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NONMALEFICENCE AND OPTIMISM Dr. A. Garrett Gouldin
NONMALEFICENCE AND OPTIMISM
Dr. A. Garrett Gouldin
We all know that our ADA Code of Ethics and Professional Conduct includes the age-old axiom of Nonmaleficence; we have a duty to refrain from harming the patient. Unfortunately, if we practice long enough, problems, failures and various catastrophes will occur to our patients in direct relation to our diagnosis/treatment, even when we are giving it our all. But if we have followed the standard of care, and since such negative outcomes are relatively rare, perhaps we gracefully move on. We fix the problem or refer to someone who may be able to assist us, we learn from any technical errors, we search for better methods, we recognize that every patient has a different healing capacity, and so on. But how do we mentally process this event? How do we feel?
Explanatory style, how you explain to yourself why you have experienced a particular event, tends to be either optimistic or pessimistic. If asked, most would self-identify as optimists, but research suggests otherwise.
If you experience an adverse life event, such as a failed dental surgical procedure for our purposes, examining your thinking about the event might be helpful, according to Martin E.P. Seligman, the father of modern Positive Psychology. The acronym known as the 3 P’s can help. If you assume the event was your fault (personal), that it is likely to have a lasting negative impact (permanent), and that it will affect all of the areas of your life (pervasive), then you probably have a pessimistic explanatory style. If, on the other hand, you think of the event as unrelated to you and more of a “one off”, and that the effects will be ephemeral, and contained to this one event, you likely have an optimistic explanatory style. Interestingly, the opposite is also true. Let’s say that a particularly difficult clinical procedure goes well and heals uneventfully. If you explain this to yourself as at least partially resulting from your high level of skill and superior focus, and as being something that could result in a long-term positive impact on your relationship with this patient, and even have a positive effect on a broad range of potential patients, then you are likely an optimist. But, if you discount the positive outcome as just getting lucky, and you see the pleasing result as contained, and of only short-term consequence, you might be a pessimist.
Dentistry seems to attract perfectionists, who by definition refuse to accept any standard short of perfection. Dentists also tend to be high on the continuum of the Big Five personality traits of agreeableness and conscientiousness (and in some cases, neuroticism). While these qualities may have led us to our vocation, if we are not aware of the potentially harmful combination of our absolute commitment to Nonmaleficence, while working in an occupation that is sure to present us numerous worrisome
challenges and setbacks, the cumulative effect can be difficult, and maybe even debilitating.
Clearly pessimism is not all bad, and it has the benefits of allowing us to maintain critical thinking, to prevent naivety and to promote rationality (realism). In fact, some pessimists lightheartedly argue that the optimist is never pleasantly surprised! However, the research is in, and the data supports an optimistic explanatory style on many fronts, especially with regard to the health and longevity benefits. Seligman’s book, Learned Optimism, lays all of this out and concludes with an easy to remember Cognitive Behavioral approach to help you predictively increase your level of optimism. In short, if we can identify the distortions in our thinking, we can dispute these distortions, and remain energized, positive and optimistic.
The principle of Nonmaleficence demands that we protect our patient from harm. It also seems fundamentally ethical to protect another valuable asset: our mental well-being.
