Dentistry is STRESSFUL – this Podcast will help you – PDP065

Jaz’s Introduction:
Hello Protruserati, I’m Jaz Gulati, and welcome to another episode of the Protrusive Dental Podcast. Today is going to be really monumental, we’re talking about stress. This is an episode I hope will change your life. Let’s face it guys, we’re part of a really stressful profession. The thing that really brings it home to me is that actually, every profession can be difficult.

Like, even ask the guy who works at McDonald’s. He will tell you his job is stressful. Right? Or ask the hairdresser when she’s got a long queue of customers and she’s got a really picky client who she’s cutting hair for. Then she will tell you that, oh my goodness, this is a lot of stress. My profession is the most stressful.

So everyone has a case and an argument for their profession being the most stressful. So, in dentistry are we really such a stressful profession? Well, I think so. Let me tell you why, right? I listened to a podcast episode who my good friend, Payman Langroudi and Prav Solanki run, Dental Leaders Podcast, which by the way, I was on recently, so if you haven’t checked that one out, do check it out.

And he had someone called Tom Youngs, who was a dentist not even just a dentist, a phenomenal dentist, like a really amazing clinician who posted lots of YouTube videos lots of great clinical cases, and you’d think, wow, what a great dentist, but then he left our profession. He started to work for a, I believe it was a, a startup, like a tech startup.

And then he had a few years with them and he’s, I believe he’s moved on perhaps from there. I’m trying to remember that podcast episode I listened to, but the long and short of it is that he has been a dentist and he’s experienced lots of other sort of professions as well. And then on the podcast, he says that.

Dentistry is by far the most stressful profession. So that’s one example I can give you about but you don’t need to know that, right? You don’t need me to convince you that our job is super stressful. Let’s face it, right? As Lincoln Harris said in many episodes ago on the podcast that we’re a surgical specialty and really it should take about 11 or 12 years to train us like in the medical fields.

But we only get 4, 5, 6 years of dental school and we come out of dental school with not so much confidence and not so much experience. So we’re kind of learning on the job as we go along. It’s the truth and it can lead to very stressful moments in our career. So that’s why I’ve got Dr Manuela Rodrigues, who is known as the mindful dentist or mindful dot dentistry.

And she will be answering some very real world tangible questions because. I’m kind of a really impatient person. I didn’t want to do the whole, because I’m the worst person to do like the headspace and the mindfulness and stuff. Like, ask my wife. We’ve tried it and I’m like, okay, I’m bored. I want to do, I want something more exciting.

Right? So I really, really, really twisted Manuela’s arm. And I said, okay, can we make this extremely clinically valuable as best as she can? Rather than, and I mean no offense to her or anyone in that space, like, I don’t want wishy washy, right? So I think what she managed to do on this episode is absolutely phenomenal.

So Manuela, thanks so much for what you did, and guys, I’m so excited for you to listen. We basically cover three main areas. Area number one is day to day clinical struggles, clinical failure and struggling with your dentistry or having difficult patients or difficult cases and how that can bring on stress and how we can manage that.

The second one is, is a darker one, is litigation, right? Some of us, many of us have had complaints against us and that can be such a dark and stressful period of our lives. It leads to sleepless nights and it’s a really nasty thing to experience. I wouldn’t wish it upon even my greatest enemy. To be honest with you.

So therefore, I want to really get her insights into how she can help you if you’re struggling with a complaint or a near miss and you’re losing sleep because of it, what can we learn? What can she teach us about being mindful that could help us to to better cope with our emotions and actually have a more fulfilling, less stressful life.

And number three is one that really bothers me a lot, which is running late. Okay. I’m guilty of being that dentist that does kind of run late time to time. So I just wanted to ask her at the end about, okay, what advice can she give me as someone who can have the tendency to run late so that I can better control my emotions and not be so stressed when it happens.

So I hope I gained a lot from this episode. So I hope you do as well. If you listen all the way to the end, Manuela has got a discount code for you. This is not like a sponsored episode or anything, but she was very kind afterwards to email me and say, you know what, Jaz, for the Protruserati she has an offering, like a journey she can take you through to through mindful dentistry. And she wants to pass on a discount to you. I was like, that’s very kind of you. So I can pass it on to you at the end. So you have to listen all the way to the end for that.

Protrusive Dental Pearl:
But before we get there, I have my Protrusive Dental Pearl for you. This is a really great pearl. I actually really love this one. It’s going to go in my like top five pearls, right? Get this, okay? In dentistry, one of the most stressful things, which is like the theme of this podcast episode, is how every sort of collision, every mental you experience, or every course you go on, they all have differing and sometimes annoyingly, opposing schools of thought.

Like, one person will say vertical preparations are terrible, vertipreps are dirty preps, don’t do them, they’re going to invade the biological width, whereas other dentists would be like, vertipreps are the most conservative way to treat a tooth, etc, etc. I don’t know if that was a good example or not.

Or, some people will say, this is the correct way to do this implant technique, or the others will say, no, that’s completely wrong and none more so. Then in the world of occlusion and splints and that kind of stuff. So especially in splints and occlusion actually. So it can get really annoying as someone who just wants to learn and do the best for their patient.

So I came across a comment on Facebook that I just had to pause and reflect on how powerful this comment was. It’s by my friend, Alan Matthews, who’s based in Scotland. And he had this to say, right? It was like some argument. Everyone was like giving their different viewpoints. And this is the way he summarized it.

He said, listen to everyone, listen to all the schools of thoughts, right? So listen to everyone, but do what feels right to you. Now, this is such a simple one, but such a powerful one. I thought, felt like a massive load lifted off my shoulders when I read that. I’m going to just accept that it’s the beauty of dentistry, that there are so many different opinions, and I will listen to you.

I will listen to everyone, no matter how wacky or how boring it is. I will listen to all the schools of thoughts, but I will always do what feels right to me. And that’s why I condone for you, the Protruserati as well. I think it’s such a great way to live your professional career. Listen to everyone, respect everyone, but do what feels right to you.

So I hope you enjoyed that pearl. I love that pearl. Alan, thanks so much for inspiring me with that. So let’s join in hopefully what will be a career changing episode for you guys. Enjoy.

Main Episode:
Manuela Rodrigues, welcome to Protrusive Dental Podcast. How are you?

[Manuela] Thank you. Thank you, Jaz. It’s a pleasure to be here. I’m doing well.

[Jaz] Amazing. And you are known as the mindful, I guess the mindful dentist in a way, your Instagram handle mindful.dentistry. It’s great what you’re doing and the messages you’re putting out and really mindfulness has become a bit of a buzzword, right? It’s become over the last probably about six years ago, I came across it.

So I want, let’s speak to the listeners and tell them what was your journey with mindfulness? What is mindfulness for about the three or four people who are listening and don’t know what it is? I don’t know how you could possibly avoid it, but for those that don’t know, tell us what it is and then how did you get involved?

[Manuela] So my journey with mindfulness started more or less 10, 12 years ago. Because 12 years ago, I had a health problem. I had the Cushing syndrome, so I had one adrenal removed, and so my body was producing 10 times more cortisol than needed. So after the surgery, after the treatment, I thought to myself, okay, maybe I need to change something in my life.

Also, so I discover mindfulness, I discover meditation also, and I started to use it as a way to reduce stress in my own life. So this, the mindfulness is this presence that you bring to not only to your life, but actually to everything that you are doing, right?

So you become aware and present moment to moment and I started to apply it also in my dentistry practice. So I graduated from dental school in 2001. So and I realized that I was, during work, I was overthinking a lot. So instead of being totally there with my patient working, my mind was running around and sometimes worrying about less good outcomes of the treatment that I was performing.

And I realized also that led me to work from a place of insecurity. So I starting to bring this conscience present to my daily work. But what actually was decisive for me was that in 2014, I started working in Belgium and and I attended the workshop that they have that is specific.

It’s like mindfulness in the difficult practice. So it’s one day workshop. And it teaches you how to apply it. And that really-

[Jaz] That was specific to dentistry?

[Manuela] Yeah. That was specific to Dentistry. And it’s something that dentists here in Belgium it’s part of their on ongoing education. So if you want to take that, you can have that.

[Jaz] Wow. So even like as part of the recognized part of the sort of learning for dentists. That’s pretty spectacular. That’s pretty cool.

[Manuela] Yeah. And in the end, because I already had my mindfulness practice, I talked to the person that was giving the course.

And I said, this is so interesting because I already started to apply mindfulness, but I now realize that I could go even further. And we continued to talk and and I realized, yeah, maybe I can really start going deeper on this and I started to apply it. And then in 2016, I started my teacher’s training as a mindfulness based stress reduction instructor teacher.

And it took me about two years. To get the certification and even during my certification, I started to working with colleagues and I started to explain this to colleagues and I had amazing feedback and that’s a certain, and when I finished my certification, I started to organizing the mindfulness based stress reduction courses for dentists.

Because I could apply all the programs due to my experience as a dentist. I could bring to every session, the dentistry practice into it with practical examples of course. And I have very good, very good feedback and very good results. And at a certain point in the end of in 2018, I decided, okay, this is, I’m dividing my attention and my time between these two things.

What am I going to do? And I decided to pause my clinical practice and to dedicate myself full time to do this project that it’s mindful dentistry.

[Jaz] Well, congratulations for making such a monumentous decision and something that obviously sounds like a bit of a passion, how you got involved sounds good.

And really nowadays, there’s mindfulness from what I’ve read in my experience in every facet of life. Like, for example, there’s mindful eating, right? I’ve come across that before. And now we’re talking about mindfulness in dentistry. So I’m hoping it’s going to open a lot of people’s eyes. Cause when I started speaking to you on Instagram, I thought, how can we make this for the Protruserati listening a valuable episode, but really clinically relevant day to day.

So how could we make it? I mean, clinical is maybe a strong word, but the real life scenarios that we face as dentists. And if you can give us from all the courses and the teaching that you do, I’m sure you can share with us how to manage the following three scenarios. So I’m going to share those scenarios with you all.

So people can, can follow along with the three things we can talk about. We’re going to talk about one, technical failure. So, as dentists or perfectionists we beat ourselves up. Like, for example, I beat myself up when I’m doing a restoration class two and I have an open contact at the end, right?

Honestly I hate that the worst I’ve probably ever felt is when something’s gone wrong, like a perforation. I’ve never extracted the wrong tooth, but I can imagine something like that happens like errors in practice or even technical difficulties that can really stress me out. So I want to know what Manuela, what you think about how we can better manage that using mindfulness.

That’s scenario number one. I mean, the example I wrote is that I once got a splint stuck in someone’s mouth. I was making a direct chair side splint and I got it stuck in a mouth. I can tell you later how I handled it. I’m proud of myself the way I handled it, but I want to know what to do. When you’re actually in that very stressful situation. So that’s a scenario number one.

Scenario number two is a very dark one, right? And something that, especially in the UK with the litigation, I’m assuming the US as well, litigation rates are high. So what if you have a patient complaint and you’re battling that? I know dentists who have sleepless nights.

I myself have had sleepless nights in my career, and I know I will do in the future. Hopefully not after today, but this is a real reality of dentists. So a litigation scenario. And the third one, last one is thing. I hate the most thing I experienced with you today. I do apologize. I was running late, but today’s show, right?

I am stressed when I run late. I hate, absolutely hate running late because then the next patient can sense it. And then you’re trying to not rush dentistry. Cause good dentistry happens slowly. I do believe that. So these are three scenarios we’ll talk about today. Before we get on to that. I want to just check with you something, if I was to boil down the definition of mindfulness as me, okay, what I’ve come across is savoring the moment, what do you think, is that a good way to explain mindfulness?

[Manuela] Speaking in the dentistry context, because that’s what I teach and that’s what we are talking here specifically. It made me made that definition that you just said a little bit more complete. For me, mindfulness, I talk about presence. I talk about not only savoring the moment, but I talk about experiencing the moment with presence.

With awareness, I talk about awareness and that’s very, and that’s what we are going to talk about later. But dentistry is actually if you look at it, if you have disappointments with challenging work, sometimes with anxious patients it’s hard, it’s hard work.

It’s hard to keep your focus. So it’s not easy and you are under mental strain, you are under fatigue sometimes, and you have challenges that might come up that we are going to talk about later. So when I talk about Mindfulness, a mindful dentist. I talk about presence. I talk about awareness in the moment to be able to maintain that present and to be able to work from that place of presence.

So to illustrate this a little bit more with the practical example is if you are working with your patient right seated on your chair working and you are done, you are doing this feeling that you already did like a million times. And your heads might want to space out because you have other things a lot of the things in on your mind. Okay.

[Jaz] So usually what’s for lunch.

[Manuela] Yeah. Food is in my mind a lot. So I know what you mean, but if we do that and if that becomes a habit, then you are missing on the big details on your work. You are missing on the subtle messages that your patient might be giving you that he’s starting to feel uncomfortable. You are missing the microanatomy that might make all the difference.

And who knows what else might you be missing? Okay, so there, it’s very easy to do that. So when I talk about mindfulness and dentistry, I talk more than just savoring the moment, I talk about presence and bringing this awareness to your daily work and to into what you are doing.

[Jaz] Right. Well, I like the way you explained that. And sometimes I enter a state of flow you know Mihaly Csikszentmihalyi, the chap who came up with a theory of flow. And would you say that is similar?

Am I down the right avenue? ‘Cause sometimes I’m doing three hours with one patient. And it feels like five minutes. And I feel good and I feel like I’ve enjoyed myself. How can you relate that the theory of flow to mindfulness and dentistry? Cause what I’m there is I’m in love with every small details. Is that something that you can relate to?

[Manuela] Yeah, that’s exactly it. When you are in the moment, when you are aware of what you’re doing, when you’re grounding, which are grounded with yourself, when you have this mind body connection then you enter in the state of flow and that allows you also to enjoy and savor the moment. So that’s exactly, that’s-

[Jaz] Awesome. Well, I like that very much. Amazing. Well, let’s tackle that first scenario then. So, technical failure. Okay. Let’s say we’re struggling. Let’s make it really tangible. Let’s say I am a dentist who on a given day is struggling with an extraction.

This lower molar is taking so much time. I raised a flap. I’ve sectioned it. I’m now still trying to use some cry or something, trying to lift this root up. It’s just not budging. The patient is breathing heavier is obviously annoyed. Your nurse is looking stressed. You are getting stressed. What lessons can you teach us to handle this scenario in an optimum way?

[Manuela] Let me just do a small disclaimer before we start just to say that it’s not realistic or even desirable, the concept of a stress free dentistry work practice, I mean, or a stress free dentist. Stress is always going to be a natural part of dentistry work, and it’s going to happen.

What we’re going to talk about here is practical ways, of course, of dealing with that stress. So going back to the practical scenario that you just proposed when we find ourselves when a situation where the procedure is not going has we planned and we start to struggle normally we react.

So we were trying to solve the situation. We are going to be trying to solve the problems because we need to move forward. So what happens is that when we work and stress, we disconnect. We disconnect from our body and we are just inside of our heads trying to solve the problem and our vision narrows.

So our vision narrows, our critical thinking narrows, our creativity disappears completely. And that’s why sometimes instead of solving the problem, we can even make the situation worse because what we are doing, it’s not solving the problem and we are not paying attention to the details. We’re not paying attention to the big picture also. So the first step-

[Jaz] Is that because of the state of panic?

[Manuela] Yes. It’s because we take our brain, take us as a threat. So we have to, we are being threatened and we have to react to find solutions. So the first step here, it’s not action, but awareness.

We go back to awareness. So awareness of what’s going on. And we actually need to pause for a few seconds or a few seconds to one minute. You don’t need much more time than that. We need to recognize the situation. We need to recognize our body tension. We need to look up. We need to take four or five big inhales and long exhales, and we need to ground ourselves again in our body again.

[Jaz] How can you explain that to a patient? Because I want to make it really tangible. I can imagine myself and I’m really trying to imagine myself in a situation and the advice seems sound. You’re right. Our creativity is gone. You can’t think on the spot. You’ll panic. You’re not thinking right. But then if I suddenly say, okay, let me pause.

Deep breaths is, I don’t want the patient to think that, oh my gosh, the dentist is now having a breakdown or something. So, so how can we, is it just okay to say to the patient, what I like to practice mindfulness. I’m just going to regroup myself. Would that be appropriate thing to do?

[Manuela] If you, it depends with the person that you have seated and in in front of you. Of course, if you feel comfortable, you can say that, but this is not something that you’re going to be even needed to explain what I mean is you just need from a few seconds to one minute. So, if you don’t want to explain it, you don’t have to explain it, okay?

You just need this pause to look up, do an intentional relaxation of some key points. Put your shoulders down, relaxing your belly, your face, your jaw. So bring this intentional releasing and do two or three deep breaths and continue working from this place of groundness, from this place of opening, because this immediate, this gentle awareness that you bring to your body, it immediately releases your critical thinking, your creativity, your flow.

Okay. So if you don’t want to explain, you don’t have to, if you think, okay, this is going to be weird, especially when you are not used to do it, when you’re not used to do it, but when you start being used to do it, you see that you don’t have to explain and the patient doesn’t find it weird because you’re not actually doing not anything weird.

But in the beginning, if you feel that need, then yeah, you can say, okay, I just need a few seconds to, cause I’m tired. I mean, this is a long appointments. This are appointments with stress, with fatigue, like I just said. So it’s normal if you need to just a few seconds to just look up. Okay. Let’s get back to it. It’s simple as that.

[Jaz] So, that I can make that makes sense to regrain your creativity. Would you say that’s the thing that we sometimes skip because when we’re panicking with a situation, we’re just digging, digging, digging to actually pause to do almost like a power pose or relaxation and get your sort of a regroup.

[Manuela] Yeah.

[Jaz] That’s what you’re saying?

[Manuela] Yeah. Because this allows you to return to that presence that I was talking about. So, and this allows you to continue working from that place of presence instead from a place of mindless reaction. Okay. So and when this natural releasing happens, this opens this open, not only your body, but also your mind, your critical thinking, your creativity, your ability to collaborate and to problem solving.

Okay. So learning to release your tensions through this intentional relaxation is an important skill that can be learned. It can be developed and it brings your full intelligence and creativity back in the game.

[Jaz] I definitely think that would be more useful to be able to plan because in that situation, you need to have a plan.

Okay, now I’m going to do this, this and this and communicate that to your nurse and be like, okay, we’re now going to try this. If that doesn’t work, we’ll have the plan B and then we have plan C and then hopefully you execute your suture in that specific type of scenario. So definitely to be able to think clearly and to show the patient that you can communicate clearly as well, not just gibberish when you’re panicking, you’re flustered, you’re sweating. So totally, that’s good. Before we move to the next scenario, did you have any more gems with that?

[Manuela] Just to make the technique practical, that it’s actually, you have to be able to recognize that you need to pause. You have to be able to pause because this is sometimes the part that I find it’s most difficult for dentists to do because they’re trying to solve the problem and they think that the pause is not going, just going to lead them to wasting time. And it’s actually the other way around.

So you recognize, you become aware of the situation, you pause, you bring this. It’s conscious relaxation into your body. You ground yourself again. You take a deep breath and you continue working from this place of groundness. So this is the actual technique. And just to take things a little bit further because dentistry is a profession that creates many triggers.

Just so what happens after that extraction that didn’t go according to plan, right? So you had the scenario that you just talked about. And of course, after that you are late, right? You are running late because it didn’t go according to plan. And maybe after you have an anxious patient and maybe after you have your assistant entering your room saying, oh, the lab would just call saying that important work that you have for tomorrow, they are not going to be able to deliver it in time. So we have to cancel the patient. So we-

[Jaz] This is everyday, this is everyday stuff. This is real world stuff.

[Manuela] That’s it. So we spend our day in fight flight mode. It’s like tense, right? And it’s one trigger after another trigger, right? So and there’s this quote from David Allen. Your ability to generate power is directly proportional to your ability to relax.

So we have to be able to be aware of all this triggers of all this stresses. Otherwise we spend our life or day just reacting to whatever is happening. And sometimes in automatic pilot and I’m sure you already worked or you know someone that’s clearly carries a lot of tension in the shoulders and the face and we notice how this tension is holding this person from expressing all his creativity, from enjoying his work.

So when we spend our days with this overstimulation, there will be this constant flow of cortisol in our bloodstream. There will be a constant muscle tension.

And of course, if this becomes chronic, then you have the physical problems. It starts to have the physical stress symptoms. So high blood pressure, insomnias, heart diseases or gastric problems, and sometimes even emotional burnout. We all have different ways, of course, of coping with stress.

And to being able to recognize the stress triggers and how to manage all of this and how to bring this relaxation can balance the stress physiology. So what I wanted to distinguish here is the first part is how to deal in the face of stress in a situation like we just said.

So to be able to pause, to be able to recognize and to be able to bring the presence again and to work from a place of groundness. And then you have the second level of coping with stress because dentistry is a highly stressful profession. So you have to be able also to balance it. With investing on your mental health, investing on your mental well being with things that better prepare you for the highly stressful days.

So if you develop hobbies that bring you joy, if you learn to play an instrument, if you learn breathing exercises or start a meditation practice or whatever, or exercise practice, whatever works for you, but to be able to compensate. Otherwise, if you develop maladaptive coping behaviors, for example, addictions or compensations or emotion can develop, can lead to emotional burnout.

What you’re actually doing is that you are even adding more stress to your already stressful day due to your job. So this is very, very, very important to be able to bring relaxation not only in the face of stress but also then to your life to be able to compensate, bring balance to that part. So there’s two different levels that are important.

[Jaz] So we talked about in the moment, to practice those awareness and relaxation techniques, whether your crown’s missing from the lab, whether your, the root has fractured, whether the tuberosity has come away or whatever’s happened, but to manage that, but then also outside your life.

And that reminds me very much of my old principal used to tell me that we spend so much money on equipment. We spend so much money on softwares for the practice, but we actually need to invest in ourselves. So like you said, whether being mental health, physical health, and that’s because we are like equipment ourselves in a way that we need to keep us keep ourselves well oiled.

So, and I also read once that for every clinical course you do to a non clinical course, that could be communication or something that you offer, for example, mindfulness, which I think is great that you’re doing that, but you mentioned a key point about the toll it takes on your body. And that leads nicely about if the situation becomes chronic, right?

Because the second scenario is litigation. So this is very much not in the dental chair, but this is something that you take home to your husband, to your wife, to your family to bed. You take it to bed with you and you lose sleep over it. Yeah. What can you share with? Unfortunately. Hundreds and thousands of dentists who may be experiencing sleepless nights at any one point because of a burden that they carry probably related to litigation or a complaint or unmet expectations or just negative emotions, staff issues at work, whatever it could be. What do we do then when it becomes chronic?

[Manuela] First, it’s important to understand the difference between what we just talked about, which is something that our brain perceives as a threat. So like a fear, so like an immediate danger. So when we are in our daily situations and to worrying, so worrying it usually means anxiety.

So it usually it’s the state that arise when we are anticipating a threat, right? So the perception that things might go wrong. So the first scenario that we just talked about relates to the immediate danger and the second scenario worry relate with anxiety and comes from a possibility of a future threat.

So they are not the same but they have the same physiological response. And this response can cause emotional and physical damage, just like you said, it can cause the physical parts like insonious, like not being able to sleep at night. And of course the emotional part, it can lead to emotional burnout.

And sometimes this anxiety becomes chronic, so it’s a chronic problem. And there’s actually studies that show that anxiety, sometimes anxiety patients can even become addicted to their anxiety thoughts, even without realizing. So it’s like the mind body looping system. So you are worrying about something that’s happening or something that might happening that it’s not good in the future.

And of course that brings anxiety and not just thoughts about what can go wrong, but anxiety on your body as well. And the more this happens, I mean, the physical feelings can generate more anxiety thoughts. And our brain again, takes this as a danger and it reacts in a physical way.

So the key point in what the practical thing is here, can we relief or how can we stop this anxiety? And it comes down to developing also three skills that you might think as a three steps process. So first to become mindful of the thoughts of the anxious thoughts. The second one to be able to drop into our body and become mindful of the physical sensations of our experience.

Because usually anxiety thoughts have a physical reflection or this not in your stomach or it is constriction in your throat, whatever it is.

[Jaz] Sweating or-

[Manuela] It has a physical expression. Always. And the third step is to actually to offer yourself some words of comfort or of care and that has the ability to calm down your inner critic. So but we can take this with a little bit further with your example and in the practical way. Okay. So imagine that in this case of litigation so usually of course, our mind starts racing with worries, fear, and the possibility of all the scenarios that can happen. So the familiar not in the stomach starts to appear or either that is all the constriction in the throat or are there is the sweating palms.

But you have the physical part now, where do you go from here? So you have two options. The first one is to go on the habitual road of your mind running free, not aware that that will lead you to even more spiral downward of thoughts and of physical sensations. And of course. Your brain takes your physical sensations as threat, so it reacts on that and it’s like a circle. And the other approach is to actually apply mindfulness and which allows you to interrupt this sequence much sooner before it gets a hold on you.

And you can break the cycle, okay? So, how do you do this? Again, with awareness. Okay, so you develop awareness of thoughts. Actually, when your mind is running free to that path, you become aware this is a skill and it can be developed, but you become aware that you are having all this awareness.

Thoughts that are making you anxious and that’s your it’s reflecting on on your body. Okay, so when the body holds to stressful thoughts it tension immediately increases due to cortisol and hormones like we already talked about and that’s why we cannot sleep at night. And that’s why we are in this circle that we cannot, so if we become aware that we have these thoughts, we can interrupt them.

And by doing that we can, after becoming aware and after interrupting them, we can offer ourselves the word of, okay, everything is okay. You don’t have to deal with this. Now you can calm and this is not something that you need to be worrying about now. And this has also, it can be developed with the second technique, which is, you have the situation, you have the practical situation, right? So you are worrying about a patient that might sue you. So my question is-

[Jaz] That might sue you or an ongoing complaint. Yeah, absolutely.

[Manuela] So, but that ongoing complaint or that might, that a litigation problem has a cause. So what is the actual cause? Imagine that is like I don’t know an endo treatment that failed and that you need to extract the tooth and the patient doesn’t accept or doesn’t understand that.

Okay. So that is the primary event, and that is the primary situation, okay? And then you have a secondary situation, which is your mind racing with thoughts. Okay, he’s going to sue me. Do I need a lawyer? Should I get a lawyer? Am I going to have money to pay for the lawyer? How am I going to do this?

I know I should not have done this. So do you understand? So, and actually yeah, and actually a practical exercise is to distinguish from the primary situation. So what actually is going on from the secondary situation that is your mind bringing all the extra suffering to the situation.

Okay. So, and my advice is to focus on the primary situation to see the situation as it is, and not as you wish it to be. Okay. So it’s like this Mark Twain phrase, I’ve had a lot of worries in my life. Most of which never happened.

[Jaz] It’s the same way as saying worrying achieves nothing but steals the happiness of today. I don’t know who said that as well, but that’s one of my quotes as well.

[Manuela] Yeah, but attention, I mean anxiety and worries actually serves us because it has a purpose, right? It’s intelligence and it’s what differentiates us from other animals, for example, right? The ability to what we are doing when we are worrying is bringing this ability to anticipate now what’s ahead.

So the problem is that when we get hooked on worrying thoughts, right? And they take over us. So when we let this thoughts get a strong hold on us, then that’s the problem, right? But so by reducing our anxiety by reducing our anxiety thoughts, this does not prevent us, of course, from using our intelligence and from anticipating and looking to the future in order to be able to anticipate things to better deal with things.

But the fact that you are being mindful to what is happening in your heads, the fact that you are being mindful of this worry thoughts will help you to distinguish which of these thoughts are actually useful for you and which ones are just bringing noise to your mind and that are totally unnecessary.

Okay. So this will also ease your self doubt. And the last part is to bring this word of comfort to yourself. And this is just recognizing also the good. I mean it’s not about positive thinking. That’s not what I’m talking about. Of course, recognizing what’s happening and if what’s happening is not good.

It’s we have to be able to do it, to find solutions of course, and to be able also to learn from failure because when we fail, we have to learn something from it.

[Jaz] But this is what we grow as clinicians. I find the more I fail, the more I learn, the less failures I have. And so failures inevitable in clinical dentistry. So you’re totally right there. And it’s just how you take it on the chin and grow from it. Really?

[Manuela] Yeah. And if we also bring this this intention of recognizing the positive, because we all have a positive and negative things on our everyday dentistry practice. And we, as humans have negativity bias. So if something goes wrong in that day, that’s what you will remember in the end of the day, and that’s what you keep on overthinking. So to be able to bring this recognition also to the positive is it helps to balance the inner critic. So if you start overthinking and start worrying about specific things and to be able to bring balance and to say, yeah, but then I had many patients today that actually are satisfied.

All the materials worked well today. Everything ran smooth. I didn’t run late. So to be able to also acknowledge the positive brings balance to our inner critic and calms our inner critic.

[Jaz] That’s that’s brilliant. And my favorite takeaway, I mean, it was all lovely things to say. My favorite takeaway of what you said was separating the event from your feelings and thoughts.

I found that very powerful. So I’m now imagining myself to last time I had a phase of sleepless nights and worrying and whatnot, which often is, ends up being for no reason, usually and I’m thinking, hey, it was you know, let’s make it up. Let’s say it was a perforation incident and then me thinking, oh, my goodness.

The patient must hate me. What’s going to happen next? We’ll have to prepare for the GDC getting sued and stuff. Whereas actually if I saw it as an event and then focus on the positive and negative and the learning and reflection. So that would have definitely have helped me. So if anyone out there is.

Unfortunately, going through this tough phase, you have to separate the actual event that I like the beautiful way you put it, the primary event to your thoughts on. So that’s a real gem from I found actually. And actually, it’s not funny, but it’s in a way like every time a nurse or receptionist has me paperwork.

The rule is that they have to say, don’t worry. You’re not being sued. Then they have to hand me the paperwork. So it’s a little thing that we have actually, and I’m comfortable with that. So it’s one of those things. Right. Well, the last question, I think you covered it a little bit already is I hate running late.

Like for me, I had a great day at work today. I had an awesome day because everything was on time and that’s me in a happy place. And no matter what you do, we will always run late in clinical dentistry is inevitable. So what advice can you give for situations like this where you’re we were running late, not in terms of, hey, you know, you should do an audit and figure out why you’re running late.

Cause that’s of course, that’s a given. How can we manage our, the way we talk to ourselves, the way that our emotions are running and those of our team in the day-to-day struggles of running late.

[Manuela] I’m going to actually tell you, start by telling you a story of a colleague that attended my stress reduction course not so long ago. So he had already contacted me last year in beginning of 2019. But due to time he could not find the time to do the course. So now due to the pandemic context and he found the time and he did the course, but it was interesting because he did the course after the lockdown.

So he was already going back to work and, during the middle of the course, he just said to me, look Manuela, the big part of stress in my daily practice is gone. It’s gone because due to the COVID protocol, I now have longer appointments and less patience.

[Jaz] This is me. This, I totally feel less stress now because every, all these fallow times I catch up with my notes and I have a coffee. This is me. You’ve just described me and I didn’t even think about it that way. You’re right.

[Manuela] That’s exactly what he said. He said, I don’t run around anymore. Like a fool trying to do everything. I don’t multitask anymore. So a big, big, 90 percent of my stress is gone. And so I asked him okay, so if everything goes back to normal, if the before protocol is installed again, and he didn’t even let me finish, he said, no, no way you don’t get me there anymore.

So and and then I asked, but okay, so before who? What was the problem? It said, yeah, but I really didn’t thought that I could do less patients. I really thought I need to have this number of patients. And now that I do it, I see that things run smoothly and the income is doesn’t make the difference for the quality that I have in my day of work.

So, of course, the first advice, and we’re not going through that, but the first advice is actually to, you have to be able to look really objectively in the way that you are running your agenda. And you have to, of course, weigh in the everything, because if you, of course, if you have appointments every half an hour.

You are going to be late. You are not going to have time to talk to your patient or to listen to your patient the proper way. So, and you are going to have chronical stress due to being late. Okay. And that can be handled. But of course, even if you are managing your agenda and in the right way, and you have the perfect flow of patients, situations might happen and you see yourself running late.

So what to do? You have to be able to first accept the situation. You use the word that I hate. I hate it. When you hate you usually what you do is that I don’t want this. This is happening. And you start reacting and working from this place of, okay, I have to solve this, or maybe you start working faster again.

If you do that, you miss the details, not only of your own cues of your body, but also from the patient. Also from the attention that you might be paying that attention to your work to the detail. You’re not going to have it. So the first is okay. Okay. I’m late. This is what it is. So again, see the situation as it is and not as you wish it to be.

That’s an important, an important one. From that moment and if we go back again, and if you ground yourself again, again, pausing, bringing the awareness to the situation, trying to relax your body and continue working from this place again of groundness and continue to do your work completely focus in what you’re doing in order to deliver your best to what you are doing, okay?

Once you finish that patient, then you deal with the next situation. So, dentists are not good in multitasking. That’s not a good thing. So, perform one activity. From the beginning through the middle and to the end before you beginning another. Okay. And truly engage with how you are spending your energy.

So this is the most important thing. Okay. Because if you are late and if you are working from that reactive place and your mind is already thinking, okay, I’m going to be late. I have already the other one waiting today. I had to be home at seven and I still have to go to the supermarket and I’m not, that’s not going to, you are not going to be able to deliver your best.

[Jaz] Yeah, absolutely, absolutely. You’re right, I wish I wasn’t, I wouldn’t be in that situation. But you are. So you have to do everything to the best of your ability and accept it. Absolutely.

[Manuela] You have to be able to bring the distinguish. It’s a very clear perspective of what you can change and what you cannot change. What can you change? If your latest chronic, maybe you should take a look at your agenda and the way that you are managing it. Okay. If it’s acute, I mean, if your agenda, everything is okay, but sometimes you get late. Then you have to accept that you cannot change it. Right. And you have to be able if you want to deliver your best to your patient, you have to be able to ground yourself to work from that place of presence and to deal with and to respond to the situation.

So to bring an accurate response, a response that serves you better, that serves your patient better that serves your work better instead of working from this place of reactivity that can actually lead you to make more mistakes.

[Jaz] I think that’s great. And the story that you said about that gentleman who has his quality of work has improved since the COVID is exactly, you described me and I know loads of associates who usually will be there one hour after their clinical day has ended.

Doing what? Guess what? Doing their notes. Making sure the notes are correct and litigation proof and whatnot. But now that we’re able to just have a bit more time to get the notes right, leaving on time, it’s been great. And I liked the point you raised about actually just being in the moment with your patient, because we owe it to that patient.

Even though we’re running late, we owe it to that patient to give them our best. And I guess one thing I’ve always managed the way of running late is. Some people speed up, which I think is dangerous, and you lose being in the moment. I actually then purposely slow down so that patient doesn’t sense that, hey, I’m rushing anything.

And you know what? It actually works well for me. And I always say to patients that, look, one day it might be for you. I’ll run late and I’ll always do my best. And patients can be understanding when you frame it like that, when you actually invite them in calmly. Even though you’re running late, then it’s infectious.

They then also become calm. So I love all those points. Please, can you tell us if anyone wants to, cause those are the three scenarios we covered really well, but if anyone wants to learn more, how can we find out more about your the courses that you offer, your Instagram page your blogs, that sort of stuff.

Cause I’m sure there are lots of colleagues. Who need more than just this 45 minute episode. They want to delve deeper cause they really see the benefit this can have to their quality of life and work.

[Manuela] So you can find me at Instagram @mindful.Dentistry and you can find my mindfulness based stress reduction courses at my website, which is mindfuldentistrytraining.Com. And what I basically do is it’s eight weeks mindfulness based stress reduction courses. Only with dentists either in group or one to one. But we cover all this aspects of bringing awareness to actually your triggers, the way that you are reacting. How you can bring a more accurate response.

And so it’s a eight weeks process, but you need that time to be able to, first, again, to be able to bring the awareness to what you are doing, right? Because sometimes you’re not even aware because I sometimes talk to colleagues that complain about stress. But when I ask, okay, but what is your actually stress?

What’s causing your stress? What are your triggers? How do you react to them? And they have no idea. So there’s this lack of awareness the same way as when I ask. At it’s in the second session of the course, for example, I asked tell me one good thing that happened in the clinic the last week. You know I think that brought you joy, I think, that make you smile.

And I have colleagues like, oh, oh yeah. I mean, if you ask me the negative, I can say, but the positive. So there’s lack of awareness of what you actually is going on in your daily work. So during those eight weeks, we go through all that and believe me, it’s a big change of perspective and it works.

So my offer is this mindfulness based stress reduction, dentistry due to my background. And you can find it at mindfuldentistrytraining.Com.

[Jaz] Amazing. And I hope some people are able to reach out to you to gain some advice if they need and again, we’re very active on Instagram.

So that’s great. Thank you for giving your time because one of the listeners Anisha, if you’re listening, I know you are, buddy, you wanted something about stress reduction at work as well. So it’s great that you’re able to offer that because my podcast is very clinical, but I wanted to bring someone onto it.

Actually, clinical dentistry is stressful. And I think the three scenarios you tackled today are golden, are really things that dentists can really benefit from. So I really appreciate you giving up your time to share those managing techniques with us. But one thing I’m going to leave everyone with as well is it’s one thing to listen to an episode like this and have some information. And it’s a totally other thing to apply it because what’s going to happen the next time you’re in a stressful situation is you might just forget this conversation. This what you heard, you actually have to be aware of it and actually implement it.

So you know, for those listening, please do implement this, actually make it part of your regime. And I think that way you will gain so much more. What do you think about that?

[Manuela] Yeah, absolutely true. And you actually I mean, you can start applying this. You don’t have to engage in a mindfulness course.

You just have to give yourself the chance to pause. Whenever you feel that you’re about to react and whenever you feel they’re about to getting into this autopilot modes, just reacting. So just take a deep breath and take a step back and give yourself the opportunity to respond. So that’s what you can start applying.

[Jaz] Amazing. Manuela, thank you so much for coming on the podcast.

[Manuela] Thank you. Thank you, Jaz. Thank you for the opportunity. It was lovely to talk to you.

Jaz’s Outro:
Thank you so much for listening all the way to the end. I told you she’d make it really powerful and impactful. And listen, if you gain from that, follow Manuelaismindful. dentistry on Instagram. And please do, if you’re listening on Apple, leave a review. I love reading the reviews and they mean so much to me. So if you found value from this, hit that subscribe button to get all the updates for future episodes and do leave a review where you can.

And reach out to me on Instagram on the Protrusive Dental Instagram page and tell me what kind of content you want next. I’m always happy to serve. I also promised you a discount code. So Manela is running a program, Mindful Dentistry. I’m just going to find the details for you. So her website is mindful dentistry training.com and she’s offering any of the Protruserati already a 25% discount with the code Protrusive.

And it’s basically mindful dentistry training course. So if you resonated with what Manuela had to say today, if you found a lot of value from it, and hopefully you feel uplifted after today. But if you just need a little bit more support, if you’re in a bit of a tough situation, and you think Manuela is the person to guide you through it, then check her course out.

And like I said, this is not an affiliate program or anything. I just love that she’s going to be able to help so many dentists. So check out Manuela’s content. I’ll put it on the Protrusive website, protrusive.co.uk/stress. And on that page, you’ll be able to find Manuela’s link and the reminder of the discount deal.

So I’ll catch you in the next episode, guys. Thank you so much again for listening all the way to the end.