Iatrosedation by Dr Nathan Friedman

The Iatrosedative Interview

The iatrosedative interview has been fashioned after the traditional open-end interview. It begins with a question such as, “Are you having any difficulties?” The question provides the patient maximum opportunity to reveal what is uppermost in his/her mind; it permits the patient to establish his/her priority of “difficulties.” If the patient elects to begin with a statement about sensitive teeth or bleeding gingiva or a need for examination because he suspects caries, the doctor responds to each particular cue. He will go on to get information about the problem or need until he is satisfied that he has all that is required to help make a diagnosis and treatment plan.

Most patients are not inordinately fearful and manage their anxieties well, hence the iatrosedative interview is not needed. However, should the patient respond with any of the many statements of anxiety such as, “I am a coward about teeth” or “I’m the worst patient you’ll ever have” or “I’m scared to death,” the interview should be put on an iatrosedative course immediately.

Strategies of the Interview

Two strategies are involved:

  1. A verbal, fact-finding, interpretative strategy, and
  2. A non-verbal, empathic strategy

The verbal fact-finding strategy is divided into 2 major categories:

  1. gathering information
  2. giving information

Gathering information has a Sherlock Holmes quality about it. The objective is to ferret out pertinent information quickly and concisely. The first question, as suggested from Janis’ findings, the doctor (Danger Control Authority) must have answered is, “What is it that the patient perceives as threatening or dangerous?”

Once the patient’s fear is determined, the second step is to determine how the fear was learned.

Knowledge of the learning paradigms mentioned above can be helpful at this point. Again, this information can be elicited quickly and concisely in a matter of four or five minutes, or less. This is not meant to be an in-depth, prolonged inquiry.

Good information gathering requires an adroit questioning technique, the ability to listen and “hear” what is central in the patient’s communication and to respond in a way that will facilitate the unfolding of the story.

After gathering information, the doctor switches to giving information. It is his turn to talk and the patient’s turn to listen. In giving information, the doctor (Protective Authority) answers Janis second question, “What can the doctor do to make the patient feel safe, protected from danger?”

The gathered information is valueless unless it is sorted out and interpreted. It is then fed back to the patient in a way that will give him insight into the specifics of the fear, how is/was this learned and how it can be unlearned. The doctor then states his commitment as to how he will behave and what effect he expects his behavior to have on the patient’s ability to relearn.

This verbal communication, coupled with empathic non-verbal communication, will initiate a feeling of trust. If the trust is maintained and subsequently deepened by the Iatrosedative clinical encounters, the fear may be eliminated because fear is soluble in trust.