Stress in the workplace
The big new word of the new millennium is stress. This blight seems to have surrounded us on all sides attacking our lives from every angle simultaneously. But what is the nature of this invisible enemy? Where did it come from? Why is it that the workplace in particular seems so especially vulnerable to it? It seems that this powerful enemy has come on us without warning and we are so weak and vulnerable to it that the only course of action is to try to keep going in spite of it. We struggle on bemoaning our lot but believing there is nothing we can do about it. This is just how it is with modern life. But is this really true? Are we really powerless? Are we just victims of systems and attitudes which are beyond our control? Are we just helpless victims of modern life?

Trying to do the impossible
These days many practitioners are disillusioned with the job and wonder why it seems to be getting more and more difficult. Put in the simplest terms, the reason that things are going this way is because we are trying to do the impossible. It is important to recognise that I am not talking about a seemingly impossible task which requires commitment and ingenuity in order to achieve success. That is a challenge which is achievable. I am talking about the really impossible. I am talking about trying to journey in two opposite directions at the same time. This is truly trying to do the impossible.

How does this apply to the practice of medicine or dentistry?
Well, again, quite simply really. We are committed to the highest standards of care and this takes time, care and attention. But the consumer notion of ‘value for money’ requires us to make the service available as cheaply and quickly as possible. ‘Healthcare’ has sadly become another consumer product to be dispensed quickly and cheaply like a Big Mac. This means that we, as practitioners, must decide to do as much as possible in the shortest given amount of time possible.

We must take less and less time for each procedure as we attempt to ‘get through’ greater and greater numbers and whether we want to hear it or not, less time means less care and attention. This is perhaps something many do not want to hear. But hear it we must if we are serious about resolving the mounting problems that all practitioners are facing. The care of health has been reduced to the level of a consumer item to be available on demand and bought as cheaply as possible. The precious gift of health has become nothing more than a saleable commodity for which you shop around to find the cheapest possible price.

The highest standard of care for an individual will always need more time and not less.
We cannot maintain the highest standard while trying to reduce the cost and the time spent. To attempt this is to attempt to travel in two opposite directions at the same time. And it is from this very attempt that the enormous stress and tension is developed. When we choose or decide to work in this way, we are choosing a lot of serious consequences many of which may not be so obvious.

The first consequence is being in a hurry, - being busy, - being rushed. This alone has many serious effects. The first effect and the one from which all others arise is that being rushed prevents the practitioner from being present to his patient/client and to the job/outcome he has set as goal for that visit.

The consequence of not being fully present is that it increases the likelihood of error, mistake and miscommunication. I could write a full book on the ‘consequences’ of the previous couple of sentences but it does not require much intelligence or imagination to figure it out.

Consequences upon consequences, stress upon stress!
A glance through the Medical Defence Annual Report gives a nice cross-section of the various conflicts that arise between client (patient) and practitioner. Many, if not all, of these errors arise as a direct consequence of rushing (being too busy) or not having sufficient time to go into the necessary explanation. Interestingly, all of the proposed solutions by Medical Defence outfits boil down to the same requirement for taking more care and improving communication. What is not said is that these solutions mean in effect taking more time to be fully present with the client and the job in hand.

Unfortunately, the solutions are always attempted in the context of practice as it stands.
No extra time is allotted but extra requirements are inserted. Obviously this approach means that the pressure actually increases. More problems consequently occur which are then reported to Medical Defence. They analyse the difficulties and make recommendations about what needs to be done to avoid or prevent the problems arising. These recommendations are circulated to the practitioners who try to implement the additional requirements but again in the context of practice as it stands and the pressure increases again. The cycle continues and the crisis deepens and practitioners begin to get sick and burn out while the clients become more and more dissatisfied with they way in which they are being treated. Litigation spirals with spiralling client dissatisfaction while the practitioners begin to break under the strain of the increasing pressure (even more especially from the fear of litigation).

Soon the caring people who became healthcare practitioners out of a genuine desire to help people begin to wish retirement would come to rescue them before the grim reaper calls the end of game.