Increasing Professional Responsibility to Society

Recent actions of the California Dental Association Board of Trustees should focus our attention on one inescapable fact. The professional responsibilities of the practicing dentist as related to the expectations of the society in which we are participants continue to increase.

There was a time when treatment skills and dental diagnostic skills dominated the dentist's scope of responsibilities. During our time in the profession, we have seen a considerable expansion in the scope of responsibility. Practice administration or management has always been a small part of the dental school experience; but, until the 1970s, there was minimal emphasis on the importance of the dentist's role as an employer and manager of a business. Each year, the increasing number of dental plans and delivery systems and the advancement in technologies available for the conduct of our business has increased our responsibility to review new systems, equipment, and technologies so that we can conduct a sound and successful business that enables us to provide treatment that meets the acceptable standards of care.

While it would seem that new technologies would simplify this process, that is often not the case. Some colleagues find themselves frustrated by change and refuse to accept the responsibility to improve their knowledge in required areas or to upgrade the business systems in their practices. They add to their frustration by believing that organized dentistry is their agent to fend off new requirements or regulations. If their association is unable to bring them relief from a new responsibility enforced from outside the profession, their dissatisfaction is often directed at their profession. They fail to recognize that these expanding societal responsibilities of a professional person have become an expectation by society.

The attitudes against acceptance of this expansion must change. We must accept these expanded societal responsibilities if we are to successfully pursue the standards expected by the public we serve -- the dental patient.

That brings us to two of the newest "responsibilities" that we see as important to our role as professionals. Many readers will recognize that they have been previously introduced to one or both. What is new is that CDA leadership, by its actions, has formalized a role for dentistry in resolving societal issues linked to these responsibilities.

The first of these actions by the CDA Board of Trustees was: "Since all licensed dental care providers in California are mandated reporters, the California Dental Association urges its members to become familiar with and report all physical signs of child abuse, child neglect, elder abuse, elder neglect, and domestic violence that are observable in the normal course of the dental visit and report the suspected cases to the proper authorities." What is new about this responsibility is that it extends beyond the current policy of the American Dental Association, which has previously addressed child abuse and neglect. Concern for domestic violence and elder abuse/neglect are significant additions to the existing policy.

This responsibility recognizes that the dentist is one of a select few who has a firsthand opportunity to observe the signs of neglect or violence that plague our society. Despite the liability that the reporting requirement can place on the dentist, the responsibility is also a legal requirement that cannot be taken lightly.

A second action taken by the Board of Trustees that we believe has significant importance to the responsibility of each dentist is that of initiating steps to deal with unlicensed practitioners who practice in illegal "dental facilities." The Board action initiated association legislative steps aimed at strengthening penalties for individuals guilty of illegal practice in order to serve as a stronger deterrent to this activity. Several Los Angeles television outlets have carried features on "unlicensed dentists" in southern California in the past five months. We believe that the individual licensed dentist also has a responsibility to help resolve this problem.

The rationale for action is not related to reduced economics or the competition for licensed practitioners, but is for the education of legislators, legal authorities, and the public at large (patients) regarding the dangers that this form of dentistry presents to the dental health and well-being of the public. Reports show that these establishments ignore proper health and safety guidelines and pose a considerable risk to those who undergo treatment there. Education is extremely important because that is the only mechanism by which laws can be made more stringent in order to discourage these businesses from starting up. Aside from the danger to the public, these facilities reflect poorly on the image of the profession. These unlicensed individuals are thought to be "dentists" by an uneducated public that is usually unaware that the illegal operator is unlicensed. Thus, we must make it our business to educate the public and report any suspected illegal activity to those who can help investigate and terminate such practices.

These expanding responsibilities may be unrelated to the business health of the individual dental practice. However, they make up a very important and growing scope of responsibility for the contemporary practitioner. While these Board decisions commit association resources to support efforts to manage these societal problems, solutions will not be successful without the responsible efforts of all individual practitioners.