John A. Wilde, DDS
One behavioral skill influences a dentist`s professional success, financial future, and personal happiness more profoundly than any other factor. I call that skill confrontational tolerance. While most dentists are aware of this issue, few comprehend it at a level that allows them to utilize this ability to enrich their practices and lives. Understanding and implementing this powerful human dynamic was the most important ingredient leading to a level of financial success that allowed me the option of retiring at age 40, 12 years after entering private dental practice. This skill can enhance the practice prosperity and life quality of any dentist who masters it.
Confrontational tolerance can be defined as the ability to skillfully, kindly, effectively, and firmly tell the truth, even (and especially) in situations where the other party may not agree with you or wish to hear it. Having this ability is a critical component of dental success. Those unable or unwilling to develop the strength and courage needed to persevere in the face of resistance fail to attain the levels of achievement available only to the brave.
This is old news. It is essential information, but a topic I`ve heard discussed for years. Yet, the customary counsel given to struggling dentists by the wise men who examine this fundamental ability to confront another in a positive, ideal manner is: "Deal with it!" or "Just get over the anxiety!" Similar to the Oakland Raiders` famous slogan of "Just win, Baby!" These suggestions sound good, but are of little help in one`s quest to conquer the innate and debilitating fear of confrontation.
Certainly, being aware that a problem exists is a vital first step toward its solution, but diagnosis alone is of little worth. If the precise mechanism of the malady is not understood, then an efficacious treatment of the condition is unavailable. AIDS is a horrific, contemporary example of this contention.
The fear of confrontation
We`ve identified our foe. Now, let`s examine its origins, so we can craft an ideal plan to deal with this potentially crippling anxiety.
Confrontational anxiety can be traced to humankind`s first societies, the small tribes of our hunter-gatherer ancestors who existed in dangerous, primeval savannahs, jungles, and forests. Then, rejection from the group - i.e., expulsion from the clan as a result of some unacceptable behavior - meant a sentence of almost certain death for a single, puny human (with the possible exemption of Tarzan). The outcast was doomed to wander the daunting wilderness alone, becoming an easy prey for many powerful, man-eating predators.
Witnessed in its historical context, one can appreciate the fear of rejection as an important protective reflex, similar to a fear of reptiles, dark places, and heights. Its existence has passed the rigorous challenge of natural selection, as people who feared rejection - and abstained from behavior that could lead to banishment - were successful in avoiding expulsion from their community. Thus, they were more likely to survive, reproduce, and pass their DNA on to future generations.
The ancient, preverbal portions of the modern mind still harbor shadowy, but puissant, memories of the terrifying death-sentence rejection by one`s group, carried in humankind`s long-ago past. A hormone-controlled response to the threat of this possibly terminal result causes the thundering pulse, dry mouth, acid stomach, and sweating palms many of us today feel when speaking in public, asking for a date ... or suggesting uncomfortable, expensive, time-consuming dental care! It`s a logical reaction. Each of the above scenarios carries with it the threat of rejection by others, and thus triggers protective reflexes that result in unpleasant feelings of anxiety, warning us away from what - in our own perception, at least - is a potentially lethal danger.
The fear of rejection leading to death is factually groundless today. Humans no longer exist in isolated tribes, and dinosaurs and saber-toothed tigers are extinct. But, despite the relative physical safety of modern society, the anxiety and painful emotional shock that is triggered by potential social banishment remains a compelling motivation to avoid such situations.
Dentists who desire to maximize their potential must come to realize that in the ancient past, this reflex protected our lives; but, in modern dentistry, this no-longer rational response limits our future! The behaviorally adept can discover ways to control this anxiety within themselves and employ awareness of the confrontational fear of others to more efficiently deal with people.
The new-patient examination
Consider the common scenario of a new-patient examination performed on a male patient older than you are. (An older male happens to be my hardest patient to confront. What`s yours? Identifying your own personal fears is a critical first step in preventing these fears from limiting your success.) This patient`s chief complaint is, "Nothing hurts and I just want them cleaned, Doc. Don`t try to sell me nothing!"
Clinical examination reveals badly worn, five-surface amalgams on teeth numbers 18 and 19. Multiple cracks are visible in what slight tooth structure remains. Aged beef is firmly wedged between inadequate contacts. There is no question of the immediate - and critical - need for full-coverage restorations.
Despite the best of X-rays, a pristine intraoral-camera image, a loyal hygienist`s suggestion that care is desperately needed - even divine revelation - a dentist who fears rejection usually will present proposed treatment in the following manner: "Ahhh ... some day ... we should ... ahhh ... perhaps, think about.... ahhh ... possibly ... (in a whisper) crowning teeth 18 and 19." This dialogue usually takes place on the "good days" when the dentist`s self-esteem is powerful enough to allow him or her to face the demons of rejection, and thus casually mention ideal treatment!
Technically, the doctor did his duty by suggesting needed care. A loyal staff member notes the recommended treatment (the staff is accustomed to the dentist`s timid mumbling) and dutifully presents a treatment plan to the patient who has no concept of what anyone is talking about. The proposed treatment undoubtedly will be refused, but our timid dentist has managed to survive another day without suffering rejection from the tribe ... even if not a very busy or productive one.
The greatest loss is that the patient remains totally oblivious to the fact that treatment to protect his comfort, function, and health was suggested. Due to the dentist`s timidity, the recommendation was made in such an ineffective manner that there almost was no chance of it being understood and acted upon.
The effects of self-talk
Let`s consider the same situation after our four-step program has been implemented and examine how properly prepared self-talk, employed by an aware, motivated dentist who possesses the internal strength to face his or her fears, can maximize communication.
Our new, improved dentist remains human, so the habitual protective reflex - i.e., warning, possible rejection - still begins the internal self-doubting dialogue: "I don`t know this patient well. Maybe I would be wise to develop our relationship for a few years before broaching the need for ideal care? Perhaps I should just wait until a cusp fractures and then hope the tooth still can be restored!"
But now, due to the dentist`s newly enhanced understanding of this protective reflex, the fear-of-rejection language is identified immediately and its veracity aggressively challenged. A precrafted self-talk - carefully prepared before an emotion-laden situation arises -- is implemented to stop the crippling effect of this trepidation.
"Wait a minute," the dentist says. That`s my fear of rejection talking. I refuse to let an ancient, emotional reaction limit my life! The need for the crowns is undeniable. It is my legal and moral duty to present any care obviously in the patient`s best interests in a clear and concise manner. I can`t allow this ridiculous anxiety to prevent me from completing my obligation to myself and fulfilling my sacred duty to my patient."
Now, the fear has been named. The penetrating light of reason is focused on the emotional situation. With this insight, the dentist can use the energy once consumed by anxiety to confront the problem in a creative manner. Now, the self-talk goes something like this:
"I must develop a relationship with this gentleman quickly and skillfully. Despite what he`s said, I`m certain he doesn`t wish to lose these teeth. By asking questions, I will help him clarify his authentic, long-term, oral-health wishes and put him more at ease. I`ll use a mirror, intra-oral camera, and X-rays to explain and document the situation accurately. Then, I`ll illustrate the care needed in a gentle, considerate manner that won`t stimulate the patient`s own fear of being rejected by me, which could lead to a hostile, defensive response on his part. I can avoid confronting him by asking permission to present my full diagnosis. Once this permission is granted, I can look him in the eye and state, "Mr. Brantley, we`ve examined the facts. If these were my father`s teeth, I`d ...` "
The wise dentist is not only able to avoid the negative consequences of his or her fear of rejection, but realizes that the same dynamics are even more powerfully at work in the patient. Because patients are forced to deal with a new (and thus "unsafe" and fear-evoking dental-office environment), their anxiety behavior is even more profound than the dentist`s. This fear sometimes is disguised as an angry reaction to a threat of rejection from the dentist and his or her staff.
Aware of the patient`s fear, a dentist must do everything in his or her power to create a comfortable, nonthreatening environment. Smells, sounds, appearance of the office and the staff, facial expression, voice, and body language must be carefully controlled to create the accurate perception that this is a safe place. After the patient feels a "part of the tribe," chances of achieving a mutually agreed-upon treatment plan - and a lasting friendship - are enhanced greatly.
The preferred future
And so it goes in confrontational situation after confrontational situation. The dentist in our example understands the fear of rejection and has made a conscious effort and enlightened commitment to deal directly with his or her own "dreads," as well as those of the patients. Courage isn`t a matter of having no fear, but of choosing to confront your fears. Only when you face your fears can they be banished.
Consistent, value-based behavior from the dentist results from his or or her efforts to confront those fears. It is a tremendous boon to staff because inconsistency bequeaths stress. It is unpleasant and confusing to work for an employer whose oral-health beliefs seem to vary from moment-to-moment. This inconsistent behavior is based on the doctor?s ability to control his or her anxiety or the current fullness of the office schedule, rather than a clearly defined and constantly expressed personal philosophy.
Confrontational ability is a muscle, and the key to enhancing its strength is to exercise it! Developing awareness, understanding, and a specific strategy to deal with the crippling fear of rejection allows you to skillfully offer each patient ideal dental care in a reduced-stress manner. By doing this, the doctor earns professional success, financial prosperity, and enhanced personal freedom and joy.
With practice, your ability to influence others appears to be magical! It is a skill you can cultivate if you are willing to summon the courage necessary to confront and conquer your fears. It is up to each of us to make the effort required to become worthy of achieving our life?s desires. Certainly, facing your fears is not easy ... but what of great value is easy?
Creating a OSafe PlaceO
The sense of smell is one of humankind?s most ancient and powerful senses. Dental offices ? as do hospitals and nursing homes ? have an innately disturbing odor. In my office, we use a bread machine to make fresh bread daily in the office. Is there any smell more pleasant and reassuring than that of baking bread?
Aromatherapy machines and vanilla candles mask possibly unpleasant or disturbing odors. Heated neck pillows emit a grainy smell, similar to Grandma?s oatmeal, while soothing tense neck and back muscles.
Are these little things worth- while? All I can tell you is that we?ve received a very positive response to them from our patients. They are Olittle thingsO that set our office apart in terms of telling our patients we appreciate them and want to ensure their comfort. And, as we?ve all learned in life, sometimes the little things mean the most!
Dealing with the fear of rejection
What follows is a four-step plan that can be implemented to effectively deal with the fear of confrontation and rejection:
(1) Be aware of this fear`s existence, its powerful historical basis, and how it has affected your life to date. Then, actively challenge the internal messages triggered by this no-longer valid or helpful emotional reaction.
(2) Analyze specific situations where confrontational-tolerance weakness has negatively impacted your chances of success. Demonstrate to yourself, beyond the shadow of a doubt, that the anxiety you feel has no basis in fact, but is merely chimera.
(3) Deliberately plan new, ideal behavior in the afore-identified uncomfortable circumstances. Visualize the problem areas and see yourself responding with enhanced competence, based on new understanding and determination. Role-play and refine specific dialogues for every situation where lack of confrontational tolerance has limited your success. At first, this will feel artificial, unnatural, and contrived ... as does all growth.
(4) Begin to display this rehearsed behavior. Monitor results and make adjustments as indicated by your success or the lack of success. Reaffirm your commitment to no longer allow this emotional discomfort to keep you from achieving goals your personal and professional values indicate are ideal.
Great rewards await those who accurately understand the basis of human motivation, formulate enlightened self-talk, and then summon the courage to confront this issue. Facing the fear is integral to dental success, wealth accumulation, and achieving optimal results in all situations involving personal relationships - the basis of peace-of-mind and joy.