What Does It Take To Survive In Dentistry?

Eighty-four percent of NHS dentists feel that their current role has negatively affected their mental health, according to the latest Dentistry Confidence Monitor released by Practice Plan. Admittedly, it’s way higher than the proportion of dentists working privately (51%), but even that figure isn’t one that you would call ‘not too bad, considering.’

The figures were similar when dentists expressed their anxiety regarding whether they felt they could meet GDC required standards. Less than 10% of dentists in either sector were confident a complaint against them would be handled appropriately and the majority of dentists expressed a desire for the GDC to be dissolved AND the ground in a two-mile circumference around it, razed to the ground.   Actually, I added that last bit, but you get the drift.

In the same week, GDPUK reported that the Faculty of General Dental Practice had told the Health Select Committee’s inquiry into dentistry services, that NHS is “highly neglected and under significant strain.” If that wasn’t enough in nailing the message to the mast, they also added that NHS dentistry is “increasingly unviable and professionally unattractive.”

I have previously written extensively about mental health and stress in dentistry, and know from communications with dentists and dental professionals far and wide, that the mental health problems experienced in the dental world are ubiquitous – ranging from anxiety and stress, to depression and even suicidal thoughts.

I trained in the 80’s and way back in the early days of post-qualification, I can’t remember being that preoccupied with the idea of being sued or dragged to the GDC. Obviously, I was vaguely aware of the fact that that nasty, grubby little men lurked in solicitor’s offices waiting for an outraged dental patient to walk in fortuitously without solicitation, but in those days, you didn’t have ‘specialist’ firms touting for business on local radio.

And if there were such law firms around in those days, they were presumably too shame-faced to wave their hands in the air, shouting “Woo-hoo! We’re here!” No, back then, head solicitors of such firms were too busy studying dentistry, going into general practice, realising they either couldn’t hack it, or were too frightened to continue in dentistry in case they got sued and then went into the law because it was way easier, way more lucrative and there was less chance of them being sued.

 

Recently, participants in a Twitter conversation lamented the fact that new dental graduates these days lack the people skills necessary to effectively circumvent the traps that modern interactions with patients throw in their way. Yes, new graduates know inside out how to bond stuff (presumably if they have an hour for each incisal tip), but do they know how to handle the half a dozen challenging patients they will meet every week in practice?

Yes, there’s a general expectation that prospective dental students spend some work experience time in a dental practice, but we all know patients who suddenly put themselves on their best behaviour when there’s an observer gawping at them from the end of the footrest. As a result, that experience of patients or the real general dental practice world is far from authentic.

A good proportion of students will go to dental school straight after their ‘A’ level retake results come in, so many will be about nineteen on entry in to dental school, or twenty if they have a go at ‘finding’ themselves in Bali. At least those who do the ‘year-out’ will have a little more experience of life, even if that experience is mainly of taking lessons on waxing a surfboard from a hirsute Australian from Wollongong.

My pre-dental school experience was working for ten years as a provincial journalist AND I grew up in Brum, so by the time I reached the clinical years, I felt I was reasonably astute at dealing with people. One of my jobs was as a court reporter and I once met and chatted to a pretty famous murderer, in the days before he branched into murder. As a consequence, I thought with my experience of life I’d be more than a match for sarcastic dental lecturers.

I was SO wrong.

But I do think my life experience and maturity when I reached dental school made me slightly more impervious to the malevolent jibes of the psychopathic lecturers on the restorative clinic, but only slightly. When you’ve been hit on the back of the head with a broken tennis racket by a traveller who didn’t like you covering the eviction of a hundred fellow travellers, by police, what can dental lecturers do to hurt you? Psychological torture, that’s what, but more of that in a future blog.

So I was thinking: What does the modern dentist need as personality attributes in order to survive in modern dentistry?

 

DENTISTS

In the distant past (it seems from all the tales I have heard from patients), all you needed to be a dentist was a hip-flask hidden under your tunic, hairy nostrils, nicotine stained fingers, hairy arms and hands like hams. It would also help if you were a little flexible at the hips, with all that kneeing in the chest you had to do in order to extract a tooth. “He said ‘ed never seen one with seven roots before.”

There was a general feeling during the Twitter debate, that the modern new graduate’s general lack of ‘people skills’ and empathy was a handicap to providing good ‘care.’ How can you empathise with the general public if you’ve never really mixed with them?

Being a ‘people person’ would seem to be at the top of the list of desirable attributes the modern dentist needs to either possess innately, or develop at speed on leaving dental school. With many dental complaints apparently being put down to poor communication between dentist and patient, it would seem to be a bit of a priority to develop a nice professional personality, even if you secretly loathe the fact your patients share the atmosphere you also breathe.

 

Having said that, a steely resolve not to be browbeaten into providing treatments you know are ridiculous and doomed to failure, would be a good tool to have in your kitbag. Ignoring patient soft-soap is a skill. It’s very easy to be swooped up in compliments and be ultimately crowd-surfed to a date with the General Dental Council, if they haven’t spent all their budget on employing Hetty Wainthropp, private investigator that is.

Of course, having a good eye for detail is an essential quality for any dentist. And I’m not talking about spotting the odd ledge or reading a BPE probe as a zero instead of a four, but more making sure your notes are water-tight and ensuring you discussed and listed every single treatment option and its risks, known to man…

“Fissure Sealant discussed vs topical Fluoride.

Risks of Fluoride discussed:

1. Fluorosis
2. Fluoride poisoning

3.Child vomits on fluoride taste

Risks of Fissure Sealant discussed:

1. Sealant leaks due to poor isolation
2. Undetected caries gets in
3. Pulpal exposure
4. Root-filling required
5. Crown required
6. Root-filling/crown fails
7. Tooth requires extraction
8. Tooth breaks during extraction
9. Surgical removal required
10. Post-operative infection
11. Osteonecrosis sets in
12. Hemimaxillectomy required
13. Obturator required – (warned there will be an extra charge)”

Patience is another essential for any dentist. I’ve known quite a few dentists over the years who lack this basic. I suppose you’ve either got it or you haven’t. Those who aren’t very patient, wear nightguards. Those who do have loads of patience, wear nightguards. I would suggest dentists who are kind and don’t shout at their patients find their practice life is generally calmer than those practitioners who act like homicidal Daleks suffering from particularly irritating haemorrhoids.

It goes without saying that dentists need to be dexterous. There’s no point in being patient if the only advantage it gives you is the ability to refrain from swearing every time you inadvertently drill into your thumb. It seems that dental schools these days do at least check that candidates have a minimum of one opposable thumb, though their motivation is probably to ensure no phantom heads will be rendered irreparable during drilling practice.

The other attribute that is probably desirable, is some form of intellect. Not only do you have to be able to assess each clinical situation and act upon your findings in the patient’s best interests, you also have to wade your way through innumerable regulations and guidelines as well as devise some way of actually making a living, especially out of the NHS. After each change in the NHS GDS contract, dentists find a way of making a (sort of) living out of it. Admittedly, it’s been more difficult with the UDA-based debacle, but even so, dentists find a way of making it work and the authorities always seem taken aback when people with a university education manage to work the system to their advantage when it was specifically designed to thwart dentists making a living.

But, what about other members of the profession? They similarly have to work with patients and clients and they must possess similar and sometimes unique attributes in order to just get through the day. I spoke to a few members of the dental team to get their views. Not surprisingly, some didn’t want to be named and associated with me, but the following are genuine quotes.

 

Dental Therapists 

First, I have to say, I am a fan of dental therapists and employed a therapist when I had my own practice. She was invaluable and as a result, I really can’t understand why dental therapists aren’t utilised to their fullest potential. I hear though, that their role and scope still isn’t fully understood by dentists. I imagine that therapists (who work under a dental surgeon’s prescription), sometimes meet resistance from colleagues.

Diana is a dental therapist with 20+ years experience. She outlined what attributes she feels dental therapists must possess:

“I expect a lot of these are common to many in the team. A good sense of humour is essential, especially when people say “Dental Therapist? Does that mean you talk to teeth?”

Patience...explaining again that the term “simple fillings” is way out of date and doesn’t mean we only do occlusals!

Resilience...standing our ground over why you really do need a written prescription for LA.

Diplomacy…especially when you disagree with a treatment plan.

Self-respect...for when you get left out of staff meetings and Christmas parties.

Calm and good communication skills.”

 

Dental Nurses 

Lucy is a lead dental nurse working in an NHS corporate dental practice:

“I would say you have to be a good listener and have good communication skills since you get told all sorts of things by patients. Some patients seem to tell you absolutely everything about themselves - almost to the point where they see you as a borderline psychotherapist.

Mrs Smith may tell you in her medical history update she has had diarrhoea this week, or Mr Smith may tell you his wife has run off with the milk man. You therefore have to be able to listen and have compassion for your patients.

Being calm is a big one. I would think 90% of patients will say they are scared of the dentist, so as a dental nurse, you need to be able to keep calm and reassure the patient throughout procedures. Essential is a good firm hand grip since a lot of the time, patients like to hold your hand for support.

Good organisational skills are another ‘essential.’ Dental nurses need to able to know what the dentist will want next without them even knowing what they want.

Above all, nurses need to be able to multi-task. You pretty much have to be like an octopus - doing the notes, bibbing the patient, aspirating and mixing the filling whilst passing the dentist all the instruments required. The list goes on.

I mustn’t forget good reflexes, especially when a numbed up patient tries to aim at the spittoon to rinse and completely misses usually. If they’re not quick, it can end up with nurses being covered in drool.”

 

Dental Technician 

Alex runs a large dental laboratory, providing private and NHS items.

“Firstly, a dental technician needs to be the best tooth artist that they possibly can be. Dental technicians must also possess a knowledge of clinical processes so that they can advise dentists on what to do and not surprisingly, how to do it.

 

Dental technicians need to be diplomats, explaining fairly but firmly to a dentist when they have made a mistake. Very few dentists seem able to admit to mistakes and find it difficult to explain their cock-ups to the patient without losing face! Mostly, they blame the technician. Arrogance seems to be an attribute possessed by some dentists, but not all.

Technicians need to have the ability to say ‘NO’ since otherwise they will be pushed around - mostly on price, but quite often on times for turning around work. Some dentists think that to make a full arch implant bridge we can just wave a magic wand but sadly Harry Potter’s wand was actually just a twig and we make these restorations with our own two fabulously dextrous hands. Unfortunately, some dentists, I believe, seem to use their feet!

Technicians need to know all aspects of a dentists working life to help encourage and cajole them into being a decent clinician and to help them help their patients to smile again. A smiling happy patient leads to a fairly happy patient and hopefully, a happy techy.

Technicians also need to be business minded. They need to emphasise to clients that labs have to be paid and we are not here to support a dentist’s overdraft or their kids school fees whilst they go skiing while technicians struggle to make the mortgage!”

 

Dental Hygienist 

Fiona is a hygienist with over thirty years’ experience. Her single most important attribute is:

“Being interested…it’s the recipe for everything.

Without that, nothing works. Getting the patient interested is all.”

 

Dental Receptionist 

Stella is a dental receptionist with 15 years of experience.

“Go away! I’m busy.”

I think I’ll put that down as ‘being forthright.’