Avoiding the ill effects of stress

So why are dentists so susceptible to stress?

Not only are they required to work in an intricate manner in a sensitive and intimate part of the body, sitting in the same position for long periods of time, but they also have to be responsible for the smooth and seamless management of their patients on their day list. Added to this may be the ever-increasing demands and expectations of patients and a constant awareness of not running behind schedule. As if this wasn't enough, they have to ensure that they maintain the clinical excellence expected by their patients, colleagues and their regulatory body.

Faced with all these factors, and for the most part, not having received any particular training in, for example, people skills or financial management, it is little wonder that dentists can fall victim to stress related illnesses, either mental, physical or both.

Two factors which can generate stress in dentists are control and change.

Keeping control

It is clear that we function best when we are in control of our circumstances; when we feel we are responsible for our successes or failures due to our own personal attributes. This could also include the responsibility of the welfare of both patients and staff. As is often the case however, bureaucracy can on occasion, militate against this feeling of control which can then result in work-related stress. It also illustrates the importance of involvement in the process of change for the best results to be achieved. 'Today's dental environment is not going to change to accommodate the individual. It's the individual who needs to learn to accommodate to the environment if he or she does not want to pay the price of chronic stress.'

Achievement

There is no doubt that we all need pressures and challenges in our lives to get us up in the morning and to keep us going. These can galvanise us into achieving great things; to work at our most productive level, but we have to be aware that having unrealistic goals or expectations can possibly result in the 'law of diminishing returns' ie. the more we push ourselves to reach that elusive goal, the less well we can sometimes perform. Indeed, in a study examining the sources of stress for Australian dental students it was suggested that the high levels of stress reported could be explained by an 'underlying tendency towards perfectionism'. Typically, students enter dental school as high achievers with powerful expectations of scholastic excellence. Once immersed in an environment where academic excellence is the norm, their self- concept is adjusted, and a new norm of competitive perfectionism can emerge.'

This is not to underestimate the thrill of achievement, but it is worth paying heed to the warning signs, and to ensure we remain in control.

Reading the signs

These warning signs are like traffic lights in our lives. Green means that everything (or nearly everything) is going well with us. We are enjoying our work; the practice is flourishing; we have a great team and the patients are appreciative. Home and social life is good; and the sun is shining. Then perhaps things start to go slightly awry - a valued chair-side assistant leaves, creating extra work for the rest of the staff, and leaving you feeling is if you've lost your right arm. You find yourself staying later at the surgery to catch up and you are aware that you are feeling more tired than usual. At the surgery you feel your concentration slipping slightly and you are becoming tense and irritable. This situation may carry on for a while with perhaps other events occurring to add to the mix - a complaint or family illness for example. At home, your evening glass of wine is turning into two or three. You are sleeping badly, relationships are suffering and you are starting to feel that you can't cope. The red light is beckoning! If the symptoms continue to intensify to the extent of absolute exhaustion, ill health and the inability to cope it could be advisable to seek help.

Running on empty

Burnout is one of the possible consequences of chronic work related stress, and is sometimes described as the gradual erosion of the person. It occurs when the person feels they are 'running on empty' on an emotional, physical and mental level and can manifest itself by a loss of enthusiasm for work, lateness and irritability towards staff. Other manifestations such as cynicism, negativity and indifference towards patients and others are not uncommon. This is known as 'depersonalisation' or 'dehumanisation'.

Lastly, a tendency develops in the person which makes them feel dissatisfied with their achievements and accomplishments and to view themselves in a negative light.

Burnout tends to occur less in people who are cynical and uncaring, but as dentists are mainly dedicated and compassionate professionals, they can try endlessly and futilely to improve the situation.

Solutions to burnout include the following strategies: 'admit the problem; assume responsibility for solving it; decide what can be changed and what cannot; and take time off to allow more objective analysis of the problems. Burnout can be avoided by taking time off regularly; making time to 'decompress' after work; keeping work and home life separate; creating a social life that is truly satisfying; establishing good personal and professional networks; and searching out people who will actively listen in a non-judgemental manner. Feelings of burnout can be used as motivators in changing priorities and improving the quality of life.'

Which type are you?

Personality can also have a bearing on the dentist's ability to cope with stressful situations. A study carried out by Professor Cary Cooper et al suggested that dentists had a tendency to exhibit 'Type A' behaviour. People with 'type A' personalities tend to be driven, highly ambitious, impatient, aggressive and intolerant.
They have high expectations of themselves and those around them. 'Type B' personalities although they may be equally ambitious and successful, are able to perform in a calmer and more relaxed manner. People can fluctuate between these two behaviours which are said to be on a continuum.

Ideal situation

A successful practice is one where effective stress management strategies are firmly in place. This contributes to the atmosphere of well-being and competence within the practice. Its positive effect emanates throughout - the staff feel valued and motivated and the patients feel more relaxed and welcome. It's a 'win-win' situation for all concerned.

Achieving this ideal situation does not come naturally to many practitioners who may require guidance. It may be necessary to consider what your goals and aspirations are in relation to both yourself and your practice. Hopefully some of the coping strategies that follow will be of assistance.

Practical steps

In terms of individual stress, try taking a step back and assess where the stress is coming from. Writing a list of causes from the most stressful down to the least stressful will help you gain some perspective of the problem and may inspire you to tackle some of the issues raised. It is even possible that you could be the cause of the stress! You may need help in dealing with some of these issues. Try not to let pride stand in the way of getting the help you need.

It could also be useful to employ this technique with your chair-side assistant and receptionist by asking them to identify the sources of stress. 'By airing and discussing grievances, concerns and new strategies, the various members will feel part of the dental team and provide mutual support in time of stress.'

Relaxation techniques:

Although it is often thought that relaxation is not compatible with working in a dental surgery, with organisation and planning it is feasible. (Some European countries manage successfully to incorporate this into their working day.) A prerequisite would have to be a competent receptionist who would not fill your appointment book so full that you do not have time to breathe, let alone try some deep breathing (which is excellent for calming you down.) Take in a deep breath (don't hold it) and count one, two three as you exhale slowly.

In your every day life having a period of relaxation is vital. It could be as basic as taking breaks in the day or going out at lunchtime to listening to music or having a relaxing bath. The importance of relaxation is that it enables you to switch off and recharge your batteries!

Equally important is physical exercise. Exercise burns up the excess adrenaline resulting from stress, allowing the body to return to a steady state. It can also increase energy and efficiency. Do find an exercise which you enjoy that will motivate you to continue doing it. Exercise also releases endorphins, which give us the 'feel good factor' and make us nicer to our patients and staff!

Balance your diet. Eat a proper breakfast, drink sensibly and include lots of water to rehydrate the system. Include complex carbohydrates (wholemeal bread, jacket potatoes) in your diet, to counteract mood swings, and fruit and vegetables to provide vitamin C to support your immune system.

Manage your time (and yourself) efficiently. Again, taking a step back and reviewing your working practise is essential. Do you have an allotted time for dealing with emergencies and administration? Are you constantly running behind schedule causing your stress levels to escalate? Developing leadership and organisational skills will enable you to feel more in control of you working environment.

Ensure that your staff have been properly trained (and, if not, ensure they are!) and are aware of their individual roles and responsibilities. Encourage a culture of mutual support, whereby asking for help (say from your practice principal or a more experienced colleague) is not viewed as weakness. Talking over your problems with someone you trust can be such a help! Dentists often relish being asked for advice by their younger colleagues and being able to share with them their own years of experience in managing stressful situations.

As mentioned previously, some dentists may be excellent practitioners but sadly lacking in interpersonal skills. An ability to listen is a gift .If you feel you need some training in communication, there are a number of courses and modules available from Dental Protection or check the events calendar for events near you.

By incorporating at least some of these strategies into your everyday life and your working life, you could create an environment which is stress free and an environment in which it is a pleasure to work. It could make the difference between a good practice and an outstanding one. Who wouldn't want that?

Ros Edlin is a freelance stress management and relaxation trainer. This article is copyright of the author [email protected]

References
1 Mark Hillman, Ph.D, Article. Stress and Dentistry: Better Practice Through Control
2 Sanders et al-Journal of Dental Education. Volume 63 (9). September 1999
3 Pride J. Journal of the American Dental Assoc. 1991
4 Sutherland V J, Cooper C L, Understanding stress: A psychological perspective for health professionals. London: Chapman & Hall , 1990
5 R. Freeman et al, Occupational stress and dentistry: theory and practice Part II Assessment and control, BDJ, 1995; 178:218-222.