It is a key lesson that a practitioner has learned from his experience

Dr Tom Munroe grew up in West Dublin and qualified in dentistry from Trinity College Dublin in 2001. He chose dentistry as a career because he was attracted by the combination of surgery and general practice. Dentistry seemed the perfect fit for him, he says, as it is technically demanding, but also requires strong people skills.

After qualifying, his first job was in the UK; working across London, Kent and Essex as a locum general dentist in both NHS and private practices. He remained in this role for almost two years and gained a great deal of experience in general practice, working in different practices and treating a very diverse patient population.

Tom returned to Ireland in 2003 and worked in the Health Service Executive (HSE) as a locum general dentist treating adults and children in West Dublin. Later that year, he established Glenview Dental Surgery in Tallaght, close to the area where he had grown up. The practice rapidly grew in popularity and, by early 2004, it was booked five weeks in advance and was employing two part-time associate dentists.

Flourishing career

In 2010, Tom completed his diploma and master’s degree in implant dentistry in the UK and the following year obtained a postgraduate diploma in clinical dentistry from Trinity college Dublin. He also completed a year-long certification in implant dentistry in Dublin from the Northumberland Institute of Dental Medicine (NIDM) and initially started placing dental implants under supervision in 2011.

Tom was then able, in 2012, to begin the sole placement of single implant units in his Glenview practice. In the following year, he achieved a silver certificate in implant dentistry from Tipton Training in London and Manchester and a certificate in cosmetic dentistry from CDE Seminars in Harley Street, London. 

In early 2014, Tom secured planning permission to repurpose a former coffee shop and in August work began on establishing his second clinic; a single-handed one room modern practice in Milltown, South Dublin. The doors opened in February 2015 and he initially limited practice work to cosmetic, implant and restorative dentistry.

While Tom worked this practice single handedly, his wife managed the Glenview practice where he now had three associates working in his absence. The practice in Milltown grew slowly and, in 2016, Tom completed his MFGDP in the UK and further certification in implant dentistry from the VSS Academy in London.

Challenging times

But his personal life had taken a turn. From 2015 to 2017, Tom’s marriage deteriorated and in that period he separated from his wife and left the family home. “It was an enormously difficult period personally and professionally and I became increasingly isolated and unhappy,” he said.

In early 2019, Tom experienced a serious mental health crisis and was admitted to St John of Gods Hospital in Dublin, suffering from depression, anxiety and stress. During his stay  he received intensive treatment and was able to return to practice four months later, while remaining an outpatient and having continuing monthly treatment through attending a stress management clinic.

But, despite this return to work, he remained professionally and personally isolated and continued to struggle. “When COVID arrived in March 2020, my feelings of isolation became significantly worse,” he said.

“Living alone, with very little contact with professional colleagues, my depression and anxiety deteriorated again. Indeed, there were mornings when I could barely get out of bed and I became increasingly fearful of going to work. I spent much of my time worrying and feeling stressed and alone.”

It led to Tom frequently cancelling patient appointments and he became caught in a continuous cycle of fear and depression. “I felt I had nowhere to go and no one to turn to and became increasingly isolated in the way that I was thinking and behaving,” he said. “I was deeply embarrassed about opening up to my patients about what I was going through and on a number of occasions, when cancelling appointments, I falsely claimed that I was diagnosed with cancer.”

Today, Tom says: “I deeply regret this and recognise how wrong it was. While not excusing my actions, at the time I felt that there was a significant stigma attached to the admission of suffering mental health difficulties and, as a healthcare professional, I was ashamed and frightened about explaining how unwell I had become.

“While this may provide context for my behaviour it does not excuse it, and  I recognise that my patients were entitled to more openness and honesty. However, I genuinely did not feel well enough to treat patients safely, but now recognise that I should have stepped away from practice and sought appropriate cover and professional support much earlier.”

In January 2022, Tom experienced a further acute relapse of his symptoms and, as he describes it, “effectively shut down.”

Following complaints to the Dental Council of Ireland, Tom voluntarily gave an undertaking not to practise dentistry and closed his Milltown practice. As a result of his inability to practice for 18 months, he became financially insolvent and, eventually, had to move back to live with his parents because he could no longer meet his financial commitments.

Getting support

“During this period I was referred to Practitioner Health Matters and saw Dr Ide Delargy,” said Tom. “Until then I had not been aware of the support available through the service and the help I received was exceptional. The Irish Dental Benevolent Society also helped me enormously, while my partner and parents supported me both financially and emotionally.”

After 18 months of this support, Tom was approved by the council to return to general practice under the direct supervision and support of Dr Paul Fitzsimons, of Finglas Dental Care, initially for two days per week. During the following 18 months this moved to four days under general supervision. Dr Eddie Cotter was also appointed as a mentor.

“Without Eddie’s support I would not be working today,” said Tom. “I am deeply indebted to him for his kindness and support and wish that to be recognised, and for other colleagues in our profession to know what he did for me in my darkest time.

“One of the most important lessons that I have taken from this experience is the importance of professional relationships. Dentistry can be an isolating profession, particularly for somebody working in their own practice, and I had allowed myself to become increasingly disconnected from colleagues who might otherwise have recognised that I was struggling.

“The Dental Council process was harrowing and ultimately took more than four years to reach Fitness to Practise proceedings. It was extremely difficult for me and for my family. While my mental health difficulties were considered as a mitigating factor in relation to my misconduct, I was censured and conditions were attached to my practice.”

A return to work

These conditions include a structured return to implant dentistry under the supervision of Dr Stuart Lutton at New Life Teeth in Dublin. “Stuart is an exceptional clinician and mentor and I feel fortunate to have the opportunity to learn from him,” said Tom. “He has been extremely supportive of me right from the start and the wider New Life Teeth team have made me feel very welcome.

“I am now working within a group clinical environment with structured supervision, mentorship, and clear clinical governance around my development. After becoming so isolated in my own practice, being part of a supportive clinical team again has been enormously important to me,” he said.

But he adds: “On reflection, I believe there is an important conversation to be had about the length of  time that regulatory processes can take and the effect prolonged proceedings can have on practitioners and their families, particularly where significant mental health difficulties are involved.

“While I fully recognise the responsibility of the Dental Council to investigate concerns and to protect patients, I do hope that there can be continued consideration of how regulatory processes can protect patients whilst at the same time recognising the human and mental health impact on the practitioners involved.

“I believe that a stigma surrounding mental health issues remains within the dental profession and in healthcare more widely. As clinicians we are accustomed to being the people who care for others and there can be enormous pressure to appear capable and in control. In my case, that made it much harder for me to admit how badly I was struggling and to ask for help.”

Tom says that the key lesson that he has taken from his personal struggles is to reach out for help early. Services such as Practitioner Health Matters, Your GP and other professional support networks are there for a reason, he says.

“Having supportive colleagues around you is also essential. Dentistry can be a very isolating profession, particularly when working independently and maintaining relationships with colleagues is incredibly important.

“The biggest mistake that I made was not stepping away from practice earlier, arranging appropriate cover so that my patients could receive continuity of care and getting the professional help that I so badly needed. Instead, I continued working until I was no longer coping and the care of my patients was affected as a result.

“I am genuinely sorry to the patients whom I let down. Whatever difficulties I was experiencing personally, they were entitled to reliable care, honest communication, and appropriate professional standards from me.

“For the future, I am focused on rebuilding my life and my career, completing my mentorship and continuing to learn within New Life Teeth. I hope to work there long-term, benefiting from the experience and expertise of the team and, importantly for me, continuing to practise within a supportive group environment.

“Most of all, I want to move forward, enjoy dentistry again and be happy.”