Reflection – The Last Six Months – Adapting to the Past, Present and the clinical future – A change journey in Mark James

“Be the change that you wish to see in the world.” Mahatma Gandhi

It’s a curious thing, working in your past, that it be still part of your present, mixed confusingly with your clinical present and future. This paradoxical conundrum has unravelled as this unorthodox journey over the past six months is now coming to it’s end. We all need to earn money, I certainly do, having coming off a nine week break from zero earnings, a self imposed cessation of an income stream that pays rent, bills and creates a degree of financial security. July through to August of last year became a journey I feel everyone should undertake, at least once in their career, if the stars align and the opportunity and inspiration presents. This I will cover further on in this reflection to add context shortly as it really guides and sets the scene for these previous six months.

My learning odyssey was planned way back in October of 2018, when life events ensured that an intended single journey from New Zealand back to the UK went terribly South. My intention was to stay and re register in the UK and find work. I was disillusioned with clinical practice in Blenheim and life in general, the tank was empty and it seemed the only, but definitely not the easiest route, out of this dilemma was to do precisely that. This simplistic explanation of the circumstances leading to my learning odyssey back in Europe, the UK and the States belies a deeper need, a sense of entrapment in how my professional ideology at the time made me feel. I was outraged that the dental industry was slowly taking over and commercially influencing learning. Also I was frustrated that I was shackled by the lack of provision for new knowledge creation within New Zealand and felt stifled by regulations that govern my annual professional recertification. I was constantly wondering if I would realistically achieve the magical number of CPD points and hours of peer group contacts time to facilitate that and, deeper in my mind, the real fear that my name would be pulled of the 10 percent of re registrants who would need to present evidence of their learning journey. Picture the scene with all the right credentials for this but not a jot of real knowledge gained that would evolve and develop one’s practice, by just sitting and ticking the boxes to avoid negative scrutinisation. Maybe, just maybe, a more permanent learning journey back to the UK would make that easier, would make plain sailing of the frustration I felt. Alas it was not to be.

“It’s only after you’ve stepped outside your comfort zone that you begin to change, grow, and transform.” Roy T. Bennett

I had a canny sense that changes to re registration might be afoot when I wrote an email to the Dental Council regarding hours I worked creating a presentation to an addiction and behavioural change clinic in Blenheim I was asked to talked to. I got a somewhat mystical reply that demonstrated that they were starting to think outside the box and the journey into self directed learning and new knowledge creation had begun in earnest. I kept the email and re read it on occasion to be certain they were saying what I though they were saying was true. This was further back up by a local peer group/ mentoring event that reinforced my suspicions.

My real comfort zone is to be indifferent to established rules, to bend or break them would be ideal in my world, but not all of course, safety must always prevail, but those which prevent growth, exploration and evolution are my nemesis. I’ve been called a maverick and a contrarian, I’m comfortable with that, I’m not wanting to be followed, more to follow my innate curiosity and creative nature. Thus, with my life partner, Toni, the ground work for the odyssey was created and constructed. The event undertaken, lessons learned and behaviours changed. To catch up with these “real-time” week by week experiences go to the reflections page of wholedentalhealth.com. This reflection can now be seen in its context and I will move onto to September of 2019, when re returned to Nelson.

“Life is a series of natural and spontaneous changes. Don’t resist them; that only creates sorrow. Let reality be reality. Let things flow naturally forward in whatever way they like.” Lao Tzu

The move from Blenheim to Nelson was on the cards from the beginning of the year, a professional and dear friend, Deb, had empathetically seen my need and advocated, on my behalf, to her boss at the time for me as a candidate when she moved to a bigger role in town. My interview was confirmation that my new clinical role was going to bring on many changes. These were welcomed but some uncertain, the move involved coming into contact with oral myofacial therapy (OMT), orthodontics, orthotropics and sleep apnea treatments. My role was to compliment most of these with oral hygiene support and additionally OMT once I attended a 4 day training course.

I was caught, however, in a situation where the new practice could only offer me 3 days and the additional clinical time I needed wasn’t available in Nelson, or so I thought. I called Blenheim to see if they had found my replacement. They hadn’t and needed support, I offered and spent the next six months, until now in fact, travelling to and from to help Blenheim and earn what I needed until work could be found in Nelson. The juxtaposition between the past, present and the future I felt profoundly, working back in my old practice, clinically in the past and the new work environment being one of dynamic change and challenges. I found the transition between the two testing and telling, the contradiction between the two at times felt profoundly uncomfortable, the tight and intense vertical learning curve of Nelson apposing the busy and comfortably numbing nature of Blenheim, the advanced equipment and technicality of one as opposed to the salubrious and simple nature of the other. The clients were also different, more children and questioning adults in one and a docile and accepting group in the other.

“Change the way you look at things and the things you look at change.” Wayne W. Dyer

The change also involved a move away from being self employed to being employed. One which had been of a self controlled professional environment, being able to say when, where and how I worked to being very much part of a team and embedded in the same boat as other colleagues. I also chose, deliberately, to have the same uniform colour as the Dental Assistants and Orthodontic Auxillaries. It turned out to be a wise move as within my adoption into the practice came the need to be affiliated to the behaviours, causes and beliefs on that clinical group, I had choices to make, processes to change and pride to put on the shelf. To say the first three months there were stressful, unsettling and confusing is an understatement. The nuanced clinical nature of my work also matched the nuanced nature of the practice personality as a whole. This is the same the clinical world over I suspect and experience has taught each and everyone of us in positive, neutral and negative ways how to steer the ship into the calmer waters and sandier shores. I needed every ounce of skill to get safely to port.

Clinically I was steady, happy and welcoming of new technology, an intra oral camera, high end airflow and ultrasonic systems and a highly organised and effective infection control regime. These were a contrast to the more laid back and laissez faire approach in my previous practice. More time was given too, initially I thought too much but as it transpired it was necessary to help build trust and create relationships with clients. It also helped me construct a new way of note writing on the Exact SOE software system which I had never done before, more really a check list of appropriate or non appropriate notes to write for my client centred and empathetic approach I was beginning to move more towards. Working within a team affords the individual the ability to feel what others feel, a shared experience, to sense the emotions both collectively and one on one. To be seperate from this is not to experience collaboration, be it clinical or social, or both. It is rich and rewarding, but can also be down right demoralising, especially to those of a more sensitive and vulnerable nature appear distressed or wounded by the turn of events. Sad too, when fortune doesn’t favour those you have emotional attachments too as they part waves and move on.

“Maturity is when you stop complaining and making excuses, and start making changes. Roy T. Bennett

The last three months have been as emotionally challenging, the uncertainty of enough work and income, the prospect of finishing in Blenheim and finally moving on from the past and plotting the future here in Nelson. Events finally came to a head when I decided the date of the Blenheim exit, a new Hygienist had been found and the prospect of travelling to and from over winter bore no benefit. The decision to leave also took into account the need to hand over to the new incumbent. I had never really thought this important before, my previous experiences were always cut a dry but the emotional loyalty I had to my clients and colleagues there really made me rightfully consider this necessary. Thinking about it we could all do with a handover period where the baton is passed slowly and deliberately to help a smoother transition. It’ll be something I undertake in Nelson but this time it’ll be more in the vein of shadowing my Hygienist colleague, Kelsey, who herself is well established, liked and respected. This will help me understand the nuances of her practice, be respectful of them, reflective of her particularly process and build commonality with it.

So, within the realm of work structure and the changes in my clinical process this is where I sign off to date. However, the direction of my approach, both personal and professional has also changed. This is mainly due to my nine week odyssey but also as a consequence of observational and empirical learning and through the post research process following on from that very sabbatical. The way I approach treatment is now more based upon changes in my beliefs and values. The essence of my practice has morphed into evidence guided, workplace learning based, sustainable and environmental practice. More on this very soon.

“Beliefs are basically assumptions that we make about the world and our values stem from those beliefs. Our values are things that we deem important and can include concepts like ‘“ equality, honesty, education, effort, perseverance, loyalty, faithfulness, conservation of the environment and many, many other concepts.” http://www.differencebetween.net/language/difference-between-values-and-beliefs/

A year ago I practiced in what I would in reality call now a limited and more conventional way, my experiences working in a semi rural practice, deep in the wine region of Marlborough had evolved my practice, The clientele were hardy folk, where the once poor agriculture region had benefitted from a vast Klondike in the proceeding three decades had brought a degree of wealth to some and a change in farming to grapes. The provision of hygiene care was itself burgeoning and the need, always there, was trying to be met by a few practices and clinicians, whereas once upon a time it was in the purview of dentists alone. I did find time to develop new ideas of practice, specific to Blenheim, for example, a wine makers protocol for effective management of erosion and wear resulting from the workplace environment was created. A protocol with Peter Yealands Wines was designed for the senior management and winemakers involving process and products.

The time in Marlborough allowed to further experiment and several research projects had helped me better understand my practice and how to evolve it, see my link in the menu bar to Action Research to discover more. I undertook them in progressive ways, to demonstrate to my Principal Dentist the commercial and well-being benefits of having my own nurse. Researching and presenting on dental health and general health nutrition also followed as well as developing a traffic light system to allow improved dental health in my clients to benefit from cheaper appointments and spend less clinical time on them. All were designed to be work based, creative, collaborative and changed my belief and value systems regarding learning towards being more action research/inquiry learning based. Significantly, the way I treated periodontal disease changed from a mainstream full mouth disinfection, two visit, half mouth approach to a more client centred and affordable individualised approach focusing initially on oral health improvement with additional follow-up and appropriate combination therapy use, if required.

“Those who do not move, do not notice their chains.” Rosa Luxemburg

It also became apparent to me that my practice was becoming one of being client centric rather than treatment outcome focused. I had found strict treatment approaches worked in a limited fashion, as I mentioned in the previous paragraph, it left out the heart of the matter, the human equation, what motivational tools beyond the floss or toothbrush demonstration were indicated to achieve dental health improvement. The connection to the individual seemed more fruitful in outcomes and my sphere of capturing that motivational trigger morphed into what I call patient/client centred practice, as opposed to what I deemed was my previous instrumental approach. But there seemed something missing, that link that adds energy to the client centred approach, listening was one thing, however I imagine what we as clinicians over time desire to develop, was empathy. We all need to, I firmly believe, to develop, constantly, the power of empathy that guides our advocacy in the oral health improvement message. What is an empath? Karla McLaren, author of The Art of Empathy describes “An empath is someone who is aware that they read emotions, nuances, subtexts, undercurrents, intentions, thoughts, social space, interactions, relational behaviour, body language, and gestural language to a greater degree than is deemed normal.”

“All advocacy is, at its core, an exercise in empathy.” Samantha Power

Also, complementary to this I had the good fortune to spend quality time, whilst in Blenheim during the last six months, with a close friend and spiritual healer. Although I don’t dare to claim that degree of energetic connection I have learned that when we engage with our audience, more often than not one on one, we create the opportunity, if grasped, to empower the space between each other with our human and clinical intuition. The silent spaces peppered between the idol chatter or gossip, the observation of the body and its reactive movements guide our conversation as well as our instrumentation. The conversations are carefully guided by estimations and calculations of where to use carefully chosen words and quantifying whether it’s too much or too little to make the all important impact. These are skills we learn along the way, refine and engage where we see fit. We are invested in people, their experiences and value systems and we in turn become the artisanal or clinical change agents. My way is one of empathy, humanism and environmentalism. The last I will discuss in the next paragraph but I will end this one in saying which ever way you chose to approach these fundamental truths of how we practice to use them albeit, wittingly or unwittingly, on almost every person we treat and we in turn learn too. How we do this, linked to the new recertification programme, with real active workplace investigation complimenting tradition learning, reflecting on our experiences, adapting and adopting new knowledge skilfully, and supported by our professional peers.

“A nation that destroys its soils destroys itself. Forests are the lungs of our land, purifying the air and giving fresh strength to our people.” Franklin D. Roosevelt

We are environmentalists, all hygienists are, whether they know it or not. We work around hard crystalline rock like structures and soft tissue surfaces forming land around them. Upon them form ecological life, benign, beneficial or potentially pathological. This delicate and dynamic environmental ecosystem provides important function to our bodies right from birth. Our own, unique ecology constantly evolves from seeding at birth being affected, altered and changed by how we behave, feel and nutrify ourselves over time. We also live in a time when the external environment around is is under pressure too. The surge in support for environmental change and protection resonates around us and nature teaches us the real truth through epidemics and geological events that we are not in total control of our world and don’t entirely control our and the planets destiny. We are lulled into a false sense of security that we are totally in control and instrumental in managing our mouths and that panaceas including fluoride toothpastes, mouthwashes and rinses and regular dental examinations and phrophys are indeed natural and completely normal.

Our conventional, instrumental and chemical approaches to oral health miss out the one component we seem to have missed with the world, that we are part of the world and the ecology of it, not far removed from the life in the oral cavity. Surely, an environment approach to balancing oral health working with the right ecology is the way forward, adapting better dental and health promoting behaviours and removing negative changes in nutritional and life style behaviours. These maybe lifestyle related, sleep deprivation or stress reduction, chemically orientated with smoking or drug use/abuse, nutritionally linked to free or processed sugars, frequent acidic events and a lack of well-being, the lack of meaningful connections or a higher calling or just plain exposure to sunlight and meaningful movement.

“You can’t fulfill your calling in your comfort zone!” Steven Furtick

How do I see an environmental approach evolving in my practice? Where do I start? The 2019 Odyssey has moved me greatly on from where I was in Blenheim and where I need and want to be in the next and final decade of clinical practice. The coming year will bring all my research and learning to the keyboard once more when I fully write up, with already published learning to date a thesis on environmentalism, humanism and empathy in hygiene practice.

With this the future changes to registration in New Zealand are a pearl in a shell. They will allow the Dental Healthcare Practitioner to follow their truth, their learning goals and aims, evolve their practice not through fear of persecution for not obtaining the satutory requirement of points. It also makes peer group contact potentially grow beyond dentistry itself and inter professional. The addition of a clinical peer to guide and critique our learning journeys is a forwarding thinking change too. To find an impartial and supportively knowledgeable peer will be a challenge though. There is a lack of knowledge and more overly, experience in this domain, but we have to start this process now and learn along the way how to get the best out of it. Finally, and more importantly, we all need to learn how to reflect upon our journey, write, publish, review and explain to others how we came to know knowledge, decided whether it was good or not, how we tested its validity in practice, it’s application into our workplace and ultimately where our journey will take us in the future.

To end this current reflection my ongoing journey involves adapting to a new practice in Nelson, creating Professional Development and Activity Plans (PDP’s and PDA’s), evolving my environmental and humanistic approach to practice, continuing my learning journey into OMT, and finally completing my odyssey journey with publication on a website, maybe even a presentation or two.

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