| Abstract|| |
Background: With the advent of Consumer Protection Act in 1986, awareness among the public on their consumer rights has increased. Health professionals can be litigated for medical negligence under the Consumer Protection Act. This had led to an increase in medicolegal issues in the recent past. The advocates (Doctors of Law) play a vital role in solving these issues and delivering justice to the victims. Hence, a sound knowledge on medical and dental jurisprudence is mandatory for these legal professionals.
Aim: The aim of this study is to assess the knowledge, attitude, and practice regarding dental jurisprudence among the advocates practising in Chennai, India.
Materials and Methods: A cross-sectional study was conducted among 180 advocates belonging to three groups each with sixty advocates namely: Group I (advocates completed under graduation in law), Group II (advocates specialized in Criminology), and Group III (advocates specialized in other fields of law). A 26 item questionnaire was used for the study. Based on the responses given, the knowledge score was calculated with one point assigned for each correct response. The knowledge score of the three groups was compared between the three groups statistically.
Results: The mean KAP score of Group I was 6.8 ± 2.1, Group II was 9.0 ± 2.1, Group III was 6.8 ± 2.4, and this difference was statistically highly significant (P = 0.001 and F = 16.007). Nearly 71% of the advocates handle medicolegal cases issues of which issues related to unethical practice (31%) was very frequent. 92% of them felt the coverage of dental jurisprudence in their study curriculum was not adequate and they required extra reading to handle such cases.
Conclusion: The present study concludes that almost all the advocates who participated in the study had inadequate knowledge in medical and dental jurisprudence, including those specialized in criminology, who fared better than the other groups.
Keywords: Dental ethics, education, ethics, medical jurisprudence
|How to cite this article:|
Brinda B, Madan Kumar P D, Sivasamy S, Balan I N. Knowledge, attitude, and practice of advocates regarding dental jurisprudence in Chennai: A cross-sectional study. J Educ Ethics Dent 2016;6:45-52
|How to cite this URL:|
Brinda B, Madan Kumar P D, Sivasamy S, Balan I N. Knowledge, attitude, and practice of advocates regarding dental jurisprudence in Chennai: A cross-sectional study. J Educ Ethics Dent [serial online] 2016 [cited 2020 Apr 7];6:45-52. Available from: http://www.jeed.in/text.asp?2016/6/1/45/216518
| Introduction|| |
The health profession is considered as a “noble profession.” The health professionals alleviate patients' distress and on numerous instances, save lives. Ironically, the doctor–patient relationship is dynamic and complex, as it is both strong and vulnerable. It is strong because of various factors such as confidentiality, trust, and the concern they show for the patients. However, the relation becomes vulnerable in instances of substandard care, overtreatment, inappropriate treatment and the like. On occasions when the faith in a doctor is breached, patients may feel deceived and may call on the judicial system for justice.
In India, with the advent of Consumer Protection Act in 1986, awareness among the public on their consumer rights has increased. Health professionals can be litigated for medical negligence under the Consumer Protection Act. In India, there is steady increase in the number of medicolegal cases filed every year since 2006. The magnitude of problem is such that a complaint cell is operated by the Government of India called the National Consumer Helpline (NCH) where complaints related to medical negligence can be filed directly by the consumers. For the year 2013–2014 alone, nearly 1.2% of the total calls received by NCH were related to medical negligence. Once these issues reach the forum, cases are settled amicably by the law professionals. Hence, law professionals are integral stakeholders in this field and they play a bridging role between the doctors and patients in delivering justice.
In India, the system is such that a person should possess an undergraduate degree to enroll in an undergraduate course in Law such as Bachelor of Legislative Law or Bachelor of Law or can directly pursue a 5-year law course after completing their higher secondary studies. on completion of the undergraduate degree in law, the advocates can pursue their postgraduation in one of the nine specialties of Law or upgrade themselves by enrolling in postgraduate diploma courses. It is prudent for lawyers to get acquainted with medical ethics to enable them to analyze and resolve ethical dilemmas. However, medical ethics or dental ethics as a subject does not exist in the undergraduate curriculum of Law in India.
Topics related to medico legal issues are being covered only in the legal specialty Criminal law and Criminal Justice (Criminology) and it is not being covered in any of the other legal postgraduate department. Hence, it can be hypothesized that there might be differences in the knowledge, attitude, and practice of legal professionals in handling medicolegal cases. Enquiry into this area is warranted as it helps both health professionals as well as public to be more informed while approaching the legal system. Hence, a cross-sectional study was conducted among advocates in Chennai city with the aim of assessing their knowledge, attitude, and practice regarding dental jurisprudence. We also intended to compare the knowledge and practice of advocates who have completed under-graduation in Law, postgraduation in Criminology and postgraduation in other specialties of Law.
| Materials and Methods|| |
The study protocol was approved by the Institutional Review Board of the institution where the study was conducted. A cross-sectional questionnaire-based study was conducted in Chennai among a convenience sample of 180 advocates with minimum 1 year of legal practice. The study subjects were selected and were categorized as follows: Group I (n = 60) consisted of advocates who have completed under-graduation in Law, Group II (n = 60) consisted of advocates who have specialized in Criminology, and Group III (n = 60) consisted of advocates who have specialized in other fields of Law.
Thirty-three item self-administered questionnaire was initially prepared of which, five questions were related to sociodemographic details of the participants, 18 questions assessed their knowledge, five assessed the attitude and five were related to the practice of advocates regarding dental jurisprudence. Out of 18 questions which assessed the knowledge, ten were framed based on trials pertaining to dental jurisprudence for which judgments have been given by various Courts in India. This questionnaire was subjected to content validation to obtain the final questionnaire.
Content validation of the questionnaire was done by four expert raters of whom two experts were Senior practitioners of Law with specialization. The other two experts were Professors of Public Health Dentistry who are not associated with the institution where this study was conducted. The questionnaire was modified according to the opinion of the experts. Two questions were eliminated as it was mimicking the same situation already described in the questionnaire. Hence, the final questionnaire consisted of 31 items with closed-ended responses. Content validity for individual items (I-CVI) and for the overall scale (S-CVI) was assessed. The I-CVI ranged from 0.75–1 while the S-CVI was 0.939 [Table 1]. The scale-level content validity index, using the universal agreement calculation method was found to range from 0.9 to 1 [Annexure 1 [Additional file 1]].
|Table 1: Computation of an content validity index for the scale for a 10-item scale with four expert raters*|
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Recruitment of study subjects
The study subjects in Group I and III were selected using snowball sampling technique within the premises of Madras High Court. However, identification and selection of subjects for Group II posed difficulty and hence were selected using the Directory of Madras High Court Bar Association as sample frame. Subjects who have specialized in Criminology were chosen randomly from the sample frame, explained about the purpose of the study over the telephone and were invited to participate in the study. Written informed consent was obtained from all the lawyers before participation in the study. The questionnaires were administered to the study subjects in person in their office, and each one of them took around 15-20 min to complete the questionnaire.
Statistical analyses were carried out in Statistical Package for Social Sciences version 19 (IBM, 2010). Descriptive statistics were calculated and expressed as mean and standard deviation, or the frequency depending on the type of data. Based on the responses given, the knowledge score was calculated with one point assigned for each correct responses. The knowledge score between the three groups was compared using Kruskal–Wallis test. Further, Mann–Whitney U-test was used to compare the intergroup variation in knowledge scores and also the difference based on gender and years of practice. Chi-square test was used for data in categorical scale. For all comparisons, P < 0.05 was considered to be statistically significant.
| Results|| |
Out of 180 questionnaires, 150 were filled and collected with the response rate being, 83.3%. Response rate of Group I, II, and III were 85%, 81.6%, and 83.3%, respectively (P = 0.96). In total, there were 93 (62%) male and 57 (38%) female who participated in the study. According to the definition of the Indian court system, 95 (63.3%) senior advocates (those who completed more than 10 years of practice) participated in the study and the remaining were junior advocates. The mean age of the subjects was 38.84 years. Nearly, 80% of the advocates were not aware that dental jurisprudence was a part of medical jurisprudence. More than 90% of them felt that the coverage of dental jurisprudence in their curriculum was inadequate. The most common type of medicolegal case handled by the advocates in the decreasing order were unethical practice (31.3%), cases involving third party administrators/insurance companies (23%), Assault/Battery and abuse (12.7%), cases related to substandard care (4.7%).
The knowledge of the study subjects were analyzed based on the gender, years of practice, and type of specialty. The mean knowledge score of subjects who have completed their specialization in Criminology was 9.06 ± 2.12 while for those specialized in other fields of Law was 6.88 ± 2.45 and for those who have completed undergraduation in Law, it was 6.80 ± 2.15 and this difference was found to be statistically significant [Table 2]. Analysis was done to compare the correct responses for the situation-based questions between the three groups. Most of the advocates have given (>75%) incorrect responses to three of the ten situation-based questions. Distribution of the correct responses to the various situations among the study subjects is shown in [Table 3]. However, Mann–Whitney U-test showed that the difference between Group I and Group III was not significant. Female advocates exhibited higher knowledge score than the male advocates [Table 4]. The knowledge score of subjects did not differ significantly between senior and junior advocates.
|Table 2: Distribution of knowledge, attitude, and practice scores based on the specialty|
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|Table 3: Distribution of correct reponses to the various situations among the study subjects|
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|Table 4: Distribution of the knowledge, attitude, and practice scores based on the gender|
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Most of the lawyers (86.6%) felt that the awareness among public on the medicolegal issues has improved greatly when compared to earlier times, with internet being the most common source of information. All study subjects felt that they require continued educational programs to update their knowledge on medical and dental jurisprudence.
| Discussion|| |
To the best of our knowledge, this is the first study to assess the knowledge, attitude, and practices of Indian advocates regarding dental jurisprudence. This study gains importance in the changing context of medical and dental practice. On the one hand, the awareness among patients as consumers of medical services is on a raising note, and on the other hand, instances of medical negligence being reported are also increasing. The media on its part widely publicizes cases of medical negligence, thereby drawing huge public attention. Hence, the health professionals, public, and the advocates who are direct stakeholders should have adequate knowledge in handling these sensitive issues.
In the present study, the lawyers who have specialized in Criminology fared better than the undergraduates and advocates specialized in other fields of law. Despite medicolegal subjects being covered as a part of their curriculum, the knowledge of the advocates specialized in Criminology had lacunae. This calls for change in the curriculum of legal studies both at undergraduation as well as postgraduation level. These situations were pertaining to substandard care or mishaps that occur in dental settings. Although in these scenarios, the dentists were not liable, most of the advocates were not aware of it.
In this study, the female lawyers had better knowledge on dental jurisprudence than their male counterparts. This is because the female lawyers who participated in this study reported to handle significantly more medicolegal cases when compared to male lawyers. It was, however, found that duration of legal practice did not influence the lawyers' knowledge regarding dental jurisprudence. This is probably because the number of cases filed pertaining to dental or medical jurisprudence was negligible till the last decade and it is only in the recent past that such a trend is noticed. Hence, the exposure to such cases might be similar for both senior and junior advocates. Since the previous enquiry into this area is virtually nonexistent, direct comparison of the study findings with other studies could not be done.
This cross-sectional study has certain limitations which should be borne in mind while extrapolating the findings. Both undergraduates and lawyers specialized in other fields of law were recruited by nonrandom sampling method and hence may not be representative of such population. Although the sample size was not estimated scientifically before the study, power analysis showed that the study has 83% power. Hence, the results of the study should be considered with seriousness as this is the first inquiry to throw light on the knowledge of advocates regarding medical jurisprudence.
It is well known that there exists a hand in glove relationship between the doctor, advocate, and patient/client in solving medicolegal issues. Doctors and advocates being white-collared professionals should be the knowledge providers to the patients/clients. However, literature shows that health professionals do not have adequate knowledge on medical ethics and jurisprudence., This is of concern as inadequate knowledge of health providers coupled with less than adequate knowledge of advocates can lead to incorrect information disseminated to the patients/clients. This may, in the future, affect the doctor–patient relationship and also make the health professionals and advocates vulnerable thus leading to failure in providing justice to the deserving side.
| Conclusion|| |
The present study concludes that almost all the advocates who participated in the study had inadequate knowledge in medical and dental jurisprudence, including those specialized in criminology, who fared better than the other groups. Hence, lawyers frequently encounter dilemmas while handling medical and dental negligence cases. The lacunae in their knowledge on these issues can be filled by upgrading the curriculum in these areas. Hence, it is recommended that the legal governing bodies should make it mandatory for advocates to attend continued educational programs on medical and dental jurisprudence to effectively handle medicolegal cases and there can be specialized tribunals setup by the respective authorities to specifically handle medicolegal cases with experts from both sides so that it will aid in delivering justice to all stakeholders in this area of concern.
We would like to acknowledge the following experts for content validating our questionnaire.
Dr. Joseph John, Professor and Head, Department of Public health Dentistry, Saveetha University, Chennai, Dr. Preetha Elizabeth Chaly, Professor and Head, Department of Public health Dentistry, Meenakshi Academy of Higher education and Research, Mr. Raghavan VS, Senior Advocate, Madras High court, Chennai, and Mr. Seshachari, Senior Advocate, Madras High court, Chennai.
We would also like to acknowledge all the advocates who participated in this study despite their busy schedule.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Pandit MS, Pandit S. Medical negligence: Coverage of the profession, duties, ethics, case law, and enlightened defense – A legal perspective. Indian J Urol 2009;25:372-8.
] [Full text]
Joga Rao SV. Medical negligence liability under the Consumer Protection Act: A review of judicial perspective. Indian J Urol 2009;25:361-71.
Polit DF, Beck CT. The content validity index: Are you sure you know what's being reported? Critique and recommendations. Res Nurs Health 2006;29:489-97.
Janakiram C, Gardens SJ. Knowledge, attitudes and practices related to healthcare ethics among medical and dental postgraduate students in South India. Indian J Med Ethics 2014;11:99-104.
Dhawan R, Dhawan S. Legal aspects in dentistry. J Indian Soc Periodontol 2010;14:81-4. [Full text]
Department of Public Health Dentistry, Ragas Dental College and Hospital, 2/102, East Coast Road, Uthandi, Chennai - 600 119, Tamil Nadu
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4]