I felt guilt, at home, conducting virtual clinics
A return to work in-person with colleagues and patients will inevitably be different, but welcome
Do I like working from home? I can’t say I do, beyond the lack of commuting. Despite putting in my hours on the computer and phone, I am left feeling inefficient and ineffective. Let ‘normal’, and the resumption of clinics, return please. Yet I know that is still far off and the ‘return’ will be very different.
My current daily routine? Morning exercise, then log-on to my computer, emails, and some pre-arranged video calls with patients targeting three messages; oral health, avoid breakages, and refer to the British Orthodontic Society (BOS) website for home-help videos. Plus, reassurance that we are still here to answer concerns and deal with any unresolved problems.
Clinical work includes phone triaging of patients with problems, being on-call as a consultant for the Urgent Dental Care Centre and managing patients in treatment via phone calls and video calls. This works well for discussion and getting an idea of the problems patients are experiencing, but is less useful for seeing details of the teeth as the image can be very pixelated. It’s often challenging for patients and/or parents, despite watching BOS guidance on virtual consultations.
I am normally based in a large district general hospital, with two other consultant orthodontists, four maxillofacial surgeons and a restorative consultant. We work across two main sites on a weekly basis and monthly at a third site. In anticipation of the pending lockdown, we agreed with our oral and maxillofacial surgery colleagues to reduce footfall of our clinics by cancelling non-priority patients and prioritising post-surgery and ‘de-bond’ patients.
Establishing remote access became the next priority but, as luck would have it, early adoption of electronic patient records, which went live at beginning of January, made this significantly easier. I was impressed by how quickly systems were able to adapt to change, with our IT and information governance teams providing vital support. In turn, the public has been very understanding and people have taken to remote consultations.
With the excellent coordination of our region’s Director of Dentistry and his team, integration with Public Dental Service, GDPs and specialist practice colleagues in dealing with emergencies in UDCs has been very rapid and smooth. A great achievement and it demonstrates the model team working attitude of the profession that this crisis has thrown up.
But I also felt an element of guilt; that support staff who were not shielding, taken sick, or were on leave, were deployed to areas of the hospital with which they were unfamiliar. While they were often the lowest paid, their shifts increased. As consultants, we were at home, working on policies, protocols, and conducting virtual clinics. Offers to be redeployed simply never came to us, and that seems to have been the case for other regions.
In between virtual consultations and keeping abreast of almost daily reports on policy, opinion, and science, I am teaching remotely, keeping in touch with trainees, and writing questions for the Member of the Faculty of Dental Surgery exam. Messages from friends and colleagues are a welcome distraction; communication, supporting one another, and maintaining a sense of humour is vital for mental well-being at this time.
We are also discussing a plan for returning to work at the hospital. With so much uncertainty, initial drafts can feel like a waste of effort. But we are drawing on the evidence from other countries where dentistry has reopened or is starting to reopen. Priority will be de-bonds and patients in treatment, particularly those who have had problems during lockdown. Treatment starts will be delayed, where appropriate, and new patient consultations will be limited.
A clear challenge is the availability of clinical space in order to maintain social distancing, and the need to reduce footfall in waiting areas. This will mean dispersing our service to satellite sites. Inevitably, fewer patients will be seen; waiting times and lists will increase. We will aim to see all patients currently in treatment as soon as possible and finish that treatment. Patients in retention will be seen remotely and discharged where appropriate.
Another is the ‘fit-testing’ of masks and general lack of PPE. We need
to understand and have clear, evidence-based, guidance on proper PPE for orthodontic procedures and not just what stock is available when we return to face-to-face clinics. This is not only for the protection of patients and us, but also to provide much needed confidence generally. Currently, nursing and auxiliary staff on the front line do not have confidence that what they have been told to wear is protecting them.
Looking ahead, I envisage greater use of virtual clinics, with initial consultations – history taking, discussion of treatments, and consent – being done remotely where possible. There will be an increase in clinical administration and professional support being delivered from home and an even greater use of remote teaching and learning. Examinations also could be delivered remotely. Crucially, we will have better contingency planning.
Externally, there is a need to recognise dentistry’s unusual funding structure; that NHS-funded practices will require increased support and that, conversely, if some patients can choose to manage their oral health outside the NHS then that option is no less valid. Currently, the promotion of oral health is funded by industry; it should be a core part of public health policy.
Put the mouth back into the body!
Lucy Chung is a Consultant Orthodontist for NHS Ayrshire and Arran and Honorary Clinical Senior Lecturer at Glasgow University.
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