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Practice Profile

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Randy Garland, DDS

Randy Garland, DDS

Exceeding expectations What can you tell us about your background?
I grew up in southern Orange County and earned a bachelor’s degree in biology at San Diego State University in 1983. There I met my future wife, Kim, at the...

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Scott A. Norton, DMD, MSD

Scott A. Norton, DMD, MSD

Focus on family, patients, friends, growth, and community What can you tell us about your background? For as long as I can remember, I wanted to make people smile. I always loved getting the class laughing in grade school. Looking back, I am sure...

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Dr. Fleur A. Blethen

Dr. Fleur A. Blethen

Empathy, tenacity, and perseverance are keys to this clinician’s flourishing practice  What can you tell us about your background? I was born and raised in Seattle, Washington, and lived there until I was 13 years old. My family relocated...

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Clinical Articles

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Management of a tooth with a large internal resorption defect

Management of a tooth with a large internal resorption defect

Dr. Robert Slosberg facilitates accurate mapping and obturation of the resportive defect with CBCT imaging Abstract
A patient presented with advanced internal root resorption of tooth No. 9. The prominent location of this tooth...

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Pulpal diagnosis of teeth presenting with condensing osteitis prior to endodontic treatment — a retrospective study

Pulpal diagnosis of teeth presenting with condensing osteitis prior to endodontic treatment — a retrospective study

Drs. Brian Shaughnessy, Margaret Jones, Ricardo Caicedo, Joseph Morelli, Stephen Clark, and Ms. Jennifer Osborne review the occurrence of teeth presenting with condensing osteitis and their associated pulpal diagnosis over a 2-year period. Introduction Read More...

GuttaCore® system: a step forward in the evolution of endodontics

GuttaCore® system: a step forward in the evolution of endodontics

Dr. Andrei Zoryan dispels some of the common myths surrounding carrier-based obturation Carrier-based gutta percha Carrier-based obturation (such as Thermafil®, GT® obturator, ProTaper® obturator [Dentsply Tulsa Dental Specialties]) is one...

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Practice Management

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Life after root canal — it’s not just about having enough money

Life after root canal — it’s not just about having enough money

Dr. Robert Fleisher ruminates on how to prepare for retirement There are so many articles about everything that you become pretty much overwhelmed and can never expect to read them all. So you pick and choose. You like to learn about the latest and...

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Superior customer service

Superior customer service

Dr. Roger Levin presents the 10 top ways to help create a perfect dental team With the changes brought on by the economy, top companies are bringing in the best resources they can find to evaluate where their organizations stand. They want to know...

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Office Matters: Hard-piped filtered water system vs. self-contained bottled water system

John Bednar helps avert problems coming down the pipe If your office currently has a hard-piped filtered water system, now is a good time to consider if and when you should change to a self-contained bottled water system. A hard-piped filtered water...

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Robert M. Fleisher, DMD, describes how to tell if you’re suffering burnout and what to do about it

Burnout

Everyone is entitled to have a bad day…except people in service industries. If they do, and you are unlucky enough to experience this type of behavior, you might be inclined to say, “I’ll never go back to that place again!”

We all have bad days; the problem is that no one wants to know about your bad day. When you meet a miserable service provider for the first and only time, you may have no idea how wonderful they are on all other days, and you really don’t care. It’s today that most people are concerned about.

For the doctor (endodontist, dentist, hygienist, physician, internist, or other healthcare provider) with great bedside manner it is important to avoid showing the effects of a bad day. Even more imperative is the need to stay focused and avoid becoming burned out, a consequence of too many bad days.

Top five signs you’re suffering burnout

1. You think how relaxing it would be if you were undergoing an IRS investigation.

2. Your secretary says you’re being robbed and you run out to confront the robber, expecting it to be less stressful that dealing with Mrs. Nudnik.

3. You’re so stressed you forget how to perform your chosen career procedures.

4. Your five year old kid says, “Good morning,” and you yell, “What’s good about it?”

5. You’re so tired you forget to go to sleep.

In essence, burnout is physical or emotional exhaustion, especially as a result of long-term stress. It doesn’t take a lot of years to become a victim of burnout when trying to seek perfection in an imperfect world, dealing with difficult patients, lackluster staff, demanding colleagues, and insurance carriers denying payments, all the while worrying about being sued and losing your home. Just about this time you should consider a career change. Yes, you should go ahead and open that candy store. There has to be a study somewhere confirming that candy store owners have no stress, just bad teeth and diabetes.

Much burnout comes from a practice that is too busy. Trying to see too many patients is physically demanding, and deep down inside there is the mental anguish of knowing you aren’t performing the type of care you are capable of providing. Rationalization often surfaces and you tell yourself the way the HMO pays you, the patients are lucky you have time to say hello. You worry about maintaining your income and you cut corners even further. Try to work toward a practice that is balanced and don’t let your practice run your life.

At the opposite end of the spectrum is the practice that can barely pay the bills because the practitioner is lacking in business skills or people skills (poor bedside manner), or the location of the office is not ready for a fulltime practitioner. Not being busy enough can be just as bad as being too busy.

____A busy neurosurgeon gives this advice to new doctors to prevent burnout:

“Make sure they are associated with a group so they can have a life.”____

Diagnostic challenges, personal physical decline, dealing with difficult people and staff, as well as forces external to your practice (like family issues or even the classic midlife crisis) are strong catalysts for burnout.

It’s easy to criticize the system and make excuses, but you really have to step back and see if you are burning out. Not only will stress cause your practice to suffer, it is implicated in so many health issues that you may actually die young.

Once you establish that you are having problems dealing with stress, you have to remedy the situation. The best suggestion is to try to work toward a practice that is balanced. Don’t try to treat everyone in the world. Depending upon your type of practice, consider getting a partner, or at least an associate, to allow you to take a vacation and have some time off to rejuvenate.

Health-care providers have some unique issues, like tremendous responsibility for the welfare of others, that can result in burnout. Some of them are difficult to identify and can lie beneath the surface resulting in generalized feelings of depression. Stress and burnout are universal and may affect most everyone.

____

“I just decided ‘no more surgery.’ The risks were too great. I didn’t want to worry about losing my house to some lawsuit. Now I am happy to treat allergy and hearing problems. I work less and make out better without all of the stress.”

-an ENT

____

It is important to recognize that failure is a fact of life in every health-care endeavor. Not every procedure is successful. While having high ego strength helps you ignore the feelings of failure, beneath the surface it may take a toll on your psyche. It may help to have contact with fellow practitioners to share war stories and common experiences to ward off feelings of isolation and failure.

Maintaining a teaching affiliation and going to professional society meetings are ways for the solo practitioner to have professional contacts. Joining a group practice provides built-in professional relations that can ward off feelings of isolation and failure.

Diagnostic challenges can make you doubt your abilities, and while no one can make every diagnosis, you can take failure personally if you dwell on difficult cases. The affect on your confidence can be daunting. Fortunately for the psyche, most practitioners become so busy they won’t remember each failure or each diagnostic nightmare.

It should be noted that with advancing age it is not uncommon for practitioners to lose their sight or dexterity. Trying to accomplish procedures with the same level of expertise they had in earlier years may become impossible. It is extremely difficult to admit physical decline, and if practitioners don’t plan for retirement, they could be forced to continue working beyond the time that they should have stopped. While still young, make sure you plan ahead so you don’t have to practice when you should be enjoying the fruits of your labor.

Dealing with difficult people and staff is a strong catalyst for burnout. Learning interpersonal skills and taking courses on how to deal with difficult people may be helpful. Consider taking these courses and you will not only learn some good skills, you will be reminded that the human experience is common to all of us or there wouldn’t be a need for all those courses.

Patients don’t know or care what causes your coldness or rude behavior, or even that you may have cut them off while they were asking you the same question for the tenth time. They only know you aren’t that doctor with the great bedside manner. If your patients know how great you usually are, they will forgive you, and because they actually feel close to you, they will often ask if something is wrong just as they would a good friend. In that case, you may get away with being moody on occasion. But it won’t take long to use up your goodwill capital if you don’t get your act together.

Doctors with good bedside manner can usually tell when they aren’t themselves. If you are the oblivious type, you must learn to recognize the signs. It may be that you snap at your coworkers or employees. Perhaps a caring patient who knows this isn’t you will say something. If your staff asks if something’s wrong, that is a sure sign you aren’t being yourself. They will often notice your bad day before you do by something as subtle as you not saying good morning.

Burnout Remedies

Vacation is a great way to unwind and regenerate. Taking several shorter vacations may provide you with more relief than waiting all year to get away for one treat. The anticipation of a respite helps make the days go by faster, and the more good things you have to look forward to the better you will feel.

Consider getaway weekends if you can’t schedule full weeks. Anytime away from the practice is recuperative.

Altered hours are a fabulous way to defeat the monotony of your routine. If you know that every Monday is a long hectic day, you begin to dread Monday. If surgery days are stressful, and Tuesday is surgery day… you get the idea. By having altered days and weeks, you can avoid preconceived anxiety. Consider making an A week and a B week with enough variety to keep you out of a rut.

Avoid high-stress, time-consuming, expensive hobbies. Sports, meditation, yoga and maintaining a regular fitness program will do wonders for dealing with stress and provide you with a healthy outlet. All too often, healthcare providers have so little time for themselves that they neglect their own health. Don’t let high school gym be the last time you had a cardiovascular workout.

Consider avoiding dangerous hobbies and sports like motorcycling, mountain climbing, and full contact football. While some of you require intensity in your lives, the injuries from high-risk hobbies can ruin your career.

You can get much relief from stress on the racquetball, tennis, or basketball court, or by playing hockey or softball. Develop hobbies and sports skills you can continue with advancing age. You aren’t going to be playing “rough touch” forever. A round of golf may be there for you once your knees can no longer tolerate a game of tennis. Golf can be so time-consuming that it may not be right for you early on when you begin practice, but as you consider slowing down, it can offer a great getaway from the stresses of practice.

Learning some simple relaxation techniques could be the difference between an extended or shortened career. While it may be nice, you don’t have to take a formal course to learn meditation. You do, however, have to take the time to utilize whatever techniques you choose.

Yoga offers both physical and mental benefits. By taking time to relax and go into the various poses you rest your mind, and the poses themselves stretch the muscles and joints to keep you flexible and fit. Like meditation, you don’t have to take formal courses, but some guidance will be helpful. Unless you really get into yoga, you don’t have to strive for the exotic poses that take much practice and extended training. It may be best to learn a few simple poses that help with your particular physical stresses. If you have a bad back, learn poses that stretch the back. Look for meditative yoga classes in your area for a less physically demanding activity.

You can also consider utilizing some basic physical therapy stretches. Anyone who has had physical therapy knows they teach many stretches that help with rehabilitation. Keep doing those that let you maintain flexibility and relieve pain.

Psychotherapy is needed when you recognize you no longer deal effectively with your stresses. While the techniques noted should keep you from getting to this point, there may come a time in your life when you need to talk with a professional. One of the biggest problems is denial or an inability to see that you need psychotherapy.

Healthcare practitioners have some of the highest rates of alcohol and drug abuse, and a high suicide rate, which shows that dealing with sick people may take a toll you didn’t expect when you chose this profession. Don’t let yourself fall into substance abuse or succumb to untreated depression. You’d never ignore the signs in your patients and you shouldn’t ignore the signs in yourself. Self destructive behavior should not be an option.

BIO

Robert M. Fleisher, DMD, Atlantic City, NJ, graduated from Temple University School of Dental Medicine in 1974 and received his certificate in endodontics from The University of Pennsylvania in 1976. He taught at Temple University and The University of Pennsylvania and is now a member of the Affiliate Attending Staff – Albert Einstein Medical Center, Department of Dental Medicine, Division of Endodontics, Philadelphia, PA. Dr. Fleisher is the founding partner of Endodontics Limited, P.C., one of the larger endodontic practices in the United States. After retiring from practice, he devotes his time to writing about practice management, aging and health issues, and fiction with a medical bent. This article is an excerpt from his soon to be published book, Bedside Manner - How to Gain Your Patients’ Respect, Love & Loyalty. He can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it. or www.bedsidemanner.info.

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