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The Conspiracy of Silence in the Dental Profession by William T. Kane, DDS, MBA

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The dental profession needs to be more diligent in identifying both its colleagues as well as patients who are suffering from addictive diseases and other well-being issues. We all know fellow dentists, dental team members and patients who are suffering from the disease of addiction. When we do not acknowledge and address these individuals we become part of “The Conspiracy of Silence” by allowing the suffering to continue.

Most, if not all, individuals with an addiction are unable to stop their addiction on their own. Most will need some type of professional assistance. Confronting an addicted person alone is very difficult depending on his or her state of denial. An intervention of some sort is perhaps the best way to begin to break the addicts denial. Sometimes an intervention takes the shape of an arrest for driving under the influence (DUI), or perhaps a visit from a state dental board investigator. Also, an intervention can be a more structured process carried out by someone trained in this area.

The disease of addiction is a complex primary, chronic progressive disease that if left untreated could lead to the person’s death. Unfortunately, addiction is probably the only condition in which diagnostic and treatment procedures are delayed until the patient is in critical condition. In dentists, the disease of addiction is almost always in its advanced stages before signs and symptoms become obvious in the office or clinical setting.

The dentist’s mindset – one of perfectionism and focus; an individual who is knowledgeable about drugs – is perhaps the greatest impediment to getting help. Also, the dentist’s status as undisputed master of his or her domain creates “The Conspiracy of Silence,” in which family, staff and colleagues are wary of bringing the addicted dentist’s problem to light.1

Dentists, similar to other professionals, frequently fail to confront addiction in colleagues, even when its presence is undeniable. Colleagues, family and staff might delay addressing the addicted dentist in an effort to protect him or her from adverse consequences such as shame, social stigmatization, income loss and licensure actions. Additionally, we are afraid of being wrong and fear retaliation.

However, failing to identify and address addiction because of its possible consequences is similar to failing to diagnose cancer because it will cause pain. We think out of loyalty and respect, we think we owe it to our colleagues and patients alike a chance to deal with their addiction on their own. Very often we believe they will be able to stop if they know they have a problem and that they can get the problem under control themselves.

Individuals with addictions develop denial; this convinces them that the disease of addiction is not present. Denial is an unconscious psychological defense mechanism that develops over time through repeated rationalization. Actual denial differs from lying in that it is not a conscious intent to deceive. It allows addicts to justify their behavior and to avoid painful knowledge of their actions.2

Taking denial out of the picture, the guilt and shame associated with addiction will cause dental professionals to avoid detection and resist treatment. Significant others, staff and family members who would not think of ignoring symptoms of diabetes in their loved one, tolerate signs of addiction or simply turn away in frustration.

The poor performance, deteriorating behavior, absenteeism and isolation of a dental professional, and patients as well, are frequently attributed to stress from a relationship, or financial or business difficulties, rather than the addiction that underlines them all. Unfortunately, addiction is a condition we really hate to look at except by the exclusion of all other possibilities. The fear of damaging the dental professional’s reputation, particularly if you are uncertain the condition exists, causes concerned colleagues to rationalize their behavior, minimize difficulties and avoid confronting the addicted person.

When an addicted individual’s behavior becomes so obvious to those around, two choices exist. One is to confront the individual or have an intervention concerning his or her behavior. If the intervention is adequately planned and carried out, often the addicted individual will receive appropriate treatment. This choice breaks “The Conspiracy of Silence” and the addicted individual begins the process of restoring his or her personal and professional lives.

The second choice is to do or say nothing, allowing “The Conspiracy of Silence” to continue. Dental colleagues, staff and family members simply let the natural progression of the disease of addiction take its toll on the individual with the addiction. It is so easy to rationalize, “it is really none of my business” or think, “I am not my brother’s or sister’s keeper.”

The majority of dentists tend to work in solo practice or small groups. In these practice settings it is very easy to become isolated as a dentist or staff member’s addiction progresses. The dentist and staff become a “highly dysfunctional family” creating and allowing “The Conspiracy of Silence” to grow and continue. It would be correct to state that most dentists know a dental colleague who is currently suffering from an addiction. The suffering colleague might be in one’s local area or even a dental school classmate in a different corner of the state or even a distant state. Dentists and dental specialists generally do not change practice locations frequently, so early identification and intervention might be somewhat easier. Indications that a dental colleague might have an addiction are generally not difficult to notice.

Dental hygienists with an addiction may be more challenging to identify early. Since a dentist employs dental hygienists, it might be possible to move from practice to practice or change locations frequently. As an addiction progresses, absences from the practice becomes commonplace. This may cause friction in the practice and the dental hygienist might leave the practice.

When a problematic dental hygienist leaves one practice, “The Conspiracy of Silence” generally follows him or her to the next practice. Dental hygienists, much like dentists, know a dental hygiene colleague who is suffering from addiction. Again, it could be someone close to home or in another part of the state.

Patients in our practices will present in both the active disease state as well as in recovery from these conditions. We need to treat these individuals in our practices just as we would treat those with other medical conditions. We need to address and break “The Conspiracy of Silence” in our patient populations as well. A place to start is with a call to the patient’s physician expressing your concerns. The best source of information about addiction is patients who are in recovery. Through them you can become familiar with the resources in your own community; interventions, treatment and support for those with addictions. Another great source of information is a dental colleague who is in recovery.

Additionally, employers in your area might have Employee Assistance Programs (EAP) designed to help these individuals. The good news is “The Conspiracy of Silence” can be eliminated. Dentists and dental hygienists suffering from addictions respond very well to adequate treatment. Virtually every state has a peer assistance program for dental professionals generally through the state dental associations. These programs are not punitive, rather they are designed to assist the dentist or dental team member begin the journey toward recovery. Hundreds of dentists, dental hygienists and dental team members have been helped by these programs. Generally, these programs can assist you in identification, gathering information, planning and conducting an intervention and referral to treatment facilities.

An individual with an addiction is dying, struggling with a chronic progressive disease. If you are concerned about a colleague, break “The Conspiracy of Silence,” pick up the phone and call the peer assistance program in your state. Several of these programs were listed in the article in the September 2011 issue of Dentaltown Magazine, and are available on the Web site. Your phone call might just save your colleague’s life, both personally and professionally. I have seen this happen hundreds of times!

References
  1. Peer Assistance Services Spring Dentists from Trap of Addiction. Nov 27, 2001. http://www.ed-dental.com/article/Peer-Assistance-Services-Spring-Dentists-Form-0001
  2. McCall, S.V., West J Med 2001 January, 2001: 174(1): 50-54.


Author Bio
William T, Kane, DDS, MBA, graduated from the University of Missouri – Kansas City School of Dentistry in 1980. He maintains a general practice in rural Dexter, Missouri. In addition to practicing dentistry, Dr. Kane’s interest and passion have been in the area of recovery and wellness. Since 1987, Dr. Kane has been the Chairman of the Dentist Well–Being Committee for the Missouri Dental Association. Additionally, Dr. Kane served as a member of the Dental Wellness Advisory Committee (DWAC) with the American Dental Association. Dr. Kane is very familiar with issues facing patients with addictive diseases and has published and presented on these topics. He also completed an MBA in 1992 from Southeast Missouri State University. In the fall of 2010, Dr. Kane received his Fellowship in the American College of Dentists.
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