A little while ago, I joked on Twitter that out of my 30 years as a dentist, I probably spent 18 months of that time waiting for my inferior dental blocks to work. When I thought hard about it, the truth of the matter is that I probably spent two to three years of my working life in dentistry on the lavatory, nursing my IBS or trying not to throw up, such was my anxiety at working as a dentist. In recent years, I started going into different Tesco’s Express so that I didn’t get marked down by the staff as being an Immodium abuser.
From the time the General Dental Council was first mentioned at dental school, right up to and beyond the moment this sentence was typed, my biggest dread was/is of being called before a GDC Fitness to Practice Committee, and this is from a man who once had to stand in front of a cub scout pack, trying to deliver a talk on teeth while the cubs spontaneously and blatantly decided to have a wind-breaking contest in full and audible view of me.
A couple of weeks ago, the British Dental Journal published the results of a study which showed that nearly half of dentists said that stress in the job exceeded their ability to cope and that the most stressful aspects of their work was related to regulation and fear of patient litigation.
Out of the survey of 2,000 dentists, more than 350 admitted that they had seriously thought about committing suicide.
There can be few people surely, who would not be absolutely staggered by that statistic. Think about that for a second. If extrapolated to the profession as a whole, nearly one fifth of dental surgeons are so stressed that they have considered taking their own lives. If two out of ten cats threatened to throw themselves off a roof because they didn’t like the flavour of Whiskas they were slopped up, there would be a YouTube outrage, yet there was hardly a peep about anxious dentists.
If those extreme levels of levels of stress revealed in the study are caused by merely the anticipation of GDC complaints or litigation, imagine what being on the wrong end of actual litigation or GDC action would do to a practitioner.
I Shall Tell MY Tale, Now.
I’m not going to bleat about how there was a miscarriage of justice perpetrated by the GDC, protesting my innocence from the rooftops, because in the end I was justly criticised for ‘stuff’ (as Donald Trump would describe it), though my case was thrown out at the paperwork committee stage. The only thing I would say in my defence is that the case was coordinated by the dentist who bought my practice, for his own perverse reasons. I would also hastily point out that he himself subsequently faced an investigation for NHS fraud on unrelated matters.
The main reason for outlining my experience is to illuminate how such investigations profoundly affect and impact on practitioners and perhaps highlight the need for dentists to be supported during investigations and indeed, throughout their practice lives. I have no idea how this support would be delivered, or by whom, but I think that if the level of anxiety has reached the stage where a significant number of dental clinicians have actually considered suicide, it might be time for action?
The case I was involved in was pretty straightforward. I had left my practice a few months previously and although a significant retention fund had been left to cover the cost of replacement restorations, the patient had not been offered replacement by the new owner of the practice. The patient admitted to a nursing colleague that “Dr ****** told me that if I went to the GDC, I would get more money.” The patient had a crown that had failed, having developed an endodontic problem a few months after placement. The case was thrown out at the paperwork committee stage and did not go on to a hearing, but I did received criticism among other things for not doing a vitality test before placing a crown and not justifying in the notes, the need for RCT on a tooth (unrelated to the complaint) which clearly showed a massive cystic area on a radiograph of a premolar, taken by a colleague.
Trouble At T’mill
The first communication from the GDC to me was a Special Delivery letter to my designated registration address. In my case, it was the corporate practice and it had already been opened by the receptionist and was delivered to me with a “Sorry but I thought it was your certificate” face. Being around the start of the year, I thought the letter might be to say my cheque had bounced for my ARF payment, but no. It was a letter stating that a complaint had been received from Mrs ******** and requesting my indemnity organisation’s details. There were no other indications as to what the problem was on the letter, just the request for those details. I can’t really remember what I did immediately on hearing the news, but I can remember being gripped by blind panic. Within a split second I could see myself on the local BBC News bulletin leaving the Old Bailey and being chased down the street by a Sun photographer. Why the Old Bailey, I have no idea though I do know that up to that point I had never had any desire to know much about the GDC or where it actually resided. I CAN remember thinking that it was all at an end – my career that is. All that work and study, all that dedication to my patients, wasted. I was an absolute disgrace.
The Jolly Indemnity People
My very first action after pulling myself together was to tell my corporate practice manager. She was very supportive (as were all my corporate managers) and told me to go and phone my indemnity organisation. The dental advisor I spoke to was very deadpan and although he tried to be reassuring, spoke in a way that I read as “You are doomed doomed doomed.” I remember spending the rest of that day in a daze, but still told anybody in the practice who wanted to hear, everything I knew. Everyone in the practice was supportive and reassuringly outraged. I was determined not to keep everything to myself. The hardest part was telling my wife (a dental nurse) about my day. She was, as always, supportive, but neither of us were taken completely by surprised by events since we had learned much from a lot of dentists in the area about the purchaser of my practice since the sale. I went to bed, numb.
“Whoosh. What was that? That was your life mate!” Basil Fawlty (circa 1973)
Next came the bulky charge sheet and accompanying paperwork. I can’t recall the time period that elapsed between the initial letter and this, but it was a massive tome in a heavy package, also delivered by Special Delivery. The receptionist wisely decided not to open this one but gave it to me like she had a time-bomb with a hair-trigger, in her hand. I opened this one near the toilet. I was instructed to send this straight on to my indemnity people, but I was taken aback by one of the charges - namely that I had acted possibly dishonestly, although it wasn’t clear with regard to what. I have since heard that this is a charge thrown in by caseworkers often, with no justification but appears to cover all bases. The tome also contained a report from an expert witness/dental assessor outlining their findings and criticisms. It ripped apart everything I had ever done on the patient, not just the complaint, and looked at past radiographs and reports and treatment plans from the year Greene Vardiman Black was born. I was frankly overwhelmed by the whole thing and sank into a despair. With all the stuff that had been written about me, I didn’t think I would fight my way out, although the actual complaint was relatively straightforward -they hadn’t discovered neglected perio disease or general neglect, they were investigating the fact that I’d missed a tooth that had become non-vital. But what struck me, was that I was potentially going to end up in a public hearing at which my reputation would be hauled up in front of the nation! It was also at that point that I realised that I was going to have to give up a lot of my spare time in preparations. My old practice at the point I had been treating the practice had been still on paper records and my scrawl had to be transcribed by me for the benefit of my defence people. My weekends and virtually every evening in the week were ruined by transcription and answering queries by the dental advisor and the specialist solicitor assigned to my case. I had to comment on every point the expert witness brought up and justify every dental decision I made, including pointing out that I thought the tooth with the large periapical are on it was obviously in need of RCT. It apparently wasn’t obvious because I hadn’t written it in the notes, or written that I had discussed RCT v XLA of an unrelated second premolar. I put my hands up - taking the tooth out had never entered my head. The patient in question was complaining about a second molar she didn’t want to lose. Why would she want to lose a second premolar? The feeling I had around this time was of being absolutely swamped and it was very difficult to throw off the air of despair I felt every time a patient walked into my surgery. At this point, I had to admit that I saw every patient as a potential threat and I became reluctant to do any advanced restorative work for anyone – including simple RCT’s or crowns, in case they came back to haunt me. I know that anything even slightly complicated in the oral surgery realm became something I wouldn’t touch. A retained molar root for example – something I would happily have previously raised a flap for in practice, I now referred.
Didn’t We Have A Lovely Time, The Day We Went To Baker Street
Next came the trip to London. This was to discuss the case in person with my solicitor and dental advisor. The two people I dealt with were terrific. The dental advisor was calm and reassuring and the solicitor was a very assured medic who had gone into dental litigation – mainly on the defence side, but she admitted she occasionally prosecuted on behalf of the GDC. The main point of this meeting was to refine the paperwork case before it was put before the preliminary fitness to practice committee. On this committee, all the paperwork is looked at and they decide if the case needs to go to a hearing. This meeting was held at The Embankment, though I parked by Madame Tussauds near Baker Street (call me a masochist) and travelled across London. On the tube station, I remember speculating on whether throwing myself on the track, would hurt very much. At this meeting I can remember feeling pretty small and insignificant. Although my defenders were charming, I felt like I was like a tiny cog in the Parliament clock and I could be splattered like an ant, at a whim of the GDC.
And Then, The Call
Late one afternoon, some weeks after the London meeting, I received a call from my dental advisor. He told me that the preliminary committee had decided not to send my case to a hearing and I would get a letter from the GDC confirming this. I never read the letter. I remember feeling relieved and grateful to my exceptional defenders AND the GDC for seeing sense in what I knew was a ‘put up job,’ but it changed my attitude towards dentistry, patients and my colleagues, forever.
What It Did To My Practice
The whole process took about 18 months and I have to admit, I became even more fearful of dental patients after my experience. It made me realise that the most trivial mistakes or oversights could lead to serious threats to my career and it made me so cautious, I was referring WAY too many patients for procedures I had previously not worried about carrying out in practice, and taking WAY too many radiographs. I was spending an inordinate amount of time in explaining to patients risks and outcomes and it started to make my practice almost unviable. Even though I had no perio problems highlighted, I became obsessed with identifying patients as perio risks and would worry about them suing me for neglecting perio. It didn’t help that an exceptionally good dentist I knew in the Midlands had just received unfair national exposure in the papers thanks to a well-known dental litigation firm for ‘missed’ perio. But what the entire experience did teach me was, it doesn’t actually matter what you put in your notes, the patient is king and if they say you didn’t explain the procedure – even if it’s written down by you – then you didn’t explain the procedure. One of the most profound effects was that I feared patients being seen by colleagues, or worse, going to other practices, just in case they encountered another dentist like my buyer, with a God complex.
I have no idea how I managed to hold myself together over the past few years – my GDC experience was also happening concurrently with civil litigation involving the buyer of my practice. I had support from my family and close colleagues, but one of the most helpful areas of comfort came from the local NHS Area Team who were quietly supportive in the background. As I said, my indemnity organisation advisor was superb and it was him and the solicitor who helped keep me grounded. But the biggest help was distracting myself by taking the p**s out of dentistry on Twitter. Fortunately, I retained a sense of humour.
What did I take away from the whole GDC experience? The process, once it got under way, was fair, although deeply unpleasant. The FTP preliminary committee fortunately saw through the whole business and I was happy to escape with a few minor criticisms. My main beef was that the whole process was so time consuming and during it, I really did feel like a Dentist Gone Bad.
They do say, that at some point you will go through a GDC experience at some point in your career, and unless you are like the idiot a few years ago, who used partially-used local anaesthetic cartridges on patients, you will survive. I did, thrice. Didn’t I say? Oops! My mistake.
Completely understand your post about stress when under a GDC investigation.
As a follow on, I have been following the case about tongue splitting where (an ex dentist) or anyone can bifidise a tongue and also pierce it yet not require GDC or CQC or performer number registration, any thoughts? The case to look up is on BBC news -search Brendan Mccarthy.