Resisting pressure: Upholding patient safety and professional integrity

In the dynamic and hierarchical environment of dental practice, junior dental practitioners (both recently graduated from programs in Australia and New Zealand, and those who have recently completed the Australian Dental Council’s assessment process) often encounter implicit or explicit pressure from senior colleagues to undertake procedures beyond their current level of competence. While such pressures may stem from perceived operational needs or a misplaced confidence in the junior clinician’s capabilities, it is essential that dental practitioners resist this pressure and prioritise both patient safety and their own professional integrity.

Patient safety as the paramount concern

The paramount principle of healthcare, that the patient should suffer no harm through dental care provided, underpins the ethical obligation of all practitioners. Treating patients without adequate competence or confidence significantly elevates the risk of procedural complications, misdiagnosis, or suboptimal outcomes. It should be stressed that blindly carrying out another practitioner's treatment plan without due personal consideration may result in placing patients, and the practitioner, at risk. This also undermines public trust in the dental profession, as the planned treatment that is to be performed may not be within your scope of competence.  This could result in you being in breach of the Dental Board of Australia’s (the Board) guidelines open_in_newand shared Code of conduct open_in_new(the Code).

Legal and professional accountability

From a legal standpoint, practitioners will always remain personally accountable for any treatment they provide, regardless of senior endorsement, coercion or direction. Claiming, “I was told to do it” or "I thought everyone did this" offers no protection if cases of professional misconduct or negligence arise. Should harm occur, the Dental Council of NSW (the Council) will assess the practitioner’s actions against professional standards, not against workplace pressures. Resisting inappropriate pressure will thus safeguard practitioners against potential litigation, regulatory action, and reputational damage.

Protecting long-term professional growth

Accepting tasks beyond one’s competence under pressure can have lasting detrimental effects on a practitioner’s confidence and professional development. Mistakes made early in practice, particularly those that are unavoidable – e.g. where appropriate referral to more experienced colleagues, or specialists, would be the most appropriate option – may have longer lasting impacts on you and your career.  In contrast, recognising and asserting personal limits is a mark of professional maturity, supporting safe skill development and reflective practice over time.

The role of professional standards and support mechanisms

Professional guidelines explicitly state that practitioners must only perform dental treatments that they have been educated and trained in, and that they are competent in. Practitioners should always seek supervision, mentorship, or referral when needed. The Board’s Guidelines for scope of practiceopen_in_new emphasise that maintaining and knowing one’s scope of practice is integral to ethical clinical care. Professional organisations and professional indemnity insurance providers often provide formal support mechanisms – such as clinical supervisors, peer review, or anonymous advice lines – to help junior practitioners navigate these challenges.

Dental Practitioner Supportopen_in_new, a 24/7 national support service, is also available for dental practitioners needing access to confidential advice.

Awareness and utilisation of these support mechanisms are vital and are strongly recommended and encouraged.

Challenging hierarchical pressures

Hierarchical structures in healthcare, in both private and institutional settings, and in some cultures, can foster environments where questioning senior direction feels uncomfortable or even insubordinate and may result in a significant drop in income and financial reward for a practitioner. However, the Board’s Code and Guidelines recognise the critical importance of advocating for patient safety.

All dental practitioners are encouraged to challenge inappropriate directives respectfully, citing their concerns around patient welfare and professional standards rather than personal limitation and a possible reduction in income. Statements such as “I’m not confident that’s in my scope at this point and I believe the patient would be better served with a more experienced clinician” balance assertiveness with professionalism. Practitioners should not be afraid to raise these concerns.

Fostering a culture of safe practice

Ultimately, resisting pressure contributes to the broader cultural shift towards safer, more transparent healthcare environments. By saying "no", junior dentists demonstrate good professional and ethical behaviour, adherence to the Board’s Code and Guidelines and, potentially (and hopefully), will encourage reflection amongst senior colleagues on their supervisory responsibilities and ethical leadership. Patient care, and not hierarchy, should guide clinical decision-making, and this should result in the development of better clinical practice for all concerned.

Conclusion

Practitioners must remember that professionalism is not defined by saying “yes” to senior colleagues, but by safeguarding patients, adhering to the Board’s Code and Guidelines, and recognising the limits of personal competence and experience. In resisting inappropriate pressure, they uphold not only their own integrity but the safety and trust that form the foundation of the public perception of the dental profession and that of the regulatory framework.