So what happened to you? That’s the simple question award-winning writer Anna Deveare Smith posed as part of her research for a play about medicine. While the query was quick, the answers were not. When discussing their relationships with doctors and the healthcare system, Smith recalls, people’s thoughts and emotions tumbled forward in a torrent. They were anxious to be heard. They needed their stories told. My own experience follows a similar trajectory. Since I began practicing dentistry in the 1980s I have cared for tens of thousands of patients encompassing a wide spectrum of personalities and backgrounds. But for all their unique characteristics I am certain my patients share this trait: not a single one was born afraid of the dentist. Yet, a very great many of these patients became afraid of the dentist. So what happened to them? I can’t always retrieve this information easily. But it’s my custom to explore, and not for voyeuristic reasons. To me this history is almost as significant as any other aspect I will uncover about my patient, such as whether they have heart disease or recently battled cancer. I probe this emotional past not to foment problems but to prevent them. If I eliminate this step, one consequence is the cycle of distrust continuing. But it’s the possibility of the worst case that makes this unacceptable. Left unaddressed my patients’ anxieties build on a foundation of psychological distress. As studies have long confirmed, fear compounds pain. The therapeutic process is made more complex for both of us. Without a bond there’s no trust or treatment, not even comfort. The search for why my patients fear dentistry has taken me to some very dark places. While I’m entirely confident that most of my colleagues are honorable and ethical doctors, there exist rare and painful exceptions. One woman reported that as a child—whose family’s poverty prevented regular care—she was punished for the “shame†of excessive plaque by being made to eat some on a cracker. There’s another thing we know about pain: it doesn’t just spring from injury. Humiliation, depression, despair—all manners of emotional harm can sometimes provoke an actual physical sensation. Fortunately, while I can’t erase a patient’s memory of a painful experience, I can hear their story. I can peel back the layers of fear and intimidation. Often that ceremony of listening—without judgment and in a spirit of encouragement—constructs a relationship of trust based upon compassion. As a DOCS Education member and practicing sedation dentist, you already know how gratifying it is to hear these painful stories and be able to provide an alternative. Many of my students are curious to learn the best way to access a patient’s emotional history. I reassure them that patience and attitude are more important than verbal skill. In fact, the entry can be very simple: So what happened to you?
