Listening to the voices of the impoverished: the humanist dentist

Study Background: According to Statistics Canada 4.8 million Canadians struggle with poverty. Disparities in access to oral care for the poor persist and are very well documented. Strong evidence reveals that oral health care practitioners face difficulties in delivery of care to poor patients while many of the latter feel stigmatized by healthcare professionals. Indeed, there is international evidence of the benefits of comprehensive health care for the poor. Unfortunately, few studies have looked at the experience of dentists working with the poor.

Objective: To describe and understand the experience of dentists who work in a deprived area with many patients on public welfare benefits.

Methods: We conducted a qualitative research project using semi-structured interviews with 35 dentists working in private offices. The interviews were tape-recorded and transcribed for the purpose of analysis. The analysis consisted of debriefing sessions, coding and interpretive analysis.

Results: Our results suggest that dentists working with the poor express little prejudice toward welfare patients and have complex perceptions of poverty. Their contacts with poor patients lead them to acquire social knowledge on poverty and specific skills that allow them to adopt a humanist approach in their interaction with the poor. “Humanist dentists” use empathy in their encounters, try to avoid moralizing to patients and adapt their clinical treatment to the capabilities of the poor. Moreover, they understand the dreadful life conditions of the poor and their resistance to oral health care. According to the dentists, this humanist approach enhances the relational continuity of care and favours better access to timely oral health care.

Conclusion: Training and continuing education should include comprehensive health care that focuses on the consequences poverty has on oral health and utilisation of oral health care services. Our findings highlight key elements that are fundamental to the improvement of access to oral health care for under-served patients. Support by GREAS and CIHR Strategic Training Program in Applied Oral Health Research, McGill university.