hen I was a general dentist in Montpelier, Idaho—more than 45 years ago—I had three patients with debilitating jaw pain. I had good success treating the problem for two, but not the third. I had to figure out why it didn’t work for that person, and that pathway eventually led me to further study, research, limiting my private practice to temporomandibular disorders (TMD) for the next 36 years, and now continuing to treat TMD patients at the University of Utah School of Dentistry.
In dental school in the 1970s I remember the instructors gathering on the first day saying, “Look to your right, look to your left. In four years, one of you won’t be here.” The goal was to weed out students who didn’t reach the school’s defined standard of “perfection,” whatever that meant. That pervasive attitude and pursuit of perfection created a culture of unrealistic expectations. We gradually adopted the belief that as health care providers we must have all the answers and rise to any challenge; otherwise we will look vulnerable or weak.
I want to discuss vulnerability among health care professionals, and why it’s not a bad thing.
Vulnerability is not a weakness
Dental and medical training programs are not easy. We train students to be systematic, accurate, precise, and focused on one small part of a person’s mouth or body to identify what’s wrong and fix the problem. In dentistry, the patient’s willingness to lay down (almost in your lap) and allow you to work on such an important and intimate part of their body, takes a lot of trust. It’s not just one tooth or one part of the body you work on, it’s a person whose tooth needs treatment. Taking time to build trust is an important part of providing care.
At the same time, providers have to confront tremendous financial pressures. Practice managers want you to cut out unnecessary stuff—chit-chat with patients that takes up time and doesn’t pay your bills. But that ignores the critical importance of building trust with your patients.
One of my favorite experts on this topic is Brené Brown, whose TED Speaker bio lists her as a Vulnerability Researcher. In her TED talk, Listening to Shame, she defines vulnerability as “emotional risk, exposure, uncertainty,” and “our most accurate measurement of courage—to let ourselves be seen, to be honest.”
To me the power of vulnerability is a very important concept that is applicable in dental and medical practice.
How to be (appropriately) vulnerable with patients
Some health care providers worry that getting vulnerable with patients is too great a risk. You don’t want to send the wrong message, so it’s important to figure out how to put patients at ease without crossing a professional line. Here are some things that work for me:
1. Take time to connect
Connection might be as simple as asking about the patient’s family and sharing something about your personal life or interests, or making conversation before a procedure or exam.
2. Remember not all patients are the same
In some cultures it is not acceptable to come in and immediately touch someone’s body or start working inside their mouth. Make a habit of first asking permission and making sure the patient is comfortable with your treatment approach.
3. Vulnerability is a two-way street
Vulnerability should not be a one-way street. Instead, it is a mutual process of trust between patient and provider. To accomplish it, you must be willing to be vulnerable by letting your human side show through. You don’t need to be an infallible hero. You must be someone they can trust with the expertise to help with their health concerns.
4. Don’t be afraid of emotion
Brené Brown talks a lot about shame. It’s something we all experience—a feeling that there is some side of ourselves that we cannot let other people see, and if those imperfections are exposed we are somehow less worthy of their confidence or trust. I also let patients know I am listening, I hear them, I care, and this is a safe space. They can be free to let go of their fear of being vulnerable in my clinic, which can help release stress that might be contributing to their jaw pain.
“When you shut down vulnerability, you shut down opportunity.”
– Brené Brown
Ways I connect and support
Over the years I have developed several strategies for connecting and supporting patients:
Ask questions that help you better understand the source of your patients’ stress or pain. I have new patients fill out a history form detailing symptoms, timing, personal habits, and respond to a written stress test to start that conversation.
Go deeper when you feel like something is important. For many patients this won’t seem intrusive; instead it will be a sign that you care enough to ask follow-up questions. For example, if I sense that stress is a factor I ask about what keeps them up at night, what occupies their thoughts each day to get to the root of the problem. I’m not a therapist, but I can listen.
Encourage self-care. One of my favorite things to do when I have a patient who is spread thin and doesn’t take enough time for themselves is give them permission to say no to more tasks. I instruct them to say, “I can’t, I’m under doctor’s orders to say no.” Or I “prescribe” 30 minutes each day for self-care doing something they really enjoy.
Let the emotions flow. I keep a box of tissues in the operating rooms and tell my patients—male and female, although 95% of my patients are female—that if they feel like crying and need to let go of some stress, that’s why we have tissues. For many it’s a huge relief.
The role of shame in preventing vulnerability
In another powerful TED talk, The Power of Vulnerability, Brené Brown says the people who don’t respond negatively to the experience of shame are those with the courage to be imperfect. “They [have] the compassion to be kind to themselves first, and then to others, because…we can’t practice compassion with other people if we can’t treat ourselves kindly.”
Shame is something we see in the dental and medical professions, and I believe some of that comes from the historical culture that focused on perfection. Fortunately at U of U Health that culture has shifted. We know the program is challenging, but I always tell my students that it’s no accident they are here. They earned the right to be here and need to replace the expectation of perfection with the quest for excellence and make the most of it to leave as a competent, confident dentist.
Letting go of the shame and embracing our human side will help us be vulnerable, and as a result, become better providers.