Ideological roadblocks to humanizing dentistry, an evaluative case study of a continuing education course on social determinants of health

Abstract

BackgroundFront line providers of care are frequently lacking in knowledge on and sensitivity to social and structural determinants of underprivileged patients’ health. Developing and evaluating approaches to raising health professional awareness and capacity to respond to social determinants is a crucial step in addressing this issue. McGill University, in partnership with Université de Montréal, Québec dental regulatory authorities, and the Québec anti-poverty coalition, co-developed a continuing education (CE) intervention that aims to transfer knowledge and improve the practices of oral health professionals with people living on welfare. Through the use of original educational tools integrating patient narratives and a short film, the onsite course aims to elicit affective learning and critical reflection on practices, as well as provide staff coaching.MethodsA qualitative case study was conducted, in Montreal Canada, among members of a dental team who participated in this innovative CE course over a period of four months. Data collection consisted in a series of semi-structured individual interviews conducted with 15 members of the dental team throughout the training, digitally recorded group discussions linked to the CE activities, clinic administrative documents and researcher-trainer field notes and journal. In line with adult transformative learning theory, interpretive analysis aimed to reveal learning processes, perceived outcomes and collective perspectives that constrain individual and organizational change.ResultsThe findings presented in this article consist in four interactive themes, reflective of clinic culture and context, that act as barriers to humanizing patient care: 1) belief in the “ineluctable” commoditization of dentistry; 2) “equal treatment”, a belief constraining concern for equity and the recognition of discriminatory practices; 3) a predominantly biomedical orientation to care; and 4) stereotypical categorization of publically insured patients into “deserving” vs. “non-deserving” poor. We discuss implications for oral health policy, orientations for dental education, as well as the role dental regulatory authorities should play in addressing discrimination and prejudice.ConclusionHumanizing care and developing oral health practitioners’ capacity to respond to social determinants of health, are challenged by significant ideological roadblocks. These require multi-level and multi-sectorial action if gains in social equity in oral health are to be made.

Providing oral care for adults with mental health disorders: Dental professionals’ perceptions and experiences in Perth, Western Australia

“…While participants acknowledged the broader social determinants impacting on the oral health of people with MHD and their often limited capacity to adhere to preventative regimens, they also recognized that each patient has different needs. Yet, their views highlight the challenges experienced in a system that appears unresponsive and insensitive to people's lived experience within different social and cultural contexts’ . Such findings suggest there is room for improvement in the current system in providing appropriate oral health care to people with MHD.…”

“…Yet, their views highlight the challenges experienced in a system that appears unresponsive and insensitive to people's lived experience within different social and cultural contexts'. 24 Such findings suggest there is room for improvement in the current system in providing appropriate oral health care to people with MHD. One approach might be to resist holding such patients solely responsible for failing to follow necessary treatment or preventative regimens or turn up for appointments, and instead consider ways the system can be more flexible and responsive to the lived reality of these patients.…”

How are the social determinants of health being taught in dental education?

“…Continuing professional education was the focus of 3 papers by Lévesque and colleagues 37,41,42 and serves as a valuable cue about the longitudinal and unbounded nature of learning about SDH. These papers described the development of the course materials and delivery of the 4‐month program aimed to educate practitioners about patients living in poverty and the SDH.…”

“…One of the challenges faced by those wishing to incorporate teaching on SDH in dental curricula is that social responsibility is positioned as the “poor relative” to clinical and technical learning 45 . The dental school environment is highly influential to student learning, with students understanding through the hidden curriculum what really matters to the school and the wider profession, providing students with insight into; “unwritten social and cultural values, rules, assumptions and expectations.” 56 Cultural competency and bias training are certainly important for dental students but should be provided to faculty members and qualified dental professionals as well 41,42,45 . Through the absence of SDH in curricula and assessments, enhanced by the relentless pursuit of clinical experience and numbers of procedures, students are sent a powerful message about what really matters.…”

Awareness on innovative techniques in dentistry among dental patients

“…The irst study which was compared was (Simonsen, 1991), and the second study was the (Senzon, 1999). The third study was the (Jedynakiewicz, 1992) and the last study compared with (Lévesque et al, 2015). In these citations, many of the people answered "Yes" for the similar 15 questions.…”