Feeling the pressure
There’s huge worry about getting people back to work. There is fear.
Day 63 in the ‘Lockdown House’. If I could enter the diary room, what would I be saying? I’d be missing my friends and patients. Anyone that isn’t my family. Actually, I get stimulation from other intelligent people as we’re working from practice in small teams and I’m doing some work in a UDCC.
I see my wife struggling though. She is solo parenting for a lot of the week as I work. She is not getting her usual exercise or adult interaction and I am a vaguely engaged attendee in our home. I feel sorry for her and struggle to fix it.
I appreciate the struggles others with less space in home and garden must have. Single parents or those alone could be in a really dark place if you’re in anyway a people person.
Why am I not more help? I’m struggling myself. Not with interaction of an adult sort. I am doing clinical work (phone triage) and some NHS redeployment. Three days a week; fair enough. I am trying to keep a practice afloat. The current financial support package in combination with some furlough and the lack of some bills and debt mitigation are working pretty well for us but these are uncertain in their continuity. This takes up almost every waking moment and gives me sleepless nights.
I am trying to plan for the future. This involves a constant round of research. I say research; there isn’t any. It’s just reading opinion pieces based on assumptions of risk, PPE requirements and discussion on what is and isn’t an AGP from various parts of the world. This goes around in circles and I’m not an expert; is anyone at the moment? We get some staging from the CDO which is gazumped by Scottish Government guidance the day later. So, which is accurate? I wasted a day of thinking time, for the staging to be skewed. OK, this time was not all lost but subtle changes so quickly give me headaches. I’m trying to decipher all this opinion, research, staging information and guidance, in order to produce an entirely new and untested workflow for our practice.
I have to communicate all these new processes to both my teams. Everything takes at least twice as long. A phone call, teleconference, Zoom-call or WhatsApp group chat to get anything done. Even then, I can’t be there to check it’s being done the way I want (yip; that’s the ‘micro-manager’ in me). These are skills I didn’t have and arguably still don’t.
I’m trying to ensure we have something akin to a financial plan for the future, but we don’t know what’s going to happen with the existing funding.The Scottish Government package is up for review at the end of June. All indications are that this will continue in some form but not guaranteed. Furlough is extended to October, but there is an onus on employers to contribute more from August.
The recent CDO letter indicates we should be working, in some capacity by the end of July. That will result in increased costs; increased staffing, staff out of furlough, additional PPE, materials, lab costs? But no increase in income. Fees generated will not increase our turnover; just reduce the Scottish Government cost of the COVID top-up. Why move from what we’re doing at the moment to work for less money? Why move up the stages if there is no incentive to do so; in fact, just further increases in costs?
I have a huge worry about getting people back to work. There is fear. What’s the risk to staff and dentists? What’s the risk to patients? What’s the risk from patients? What am I doing to mitigate those risks? Are there associated costs? Do people want to come back? (If someone’s getting 80% of their wage to stay at home with no risk; is 100% worth the risk?) Can I make people come back? What if they’re in a vulnerable group? Will the definition of the vulnerable group expand? (BAME, BMI, Blood type, SIMD category.) If someone can’t work, do I have to make them redundant, with the associated cost? For dentists; why would they do more work for the same money or less? How do I sell a return to work to my people?
All of these things I’m doing alone. At least it feels like that. It feels amplified by the (apparently) satisfactory financial status of colleagues. They don’t have the worry of what is going to happen; they just assume that I’ll take care of it and the Scottish Government or I will provide. I’m feeling the pressure of trying to pull a rabbit out of the hat. Especially when there are so many variables I can’t influence.
To be fair, I appreciate that the virus has not been around long enough to generate evidence. We are all uncertain about what to do and how to do it. I hope for clear, national guidance on what we can and can’t do and the PPE we have to use for each phase. A relevant and flexible financial package that will reflect the differing levels of cost vs income generation in each phase. I hope for some evidence from other parts of the world that are already working to show dentistry is safe for all concerned (or not, as the case may be). Not much of a wish list!
In the meantime, I’m trying not to be collateral damage in all this. My mental state and stress levels are not helping me be at my physical and well rested peak to stave off the inevitable infection (if I haven’t already had it). Roll on a decent antibody test to tell us who’s had it and some evidence of continued immunity to be sure our risk levels are low. We should be comforted by the relatively low serious illness and death rates.
Ultimately, it’s about managing risk and risk of infection. That’s something we’re trained to do. Daily. Very, very, very well.
Arthur Dent is a practising NHS dentist in Scotland
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