Working with patients who are from a different socioeconomic status can be one of the most challenging and rewarding aspects of providing dental hygiene care. Inevitably, shifting to a public health setting will mean that dental providers and their patients will belong to different socioeconomic groups.
Cultural competence involves treating patients who are different from the provider, who may not necessarily live within the same zip code, speak the same language, or possess the same degree of oral health literacy. “More than 49 million US residents live in areas designated by the Health Resources and Services Administration as Dental Health Professional Shortage Areas. This shortage has been compounded by the COVID-19 pandemic, which has resulted in limited preventive dental services in the interest of public health safety.”1
As all oral health-care settings attempt to bounce back from the impact of the COVID-19 pandemic, there will be a call for an increase in providers in health professional shortage areas. What follows is a series of tips for providing care outside of a traditional, insurance-based, private practice setting.
1. Explore differences, do not take them personally
If I could go back several years ago in time and tell myself what to avoid when starting a journey in public health, it would be not to evaluate my patients, my coworkers, and the setting where I worked as if I were still working in private practice. You cannot realistically expect to have the same dynamic with clients that you did when you worked in your own backyard. Seek to work through misunderstandings, be direct with both your coworkers and your patients, and take time to think about how everyone goes through things that you may not know about. Just because the people around you may have a lower affect or conversational enthusiasm does not mean that they are not as dedicated, hard-working, or worth your time. A career in public health presents an opportunity to grow in cultural competence. Commit to understanding and respecting the racial, ethnic, socioeconomic, and cultural backgrounds of those you treat.
2. Focus on small victories
In a public health setting, patients will generally have a lower dental IQ and less familiarity with the routine of seeing an oral health-care provider at set intervals. Rather than expect your patients to match your recommendations to brush twice a day and floss nightly (although this will sometimes happen), start with small, achievable goals that they can understand and comply with. Practice placing yourself in a specific person’s shoes and tailor your recommendations to meet their reality. Many patients who have lacked access to care have never prioritized buying a toothbrush. Learn to commend the things that are taken for granted.
3. Take time to care for yourself
“There is a paradigm-shift in the workplace from a production mentality to a service-oriented mentality. As a result, there is a greater need on employees to expend emotional labor in dealing with the challenges of meeting the demands of a service-oriented economy.”2 Nowhere is this truer than when dental clinicians transition from a private practice setting to a role in public health. Small things may stress you out throughout the day in private practice, and those small stressors add up over time. However, the potential for patients to share traumatic stories or events with you—a trusted health-care provider—and for vicarious trauma to be passed on, is generally higher in a community clinic. Outside of working hours, take time to expel some of this stress. Schedule walks in nature, exercise, eat nutritious food, and talk to loved ones who have careers outside of dentistry. Making your well-being a priority during your time off will ensure career longevity.
Conclusion
Cultural competence, in all forms, is a lifelong process that clinicians must remain open to if they are to treat everyone successfully while implementing the principle of nonmalfeasance. The practice of treating patients in a community-based or public health setting requires a commitment to increased cultural competence on behalf of oral health-care providers.
References
1. Brian Z, Weintraub JA. Oral health and COVID-19: Increasing the need for prevention and access. Prev Chronic Dis. 2020;17:200266.
2. Aung N, Tewogbola P. The impact of emotional labor on the health in the workplace: a narrative review of literature from 2013-2018. AIMS Pub Health. 2019;6(3):268–275. https://doi.org/10.3934/publichealth.2019.3.268
