Mental Health in Dentistry – PDP185

Protrusive Dental Podcast

We need to talk about the ‘S’ word and our mental health.

I never, EVER want to lose a colleague again due to the pressures within Dentistry.

This is why I interviewed Dr Mahrukh Khwaja, a positive psychologist and Dentist, to help us with strategies to improve our mental health.

Why is it that we have so many support channels during a crisis, but no structured pathways to help us AVOID burnout, crisis and stress in Dentistry?

https://youtu.be/3JKwoO_nEeo

Watch PDP185 on Youtube

Protrusive Dental Pearl: What are you doing on a daily, weekly and monthly basis to look after your Mental Health? Do not wait until a crisis, as we already know that prevention is better than the cure.

Take the first steps in looking after your mental health with Mahrukh and her Mind Flossing Toolkit

Buy Mahrukh’s new Book on Resilience and Well-being for Dental Professionals

Need to Read it? Check out the Full Episode Transcript below!

Highlights of this Episode:
3:01 Protrusive Dental Pearl
4:22 Dr. Mahrukh Khwaja Introduction
7:34 Seeking Professional Help
12:10 Helping Dental Professionals
17:08 Suicide Issue within Dentistry
20:02 Reducing Suicidal and Burnout Rate
24:24 Inner Voice
29:51 Cognitive Reframing
36:31 Toxic Work Cultures
42:24 Signs to Look Out For
49:30 Learn more from Mind Ninja

If you liked this episode, you will also enjoy IC036 – The Secrets to Finding a Passion in Dentistry

Click below for full episode transcript:

Jaz's Introduction: April was Mental Health Month on Protrusive Dental Podcast. And you're thinking, wait, hang on a minute, Jaz. We're in May. Why are you telling us about April? Well, I had a stressful month myself, actually, my youngest son was on and off sick and like nothing too serious, thankfully. Like it was antibiotics.

Jaz’s Introduction:
It was tonsillitis. It was a couple of bugs. It was a night in A&E. And it really made me grateful in a way, in the sense that look, yes, my son was sick and I hated it and I felt really bad for him. And it can take your toll when your children are not sleeping very well. But it really made me feel bad for parents who had children with chronic illnesses, think, I don’t know, leukemia, or parents with children who have severe learning disabilities, and having to care for those children, it really takes its toll on a parent.

Or someone maybe with a child’s got cleft lip and palate, feeding issues. Or of course Nafisa, the little girl in Tanzania that we’re supporting, which Protrusive are supporting as a charity to help her raise money to fight her SMA type 1 so she can get genetic therapy. If you’ve been reading my emails, I put a donation link there and we’re pretty much there to raising enough money to help this little girl.

But anyway, going back on topic, it’s been a stressful month, which is why this episode has spilled over into May. A few years ago, I probably would have been stressing about this, like, oh my god, it was supposed to be out in April and that would have eaten me alive. But my mindset has shifted a bit.

It’s a silly little story, actually, in terms of this mindset shift. Okay, the story goes that my son was on a playdate. It was like an early afternoon thing. And children nowadays, they have better social lives than their parents. So after this playdate, he had a birthday party to go to. So we were driving my son to the birthday party and we were really late.

Like we spent too much time on the playdate and we were really late for the birthday party he had to go to. I hate, I absolutely hate running late. So, I was in a stressed state. If you ask me then, Jaz, how do you feel? I’m like, oh my god, I’m so stressed, we’re late, Ishaan’s gonna miss everything, the cake cutting, everything, he’s gonna miss it, this is so stressful, and of course, two kids in the car, and that can get sometimes quite stressful.

So, I reached the birthday party, and yes, he just about made it for the cake cutting, but he kind of missed the fun part, and as I was going home, I met one of the parents, Lorenzo, and he said to me, oh Jaz, how are you doing? How come you guys were late? And I said to him, Oh, you know what? I had a really stressful journey here.

We got carried away at play day and oh man, I really hate running late. And Lorenzo, he just looked to me. And he’s like really nice guy. Someone who you just think is just like always calm and happy, happy go lucky. And he looked at me and he smiled and he said, Don’t stress. That’s it.

That’s all he said. He looked at me like what are you stressing for? That doesn’t sound stressful at all. And that little moment just put things into perspective for me. It reminded me that stress is almost like a choice. Like it’s like we choose to stress. And I’m sorry if I’ve repeated the story and I’ve told you the story before and it’s not even like a major life event, but it was a helpful reminder. Don’t stress.

Easier said than done, but I took it on board and that’s why I chose to not to stress about the fact that this episode is late because I know you guys are a forgiving bunch and you guys are the nicest and geekiest dentists in the world so I know you guys will forgive me.

Dental Pearl
And this episode with Dr. Mahrukh Khwaja will more than make up for it. It’s a really big one discussing all things to do with mental health. in dentistry and the biggest takeaway I can give you and really the Protrusive Dental Pearl for this episode is to really ask yourself, what are you doing to look after your mental health?

Now we know we should be looking after our physical health, like that’s been drummed into us, and we know that mental health services do exist in dentistry, when we reach crisis mode. So when there is a crisis, then there are these phone numbers we can call, for example, ConfiDental, and people we can reach out to when we’re really in crisis mode.

But why are we waiting for the crisis to happen before we choose to look after our mental health? So I’m hoping this episode will give you some ideas of things to do, but really, you need to really ask yourself, as well as your physical health, what are you doing on a daily, on a weekly, on a monthly basis to look after your mental health and those around you?

That could be your family, that could be your spouse, that could be even your teammates, your work colleagues. And one of the things that this episode focuses on is looking out for our colleagues. Like, I do not want to ever lose someone again from suicide. Like, I’m so sorry for using the S word, but it’s a theme we do cover in this episode.

Because it is getting too much. It is absolutely tragic that there are so many dentists that we all know of, who have lost lives in this way. So if there’s one contribution this episode has, is that if we can start recognizing these signs or self help, maybe if you’re in a dark place, I want you to really take something away from this episode to look after your mental health. And if there’s any way I can ever help, I’m just a DM away. And anyone in our community is just a message away.

So hello, Protruserati. I’m Jaz Gulati. And let’s listen to what Dr. Mahrukh Khwaja has to say. Dr. Mahrukh Khwaja, welcome to the Protrusive Dental Podcast. How are you?

[Mahrukh]
I’m really good. Thank you so much for having me on.

[Jaz]
It’s been great to see your growth over the last few years. And for obviously I’m gonna get you to introduce yourself, but the way I see you as someone who is there to uplift people, to help people, not only in this time of difficulty, but to show up as their best and this whole thing about building resilience is what the vibes I get from you.

And obviously you’re behind mind ninja and we’ll talk about that. So just tell us, how did you get into this space? Cause you’re still a clinical dentist a few days a week, but you’re pivoting, you’re helping the profession in a different way. How did you get into it? And what qualifies you to speak about these kinds of things as a dentist?

[Mahrukh]
Yeah, I mean, that’s a really great question and a great place to start. So I graduated back in 2010 from King’s and prior to that, I didn’t really have any mental health challenges, but it got to around 2014, 15. I was in a marriage that wasn’t going very well. I was going through a divorce that was unexpected.

And that was my first period of experiencing depression and burnout. And I was really fortunate, actually, that I didn’t feel any sense of taboo in seeking a therapist. So my first port of call was, okay, I feel emotionally unable to manage this. I’m noticing a rollercoaster of emotions, finding it a lot more difficult to focus. And I’m just losing my sense of meaning. Like I don’t have that sense of purpose anymore. And so-

[Jaz]
Is this something that you think was palpable for your nurse, palpable for those who are around you in the work environment?

[Mahrukh]
I think it’s quite easy to hide, to be honest. So I don’t think people did notice that I was perhaps more withdrawn, but I don’t think it was massively noticeable otherwise. It was just something that I really felt in myself that I was really struggling to make sense of my why. If you don’t have that, you don’t have well-being and that’s a horrible kind of place to be.

You’ve got a bunch of negative emotions and also you’re constantly either fast forwarding into the future, which feels like a really anxious place, or you’re time travelling to the past, and you’re ruminating about sorts, and chewing over events.

And so, your mind is just so busy with all this chatter. So it was a really difficult space to be comfortable with who I was. And like I said, prior to that, I’m a really sociable person. I have a lot of positive emotions I experience. I’m very grateful. And so it was quite jarring, to be honest, and then also not knowing what to do.

I had friends, I had family to fall back on, but that’s not enough. And so for me, it was, okay, what can I do? Which professional can help me? And in my head, it was like, okay, I’m going to go see a psychotherapist. And I didn’t go via the NHS route. I actually went privately because I wanted to be seen ASAP. So I booked my sessions.

[Jaz]
Can I just stop you there? And I hate to interject, but I think I want to pick apart some things there. So it’s great that you had this amazing self awareness, which I wish upon anyone. So that’s amazing that you had that, I think, and to seek out the right type of professional and to actually go for it.

What advice would you give to someone who’s perhaps feels like it is a taboo to seek advice for this kind of stuff, who might be embarrassed or in denial. I’m sure you’ll probably mention it actually, but a lot of people may think that I should get, even maybe taking a step back, if you don’t mind me asking, please, if you want to reject this question, you can do, like, when you were having a difficult time in your relationship, did you consider, did you have relationship sort of counselling and that kind of stuff?

[Mahrukh]
Yeah, so actually, I wanted to, my first port of call with the marriage was to get relationship therapy and counselling, but my partner didn’t want it, so if your partner doesn’t want therapy, it’s just not gonna happen, right? So, that wasn’t on the table for me. Yes, you’re right, there is a big, big taboo. And the way I like to think about it is, look, if we’ve got a physical problem with our physical body, we’ve got pain somewhere on our leg, we might see physical back pain, therapist, back pain.

[Jaz]
The common one.

[Mahrukh]
Exactly. That’s a really common one. We might go see a doctor if we notice physio, dizzy, et cetera. Yeah. So we’re gonna see a professional for a physical health, it’s the same thing with our mental wellbeing and mental health. I think we need to normalize that it’s okay to seek a professional. And the way I think about it is they’re ones who, these professionals actually have the psychological tools, they’ve got the tools and strategies that can help you thrive.

Help you get to a place of not only, not feeling depressed and feeling less anxious, but actually going beyond that, feeling a bit more resilient, getting back to those happiness levels. And they’ve got those tools and strategies, so why not actually seek them? And actually, it’s not just benefiting you, of course, it’s got this beautiful 360 degree benefit where you’re actually helping your children, you’re helping your relationships, you’re helping your work colleagues with that knowledge, and you can pass those on.

And in fact, I really feel that the tools that we learn in therapy need to be accessible to all of us, because of course, not everyone can afford therapy. But if we make it accessible to children, for example, at school level, or through our undergraduate curriculum or postgraduate training, which is essentially why I created Mind Ninja in the first place.

It’s those tools that we kind of leave at crisis point. Well, why don’t we actually gain access to them much earlier on? They’re so much easier to work through in that period. When you’re feeling more content than when you are depressed or anxious or suicidal, right? It’s much harder to learn a skill of mindfulness when you’ve got suicidal thoughts in your mind, right?

[Jaz]
The way I see this mark, and I love what you’re saying, is I mean recently it’s been last 4 months I’ve been using an app called Balance for meditation. Absolutely in love with it. I bought the lifetime subscription and it’s just five minutes a day and something I have never done before meditation. I’ve started to do it now and you get to select your goals.

And I selected, yeah, reduce stress. And it keeps mentioning to me, okay, I know you want to reduce stress. Let’s do this today. It’s helped me massively because things can get very stressful in life as a father, as a businessman, a dentist, that kind of stuff. So it can get very stressful. And this has helped me.

And so I’m really glad I discovered this and I took this plunge and I step into it because I like to work out. I like to do my physical health and that’s look after looking after my physical health, but you’re totally right. What are we doing on a daily and weekly basis to look after our mental health?

Maybe I could be doing a bit more for spiritual health, but I feel like the meditation overlaps that and that’s an area that I have neglected. But I think just as much as looking after your physical health, mental health, especially for what we do as dentists, it’s so important and I completely resonate with everything you’re saying, I think.

[Mahrukh]
Yeah, absolutely. I think it’s so, so crucial. It’s taking those small actions. And as you know, it has massive compounding effects. So over time that meditation habit that you’re building is going to grow and it’s going to help you increase your sense of focus. And it’s not just about stress when it comes to meditation.

So it’s focused, feeling more engaged with your life, more connected to others, this skill of even mindfully listening to our patients and our loved ones and being present. This is a skill that is slowly being demolished with social media, attention spans are so different where they used to be.

So there’s so many benefits and it’s that simple when we ensure that the exhale is slightly longer than the inhale, that triggers the parasympathetic nervous system and invites this massive host of potential positive emotions. Things like gratitude, curiosity, self compassion. These are really important in not only kind of buffering those stresses, but it’s also helping us feel more engaged and having that sense of meaning and purpose.

[Jaz]
So with what you’re doing now with your sort of newfound purpose and all the wonderful things you do, how did that snowball into what you’ve become now? And what is your mission in terms of how you want to achieve to be able to help as many dental professionals as possible? And maybe just generally people.

[Mahrukh]
Yeah, absolutely. After that period when I was going through depression and I had therapy, I discovered these gorgeous psychological tools, and I started thinking more about dentistry and how bizarre it was that yes, there were crisis point services set up, we’ve got ConfiDental, we’ve got NHS Practitioners Health Support, we’ve got all of these amazing charities, but there just is zero conversation around clinician well-being, and it’s mad.

From my perspective, this makes no sense. As a dentist, we’re taught as a student that prevention is better than cure, right? So why don’t we answer the same problem, this burnout problem, the suicide problem, but flip it around and actually just give clinicians tools early on. So that’s part of it, part of resolving the stats.

Of course, it’s not everything, but it is a big part. Also, organizational culture is a big part. Those are the two really big factors when it comes to those stats, right? And that led me to kind of upskilling. So I had actually done a Psychology BSC as a dental student. So I integrated in psych. I’ve always been interested in psych, interested in what makes people tick, why people do certain things.

And so that led me to then find positive psychology. So this is a specific branch of psychology that actually focuses on what makes people and organizations flourish. So we’re talking about resilience, we’re talking about growth mindset, we’re talking about strengths. happiness, positive emotions, productivity, all of those aspects.

And so I ended up doing a master’s, which I absolutely loved. And then I trained up as a mindfulness teacher and I’m currently doing a diploma in organizational psych. And so the mission was set up, or I founded Mind Ninja back in 2019 as a result of just being frustrated by the lack of preventative tools and wanting to come up with a solution.

So I paired up neuroscience with mindfulness and positive psych. It felt like it needed to have a very science based grounding that resonates with me and resonates with, I think, dental professionals, which is my niche. And the mission really was, is to help dental professionals across the globe lead happy and healthier lives.

And I do this in various ways. I do workshops and programs and products. And I have actually, since last year, thought about broadening out to other niches, like medical professionals, as well as the general public. And I created a mindfulness toolkit for the general public last year. So I’m thinking of some other ways I can help organizations. So, yeah, that’s really exciting kind of mission.

[Jaz]
It’s something I mentioned a lot on the podcast, but you can’t connect the dots looking forward. You can only connect them looking back. And with your psychology, it kind of all makes sense. I love this bit of the journey when I speak to my guests about, okay, why did this person get fascinated with removal pros. Why did this person get fascinated with this element of dentistry?

And obviously what you’ve done is it is outside dentistry, but you’re connecting it. You’re bringing it all together, which I love. Now, sorry to pivot in a sadder and darker trajectory. And I’m just publicly thanking you in advance for trying to tackle this thing, which I think about a lot, Mahrukh, it really worries me, not for myself.

But for the people we’ve lost along the way for mentors, for friends and stuff, and it is really hurtful, and if this episode from our, even this, five minutes of chat on this topic before I move on to the other topics, can help a few people, then I think it served its purpose, and it is the thing about suicide, like, when I was applying to dental school, you read about dentistry, there was Google back then, and so, as well as knowing how much a dentist earns, you also read a few other things, and then one of the things you read about is actually, dentistry has got, or did at that point, had the highest suicidal rate, i heard veterinary sciences as higher, and all these things, basically.

Well, now that I’m a dentist, now that we’re in this space, we kind of see, okay, yeah, you know what, it’s a very stressful job. Lots of expectations we need to meet and lots of pressures that you put ourselves both financial hitting targets, that kind of stuff. And maybe even like, there’s an element of keeping up with the Joneses.

And like, oh yeah, I’m a dentist. I need to be driving a nice car and that itself could be an issue. And then patient complaints. Like you had this horrible experience with a relationship and you had the resilience and the self awareness to seek help, but there are so many dentists out there who last week, last month, we got this dreaded letter and they are in crisis mode.

And some of these people reach out to me and they use the S word and whatnot. And I tried to reach out and one of the reasons I want to record with you is, okay, how can I lead them to help? Okay. And then, yeah, there are lots of these crisis things, but I want to talk about prevention as well, like what you could do daily so that when that complaint happens, right, come on guys, we’re going to, it’s going to happen, right?

Let’s take [inaudible]. When it happens, we can deal with it in a much better frame. So what do you think, based on helping certain people with just their mind, their well being, mental well being, and your experiences as a dentist, why do you think there is an issue of suicide within dentistry? Why do we hear about it now and again? It sends us chills down our spines.

[Mahrukh]
It’s all the factors that you’ve mentioned and looking at the research that completely supports it. So you’ve got organizational factors. So the kind of workplace you’re at, is it toxic place? Is there bullying? Is there instability?

And that seems to be quite commonplace because actually, dental principals maybe don’t have training in management. They’re not really aware of how to create the right culture, right? So you’ve got the organizational side. And in that, that might be even how the UDA contract is, how it is currently in its format, if you’re working in the NHS, you’ve also got patient factors.

So you’ve got high demanding cases, difficult cases, you’ve got anxious patients, that’s really common. You might get aggressive patients. You might get complex, compassionate care challenges. If we see patients regularly every three months, we’re going to see our patients going through divorces, going through bereavements, going through mental health challenges, and that’s tough as well.

So you’ve got all of those factors, as well as the actual personality factors of the individual, right? So a lot of us might have a type A personality, so high levels of perfectionism, and often that’s associated with things like psychological distress. And in fact, there was a study during the pandemic 2020 looking at dental, UK dental students, and they reported high incidences of perfectionism, it was like a 30 something percent, and that’s-

[Jaz]
And that surprised me. I thought we were way more than 30%. Like I speak to dentists in a room and restorative dentists, like I thought their perfectionism level would be even higher.

[Mahrukh]
Yeah. So this was what they called maladaptive perfectionism, which was associated with burnout and distress. So it’s out of those people that were burnt out. So it’s really high compared to the general population of students. And so all of those factors accumulate together. You’ve got the organization side of things. You’ve got the personality factors.

[Jaz]
And the constant fear, right, of messing up because, I mean, yes, in medicine, if you mess up, then someone could die, right? And that itself, I’m sure in medicine, there’s all sorts of these issues and they need well being support and that kind of stuff. But in dentistry, okay, fair enough, that’s not likely to happen. But it still hurts us, right? It still hurts us when we take a rubbish impression. It still hurts us when we fail at an extraction and we ruminate as you use that word early.

We think about it and we doubt ourselves. We think we’re rubbish. We think we need a career change. Then when you compound on top of that, the argument that you had with a spouse or your relationship with your child had a hiccup along the way and a toxic relationship, like all these things can compound.

So I guess we’re coming to is okay. We realized that we had a problem in our profession, unfortunately. Where can we even start? And I don’t expect you to have the answer, the cure. I’m just coming to you as someone who’s curious, because I feel like you’re in a much better position to help everyone than I am. What do we think we can do?

[Mahrukh]
So in terms of reducing the suicide rate and burnout rate, is that the question?

[Jaz]
That, and I think it may tie in with all the things that you said, that is a daily practice of well being all the resilience training so that when the crisis mode happens, we’re better able to adapt to it and overcome it.

And also what kind of help should we be seeking? Who should we be speaking to? And then I later want to ask you, are there any signs? I imagine you have a colleague that you have worries about and maybe they’ve said a few things. What’s our responsibility as a friend, as a colleague? What can we do so that it doesn’t end up leading something bad?

[Mahrukh]
Yeah, absolutely. I think there are so many ways we can address this problem and I think actually what we’ve been doing so far is not the whole picture. So, so far, what we’ve done is we’ve created crisis point services. So, like I said, if we are unwell, we can then be signposted to NHS practitioners Health Support.

That’s one of them. So we don’t have to go to our GP, for example, to get CBT sessions, therapy sessions. We can actually go through this service. We can call ConfiDental. We can speak to Dentists’ Health Support Trust. There’s numerous ones. BDA have got Hotline as well. So we’ve got crisis point services set up, but what we don’t have is any of the preventative stuff really.

I think, prior to me starting this, there was really very little talk about psychological wellbeing from my perspective. So what we could be doing is in our undergrad curriculum, we can have a resilience module, right? Wellbeing resilience module. So we’re not only just learning about stress management, of course, that’s important, but we’re also learning about those important psychological tools to help us feel more resilient and thrive.

[Jaz]
Why not even make this like a core CPD? Like, we run about radiation, there’s irons every bloody five years. Let’s also learn about resilience and it might actually really help.

[Mahrukh]
Yeah, absolutely. So, get that in the undergrad level, then have it in postgrad level, not just, your little webinar now and again, but I’m talking about programs. And this is what I’ve been doing with Mind Ninja, working with organizations. We’ve done four week programs. And I’m currently doing the NHS pilot resilience program for West Midlands, and that’s both with trainers and trainees. So, you know, there are programs that we can do, get those in, then at a team level.

Teams, principles should be actually, or ideally having a wellbeing lead. Ideally having the whole team trained in mental health first aid. This course is really accessible. You can book it very easily. And it’s a low costing course. And in that course, you’re going to learn all about all the early signs and symptoms of the common mental illnesses, right?

And then you’re going to learn how to talk to your colleagues in a better way, in a more supportive way. So you actually know how to have these mental health conversations. So, that kind of training is important. Also having annual resilience and wellbeing training for the team is really kind of important and setting up positive practices for the team.

It can be simple as when you start a team meeting, instead of going into the agenda straight away or talking about things that are not going well to spotlight things that are going well. So go around your team members, sharing moments of gratitude or compliments from patients. These are great ways of building positive emotions.

Now, positive emotions are not just feel good factors. They do so much more. We’re talking about broadening our resources, like resilience, buffering against stress and creating that positive culture because happier teams equal more productive teams, more profitable teams. And so, there is a big business case for principals to actually invest in wellbeing.

So, there’s lots of different ways. Of course, as you said, the CPD is so, so important. The GDC could be doing much more about this. CQC could be doing so much more. They do need to make this a core topic. They will do at some point. This is a-

[Jaz]
If any of these aforementioned organisations have come across this podcast, Let’s do something. Please. Let’s do something. Reach out to Mahrukh. If she can help you, that would be good. I love the whole well being lead. I like the idea. We have a safeguarding lead. I think that’s a very simple thing that all institutions can implement totally. So some great ideas there and I love it. And I feel like if we can get this message out there, then hopefully we can make an institutional change that will lead to better outcomes in the future.

One thing I want to talk about is that inner voice. That inner voice of anxiety. And this could be over a procedure or something that’s gone wrong or defensive dentistry for those people who are not sure what defensive dentistry means that you’re really, really trying to be extremely safe. You’re taking the easier option that’s more, maybe a little bit more predictable, but maybe you might not be the best thing for the patient, maybe, but you know that the chance of getting sued for this thing is going to be less.

It’s like you’re constantly covering your tracks, you’re writing notes, which are way, they don’t need to be that lengthy, but you’re staying behind, you’re doing all these things that you’re constantly thinking. You’re not thinking, how can I serve this patient?

You’re thinking, how can I not get sued for this patient? It’s a different mindset. So there’s a whole, thing about that, about how our mindset works. So let’s say someone gets a horrible thing about getting their complaint. It could be their first complaint, or for example, that’s when it probably hurts the most.

And that inner voice takes over. What advice could you give to that dentist who is having these sleepless nights a moment and getting worked up and that inner voice is not in a good place? How can they get back into feeling themselves? Because one thing I love what you mentioned that when teams feel good, they’ll be more productive and your bottom line improves.

I’m actually reading and listening to Ali Abdaal’s feel good, but positivity, right? And the whole ethos of it is actually, you’re going to be a feel good productivity. He said, if you’re feeling good, that’s when you’ll be most productive. And so let’s focus on how we can feel good. And little things like making sure that when you’re working, when you’re doing, like you try and do the more procedures, the procedures that you like doing, for example, but put on your favorite music when you’re doing it.

And I’m trying to formulate a podcast with like, extrapolating that book and presenting it for the dentist, in terms of like little things we can do to make our daily practicing lives better. But that’s a different thing. What do you think to how we can help that dentist who needs help? Because that inner voice is now not in a good place.

[Mahrukh]
Yeah, just going back to Ali Abdaal point. So his book is based on positive psych. I don’t know if you’ve read the broaden-and-build. That’s back in chapter one. He’s mentioned so much research from positive psych. So, his whole talk about using our strengths, values is such a big meaning, and then obviously injecting fun and pleasure that comes from-

[Jaz]
Play. I love the word the use of play. I think there’s not enough play in dentistry. I think the happiest dentists are the ones who are playing the most.

[Mahrukh]
Yes, yes, absolutely. So I think it’s great to see Ali bring PP (Positive Psych) to the world, which is kind of like my mission as well. But going back to the question then. So the way I wanted to address this is, it’s firstly focusing on when you’re in that moment and you experience that unhelpful thought pop up. So for example, it might be, I’m going to give you a scenario, you’re doing a crown prep and you’re looking at your margins, and you notice a thought pop up in your mind, like this crown is not going to fit, you’re so crap at this, you should be better at this by now, patient’s going to complain.

And then before you know it, that thought has gone to the GDC, like this is going to be a really bad case, right, for me. So the first step. And I want to really give you practical tools there and in that moment, what can you do, right? So the first step is just simply noticing that thought and using mindfulness to do this.

So mindfulness gives us this tool to be present. And you want to catch that thought. So you can say to yourself, I notice I’m having a thought that I’m not good enough. For example, like fill in the blanks, whatever that thought might be. Now simply putting some psychological distance between you and that thought is really, really powerful because it reminds you that you’re not your thoughts, that thoughts come and go, that you don’t need to buy into the story.

And that’s the tool of mindfulness, that’s what you can gain from it. And what you might want to do is to take a deep breath. A couple of deep breaths. Making sure to exhale slightly longer than the inhale and catch that thought. Say to yourself, I notice I’m having a thought that I’m not good enough.

Next, we can use a self compassion tool. So, self compassion is about giving yourself kindness, speaking to yourself in a kinder, loving way, like you would a friend or a loved one, like we do for our children, we instinctively know how to react with our loved ones, right? So we’re just giving the same loving kindness that we show to everyone else in the world to ourselves.

So instead of having that critical thought that pops up, replacing it with a kinder voice. And you might say to yourself, Look, I notice that you’re going through a hard time. I notice that you’re experiencing these thoughts. I’ve got your back. What do you need right now? How can I help you? Just whatever it might be.

It might not be that. That’s what I would say to myself. But you just coming up with words right now. It might be that you want to physically soothe yourself. So when we’re stressed, we actually have a physiological response, right? To that stress set. And that critical thought actually is stress. And so we can buffer it through physical touch. So this sounds a bit weird, but you could do this in the moment, right? You could even squeeze your arm, your hand, something like that. Like that’s something really simple that you can do.

[Jaz]
I have a really good massage gun if anyone wants a recommendation. Hits the spot, but would that count?

[Mahrukh]
Probably in the moment you can’t do that. This is my point. I want to give you tools that you can do in the moment and something as small as just putting your hand on your leg or like on your arm, squeezing your arm.

[Jaz]
I’ll just stroke my beard then.

[Mahrukh]
Just whatever you can do that just brings that sense of calm again. And we know from the research that these little things can work. I know they sound a bit-

[Jaz]
It’s like a trigger that constantly reinforces it, right?

[Mahrukh]
Yes. Yeah, exactly. So that’s the self compassion tool. The other tool that’s quite useful is cognitive reframing. So that’s thinking of the situation in a different way, in a more helpful way. So you might say to yourself, a more helpful way of thinking about this is that the crown will fit that I’m going to figure out. I’m going to look at these margins. I’m going to correct this. I’m going to change this. And actually the worst case scenario isn’t going to happen. Right.

[Jaz]
Or just to add into that, because I love what you’re saying here. Real practical tools that you can speak to technician, hey, this is what happened. It’s a really tough case. How can we work together to make sure that we get a good crown fit? So instead of just waiting for to see what turns up, giving the technician a bit of backstory. Hey, this is what happened. Can you help me out? How can we rectify this? And they may give some suggestions of how to overcome it.

[Mahrukh]
Absolutely. So thinking of ways of problem solving, if the worst case scenario does happen, right? Like, or if the crown doesn’t fit, going forward.

[Jaz]
So top tip there then. So, my episode is so clinical based. I love bringing this into compound what wonderful things you’re saying is if this happens, then tell the patient, don’t say that we’re fitting your crown in two weeks time, say we’re going to do a try in.

I want to make sure everything’s perfect. We’ll check the shade. If it happens to be good that day, we might glue it in, but we’re going to book a try in and then the fit appointment. So it’s a good little tip that I learned. I’m just passing on. I think it was Gurvinder Bhirth that told me years ago about this. And so we do this with all crowns routinely is a good thing to do because the one in 20, one in 30, there’s an issue. Patients understand, oh yeah, this was a try in anyway. So that’s another way you can manage them.

[Mahrukh]
Yeah, absolutely. So just to kind of recap on that. So when you’re in that moment, When you are noticing you have an unhelpful thought, try mindfulness, try the self compassion tool, or try the cognitive reframing.

This isn’t an easy thing to do, and I appreciate that, so it’s going to take time, like any muscle of the body, right? The muscle of the mind takes a bit of time to build, so keep working at it. And with time, this will become a bit easier. Now, things you can do outside of the clinic. Because obviously there’s only so much you can do in the moment, right?

So outside of the clinic, what you can do is just doubling down on lifestyle factors. So we’re all aware of this, but just ensuring that we have enough sleep. We’ve got sleep hygiene practices in place where we’re eating well, so nutritious food rather than ultra processed food, right? Water, getting your waters in.

Also things like movement, simple ways of getting more movement. It might be going for that morning walk before you start work. It could be going for a walk during lunchtime. Those factors are really, really crucial. We can also lean into our relationships and community, and that’s really, really important when we’re talking about building resilience, right?

So if you have people that you can trust and connect with, your loved ones, as well as a community, you’ll feel less alone because when you share that thought, for example, in a safe space, right? You’ll probably find that actually this thought is really common, that a lot of people experience this unhelpful thought and you’re not alone in that experience.

And once we know that we’re not alone, it feels like it’s less about us being weird, that we’re having this thought and we’re less judgmental about it, right? So there’s that aspect when we connect with others. And so kind of drawing upon your relationships, but it also could be drawing upon coaches or mentors, and that can be really a great way to help us even reframe our language, which sometimes can be very critical.

It might be that we say the crown failed or my crowns fail, having a very fixed mindset that actually whenever I do this specific treatment, it always goes bad. And reframing that in a different way, a coach can help you with that with positive language, and they might really get you to hone into your progress that actually, every time I do this, I get better or my failures are the stepping stones for success, right?

I need to be aware of all the obstacles to actually get really good at something. And also just to emphasize that. Clinical dentistry takes time. It’s not like social media where you’ve got this perfect, composite that looks gorgeous and translucent, looks like a tooth. That is a skill that has taken a lot of obstacles, challenges, failures, and so you need to have, like you said, that mindset.

And we’re really talking about a gross mindset here, a gross compassionate, optimistic mindset, which are all skills that we can hone into, but take time. So if we look at Carol Dweck, she’s a lead researcher in mindset. So she’s a psychologist that came up with this term. Now she studied children and what she found really interestingly was that there were some kids that had challenges and they were super excited about the challenge.

They were like, I’ve wanted this to be tough. And then other people would really crumble, right? And they tended to be the ones with a fixed mindset. They believed that their intelligence was fixed, whereas the growth mindset. really believed that their intelligence was dynamic, ever changing, they could grow, and they really honed into neuroplasticity, which is this science that shows that our brains can rewire and change structurally at any age.

Now, we didn’t know this back, 30 years ago. We actually thought that after a certain age, our brain was quite fixed. But what we know is that the skills of mindfulness and self compassion reframing all of these tools-

[Jaz]
And emotional intelligence that’s not fixed either. You can raise your EQ as well.

[Mahrukh]
Absolutely. And it doesn’t matter how resilient you are currently, you can become more resilient. All of these traits are very changeable. We can work on them. They’re teachable, which is really epic to know. And this is kind of exciting for me because these are skills that we can pass on to our children and we can really help them thrive, right?

[Jaz]
I mean, that’s so, so current for me. The thing I think about the most for my four year old is making sure he doesn’t get into his fixed mindset. Like I see how he reacts to a challenge, he puts a strop on. I really want to change that. Look, you in a different light. So I love that. It’s something that it’s going to affect our relationships with our loved ones as well.

And it’s so, so important. It’s infectious, all these things you’re saying. So if you are in a difficult spot at the moment and you’re having these thoughts, because maybe you’ve had a complaint, recognize the thought, step out of your body and look at it as a thing floating in the air, this thought, give yourself some self love, as Mahrukh said, cognitive reframing, think about it, don’t think it’s going to a GDC, think, oh, my indemnity is going to try their best, because my notes are really good, the tools that Mahrukh mentioned, exercise, sleep, relationship, there’s too many to name them, they’ll all be in the show notes, and the PDF and the transcript to look at it again, but that’s fantastic.

In the interest of time, I want to get to my last question, which I think is huge, right? So this might take us a little chunk of time, but this is absolutely enormous because I think is this is so linked to all the three other themes that we talked about today. And it’s a toxic work culture of how we’ve talked about this before.

I’ve interviewed some, some dentists who’ve been in a toxic work culture at that time. How do you think we can manage it? Because the most sensible thing that I’ve read online on dentists, helping other dentists on Facebook groups and stuff is get out, leave, get out, leave. Is that the only way?

Is it just to flee in a toxic culture? Or should that associate dentist, for example, be putting all that strain to and time to invest in trying to help this toxic culture? Obviously, it’s a huge, big little problem without the fine details. But how do you support colleagues when they’re in a toxic culture? I’m curious.

[Mahrukh]
Yeah, great question. I actually feel that if you’re in a toxic workplace, and I’ve been in multiple toxic workplaces over the 13 years, right? I feel as though it is really important that you leave that practice. Leave that environment. You can’t outrun a bad, toxic workplace. Just like with a diet, you can’t outrun it.

So it’s just really important to actually, from my perspective, leave that place. Culture is set by management. It’s set by the higher up. You’re not going to be able to change it. Of course you can try, but I think you need to prioritise your well being and your happiness. And if you notice simple things, like bullying’s happening, people are being unkind.

[Jaz]
Which, Mahrukh, happens a lot. I don’t know if you’ve experienced this, but a lot of the messages I get, I’m just reflecting on these, a lot of young female dentists have told me that their slightly more senior female nurse bullies them. I don’t know if you’ve seen this. I’ve seen this so, so often.

[Mahrukh]
Yeah, absolutely. It’s happened to me several times as a new graduate to dentistry. And then other bits, I remember having a principal dentist that had a really shaming way of teaching. And so when he had his meetings, he would put pictures up of other people’s work. It wasn’t my work, but it was colleagues that was so much more experienced than me.

And he would ask us to critique that radiograph, oh, there’s an overhang there. Oh, the root feeling is short, but it was in such a shaming way that you just really couldn’t learn. And so you didn’t feel psychologically safe to raise concerns, to be yourself, to be authentic.

So if you notice that there is bullying, there is a shaming culture that people are being unkind. You’re right. It’s really, really common. There’s no reason for you to stay. There’s nothing more important than your health, so please leave. There are times when, obviously, you’ve got a mortgage to pay. You feel as though you can’t actually leave. What I’d say to that is, look for other jobs. There are lots of jobs out there. There’s lots of really nice

[Jaz]
And if you think there aren’t, that’s a mindset issue. That’s a fixed mindset issue. If you think there aren’t any other opportunities around, and this is the only one, They got to stick with and totally as a mindset issue going back to what you said.

And my wife has been this scenario. I’ve been this scenario throughout the many years, many associate positions. Isn’t it absolutely liberating? You work yourself up. You think how I’m going to tell them you spent hours writing that letter. And then once it’s done, they’re like, okay, go. It’s like you’ve broken the shackles.

[Mahrukh]
It’s the best thing. Like, honestly, it’s such a big burden when you’re in the wrong place. Your environment matters massively. And it can even be little things like if you’re in a practice that isn’t supportive and everyone’s super stressed. I’ve worked in busy London practices in like central London where they don’t have enough equipment.

It’s bizarre when you don’t even notice your receptionist. So all very, very stressed and overwhelmed and burdened with tasks, as well as your nurses, it creates this culture of like, high stress, no one’s managing it very well. And everyone feels quite negative, it puts the morale down. So, when you notice those things, I think it is important to leave. And you’ll be in such a great space for it. There’s other jobs out there. There’s other ways of also making income.

[Jaz]
Even if you’re out of work, God forbid, couple of months, it gives you a time to regroup, reflect, work on yourself and better things will be around the corner. Because I agree it’s detrimental to your health to be in a toxic environment long term. Sure, the strain it has in mental health, which actually carries over to your physical health and your relationships. Every dentist I’ve ever spoke to, and we all have these stories, we all have friends who’ve been in a, what they describe as a toxic place, and they all just describe this, they kind of smile when they say, oh, when I left.

And so I’m totally, I didn’t know where this conversation would go. I don’t know if you had some tools to use in that scenario to battle it, but I agree that it’s a demon that’s not even worth battling sometimes. And to accept that this it’s not my vibe. I deserve better.

And to make that difficult decision. Cause I think it’s easy to underplay that. Oh yeah, just leave. I totally understand. I think we totally understand. It’s such a tricky thing to do, but you have to do it for yourself.

[Mahrukh]
Yeah, I think it’s important to just clear, get really clear as to what is successful for you. What does success mean to you? Is it about just having a job and any job in that toxic workspace? Or is it about what’s your longer term goal? And I’m sure it probably is that you want to work in a supportive environment with a team that gets on, patients that you love, all of those aspects are going to be important.

So I think once we kind of get clear as to what means success to us. It might be journaling. That’s quite helpful for you in this process. And you just get really clear as to like, okay, what is important? And then you become also clear that actually my health, my relationships are important. My physical health, my long term physical health is really, really crucial. And then it becomes a little bit easier.

[Jaz]
So, Mahrukh, like the whole point of this is how can we help people that we care about to make sure they don’t become a statistic? So what are the signs to look for? Because as we’ve alluded to, sometimes it can be very easy to mask and hide, and you might not know that your colleague was fighting an internal battle. But what are the different signs to look out for so that we can be helpful to our colleagues and try and give them the support that they might need?

[Mahrukh]
So there are some signs that we can look out for when it comes to our colleagues, and that includes, are they changing in appearance? So, when we are going through mental illness, things like depression, anxiety, or suicidal thoughts, it can be quite difficult just to maintain our appearance.

So if you notice that, for example, they’re a bit scruffier than normal, if they were really kind of polished before, you might notice that perhaps that they’re not sleeping as much as they normally do. Or they might be sleeping more than they normally do. So if you notice like changes in their behaviors with their sleep patterns, you might also notice their eating patterns change. So if you notice, for example, they’re just not eating lunch anymore. They’re skipping lunch. They might be losing weight. They might be gaining a lot of weight. Those are telltale signs.

[Jaz]
What about someone who is, they used to be punctual and then they become 8. 30 but now they’re late every single day. Is that something that, along with other things to consider? I’ve just thought of that.

[Mahrukh]
Yeah, absolutely. If you notice like changes in the way they show up and their energy, that’s like a really kind of crucial one. So just looking at their behaviors and actions, sometimes they might be withdrawn as well. So if you find out they used to be quite sociable, they’d go out and have lunch with you, or they’d have a little chat with you in the day, and they’re just not doing that as much, or they want to be by themselves, that can be a telltale as well.

So the key, I think, is to not be, don’t be afraid to have conversations with your colleagues and just simply check in and talk to your colleagues and ask them, look, how is everything? I’ve just noticed that things seem a bit different. How are things really going? I’m here to listen and actually really listen at this point.

[Jaz]
Like a genuine, how are you, rather than, hey, how you doing? Like a genuine, sit down, hey, you okay? Let’s talk, what’s going on, you all right? Is there anything you want to share?

[Mahrukh]
Absolutely. So you want to take them aside, have an alone time, not like in front of everyone, and really just ask them, how are things going? How are things with you? And I think that’s really, really important to then mindfully listen. Rather than at that point say, look, I really want you to go and see a therapist. That’s not going to go down well, mostly, with people. It’s really important to build trust. And so, at that point, you just want to listen to what’s going on.

Be there to listen non judgmentally as well. And don’t give what we call G. L. I. P. advice, which is, pull your socks together, you’ll be fine. Don’t say any of that. Just listen, right? Be there, show compassion, kindness, and friendship to your colleague. And then, if you find that you’ve had these conversations, and you’ve built that trust, you can then also, if you do find that person is shared, that they are experiencing suicidal thoughts, you can then signpost them to seek help.

And I think that’s really, really important. Don’t be afraid to go in help your friend. So it might be that you speak to NHS Practitioners Health Support, you might speak to the other charities, ConfiDental, Dental Health Support Trust. Those are the dental specific ones that can be quite useful and I myself have used for other colleagues.

I have spoken to Rory at Dental Health Support Trust and then Lauren at ConfiDental and they will then signpost your colleague to the right person. It’s really important if someone is suicidal, what we mean by suicidal is not just having thoughts of suicide, but you’ve got a plan, what we call suicidal ideation.

You’ve got a plan to commit suicide. So if your colleague tells you, I have a plan, you don’t have to keep that in. I think it’s really, really important to then pass that knowledge so that they can be safely looked after.

[Jaz]
It’s a bit like when you’re safeguarding a child and there are certain things that most things you need to get consent. Okay. I’m a little bit concerned. Can I speak to that? And then they can be allowed to say no, but there are certain submissions where you don’t have to get the patient, the parents consent to seek help because it’s in the child’s best interest.

[Mahrukh]
Absolutely. So in that situation, I think it’s really, really crucial. So if someone has given you that information, I think it’s really important to pass that on. And often if they have shared it with you. They might subconsciously want help, but they don’t know how to ask for help. You can also say to your colleague at any point, look, how can I support you? Can I actually organize a call to the GP? Can I organize this call? Can I take something off your plate?

[Jaz]
Because at that point, people might think, oh, but are you crossing a line? But at that point, they’ve already admitted to you the ideation aspect of it. And then they trust you enough that they’ve told you something like that, and therefore that’s kind of broken a barrier that allows you to hopefully assist them.

[Mahrukh]
Absolutely, yeah. I think it’s really, really important at that point to do that. And then, like I said, even it might be that your colleague isn’t suicidal, but they’re just really struggling. They might be experiencing some signs of depression, and they just don’t really know what to do. You can literally say to them, say to your colleague, look, how can I support you? Is there anything I can take off your plate? Do you want me to help you with groceries? Or like, what can I do? And then-

[Jaz]
Even just maybe, oh, I noticed that you’re running a bit late today. Can I see your next patient? Just maybe have a go, have a cup of tea. Just little things like that to show that, hey, you’re in it to help them maybe.

[Mahrukh]
Yes, absolutely. Any ways, any acts of kindness, like that’s really, really important. And then when you do have that trust, you can share those resources, right? Because actually a lot of dental professionals aren’t aware that there are dental specific places they can go. They might not feel comfortable going to the GP, which is where these charities are really, really useful. And so just sharing that’s going to be really, really powerful.

[Jaz]
Thank you. Well, I’m going to put all those links in the show notes so that God forbid anyone needs to signpost anyone, but it’s there, for when we need it. And it also helps to improve the algorithm for the search engine optimization, all that kind of stuff is really important.

And I mean, Mahrukh, I’m all about your fulfillment of dentistry. If you’re in a toxic place, sometimes it is that your patient’s nice, but it’s toxic environment, but the patient’s nice, or it’s a toxic environment, but I get all the toys to play with. And that’s important as well. But, for the fulfillment from your clinical dentistry, which is what I’m all about, right?

You’re enjoying the actual minutiae of daily dentistry. That’s going to be much more enhanced when everything around you, the environment around you is much more supportive. I’ve really enjoyed today’s chat, Mahrukh, because you’ve given really great tools and you covered that really dark and unfair on you, topic of suicide, but I felt like you gave such great things that we can reflect on as a profession and maybe you’ll reach higher up positions that people can think, you know what, that episode Mahrukh’s, right?

Let’s why don’t we one, maybe, maybe King’s, right? Your alma mater will say, you know what? Let’s tribute this. Let’s have a module in there about resilience. You never know, right? These are things that could spiral into something beautiful. How can people find out more about Mind Ninja? How can they connect with you?

Tell us on your social media, because I really want people who need that kind of daily training and who think, and I think everyone should look after themselves in this way. How can they find you?

[Mahrukh]
So I’m on Instagram, mindninja. wellbeing, but you can also find me on my website. So mind-ninja.co.uk. I’ve got free resources on there as well. And I’ve got the Mind Flossing Toolkit as well as the Resilience and Wellbeing for Dental Professionals book.

[Jaz]
I love the name Mind Flossing. It’s so good.

[Mahrukh]
Oh, thank you. Yeah, just for me, like I think one of my strengths is creativity and fun. So I try and in terms of the illustrations and making things engaging, even the workshops, I’ve got Lego in it, you know, I try and make things as engaging and fun as I can. So, yeah, I’m glad that resonates with you.

[Jaz]
It totally does. And I’m going to put all this in the show notes. Thank you so much for listening everyone to the end. And Mahrukh, thanks so much for sharing all these wonderful things. And I really do think we’ve helped some people today, which is what it’s all about. So thank you.

[Mahrukh]
Thank you so much, Jaz. It’s been lovely to be on.

Jaz’s Outro:
Well, there we have it, guys. Thank you so, so much for listening all the way to the end. I’m hoping some of these themes are really going to help you. And if you’re ever in a dark place or you will enter a dark place in life, I’m hoping you can always come back to this to find some practical help.

And actually, if you need the next step, I would totally reach out to Mahrukh. She’s doing some wonderful things. She’s got some cool toolkits and we’re doing a little giveaway as well. So do check out our Instagram @protrusivedental, where I will be tagging Mahrukh as well. And if you can think of anyone who might need this episode, please, please share it with them, right?

Share it in your socials because you never know how badly someone might need this reminder of the importance of mental health and looking after it, not just at crisis point, but on a daily, weekly, and a monthly basis. And remember the next time you get that tight feeling in your tummy, don’t stress. Just like Lorenzo taught us right at the beginning.

Now, this episode is eligible for CPD. It’s on Protrusive Guidance. So if you’re on one of the paid plans on Protrusive Guidance, you just have to answer a few questions and get your CPD. This type of CPD is rare. We talk about all the DME and onlays and extractions, but this is also really important CPD.

This is what guarantees longevity of your career. Your mindset is more important than your skillset. So thank you again, Protruserati. I’ll catch you same time, same place next week. Bye for now.