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ORIGINAL ARTICLE  
Year : 2018  |  Volume : 8  |  Issue : 1  |  Page : 32-40
An ethical awareness among dental interns in dental practice


Department of Prosthodontics, Dr. M. G. R. Educational and Research Institute, Thai Moogambigai Dental College, Chennai, Tamil Nadu, India

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Date of Submission18-Aug-2020
Date of Acceptance19-Aug-2020
Date of Web Publication19-Feb-2021
 

   Abstract 


Background: Code of ethics has to be maintained by the dentists at all levels, however for marketing reasons this has been ignored to a greater extent to establish or grow a dental practice, but does this degrade or have a negative impact by undermining the profession as a whole?
Aim: The aim of this study is to determine the level of cognizance and implementation of marketing dentistry among dental interns.
Materials and Methods: A questionnaire-based study survey comprising 25 multiple-choice questions was provided to 300 dental interns from different colleges. The filled questionnaires were collected in 15 days and the results were tabulated and subjected to statistical analysis using Chi-square test and Fisher's exact test is used.
Results: 24.7% of interns report marketing is ethical and 59.3% of interns think that without marketing, dentistry is seen inferior on the whole. Despite 56.4% of interns agreeing that it does have a negative impact on the profession, around 87.6% of them strongly agree that it has served the community when combined with better quality services.
Conclusion: An attitude change seems to be emerging in the upcoming budding dentists. It should be understood that the Council did not intend to moralize, but to guide and a truthful advertising can be a solid foundation for building a trusted dentist-patient relationship. The emergence of modern technology and socialization itself is another challenge, with the nature of change ethical issues remains the same.

Keywords: Advertising, attitudes, awareness, code of ethics, marketing, superiority

How to cite this article:
Alsadiya H, Rai R, Eswaran B. An ethical awareness among dental interns in dental practice. J Educ Ethics Dent 2018;8:32-40

How to cite this URL:
Alsadiya H, Rai R, Eswaran B. An ethical awareness among dental interns in dental practice. J Educ Ethics Dent [serial online] 2018 [cited 2021 Jun 17];8:32-40. Available from: https://www.jeed.in/text.asp?2018/8/1/32/309671





   Introduction Top


Albert Schweitzer states “Ethics is the activity of man directed to secure the inner perfection of his personality.” As he stated, integrity is an ethical stance that leads an individual to adhere to his or her values.

In civilized life, law floats in the sea of ethics and advertising in dentistry has traditionally been seen as a controversial issue in India. The whole notion of using marketing and advertising to promote a professional dental practice is a relatively new trend. However, these marketing skills by dental professionals in India have increased strikingly during the past tenner, and this vogue seems likely to continue despite a government ban. Even though many dentists find themselves ill-equipped to handle the zestful of this new and changing environment, especially without some ethics of marketing plan. Kent et al. stated, “For a dental practice to grow and attract new patients, it should offer a competitive product at competitive prices, along with convenient and quality services – all supported by a solid market plan.”[1]

A dentist may advertise provided they maintain the decorum, keeping in mind the high moral obligations and the value that the society plays on the important nature of their work and the virtuous character and integrity expected of them. Dental surgeons are expected to exhibit probity, fidelity, and selfless service. Despite these norms, several dentists ignore the Code of Ethics to advertise their services. They consider marketing as a necessary part of running a business some argue that these tactics have the potential to be beneficial.[2] All these arises a controversial question of whether the dentist wants to be the doctor or merchant although there are certainly many opportunities for the dentist to be either option or even both. Because this is a relatively new craze, many interns will either be unaware of the ethicality or be carried away practicing its use. The purpose of this study among the interns is to determine the extent of awareness and active practice of marketing dentistry and its impact on the profession as a whole.

Aim

To determine the level of cognizance and implementation of marketing dentistry among dental interns.

Objectives

  • To evaluate and determine the primary notion of marketing
  • To focus the correlation between the employment of marketing and its impact on dentistry over the years to come
  • To assess if there is an advantage behind its use or downside within dentistry.



   Materials and Methods Top


A questionnaire-based study survey consists of 25 multiple-choice questions and began by collecting demographic by age, gender, current practice and other related information. This survey was conducted in Chennai among 300 interns from different colleges namely Thai Moogambigai Dental College, Meenakshi Ammal Dental College, Balaji Dental College, and Sri Ramachandra Dental College.

The details of the questionnaire were shown in Appendix 1. The filled questionnaires were collected at the end of 15 days and the results were tabulated and subjected to statistical analysis. To compare proportions between genders Chi-Square test is applied, if any expected cell frequency is <5 then Fisher's exact test is used. To analyze the data SPSS (IBM SPSS Statistics for Windows, Version 25.0, Armonk, NY, USA: IBM Corp. Released 2017) is used. Significance level is fixed as 5% (α = 0.05).


   Results Top


This survey provides information on the personalized approach of marketing being considered over the ethical nuances of marketing for successful practice with clinical skills.

Each intern was questioned if he or she is aware of whether marketing is ethical in dentistry. There were 300 total responses to the question with 74 interns reporting (24.7%) ethical, 119 interns reporting (39.7%) unethical, with 107 interns being unaware if marketing dentistry is ethical or not [Figure 1].
Figure 1: Shows whether interns are aware of marketing being ethical in dentistry

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Interns were also questioned on whether they are aware of various marketing skills, and communication skills [Figure 2] and [Figure 3].
Figure 2: Whether interns are aware of various marketing skills

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Figure 3: Whether interns are aware of various communication skills

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Marketing of newer technological equipment/procedures is being widely practiced and interns were questioned on their opinion on it. About 213 interns (71.0%) agreed to promote newer technologies in their future practice, 75 interns (25.0%) reported not being sure of promotions and the rest (4%) agreed not to promote until evidence-based studies are supporting them [Figure 4].
Figure 4: Opinions on the marketing of newer technological equipment/procedures

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It was further questioned whether dental practices that do not advertise are seen as inferior. Out of 300 178 (59.3%), interns think that without marketing, dentistry is seen inferior on the whole and 122 (40.7%) reported that marketing has no role in dental practice [Figure 5].
Figure 5: Opinions on whether dental practices that do not advertise is seen as inferior

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The main rationale of marketing seems to be noticed was a competition within the industry as reported by 133 interns (44.3%), followed by awareness among crowds by 71 interns (23.7%) and to deliver quality dental service by 62 interns (20.7%) and the rest reporting combination of all of the above [Figure 6].
Figure 6: The rationale of marketing according to interns

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Interns were questioned about their notion of marketing trends being a degrade to the image of the dental profession. Around 169 interns (56.4%) agree that it does have a negative impact on the profession and the rest disagreeing with the statement (43.6%) [Figure 7].
Figure 7: Whether the marketing trends degrade the dental profession

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Despite reporting a negative impact of marketing around 263 interns (87.6%) strongly agree that it has served the community when combined with better quality services [Figure 8].
Figure 8: Whether marketing as a whole serves the community or not

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To compare proportions between the Genders Chi-Square test is applied, if any expected cell frequency is <5 then Fisher's exact test is used. To analyze the data SPSS (IBM SPSS Statistics for Windows, Version 25.0, Armonk, NY: IBM Corp. Released 2017) is used. Significance level is fixed as 5% (α = 0.05). On applying the Chi-square test, it is seen that there is a highly significant association between the genders of interns under study. It can be observed that males are more in favor of marketing their practice than female interns [Table 1].
Table 1: Chi-square test for comparison between genders

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Ethical statement

Participation in our study was voluntary. The subjects were informed about the study, the content of the questionnaire, and signed the informed consent. The study was approved by the Institutional Committee of Research Ethics.


   Discussion Top


The present survey proves that more than half of the respondents (87.6%) are in favor of marketing in India. Nonetheless, many still consider advertising by dentists to be unethical as it might risk undermining the ethical standing of the profession. Though marketing and advertising have an adverse effect on the image of the profession in general it has no impact on competition price reduction. Most dentists would be of opinion that due to numerous constraints every professional should know and follow an appropriate Code of Ethics as proposed by The Revised Dentist Regulations 2014 for promotion of the dental office/dental clinic.[3]

Participation in our study was voluntary. The subjects were informed about the study, the content of the questionnaire, and signed the informed consent. The study was approved by the Institutional Committee of Research Ethics. Comparative unethical deeds in an advertisement between DCI and ADA of their Code of Ethics[4],[5] is mentioned in [Table 2].
Table 2: Comparative unethical deeds in an advertisement between Dental Council of India and American Dental Association of their code of ethics

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Although all Indian health universities include ethics in their syllabus, the subject is often overlooked or given secondary importance by institutions and academics. Contrary to this there are many studies and surveys that favor advertising for many reasons. Advertising services should not be misleading to the public and make them believe that a superior service will be rendered with the use of high technology equipment.[6]

There are many who consider advertising a necessary factor to build up and run their business in the show of well-established dentists. Many of them are still trying to attach themselves to the grip with the idea that advertising may be necessary to compete successfully. The social media have also changed the environment immensely that it emphasizes the reality that if the practice fails as a business, the dental practitioner fails as a medical professional.[7] However, it is easy to overstep in communication and marketing which imply superiority that may not be science-based or be substantiated by fact, such claims may materially mislead the public and risk denigrating other practices. It should be understood that the Council did not intend to moralize, but to guide and a truthful advertising can be a solid foundation for building a trusted dentist-patient relationship.


   Conclusion Top


Despite the revised regulations on advertising and marketing of dentistry, there are some who have resorted to some kind of modes to promote their services. Both the managerial literature and practice still fail to fully recognize the importance and the great opportunities associated with ethics in dental products and services.[8] Unethical advertising is neither being discouraged nor appreciated, but there is a demand for relaxation in the restrictions, which would be beneficial in helping upcoming dentists to establish themselves in the race of the competitive world. An attitude change seems to be emerging in the upcoming budding dentists, as the majority of interns approve marketing when combined with clinical skills. It may be a force for betterment, but it could invariably also undermine the health care role of dentistry. Social media marketing firms utilized by dentist needs to be reminded that claims of superiority in this or any other area without substantiation will be not acceptable and violate Code of Ethics. The emergence of modern technology and socialization itself is another challenge, with the nature of change ethical issues remains the same.

Acknowledgment

I owe my sincere thanks to all interns from different colleges who participated in this survey. I genuinely thank the institutional authorities who conceded permission to conduct this study. I am also grateful to the statistician Mr. Boopathy Kangusamy for his advice on statistical methods employed in this study, and to Dr. Rathika Rai for her constructive help through my study and in editing this article. I owe my sincere thanks to my parents Mr and Mrs. Meeran, who traveled alongside and will always be there through my thick and thin.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Annexure 1: Questionnaire (an ethical awareness among dental students in dental practice)

  1. What is your idea of future practice post under-graduation?


  2. a) Joining an existing practise b) Doing specialization

    c) Buying a practise d) Launching a start-up

  3. Is there any need for any form of marketing dental practice?


  4. a) Yes b) No c) Maybe

  5. Do you consider marketing ethical according to Code of Commission?


  6. a) Yes b) No c) Maybe

  7. What are the communication skills you prefer to be considered?


  8. a) Practice brochures b) Business cards c) Thankyou notes

    d) Direct calls/mails to the patients e) All of the above

  9. What are the marketing skills you prefer?


  10. a) TV channels b) Print ads in publications

    c) Creating own websites d) Social media

  11. Other modes of marketing preferred?


  12. a) Attending community events b) Shopping and dining locally

    c) Joining the chamber of commerce d) Connecting on a person to person basis

  13. What do you think marketing of dentistry depends on?


  14. a) Dentist expertise b) Designer and web professional expertise

    c) Combination d) None of the above

  15. Will you prefer to maintain a long term connection with patients through these web professionals?


  16. a) Yes b) No c) Occasionally d) Not effective

  17. Do you want to have a logo for your practice?


  18. a) Yes b) No c) Maybe in future d) No importance

  19. What kind of rate of marketing would you prefer?


  20. a) Set monthly fee to the agency for online ads

    b) Fee splitting to the agency for referral

    c) Daily deal sites

    d) Combination of the above

  21. What are the enticements being used as per your knowledge?


  22. a) Low fees b) Free check-ups

    c) Complimentary gifts d) All of the above

    e) Not much of knowledge of the above

  23. Will you prefer marketing of newer technology installed in practise?


  24. a) Yes b) No c) Maybe

  25. Will you refer and read online review sites?


  26. a) Yes b) No c) Occasionally

  27. How often will you recall the patient?


  28. a) One month b) Three months c) Six months d) Yearly

  29. Do you think external factors such as frayed carpets, stain on ceilings, bad odour etc., make lowered subconscious impression on patients?


  30. a) Yes b) No c) No importance

  31. Do you think Indian dentist should advertise their services?


  32. a) Yes b) No c) Maybe

  33. What do you think advertizing of practise would yield at?


  34. a) Empower patients to make good decisions regarding their oral health.

    b) Increase community's awareness of dental health care

    c) Encourage better quality dental services by dental suppliers

    d) All of the above

  35. What is the rationale of marketing according to you?


  36. a) Industry competition b) Awareness among crowds

    c) To deliver quality dental service d) Combinations of the above

  37. Will these marketing protocols be checked in by the Federation Trade Commission?


  38. a) Mostly b) Sometimes

    c) Never

    d) Not known

  39. Do you think dental tourism a boon?


  40. a) Yes b) No c) Occasionally

  41. Do you think there is a disadvantage of not marketing in dentistry?


  42. a) Yes b) No c) Maybe

  43. Do you think that dental practices that do not advertise are seen as inferior?


  44. a) Yes b) No

  45. Does inclusion of dentistry in beauty centres pose a threat to dentistry?


  46. a) Yes b) No c) Maybe

  47. Does marketing by dental professionals has the potential to degrade the image of profession and undermine its creditability?


  48. a) Agree b) Strongly agree c) Disagree d) Strongly disagree

  49. By ensuring better quality services, do you think marketing by dental professionals serve the community?

    a) Agree b) Strongly agree c) Disagree d) Strongly disagree




 
   References Top

1.
Nash KD, Brown LJ. The market for dental services. J Dent Educ 2012;76:973-86.  Back to cited text no. 1
    
2.
Dable RA, Prasanth M, Singh SB, Nazirkar GS. Is advertising ethical for dentists? An insight into the Indian scenario. Drug Healthc Patient Saf 2011;3:93-8.  Back to cited text no. 2
    
3.
Schenker Y, Arnold RM, London AJ. The ethics of advertising for health care services. Am J Bioeth 2014;14:34-43.  Back to cited text no. 3
    
4.
Gazette notification no.DE-97-2014 – Dental Council of India. http://www.wbja.nic.in/wbja_adm/files/The%20Revised%20Dentist%20(Code%20od%20Ethics)%20Regulations,%202014.pdf.  Back to cited text no. 4
    
5.
Principles of ethics and code of professional conduct 2018 – American Dental Association. https://www.ada.org/~/media/ADA/Member%20Center/Ethics/Code_Of_Ethics_Book_With_Advisory_Opinions_Revised_to_November_2018.pdf?la=en.  Back to cited text no. 5
    
6.
Mulder R, Myburgh N. Ethics case: Advertising and marketing lasers in dentistry. S Afr Dent J 2018;73:302-3.  Back to cited text no. 6
    
7.
De Lira AD, Magalhães BM. Digital marketing in dentistry and ethical implications. Braz Dent Sci 2018;21:237-46.  Back to cited text no. 7
    
8.
Brusoni S, Vaccaro A. Ethics, technology, and organizational innovation. J Bus Ethics 2017;143:223-6.  Back to cited text no. 8
    

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Correspondence Address:
Dr. Halima Alsadiya
743/1 Vinayaga Avenue, Rahmath Nagar, Tirunelveli, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-7761.309671

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
 
 
    Tables

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