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.
A few things happened last week which inspired me to finally write this piece, having studiously avoided writing it for a few years.
Firstly, The Jeremy Kyle Show was suddenly taken off air by ITV and at the time of writing has just been scrapped completely. Its removal from the schedules followed the death of a guest a week after taking part in the recording of the show they were due to appear in.
On the day the suspension was announced, I Tweeted that I was ‘bereft’ that the show had been pulled. I wasn’t. I’ve watched segments of a handful of shows over the years and I thought it an appalling disgrace - car crash, often prurient TV, in which ‘guests,’ many of whom who quite obviously have deeply ingrained mental and social issues are thrown into a dog fight for the nation’s entertainment. In 2007, district judge Alan Berg described the show as “human bear-baiting” as he presided over an assault case brought against a guest who head-butted his love-rival on the show. I likened the Kyle show to those awful first rounds on Britain’s Got Talent or The X Factor in which the talentless and delusional show the world what it’s like to not possess an iota of self-consciousness. I wrote on Twitter this week that I watched Jeremy Kyle (the man) with a fascinated loathing. It was like watching a sewer rat perform card tricks. I honestly cheered when I received a Twitter notification that the programme had been scrapped.
The reason I mention JK is that the same week, I became aware that it was actually Mental Health Awareness Week and to highlight the week, BBC’s The One Show interviewed the marvellous actor David Harewood, who spoke openly about living with his diagnosis of psychosis. I don’t know whether it was coincidence but I also learned that Practice Plan is to run its annual survey (The Dentistry Confidence Monitor) asking practitioners about their confidence in the GDC’s ability to handle complaints appropriately, their feelings about the proposed new NHS contract and the effects that dentistry has on their mental health. I was a little disappointed to see there were only a handful of questions on mental health, but at least the subject has started to be broached and recognised by organisations outside the pages of the British Dental Journal. For example, Mental Dental, a group set up for dentists in crisis by Dr Lauren Harry and which has a Facebook presence is currently illuminating the problem of mental health issues among the dental fraternity. But since many colleagues are talking more openly about mental issues as individuals – particularly on Twitter – I thought it was about time I threw my two pennies worth in.
Now I’ve refrained from writing a serious blog on mental health issues in dentistry for a number of years. I think the main reason was down to my own embarrassment and shame, but partly because I couldn’t wring any humour out of it and it’s frankly, a subject which needs to be taken very seriously. Whenever the subject of mental issues comes up anywhere – let alone dentistry – I take it very personally and my account is based purely on my own experiences.
This is me:
I am a seething bag of neuroses and anxiety. Always have been and always will be. Not only am I anxious, I also suffer from Irritable Bowel Syndrome. Anxiety and IBS is the dream team. I’ve met quite a few practitioners over the years who have suffered similarly.
As a child I suffered anxiety (I now think it was panic attacks) during my 11 Plus exams and consequently failed. I also suffered from Obsessive Compulsive Disorder. That was a weird one. I was about eight or nine when it started. Before I would get into bed I’d go over to the electrical socket in the bedroom and pull up on the old-fashioned switch to make sure it was off. I’d keep this up for about five minutes. After ten minutes in bed, I’d be convinced I hadn’t done it properly, get out of bed and repeat. This would happen several times a night until I was too exhausted to do it anymore. I still bear the scar on my right forefinger where my routine cut into the flesh. That particular manifestation of OCD fizzled out after about five years, only to be replaced by worries over house security. Even now I will check the house is locked several times before I leave it – even if a member of my family is still in, and when I worked for the corporate, I would ensure I was the last one out of the practice every night (unless the cleaner came in, who I trusted) because I couldn’t trust my other colleagues to lock up properly. I had no reason to distrust my colleagues, but mental health issues have no logic. My security obsession probably wasn’t helped by the fact that a few years ago as a practice owner, a dental therapist who I thought the world of, stole cash put aside for staff wages and wrote fraudulent cheques for £1,600.
And even as a young press photographer in the 70’s in my first staff job, I worried about everything. I was sent out to take a glamour photograph of Barbara Windsor who was appearing at the Hippodrome in Birmingham. I arrived late because I was held up at another assignment and as I got there, Ms Windsor was going inside. It was a cold November day and the national papers had put her through the mill before I arrive. Desperately fearful that I would lose my job if I didn’t get the picture (I wouldn’t have done; the editor would have just called me a ‘t****r”) I ran into the theatre foyer after her. As I explained to her my predicament, I think probably teared-up and she took pity on me, took me round the back of the theatre and I had a one-to-one photo session with the first ever film star I had met.
So how on Earth I came to the conclusion that dentistry was for me, is not clear.
Dental school was a nightmare for me. I was a mature student and there was a lot at stake. I was married at the time and had given up the opportunity to go to Fleet Street in favour of dentistry. The dental lecturers gave me a hard time (it wasn’t exclusively me, but it felt like it was) and I had several run-ins with members of staff despite trying to work in a professional way. I was desperately anxious that I came up to scratch.
Because I was again, worried about being thrown out of dental school, I feared the smallest mistake and one day I was polishing a composite on a patient when the mandrel carrying the polishing disk I was using, slipped out of the handpiece and into the patient’s mouth. Although the whole assembly was retrieved in a second, it shook me up. In my mind I had nearly choked the patient to death (I hadn’t), but the patient as an act of ‘kindness’ mentioned the incident to a lecturer as she went off clinic. She felt, apparently, that I was distressed after the incident and that I needed reassuring that it was ok. The next morning, I found myself in front of the head of the restorative department being told off – not for dropping the mandrel – but for shaking afterwards.
On qualifying and entering practice I tried desperately hard to give the outward appearance that I was cool, calm and collected to the point that over the years patients and some colleagues have described me as ‘chilled.’ Nothing could be further from the truth.
I suffered terribly from insomnia during my time in dentistry and early in the morning I struggled to brush the palatal or lingual surfaces of my molars because of retching. Early on in my career I would actually throw up so anxious was I about the day ahead.
I can’t honestly say that my anxieties were related to money worries or staff problems. It was the act of treating patients - trying to satisfy their desires and trying to hit a high standard of work – something I felt I never ever achieved.
When I first started work, although dental litigation wasn’t anything like the level it is now, I was paranoid that I was going to get struck off or get a complaint. Once, a marginal ridge fell off an amalgam a day after I placed it. I was convinced I would end up in front of a health service committee for shoddy workmanship and I remember planning out a new career the night before the patient came in to have the restoration replaced.
So where were the pressures?
For me, they simply came from patients and anxious patients in particular – you know the ones, the type that come in and say “I’m not looking forward to this.” An innocuous enough remark but it would put me on edge, often inducing the shakes. And if a patient ever jumped during treatment, you would have to scrape me off the ceiling virtually. I would go to enormous lengths to make the patient comfortable and I could be accused of overdosing the patients on surface anaesthetic and lignocaine. For needle phobics I even developed a technique where in order to avoid the pain from an infiltration around the upper incisors, I’d start numbing from the upper premolars and work my way around until I got to the tooth I actually needed to anaesthetise. Sometimes I’d deliver 3-4 cartridges just to numb an upper central.
And as for delivering local, that was the worst. Apart from exacerbation of my IBS, anxiety also had an effect on my heart rhythm. I was only in my early thirties at the time. On more than a few occasions when I was working in the early days, my heart went into overdrive, dropping beats along the way till I felt faint. I ended up having a 24-hour heart monitor on several occasions and had to make a note of what I was doing when I felt palpitations. Analysis of the readouts showed that every time I gave local, my heart rate shot up. On one occasion when I was giving an ID block, my heart rate went up to 140 beats per minute.
Time pressures were also something I succumbed to. I tried to give myself the right amount of time to complete procedures, but the odd emergency or delay would really stress me out. That wasn’t helped by a man coming in one day and virtually screaming in my face because I had unavoidably kept him waiting thirty minutes or so.
Patient contacts over the years became something I dreaded so much, I have to admit that when patients didn’t turn up to appointments, I was mightily relieved.
Forget your worries? Easier said than done.
We ALL face pressures out of the practice and yet have to try and put that to one side when working. For me, I had to cope with the death of my wife from cancer at the age of 40. This left me with three young children to raise as well as run my new practice and although the local health authority and the dental practice advisor were well aware of this, I received not even a message of support, but criticism for some piece of paperwork I’d failed to submit on time.
In the mid-nineties, I ended up on antidepressants. Frankly, they were wonderful – initially anyway. They numbed me from the horrors of my lost family life and running a practice. Had I been in anyway a fan of alcohol, I might have ended up drinking. Fortunately, I can’t generally stand the stuff although I occasionally try wine on holiday.
Having come to the conclusion that I couldn’t numb myself forever with drugs, I sought help from a clinical psychologist. It’s probably relevant and honest to mention that I also seriously contemplated suicide at that time and had the method and time mapped out in my head. William was a brilliant man, who previously dealt with patients from a very famous secure psychiatric unit, so a nervous dentist was easy peasy. Having said that, I still relied on prescription antidepressants until 2012.
I saw William on and off from 1994 until 2013. Sadly, he died shortly after my last visit, but I learned a lot about myself and developed strategies to cope. If there had been a dentally based organisation I felt I could go to without being reported, I would have done.
Somehow, I managed to get through my last few years in dentistry in the corporate without William or antidepressants. In my own practice, I felt isolated. I had two part-time colleagues who I got on with but I didn’t really feel I could confide in them. At the corporate I had really good set of young colleagues who shared my own anxieties and it made me realise that I wasn’t completely alone in suffering in my head. That helped enormously since the whole of my period in the corporate was plagued by problems with litigation brought about by the individual who bought my practice. I have written about that episode in previous blogs. But I have to say that the single most helpful thing in my professional life over the final few years of my career was joining Twitter. Connecting with many colleagues all over the world showed me that a lot of them suffer from exactly the same anxieties and succumb to the same pressures that I did.
I feel really deeply for youngsters who are coming into dentistry nowadays. They face enormous risks of litigation during their careers and soon even more changes in the dental contract and patient expectations.
Where we go from here, I have no idea, but at least there is a positive move in society in general to accept that mental health is important and is not something to be swept under the carpet.
I kept my poor mental health under wraps from my colleagues for thirty years. If I had felt able to seek help, my whole career might not have been a nightmare. Hopefully there will soon be a change.
But in the meantime, if you feel as I do – regretting ever having gone into dentistry – seek a William as soon as you can.
I'm glad that you retired and have respite from the anxiety caused by being a dentist. I know the sense of relief that arrived the day that I stopped treating patients. For almost all of the time I was in practice, I didn't feel like that except for the kind of patients that we all get from time to time who ruin our day or make an unjustified complaint. The last few years became different, I had the constant feeling that someone would make a complaint , not helped by interference by a corporate manager who bullied me ( and I am generally a tough cookie ! ). Outwardly I was confident but internally full of anxiety.