Fear of the diagnosis: Case study Elaine
Nobody likes going to the dentist. But for some people, the problems run deeper and form a phobia. The causes of dental phobia can be many and varied. This case study is of a patient whose dental phobia resulted from not understanding fully what certain treatments involved.
Elaine is a woman in her late forties who visited the dentist irregularly throughout her adult life. On her last visit, her dentist had recommended some adult orthodontic treatment to correct tooth movement. The scale of the treatment and the ballpark costs shocked Elaine, who decided that not knowing the extent of the treatment that she required would have been preferable. However, that initial conversation with her dentist meant that she suffered additional stress – she knew that she would have to go back to the dentist eventually, but she did not want to hear what he had to say.
Fear of "the diagnosis" - of finding out what or how much needs to be done and of not being able to cope with the news, is a very common fear. If you have avoided dentists for a long time, you may need a lot of treatment. But then again, you may not. You'll come across a lot of posts on discussion boards where people were pleasantly surprised at how little treatment they needed, even after a very long absence (sometimes several decades!). It used to be common that people needed fillings every time they went to the dentist, but things like fluoride toothpastes and fluoridated water supplies and drinks have led to a decrease in tooth decay in the general population. When you suffer with dental phobia, you tend to assume worst-case scenarios, which is often simply not the case.
The problem for Elaine now was that she didn’t want to go forward with the treatment and yet she couldn’t go back. The stress of the situation resulted in her developing a phobia about visiting the dentist again. She’d be given an insight into what the next diagnosis could be and she was now terrified of finding out any more information.
The second part of the problem is that, by refusing to revisit the dentist, the patient was excluding herself from any further information about the type of treatment required. Dentists sometimes forget because they use them every day, but phrases like ‘orthodontic work’ or the use of hi-tech brand names can be confusing and scary for patients.
The result was that Elaine exacerbated her condition by trying to find out more online. Of course, the internet can be a valuable resource (even though we say so ourselves), but it should not be a substitute for face-to-face consultations with your dentist. A quick search under ‘orthodontic treatment’ will reveal any number of visceral images. If you aren’t quite sure what you are searching for, it can potentially make thing much, much worse.
Every type of treatment has extreme cases. But those cases are usually also very rare (part of the reason they are on the internet is simply because they are so remarkable). What is becoming clear is that Elaine’s phobia is not only a fear of the diagnosis – it is also stopping her from getting a proper, professional diagnosis.
Simply the thought of going back to the dentist was enough to make Elaine ill with fear. She would suffer from nausea, diarrhoea and sweating even before she had made an appointment. The more she thought about visiting the dentist, the worse she felt.
Her fear of the diagnosis was enhanced by her concern about other issues which surrounded the treatment. Googling orthodontic work suggested that it is lengthy treatment. Of course, this does not always have to be the case. However, the problem with a phobia is that a patient will only ever focus on the worst case scenario. If she dared to glance into the future, all Elaine could envisage was spending years of her adult like in awkward, uncomfortable and unsightly braces.
The worst case scenario idea applied to thinking about costs too. The more she worried about what might be wrong with her teeth, the more she worried about how much it would cost to put them right. The more she read about orthodontic work, the more she feared her future dental bill could run into thousands and thousands of pounds.
In this case, it is fairly clear what has caused the problem. Elaine has had a quick conversation with her dentist that has left her with too many unanswered questions. While her dentist probably mentioned orthodontic work and then thought no further about it for the rest of the day, Elaine finds it hard to think about anything else.
What’s the best way to tackle this type of phobia? Obviously, in a busy practice, it isn’t always easy for a dentist to know and understand every individual patient. However, most dentists will have a strategy for helping to manage patient expectations and for ensuring that they feel comfortable with any further treatment.
Of course, if the patient is too frightened to speak to their dentist about it, it is difficult to put this strategy into action!
The key for Elaine was being able to visit her dentist without worrying about making a decision there and then. Rather than simply mentioning orthodontics at the end of a check-up, she was able to spend a full consultation session with her dentist, discussing x-rays, treatments, costs and what further work might be needed in the future.
By knowing in advance what to expect, Elaine was able to accurately research the treatment, prepare questions and arrange her treatment in a way that suited her. In a more informal way, it also gave her the chance to get to know her dentist better (and vice versa). This means it is much easier for the dentist to understand the patient, respond to questions in the right way and to begin creating the right sort of patient experience.
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