Task saturation in dentistry

Why dentists become overwhelmed and what to do about it

You can be an experienced, conscientious dentist and still find yourself making poor decisions on a difficult day.

Your knowledge hasn’t disappeared and your standards haven’t changed but the patient arrived late, the procedure is proving more difficult than expected, your assistant cannot find something you need and reception has just asked you another question. You’re treating the patient, watching the clock, directing the team and trying to work out how to recover the rest of the morning. Then something else goes wrong.

That situation has a name: task saturation.

One of my favourite YouTube channels is Mentour Pilot. Even though I fly a lot (as a passenger, not a pilot), I find its accounts of aviation accidents fascinating. What interests me is how a manageable problem can develop into a much more serious situation as the demands on the pilots accumulate. The crew becomes occupied with one problem. Something else needs attention. Workload increases, the broader picture becomes harder to understand and the response to one difficulty creates another.

Dentistry has its own version of this downward spiral. I believe one of the most useful things a dentist can learn is how to recognise this spiral early, interrupt it, and organise their practice so it happens less often.

What is task saturation?

Task saturation occurs when the demands competing for your attention exceed your ability to manage them effectively. In healthcare, excessive information, interruptions and competing tasks interfere with performance. An Agency for Healthcare Research and Quality review describes how cognitive load reduces the capacity for diagnostic thinking.

For a dentist, the competing demands may be individually quite small. Finding a missing instrument is manageable. Answering a scheduling question is manageable. Reassuring an anxious patient is manageable. Dealing with all three while performing a demanding procedure is a different proposition.

The number of patients in the appointment book tells you very little about how difficult a day will feel. An uninterrupted session of substantial dentistry is far easier to manage than a succession of short appointments filled with interruptions and last-minute changes. The question is how much you have to manage at once.

Thinking, Fast and Slow

Daniel Kahneman’s book Thinking, Fast and Slow is one of my all-time favourites. If you haven’t read it you should. It provides another way to understand the problem. Kahneman says we have two modes of thinking. System 1 thinking is fast and largely automatic. System 2 thinking involves deliberate, effortful attention. The distinction is explained in this book excerpt.

In dentistry, experience allows many actions and diagnoses to become effortless i.e. System 1. Sometimes, however, if the procedure is difficult or the diagnosis is unclear you need to use System 2. System 1 always operates. System 2 can become fatigued and hard to access if you overwork your brain. President Obama famously said (Vanity Fair, October 2012):

“I don’t want to make decisions about what I’m eating or wearing. Because I have too many other decisions to make.”

Kahneman also describes how, when System 2 is tired, we can unconsciously replace difficult questions with easier ones. For example, the question should be, “What’s the most appropriate treatment for this patient?” Under pressure, an easier question becomes more attractive: “What can I finish before the next patient?”

When System 2 gets exhausted. System 1 runs the show. You start making snap decisions.

Recognising the warning signs

Task saturation doesn’t necessarily feel like panic.

It can feel like irritation. You may resent reasonable questions. You might hear someone speak but not absorb what they’ve said. You could repeatedly look at the clock. Perhaps you have a strong urge to get the appointment finished. Maybe you become unusually quiet, give incomplete instructions or stop acknowledging what people say.

The question to ask is whether your behaviour has changed in ways that suggest you’re losing the plot. Probably your team will notice before you do. It’s worth discussing this when everyone is calm. “What do you notice when I’m getting overloaded?” is an uncomfortable question, that will produce very useful answers.

What to do if you’re overloaded

When demands accumulate, the objective is to reduce the number of things you’re trying to manage. Here are three suggestions for getting out of a state of overload.

1. Take a pause
   Attend to immediate needs, then stop to reconsider. You might say, “Let’s pause here. I want to review where we’re at before we continue.”

2. Focus on the essential
   Separate patient care from things that can wait. A fee query, supplier call or future booking question can wait. Identify the next necessary action rather than trying to solve the entire morning at once.

3. Delegate
   Within their roles and competence, team members can do a lot more than many dentists allow them to do. Delegation is a great way of reducing overload. Hand off tasks to team members.

Preventing task saturation

Knowing how to recover from overload is useful. Reducing the occasions when you become overloaded is even more valuable. The following are the structures that I would put in place.

• Establish clear rules for interruptions
  In my practice I couldn’t be interrupted during a procedure unless the building was on fire. Agree with your team that anything except an emergency can wait until the break between patients.

• Perfect your setups
  Develop checklists and clear accountability for surgery setup so that instruments, lab work and materials are never missing.

• Standardise routine treatments
  Every variation creates something else to remember. Consistent layouts, materials, burs, instruments and procedure steps reduce the number of decisions required during an appointment.

• Delegate as much as possible
  In a perfectly run dental practice the dentist diagnoses and treats patients and the staff handles everything else. The goal should be to develop and document systems so the staff never need to ask the dentist a question.

• Put a small buffer in your appointments
  Scheduling appointments as if everything will run perfectly can lead to disaster. There’s no wiggle room. Adding a small buffer to appointments gives you margin and a way to recover from procedures that don’t run smoothly.

• Practice mindfulness
  Pausing for a moment, relaxing your shoulders and taking a deep breath before going on to the next patient is helpful. It’s like putting a full stop after each procedure.

A calm practice is something you design

Task saturation deserves attention because it affects the conditions in which we deliver care.

We put effort into improving our clinical knowledge and technical skills. We should apply the same serious effort to the environment in which we use them.

For me, being a relaxed dentist means having enough control of the working day to pay attention, think clearly and respond properly. It makes for a happier and more productive practicing life.

If you would like to explore this further, my work on clinical efficiency examines how to organise dentistry so that doing it well becomes easier.

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