Dangers of Stress
Dentistry is a stressful profession. Indeed, Professor Cary Cooper’s famous study of stress in the workplace found that, of 104 jobs, it is one of the 10 most stressful in the UK, alongside fire fighting, police work, social work, mining and medicine.
It’s easy see why: here is public-facing job that requires you to remain calm and in control despite carrying out what can be extremely difficult and intimate procedures. Even the routine things, such as giving an injection, cause a surge of adrenaline every time you do it.
And it would take a clairvoyant to arrange for every difficult patient to arrive when you are at your peak. Many dentists will have had that difficult molar endo that comes in at 5.20pm: you’re tired, your blood sugar is low, your partner’s out of town, you’re meant to be picking the kids up from the childminder at 6.15pm – and you can’t find the third canal.
It’s hardly surprising, then, to find that as a profession we experience higher than average levels of anxiety, addiction and both attempted and successful suicide. So, while there are a number of reasons why a dentist might come before the General Dental Council with health problems – they could, for example, be seeking a ruling on fitness to practise in cases of neurological disease such as Parkinson’s or multiple sclerosis, or blood-borne diseases such as hepatitis B and HIV – mental health problems and addiction are by far the main ones.
In the past, the abused substance was almost always alcohol, but increasingly drugs are involved too, and it is currently estimated that one in seven practitioners will have a problem with one and/or the other at some point in their career.
Everybody has their own way of managing stress. Some knock seven bells out of a squash ball, others take up yoga or meditation; an acquaintance of mine even took up weightlifting in his late middle age. But many of us reach for a glass of wine when we get home. Of course, this is not in itself a problem. That comes much further down the road when a patient complains they can smell alcohol on your breath in the morning or you’re caught driving over the limit on the way in to the practice.
In most cases of substance abuse reported to the GDC, the members of the Fitness to Practise Committee, operating in private session in their ‘health’ mode, will ask for blood tests and a report from an expert psychiatrist, all in strict confidence. The dentist is likely to be suspended as they decide what to do. While protection of patients is paramount, let me emphasise here that the committee’s role is also to help dentists recover and get back to work.
To this end, committee members will be looking for evidence that an alcoholic or a dependent drug user can get their life in order. They might well revoke their fitness to practise, but they might just as well allow a dentist to work under certain provisos – such as having to work alongside a colleague or being limited to three days a week. After a time, even this condition might be lifted. Each case is treated on its own merits. The point is to help dentists in trouble stage a recovery, by setting conditions that are helpful and helping them get back to work.
It would, of course, be better all round if someone with a growing drink or drug problem sought help before the GDC got involved. The local GP and Occupational Health are obvious ports of call. The Dentists’ Health Support Programme (DHSP, formerly known as the Sick Dentist Scheme) also has a crucial role. Independent of the GDC, it is run by dentists in recovery themselves and is strictly confidential. That it exists at all is partly an acknowledgement that dentists, particularly in small towns, are unlikely to go to a support group like Alcoholics Anonymous where they may run into their own patients. With regular meetings all over the country, the DHSP aims to overcome that obstacle.
To see ourselves as others see us is a rare quality, so it may well be a colleague who has to persuade a troubled dentist to seek help or quietly contact the DHSP to seek help for them. It will be difficult, but I urge all of you to be vigilant – it is far better to intervene than to stand by while a colleague implodes.
In one tragic case, a dentist became so stressed that he left the surgery after a day’s work, filled a couple of forged prescriptions at two chemists, checked into a hotel and downed the lot. He woke up in his own vomit a day and a half later, realised his family would be worried sick, and decided to drive home – and ended up crashing into a police car as he left the hotel. He was charged with driving under the influence, and then, when the police found out where he had got the drugs, he was charged with that too. How different things might have been had he felt able to seek help or had a colleague intervened.
The Dentists’ Health Support Programme can be contacted confidentially on 020 7224 4671.
Hew Mathewson is a general practitioner in Edinburgh, a special adviser to the MDDUS and a former President of the General Dental Council