What kind of doctor are you becoming?

Muhalab Al Sammarraie, D.D.S., is a site dental director at AltaMed Health Services, the nation’s largest federally qualified health center. A fellow of the International College of Dentists and graduate of the ADA Leadership Institutes, he was named a 2023 ADA 10 Under 10 Award recipient and an Incisal Edge magazine 40 Under 40 Top Dentist. He serves as a delegate for both the American Dental Association and California Dental Association, an international lecturer at Universidad De La Salle Bajio, and a preceptor for Tufts University School of Dental Medicine students.

Earlier this year, I stood in front of a room of dental students in their second year, only weeks away from the day a real patient would sit in their chair for the first time. I had been invited to talk about emotional intelligence in dentistry. I chose to begin somewhere less comfortable: what they were afraid of.

Early in a career, you are afraid — afraid your hands will shake, afraid you will hurt someone, afraid everyone will see and, underneath all of it, afraid you are not good enough to be there. The room changed. I was no longer describing a hypothetical. I was saying out loud the thing no one in the room had said yet.

Fear is not weakness. Every clinician I admire carried some version of it into the operatory. I did and so did the doctors those students will spend their careers admiring. The mistake is not being afraid. The mistake is hiding it and letting it harden into a wall.

So I asked them to do the opposite. Name it. Study it. Say it plainly. The fear you name becomes information while the fear you hide becomes a wall. Then I asked the question I care about more than any technique I could teach. Take two dentists: same school, same training, the same diploma on the wall. Why, 10 years later, are their careers, and the kind of doctors they have become, completely different?

It is not the degree because they hold the same one. Most of the time, it is not even the skill. The difference lives somewhere quieter, in what I have come to think of as a clinician’s internal architecture: the self-awareness, the mindset and the core values that quietly govern how we practice when no one is grading us.

Your skills tell the world what you are capable of while your internal architecture decides what you will do with that capability and who you become while doing it. We spend years in training, and training is good. It teaches diagnosis, technique, materials and judgment, but training and formation are not the same thing. Training builds the skill while formation builds the person.

The longer I practice, the more convinced I become that the only part of a professional life that is truly ours is the interior we build. Skills evolve, and techniques change. Titles come and go. But the person making the decisions behind all of them remains, and eventually, it is the person, not the skill, who decides how the skill gets used.

We measure the first constantly and the second almost never. Yet formation is usually what separates two clinicians who began in the same place and arrived somewhere completely different. Every procedure passes through the person performing it. Dentistry is not only the application of skill; it is the application of self.

I learned what that really means a few years ago, at the height of the pandemic, and I did not learn it from a moment I am proud of. We were working under strict time limits, and I had been in a respirator all day, the kind that leaves marks on your face by noon. A patient arrived, and there was a significant language barrier. Even with an interpreter on the line, I could not understand what she needed.

I want to be precise about what happened next because the easy version of this story is not the true one. The true version is smaller, and more uncomfortable.

I did not lose my temper. I did nothing a chart would ever record. I simply became efficient. I decided, somewhere beneath conscious thought, that this patient was taking longer than the day allowed. I told her, in so many words, that I did not understand what she wanted. And I left the room.

Nothing about that felt like a failure in the moment. That is the part worth sitting with. It felt like coping. It felt like keeping up.

That is how it actually works. No one decides, on a Tuesday, to become a smaller version of themselves. The pressure never asks for the whole thing at once. It asks you to see a little less, to move a little faster, to treat the chart and not the person, just this once, just today. Conscience does not collapse. It narrows, quietly, by degrees. And the respirator marks and the clock and the backlog were all, very politely, asking me to narrow.

I walked into the next operatory and began greeting the next patient. Then I stopped. Something in me said, “Go back.”

I have thought a great deal about where that voice came from because it did not come from my training. No course taught it. No board examined it. It came from the only part of me the diploma never touched. It was not empathy arriving out of nowhere. It was the interior catching the drift before the drift became who I was.

I excused myself and walked out to the lobby, which I almost never do. The first person I saw was her. She turned, and we made eye contact. I apologized. She broke down, hugged me and cried. Then she told me why.

Her oldest son was dying overseas. She could not travel and would not get to say goodbye. She had not come in that day for a denture. She had come in needing to be seen, to be heard, to be felt by another human being who was paying attention.

Here is what I understood, standing in that lobby. I had the clinical skill to help her the entire time. The skill was never in question. What the day had been quietly taking from me was not a skill at all. It was the willingness to stay present when everything in the room was rewarding me for moving on, and I had almost let it go.

The dentist who walked out of that operatory was the same dentist I had just described to a room of students. He was afraid — afraid of the language he could not speak, afraid of falling behind, afraid, underneath all of it, of not being enough for a day that was asking too much. I had not named any of it, so it did what unnamed fear always does. It hardened into a wall, a real one this time: the door I had closed behind me.

The fear I hid that day almost cost a grieving mother the one thing she came for. The fear I might have named would have been information. It would have told me to slow down, not speed up.

What kind of doctor are you becoming?

I said those words to a room of students, but somewhere in the middle of saying them, I understood the question was never really theirs. It belongs to the new graduate and the practice owner. To the educator and the clinician approaching retirement. It belonged to me, on a Tuesday, in a respirator, at the worst moment of a long day. And here is the part I would ask every young dentist to hold onto: The answer to that question was not in the scene where she cried. That is the scene everyone remembers, but it is not the scene that decided the kind of doctor I was. The answer came three seconds earlier, in an empty hallway, when no one was watching and no one was grading me, and I turned around.

That turn is not taught. It is built quietly, over years, in the choices no patient ever sees, until one day it is strong enough to turn you around when the entire system is pushing you forward. Your patients will never see your internal architecture. They will only ever live inside the decisions it makes.

So build it on purpose. The diploma decided what you are capable of. Formation decides what you will do with it, and who you will be in the three seconds when it is only you, the hallway and the choice to go back.