Betty Dodson with Carlin Ross

Better Orgasms. Better World.

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Today I went to the dentist for one of my regular twice yearly cleanings and I found myself in the midst of a similar dynamic that many of my clients experience with their doctors during pregnancy and labor. The difference for me, today: the stakes were low. Very low.

I have healthy teeth and gums free of any discomfort. I could have easily walked out and gotten my teeth cleaned another time by another dentist. There was no one else and nothing else to consider but me and my teeth. All this is different from a pregnant or laboring woman.

But it really got me thinking about how difficult it is as a patient to express our questions and preferences, and how ruthlessly many doctors will work to keep us silent so they can do things their way because “I’m the doctor”.

So here’s what happened with my dentist:

She’s been my dentist for about 4 years, I think she does a good job with my teeth, is very caring, is very aware of the times that something about the cleaning is uncomfortable. She’s always been straight up sweet as can be. That is, until I said I’d prefer to not get x-rays today.

You see, I've never had a cavity. Ever. I lucked out and got the good teeth genes. And I'm one of those people who flosses and brushes A LOT. So it recently dawned on me that it seems excessive to get the same kind of screening as someone who gets frequent cavities and doesn't take care of their teeth. And it doesn't seem necessary to expose myself to that extra radiation or spend that extra money given my circumstances.

So, when I arrived at the office today and she told me I was due for x-rays, I told her I'd rather not get them today. She told me I had to. We went back and forth several times. Both of us maintained a nice and conversational tone with each other. I explained my reasoning. At one point at a loss for what to say because she was pressing so hard, I said, "But they're my teeth and I really feel comfortable with this." My dentist responded, continuing her nice tone, saying "I'm your doctor and I am not okay with it."

I felt backed up against a wall and did not want to be forced into it because she "said so". Had she given me a convincing argument for why, in my circumstance, it makes sense, I would have talked about with her and potentially changed my mind. But instead I felt like she was trying to strong-arm me. I started to wonder if the only options were to either get the x-rays, against my will, or decline my appointment altogether and leave. We finally agreed I would skip the x-rays today and get them next time. The most disappointing moment for me was when she actually touched my cheek and said "Look me in the eye, Jessica. You must get them next time." I'm a 35 year old intelligent and communicative woman and I did not like being treated like a 5 year old by my doctor because I wasn't doing what she wanted.

I have many clients who describe their doctors as being extremely nice, just as I would describe my dentist. But disrespectful and patronizing tones can be disguised in nice-ness. Manipulation and threat of severe illness and death (many of my clients are threatened with potential dead baby stories) can be disguised as caring. Repeatedly telling a woman the worst case scenarios if she doesn't do what the doctor says, or maintaining a kind tone while refusing to listen or respect a woman's choices, is not care, is not kind, is not respectful.

Not long ago I had a client giving birth with a doctor who is a great communicator. I called her to update her on what was happening with the client who was still laboring at home. The doctor said at this point because of a combination of things taking place, it is her recommendation that the client go in to the hospital to listen to the baby and see that he’s doing well. She explained why it was her recommendation, asked me to pass the info along to the client and then said, "Just give me a ring back if she refuses, so I know what's going on." In this instance, after explaining to my client why it was the doctor's preference that she go into the hospital, they understood and happily went in feeling like she was getting thorough and thoughtful care from her doctor. Care that she could trust and a relationship where she could ask questions and communicate. And, while this did follow the doctor’s preference, the client truly had a right to decline that recommendation and make her own choice for her body and her baby.

Without open communication like the above story, the attempt to carve out space for a mother's instinct, desires, and preferences becomes difficult. When doctors communicate with patients under the assumption that the patient will do exactly what he/she wants, exactly when he/she wants, there is a much greater possibility of anger, disappointment, and feelings of inadequacy and entrapment on the part of the patient. It is difficult to carve out space for a mother when doctors don't feel they should have to explain why they want to do, what they want to do. It is difficult to carve out space for an experience that takes a mother and family into account when the assumption in the medical culture is that doctors know best and get to make all the decisions.

It is difficult when the medical culture, by and large, believes that questioning of a doctor's protocol or recommendation is a threat to their power, rather than an inquiry from one human being (patient) to another human being (doctor) about what they are doing, why they are doing it, and if this is necessarily the best fit for the circumstance. It is difficult to provide care without overwhelming risk of litigation when the assumption is that a doctor is/should be omniscient and omnipotent and there is no need for individuals to take responsibility for their comfort, preferences, experiences, instinct.

When we ask questions of our doctors or suggest we have different preferences, and the doctor goes into a mode (however sweetly) of trying to make us do it because "I'm your doctor", most of us will go into fight or flight mode. “I’m backed up against a wall. What are my options? How do I get out of this situation?” At my dental appointment I started to wonder if my only option was going to be walking out the door.

For a mom who is pregnant and has established care with her doctor for months, or is in labor and has been admitted into the hospital to give birth - walking out the door becomes either scary ("Who will take care of me?" "Do I have the energy to start all over with a new doctor or midwife?" "Is it too late?" “Will I get a reputation among obstetricians?”) or near impossible ("What am I going to do? My baby is about to be born and they won't listen to me? I have no options." "I could leave the hospital now but then I'll have no care at all?").

After my appointment today I’m sad to say that I need to change dentists because I'm not comfortable with one of my care providers condescending to me and trying to strong arm me into a certain kind of care. As for how frequently I want to get x-rays in the future? I’m going to have to do some research and see what the recommendation is given my health history. Who knows, I may end up getting the annual x-rays my dentist recommends or I may decide I need a dentist who is comfortable with me going a few years without x-rays.

I wishfully look forward to a day when women believe they have the right to communicate with their doctors, ask questions, change care providers when they are being threatened or forced into things, be generally treated as an equal human being, and when doctors expect their patients to have questions and preferences with a mutual interest in communicating as equals.

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