I went to a periodontist to have a tooth removed.
It was clear I was entering a business. There were multiple indications, mostly communicated via legal forms denying me recourse if the doctor screwed up, and several other forms focused on the money I’d owe if insurance didn’t pay. The place was cool and efficient. I was told by staff orally what I was to pay for, what I would not. The numbers were exact, the manner disciplined. No one asked me how I felt about my fractured tooth, or losing it.
They took an initial x‑ray (I didn’t have to pay for that.) They did a multi-layer scan with a very expensive machine (for which I did have to pay). The doctor showed me the comparative advantages of removal of the tooth versus rebuild as thoroughly as a sales person might sell me a new car rather than a used one.
While I waited for the event to happen, I sat in the waiting room. One of the staff took a call from an angry customer who had received a bill for more than she thought due. The tone of the staff member was patient but patronizing. The call went on for awhile.
Then it was my turn to lay down on the chair. The doctor appeared and chatted with me and his assistant while I prepared to get numbed up. Offhandedly, he complained about his accountant and how much he was charged for his taxes, his dozen LLC’s. Then the subject of the angry customer came up. “It’s only a couple hundred bucks,” the doctor said plaintively, as if this was a pathetically small amount to argue about. “I know,” said the assistant, “she’d been clearly told how much the service is.” I could hear the eye-roll in her voice. “She thought it should be free. I think she’s Somalian or something.”
The doctor gave me a moment for my jaw to rest between shots of anesthetic. “I heard the call,” I said.
“You did?” the doctor said, implicitly asking me to open my mouth for another needle-ful by bringing the syringe forward. “This one will sting a little more,” he said. Then he asked, “So who was right?” as he continued to poke the needle into my palate.
Under the lights and leaning far back in that chair with my head tilted down and to the side for his better angle, I just said “I have to trust you.”
“Well, that’s it, isn’t?” he continued. “They either trust you or they don’t — they have to decide if I’m competent, and then they have to decide to let me do my job.”
Later, after a few minutes, the fractured tooth came out and the implant went in. “Damn, I’m good!” he said. “We’ve got time left — you want to do that same tooth again,” he joked.
Later still, I walked to the door. He was there at the counter. I said to another assistant, “Is there anything else on my account or have I paid everything?” She obligingly began to look up my records but he chimed in humorously, “I have a big trip coming up, so of course there’s more charges.” He thought I was laughing with him.
I have to say he did an excellent job — technically speaking. I hardly have any pain at all today even though a whole tooth is gone and a little screw has been inserted into my jaw bone so that a new false tooth can be attached to it later.
But I’m disappointed in myself for not calling him out for insensitivity, maybe even racism. I could have taken him aside and offered him some tactful feedback about his tone, the tone of his whole office, not that I actually believe it would have done much good. After all, he owns the place and certainly wasn’t asking for my opinion. Who knows, maybe some of my courage was removed with the tooth. After this many years in my business you kind of know when there’s an open mind on the other side of the wall. But that’s no excuse for me, really. We are responsible for our lies.
I hear myself reassuring myself that I don’t have to go back again, that I can explain my experience to my regular dentist who currently makes frequent referrals to this guy. That maybe I can write a letter. But I’m still disappointed with the trade-off I settled for. And as I look over this post I also wonder if this isn’t my little act of personal revenge, hanging this guy out to dry with all my judgments but not talking to him about it directly. Is there a pattern there, I also have to ask myself, a certain passive aggression? There’s a lot to think about, and maybe I’m overthinking it, too.
Such a sign of the times, so much distance between people that some of us have become objects and we put up with that. So much numbness. So much distance between the haves and have-nots.
It’s only a couple hundred bucks, you know. It’s not that much.
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This post really hits close to home as I’ve been in and out of the dentist office several times since early November! Fortunately, I haven’t had to deal with as much hubris in the dentists and staff as you did. Cringing at the thought.
HOWEVER…there was still the same formalities that tend to lack in empathy when it comes to all the legal forms to cover their behinds in case they mess up and also when it comes to the cost of the fees. I had some unsettling moments in their financial office after the initial x‑rays and exams and before they started treatment as I contemplated what I would have to sacrifice to help cover costs or if I would have to put off treatment altogether. Something that if I did, could have led to other serious health implications. Fortunately I was able to get a loan to cover my costs so I could start treatment.
I had to pause when I read what you said here: ‘Who knows, maybe some of my courage was removed with my tooth.’
I paused because the day before yesterday I began a draft for a post that is still saved in WP that was about my dental ordeal. The quote I selected for the post was one by Lao Tzu:
There were areas of my jaw that have 80% bone loss and it has progressed rapidly over the course of the last 1.5 years. I was reminded of the quote above as it happens to be a favorite of mine.
I was reminded that I must have plenty of courage because I have and do love others deeply. Yet since my husband died, I have not known that love in return. Yes, in little ways here and there by treasured friends/family/people. Yet still…not the kind of love I had with my husband. The kind that helps me feel strong. I told another Twitter friend awhile back that when I was in the military, I felt that the only reason I did so well and made it through the toughest of times was because I knew my husband (early on we were only engaged and not married yet) loved me and it was his love, devotion, and regular letters that he wrote to me almost daily that helped get me through.
His love was my strength. My love is someone else’s strength.
Having such rapid bone loss has seemed more like a metaphor that I have lost a great amount of love and strength and it hasn’t been replaced.
Anyway, thanks for sharing your experience. Now neither of us have to feel like the lone ranger when it comes to the dentist today! : )
I love the way you find metaphors in things, as I do. And then the metaphors lead to associations, and the associations to insights and even more questions.
A beautiful comment, my friend. My wish is that your work heals quickly — and that somehow that bone loss can be undone, which is to say that the loss of love and strength won’t last because something new — or someone new — comes into your life.
All the best
nice post Dan, too many things said in here so not sure which appeals to you more.
Are you dissatisfied as a customer who is to bear all the risk while your dentist enjoys unaccountability or
Are you dissatisfied with the costs associated with such work or
Are you unhappy about the fact that a doctor/dentist behaves like a salesman for his services or
Are you upset with the fact that the so called dentist who is technically qualified & good, factual about his matters & highly efficient in his work fails to be effective for you because he lacks the sensitivity towards the patients & lacks empathy in his dealing with people or
Are you angry with yourself that you lacked the courage to diplomatically bring his personality flaw to his attention & subsequently guide him toward proper behavior or
Are you upset with the so called realization that there can be behavioral issue on your side to escape such responsibilities by justifying yourself with
” you kind of know when thereâ€™s an open mind on the other side of the wall”
Abut your personal revenge or “Passive aggression”.
Cant really comment much here but will say two things;
1. Do you think you are responsible to change people (to better 🙂 )even when you are not solicited or welcomed?
2. Does that Dentist also have a need for empathy for what he is & does?
Hope these will add to your quest of reflection.
Always a pleasure reading your thoughts.
Have a nice day ahead 🙂
Interesting questions Gurmeet. 🙂
I certainly can’t speak for Dan however I did want to share what came up for me when I read some of your questions based on my own experience.
In my experience, reporting IMPACT is a part of assertively expressing our integrity. It’s a form of self-respect as well as providing valuable information to others.
Reporting IMPACT does not mean we lack empathy for others. It means we include empathy for ourselves. If we have a poor customer service experience, reporting the impact of our experience gives the business an opportunity to improve. They don’t HAVE to change yet if they don’t, it could eventually impact their business in a negative way that results in loss of customers and business.
Reporting impact doesn’t force anyone else to change. Yet withholding the information does not allow for honesty in relations.
Thanks for your questions and insights that caused me to wonder more on these things. 🙂
As always, thank you for stopping by. Your questions are always are provocative, and while I know that you intend them to help me with my own reflections, I certainly hope they help you with yours, too.
The post is, I think, pretty straightforward in its message about insensitivity and an appropriate response. As you know, I write more as an artist than philosopher, so I can understand that this style might create some confusions — hence all the questions you generated!
Possibly, too, you identify with the dentist, Gurmeet, which is fine. In fact, I’d say it is crucial to find that empathy — and also compassion — for the dentist as he is an emblem for the insensitivity that is potential in each one of us, don’t you think? Hence, had I chosen to offer him feedback in the moment, I would have done so tactfully and as a matter of personal integrity more than with any sense of responsibility for changing other people. In addition, in a very practical sense, this is also a matter of customer feedback on the professionalism of the business, so it could be very helpful even without the moral questions being involved.
The point for me is that if none of us speak up in the face of insensitivity — in this case also including some potential racism — then we are tacitly complicit in the injustice. What I found discouraging in this situation, in addition to simply finding myself in it, was a certain lack of congruence, my passive response until I started writing. Then I realized just how deep my feelings were. Hopefully I can consciously model here what I think many of us go through.
Oh, well, I am quite sure you understand from your own life experiences exactly how much we are all learners and how we can help one another with our mutual education. So perhaps that is a deeper purpose of the post.
Thank you again for writing.
All the best
A great multi-layered thought piece.
Dentists, of course, evoke emotional triggers for many people, certainly for me. I’ve spent exorbinant sums of money, way too much time and lots of discomfort and frustration dealing with dentists. In fact, just recently. Most approach their work like mechanic engineers. When I shared with my latest dentist that the last time I had an extraction, I sat in my car afterwards and cried. She looks puzzled as if she had no sense of the feelings associated with the work she does.
But this post goes much deeper. For me it is about the tacit consent we give for people to speak and behave in ways that we find unacceptable and even offensive. Even when they are “caring” for our bodily needs!
Yes, dentistry, like most all health care delivery in the US is a business — first and foremost. They are structured as such with perfunctory manners with an eye to executing the tasks at hand. All of the docs and related services I deal with ask the insurance question before they ask anything. I find them mostly cold and “professional” far from the model of empathetic “care-giving” I want and expect. For me this routine behavior — these protocols — are less and less tolerable.
But the deeper question is when and how we step out of our comfort zone and share what we feel. In the case of your dentist you were literally in a “difficult” position.
The unconcsious comments made by the dental staff, as you know, speak to the culture of that office. It’s OK to talk about patients (and with this sort of casual judgment and bigotry) with other patients.
These are choices we all make in our daily life to get things done. We rationalize and lower our expectations. That’s the way things are. Well he’s a jerk but he does good work. I believe we condone the compartmentalization of experience when we do not personalize these routine interactions and expect more.
These days the challenge for me is how do I communicate my feelings and needs when I encounter these experiences (especially as a “customer”) with empathy and clarity? Yes, of course everyone deserves empathy — but I being assertive does not preclude being empathetic
Compassionate care and service is not the norm. But we do ourselves and the larger culture a disservice when we tolerate callous and thoughtless behaviors.
Thanks for your candor — and as always weaving words together to provoke deeper thought.
Best ~ Louise
Thanks for sharing your thoughts. I am sure you do make constructive impact in lives of people around you. Assertiveness is a new mantra nowadays as a balance between aggressive & passive. Though I believed the message in your story was providing different perspective to the matter. ïŠ
Thank you for your response; itâ€™s always a delight to have a conversation with you on any matter.
I don’t know if I can put myself into any category (artist/philosopher) ïŠ as easily as you therefore all I have are questions and rarely the answers. This is also the reason why I have difficulty to say something with absoluteness on things.
I do not think I identify with the dentist, and only tried to state that its bit difficult for me to conclude him as insensitive. I have known people, families and cultures which are so diverse that where one behavior which is seen as brash is considered jovial by others. I am sure for person of your experience this is something commonly seen. I live in a country which is so diverse that with every 100 miles there is a change of language, culture, norms etc. So I always shy away from forming opinions on matter or people per se.
I remember a story which I was told quite some time back. In one culture if you visit a family and are served tea, you should not empty the cup & leave a bit to show that you have been nicely fed with no more scope to drink. On the contrary in another culture if you leave some tea in the cup it is seen as youâ€™re not appreciative of the taste of tea.
But even if we can somehow come to this conclusion that the person is not sensitive and lacks empathy, would it be right to state that even as a customer when it was not solicited by him. If customer satisfaction would have been important to him, he would have surely asked. Do I as a customer am responsible for him or his business. Since it is not relevant or important to him, why is it so important for me to make him aware about it? What is the purpose of telling someone that he needs to improve (as per my definition) when the other person do not see it that way. It would have been a matter of integrity if it was my job to make him aware of his flaws & he was keen to know about such things.
And if it is indeed the purpose of my life to improve his life irrespective of the fact that he desires so or not, wouldnâ€™t it be better to be empathetic with him so as to convey the message better. Wouldnâ€™t it be nice to know him & his life first before making any judgment about him?
One friend of mine used to quote his father, â€œIf you want to understand somebody, live that person entire life exactly the same way he did. Till than donâ€™t draw conclusion or judgment and avoid advice.â€ Not sure how relevant his view is but it does give a perspective.
I can understand your point on people tacit acceptance to what is considered immoral or illegal & our behavior turned into a habit to be passive about it, but sometimes such thoughts do take the form of moral policing which can turn into much worse scenarios than they actually were. Where do we draw the line? And who will decide that? In matters of racism, equality is slowly turned into uniformity.
Thank you again,and have a nice day 🙂
I so appreciate the flow of your reflections and feelings! They are clarifying and assertive — and beautiful. As you point out, this is not just an issue of individual doctors and offices but an issue of mechanistic, money-based business culture driving health care and, in turn, the expectations of society for how people are to be treated. This is a systemic issue, not a personal one — and that makes it so much worse. It is just remarkable to me what we’ve all learned to put up with.
Thank you again for sharing your experiences and perspective. You make me glad I wrote this post. Apparently, I’m not alone in facing the dilemmas of intervention.
All the best, Louise!
Yes, I enjoy our dialogues very much, as well!
I think you raise very important questions about judgment and empathy, and especially from a cross-cultural perspective. I’m totally with you on the point about providing feedback when it is not asked for. However, and it’s a big “however” for me, I don’t believe in absolute relativism.
I think your point is that we need to be sensitive before diving in to criticize someone else’s lack of it. I’m in agreement there, but also know when my gut tells me my needs aren’t getting met or my values are being abridged. I will make a judgment. Failing this, there’s a very long slippery slope that reduces my capacity to stand up for myself in my own life, to stand for certain things I believe are important. In a perfect world, yes, it might be better to get to know the doctor over time before offering my observations or advice. Dialogue rather than simply dumping feedback is always better in my book. But there is also a time and place for clarity and plain spokenness, which if one could call it a duty, would be a duty to my self and the world I seek to help co-create. Such is, in part, what I believe it means to lead.
Thank you, again, Gurmeet for embracing a challenging exchange!
All the best
Dan, another delightful personal reflection from you that triggers so many memories and connections. One is a memory of something that happened only last week: a meeting up with an old connection from New Zealand, Dr. Robin Youngson, who was in London delivering some workshops around compassionate healthcare. He set up an organisation, Hearts in Healthcare, some years ago and has written a book, Time to Care. Here is a man with a respected medical pedigree any medical professional would be envious of who decided that healthcare needs more compassion and sets out to build a global movement. A real inspiration and someone who had me so rapt in conversation, that he had to excuse himself to go back to his hotel room at a late hour so he could sleep. There are people who know how to do it.…. and.…another.. a dear dear friend of mine who I used to be co-therapist in a group with some years ago who was a psychotherapist AND a dentist. …who related how many of her patients had experienced abuse in their lives and how deeply panicked they would be in a dentist’s chair, lest the ‘powerful one’ take advantage of their vulnerability. The sensitivity with which she administered her dental care was core to her work as a dentist. …there are compassionate ones out there. I’m so sorry that you had the experience you describe and the notion of bigotry, money-grubbing and nonchalance entering a healthcare professional’s surgery fills me with revulsion. I’m glad you are on the mend, my friend.
It is wonderful to hear from you! It is eminently clear that there are individual practitioners who care deeply, although the overall culture of health systems seems to continue sliding in the direction of mechanical, buyer-beware care; not much different than airlines.
On the positive side, however, I do think of the very sensitive physicians I’ve known, including a current colleague of mine who is a principal of Oncotalk, a program that aims to teach physicians better communication skills with their cancer patients. Absolutely fabulous and fascinating work.
Clearly, it isn’t that we are not capable. To me, it’s just another kind of entropy that proves if love is going to have a foothold, it’s going to happen with intention and consciousness, with awareness and desire for even more awareness as time goes by.
I do hope you are doing well in your new location. We’ll need to talk one of these days…and thank you so much for your kind tweet about the artistic value of some of my posts. I return the compliment!
All the best
After cringing, biting my tongue and doing other things in my mouth that could precipitate a visit to my own dentist while reading your observant, contemplative post, here’s my two cents:
Never mess with a dentist when he’s got you in the chair.
I totally support the more passive “hanging this guy out to dry with all my judgments but not talking to him about it directly” approach in this instance — but then again … maybe I’m simply justifying my own habitual instincts of self-preservation!
Great post, Dan.
Thank you for this wonderful (self-preserving) support!
All the best
Dan I enjoyed this and found it really impacted me emotionally -
It’s impossible to know when to say something and when to let it slide — we have to assess it at the time and within the context —
The event was about subtleties — these are always harder to call out — and also harder to assess — the receptionist may have made the comment as a matter of fact — “that’s an apple — that’s a pear” — or as a matter of judgement — “that’s a good apple- that’s a bad pear” —
All we can do is be as conscious as possible about our own values and behaviour and continually act with high regard for the circumstances that we are in — you had a needle in your mouth — some people have a mortgage and a bully boss — decision are complex -
Yes, absolutely: “we have to assess it at the time and within the context.” And we usually need more information, which is why at best I might have offered feedback about the way things sounded, not conclusions about the way they were. I would have expected some form of defensiveness, as well as some of my own learning.
It’s been extremely helpful for me to hear so many reactions to the situation. It now feels like one of those existential moments of choice where there is no right or wrong necessarily, only a choice as if for all of us about what to do and how to do it.
Thank you again, Dionne!
All the best
I believe you are right. A business person should be professional. He really did know you and they certainly should not have been talking about another patient’s situation in front of you. With regards to the assistant, she should have removed herself from the room when she perceived the call was going to be difficult.
Key for a business is its reputation. I believe this group damaged theirs. If that part had not occurred I bet you would have thought more positively of the office and probably provided referrals.