How to ensure minority groups feel seen in dentistry
Hassan Shariff considers how teams and practices can take steps to support gender minority groups within dentistry.
According to the World Health Organisation, gender can be defined as characteristics that reflect masculinity or femininity, that are socially constructed. This can include behaviours and roles. As gender is a social construct, it can change over time and differ between cultures (World Health Organisation, Gender and Health).
In contrast, sex is assigned at birth. It is considered a dictation of biology, where physical anatomy is a consequence of the way our chromosomes are organised (Office for National Statistics, what is the difference between sex and gender?).
Whilst sex and gender norms can be aligned for many individuals, for some they are not.
For example, someone who is biologically male may resonate with this, whilst simultaneously not identifying or presenting as masculine. These individuals may describe themselves as non-binary (Office for National Statistics, what is the difference between sex and gender?). What does this mean in terms of dentistry?
In dentistry, practitioners must behave in a way which allows both patients and the public to maintain their trust in the dental profession. The GDC, however, do not have specific directives on image or how practitioners present. Similarly, the NHS have guidance for a dress code to prevent cross-contamination and ensure patient safety. But there is no reference to gender identity (National Health Service, guidance on uniform and workwear policies for NHS employers).
For some instances, sex is referenced in the NHS guidance. For example where religion plays a role. But once again personal identity is not considered.
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Importance of legislation
GDC, GMC and NHS regulations reflect the importance of the Equality Act 2010. By law all persons, including practitioners should be free from discrimination if they fall into one of nine protected characteristics.
Under the protected characteristic, ‘gender reassignment’, the Act provides protection for those who are considered a gender variant due to how they physically present/dress (Equality and Human Rights Commission, gender reassignment discrimination).
As a dental practitioner, it is unlikely that the gender we gravitate towards will affect our academic ability or clinical capability to produce high standard work.
With existing uniform guidance not referencing gender and the law providing protection against sex/gender-based discrimination, dental professionals should not hesitate to dress in a way which is harmonious with their internal gender.
Despite the presence of protective legislation, a 2021 qualitative study suggested that those from gender minorities commonly hid their identity due to a fear of poor acceptance.
Additionally, those who did disclose their non-conforming status were subject to discrimination during their employment (Seiler-Ramadas et al, 2021).
Fearful of discrimination
GDC standards fortunately prevent staff from displaying prejudice against one another.
However, we should consider that not all members of staff in a dental practice are required to be registered with the General Dental Council/have experience with university ingrained knowledge regarding equality.
In these cases, practitioners who are fearful of discrimination may be unlikely to challenge management and instigate change at the policy level.
The relevance here extends to both clinical and non-clinical outcomes. A 2021 cross-sectional study assessed the stress levels in ‘gender non-conforming’ individuals.
It was suggested that prior to expressing themselves, a high level of shame, confusion and isolation was experienced (Scandurra et al, 2021).
Dental clinicians are already documented to have a high self-reported stress level. Additional stressors compromising clinician mental health could result in distraction and poor patient care (BDA, ‘don’t let the risk of litigation cause you stress’).
Not only does a lack of self-expression result in poor psychological wellbeing for a non-binary individual, but in a healthcare setting it can affect how patients feel regarding interaction with the service.
A survey by the government-funded charity Scottish Trans Alliance found that when gender non-conforming individuals experienced a service to be non-inclusive, they felt:
- Their gender identity was not valid
- Increasingly isolated
- Their self-esteem and mental health were negatively impacted
- They were less likely to access the service (Scottish Trans Alliance, non-binary people’s experiences in the UK).
The same survey reported that 60% of respondents had never felt comfortable disclosing their non-binary identity when utilising a NHS service.
Dental practitioners have a duty to respect the values and cultures held by their patients. The organisation Stonewall stated that one in eight LGBTQIA+ individuals have experienced a form of discrimination due to their identity when utilising a healthcare service (Stonewall, LGBTQ+ facts and figures).
Gender non-conforming dental practitioners are not obligated to disclose their personal identities to patients. But they can create an environment where gender minority groups feel seen. For example, by:
- Ensuring patients are aware of how the dental practice is a safe place. Refer to laws such as the Equality Act 2010 via appropriate signage
- Ensuring patients are aware of complaints procedures in the event of discrimination and making these processes easy to access
- Asking patients if they have a preferred pronoun
- Utilising imagery in brochures/posters which is inclusive of gender non-conforming citizens
- Supporting charities which aid the LGBTQIA+ community with fundraisers and visible donation boxes
- Allowing staff to wear badges which reflect LGBQTIA+ charities
- Having gender neutral bathroom facilities
- Providing staff with training on the differences between sex and gender.
Whilst modern western societal views have increased tolerance and acceptance of the LGBTQIA+ community, hate crimes remain prevalent.
The Home Office reported for 2020/2021, 2,630 transphobic related criminal offences were recorded.
In contrast, the Government Equalities Office have stated that 88% of transphobic attacks go unreported. This is due to a fear of retaliation.
This suggests the aforementioned data is highly inaccurate (Stop Hate UK, transgender Hate)
For LGBTQIA+ individuals who do not have equal access to safe places in comparison to their cis-gendered heterosexual counterparts, dental practitioners have the ability to create environments where all feel heard and welcomed.
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