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F E AT U R E


D E N TA L P R O F E S SI O N A L ISM F


EW would argue that the way we interact, in all aspects of our life, is in a state of flux. The ever-rising use of social media means we rely less on face-to- face contact, interacting via digital platforms such as Twitter, Facebook, WhatsApp or Instagram. Behaviours that in the past might have been tolerated or even accepted as appropriate interaction are now being challenged.


The dentist-patient professional relationship has also


seen radical change in the UK over several decades, with a marked departure from medical paternalism to the autonomous patient. Throughout all of this change, we are obliged to navigate the complexities of human interaction whilst maintaining professional boundaries. As dentists, we often see patients at their most vulnerable, in pain and nervous, facing necessary procedures. The treatment we provide is by nature invasive, probing into the intimate body space of a conscious patient who cannot see what we are doing. Good communication is key to gaining patient trust in such a precarious situation. It is important to give the profession credit in overcoming this challenge on a daily basis.


JUSTIFIED TRUST Professional boundaries can be defined as those “between what is acceptable and unacceptable for a professional to do, both at work and outside it, and also the boundaries of a professional’s practice”.1


These boundaries exist


to protect both the patient and the professional. Professionalism is a dynamic concept – given the variety of dentist-patient interactions – to which we must pay


It’s never been more difficult to judge when you may have “crossed the line” with a patient or colleague. Dental adviser Sarah Harford offers some insights


BLURRING THE BOU


careful attention in order to manage the interface between our personal and professional selves. It can be difficult to absolutely define what is and what is not professional. In its guidance, Standards for the dental team, the GDC asks that you “ensure that your conduct, both at work and in your personal life, justifies patients’ trust in you and the public’s trust in the dental profession”.2 All health and social care professionals are expected to maintain professional boundaries. Research appearing in the British Journal of Social Work found that rather than relying on professional codes of practice, a clear majority of social workers relied on their own sense of what is appropriate or inappropriate, and made their judgements with no reference to any formal guidance1


.


Making such a judgement comes with an assumption that we can always determine for ourselves what is appropriate, even at potentially turbulent times in our life. It is of note that dentists involved in regulatory proceedings due to a breach in professional boundaries have often been facing difficulties in their personal life.


PATIENT BOUNDARIES The GDC states: “You must maintain appropriate boundaries in the relationships you have with patients. You must not take advantage of your position as a dental professional in your relationships with patients”.2 In some circumstances you might be the health


14 / MDDUS INSIGHT / Q1 2019


professional that a patient sees most often, especially if a regular attender at the dental surgery. Patients may offload information about their personal lives during chair-side conversations and, whilst you would want them to feel relaxed and at ease, it is still important to maintain a professional distance. It is therefore wise not to share personal information about your own life. You should not accept “friend requests” from patients on social media sites, and if you are concerned that a patient is making inappropriate advances, you should politely remind them that your relationship is strictly professional and document that discussion. In such circumstances you may need to suggest that the patient is treated by another colleague in future (unless in an emergency). MDDUS has found that when boundaries become


blurred and a patient is communicating with a dentist via text or social media there is always the risk that a “platonic” relationship can turn sour, especially if treatment problems are encountered. Any resulting complaint could soon escalate, with the dentist facing criticism for not maintaining professional boundaries. Professionalism is, again, a dynamic concept and adaptation may be required in dentist-patient relationships, for example with cultural differences. On the European continent, kisses on the cheek when greeting might be commonplace but they would likely take UK patients by surprise. Equally some patients might not feel comfortable


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