Board Forum: Inclusive Practice

What does it mean for you/your practice to be “inclusive”?

Joe Niamtu, DMD: I think “inclusive” is one of the most important and relevant words of the 20th and 21st centuries. It is the pulse of progress that previously held people back based on many things, including race, religion, gender, sexual preference, and disabilities.

Jeanette Black, MD: For you and your practice to be “inclusive” means that your practice is welcoming to patients and staff regardless of gender, ethnicity, age, or religion, in addition to those with physical or mental disabilities. Inclusivity takes effort and requires us to be conscientious of those who might otherwise be excluded or marginalized. As patients come from a wide variety of backgrounds, it is important to be sensitive to the cultural differences our patients might have and be sensitive to each individual’s needs.

Dr. Naimtu: I can say that my practice welcomes everyone. I offer procedures that are more specific to certain races, such as lip reduction or keloid treatment. We see patients desiring transgender feminization or the opposite. We see patients with disabilities that have mobility, physical, or cognitive impairment. Basically, cosmetic facial surgery crosses all types of human interaction and I feel contemporary practices are highly aware of and adaptive to this.

Is it important for you/your practice to be perceived as inclusive by current or prospective patients?

Thuy-Van Tina Ho, MD: Definitely, because that is how I would want to feel/be treated as a patient. Patients are trusting me with their face—there must be a sense of privacy, comfort, and trust with me. Inclusivity must be promoted by all staff; it starts at the front desk staff welcoming the patient to the provider. I try to maintain the same level of bedside manner: sit with patient, smile, shake hands, ask open-ended questions to begin with, make sure we have enough time for all questions and concerns addressed—show that I care.

Dr. Black: It can be intimidating for patients to navigate the healthcare system and seek medical care. Those seeking cosmetic treatments often face unique insecurities and concerns. Creating a culture of inclusivity in your practice can help the practice grow, enhance the quality of care, and can help to avoid misunderstandings or feelings of discrimination.

Dr. Niamtu: I think it is very important, but it can be a bit patronizing. Some practices display the rainbow flag with a statement “LGBT Friendly.” I would hope that all practices would be that way in this era of inclusivity. My practice certainly is. Shouldn’t you have the same for every other aspect of the population that may face discrimination? I don’t have any problem with someone making such a statement, but I would rather see a broader statement that, “Our practice welcomes everyone and does not discriminate based upon…”

Do you strive to have an inclusive staff?

Dr. Niamtu: I have partners and staff that are Caucasian, Indian, African American, and Latino. I want my practice to represent a slice of American culture, and I think it does.

Dr. Ho: Each patient needs to feel welcome from when they step in the doors of the office to when they walk out—and also on the phone, as well.

Dr. Black: In Los Angeles my staff comes from a wide range of cultural backgrounds; helping them to feel included in the office starts with communication. It is important for me to learn about each individual on my staff so that I can be aware of their unique needs and incorporate these needs into the practice. Learning about each staff member’s cultural background helps us to be respectful of their circumstances, including needs for religious holidays, childcare, and necessary medical appointments.

Have you had any experiences where cultural differences or similarities between you and the patient impacted the care you provided?

Dr. Black: As patients come from various cultural backgrounds, it is important to ask questions about their needs in the office. I have had experiences where brining in a translator or bringing in an assistant of a different gender has significantly helped to open communication and enhanced the quality of care I was able to provide to the patient.

Dr. Niamtu: In the past week, I had a consult and treatment with an Arabic patient who required an interpreter and a hearing impaired patient who required the same with sign language. The latter patient had gone to another provider and had a bad experience with the interpreter and evidentially was embarrassed or humiliated. For both of these patients I paid for the interpreter and I will pay for future visits, but I view this as the price we pay to assist those in need. Most of us reading this article had relatives who at one time came here from somewhere else. This is an important point to remember.

Dr. Ho: I had a negative experience where a difficult patient with unrealistic expectations was unhappy with her results (and never going to be made happy, I realized after the fact). In our last conversation, she lashed out at me and stated that if she were a white patient, I would have treated her differently. I was taken aback and did not respond aggressively, which was good. I’ve learned to not take it personally, to do my due diligence, to apologize in general even though I was not in the wrong, to learn what I could have done better in this situation, and move on.