The Personal Side of Stress



There is a dark side to stress and it shows itself in the offices, homes and lives of dentists so overwhelmed they turn to extreme measures to avoid and dull the pain. These maladaptive coping methods range from excessive gym visits, lengthy hours of screen time, sleepless nights, self-injurious behaviors and drug abuse. The shame and embarrassment of these actions make dentists feel alone. But they're not alone. In fact, the statistics on substance abuse among dentists are staggering. Fortunately, there is a way out.

Before

As a new graduate, I purchased a well-established but antiquated dental practice. I was stuck with old equipment and a hygiene program I didn't want a part of, so after only six months I realized the way this practice was going wasn't for me. I implemented changes including new equipment and better practice management. The next seven years, my gross increased 400 percent (with an average of 52 percent overhead).

I was practicing dentistry, had time for my family and for golf. I was doing what I loved to do. I had money and time and toys. Life seemed great. Unfortunately, I didn't know how to make a budget and I was afraid to admit it so I never asked for help.

The Catalyst

After a few years my practice took off but I was stressed about treatment acceptance. I attended CE courses to offer the very best treatment but became frustrated when I was relegated to basic procedures. It became very taxing and stressful to me when patients refused what I considered ideal treatment. The stress and pressure of gaining case acceptance was mounting and patients could tell by how I presented treatment.

I was the first in my area to use modern technology, and word of mouth spread fast, so quickly I became overwhelmed. I began to feel apprehension each morning on my way to work. It wasn't clear what was wrong at first. I finally realized I was afraid of losing patients. I had them and I needed to keep them.

The practice had exploded. My hygiene schedule was booked eight months out and my operative scheduled six months out. I went from 36 hours of office time to 54+ hours a week. We overfilled our schedule from the cancellation lists. Weekends were spent doing lab work. I wouldn't allow myself to delegate anything. I was working like a machine and ignoring what my body was trying to tell me; I was burnt out. It was so bad my wife quit setting a place for me at the dinner table. Of course, I justified it like everything else, as part of the job.

During this time, I developed chronic sinus headaches. I was so busy I didn't dare miss a day of work to take care of myself. I was taking up to 20 Tylenol per day to get through. The pounding of my head and the constant stress became so much I finally had to do something.

The Slippery Slope

One evening before leaving the office, I decided to take one of the many hundred Vicoprofen samples I kept for patients but rarely remembered to dispense. It wasn't 40 minutes later I felt like a new person. I had energy! And a (false) sense that my stress had just been chopped in half. My headache was totally gone - why go see a doctor now?

Eight months later I was addicted to hydrocodone. Instead of waking up looking forward to the day, I woke up to count how many pills I had available to make it through the day. It seemed the only thing that mattered.

The Bottom

At the same time, the rest of my life became unmanageable. My family became a superficial presence in my life, my friends and social acquaintances didn't matter any more, hobbies no longer interested me, my spending became out of control and I neglected several quarterly estimated payments. I isolated myself from everyone and everything, not realizing the extent or impact until later. The worst part: I was afraid to confide in the very people who loved and cared for me. The shame and guilt was stifling. The little pill that cured my headache and relived my stress was now controlling every facet of my being.

When I couldn't get pills, I would substitute with alcohol or shopping. Living in excess was a habit my body and mind had become accustom to. At this point, I'd been fighting this for four years. I knew I had become addicted but still never considered myself an addict.

Even Lower

As a result of the sinus infection and the surgery required to resolve it, I came clean to my wife and we decided it would be best to sell the practice and move. The stress of running the practice coupled with the stress of returning to a comfortable environment was too much. With all my spending, practice upgrades and extra toys we'd racked up such significant debt that we had to declare bankruptcy. It all happened so fast, I had no time to divert funds and we lost everything.

I moved to a new location and was set up to start as an associate in a large practice. I should have done my homework better. The practice that had promised a nice paycheck did nothing but frustrating dentistry for PPO pricing. I tried to work more hours to make up the financial difference but ended up with terrible tendonitis in my elbow. I ended up at a pain clinic only to be prescribed oxycodone. I knew better, but the addict was stronger. Within a short period of time, I was back to a full-blown addiction. Three months went by and a friend who understood what I was dealing with referred me to a psychiatrist who prescribed me a medication which had only been available for about four years - Suboxone. It immediately changed my life for the better. It took away the compulsiveness to use opiates and blocked the receptors if I did decide to use.

What he didn't tell me or realize is that only nine states currently allow physicians and dentists to practice while taking Suboxone, my state not being one of them. After I switched practices, my previous boss called the state's wellness committee concerned about my use of Suboxone while practicing. On the phone, the wellness committee requested I be evaluated for five days for addiction. Five days turned into 90, which my insurance did not cover.

Once I finished the program, I took two months off work. I didn't realize the toll my environment would play when I returned. I went back to the same dilapidated office and back to the same routine I'd burnt out on just months before. I was still accountable to the state wellness board. I had to call every morning to see if I needed to take a drug test. When I learned they would only ask for one drug test a month, my addict brain kicked in again.

Despite my diligent attendance at 12-step meetings, I was already emotionally relapsing. I felt like hell every day. I ended up relapsing about 11 months into my contract. I didn't care. All I wanted was to feel "normal" again. Another relapse and more treatment that I felt to be a total waste of time - group therapy and one-size-fitsall treatment.

After returning home I received a call from the wellness committee stating they were turning me into the board. In the end, I felt it was in my best interest to surrender my license. I knew I had to focus on my depression and anger issues, which had been diagnosed both times on admission to treatment. The time was now for me.

The Phoenix

Now I'm without a license in the state I live in. I am full of resentment and anger toward the wellness chairman, the treatment center and myself. After 135 days of inpatient treatment, I had to find a way to stay emotionally healthy. Resentments and anger left unchecked will lead to relapse.

Since I wasn't going to be practicing, I knew it was in my best interest to get back on maintenance Suboxone. I spoke with my physician and psychiatrist who both agreed.

Don't be surprised if you might relate to parts of this article as the prevalence of stress-related addiction (including alcoholism) is high in our professional community. We are not born with innate coping mechanisms to stress. Everyone handles it differently. My addiction started from self-medicating to relieve chronic pain, but stress fueled the fire.

Advice for Managing Stress
  • Find a healthy work-life integration.
  • Only practice and live the way you feel comfortable.
  • Seek others who have different expertise. Refer procedures you don't like or are uncomfortable performing.
  • Hire a CPA for your practice finances.
  • Hire a broker to help you find an associate.
  • Delegate.
  • See your doctor if you're in chronic pain.
  • Find outlets outside of work.
  • Talk about it (contact your insurance company for a referral for a therapist).

Today

My brain never seems satisfied and is on constant guard, even with four years sobriety. My mind frequently ruminates with recurring episodes of what I've managed to throw away. To put my circumstance in perspective, I calculated very loosely that my lack of stress management and addiction has cost me and my family more than $3 million. This disease will decimate you and those around you in the worst ways. It strikes insidiously, stealthy and often unintentionally

The disease always wins. It lurks around in your brain's pleasure centers "holding cell" just waiting for a bondsman to let it out. Once it's out, it tells you that you can control everything now and the cycle starts again, only worse. And while my experiences is with opiates, all chemical and process addictions will lead you down this path if not intervened upon.

Having lived through this experience, reflecting on the best of the best and worst of the worst, the key for all professionals is to find a healthy work-life integration and only practice and live the way you feel comfortable. Take CE courses on topics you want to learn more about - maybe self-management or finance. Also utilize professionals - hire a CPA for your practice finances. Hire a lawyer whose forte is health care. Have an expert explain the loan process to you. Teach yourself to delegate, and don't be afraid of what you don't know.

The Doctor's Advice

We don't have to be everything to everyone. We are, by the nature of our profession, subject to "secondary traumatic stress" or "compassion fatigue." But you do not have to absorb others' stress.

Think about where to set your personal and professional boundaries. Since we can't see ourselves, and our loved ones usually enable us, our employees are scarred of us and our friends rarely see us, this overburdening stress can easily go unchecked.

Because dentists are overachievers who carry an enormous workload and stress, the tendency to escape from daily problems is often through the use of alcohol and drugs. For those who think they are off the hook, there are process addictions including gambling, Internet porn, and eating disorders; anything that overloads our dopamine receptors can become "addicting." Find a healthy outlet to relieve daily stress, lower the workload, enjoy practicing again and enjoy yourself and your family.

How to Get Help
For Yourself:
Recognizing and acknowledging you need help can be difficult. It's scary to think you are at the point of helplessness. But you're not helpless. Here are some steps on how you can get help.
  1. Expand your network to gain some perspective and support.
  2. Reach out to your medical providers. They have a referral network of professionals who can assess your candidacy for medical intervention.
  3. Contact your insurance company and ask for a mental health referral.
  4. Seek out a support group. Some ideas include: a study club, a religious group, a men's/women's group, an outdoors club.
  5. For tools and resources, contact your state board wellness representative, or Jen Butler at 623-776- 6715 or jen@jenbutlercoaching.com.
For a Colleague or Friend:
Confronting a colleague or friend around concerns you might have regarding their stress levels and the way they cope with them can be uncomfortable. Having the courage to talk to them, despite their resistance, might save them (and their family) from embarrassment, pain, legal issues, career problems, depressions and burnout. Here are a few ways to conduct courageous conversations:
  1. Come from a place of concern not judgment. Use phrases like: "I'm concerned, "I want to help," and "I'm here to support."
  2. Ask empowering questions. Don't tell them what to do.
  3. Be honest and persistent. Create a place of trust. Be persistent but not pushy. They may not open up the first time. Be patient.
  4. Offer help and gain commitments. It is not your responsibility to resolve their problems or offer solutions. Helping them to realize they are in charge of their own stress will help them be accountable.
  5. Let the pros take over. Provide them with a professional resource. You've done the heavy lifting by finding a name and contact information. Two professional resources you might put them in touch with include their state wellness board representative and stress expert Jen Butler (jen@jenbutlercoaching.com or 623-776-6715).


Author's Bio
The author of this article is a real dentist. Because of the nature of his story, he has chosen to remain anonymous to our readers. If you are having issues with substance abuse and would like to further seek the author's advice, he can be reached by way of our stress management expert Jen Butler. Jen can be reached at jen@jenbutlercoaching.com.

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