Putting patients' interests first

The recently published General Dental Council publication, Standards for the Dental Team¹ will, without doubt, have been top of UK readers' holiday reading. It provides all who work in the UK with guidance on core principles of practice, patient expectations, standards which will ensure that patient expectations are met and guidance on how to meet the standards. As such, it contains much useful information and readily digestible points on how best to practise dentistry, with the recommendations on appropriate reading for those outwith the UK.

The guideline, ‘Patients expect that their interests will be put before financial and business gain’, made me think. Average-sized dental practices may be classified as small businesses, with the attendant need to make sufficient income to provide for the practice owner and his/her staff. However, some dental businesses are now very large – among these being the dental corporates. How do such organizations square the recommendation above with the need to make a profit for shareholders and/or financiers? It has recently been pointed out that dentistry is now big business and it has been considered that Corporate Bodies introduce an additional layer of management which must be paid for.² These managers may ask their dentists to work with specified laboratories,² presumably because they have arranged an attractive rate for the work. What happens if the laboratory work is not up to standard? Will the dentist employed in such an organization feel able to challenge the practice or group manager?

Alongside advice regarding reputable laboratory work, it would have been helpful if the new ‘Guidance’ document had included something about using materials which had proven effectiveness because, as dentists, we should inform our patients about the materials that we are putting into their mouths (section 4.1.2 – record details about discussions with the patient), given that patients are likely to have a paucity of knowledge about dental materials. Section 7.1.1 touches on this when it mentions providing good quality care based on current evidence. Does this include dental materials? In my travels around the country, I am told, time and time again, by dentists who work for large organizations that they have no control over the materials that they have to use and that these are chosen by a manager solely on the basis of cost. This journal has pointed out that own label brands, while cheap, may not have any research to back up their effectiveness.³

So, can the delegation of the choice of materials and/or laboratory to a third party (who may be a business manager with no dental training) ever be justified? I think not. The decision about what we put into a patient's mouth must be made by a clinician and, better still, by the clinician who is responsible for the care of a given patient. It would have been helpful if Standards¹ had spelt this out word for word, but at least there is sufficient advice in the publication to help those dentists who have lost control of the materials and laboratories that they use to help wrestle back the control of the treatment of their own patients, and perhaps therefore their own destiny.