It would come as no surprise if I were to tell you that dentistry is a stressful profession and that dentists are renowned for having a higher than average suicide rate. But why is that and how can we as dentists learn to deal with our stresses better rather than simply accepting it as a fact of life.
Dentists are subject to a variety of stress-related problems, including a high incidence of cardiovascular disease, peptic ulcers, colitis, high blood pressure, lower back pain, eye strain, marital disharmony, alcoholism, drug addiction, mental depression and suicide.
* The suicide rate of dentists is more than twice the rate of the general population and almost three times higher than that of other white-collar workers.
* Emotional illness ranks third in order of frequency of health problems amongst dentists, while in the general population it ranks tenth.
* Coronary disease and high blood pressure are over 25% more prevalent among dentists than in the general population.
* Dentists suffer psycho-neurotic disorders at a rate of 2 1/2 times greater than physicians.
* The number 1 killer of dentists is stress-related cardiovascular disease.
CAUSES OF STRESS
Why is our profession so prone to stress and the physical, mental and social problems that go with it? Can we find ways to support ourselves to deal with the pressures we face and hopefully live longer and happier?
As a dentist we spend most of our working life confined to a small, sometimes windowless, 2m by 3m treatment room, which is smaller than the average prison cell. The work we do is intricate and meticulous and is performed in a small, restricted space called the mouth filled with saliva and moving pink bits called cheeks and tongues, which is attached to an often-anxious human being. The procedures are both physically and mentally taxing and as a result, muscular strain, back troubles, circulatory disorders and fatigue are common. It is relatively easy, over a period of time, for a dentist to become both physically and emotionally burned-out.
As most dentists practice alone we do not have the opportunity to share and solve problems with our colleagues the way other professional groups do through peer support. This problem of isolation is compounded by the fact that we tend to be competitive with one another, a trait that is unfortunately a bi-product of our competitive dental school training. This is then reinforced after graduation by the intense competition created by the surplus of dentists that now exists in many cities and large metropolitan areas.
Dentists suffer from a relentless pursuit of perfection whilst attempting to create permanent solutions to dental disease in an inhospitable oral environment. The stress of perfection is instilled in us in dental school, creating a major cause of stress and frustration as we strive for that perfect restoration that will ultimately be rendered imperfect by time and patient neglect, despite the our best efforts.
In dentistry we face a unique position of being both the business owner, manager and producer of income which means we wear several hats all the time and can not be everywhere in our dental office, often having to trust others to work unsupervised to provide our patients and business with the level of service and care required for our office to be successful and profitable. The typical dentist is paying off huge loans to cover the cost of dental school and the cost of setting up a private practice. Economic pressures forces us to work long hours, take limited holidays, work when we are sick and even work through our lunch.
When a dentist is absent from the office, the income totally stops, but the high overhead expenses continue to accrue. The dentist who works all the time and never takes time off might seemingly make a few dollars more, but there is a high price to pay — BURNOUT! And when dentists burnout, we become emotionally and mentally exhausted, develop a negative, indifferent or cynical attitude towards our patients and our staff and are negative and self-critical. The more burn out we suffer the more our ability to produce quality dentistry and bring in that much needed income falters.
When it comes to holidays and taking a break, ask yourself who would you rather see, a dentist who needs a holiday or takes one? Ironically the dentist who takes holidays is often more productive as they are less stressed and exhausted!
Oh and if these pressures weren’t enough, what happens when we factor in time and attempting to stay on schedule in a busy dental practice. Dentistry, unfortunately, seems to be governed by if any thing can go wrong, it will go wrong and usually at the worst possible time and as we all know, once we are behind schedule it is almost impossible to catch up and as our time ticks away our stress levels rise at an inversely proportional rate.
We spend four to five years in dental school learning perfection and “ideal” treatment for our patients. Yet the realities of private practice are that many patients, due to financial restraints, poor insurance plans or low appreciation of quality dental care, will not accept “ideal” treatment plans. The result is that we are continually forced to compromise treatment and are left frustrated at not being able to reach our ideal treatment goals, always doing compromised work that inevitably fails leading to stress and tension with the patient who can’t or is unwilling to accept that the treatment failed because they forced us in to offering substandard treatment in the first place.
Consequently, the dentist is often forced to operate a “fix-and-repair” business, providing compromised treatment for patients who refuse the best of dental care. The dentist then ends up emotionally carrying the responsibility for less than ideal results while the patient continues to express unrealistic expectations.
The stress of working with apprehensive and fearful patients can be devastating to the dental practitioner. There is now considerable evidence that dentists experience patterns of physiological stress responses (increased heart rate, high blood pressure, sweating, etc.) that parallel the patient’s responses when performing dental procedures that evoke patient fear and anxiety. Wouldn’t it be great if we could work in a way where we can observe the patient’s anxiety and fear but not take it on ourselves, instead staying calm and focused whilst we do our work in a way that is supportive and reassuring to our patient? That would do wonders for our stress levels and for everyone else involved too.
Whilst it is easy to blame all these outside influences for our stress, at the end of the day there is actually no such thing as stress only our reactions to life and situations which cause us to feel stressed. With that being said how we choose to feel and deal with our jobs will have a massive impact on our perception of stress and being able to cope. Sadly the personality traits that make for a good dentist are also traits that predispose us to depression in mid-life, drug and alcohol abuse and the attendant risk of suicide. How many of us would recognise these in ourselves: compulsive attention to detail, extreme conscientiousness, careful control of emotions, unrealistic expectations of self and others, needing recognition for individual performance and prestige.
Stress can never be totally eliminated from dental practice. However, it must be minimised as much as possible in order to avoid the many problems that it causes. And this is where taking control of what we can control is important for example we can improve the working environment at the office, reach out to others to share problems and seek support with fellow dentists, work more sensible hours and take time each day for a leisurely lunch break, take holidays whenever the pressures of practice start to build, learn how to better handle patient anxiety and hostility, adopt a program of physical exercise and self-care and most importantly, start being kinder to ourself and be less critical and demanding of our efforts.
In dental practice we devote so much of our time and study to caring for our patient’s health, what about dedicating some time to yourself, your health and your future.