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Patient anxiety and distress can affect practitioners, depleting reserves of empathy and understanding that are so important in the profession. Here’s why dentists are at risk of compassion fatigue and what to do about it. By Angela Tufvesson
Working in dentistry can be a serious drain on your emotional reserves. Nobody likes going to the dentist, and a significant number of patients experience anxiety and serious distress, which can rub off on those around them.
Over time, dealing with other people’s stress and trauma can take a take a big toll on even the most empathetic dental professional and deplete reserves of one of the key qualities that brought you to the profession initially: compassion.
Irritability, insomnia, adaptive behaviours like substance use, detachment and insensitivity are signs of what psychologists call ‘compassion fatigue’ or ‘empathic distress’, explains Elle Brown, a telephone counsellor at Dental Practitioner Support, a national support service for dental practitioners.
“People say they’re exhausted, and they feel sad,” she says. “They find it difficult to concentrate, and they have difficulty maintaining interpersonal relationships.”
Nursing researcher Carla Joinson coined the term ‘compassion fatigue’ in 1992 when she noticed nurses dealing with frequent heartache had lost their ability to nurture. It’s best described as a state of exhaustion and dysfunction as a result of prolonged exposure to compassion stress.
Compassion fatigue is common in ‘helping’ professions that depend on a compassionate workforce like nursing, social work and clinical psychology. For dentists, perfectionistic tendencies and the twin demands of patient care and running a business are common triggers.
“Dentists tend to be perfectionists as that is the nature of the job,” says Professor Alastair Sloan, head of Melbourne Dental School at The University of Melbourne. “The challenges of juggling high levels of patient care—in particular, challenging patients and big waiting lists—having that level of perfectionism and managing staff and running businesses form a triangle that is never really that solid. It can lead to some very significant areas of distress for practitioners.”
He says lack of job satisfaction, a feeling that nothing you do is good enough and an inability to listen to feedback are classic signs of compassion fatigue. “You might also be withdrawing into yourself, becoming quite insular, not engaging as much as you normally do with colleagues and making rash decisions,” Professor Sloan says. “There’s also a strong feeling of not being yourself when you’re with patients.”
There’s very little research examining the prevalence of compassion fatigue among dentists, but Professor Sloan says it’s a lot more common than many practitioners might expect. Likewise, Brown says “it’s definitely one of the things people call us about” at the support service.
What happens to wellbeing
If left untreated, compassion fatigue can have serious long-term effects on mental health. It’s associated with anxiety, depression and post-traumatic stress disorder, and there’s also significant crossover with burnout, a work-related syndrome characterised by exhaustion and loss of personal identity.
“With healthcare professionals in general, you’re putting another human being—your patient—before yourself, so compassion fatigue ties into burnout and working very much at the edge of your stress levels day in, day out,” Professor Sloan says.
Then there’s the impact on the quality of your work as a clinician, colleague and business owner. Compassion fatigue can impair your ability to make decisions and care for patients because you’re trying to protect yourself from compassion stress, explains Brown.
These impairments can also show up in your relationships outside of work. “You can lose connection with others and your personal relationships can become fraught because you don’t stop the depersonalisation when you end work for the day—it happens at home and with people you care about,” Brown says. “It can lead to a fracturing of your support systems, which is really important to your overall health.”
Setting up support systems
Now for the good news: compassion fatigue can be prevented and treated. Professor Sloan says a first step is cultivating profession-wide acceptance of compassion fatigue as a valid and serious problem, and fostering an understanding of common signs and symptoms.
“We have to accept that it’s not claiming weakness or that you can’t do your job,” he says. “It’s recognising that at this point in time you’re not yourself, you’re not working as you should do, and you need some help and support.”
Professor Sloan recommends setting up support systems in your practice that people can access if they’re concerned about compassion fatigue. They can be as informal as nominating a colleague to talk to, or more formal like providing access to employee assistance programs, setting up a wellbeing team or contacting the Dental Practitioner Support service. “If you talk to somebody, it’s a big step forward to changing your behaviours and improving your wellbeing,” he says.
Despite the time pressures dentists often face, Brown says taking regular breaks throughout the workday can help to maintain a positive mood. “It’s very difficult in dentistry as there’s often people in the waiting room, and they’re waiting a long time, but you’re going to feel better and do better if you feel refreshed when you see clients.”
Professor Sloan says the same goes for the type of dental work that fills your schedule. “Should dentists be operating at the highest level of their scope of practice day in, day out, or do they need to do a simple scale and polish now and then to relieve some of the pressure of doing very delicate work? These are conversations we need to have.”
Outside work, Brown says the same health advice that works for everything from heart health to depression holds for compassion fatigue: regular exercise, adequate sleep and participating in activities that bring joy.
Amid the wash-up of the pandemic and the enormous waiting lists confronting many dentists, Professor Sloan says it’s crucial to recognise that “clinicians are not machines”, warning that the impact of compassion fatigue could become more widespread.
“Dentists are human beings, and they just can’t keep working on a treadmill to clear a backlog of patients. We need to have a different way of approaching this, and these conversations have to happen now—otherwise it will be too late.”