July 9, 2010
What’s in a name? The pride and dignity of all patients.

by Noel Kelsch, RDHAP, and Ma’rhya Kelsch, MSW, LSW

Dave (our husband and father) went to school with a boy named Paraclease Nicolococus, a name he has yet to forget after 34 years. Dave’s grandfather’s last name was Ferre. He was born on Valentine’s Day so, of course, his mother named him Valentine Ferre. Noel’s name is Joyous Noel because she was born on Christmas Day. She knows all the verses to “The First Noel” because it has been sung to her only a zillion times, and, yes, she hated her name as a child. Ma’rhya ... well, just look at the spelling ... gave up on expecting anyone to figure that one out a long time ago, although she always appreciates the effort when a new hygienist or front desk clerk attempts it.

Under the circumstances described above, it’s easier for some people to grasp a better understanding about the act of name-calling than others.

However, Noel recently discovered that she has been guilty of name-calling. Upon reviewing a client’s health history, she said, “I see you are a diabetic.” The client turned to Noel, looked her straight in the eye, and replied, “I am not a diabetic.” Noel countered by asking about the insulin listed in the history, and the patient said, “I am a person. I am not a diabetic. I am a human who is dealing with the effects of diabetes.” Noel’s patient was right.

Often, we confuse people with the disease they experience or the status of their life at a point in time. We often miss the human being that is involved and the stigma that we can create.

Noel started really listening for the “name-calling.” She was taken aback how often situations, conditions, and labels replace the personal feeling and pride of being called by name. At the grocery store, a clerk snickered when a male customer’s credit card was refused. When her boss came by she said, “The check bouncer just left.” At the post office, when a young man stepped out of the rain into the shelter of the post office, a postal worker said, “Oh, that smelly homeless kid is back.” In the dental workplace, an employee announced, “The meth addict is in Room Two. There is an abscess in Room One. I need to make an appointment for the homeless guy, but I cannot get ahold of him.” By labeling clients and putting their life conditions first, we lose the ability to see the possibilities in their lives.

A story to tell and a name to honor

Understanding the stories behind the circumstances of life can enlighten us all. The customer at the grocery has two very important names: Stuart and Dad. He lost his job last June and has been fighting hard to raise four children by himself since his wife walked out when life got hard. He has gone from a top executive job to managing a fast food establishment. He has more courage than just about anyone. He would simply do anything for his kids and is proving it every day.

Anthony is the young man at the post office. His life on the streets beats the home he came from. He is a brave soul that knows no other life. He has achieved his GED at night school and is working at a car wash when it is not raining. Everyone has a story to tell — everyone.

We are all equal in that we are people before we are anything else. Our culture fixates on differences, separation, and classification. By reframing our language to acknowledge that our clients are people first, we allow intimacy and empathy to enter in the conversation. The meth addict in Room Two seems much more approachable when labeled as Sally, the woman suffering from complications of methamphetamine addiction.

We all develop coping skills to make it through life. Some of the infamous negative coping skills are overeating, purging, alcohol abuse, and drug addiction. The negative coping skill that may get in the way of dental health-care professionals’ interactions with patients is compartmentalizing, separation, and denial. In our current economic state, we all have begun to use self-preservation skills — skills that people use in trauma, tragedy, and sometimes the health-care field. We witness friends losing their jobs and think, “That would never happen to me because people will always need their teeth cleaned.” Patients cannot pay their bills because their house went into foreclosure, and we think, “That would not happen to me because I manage my money well.”

The only thing separating “us” from “them” is what chair we happen to be sitting in. To an extent, we can only open up so much without burning out on emotions and empathy for our clients. However, it is important to balance our clients dignity during our interactions with them. We need to help our clients to carry their weight with dignity while in our offices, in our files, on our phone lines, and let them carry their weight out of our offices with dignity.

The most dignifying act would be to use their preferred names in and out of their presence; it changes the way that we think about them. In turn, it changes the way that they think about us, our offices, their treatment, and their recovery from whatever procedure was completed in our office. The latter, of course, affects prognosis.

State the person before we state the disease

People who enter your life have names and stories to tell. The diseases, conditions, or status at any point in time may confuse us and lead us to conclusions that are inaccurate. Take the time to find out who patients are, where they came from, and what brought them to the office. It can change our understanding and give us the opportunity to make a difference in their lives. Calling people by name gives them dignity and allows all of us to remember we are not dealing with a condition but with someone’s child, a member of our community. By simply calling someone by name, we remove the stigma and label and that allows us to see the human being.

Dave is not sure what happened to Paraclease; they lost touch after high school. His grandfather, who preferred the name Val, passed away many years ago. But the Valentine’s fairy still visits our home every Feb. 14th. Joyous Noel is now happy with her name and pleased no one forgets her name or birthday. Ma’rhya is elated that her new hygienist made a note in her chart explaining how to pronounce her name.

Noel Brandon Kelsch, RDHAP, is a syndicated columnist, writer, speaker, and cartoonist. She is a member of the Organization for Safety and Asepsis Procedures and has received many national awards. Kelsch owns her dental hygiene practice that focuses on access to care for all. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamine and drug use. She is immediate past president of the California Dental Hygienists’ Association, and is on the board of directors for the Simi Valley Free Clinic.

Mar’hya Kelsch, LSW, is a practicing clinical social worker in the state of Colorado. She has been working in the mental health field for 10 years, specializing in developmental disabilities and crisis intervention. She lectures nationally on developmental disabilities, crisis intervention, and addictions.

Gilbert P. (2001). The Origins of Stigmatization. In A. Crisp (ED), Every Family in the Land: Understanding prejudice and discrimination against people with mental illness. London: Robert Mond Memorial Trust.
Johnston J. 1999-12-28, www.suite101.com/article.cfm/libertarian/30709 People First Language – But Which People Come First?
Anspaugh DJ, Hamrick MH, Rosato FD. Wellness: concepts and applications, St. Louis, 1991, Mosby.
Thomas KB. (1987) General practice consultations: is there any point in being positive? Br Med J (Clin Res Ed). 294:1200-2.
Evans D. (2003) Placebo: The belief effect. HarperCollins ISBN 978-0007126125.
Waber RL, Shiv B, Carmon Z, Ariely D. (2008) Commercial features of placebo and therapeutic efficacy. JAMA.;299(9):1016-7.