I had two fillings done today, at 8 am. I wasn't thinking about HeLa or Henrietta Lacks during, just clutching my hands and trying to listen to my audiobook instead of the drill, but after, it occurred to me that there is a lot dissatisfying to me about the way I'm treated at the dentist's office- not the dentistry, but the doctor patient relationship, the part that involves informed consent is lacking.
Much of this is on my shoulders, in that I don't take charge of making sure I'm satisfied and feel like I know what's going on, but I think the psychology of the dentist interaction is also at fault. I had my first filling a long time ago, when parents came along to the dentist, but I didn't know then that I could have the entire procedure explained and all my questions asked and answered. Since I've had lots of fillings, my dental health folks assume that I know all that I want to about the matter, and it's on me to ask if I have more questions, but the nature of the dentist visit discourages seeking informed consent. The person that greets you in the waiting room is the assistant, not the dentist, not the person who will perform your procedure. When the dentist does arrive, you are sitting in the chair, she enters and sits behind you, so no eye contact can be obtained. You converse, but it's usually chit chat, ice-breaking on how one is doing, and that is done as you are lowered into what I usually think of as the Position of Helplessness. It's hard to be assertive and feel in charge laying on your back with your feet above you, a bright light in your eyes (akin to interrogation scenes on TV). You feel vulnerable, exposed, and you want to please those in charge precisely because of your powerlessness. Then they stick fingers in your mouth, and your ability to communicate is severely diminished. The dentist and her assistant discuss what they are doing, and the general condition of what they find, but as they are professionals consulting with each other the conversation is going (literally) over your head. The dentist usually takes her leave before the chair has even sat up, so followup questions or concerns can't usually be addressed by her.
At the dentist I arrive feeling anxious, cowed and docile. I leave feeling shaky and a little violated. And I have a good dentist! Trying to be forthright, or even curious in this mindset is difficult, and even when you ask questions (which I try to do) and even if there are good replies, I'm not in the frame of mind to fully absorb the information.
All through reading the Henrietta Lacks book this week I was intrigued by the difficult ethical questions brought up in the book, but I was having trouble tying them into libraries in ways we haven't covered in class (privacy, authority of librarian, help or body blocking medical questions). The bio ethics questions, especially those raised by the underhanded doctor behavior with the Mo cell line are tangled in such a way that neither side is in the right as to how this should be handled, but the current state of affairs is unsustainable. Too tangled an issue for one class.
Today it came to me, in that I was struck when reading the passage discussing Day's general medical reaction when he gave autopsy permission- that his response is yes to what the doctor says and wants. The Henrietta sections also emphasized her lack of information and understanding when it came to her medical care, especially when it came to conditions like her neurosyphilis. This surprised me as my doctor relationship has never been that way, even as I child my pediatrician would explain diseases, symptoms and mechanics, and treatment options.
So what the heck does my dentist visit and Skloot's book have to do with library stuff? It has a lot to do with reference interviews. My dad is a reference librarian, and when I was little the reference desk, just like the Circulation desk, was high up, with the librarian sitting on a stool above the patron, and the computer screen only facing the librarian. I was weirded out and nonplussed when the model shifted to what is currently in vogue (tho not at Memorial Library) where the librarian sits at a low desk with a chair for the patron as well, and a swiveling screen that is patron inclusive in design. I was bothered by how much less authoritative the lowered desk looked, but it's essential to its purpose, which is equalizing. Making the librarian less intimidating, and less distanced makes them more approachable, the shared screen makes searching for information more collaborative, and even if it makes the finding of the information take longer, it also makes the how to find the information (our new emphasis, teaching) much easier. So does the structure of the interview, with lots of leading questions, tips and preferences, and checks that the patron is satisfied or has any further questions.
I understand that the physical limitations of dentistry preclude any sort of equal standing (really sitting) to occur, but I wish it would be something that they try to improve. My doctor experiences are nothing like those that the Lacks family went through, but my dentist ones bear a resemblance. HeLa helped me in a professional sense in that it emphasized that ease and feeling of control are important things for the patron to feel in any interview for it to be a successful one.
No comments:
Post a Comment