League tables, institutional success and professional ethics.
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League tables are just one example of the growing importance of "institutional success" in the health service. What are the implications of attaching importance to institutional success, and what impact might this have on professional ethics? This paper considers these issues and argues that public policy processes which centre on institutional performance, and which co-opt professional loyalties to this end, shift the balance between person-centred and impersonal standpoints in health care (from the former and towards the latter). There is no attempt to make a global ethical appraisal of this putative shift but rather to raise a matter of concern for those committed to a person-centred conception of professional ethics. (+info)
Power and the teaching of medical ethics.
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This paper argues that ethics education needs to become more reflective about its social and political ethic as it participates in the construction and transmission of medical ethics. It argues for a critical approach to medical ethics and explores the political context in medical schools and some of the peculiar problems in medical ethics education. (+info)
Ethics consultation on demand: concepts, practical experiences and a case study.
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Despite the increasing interest in clinical ethics, ethics consultation as a professional service is still rare in Europe. In this paper I refer to examples in the United States. In Germany, university hospitals and medical faculties are still hesitant about establishing yet another "committee". One of the reasons for this hesitation lies in the ignorance that exists here about how to provide medical ethics services; another reason is that medical ethics itself is not yet institutionalised at many German universities. The most important obstacle, however, may be that medical ethics has not yet demonstrated its relevance to the needs of those caring for patients. The Centre for Ethics and Law, Freiburg, has therefore taken a different approach from that offered elsewhere: clinical ethics consultation is offered on demand, the consultation being available to clinician(s) in different forms. This paper describes our experiences with this approach; practical issues are illustrated by a case study. (+info)
Should the use of smoking cessation products be promoted by dental offices? An evidence-based report.
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To address the issue of whether dentists should promote the use of smoking cessation products, an evidence-based methodology was applied to find answers to 3 questions: Does tobacco use affect periodontal health? Are dentists effective cessation counsellors? Do smoking cessation products improve the effectiveness of cessation interventions? MEDLINE and manual searches uncovered relevant evidence to use in developing evidence-based recommendations. There is fair evidence that tobacco use is a major factor in the progression and treatment outcome of adult periodontitis and that quitting tobacco use is beneficial to periodontal health. There is good evidence to recommend that oral health professionals provide cessation counselling. There is good evidence to recommend the use of smoking cessation adjuncts. In view of the strong supporting evidence, dental offices should incorporate systematic smoking cessation services into routine patient care and should promote the use of proven cessation products by patients who are attempting to quit. (+info)
New roles and responsibilities of NHS chief executives in relation to quality and clinical governance.
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The role of the chief executive in the NHS is to act as organisational head, with financial and managerial responsibility, and now responsibility has been extended to include clinical standards as part of the duty of quality and the introduction of clinical governance. These new responsibilities have implications for relations with staff inside the organisation and, in particular, with clinicians, as well as adding to the overall public accountability of chief executives. As well as increasing expectations of chief executives to meet performance objectives and other targets within the organisation, their role remains relatively new and sometimes contentious in the health service, forming part of the history of NHS management reform. The developing role of chief executives and the complex world in which they operate in the health service is discussed. It is suggested that support from colleagues at both the organisational and national levels is required to help them discharge their new responsibilities, together with a greater focus on the development of their role and skills. (+info)
A preliminary communication on whether general dental practitioners have a role in identifying dental patients with mental health problems.
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OBJECTIVE: To examine whether general dental practitioners regard themselves as having a role in identifying dental patients with mental health problems. METHOD: Telephone interviews were conducted with, and postal questionnaires were sent to, a random sample (n = 94) of general dental practitioners on Health Authority lists within the Mersey Region. A total of 84 general dental practitioners responded, resulting in an 89% response rate. RESULTS: The majority of general dental practitioners had encountered patients with mental health problems (78% of interviewees, 56% of questionnaire responders). However, nearly half of the interviewees (46%) do not refer patients with mental health problems. When referrals to dental specialists were made, they tended to be regarding a physical manifestation rather than a psychological one. The majority of interviewees and questionnaire responders (55% and 82% respectively) expressed a 'positive' response to the development of a referral role. Nevertheless, there were some reservations concerning the practicalities of its development and implementation. CONCLUSION: The majority of general dental practitioners consider a role in identifying patients with possible mental health problems. This role might include, being able to identify patients with undiagnosed mental health problems, and being aware of dental conditions which may be caused by mental health problems. To achieve this, inter-professional co-operation between general dental practitioners and other health professionals requires development. (+info)
The dentist as biobehavioral clinician.
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At the core of all clinical dental practice is the interpersonal interaction between dentist and patient. An expansion of the dentist's responsibility in the unique dentist-patient relationship is suggested. Such an expanded role encourages dentists to engage the emotional and behavioral health of dental patients who are appearing in dental offices for treatment of orofacial diseases and other conditions. The term "biobehavioral clinician" is used to refer to this broadened role for the dentist. It is suggested that such a biobehaviorally oriented dentist will be a powerful ally on behalf of the health of patients, attending to more dimensions of the patient's presentation and management than the diagnosis and treatment of oral pathobiology. It seems entirely appropriate that dentists have such a role in its future, engaging as they do millions and millions of Americans on a regular basis and a productive and collaborative dentist-patient relationship is already an accomplished fact for most dentists with most of their patients across all stages of the life span. The benefit to patients' overall health and well-being could be tremendous and would add an enriching and personally rewarding dimension to being a dentist. (+info)
The role of dentists in dentistry.
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The extent to which dentists influence the outcomes of dental care, compared to the effects of dental technology or patient variation, has not been well studied. A review of the literature on the personality and value structures of dentists and dental students reveals general trends involving preferences of concrete, utilitarian, unambiguous, and conventional situations that are classified and judged in terms of their potential for dentists' power and control and for relationships of helping others but avoiding mutual dependency. These findings are summarized in a hypothesis that dentists seek situations where they can exercise control and establish paternalistic relationships with others. The evidence about career satisfaction of dentists is difficult to interpret. Between 20 percent and 50 percent of dentists report that they would not choose to enter the profession again if given a chance. Yet the number leaving the profession voluntarily is less than the number of career changers in the general population by a factor of about 1 to 15. Career satisfaction of practitioners can be partially predicted from an understanding of dentists' personality and values. Factors such as uncooperative patients, incompetent staff, and government and insurance intrusions are major dissatisfiers; they threaten dentists' core need for control. Factors such as quality of work, which is under the control of dentists, are major satisfiers. The personalities and values of dentists and the expression of these in professional norms may function to limit our understanding of dentistry. Based on this analysis, eight predictions are offered about the profession. (+info)