The Fragile Ego - aspiredental

The Fragile Ego

It’s been interesting to receive feedback during the release of this blog series on ‘difficult personalities’. There has been a lot of gratitude, people recognising certain traits from patients they dread, laughs at the predictable and almost identical behaviour different patients exhibit to different dentists, and for me the most important part is people writing to say the blogs have helped them on some level.

Most of the help has involved permitting others to realise not everyone is nice when they go to the dentist. That is not to say they are nasty. At the best end of the spectrum, even the nicest people come with emotions, the ability to feel pain and aren’t always relaxed; as we move towards the more negative end of the spectrum we might encounter the litigious and the not-so-nice. The point is, whether it becomes apparent to us or not, we don’t have to ‘take it as a given’ that every patient is a benevolent person. Even Jimmy Savile went to the dentist, you know.

Some patients are awkward, draining and exhausting and can really take a toll on you, depending on how easy it is to access your emotional energy reserves. Is it right that you should make your kindness and benevolence endlessly available to all, regardless of their disposition to you?

So the feedback has been lovely. Mostly. Some, clearly motivated by genuine, measured and informed disagreement have repudiated certain parts. Others, motivated more by frustration at their own anonymity/ inability to construct coherent sentences/ lack of time/ insecurity/ living in their parents’ spare room….whatever, I don’t know… have made wilder criticisms. Some may be valid. Either way, it doesn’t matter; the point is, they expose my fragile ego.

My weakness. Vulnerability. Self-doubt and fear. Hidden. Hidden behind bluff, energetic bravado, volume and ferocity. Imposter syndrome. Alpha male, no chinks in the armour…

You’ve got some of those weaknesses and so have I.

No-one is 100% confident and self-assured 100% of the time. I’m old enough to not need to pretend anymore. Don’t get me wrong; I’m as emotionally tough as anyone I’ve met…but I’m not immune, and no-one is.

I see so many who portray immunity from ego-fragility on their social media accounts. Not narcissism but a ‘shiny smiley, everything is ok and is in fact getting better’ narrative. Then they come talk to me about what went wrong with a case or a complaint; and this is done quietly, hidden from view, check no-one is listening, surreptitious and in the shadows. Finish up, smiles back on. Keep Calm and…well, you know the rest.

Let’s make it clear. None of us are perfect. No one has perfect outcomes, whether as a dentist, parent, spouse, technician, sportsman or artist. No-one. And the best of us dwell on our failures and criticisms from others, and they hurt. Maybe a little, maybe a lot. It’s all still pain. You learn from it, seek help to improve and move on, hopefully, to a still-important life, albeit one that is not always perfect.

(The above perhaps forms part of the reasoning why dentists’ suicide rates are 2.5 times the national average and people are leaving the profession in their droves. This will be covered in a forthcoming two-part series on stress management in dentistry and life).

So if you know a colleague who paints the picture perfect: remember, it’s not true. No wiggle room, no exceptions, no outliers; they are lying.

And patients have fragile egos too. All of them. Some people’s fragility in this respect is minor and is largely irrelevant regarding their dental care. For others, it’s massive. When new patients cancel on the day of their appointment, I often eventually discover when I do get to meet them that they cancelled due to embarrassment at their problem.

My fragile ego told me they cancelled as they hold my professional time in contempt; I’m hurt and offended. Then I meet them and they are lovely and they like me, but they have an ugly, embarrassing problem…that smells…and they needed to know I’m not a twat and I won’t judge them. Of course I can help. I’m good at helping, and when they are happy and joyful at the end I will feel some of that joy and share it with them.

Now all is well. That’s not a bad place to make a living, and they will tell their friends about the dentist who helped them. So I don’t need to go trawling through Instagram begging people to knock on my door. She has told them for me. If we could have just made it clear from the outset, maybe they wouldn’t have cancelled…three times…(true recent story, BTW!)

Let’s explore the fragile ego a little more fully and away from the dental environment.

Elvis Presley is perhaps the best example I can think of. Don’t get me wrong, I’m a fan of ‘The King’; but his example is just too good and too clear for me to ignore.

Elvis was the biggest star on Earth – ‘the King’, and an unrivalled heart throb. But…he probably had a pseudo-Oedipus complex. He never fully trusted his wife Priscilla (due to his fragile ego), and when his controlling, insecure and frankly odd behaviour led to a ‘mutually agreed’ break up and she ran off with her karate instructor, the thin veneer of his ego publicly cracked.

The words to “Are you Lonesome Tonight?” are sung so beautifully by him and ask a list of questions similar to the title. They focus on how terribly sad this now ex-lover must be, how she must be wandering lost and regretting their remoteness from one another.

But mid song there is a spoken soliloquy where the tone is reversed.

Shakespeare: As You Like It (1623) vs. Elvis: Are You Lonesome Tonight (1969).

No contest, Shakespeare wins. Read this carefully out loud (not if you’re on the train with headphones on!)

I wonder if you’re lonesome tonight
You know someone said that the world’s a stage
And each must play a part
Fate had me playing in love, you as my sweetheart
Act one was when we met, I loved you at first glance
You read your line so cleverly and never missed a cue
Then came act two, you seemed to change and you acted strange
And why I’ll never know
Honey, you lied when you said you loved me
And I had no cause to doubt you
But I’d rather go on hearing your lies
Than go on living without you

Now the stage is bare and I’m standing there
With emptiness all around
And if you won’t come back to me
Then make them bring the curtain down

In live performances Elvis simply couldn’t get these words out. Especially the underlined ones. Go on Spotify and listen. He giggles, makes jokes, pauses and coughs, and relies on his backing vocalists. I’ll post the link here.

He cannot face the pain of his own fractured ego, his weakness and responsibility in creating his own pain and the fact that she isn’t there to protect him from pain anymore. I’m not revelling in writing this, by the way. I like stories where the hero wins, marries a princess and they live happily forever after. But that would be another lie. I hate to write about another person’s pain, and ego fragility is painful when it’s exposed.

So even Elvis had a fragile ego, and during my psychology training I’ve been shown lots of video footage where chinks in the armour show. His micro-expressions of pain in a sea of smiling self-assuredness. Glimpses of the scared little boy behind the gyrating tassels of God-like stardom. The little boy couldn’t take the lie for long, and we all know how that story ended. RIP.

It’s perhaps an extreme example but one worth noting.

So how can a fragile ego manifest?

It depends on the ‘where and how’ the patient feels fragile. Oh and by the way, they may not even know this fragility exists as they haven’t wanted to look inwardly at it.

Nevertheless, accepting we are all fragile in some way or another, when you find your patient’s fragility, be empathic and gentle. Your patient may have a number of areas they feel fragile about and are hiding:

– Their finances
– Their aesthetics
– Their age
– Their intellect
– Their social intellect
– Their dental disease history
– Their social skills

The list goes on. Either way, a fragile ego should, in most cases, be the least threatening personality type. If you ask open and non-threatening questions and don’t pass judgement they can warm to you immensely.

In fact it’s possible, if you are emotionally skilled, to show you empathise with this fragility and will help by providing treatment options which are mindful of it. You can make your patient feel forever loyal and become a walking advert for your kindness and bedside manner.

Let’s look at a financial and aesthetic example.

This was a 55-year-old lady who used to work in the city as a financier. Her kids had boarded at school and had now flown the nest to start families of their own in other countries. Her husband had left her for his secretary and he was running a company she had helped him set up.

She wasn’t poor but was out of steam for building a financial empire again and was probably feeling lonely and betrayed and that life had been unfair. She was a strong, clever and impressive person who did NOT consider herself a victim. Until she fell and avulsed her UL1, which fell through a drain beside the road. The brown metropolitan fat-berg sludge isn’t quite the isotonic medium for tooth storage we hope for, so this tooth was lost.

She was wearing a denture. She hated it.

The interesting part here was her refusal to discuss a potential implant.

“No, I’m not interested in even talking about that.”

Ok, sure, is there a reason in particular I should know, so I can be careful to not annoy you or bring it back up?

“No, I just don’t want to even think about it.”

The truth here is that she felt too uncomfortable telling me that she once could have lost 3k from her wallet and not noticed and now she simply didn’t have the funds. The better part of £3000 for an EthOss graft (wonderful stuff, BTW) followed by implant rehab was now not the kind of money she could nonchalantly part with. Her ego prevented the truth coming out and prevented her from even talking about the treatment she really wanted, needed and ended up with when I had got past the ego barriers. She wanted the implant and wanted to pay for it over a long period. When she walked in she was so emotionally remote from getting to what she actually wanted; it was only after the anticipation of her fragility and resulting empathy that I could help her achieve her goals.

Honestly, it’s simple when you know how. Gentle descriptions leveraging the power of social proof, making comment on the normal and understandable barrier many people have regarding implants, endorses her disposition. It means she is not alone and means I’ve met lots of others with similar feelings. I then explain how ‘a few of them overcame such barriers’ with opportunities like payment plans, staged treatment, etc. All of a sudden she now has easy access to the treatment she really wanted but couldn’t ask about.

I fitted her Straumann-supported crown a few weeks ago and it looks and feels awesome. She cleans it well as I have ‘soft skilled her’ into not finding oral hygiene a chore but something she internally values so now wants to do. Doing something you want to do isn’t a hardship or task, it’s a joy.

This is a single example and, honestly, I could write a hundred more.

Such as responses to:
“I hate the dentist.”
“You look a bit young.”
“All my teeth are bad because of two previous bad dentists.”
“Is that your BMW in the car park? Dentists do alright, hey?”

The list is endless

The points I’m trying to make as we approach the end of this blog series are these:

– Your emotional intelligence is the biggest influential factor on your success in both your career and personal life.
– You can still be a lovely, kind person without high social intelligence, but there is a version of you that you can bring out and it will give you more of the things you love, not least of which is the power to help people you love.
– Highly socially intelligent people earn more. I’m sorry if reading this hurts, but it’s not just more, it’s MUCH more.
– Everyone is fragile about something. Everyone. Social intelligence is applicable to everyone, all the time, and is active during every single human interaction.
– A further leap for me, one year ago, was being convinced you can teach people to increase their own social intelligence and we want to help you increase yours.

I hope to see you soon to explore this journey with you. It’s the best thing I have ever done.

If you want to learn more about patient personalities and how the ability of identifying these leads to more powerful relationships with your patients then click here to learn more about our Dental Emotional Intelligence course.


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