Iatrosedation by Dr Nathan Friedman

Euphemistic Language

The term “euphemism”, derived from the Greek Ew (well) and Phanai (to speak), originally meant “to use words of good omen.” The definition of euphemism as we know it today is similar; it is the substitution of a mild or inoffensive expression for one that may offend or suggest something unpleasant. With respect to dentistry, the use of euphemisms is particularly indicated in place of:

  1. fear-provoking or threatening words, and
  2. technical terms

The use of threatening and technical language is a frequent barrier to communication between doctors and patients. It either creates apprehension and confusion or intensifies them if already existent. In order to prevent potential problems that can result from the use of emotionally-charged language (with which dentistry is richly endowed) or technical jargon, the doctor must develop alternative methods of communicating potentially threatening information to patients.

Euphemistic language should be used with all patients. Since it tends to minimize anxiety, it is an integral part of iatrosedation. An example of its use may be seen in the communications used above for the atraumatic injection. Although these preparatory and explanatory communications are very brief and quite simple, thought has been given to substituting low threat words for threatening ones and non-technical for technical ones. For example, few lay people know what a topical anesthetic is, hence it is referred to as a surface anesthetic. Instead of saying “This won’t hurt,” the phrase used was, “I don’t expect you to feel this.” “I will be injecting slowly” is replaced with “I’ll be doing it slowly”, since some people may have disturbing imagery stimulated by the word “injecting”, particularly if the injection is the primary fear problem.

These simple euphemistic substitutions are not earth-shaking. Most dentists seem to be aware of the many threatening words and terms with which the dental vocabulary is laden: drill, needle, shot, cut, clamp etc. What is consequential is the decision to avoid these words, to replace them with euphemisms and to develop the constant, ongoing vigilance required to avoid falling into the trap of being verbally threatening. When one considers the dilemma of describing, in non-threatening terms, a pulp tester and its use to an anxious patient, one realizes how euphemistically agile the dentist must be!

It is necessary to maintain the iatrosedative posture in all phases of involvement with your patient. Another communication principle for reducing threat in what might be a threatening situation is the use of a preparatory interview.

Preparatory Interview

The preparatory interview is a brief interview conducted with the patient prior to performing a treatment or diagnostic procedure for the first time with a patient which could be threatening to him. The objective is to learn 2 things:

  1. Has the patient ever experienced this specific procedure before (e.g. endodontics, injection, periodontal probing, periodontal surgery etc.)?
  2. How does the patient feel about it?

The general principle of knowing how it is with the patient before taking him into an area of potential threat seems irrefutably sensible and sensitive. Preparing to use potentially fearsome instruments or procedures with no knowledge of the person’s experience with and feelings about them seems illogical.

Let us assume that Mrs. X has successfully shed her fear of injections. However, in the course of continuing dental treatment it becomes apparent that endodontics is required. Following the examination, the need for it had been discussed briefly. How should Mrs. X be approached? If the roentgenograms indicate that endodontics had been performed should you assume that no problem would be encountered, tell her of the need and proceed to refer her to an endodontist or set up an appointment to treat her? Or should you learn something of her feelings about having endodontic treatment? The obvious answer to an obvious question: yes.

Doctor: “Mrs. X if you recall I had mentioned that you would need to have a root canal treatment. The X-rays indicate that you have had this kind of treatment. How did it go?”

Mrs. X: “Well, (hesitantly) I really had a bad time with it.”

Doctor: “A bad time?”

Mrs. X: “Yes, the tooth was very painful, it ached badly and although the doctor gave me several shots, all of which scared me, when he took the nerve out I almost died, it hurt so much.”

Doctor: “I can see that you did have a bad time of it and I can appreciate how you must feel about considering root canal treatment again. Fortunately, however, we have a different situation now. You see, when the tooth is very inflamed such as yours was last time, it is very difficult to get good anesthesia. This is not the case with the tooth now. As a matter of fact, no anesthesia is needed at all because…”

The remainder of the discussion need not be pursued here. The example is used to point out the wisdom of exploring potentially threatening procedures with the patient before starting treatment.