Yerkes-Dodson is still relevant – if you want to enjoy your clinical career

Why should a “law” described first in 1908 be relevant to everyday Dentistry (and more)?

Robert Yerkes and John Dillingham Dodson described their tests with rats that could be encouraged to complete a maze when stimulated with slight electrical shocks. When the strength of the shocks was increased however the rats just ran about looking for an escape. They concluded that arousal levels helped to focus attention and motivation on the task at hand but only up to an optimum point and after that point fatigue appeared and performance declined.

Research has found that different tasks require different levels of arousal for optimal performance. For example, difficult or intellectually demanding tasks may require a lower level of arousal (to facilitate concentration), whereas tasks demanding stamina or persistence may be performed better with higher levels of arousal (to increase motivation).

The first image shows the classic inverted ‘U’ shape of a difficult task (placing implants, molar endo, treating some children are examples that come to mind). It also shows a continuation without decline of more simple tasks which can be maintained for longer without reaching a point influenced by fatigue (examinations, routine restorations on well adjusted patients).

 

 

The second image shows the typical “stress curve” where performance takes a while to peak if we are under too little stress, then goes through a short period of optimum stress before reaching too much and heading down through exhaustion to burn out.

The reason that I have written about this is that we need to look at the time periods that these curves represent from the short (an hour say) to long (months or even years). There are different challenges that dentists face with differing solutions.

Firstly of course there is the fatigue that comes from trying to do too much challenging work in a short period of time. This results in high stress levels and possibly poor performance on a daily basis. Often there are time management issues where we are obliged to match our performance to the patients availability. This can see a clinician “coasting” by dealing with the relatively straightforward whilst at their peak in terms of readiness and responsiveness but then having to find reserves of energy when the patient “demands” treatment at later times in the day. I have never understood why dentists are reluctant to tell the patient exactly when and why they would like to see them. My own experience in a practice with large numbers of children was to insist on seeing under 11s for any treatment (examinations excepted) first thing in the morning. For the most part when people have reasons explained to them and can understand that it is for their benefit then they will comply with your wishes.

Also to consider are the long term problems of fatigue that arise from the day after day, just doing it without time off. Even in the best time managed (at a relatively micro level) practice if there is often not enough time spent away to unwind, recharge the batteries and recover, then burn out will creep up on you. The prodromal signs are a lack of efficiency and, more importantly, effectiveness.

Dentistry is still a macho occupation for many who seem to get a perverse enjoyment from overwork. It’s sad but true that for many there is an opportunity to build the life they want but put obstacles in their own way as if frightened of taking control.

Time management on both micro and macro levels is hugely important, ignore it at your peril. Get help if you need it.

Our society is being highjacked

Thanks to Cal Newport for pointing me towards this site in his latest Study Hacks blogpost, “Beyond Digital Ethics”.

He talks about the work of Tristan Harris and The Centre for Humane Technology from whose website I have taken a page.

What began as a race to monetize our attention is now eroding the pillars of our society: mental healthdemocracysocial relationships, and our children.

What we feel as addiction is part of something much bigger.

There’s an invisible problem that’s affecting all of society.

Facebook, Twitter, Instagram, and Google have produced amazing products that have benefited the world enormously. But these companies are also caught in a zero-sum race for our finite attention, which they need to make money. Constantly forced to outperform their competitors, they must use increasingly persuasive techniques to keep us glued. They point AI-driven news feeds, content, and notifications at our minds, continually learning how to hook us more deeply—from our own behavior.

Unfortunately, what’s best for capturing our attention isn’t best for our well-being:

  • Snapchat turns conversations into streaks, redefining how our children measure friendship.
  • Instagram glorifies the picture-perfect life, eroding our self worth.
  • Facebook segregates us into echo chambers, fragmenting our communities.
  • YouTube autoplays the next video within seconds, even if it eats into our sleep.

These are not neutral products.
They are part of a system designed to addict us.

Take a look here.

 

 

Should you lie in the sun?

I periodically share information gleaned from a well know dermatologist.

This time there’s also a video where, to celebrate an auspicious birthday, my little brother shows the results of his experiments in cloning.

It is well worth a watch, or two.

The Weekend Read – This is Going to Hurt by Adam Kay

Very few, if any, books have made me weep with laughter and cry with upset in the space of a couple of pages but Adam Kay’s memoir of his years as a junior hospital doctor managed it. The final chapter left me in bits for many reasons.

I ordered the book thinking it would be a 21st century continuation of Richard Gordon’s, “Doctor in the House” or Colin Douglas’s “The Houseman’s Tale”. In one sense it is; the language is not entirely medical, Adam refers to Obs & Gynae, his chosen speciality, as “brats and twats” and there is plenty of normal hospital human behaviour. Clearly the author was able to tolerate the life of a junior doctor even though, “The hours are terrible, the pay is terrible . . . But there’s no better job in the world”, until something happened.

The significant difference is that whilst the idealism, the diseases, the people and their mistakes have remained much the same, the political interference and attitude to professionals has fundamentally changed. Doctor in the House was written in the idealism of the immediate post-Bevan years (1952) and The Houseman’s Tale just pre-Thatcher (1978) when I was just starting my spell as a hospital resident. This is set in am era dominated by Jeremy Hunt’s predecessors and their ilk, (the author includes an open letter to The Secretary of State for Health) where there has been a slow strangulation of health care in spite of the best efforts of those working within it the system. These diaries were written during the years 2006-10, sadly things have not improved.

Essential reading for anyone who works in or is a recipient of healthcare in the UK – perhaps not if you and your partner are expecting your first child.

Available from The Book Depository HERE

 

 

The rising north–south divide in health in the UK

This doesn’t make great reading.

….in the past 20 years, age- and sex-adjusted excess mortality has increased by as much as 46 percentage points in people aged 35–44 years in the north of England compared with the south, and by 27 percentage points in people aged 25–34 years…

….One cause of this higher mortality is an increase in suicide in young people since the 2008 recession, mostly in the north of England. This has been linked to increases in unemployment, associated with poverty, inferior social welfare, educational attainment, and poorer health outcomes. Rates of drinking, smoking, and obesity are also comparatively higher in the north and are at least partly driven by more fast food shops on northern high streets….

The Lancet

Peter Ward exposes the NHS(E)’s “Cunning Plan”

Nice editorial in the BDJ from BDA Chief Exec Peter Ward. HERE

Edited highlights only

Death by commissioning

….That master plan looks like a determined effort to wrest away NHS dental care from small autonomous units. That model that has been supplied by a legion of conscientious practitioners ever since the beginning of the NHS. This applies both in salaried dental service and in general practice.…….

….’Savings’ is the name of the game. That coupled with ongoing ‘efficiency’ signals a race to the bottom, as each year becomes more and more squeezed than the last. It can’t be long before the social enterprises seek freedom from the obligations of NHS terms and conditions – think about the savings to be had there!…..

…..So, it is clear that the NHS in England stands to gain by ‘going large’ in all its areas of practice. But its gain is at the expense of the dentists who serve it. In essence, the wholesale dismantling of access to NHS terms and conditions provides the opportunity for savings. Proposing such a move overtly would be met with horror and outrage. Doing it stealthily and by downstream consequence may be less dramatic but the result is the same. It is not a good result for either dentists practising in England, or for patients expecting enduring, high quality care…

If only it was as easy to dismiss as Baldrick…

 

The Painful Truth About Teeth (USA)

From The Washington Post

SALISBURY, Md. — Two hours before sunrise, Dee Matello joined the line outside the Wicomico Civic Center, where hundreds of people in hoodies, heavy coats and wool blankets braced against a bitter wind. Inside, reclining dental chairs were arrayed in neat rows across the arena’s vast floor. Days later, the venue would host Disney on Ice. On this Friday morning, dentists arriving from five states were getting ready to fix the teeth of the first 1,000 people in line. Matello was No. 503. The small-business owner who supports President Trump had a cracked molar, no dental insurance and a nagging soreness that had forced her to chew on the right side of her mouth for years. “It’s always bothering me,” she said. And although her toothache wasn’t why she voted for Trump, it was a constant reminder of one reason she did: the feeling that she had been abandoned, left struggling to meet basic needs in a country full of fantastically rich people.

As the distance between rich and poor grows in the United States, few consequences are so overlooked as the humiliating divide in dental care. High-end cosmetic dentistry is soaring, and better-off Americans spend well over $1 billion each year just to make their teeth a few shades whiter. Millions of others rely on charity clinics and hospital emergency rooms to treat painful and neglected teeth. Unable to afford expensive root canals and crowns, many simply have them pulled. Nearly 1 in 5 Americans older than 65 do not have a single real tooth left. Over two days at the civic center, volunteer dentists would pull 795 teeth. A remarkable number of patients held steady jobs — a forklift operator, a librarian, a postal worker — but said they had no dental insurance and not enough cash to pay for a dentist….

….Trump’s assurance that he would build a “beautiful” health-care system to serve every American, a system that would cost less and do more. But nearly four months into Trump’s presidency, Matello sees Trump backing a Republican health care plan that appears to leave low-income people and the elderly worse off…..

….“I am hearing about a number of people who will lose their coverage under the new plan,” Matello said. “Is Trump the wolf in grandma’s clothes? My husband and I are are now saying to each other: ‘Did we really vote for him?’ ”…..“Was he just out to get our votes?”

Full article here

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