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MyView: Professionalism in dentistry

June 20, 2016

Ralph A. Cooley, D.D.S.
When one looks at the concept of dental professionalism, what exactly does that really mean? The dictionary definition of professionalism is quite simple: "The conduct, aims or qualities that mark a profession or professional person." When we add the dental aspect to it, it can further be defined as "a life characterized by display of high intellectual, technical and moral qualities and abilities, in service to patients and community." I think it is interesting that the term "professionalism" is a relatively new word in dentistry, first appearing in the Journal of Dental Education in 1968. Virtually all groups in dentistry have looked at what this really means. The ADA and the Academy of General Dentistry have their own codes of professionalism and ethics. Currently, the American College of Dentists is doing a three-year study on ethics and professionalism in dentistry. The American Dental Education Association assigned a task force to look at it a few years back, and developed its "Statement on Professionalism." And finally, The American Student Dental Association has a white paper on the subject, and after reading that, I found out how technology has opened so many avenues on how to cheat academically. I have to admit, I was pretty clueless on that subject.

With everyone asking the question, 'What is professionalism?' maybe more important questions to ask are: is professionalism really important?; how is it taught; and what are the values of professionalism that we should strive to model during our careers if we truly believe in it?

Professionalism today faces challenges from many different fronts, with society's view of ethics being one of these. U.S. News and World Report showed studies that in 1950, only 20 percent of college students reported cheating, and today those same studies report 84 percent of students believe they need to cheat to get ahead in the world. That is definitely a societal change, with the 'me first' mentality being encouraged.  

After reading and researching about a quest for professionalism, I had to do some soul searching on my own. I realized that professionalism is much more than simply having good elevator manners, being a nice person or treating patients well. It encompasses several distinct qualities, so I looked into those to do a self-examination, if you will. Although the qualities of professionalism can be defined by a lot of different terms, I looked at the six values that the ADEA task force defined: competence, fairness, integrity, responsibility, respect and service-mindedness.


What does that look like on an everyday basis? It requires some reflective thinking to answer the question, "How can I improve?" It means being what the AGD and others have coined, a "lifelong learner." Competence today does not always translate into competence tomorrow. It is truly a lifetime process. My grandmother was a high school English teacher for more than 40 years, and she always reminded me about continuing to grow and learn with a quote. She said, "If you are a little green, that means that you are continuing to grow, but when you ripen, that's when you start to rot." I want to stay green.


What does this really mean? I believe it means giving the best effort (100 percent) to each and every patient, as well as treating students in a fair manner. It also means evaluating students, staff and colleagues consistently based upon their performance without prejudice. While life itself may not be 'fair', we do our best to exhibit the value of fairness with the people around us.


Earlier I said that a big part of professionalism involved putting the patient's interests first and foremost, and that can only occur if one has integrity when interacting with patients. With financial pressures in the dental marketplace, or when looking for the right patient experiences for dental students, we sometimes can be influenced to see only opportunities for the dentist rather than options for the patient. The old cliché of looking at the patient's treatment plan like you were treating a valued family member still rings true today.


How does that flesh out on a day-to-day basis? It means showing up, being where you are supposed to be and being dependable. As my father told me one time when I was grappling with an issue and asked his advice, "You know the right thing to do … just do it." My dad was way ahead of the Nike phrase. When treating patients, it means being available and having a plan for patients of record who have an emergency. And frankly, from day to day, it may mean admitting mistakes, adjusting the course of action, and going to a team member or colleague and saying, "I was wrong, I'm sorry." Sometimes those words are difficult to articulate.


I believe that respect plays out in many ways in dentistry. In regard to patients, it absolutely requires maintaining confidentiality of health information, and also protecting patients from harm in our care of them. It is respecting their right to choose their course of treatment within a correct standard of care parameter. For student/faculty interactions, it forced me to look carefully how I criticize and critique. In regards to colleagues, I had to evaluate myself with two questions, "Am I quick to rush to judgment on dental treatment or decisions that I observe, or do I ask more questions to find out what exactly happened?" And secondly, "Do I criticize my colleagues when they are not present, or do I support them?" I have to tell you, these are tough questions, but necessary.


Service to our profession — we expect this quality from the prospective students who are seen by the admissions committee at our dental school, and in the same way that learning is a lifelong commitment, so is service to our profession. This is demonstrated through many venues — activities and volunteerism at ADEA, the ADA, AGD, Texas Mission of Mercy projects, community outreach programs, and the list continues.

The values of professionalism: competence, fairness, integrity, responsibility, respect and service surround us daily. If we, as dentists, ever lose the commitment to professionalism in the future, there will be no profession of dentistry. Let me repeat that succinctly: no professionalism, no profession. We will be reduced to being a trade that can perform duties well, but not viewed as a cohesive, respected group that lives for the betterment of society.

Two things truly came to light when I started investigating what professionalism in dentistry means. One, professionalism does not mean perfectionism. We all fall short at times; we are human. When we fall, we pick ourselves up and get back in the game. And secondly, but even more importantly, I realized how fortunate I was to be surrounded by colleagues and mentors in dentistry who live and teach these values every day. Although we have great courses on ethics in our dental schools, professionalism many times falls into the category of a hidden curriculum, and is something that is "caught" as well as "taught." So in the future, may we continue to encourage one another in our lifetime journey of professionalism, and in the words of my grandmother, may we "always stay green."

This editorial, reprinted with permission, first appeared in the August 2015 issue of The Journal of the Greater Houston Dental Society. Dr. Cooley is an associate professor in general practice and dental public health at the University of Texas Health Science Center at Houston and is a fellow of the Academy of General Dentistry.