S2 E4: Your mental health

Wright[00:00:00] How do you prioritize your mental health? Hello,Hello, everyone. I'm Dr. ArNelle Wright.

Ioannidou[00:00:05] And I'm Dr. Effie Ioannidou.

Wright [00:00:07] And this is Dental Sound Bites.

Announcer [00:00:13] From the American Dental Association this is Dental Sound Bites created for dentists by dentists. Ready? Let's dive right into real talk on dentist's daily wins and sticky situations.

Ioannidou [00:00:28] May's Mental Health Awareness Month. And today we have a special guest to talk about the mental health challenges dentists face. Please welcome Dr. Diana Dill.

Dill [00:00:38] Thank you, Effie. Thank you, ArNelle.

Wright [00:00:40] You are very, very welcome. Welcome here. We are so excited to have you, especially because of all of your experience with working with dentists. What can you tell us a little bit about yourself?

Dill [00:00:51] I'm a psychologist. I have a mission to support caregivers in medicine and dentistry. The people who are doing all the heavy lifting for all of us. And I work with clinical groups and one-on-one to help people develop the best workplace experiences they can have and to prevent and come back from burnout. So, over the last ten years, we know clinicians have recognized that they're not as sturdy as they are. They've recognized that they're not superheroes, and they have limits like everyone else. And so where I work is helping people understand their limits and helping them figure out workarounds so they can get back to being, performing their best and feeling their best at work.

Wright [00:01:37] That is so good. You said a mouthful, that I hope we get to unpack throughout this episode. Seriously. Since we started the podcast, we have heard some of our colleagues share challenging stories related to their mental health, both with interacting with patients and on their own interpersonally. And that's amazing because the more we talk about it, I really believe the better we will be. So if you can briefly tell us the importance of mental health, what is it and what are we really talking about here?

Dill [00:02:08] Well, when I think about mental health in the workplace, I think the key issue is are we above the line or below the line? Do we have enough resilience to bounce back from the daily stressors or are we really just, have we gotten to a point that we're overwhelmed? Burnout is when people are overwhelmed day after day and can't come back from it. High functioning, well-functioning is when we can do our best and regroup. If we have a negative interaction with a patient, if we have an argument with a coworker, if our child calls us upset, we can regroup and we can problem solve. These are events that happen in everybody's life. When we can no longer regroup and problem solve when we're in deficit mode, we're heading towards burnout. And that's a problem for a lot of reasons, and it shows up in different ways and different people.

Wright [00:03:06] So you mentioned regrouping and being above or below the line. So, would high functioning be above the line?

Dill [00:03:14] Yes. Okay.

Wright [00:03:15] Awesome. Awesome.

Dill [00:03:16] Yes. Thank you for clarifying. Yes, yes, yes. It's like you're in the black. You've got enough to draw on. And in fact, ideally, you feel good most of the time.

Ioannidou [00:03:26] Yeah.

Wright [00:03:27] When I think of high functioning, immediately when I hear the phrase, I instantly feel that it's a negative thing. Could you expound upon...

Dill [00:03:37] What does it look like?

Wright [00:03:38] Yeah, what does it look like? And I know it manifests differently in others, in everybody.

Dill [00:03:42] Yeah. Yeah.

Wright [00:03:43] But is this a good thing? Is it a bad thing or?

Dill [00:03:46] Great question.

Wright [00:03:46] Yeah, we jumped all in already. We are here right.

Dill [00:03:50] When we're well, we have a lot of energy, both physical energy and emotional energy. We feel connected to people. We can use really good relationship building with new people. We can be comfortable and secure with the people we know well, and we're doing our best work. Those are signs of feeling well. Okay.

Wright [00:04:12] Okay.

Dill [00:04:12] Anything that interrupts that and interferes with it, then we start thinking, What's going wrong? Like you probably both have great days. You can describe times when you really felt like you were in a groove. What were they like for you?

Wright [00:04:27] When you said not having the, I guess, the ability to regroup? That struck a chord with me, actually. So I'm sitting here, I'm listening intently because I'm like, “Hmm, when were those opportunities or those, there was times in the office when I felt depleted.” I don't know if that's the right term?

Dill [00:04:46] Depleted, that is a great word, ArNelle, like emptied out. Like you don't have the fuel you need to do what you want to do.

Wright [00:04:56] But where do we draw from?

Dill [00:04:57] Ordinarily when we're feeling good? Yeah. It's our natural state to feel good. Yeah. I think the things that we can be aware of to keep ourselves feeling good are to make sure we have enough positive experiences in our life. In fact, I put a website in the resources for the listeners so that they can look at. Barbara Fredrickson did some really beautiful work on how to go and seek out positive emotions for yourself and just how important they are. So if we have enough positive experiences in our daily life, we just naturally feel good. I love that. Unless something's going wrong. That's human baseline.

Wright [00:05:38] Right.

Ioannidou [00:05:38] In previous discussions that we had on the podcast, we brought up the different personality traits, which I'm sure apply here too, as well as you know, I will, I will go to this and they will say aging, right? So when I reflect on myself and I think about me, you know, 15 years ago or 20 years ago, right, I could go 24/7, communicate with people, speak the whole day, you know, respond, write emails, do this, do that, come home and still be equally available. Right.

Dill [00:06:14] Right.

Ioannidou [00:06:14] As time goes by, based on my personal experiences, and my own reserves, they seem to be consumed. And sometimes you feel that, you know, this 24/7 is not possible. And I know that my personality hasn't seen some equally extrovert as I used to be when I was 20. But you need some moments of silence.

Dill [00:06:36] Yup. You're raising such an important issue, Effie, I'm so glad you did. And in fact, when I was talking about clinicians realizing they're not superheroes, they're realizing they cannot meet not never ending demand. They just can't do it. They don't have a minute to catch their breath anymore in our current workplace. So what I would like to see is workplaces adapting to make sure clinicians do have the breaks they need. And also I think we have to realize, again, we're not superhuman. We can work 3 or 4 hours and be fully, fully top of our game, and then we need a half hour downtime and more and more so as we age. It's definitely true that aging affects this, but I think somebody like ArNelle probably relates to that too. Like if you don't get half an hour off every 3 or 4 hours, you feel it. You start getting fried. Maybe you're able to do things okay there you can do automatically. But any of the outside of the box thinking or the dealing with a complicated relationship that gets harder to do if we're going all day long. 8 to 6, 8 to 7. No break, no lunch. Yeah, we need the calories.

Ioannidou [00:07:55] Yeah. With your experience in the dental community what do you see as the most common mental health problems in practicing dentists?

Dill [00:08:03] Probably anxiety, stress and burnout, some depression and some substance abuse. But I think the ADA just did a nice survey of well-being, and that was like 12% of dentists might report being depressed or might report having a substance use issue. Anxiety, stress, burnout, or much more frequent. And the anxiety comes from meeting the steady demand of being a technical person and an intellectual expert and combining all that to meet a patient's needs.

Ioannidou [00:08:43] Yeah.

Wright [00:08:43] Man, there are so many things like that I'm just thinking about right now of how just like my day-to-day can be affected. And to your point about the Wellbeing survey, some of our dentists have even told us that they feel a stigma associated with asking for help.

Dill [00:09:00] Right? Isn't that such a shame?

Wright [00:09:02] Yeah.

Dill [00:09:03] It's true of American society in general that we're not supposed to admit shortcomings or vulnerabilities. It's our culture, and I think we're up against that. But then plus, anybody who works as an expert with people and their bodies, they're worried that their patients may freak out if they show vulnerabilities. There is added pressure on them to be perfect and probably in their training they learn to accept the pressure to be perfect, to present a certain professional face to their patients. So of course we don't want to lose it in front of our patients ever. However, I don't think this message has to extend to our whole lives. Right?

Wright [00:09:49] Right.

Dill [00:09:49] Can't we confide in our colleagues?” Wow, I'm having a rough day.” Can't we go home and tell people "I need a day off?" Can we not, like, find somebody to confide in, to say "I'm just worried all the time and I can't seem to put the worry aside and refocus and be present in my life?".

Ioannidou [00:10:12] Yeah. You brought up so many very interesting issues, and I'm thinking even to the level that we express vulnerability, I think our community evolved a bit.

Wright [00:10:24] Definitely.

Ioannidou [00:10:24] Perhaps 20 years ago, I always count with 20, 20 is my reference point.

Wright [00:10:29] Your favorite number.

Ioannidou [00:10:30] Yeah. Yeah. You know, 15 years ago, it was not socially acceptable in the scientific community to even bring up the work-life balance. It's this is a pretty recent setup.

Dill [00:10:41] We're accepting now that we're not superhuman.

Ioannidou [00:10:44] Absolutely. And not only this, but, you know, I'm bringing another aspect to this. As women come to the workforce in a lot higher numbers, especially in dentistry you know, being a mother or being a caring, elderly, caring person. Right. Is not anymore held against you. Right? It used to.

Wright [00:11:04] Absolutely.

Ioannidou [00:11:05] I have memories of this. It's not like a different generation. It's, I'm talking about me. When I, when I had my daughter in the back in 2004.

Dill [00:11:14] Right.

Ioannidou [00:11:14] I had to manage this in a way that God forbid anybody knows that they have to go home or I have to pick up from daycare. Like it was another undercover kind of life.

Dill [00:11:26] Oh, my gosh. You needed to still present the image that you were all there for your professional self and your patients?

Ioannidou [00:11:34] Absolutely.

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Wright [00:12:20] So people often ask, what can we do to support our peers if they're struggling with a serious issue? Dr.

Dill wants to walk us through a demonstration of what we can say and what we can do to support a colleague. So Dr. Effie is going to be playing the part of a dentist going through a tough time.

Ioannidou [00:12:36] Let's do it.

Dill [00:12:38] So, Effie, I noticed that lately you don't quite seem yourself. What's going on? You're a little low down, it seems to me. What's going on for you?

Ioannidou [00:12:48] There are so many things in my mind, and I kind of feel a little bit overwhelmed at work. I feel like 24 hours are not enough to finish what I start in the morning. So just like by 10 a.m., I'm already ready to go and take a nap.

Dill [00:13:04] Wow. So you're feeling pretty overwhelmed at work, and by mid-morning, you've run out of steam.

Ioannidou [00:13:11] Yeah.

Dill [00:13:11] Wow.

Ioannidou [00:13:12] This happens frequently, I think. I tried to get some coffee, get hydrated, and I tried to do all the right things, but still, the mind is really tired.

Dill [00:13:24] Hmm. So that must be upsetting for you to see that.

Ioannidou [00:13:27] It is. I try to regroup in the weekend, but maybe two days, Saturday, Sunday are not enough to regain energy. So I feel like Monday we start and again the same cycle of hard work with no end.

Dill [00:13:44] Hard work with no end.

Ioannidou [00:13:46] I mean, don't get me wrong, I love my patients, but, you know, without, you know, having, having this level of commitment and the hard work during the day, this really, really exhaust me.

Dill [00:13:59] Mm hmm. You're noticing that you don't have the energy you're used to having. And yeah, I've seen you seeming a little less of the usual bounce that I think of you as having.

Ioannidou [00:14:11] Yeah.

Dill [00:14:12] How long has this been going on, would you say?

Ioannidou [00:14:14] I would say a few months.

Dill [00:14:16] And what do you think is causing this downturn in your energy, Effie?

Ioannidou [00:14:21] Oh, I think I overextend that. And I double booked patients, took some more responsibilities outside the practice. And, you know, maybe I should have learned earlier to say no.

Dill [00:14:35] So you're thinking that maybe you're tired and tired enough to feel like you can't go on a 10 a.m. at work?

Ioannidou [00:14:44] Yeah.

Dill [00:14:44] You're feeling tired because you're trying to do more than you can actually do.

Ioannidou [00:14:49] That's right.

Dill [00:14:50] So that's a tough situation to find yourself in. When you hear yourself say that, Effie, what do you think would make sense as a way of getting your energy back?

Ioannidou [00:15:00] I probably need a long vacation.

Dill [00:15:02] A long vacation.

Ioannidou [00:15:03] Maybe, you know, some peace and quiet. People not asking questions, no phone calls.

Dill [00:15:09] Some peace and quiet.

Ioannidou [00:15:11] And I need a break.

Dill [00:15:13] And after you had a break and got restored, what do you think you would do about the schedule you've taken on, given that it sounds like it's really too much?

Ioannidou [00:15:22] Yeah, I think what you're guiding me towards is something really obvious. I would need to structure my schedule in a way that it's more humane. I think, I, I really load my schedule with too many things and too many patients and then too many responsibilities after 5. So I would definitely need to kind of find a balance, which sometimes is difficult to do so. But I know I have to work on this, but I keep postponing and postponing and postponing.

Dill [00:15:52] So you're really pretty aware that your schedule is over packed?

Ioannidou [00:15:57] Yes.

Dill [00:15:57] But it's hard to make a change.

Ioannidou [00:15:59] That's right.

Dill [00:16:00] And do you think you'd consider with me right now what change it might make?

Ioannidou [00:16:06] I guess I would try to keep my appointments and allow some space between patients to regroup a little bit and be able to breathe and.

Dill [00:16:17] Okay.

Ioannidou [00:16:17] Have the time to go to the bathroom, which sometimes I don't.

Dill [00:16:20] So you'd set up your patient schedule during your work day so that it's not quite as jammed?

Ioannidou [00:16:27] Mm hmm.

Dill [00:16:28] So tell me what that might look like. How much time would you take as a break and how often?

Ioannidou [00:16:35] Ideally, I would like to take five, 10 minutes between patients, which right now I don't have. I go from room to room and, you know, maybe have a decent lunch break for a change and be able to sit down and have a salad and to speak with my staff or my colleagues in a slow pace without rushing and be able to breathe a little bit.

Dill [00:17:01] That sounds pretty tempting, doesn't it?

Ioannidou [00:17:02] Very tempting.

Dill [00:17:05] And so given, Effie, that you're saying, you know, you're feeling the effects of overworking and given that you have a picture in mind of how to set things up differently what do you think you can do to make that happen for yourself?

Ioannidou [00:17:20] I definitely need to restructure the office and train the front desk to respect those requests and make sure that we schedule to set up some ground rules and schedule the patients in a way that we just fantasized about.

Dill [00:17:38] That we're just fantasized.

Ioannidou [00:17:40] To deal with. Yeah, yeah, completely. Like the ideal way that the way that space is out the appointments and allows for me time to decompress at lunch. Right now my front desk things that I can really get going all the time like from 9 to 5. But clearly this is not the case. I think I'm losing my limit.

Dill [00:18:01] And they are probably looking for a direction from you, aren't they?

Ioannidou [00:18:05] That's right.

Dill [00:18:05] So I am wondering if I might challenge you to tell me when you might make this change.

Ioannidou [00:18:13] It's hard to make change because you have committed appointments, so I have to just do this gradually, I guess, and maybe even next week, sit down the staff, and just let them know what the decision is and how we can proceed for new patients and new appointments. Obviously, we it's very difficult to go back to the schedule as it is and restructure it.

Dill [00:18:35] Okay

Ioannidou [00:18:36] Starting from now, anybody new, perhaps we we can consider spacing out the appointments in a friendlier way to me and the staff, of course.

Dill [00:18:46] What a good idea.

Ioannidou [00:18:47] You made me come to the idea of seeing miracles.

Dill [00:18:51] And if you're feeling that exhausted, Effie, it may even make sense to postpone some patient appointments because you have needs too.

Ioannidou [00:19:02] Many times we feel that we disappoint people if we do this. But, you know, I guess you're right. Yeah.

Dill [00:19:07] And you're learning that you have a limit to how far you can push yourself. And, you know, if you want to be there for your patients, you may need to back off and reset the schedule sooner rather than later.

Ioannidou [00:19:19] Yeah, that's a great idea.

Dill [00:19:21] Okay. So may I check in with you about this in a few weeks and see how it's going?

Ioannidou [00:19:27] Yeah. Let's do this. Will be great.

Dill [00:19:29] Okay. Okay. All right, guys. That is how a coaching intervention for what turns out to be burnout, straightforward burnout. Effie is exhausted from overworking and it's finally caught up with her and she's trying to make sense of what's going on for her and find a solution, this is how a peer supporter could help coach someone to find that solution.

Ioannidou [00:19:55] Now, side note, this is the funny thing that they don't see patients anymore. I haven't seen patients for the last ten years. The whole scenario is like complete fantasy, but it works so well. and naturally, right.

Dill [00:20:06]  Yeah, you did.

Wright [00:20:07] You did a great job for sure.

Wright [00:20:10] It was very, very relatable. And as you were both going through the role play, one of the things that came up in my mind were those doctors out there who work for a corporate, kind of like me. Oh, you know, with, like restructuring their schedules, training the front desk. And it is not that you don't have that autonomy, but some of that operationally may be out of your control. So if you can I know this is, you know, a little on the spot, but what are your thoughts about maybe some suggestions on how we can go about talking to our staff and, yeah, kind of just curtailing some of those appointments.

Dill [00:20:47] You know, we're learning more and more all the time about what are reasonable workplace conditions, what are the best conditions for people to see patients, make their patients happy, do good work and enjoy the work so they want to stay?

Wright [00:21:05] It's a good phrase, right?

Dill [00:21:06] I think organized medicine and dentistry, you're finding that they're most compelled by wanting to retain their good people and if they exhaust them, they're not going to be able to keep them. Okay, So there is where the lever is for dentists. We need to have a good workplace or we're not going to be able to keep this up.

Wright [00:21:26] Okay.

Dill [00:21:26] And so we know a lot about what is a good workplace. Ideally at the local level, you define it for yourselves. You know, these are the hours we can manage here or when we need breaks. Here is the staffing we need to be able to do things well. And, you know, I'm trying to make that argument to your management. Yeah, that makes a lot of sense. I mean, I think for me, starting by for one, I think speaking up is one of those things. It's kind of like figuring out what you're struggling with and then kind of sharing that with someone.

Dill [00:22:03] Right.

Wright [00:22:03] Might be a starting to. Yeah, I mean, because.

Dill [00:22:06] Perfect start, perfect start. And if you find the three or four of you are all struggling with, how do we keep this up, then it's time to acknowledge this is too fast to schedule. It's too much. We're not going to be able to keep it up comfortably. I put in the resources for this podcast something called Med Pep, where there are 20 segments that people can choose from. It's a link to a series of talks about how clinicians can approach burnout, and a lot of them have to do with organizational interventions. So if people want to follow up on that, they might want to look at that resources.

Wright [00:22:46] Nice, nice. I'm pretty sure our listeners are going to enjoy some of the resources that you provided us. In addition to speaking up, what are some other things that we can do to reduce the risk of major mental health issues in our lives or in the workplace?

Dill [00:23:02] So, I mean, of course things happen, right? We have disappointments, we have heartaches. We have things that scare us. The pandemic scared everybody, you know, about their physical safety and their financial security.

Wright [00:23:17] For sure.

Dill [00:23:18] And it scared patients who came in and started sometimes taking it out on their dentists and the staff. So things happened and we're not going to be able to make them not happen. However, I think, you know, back to the idea of resiliency and feeling that we have enough oomph to rebound from the hits that happened is important. So the Barbara Fredrickson piece I mentioned, she thinks that people need a ratio of three positive experiences to every one negative experience to thrive and be able to rebound. And this is something individuals can take control over for themselves, whatever the workplace circumstances. In fact, Barbara, on her website, which I have linked the listener to, has a self-assessment tool where people are asked to rate how positive or negative, did they feel during these times of the day? And it gives them a baseline to redirect themselves from. So, I mean, it requires a certain amount of planfulness, but not too much. I think it means valuing ourselves enough to say our happiness is important and worthwhile. Valuing ourselves enough to say, "Well, I'm going to see my friends tonight because I need to and because it makes me happy," or "I'm going to go home and cook my favorite meal and unplug everything and make people leave me alone because it makes me feel peaceful." So seeking out positive experiences is what gives us that resilience. We want to have trusted confidants to turn to if we're feeling like we don't have our usual good spirits. And they can help us figure out what's going on and what we need to do. Of course, some people love being social and some people don't love being social. So I think it's important to figure out what makes you happy. Positive experiences are things like finding meaning in the work you do, feeling proud of what you were able to do at work, feeling proud of the friend that you are, or the wife or husband or parent that you are. Positive experiences are connected with somebody who's important to me. Or just like I like to play pickleball and I can't wait to get on the court. Seeking out positive experiences. We're in such a work culture, we lose sight of that.

Wright [00:25:59] Yeah, it does. If you or someone you know is struggling, please know that there are resources and people available to help. There's a newly updated dentists well-being directory available online. It's a state-by-state list of health care professionals who will serve as a point of contact and offer support during a time of need. And it's free for everyone, not just members. The ADA has a series on resiliency available, and you can even get see credits for watching.

Ioannidou [00:26:28] Learn more about the value of mental health in your practice through resources from the Hope for the Day organization. You can find all these links and more resources on the show notes for this episode at the ADA.org/podcast. Keep in mind if you or someone you know is experiencing suicidal thoughts or a crisis, please text or dial 988 to be connected to the National Suicide Prevention Lifeline. This service is free and it's very confidential.

Announcer [00:27:02] On the next Dental Sound Bites, how did you decide which direction you wanted your dental career to take? Solo Owner. Small Group Practice. DSO. A medical setting or a federally qualified health center? Faculty or military. So many practice options. Where do you start? Join us as we talk to dentists who choose different paths and dig a little deeper into how their choices fit their career interests, lifestyles and goals. Your career roadmap next time on Dental Sound Bites.

Ioannidou [00:27:37] Thank you so much. This was a great conversation. We really, really enjoyed it.

Dill [00:27:41] Well, it was lovely to talk to you both. And I hope the discussion helps some of the listeners and that they find a way back to peace and happiness if they're struggling.

Wright [00:27:51] I had a great time. Yeah. Thank you so much for all the information that you shared. I mean, I was over here taking notes for myself.

Ioannidou [00:27:58] And I'm sure our audience would love to hear more and learn more about Diana Dill. So where can they find you?

Dill [00:28:05] I have a website. It's just plain Dr. Diana Dill dianadill.com, and they can find out more about me and my work at their website.

Ioannidou [00:28:16] I'm sure that they will be very curious and very helpful.

Dill [00:28:20] Thank you both. It was a pleasure.

Ioannidou [00:28:22] Thank you.

Wright [00:28:23] Thanks for being here. If you like this episode, go ahead and share it with a friend or a colleague.

Ioannidou [00:28:28] Also, don't forget to subscribe to this podcast wherever you are listening so you can get the latest episodes.

Announcer [00:28:35] Thank you for joining us. Dental Sound Bites is an American Dental Association podcast. You can also find this show's resources and more on the ADA member app and online at ADA.org/ podcast.