Is practice getting you down? Do you feel like you can’t face another day? These are some of the classic symptoms of burnout, and you are not alone, with one in two dental practitioners in Australia suffering from burnout.^[1] Dr Annalene Weston, Dental Protection dentolegal adviser, shares some advice on how best to recognise and manage burnout.

As many of you will be aware, my colleague Dr Sam King and I have recently presented the national lecture tour entitled ‘Under Pressure’, as we wanted to start the conversation on burnout. 

We want to thank each and every one of you who attended to support the profession, as we cast the spotlight on our mental and emotional wellbeing, and take positive steps to help and protect ourselves and our colleagues. 

The response has been overwhelming. It is one thing to be told that every other dental practitioner in Australia is burned out and quite another to have them come up to you in tears, take your hand and thank you for giving them permission to admit how they feel and to talk about it freely.

What is burnout?

“Burnout occurs when passionate, committed people become deeply disillusioned with a job or career from which they have previously derived much of their identity and meaning. It comes as the things that inspire passion and enthusiasm are stripped away, and tedious or unpleasant things crowd in.” ^[2]

Burnout is a measurable analysis of ‘stress’, with the most commonly used measure being The Maslach Burnout Inventory Triad: ^[3]

• 1. emotional exhaustion
• 2. low sense of personal accomplishment
• 3. depersonalisation (an increase in cynicism or distancing ourselves from others).

When you consider these in the context of dental practice:

Burnout is a condition born out of good intentions. Dentists [sic] who fall prey to it are for the most part unselfish individuals who have painstakingly striven to reach perfection in their careers, pushing themselves too hard for too long, failing to acknowledge their limitations for fear of ridicule or failure.^[4]

Depersonalisation can lead to more frequently occurring difficult patient interactions as a practitioner burns out, compounding the problem, and creating overwhelming feelings of; frustration, resentment, angry helplessness, hopelessness and powerlessness.^[5] Not only can these load the underlying issue, but also long term stress is damaging to our health.

Finally, dental practitioners suffering from burnout are far more likely to experience an adverse outcome or receive a complaint, as burnout affects all of our body’s systems:

Emotional
Feelings of failure, guilt, negativity, anger, resentful, loss of sense of humour.

Cognitive
Poor concentration, distancing, ruminating, cynicism.

Behavioural
Work avoidance, habitual lateness, addiction.

Physical
Tiredness, lethargy, poor sleep, increased minor illnesses, anxiety.

It is self-evident then that we need to recognise when we are burning out, not only for ourselves, but also for our patients’ safety, and take appropriate steps to manage it.

One important point to make is that burnout is not a sign of weakness, nor evidence that you are any ‘less than others’. Any and everyone will eventually burn out if they carry too much pressure for too long. As pressure does not discriminate, any one of us could be affected at any given time.

What can we do about it?

The more you read about burnout, the more you will learn, and the more solutions will present themselves. This list, however, nicely summarises the steps a dental practitioner can take to address burnout:^[6]

1. Avoid isolation and share problems with fellow practitioners

   Not only is ‘a problem shared a problem halved’, but there is strong evidence to indicate that increasing your social interactions increases your ability to handle stress and pressure, therefore decreasing your risk of burnout. The evidence base also demonstrates that getting involved in organised dentistry groups can lead to feeling more content and less isolated. ^[5]

2. Work sensible hours and take time each day for a leisurely break

   While we have explored the risks of working Hungry Angry Late and Tired (HALT) many times in our presentations and publications, to summarise: be your best self to give the best care to your patients.

3. Take time off whenever the pressures of practice start to build

   Burnout can mimic depression, so how do you know if you are burned out or if you are depressed? Broadly, burnout will improve with a break or time away from the workplace. Depression does not, so perhaps a good first step is to take a break! Not only will this give perspective about your workplace, and perhaps identify some changes you may wish to take place, it will also help identify whether you need to seek medical help for an underlying condition.

4. Learn how to better handle patient anxiety and hostility and attend courses on stress management and communication skills

   With a CPD requirement of only 60 hours every three year cycle, we would suggest that you consider investing in your soft skills too. Communication can be practised and learnt, and the evidence strongly points to improved communication capabilities decreasing the likelihood of ever receiving a complaint.

5. Adopt a programme of regular physical exercise

   Exercise not only serves to release endorphins, but it’s also an outlet for the built-up tension you carry. Developing the positive habit of regular exercise can benefit you, both body and mind, with the benefits of exercise shown to be greater, and longer acting, than taking antidepressants for those suffering mild to moderate clinical depression.^[6] 

6. Be kind to yourself and less critical and demanding of your efforts
   Judging your day-to-day efforts through a clouded filter of negativity will create great distress. Be kind to yourself. You help patients. Every day. Without exception. This is something to be proud of.

Bringing it all together

Burnout is real and impacts dental practitioners at a higher rate than it impacts the general populace. Not only do we need to recognise it, both in ourselves and others, but we also need to take active steps to manage it once realised.

“Under Pressure” is available to view on Prism, accessible via the Dental Protection website. If you feel you may be suffering from burnout then get in touch with the experts here at Dental Protection to get the support you need.

^[1] Stress, Strain &Burnout among NSW & ACT Dentists: April 2014: Dr Robyn Johns, University of Technology, Sydney and Dr Denise Jepsen, Macquarie University