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The Emotionally Compromised Dentist
Fear. Pain. Confusion. Angst. Dentist? My dentist is not someone I have ever considered to be the “emotional type”. Who can have feeling and wield a flying bur at 500K per second? And yet my earliest negative memory, many years ago, with my first dentist mentor involved an emotional outburst toward a frustrating male pediatric patient. I was shocked. I have never seen my dentist behave this way. I looked up to him. I wanted to be him. I had wanted to be him. Did I want to be him anymore?
I have discovered that no one is immune from becoming emotionally compromised. How the seasoned professional deals with distress may be different from the young clinical student. However, the young clinical student is given a rare opportunity to learn one of life’s most important lessons in a *relatively* stress-free environment, if he is exposed to emotional trauma.
Many articles have been written about emotionally compromised children, adults, spouses, patients, and so on. Google “compromised dentist” and you will see 60 results and none of them are particularly informative. Google “emotionally compromised dentist” and you will have no results. Is the dentist immune to emotion? Can we admit that we are human too, or are we too afraid? Many google sites that do arise when searching for the emotion in dentistry are about the patient opinion of their “crazy emotional dentist,” and the rest of the sites are incoherent, or about drug use or medical problems. Can the fear of having emotions be so strong that no one is willing to publish it? Or, is the emotional dentist simply an objectively impertinent topic to dentistry?
We discuss it in ethics. The compromised, impaired, and incompetent dentist are all recognized in theory and discussed at length regarding old age (which is inevitable for all of us) and drug use/abuse (which has been shown to be a problem), even CE is cited for discussion regarding competency. However, the emotionally compromised dentist is at risk of developing poor clinical judgment, negligent behavior, and drug abuse. With sufficient support and preparation this person could seek a support system rather than spiraling out of control. Where is the research regarding prevalence of emotionally compromised professionals? Undoubtedly, this material is present in some psychology journals, but why aren’t dentists talking about it?
Emotional life permeates all we do and filters our experience. Treating a patient with an appropriate level of emotional investment is advisable. Patients feel our emotional investment; they appreciate it, and can do better under the same care with the added benefit of feeling care about.
What about the emotional dentist. What do we need to know about? Can emotions be prevented? Are they contagious? How dangerous are emotions? What is good prevention? Are universal precautions effective against becoming an emotional dentist?
I look to the different association websites for dentistry regarding this topic. August 2011 at a Conference on Dental Health and Wellness in Chicago, IL 1 focused on these perspectives: general physical well-being during practice, working with an impaired dentist, and current education, prevention, and treatment of impaired dentists and patients. The ADA’s goals are to establish a framework for support and develop of well-being while increasing awareness of health and social impacts of impairment. It sounds great. However, the conference program clarifies the limited scope of the conference. Drug screenings, range of motion tests, tendinitis diagnostic and prevention, addiction, and some particular drugs are addressed.
However, I didn’t notice any part of the schedule devoted to dealing with personal crisis while at work, or how to get out of bed in the morning when your life has fallen apart. Perhaps it would even be appropriate to discuss what types of emotions are appropriate for a dentist to display, which emotions are understandable, how to deal with the expectation that clinicians should be unfeeling, objective, and omniscient. Can a dentist be sad? Can a dentist be frustrated? What is a dentist allowed to feel?
I know a man whose wife died a few years ago. This man is one of my favorite people ever. Knowing him is a joy. “See a penny, pick it up… then all day you’ll have good luck,” is something you may catch him say. His work helps him get out of bed and working. However, what is being done to prepare us for the loss of a loved one and how it will affect the unprepared. He seems to manage his emotional state excellently, but he has also been a dentist since before almost anyone alive today. I would never be surprised to see him embrace his feelings become teary eyed. Would he do it in front of a patient? Probably not.
Is it our responsibility to gather information, develop research, distill it into an instructive format, and teach it to our colleagues? Is emotion a private problem that has nothing to do with the realities of the workplace? Or is our profession starving, even desperate, to acknowledge our humanness?
Private practice is isolation for many dentists. It is not unique among professions in separateness, but access to drugs, exposure to emotionally varied patients, and extremely precise procedures can set a susceptible dentist off into chemical dependency. As discussed in an article published 1999 in the Journal of the California Dental Association, dentists are getting help. Some dentists feel better simply to know they are not alone in their feelings of anxiety and depression.
The Talbot Recovery Campus has treated over 400 dentists (as of 1999) for elevated fear, unhappy in dentistry, OCD, perfectionism, interpersonal sensitivity, and depression. I can understand each of these items except for one: interpersonal sensitivity. So, I looked it up. Wiki.Answers.com states that interpersonal sensitivity is the, “accuracy and/or appropriateness of perceptions, judgments, and responses we have with respect to each other. Another resource
home.uchicago.edu says that interpersonal sensitivity is the, “ability to perceive and respond with care to the internal states (e.g., cognitive, affective, motivational) of another…” So, internal states can be perceived…
These dentists are struggling with an inability to connect with other people: staff, patients, other dentists, friends, family, and more. Is Dentistry unique? Do we have problems because of our type of work that requires a special approach?
Talbot Recovery Campus spends time re-initiating these dentists to dental procedures. Dentists may feel as though they do not get the respect that other clinicians enjoy and internalize a low self-esteem. Through a relationship with a nearby dental school these dentists refine and refresh their skills to help establish increased confidence and prevent relapse upon returning to work. The group setting improves the dentist’s self-esteem through collaborative struggle. The entire junior class of dental students voted unanimously to spend an entire day with the dentists receiving treatment. They learned first-hand about the danger of drug accessibility and the loneliness of private practice. This is a powerful tool for teaching young dental professionals about the challenges of dentistry and an important experience for the mature professional to have and rebuild self-esteem.
We are encouraged to sweat from the back. We must appear sure, capable, and correct. Patients sit down, tell us their secrets, open their mouth, struggle to remain calm as we approach them with a hypodermic needle, and then remain mouth gaping, unmoving, patient until we say their time is up. I have to tell someone what is healthy about them, what is unhealthy, soothe their concerns, and fix their problems. I am supported by a framework of approvals, limited in practice by competing clinics, and propelled by graduation requirements. Patients in private practice will hopefully be amenable, tolerate mistakes, and trust their dentist fully, but when they have questions or concerns about treatment is the clinician justified in calling them paranoid? Should the clinician embarrass the patient in the clinic filled with people, as what happened today with Dr X and Dr Y when discussing implant #10?
Perhaps emotions can actually lead to unethical and even negligent treatment of patients. If the dentist has strong emotional problems regarding their skills and practice, is it then possible that he actually makes mistakes regarding patient treatment due to a need to support his decisions and clinical skill? If so, then the emotional state of the clinician is paramount to the safety of a patient. Should the patient turn out to be wrong or have unfounded concerns upon further evaluation and fact finding, were his feelings then inappropriate? Or, does the patient always have the right to be afraid and concerned about outcomes?
If the patient has the right to be emotional and the doctor does not, then what should a patient do when they calming explain their concern or problem and the doctor responds defensively or aggressive? Was he wrong to announce to the room that the patient was paranoid? Was he wrong to behave emotionally? I don’t know who was wrong, but I am sure the parties will reflect on the situation for years to come.
I don’t know the answer to these questions because I have not developed a framework from which to understand the problems or solutions as they may exist. I am not even so sure that a problem does exist. Perhaps it is all normal and good, these emotions, since we are human. Then what is the difference between a simple human and a clinician?
The ideal clinician as I have come to understand him gathers all the relevant facts, assembles them into a meaningful picture, correctly determines cause, prescribes treatment, and executes procedures, quickly, painlessly, and perfectly, every time. I am not the ideal clinician. I want to greet my patients with a genuine smile. I want to feel honored by a person who wants me to be their dentist. Remember that a dentist does not have patients, a patient has a dentist. For example: you cannot steal my patient, since I do not own my patients.
Again and unfortunately, most of the discussion on this topic of emotions centers on escape. A variety of coping mechanisms are learned to attenuate the stress of daily dentistry. Perhaps our most important oversight has been the preparation of each dentist toward greater emotional intelligence. Perhaps more important than crowns, implants, and IAN block is the training for what to do when you are terrified to perform a procedure, distracted by a sick or injured loved one, or treating the next patient after realizing the patient you just messed up on will be contacting a lawyer.
I constantly think about the legal ramifications of every patient interaction I have. Some dentists mismanage a patient knowing they have made a clinical mistake. Their fear keeps them from solving the problem head-on. The sad part of the story is that most patients simply want to be listened to and treated with respect. Doctors tend to have strong emotions about their knowledge and importance. Perhaps showing a patient respect can actually threaten their sense of confidence.
I don’t have much clinical experience. I’ve been practicing only 18 months or so and during that time I have made little to no decisions on my own, entirely on my own. I’ll share with you something I have learned in my short time in dentistry. I feel much more comfortable treating a patient who trusts me and I will make the time needed to earn that trust. I do not feel confident treating a patient who does not trust me. When I get to the point where I expect my patient to trust me because of my world renowned reputation, then I have failed myself to have a legitimate sense of confidence with my patient, and the patient’s distrust is justified.
Does it matter who is right? No. It matters how what the dentist does makes the patient feel. Does it matter how the dentist feels? Yes, especially when it compromises the patient-doctor relationship and treatment.
In this discussion I hope to have laid some of the groundwork necessary to start a meaningful discussion regarding the appropriateness of emotion in dentistry. We embrace and understand the heightened emotional experience of the dental patient because we understand that the mouth is the most emotionally charged organ of the body. But rarely do we discuss how it affects us to enter that space. And even rarer still is the role of emotions in dental practice a topic of discussion from our intraspective.
I will continue to develop materials regarding this topic in my studies as I proceed through my practice. My daily experiences serve to scaffold structural-ideas of behavior. I’d like to conclude this discussion with a quote from Bob Frazer Jr., DDS, FACD, FICD about emotional intelligence.
"Research studies on some 2,800 star performers done by Harvard and Rutgers show that 75 percent of high achievers' success comes from emotional intelligence (EI), while 25 percent comes from necessary technical competency.
Often, the most intellectually gifted (high IQ) and technically excellent dentists seem to be on a never-ending journey to elevate their technical competency. But many end up frustrated, sometimes even depressed, as they encounter countless recurring leadership and staff problems."
References:
- http://www.ada.org/5571.aspx http://www.ada.org/5571.aspx Conference on Dental Health and Wellness in Chicago, IL
- http://www.cda.org/library/cda_member/pubs/journal/jour199/impress.html January 1999 JOURNAL OF THE CALIFORNIA DENTAL ASSOCIATION
- http://wiki.answers.com/Q/What_is_the_meaning_of_interpersonal_sensitivity Interpersonal Sensitivity
- http://home.uchicago.edu/decety/publications/Decety_SN07.pdf Interpersonal Sensitivity
- http://books.google.com/books?id=5MP8gXv87OoC&pg=PA102&lpg=PA102&dq=emotionally impaired dentist&source=bl&ots=n2l-quPpy7&sig=vF11OwQ6vOQPXOuau_shWRSESmw&hl=en&sa=X&ei=Cj0wT_iKJcH00gHfvaTcCg&ved=0CEsQ6AEwBA#v=onepage&q=emotionally impaired dentist&f=false Drug-Impaired Professionals. Chapter 3 page 1, 3
- http://www.dentaleconomics.com/inde...ordinary-power-of-emotional-intelligence.html The Extraordinary Power of Emotional Intelligence.
