Catherine Rutland speaks to Mahrukh Khwaja about working with dental professionals on enhancing the wellbeing of the profession.
Never has mental health and wellbeing been higher on the agenda. A member survey from Denplan, part of Simplyhealth, showed 42% saw mental health and wellbeing as the most significant challenges facing the dental sector in the coming year (non-COVID-related). Figures also show that burnout in UK general dental practitioners is as high as 30% (Toon et al, 2019).
As a practising dentist of more than 11 years and a positive psychologist, Dr Mahrukh Khwaja knows the challenges and impact mental illness can have. Her passion has always been psychology and wellbeing with a key focus on resilience. She founded Mind Ninja two years ago.
Catherine Rutland (CR): Why did you found Mind Ninja?
Mahrukh Khwaja (MK): I experienced both burnout and depression during my career. This led to my own personal development journey. I upskilled with a masters in positive psychology, as well as becoming an accredited mindfulness teacher.
Positive psychology is the science of what makes individuals and organisations thrive. It helps us invite more positive emotions, focus on strengths and really boost our purpose and emotional wellness.
When I looked at different interventions targeting clinician mental health, I discovered that there were no programmes that were preventive in dentistry. This led me to found Mind Ninja – supporting the industry to fly the preventive flag for our wellbeing.
CR: Your work started with dental students. What is your experience working with our future dental generation?
MK: Last year, I did several resilience and wellbeing workshops with universities, including King’s College and Barts. It was amazing connecting with students and touching on topics that we don’t focus on in the wellbeing conversation: social comparisons, imposter syndrome and the impact of social media.
I hope in the next few years we can embed resilience training in the undergraduate curriculum and focus on clinician wellbeing. It is paramount when we look at research into burnout. It often starts at undergraduate level and it seems really bizarre not to support our profession early-on before crisis point and give them tools on prevention, so they can thrive and flourish.
CR: What is burnout and how does it manifest in the dental profession?
MK: It is a topic that is really important right now, but was also very much there before the pandemic. Many don’t know what it is and may get to crisis point before picking up the warning signs and symptoms.
There are three components of burnout:
- Emotional exhaustion; you are severely emotionally drained and this isn’t something you can fix by going on holiday – it’s a big drain on emotions
- A lack of personal achievement – you may go to work and feel what is the point or that patients don’t value you
- De-personalisation. This is really when we view our patients almost as objects. It is a really big component of burnout – we lose our prime skill of empathy. We can’t connect with our patients and this is exactly why burnout is so troubling.
Burnouts impact our thoughts, how we feel and, of course, our actions. In terms of our behaviour, we withdraw, we may take time off and we might even go into work but are unable to function as normal. It has a really big impact when it comes to our lives.
It’s key to remember that burnout is not caused by a flaw in you – it is an occupational hazard and some researchers think that morale injury may be a better term.
CR: In my career, I learnt that losing empathy is almost your guard point for your professional care level. The danger of that is that you start to lose that point of realising if you’re working in the best interest of your patient and that is a dangerous place from a professional viewpoint to be. What is compassion fatigue and how does it present itself?
MK: Compassion fatigue is an extension of burnout and is considered more serious. Both this and burnout are occupational hazards as a dental care professional, meaning that we are more likely to experience this.
In compassion fatigue, we are literally absorbing our patients’ pain. As dental care professionals we are treating our patients who may be going through depression, divorce, may have had an accident, severe loss, house move – tremendous highs and lows. Many of us are compassionate people and very empathetic and, of course, we want to connect to our patients and we can take on our patients’ suffering. Signs include emotional exhaustion and feeling cynical about work. With compassion fatigue you get the same signs as burnout but you also might experience symptoms akin to post-traumatic stress disorder (PTSD), including flashbacks and being very alert.
CR: What positive and preventive steps can we take to tackle some of these issues?
MK: We can all shift our mindset more towards a growth mindset. We all have the capacity to teach our brain to learn and grow. What is amazing is that we can adapt our brain to our habits and can train it towards more positivity.
Self-compassion training is very topical at the moment. To break it down, it means really offering yourself love and kindness when you are suffering. Ways to talk to yourself in the way you’d talk to a best friend offering comfort and that is very important.
I’d say to explore Dr Kristin Neff’s work about self-compassion, which I break down in my training in more detail. She describes three key components. One is mindfulness, which means if you go through things like stress from the day, a patient complaint or other issue then it leans into exactly what is happening and labelling those emotions and thoughts but without judgement. Just letting it be and making room rather than resisting it and getting lost in the story. Being self-critical in that moment isn’t going to help you and motivate you. It will make you feel bad and may even make you avoid doing crown preps.
The second is leaning into common humanity. Reminding yourself that we all suffer and experience these negative thoughts. We are not alone, which can be soothing in itself.
Thirdly, it can be offering ourselves words of kindness. Even: ‘I’m sorry you’re going through this. I am here for you and going to help you get through this situation’. It might be to offer ourselves warmth and a soothing touch. While with a patient, if you’re experiencing these thoughts, you can squeeze your hand or your arm and things we know how to do with a friend – but do them to yourself and you’ll be so surprised how effective these practices can be. There are other tools, but these are big ones, which I look at with teams in more detail.
CR: How do you practise what you preach?
MK: I practise being mindful, incorporating it into my work routine. I take a few deep breaths as I’m curing my composite. Even in moments like making tea, I try to savour that moment – drink that tea and savour every aspect of it. Training our muscles to be present is so important, as so many of us feel very rushed, tired and exhausted. Slowing down and having those moments is really nourishing.
CR: Besides your work with students, what is your next focus to help the profession in the future? Has the pandemic changed some of the stigma around mental health issues?
MK: The pandemic has helped the stigma around this whole topic. All of us have thought about our wellbeing and how to boost it over the past 18 months especially. It has been a tough time and we have all gone through grieving of some sort of loss. We are now all on some sort of plain level field.
I’m really excited to bring self-compassion training to dental practices more. While I’m keen to return to face-to-face training next year, I’m creating an online platform, so I can help practices more virtually, as they are still stretched for time fitting in development with busy appointment books.
I’d love to see some more research that can move the conversation on in terms of interventions and solutions for dentistry. We know there is a problem, and funding is crucial to research which intervention is best. Self-compassion and being mindful is not just about reducing stress and anxiety; it can increase our happiness, optimism, help us to thrive and flourish. You can do it anywhere as part of your life, which is why I love it.
This interview is from Denplan’s series of podcasts. To listen to Denplan’s ‘The Dental Podcast’ with Dr Mahrukh Khwaja, visit www.denplan.co.uk/dentists/denplan-dental-podcast-and-webinars.
To find out more about Mind Ninja, visit www.mind-ninja.co.uk.
This article was commissioned for Dentistry magazine. Read the latest issue of Dentistry magazine here.