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The importance of breaks

Dentistry can be an extremely rewarding profession. The last unprecedented months of uncertainty and anxiety in the eye of the COVID-19 pandemic storm, however, have tested us all. Particularly as we move back to active treatment for our patients, it is inevitable that it will take some time to understand how best to manage the backlog of their needs and demands and our financial challenges, all within the overarching imperative to control the transmission of the virus.

So, what was already a stressful job for many of us is now including new pressures. We have been concerned for some time that burnout is an ever-present risk. The World Health Organisation has recently recognised burnout as an emerging syndrome brought about by chronic stress in the workplace environment that is not managed successfully.1 The danger in dentistry's new and challenging work environment is that this risk may be forgotten as we understandably concentrate on developing procedures designed to catch up on the lost time and opportunities of the first half of 2020 and maximise the throughput of patients.

Some predisposing factors for burnout include workload, time pressure and long hours without sufficient time to rest and recover. A survey of dentists in the UK carried out before the COVID-19 outbreak revealed more than 60% of respondents found it difficult to take a short break and 68% disagreed that regular rest and recovery periods are the norm during work sessions.2

These results highlight that significant numbers of dentists are not including timed short breaks in their day and are at a higher risk of burnout. In our Breaking the burnout cycle report, we recommend that dental teams have policies in place to allow for breaks during work sessions.

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The survey also reveals that 68% of respondents feel unable to take a short break in between two consecutive clinically demanding procedures. Worryingly, 43% of our colleagues feel unable to take a break during the day to eat or drink.

In addition, 28% suspect that emotional exhaustion has contributed to an irreversible clinical error, with 48% saying it was related to a lack of concentration. The link between a failure to meet physiological needs (food, water, sleep, rest) and patient safety is evident.

If we now align these findings with the additional burdens of managing the wearing of cumbersome and stifling personal protective equipment (PPE), working long hours to make the most of precious space and time and the anxieties of maintaining safe practices throughout, it would not be hard to imagine that a similar survey carried out now would report even higher levels of exhaustion. Indeed, speaking with dentists as I do regularly, they confirm my own suspicions that it's tough at the moment.

I find it strange how a dentist can become isolated even in a large practice with many clinicians working in the same building. How easy it has always been to arrive first thing in the morning, disappear into our own surgeries and not emerge until it is time to go home. In my own practice, we introduced a formal break in the appointment book for 10 minutes for the entire practice at 10.20am and then again at 3.20pm. Stopping for a chat and a cup of coffee with everyone in work that day has been a huge bonus and immensely valuable. Despite the requirements of social distancing, this is all the more important today. It's not only social and team down time but also an opportunity to share experiences about tricky patients, clinical and management issues for those who find that helpful and reassuring. In my opinion, those 10 minutes should be firmly protected.

Analysis from the NHS Staff Survey - which covers a wide range of healthcare professionals - found that opportunities for employees to recover from work demands can have a strong influence on organisational and patient outcomes. Greater satisfaction with work/life balance was linked with better financial performance and lower absenteeism, as well as higher patient satisfaction and lower risk of infection rates in hospitals. Such findings further highlight the need for evidence-informed initiatives to promote work/life balance and recovery from work.3

Although dentists seem to feel unable to take a short break during the working day, almost 60% of dentists would be prepared to cover a colleague's work for a short period so that they may take a break. It is interesting to see that respondents recognised the need for others to take a break but did not feel able to do so for themselves.

Breaks are necessary for dental professionals so that we can work efficiently and safely, and it seems only sensible that all organisations recognise the need for recovery periods throughout the time spent at work and allow the appropriate time to eat and drink. This will provide you with the opportunity to give the best care to your patients while reducing the levels of burnout, effectively translating into fewer dentists abandoning the profession.

References

  1. 1.

    World Health Organisation. Evidence and research: mental health. Available online at: https://www.who.int/mental_health/evidence/burn-out/en/ (Accessed July 2020).

  2. 2.

    Dental Protection. Breaking the burnout cycle. Available online at: https://mpscdnuks.azureedge.net/resources/docs/librariesprovider2/default-document-library/1907310561-uk-dp-burnout-policy-paper-web.pdf (Accessed July 2020).

  3. 3.

    Powell M, Dawson J, Topakas A, Durose J, Fewtrell C. Staff satisfaction and organisational performance: evidence from a longitudinal secondary analysis of the NHS staff survey and outcome data. NIHR Journals Library 2014.

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Correspondence to Susie Sanderson.

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Sanderson, S. The importance of breaks. BDJ In Pract 33, 10 (2020). https://doi.org/10.1038/s41404-020-0471-z

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