High anxiety

Industry discussion – high anxiety among dentists

Suki Singh NHS Confidence Monitor - Industry comments, NHS Dental Landscape Leave a Comment

Suki Singh discusses dentists’ anxiety levels about complaints and litigation with Stephen Hudson and Tony Kilcoyne…

Anxiety among dentists in relation to complaints and litigation is high. For those in the profession, or anyone who has even glimpsed the headlines on this topic in the past year, this statement won’t come as a shock. However, our latest NHS Confidence Monitor Survey of almost 500 dentists revealed another layer of insight into these anxiety levels and differences between those working in the NHS and those in private practice.

For example, when it comes to the risk of litigation when working in NHS dentistry 1% of dentists were not at all anxious, 8% not very anxious, 28% anxious, and 63% very anxious. This is compared to private dentists’ results which revealed that 3% were not at all anxious, 32% not very anxious, 39% anxious, and 26% very anxious.

I asked Stephen Hudson, a dentist who left the NHS and author of ‘The Stressed Dentist’s Guide to Dental Law’, for his thoughts on these statistics and what they suggest about practising dentistry today.

Stephen: ‘Mitigating risk requires time. It takes time to get consent, to write decent notes and to do treatment that actually satisfies yourself and your patient. Most dentists can’t do all that on the NHS and make a decent living. If you do treatment to a high standard this means you do less of it, resulting in the risk that you don’t hit your targets and thus face a clawback.

“Mitigating risk requires time. It takes time to get consent, to write decent notes and to do treatment that actually satisfies yourself and your patient. Most dentists can’t do all that on the NHS and make a decent living.”

‘If something goes wrong with treatment, there is a chance they are going to complain. You can limit the risk of that by being in rapport with patients, but again, that means building a relationship built on trust, and that also takes time. If you are sheep dipping patients to get as many through the door as possible, you won’t be THEIR dentist, you will be just another person they can potentially sue.

Remember, generally, people do not sue dentists they like.

‘The rate of litigation should be lower in private practice because you are (or at least you should be) seeing less patients and spending longer to get the job right. But, conversely, you are charging more which risks higher expectations. It’s also a bigger blow to your budget if you have to refund money.

So I can see why, although lower than NHS, there are still problems with anxiety. In an ideal world, it shouldn’t be that big of a problem though, because how often do things actually go wrong? The risk can be lowered by making sure you only treat people you are in rapport with, that you get good valid consent that warns of all the relevant risks AND perhaps consider calculating the refund rate for treatments and factoring that into the fees charged.’

The survey results around anxiety and the risk of complaints followed a similar pattern to that for litigation. 1% of NHS respondents were not at all anxious, 10% not very anxious, 26% anxious, and 63% very anxious. This is compared to private dentists, of which 4% were not at all anxious, 33% not very anxious, 38% anxious, and 25% very anxious.

I asked Tony Kilcoyne, who works mainly in his own specialist referral practice and teaching centre as well as being a member of the BDA’s Principal Executive Committee, for his own independent thoughts on these figures.

Tony: ‘This latest survey result looking at anxiety are very revealing. These results demonstrate huge differences in anxiety felt between dental practitioners working in NHS systems and privately. Nobody will be surprised that the NHS is reported as worse than working privately at every level, but you may be shocked that so many more colleagues are feeling highly anxious working in the NHS (63%) compared to privately (25%) and over three times more colleagues are feeling little or no anxiety working privately (37%) compared with NHS colleagues exhibiting little or no anxiety (11%).

‘These differences are very significant and must have serious negative implications not only for the wellbeing of the dental workforce in the NHS, but also the qualitative consequences for NHS patients being treated in such high-anxiety-generating systems and stressful processes.

‘Ultimately, dentists are human beings too. We have vulnerabilities and health issues that affect performance and even as independent contractors, there is a ‘higher’ duty of care to both prevent ‘unhealthy’ circumstances for a majority AND acknowledge when concerns are raised by surveys like this, again and again, that high pressures, high targets or high expectations put upon NHS dentists in limiting systems, are unreasonable, unrealistic and unhealthily generating high anxiety.

“Ultimately, dentists are human beings too. We have vulnerabilities and health issues that affect performance”

‘Significantly even in private practice, some colleagues felt anxious (38%) or highly anxious (25%), so why is it that high? Maybe an onerous GDC causing insecurity, a lack of professional confidence in GDC fairness and competence, plus bias encouraging a complaints culture, instead of a resolution culture, is bad for ALL of dentistry and of course, bad for patients too?’

To see the full Confidence Monitor results click here.