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Liability

Vol. 1 2021

IN THIS ISSUE The causes and implications of today’s evolving wellness issues 2 The impact of well-being on your practice 3 Where do you start? 6 Well-being resources 6 Reaching out for professional support 9

Health + Resilience: Supporting total well-being in challenging times


Has anyone felt “happy, healthy and comfortable” this past year? If you’re like most dental professionals, the answer is probably not a resounding, confident yes. The pressures of practicing dentistry have increased exponentially during the pandemic. For many, there are also significant stressors outside the office — family health, personal finances, disruption in education and social isolation. The dictionary definition of well-being can make the concept seem like a luxury. However, it’s an essential measurement of how dentists feel and function. And a healthy state of mind supports smart decision-making, especially in times of crisis. Your body has developed a fightor-flight response that delivers an extra dose of cortisol to help you hyperfocus during a crisis. But in times of sustained challenge and uncertainty, this primitive response is less helpful — keeping your brain manifesting on perceived danger. This means you may need to make a concerted effort to quiet your brain. The guidance that follows in this issue is intended to increase awareness on well-being issues for dentists, the impact of these issues on the practice, associated potential risks and, most importantly, actionable steps to total health and resources to support wellness.

The causes and implications of today’s evolving wellness issues Well-being is an expansive concept — not a measure of momentby-moment happiness. Physical, psychological and emotional health 2

all factor into total wellness. And COVID-19 has added or escalated several factors of well-being: Finances. Practice interruption, instability in scheduling or staffing and investment in new infection protocols are all weighing on dentists, in addition to any financial issues at home. It physically hurts to be economically insecure. Financial stress contributes to migraine, cardiovascular disease, absences from work, insomnia and more. Fitness. Wearing more personal protective equipment for longer durations can lead to physical and emotional exhaustion. Health care providers are experiencing dehydration, difficulty breathing, profuse sweating and skin irritation due to new PPE protocols. At the same time, the combination of social distancing and fatigue are keeping many people from participating in sports, workouts or fitness activities that they’d once enjoyed.

Physical, psychological and emotional health all factor into total wellness. COVID-19 has added or escalated several factors of well-being. Isolation. Because we live in such a technologically connected world, many social relationships were already distanced before the pandemic. The

“loneliness epidemic” is a profound public health issue – and dentists aren’t immune, even those who interact with patients and dental teams constantly during the day. Biologists have shown that feelings of loneliness trigger the release of stress hormones associated with higher blood pressure, decreased resistance to infection and increased risk of cardiovascular disease and cancer. The reduction in life span for loneliness is similar to that caused by smoking 15 cigarettes a day, and it’s greater than the impact on life span of obesity, according to Vivek Murthy, former surgeon general. Diet. While some households have taken the COVID-19 restrictions as an opportunity to pursue more healthy, home-cooked meals, the work-life disruptions have disturbed eating habits for others. Foods and beverages consumed for comfort — sugar, caffeine and alcohol — can instead ramp up anxiety. Change in schedule, or lack of a set schedule, can affect drinking norms: more alcohol consumption that begins earlier in the day or caffeine consumption later at night. “Stress snacks” can also quickly add up, especially without as many physical fitness outlets to offset them. Hydration. It may seem like common sense, especially for those in the oral health field, but staying hydrated is often overlooked in hectic times. You constantly lose water through the day, especially when wearing layers of PPE, and replenishing fluid is essential to stabilizing mood, weight and overall health. Dehydration makes your body work harder to regulate temperature and flush toxins. It also can contribute to poor cognition, impaired short-term memory, low sleep quality, irritation and anxiety.


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Sleep. Insomnia and restless nights were common health concerns before the pandemic. Now, coronasomnia is keeping people awake with worry and fear. Broken routines during the day affect circadian sleep-wake patterns. And various disrupted aspects of wellness — anxiety, depression, poor diet, dehydration — fuel a vicious cycle. The less sleep you get, the less objectivity and optimism you have to deal with frustrations; the more perceived problems, the less you can sleep.

The impact of well-being on your practice Wellness often takes a backseat to the more tangible and urgent-feeling aspects of life and work. The focus tends to be on how to pay this bill or talk to this upset patient right now; then, navigate the feelings about it later, if ever. The truth is that dentists are highly vulnerable to workplace burnout. Without coping and resilience strategies in place, physical and psychological stress takes a toll on work performance, relationships and even the quality of patient care. These stressors put you and your practice at risk for potential liabilities.

Communication gaps between dentists and the team, or the team and patients, make the practice vulnerable to errors and liabilities. Stress and fatigue also mean it takes much more effort to be patient and cheerful. Being adaptable to small social cues can smoothen interactions and mitigate conflict. Poor communication affects patients’ perception of being treated at a well-run, trusted practice. Information Overload The firehose of news and changing regulations during the pandemic can be overwhelming. There’s just so much information on financial relief, vaccines, infection control and more, all changing on the daily. It can be difficult not to “doomscroll” on social media or be confused by conflicting guidance. This overload can obscure the trusted information dentists really need, and even make them paralyzed to make a decision. Mental health necessitates boundaries on news and social feed consumption. And

dentists need a methodical approach to responding to evolving updates, instead of feeling rushed and reactionary. Focus and Attentiveness That fight-or-flight reflex? It kicks in when we’re stressed, hijacking the amygdala and readying the nervous system in ways that are not helpful to the dental office — nor most offices today. Pulse and heart rates increase and the mind races. This illusion of urgency, hyperfocusing on fight readiness, is actually a distraction from the important issues. Attentiveness and engagement in patient care is compromised. And, in absence of the focus needed to listen and plan, dangerous shortcuts are often made in an effort to catch up. Conflict Resolution Irritation, annoyance and exhaustion fan the flames of conflict. Whether the disagreement is about a treatment plan or a PPE protocol, the stakes feel higher when you are stressed. Your patients and staff have personal stresses too,

Interpersonal Communication When you’re not at your best — whether from distraction, stress or lack of sleep — it’s a struggle to communicate clearly and empathetically with patients and staff. Sleep loss, for example, impairs your understanding of emotional information. In other words, you can miss context, making it more difficult to analyze a problem or make a decision. 3


Dentist-Centered Support ADA COVID-19 Mental Health Resources success.ada.org/wellness On-demand webinars, help hotlines and resources for staying well. TDIC Risk Management Advice Line tdicinsurance.com/ advice-line One-on-one guidance from experienced risk management analysts. Well-Being Programs by State dentistwellbeing.com A directory of resources and referral sources for dental association members and their families.

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and all sides may be entering a crucial conversation with emotional baggage unrelated to the conflict. When time is at a premium, it can be hard to take a breath and find calm, or even to moderate tempers. It can also be tempting to avoid conflict altogether, postponing tough talks or sweeping them under the rug. Procrastination only makes eventual confrontations more difficult, desperate and risk-prone. Courage, calm and clarity are needed for purpose-driven decision-making. Workplace Safety Distraction and disorganization are bound to lead to more mishaps. A large research study published in Occupational & Environmental Medicine illustrated how stress can be predictive of workplace accidents. Researchers found that employees who experienced stress at work were more likely to have a workplace injury, and certain sources of stress influenced the overall cost of workers’ compensation claims. Stressors in dentistry today range from fear of COVID-19 to understaffing or expanded responsibilities to a lack

of clear feedback. In addition, new protocols can lead to new challenges in ergonomics and risk exposures. While these issues can’t all be avoided, they can be mitigated to reduce the potential for injuries and errors. Organization & Record-Keeping Finding it hard to plan past today? New paperwork, shifting schedules and evolving protocols can feel like more information overload. Organization is another self-perpetuating aspect of wellness. Having a system in place reduces the stress related to last-minute scrambling. Extra attentiveness to record-keeping, both as a clinician and an employer, is also the first line of defense when it comes to potential liabilities. Employment Practices & Productivity For close-knit dental teams, stress in the practice can feel like family dysfunction. Absenteeism rates are rising, with one-third of employees taking sick days due to stress.

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PROFESSIONAL LIABILIT Y

Dentistry isn’t like anything else. Better protection, built just for dentists. The Dentists Insurance Company was founded by dentists, to protect only dentists, and is led by your peers. In fact, TDIC’s Professional Liability coverage follows the scope of practice, which means you’re protected for the administration of the COVID-19 vaccine.* See more ways you benefit.from exceptional protection at every stage of practice: • One-on-one guidance by Risk Management analysts • In-house claims team and razor-sharp legal team • Higher limits for specialties with higher exposures Plus, get premium discounts for bundling your policies or completing our current risk management seminar. Talk to an agent or apply today at tdicinsurance.com/PL.

Protecting dentists. It’s all we do.

®

800.733.0633 | tdicinsurance.com | CA Insurance Lic. #0652783 @TDICinsurance

*Coverage is subject to compliance with all requirements of a vaccine emergency waiver; vaccine manufacturers requirements and policy provisions.

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Well-being resources Helpful Wellness Apps For easing anxiety: • Shine: The daily self-care app • Headspace: Meditation made simple For better sleep: • Calm: Sleep stories and relaxing music • 10% Happier: Sleep meditations For creating routines: • Todoist: Task manager for work and life • Fabulous: Motivation and habit tracker

A persisting stigma around mental health impedes many employees from talking openly about their challenges. Rising pressures, especially in an environment that doesn’t feel psychologically safe, strain employee loyalty and team morale. And the resulting short-staffing and turnover continues the cycle of stress for the team.

Where Do You Start? Well-being is a complex issue. It’s flippant — and dangerous — to reduce the solution to “fake it until you make it” or “just buck up.” While wellness is a holistic concept, it doesn’t have to be an abstract, aspirational one. Resources and guidance are available to support you and your team. 6

Guidance for Dentists Put on your own oxygen mask first! Being mindful of your own well-being allows you to be stronger for your family, peers and team. Self-care is another term that’s sometimes reduced to a bubble bath or pedicure. However, it’s the practice of taking an active role to preserve, protect or improve one’s own health, especially during periods of stress.

While wellness is a holistic concept, it doesn’t have to be an abstract, aspirational one. Resources and guidance are available to support you and your team. Self-care ensures that you are giving yourself the necessary time and space to be mindful, connected, rested and build supportive routines.

like racing heartbeat, jitteriness or loss of appetite. Sometimes, just the act of acknowledgment forces you to slow down and feel less overwhelmed. Don’t feel pressured to solve stress or decode its origins. Rather, use tools to help you navigate stress in a better, more sustainable way. Have just five or 10 minutes? That’s enough time to: n Practice guided meditation with the help of apps and online tools.

n Try breathing exercises throughout the day to relax and find focus.

n Keep a journal to record what went well or what you learned each day.

n Rose-rose-thorn-bud: List two

successes, one frustration and one hope.

Connectedness. Reach out to your dental community. Remember that you are not going through the pandemic or future challenges alone. Try not to conflate physical distancing with social distancing. We’ve changed the way we get together, but there are easy ways to connect. If you live alone, consider creating daily or weekly check-in routines with peers. If you live with others, make time to do things you all enjoy (and still preserve time to rest and recharge on your own). n Set virtual coffee breaks to chat

live with peers via videoconferencing.

n Get social in your dental association’s

Mindfulness. Start by taking inventory. How can you improve your mood if you’re unsure what it is? Try to find the right word for the emotions you’re experiencing. Like the axiom, “Happy families are all alike; every unhappy family is unhappy in its own way,” unhappiness that stems from anger is different than malaise, uncertainty, restlessness or fear. Take a few minutes to identify the physical signs of stress,

Facebook group or online events.

n Take a class, whether to earn C.E. or learn a hobby, in a virtual space.

n Be an advocate and get involved in

grassroots efforts on behalf of dentistry.

Restfulness. Take sleep seriously. It’s your body’s time to process the day’s information, restore itself and ready you for the day to come. Sufficient sleep, hydration and sunscreen are three factors of lifelong wellness that you can control — and


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deliver invaluable results. If acute stress is contributing to restlessness, try these techniques: n Turn off the tech to give yourself a

needed break from blue light at night.

n Adhere to a strict schedule,

going to bed at the same time, even on weekends.

n Get active during the day for 20 to 30 minutes to wind down more easily later.

n Find a soundtrack that allows you to close your eyes, calm down, listen and drift.

Remember: You are not going through the pandemic or future challenges alone. Try not to conflate physical distancing with social distancing.

Routine. In uncertain times, find comfort in knowing just what comes next. Implementing structure to your day can help you gain a sense of control. Even having a simple checklist can keep a distracted mind on track, while fostering a sense of satisfaction as items are successfully checked off. What’s the trick to sticking to your list? n Schedule outdoor time daily, even if for just 10 minutes, for a fresh perspective.

n Use app reminders for taking

supplements, staying hydrated and stretch breaks.

n Do tasks at the same time each day (dishes, email catch-up, dinner prep, etc.)

n Streamline options by clearing out clothes you don’t wear or gadgets you don’t use.

Support for the dental team

Keep covered and confident. While you can’t plan ahead for every scenario, you can take steps to choose the right type and amount of insurance. Knowing that you’re covered when facing a claim — or have quality health insurance in place when facing an illness — can help mitigate stress and let you focus on your practice and your family. Talk to your TDIC agent about your coverage needs so you can stay ahead of the unexpected.

As a practice leader, you can model your wellness efforts while continued on page 9

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NEW RISK MANAGEMENT SEMINAR

Calibrate Your Risk Radar By identifying the warning signs of a problem patient or adverse outcome, you may reduce, mitigate or eliminate potential complaints, claims or lawsuits against your dental practice. Through The Dentists Insurance Company’s new seminar, learn how to spot issues arising during treatment from actual cases and Risk Management Advice Line calls. Upon seminar completion, you’ll better understand: • • • •

Patient and case selection criteria and when to refer Warning signs of high-risk patients, situations and cases When to contact TDIC for advice on a patient or case Building and maintaining trust in doctor-patient relationships

Understand the role of good communication, documentation, patient selection and case management in lessening risk. Plus, earn 3.0 ADA CERP credits upon course completion.* See details and register at tdicinsurance.com/seminars.

* Important information about your 5% Professional Liability premium discount: TDIC policyholders who complete a seminar or eLearning option will receive a twoyear, 5% Professional Liability premium discount effective their next policy renewal. To obtain the two-year, 5% Professional Liability premium discount, Arizona, California and Nevada dentists must successfully complete the seminar by April 23, 2021. Alaska, Hawaii, Illinois, Minnesota, New Jersey, North Dakota and Pennsylvania dentists must successfully complete the seminar by October 29, 2021. Any eLearning tests received after the deadline will not be eligible for the discount. Non-policyholders who complete a seminar or eLearning option and are accepted for TDIC coverage will also be eligible for this discount.

Protecting dentists. It’s all we do.

®

800.733.0633 | tdicinsurance.com | Insurance Lic. #0652783 @TDICinsurance


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being attentive to the changing wellness needs of your staff. But team well-being isn’t just the absence of observable problems, and a healthy work environment is so much more important than a wellness app or class. It means providing your employees: n Psychological safety. Build trust with staff that they can come to you or your management team and speak openly about workplace stresses and be heard.

n Well-being checks. Meet one on

one with team members and open a dialogue about what’s going well, what’s a struggle and where they may need more support.

Mental Health Helplines

Addiction Support

National Suicide Prevention Lifeline: 800.273.8255 (TALK)

Alcoholics Anonymous: AA.org

National Alliance on Mental Illness: NAMI.org Crisis Text Line: Text HOME to 741741

n Conflict resolution. Provide staff

training and create a practice strategy for managing tense situations with patients, so you’re all working through it as a team.

Nar-Anon (family and friends of addicts): nar-anon.org Substance Abuse and Mental Health Services Administration (SAMHSA): 1-800-662HELP (4357)

n Clear communication. Ambiguity

n Accommodation. Even good days

are long days. Exercise flexibility and empathy where you can, like providing comfortable break spaces to safely take a breather.

Reaching out for professional support Sometimes stress and its resultant health issues are too much to manage on your own. The pressures of this past year have prompted higher rates of substance use and relapse as well as depression and emotional distress. For those who are suffering from drug or alcohol abuse or behavioral disorders, confidential assistance is available.

Find calm and control with a simple, quick breathing exercise. Square breathing, also known as box breathing, has four parts that you can repeat in succession as long as needed.

Breath in for the count of four... Hold breath for the count of four...

External resources and healthy coping mechanisms can support your leadership of a safe and productive practice. Practicing self-care, building resilience and creating connections can help you battle burnout during COVID-19 and beyond.

Square Breathing

Hold breath for the count of four...

fuels stress. Whenever possible, be direct about what staff can expect as far as schedules, protocols and practice standards.

Breath out for the count of four...

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Liability Lifeline is published by: The Dentists Insurance Company 1201 K Street, 17th Floor Sacramento, California 95814

©2019, The Dentists Insurance Company

Endorsed by: Alaska Dental Society California Dental Association Hawaii Dental Association Idaho State Dental Association Illinois State Dental Society Nevada Dental Association New Jersey Dental Association Oregon Dental Association Washington State Dental Association Also in: Arizona, Minnesota, Montana, North Dakota, Pennsylvania and Tennessee

TDIC reports information from sources considered reliable but cannot guarantee its accuracy.

Need one-on-one risk management guidance? • Get answers to your critical questions through a confidential phone consultation with an experienced TDIC risk management analyst. • Request a consultation at a time that’s convenient for you at tdicinsurance.com/RMconsult or by calling 800.733.0633.

Protecting dentists. It’s all we do.

®

Risk Management Advice Line | 800.733.0633 | tdicinsurance.com

@TDICinsurance