Patients' assessment of the professional and business

aspects of dental practice

El-Fatih Ibrahim El-Amin*, BDS, MSc, FDSRCSI, AIMPT(UK)
Nadya A. Al. Ghannam**, BDS, MDS, Nazeer B. Khan***, BSc, MSc, PhD
*Faculty of Dentistry & Dental Technology, The National Ribat University Khartoum, Sudan
** Al-Ahsa Dental Center, Ministry of Health, P.O. Box 10546, Al-Ahsa 31982, KSA
*** College of Dentistry, King Saud University, P.O. Box 60169, Riyadh 11545, KSA

The study was conducted in Al-Ahsa area, Eastern region of KSA. The study was divided into two phases: the first phase was the generation of criteria which defined good dental practice in the eyes of the general dental practitioners, while the second phase dealt with the evaluation of these criteria by the patients.

A sample of 40 general dental practitioners who attended one of Al-Ahsa Dental Center Continuing Education meetings was asked to suggest at most 10 important criteria of a good dental practice.

They gave 258 answers which were summarized in 16 statements. The criteria were categorized into two groups: professionalism and business matters (Table 1).

A questionnaire was then designed in English and Arabic to assess which criteria were considered more important for dental patients. The questionnaire forms were left at the reception desk of each of the 25 general dental practices of Al-Ahsa area. When the patients checked-in for their appointments, the receptionist explained the study and invited them to participate. Three hundred seventy-eight patients out of five hundred respondedtfuring a period of three months.

To analyze the opinion of the subjects according to the patient's age, the means and the standard deviation of the age of the respondents in each of the 16 criteria were first calculated. Then the t-test was used to examine the subject's age in regard to their responses to the employed 16 criteria.

To facilitate data analysis the responses were grouped into two. The very important and important group responses were pulled as important, while the least important and not important group responses were pulled as not important. The education levels were categorized into three groups, the elementary and intermediate levels as one group while the secondary and university levels were considered as separate groups.

The data were entered into microcomputer using Foxpro (version 2.6 window). Statistical Package for Social Sciences (SPSS version 10.0) was utilized to generate one- and two-way frequency tables and to find statistical significance for relationship of demographic variables with the responses.

Out of 378 patients, 215 (56.9%) were males. The mean age of the patients was 33.82 + 8.80 years with almost 80% of the patients aged between 20 to 40 years. Three hundred and one patients (79.65%) were Saudi nationals and all the subjects were literate. Ninety-one of the responding patients had finished elementary and intermediate schools. One hundred and twenty respondents (31.7%) had secondary level education, while 167 (44.2%) had university degrees.

Analyses of subject's gender, education and nationality in regards to the 16 criteria showed the following: significantly more male than female patients stated that the dentist skills, good practice image and friendly staff were important criteria in their opinion (P< 0.05, Table 2). Table 3 showed the relationship of education level of the subjects and the responses. Significantly university-educated patients indicated that giving oral hygiene and postoperative instructions were more important criteria for good dental practice (P<0.05). No significant difference was observed between Saudi and non-Saudi subjects (Table 4).

Younger patients gave significantly higher importance to dentist skills, appointment system and explanation of the procedure of the clinics compared to older patients (P<0.05, Table 5).

The higher percentage of male participants in this study (215 out of 378) could be explained by cultural background rather than by a higher rate of male attendance in the general dental practice. In Islamic societies, women tend to be more conservative and hence would delegate most of their official papers processing to their guardians.

The study showed that males were significantly more interested than females on the practice of good image and friendly staff (Table 2) depending most likely on what their friends, relatives and other people tell them in their choice of dental clinic. However, these criteria were related more to business advertisement and publicity. Again in Table 2, males showed preference for dentist skill more than females, which was a criterion of professionalism. Data in Table 3 imply that highly educated subjects preferred to visit dental practices where dentists gave professional oral hygiene instructions. Interestingly, Ramkin and Harris4 in a study conducted in U.S.A. indicated that most of their respondents did not like to be scolded for poor oral hygiene. However, some other studies5" have also suggested that the number of patients who did not mind being scolded or were not certain about it may feel more comfortable with more authoritarian dentists.

Data in Table 5 showed that the dentist's skill, which is a professional criterion, was more important for young patients (24.1 ± 9.03 years) than for the older patients (30.5 ± 2.7 years). Burke and Croucher7 in a study of patients' preferences for dentists5,6 behaviors indicated that patients ranked dentists skills together with explanation of procedure and caring dentist as the most important criteria of a good dental practice. The most interesting finding in the present study was that it didn't show any significant differences between Saudi and non-Saudi patients concerning their perception of the studied variables (Table 4).

As can be observed in this study only six variables showed significant results, three of them were categorized business criteria:, good practice image, friendly staff (Table 2) and good appointment system (Table 5), while the other three fell under professional criteria: dentist skills (Table 2 and 5), giving oral hygiene and postoperative instructions (Table 3) and explanation of dental procedure (Table 5).

These findings made it difficult to decide which direction the results of this study were pointing. This difficulty was well put by Burke3, who stated that the difficulty which faced the dental profession came with the marrying of business, where volume and profit are paramount with the moral and professional obligations to patients, where quality and care are the watch word. However, this balance between professionalism and business in dentistry depends on practicing dentists who should combine quality professional services with improving and welcoming   friendly   environment   in   dental practices.

Corporate group dental practice gradually continues to replace single-doctor surgery in general dental practice nowadays. The potential impact of this in the profession should be studied more thoroughly since these corporate dental groups take into consideration the rules and practices of the market.

The effect of corporate groups on general dental practice can be looked at from two perspectives.2 One is the fact that the dentists employed by such organizations might loose their independence because they would likely have monthly targets to meet. The other viewpoint is that the dentist so employed would be freed from much of the administration surrounding everyday general practice and would therefore be more able to concentrate on the clinical aspect of dentistry and hence increase the quality of professional performance.

1. Ethnic differences between the patients in this study did not result in significant difference concerning their perception of the studied variables.
2. Patient's assessment of professional and business criteria in the study showed significant difference in six variables. Three of these criteria were categorized as business (good practice image, friendly staff and good appointment system), while the other three were put under professionalism (dentist skills, explanation of the procedure and giving oral hygiene and postoperative instructions).
3. The results of this study suggested that success in general dental practice might be through a combination of business practices with ethnical professional obligations to the patients.