Release the pressure

IMAGINE the following scenario. You’ve arrived late for work. Your nurse has phoned in sick. The lab hasn’t delivered the first patient’s denture work. You’ve run out of the required shade for that anterior composite and the external assessor is not impressed you’re running late for your performance evaluation.

It’s not uncommon to experience a variety of untoward events during a day in general practice. Add patients to the mix, and a day which wasn’t going terribly well can become a whole lot worse. No two days in dentistry are ever the same and that can make it an interesting, but challenging career. Indeed, dentistry has a reputation for being one of the most stressful jobs, with dentists often said to be amongst the professionals most at risk of suicide.

Sometimes a certain level of stress can be a positive thing. If you are working in a well-organised environment with a degree of pressure, it can help focus the mind to achieve high quality results under tight deadlines. This would be the ideal scenario for working in a general practice but if stress levels rise to the point where it affects the way you live and work, then that can have negative consequences.

Get organised

One of the best ways to avoid stress is good organisation. At university, you can lead a relatively structured existence as lectures, patients, exam dates and holidays are dictated by dental school staff. The transition to working life, however, can present a challenge to some new graduates. Balancing a demanding career with increased clinical pressures, an inevitably busy social life and potential family commitments can take its toll on a young dentist’s mental and physical wellbeing.

As an associate, financial pressures can bring about a great deal of stress. There is a stark contrast between being self-employed and being a salaried vocational trainee. It is important to budget accordingly and, for those practising in Scotland, to keep a note of the cost of submitted GP17s in order to appropriately financially plan for the following month. It’s also advisable to have a degree of savings in case of a poor financial month, brought about by sickness or poor patient attendance. Whichever sector of the dental profession you work in, it is worth planning how you will continue to pay your bills for unpredictable events such as accidents or illness.

Time management is also key. Although it’s important to increase the pace at which you undertake clinical procedures once you start vocational training, do not over-estimate the amount of work you can achieve in a specific timescale. It is imperative to remember that, given time, the increase in productivity will come naturally and that initially the focus should be on obtaining sound clinical results.

If you feel that you are being put under undue pressure by your VT trainer to set appointment times which will not allow you to achieve satisfactory results, you must raise the issue. A day spent constantly running late will inevitably result in unhappy patients, an unhappy nurse and a stressed dentist. Your clinical work is also bound to suffer, leading to treatment failures which will further compound this stressful environment. Poor performance can also lead to patient complaints and, while it would be a great achievement to complete a clinical career without receiving at least one complaint, carefully organising and managing your time can help to minimise the risks.

Team support

The daily stresses of dentistry shouldn’t be tackled alone. Remember that your dental nurse can be a source of re-assurance and organisation. A well-trained and helpful nurse is invaluable in reducing the day-to-day stresses of practice. It is advisable to meet with a new nurse prior to treating patients in order to establish a fluent and rehearsed approach to performing various treatments. Making sure the dentist and nurse are singing from the same hymn sheet will avoid those awkward moments when specific requests for materials or equipment are met with blank faces.

If you have the unfortunate experience of having to work with a difficult nurse, try to iron out any potential problems as soon as possible in the most tactful of manners. It may be appropriate to raise these issues with your trainer or practice principle if they persist. You are likely to spend more time during the day with your dental nurse than you are with family members. Like all relationships, if there is an element of dysfunction, it can lead to a great deal of unnecessary stress and decreased productivity.

Spot the signs

I would be surprised if there was a dentist who hasn’t at some point felt anxious about a looming exam or a pending patient – but how do you know if you are suffering from stress? Some classic signs include: being unable to sleep, weight loss/gain, procrastination/ lethargy, not being able to switch off, being short-tempered, performance issues, headaches, frequent colds, working longer hours or alcohol/substance abuse.

All of these factors can jeopardise your fitness to practise and any dentist deemed unfit by the General Dental Council faces being suspended or erased from the register. It is vital that you heed the warning signs and seek help as soon as possible. Discuss the problem with a partner or trusted friend, or seek help from your postgraduate tutor or doctor – don’t try to deal with it alone. The Dentists’ Health Support Programme can also help those with alcohol problems or other addictive illnesses through their emergency helpline on 0207 224 4671. Likewise, don’t ignore the warning signs in colleagues. In these cases, your defence union can offer advice on the most appropriate course of action. Patient safety is paramount and matters such as these cannot go untreated.

Apart from addressing the specific issues head on, there are general day-to-day activities which can be employed to reduce these symptoms. Setting aside dedicated breaks throughout the working day is a great way to take a step back and relax or possibly re-assess difficult situations. One of the main physical changes to working in practice as opposed to working as a dental student in hospital is the lack of movement throughout the day. Sitting in a chair in the surgery five days a week doesn’t quite burn off the same amount of energy as running up and down stairs between different departments in hospital. It’s therefore advisable to undertake regular exercise.

Team sports are also a good way of interacting with friends outside of the dental ‘cocoon’. Planning regular holidays throughout the year also provides a break from what can become the regular pattern of a working week. ‘Getting away from it all’ can help focus the mind on addressing problems which are otherwise difficult to deal with when you have the added pressures of clinical practice.

Many dentists will have experienced symptoms of stress, and if you do feel you are struggling in any way don’t hesitate to seek help. It’s a steep learning curve as a young dentist, and you should realise that there is always someone to turn to if you require that extra piece of advice.

Martin Nimmo is an SHO in oral and maxillofacial surgery and is editor of SoundBite