DISCLOSURE: Please understand that this article is not intended to foster an “us (women) versus them (men)” mentality. The experience outlined below, which is my own, does not diminish the experiences of others. The challenges faced in this encounter do not, in any way, negate the difficulties experienced by male providers or any providers. Writing this article has been challenging as I grapple with the notion that whatever has made it inclusive to women could equally have made it exclusive of men. I continue to wrestle with this idea, uncertain of how to navigate it.
We live our lives colored by our past, our stories, and our experiences. I don’t seek pity for my own challenging experiences any more than I would lament yours. Fair or unfair, a challenge is nothing more than an opportunity to grow. It’s a chance to wake up tomorrow as a better person than the one we were today. The purpose of this discourse is solely to provide any doctor whose words were muted an opportunity to find confidence in moving past a patient’s ignorant gaze. Additionally, it aims to uncover the humanity behind why patients may act a certain way, particularly toward the ‘gentler’ sex.
Rising Above “The Gaze”
Challenges Faced by the Female Provider & How to Overcome Them
As healthcare providers, there are moments when entering our operatory fills us with dread. One of the most challenging situations is having to prepare a patient for a visit with an oral surgeon because you’ve discovered a suspicious lesion and then ensuring the patient understands the urgency of the referral. We also face difficulties when patients express dissatisfaction after receiving a smile makeover that falls short of their expectations or when a seemingly minor restoration leads to painful and irreversible pulpitis. Additionally, everyone dreads having to attend to financial arrangements gone awry.
A 60-year-old retired male patient, whom I will refer to as “Tim” (not his real name), arrived at our office. Tim had faithfully visited both his general dentist and periodontist for the last 15 years. Unfortunately, both had recently retired. The most recent radiographs provided to us were almost exactly six months old and consisted of non-diagnostic analog bitewings. Our hygienist gathered Tim’s history and revealed that he did not have any outstanding treatment plans. Tim had been informed that his periodontal disease was under control, and as long as he continued his alternating visits between the two dentists every three months, he shouldn’t face any issues.
Tim was an excellent communicator, engaged, likable, and even seemed enthusiastic about forming a new dentist-patient relationship to replace the one he lost. We conducted a thorough periodontal examination and took a full series of radiographs. To our dismay, the radiographic exam revealed two abscesses: one from a failing root canal treatment, the other due to a fractured root. Additionally, two more teeth were deemed “hopeless”: one due to external resorption, the other with only 30 percent of the bone remaining. There was also a failing implant that had been placed “not that long ago,” according to Tim. Periodontal probing depths, though stable in most areas of his mouth, in the aforementioned regions had depths exceeding 9mm.
As I examined Tim’s X-rays, a sense of bewilderment washed over me. I knew my diagnosis and proposed treatment plan would not align with the information Tim had received six months ago when he was given a clean bill of health. This particular circumstance, the impending interaction I was about to enter, was something I had dreaded throughout my career. Past experience taught me that in the next 30 minutes, I would need to exercise and “flex” every part of my almost 20 years of experience and education, including the extensive 150 hours of continuing education I completed that year alone. These previous encounters had also taught me that I needed to mentally toughen up and prepare for the possibility that Tim would not believe me after I told him what I found. I had to ready myself for the likely outcome of my professional opinion being dismissed and discarded. I had to prepare myself to deliver what would ultimately be empty words to my new patient.
When I meet a new patient, my approach always begins with a conversation unrelated to dentistry. It’s a chance for me to connect and establish a rapport, not solely for the sake of treatment plan acceptance, but because this aspect of the relationship is what I genuinely cherish. I get to engage in an authentic conversation with another human being, allowing them to reveal who they are and what they value. After our informal exchange, I reconfirm their medical and dental history, as well as their primary concern, before gently reclining the patient for a comprehensive clinical exam. Finally, armed with the data gathered from the radiographic and hygiene exam, I ask the patient for permission to discuss my findings.
During an appointment like Tim’s, it was usually during the presentation of my findings that dread would set in. This is where the appointment would become heavy, and, in the case of Tim’s appointment, it did. Seated before Tim, I lowered my chair to position myself below his eye level, and I asked him to confirm whether he had been informed of any outstanding issues in the past. Then I positioned myself between the computer screen and Tim, ensuring that we could still make eye contact. From here, I started to teach Tim how to interpret X-rays, how to distinguish between bone and tooth structures, what the root apexes needed to look like, and how the whole picture came together with the periodontal probings. I also showed Tim intra-oral photographs of his mouth to fortify my findings. I took my time to meticulously cover each tooth individually, constantly reconnecting through eye contact.
Tim’s reaction to my findings can not only be characterized as surprised but more noticeably, angry. He would puff out his chest after every sentence I said. He clenched his jaw and folded his hands firmly against his belly, revealing to me his inclination to be more upset with me, “the messenger,” than to confront the fear of what all of this meant. Tim seemed more comfortable avoiding the fear of potential health consequences, losing his teeth, and the fear of the financial burden this would most certainly cause.
However, for female providers, there is an added layer of apprehension: the fear of being unheard, dismissed, and having our expertise and professional opinion disregarded the moment we walk into the room.
At that moment, I stood up and positioned all 5’2” and 115 lbs of myself against the operatory wall. I was met with an all-too-familiar gaze that sneered and growled, “What do you know, little girl?” Tim adjusted his 6’2”, 200-lb frame, his gaze attempting to establish superiority over me. I’m no stranger to this gaze. I had encountered it for years, not just from patients but also from colleagues, mentors, and even vendors at professional meetings. This gaze would erode my self-confidence and silence my voice. It suppressed my hard-earned right to be heard, burdening me and making me question often who I was and why I had even bothered to work so tirelessly. Tim wanted to let me know he wasn’t just bigger than me; he was better than me, and in no way, shape, or form was he going to accept the opinion of some girl dentist. That’s what his gaze meant.
Thanks to years of experience and valuable guidance from personal and professional development coaches like Lani Grass and Productive Dentist Academy, I have learned to neutralize that gaze. I have dedicated months to discovering, understanding, and fostering my gifts so I could effortlessly demonstrate them in moments like these. I use my empathy as an asset and an anchor, and I have learned to establish firm boundaries. Most importantly, I have come to learn that a single interaction has no power to diminish my capabilities or my worth.
When I met Tim’s gaze, I understood that he was not superior, and I was not, by any means, in the wrong. Despite his stunned, and perhaps even terrified expression, I knew that I had a responsibility to support him. Instead of abruptly leaving the operatory to avoid further contact and leave Tim in silence, I chose to stay and help him process this overwhelming experience. I owed Tim every ounce of the expertise I had diligently cultivated as a provider, even if my advice would ultimately be disregarded. Equally important, I owed it to myself to be confident and brave, to embody the provider I had worked tirelessly to become.
I empathetically told Tim that I understood how difficult it must have been to hear my findings, particularly given Tim’s unwavering compliance over the past 15 years. I told him that if I were in his position, I would feel disappointed, and probably even angry. I then reassured Tim that confusion and a loss of faith in all of his providers would be natural.
I continued by suggesting, “Considering how surprising and frustrating this information must be, what if we arranged for you to meet with a periodontist? This way you’ll have an opportunity to process and reflect on these findings between appointments. You can also jot down any additional questions (which you can also reach out to me through call or text) and bring them to the specialist appointment. Having someone else reiterate the information might help you build trust in it.”
However, I advised against delaying the next appointment for too long or avoiding necessary care. I explained that even though he might not be experiencing any pain or swelling at the moment, relying on infections in his mouth to resolve on their own is not a healthy strategy.
I assured Tim that I am here for him in any capacity he needs and that I am willing to meet with him as many times as necessary to review the information. I also offered to involve his wife or another family member in the conversation if it would provide him with support or assist in his decision-making process.
Despite my efforts to encourage dialogue, Tim remained silent. He avoided eye contact as he tightly clasped his folded arms. I then handed him my business card, which included my personal cell phone number, and expressed gratitude for his time. I had reached out to our periodontist introducing my findings. I had also asked him to send me a message if Tim schedules or has, in fact, been seen. I have received no indication that the patient has followed up with the specialist.
I made two conscious decisions at that moment, influenced by my gender and the current circumstances.
- I deliberately lowered my stool to avoid any perception of condescension when I spoke with Tim.
- I suggested he seek a second opinion.
I have learned that with certain male patients, I need to allocate more time and provide evidence to support my findings by teaching them how to interpret radiographs and showing them intra-oral photos. Those appointments tend to progress more smoothly when I employ advanced dental terminology, showcasing the depth of my education. I have also noticed that I am better received when I am physically more presentable, wearing makeup, and making sure my hair is freshly highlighted. Unfortunately, these are just a few of the additional expectations that women in the healthcare profession often face.
I often wonder what the chairside conversation would be like if a male provider presented the same clinical findings. I can assure you that Tim’s gaze was not a unique perspective nor my perception. Every practicing female provider has encountered challenges that call into question her education, experience, and expertise. At some point in our careers, we have all been viewed as having an inferior opinion. Due to countless interactions like these that I and every other female provider have endured, I have discovered a formula to help prevent us from giving in, being waved off, and/or dismissed.
After nearly 20 years of conversations like the one I had with Tim, I have come up with the following strategies:
- Trust your gut: Both the patient’s history (if obtained adequately) and your intuition will prepare you for conversations like these. Anticipating and preparing for the interaction is crucial, not because you have something to prove, but because it will help you guide and support the patient effectively.
- Allocate time: Spend a significant amount of time with the patient. Offer to answer their questions as many times and in as many different ways as they might ask them. Slow down your presentation of the treatment plan. Remove any blame from the conversation and approach it with gentleness and kindness.
- Do it anyway: When every fiber of your being wants to walk out of the operatory to avoid disrespect, stay anyway. Stay there for the patient, not because of how they are treating you, but because it is your role as their provider.
- Discover who you are: Write down and commit to who you aspire to be and develop into that person. Grow with confidence in the direction of being seen and heard. Understand the reasons why and when you might be ignored. Evolve alongside the community of female providers to challenge and eradicate the misconceptions about our capabilities. Self-discovery becomes easier when you have the guidance of a coach or consultant. Seek professional help to uncover the talents you might be hesitant to showcase.
- Be a cheerleader: Find a community of like-minded providers, both men and women, and offer your support to them. When you support someone, they will likely become your cheerleaders. Celebrate with them each time you decide not to mirror the negative energy of your patient. Celebrate when you navigate the appointment with flow and grace despite the challenges.
Fortunately, experiences like the one described above are less frequent than they were decades ago. Women are learning to neutralize “the gaze,” thus changing the narrative of how we are perceived. Our actions, empathy, and ability to support our patients are reshaping how we are treated. Our ability to collaborate and exchange experience as well as ideas with one another has created communal learning and teaching moments.
The dread of entering the operatory is part of the healing profession, just as is exciting, encouraged, and elated for having helped. It’s just a matter of understanding and perspective. Women are learning to neutralize “the gaze,” thus changing the narrative of how we are perceived. Our actions, empathy, and ability to support our patients are reshaping how we are treated.
ABOUT THE AUTHOR
Dr. Maggie Augustyn is a practicing general dentist, the owner of Happy Tooth, a faculty member at Productive Dentist Academy, an author, and an inspirational speaker. She obtained her Doctorate of Dental Surgery from the University of Illinois at Chicago (UIC). Augustyn is passionate about reading, researching, writing, and speaking on topics that encompass the human experience, including our struggles, pain, and moments of vitality.
Her personal mission is to inspire individuals to embark on a journey toward a more authentic self-actualization. She has a notable presence in the media and is a frequent contributor to Dental Entrepreneur Woman. Dr. Augustyn takes great pride in her role as a contributing author to Dentistry Today, where she publishes a column titled “Mindful Moments.”
She has also been featured on various podcasts and is a sought-after national speaker, emphasizing the significance of authenticity and self-discovery.