GOALS IN EDUCATION
The learner should be able to do the following after finishing the material in this course:
Explain the current trends in healthcare worker burnout and how it can be diagnosed.
Discuss the notions of perfectionism and burnout in the dental profession, as well as their potential effects on clinical work.
We need to talk about ways to keep stress from leading to burnout in the workplace.
Professional exhaustion is becoming increasingly common in the medical field.
1 Burnout will be included in the upcoming revision of the International Classification of Diseases as a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed, as the World Health Organization will begin developing evidence-based guidelines on mental well-being in 2022. However, this is not recognized as a medical issue. 2
The three most common components used to identify burnout in the workplace, including dentistry, are all psychological symptoms of burnout. Maslach created the Maslach burnout inventory, a simple tool for assessing and diagnosing burnout in the workplace that has been shown to be both reliable and valid. 3 Emotional tiredness, depersonalization (a feeling of distancing oneself from one's work or becoming pessimistic or cynical about one's career), and a loss of professional effectiveness are the three hallmarks of burnout (reduced personal accomplishment). Dental team members, patients, coworkers, acquaintances, and family members may all feel the ripple effects of burnout. 3
Clinicians can become mentally, physically, and spiritually depleted from prolonged exposure to stress that is not effectively managed. This could make the affected person feel that they can no longer successfully give of oneself. It's not uncommon for them to say they're exhausted, weak, and drained of strength. 3 Depersonalization, characterized by inappropriate or negative judgments of others and by sarcasm and cynicism, might result from this. Irritability, a decline in idealism, and a desire to isolate are also possible symptoms. 3
Dental providers who are depersonalized and emotionally drained may give the impression that they don't care about their patients' problems or requirements. Compassion fatigue, or the exhaustion and weariness one feels after dealing with unreasonable or difficult people, is a common symptom of burnout. It has been said that compassion fatigue is the result of a combination of secondary traumatic stress and cumulative burnout, a condition characterized by extreme exhaustion and an impaired capacity to deal with daily challenges. 4 Reducing one's sense of personal success is a third sign of burnout syndrome, which can lead to a lack of resiliency on the part of the affected individual, as well as a pessimistic outlook on life and a lack of pride in one's profession. 4 Job instability, absenteeism, low morale, insomnia, and increased drug and alcohol use are all possible outcomes. 3 Dentists are one group that can be particularly vulnerable to burnout if they discover that corporate dentistry is not a good fit for their skills and work ethic.
DANGERS OF THE PANDEMIC
It would be irresponsible not to address the potential effect the COVID-19 pandemic has had on the beginnings and development of burnout in healthcare, particularly during the first several months of the pandemic. There is accumulating evidence that dentists' lack of relational (i.e. in-person) interaction with their patients has had a negative effect on patient health. Provider burnout can occur when professionals avoid social interaction, especially in the doctor-patient-staff paradigm, as a result of feeling powerless over their work and worried about their professional and personal futures5.
Given that nearly half of U.S. doctors experience burnout symptoms, it's safe to assume that environmental and systemic factors, rather than individual flaws, are to blame. 7 Top sources of stress in the medical profession, according to doctors, include time restrictions, electronic health record use, and other work-related problems. Physicians experiencing burnout may be more prone to making mistakes and delivering subpar care, leading to higher expenditures and poorer outcomes than their fully engaged counterparts. 8 It has been hypothesized that dentist fatigue is a significant predictor of reporting perceived dental errors, according to a research of U.S. providers scheduled for 2020. 9
Given the wide variety of settings in which dentists in the United States provide oral healthcare (solo, group, specialty, dental service organization, and other models of practice), one might reasonably wonder whether the causes of dentist burnout can be traced back to the system in which dental services are provided, as opposed to the personal traits of the individuals working in the field.
Researchers at the University of Barcelona showed that narcissistic and borderline personality types were more prevalent among dental students experiencing burnout than any other personality trait. Seventy-five percent of the dentists tested showed symptoms of obsessive-compulsive disorder. The dentists who were most at risk for burnout exhibited the narcissistic personality traits of being emotionally unstable and impulsive and needing an abundance of admiration. 10
Burnout in dental offices can be investigated using a six-factor driving force model (areas of worklife scale). Unsustainable workload, a lack of perceived control, inadequate incentives for effort, an absence of a supporting community, a lack of fairness, and a mismatch between values and talents are all examples of these. 3,11
STRESSORS
In their line of work, dentists face a number of potentially stressful scenarios. Schedule conflicts, impatient patients, a requirement for intense focus, and problems within the team are among the most problematic aspects of the job. 12,13 According to a survey conducted in New Zealand, the three most often cited sources of stress were dealing with challenging children (52%), working under constant time pressure (48%), and sustaining high levels of focus (43%). 12 Interacting with others (78%), participating in sports (64%) and diverting one's attention away from work (59%) were the most common methods used to deal with stress from one's job. 12
The vast majority of dentists (86%) report dealing with at least one of these stressful situations annually, according to a study conducted by the American Dental Association (ADA). That's an average of 60 days a year where dentists are severely stressed and uninterested in their work. 13 Dentists, say researchers Rada and Johnson-Leong14, are especially vulnerable to stress-related disorders including anxiety and depression, as well as professional exhaustion, because of the nature of their work and their own temperaments. Anxiety, sadness, musculoskeletal symptoms, sleep disorders, memory problems, and substance-use disorders are all linked to burnout, and all can be caused by chronic interpersonal pressures in the job. On a daily basis, 14 dentists report feeling stressed out by their jobs. One poll revealed that 82.7% of dentists felt moderate to severe stress,13 while another reported that the number was getting close to 86%. 15
New information on dentists' levels of job stress was revealed in the ADA's 2015 Dentists Well-Being Survey. 67% of dentists said they feel some degree of stress on the job. 16 Work-related stress was noted by fewer than one in eight dentists (12%). Female and male dentists had similar levels of stress on the job, as did those of different ages. Stress was shown to be more prevalent among part-time dentists than full-time dentists. Stress at work was noted by more than one-third of dentists who work part-time (39%) but by only one-eighth of dentists who work full-time (18%). Among dentists, only about 25% of those who only practice part-time said they were under a great deal of pressure. 16
While only one in ten dentists is deemed to be at risk for alcoholism, nearly one in five dentists (18%) believe they need to reduce their alcohol consumption. Higher risk for alcoholism was seen in those who reported feeling powerless in their workplace and those who were dissatisfied with their dental practices. 16 Almost a quarter of dentists (23%) were diagnosed with moderate depression, and 4% were diagnosed with severe depression. About half of the dentists who gave themselves a high score said they have never been diagnosed with depression or did not think they had it (Figure 1). 16
One example of a stress diagram. There can be negative outcomes if stress isn't dealt with properly.
One example of a stress diagram. The impact of stress can be harmful if it is not well managed.
FROM THE VERY BEGINNING, THERE WILL BE PRESSURE
In dentistry, stress is ever-present and often begins early in a dentist's career. One of the most important ways to avoid burnout is to learn to identify stressful situations for yourself and deal with them effectively. Fresh dentists are more susceptible to stress that may lead to burnout, according to a 2016 research of 121 Indian dentists who were considered "new" (having graduated within the previous six months to five years). Emotional exhaustion (39.27%), frustrations (47.13%), exhaustion at the end of the workday (46.80%), exhaustion at the end of the evening (35.05%), exhaustion in the morning at the thought of another day at work (35.05%), exhaustion because every working hour is tiring (46.80%), and having less energy and time for family and friends (47.83%) were all factors contributing to burnout. 17
Five-forty-nine percent of the 2053 dentists surveyed in a 2019 study in the United Kingdom reported feeling extremely stressed out by their work, with general dentists reporting the highest levels of stress.
18 The General Dental Council, which regulates dentists in the United Kingdom, was cited as a major source of stress by 73.8% of respondents, followed by work pressure from the National Health Service (NHS) to meet financial goals (72.4%), running behind schedule (64.9%), performing NHS work (63.2%), and dealing with difficult patients (61.2%). 18 Dentists are more likely to experience stress, burnout, and psychological distress than the general population because to their fear of lawsuit and external rules, according to the research. 18
Researchers Lloyd and Musser19 evaluated the personalities of dental and medical students and found that the former were more likely to be competitive and less likely to seek care for their OCD, while the latter were more likely to be codependent and more likely to suffer from OCD. These characteristics are consistent with those of people who choose careers in dentistry. 19 The levels of symptoms reported by dentistry students are significantly higher than those recorded in a general population study. 19 Dental students had a substantial increase in anxiety and depression symptoms, a marked increase in OCD symptoms, and a slight increase in somatic symptoms compared to the general population. 19
These dramatically increased OC symptoms and heightened interpersonal sensitivity may be a result of heightened sensitivity to pressure to perform. As a result of this sensitization, you may become overly sensitive to the evaluative assessments of others, and have cognitive impairments like indecision, blockage, or memory loss. 19 Dental students were shown to exhibit greater psychiatric symptomatology than general medical subjects considered free of psychiatric illness and to approach levels of symptomatology reported in general medical subjects deemed psychiatrically sick or in need of psychiatric treatment. 19 Massachusetts dentists were found to have stress, alcohol usage, prescription medication use, back pain, neck pain, headache, osteoarthritis, and gastroesophageal reflux disease at rates comparable to or greater than the general population in a study conducted in 2017. 20
PERFECTIONISM
In dentistry, perfectionism refers to both perfectionistic worries and ideals.
Obsession with Perfection:21 An unhealthy preoccupation with perfection can be debilitating. This is characterized by the dentist's setting of unachievable or unreasonable goals, such as the belief that he or she must learn and provide all possible forms of dentistry to patients. Another case in point would be making debt repayment a priority while setting fictitious production targets. In a practitioner, an unhealthy fixation on perfection is a red flag. It's possible this may be a huge roadblock. Good dental treatment strives towards excellence, not perfection. A dentist should view dental procedure that does not go as planned as a learning experience that will help them provide better care in the future. It is important to remember that a practitioner's humanity is on display through their mistakes, and not to regard them as evidence of inadequacy. A dentist can grow as a practitioner and a person by doing this. Keeping a humble and teachable attitude is essential to enhancing the clinical drive of excellence.21
Strives for Perfection:21 A dentist who has a balanced view on perfectionism will aim towards attainable goals. This healthcare practitioner values the opportunity to practice dentistry, regards patient care as a journey, and is committed to lifelong learning. When clinical results fall short of expectations, the individual is able to bounce back fast by accepting the reality of the situation and thinking about what can be done to better. A healthy professional doesn't dwell on past mistakes or setbacks, but rather strives to maintain a teachable attitude and an open mind to criticism.
Dentists with a tendency toward perfectionism are more likely to experience the negative effects of burnout, exhaustion (emotional and physical), depersonalization (including cynicism), sarcasm, and compassion fatigue in the workplace. They are damaging and indicative of a lack of coping mechanisms. On the other hand, dentists who strive for excellence are less likely to engage in these unhealthy patterns. Motivating and indicative of healthy coping mechanisms, their behavior is inspiring. 21
There are several factors that can lead to burnout for perfectionists, including having too high of standards for themselves, making too many mistakes, having too many doubts, being too hard on themselves and others, and having too little mastery and knowledge. A clinician's perfectionism can be paralyzing, preventing them from moving on with decisions and treatment. The dentist who demands nothing less than flawless results is not only unreasonable, but also in denial of his or her own humanity. It's a known fact that nobody's flawless. The ultimate aim of healthcare should be to reflect a level of excellent treatment, an ongoing evaluation process for how to enhance care through education, and an acceptance of human fallibility.
EXAMPLE: TABLE 1: Distinguishing Between Stress and Burnout
SAFEGUARDING AGAINST OVERWORK
The current trend is to go to online solutions, such as those that target relaxation, breathing, mindfulness, meditation, online cognitive behavioral therapy, and suicide prevention rather than the tried and true methods of eating well, getting plenty of sleep, and being physically active.
22 These are wonderful resources to have at your disposal, but they should be used in conjunction with other strategies for dealing with work-related issues, making more friends and acquaintances at work, avoiding feelings of isolation, balancing personal and professional responsibilities, and, for the spiritually inclined, carrying out religious rites and rituals. Practitioners can take immediate action to alleviate stress by using block scheduling to gain control of the office appointment book.
CONCLUSION
One definition of burnout states that it is "an inflammation that occurs when people and work don't fit together properly." Living with burnout can be likened to dealing with a persistent irritant that won't go away unless it's addressed, which is why the term "inflammation" is often used to describe it (Table 1). However, if burnout is diagnosed in time and assistance is sought, it can be avoided.
For people who are suffering from work-related stress, there has never been a better time to get treatment and learn effective coping mechanisms. The purpose of this essay is to educate dental professionals about what goes into professional burnout and to inspire them to take charge of their own health and wellness, as well as to reach out for assistance if they need it.
Σχόλια