‘To Stress a Point’ by Michael A. Gow BDS (Gla) MFDS RCPS (Gla) MSc Hyp (Lon) PGCert (Edin), editor, DentaltownUK magazi

Holmes and Rahe famously developed the social readjustment rating scale (aka The Holmes and Rahe Stress Scale) back in 1967 to help identify people who may be more at risk of health issues related to stress.^1,2

One common understanding of the word stress is that it is a ‘condition or feeling experienced when a person perceives that demands exceed the personal and social resources the individual is able to mobilise’.

This sense of ‘demands exceeding resources’ seems to be more prevalent than ever in the profession now. This was highlighted recently when an unofficial online poll for dentists (with no quality assurance) revealed that out of 964 registrants, 62 percent said either they or someone they knew has suffered mental health issues that required professional treatment due to an FTP case at the GDC.

Ninety-five percent admitted to practicing ‘defensive dentistry’ through fear of the GDC and a staggering 87 percent admitted to having considered leaving the profession.³ These statistics certainly suggest that further robust investigation is merited. New social media groups for dentists/dentistry have arisen, dedicated to the topic of supporting dentists in crisis.

Holmes and Rahe1 ask 43 questions about various life events in the preceding year, ranging from the death of a partner to the birth of a child. Each question’s score is weighted, as obviously certain life events are likely to create more or less stress than others. The end score reveals the likelihood of the respondent experiencing health issues related to stress in the near future. The obvious issues with such a scale are that it does not allow for unusual sources of stress to be recorded, and that not everyone will interpret ‘stressful events’ in the same way. It would be hard to know where, for example, difficulties conditions or demands at work, a patient complaint or a GDC FTP hearing would fit into the scale when responding.

Nevertheless, importantly Holmes and Rahe’s scale recognises that usually for the ‘demands to exceed the resources’, there is more than one stressful trigger/event. It is therefore extremely likely that a dentist who scores highly on the scale is more at risk should they then experience a patient complaint or FTP hearing. I believe it would be a useful exercise for dentists to take the test for themselves to help identify if they’re already perhaps at risk. An active complaint or FTP hearing would obviously then add considerable additional stress and increase the risk of health issues.

For those interested, an online version of the scale can be found here.

As the discussion about stress in dentistry and especially the impact of GDC FTP hearings increases, the discussion about solutions and sources of support increases as well. There have been several articles in DentaltownUK recently which are particularly relevant to these topics.

• ‘Finding the Right Work/Life Balance’ by Niall Campbell: Part 1 and Part 2.
• ‘Plan Z’ by Stephen Hudson.
• ‘Stress: What Exactly Is It and How Do We Manage It?’ by Aditi Goel.
• ‘Regulating Dentists in the UK’ by Stephen Jacobs.
• ‘Managing Systemic Disorder’ by Stephen Hudson.
• ‘Overcoming Stress in Dentistry’ by Mohammad Moinuddin.
• ‘Time Management Tips for Busy Dentists’ by Allun Rees.
• ‘How Can Dentists and Dental Students Minimise the Level of Stress That They Experience?’ by Kishan Sheth.
• ‘Tackling Stress and Burnout in Dentistry’ by Anish Patel and Balraj Sohal appears in this issue.

I think it is important that all dentists read these articles. We’re happy to talk to patients about the importance of prevention in dental health, and we should be taking a leaf out of our own book and really understand the importance of prevention in our mental health. Understand the triggers that make you stressed, identify ones which you can control, and actively take action to reduce stress. In a few weeks (on 31 August), I am giving a practical workshop titled ‘Stress Management and Effective Communication’ alongside Dr Gabor Filo (Canada) and Dr Ashley Goodman (USA). Please contact macscotland@outlook.com for more information.

Some of the learning outcomes are:

1. A general awareness of the physiology and psychologically deleterious effects of chronic stress.
2. A review of the neurological and endocrinological basis of the stress response.
3. Understanding of the multicomponent nature of a stress management program.
4. An overview of meditative and self-hypnotic techniques for stress management.
5. Most importantly, experiential exercises of the described techniques that can be used at home or at work.

Here are a few important but simple general tips for dentists to help reduce stress.

Communicate
Talk to friends, family and colleagues. Ask for help and advice from people in your life whom you trust. Connect with the hundreds of thousands of dentists on the Dentaltown forums! Any question you have about clinical cases, practice management issues or anything else dental-related will be answered by someone who has experience in similar situations. Communicate with staff and employers. If there is a problem, talk it out rather than letting it build up.

Be thorough
Have systems in place that mean your recordkeeping, consent and complaint procedures are all efficient and thorough. Ensure your CPD is up to date.

Stay within your comfort zone
If you encounter a patient or case you’re uncertain about treating, have a referral pathway in place. If you wish to extend your comfort zone and increase your confidence, take courses in elements of dentistry that you find more challenging.

Look after yourself

• Take time off work occasionally, just to have a break. (By this I mean, avoid using up all your days off just to attend conferences or commitments. Have some ‘you’ days!)
• Eat well and practice good sleeping habits.
• Exercise and take time to pursue activities that help you unwind. This is the raison d’être of DentaltownUK’s Lifestyle section: You may not have the money or passion for fast cars, expensive watches, etc., but it’s important to have something in your life that helps you unwind, and DentaltownUK’s Lifestyle articles are all written by people who work in dentistry—your peers!
• Dentaltown’s online forums include a huge Leisure section if you need any further inspiration for what dentists do to unwind.
• Visit this Stress Management message board on Dentaltown.