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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
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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
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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 as a true line
in my personal life since I was a child. I think I have been called a loudmouth 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 whatever a 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 exited my own private interest, and became something
that I felt I could do more explicitly at 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.
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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 school as 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 percentage of us in. 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 – the way 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, and I
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
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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, Caucasian will 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’m just wondering if any of them are thinking, well,
this whole issue doesn’t even apply to me. Do you think that’s something
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 a lot 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 different than 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 the community
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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 something that 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 be the 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,
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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
do you 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 got to 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 Essex
And 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 probably look at an
instance where 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 a long
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 all of 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.
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Richard Madow:
You’re doing the old with-my-fingers quote marks on “politically
correct”?
Gwen Essex:
Yes, I got air quotes going on “politically correct.” And the reason I’m
saying that, because I think that is a term that when it came to be... it got a
lot of flak. And I think it’s used more now as: “I know I need to say this
but I don’t believe in it.” Do you know what I’m saying? Like, oh, I need
to be politically correct, so I’m going to say whatever it is I’m going to
say.
Richard Madow:
Or as some politicians saying, like, I’m tired of being politically correct;
I’m going to tell it like it is.
Gwen Essex:
Right, exactly, and you know what I think of with that is that if you’re a
member of a lot of minority groups, whatever they are, you raise the point
of Judaism being derided in dental schools decades ago. If you’ve ever
had those experiences, whatever it is, you, I think, have the ability to be a
little more sensitive to somebody’s feelings around whatever their issue
might be. And it’s really just a way to try to get to know somebody in a
way that is going to be in a dental setting, but it’s going to facilitate their
attaining optimal oral health, and you being a part of that with them. I
think patient care is improved when we can work with our patients
comfortably.
Richard Madow:
So why don’t you like the term “politically correct”? I want to get to that
before you go on.
Gwen Essex:
Yeah, let’s go back to it. I don’t like it because I think that it’s sort of a
holding your nose as you do what you know you need to do a little bit. It’s
saying “I have to do this because it’s politically correct” rather than “I’m
doing it because I believe in it.”
Richard Madow:
I gotcha, interesting.
Gwen Essex:
And so, instead, it’s sort of like when somebody says, “Gentlemen, this
way. Oh, I’m sorry, ladies and gentlemen. I need to be politically correct.”
I realize it’s an afterthought.
Richard Madow:
It couldn’t just be they were using a colloquialism, and didn’t really think
twice about it?
Gwen Essex:
It could be. Again, circumstance in context, and individual people; that
changes everything. But as a general statement, I think that if you don’t
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ask, for example, in demographics and we could even get off sexual
preference or gender orientation; we could get into any area where people
are individuals. If you’re collecting information, and you don’t allow
somebody to share that part of their information in your data collection,
you’re kind of sending a message inadvertently that they don’t matter. I
don’t need to know this because it doesn’t matter. Does that make more
sense? And so that politically correct idea of: I know I need to do this but I
don’t really agree with it, and it has, for the people who need that
inclusivity, that’s the message. It’s not “Yes, I am welcoming you.” It’s
the “okay,” it’s more of a begrudging kind of thing; it may be a better way
of describing my opinion of that.
Richard Madow:
I’m just thinking, when you think about diversity, inclusivity, all those
things, I think one thing we think about is male versus female; then we
think about gay/straight; then we think about gender identification; then
we also think about race; we also think about…
Gwen Essex:
Ethnicity.
Richard Madow:
Ethnicity, exactly; we think about maybe if English isn’t your first
language, that kind of puts you in another group as well. So given all
these...
Gwen Essex:
Disability and ability.
Richard Madow:
Yeah, good one.
Gwen Essex:
And also visible versus invisible disability. You know how many times
you have heard a comedian, or a talk show host, or whatever, go off on the
person that’s parked in the handicapped zone that didn’t look handicapped
enough to them.
Richard Madow:
Oh yeah, that’s a classic.
Gwen Essex:
Right? And yet, I want to offer... we have no idea what’s going on for that
person. There could be an invisible disability, there could be debilitating
pain, maybe they can only walk a certain distance a day before they can’t
walk anymore, and why should they spend that at the grocery store?
Richard Madow:
True, they could have had quadruple-bypass the week before.
Gwen Essex:
Absolutely, they could have all kinds of things. I think that in some ways,
the wheelchair symbol, I mean, it gets the point across, but it also
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somewhat limits again, diversity of ability. Not to say that we don’t have
things to gain and learn and benefit from everybody, regardless of what
their physical ability is, or if their ability is obvious or not.
Richard Madow:
So we just named a ton of different ways in which people are identified as,
whatever, different or maybe not always included, or all those kinds of
things. So let’s just get a general question here and that is, how can a
practice know that they are being maximally inclusive? I mean, there are
so many different groups and types of people that we need to think about,
and as you said, some are visible and some just don’t have that top of
mind awareness than maybe race or gender. I think sex is actually the
correct term and not gender; gender is like a grammatical term, but what
the heck.
Gwen Essex:
Gender is how you present; sex is what your body is. Gender is you are
female or male in how you appear.
Richard Madow:
Got it. So how can you really be inclusive with all these different things
going on, and some of them maybe even subconsciously you’re not doing
the right thing. You know what I mean? It’s such a complex and difficult
issue.
Gwen Essex:
I absolutely do. Well, you just handed me the perfect… so I wanted to, so
I think the concept of unconscious bias is incredibly important, because
we’re all humans, and what we do is we evaluate. I mean, that’s what the
human brain does. It looks for patterns and it evaluates quickly. And bias
is very often unconscious, and that, by definition, means you don’t know
about it. So one of the things that I think is really amazing to do is,
Harvard has online the unconscious bias program. They’re doing a whole
research project, and anybody can do it; you can just Google Harvard
Implicit Bias test. You’ll get an opportunity to participate in a number of
different research projects, and they use your keyboard. And what they do
is, they test your reaction time and they give you a bunch of shapes, a lot
of it is just so abstract, you don’t even actually get an opportunity to figure
out what you’re reacting to. And this is very reliable and valid, and it is
showing us what it thinks it’s testing; it’s been shown to be very valid.
And the concept, kind of, is: so you become a little more aware of what
your unconscious bias may be, and then you try to work with it. I think
this phrase that I like a lot is: when you know better, you can do better,
and it’s really all you can do.
Richard Madow:
How does the test of having you look at different shapes and keyboard
reactions uncover your unconscious bias?
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Gwen Essex:
They are just testing what is your reaction time, just what’s your
neurological cognitive reaction time on just shapes; when I show you this
shape, use your right key; when I show you this one, use your left key.
And then they begin to show you things that they can correlate to different
attributes, so they have race, gender, they have mental illness, which is a
fascinating one, and they have a whole bunch of them. It started with race
and ethnicity, and you could identify, were there ethnic groups that you
had more bias towards than others, that you weren’t consciously aware of.
And it’s kind of a shocking experience; I had my dental students do it last
year and some of them were really upset.
Richard Madow:
Is this something that you can do online for free?
Gwen Essex:
Yes.
Richard Madow:
How do you do it? I got to do this.
Gwen Essex:
You’ve got to Google “Harvard Implicit Bias” and it will take you to the
research page, and you can choose which ones you want to do. And I think
it’s a great thing for people to do, because it gives you the idea, like, jeez,
there is a whole part of my brain that makes decisions that I don’t even
have access to. And so, what that did for us, it allowed me to realize that I
want to be aware as much as I can be, so I’m going to do the best I know
how to do, which is: I’m going to try not to make assumptions about
people, I’m going to try to push past that and get to know them as
appropriate to whatever the context is. And it is an eye-opener, it really is.
I had a number of students that were just really blown away, and it’s an
interesting thing for people to do as a starting point. I think if I were in a
dental practice and I wanted to start to explore these things, I might invite
the team to do this, as sort of a team-building experience, to open up the
idea of how people feel about it. Because when you’re talking about how
to implement this, every successful office has a good team. I mean, no
dentist can do dentistry by themselves, and your team makes or breaks an
office a lot of the times. So if you’re going to try to approach these things,
I think it’s really important to do it internally first.
Richard Madow:
You got my mind spinning here. I’m not really trying to make fun of the
issue, but I’m just thinking, are we treating obese people differently, are
we treating ugly people differently, are we treating stupid people
differently? You know, it’s a real tough issue.
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Gwen Essex:
It is, and in fact, last year, one of the master’s students that I worked with
did a study of dental hygienists and how they treatment-plan or treat obese
patients, and there was a difference. And what is interesting is the dental
hygienists in this study scored better than the study she replicated on
nutritionists; nutritionists had more negative bias towards obese patients.
And so I think that this kind of research is very interesting, because if we
are allowing personal bias, for example, to go with the same example, to
impair our professional work with somebody who might benefit from
dietary counseling, for example. But you see a large person in your chair
and you think: I’m not going to talk to them about their diet, but yet, we
might have the ability to positively support their health.
Richard Madow:
Yeah, but I think maybe in the back of our mind, we think they know they
need to lose so much weight; I’m not going to be the next one to tell them.
It’s tough.
Gwen Essex:
Right, it is tough. It’s like telling somebody they need to do something
about the plaque in between their teeth every time you see them.
Richard Madow:
Right, and you know that they’re not going to floss.
Gwen Essex:
See what I did there?
Richard Madow:
That’s right, if we’re kind of being biased against anyone, it should be
people that don’t take care of their teeth.
Gwen Essex:
I think that, you know, for a minute I might even get behind that.
Richard Madow:
But those are the ones that need our help the most.
Gwen Essex:
Right, they need our help and maybe, why don’t they? Maybe they didn’t
have the access. I mean, that’s a perfect example, and I love the idea of the
joke, and then if you break it apart with this lens, you realize that even
there, the people who don’t take care of their teeth, there may be barriers
that have nothing to do with who they are, that set that up. And that’s one
of the things that I think this diversity issue is so important; is that access
to care is really what it all comes down to. It’s people having the ability to
get the health care that they need, free of embarrassment, or shame, or
whatever it is.
Richard Madow:
Okay, so let’s say now we’re team members, we’re listening to this, or
doctors too, and maybe a little light is starting to shine, and you think,
maybe I shouldn’t have acted this certain way when a patient came in, or
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maybe we shouldn’t have made fun of that guy who was kind of feminine
after he left. We shouldn’t have imitated that guy in the break room. I
mean, let’s face it, this stuff happens all the time, every single day.
Gwen Essex:
It does.
Richard Madow:
So now what do we do, how do we take a step back and learn from this,
and learn not just how to better ourselves, but to help our patients as well?
Gwen Essex:
Exactly, well, I think that another term that is sometimes helpful in
framing these things is the term micro-aggression, and imitating somebody
is more of a macro-aggression. But a micro-aggression is, I think the first
thing that happens, and it’s kind of very often these comments are not
meant to be offensive, but they are kind of clumsy comments. They are
comments that kind of make the case that there isn’t a full appreciation of
the differences that people can have in their lives. So it might be
something like “You did an excellent job; I haven’t seen a woman do
something like that so well before.”
Richard Madow:
Come on, people still say stuff like that?
Gwen Essex:
Of course they do, or “That was really articulate.”
Richard Madow:
I totally get where you’re going with that one.
Gwen Essex:
You see where I’m going? And the speaker probably does not intend an
insult, right? But the receiver, the person who has maybe been on the end
of a whole lot of different experiences where they didn’t feel like a
member of the overall group, even if they looked like one. Let’s go back
to the invisible disability or the things that are less obvious. Those things
are very readily perceived by people who have been on the receiving end
of discrimination of some kind. So what am I saying, that you don’t say
anything that should be hurting people’s feelings? No, I think that’s the
opposite of what will work. I think being open and trying to expand your
understanding of life experience beyond what you’ve only personally
experienced, and I think that’s a big one. I don’t think people do this as
much anymore, but, like, assumptions that all women are at home with
their children. I know that in the ’80s, all of those articles about women in
the workforce and the mommy track and all of that stuff. A lot of that, I
think, was trying to address the fact that people can feel bad when you say
“So your wife takes care of the house?” or “You’re home with your
children?” And people don’t assume that anymore, right? I mean, I’m
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assuming when you see a woman in your practice, you don’t assume that
she doesn’t have a job.
Richard Madow:
Correct.
Gwen Essex:
But there was a time when that was the assumption.
Richard Madow:
Absolutely.
Gwen Essex:
And so think about how that was changing, the kinds of things that were
said to both men and women that might not have recognized that their
family experience was different; so maybe that’s a more relatable
example. But I think that you touched on it with English as a second
language, or countries of origin. Of our traditional students, for example,
at UCSF, I think we have something like 23 countries of origin, and these
are our traditional students, not our international students; so we have a
very international community in dentistry that’s really building. And I’m
excited. I think that we’ve not really seen the full effect of a much more
diverse profession. You know, as you pointed out, you are a white, straight
male, and most of your class looked like you to some extent. And now that
that’s really changing, we have a much greater presentation of race and
ethnicity; we have a majority of women in our incoming class, and I think
of all the classes that are in school right now. And so that’s going to be
happening in private practice; it takes a while, but the workforce is
changing.
Richard Madow:
It’s as if I’m kind of thinking, these micro-aggressions, I’ve heard this so
many times, even in a semi-academic setting: “It’s great that women are a
majority in dental schools now, because they are much more likely to
work part-time, or retire after five years to stay home with their kids.” I
mean...
Gwen Essex:
Can I tell you, that actual phrase has been uttered to female dental students
who have come to me really upset about it.
Richard Madow:
You hear it all the time, and another thing I hear all the time is somebody,
like, “Oh, I haven’t been to the dental school in 25 years. I went to visit.
That place looked like the United Nations.”
Gwen Essex:
Yeah, and you know what’s interesting? I think what’s meant by that is
maybe not such a... and it looks like the United Nations!
Richard Madow:
And I think it’s kind of said in a slightly negative way.
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Gwen Essex:
Exactly, and I’m saying that too, because I know that there have been
alumni that haven’t necessarily understood. Again, I invite people rather
than feeling left out or cut out, or get the idea that they are no longer
important to the profession, that’s not the case at all, every new dentist
needs mentoring; and dentistry needs everybody along the career path, we
really do. But just because the face of the profession might be looking
different, that’s going to strengthen things; that’s not going to weaken
things. I think in any system, science, if you look at what diversity does, it
strengthens the system, because you have more perspectives, and you have
different places from which to act, and you bring different things to the
table. I am very excited to see that happening in dentistry, and I’m excited
to see it diffuse into private practice and become more of what people
experience. But it is a change, and again, those who are feeling badly
about it, that’s a legitimate feeling, but I think that making a difference
does not necessarily mean it’s a repudiation of the past. Does that make
sense?
Richard Madow:
If you can define repudiation...
Gwen Essex:
I just think it’s very important that if anybody feels that this profession
doesn’t look like them anymore, not to take that to mean that there is not a
place for them; because there is a place for everybody and we all have
some things to contribute. So I do think it’s changing, and I hope that
those who have been in practice will gain more comfort and see how it’s
going to change things for the better, I think.
Richard Madow:
Okay, this has been an incredible, I think, conversation, but as our
listeners may have guessed, we’ve really gone off script. I mean, we’re
just kind of winging it here. But I want to continue to go off script, and
maybe shift to maybe something a little bit more practical versus
educational, and let’s say dentists and team members are listening to this.
Now, a female dentist listening, it doesn’t matter, because they are going
to retire and have babies the next year, so we’re not talking about them.
Gwen Essex:
I know what you... yeah, we know neither one think that.
Richard Madow:
So let’s say dentist and team are listening. You know what, of course I’m
not the kind of person that doesn’t want to have diversity, inclusive, and
maybe not everybody is, whatever. So what do we do now? Let’s have a
team meeting and figure out how we can make sure that our practice is one
that’s truly inclusive. What do we discuss at this team meeting? What can
we do?
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Gwen Essex:
Well, I think that that unconscious bias is a great place to start and what
are the surprises that come up. And first of all, having a safe environment
is really important. These are personal issues, so I think I need to preface it
with that. I think that for this to be successful in a team, the team has to
have good communication and feel safe communicating. That’s a given. If
that exists, then I think that talking about what are the different life
experiences, because you very often assume you know the people that you
work with, and you may not. And not that everybody has to get personal
and touchy-feely, but recognizing what are values that you may not know
that are held in the people that you work with. And how can you ensure
that you’re not impinging on those in any way, and the same thing in the
other direction, and I think just opening those conversations. I know,
myself, I did not have the upbringing that everybody might think that I do
to look at me. And socioeconomic diversity, I think, is also important, and
when I’ve had the opportunity to share with people what it was like for me
growing up, I feel I’m seen more authentically, and then I like and enjoy
knowing a little bit more of the authentic things about the people that I
work with that can help me appreciate what they are bringing, and what
their special gifts are to whatever it is that we’re doing together. So I
would really recommend having an opportunity for people to talk about
those things and to try to take turns looking at the practice and your
procedures, administrative, and the ways you interact with your patients,
to see if there are ways that things could be more open. I think a perfect
example is if you have more than one restroom in your practice, don’t put
a silhouette of anybody on either one of them.
Richard Madow:
So you’re saying that all bathrooms should just be for anyone, a total freefor-all?
Gwen Essex:
I would appreciate it, when the women’s bathroom is busy and the other
one, with the man on it, I’d really like to be able to use it.
Richard Madow:
We all know women spend much more time in there so it’s really not fair
to the guys.
Gwen Essex:
Yeah, I know. See, here we go again. But I think that that’s a perfect
example of having gender-neutral bathrooms that anybody can take their
kid of either gender, or you don’t have to decide which room to go into in
an office so small. You know, I have been in practices where you can have
one bathroom; that’s what they are doing anyway.
Richard Madow:
True.
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Gwen Essex:
And it’s what everybody does in their house.
Richard Madow:
For the most part.
Gwen Essex:
For the most part, yeah, you know, I just think that’s a perfect example
that maybe in a team discussion is something that might come up, or a
discussion of maybe there is a habit of somebody in your team, “so tell me
about your children,” and that’s how they discuss things with people.
Maybe there would be something that’s maybe a little less assumptive that
people have children; you know what I’m saying? And it doesn’t have to
be super-targeted, it just may be, for example, even more open, you know,
“What do you like to do in your summers?” or whatever (I’m making this
up as I go along). But something that doesn’t make assumptions about
family structure or lifestyle. I think a perfect example is very few dental
offices sit their patients down and talk about religion and politics.
Richard Madow:
It’s funny, I have written in so many articles, blogs, lectures, that those are
two topics you always stay away from, no matter what, even if the patient
is trying to bait you and saying, “Oh, did you see those crazy
Republicans?” or “I can’t stand the Democratic president,” or whatever it
is. You’ve just got to stay away from it.
Gwen Essex:
And why is that? Because you don’t want to offend anybody, right?
Richard Madow:
Yeah, and they are highly polarizing topics.
Gwen Essex:
They are. And I’m not saying that everything is that polarizing, but is the
same practice, in the same thought, finding ways to make sure that you’re
not directing a conversation or topic that you put somebody on the out that
you wouldn’t necessarily know. Actually, you and I had a conversation
where you shared something about that, and somebody made the
assumption looking at you, that you shared their values and you really
didn’t. Because that can go in both directions, and just that feeling…
Richard Madow:
That’s so true. I don’t know how much I should reveal about my personal
self in this interview.
Gwen Essex:
And you don’t have to, but I’m just saying that idea, that what does it feel
like when somebody does that and you go, “Wow, you’re really, you’re
not getting me.” And isn’t that interesting? And that’s okay; not
everybody has to get everybody. But imagine if you’re the patient then.
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Richard Madow:
Not everybody has to get everybody, but I think it’s dangerous to look at
someone and assume they’re of a member of a certain political party, or a
member of a certain religion, and I think we do that all the time. And I
think there are parts...even where I live in Baltimore, extremely diverse,
there are certain parts of Baltimore where very conservative people live;
there are certain parts where very liberal people live. And I think people
always make assumptions based on that, and they bring you into that
conversation, or if you belong to a country club or go to a school or
whatever it is, so many assumptions are made.
Gwen Essex:
Absolutely, and I think that a perfect example of how dangerous that it is
Ted Bundy.
Richard Madow:
Ted Bundy, you don’t hear much about him anymore.
Gwen Essex:
But if you look at him and you know nothing else, he doesn’t look like a
psychopath, you know, and so you can make the assumption positive or
negative. And I think that that’s important to think of too. We talk about
unconscious negative bias and things, but there is also unconscious
positive bias that may not necessarily be appropriate. To me, it’s
fascinating to think about all the ways that human beings interact and how
we can support or hold each other back just by choices that we make, and I
think that that’s kind of what fascinates me about this and about these
topics. And just seeing how letting people be who they are, people can
achieve more and therefore our society moves along, and I know that that
sounds really rose-colored glasses, and very idealistic, and I own up to
both of those.
Richard Madow:
It does. I feel like I’m at a Tony Robbins seminar.
Gwen Essex:
Yeah, well, no, I’m not going to pass out any books or...
Richard Madow:
Or pound on your chest. We’re almost running out of time, so
sometime towards the end of this interview, I try to imagine that instead of
an interview, this is like a seminar, and now its Q & A time. So let me
throw just a couple of questions at you. This one I saw recently on one of
the great dental Facebook forums; you know, there are tons of dental
forums. There’s Dentaltown, of course, and a lot of people have forums on
Facebook, and you see some of the craziest questions on there. But I saw
this one recently, and I thought it was really interesting. They said that
they have a team member, I’m assuming this team member was a person
of color or, as one might say, African-American or black, whatever term
you want to use. And they said that she was a great team member,
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everything was great, but one day, like, a weekend passed, and the next
morning she came in wearing dreadlocks. And didn’t do her job any
differently but some people were just horrified by that, and they didn’t
know what to do, and can they legally tell this person, hey, you can’t wear
dreadlocks. How do you answer a question like that?
Gwen Essex:
Wow, that’s a great question.
Richard Madow:
You know, I’ve seen plenty of Caucasians wear dreadlocks, so I take that
part of it back. But I think it’s typically considered to be an Islander
hairdo, so…
Gwen Essex:
Right, and I think that that’s an interesting example, but if you don’t have
an understanding of different kinds of hair, you might think that it’s just a
fashion choice, you know, and just don’t wear a top hat to work; it looks
strange, you know.
Richard Madow:
Or don’t cut your hair into a Mohawk. I don’t think too many people are
going to do that, right?
Gwen Essex:
Yeah, well, actually, hmm. I mean, that might be a more troubling
hairstyle for a dental office perhaps. But I think that I can relate to the idea
that not all hair is the same; some hair is more unruly than others, and then
braiding hair or doing things like that can actually make hair easier to
manage, depending on what kind of hair you have. So I think that that’s a
very white centric view on what hair needs to look like to be appropriate.
So I would invite you to say that what is the danger there. I mean, if you
say the job is being done the same way and it’s not unsafe. Certainly there
are hairstyles that aren’t safe in dentistry.
Richard Madow:
Yeah, that’s for sure.
Gwen Essex:
You know, catch your hair on a piece of lab equipment and there is going
to be a problem. So I think that that is kind of more of an issue to... I
would ask the people who are uncomfortable to try and understand why
they’re uncomfortable, because it doesn’t sound like it’s impacting safety
or quality. So then it’s probably just a preference, and then preferences are
so individual that maybe it isn’t actually appropriate to impose that
preference on somebody else.
Richard Madow:
Then you could go the direction of, well, I’ve got this dental assistant who
is kind of young and hip and crazy; she came in on Tuesday and she had
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blue hair. What am I supposed to do here, how can she be treating patients
with blue hair?
Gwen Essex:
Now, that I think is really interesting too. I have never been one that
appearance has really thrown me off, but I realize that I’m different in that
way. I think it would be an interesting thing; it would depend a lot on the
practice and a lot on the demographics of your patients, and the town that
you’re living in. I mean, if it was really off-putting to people, which it can
be, that would maybe be something that would have to be addressed and
talked about. I can say, in the area I live, blue hair is everywhere, so it’s
really not going to get anybody’s attention. But I know that isn’t true
throughout the country. I would maybe talk about what that was about,
and how long they were intending to do that, and have they thought about
if it was going to help them make connections with the patients or not.
And if it became a problem, obviously then it gets addressed, I suppose.
Richard Madow:
And, of course, if we’re going down this road, we can talk about visible
tattoos.
Gwen Essex:
Well, that’s going to become really hard to avoid here pretty quick.
Richard Madow:
Yeah, for sure.
Gwen Essex:
I was surprised. There seems to be more tattoo parlors now than
Starbucks, which, that’s saying something. I don’t know, I think that that’s
another interesting question. I think that working at a medical center, there
was a time where you didn’t see tattoos, and now you do. You still don’t
see them at Starbucks, funny enough; they have to cover them up. But I
think that they’re becoming more ubiquitous, and I also think it has a lot to
do with the content. I mean, obviously there are some offensive tattoos,
and there are others that are not. I think the mores of your community are
really where you have to look, because if what you’re looking at is trying
to provide health care in a comfortable way, there is some obligation to
not be offensive to your patients. So I kind of went around and around
about that. I mean, I’ve had some odd hair, but I toned it down in patient
care, and I recommend that to my patients.
Richard Madow:
So it sounds like you think it’s okay for an office to have a policy of no
visible tattoos, no blue hair, you know…
Gwen Essex:
I hesitate to say I think it’s okay. I think it would be unfortunate, but I
think there might be places where that might be necessary. I know that
sounds like I’m not answering it; I would always want to advocate for
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people to be able to express themselves in appropriate ways authentically.
But if it’s really a boundary, if it’s a problem for the person, I mean, it can
impede them doing their job right, and if they are off-putting to patients
in a way that is really becoming a problem, then that impairs their ability
to do their job. Now, if it’s a simple thing, if the patient population isn’t
accustomed to somebody of a particular culture or whatever, and they just
need to maybe become familiar with it, I think that’s one thing. And, you
know, so the comment about braids feels a little bit different to me. And I
also want to say I’m not an expert that knows everything about this,
because I think it’s changing all the time. I think the best thing anybody
can do on this topic is always try to do the best they know to do at that
given time, and when they learn more or know better, do better and be
willing to apologize, and do the best you can. So I’m saying, would I
outlaw blue hair? Geez, me personally? No. But do I see that there could
be a need for that? Yeah, I guess I do, and I have to say I’m a little
disappointed in myself with that answer.
Richard Madow:
It’s funny, I remember when I was a young dentist, I just got my practice,
and I had a dental assistant who was a little edgy and, you know, she was
kind of a young, sexy woman and she usually dressed maybe right up to
the line, but never over. And once she just came in wearing, like, a leotard,
and it was just way over the edge for a dental practice.
Gwen Essex:
Yeah, club wear.
Richard Madow:
And I told her you can’t wear this in the dental office, and she went out to
her car. She knew it was the wrong thing to do, because she just happened
to have her regular clothes in her car, that she went out and brought in the
office and changed into. I think sometimes team members like to push the
boundary too, to see what happens.
Gwen Essex:
Oh, I think so too, and I think it’s absolutely appropriate to maintain, I
mean a leotard doesn’t sound safe so... that’s the other thing that’s kind of
nice about dentistry; there are so many infection control requirements, you
can sometimes just pass it right on to OSHA.
Richard Madow:
That’s good because I cannot stand those hipster beards, and I think they
are not safe for dental practice too.
Gwen Essex:
If your mask doesn’t fully cover it, they are not safe for dental practice,
that’s the bad news I got to deliver to all those students two weeks ago.
Richard Madow:
And I just revealed my macro-aggression against hipster beards.
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Gwen Essex:
Yeah, I know. I wasn’t going to, like, point it out or anything. I was going
to let you work that out in your own time.
Richard Madow:
I don’t know. I’m looking at Chris through the glass. I don’t know if that’s
considered a hipster beard; he’s just like a half an inch below hipster.
Gwen Essex:
Oh, okay, then it sounds like he would be covered by a mask, so it’s
probably okay.
Richard Madow:
He doesn’t wear a mask; he’s an audio expert and engineer, so he doesn’t
have to wear a mask.
Gwen Essex:
All right, well, see, there is another workplace freedom that we don’t have.
Absolutely.
Richard Madow:
Well, hey, Gwen, not your real name.
Gwen Essex:
It’s actually my real name, just not the first one I was given.
Richard Madow:
I got to say this has been, first of all, a lot of fun, because you are... you
handle a really serious, important subject very well, but you also have a
sense of humor about and understand that some people can be a little
uncomfortable and you’ve got to tackle it gently, so to speak, so I really
appreciate that.
Gwen Essex:
Well, that you and I think that that’s really critical for everybody to think
about, you start where you are, you know, and it’s not a contest; you start
where you are.
Richard Madow:
That’s good. I was going to ask you for some great closing words and
maybe that’s it: that wherever you are on this issue, you can always
improve. Even if it’s just little by little, and become a little bit more
inclusive, even if it’s just little by little and you’ll be helping someone
along the way.
Gwen Essex:
Absolutely, and the thing that I think people might find is, you know you
find some amazing things, and you just learn some great stuff that you’d
never learn or experience. And if you’re into food, and you start
experiencing, getting to know different people, and eating different kinds
of food, man, is there a reward there. So I think that, as we’re saying, start
where you are and make sure that you enjoy the benefits of increasing
your worldview.
23
Richard Madow:
Sounds like fantastic advice. Gwen, this is something we didn’t discuss
ahead of time, and I hope you’re open to this. If anybody wants to get in
touch with you just for a quick question or whatever, what’s the best way
to contact you?
Gwen Essex:
Absolutely. gwen.essex@ucsf.edu
Richard Madow:
Why didn’t you say University of California, San Francisco?
Gwen Essex:
I don’t know, we are just so UCSF oriented. I don’t know, it’s probably
easier to have said that. But gwen.essex@ucsf.edu and I’d be happy to
address any comments anybody has, or questions.
Richard Madow:
That is just fantastic. I’ve got to say, this has been, for me at least, really
fascinating, and interesting, and helpful. Oh, there’s a dog barking there.
Gwen Essex:
And I was going to say, there we go; there are the dogs.
Richard Madow:
You warned us that could happen, so it’s good towards the end. I hope that
everybody really enjoyed this, and everybody learned from it a little bit, or
maybe learned from it a lot, and it gets you to think twice about some
things.
Gwen Essex:
I hope so too, and I really appreciate the opportunity. You’re a lot of fun
to talk to.
Richard Madow:
Oh, it is my pleasure, totally my pleasure. So I will say for Dr. Gwen
Essex, this is Dr. Richard Madow on the Madow Brothers audio Series.
This has been totally different than any other of the hundreds of interviews
we’ve done over the years, so I really thank you for that. And we will see
you next time.
Gwen Essex:
Sounds good, thanks so much.
Richard Madow:
Thank you.
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