Mark Hillman, Ph.D.

Stress and Dentistry: Better Practice Through Control
By Mark Hillman

Synopsis: It's impossible to give a single definition to stress. That's because people experience it in different ways. It is possible, however, to get it and keep it under control. In fact, stress control is necessary to every successful dental practice.

Your first patient of the day is seated in the chair. As you move to greet him or her, you try to clear your mind of feelings of discontent. You're an excellent dentist, this is your office, your practice, and yet you can't quiet concerns you have about production, accounts receivable and cash flow.

You've taken courses on risk management, practice management, OSHA, and new procedures to benefit your patients. You've worked hard to train your staff. You strive to give your patients the best quality care you can, and to stay efficient. And yet you're angry. The drive you once had and the pleasures you once gained from tackling new procedures has been replaced by lethargy, procrastination and resentment.

Why, you ask. You didn't go to dental school to deal with all these different frustrations. You went to learn how to practice dentistry. But now, instead of practicing the way you want to, you find yourself caught up in a cycle of stress.

Richard Lazarus, noted author of books on stress and coping, emphasizes that stress is a decision making process, causing one to access what is at stake (appraisal of cost), and what options are available (appraisal of coping). Only after one sees the potential of threat or harm-loss can the term stress be used. The events you face every day in the office put you in this decision making process. The responsibility and the pressure are on you; the costs of the stakes are borne by you. You are the one who determines what options are available.

A Singular Affliction

Because everyone has different values and beliefs, a universal definition of stress seems highly improbable. Stress is defined differently for each of us. Assuming that you do have stress, the big question is: How are you going to cope with something you don't necessarily want? You certainly don't want stress to effect your work, your family or your personal life.

Coping has been defined by many researchers. The universal thought seems to be that coping consists of the problem-solving efforts made by an individual faced with demands that are highly relevant to his or her welfare.

Dentistry has changed over the years. There are new techniques, new OSHA laws, and new sterilization requirements. Dentists 25 years ago didn't worry about sterilizing their hand pieces, or if their offices met OSHA standards. Dentists today do worry about these things, which adds to the stress they feel. Managing this stress successfully demands change.

Accommodating Change

Change is a process, not a plan. The question is not does one want to change, but does one want to influence the change? 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.

People only resist change when it is imposed. Change is most successful when those who are effected by it are involved in the process that brings it about. But not every dentist can be directly involved in the changes taking place in dentistry, even though he or she will be effected by these changes. Will they cause stress? In some instances definitely.

People need to develop a vision and a strategic plan for themselves and their organization, and then go about the business of acting on the plan and feeding back into the system information from that action. This will provide a basis for building real consensus and unity and a creative environment for strategic thinkers in control of their future.

Individuals change by themselves or in concert with others. While change can be individually and/or collectively positive or negative, it's our goal here to encourage positive change, and to help people get from their lives what they want.

Stress-Free Environment

The dental profession is undergoing many changes, such as the use of intraoral video cameras, increased patient interest in cosmetic dentistry, practice computerization and implant restoration. And these are just some of the trends that contribute to stress among dentists and their staffs. Successful stress management complements practice management, production, attitude--in other words, the whole environment in the dental office. The ability to deal with stress more effectively contributes to the success of the practice. Harmony among coworkers is also enhanced, which, in turn, aids in their dealings with the public.

Many people's anxiety increases substantially when visiting the dentist; however, when they are embraced by a warm and friendly atmosphere, their anxiety is lessened. To achieve the desirable atmosphere in the office, it is necessary that employees sincerely enjoy working there. This will make the patient more comfortable, thus creating not only a loyal patient, but also an excellent new-patient referral source.

Stress Relievers

Strategies to deal with stress vary from the physiological technique of progressive relaxation to the cognitive strategy of thought-stopping. The goal of all these strategies is to increase self-understanding and self-awareness as a means of encouraging healthy adaptation.

The progressive relaxation technique is based on the premise that the body responds to anxiety-provoking thoughts and events with muscle tension. The technique involves deep muscle relaxation, which reduces physiological tension, a state that is incompatible with anxiety.

Thought-stopping can best be defined as a form of thought control. It involves concentrating briefly on the unwanted thoughts and then suddenly stopping and emptying your mind of these thoughts. It has been well-documented that negative and frightening thoughts invariably precede negative and frightening emotions. If the thoughts can be controlled, overall stress levels can be reduced significantly.

How can these techniques be incorporated into the daily routine of the dental office? It is surprising how quickly and easily these techniques can be learned and adapted to the work environment. When mastered they can be valuable tools for reducing stress and anxiety in the workplace, thereby creating a comfortable climate for yourself, your patients, and ultimately a more successful practice.

Published in the Wisconsin State Dental Journal - January 1999

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