Vulnerability is Not Weakness - It's Why Our Patients Trust Us
Dentist Gary Lowder has spent the past 36 years working with patients who suffer from jaw disorders that result in chronic pain. As faculty in the School of Dentistry, hes passing along the power of vulnerability as a patient trust-building exercise with his trainees.
By Gary W. Lowder | 4 Minutes
When I was a general dentist in Montpelier, Idahomore than 45 years agoI 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 didnt 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 泫圖弝け 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 wont be here. The goal was to weed out students who didnt reach the schools 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 its 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 persons mouth or body to identify whats wrong and fix the problem. In dentistry, the patients 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. Its not just one tooth or one part of the body you work on, its 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 stuffchit-chat with patients that takes up time and doesnt pay your bills. But that ignores the critical importance of building trust with your patients.
One of my favorite experts on this topic is Bren矇 Brown, whose 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 courageto let ourselves be seen, to be honest.
"To me, the power of vulnerability isa 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 dont want to send the wrong message, so its 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 patients 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 someones 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 dont need to be an infallible hero. You must be someone they can trust with the expertise to help with their health concerns.
4. Dont be afraid of emotion
Bren矇 Brown talks a lot about shame. Its something we all experiencea 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."
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 wont 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. Im 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 doesnt take enough time for themselves is give them permission to say no to more tasks. I instruct them to say, I cant, Im under doctors 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 patientsmale and female, although 95% of my patients are femalethat if they feel like crying and need to let go of some stress, thats why we have tissues. For many its a huge relief.
THE ROLE OF SHAME IN PREVENTING VULNERABILITY
In another powerful TED talk, The Power of Vulnerability, Bren矇 Brown says the people who dont 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安e cant practice compassion with other people if we cant 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 泫圖弝け that culture has shifted. We know the program is challenging, but I always tell my students that its 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."
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CONTRIBUTOR
Gary W. Lowder
Associate Professor, Dentistry, 泫圖弝け of Utah 泫圖弝け
