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Monday, August 15, 2022  

The Down Side of AdmonishmentPublished 8/16/2004

Many nurses know that experiencing health care as a patient can shed a harsh light on one’s own nursing practice habits. Hopefully, the experience leads to a more tolerant and compassionate approach to one’s own patients. In my case this happened.

The good fairies did not smile upon me when it came to the genetics of my mouth and teeth. I was born with major dental and jaw problems, soft, cavity-prone teeth, adult teeth missing, and consequently a severely crooked bite. The orthodontists wanted to break my upper and lower jaws and realign my teeth and bite. I said heck no to that.

At age 38, I finally heeded my dentist’s advice and got braces, lest my teeth fall out prematurely. As part of this undertaking, I was to see a periodontist every three months, to ensure that my gums stayed healthy.

My childhood years, (thanks to frustrated dentists who didn’t give me enough novocaine) left me with a nagging sense of profound vulnerability whenever I had to have dental work done. So I was ill-prepared and feeling quite fragile when, at my last periodontist appointment, both the dental hygienist and the periodontist admonished me about some gum inflammation I apparently had.

I felt so attacked, and attacked while at my most vulnerable. In my car after the appointment I broke down crying (in typical girl fashion!). I called my significant other. He and I both agreed that I needed to see a more understanding practitioner, someone who would give me positive feedback for the hours I spend on my oral hygiene. People in my life can verify that I perform my dental hygiene with a religious fervor. If the periodontist and the hygienist wanted to offer me suggestions, I would have gladly taken the advice.

Instead, on my own I found that if I cleaned my gums a certain way and used a special kind of mouthwash, I could get the inflammation under control. Would it have been so hard for the practitioners to give me some helpful hints? Instead I received a dressing down (!), as if, like a nonchalant adolescent, I didn’t understand the grave implications of periodontal problems.

Though he is at least ten years my junior, the periodontist condescendingly intoned, "Well, I will allow you to continue with your orthodontics…." as if I were an errant child who had misbehaved. The positive outcome from all this is that after this episode I seriously revisited my own approach to patients. I realized that paternalistic admonishment is just not appropriate.

Not that I engage in it often, mind you. But the rare times that I do are a few times too many. My patients and their families are as vulnerable as I am in that dentist’s chair, and I plan to honor this realization as best I can. I will try and provide positive reinforcement, and make helpful suggestions that fit within the realm of what patients are able and willing to do.

It is so easy to admonish patients when we think that they cannot or will not follow what we think is best for them!v

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