Dealing with stress in the 21st century

Ask the average man in the street for his opinion as to whether or not dentists experience stress, and your query will, in all probability, be met with a look of incredulity and a snort of derision. After all, isn’t stress the domain of the poor patient rather than the high-earning, fast-living, Porsche-driving dentist?

A media-fuelled opinion such as this may be true for a small minority of dentists, but for the vast majority this is an entirely inaccurate assessment of dentistry today.

What is true, however, is that dentistry has been identified as one of the most stressful of the health professions.

A recent study by Myers and Myers (2004) conducted using an anonymous cross-section of 2,441 UK general dental practitioners (GDPs) found that 60% of GDPs reported being nervy, tense or depressed, 58.3% reported headaches, 60% reported difficulty sleeping and 48.2% reported feeling tired for no apparent reason – all signs possibly attributable to work-related 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 running of the practice with regard to both staff and patients, as well as managing the financial aspect. Added to this are the ever-increasing demands and expectations of patients and the constant awareness of running behind schedule. As if this wasn’t enough, they also have to ensure that they maintain clinical excellence.

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

Stress itself is not an illness but is, according to the Health and Safety Authority (HSA): ‘A negative reaction to pressure, accompanied by fear of not coping, loss of control and lack of support’.

The HSA also acknowledges that ‘we all have different levels of coping ability and a different tolerance for stress. There are those, often categorised as “Type A” personalities, who tolerate relatively high stress levels and thrive on the stimulation and alertness brought about by stress. There are others who have very low tolerance levels and thrive in slow moving environments with low stimulation and even paced work.’ 

The concept of perception is particularly relevant in that, faced with the same situation, for example a difficult procedure or a demanding patient, one dentist may relish the challenge and yet another be trembling in their shoes!

Control and change

Also pertaining to the definition of stress are the notions of control and change.

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, the bureaucracy of the governing bodies mitigates against this feeling of control, which could result in work-related stress.

The recent PRSI reduction is a prime example where it can be argued that dentists have a loss of control of their own destinies. 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’, wrote Mark Hillman (1995). 

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; i.e. the more we push ourselves to reach that elusive goal, the less well we can sometimes perform. This is not to underestimate the thrill of achievement, but it is worth paying heed to the warning signs.

Red alert

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, the children are behaving themselves and the sun is shining.

Then, perhaps, things start to go slightly awry – your valued nurse leaves, creating extra work for the rest of the staff and leaving you feeling as 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 point of absolute exhaustion, ill health and the inability to cope, it could be advisable to seek help.

Personality can also have a bearing on the dentist’s ability to cope with stressful situations. A study carried out by Cooper et al (1990) suggested that some 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.  

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, while the patients feel more relaxed and welcome – 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.

Coping mechanisms

In terms of individual stress, try taking a step back to 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 on 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 staff 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’, wrote Freeman et al (1995).  

For the individual, relaxation techniques are also recommended. 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 to incorporate this into their working day successfully.) 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 everyday 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 listen to music. 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 that you enjoy, which will motivate you to continue doing it.

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

Manage your time (and yourself) efficiently. Again, taking a step back and reviewing your working practices 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 your working environment.

Ensure that your staff are properly trained and aware of their individual roles and responsibilities. Encourage a culture of mutual support, whereby asking for help is not viewed as a weakness. Talking over your problems with someone you trust can be a great help.

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 plenty of courses available.

By incorporating at least some of these strategies into your everyday working life and home life, you could create an environment that is stress-free and 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?

References

Myers HL, Myers LB (2004) It’s difficult being a dentist: stress and health in the general dental practitioner. BDJ 197: 89-93

Mark Hillman (1995) Stress and dentistry: better practice through control. NY State Dent J 61(6): 50-52

Sutherland VJ, Cooper CL (1990) Understanding stress: a psychological perspective for health professionals. Chapman & Hall, London

Freeman R et al (1995) Occupational stress and dentistry: theory and practice,  part II. Assessment and control. BDJ 178: 218-222

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