A need for change: discrimination in dentistry

discriminationWe talk to Dr Kim Chan, the principal at Avenue Dental Surgery, part of the Dentex group, in Torquay. She is researching the effects of patient bias and microaggressions in the dental profession, to shine a light on the changes that need to be made.

No one should face discriminatory behaviour at work, and yet new research by Dr Kim Chan into discrimination in the dental profession returned shocking findings: 100% of participants (which included dentists, receptionists, nurses and a practice manager) reported that they had experienced patient bias or microaggressions, with all stating these types of behaviour had a negative impact (unsurprisingly).

Incidence of discrimination

Incidents of discrimination are sadly on the rise. The online National Health Service Staff Survey in 2020 found that 7.2% of NHS staff in England had experienced discrimination from a patient or a person connected to that patient, an increase from 5.8% in 2015.

Racism was the most common form of discrimination, but 2019 also saw a rise in reported sexism and intolerance of religion and sexuality.

According to the MDU, an investigation by ITV revealed that the number of racist incidents recorded in the NHS rose from 589 in 2013 to 1,448 in 2018 – an increase of 145% (also, more cases of abuse may have been unreported).

The stats make grim reading – particularly in light of the Black Lives Matter and Me Too movements, which we would have hoped made people more aware of their own biases and discriminatory behaviour – but acknowledging this issue could be the first step towards facilitating positive change. 

Dr Chan, who is principal at Avenue Dental Surgery in Torquay (part of the Dentex Group), is writing a dissertation on her research, with the aim to identify and address patient bias and microaggression and improve the patient/clinician experience as a result.

What are patient bias and microaggressions?

‘Basically, both are forms of discriminatory behaviour,’ explains Dr Chan. ‘Patient bias is when a patient requests that they don’t want to see a particular clinician based on their protected characteristics. This can be related to their age, gender, race or ethnicity. They may say: “Can I see a male dentist, because I’m not sure she’s strong enough to take my teeth out?”; “Can I see a more experienced dentist, because that dentist looks a little bit young?”; or “Can I see an English dentist?”

‘As for microaggressions, Dr Chan elaborates: ‘Microaggressions are those little remarks, whether they’re intended or not intended, based on the protected characteristics of the dentist or team. So, it could be a female dentist is about to extract a tooth for a patent and the patient will say: “Have you eaten your Weetabix this morning?”  They wouldn’t say that to a male dentist.

‘Or the classic one is “have you been home yet this year?” While individually they may seem innocuous, you wouldn’t say that to a non-ethnic dentist.’

The idea for the research

Dr Chan first embarked on her research following an incident she observed at her practice: ‘I was in the reception area and overheard the receptionist say “Oh gosh, that’s another one. I’m getting fed up with this” as she was putting the phone down.

‘We had an English dentist that had left, and a patient rang up to book an appointment. When she was told this dentist had gone, she said: “There’s no other English dentist at your practice is there?”

‘I enquired if this happened often, and the receptionist said yes. I asked one of the other nurses: “How does it feel when they (patients) bring this up?” She said: “Well, we’re embarrassed, and we don’t know what to do.”‘

The incident was a catalyst for Dr Chan; she saw first-hand how patient bias has an impact on not only the victim, but the team around them.

‘I am aware that the targeted person will have feelings of pain, anger, fear amongst many other emotions,’ she describes.

‘I was, however, surprised that discriminatory behaviour also affected the team. They often feel embarrassed and will not report it. I wanted to conduct a case study to examine the dental team’s experiences of patient bias and microaggressions.’

As she began her study, it soon became clear that the problem was widespread. Speaking to other dentists, who are not involved in the research, has been interesting. They confirm that patients can make derogatory remarks either about her or about other clinicians. Mostly related to race. She describes how a fellow dentist told her he has had patients saying things like: ‘Oh, we used to see that Chinese one downstairs’ amongst other derogatory remarks.

She added: ‘It is incredibly, incredibly rude how patients sometimes address us.’

Where to begin on tackling discrimination? 

Having seen that the issue affected the dental team, Dr Chan asked her study participants what they needed. Eighty eight per cent agreed that they would like some form of training. And that policies need to be clearer on how to manage discriminatory behaviour.

Those who took part in the research attended a training session. This allowed them to discuss issues and find strategies to manage future episodes of discrimination. The final stage of Dr Chan’s research, taking place in March 2022, will evaluate this training to see if it made an impact on how the team deals with negative patient behaviour.

Once she concludes her findings, Dr Chan hopes that the results could kickstart a drive within the profession. And that it could help empower teams to not tolerate discrimination.

‘I hope we can increase awareness of this issue and deliver strategies to help members of staff. Then they won’t feel embarrassed. And also create strategies to support the person that’s targeted,’ she says.

‘Furthermore, it’s about binding teams together. If you’re the targeted person and you know your nurse stood up for you, you feel supported. And for nurses to know that there will be no recrimination for them for speaking up for their colleagues.’

Why is dentistry not addressing discrimination?

As Dr Chan explains, the dental profession all too often ‘brushes discrimination under the carpet’. She elaborates: ‘I think institutions need to acknowledge that this type of behaviour does happen… For them to be proactive and set out policies and training to prepare staff on what to do and say in these situations. It will be nice if we all develop an open culture where we can discuss these issues.’

How Dentex is working with Dr Chan 

Dentex is working with Dr Chan to publicise her findings. ‘It’s been invaluable having Dentex’s support.

‘As a member of the Dentex community I had a wide network of colleagues to tap into to inform my studies. As well as the opportunity to publicise my research that I would not have otherwise had.’

She continues: ‘I hope after my dissertation is completed, the findings can be shared across the Dentex community and beyond. And that Dentex takes the lead to make changes to support our diverse workforce. Then everyone is able to work in an environment where they feel supported and safe.’

Dr Chan hopes that her work will contribute to the evolution of training programmes. This way they may eventually become standard employee training. ‘Many practices find these issues extremely difficult. They struggle to know how best to provide training and support to their teams.

‘Through a better understanding of the issues faced by dental practices, we should be able to develop both induction and ongoing training programmes. As well as tailor them specifically to the dental community.’

Dentex agrees with this sentiment. In addition to promoting Dr Chan’s research, Dentex is looking at how it can support diversity and inclusivity initiatives within its community as part of its ongoing ESG work.

Ultimately, Dr Chan hopes the same zero tolerance policy that practices have towards violence and abuse extends to discrimination: ‘The clinicians in our practice feel very strongly about the importance of avoiding bias and we would like this reciprocated by our patients.’

For more information visit www.dentexhealth.co.uk.

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