My first job was as an Associate Dentist (one of only two) in a small community hospital in Renmark, South Australia. If you follow the hyperlink and zoom out…you will see that we are one of the last hospitals before you head north into the Outback. We were an important resource for Aboriginal Australians and Mine Workers in the Outback.
Within 6months my boss retired and I inherited the role of Dental Director……and I inherited a group of administrative staff and clinical assistants who were wonderful women born and raised in the area. In this region, Aboriginals had a reputation (among Non-Aboriginals) of drinking alcohol excessively, generally being good-for-nothing and failing to attend their medical appointments. None of my staff was Aboriginal.
When Aboriginal patients rang (recognized by their name) with oro-facial pain we would schedule them such that their appointment would be the last for the day (5.30pm). This was because, if the Aboriginal patient failed to attend (as we knew they would) we could go home early. This was a practice long established by my team and, rather than try to change it, I adopted it. Often, the postponement until the end of the day was unnecessary because we had openings (apart from 1 other dentist I had 7 Dental Therapists working for me too)…but those appointments were saved for other “more reliable” patients that may call later…but would be offered earlier emergency times because they were “more reliable” attenders.
2016 is my 16th year practicing Dentistry and, on reflection, I recognize how awful and unprofessional my team and I were. I now acknowledge that severe cases may not have been able to wait until the end of the day and my Aboriginal patients may have found an alternative intervention.…hence, failing their appointment with us. Also, many traditional Aboriginals do not own a car and rely on public transport or ride-share arrangements. An end of the day appointment would be less convenient for such a set-up (for example, our grocery store and most other places of business would close at 6pm). Factors like this perpetuated our belief that “Aboriginals are poor attenders.” This is discrimination by race and the intentional withholding of care based on race. It is deeply disheartening to reflect and realize how you may have contributed to someone’s poor health outcome by what seemed like a silly office tradition.
So what? My perspective is that it is critical that we, as healthcare providers, step back and consider how are we negatively impacting our patients’ health outcomes? Are we offering the best care to Medicaid patients or just offering a compromised alternative because we assume they won’t pay out-of-pocket. Do we assume a patient won’t improve their oral hygiene, and therefore, offer a complete denture rather than the opportunity to try and maintain their periodontally involved dentition? How aggressively do we work at getting a patient with hypertension to see their primary care physician? By the way, is compliance our problem or should we just drill fill and bill?
Some time ago we wrote a paper entitled “What is the Dental Profession’s Contribution to Worsening Access-to-Care Problems” and we received close to 50 heated emails from angry dentists. They felt we were undermining the reputation of our profession. Previous blogs have talked about how our Dental Profession has opposed Dental Therapists and how the solo-practice model may be in conflict with achieving improvements in quality. It’s time we worried less about how we are perceived by society, and worry more about delivering the highest quality care to them. The improved reputation will follow!