Incompatibilities

Unless you live in a cave - or had exceeded your rate limit - during the first weekend in July, you will know that during the second men's Ashes test match at Lord's, there was an incident involving one English batsmen being run out - quite legitimately - that evoked a discussion between the rules of the game and the 'spirit of the game'.

For those unaware, the spirit of the game is akin to a moral code - if it doesn't feel right, you should dig deep into your character to decide whether to uphold an appeal (if said batsmen is given out) or to rescind it, recalling them back to the crease. It's all rather archaic and makes no sense, but it got me thinking about this dichotomy between what we have to do and what we should do.

This is why I re-read the latest article in David Rahman's excellent series on putting yourself physically, mentally and emotionally in the best place(s) possible to be the best dentist you can be. In his article, David mentioned one rather innocuous and straightforward sounding tip that was rather reminiscent of the rules vs spirit discussion: 'take breaks'.

Much like the rules of cricket and the spirit of cricket being incompatible, within my network of professional colleagues I'm lucky enough to call friends, as well as the many dentists I speak to on a daily and weekly basis, there's a growing feeling that knowing you need to take a break and actually taking a break are two very different things that are often incompatible. They apply to practice owners and principal dentists - not only do they have to run a business, a skillset that doesn't often come as first nature for a clinician - but they have to deliver dentistry, too. Lunch breaks of one hour become 50 minutes or 45 minutes because they need to keep the business running smoothly or see a patient who is running late. That becomes their norm, their baseline, and as life in the practice evolves, that number continues to dwindle.

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For associates working in multiple practices, is the feeling of 'I've only got two days here' so overriding that they work longer hours and take fewer breaks? Within the network I'm in touch with, it seems to be a growing trend. For those in wider community dental settings, you deal with unpredictable patients at times. If they are in dire need of dental treatment, how often do you treat them over a lunch break, or time when you need to fill out paperwork? You might end up taking that paperwork home and completing it in your own time, thus eroding the rest you both deserve and need.

David alluded to the belief that he thinks 'taking short breaks throughout the day can help dentists to be more productive and think more clearly'. While in theory he is 100% correct, for many working in general practice, they tell me this is little but a pipedream. They barely have the hours in the day to see the patients they have, let alone the unscheduled, unpredictable elements to their day.

As someone who is very keen to stress the value of downtime and rest and recuperation, these approaches are not compatible with mine. Little wonder then that stress and burnout is on the rise. And before you crack the knuckles to write ranty emails to me telling me it's the system - of course I know that. The above individuals know all of that. You probably know that. And yet, a duty of care to the patient - even when it is detrimental to yourself - is the leading reason many give as to why they eek into their lunch hour, start the day 20 minutes early, end it 30 minutes late or take admin home with them.

For too long, NHS dentistry has relied upon the goodwill of practitioners to make up for the shortcoming in their system. I am not advocating you drop your mirror and scaler at 5.31pm screaming 'see ya later suckers!' to patients waiting in reception as your day has overrun - but there has to be a better balance. Make sure you take that break, and take every minute you're allowed. You cannot perform dentistry to your highest level if you do not recharge your battery is a mantra we discuss in this issue's cover feature, too.

The systems and structures within our profession need overhaul and are incompatible with a positive working environment - those are obvious - but be in control over what you are in control of. It will help you, and most importantly, your patients. ◆