, Bhat N, Sharda A, Agrawal A, Chaudhary H. Awareness of Consumer Protection Act among doctors in Udaipur City, India. J Dent (Tehran) 2010;7:19-23.
Gupta VV, Bhat N, Asawa K, Tak M, Bapat S, Chaturvedi P. Knowledge and attitude toward informed consent among private dental practitioners in Bathinda city, Punjab, India. Osong Public Health Res Perspect 2015;6:73-8.
Memon KN, Sushel C, Shaikh SR, Memon FA. Informed consent; awareness and practice among general medical practitioners. Prof Med J 2015;22:1262-5.
Khare A, Saxena V, Jain M, Sharva V, Singh P, Dayma A. Knowledge and attitude toward informed consent in medical and dental practitioners, of Bhopal City, India. J Dent Res Rev 2017;4:17-20. [Full text]
Saltstone SP, Saltstone R, Rowe BH. Knowledge of medical-legal issues. Survey of Ontario family medicine residents. Can Fam Physician 1997;43:669-73.
Garbin CA, Garbin AJ, Saliba NA, de Lima DC, de Macedo AP. Analysis of the ethical aspects of professional confidentiality in dental practice. J Appl Oral Sci 2008;16:75-80.
Baheti MJ, Thakur S, Khokhani R, Mahagaonkar P, Toshniwal NG, Gangadhar SA. Medico legal awareness: Where are we? – A survey among health professionals in Maharashtra and Haryana. Int J Public Health Res 2015;5:525-30.
Yashoda R, Puranik MP, Kumar V, Farhanaz F. Dental practitioner's perspectives about the consumer protection act, informed consent and professional indemnity insurance in Bangalore city: A cross-sectional study. J Indian Assoc Public Health Dent 2017;15:225-9. [Full text]
Mohandas R, Ramani P, Sherlin HJ, Gheena S, Ramasubramanian A, Jayaraj G, et al
. Awareness of professional indemnity insurance among dental practitioners in Chennai – A knowledge, attitude, and practice survey. Drug Invention Today 2020;13:37-4.
Gupta D, Thomas S, Dagli R, Solanki J, Bhateja GA, Mahajan R. Professional indemnity insurance used among graduated and post graduated dental surgeons in Mumbai city, India. J Health Res Rev 2014;1:44-8. [Full text]
Haripriya A, Haripriya V. Knowledge about medical law and its negligence among doctors: A cross-sectional study. Int J Sci Res Publ 2014;4:50-3.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]