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Orthodontists Are People Too

People are people, so why should it be,  you and I should get along so awfully.
 - Depeche Mode, 1984

Our maker made a grievous error when he/she/they made us in his/her/their image.   Human nature, being what it is, yearns for peace and harmony amongst its peoples, as long as certain terms and conditions are met.  We are in the latter half of 2021 and it took the murder of George Floyd and the continuing presence of the Black Lives Matter movement for the world to wake up to the injustices inherent in its citizenry.  Slavery.  The Holocaust.  Residential Schools.  History is fraught with repeated examples of violent and disturbing discrimination, of which the aforementioned occurred too recently for excuse.   

If our maker did one thing right, he/she/they made teeth the same in everyone.   As far as I know, it’s impossible to look at a set of models or a set of intraoral photographs and to know with absolute certainty which teeth came from what colour, background or creed.   In today’s divided world, one would think that’s got to be good thing, especially for the profession of orthodontics, right?

Wrong.  Cecil Steiner, in his landmark article Cephalometrics for you and me (AJO, 1953) clearly based his analyses on Caucasian features.  He developed skeletal and dental norms that defined treatment objectives.  Dr. Steiner cannot be faulted for his actions.   He lived in California at the time and no doubt, he was surrounded by and treated a homogenous population.   Numerous articles have been written since that speak to the need for and the value of cephalometric standards for populations other than Caucasians.   We all know now how important it is that we interpret our ceph numbers accordingly.

But something still bothers me.  As an orthodontic resident in the late 90’s, I clearly recall interpreting the numbers as ‘within normal limits’ or not, meaning that if a patient’s numbers were within accepted range of the Caucasian standard, the patient was normal.  If the patient’s numbers fell outside the range, the patient needed correction, regardless of his or her cultural or ethnic background. How insensitive is that?  Although I have learned a lot since then and can appreciate the need to tailor’s one’s treatment plans to cultural norms, it’s difficult to shake the unconscious bias within.   

Which got me thinking.  Do I possess other forms of bias when it comes to my delivery of orthodontic care?   My first reaction would for me to stand up and categorically declare “No. I treat every case to the best of my ability, with the patient’s best interest at heart, regardless of the patient’s background”.  But when I look at myself critically, objectively and honestly, I admit there are differences in the way I interact with some patients and their parents (if applicable).

I don’t think this admission makes me a bigot or a racist.  I recall having a discussion on racism with my children where I admitted that sure I was prejudiced: Prejudiced against idiots regardless of what they looked like or from whence they came (actually, I used a term other than idiots that isn’t fit for print, but suffice it to say, I made my point).   No, I think this admission highlights a difference in comfort level between cultures that I possess and represents something for me to work on to overcome.

Please permit me to provide an example of what I speak. I used to practice in Midtown Toronto treating a fairly consistent crowd.  Every patient entered with a concerned parent in tow, who expected a full report on how great their kid was doing at every appointment.   I did my part and played the game.   And yes, by and large, every patient was white.  

Today, my practice is in the University and my clientele is significantly more diverse.   I recently started a functional appliance on one of my few Caucasian patients from Midtown Toronto (in fact, I think he is the only one).  Needless to say, he wasn’t overly keen on the appliance.  So, after every appointment, I followed him out to reception to provide his mother with a progress report. I did this automatically because of who this patient was and because I was comfortable speaking to his mother, who’s background was just like mine.  I admit that this isn’t the first time this has happened and I admit that I don’t provide this service to families of which I don’t have the same level of comfort.   

I don’t think I am providing better care to this one patient, but my own unconscious bias has me programmed to assume that this particular parent type expects a report at every appointment while others do not.  To be fair, this patient’s mom never asked me for one: I did this all on my own.  I am first to admit my behavior has to change.  I am grateful to those who have spoken so loudly of late, for making me look inward and for seeing something in me that up until now, I was oblivious.    

Admission of a problem is the first step to resolution and I realize the error of my ways. Long-standing patterns and habits die hard, but I’m going to work to be better.   I owe that much to those who entrust to me their care, and to the care of their children. 

This is painfully real, life-long learning.  

Jimmy P