“Before you judge a man, walk a mile in his shoes,” is an oft-spoken idiom, cautioning the person not to make assumptions without an understanding of the wider circumstances. In short, it is cautioning empathy rather than judgement. So when could this cautionary phrase be helpful in dental practice? Dr Annalene Weston, Dentolegal Consultant at Dental Protection, explores this issue 

Empathy is a helpful tool of successful communication, as understanding others’ positions, or putting ourselves in their shoes so to speak, can assist us in understanding their point of view, hopes and expectations. What happens if we fail to step into a person’s shoes, and see things from their point of view?

Scenario 1

Ms M was suffering with terrible morning sickness, while trying to maintain her job from home, and wrangling an energetic toddler. She was exhausted and knew her toddler was suffering too, living on a convenience diet of takeaway children’s meals. However, Ms M managed to get herself and her toddler to their annual check-up, and attended Dr R. 

Dr R found that the toddler had not had his teeth brushed that morning and was somewhat appalled at the state of his diet. While he had no caries yet, Dr R felt duty-bound to provide Ms M with all the relevant OHI and dietary advice, in order to avert disaster.

Naturally, Dr R’s information was critical to provide but the delivery here is important, as this is a transient and circumstantial phase in Ms M’s life, which Dr R would be able to establish from her oral cavity and lack of restorations. Empathy would be needed to provide this requisite information, in a way that supports, not criticises.

Regretfully, Dr R did not consider how Ms M may be feeling, and why, and delivered the information sternly, to ensure they ‘made an impact’. Ms M felt ashamed and judged. She cried when he set out her failings as a parent. Humiliated, Ms M lodged a formal complaint with the practice, to try to ensure no-one else was degraded by Dr R as she had been.

Sometimes we may even step into the wrong shoes; not those of the patient at all, but someone else entirely.

Scenario 2

Mr L attended the practice to enquire about options for tooth replacement. He managed his own business, and so put ‘business owner’ on the new patient form. He did not disclose that his business revolved around trading in pink diamonds and was consequently very lucrative, as he did not believe this to be relevant.
 
Mr L booked to attend his appointment when he was on annual leave, and he was taking his leave as an opportunity to work on his hobby farm. He came across some trouble while fencing, so arrived at his appointment late and flustered, and he had not had the time to shower and change as he had planned.

Dr W, irritated by the late attendance, called Mr L through.

Now imagine you are Dr W. What options for tooth replacement are you going to offer Mr L based on his appearance? Be honest with yourself. Are you REALLY going to give him all of the options in a balanced manner, or are you perhaps going to brush over some options based on what you believe he can afford?

Regretfully, Dr W did indeed judge Mr L on appearance, and fail to fully outline implants as a meaningful solution for Mr L. Mr L, initially amused by this judgement, took his business elsewhere, seeing it as Dr W’s loss. However, with time, he began to resent being judged by a practitioner half his age and made a complaint to AHPRA on the grounds that he had been discriminated against based on his appearance.

Scenarios such as these occur so commonly in practice that they are addressed in the first section of the Code of Conduct, our roadmap document for professional practice:

2.2 Good care

Maintaining a high level of professional competence and conduct is essential for good care. Good practice involves:

• recognising and working within the limits of a practitioner’s competence and scope of practice, which may change over time

• ensuring that practitioners maintain adequate knowledge and skills to provide safe and effective care

• when moving into a new area of practice, ensuring that a practitioner has undertaken sufficient training and/or qualifications to achieve competency in that area

• practising patient/client-centred care, including encouraging patients or clients to take interest in, and responsibility for the management of their health and supporting them in this

• maintaining adequate records 

• considering the balance of benefit and harm in all clinical management decisions

• communicating effectively with patients or clients 

• providing treatment options based on the best available information and not influenced by financial gain or incentives

• taking steps to alleviate the symptoms and distress of patients or clients, whether or not a cure is possible

• supporting the right of the patient or client to seek a second opinion

• consulting and taking advice from colleagues when appropriate

• making responsible and effective use of the resources available to practitioners

• ensuring that the personal views of a practitioner do not affect the care of a patient or client adversely

• practising in accordance with the current and accepted evidence base of the health profession, including clinical outcomes

• evaluating practice and the decisions and actions in providing good care, and

• facilitating the quality use of therapeutic products based on the best available evidence and the patient or client’s needs.¹ 

Consider for a moment: did Dr R communicate effectively and practise patient-centred care? Did Dr W practise in accordance with the current and accepted evidence base, and provide treatment options based on the best available information? Or did Dr R fall foul of judging a patient, without truly knowing the facts of the matter or stepping into their shoes. And honestly, would you have perhaps done the same? 

Regretfully, many practitioners fall into the traps of pre-judgement and bias; please know that it doesn’t help us as clinicians, and it most certainly doesn’t help our patients.

We need to be mindful that bias is pervasive, and often based on our experiences. Bias affects us all. As a working mother, I can recognise a ‘Ms M’ at 40 paces, because I have walked in her shoes, but it would be unreasonable to suggest that we have to have experienced every life experience a patient faces to truly understand them. Rather, perhaps we ought to take a moment to get to know our patients and talk with them about their expectations, hopes and values relating to their dental care, so we can provide them with the requisite information and treatment options appropriately and with respect. 

We were able to assist both practitioners in their responses, and both had good outcomes, but this didn’t make them feel good; both expressed that they knew they had let themselves and their patients down through being biased.

Learning points

 • Accept bias is real, and affects us all

• Try to get to know your patients before making decisions about them, or for them

• Engage empathy, not judgement, as you never truly know what another person is going through, if you don’t walk in their shoes. 



¹Dental Board of Australia, Code of Conduct