Shame and its subtle expression

During a recent coaching visit, I witnessed an all too common emotional response by a new patient that dentists and their teams often miss. It can cost them dearly!

During a recent coaching visit, I witnessed an all too common emotional response by a new patient that dentists and their teams often miss. It can cost them dearly!

A 64-year-old, civically prominent woman had come in for a case presentation with my client, a well-qualified restorative dentist. I was there to observe the new-patient experience for critical feedback and course correction. My client doctor, we'll call him Dr. J, had beautifully documented this case with intraoral 35 mm digital photographs, mounted original models, and a beautiful tooth-colored wax-up. He had "before" and "after" digital slides of similar cases he had done, along with slides of the patient, Ann. We were seated comfortably in a well-appointed consultation room with appropriate diplomas, certificates, visual aids, and a 64-inch LCD flat screen. Sounds perfect, doesn't it?

After niceties acknowledging Ann's recent outstanding charitable citizen award, Dr. J reviewed why she had sought his help, so that I would understand her severe periodontal and restorative problems. Ann nodded, commented briefly, and generally appeared pensive. Then, Dr. J, said, "Well, Ann, let's take a look at the photos of your mouth." Ann's brow immediately wrinkled. With a slight frown, she sat back, leaning away from Dr. J, crossing her arms and legs.

He brought up the first slide of Ann's forced smile, showing lips and teeth with obvious periodontal recession. Dr. J said he had seen her picture at the award ceremony on the newspaper's front page. He noted she had her lips together with a forced smile. Before he could get those words totally out of his mouth, I saw Ann shake her head and look away.

At that moment, I asked Dr. J if he would mind if I intervened. He was surprised, but said no, that was OK. I asked him to turn off the slides, and then I asked Ann how she was feeling about seeing these pictures. She looked at me with disgust written on her face and said, "I hate it!" I nodded, leaned toward her, and said, "Can you tell us why?" Ann said, "Of course I can! I feel so guilty! I'm responsible for this and should not have let this happen." Reflecting those feelings back with a gentle understanding, I said, "It sounds like you're feeling ashamed of your mouth and in some way responsible." (Note: My client resides in the British Isles, where many people Ann's age are edentulous.) She concurred and reiterated how she hated to see those pictures. I told her I understood how she could feel that way. Then, I asked her how she would like Dr. J to present what can be done for her. She said the models would be fine, and maybe slides of a "before" and "after" full-face smile of a patient with similar problems. Clearly, the intensity of Ann's nonverbal response - which my client missed - conveyed strong emotions, primarily of guilt and shame.

John Bradshaw, in his book, "Healing the Shame That Binds Us," describes shame this way: "What I discovered was that shame as a healthy human emotion can be transformed into shame as a state of being. To have shame as an identity is to believe that one's being is flawed, that one is defective as a human being ... it becomes toxic and dehumanizing." Three times over my 30-year practice, we professionally videotaped our new-patient process. After the taping, we had patients view themselves on the tape with a counseling psychologist. Whenever they had a feeling or thought that they didn't express to us, they stopped the tape and discussed it with the psychologist. We also filmed that interaction and gained profound insights, so important that we created a training video.

We found that new patients, regardless of how they were referred, came in guarded and with feelings of guilt for something they had not done that a previous dentist had told them to do. With one, it was a crown on a root canal tooth; with another, it was added periodontal therapy; and with a third, it was being overdue for recare and not flossing. It became my habit during the intake interview -when I heard or observed (92 percent of communication is nonverbal, often expressed in the face) such emotions - to simply reflect the patient's feelings and pause briefly for confirmation or expansion. Then, I would reach over, quickly and gently touch the person's forearm and say, "We give forgiveness and absolution here." In each video you can see the patient visibly relax, often smile, or chuckle. The fact that I understood and was OK with wherever the client was emotionally made an important difference. It will work for you, too!

Dr. Bob Frazer, Jr., FACD, FICD, is founder of R.L. Frazer & Assoc., whose custom programs help dentists achieve top 5 percent status in financial achievement and life balance (fulfillment with significance). Thirty-one years of quality practice and superb communication skills have propelled him to a 28-year international speaking career. For information on his upcoming "New Patient Experience for the Values-Driven Practice Practicum," 1/27-29/2005, or a new audio CD series, "How To Build the Exceptional Life and Practice," contact him at (512) 346-0455, fax (512) 346-1071, or email him at bob@frazer Visit his Web site at

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