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“Diversity? In My Office???”

Dr. Richard Madow

With special guest –Dr. Gwen Essex

EDITED TRANSCRIPT

Richard Madow:Hi, this is Dr. Richard Madow and our guest today is Dr. Gwen Essex.How are you doing today, Gwen?

Gwen Essex: I’m really well, thank you very much for having me. I’m excited to speak with you.

Richard Madow: You know, the few times we’ve spoken, you’ve always been very upbeat and excited and passionate about your topics and all that great stuff; you really are into it.

Gwen Essex: I am quite into it, it’s true.

Richard Madow:That’s fantastic.Well, Gwen, I’m guessing that most of the people listening to this interview don’t know what you’re passionate about or what you’re into, so maybe we should let them find out. I’ll give you a little introduction.How does that sound?

Gwen Essex:Perfect.

Richard Madow: Great.Well, our guest today is actually from the other side of the country. As most of you listeners know, I’m here at beautiful Unsound Studios in Baltimore, Maryland, and Dr. Gwen Essex is on the other coast.Some people call it the left coast or the best coast or the cool coast,whatever.You’re there in the Bay Area of Northern California, certainly one of the most interesting and beautiful parts of our great country.So, Gwen, you are an RDH, a dental hygienist, you have a master’s degree and a doctorate in education; you’re a clinical professor in the division of oral epidemiology and public health at the University of California, San Francisco, School of Dentistry. And you do a lot of neat things there.You direct the introductory clinic course for first-year dental students, you’re sucking nitrous oxide with the second-year dental students. I’m kidding, you’re actually teaching nitrous oxide, so...

Gwen Essex:I sure do.

Richard Madow: Someone’s got to do it, right?

Gwen Essex:Yeah.

Richard Madow: You tell them, like, listen to Pink Floyd or anything like that; you probably don’t go there.

Gwen Essex: I think you’ve taken my course.

Richard Madow:You’re also a research mentor for graduate dental hygiene students; you’re pretty busy.You’re a member of the faculty of the master’s of science program in dental hygiene at UCSF, and the odd thing is that’s not how we met.So I’ll tell people how we met, and then you can talk a little bit about how you got involved in this topic and what we’re going to talk about today.I’m really excited; it’s a topic that we’ve never even come close to discussing on the Madow Brothers audio series, and obviously I think it’s a really important one or we wouldn’t be here together today.So I was introduced to you because I read and watched, I believe, an interview on Dr. Bicuspid, the great dental website, drbicuspid.com.I’m not sure there actually is a Dr. Bicuspid; do you know any info on that?

Gwen Essex: I’ve not met a Dr. Bicuspid, so it may just be more of an artistic license but it’s working.

Richard Madow: It’s working very well.Anyway, you were interviewed on the topic of diversity in dentistry.And no, diversity in dentistry does not mean that you should do a certain amount of endo and a certain amount of crown and veneers and a certain amount of implants, although that’s a good kind of diversity too.But diversity as we’ve come to know it in the US these days, and we’ll talk about all these things: inclusivity and...Maybe I’m gonna just totally bosh this, so I’m going to ask you to explain to our listeners how you even got involved in diversity in dentistry and this topic.

Gwen Essex: Sure, but you’re right, it doesn’t come from my bio.I think that my interest in diversity and inclusivity really has been something asa true line in my personal life since I wasachild. I think I have been called a loud-mouth advocate, you know, I just always wanted to make sure that those who were more vulnerable, or didn’t have a way to voice their concerns or needs, had the support.And that’s just sort of how I lived my life.I have the save-the-whales-sticker kind of mentality.And in my work I’ve always made a real attempt to connect with dental students that I worked with, to really help them have the best educational experience, and so I’ve gotten to know them beyond their provider number or what their tasks are in a course.And getting to know students personally, to an extent, I began to really understand how many people had come into dentistry from nontraditional pathways, or pathways that weren’t necessarily as well represented among faculty or clinicians.And with that there was both a gift and also a challenge; certainly I could see that many of these students have brought things to their education and eventual practice that were maybe not so well represented overall in the profession.But sometimes they also had challenges of needing to feel like they need to assimilate or fit in, or be like whatevera typical dentist is.And that aggregate typical dentist is really changing. I think if we look at who is in school now, we see a lot more people of color; we see a lot more women than we had traditionally.And taking that in and also looking at a particular population of students that maybe didn’t have support, it became more a part of my work life.It sort of exitedmy own privateinterest,and became something that I felt I could do more explicitlyat work to help people who maybe didn’t feel like they were a part of the overall culture have some recognition and support.Formally I think that came to be when I helped found Gay-Straight Dental Alliance at USCF in 2008.And when we did that, we didn’t have any students who were publicly identifying as lesbian, gay, bisexual, transgender, queer, questioning or intersex; we just had staff and faculty and a lot of students that were not happy about having what they call a “gay club”;and I have to tell you, I was really surprised.And my feeling that we needed to do something just became more urgent and a higher priority, and I’m very happy that in 2010, we had a student matriculate who was publicly out and brought a partner to one of the early events.And thankfully, he withstood the fact that I nearly tackled him and begged him to please join me.

Richard Madow:Let’s just back up for a second.You’re telling me in 2010 in San Francisco, which, you know, has the reputation as the most gay-friendly city in the country, that some...

Gwen Essex:We have the biggest rainbow flag, yeah.

Richard Madow:Somebody had to think twice about bringing a same-sex partner to an event?

Gwen Essex: And that is worth stopping and letting us all kind of gather ourselves, because it’s a shock isn’t it?

Richard Madow: It really is.

Gwen Essex:It is a shock, and I don’t know if it’s because we are in San Francisco, that it seems we don’t need to worry about that because, of course, we’re inclusive and that’s a part of our culture;but dentistry as a whole has not always been a terribly progressive, liberal, social profession.

Richard Madow: It’s so funny, when you’re saying this, I’m thinking back to when I was in dental schoolas I was...men were still, I guess, 70-75% of the dental school class.I was a straight, white Jewish male, I was like the stereotypical typical dental student, and everybody was like me.But I know that in the generation before me, my parents’ generation, there was a tremendous amount of anti-Semitism, and Jews were berated by the instructors and they only allowed a certain percentageofusin.I guess tides turn and things change, but it still hasn’t fully righted the ship, I guess we could say.

Gwen Essex:No, and it’s incremental; I mean, changes are incremental, and just as faculty or others that you’re speaking of in the generation of practitioners ahead of you thought that maybe this was degradation of the profession, I’m assuming.But I think that there have been other people that thought that, well, this is how dentistry needs to be – theway that we do it.And opening that up to somebody who might do it differently or might look different.I think dentists and dental professionals really care about what we do and we want it to be ... we’re perfectionists,we know that, andI think there is a lot of concern that dentistry remain a very high quality, patient-centered profession.And so we do gate-keep.We make people take exams before we’ll even talk to them about admission, we make them do interviews, and we set up a lot of obstacles to make sure that we’re selecting people that deserve the privilege.However, making sure that we’re being open enough that we don’t just accept and promote the same types of clinicians that we always have, I think is a challenge.And I think dental education is doing a really good job of recognizing that.In California, our demographics, Caucasianwill not be the majority population really soon, and we need to have a workforce that represents the population that needs care.So if you take that concept and you just apply it liberally across diversity attributes, I think it makes sense to think that we can better serve human health if we are more open to the many different ways that people live their lives, or the beliefs that they have, and not see that so much as a threatening thing.

Richard Madow: I’m really glad you brought that up because I want to take this conversation out of the academic environment, even though that’s where you’re mostly involved, and bring it into the practice environment.But I also want to take it out of the West Coast where you are and the East Coast where I am, because, let’s face it, I guess it’s somewhat true that, the trends started on the East Coast and the West Coast were typically perceived as being more liberal, more diverse, more inclusive, although, I guess, there is still a lot of work to do.But I’m just thinking many of our listeners are in small towns in the Midwest to the Southwest to the Mountain States, and I’mjust wondering if any of them are thinking, well, this whole issue doesn’t even apply to me.Do you think that’ssomething that you’ve seen and needs to be addressed?

Gwen Essex: I do think it needs to be addressed and I think it’s a completely rational, logical thought that I don’t necessarily believe; it’s not necessarily true.I think that in a larger area like you’re talking about on either of the coasts or any of the big metropolitan… Chicago is not on the coast and it’s big.But I think in those areas, these principles matter all the time, but I think they’re even more important in communities that are smaller, and in communities where patients and people in the area do not have access to as many care providers, or maybe they do, but it’s quite a way’s travel.I think that people by and large want to get along and they want to be perceived positively, and for people who identify within themselves just being different, sometimes alot of energy is put towards being perceived as somebody that they may not be, and that’s probably happening in communities that are smaller to a degree, that maybe not everybody is aware.I almost think that these concepts of inclusivity and being welcoming to ideas differentthan your own have more impact implemented in smaller areas, particularly small dental practices.I’m thinking of people that I know who’ve graduated that I’m in touch with who have practiced in small communities, and just realizing that they are the only provider within 200 miles.That’s a very different reality and that means that they really want to be somebody that anyone in thecommunity feels comfortable and safe taking care of them.So I actually think it’s very relevant outside of the East and West Coast.

Richard Madow: And do you think that most practices are places where people of any type would feel comfortable?

Gwen Essex: I think that’s a really hard question to answer, and maybe I have the perspective as a hygienist having worked in different private practices.Each office is an entity unto its own and they are so different.And yet each dental clinician working in that practice doesn’t always have the awareness of how different their office is from the one across the hall, so I’d think it’d be hard to generalize.But I think that it’s possible that practices could be more welcoming and inclusive, even those that are, and I also think it’s possible that practices that are run by teams that really have those feelings might not be accurately communicating that, and there might be things that they could do to make that more obvious.And that’s what I think is really important, is that if there is an office that holds theses values and they are inadvertently doing somethingthat doesn’t communicate that, then that is an obstacle to care for somebody who probably would appreciate a more obvious welcoming environment.A good example of that, I think, would bethe forms you need to have a patient complete in order to address insurance or payment; you know, just your regular administrative process.I think a lot of those forms are what we call heteronormative; they are sort of assuming that everybody is heterosexual and has an opposite sex partner.I think they are also very cisgendered normative, meaning people who were born male or female and present as male or female.We don’t always have opportunities on a form for somebody who has maybe changed their name or the way that they want to present themselves in the world, to tell you that without having to scratch something out, or write it on the side.And there are ways that you can get the information you need, for example, to bill insurance, because you’re going to bill it by a legal name, and a legal name may not be the same name that the person wants to be called.And that’s actually true, I mean, I don’t go by my first name.

Richard Madow:I’ve been calling you Gwen all along and it’s not what I’m supposed to be calling you?

Gwen Essex: No, you should be, that is my name that I want to be called, but that isn’t my legal name.So it’s a perfect example; if even somebody who is cisgendered and identifies in that way, I don’t go by the name on my insurance card.So it’s just an example of making it easier for everybody, even though if they are a transgendered person, they might appreciate that the most.

Richard Madow: So do you think it’s just as simple as increasing the number of check-off boxes,so to speak, on our intake forms?

Gwen Essex:I think it’s simple in terms of allowing more options but doing it in a respectful, dignified way.There is actually research that’s been done about how to ask biological sex and gender preference and name preference questions, in ways that recognize the options that people may have.So, for example, I think, many years ago, I started to see male/female/transgendered as an option, which on the surface, that’s a great thing because you’re actually giving somebody an opportunity to tell you something that they didn’t have that opportunity before.But transgendered isn’t a gender; it’s a little bit of a clumsy way of trying to be welcoming.I think the latest research is a two-step process of how was your biological sex identified on your original birth certificate, and how doyou identify today.And that’s a way of letting people tell you if there’s been a change or just what their preference is.So I think that, yes...

Richard Madow:I can just hear the heads shaking, listening to this interview, thinking, “You’ve gotto be kidding; it’s not enough I’ve got male/female/transgender, now I’ve got to start asking long essay questions for somebody’s gender identity? You’ve got to be kidding me!”

Gwen EssexAnd you know what, that’s a totally legitimate response if it’s not an issue you’ve personally faced and haven’t understood the tension.And I think we’ve all done that, and I think we all could probablylookat an instancewhere something was really important to somebody and we couldn’t understand it, because we had not experienced it.Also that’s the beauty of individual practices, people can do what they want to do within the law and practice with whom they want to practice with.But I think that every office I’ve ever interacted with has always wanted to have happy patients that felt really cared for.And I think that they go along way to do that. I’ve been in offices where there are paraffin dips for your hands, or choose-your-own-music in the operatory, or allof these things to try to meet the patient on a personal level.And I think that respectfully allowing someone to tell you something about themselves is the ultimate way to personalize and respect patients;so I think if you look at it from that viewpoint, it is a little bit different...So the term “politically correct,” and if you could see me, I’d be making quote marks.