Assessment of Dentists' Knowledge, Attitude and Practice towards Dental Indemnity Insurance in Saudi

Define Assessment Of Knowledge, Attitude And Practice Of Dentists Towards Dental Indemnity Insurance In Saudi Arabia Need.

In a health system, professional indemnity insurance is a program that can protect the health professionals from any obligation that is forced on them as a result of committing any errors or malpractice of treatment procedures or not obeying the legal issues related to patient care (Karl, Born & Viscusi, 2016). The dental indemnity insurance covers acts or errors made by the professionals in the course of their duty. It involves misdiagnosis, physical or mental harm, or delays in referral, any injury to a patient. Nowadays, the common people are more aware of their rights- legal literacy supported by new legislation has increased this among them. In recent years, the claims are made for personal injuries such as road accidents, in health services or in workplace. These issues become sensitive as some doctors perform malpractice, misuse their power, unnecessary recommend tests and treatments (Bhanushali, Shivakumar, & Kadashetti, 2018). Several studies reported that health experts do not take any responsibility of the medical liability regarding the health practice issue.

This paper focuses on the reviewing of the articles related to the attitude, practice, and knowledge about health care practitioners to professional indemnity insurance.

Current scenario revealed that the judicial authorities are more consumers friendly and hospitals are liable to compensate for their mistake. Therefore, there is an increased necessity to provide protection to the doctors from the rising financial risk. For this reason, a special financial protection, known as professional indemnity insurance, is implemented. The insurance ensures legal liability arising from committing any mistakes on the part of Registered Dental practitioners at the time of service execution. The dental profession confessed extraordinary changes during the last decade.  Nonetheless, any distinct legal cases do not exist. Though, practicing dentistry has transformed, affecting the health care process both in a positive and negative way. There is an increased population facing the problem regarding dentist’s authority planning of care and consent issues. The patients are more conscious and demand better facilities and want more information about their treatments that are supposed to provide them and aware in both ways ranging from inadequate and inappropriate to a serious issue regarding dental malpractice and negligence. Therefore, the dental indemnity insurance was implemented to protect the dentists from any legal issue arising from conducting any mistakes or malpractice. Hence, the professionals must be aware and should keep detailed knowledge of this insurance (Shimpi et al., 2018).

Significance of The Study

The aim of this systemic review literature about dental indemnity insurance is based on a theoretical model. This framework will explain the perception, knowledge, and practice of the dentists towards “dental indemnity insurance”. It, in turn, will assist in categorizing the factors influencing the idea through a literature review. Thematic analysis using grounded theory approach will be applied in this qualitative research (Mohan & Ravindran, 2018). It highlights analyzing, interpreting, and detecting patterns within data. These themes are different categories of this study. A conceptual model explaining the attitude, practice, and knowledge are organized by different areas. They include academic and technical proficiency, professional attitude, social and community coordination, awareness of the insurance, perception about this indemnity. The factors influencing the necessity of structuring this insurance were examined using different parameters such as knowledge of the dentists, that means if the dentists were aware of this insurance or not. The second one was an outlook that includes how they reflect the usefulness of the dental indemnity bond in their workplace. Finally, the last parameter considering the fact was implementation of that insurance in their practical environment. All these factors together provide a detailed exploration to evaluate the knowledge, perception and practice of dental health professionals to dental indemnity coverage.

Gupta et al., (2014) stated that a dentist needed to be aware of the policies related to the professional career of the dentist and avoid violation of legalities. The objective of their study was to assess the awareness and practice of dental indemnity insurance among health professionals in Mumbai city. The methodology used by them was a cross-sectional survey of 306 dentists where the participants were selected by random sampling and consist of practitioners who have either completed bachelor's or master's degrees in dentistry from private or government sector. The data was collected through a questionnaire on their details and their knowledge about of indemnity insurance, and the data was analyzed using SPSS software and Chi-square. The findings showed a significant association between professional liability insurance and increasing age, qualification, practice years, knowledge about the insurance and dentist working in private sector. Among the participants, 35.6% of dentists did not feel that knowing about the insurance is mandatory for every dentist, and 13.6% of dentist were uninterested in knowing about the insurance (Gupta et al., 2014). Finally, they concluded that most of the dentist does not have dental indemnity insurance, and it is necessary to spread awareness among the practitioners on the application and advantages of professional indemnity insurance.

Theoretical Framework

Yashoda, Puranik, Kumar & Farhanaz, (2017) explained in their study that patients are more aware of their legal rights over their treatment plan and consent matters. A judgment on consumer protection act was declared where all services provided any profession related to health such as doctors and dentist are defined under this act and the professional indemnity insurance was launched to reduce the mistakes leading to legal liability while providing services to patients. The objective of their study was to evaluate the awareness, practice, and utilization consumer protection act and dental indemnity insurance and informed consent from the patients. The methodology used by them was a cross-sectional study of 310 practitioners of dentistry in Bengaluru. A questionnaire was provided with close-ended questions that contain demographic details and questions about their understanding and practice of informed consent and awareness of dental indemnity insurance, and data analyzed the data using SPSS software and chi-square test. The findings showed 51.9% of the dentist used informed consent from the patients, and 63% of the dentists had knowledge about indemnity insurance, but only 35% of them possessed the indemnity insurance (Yashoda, Puranik, Kumar & Farhanaz, 2017).

Knowing about the profession is as important as knowing about the legalities related to the profession. A study conducted by Baheti et al., (2015) aimed at evaluating the understanding and awareness about medico-legal issues in the different medical profession such as dentist and physiotherapist in two medical institutes. A pilot study was conducted using a quantitative method. Data was collected by a survey using a questionnaire consisting of questions on the consumer protection act 1984, medicolegal issues, and informed always were given to 325 health professionals. Data were analyzed using SPS software were the responses of the participants were recorded. The findings revealed that most of the participants could give answers on informed consent, around 80% of the participants had awareness about it whereas 41.84 % were unaware of the consumer protection act, and 92% of participants did not know the medico-legal issues (Baheti et al., 2015). Finally, the authors concluded that health care professionals were aware of informed consent but lack the knowledge of indemnity insurance and consumer protection act.

The medical profession is doubted due to the increasing complaints against doctors and lawsuits filed against them. To avoid these, doctors should gain knowledge of medical law and ethics. Rai, Acharya, & Dave, (2013) conducted a study to understand the ethical knowledge of practitioners in the medical field, a random selection of intern doctors, and residents who were chosen from a medical college in Vadodara, India. A random selection was made, and survey was performed as a methodology to find out whether the interns who are practicing to become a physician have ethical reasoning knowledge. The questionnaire was provided randomly to 300 students of that medical college, which included questions on medical law, documentation, ethics, medical negligence, and informed consent. The findings showed that knowledge on medico-legal issues were more in interns than in other groups, more than 56% of interns were unaware of medical ethics, whereas 90% of the subjects were aware of the informed consent and 73% of respondents had awareness on medical negligence (Rai, Acharya, & Dave, 2013). Therefore, awareness about medical always and liabilities should be spread amongst the students who are practicing in this field.

Literature Review

There is less known about medical errors in Saudi Arabia because of limited study. Therefore, AlJarallah & AlRowaiss, (2013) conducted a review on legal actions against healthcare professionals in Saudi Arabia whose objective was to identify the litigations and errors in medical practice. The methodology consisted of the use of datasheets on the medical jurisprudence committee and medical violation committee, and subjects of the study were workers of the committee and their subordinates. The datasheet contained demographic and medical details of the legal issue. Details on the medical error and the claim brought by the victim, the validation of the error and the penalty given for the error. Data were analyzed using SPSS software and Chi-square test. The findings revealed from 642 cases that most of the errors take place in the operating room and the emergency room, and 25% of error occurs in surgery, whereas 5.9% error in dentistry. Therefore, they concluded that litigation and record processes should be improved to reduce medical errors in future.

Medical practice can sometimes lead to injury of the patient that increases the chances of litigation against malpractice and increases charges for insurance. Due to lack of transparency in the records of malpractice and litigation; therefore duration of litigation should be reduced by using certain interventions. The objective of the study by Alkhenizan, & Shafiq, (2018) was to review the comparison between litigation process of Saudi Arabia and UK. the methodology used by them was a literature review using various literature search engines about the litigation against medical errors in Saudi Arabia and UK. The finding includes that to compensate for the clinical malpractice, financial caps and legal fees are to be used as interventions that can control medical error costs in Saudi Arabia.

Alsaeed, A. H. (2015) stated that medical practices had improved in all the provinces of Saudi Arabia however avoiding medical errors is difficult, and medical liability claim should be practiced. The objective of their study was to analyze the medical litigations due to closed medical claim mentioned at the legal health organization from various provinces of Saudi Arabia. The methodology used was a pre-designed data collection record from the yearly reports by Legal Health Organization over the years 1999 to 2013. Statistical analysis was done on yearly report, and then differential analysis was performed along the same years. The data include personal and professional details of the accused medical worker along with a number of investigations done on the medical claim. The findings showed that the number of claims had increased by the years from 1999-2013. The number of cases of medical claim was 440 in the year 1999, which increased to 2413 cases by 2013 (Alsaeed, 2015). However, guilt reduced with increasing claims. Their study concluded that to reduce the incidence of malpractice in medical field, medical professional liability should be improved.

Defensive medicine has been defined as the management of high-risk patients or process of medical care that reduces malpractice lability among health professionals. Very few studies were performed on defensive medicine in the field of otolaryngology. Therefore, a study aimed at verifying the interaction among the medico-legal issues, defensive behavior of health professionals, and their knowledge of professional liability was done by Motta, Testa, Cesari, Quaremba & Motta, (2015). The methodology used was a quantitative data collection by survey using a questionnaire on medico-legal issues and coverage of liability insurance. Around 100 otolaryngologists were questioned and their data were analyzed using chi-square and ANOVA test to find out the value of significance. The findings revealed that doctors behavior towards their patients was influenced by the implications of the medico-legal acts in 50% of the cases, out of which 29% of the time the doctors are concerned because of their decision on selection of the diagnostic or treatment approach so that they are saved from being involved in any legal issue. However, medico-legal issues raised in cases where the doctor had no knowledge on the medico-legal aspects, insurance policies, informed consent, and the coverage provided by the healthcare system. Therefore, there is a necessity for the doctors to have knowledge about the medico-legal aspects and insurance policies to reduce chances of limited coverage to patients (Motta, Testa, Cesari, Quaremba & Motta, 2015).

Many patients have been treated with dental implants for several years, and it was found that it poses no long term benefits for the patients. There are cases where dental implants have failed in patients to improve their condition and cause bone loss and adverse effects. A study conducted by Al-Safadi et al., (2019) aimed at detecting and analyzing the malpractice in dental profession concerning implant dentistry in Saudi Arabia. For this study, the author selected 106 patients above the age of 18 years and have suffered professional malpractice in the field of implant dentistry in the health premises of Saudi Arabia. The methodology used was a clinical examination, which detected the complications at different stages of operation. Data was collected from each patient, and it included their age, gender, which was documented in the patient examination form. Data were analyzed using chi-square and correlation coefficient test. The findings showed that patients were equally divided in the different stages of the operation and majority of the patients had their implants under malpractice at posterior region. Around 75% of patients had a failure in their dental implants (Al-Safadi et al., 2019). Finally, the author concluded that malpractice can occur during dental implant by the dentist at different stages of operation that is preoperative, intraoperative and postoperative stages.

The medical facilities in Saudi Arabia have evolved due to the rising technology, training improvement, and experience of practitioners, but due to increasing population and their awareness about health issues, incidence of litigation related medical practice has increased. The medico-legal committee in Saudi Arabia takes responsibility for medical claims and investigates the malpractice of health professionals resulting in injury or death of the patient. Related to this concept, the objective of a study conducted by Ghaffar, Ahmed &Faraz, (2015) was to evaluate the number of medical errors that have occurred and the prevention methods for it in Saudi Arabia. The methodology used was an integrative way of reviewing the medical error cases and then summing up all the facts of the cases to understand medical errors while giving medical care. The data collected from the medical, legal committee contained many cases that were resolved and some were unresolved from different provinces of Saudi Arabia. The data was analyzed qualitatively and represented narratively. The findings from the tables show that the incidence of medical error increased from 2007 to 2013 and was found mostly in surgical practice; however number of cases resolved was increasing over the years.

Due to rising economic growth, healthcare environment is growing fast with increasing health awareness among the urban people than the rural ones and requirement of improved medical along with dental care at low cost. However, malpractice and negligence in medical practice is seen because health professionals fail to deal with medical cases and provide compensation to the patient as they lack dental indemnity insurance. Based on this, a qualitative study was performed by Gupta et al., (2018) whose objective was to assess the healthcare provided by the dentist and making them aware of the process that should be followed by them to avoid malpractice and litigation related to it. The methodology used electronic search of published literature from popular search engines on the medical carelessness and medico-legal issues. The review articles were screened, and the findings established all articles related to malpractice in dentistry were used in their study. The authors concluded that when a health professional makes a mistake, it is better to take the help of a litigation specialist, and the dental records should be maintained to produce them as proof of any malpractice.

There are certain situations where the patients are in pain due to the medical negligence of the doctors, which forces the patients and legislature to link twice before receiving the treatment. According to the consumer protection law, all the health professionals are punishable for causing harm to the patients and neglecting their treatment. Therefore, doctors should analyze the case of the patient carefully and decide on how to treat the patient so that it causes minimal injury to them and does not make the health professionals fall under the negligence act. Thus, on this concept, a study was performed, which aimed at assessing the knowledge of medico-legal aspects among the health practitioners (Haripriya & Haripriya, 2014). The methodology of this epidemiological study included qualitative data collection by survey using a self-structured questionnaire. The subjects were selected from two specialization- general physician and gynecologist, which comprised a total of 123 health professionals and among which there were 55 females and 68 males. The questionnaire contained questions on consumer protection act and to know whether they were practicing in their profession by considering the medico-legal aspects. The data was analyzed using SPSS software and student t-test for finding significance. The findings include- participants who were aware of the medical law make up 79.2% of the doctors, male doctors had more knowledge on the medical law and its negligence than the female doctors, gynecologists were less aware of the medical law than the general physician and finally significant difference was seen in relation to the participant’s experience (Haripriya & Haripriya, 2014). The authors concluded that doctor’s knowledge of consumer protection act was limited even though they had enough knowledge of medico-legal aspects.

Reference

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