BDJ In Practice spoke to Life Coach and Consultant Orthodontist Nadia Ahmed about stress, burnout and its relationship with resilience.
In your experience how often do we identify stress and burnout yet leave dealing with them until it’s too late?
NA A degree of stress can be beneficial to improve performance and stretch ourselves to reach our full potential, but it is essential to take care of ourselves and manage increased levels of stress before it becomes too much to manage.
We must monitor stress levels and be aware of our wellbeing to ensure we do not experience excessive levels of stress and subsequently burnout. We need to be aware of tools to manage stress when it arises and seek professional or medical support where needed.
One issue may be that we cannot identify stress and burnout so awareness is key. Human nature, more often than not, leads us to often have tunnel vision and feel that we must push ourselves and judge ourselves if we do not complete our never-ending to-do lists and juggle work and family commitments.
It is essential to remove self-judgement and identify when we may be experiencing high levels of stress and burnout so we are aware we need to pause and prevent the potential significant impact on our mental and physical wellbeing.
Dental professionals strive for very high standards of achievement and often do not recognise the need to pause and take time off for ourselves and prioritise our health.
Burnout is a state of emotional, physical and mental exhaustion caused by prolongedstress. It is essential to be aware of tools to identify stress before it reaches burnout.
What are the classic signs and causes of stress and burnout?
NA Signs of stress and burnout can include making errors or being forgetful, fatigue, headaches or muscle tension, irritability and increased frustration, difficulty sleeping, dependency on alcohol or substance misuse, worrying about work when out of work and/or high levels of anxiety.
The causes also can be multi-factorial: perfectionism, financial circumstances, time pressure, excessive workload, personal circumstances at home and/ or poor work-life balance.
Dentistry revolves around prevention being better than cure – is that applicable to stress and burnout? If so, how can you put structures in place to help prevent them?
NA Prevention is absolutely applicable to stress and burnout. There are many activities and habits we can adopt in our daily routine:
a healthy diet, self-care and making time for ourselves, taking quality time away from work (especially switching off from emails and work admin), practising mindfulness throughout the day, practising regular meditation to be ‘present’, regular exercise or more importantly re-phrasing this as regular ‘movement’ throughout the day and having a peer support network and community can really help.
There is no structure that applies to everyone as we are all differ in our approach to stress and what works for one individual may not work for another. It is also pertinent
to mention that prevention may also involve having therapy or coaching to navigate a way
through difficult or challenging times and talking to a trained professional.
On a daily basis, being still and present whilst practising mindfulness or meditation gives us an opportunity to slow down and pause so we can recognise if we are experiencing burnout, instead of continuing to push through without adequate ‘downtime.’ These are just two examples of tools that work for me and many of my colleagues, but everyone has different preferences about their own coping methods. Some may find time alone to read or watching tv can help them switch off from a busy day. I have worked with colleagues who sit in solitude at lunchtime reading a book which is a great way to pause. I find a daily walk every lunchtime outdoors helps too!
What does the research say about the long-term impacts of stress on mental and physical health – which in turn will no doubt affect performance at work?
NA Occupational stress and burnout have become such a prevalent issue that the
World Health Organisation characterises work-related stress as a global epidemic.
High levels of stress, burnout and absence from work affecting the health and care workforce are a symptom of the current state of health systems.
Healthcare workers have been particularly impacted after COVID-19. Stress can be defined as the relationship between the stress felt by the person and the psychophysical responses it elicits.
It is generally accepted that stress occurs when environmental demands overcome the person’s capacity to adapt, leading to a negative impact on health and wellbeing.
Investigation into dentists’ wellbeing reveals stress and burnout at consistently high levels and general practice can carry multiple sources of stress including clinical, managerial and administrative tasks.
One study identified four subdimensions of stress in general dentistry: productivity stress,
work content stress, patient-led stress and regulatory stress. Each dimension of stress
is shown to have a significant causal link to burnout among the GDP population.
There are a number of reasons for stress that are identified from an early
stage of dental careers. One systematic review identified several significant factors
contributing to burnout in dentists and dental students and that longitudinal and prospective studies are required to assess causation.
Burnout should be considered a multifactorial phenomenon that can develop early in a dental career.
Identifying stress and burnout must be addressed from an early stage, teaching
undergraduate students how to be aware of their stress levels and tools to manage this,
so they can take these tools into their future careers and prevent detrimental effects on
their mental and physical wellbeing.
Is there a difference between being resilient and being ignorant to the signs and symptoms of stress and burnout? How would you define the differences?
NA Resilience refers to the ability to adapt, recover and thrive when faced with challenging situations. It involves developing the skills and mindset to cope effectively. If we do not have awareness and insight into our abilities to manage stress or scope to identify when to pause and seek support where needed, then the signs and symptoms of stress and burnout may not be noticed. I feel this is not ignorance but rather not knowing how to identify it. Those who do intentionally recognise the signs, however, and continue to push through heavy workload and challenges in their work-life balance may not be aware of the consequences until their health is impacted and at that stage may reach high levels of stress and then burnout.
How do you teach and instil coping methods to enable practitioners to learn from past challenges and overcome hurdles to get them on a path to success?
NA There are a number of ways that we can learn from past challenges and build resilience so we can approach future hurdles we may face. Ultimately, we all manage what we are faced with in our own ways and find methods that work for us. We naturally build resilience with experience and time.
Having a positive outlook and maintaining hope and belief that we can overcome a difficult situation certainly helps in the face of challenges. Reminding ourselves regularly of our ‘wins’ is essential to building resilience and having self-belief that we can do it! I remind my colleagues regularly to reflect on their achievements and accomplishments as this is a great way to remember that we have overcome challenges in the past so can do it again when the need arises. We often surprise ourselves!
References
1. World Health Organisation. News release:
Protecting health and care workers’ mental health and well-being: Technical Consultation Meeting. 2024. https://www.who.int/news/item/25-04-2024-202404_protecthw_mentalhealth (accessed January 2025).
2. Lazarus R. From psychological stress to the emotions: a history of changing outlooks. Annu Rev Psychol 1993; 44: 1-21.
3. Gonçalves A, Fontes L, Simães C, and Gomes A R. Occupational and Environmental Safety and Health. Cham: Springer International Publishing,2019.
4. Toon M, Collin V, Whitehead P et al. An analysis of stress and burnout in UK general dental practitioners: subdimensions and causes. Br Dent J 2019; 226: 125–130.
5. Singh S, Aulak D S, Mangat S, Aulak M S. Systematic review: factors contributing to burnout in dentistry, Occu Medicine 2016; 66:27-31.