Awareness Regarding Dental Jurisprudence among Advocates in Davangere City - A Cross-sectional Survey

Introduction

A dentist as a member of the medical community treats patients. They have a unique level of trust with their patients.¹ The dental expert promises the patients that they will uphold a high ethical level of care and conduct to maintain this confidence.^2,3 However, monetary gains have caused this standard of care to decline.⁴ Negligence is the term used to describe a violation of these obligations that causes patient harm. A lawsuit against the dentist may come from such negligence.³

Paradoxically, the dynamic and intricate nature of the dentist-patient relationship embodies both strength and vulnerability. Strength stems from elements like confidentiality, trust, and genuine concern demonstrated by dental professionals. Yet, vulnerability surfaces in instances of substandard care, overtreatment, inappropriate treatment, and similar issues.²

However, the foundation of trust remains generally robust. Yet, if there are instances where this trust is compromised, patients may not regard the healthcare provider sympathetically. Instead, they might feel deceived and could resort to seeking justice through the judicial system.^2,5-7

There is a recognized symbiotic relationship among dentists, lawyers, and patients when it comes to addressing medicolegal issues. As white-collar professionals, dentists and advocates are expected to serve as sources of knowledge for patients. However, the literature indicates that health professionals often lack sufficient knowledge of medical ethics and jurisprudence.⁸ This is troubling because the combination of insufficient knowledge among healthcare providers and less-than-adequate understanding among advocates can result in the dissemination of incorrect information to patients. In the long run, this could jeopardize the dentist-patient relationship and leave health professionals and advocates vulnerable, potentially leading to a failure to deliver justice to those rightfully deserving.^5,6

Since the introduction of the Consumer Protection Act in 1986, there has been a heightened awareness among the public regarding their consumer rights. Health professionals can now face prosecution for medical negligence under this act. Consequently, there has been a surge in medicolegal issues in recent times.⁵ Advocates (Doctors of Law) play a vital role in solving these issues and delivering justice to the victims.² So, these legal professionals must have sound knowledge of medical and dental jurisprudence. Hence, a cross-sectional questionnaire-based survey was planned to assess the level of awareness regarding dental jurisprudence among the advocates in Davangere city.

Materials and Methods

The present observational, descriptive, cross-sectional survey was conducted among advocates practicing in Davangere city. Data was collected at the premises of Davangere court or at the advocates’ office. As per the Directory of Davangere BAR Association, 1000 advocates were registered in the association. The inclusion criteria considered were, the registered advocates of the Bar Association council of Davangere city consenting to participate in the study, and advocates with a minimum of one year of legal practice. Ethical approval was obtained from the Institutional Ethical Review Board of Bapuji Dental College and Hospital, Davangere before the commencement of the study. Written voluntary informed consent was obtained from the study participants after explaining the objectives of the study.

Sample size calculation

Sample size estimation was done using Morgan’s table⁹ and was found to be 278 for a defined population of 1000. It was then rounded off to 280.

Study proforma

The proforma included three sections:

Section 1: Participant’s information letter and informed consent.

Section 2: Provision to record demographic characteristics like age, sex, years of practice, and educational qualification.

Section 3: Provision to collect the data regarding awareness of dental jurisprudence among advocates.

Questionnaire

Self-administered, closed-ended, structured questionnaire containing 26 items, developed and validated (CVI0.93) by Brinda B et al.² was used in the present study after obtaining consent from the author (Brinda B). The face validity of the questionnaire was again checked by consulting five senior legal experts. A few modifications were made based on their suggestions. A satisfactory level of agreement was found among the legal experts regarding the clarity, understandability, and language of the questionnaire.

Scoring procedure

One point was assigned for each response. The participants were categorized based on their overall mean knowledge scores as, inadequate (<mean score) and adequate (>mean score) levels of awareness.

Method of administration of survey questionnaire

The participants who voluntarily signed an informed consent to participate in the study were given a separate copy of the questionnaire in person in the advocates’ office by requesting them to complete all the questions. Fifteen investigators in the study were assigned to collect the data from eleven advocates each. The questionnaire was collected on the same day or the next day after checking for the completion of responses. An average time of 20 minutes per participant was allowed to answer the questionnaire (fixed based on a previous study by Brinda B et al.).²

Statistical analyses

The data obtained was compiled systematically in a Microsoft Excel sheet and subjected to statistical analyses using the IBM statistical package for the social sciences (SPSS) statistics for Windows, version 21 (IBM Corp., Armonk, N.Y., USA). Descriptive statistics were generated and expressed as frequency, percentages, mean, and standard deviation depending on the type of data. The Chi-square test was used for assessing the categorical data. An unpaired student t-test was used to compare the mean knowledge scores across gender, qualification, and years of practice. For all comparisons, P <0.05 was considered to be statistically significant.

Results

A total of 280 advocates participated in the present survey research. The general characteristics of the participants in this study according to their age, gender, qualification, and years of practice are depicted in Table 1.

Awareness regarding dental jurisprudence was assessed in terms of knowledge, perception, and practice. Distribution of study participants based on their practice in medicolegal cases, the type of medicolegal cases they have handled, their response regarding the coverage of medical or dental jurisprudence in their study curriculum, and the source of upgrading their knowledge regarding dental jurisprudence was depicted in Table 2.

Based on the responses to knowledge-related questions, the study participants were distributed as depicted in Table 3. The overall mean knowledge level of the participants was 10.28±1.61. The participants below the mean score were defined as having inadequate knowledge (45.4%) and above mean score as having adequate knowledge related to dental jurisprudence (54.6%).

When the mean knowledge scores were compared across gender, qualification, and years of practice, the knowledge scores of the participants did not differ significantly between any of the variables as shown in Table 4

The data included in Table 5 indicates that 53.6% of advocates did not have an idea if medical/ dental jurisprudence was adequately covered in their curriculum. About 71.4% of the advocates did say ‘yes’ to the public awareness about the filing of cases over medical/dental practitioners’ negligence. Ninety-five percent of respondents expressed the belief that public awareness of medicolegal issues has significantly improved compared to previous times. The media (51.4%) emerged as the primary source of information, followed by word of mouth (24.3%). About 62.1% advocates expressed the need for Continuing education programs regarding medico-legal issues.

Discussion

Dental jurisprudence is the application of dental science to legal problems. It comprises a set of legal regulations and limitations related to the practice of dentistry, which should be followed by a dental practitioner.⁵ It is the domain that uses dentally relevant facts and then integrates them with the legal system, assisting the criminal justice system.

Over the past two centuries, the discipline of dental jurisprudence has been renamed as ‘Legal Medicine’, and applying the law to medicine has expanded from medical law to health law. A significant number of dentists are being summoned to the court for grievance redressal by many patients.¹⁰ The advocates working on such cases on behalf of the doctor and the patient, should have ample knowledge for understanding the reasons which have led to such issues to deliver justice. Therefore, a cross-sectional survey was carried out among the advocates in Davangere city to assess the awareness regarding dental jurisprudence in terms of knowledge, perception, and practice. We believe that this was the second study conducted to evaluate advocates’ awareness related to dental jurisprudence in the Indian context, considering the study conducted in Chennai city. Hence, a very valid comparison could not be made with the present study findings.

In the present study, distribution of male (77.9%) and female (22.1%) advocates was unequal. The ratio of female advocates in the Indian Bar continues to be very low, and the current study confirmed the same. The same was reflected in the study done by Selvajothi et al., where male advocates (80%) were larger in number compared to female advocates (20%).¹¹

The mean knowledge score of the advocates regarding dental jurisprudence was 10.28±1.61. Female advocates showed a slightly higher knowledge score compared to males. However, this was not statistically significant. This is inconsistent with the results of the study done by Brinda B et al., where female advocates had better knowledge.²

The advocates' awareness of dental jurisprudence was unaffected by their length of legal practice. The knowledge of junior advocates (1-10 years) was comparable to that of senior advocates (>10 years). The study by Brinda B et al. reported similar outcomes.² This is most likely because most advocates reported handling medical-legal cases. Of late the patients are becoming more aware of dental malpractice and the legal remedies available for such problems. There has been a recent trend toward an increase in the filing of dental-related lawsuits.

The knowledge levels of undergraduate (LLB) and master's (LLM) advocates were not comparable in this study. This was because majority of the advocates (97.9%) who participated in this study had a bachelor's degree. This is probably because most advocates begin their careers after getting a bachelor's degree. In the study conducted by Brinda B et al., criminology lawyers performed better than bachelor’s degree and other specialty advocates.² This requires a change in the curriculum both at the undergraduate and postgraduate levels. Most of the advocates also expressed their desire to expand their knowledge by participating in Continuing Education Programs.

However, there were certain limitations associated with this study that we should be aware of. First of all, this was a cross-sectional survey with a relatively small sample size, and advocates were recruited by a non-random sampling method. Therefore, the results obtained may not apply across nations. Further research with a larger sample, including advocates with different legal specialties, is required to gain deeper insight and to expand the knowledge of dental jurisprudence among the advocates.

Conclusion

The current study concluded that practically all the study participants regardless of gender, education level, and years of experience had sufficient knowledge regarding dental jurisprudence. Most of them claimed to handle medico-legal matters in their practice. Their knowledge gaps regarding these issues can be filled by improving the curriculum in these areas. It is still necessary for the advocates to participate in continuing education programs to enrich their knowledge for effectively handling the medico-legal cases.

Conflict of Interest

Nil