Are you at the end of your tether?

14 April, 2011 / Infocus

My interest in stress management started as a result of supporting recent graduates experiencing the problems of transition from undergraduate dental school to general dental practice. These problems were shared with me in my role as regional adviser for vocational training in the west of Scotland.

Many young graduates were under considerable stress with the potential risk of clinical errors, as well as risks to their health and wellbeing. This led me to gaining the Diploma in Stress Management in 2005. Since then I have been presenting courses on stress management to GDPs and VDPs. This article will draw on the experiences of these courses.

General dental practice has the reputation of being one of the most stressful professions. The league table of suicide rates by profession identifies dentists and vets to be at the highest risk. This article will also explore the reasons for the apparently stressful nature of dental practice, examine the perception that the job is becoming more stressful and discuss how dental teams can reduce their levels of stress.

The conflict between the profit motive implicit in running a business and delivering the highest possible standard of healthcare is a major stressor. Young dentists telephone defence societies on a daily basis with real concerns about the quality of care they are delivering due to constraints such as lack of nursing support, ineffective systems and absence of teamwork.

Practice owners and dental companies tend to focus on providing modern equipment, an extensive choice of materials and selection of high-quality laboratories, but often fail to recognise the importance of team working, effective systems and good communications. For those of you who are thinking:“Not more management gobbledegook”, the analysis of complaints and referrals to the GDC clearly identifies these failures as the root cause in most cases.

In addition, these areas of management in general dental practice cannot be taught in dental school. Modern dental practice is delivered by teams and if these teams are supported and developed as teams, rather than as groups of individuals, job satisfaction and patient satisfaction will improve. It is noticeable that well-organised, efficient practices find it easier to recruit associates and retain them to ensure continuity.

In relation to the perception that the job is becoming more stressful, as part of my presentation to VDPs on the fight or flight response, I ask if they have felt this response happening in the surgery. All participants report that they have experienced the response to varying degrees. The commonest reason for this is the increasing incidence of aggressive patients attempting to bully the dentist into treatments against their better judgement.

The concept that we are the dentist and we know best may be old fashioned, but we do have to sometimes say: “No, I am not prepared to carry out that treatment as it is not appropriate.” If the patient storms out of the surgery saying they are going elsewhere, then this outcome may not be as disastrous as you think at the time. Assertiveness training – how to say no – should be an integral part of VT.

Increasing bureaucracy is the other oft-quoted reason for the job becoming more stressful. The list of organisations that have become involved in some aspect of dental practice grows by the day. Disclosure Scotland, Medicines and Healthcare Products Regulatory Agency, Vulnerable Groups Scheme, Care Commission and IHAS Quality Mark Scheme are just some of the recent additions. It seems obvious that if the dentist is attempting to deal personally with these agencies, as well as the ones directly involved in patient care, then overload and stress will occur. Delegation is the key.

I have been involved in training programmes for dental practice managers for more than 10 years and it is refreshing to see practice managers playing an increasingly important role in teamwork in practices. This is especially relevant in relation to patient complaints, which are on the increase and patients can now complain directly to GDC.

We should remember that a complaint is an expression of dissatisfaction, verbal or written, about a dental service or treatment – whether justified or not. In dealing with a complaint, some dentists will concentrate on the ’whether justified or not’ element rather than listening to the patient and finding out their perception of the problem.

When a veneer becomes dislodged, the dentist’s first words to the patient are often: “Well, you must have been grinding your teeth.” A practice manager on the other hand will usually establish a rapport with the patient, ask how it happened and begin to explore solutions to the cosmetic disaster. The teamwork solution is again appropriate.

My stress management courses were initially aimed at dentists and focused on the above examples of why dental practice appeared to be more stressful than before. Other areas discussed were staff shortages/absences, demanding patients, pace of change, bad debts, etc. There were several dentists on these courses who stated that they felt fairly stressed.

My recent courses have been provided for dental teams and have been held over two separate days. This format has allowed the development of action plans on the first day which can be implemented back at the practice. There is no doubt in my mind that if the problem is tackled by the dental team rather than just the dentist, the chances of success are higher.

The second day can then assess the success of the action plans as a group discussion. Action plans often include making basic changes to appointment systems, delegating complaints to the best communicator in the practice, improving the system for coping with emergency patients and developing a team approach to avoiding bad debts. These improved systems will reduce practice stress levels.

In relation to a dentist’s individual stress levels, the solutions have included making a thorough assessment of patient expectations, developing listening skills, avoiding constant time pressures and being willing to change.

Remember, in relation to change, if you do what you have always done you will get what you have always got. Changing the way you work can prevent stress developing.

Robert Broadfoot was a general dental practitioner in the west of Scotland for 30 years. He runs courses and workshops on stress management and also works as a part time associate dento-legal adviser with Dental Protection.

Identifying Your Stress: Warning signs

Everyone suffers stress to one degree or another. But when it rises to levels which impact on the way you work and live your life, then it is vitally important that you act to reduce these stress levels.

However, sometimes it can be difficult to identify the symptoms of stress and, often, the root cause of the stress.

So, to help you look out for the things that you can identify if you think you’re stressed, here’s a list of classic indicators:

  • Not being able to switch off
  • Needing alcohol regularly
  • Losing temper quicker than usual
  • Sleep affected
  • Weight loss/gain
  • Headaches
  • Back/neck pain
  • Digestive disorders
  • Longer working hours
  • Less time for family
  • Frequent colds
  • Performance issues.

Taking Action: combat stress

If you are aware of one stress indicator in your life, then give the cause serious thought.

If, however, you are aware of several of these indicators in your life then you should seek help and make changes to counteract these stress levels.

There are a number of key routes down which you can go to get the help that you will need to reduce the stress and put you back on the right track.

Here are some suggestions on where to seek help:

  • Initially, discuss your thoughts with your partner (if appropriate) or with a trusted friend
  • Your next step could be talk to your doctor. It is important that you never self-medicate
  • An excellent source of advice and guidance is the Dentist Support Scheme. Their helpful staff can be reached by calling 0207 224 4671
  • If your circumstances are appropriate, why not talk to your dental practice adviser?
  • Your postgraduate tutor can also be an excellent source of help.

It must be remembered that self-medication prevents the essential communication with a second party who can be objective. And it can also lead to addiction.

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