Shifting gears; the unexpected, the uninvited and the inevitable

I have a birthday looming. When I’m sixty-four isn’t that much farther. Eliot’s suggestion that I grow old, I grow old, I shall wear the cuffs of my trousers rolled is beckoning, and the Simonesque image of sitting on a park bench like bookends is forthcoming. Friends are missing by design and default, family members are no longer in attendance at holidays or celebratory events. Medications I’ve read about are now being taken, allergies and maladies aren’t simply words, and parents are becoming children and I the parent to the parent. In my practice, words like Alzheimers have real significance in treatment; cancer, heart disease and diabetes, the real Big Three are taking spouses and impacting on care giving. The aging population is no longer an op-ed piece, it’s a fact of daily life. As part of the prep work for this blog, I read about practice management; bad economy, maximizing production, social media, internal marketing, but nowhere do I read about dealing with morbidity and mortality in my client base.

As a profession dentists are prone to the other Big Three; divorce, addiction and suicide. With all due respect, dentistry can be a golden handcuff, burn out is common. Nowhere do I read about dealing with the stresses of dental practice, how to cope with the anxieties of our clients, dealing with their historic fears of us as a profession or as a trigger for issues that have nothing whatsoever to do with root canals or periodontal disease.  By chance,  I fortuitously met Claire Edmonds, PhD. She and her family were at the same cinema as my wife and I watching the grossly overrated A Dangerous Method. For some reason that only the gods can address, we chatted and I learned that Claire’s PhD has taken her down the road of counselling care givers in high stress occupations; oncology and ICU nurses, anon. As is my penchant, I arm twisted her into writing blog entries on dealing with the stresses in dental life that only get cursory acknowledgement; the personal angst of dealing in a profession that in spite of hot towel dispensers remains a negative consumer perception and the sad reality that baby boomers get sick, incapacitated, incontinent and die before their time. Claire has agreed to find her way with this initiative; neither of us are sure where it will lead. But after 137 years in dentistry, it’s a part of dental life that should be addressed. In a very skewed perspective, we are in the trenches daily. Pull out a syringe and I don’t care how spa-like your facility, you are an aggressor. I don’t care how many buzz phrases you’ve learned, a patient with a chronic disease requires incredible tolerance and a level of acceptance and understanding we were never trained to address.

Dr. Edmonds:

The doctor is in… I have a friend who is the principal of a school. He once commented that sometimes he wished he ran a school for orphans. Apparently, its not the kids that drive him crazy, its their parents. In dentistry I can imagine that the feeling is similar; its not the teeth but the owners that you dread. This challenging interface between the patient and the practitioner is the zone that few are trained for, and yet it can make or break the experience for both parties. As a consultant in patient education and support, this arena is a familiar comfort zone for me. We have an interesting relationship with our dentist. It is based on trust (who else would you allow in your mouth waving about sharp instruments). It is fraught with ambivalence (I know I need to go to the dentist, but I don’t want to). It can even be tainted with guilt (and how often do you really floss) and shame (yes, my bottom teeth are crooked). There is an element of mystery (what does he see in those x-rays). And very often there is fear, fear of needles, drills, helplessness and pain. A visit to the dentist is stressful for most of us. Added to this is the fact that life is generally a pretty stressful endeavour. You may have noticed that your patients are coping with more serious stressors, particularly as the population ages. There is more financial insecurity and job uncertainty. Your patients may have aging parents and young children. They may be aging themselves and coping with ill health, loss of a spouse, changes in their living arrangement and other major life changes. There is more time pressure; remember when dentists didn’t need to have evening appointments? Many people are feeling pulled in different directions and this stress is played out in traffic, grocery lines and dental chairs. I have been seeing my dentist for over twenty years and he is acquainted with more than just my bicuspids. He treats both my parents who are in their 80’s, my husband and our two teenage daughters. He’s almost a member of the family. When I visit him he asks about them all – and the news can vary from good to bad to indifferent.

Added to these realities of modern life are the very dynamics of a dental appointment that can precipitate challenging interactions. The stress of a dental visit can exacerbate the underlying stressors a patient is already dealing with, increasing arousal and emotional volatility. Patients are placed in a vulnerable position, lying on their backs, staring at the ceiling with their mouths open. Freud understood how the supine position on a couch can do an end run around the defences. The long term, intermittent and yet intimate nature of the relationship often entails a ‘catching-up’ precipitated by the question, “So, how are you?”. It may even be important for a dental professional to ask about the patient’s state of mind because of the relationship between dental health and mental health (who knew there was a difference between clenching and grinding?). So, the goal of this blog is to explore the tight psycho-social space between the dental professional and the patient. There are strategies and techniques that can be used to support patients who are dealing with stress, and ways for dental professionals to navigate the psychological arena. In the coming weeks, we shall explore some of the challenges that arise in the charged spaces between patient and practitioner. I hope to offer practical suggestions and strategies for managing and navigating these relationships. The doctor is in…