Articles

Bias is pervasive and as such infuses all of the interactions we have. As dental practitioners, we try our very best to treat all patients as they would wish to be treated. But what about their bias towards us? And bias between clinicians? Dr Louise Eggleton and Dr Annalene Weston, Dentolegal Consultants at Dental Protection, share their own experiences of bias in the workplace
 

Louise

My ethnicity is a mix of Malaysian Chinese and White British. While I have encountered issues regarding my ethnicity in other areas of my life, I have not experienced race-related bias working as a dentist. 

Annalene

My ethnicity is also a mix, of Eastern European and White South African. I did not experience racial issues when I worked in the UK, but regretfully this did become an issue when I started work in Australia. A memorable racial interaction was a complaint I received while working for DHSV in Wangaratta for “not speaking English properly”. The irony was not lost on me! 

Both of us have experienced comments and negativity with regards to being young (when we still were!) and for being female. Both of these factors were used to query our abilities and our appropriateness to provide care, by patients and by colleagues. 

Louise

I worked in an emergency access clinic for a number of years, extracting a lot of teeth. I encountered many male patients suggesting I would not be able to extract their tooth as I would not be strong enough. I was very direct in telling them I was the treating clinician and the extraction of a tooth was not related to strength, rather it was the experience and use of appropriate techniques. I would not wish to move forwards with treatment if a patient did not have complete trust in my clinical abilities; however, I made it clear I was the senior dentist for the emergency service and any patient was free to seek care elsewhere. All the patients elected to receive treatment and the teeth were extracted successfully. 

I have experienced a patient grab and kiss me after I had extracted his tooth. At the time, I remember the patient being so pleased to be out of pain, with the tooth having now been extracted following a previous failed attempt at a different clinic, this was perhaps an impulsive action on the part of the patient. While I do not believe this gesture was meant in a sexual way, it was certainly not pleasant to be seized and embraced by a patient with an open socket full of blood and saliva in his mouth. I very much doubt this would have happened if I was a male dentist!

With the nature of our profession – no matter if you are a dental assistant, therapist, hygienist or a dentist – there is obviously a necessary aspect of our jobs to infringe upon our patient’s personal space in an appropriate manner when providing dental care. As a female working in this environment this becomes perhaps even more challenging when you are working during pregnancy, especially when reaching the latter stages. It can be difficult to manoeuvre yourself in a comfortable position, with your stomach being much closer to a patient than usual. While of course this is entirely natural, I have experienced many patients reaching out to stroke my pregnant stomach. In providing emergency care, often I had never met any of these patients before and so for me, this was overstepping the boundaries.

Other uncomfortable experiences include a patient who was under the influence of drugs exposing himself to me in clinic. The patient was clearly less inhibited but was not acting in an aggressive or threatening manner. During the time, I did not think his actions were meant in a sexual way. He may well have repeated the same actions to a male dentist. My experience was perhaps not necessarily related to the differences in how male and female clinicians are treated but it certainly does make you consider your working environment and safety as a female dentist, carrying out treatment in very close proximity to individuals you have often never met before. 

The feeling of safety is essential if you are expected to carry out your job properly. I feel very lucky that the clinic I was working at did have security protocols. Emergency call buttons were available within every surgery, with an open-door policy when treating patients. If a security alarm was triggered, all available staff immediately went to investigate every situation. I worked with a great team who shared a huge amount of trust and camaraderie, which is so important. I realise, sadly, that other clinicians do not always experience this.

Annalene

I too had patients touch my pregnant stomach without permission. It was a strange experience as on the one hand, I am grateful they felt comfortable with me and saw me as a person, but on the other, I do agree that this is a boundary transgression. I was surprised by how uncomfortable it made me feel.

I suspect that every young practitioner has their ability to provide care questioned. I certainly have had my strength and ability to extract teeth questioned, by both patients and colleagues. It can be very challenging when you are a recent graduate to be questioned in this way, as your confidence can already be shaky. As Louise said, I used to back myself, and I would encourage every practitioner to do so.

The threat of sexual harassment and assault is a creepy reality for many female practitioners. I have had patients ask me on a date and bring me gifts. A dear friend of mine had a patient present her with tickets for a flight and a mini-break – with both his and her names on. She dealt with that firmly and handed his care over to another practitioner. 

I have had more than one patient touch me inappropriately, in an attempt to sexualise our time together. It is critical to have a protocol and for this to be understood practice-wide. It is also critical to be chaperoned whenever possible, and to consider an open-door policy when providing treatment if not. Naturally, these patients are best treated by others once a boundary violation of this nature has occurred. 

Bias is broader than gender

Racial bias and racial abuse remain a regrettable factor in practice, as in the balance of our lives. While the expectation that every clinician will be a ‘middle-aged male’ may have shifted, there can be no doubt that racial bias, whether it is conscious or unconscious, exists for both male and females of different ethnic origins. The Black Lives Matter movement has certainly demonstrated this still exists in society in general and therefore we would be ignorant to think dentistry would not be affected by it. 

It is also worth mentioning that bias may be completely unconscious, with many a young clinician being expected to perform independently, or make their own bookings, when a more mature age practitioner would not be asked to do so.

Challenging the challenge of bias

We have shared our stories with the hope this will help others recognise situations where they may not have been treated fairly, and to offer support. 

There are many steps we can take both at individual and organisation level to challenge bias and elicit change. The first one being to acknowledge that bias exists, and that we all can view situations and circumstances through our own filter of bias. By acknowledging this, we can then take steps to ensure that bias does not become prejudicial, both in our decision-making and also against others.

Needless to say, we should have a zero-tolerance policy to discrimination, and call it out when we see it rather than letting a silent endemic persist.

And finally, we should encourage our workplaces to develop policies that support staff and categorically set out that bias or discrimination against any person cannot and will not be tolerated. 

We need to speak up, both for ourselves and others, and it is important to acknowledge that if we do not have trust and support from our colleagues, our career in dentistry will be so much more stressful and challenging if you are on the receiving end of discrimination of any kind.