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Fear Persuasion Paralysis

Linda, a new patient, comes into the operatory, spots the dentist and says, “I’d rather have a baby than be here.” Jack is told by the dentist he has gum disease and will likely lose all of his teeth and replies, “Doc, I can’t stand the thought of dentures and I won’t go through that gum surgery again. I just don’t know what to do. I just think I’ll let it go till they all fall out.”

Fear often makes people do something to reduce the threat that caused that fear reaction. But at times, fear has a way of causing paralysis…inaction because of certain understandable psychological processes patients go through. Robert Cialdini in his book YES! 50 Scientifically Proven Ways to Be Persuasive, says that, “When the fear producing message describes danger but the [patient] is not told of clear, specific, effective means of reducing the danger, they may deal with the fear by “blocking out” the message or denying that it applies to them.”

“Juanita, you have an abscess in your upper molar and its draining into your sinus causing your chronic sinus condition most likely. But don’t worry; we’re going to take good care of you by giving you a strong antibiotic first, then gently cleaning out the infection in the tooth while it’s all numb. Once the infection’s source is removed, your sinus infection will also likely resolve and you’ll feel like a new person. How does that sound? Do you want to get going to get those infections out of your system?”

A high-fear message such as the need for a root canal or extraction will create action towards the dentist’s desired endpoint only if it includes a plan identifying the specific action that could be taken to secure relief or comfort and thereby reduce their fear of pain during the procedure or postoperatively. The more clearly patients see behavioral means for ridding themselves of fear, the less they will need to resort to denial.

Beware of using fear as a scare tactic to move people into action. With no specific plan offered to counteract the fear, the patient may indeed be locked into static avoidance and not move forward at all. It is always wise to offer at least one viable plan of action immediately. Delay can cause objections to arise based on escalating fear responses.

In dentistry we do not want to merrily go about our day pronouncing disease and doom everywhere in our patient’s mouths unless we are offering the follow up, straightforward steps that the patient can do to eliminate that threat of destruction. Simply pointing out risks with no plan to eliminate them may be counterproductive. Be sure that the New Patient Experience is equal parts doom and gloom mixed with hope and an expert plan. If not the whole plan, then at least we need to give our patient the logical first step.

When I get a phobic patient, the first message I want to send is that we are different and that we understand their fear. I ask what they are afraid of or fearful over. I speak to that fear specifically and tell them about how we have dealt with in with our patients in the past and how they have done so well in our care. Giving them hope and letting them glimpse my confidence that I can definitely help them is the goal of that first interaction.

At Suwanee Dental Care, we offer five levels of fear elimination: TLC and good chairside manner, nitrous oxide, NuCalm, Oral Conscious Sedation and I.V. Sedation. Every patient has a fear threshold that we must overcome. Some show it openly, all exhibit some level of dental fear. We are challenged to be astute diagnosticians of the oral environment as dentists. I also challenge you to become astute evaluators of the fear and phobia levels in patients also. I treat all my patients as phobia patients until proven otherwise. That may be a gem.

Let me put forth a thesis: Dentists inject fear into their patients. They literally do, because epinephrine is the drug of fear. When adrenalin rushes occur during flight or fright reactions, nervousness, panic attacks and such, the patient recognizes the cause of the feeling they experience. But, in dentistry, the fear is transfixed to become associated with “getting a shot”, “getting teeth drilled on”, “getting a root canal” or “pulling a tooth”…all dental services associated with having anesthesia and in most cases epinephrine. Patients don’t know they are getting epi when they are young, but they recognize the feeling sure enough. They grow up associating the dentist with fear. They grow up deathly afraid of the dentist often because someone told them how it would be. That attenuates the epinephrine even further.  Flip the coin over. I now tell my patients about the “fear drug” we routinely employ and that its benefits of keeping the anesthetic in the area needed for a sufficient time to complete the treatment far outweigh the side-effects of a momentary rapid pulse and a fleeting feeling of fear. Having a story, a good, plausible explanation, is next to having a gold mine.

The Solstice Rx for Success is this: Always give the patient a step-by-step, logical solution for each problem you wish to correct or treat. The checklist dentist is the prepared dentist who always has the verbal and written answer to the patient’s fear, whether it’s of the unknown or the known due to their past experience. Be confident, be compassionate, and be professional in your approach, but above all, be reassuring.


Bill WilliamsComment