primarily toward aesthetic enhancement are being per-formed. Many patients refuse even these conservative ap-proaches because they feel they cannot afford it. Theresulting challenge has both positive and negative aspects.Dentists who promoted primarily aesthetic procedureshave seen their practices change significantly. Thosewho re-mained with more conventional dentistry have seen less im-pact. Patients who are unemployed and have put off neededoral therapy may face a significant financial result in the fu-ture when they can address their neglected problems.

Clinical Significance.—Because of the reces-sion, dentistry has shifted away from expensive

comprehensive treatment procedures to morepreventive and less aggressive restorative andperiodontal procedures. Thus, the current prac-tice of dentistry is focused on preventing oraldisease, intervening early, and providing con-servative options.

Christensen GJ: Dentistry’s forced return to its roots. J Am DentAssoc 142:1393-1395, 2011

Reprints available from GJ Christensen, CR Foundation, 3707 NCanyon Rd, Suite 3D, Provo, UT 84604; e-mail:pr@cliniciansreport.org

EXTRACTS

MINDFUL COMMUNICATION

Up to one in three doctors suffers physician burnout caused by increased paperwork demands and other time andproductivity pressures. With the loss of enthusiasm and engagement come increased errors, decreased empathy andcompassion for patients, and poor professional behavior, along with the risk of substance abuse, abandonment of clini-cal practice, and suicide. To counter this trend, doctors are being trained to bemindful, or fully present and attentive tothe moment. This is designed to improve how they engage with patients and help them manage stresses associatedwith clinical practice.

Few interventions are effective against burnout, but a University of Rochester group studied the effects of a year-long course inmindful communication designed for practicing primary care physicians. Doctors who took part becamemore present, attentive, and focused on the moment; less emotionally exhausted; and better able to empathize withpatients and understand how family, work, or social situations influence illness. Drs Michael S. Krasner and RonaldEpstein developed the course, which includes training in meditation, group discussion, and writing and listening ex-ercises. Training can be especially challenging for physicians who are used to denying their personal responses to dif-ficult situations. Small group discussions increase awareness of how emotions and physical sensations influencebehavior and decisions. Topics for the exercises include medical errors, managing conflict, setting boundaries, andself-care. In one exercise, doctors write about a mistake in their professional or personal life and then discuss the issueand associated physical and emotional responses with two peers. One peer practices appreciative inquiry (listeningwithout judging or leaping to conclusions) and the other observes and proffers suggestions for improving listeningskills at the end of the session.

Many participants describe the 4-day experience as ‘‘transformative,’’ but recognize that the real challenge is notacquiring mindfulness but finding the time and support needed to sustain their skills and teach others when they re-turn home. It is easy to slide back into old patterns. Participants also struggle with how to introduce the ideas they havelearned to colleagues whomay be skeptical or to administrators whomay not want to sacrifice clinical time for trainingcourses or pay for a program that does not generate revenue. Drs Krasner and Epstein remain optimistic. Their resultsare exemplified by a patient of Dr Epstein who has suffered for years from chronic pain. He remains Dr Epstein’s pa-tient because, ‘‘He’s the best doctor I’ve ever had because he can get to what I am trying to say quicker than any otherdoctor. I’m not sure how he does it, but he just really gets it.’’

[PW Chen: Teaching Doctors To Be Mindful. New York Times, October 27, 2011]

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