Under pressure

THE working life of a dentist is a physically and mentally demanding one and evidence suggests levels of occupational stress are high. With the risk of suicide amongst dental practitioners now greater than in the general population, understanding and finding ways to tackle work-related stress are crucial.

The Health and Safety Executive defines work-related stress as: “The adverse reaction people have to excessive pressures or other types of demand placed on them at work.”

This highlights an important distinction between stress and pressure: pressure can provide positive motivation enabling us to perform better, whereas stress is a response to excessive and prolonged pressure.

Short-term stressful experiences such as the compressor breaking down in the middle of a busy working day, or a sudden staff shortage, may feel like a major irritation at the time but they are unlikely to have a long-standing impact. It is the persistent, lower levels of stress that build up over time that can have more serious physical, emotional and behavioural effects.

Health impact

Myers and Myers published a study in the British Dental Journal in 2004 called “It’s difficult being a dentist”: stress and health in the general dental practitioner. They questioned more than 2,400 dentists across the UK and found that perceived stress was significantly correlated with measures of dental stress.

“Running behind schedule” and “coping with difficult uncooperative patients” were the most common work-related stress factors, alongside staff and technical problems, job dissatisfaction and long working hours.

When asked about their health and wellbeing, 60 per cent of dentists reported feeling tense, depressed and had difficulty sleeping. Minor psychiatric symptoms and cases of backache were also high. Researchers also noted a link between occupational stress and both alcohol consumption and lack of exercise, with more than a third of dentists admitting to being overweight.

In 2014 the British Dental Association conducted the Dentists’ Wellbeing and Working Conditions surveys which found that almost half of GDPs (47 per cent) reported low levels of life satisfaction, while six out of 10 said they had felt anxious the previous day. Compared to the UK population, wellbeing among dentists was lower, and had dropped significantly from the previous year. There was a strong association between personal wellbeing and workrelated stress, with those doing mostly NHS dentistry reporting a lower state of wellbeing than those doing mainly private work.

Stress-related illnesses are a common cause of early retirement amongst dentists. Income protection company Dentist Provident reported last year that the majority of claims they received for time off work were due to psychiatric and musculoskeletal disorders, with high pay-outs for conditions such as depression and anxiety disorders.

Stress is also an issue for our medical colleagues. In a bid to address this, a dedicated occupational health service for GPs in England will be launched in April 2016. Announcing the programme, NHS England chief executive Simon Stevens cited burnout and stress as some of the reasons why GPs are leaving the profession. In addition to the occupational health scheme, all NHS staff will be given access to physiotherapy, mental health therapies, and smoking cessation as well as fitness classes such as Zumba and yoga.

It will be interesting to see the uptake and outcome of such an initiative, and perhaps this is something that could be introduced to the dental profession.

Minimising stress

In the meantime, there are a number of areas dentists can look at to reduce stress. First and foremost, dentists who are feeling stressed should not ignore the warning signs and should take swift action.

Keep moving

Busy dentists may feel they do not have the time or energy to exercise, but in such a sedentary career, even simple adaptations can help. This could be as basic as walking to the waiting room to collect and receive patients, going for a walk at lunchtime, or walking to and from the work place.

Making connections

Dentistry can be viewed as a rather solitary profession, a factor that does nothing to alleviate stress levels. The clinical working environment is usually relatively small, with an even tighter focus on the patient. Busy dentists often find themselves sitting still for extended periods, with little opportunity to interact with colleagues, even in larger practices. Having worked in a one-surgery practice, I am only too aware of the isolation that can be experienced as a dentist.

Seeking out opportunities to regularly speak with other dental practitioners, such as through peer review or social gatherings, can reduce stress factors and help you maintain an important perspective on day-to-day issues.

Positive moves

It is important to remember that we are in control of where we choose to work. Think about what key factors allow you to feel valued and increase satisfaction in your working environment. If any factors are missing, what could reasonably be done to alter this? Would you consider changing to a job which better meets your needs? Such changes may have perceived negative factors such as increased travelling or lower pay, but long term you may be happier in the workplace.

Patient autonomy

As dentists we are constantly identifying and diagnosing multiple diseases in our patients, and we will each have our own views on how these should be managed. We must remember that patients have their own perspective and beliefs which will impact on the decisions they make about their treatment and general oral healthcare. We may not always agree with them but it is important that we allow patients to retain ownership of their problems and that we do not take them on as our own.

Time management

Effective time management can significantly reduce stress in the workplace. Team work is key, so form a good relationship with the reception staff who organise the appointment book, and with your dental nurse.

The more research there is into the causes of job dissatisfaction and occupational stress, the more we can learn to implement the most effective ways of tackling it, both at an individual and organisational level. National schemes such as Investors in People, as well as training and advice provided by the likes of the MDDUS Risk Management team, have helped many dental practices develop effective management systems which address potential stress points in practice and work to reduce stress occurring in the workplace. As dental practitioners, we will inevitably be exposed to stress throughout our working lives. We are all affected by stress differently so it is important that we are able to manage it effectively and aim for fulfilling, valuable and successful professional careers.

Sameera Teli is a dentist and editor of SoundBite