01 Apr Managing Anxiety in Dentistry
Written by Dr Marco Maiolino
As I have posted before, we in Italy are on total lockdown due to this pandemic, and since I am unable to post many cases, thought of sharing my past experiences in dentistry with all. I know many of us have faced similar situations and learnt from them. Hopefully, this helps some or many :-):
“This was many years ago but still the memory is deeply etched in my mind……….
I was a “Junior” dentist working under my father without a dental assistant at my side and a huge row of patients behind my office doors with very limited time allotted to work on them. It was an endodontic treatment on a molar that day….obviously no rubber dam at that time…but I was already working with NiTi instruments while, suddenly, a strange noise and a scary tactile feeling made me realize that an instrument broke inside the canal.
My heartbeat immediately shot up, blood coming up to my head. My mind lost its clarity and wanting to desperately solve the situation, I tried immediately to bypass the broken one with a new one. YESSS …broke also the new one!!!! I was growing so hot that I had the feeling I was sweating from all over…for sure under the neck, my mouth dry like in a desert.
I forced my self to think of the situation, it was an MB canal of a lower molar …I had hoped…maybe it was connecting with the ML and I would be able to gain the apex from that side. I quickly, too quickly, opened my drawer to look for a new instrument, I was breathing fast, too fast, and the patient was starting to open less and less..the space for working was very limited, I forced the instrument bending the tip in order to access the canal and…… guess what I broke the third one! By this time, the patient got up asking to stop the session saying that he was tired and unable to go on. I dismissed him. I had a bitter feeling of sadness, anger and impotence.
That was the first time, but it wasn’t the only one. I got myself into trouble doing extractions and breaking some root tips deep in the socket without being able to recover them…or while placing some implants I was fighting to find enough implant stability and much more….
Complications are a strange world ..it’s the typical situation in which everything seems to collapse ..not just one detail but a collection of many seemingly unrelated details..patient losing his compliance, doctor losing mental clarity, tough situation to manage and so on…
And nobody speaks about these kinds of stuff in courses and congresses. All we see is just at perfect straightforward cases. I had no path to follow in managing these situations, I had to rely on my self. In the beginning, I put much more focus and emphasis on the procedures and this paid a lot in terms of reduction of complications….I was breaking less endodontic instruments, removing more broken tips, placing better implants…but even if few when happening the situation was always stressful..the key of managing these situations was not just in improving my clinical skill, it was in changing my behaviour and a deeper comprehension of my patients.
We have evolved in thousands of years and, despite our technology, our cars, social media, hyperconnected world our mind is the same as the primitive ones.
The irrational and automatic part of our brain is much smarter than the rational one. It was when I read an article talking about a part of our brain that, unconsciously, recognizes anxiety in neighbouring people that I realized something.
Fear was one of the most important emotions of the primitive human and the ability to recognize fear among our neighbour, a skill that in some situations can save your life.
A part of our brain works in background recording everything that happens around us …and it recognizes perfectly the rate of breath, the speed of motion doing gestures and much more. In a perfect unconscious way, a patient ’s brain is able to recognize if you are scared or not and, being a patient in an uncomfortable situation, it will produce hormones fear-related in order to move away from that unreliable doctor. When you start to breath faster, the patient’s brain will start to produce fear-related hormones, his muscles will start to contract, his mouth opening will start to collapse and his compliance will start to fade irremediably.
It’s the perfect scenario for a tough situation shifting to an impossible one.
So I learnt at my expenses that in hard situations the real treasure is not in your hands, as skilled as they are…the treasure is in your mind.
The ability to stay completely focused and relaxed when things go bad, the ability to breath at a normal rate, to move your body without hurry is chief in the management of these situations.
It has been a long journey, you have to train your mind and body to do what you want failure after failure but it’s a skill definitively valuable.
You will find this skill again when you manage medium or long term failures…in these situations usually, the doctor is in a weak psychological situation and the patient immediately can feel this weakness but misinterprets, in many cases, this weakness for faulty behaviour.
This misinterpretation leads to a complete loss of trust from the patient. We everybody know this situation, we got in trouble, we would like to escape, we start to produce bad hormones …and the patient feels it immediately reinforcing their perception.
The doctor-patient relation in these cases is immediately destroyed ….to lose a patient is sometimes the better scenario; because the second scenario is the doctor trying to fix something with the patient still in the practice often just to save some money, but with a lot of stressful chair session with a scarcely collaborative patient.
I needed years to understand clearly these things in my mind….now I recognize the high educational value of failures and, someway, I started to appreciate them; not in the immediate honestly, but I know from the beginning that thanks to them I will further improve my dentistry and my self.
My dear friend Daniele in these days referred me a sentence of a famous writer, Isabella Allende.
“Crisis and adversity become opportunities for inner growth”.
She is so right !”