Communications of this kind should be used consistently with all operative procedures. The above interpretation of the doctor’s preparatory communications is based on feedback from patients with whom these kinds of exchanges have taken place. A patient who had stated that she was no longer fearful was asked why she felt this had occurred:
Doctor: “What is it that permitted you to overcome your fear?”
Patient: “Well, I think when you first saw me I had this tremendous fear built up because of my past experiences. I’d heard so many stories about the amount of pain I would suffer with your work… but I have to have it done. I’ve suffered so greatly with other dental work, surely I’ll have mountains of pain with this. By the time I came to you and with my own frightening experiences, the thing that calmed me was your ability to work psychologically with me. (Expertise and Recognition) First, knowing my tremendous fear. I had made just a couple of comments, you know, about one dentist and how I should have been here many years ago. (“Hearing” and responding to critical cues during the interview.) The method you used to tranquilize me by words (Interpretation, explanation, suggestion and commitment) logically, something for me to accept within my fear, so strong that I automatically began to relate and listen to what you had to say instead of closing my mind; logically you approached me and tranquilized me… I don’t know how else to explain it. In other words, the very words that you used put me at ease enough to say, ‘listen, maybe he is telling the truth…’ and I gained more confidence as you talked to me… as you explained. (Trust developing) I felt very confident; then when I came in for the surgery, I only had a slight apprehension. (Iatrosedative interview dropped fear level, but was still higher than normal) Yet I figured I might suffer the tortures of the damned…but I felt no pain whatsoever.”
Doctor: “Well, you were very apprehensive predicated on past experiences. You say the words that I used … what words?”
Patient: “You were willing to go out on a limb in telling me what to expect from what you were doing. (He made clinical preparatory iatrosedation communications so that she would know what sensations she may feel, thus minimizing the fear of helplessness and the unknown.) You have a habit of saying in advance “You may feel this, but it will not be very much if anything”, “you will feel pressure but no pain.” This in itself, when the surgery began, is the thing that puts your patients at ease… because every time a dentist picks up an instrument, just like everybody else, they want to run away… because he sees you picking up all kinds of things. He doesn’t know what you are going to do… and it’s the not knowing that upsets the patient.” (“Knowing” lessens the fear of the unknown.)
- “I can understand why you would be afraid of injections …” Support, respect, empathy.
- “It seems to me that you couldn’t trust that doctor to protect you from pain. You were depending on him but he didn’t seem to want to help you. These feelings still exist within you and you are still feeling today the same terror and distress you felt as a child.” Interpretation and explanation of why the patient is still fearful years after the original events.
- “But you can unlearn and learn a new set of feelings based on our relationship.” Suggestion and a promise of a new and different kind of relationship.
- “Let me tell you how I think things will go. First, I am confident that I can give you an injection with very little, if any, pain. If there is some, it will not be enough to be upsetting.” Beginning of the commitment. This offer is based on the ability to give injections in that way. To promise what you cannot deliver would be disastrous.
- “I will keep you informed at all times …” This to dispel the fear of the unknown.
- “If you feel any concern or discomfort I will stop. I will not do any treatment until you are ready and the area is numb.” This to dispel the fear of helplessness and dependency and to create some sense of control for the patient … as well as a sense of trust.
- “I know from past experiences that you can learn not to be afraid.” Suggestion that the patient can learn not to be afraid is coupled with the assurance of the doctor’s knowledge and expertise.