Lynn D Carlisle, DDS

I saw a cartoon one time that had the caption "I am going to the dentist to get my teeth criticized". This is the perception many patients have of their visits to the dentist or hygienist. It is telling that a cartoonist would draw it.

A few years ago, there was an episode on Seinfeld called "The Soup Nazi". In the episode, there was a Deli type restaurant that was a popular place to get soup. The owner ran his restaurant like a Nazi soup line. Each customer approached the counter in a cafeteria line with soup bowl in hand like a supplicant to a priest.

If the customer dared to change his order or request an additional item, the owner would yell at him and the customer would cower and slink away afraid to change his order or ask questions. It was one of the most popular episodes of Seinfeld.

Almost every hygienist I have had related to their patients this way when they started with us. They lectured, berated, "taught" their patients about the importance of dental hygiene and home care. Some were nicer than others while doing this, but they still preached and lectured. They were constantly frustrated that their patients did not comply.

I saw a cartoon one time that had the caption "I am going to the dentist to get my teeth criticized". This is the perception many patients have of their visits to the dentist or hygienist. It is telling that a cartoonist would draw it.

I think this way of teaching/lecturing is a continuation of the ineffective way dentists and hygienists were taught in dental school - a very authoritarian, judgmental, adult/child way of working with people.

Just like dysfunction in a family is passed from generation to generation, so is this dysfunctional way of relating to patients passed from generation to generation of dentists and hygienists.

Bob Barkley DDS, with the help of Nathan Kohn, PhD, changed the way he related to his patients to a more humanistic way of facilitating or coaching patients instead of lecturing. Then he helped change the way many of us related to our patients.

Barkley wrote in 1978: "It is almost certain that this (facilitating learning) is a major area of study needed by dentists in order to improve their preventive practices and auxiliary management. Let us consider the managerial background of the average dentist. By the time, he hires his first auxiliary or sees his first patient, he has lived through nearly two decades of authoritarian schooling, the last four years (dental school) being the worst in this respect.'

'The method of patient management that he saw demonstrated daily in the school clinic was almost purely authoritarian. Patients have relatively little control because they either accepted what the school recommended or were considered "not good teaching cases." Long-term working commitments with patients were neither desired nor sought.'

'Personnel management training for dental students was woefully inadequate, perhaps nonexistent, or highly artificial. The dental student was almost totally absorbed in "how to do it" technical subjects. Personal growth and philosophy development opportunities were rarely valued. In short, management skills were simply not developed in the process of becoming a licensed dentist."1

This is still going on in dentistry. Dentists and hygienists are still struggling with learning how to be educators, facilitators or coaches instead of lecturers.

The good news with the hygienists that worked with us is that when the light went on and they started facilitating instead of teaching, their enjoyment level went up and their frustration level went down. They learned to "stay in the question" or "speak to the obvious ask a question" and to active listen instead of preaching. "Stay in the question" is Mary Osborne's apt phrase and "speak to the obvious, ask a question" is Omer Reed's classic question.

The patients also started taking responsibility for their own dental health -- a remarkable concept that frees both the patient and hygienist.1

This change did not happen over night and in some cases took up to 2-3 years. Some of the hygienists became total converts to this way of working with patients - others resisted. The resistors did not last long with us. They couldn't give up being the expert.

They stayed hygiene Nazis.

1. Bob Barkley looks at what makes an effective dentist. Becoming an effective leader and helper.