Lynn Leach talks to Rory O’Connor and Jeremy Cooper about the issue of loneliness within dentistry and how this can be tackled…
The 18th of May is the start of Mental Health Awareness Week, a subject that has become increasingly discussed and prioritised within dentistry.
One of the things that I often hear is the sense that dentists can feel very isolated while at work.
Of course, with the recent outbreak of Covid-19 many people outside of dentistry have experienced a level of isolation they may never have had before, and there has been a lot of discussion nationally about the impact this can have on mental health and how people can stay well.
But, while clearly not as extreme as the self-isolation imposed during the pandemic, many dentists are spending long periods of time on their own. It’s not uncommon to hear a practice manager say that they see the dentist in the morning when they arrive and don’t see them again until they leave.
We know that poor mental health is an issue in the profession, and this way of working may well impact that. With all of this in mind, I spoke to Rory O’Connor, Clinical Lead at the Dental Health Support Trust (DHST), and Jeremy Cooper, a dentist and founder of the Confidental helpline.
Lynn: How big an issue is loneliness while at work?
Jeremy: Even if you work in a group practice, you often feel a little bit lonely because you’re in a room with a nurse and a patient, so it is a bit isolated. In a single-handed practice, like I am, you can feel very isolated.
I think you feel isolated sometimes because you’re in your own little room having to make instant decisions.
Not only that but you’re dealing with a business with issues such as staff and cash flow, unlike doctors, and with patients who can be frightened, aggressive or both – they generally don’t want to be at the dentists. The clinical side is not easy, you have a feeling of limited time in which to complete treatment and then there has been the exponential rise in litigation coupled with an environment in which there are more regulators who are seen by the profession to be very active.
In my opinion, we now have the most stressful job role out of all the professions.
Rory: It is difficult to determine how big an issue this is without doing a survey specifically on the matter. However, I would say that based on those who are contacting the DHST and Practitioner Health scheme, there is significant evidence that people are feeling lonely and isolated.
This needs to be seen in the context of my perception of mental health and addiction disorder issues; I often describe this as the journey of perseverance into isolation whereby the natural repertoire of the being diminishes, i.e. loss of interest in hobbies, friendship, etc.
Lynn: What do you think are the causes of this feeling of loneliness and being isolated?
Rory: These individuals are confined to a clinical sterile setting for most of their working day with pressure to provide good patient care whilst giving time to patients, while also managing the stress of completing UDAs (for those in the NHS).
There are also concerns around complaints, patients’ reaction to treatment, managing patients’ anxieties, having to focus on the patient less than themselves, along with any other mental health or addictive disorders some dentists may have.
Jeremy: You’re in an enclosed room making these decisions on your own and, particularly when you are newly graduated and less experienced, you know the threat of litigation is out there and this can be very worrying. I am not shy and am basically an open book, but in general dentists can be described as closed books and they feel if they share their worries, they will look a fool.
You can see this from the amount of anonymous posts you see on forums like GDPUK and in groups like Mental Dental. Often the situation that anonymous person is worrying about is nothing to be ashamed of, but there is a culture in dentistry that leads people to be so worried about making a mistake that they feel they have to be anonymous to discuss it.
I’ve heard that a large number of complaints made to the GDC about dental professionals are made by other dental professionals. Sometimes that will be for the right reasons, but sometimes it’s not. Given that, it’s not really any wonder that dentists prefer to remain ‘closed’ rather than talk to each other.
Lynn: Are there any steps dentists can put in place to reduce being so isolated in the practice?
Jeremy: The treadmill that dentists are on means that they feel as if they can’t build in time in the day to enjoy the job or reflect or meet with colleagues to discuss any problems, which would reduce that sense of isolation.
Particularly if you are in the NHS, there is a sense of time pressures. Dentists are so busy doing dentistry and meeting their targets that they don’t have time in the work day for anything else, it’s not uncommon for people to take their notes home to write up.
People need to make time to go on courses, not just for the learning and the chance to upskill but to meet colleagues, discuss professional issues and socialise. Even though I lecture I often go on courses for these very reasons.
Rory: It depends on the practice site and the practical implications that may have, but there are some simple small things you can do. Encourage open conversation with the whole practice team, have weekly lunches together, take the time to say hello in the morning and goodbye in the evening. Be willing to explore and share problems in the practice, whether they are interpersonal or professional.
Lynn: How can the profession be encouraged to talk more to each other (and not just when they have problems)?
Rory: In the modern-day telecommunications world, this can be an issue. Online communication and teleconferencing, etc can be extremely useful and important and, at times necessary, as we have seen during the Covid-19 pandemic. However, under normal conditions it’s important to spend time with real people, and have face-to-face contact (as many of us found once we were unable to do so).
Strongly promote the LDC meetings and other gatherings. Encourage people to attend conferences and other live CPD rather than online streamed CPD. Take an interest in each other beyond dentistry, encourage colleagues to be more than a dentist, to engage with family and friends and develop interests or re-discover old interests they may have had before they went to dental school.
Jeremy: I think younger generations are less robust than previous ones, and the concept of stress and mental health need to be introduced at dental school.
At Confidental we are trying to get into the dental schools to talk to students about mental health and let them know that there are sources of help out there.
Lynn: Thank you, Jeremy and Rory for taking the time to talk about this issue with me, hopefully this discussion will help those feeling isolated that they are not alone and get dentists talking.
Lynn Leach is a Regional Support Manager at Practice Plan.
Rory O’Connor is the Clinical Lead at the Dental Health Support Trust.
Jeremy Cooper is a dentist and founder of Confidental.