Quietly confident

STARTING OUT as a newly qualified dentist isn’t easy and most of us would admit to lacking confidence at some point.

The first confidence knock in your new role can happen for various reasons – perhaps due to a situation beyond your control or, more than likely, when dealing with a difficult patient. But many confidence issues can be dealt with by simply taking a step back and looking closely at situations that fill you with dread.

Team dynamics

On your first day in a new job – whether as a VT, associate or SHO – there are always a barrage of new faces and names that you can never seem to remember. It can take some time to adjust to the different personalities and dynamics of the team and this can be difficult when you are expected to hit the ground running. It can lead to a loss of confidence as, understandably, you don’t want to ‘rock the boat’ or seem pretentious.

For these reasons, you should consider visiting your new place of work at least once (or twice) before starting the post. A casual introduction to staff can help establish a rapport prior to that dreaded ‘first day’ and give you a feel for how you will fit into the established team.

It is also a good idea to have a one-to-one with your trainer/practice-owner and nurse. Make sure you know what your supervisor expects of you and find out if there are certain protocols they would like you to follow. This will build confidence by preparing you for what is to come in the post and avoid potential confrontations due to a lack of communication.

The most important meeting will be with your nurse. Have them show you around your surgery so you can familiarise yourself with where everything is. Also check what materials are available and advise the nurse of what instruments you would like for different procedures. Don’t be afraid to find out how the nurse currently works, and ask (tactfully) if they could change something if you feel it would benefit you and, in turn, patient care. It is beneficial to iron out any potential differences prior to seeing patients, as you will be seen in a more professional light by the team, and give the patients confidence in you as an operator if a procedure appears seamless.

First ‘impressions’

So you’ve visited the practice, pulled on the new tunic, found out how to work the chair and are waiting with baited breath for the first patients. If there was a code in the Statement of Dental Remuneration for “Management of Patients who say: ‘You look awfully young to be a dentist’” it would be worth a small fortune. It is inevitably something we fresh-faced members of the profession will have to deal with until the wrinkles set in.

There is no point in pretending that you have been qualified for years as many of these patients will be used to the continual turnover of VTs. I find the best way to deal with this is to laugh it off and casually remind patients that it takes five years of training to reach this stage and young graduates have the benefit of being trained in the latest techniques. If you address patients in a confident manner, they in turn will gain confidence in you.

After the first impressions are out of the way, the transition to treatment and first ‘impressions’ will occur at a fairly rapid pace. When taking over treatment plans from the previous dentist, the patient will be consciously comparing you with what has gone before. Explaining to the patient the order in which you are about to undertake a procedure will let the patient know what to expect and instil confidence that you are competent with that procedure (even though you may only have performed it a handful of times before). Speaking through a procedure with the patient will also aid your confidence as you will be able to mentally prepare for what is about to come and ensure that you have a sound understanding.

In taking over existing treatment plans, it is essential that you are happy with the proposed treatment in order that you appear confident that the treatment is in the patient’s best interests. Quite simply, if you are not happy with what has been proposed – stop. Obviously the patient will have to engage in informed consent to make any amendments to the plan, but they will more than likely be thankful that you have taken the time to think about their case, resulting in a better relationship between patient and dentist.

When things go wrong

It could be a difficult procedure, a difficult patient, or just a bad day, but at some stage you will have to deal with either clinical or communication problems. This is when your confidence will take the biggest knock. As practitioners in a naturally caring profession, it is difficult to deal with incidents that may not have gone to plan.

As you were taught in dental school, tell the patient straight away. If the subject is approached in a professional clinical manner the patient will hopefully understand. I find if you empathise too much with the patient, they may start to question your ability to perform the procedure.

If you require help from your trainer at this stage, tell the patient that you would like a second opinion from another dentist in the practice, rather than simply saying: “I’m just going to get my trainer to look at this, and then they can tell me how to fix it”. I find if you refer to your ‘trainer’ it appears to the patient as though you require ‘training’, when prior to that they may have seen you in the same light as any other dentist in the practice. When patients start to lose confidence in you, it is difficult to regain that trust and in turn they may become ‘that patient’ who makes your heart sink a little when you look at your day sheet.

Obviously, the best approach to dealing with problems (and subsequent loss of confidence) is to avoid them happening in the first place. If you are performing a procedure which has known risks – e.g. a file fracture during a root canal treatment or a possible pulp exposure when drilling a deep cavity – it is best to warn the patient prior to commencing treatment. This means they will think you are a great dentist if the procedure goes to plan but are prepared for problems if encountered.

However, if there are incidents which occur on a more than occasional basis, it is recommended to look at possible weaknesses in your knowledge. The long summer between sitting the last exam of finals and commencing VT can have a drastic effect on the retention of information that was once so fresh for the vivas.

It is important to keep up-to-date with relevant CPD, and find the motivation to dig out some old textbooks during your career to freshen up on procedures and conditions you may not encounter on a regular basis. Membership of the Faculty of Dental Surgery (MFDS) or Membership of the Joint Dental Faculties (MJDF) exams are ideal for consolidating the knowledge from university with the experience gained from practice.

Work-life balance

An essential aspect of staying confident and motivated in practice is leaving work issues in the workplace. At the end of the day, there are more important things in life than teeth. By maintaining a healthy social life with dentists and ‘non-dentists’ alike and making good use of precious annual leave, you should be able to approach working life in a more confident and relaxed manner. Hopefully, this should enrich your professional experience and encourage good relationships between both patients and staff.

Martin Nimmo is in his second year of longitudinal dental foundation training and is chair of the BDA’s student committee