NHSE suddenly announced on 12^th April that it had decided to cut the funding for secondary care practitioners accessing NHS Practitioner Health with immediate effect. This decision shocked the medical and dental profession, particularly those who have used the service or have recommended the service to colleagues. 

Last week, the NHS made a plea to victims of abuse to contact the health service for support. The call came after it was shown that calls to support lines had almost halved since the lockdowns started. It was suggested that because domestic abusers were also at home more, there was less opportunity for victims to seek help.

Before I retired, I naively anticipated that the day after my last clinic, all my anxiety would melt away, like the Cadbury’s Flake I found under the spare wheel of my car the other day.When I fantasised about reaching my retirement, I pictured myself floating on air, with not a care in the world, other than trying to figure out which colour bin to put out on a Monday night. Earlier this week, I finished therapy.

It's a Question of Taste - (Practice Ownership - Love it or Hate it).

At long last, the mental well-being of dentists and dental professionals is being discussed openly. Hopefully the discussion will lead to practice help and support.

Almost half of British adults say they feel stressed every day – that’s according to the Mental Health Foundation. It is generally well known that stress can contribute to health problems such as depression and heart disease. What is less well known – but imperative to address for emotional and physical well-being – is that it can also damage your teeth.
 

This is what happens – one of the more common signs of stress is tooth grinding but there’s a good chance you don’t even know you’re doing it, as it often happens in your sleep. However, its effects cannot be underestimated, often resulting in physical symptoms such as tooth sensitivity, gum problems, difficulty chewing, headaches and neck ache, as well as the possibility of ultimately losing teeth, which can have a devastating emotional effect.
 

If a dentist examined your mouth, they might find teeth that are:

• Sharp or chipped

• Broken

• Shortened

• Loose

• Wearing flat and looking shiny and pitted.

The good news is that making a few simple lifestyle changes can be a big help, such as:

• Doing something relaxing before bed, such as yoga, reading or having a bath

• Learning to brush effectively yet gently with a relatively soft toothbrush and a toothpaste that is low in abrasivity (ask your dentist for advice on this if you’re not sure).
 

In addition, if you’re suffering from sensitivity (which should be diagnosed by a dentist to ensure there is no underlying condition that needs treatment), using a fluoridated mouthrinse every day at a different time to toothbrushing is an effective first line of defence. A desensitising toothpaste used when brushing or applied directly onto a sensitive tooth can also be helpful to calm any sensitivity.
 

Commenting on this growing problem, Professor Andrew Eder, an expert in tooth wear and Clinical Director of the London Tooth Wear Centre^®, said: ^‘If you’re worried that your teeth may be wearing, tell your dentist. They are, after all, there to help and will be able to make a diagnosis, provide guidance or refer you, if appropriate.
 

‘Possible treatment options include the provision of a suitable mouthguard to be worn at night to relieve pressure on the teeth and jaw, prescribing muscle relaxants or recommending care from a physiotherapist or osteopath with specialist knowledge of the muscles involved.
 

‘If there was one piece of advice above all others I’d offer, it would be this – don’t delay in seeking help. If damage resulting from tooth wear is diagnosed and addressed in its early stages, you can avoid extensive and expensive dental treatment that might otherwise be necessary to correct the situation. The bottom line is that you needn’t suffer alone or long-term.’
 

If you have any concerns about your oral health or would simply like some preventive advice, please contact your dentist. If you prefer, the team at the London Tooth Wear Centre^® is happy to help. For further information, please visit www.toothwear.co.uk, email This email address is being protected from spambots. You need JavaScript enabled to view it. or call 020 7486 7180.

Capacity

In our last blog we considered the importance of patient consent. One of the key elements of valid consent is the patient’s capacity to give that consent and the Mental Health Act 2005, which came into force in October 2007, deals with all issues surrounding mental capacity.

First and foremost the Act imposes a duty on all healthcare professionals to have regard to the Mental Capacity Code of Conduct. It is therefore important to read and understand this document when considering whether a patient has capacity to provide consent.

Capacity  
 
A person lacks capacity if:

1. They have an impairment or disturbance (for example a disability, condition or trauma or the effect of drugs or alcohol) that affects the way their mind or brain works; and
2. That impairment or disturbance means that they are unable to make a specific decision at the time it needs to be made.

It is very important to note that capacity is to be assessed at the time the specific decision is required. Therefore, a patient may have capacity to consent to some treatment but not to others, or may have capacity at some times but not others.

Under the Act you must assume the patient has capacity unless you can establish that they do not. And simply because a patient’s decision to refuse treatment is unreasonable does not mean they lack capacity.

Assisting Those Who May Lack Capacity

If you are unsure whether a patient does lack capacity, all practical and appropriate steps should be taken to assist the patient in making the decision before you determine they actually do lack capacity. This will mean changing the way you provide information to the patient; giving the patient all alternatives to treatment; considering whether there is a time in the day they have more understanding to make the decision.

Best Interests of the Patient

Under English Law no one is able to give consent to the examination or treatment of an adult who lacks the capacity to give consent, even parents, relatives and healthcare professionals. The exceptions to this are where there is a Lasting Power of Attorney or a court appointed deputy.

However, the Act protects healthcare professionals from civil and criminal legal liability if treatment is provided in the patient’s best interests. The Act states that you must take the following steps before acting in the patient's best interests:

1. Consider whether the person is likely to regain capacity and if so whether the decision can wait:
2. Involve the person as fully as possible in the decision that is being made on their behalf;
3. As far as possible, consider:

• the person’s past and present wishes and feelings (in particular if they have been written down).
• any beliefs and values (eg religious, cultural or moral) that would be likely to influence the decision in question, and any other relevant factors.
• the other factors that the person would be likely to consider if they were able to do so.

         4. As far as possible, consult other people if it is appropriate to do so and take into account their views as to what would be in the best                         interests of the person lacking capacity, especially:

• anyone previously named by the person lacking capacity as someone to be consulted.
• anyone engaging in caring for or interested in the person’s welfare.
• any attorney appointed under a Lasting Power of Attorney.
• any deputy appointed by the Court of Protection to make decisions for the person.

      5. For decisions about serious medical treatment, where there is no one appropriate other than paid staff, healthcare professionals have to              instruct an Independent Mental Capacity Adviser

      6. If the decision concerns the provision or withdrawal of life-sustaining treatment, the person making the best interests decision must not be            motivated by a desire to bring about the person’s death.

Assessing whether a patient has capacity will be a balancing act. You will also need to bear in mind your duties to treat patients with dignity. This may therefore lead to difficult situations; remember to take notes of any decisions made as this will later assist if any queries are raised.   

The biggest step
I finished out that week pondering on my therapy session and the work stresses. My wife, ever the paragon of being right, shied away from the blunt “I told you so” but did make it clear that I should be taking it easier. I asked the PM to block out some time where cancellations had arisen so that I would have a little breathing space, with the proviso that I would of course see any emergencies in those gaps if necessary. I did at this point advise the PM that I was having some issues with stress and needed to cut back a bit (master of understatement here!), and would be looking to book some time off when the books were quieter – about 4 weeks into the future.

I was by now quite aware of the mask I was wearing at work, and of the times when it would slip. I was concerned that it could create problems for the staff directly and put them in an awkward position if my behaviour impacted on a patient. I had seen this happen before when a colleague had suffered from depression, and their extended absences had been explained away at the time as a back injury – a number of patients refused to believe it and some even hassled the staff with questions such as “it’s the drink isn’t it?”.

This led me to discuss the most difficult step in dealing with depression with both my wife and my therapist – that of telling my workmates and staff. It’s one thing to admit to oneself that you need help, another entirely to admit it to others. It’s natural to want to hide our weaknesses from others, even those closest to us, but you can’t expect to get support without laying a decent foundation. My wife was concerned, as was I, that such a disclosure could leak to the patients and potentially put them off seeing me. My therapist countered with the argument that if I didn’t have support in my recovery, I potentially wouldn’t be in a position to see patients anyway. I couldn’t argue with that logic, particularly being a Star Trek fan, so I decided to tell everyone at work and hope for the best.

Except – I couldn’t actually bring myself to tell them face to face. Every time I looked at my nurse, my colleagues and thought of saying what I was going through I felt I may cry. I chickened out and put it in writing, asking the PM to read it to everyone at the staff meeting that week as I wouldn’t be present. The PM graciously agreed, following a short but teary chat at the end of the day.

Below is a copy of the letter. I know this may identify me to any of my colleagues who lurk on GDPUK, but their response to the letter at the time assured me that I can trust them to maintain my anonymity.