The emotional experience is more important than the clinical experience
by Elizabeth Sciarratta, RDH
Doctor and assistant meet in the sterilizing area after dismissing Mrs. Jones. They have just completed a grueling crown preparation.
The doctor rubs the back of his neck: “Wow. I didn't think we'd ever get that temporary on!”
“Tell me about it!” says the assistant as she dumps instruments into the ultrasonic.
“She's such a pain to work on. She won't keep her mouth open; she wants to spit every other minute. Thank God we used the rubber dam or we'd still be in there.”
“And does she have to be so nasty?”
“Really, you'd think she'd be grateful after all the crap dentistry her old guy did.”
Out in the parking lot, Mrs. Jones flips open her cell phone and calls her husband. Her hand is shaking as she plugs in the earpiece.
“How was it? I'll tell you how it was. First, they put this horrible rubber sheet over my mouth. I couldn't breathe. They wouldn't let me spit. My jaw feels like it's going to come apart. They were so rude, talking over me like I'm a piece of meat. Dr. Joe never did that. I don't care what the insurance says — I'm going back to him!”
These comments illustrate a common dental dilemma. Our patients' experiences of the dental setting are vastly different from ours. This creates a lot of the misunderstandings that lead to problems.
A patient experiences the dental appointment on two levels — clinical and emotional.
The clinical experience involves what was actually done: injection, cavity preparation, restoration, scaling, and polishing. This is fairly objective, and most patients and operators can agree on what happened even if the nomenclature varies.
The emotional experience is how the patient felt about what was done. It is the emotional experience that is subjective, and it can vary considerably between patient and operator.
Take the example: The dentist viewed the rubber dam as helpful, while the patient referred to it as a “horrible rubber sheet.”
The patient carries the emotional experience long after the clinical experience. It is how he or she judges the situation. It is also how the patient portrays the situation to others. What sort of a picture did she present to her husband?
The problem with the emotional experience is that it sometimes has little bearing on reality. As professionals, we don't attach the same meaning to what we are doing as those to whom we do it. Patients don't even seem to notice the difference between good and poor clinical quality, as shown in the example. What they notice is physical discomfort and how they felt they were treated.
Several Web sites are dedicated to dental fear. The idea is presented over and over that the perception of a caring dentist is what makes for a more positive emotional experience.
Many dental professionals believe pain is the biggest trigger of a bad experience, but it is not. Patients seem to be more responsive to the attitude of the operator than their actual physical sensation. Therefore it is not what we do; it is how we do it. This cannot be emphasized enough.
Another problem arises when the desire to get the task completed overrides the need to make the experience positive. Thus a patient can have clinical and emotional experiences that are opposite. A patient can leave with a perfectly placed restoration feeling like he or she has been violated. This creates a negative impression that can affect payment for services or keeping future appointments. Patients may not disclose this.
I have witnessed situations where patients truly believed they were receiving good care, when in fact they were not. They spoke highly of their dentist when their radiographs showed overhanging amalgams, undiagnosed decay, and periodontal disease. This has led me to believe that the emotional experience of a dental appointment is far more important than the clinical experience.
How can dental professionals provide a positive emotional experience? It begins with the desire to do so, and the belief that is it important. This is critical. After that, it is a matter of learning how to communicate with patients so that they feel comfortable. Allowing enough time to accomplish procedures is vital, as is never talking over a patient who is in the chair.
There is an abundance of information available on patient communication. However, it is up to each of us to put it to good use.
About the Author
Elizabeth Sciarratta, RDH, has practiced dental hygiene for over 20 years. She graduated first from SUNY Fredonia with a BA in English and a minor in Theater Arts. She graduated from Monroe Community College in 1988 with her AAS in Dental Hygiene. She was published first in RDH magazine in 2004. Her ideas were cited in a published case study in 2005. She developed a seminar called Serdentity to help dental professionals deal with difficult patients. She is a member of the ADHA and actively involved in her local dental hygiene association. Beth lives in Rochester, N.Y.