|Year : 2017 | Volume
| Issue : 3 | Page : 225-229
Dental practitioners' perspectives about the consumer protection act, informed consent, and professional indemnity insurance in Bengaluru city: A cross-sectional study
R Yashoda, Manjunath P Puranik, Vijay Kumar, F Farhanaz
Department of Public Health Dentistry, Government Dental College and Research Institute, Bengaluru, Karnataka, India
|Date of Web Publication||18-Sep-2017|
Department of Public Health Dentistry, Government Dental College and Research Institute, Bengaluru - 560 002, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Dental profession saw unprecedented change during the last century. Worldwide, patients have become more aware of their right-legal literacy including India. Aim: The aim of this study was to assess the awareness of the Consumer Protection Act, practice of informed consent (IC), and the utilization of dental indemnity insurance among dental practitioners in Bengaluru city. Materials and Methods: This cross-sectional study was carried out among 310 dental practitioners in Bengaluru city. A prevalidated self-administered 30-item questionnaire was to assess the awareness about the Consumer Protection Act (CPA), knowledge and practice of IC, and utilization of professional indemnity insurance among practicing dentists. Results: There was an equal distribution between both the genders in the study. A total of 67% of the study participants were aware about CPA and only 50% of the participants responded that they had a practice of taking IC for every patient. Only 35% of participants had dental indemnity insurance. Age and qualification positively correlated with awareness of the CPA (P = 0.007); utilization of professional indemnity insurance is also associated with years of practice (P = 0.002). Conclusion: Majority had awareness regarding CPA but practice of taking consent and utilization of professional indemnity insurance among dental practitioners were less than adequate.
Keywords: Consumer Protection Act, dental practitioners, indemnity insurance, informed consent, legal liability
|How to cite this article:|
Yashoda R, Puranik MP, Kumar V, Farhanaz F. Dental practitioners' perspectives about the consumer protection act, informed consent, and professional indemnity insurance in Bengaluru city: A cross-sectional study. J Indian Assoc Public Health Dent 2017;15:225-9
|How to cite this URL:|
Yashoda R, Puranik MP, Kumar V, Farhanaz F. Dental practitioners' perspectives about the consumer protection act, informed consent, and professional indemnity insurance in Bengaluru city: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2017 [cited 2020 Sep 25];15:225-9. Available from: http://www.jiaphd.org/text.asp?2017/15/3/225/215068
| Introduction|| |
Worldwide, patients have become more aware of their right-legal literacy including in India, i.e., the ability to make critical judgments about the substance of the law, the legal process, and available legal resources and to effectively utilize the legal system and articulate strategies to improve it.
Legal literacy goes beyond the development of a basic legal competence and implies the acquisition of knowledge, understanding and critical judgement about the substance of law, legal process and legal resources, and enabling and encouraging the utilization of capacities in practice. According to a Global Burden of Unsafe Medical Care study, of the 421 million hospitalizations in the world annually, about 42.7 million adverse events of medical injury take place, two-thirds of which are from low- and middle-income countries. India records approximately 5.2 million cases a year, ranging from incorrect prescription, wrong dose, wrong patient, wrong surgery, and wrong time to wrong drug. Multiple factors – the increasing use of technology, paradigm shifts in patients' attitudes to doctors (and vice versa!), consumerism, litigation, and so on – have resulted in making the law an integral aspect of healthcare today.
Dental profession saw unprecedented change during the last century. Although separate legal cases in dentistry are not available, practicing dentistry in India has revolutionized during the last five decades, affecting the health-care delivery in both positive and negative directions. There has been an increase in the number of patients challenging the dentist's authority over treatment planning and consent issues in the past few years. The Consumer Protection Act (CPA) was essentially envisaged to cover business and trade and to protect the interest of the buyer of goods and user of the services who pay for the same. In the Supreme Court Judgment of IMA versus V. P. Shanta and others III (1995) (CPJ) SC, the court clearly stated that professional services rendered by professionals such as doctors and dentists fall in the definition of section 2 (0) of the CPA.
At present, the level of information given to the patients about an informed consent (IC) can vary in practice among dentists. Patients are demanding better services and more information about their treatment plan in health-care disputes between both of them range from inadequate and inappropriate treatments to serious problems of dental malpractice and negligence. The Indian Dental Association launched the first professional indemnity insurance. This insurance covers legal liability arising from errors and/or omissions on the part of Registered Dental Practitioners while rendering professional service. It is now a firmly established belief that legal modalities are integral to dental practice. Hence, dental practitioners should be aware of the related laws and preventive approach from litigation. Hence, this study was conducted to assess the awareness of the CPA, practice of IC, and the utilization of dental indemnity insurance among dental practitioners in Bengaluru city.
| Materials and Methods|| |
A cross-sectional study was conducted among dental practitioners from February 2016 to May 2016 in Bengaluru City. Ethical approval for the study was obtained from the Institutional Review Board, Bengaluru and IC was obtained from the participants.
A pilot study was conducted among thirty dental practitioners to check feasibility and sample size estimation. Considering awareness of CPA among dental practitioners (58%), with α = 0.05 and power of study, 80%, estimated sample size was 310. A list of 3,981 current dental practitioners in Bengaluru city was obtained and compiled from information available at Karnataka State Dental Council, Karnataka Private Medical Establishment and Pollution Control Board, Bengaluru. Bengaluru city was divided into north and south zones and care was taken to admit the equal number of dental practitioners from clinics and hospitals from both zones of Bengaluru city, by following probability proportion sampling method. All dental practitioners who were practicing dentistry were included in the survey.
The questionnaire was prevalidated and constructed from previous studies and internet source., Internal consistency of the questionnaire was evaluated.(Cronbach's alpha = 0.90) indicative of good reliability. The close-ended self-administered prevalidated 30-item questionnaire was used for data collection. The first part consisted of socialdemographic data variables such as age, gender, educational qualification, type of practice, and duration of dental practice. The second part consisted of questions regarding awareness of CPA and knowledge and practice of IC. Third part consisted of utilization of dental indemnity insurance.
All dental practitioners were visited at their working hours on weekdays. All the available and willing dental practitioners were given the questionnaire on the day of a visit. The participants were asked to respond to each item according to the response format provided in the questionnaire. Dental practitioner's identities were kept confidential and questionnaires were collected on the same day. Correctness and completeness of questionnaires were assessed.
Data spread on excel sheet and were analysed using the Statistical Package for Social Sciences (SPSS for Windows, version 22.0, SPSS Inc. Chicago, IL, USA). Mean scores for knowledge and attitude were derived. Descriptive and inferential statistics were used for analysis. Chi-square test, independent t-test, and Spearman's correlation were applied (P < 0.05).
| Results|| |
About 56.3% of the study participants aged <35 years and 51% were females. Based on the level education, 50.8% were BDS graduates and 30.4% were practicing for more than 10 years. A total of 67% of the study participants were aware of CPA and their implications.
Nearly 51.3% of the survey participants answered that a consumer can lodge a complaint without the presence of a lawyer and 11.9% of the participants had reported that a patient cannot sue a doctor for rejecting an emergency event. Regarding rejecting medically compromised cases, 69.7% reported that the patient could sue them. A total of 60.6% believed that doctors or insurance paid by an insurance firm is also liable under COPRA. About 25.8% participants knew the compensation of 15 lakhs at district commission. only 32.6% responded that compensation amount of consumer quote determine where the patient should approach to file the complain. A total of 44.5% mentioned the period to sue the concerned doctor is 2 years [Table 1].
|Table 1: Knowledge of Consumer Protection Act and informed consent among dental practitioners (n=310)|
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A total of 51.9% responded that they always take written consent from the patients and 58.1% restricted to IC to one specific procedure at a time. Regarding the practice of IC, 75.8% responded guardian should provide the consent for patient 15 years or less and most of the participants agreed to preserve the consent till the treatment is over [Table 2].
|Table 2: Responses of the study participants based on the knowledge of Consumer Protection Act and practice of informed consent (n=310)|
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Regarding knowledge of the professional indemnity insurance, about 63% of the participants had the knowledge and only 35% of participants had indemnity insurance. Only 41.8% (n = 130) respondents believed, indemnity insurance should be mandatory for all the dentists working in India. The main reason for not having indemnity insurance was that dentists thought it is not mandatory (31.6%), followed by lack of knowledge about dental indemnity insurance (27%).
Dental practitioners aged >35 years had significantly higher mean knowledge score regarding CPA compared to participants <35 years of age (P = 0.007). Males had higher mean CPA knowledge score (5.34 ± 2.41) than female dental practitioners (4.70 ± 2.22) and the difference was statistically significant (P = 0.002). Dental practitioners with MDS degree had significantly higher mean CPA knowledge score than dental practitioners with BDS degree.(P = 0.004). Dental practitioners who were practicing dentistry more than 10 years had significantly higher mean CPA knowledge score (5.71 ± 2.25) than practitioners have experienced <10 years (4.61 ± 2.30) (P < 0.001).
Regarding knowledge of IC among dental practitioners, who were aged <35 years (3.49 ± 0.76) had a significantly higher mean score compared to participants >35 years of age (3.48 ± 0.89) (P = 0.006). There was no significant difference regarding mean IC knowledge scores between male and female participants. Dental practitioners with MDS degree had significantly higher mean IC knowledge score than dental practitioners with BDS degree (P < 0.001).
Dental practitioners who were practicing dentistry more than 10 years had significantly higher mean IC knowledge score (3.79 ± 0.75) than practitioners have experienced <10 years (3.35 ± 0.84) (P < 0.001). However, there was no significant difference between the type of practices among dental practitioners regarding mean knowledge of CPA and IC [Table 3].
|Table 3: Mean difference among participants regarding knowledge of Consumer Protection Act and informed consent based on age, gender, education, type, and years of practice|
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Male dental practitioners aged >35 years (P = 0.002) with postgraduate degree (P = 0.01) and <10 years of practice (P = 0.02) had more utilization of professional indemnity insurance. There was no significant difference among participants with the setting up of practice (P = 0.137) [Table 4].
|Table 4: Distribution of study subjects based on age, gender, education, type, and duration of practice and utilization of professional indemnity insurance|
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There was a weak but statistically significant correlation between knowledge of the CPA and practice of IC among dental practitioners (r = 0.26, P < 0.01).
| Discussion|| |
The CPA, 1986 is one of the examples that are to be treated as a milestone in the history of socioeconomic legislation to protect the interests of the consumers in India. In the era of consumerism, dental practitioners should be updated with the different type of law related to healthcare practice. Patients today have become very much aware of their rights and are far more likely to question due to the CPA of 1986, which was enacted for the better protection of the interests of the consumers and to provide simple and quick access to redress consumer grievances.
In the present study, awareness regarding CPA was 67%, which is lesser than previous studies (71.4%–86.85%) conducted among dental practitioners.,,,, Regarding knowledge of CPA, more than half of dental practitioners, said patients can lodge a complaint without the presence of lawyer. Similar responses were given by participants in previous studies., Majority (69.7%) of dental practitioners agreed that patients can sue a doctor for rejecting medically compromised cases which were similar to previously done studies., More than half of the dental practitioners agreed that dentists or hospitals paid by an insurance firm for treatment are liable under the CPA, while dental practitioners who were not charged from patients at all are not coming under the CPA. Regarding knowledge about consumer courts, less than half of the dental practitioners knew that patients can sue within 2 years of treatment; similar responses were found in previous studies.,
Patients visiting to private practitioners are among the better social class, have more tendency toward consumerism. These patients are educated and sometimes go for multiple opinions. Gender-wise male dentist has more tendency to go for private practice than females and comparatively males devote more time to routine practice than females. Hence, in spite of gender difference in the present study, both males and females should be updated.
In this study, there was a significant difference between male and female participants' knowledge of the CPA, which was similar to previous studies. However, some of the previous studies,,, found no significant difference between different gender. Studies had shown significantly higher knowledge of CPA among private practitioners., However, there was no significant difference in the knowledge of CPA between government and private practitioners.
The practitioners with higher qualification and more numbers of the years of practice had better knowledge of CPA, which was similar to previous studies., This might be due to the reason that with the increase in academic knowledge, increase in a number of workshops, CDE programs, conferences, and awareness number of negligent cases related to legal issues in dental practice
Maintenance of dental records is mandatory by law. IC is the main part of a dental record, under Article 51 A (h) of the Constitution of India. It is important for a dentist to convey that all treatments can have risks as well as side effects. The dentist should explain all the possible outcomes of the treatment, before starting of the procedure to a patient., Other than providing a safeguard to the practitioner from medicolegal issues, the process of IC will also help build a good rapport toward the patients and parents.
In dentistry, like other health-care fields, sometimes unforeseen mishaps occur despite our best efforts. Therefore, it is mandatory for all healthcare practitioners to obtain IC from their patients before every procedure. In previous studies,, practice of obtaining IC ranged from 5.3% to 27%, which is lower than the present study, where more than fifty percent of dental practitioners (51.9%) always took IC from the patients. Still, this may be considered inadequate. The majority of the dentists explained the diagnosis, prognosis, and treatment plan to patients, which was higher than the previous studies., Most of the dental practitioners agreed that IC should be obtained from the guardians in the situations where it cannot be obtained directly from the patients and should be preserved by them.
Regarding overall knowledge of IC, dental practitioners who were younger than 35 years had more knowledge than older participants. The practitioners with higher qualification and more than 10 years of practice had better knowledge of IC which was similar to previous studies.,, This may be attributed to exposure to the recent knowledge in young graduates, postgraduate curriculum, and experience gained in years of practice.
The importance of having professional indemnity insurance as a preventive measure helps protect against litigation and provide security to the dental professionals. In the present study, 63% dental practitioners were aware and 35% hold professional indemnity insurance, which was higher than the study done among dental practitioners in Mumbai city. Professional colleagues were the main source for other practitioners to know about the dental indemnity insurance while the state government had the least role to provide the knowledge about indemnity insurance.
Professional indemnity insurance was related to age, year of practice, and gender. The utilization of professional indemnity insurance was significantly related to the educational level of dental practitioners. Knowledge of CPAs and practice of IC demonstrated a positive correlation which suggests that better knowledge leads to better practice.
A cross-sectional study design and inherent biases such as social desirability bias are limitation of this questionnaire study. Public awareness of dental negligence is on the rise in India. Dentistry has changed from paternalism to consumerism era. Quality of care and standard operating protocols are needed for the routine practice. Most of the litigations could be avoided by maintaining healthy dentist patient relationship and maintaining proper dental records. A proper guideline document on examination and record-keeping in dental practice should be prepared. A new form of record card should be made available to prompt the practitioners for what should be routinely recorded. A dentist should be aware of the various professionals' insurance policies currently available in the market and its implications. To achieve the positive changes, dental students and the practitioners should be trained and oriented in issues such as dentist-patient relationships, maintenance of dental records, and professional indemnity insurance for a better success and satisfaction in dental practice.
| Conclusion|| |
There is a disparity in having knowledge of IC and practicing it. However, awareness regarding the CPA, among dental practitioners, was satisfactory. Utilization of the professional indemnity insurance was less and related to higher age, year of practice, and gender.
In this current era of consumer satisfaction, dentists are increasingly facing legal challenges from dissatisfied patients. With this changing scenario, doctors have to adapt to the situation and may have to face such legal tangles, which is intangible and disturbing sometimes. It is imperative that all dentists should be aware of the medicolegal aspects of the field.
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Conflicts of interest
There are no conflicts of interest.
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