Caring in crisis - Coping with the pandemic in dental practice

Here’s a poser.

Are dental professionals innately caring? If not, do they learn to care? But if caring doesn’t come naturally or they refused during training to go to lectures on intermediate and advanced caring, do they pretend to care?

I’ll leave that one for you to ponder for the moment.

A couple of months ago, my elderly mother, who is nearly 88, broke her femur. She lives alone, but independently. We still don’t quite know how she did it, but I suspect she was clambering up the side of her house to clear the gutters again. Despite all our entreaties, she steadfastly refuses to use the scaffolding we bought her a couple of Christmases ago and I guess she almost certainly shunned the safety harness we bought for her 80^th birthday. Mercifully she didn’t suffer any further injuries though she complained that the hard hat she was wearing had flattened her perm. I jest. She got dizzy while putting a Weetabix box in the recycling and fell over.

Her recent leg break was the third skeletal trauma she has experienced in as many years and I think it’s fair to say that her bones are knackered. After she shattered her scapula and humerus eighteen months or so ago, she decided to go for ‘conservative treatment’ - basically leaving it alone - an option I suspect the surgeon was relieved at. Repairing the chalky shoulder with…what I believe are called ‘fixings’ would have been like trying to drop a dentine pin in a carious root-face.  I tried to count the number of bony fragments shown on the radiograph of her shoulder, but lost track after fifteen. The orthopaedic surgeon said it was zillions.

I began to wonder if I had shed my own professional capacity for exhibiting patience and care a few weeks later when I attended the teaching hospital at which she had been treated, for a follow up appointment. The review was opened by an Orthopaedic Nurse Practitioner. The nurse began by taking a general medical history and near the end, asked my mother if she smoked. In front of my wife and I, my mother brazenly replied “Nope.” We both laughed, mainly out of sheer embarrassment. In fairness, ALL parents are embarrassing, me in particular. After a few seconds to pull ourselves together, we put the nurse straight – my mother smokes like one of those chimneys Fred Dibnah was famous for demolishing. My mother then went on refuse a bone density scan and annual injections of Zolendronic acid which would have theoretically reduced the risk of further fractures. At that point I lost patience and made it clear to her that on her ‘own head be it.’ I should point out that a year previously, she had turned down EXACTLY the same investigation and treatment when she had broken her wrist.

And so here we are - my mother is currently in a hospital bed in her own living room with carers and district nurses and physiotherapists and occupational therapists going in daily. And daily she is telling all the healthcare professionals why she won’t cooperate with their advice because she feels she knows better, having once been…a district nurse.

The point I am making here is despite all the lack of cooperation my mother is offering, these care professionals are saints. They take all her stubbornness and I hate to admit it, rudeness, carrying on with their tasks with a smile and apparent lack of resentment. And despite the fact that she is refusing to eat, they still gently try to encourage her, even when she spits ‘It’s horrible!”

I am envious of the patience and care her minders have displayed. Even my mother’s younger neighbour looks in on her at least once a day with a diligence I can only admire.

I can only look on as a son who is thoroughly frustrated by my mother’s obstinacy and lack of cooperation with fellow health professionals. I realised recently that if I were in their position now, I really think I wouldn’t have the patience to be as professional as they are. They have a job to do and they do it - they CARE but it has made me wonder how I would be reacting now if I were in the position that dental professionals are presently in.

I suppose the bottom line is that my mother is yet another patient who wouldn’t take my advice, and she’s now paying the consequences.

I would like to think that in the current Coronavirus and mask shortage predicament I would also be as caring as former colleagues and many other members of the profession appear to be in the face of real potential dangers. Dentists, hygienists, therapists, nurses and receptionists are all on the health frontline – they are just as vulnerable as health professionals in primary or secondary medical care, and they all do their jobs without letting the potential risks affect the care they give to their patients.

Back in the eighties when AIDS reared its ugly head and HIV infection was poorly understood, I can’t remember being particularly fearful of personally contracting the disease.  The focus of the dental profession was on how to deliver safe treatment to our patients, AIDS sufferers included. I’m sure this is how former colleagues are tackling the current pandemic crisis, but I don’t know how I would personally be reacting in the light of the recent discovery that maybe since I left the profession.

I appear to have shed my hands-on caring side.  

I’ve not read one comment from any dental worker indicating fear at working in the current environment.  There have admittedly been some moans about the difficulties in securing supplies of masks, but there is an almost nonchalant dismissiveness of the risks to dental people.  They have a job to do and they are going to do it, come what may.  I know I would have moaned if I’d still been working.  In fact if the betting shops were still open (I am assuming by the time this piece is published all the betting shops will have been closed), I would have put money on it.

A dentist I follow (@MrsBDent) summed up the attitude of dentals in this tweet: “Also doctors and nurses, in fact all health care providers have to stoically carry on, as do delivery drivers, food shop workers and factory workers providing essentials. People who moan they can’t get loo roll  would have a lot more to moan about if the above stayed at home.”  The degree of selflessness is emphasised by the fact that most self-employed dentists won’t be covered by their sickness insurance if they voluntarily self-isolate.  They will only be covered if they succumb to the virus.

Dental staff are as much exposed to the current lurgy potentially as those more glamourous frontline hospital staff who specialise in things like chests and rectums. They all approach their everyday duties selflessly and with apparent enthusiasm and looking on from the outside as an ex-dental professional, I am filled with admiration. I don’t know whether I could do it now. In fairness, I am one of the group of patients who the epidemiologists keep emphasising are most prone to severe infection - an insulin-dependent diabetic, asthmatic, prone to severe chest infections. Also, in my defence, I was once diagnosed with terminal hypochondria.

An example of how calmly the profession is taking the Coronavirus pandemic was highlighted last week when I met up with two close friends, a young dentist in her early thirties and her slightly younger nurse. We meet up once a month or so for Sushi evenings but decided for a change, to go Italian. The mother of the nurse apparently expressed some disquiet at her daughter (half-Iranian) going to an Italian restaurant and she was pressing her daughter to take travel histories of the waiting staff before taking her seat. She didn’t of course. And neither were either of us worried at being in the company of the dentist, who that day had gotten off a plane from Barcelona with her son. (As I write, Spain has declared a national emergency).

During the whole evening, not once did my friends bring up the Coronavirus in relation to their work, until I asked if the practice had been affected by the mask shortage. While fully aware of the precautions they had to take in their work, both dismissed the potential dangers of getting close to the public as something that was all ‘in a day’s work.’ Neither expressed any concerns for their own health.

I don’t know quite what has happened to me over the fifteen months since I retired, but the change in my own attitude has surprised me. I believe I was a caring dentist and I am often told by ex-patients when I bump into them that my care has been missed.

I must have possessed some degree of caring as a dentist – I was one of those practitioners who would ring up a patient to see if they were okay if they had been through a particularly difficult procedure (though that might have been in an attempt to mitigate a potential law suit) – but if I hadn’t been caring, would I have been able to gently treat the gentleman who whenever my nurse was out of earshot would whisper menacingly “It’s alright for you. You’re ok for money?”

If I hadn’t been caring, would I have completely ignored the sarcastic builder who every time he entered my surgery said “Where you parked your Roller today then?” He was particularly irritating. Firstly, I am not a fan of cars and as an NHS dentist always drove pretty modest vehicles, my beloved Peugeot 107 being my favourite. I resented his belief that all dentists were ‘rolling in it.’

I can say that as a dentist, even the most revoltingly obnoxious patients received nothing less than my 100% professionality. In fact, as I’m sure most dentists would identify with, the most horrible of our patients are probably treated with most courtesy and sometimes (in my case) out and out obsequiousness.

To try and answer my question at the start of this piece, I don’t feel that caring can be faked. The challenges we face over our working days would quickly fracture fakery into a thousand pieces, several times a week – you’d appreciate this if you ever met a group of my patients.

Can the ability to care be taught? I’ve met a couple of dentists over the years who clearly didn’t care one iota about their patients. They went through the same BDS course as the rest of us and yet nothing appeared to have sunk in. In both instances, money was the driving force behind their entry into the profession and I can only think that for them, their professional existences must have been pretty empty and unfulfilling. The dentist who bought my practice, on the day of sale, contacted her solicitor to ask her to take £2.59 off the sale price since on that day we sold a packet of TePe brushes. Having said that, I truly believe that for the vast majority of dentists, the pursuit of filthy lucre isn’t a prime motivator to go into the dental profession, the desire to care for patients, is.

So is caring innate? I believe it is. Why else would dental or any other health professional, particularly in the middle of this current pandemic, put their own health concerns on the back burner in order to help others?

As for me, I think my caring side, like the sanity of most who have stripped the supermarket shelves of hand sanitiser and three-ply quality quilted, has been temporarily mislaid.