The number of dentists in the country suffering from anxiety and stress is soaring according to a new report from the BDA. Here, Scottish Dental magazine examines the issue and talks to professionals tackling the problem
It’s 6.45 am and Stuart’s day is getting off to its normal start. Or so it appears. He sorts out some clothes and heads for the bathroom, already turning over in his mind the case files he reviewed the previous evening in preparation for the usual stressful day ahead. He begins to think through a particularly challenging procedure that he knows is scheduled for 11.30 am. Not only is the work difficult, the patient is, frankly, a bit of a nightmare. If he’s late getting started, she’ll create merry hell. He heads for the shower.
Suddenly, under the torrent of hot water that should briefly calm his already anxious thoughts, something in his head says: “I can’t take any more of this”. Stuart begins to shake. He can’t get out the shower and now he is beginning to weep; and he can’t stop. Through the sobs, he keeps asking himself: “what’s happening to me?”
Concerned about her husband’s non-appearance at breakfast, Stuart’s wife pushes into the bathroom to find her husband crumpled on the floor of the shower. Frightened, she helps him out the cubicle and into the bedroom. What on earth has happened to this strong, confident, professional man she has known so long? The answer, as quickly becomes apparent, is that he’s having a breakdown; not a word now used by professionals – it’s “anxiety and depression” – but it amounts to the same thing. And no-one, not even Stuart, saw it coming.
Whether that’s with a friend, partner, colleague or GP, the crucial thing is not to keep it bottled up – share it
Dr Robert Broadfoot
Stuart’s story is far from being an isolated one. There are dozens of others around the country who have either been over, or are standing far too close to the edge. Today, he is back at work. But it took a spell in a clinic and six months out of the practice, thankfully supported by his colleagues, to recover. Now, through Scottish Dental and with his name changed – the stigma of mental illness continues to run deep – he is happy to talk about his experiences in order to support others who are in danger of following in his painful footsteps. His story is now particularly apposite in light of the evidence from a new BDA report that has highlighted worryingly high levels of stress and poor wellbeing within the profession throughout the country.
The survey, carried out in 2014 by a team from the BDA, surveyed two groups of dentists, those working in the community and a wide selection of GDPs.
Frighteningly, almost 60 per cent of GDPs said that they were experiencing high levels of anxiety. The figure was not much lower among community dentists of whom 55 per cent said they were suffering similar anxiety and stress levels.
As with community dentists, almost half of the GDPs (47 per cent) reported low levels of life satisfaction, with 44 per cent reporting low levels of happiness.
The problem is not regional specific and it’s well known that dentists in Scotland are suffering similar levels of stress and anxiety to their counterparts south of the border.
If there is one thing Dr Robert Broadfoot understands about stress in the dental profession, it’s that it can hit any practitioner, at any time – and that the consequences can be severe.
Dr Broadfoot spent 20 years as a practising dentist in Ayrshire before becoming involved in vocational training (VT) and teaching at the Glasgow Dental School. He then worked with Ayrshire and Arran Health Board as a dental adviser, doing an MBA in Healthcare Management in the process, before becoming Director of the Primary Dental Care Trust at Gartnavel General Hospital in Glasgow in 2001.
“I loved that job, it was a very fulfilling and satisfying role, and we did lots of innovative preventive work with children in Glasgow,” says Dr Broadfoot.
“But then the NHS went through one of its periodic reorganisations, and the Primary Care Trust became the Primary Care Division of NHS Greater Glasgow. My role changed, a new manager came in, and I didn’t feel on top of the situation, so I took some time out. I had never felt stressed in my entire career, but I didn’t know how to deal with this, and I ended up taking early retirement at the age of 59.”
That experience, along with the insights he had built up through his VT work with young dentists, motivated Dr Broadfoot to undertake a diploma in stress management, after which he set up his own consulting service aimed primarily at GDPs and VDPs.
“I was already conscious of the implications of stress through my VT work,” says Dr Broadfoot.
“But suddenly this was happening to me. I was a confident dentist, I had run a successful practice, I had my MBA, and I still got stressed. It came home to me that this could happen to anyone, at any point in their careers, and I thought I could do something to help other dentists.”
After gaining his diploma, Dr Broadfoot started lecturing, giving talks and contributing to postgraduate courses on the subject of stress, as well as working as a part-time associate dento-legal adviser with Dental Protection.
“I realised dentists don’t get sufficient training in these areas,” he says. “They might have the clinical knowledge, but less experience in dealing with difficult patients, colleagues, or with the business or human resources sides of running a practice.
“They are also having to cope with more and more bureaucratic demands, as well as increasingly unrealistic patient expectations about achieving the perfect Hollywood smile – and their likelihood of taking legal action when those expectations aren’t met. For dentists without adequate support within their practice, this can all be overwhelming and leave them feeling stressed and isolated.”
Dr Broadfoot can laugh now about his own Friday night routine after a demanding week in the practice, sitting by himself at home in a darkened room listening to music to decompress.
“My daughter would say to her pals who were visiting: ‘Don’t worry, dad’s just having his nervous breakdown, he does it every Friday!’ But it was my way of unwinding. I found during VT that some young dentists were struggling already and weren’t able to switch off. I’d say to them: ‘Don’t let it all be about dentistry – find what works for you to help you unwind.’”
The danger for many stressed dentists, however, is that instead of seeking a healthy outlet for their stress, they start to rely on alcohol or drugs to numb them from their issues. But that can only serve to make the situation even worse.
“Self-medicating or turning to drink is another form of self-denial about the source of the problem, when what stressed dentists need to do is to talk to somebody about the underlying issue,” says Dr Broadfoot. “Whether that’s with a friend, partner, colleague or GP, the crucial thing is not to keep it bottled up – share it.”
Dr Broadfoot also worries about the isolation of many dentists, working in single-handed practices and spending all day every day in that same room. Unlike for doctors, there is no annual appraisal for dentists in Scotland where potential issues could be flagged up. Even CPD obligations can be completed online, increasing the likelihood of isolation.
“One of the benefits of appraisal is that you’re at least having face-to-face contact, and if you’re struggling it will come out and any issues can be addressed,” says Dr Broadfoot.
“Even in their CPD, dentists can deliberately stay under the radar, tick the right boxes, and nobody can tell if there’s something wrong. We need to move towards a better system where dentists have a regular appraisal. If they keep their problems quiet, the danger is that they snowball and make the issue even worse. It’s time to change that.”
Without any official statistics or surveys about the severity of the problem in Scotland, Dr Broadfoot can only rely on his own experience to gauge that it’s an issue that is more widespread than we might like to acknowledge.
“Demand for services such as the one I’ve been offering has been going up, but at the age of 67 I’m stepping back,” he says. “Now I’d like to see dental teams, including practice managers, taking on more responsibility in looking after the mental health and wellbeing of their colleagues. I am happy to help any dental practice team interested in developing this role.”
About the authors
- Richard Goslan is the senior writer on the team at Connect.
- David Cameron is managing editor of Scottish Dental magazine.