Kevin Lewis – woke-up call

Kevin Lewis is excited to discover that he has a pronoun as well as a noun, and heads off in search of things that he can be offended by.

Kevin Lewis is excited to discover that he has a pronoun and a noun, and heads off in search of things that he can be offended by.

I was sitting on a train a few months ago, and my ears pricked up at the mention of the word ‘dentist’ emanating from the seats behind me.

There was the predictable chat about how difficult it was to find an NHS dentist these days.

Then, one of the assembled throng recounted that her husband hadn’t attended for a while, and showed up at his ‘usual’ dentist complaining of pain, only to be told that he was no longer registered as a patient (whatever that meant) and he probably couldn’t be helped anyway because they weren’t that kind of dentist.

Cue peals of laughter from the travelling public, and a curious raise of the eyebrow from yours truly. But if that was curious, the next comment took me completely by surprise.

Apparently, the main problem was that the dentist in question was ‘only’ a ‘cosmetic dentist’. Therefore, he couldn’t do everything that a ‘real’ dentist could do.

One passenger firmly believed that a dentist wasn’t the same as a dental surgeon. Another member of the party suggested that a ‘cosmetic dentist’ probably wasn’t trained to the same level, and it might be like many others in the health and beauty industry who had done a course at night school and set themselves up in business.

Listening in on that conversation, I wondered if that dentist realised that his/her intended branding, marketing and communications coup was turning out to be more of a disaster than a triumph.

It was a striking example of the unintended outcome that happens when a decision is taken for inward-facing, self-indulgent reasons without fully thinking through the implications.

Change

Part of the problem is that attitudes and popular trends are moving at an unprecedented speed. We could blame the pandemic, but I think it’s a lot more than that.

For example, social media accelerates the propagation of opinions and attitudes and adds a gloss of trendiness in many cases. Social and peer pressure (always powerful influences) have grown exponentially.

But just as the dental profession is itself changing at speed, so is the public, and we can be on a collision course without realising it – until it’s too late.

Wokery is a perfect illustration. It’s only six years since the Oxford English Dictionary included the term ‘woke’ for the first time and, notwithstanding its origins and the specific context of its early use, the woke culture has expanded rapidly and now divides society quicker than a hot butter knife (my apologies to those who are offended by any reference to the possession and usage of knives, naturally).

Preferred pronouns

The Dentists Act 1984 legally protects the use of certain nouns like ‘dentist’ and ‘dental surgeon’, but it could be a while before it catches up on the need to protect pronouns as well.

I didn’t even know I had one until quite recently, and I’ve found it difficult to contain my excitement. But what will the Dentists Act, or its enforcer (the GDC), do about protecting adjectives? They too have feelings and are easily offended.

Why should poor defenceless adjectives be marginalised and left out of the debate? On that subject, helping yourself to an unprotected descriptor like ‘cosmetic dentist’ is right on the proverbial cusp, is it not?

And I’m sure we can find some ‘ordinary’ dentists who are willing to be offended by the implication that they do the simple, ugly (and necessary) stuff while the overachiever up the road does all the fancy, sexy (and perhaps unnecessary) stuff.

Once we accept that patients (and dentists) must be granted the self-determination and autonomy to decide their own preferred pronouns, then why stop at pronouns if a dentist chooses to self-identify as a ‘Cosmetic Dentist’ (note the capitalisation) and claims the adjective as central to their personal and professional persona?

It may or may not make you cry, but it certainly makes you think, doesn’t it?

Incendiary device

You may not have followed, or even been aware of, the heated debate in the British Medical Journal (BMJ) prompted by the publication of a paper last April (Cox and Fritz, 2022).

If you were wondering, that’s why you can’t find a GP these days – they’re all at home or deep in a forest somewhere, taking a mental health day to recover their sensibilities after reading the article and the ensuing angry thread.

In Take Two Aspirin and Call Me By My Pronouns, an outspoken associate dean at a US medical school in Pennsylvania described the ‘quiet woke revolution’ that he believes was having a huge negative impact on the US medical profession’s morale.

Two years later, with a pandemic intervening, it’s a hot topic and seems to be equally infectious.

Using terms like ‘complains of’ or ‘presenting complaint’ belittles patients and obstructs and undermines the therapeutic relationship (the BMJ article argued). Even the use of long-established shorthand like ‘c/o’ in records is frowned upon because it reinforces pre-existing subliminal bias in the relationship.

Similarly, the terms ‘compliance’ and ‘non-compliance’ (regarding following advice or taking medication) are also authoritarian, as is ‘pre- and postoperative instructions’. The empowered patient has autonomy and should never be ‘instructed’ to do anything.

The following example from the ensuing debate probably gives you a flavour of the discussion…

The original record of a medical consultation read as follows: ‘Patient’s presenting complaint was breathlessness. They denied chest pain. Sent for tests, but the patient failed to attend and was rebooked’.

It was suggested that this was truly awful, offensive, demeaning and unacceptable on many levels, and the following text was far preferable: ‘The patient was concerned about breathlessness, without chest pain. Tests were agreed, which they were unable to attend due to other responsibilities. Follow-up arranged.’

Missing the point

The tragedy of this debate in the pages of the BMJ, for me at least, has been that much of the original article was constructive and thought-provoking. But these potentially useful messages and lessons were quickly lost in the mostly adverse reaction provoked by the article.

By pushing the point too far, the reaction becomes defensive and hostile, and much of the potentially valuable content is rubbished.

Excess is invariably counterproductive. You can have too much of a good thing, as the saying goes. The authors of the BMJ article would do well to pause their research long enough to read and reflect upon Richard Thaler and Cass Sunstein’s wonderful book Nudge.

Subtlety can persuade and influence behaviour much more compellingly than shock and the wagging finger. Perversely, having gone to such lengths to make the point that it is counterproductive to blame the patient, question their motives or state or imply that the patient is misrepresenting the truth, the article does precisely that to blame and diminish its intended readership – medical professionals.

The inescapable premise is that patients are generally in the right and clinicians in the wrong. It’s even suggested that a patient’s non-compliance may well be the clinician’s fault for not having the competence to motivate the patient to comply.

‘You cannot be serious’

In the past few months, a number of examples of these new attitudes have come to my attention.

Dentists who have, in good faith, recommended one treatment approach over another have been accused of discrimination on the grounds of race, gender, protected physical characteristics, HIV or hepatitis B (or COVID-19) status, sexual orientation and on one occasion, even the fact that the patient sported a number of piercings and tattoos.

Unfortunately, the GDC’s default position seems to be that the patient is probably right. Another patient complained that the dentist had extracted their tooth simply because of their age (they were past retirement age), and claimed that a younger patient would have been offered a root canal treatment (RCT) and a more enthusiastic attempt to save the tooth.

And it doesn’t stop there – another practice owner recently told me of a genuine enquiry from a prospective member of staff that they were interviewing.

The applicant wanted to know whether the (generous) annual number of sick days for which full pay was offered, included their mental health and wellbeing days, or whether there was separate annual allowance for each of those.

If ever you find yourself bristling against some new manifestation of wokery, and are thinking ‘you cannot be serious’ – invoking the immortal words of tennis legend and sage of the greensward, John McEnroe – think again.

It is serious, deadly serious, and we may well discover in the fullness of time that not even adverbs are safe. I’ll let you know.