LETTERS

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the profession and for the him/her- 1. Arnold L. Assessing Professional Behaviour: Yesterday, Today, and Tomorrow Acad. Med. 2002; self. Therefore we must be clear about our 77: 502-515. Sir,- I am very aware of the current prob- aims. By stating that the correlation 2. Eindrapport van het Projectteam Consilium between attitude and behaviour is not Abeundi ingesteld door het DMW (VSNU) Utrecht, lems associated with peroxide-related juli 2002. whitening of teeth. There is considerable always high and then going on to state that market pressure to supply this treatment. unprofessional behaviour could be described as a product of attitude, seems to The authors of the article reply: However, I am appalled that the dental As we said in our article, views about atti- profession, including defence societies, has me to be confusing, if not contradictory. In their arguments for focusing on atti- tudes do differ. The view that Drs Shaw not emphatically stated that any dentist and Hokwerda take is behavioural whereas providing peroxide bleaching, especially tudes they cite a list of activities (e.g. advo- cating extractions and adhering to a dress our view is closer to an approach based on with regard to the high concentrations cognitive and social psychology. However, associated with such products involved in code) which are thus by definition not atti- tudes. Some of the questions posed in this the differences between our viewpoints are office techniques, is in contravention of not as great as might first appear. European Law and, therefore, UK law. We list are of a moral or ethical nature, but their answers lie in the appropriate behav- We agree that professional behaviour is may strive to use this clinical technique important but to merely focus upon profes- where appropriate, however, in the mean- iour being exhibited and a decision being made over what this behaviour entails. sional behaviour is to avoid the central time, I feel that the arrogance of some of question: from whence does this profes- our profession in contravening British and They rightly point out that inferring atti- tudes from behaviours is complex and then sional behaviour come? If it is not random European Law, can only be perceived as or merely a mechanical response to envi- unprofessional, until the product has go on to suggest the use of direct observa- tion as a method of assessing attitude. The ronmental stimuli, then it must be stored obtained the adequate licence. Until then, in the human memory along with knowl- please correct me if I am wrong, these other methods have the same shortcom- ings; they assess the level of knowledge of edge, understanding and skills. If it is products are illegal, and supply of them stored, then we suggest that attitudes are a carries penalty of fine and prison sentence. expected behaviour. 1 useful way of labelling this ‘predisposition Surely this is not the public image that we Louise Arnold in her excellent article , suggests that assessment of professional- to act'. And, if professional behaviour is are trying to achieve for the British dental stored, how is it best learnt and retrieved, profession. ism should focus on professionalism in and of itself. The recent Dutch report on the assessed and used? This was the basis of L. Mullarkey our article and we point out that attitudes by e-mail assessment of professional behaviour by the project group Consilium Abeundi2, also may be worked on directly or indirectly by changing knowledge, understanding, skills The Editor comments: This letter is timely suggests that efforts are focused on the observable behaviour. and behaviour itself (see Figure 1 in our as the current legal position has recently paper). been clarified by the BDJ’s legal advisor, At the end of the day the dentist is assessed by patients and his/her colleagues We do not confuse attitudes and behav- who has published a short paper in this iours but we do point to the challenges of issue on pages 375-376. on his/her professional behaviour. The GDC disciplinary committee examines inferring attitudes from behaviours and the unprofessional behaviour/conduct (not risks of assuming an expressed profession- Assessing attitudes in attitude). al attitude as a guarantee of professional It is therefore reasonable to include the behaviour. People often say one thing and dental education development of professional behaviour do another. within the undergraduate curriculum and The authors are right to point out that Sir, I was most interested to read the article thus assess the professional behaviour of ‘dress codes' and ‘extractions' are behav- by Brown, Manogue and Rohlin over the dental students. Surely as educators of iours not attitudes. They could also have need to assess attitudes in dental education dental students we have the responsibility pointed out that the GDC list of attitudinal (BDJ 2002;193:703-707). I agree with their to clearly demonstrate and assess the level objectives are manifested in behaviours of cautious ‘yes’ as a conclusion and with of professional behaviour expected from differing types and degrees of complexity their description of the relationship them on qualification, and the responsibil- (our Table 1). The point we wanted to between attitudes and behaviour. Unfortu- ity to give them the knowledge that the make is do have different attitudes nately they then go on to confuse these exhibition of professional behaviour is towards these behaviours. We also remind- two aspects and in doing so set unclear and expected throughout their practising life- ed our readers that attitudes are, in part, therefore unattainable aims for the educa- time. historically and culturally determined. tion of dental students. I wholeheartedly Behaviour is observable, assessable and Hence we are wary about the notion of agree that the development of professional therefore clearer to teach. The fact that this measuring attitudes as if they were lengths behaviour should be one of the aims of the may also have a desirable effect on the stu- on a ruler. Assessing attitudes is more a undergraduate programme, not least of all dents’ attitude can only be a bonus. matter of judgement than measurement, because the consequences of unprofession- S. Shaw and O. Hokwerda although the judgements may be subse- al behaviour are adverse for the patient, Groningen, The Netherlands quently mapped on to numbers.

BRITISH DENTAL JOURNAL VOLUME 194. NO. 7 APRIL 12 2003 353 LETTERS

We agree that all behaviour is potential- regularly with meat. On the ill-fated day ly observable but we are less confident there was no meat for the dog but he that it is always measurable precisely. himself had meat for the afternoon meal. There are technical difficulties about Following lunch he just rinsed his observing behaviour - how often, by mouth and had neither brushed nor whom, when, how many different contexts cleaned the denture. Then, as was his and criteria are all relevant issues. In usual practice, he removed his dentures, addition, there is a temptation to take kept them under his pillow and went to 'easy' observations and measurements sleep. His pet dog was also in the same rather than tackle the important and chal- room. lenging issues. The next thing he remembers is hearing We think that the effects of education a cracking. He woke up and realized that on students' attitudes should be more than the dog was chewing up his dentures. He a bonus: it should be a primary focus. then quickly rescued the denture (see Unless professional attitudes and abilities below) and rushed his pet dog to the vet- are developed along with other competen- erinarian, as the dog had eaten part of the cies then professional behaviours may not denture. The patient was highly embar- be sustained in later life. rassed while narrating this story. G. Brown, Nottingham This report shows the need for proper M. Manogue, Leeds denture hygiene. Also the need to feed pet M. Rohlin, Malmo, Sweden dogs with their regular allocation. Hence, we in the dental profession should warn the patient of the possible consequence of No smoke without ire unhygienic dentures. While it can be con- cluded that this is an extreme case, it Sir,- I am disappointed with the cover of nevertheless underscores the need for the BDJ (Vol 194 No. 4). At first glance it excellent denture hygiene. appears to be an image of someone smok- A. Fernandes ing. It is only with closer scrutiny that Goa, India you realise that it is an artistic image. Indeed, a small survey of staff in our department agreed that it appeared to be someone smoking. However with the knowledge that smoking increases the risk of oral carci- noma, and is detrimental to ones health generally, is this the sort of image that the BDA/BDJ wants to be associated with? I think not. Indeed we have a duty to actively encourage people to stop smok- Forgotten Fish ing. This is not helped by the publication of such images. Sir,- In The Times (22.02.03) the colum- A. Curtis nist Jonathan Meades has an article, ‘Ask Aylesbury your children who Graham Sutherland was...’, in which he describes polling The Editor replies: This letter took us all young people to find out if they had ever by surprise at the editorial offices, and I heard of this great British painter. None of can confirm the BDJ is still committed to them had, and I was reminded that when its anti-smoking policy. Obviously we will researching at the BDA library for my try to be more careful of the potential biography of Wilfred Fish, I asked several interpretation of future covers. young dentists there if they had ever heard of Fish. None of them had. Denture cleanliness? Lawyers have access to their history through case law, which is full of names, and in medicine the history of the profes- Sir,- A patient attended the Department of sion can be traced through many anatom- in Goa, India, requesting a ical features and diseases which have complete set of dentures on an emergency eponymous names, e.g. Adam-Stokes, basis. His complaint was that his dentures Addison, Willis, Boyle, Colles, Mantoux, were fractured and he was suffering con- Von Willebrand etc. come to mind. In siderable embarrassment due to loss of dentistry we have Riggs, Tomes, Koplik, anterior teeth. Briault, McCall, and of course Fish of the On careful questioning, his history was gingivectomy knife. There must be many astonishing. His pet Pomeranian dog more. allegedly ate up part of the denture. He J. D. Manson said that he used to feed his pet dog London

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