Are you mad at me?

I really am uncomfortable with anger; whether it be my own internal emotions or such feelings directed at me from others. I have a theory that this slight personal foible is somehow related to my toilet training, however, recollections of that troubled period of my life are vague, despite the fact that I was 10 years old when said training occurred. Whatever the reason for my particular discomfort, anger and I make uncomfortable bedfellows. (In deference to Freud, we`ll just leave that statement

Jan 1st, 1996

Have the courage to face anger in a proactive manner and the quality of your life will be improved.

John A. Wilde, DDS, PC

I really am uncomfortable with anger; whether it be my own internal emotions or such feelings directed at me from others. I have a theory that this slight personal foible is somehow related to my toilet training, however, recollections of that troubled period of my life are vague, despite the fact that I was 10 years old when said training occurred. Whatever the reason for my particular discomfort, anger and I make uncomfortable bedfellows. (In deference to Freud, we`ll just leave that statement alone.)

I suspect my discomfort with the emotion of anger is shared by many of the fine members of our dental profession, both doctors and staff. Most of us are nice folks. We don`t want to make anybody mad. In a perfect world, that desire might suffice to keep the wolf of anger from our door. Unfortunately, on this mortal coil, there are a lot of "little Johnny one-notes" running around whose entire emotional arsenal ranges from mad to real mad. (I believe the late writer and critic Dorothy Parker once described an actress as being able to emote the entire range of emotions, from a to b.) You can run from these upset and upsetting people, but you can`t hide. Dealing with anger is an unavoidable fact in the service profession of dentistry.

Anger does have a beneficial and functional place in our lives. If you are being attacked by a saber-toothed tiger, getting mad most likely would prove efficacious. I can`t speak for everyone, but life-threatening physical peril (with the singular exception of dealings with my spouse) rarely occurs in the course of my daily existence. So, today, we`re sort of all dressed up (with our full complement of anger) with no where to go. Physiologically, anger has become the ap-pendix of emotions. Or, at least it should be. Despite our modern world`s lack of physical danger, most of us still are forced to deal with anger frequently; either our own or that of others. I`d like to address both scenarios of internal and external anger, but to emphasize, especially, the problem of how to deal with angry people when they confront our own lives. (First hint: disarm them.)

Our Own Anger

We can`t control the fact that we have emotions. They exist. What we can influence is how we deal with them. The behavioral course I`m about to suggest is difficult, but I know of no other solution that works to eliminate anger so effectively in myself. We become angry when we have judged. Thus our act of judgment-i.e., the evaluation that another is wrong- proceeds the emotion of anger.

I attempt to recall two facts in these emotionally-charged situations:

1. People have the inalienable right to be wrong. I`m not sure if this right is God-given, or just in the Constitution, but the certain right to human error exists. Hopefully, self-understanding and growth results when we realize our blunders; but nothing states that people must always be fair, correct or pleasant.

2. We have no right to judge. Certainly, I don`t possess absolute knowledge. It is from this act of judgment that anger occurs.

My point: We`re on shaky ground with our anger to begin with, not only philosophically and morally, but also pragmatically. With the exception of the occasionally saber-tooth attack, responding to situations with anger seldom leads to the preferred outcome.

We, in the healing professions, are aware of the pernicious effects of anger to our body. These range from hypertension, ulcers, colitis, bruxism and TMJ problems and possibly include even cancer. Anger is a great source of stress, and Hans Seyle, in his seminal work on stress, described the last state of stress clearly and chillingly: Death of the organism.

Thousands of years ago Buddha told us that we are not punished for our anger; we are punished by our anger. Reflect on the loss of sleep, appetite and interest anger has caused you in the past. Is this the way you prefer to exist?

If we agree on the ill effects caused by this internalized ire, what can we do about eliminating the unpleasant ramifications of this emotion? There are two basic paths we can seek to ameliorate the destructive effects of anger.

One is behavioral. We can meditate, exercise or involve ourselves in other activities to dull our awareness of anger. These are simple and effective techniques, but the anger remains inside us; only temporarily displaced (for me often until about 4 a.m.).

More effective for me has been to choose consciously to relinquish my anger. To realize I have judged, and that the person who I am angry with had the right to act as he/she did, no matter how poorly I feel his/her behavior had been. I must not only forget, but I must forgive. I must mentally wish them nothing but goodness and continue wishing them the best until all traces of the anger have disappeared. (Complete resolution of anger sometimes takes days for me to achieve.)

If this behavioral choice seems unfair or even impossible, consider, again, the "benefits" of retaining your ire; some of which were noted previously. Carefully consider what is the best and most intelligent choice for all parties involved. Do you think holding on to your anger causes a lack of sleep or unsettled stomach in the person you are upset with-or is it your own body you are punishing by choosing to stay mad?

Others Angry at Us

I have heard it said that mastery is grace under pressure. Nothing tests my Right Guard like a confrontation with an angry patient. Seldom am I verbally (and not since high school, physically) attacked in our sophisticated, modern world; yet, all of us are very aware of anger in another. The emotion seemingly rolls off in waves, like ripples in a pond. In the event that we are forced to deal with angry people (and we will be), I have a few suggestions I hope may prove helpful.

When I enter a room and sense aggression, I always greet the emotion and the person modeling it with a big smile, a hearty hello and a firm handshake. The handshake is the key.

I don`t understand the mechanism, but it`s very hard to be angry with someone you are touching. I realize that such a greeting in these uneasy circumstances is both unnatural and uncomfortable, but mastery of any worthwhile art is difficult.

Most of the time, patients don`t verbalize their anger, but just emote it. Often, they aren`t angry with you as a person. It may be his/her last dentist, a member of your staff or even his/her own stupidity or fear he/she is reacting to. Whatever the true focus of his/her ire, you`re still the person in the line of fire (a little poem!).

I, once again, am going to request of you an unnatural act. Instead of confronting this uncomfortable situation by thoughtfully looking at your shoes (hadn`t noticed which pair you wore today, until you experienced this person`s stare), look the patient in the eye and quietly ask, "Are you mad at me?" Then push back your chair, shut up and listen.

The most common response to such a candid query is a rather shocked look and a denial of anger. In this usual case, I reply "good." (I do love witty repartee!) "Because, if, somehow, I had caused you to be angry, I`d like to know what I`d done and correct the problem right away." Often the patient will apologize if he/she "seemed" out of sorts and explain that "some other thing" had upset him/her. Secure now in our mutual admiration, we are free to proceed on a positive note.

This small act of courageous confrontation diffused the anger instantly, and leaves you The Master. I believe, at some level, patients realize the event which occurred is a singular thing. Anger was dissolved as quickly and surely as a lump of sugar added to boiling water. Most people don`t realize such an alchemy of emotion to be even possible.

Over the years, this emotion-defusing technique has held me in good stead. I have both avoided the unpleasantness of conflict and gained goodwill in exchange. Candor compels me to relate the singular circumstance when this approach failed me.

On this ominous day, we had a young doctor (who, eventually, despite the soon-to-be-related contretemps, became our associate) visiting our office. I was about to go greet my next patient, whom we had previously seen only on an emergency basis a few days before. At that time, we had prescribed an antibiotic for relief of an abscessed tooth. She now was seated in a treatment room, waiting for me to perform a root canal. Just before I was to enter the room, my chairside slipped me a note saying Mrs. Smith was seated, but was very angry.

I calmly fought off my first reflexive response (to go home!). I reasoned that since I had never touched Mrs. Smith, how mad with me could she be? Young visitor in tow, me and my mastery advanced on our unsuspecting foe. (Poem two!)

Big smile, warm handshake. She sure did look mad! Not to worry, I threw my strike-out pitch: "Mrs. Smith, are you mad at me?"

"Yes."

I`ll spare you the dialog that followed. Mrs. Smith was fairly articulate. I lapsed into my habitual response to anger that involves mostly sweating and stammering. When the smoke cleared, it turned out Mrs. Smith was angry with me because her tooth still hurt. Under close questioning, she admitted she hadn`t taken the medication we prescribed, as she had been "just too busy" (that`s darn busy!).

Believe it or not, the root-canal procedure went flawlessly. By the time the day was over, I`d almost quit shaking. Everyone agreed I`d handled a difficult situation well, with the singular exception of my gastric lining. I needed new cells down there, anyway, I`m sure.

There is no perfect plan. I guess this one occurrence in 20 years of practice is proof of that. Despite the aberration of Mrs. Smith`s conduct, this direct and confrontational approach to anger has saved me from a great deal of emotional distress over the years. By defusing the patients` emotional state, it saves me having to get angry.

Consider how the effects of negative emotions linger in your office and drag down your whole staff`s energy and enthusiasm. What effect does anger have on your ability to perform and communicate with staff and patients for the remainder of the day? Choose to have the courage to face anger proactively, both in the office and outside it. I think you`ll find the quality of your life improved by the exercise.

The author has a private practice in Keokuk, IA. He is the author of Bringing Your Practice Into Focus, A PennWell Books publication, and How Dentistry Can Be A Joyous Path To Financial Freedom, which can be ordered by calling 319-524-8811 or faxing 319-524-9785.

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