Do I get another go?

Have you ever regretted a decision? Have you ever leapt at a chance only to end up slipping on a banana skin? That pretty much describes my dental career. "Do I Get Another Go?" Rethinking A Dental Career After Retirement By @DentistGoneBadd

This is how much I wanted to be a dentist.

My childhood dream was to be a journalist. My hero was David Frost. I was a weird kid. My favourite possession as a six-year old was a John Bull printing kit and I used to try and make newspapers with stories about the dog and Andy Pandy. When I got to senior school, I got together with some friends and we made a school newspaper which sold like hotcakes. It got banned after the second edition when one of the teachers actually read it and discovered the whole thing ripped the urine out of his colleagues.

I never fully shook off this ambition to be a newspaperman as a youth and I was lucky enough to become a reporter first, and latterly, a press photographer (nowadays I’d probably be called a paparazzo). I worked for a number of weekly newspapers before working on two large regional evening newspapers. I was obsessed with photography and newspapers and I absolutely loved the job. I was determined to get to Fleet Street, which was always my main goal, and in 1979 I was approached by a national newspaper to be their man in the Midlands.

To cut a long story short, I turned the offer down. It‘s a decision I’ve regretted every day since, but I did.   The offer came a couple of days after I had been the duty photographer over a weekend and a couple of youngsters had been killed in horrific circumstances and I found myself with the duty reporter, door-stepping the parents of one of the teenagers who had died. I found the whole experience difficult and pointless. I mean, what were the parents supposed to say to us? And why would they want their picture taken by me and the half a dozen or so national press photographers who had also turned up?

It was time for a rethink. In previous blogs and on Twitter, I have previously mentioned I was a very anxious dental patient and when I went to my last newspaper, the photographic department’s secretary, who later became my wife, suggested I went to her dentist, who worked at a practice that was well-known for treating the anxious. He was an incredibly gentle and skilful dentist. But part of his secret is that he gave me Relative Analgesia and I immediately became a fully compliant dental patient and lost my fear. It was on one of the many visits to my dentist (I’ll call him Dan), that I decided that was what I needed to be – a dentist. I think I was mildly hypnotised by the nitrous oxide, but my new ambition was deep seated. To me, Dan’s profession was ‘worthy’ – not the useless, almost parasitic profession I was currently in.

So, not having any ‘A’ levels to speak of and not even having ‘O’ levels in chemistry or physics, I went to evening classes, virtually abandoning any semblance of a social life (journalists do a lot of evening work) while I studied. Press photographers also do a lot of hanging about waiting for things to happen – like hiding to get the picture of the bloke going into court with a bag over his head, or waiting for the Women’s Institute chairwoman to get the keys to the village hall so you could get a set up shot of the jumble sale. So at the bottom of my camera bag of Nikon F’s I kept a copy of ‘Biology – A Functional Approach,’ dipping into it every time I had to load my camera up with Tri-X (a film – cameras used to use film in those days). In short, over two years, I got three ‘A’ levels and the required physics and chemistry and managed (mainly by badgering the admissions officer every couple of weeks) to get an interview to do 1^st BDS at dental school. The interview panel couldn’t fathom why a 29 year-old journalist would suddenly give up a reasonably successful career to go through five and a half years at dental school. They said it would be a big sacrifice. At one point one of the interviewing panel, a physiologist, asked what car I drove. Bizarrely, he asked if I would be prepared to give it up, and could he see it.   I pointed out the window and he was taken aback by the gleaming new MG Midget sitting outside. I think they must have been impressed by my commitment, because just as I was leaving, the admissions officer scuttled out after me and said my interview had been successful and I was going to get an unconditional offer.

So not only did I happily give up my frankly, doddle of a worklife and my sports car I also effectively lost the first six years of my married life (I got married four months before I went away to dental school). That’s how committed I was.

So it was a crushing disappointment to discover after a month in practice, that I had made an almighty mistake in going into dentistry. My career was like stepping on a banana skin and skidding out of control for the next 30 years.

I hated dentistry from the starting gun.

I think the biggest mistake I made during the whole of my career, was taking my troubles home with me. From day one, I’d go home and mither about EVERYTHING I’d done at work during the day, and worry about what I thought I might not have done.

From being a reasonably, happy almost devil-may-care-with-explosive-IBS newpaperman, I’d become an absolute misery in the space of about six years and one month. It’s difficult to pinpoint exactly what it was about the job that I couldn’t tolerate. I’ve explained in a few blogs of late, that I was a seething sack of stress throughout my career.   I’d worry about hurting patients, that I’d left ledges, that I’d missed pockets, that the RDO would spot something I’d not done very well, at a random check. (Yes, they used to do those). Sometimes I think that the problem was that I was over-committed - that I stressed way too much over stuff, and I recognise this in many, many dental colleagues these days now we have such a microscopically scrutinised profession. The fear of litigation from the specialist injury solicitors and reprimand from the GDC didn’t help my demeanour in latter years.

Pressures from patients, time pressures, financial pressures and the pressure from myself to try and perform way beyond my skills added to my stress and they were burdens I carried with me all the time. Even when I was supposed to be enjoying the weekend or holidays, there was always that background niggle that the respite from work was only brief and that I would soon be thrown back headlong into the middle of it. It probably didn’t help that (particularly when I was a practice owner), I would take referrals home to complete over the weekend. When I was writing practice policies in preparation for the introduction of the CQC to dentistry, it felt that I could never get away from dentistry.

A few years ago I attended a day-long talk in London, on minimal intervention by well-known Australian dental speaker, Geoff Knight. It was a very interesting day, but at one point he made a very simple statement: “Dentistry is a stressful way to make a living.”

It was the first time I had ever heard a dentist, let alone a prominent dentist, actually acknowledge that dentistry is stressful out loud. Dr Knight’s way of combatting stress was to throw himself into his passion for developing a Ski Doo, which moves people about on snow, apparently. He referred to his hobby as ‘the cash-burner’ and I was envious of the Australian’s relaxed demeanour and outlook. Relaxation was something I never truly achieved as a dentist, even though I tried. Even two stints in therapy with a psychotherapist didn’t fully help.

Now I don’t believe I was the best dentist in the world and I don’t believe I was the worst either. I just think I might have been maybe a bolder and more effective dentist if I’d managed to control my stress. I might have also been a much better parent and husband to my late wife if I hadn’t been such a miserable, intolerant, irritable bugger at home. One day I was pulled up sharply when my daughter – about 16 at the time – shouted in my face “God, you’re a stress-monger!”   I didn’t precisely know what she meant, but I got the gist. I recognised that I was constantly like a bear with a sore head AND particularly itchy haemorrhoids. The question was, how to stop it (the attitude, not the piles).

One of my close colleagues once said “I think subconsciously, dentists are allotted daily ‘nice points.’ We use up all the nice points on our patients and have none left when we go home.”   I think he was right. Perhaps if I’d been a git in the surgery, I might have been a tad easier to live with at home.

I read a meme on the internet recently that said, “Never in the history of the world has someone cheered up by being told to cheer up.” And that also goes for the words “Don’t stress.” How DO you reduce dentistry-induced stress? I have no idea, but I think a few things did marginally help.

Selling my practice was one of the biggest stress-reducers in terms of eliminating a lot of out of hours paperwork. Having a non-clinical practice manager was a bit of a hindrance and I was unable to delegate a lot of work. Taking on a practice manager with a clinical background would have helped substantially, but I didn’t have that option.

After I sold up, just the act of moving on to a new practice (despite being a corporate), initially, at least, helped reduce my stress. I was suddenly in a new environment with new patients and was not having to take on the responsibility for my old patient’s problems and anxieties. Also, having moved from a very small practice to one with loads of dentists and staff around, meant that interpersonal relationships weren’t as intense and burdensome. In addition, I was suddenly working with dentists from the EU and that was a complete joy. It was like my horizons had suddenly taken on galactic proportions.

After a few years at the corporate practice I dropped one day, having suddenly developing (literally) blinding migraines every couple of weeks or so. That worked quite well on reducing the headaches and my stress levels. Eventually I filled my spare day with sessions in a very laid-back independent practice (still NHS) that kept income flowing, but at a more leisurely pace. Again, I felt my stress levels reduce, though I’m not sure if my family felt the full effect.

By the time I was due to sell my practice, most of my brood had left home and I found myself with a bit more time to spare. At that time I took up Twitter and through it, discovered that I wasn’t alone in feeling like I did. Many dental colleagues revealed they too worried all the time about their work lives and in a way, that helped ease my, for the want of a better word, ‘guilt’ at having been miserable for the previous 30 years or so. Through Twitter I have become aware of a number of dental colleagues who have either retired early or quit while they still clung on to sanity.

I’m really not sure what the answer is to stress in dentistry. It’s obviously inherent in the job, but there is still an attitude that prevails that implies that you just need to ‘man up.’

Certainly, reform in the general dental service which results in adequate pay not reliant on the hitting of impossible to achieve targets would be a start. And if that were structured and dentists were compensated in such a way that clinicians aren’t always having to watch the clock and having to cram patients in sideways in order to break even, that would be a bonus.

Now you WOULD think, that having retired, I would be totally free of stress. Well, mostly. I still spend much of my day with the nagging feeling that something I did or didn’t do in the last couple of years before my retirement will come back and bite me on the bum. I don’t know if that feeling ever goes away for dentists or medics, but at least being retired, I’m not accumulating potential problems at the moment, unlike my former colleagues still hard at it and currently sweltering in the heat.

Having said all that, Boris Johnson has just been announced as the new Prime Minister.

I wonder if I still have my therapist’s number on my iPhone?