Rudy Dunnigan, DMD
I suppose it could be called an epiphany. I was polishing a denture when the rag wheel took it and flung it to the back of the pan. It had happened many times before, but this time I wondered why it happened. It happened because I was operating the lathe at maximum speed in my haste to finish the task and get on to my next patient. Now I had to repair the fracture and repolish the denture. It was on that day that I turned down the lathe to "slow" and began to turn my practice into a pleasure rather than a chore.
I had been hurrying to get to the next patient for most of my practice life. As some of you may have discovered, if you hurry at one thing, you probably hurry at everything. When I began to read and think about how I practiced, I discovered that I was angry because I was stressed. Maybe you are too. If you aren't, then read no further; but if you are or even suspect you are, maybe I can be of some help.
I realized that when things weren't going right, I would snap at everyone around me and then they would snap at those around them. It was contagious, and my staff caught it from me. Oh, I wasn't angry at my staff; I was angry with a patient or maybe with myself, but I made my staff (and sometimes my family) pay the price. My assistant wasn't angry with our lab technician, but she couldn't yell at me, so she made the lab tech pay. I would start a battle among my staff members by proxy.
Expression and repression
Do you know what anger translates to? Stress. Anger in its simplest form is stress for both those who are angry and those around the angry person. Stress is a killer. Some of us strike out verbally and, sadly, sometimes physically, to express our anger. Out-of-control anger is guaranteed to be a train wreck in our lives.
Thirty-two years ago in a dental school jurisprudence course, I remember hearing the story about the dentist who was sued over a denture. It seems that after the umpteenth adjustment and loud complaints from the patient, the dentist threw the denture to the floor and proceeded to jump up and down on it. "Now it won't be loose anymore," he announced with a broad smile on his face. The patient sued, and the doctor lost.
I know we all have been tempted to destroy the object of our frustrations, but most of us have more control ... or maybe less nerve? Just kidding! Out-of-control anger is never constructive or healthy, but is it any healthier to sublimate our anger? No, unexpressed anger is equally unhealthy and maybe more destructive to our health and our relationships. Those who hide anger may suffer from hypertension, depression, or any number of untoward maladies. You've seen individuals who are cynical, who always put others down, who criticize everyone, and who never seem to have a pleasant word to say. Maybe some of them work for you or are your patients. Maybe you are one of them! Those who don't openly express anger will express it some other way, and it's usually in unhealthy or destructive ways.
Many years ago, an employee became angry with one of the doctors in the practice and chose an interesting way to let him know. He placed a denture repair in hot water to cure, but the hot water was in the coffee cup that the doctor drank from every day. Certainly the doctor received an apology, but there's no doubt that the act was purposeful and precipitated by repressed anger. We can only wonder how many mishaps each week in our offices are really retaliatory acts.
Stress and the workplace
However one responds to anger, stress is involved ... and too much stress is our enemy both personally and economically. The American Psychological Association cites research by Lyle Miller, PhD, and Alma Dell Smith, PhD, that shows 43 percent of all adults have experienced adverse health effects from stress. Seventy-five to 90 percent of all medical office visits are due to stress-related ailments and complaints. Stress is linked to the six leading causes of death in the United States — heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide. Stress also has been identified by OSHA as a workplace hazard. Absenteeism, reduced productivity, and worker's compensation cost American industry $300 billion every year. This works out to $7,500 per year per worker.
Stress and anger aren't the same for everyone, and it is not my purpose to tell you whether or not to get help. However, I can suggest several ways to lessen stress in your professional life, which always affects your family relationships.
I am not an exercise nut, but I can tell you that regular exercise will help you deal with stress. I run/walk a mile at least three times a week, and it has done wonders for my disposition. By the way, if you decide to exercise, consult your physician first and don't overdo it in the beginning!
Some excellent research on stress and exercise has been conducted on animals, and I think the results can be extrapolated to humans. All exercise is not equally good. Mark Sothmann, PhD, of the Indiana University School of Medicine, has done some interesting work relating to stress. Exercise increases brain concentrations of norepinephrine in regions involved in the body's stress response. Rod K. Dishman, PhD, of the University of Georgia, has conducted some of this research.
Norepinephrine is thought to play a major part in affecting other neurotransmitters that play a role in the stress response. Some antidepressants also increase concentrations of norepinephrine, which is further indication of the role it plays. Sothmann believes, as stated by the American Psychological Association, that it's not a simple matter of producing more norepinephrine, but that exercise thwarts depression and anxiety by enhancing the body's ability to respond to stress. He also found that voluntary exercise is more beneficial than forced exercise or medication (imipramine) in rats.
What does this mean to you and/or your staff and, more importantly, to your family? It's not good enough to say you get plenty of exercise by running down the halls of your office or climbing stairs where you work. Medication may help, but not as much as purposeful, planned, regular activity, performed specifically to improve your health. Rats who were forced to run on a treadmill were physically healthier, but their stress levels were greater than those who were given the opportunity, but not forced, to run in a wheel. Research in humans finds the same trends. Sothmann says that as we become deconditioned through sedentary living, the psychological stress system becomes less and less efficient in its ability to respond to a variety of stressors.
What to do?
I am not a personal trainer nor am I a psychologist, but I have practiced dentistry for nearly 33 years and I have learned — albeit belatedly — a few things about stress and anger. All of the things I am about to suggest can help reduce your state of anger, stress, or both.
• Take continuing-education courses several times a year. Have you noticed how much more enthusiastic you are after attending a course? You get a break and you learn new skills — what a great combination!
• Schedule longer appointments. Oh, I know you've been told that already, but that was to increase your production. I'm saying to do it so you can see fewer patients per day. No matter how much you love your patients, all of them are stressful in one way or another. Cut down on your number of chances to experience stress.
• Get rid of what an old associate of mine used to call "gut growlers." All of us have or have had these kinds of patients; they come in many varieties. High-maintenance patients who require too much attention far too many times should go. Chronic complainers who always find something to gripe about should go. Slow payers should go. Patients with high expectations and low compliance should go. "Friends" who chronically exploit the "friendship" should go. Anyone ... I repeat ... anyone whose name on your schedule automatically gives you that gut-growling feeling should go. Yes, it's easy for me to tell you to rid your practice of these patients, but you can do it. I did! It was worth the three minutes of discomfort, after I told them to find another dentist, to know that I would never again have to see those names on my schedule.
• Get rid of any employee whom I have described anywhere in this article. Counsel, consult your legal adviser, and document, document, document ... but get rid of your problem staff members. I know you have heard your favorite guru say that if you hire wisely, train effectively, and pay well, you'll never have staff problems. I have heard it and read it, too, but I still have had problems from time to time. Maybe you're better at hiring than I am, but over the years I have made some very bad choices. Get rid of the problem people with whom you deal on a regular basis, and you'll get rid of a ton of stress as well. If you frequently make poor hiring choices, get some help. That's what I did, and we are a happier family for it both at home and in the office.
Money isn't everything
Money isn't everything. As a matter of fact, it isn't anything if you're not around to spend it. How many people do you know who died rich at an early age? How many colleagues do you have who retired early because their health forced them to? I have a very good friend who made a lot of money by enduring all of the stress that those around him produced just because they made him money. He retired early because of panic attacks — attacks that still consume him today. How he must long for the days when he was poor and secure. He should have done what you still can do.
Turn down the lathe, lessen your pace, slow down your life, and stop and smell the eugenol. Dentistry is a wonderful, fulfilling profession. Take the time and steps to enjoy it. You will never rid your life of all its stress, nor should you want to. Some stress adds variety to our lives. You can, however, rid your daily routine of a great amount of destructive stress. I truly hope I'm still practicing my profession when I'm 70, but not by necessity and not under undue stress. I want to do it because I love it and because I love the relationships I have with my patients and my staff — you know, the nonstressful ones. They're the only kind I keep now!
Rudy Dunnigan, DMD, has been in private practice for 33 years. He practices in Ashland, Ken. He may be reached by phone at (606) 324-1117 or by email at firstname.lastname@example.org.