The Patient’s Perception of the Doctor

Fearful patients require a specific kind of behavior from doctors. Janis constructed a blueprint of such behavior based on his results obtained from a five-year study of the psychological stress endured by patients preparing for and undergoing major and minor surgery, including operative dentistry. He explored, in great depth, the emotions, needs and responses of these patients relative to the doctors who were caring for them. The behavior of the doctors was determined to have a powerful influence on the patients’ fear and stress levels. What they needed from their doctors became apparent. To begin with, Janis concluded that the patient perceives his doctor in 2 important ways as:

  1. A Danger Control Authority, and
  2. A Protective Authority.

Surrounding the perception of the doctor in these roles were strong feelings and needs. Janis summarized them as follows:

The doctor controls what the patient perceives as threatening or dangerous and is the only one able to protect him from that danger. The patient facing a threatening situation becomes anxious and looks for emotional support. The Danger-Control Authority, able to protect him from that danger, becomes invested with strong emotional significance. His behavior and communications assume greater importance than would ordinarily be expected. The patient’s ability to tolerate stress and learn to cope with this fear depends upon his being able to develop a sense of trust and maintain high confidence in the Protective Authority figure. In order to do this and develop a feeling of safety, there must be a “working through” before the patient is exposed to what he considers dangerous. This “working through” is the iatrosedative interview, the first interaction between the fearful patient and his doctor. Skillfully performed from a base of knowledge, it ordinarily should not exceed five to ten minutes. Janis’ findings suggest 2 questions that must be answered in order to solve the problem. They are:

  1. What does the patient perceive as threatening or dangerous?
  2. What can the doctor do to make the patient feel safe, that he will be
    protected from the danger?

The answers to these questions are the heart of the iatrosedative process.