CODE OF PROFESSIONAL CONDUCT

MALAYSIAN DENTAL COUNCIL

Malaysian Dental Council

July 2022
CONTENTS

Preamble 1
Infamous Conduct 2

PART A OBLIGATIONS & RESPONSIBILITIES

1 THE PATIENT
1.1 Patient Care 3
1.2 Patients’ Right to Change Practitioner 4
1.3 Chaperone 4
1.4 Visual and Audio Recordings 4
1.5 Consent for Treatment 6
1.6 Quality of Care 9
1.7 Treatment of Children 10
1.8 Dental Fees 11
1.9 Communicating with Patients 12
1.10 Consultation & Referral 14
1.11 Emergency Treatment 15
1.12 Confidentiality of Information 15
1.13 Maintenance of Professional Relationships 16
1.14 Patient Complaints 16
1.15 Termination of a Practitioner-Patient 16
Relationship
1.16 Managed Care Organisation 17

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2 THE DENTAL PROFESSION

2.1 Maintaining the Integrity of the Profession 26

2.2 Updating Professional Knowledge and Skills 26
2.3 Advancement of the Profession 26
2.4 Ethics in Research 26
2.5 Professional Indemnity 27

3 COLLEAGUES

3.1 Upholding the Professional Image 27

3.2 Justifiable Criticism 28

4 THE PUBLIC

4.1 Oral Health Promotion 28

PART B PRACTICE MANAGEMENT

5 ESTABLISHMENT OF PRACTICE 29

5.1 Location 29
5.2 Name of Practice 29
5.3 Practising Certificate 29
5.4 Minimum Standards in Dental Practice 30
5.5 Patient Records 30
5.6 Practising as a dental therapist 31

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 6 PROFESSIONAL QUALIFICATIONS, RANKS &
AWARDS

6.1 Degrees 32
6.2 Use of Degrees and Awards 32

7 NOTICE TO PATIENTS 32

8 ADVERTISING 33

9 INFECTION CONTROL 33

10 CONTRACTS 33

11 ENDORSEMENT & USAGE OF 34

PHARMACEUTICAL & DENTAL PRODUCTS

12 DENTAL RADIOGRAPHY & RADIATION 34

PROTECTION

13 LICENSING, CERTIFICATION & MAINTENANCE 34

OF EQUIPMENT

14 STATEMENTS & CERTIFICATES 35

CONCLUSION 35

COMMITTEE FOR REVIEW OF THE CODE OF 36

PROFESSIONAL CONDUCT

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 PREAMBLE

One of the core functions of the Malaysian Dental Council

(Council) and the Malaysian Dental Therapists Board (Board) is
the promotion of high standards of personal conduct and
professional ethics among practitioners. Ethical considerations
encompass qualities of honour, integrity, trust and
professionalism, and should be motivated by the aim to
safeguard the health of the patient, promote the welfare of the
community and maintain the honour and integrity of the dental
profession.

In line with this objective, the Council established the code of

ethics entitled ‘Disciplinary Jurisdiction and Code of Practice’ in
1983, followed by the ‘Code of Professional Conduct’ in 1997
and later in 2008. Under the Dental Act 2018, the Council
established this Code of Professional Conduct 2022 to be
observed by all practitioners. Practitioner means any dental
practitioner or dental therapist registered under the Dental Act
2018. This version of the Code of Professional Conduct, in force
on 1 July 2022, supersedes all previous versions.

The dental profession has a long and honourable tradition of

service and care and holds a position of trust and respect in the
community. This reputation is founded on technical knowledge
and skills, and a high standard of personal and professional
behaviour. This document contains a set of ethical guidelines
that guide practitioners on the principles of personal conduct
and professional ethics in relation to their patients and their
clinical practice.

The Council and the Board take a serious view of

noncompliance to the laws, regulations, and guidelines relating
to the practice of dentistry, and practitioners should ensure that
they are conversant with this and all other relevant documents.

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 INFAMOUS CONDUCT

Under section 83(3) of the Dental Act 2018, any practitioner who
fails to comply with the guidelines or directives of the Council
shall be subjected to the disciplinary authority of the Council or
the Board, as the case may be.

One of the functions of the Council and the Board is to institute

and carry out disciplinary proceedings in regard to a
practitioner who has been accused of infamous conduct in
professional respect or accused of contravening any provision
of the Code of Professional Conduct or any guidelines endorsed
or issued by the Council or the Board, as the case may be.

The Council and the Board maintain the principle that ‘infamous
conduct’ means a failure to meet the minimum standards of
professional practice expected by profession. It includes any
behaviour that reflects adversely on the reputation of the
profession, such as acts that are dishonourable, immoral,
dishonest, indecent or violent, even if not directly connected
with the practitioner’s dental practice. Circumstances may arise
from time to time in relation to which there may occur questions
of professional conduct which do not come within any of these
categories. In such instances, as in all others, the Council or the
Board has the right to consider and judge upon the facts
presented.

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 PART A: OBLIGATIONS & RESPONSIBILITIES

1. THE PATIENT

1.1 Patient Care

A practitioner is morally obliged to provide professional

care to those in need.

a) In the discharge of this duty, a practitioner shall not

discriminate in selecting patients for their practices on
the grounds of nationality, race, religion, gender, sexual
orientation, creed, political views, or social standing.

b) For the elderly, the medically-compromised and

physically or mentally challenged patients, a
practitioner should exercise his best judgment to ensure
the dental needs of these patients are appropriately
managed and refer the patient to a specialist or a
suitable facility if necessary.

c) A practitioner shall not refuse treatment on the grounds

that the individual has a communicable disease for
which acceptable methods of protection are available.

d) A practitioner may refuse treatment if:

(i) The patient does not comply with the requirement of

being admitted to the clinic;
(ii) It is in the patient’s best interest;
(iii) it is beyond his capacity to manage the patient’s
problems; or
(iv) he is unable to manage the patient.

In such cases, the patient should be referred.

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 e) In all other cases, unless the patient discharges himself
from the practitioner’s care, the practitioner remains
responsible for the patient’s care once treatment
commences.

1.2 Patient’s Right to Change Practitioner

A practitioner should recognise that a patient is entitled to

seek treatment from any other practitioner at any time. In
such cases, a practitioner should provide a copy of the
medical/dental record upon request by the patient.

Nevertheless, the patient’s contractual obligations up to

that point in time, with all previous practitioners, should be
fulfilled.

1.3 Chaperone

When treating a patient, a practitioner should have a

member of his staff or another person present in the dental
surgery at all times.

1.4 Visual and Audio Recordings

Visual or audio recordings of patients are often made for

security or other legitimate purposes.

A practitioner must handle such recordings ethically. This

means:

a) Ensuring that visual or audio recordings do not

compromise patient’s privacy, dignity, confidentiality
and autonomy and the presence of the recording
device is obvious.

b) A clinic with a visual and/or audio recordings system

must display a notice informing the public of the

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 presence of the recording system before they enter the
clinic.

c) Obtaining patients’ consent for –

(i) any clinical recordings. If patients modify or

withdraw their consent at any point, this must be
respected. Patients must be allowed to view or hear
the recordings, if they wish.
(ii) storage of the recordings and taking reasonable
care to ensure that the recording is secure and that
no unauthorised persons have access to it. Such
recordings must be accorded the same level of
confidentiality protection as dental records.
(iii) transmission of the recordings and taking
reasonable care to ensure that the transmission of
the recording is secure and that no unauthorised
persons have access to it. Such recordings must be
accorded the same level of confidentiality
protection as dental records.
(iv) the use of the recordings for purpose of consultation.

d) Separate consent must be obtained in the following

cases:

(i) where audio and/or visual recordings of patients are

intended to be used for purposes that advance
healthcare, such as dental education, research and
publication.
(ii) where audio and/or visual recordings are intended
to be used anywhere in the public domain (such as
advertising, public lectures or any kind of media
output).

e) If patients are minors (under 18 years) or have

diminished mental capacity, consent must be obtained
from parents, legal guardians or those with legal

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 authority to decide for them. Where possible, the
patient’s consent should also be obtained.

f) If patients or accompanying persons ask to record their

consultation, a practitioner may accede to this
according to their judgement of the situation.

g) Despite taking consent and, where necessary separate

consent, the practitioner must take every reasonable
measure to remove all identifiable characteristics
(unless the patient consents to be identifiable) and
ensure that patient confidentiality and privacy will not
be breached.

1.5 Consent for Treatment

a) Consent is granting someone the permission to do

something they would not have the right to do without
such permission.

Specific to dental treatment, it can be defined as the

voluntary and continuing permission of the patient to
receive a particular treatment.

b) There are two types of consent; implied and expressed.

(i) Implied consent

It is accepted that consent is implied in many
circumstances by the very fact that the patient has
come to the dental surgery for dental care.

Nevertheless, it must be remembered that a patient

who walks into a dental surgery gives implied
consent only for a clinical and oral examination and
consultation.

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 (ii) Expressed consent

Expressed consent may be verbal, non-verbal or

written and should be clearly and unmistakably
stated. Expressed consent shall be obtained from the
patient before the commencement of any
treatment.

1. Verbal consent is given using verbal

communication.
2. Non-verbal consent is acceptable only in
situations similar to verbal consent where the
patient is unable to express himself orally.
3. Written consent is consent for treatment signed
by the patient, the parent or the legal guardian
and duly countersigned by a witness.

c) Where a private clinic is part of the hospital setting or

Ambulatory Care Centre, Part VIII Consent under
section 47(3) of the Private Healthcare Facilities and
Services (Private Hospitals and Other Private Healthcare
Facilities) Regulations 2006, consent shall be in writing.

d) If patients are minors (under 18 years) or have

diminished mental capacity,

(i) written consent must be obtained from parents,

legal guardians or those with legal authority to
decide for them.
(ii) In a case of emergency, an adult responsible for the
child (a person who bears temporary responsibility
for the child) may give consent after all possible
attempts have been made to get consent from the
parents, legal guardians or those with legal authority
to decide for them.

e) Before giving consent, the patient and the person giving

consent should have all treatment or procedures

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 explained to him clearly in lay terms so that he
understands the treatment to be carried out. The
explanation should include information on treatment
options (including those of delaying treatment or
choosing not to undergo treatment) with the risks and
benefits of each, the likelihood of success and/or failure,
limitations and cost of treatment.

f) Where the proposed treatment is complicated, a

written treatment plan with a cost estimate should be
prepared, discussed and agreed upon before
treatment commences. The patient should sign consent
for this treatment plan, and a copy of the treatment
plan may be given to the patient.

g) Specific written consent must be obtained in the

following circumstances:

(i) Any procedure carried out under sedation, or

general anaesthesia; or
(ii) Where treatment carries a significant risk.

h) If, in the course of treatment, the treatment plan has to

be changed and/or the cost estimate has to be revised,
a full explanation should be given at the first
opportunity. A revised treatment plan and cost estimate
should be consented in writing.

i) Informed Consent

Informed consent is a medico-legal requirement to

ensure that a patient knows all the risks and costs
involved in a particular treatment.

Informed consent can only be obtained by a

practitioner, who is able to explain the procedure in
detail, the risks and benefits of the procedure and the
alternatives (as stated in paragraph 6 of this section).

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 Informed consent can be said to have been given
based upon a clear appreciation and understanding of
the facts, implications, and future consequences of an
action. To give informed consent, the patient or a
responsible adult concerned must have adequate
reasoning capacity and be in possession of all relevant
facts at the time consent is given.

j) Notwithstanding the previous provisions, for consent to

be valid, it must be:

(i) taken prior to carrying out treatment;

(ii) voluntary; and
(iii) conveyed to the patient in a language that the
patient understands.

k) A practitioner should-

(i) not give guarantees or make unreasonable promises

about the outcome of treatment;
(ii) not coerce or induce a patient; and
(iii) give the patient sufficient opportunity to seek further
details or explanations about the proposed
treatment or procedure.

l) For the treatment of children in schools, the specific

policy of the Ministry of Health for obtaining consent
from parents, legal guardians or those with legal
authority must be adhered to, and this policy must be
made known to them.

1.6 Quality of Care

The Council and the Board takes a serious view of any

neglect of the practitioner’s professional responsibilities to
his patients for their care and treatment.

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 In the event where the practitioner utilises technology such
as computer-aided diagnosis and artificial intelligence, the
practitioner still holds the ultimate responsibility for the
patient care.

a) A patient is entitled to expect that a practitioner will

provide a high standard of care, which is evidence-
based. The practitioner should not undertake treatment
that exceeds his training, competence and expertise.

b) Recommending or performing unnecessary dental

services or procedures is unethical.

c) The needs of the patient should be the main concern

and should be met by a practitioner by offering all
possible treatment options with, if necessary, the
assistance of professional colleagues.

d) Practitioners are obliged to protect the health of their

patients by assigning only to qualified auxiliaries those
duties which can be delegated. Practitioners are
obliged to direct and supervise the work of all auxiliary
personnel.

e) Practitioners should take part in activities that maintain,

update and develop their knowledge and skills.

1.7 Treatment of Children

A practitioner should place the interests and - of the child

first. There can be no justification for intimidation.

The judicious use of physical restraint in an emergency, in

special circumstances, or to treat a difficult patient is
acceptable, provided there is consent from the parent or
responsible adult.

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 When faced with an uncontrollable child, it is better to
cease treatment, make an appropriate explanation to the
parent or responsible adult, and reschedule treatment or
arrange for a referral.

1.8 Dental Fees

a) A practitioner has the right to charge such fees as he

deems proper and reasonable, which are in
compliance with Schedule VII and Schedule XIII of the
Private Healthcare Facilities and Services Regulation
2006 (Fee Schedule).

b) A practitioner must have a schedule of fees available

for his patients within the clinic premises. These fees may
be displayed on the official clinic webpage/ social
media platform under the name of the practice.

c) A practitioner should not:

(i) entice prospective patients by offering packages,

discounts or special promotions.
(ii) offer discounts for the purpose of obtaining the
payment of fees promptly or within a specified time.
(iii) charge the fees for providing care in a misleading
manner.

d) Upon request, the patient shall be provided with an

itemised bill for all treatment carried out by the
practitioner.

e) The patient should be informed prior to the initiation of

treatment of the estimated charges and, during the
course of treatment, any other charges which may
arise.

f) A practitioner may collect a deposit from patients prior

to the commencement of treatment. Such deposits

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 should not exceed 30% of the total cost of the
treatment. If treatment is terminated at any point, the
deposit should be refunded after deducting the cost
incurred.

g) Fee splitting, rebates or any form of kickback

arrangements for referrals are unethical.

1.9 Communicating with Patients

a) A practitioner should act professionally, empathetically

and courteously towards patients at all times.

b) Prior to the commencement of treatment, the patient

should be given complete pre and post-operative
instructions. Any post-operative instruction should be
reinforced after treatment.

c) Prescribing of medications

A dental practitioner should inform the patient about

any medication prescribed to him, including:

(i) the purpose of the medication;

(ii) the possible side effects;
(iii) the need for avoidance of any food or drinks;
(iv) the possible interaction with other medications;
(v) the duration of administration necessary for any
medication prescribed; and
(vi) where he can seek medical or dental treatment
should the need arise

All medication prescribed shall be labelled with the

name of the patient, name of the drug, information on
dosage, frequency, duration of administration and
expiry date.

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 Prescriptions based solely on the information provided
by telephone or electronic means may be allowed for
continuing care.

d) Electronic communication

There are situations in which a person could initiate a

consultation through an electronic medium or via e-mail.
In such circumstances, only general information should
be given, and the person should be advised to seek a
personal consultation. Although no consultation fee may
be charged or received, the practitioner is responsible
for the advice given.

If a practitioner has already established a professional

relationship with a patient through direct personal
contact, has made a diagnosis and has commenced
treatment, adjusting treatment or providing continued
treatment after remote contact with a patient or based
on transmitted clinical data may be acceptable.

If, on the other hand, it appears from the communication

that the patient has developed a new problem or a
significant complication, the practitioner should
endeavour to see the patient personally for further
evaluation before offering further treatment.

e) Failure of Disclosure

(i) The concealment of the truth about any aspects of

a patient’s state of oral health, treatment or
standard of work done may be construed as
dishonesty.
(ii) Lack of disclosure from fear of repercussions is not in
keeping with a practitioner’s moral obligations and
duty of care to his patients.
(iii) The patient should be informed of any complication
that may arise during the treatment.

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1.10 Consultation & Referral

a) Where a practitioner is in doubt regarding the

management of a patient, he should seek consultation
from colleagues who have the relevant training,
competence and expertise.

b) A practitioner requiring an opinion from another

colleague should:

(i) communicate all available information relevant to

the matter upon which an opinion is sought; and
(ii) seek the patient’s consent for the consultation.

c) A practitioner examining a patient for a consultation or

who has been referred to him should limit his comments
to his professional findings and opinion. He should not
say or do anything which may undermine the
confidence that the patient has in the referring
practitioner.

d) In a consultation, the dental practitioner to whom the

patient comes for a consultation, in addition to that
which is aforementioned, should report the condition
and recommend appropriate treatment direct to the
practitioner who sorts the consultation.

e) If a patient requests a referral for a second opinion, the

practitioner is obliged to accede to the request.

f) When a patient is referred to a dental practitioner for

treatment, the patient should be returned to the
referring practitioner upon completion of the particular
treatment with a report on the patient’s condition.

g) In the event that a dental practitioner requires a

medical opinion in the course or prior to managing a

14
 patient, he should refer the matter to a medical
practitioner.

h) A practitioner shall only accept a referral from a

registered healthcare professional. Any referral from a
non-healthcare practitioner for investigation or
procedures not limiting to impression taking, dental
photography, interproximal stripping, aligner
attachment bonding or removal and any other devices
approved by the Medical Device Authority are
deemed unethical.

1.11 Emergency Treatment

a) A practitioner has a moral and ethical obligation to

attend to any dental emergency. The practitioner may
refer the patient for any follow–up treatment required.

b) A practitioner should be able to manage medical

emergencies which may occur in his dental practice.

1.12 Confidentiality of Information

a) All information obtained in the course of attending to

the patient is confidential. A practitioner shall not
disclose this information without the patient’s consent.

The patient’s consent may be overridden by

legislation, court orders or when public interest
demands disclosure of such information.

b) A practitioner shall keep all patient’s information

confidential and take appropriate steps to ensure that
it is not accessible to unauthorised persons.

Particular care should be taken when the information

is stored electronically.

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 c) A practitioner is responsible for ensuring that all
members of the dental team and supporting staff are
aware of the importance of confidentiality and that
they keep patient information confidential at all times.

1.13 Maintenance of Professional Relationships

a) Every patient has a right to be treated with respect and

courtesy.

b) A practitioner shall at all times maintain professionalism

in his relationships with his patients and not abuse this
through personal relationships or for personal gain.

c) Acts of indecency or dishonesty or other acts involving

abuse of the professional relationship are unethical.

d) A practitioner should not allow himself to be abused by

patients or their relatives. The practitioner is advised to
end such engagements with patients as quickly as
possible and in a professional manner.

A practitioner is reminded that in such cases, unless the

patient is referred to another practitioner or the patient
discharges himself, the practitioner remains responsible
for the patient’s care.

1.14 Patient Complaints

If a patient complains, the practitioner should make

reasonable efforts to resolve the matter at the practice
level, as provided under Section 36 of the Private
Healthcare Facilities and Services Act 1998.

1.15 Termination of a Practitioner-Patient Relationship

In cases where the practitioner-patient relationship is to be

terminated, the practitioner has the responsibility of offering

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 a referral to another practitioner. The referring practitioner
shall also ensure that sufficient information is
communicated to the new practitioner, with the patient’s
knowledge, to enable a seamless transition of care.

1.16 Managed Care Organisation

1.16.1. Introduction

a) There is an increasing presence and influence of

Managed Care Organisations (MCOs) or Healthcare
Management Organisations (HMOs) in the country in
recent years. Panel practitioners serving corporate
bodies have come increasingly under scrutiny and
pressure to act as primary care practitioners, taking cost
controlling risks, or in other words, to act as gate-keepers
on a pre-paid fee system. This arrangement requires that
the practitioner operates according to schedules and
manuals drawn by the MCOs.

It is good dental practice for the practitioner to

remember his primary professional responsibility to his
patients, when operating under such stringent financial
constraints and controlled patient care, which may be
imposed by MCOs. It is important to preserve a good
relationship and confidentiality in whatever adverse
practice environment, and to remember at all times
that practitioners exist because there are patients who
need individual care, and the practitioner’s primary
concern is for their health and well-being.

Under Section 82 of the Private Healthcare Facilities and

Services Act 1998 [Act 586] - “managed care
organisation” means any organisation or body, with
whom a private healthcare facility or service makes a
contract or has an arrangement or intends to make a
contract or have an arrangement to provide specified

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 types or quality or quantity of healthcare within a
specified financing system through one or a
combination of the following mechanisms:

i) delivering or giving healthcare to consumers through

the organisation or body’s own healthcare provider
or a third-party healthcare provider in accordance
with the contract or arrangement between all
parties concerned;
ii) administering healthcare services to employees or
enrolees on behalf of payors including individuals,
employers or financiers in accordance with
contractual agreements between all parties
concerned.

b) In reference to this document, the term MCO covers a

variety of entities and includes, among others Health
Maintenance Organisations (HMO), Preferred Provider
Organisation (PPO) and Point-of-Service (POS) plans.

c) There are specific provisions in relation to managed

care in the Private Health Care Facilities and Services
Act 1998. They include, among others:

(i) “The licensee of a private healthcare facility or

service or the holder of a certificate of registration
shall not enter into a contract or make any
arrangement with any MCO that results in-

1) a change in the powers of the registered

medical practitioner or dental practitioner over
the medical or dental management of patients
as vested in paragraph 78(a), and a change in
the powers of the registered medical
practitioner or visiting registered medical
practitioner over the medical care

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 management of patients as vested in
paragraphs 79(a) and 80(a);

2) a change in the role and responsibility of the

Medical Advisory Committee, or Medical and
Dental Advisory Committee as provided under
section 78, the Midwifery Care Advisory
Committee as provided under section 79 or the
Nursing Advisory Committee as provided under
section 80;

3) the contravention of any provisions of this Act

and the regulations made under this Act;

4) the contravention of the code of ethics of any

professional regulatory body of the medical,
dental, nursing or midwifery profession or any
other healthcare professional regulatory body;
or

5) the contravention of any other written law.”

(Section 83)

(ii) “A licensee or the holder of a certificate of

registration having a contract or an arrangement
with a managed care organisation shall furnish such
information relating to such contract or
arrangement to the Director General as he may,
from time to time, specify.” (Section 84)

(iii) “A managed care organisation or the owner of a

managed care organisation having a contract or an
arrangement with a licensee of a private healthcare
facility or service or a holder of a certificate of
registration shall furnish such information relating to
the organisation as may be required by the Director
General.” (Section 85)

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 (iv) “The Director General shall maintain a Register of
managed care organisations having any contract or
arrangement with any licensee of a private
healthcare facility or service or any holder of a
certificate of registration and such Register may
contain such particulars as may be determined by
the Director General.” (Section 86)

d) The Thirteenth Schedule of the Regulations (2006) to the

Private Healthcare Facilities and Services Act contains
the professional fees for procedures carried out in
private hospitals and other healthcare facilities. These
fees are accepted as the maximum professional fees
chargeable.

e) Managed care organisations or third-party payers

sometimes request for lower professional fees as an
inducement to refer corporate patients.

f) Managed care organisations or third-party payers

sometimes restrict a practitioner’s right of choice of
referral to a dental or medical practitioner or health
care facility.

The MDC’s position is that these practices are unethical.

1.16.2. CONFIDENTIALITY

a) A practitioner may release confidential information in

strict accordance with the patient’s consent, or the
consent of a person authorised to act on the patient’s
behalf. Seeking patient’s consent to the disclosure of
information is part of good dental practice.

Disclosures for which expressed consent shall be sought.

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b) As a general rule, a practitioner shall seek a patient’s
expressed consent before disclosing identifiable
information for purposes other than the provision of
care.

c) Where a practitioner or the healthcare facility in which

the practitioner practises have contractual obligations
to third parties, such as companies, insurance
companies or MCOs, the practitioner shall obtain a
patient’s consent before undertaking any examination
or writing a report for the third party. Before seeking
consent, the practitioner shall explain the purpose of the
examination or report and the scope of the disclosure.
The practitioner shall ensure that the final report is shown
to the patient and the patient’s consent is thereafter
obtained before submission and that the copies of
reports are given to the patient, upon request.

d) A practitioner shall ensure that the relationship between

the practitioner or that of the healthcare facility in which
the practitioner practises, with third-party payers such as
insurance companies or MCOs do not contravene the
Principles of Confidentiality.

1.16.3. DENTAL RECORDS AND DENTAL REPORTS

Disclosure to Third Party Payers and MCOs

a) Dental records of patients who are employees of

corporate bodies, or who are under healthcare
insurance cover, belong physically and, as stated
above, intellectually to the practitioner (and the
healthcare facility or services) and ethically to the
patient. Release of information from the medical
records to third-party payers and Managed Care
Organisations, and through them to the employers,

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 should only be made with the informed consent of the
employee/patient.

b) Employees may be compelled to sign a blanket

document of consent by the corporate employers
giving the Third-Party Payers or Managed Care
Organisations the right to obtain confidential
information from the healthcare providers. Such blanket
consent, without reference to specifics, is not
acceptable. Informed consent for disclosure must be on
a case-by-case basis and should be obtained by the
practitioner personally from the patient. This is to
safeguard the patient’s right as some points in the
disclosure may adversely affect or influence the
patient’s employment status.

1.16.4. PRACTITIONERS IN CONFLICT SITUATIONS

a) Private hospitals may enter into business arrangements

with MCOs, or directly with the corporate client, to
provide healthcare services for employees. Some of
these arrangements require practitioners to reveal the
diagnosis and treatment details of the employees to the
third party. The third party often obtains blanket consent
from the employee to facilitate this arrangement. This is
not acceptable, and specific consent for disclosure
should be obtained as and when necessary.

b) The extent of such disclosures must be explained to the

employees while obtaining their consent to release
confidential dental information. In such circumstances,
too, the practitioner’s primary professional responsibility
to his patient, in the context of doctor-patient
confidentiality, should not be compromised, and the
person in charge of the private hospital must be advised
as such.

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c) Private hospitals are known to act as their PPO by setting
up a chain of primary care clinics that refer patients only
to the parent hospital for investigations and
management. This practice is a hybrid of the managed
care system and is not encouraged by the MDC. This
restrictive referral system with its implications and
restrictions must be explained to the patient, as there
are fine ethical issues involved in such arrangements,
primarily the employee being limited in his choice of
practitioners and hospitals.

Fee-splitting

d) The definition of fee-splitting in the Private Healthcare

Facilities and Services (Private Medical Clinics or Private
Dental Clinics) Regulations 2006 is as follows:

“Fee Splitting means any form of kickbacks or

arrangements made between practitioners, healthcare
facilities, organisations or individuals as an inducement
to refer or to receive a patient to or from another
practitioner, healthcare facility, organisation or
individual.”

As defined above, referral or acceptance of patients

between practitioners must be based on the quality of
care (and not on considerations of monetary benefits).

e) Fee splitting, which implies that a practitioner makes an

incentive payment to another practitioner for having
referred a patient to him, is an unethical practice.

f) Payment of a monthly/yearly retainer and/or a fixed

quantum per patient is not considered fee-splitting.

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Fee sharing

g) Fee sharing between two practitioners managing a

patient is permissible, the basis for such sharing being
that the practitioners must have direct responsibility and
involvement in the management of the patient.

Practitioners in Managed Care Organizations

h) The practitioners working within the traditional or

“classic type” of MCO system can be considered to be
under a special kind of employment, since their services
are often pre-paid and they are subject to certain
prearranged conditions of professional service to
employees of their corporate clients.

i) The ethical conflicts are many and primarily involve

practitioner-patient confidentiality and rights. Some of
these issues are:

(i) The patient records and documents “belong” or are

freely accessible to the third-party administrators,
namely the MCO, and dental information on the
employee is to be made available at all times (for
every clinic attendance) to the MCO. The employee
is said to have given blanket consent to this release
of information by virtue of having accepted
employment with the corporate body.
(ii) The practitioner can only prescribe medications
contained in a schedule prepared by the MCO.
Drugs not in the schedule may be prescribed only
after approval has been obtained.
(iii) The practitioner has to obtain prior approval
before ordering investigations not on the MCO
Schedule, and has to obtain approval before
referring the employee to a specialist or a private
hospital for further management.

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j) The practitioner, acting as the so-called “gate-keeper”,
takes all the risks in the management of his patients, and
is liable to disciplinary action in the event of professional
negligence, which may arise because of the unfriendly
professional environment in which he operates under
the system.

k) The pre-payment scheme imposes on the practitioner

to provide professional care within the per capita
allocation for each employee. Should he exceed this
allocation without seeking prior approval, the
practitioner may be blacklisted and fall out of favour
with the MCO for continued retention on the panel.

l) In all instances, the practitioner in a managed care

system has to place the interests of the patient and
confidentiality above all other considerations. He should
refrain from entering into a contract with an MCO if
there are potential ethical conflicts in his professional
autonomy and practitioner-patient relationship.

m) The nature and stipulations of contacts between the

licensee or the holder of registration of a managed care
organisation and the licensee or the holder of
registration of a private healthcare facility or service are
laid out in the Private Healthcare Facilities and Services,
1998.

1.16.5. CONCLUSION

All registered practitioners have legal and ethical duties in

relation to managed care. A practitioner must not at any
time abrogate his duties as the healer and provider of
healthcare service, on the ground of the influence of
market forces or managed care organisations.

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2. THE DENTAL PROFESSION

2.1 Maintaining the Integrity of the Profession

A practitioner should maintain the integrity of the profession

and refrain from any action which may compromise that
integrity. Practitioners should bring to the attention of the
Council or the Board any action on the part of any
practitioner which, in his opinion, may undermine the
honour of the profession.

2.2 Updating Professional Knowledge and Skills

A practitioner should take steps to continually update his

skills and knowledge throughout his career for the benefit
of his patients.

A practitioner is responsible to obtain the requisite

continuing professional development (CPD) points for
renewal of his practising certificate each year and
obtaining the points within the required time.

2.3 Advancement of the Profession

A practitioner has an obligation to support the

advancement of the profession through membership in
scientific and professional organisations locally, nationally
and internationally.

2.4 Ethics in Research

a) All research involving patient/ community must have

the approval of the relevant research ethics committee,
and research should be conducted in compliance with
the approval.

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 b) When undertaking research involving human or animal
subjects, current and relevant directives regarding
ethics should be complied with.

c) A practitioner has an obligation to make the results and

benefits of their investigative efforts available to
relevant agencies when it may be useful in
safeguarding the health of the individual or the public.

2.5 Professional Indemnity

All practitioners are advised to be adequately covered by

professional indemnity insurance as long as they are
involved in patient care.

3. COLLEAGUES

3.1 Upholding the Professional Image

a) A practitioner should act in a manner that respects the

rules and etiquette of the profession and should be
willing to assist colleagues professionally.

b) When a practitioner comes across a treatment that in

his opinion is unsatisfactory and it must be retreated, he
has an obligation to inform the patient. However, a
practitioner should not comment disparagingly, either
orally or in writing, regarding the services of another
practitioner.

c) A practitioner should always speak out in recognition of

good work. Such recognition is just and generous and
gives confidence to the patient and much
encouragement to the fellow practitioner.

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3.2 Justifiable Criticism

When a practitioner has reason to believe that a colleague

is incompetent to practice whether but not limiting to by
reason of drug addiction or physical or mental incapacity,
or evidence of gross or continual faulty treatment, it is his
duty to draw this fact to the attention of the Council or the
Board.

4. THE PUBLIC

4.1 Oral Health Promotion

a) A practitioner has a responsibility to promote the health

of the community through disease prevention and
control, education and, where relevant, screening
programmes.

b) During oral health promotion activities, practitioners

must ensure that they do not solicit for patients or
encourage the public to seek consultation or treatment
only from them or the organisation with which they are
associated.

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PART B: PRACTICE MANAGEMENT

5. ESTABLISHMENT OF PRACTICE

A practitioner should abide by the laws, regulations and

guidelines affecting the profession. This includes, but is not
limited to, those relating to:

a) registration with relevant regulatory bodies;

b) safety and health;
c) employment;
d) data protection; and
e) human rights and equality.

5.1 Location

A practitioner must ensure that the clinic complies with

local by-laws and the provisions of the Private Healthcare
Facilities and Services Act 1998.

5.2 Name of Practice

Unless the person-in-charge is registered under the

Specialist Division of the Dental Register, the name of the
clinic should not include the word ‘specialist’, in any
language, or any word that may imply a specialty (for
example, the word ‘braces’ or ‘gums’ or ‘children’).

5.3 Practising Certificate

When practising dentistry, a practitioner must display a

valid Practicing Certificate at every place of practice.

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5.4 Minimum Standards in Dental Practice

The minimum standards in a dental practice are covered

by various laws and the guidelines issued by the Council or
the Board. They include but are not limited to the following:

a) Physical amenities and equipment;

b) Infection control;
c) Dental radiation protection;
d) Use of dental materials and devices;
e) Management of drugs and pharmaceuticals;
f) Waste disposal;
g) Emergency care services; and
h) A patient grievance mechanism.

5.5 Patient Records

a) Maintaining clear and accurate health records is

essential for the continuing care of patients. This
involves:

(i) keeping accurate, up-to-date, factual, objective

and legible records that report relevant details of
medical and dental history, clinical findings
including dental charting, investigations,
treatment plans, treatment carried out,
medication prescribed, information given to
patients or family members and any other
relevant management, in a form that can be
shared with other health practitioners;
(ii) making records at the time of events or as soon as
possible afterwards;
(iii) ensuring that records are sufficient to facilitate
continuity of care;
(iv) ensuring that records are kept securely,
retrievable and are not subject to unauthorised
access, regardless of whether they are kept
electronically or in printed or written form;

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 (v) recognising the right of the patients or his legal
guardians to access information contained in
the patient’s medical/dental records, and
facilitating that access;
(vi) providing the patient or his legal guardian
with a copy of the records or a report, upon
request;
(vii) facilitating the transfer of health information
when requested by a patient or his legal
guardian; and
(viii) keeping patient records for a minimum of
seven years from the patient’s last visit or the
date the patient attains the age of majority.

b) A copy of the dental records may be released to

other parties if necessary. However, the practitioner
must obtain the patient’s consent, and this should be
documented before any records are released.

c) All clinical details, investigation results, discussion of

treatment options and drugs prescribed should be
documented and initialled by the practitioner
concerned.

d) A practitioner should never falsify a patient’s record.

5.6 Practising as a dental therapist

Practitioners are reminded that dental therapist practising

in the private sector are regulated under section 43 of the
Dental Act 2018, which state:

a) A dental therapist in the private sector shall practise

dentistry only under the direct supervision of a dental
surgeon.

b) For the purposes of this section, “direct supervision”

means a dental surgeon shall be present at all times

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 in the healthcare facility when the dental therapist
carries out any treatment according to the treatment
plan approved by a dental surgeon.

c) A dental therapist who practises dentistry in the

private sector shall carry out only the procedures
listed in the Fifth Schedule of the Act.

d) A post-basic dental therapist who practises dentistry

in the private sector shall carry out only the
procedures listed in the Fifth Schedule and the Sixth
Schedule of the Act in relation to the discipline for
which he is qualified.

6. PROFESSIONAL QUALIFICATIONS, RANKS & AWARDS

6.1 Degrees

Practitioners may display only the qualifications by which

they were registered with the Council or the Board, and any
other qualification approved by the Council or the Board.

6.2 Use of Degrees and Awards

Only the degrees mentioned in Section 6.1 and state or

national honorary awards may be used on nameplates,
business cards, letterheads and any other notices or
correspondence associated with the practice.

7. NOTICE TO PATIENTS

a) A practitioner may only inform patients already on

record of any change of clinic premises or consultation
hours. All notifications must comply with the current
Guidelines and Provisions for Public Information
endorsed by the Council or the Board as applicable.

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 b) A practitioner about to leave for another practice
should refrain from any action which may entice
patients away from the current practice.

8. ADVERTISING

Practitioners must comply with the current Guidelines and

Provisions for Public Information endorsed by the Council or
the Board as applicable.

9. INFECTION CONTROL

A practitioner should practise the highest standards of

infection control and comply with the current Guidelines on
Infection Control in Dental Practice endorsed by the
Council or the Board as applicable.

10. CONTRACTS

a) In entering into any contract, a practitioner should not

compromise professional standards or the health of the
patient. When contracts are established, they must also
abide by the provisions of the Private Healthcare
Facilities and Services Act 1998 and its Regulations.

b) A practitioner should not enter into a partnership or

association or become financially interested in a
practice owned or controlled by a practitioner whom
he believes to be unethical.

c) It is unethical for a practitioner to contract out his

services under conditions that compromise his patients’
health and well-being.

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 d) When entering into any contracts involving managed
care systems, all ethical considerations of the Council
and Board must be adhered to.

11. ENDORSEMENT OF PHARMACEUTICAL & DENTAL PRODUCTS

A practitioner should not endorse any dental or

pharmaceutical product unless it is in the best interest of his
patients.

12. DENTAL RADIOGRAPHY & RADIATION PROTECTION

a) In procedures that require radiographs, all necessary

radiographs should be taken. Nevertheless,
unnecessary exposure to radiation should be avoided.

b) A dental practitioner who stores machines for the

purpose of dental radiography and imaging shall abide
by the Atomic Energy Licensing Act 1984 and the
current Guidelines on Radiation Safety in Dentistry
endorsed by Council.

c) A practitioner who operates machines for the purpose

of dental radiography and imaging shall abide by the
Atomic Energy Licensing Act 1984 and the current
Guidelines on Radiation Safety in Dentistry endorsed by
Council and the Board.

13. LICENSING, CERTIFICATION & MAINTENANCE

OF EQUIPMENT

Practitioners must ensure that all necessary licenses or

certifications are obtained, and calibration and tests are
carried out on equipment and appliances at the
appropriate times.

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14. STATEMENTS & CERTIFICATES

Practitioners should not make statements or declarations,

or sign certificates or other documents, or induce any other
person to do likewise, which the practitioner knows, or
ought to know, to be untrue or misleading.

CONCLUSION

While this code does not cover every aspect of behaviour in every
possible circumstance, it will certainly, together with all other MDC
guidelines, assist a practitioner in a particular situation to exercise
professional care and judgement, and accept personal
responsibility. In all situations, it is mandatory that a practitioner
adheres to this code and the guidelines and behaves
professionally and responsibly and acts in the interest of his
patients and the public in general.

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 COMMITTEE FOR REVIEW OF
THE CODE OF PROFESSIONAL CONDUCT

1. Dato’ Prof Dr Ishak bin Abdul Razak – Chairman

2. Dr Noormi binti Othman
3. Prof Dr. Rahimah binti Abdul Kadir
4. Prof Dr. Dalia binti Abdullah
5. Dr Ng Woan Tyng
6. Dr R.T. Arasu
7. Kolonel Dr Mohamad Asri bin Din
8. Dr Abdul Latif bin Abdul Hamid
9. Dr Elise Monerasinghe
10. Madam Normala binti Omar
11. Dr Sofiah binti Mat Ripen

MDC Secretariat:

1. Dr Nurul Syakirin binti Abdul Shukor

2. Dr Suziyana binti Sudin
3. Dr Nur Hamizah binti Abu Bakar
4. Dr Noorhidayah binti Mohd Arof
5. Dr Navina a/p Nagaratnem

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