Since I retired a couple of years-or-so ago, I’ve had many dentistry-related dreams/nightmares.
Many of these dreams find me suddenly planted back in a surgery somewhere, working on difficult patients with tricky clinical needs.
Usually, by the lunchtime, I realise I’ve not only not registered with the General Dental Council, but I also haven’t arranged indemnity cover either.
In fairness, if I’d KNOWN I was going to have one of these dreams on a particular night, I would have arranged cover in a dream the previous night.
The other recurring nightmares I have, are where I’m about to take finals and realise a few days beforehand, that I haven’t really done any revision.
That genre of dream DOES have some basis for it though. I passed LDS before I sat BDS finals and was already on the dental register at the June sitting. Other than boning up on oral pathology, I did very little towards revision for BDS finals, having worked myself into a frazzle for the April sitting of LDS in London.
From the feedback I get after boring Twitter people with my dreams, exam anxiety is a common dream-theme for dental people.
But last week, I had a slight variation.
Although we’ve spoken a few times and he’s overly indulged me by publishing my dental blog drivel for a few years now, I don’t know Tony Jacobs, editor and creator of GDPUK, that well.
So, in this dream, I suddenly found myself as a new associate in his own Manchester practice.
Tony greeted me at the door. He was very friendly, and slightly overwhelming, since he towered over me. I met him once at a dental show at the NEC and he seemed to be having to stoop to make eye contact, since I’m, to quote Detective Inspector Steve Arnott, “A short-arse.”
Anyway, height aside, Tony was dressed head to toe in a NASA astronaut suit.
Not surprisingly, I was taken aback a little, until he explained that’s just the way it is in practice now, due to COVID-19 precautions. “You can never be too careful” he winked.
Tony introduced me to the staff, who were also dressed like Neil Armstrong and the head receptionist warned me not to use Tony’s “special toilet” and that I was expected to treat the practice with cakes at least twice a week.
The head nurse, who I actually once worked with, grumpily showed me to the staff changing room, where Buzz Aldrin was waiting to help me into my spacesuit.
Buzz barked at me to take my Apple Watch off, and then the cheeky bugger pocketed it and I never saw it again. ALSO, he wasn’t wearing a space suit. “I’m an astronaut, I know the risks,” he reassured me.
When I got into the surgery, I struggled for ages to get a yellow plastic apron on, questioned the need for a blue surgical mask and visor, and gave up on trying to get blue nitriles over my astronaut gloves.
The dream ended, when I tripped over the long pipe trailing from my nurse’s life-preserving, oxygen backpack.
Now what I took from that dream is that I’m REALLY glad I don’t work in practice now, drowning in a sea of SOP’s and all the other acronyms that sprang up during the pandemic.
What would disturb me most, I think, would be the extra PPE and accompanying discomfort and sweat, as graphically demonstrated by a dental professional who tweeted this last week.
The Tony Jacobs dream made me think of how I would actually cope in the current situation, if I were to go back to practice after a two-year break. The thought has crossed my mind fleetingly on a few occasions over the past couple of years that it might be jolly to go back a day a week, just to keep my brain active, but that thought usually lasted a millisecond and went away after I had a little lie down.
Apart from the fact that I really don’t look good in orange or yellow polythene, the other thing that would put me off is the ever constant and increasing threat of litigation.
Having more time for web-browsing these days, I despair at the number of stories I see in local newspapers that tell of Mr or Mrs X winning n amount from their dentist in compensation in out of court settlements.
That’s right, ‘out of court settlements.’ And how does the press find out about these private litigation cases?
Because the law firms circulate the stories to local newspapers.
I don’t know if this is done deliberately to inflict maximum shame on individual practitioners, or whether it’s to publicise their grubby little business, but the practice is beyond the pale.
One well-known dental litigation firm pretty much ruined the professional life of one dental acquaintance of mine, when her out-of-court settlement ended up all over the national newspapers. She decided to retire early and her excellent reputation in the town where she had worked tirelessly and diligently for thirty-plus years, was permanently destroyed.
This penchant for promoting their out of court success is even more galling when a good portion of dental litigation lawyers started out as dentists. How would they have liked it?
I know of one of these lawyers and am told he confessed to a colleague when he was still practising “I can’t face dentistry anymore.” I HOPE the reason he couldn’t face it wasn’t due to the fear of litigation or action by the GDC, but I don’t know.
So, I asked myself this week, “Why is the threat of litigation becoming an increasingly real and dominating worry for practising dentists?”
I keep in touch with practising ex-colleagues and recently a young friend told me the other night that she was fearful of losing her house if she had a big complaint. She hasn’t had a serious complaint yet, but admitted she would give her home to someone else, rather than see it repossessed. I spent a considerable amount of time trying to reassure her that it wouldn’t come to that. At least, I hoped not.
When I first qualified in 1988, you rarely heard of dentists being sued or struck off, in the papers. Nowadays, you hear about it all the time, either in the papers, on the internet, or from alarmed colleagues.
So, what has changed? In the 80’s, dental litigation SEEMED rare. Nowadays, it is ubiquitous.
Have dentists gotten markedly worse since the late 90’s? No, I don’t think so, but the work they do HAS gotten more complicated and refined and hence it’s presented potential litigation lawyers with more opportunity.
My own theory is that it all started to go pear-shaped with the demise of the RDO.
For anyone who didn’t roam the Earth alongside the Diplodocus, RDO’s were otherwise known as Regional Dental Officers.
I’m not sure when they hibernated, but in my early days and well into the 2000’s, NHS dentists had half-a-dozen or so patients pulled by the RDO’s office, to my recall, every four to six weeks. The patients were selected at random and had recently completed treatment. By signing the NHS consent form, patients actually also consented to subjected themselves to examination by an RDO.
When I worked as an associate in the city, patients usually toddled off to the local community dental centre for their examinations, but when I bought my own practice out in the sticks, it was easier for patients to come to my practice rather than travel 20 miles to the two nearest community dental centres.
So, one day, after having had RDO’s check on my work for over 25 years, I invited the RDO into my place, giving him access to one of my two surgeries vacated by a part-time associate.
Far from being a scary experience, the RDO’s visit was enlightening. He did me up on a little ledge I’d left on an amalgam and suggested I replace the filling some time, and went through my notes.
At the time, I was still pretty much. writing my inveterate “Exam, ST – NAD, EOE – NAD. NTR,” which I’d been doing since I entered practice in 1988. The RDO said not a dicky bird. Even back then, it was passable. At least I had done a BPE and noted it.
It was only after I sold up and went to the Corporate in 2013 that I realised how rubbish my notes were.
The one good thing about having the prospect of an RDO check on your patients every few weeks, is that it kept you on your toes. At least it had that effect on me.
I think I’m right in saying that the ‘disappearance’ of the RDO came about at the same time the new UDA-based contract was introduced. I remember at the time saying to a colleague that the cessation of random face-to-face checks on patients wasn’t a great idea for standards.
I couldn’t for the life of me see how paperwork checks on dentists only, could keep tabs on the work that dentists were doing in people’s mouths.
And sure enough, here we are now, with a profession becoming obsessed with crossing the T’s and dotting the I’s and occasionally not hitting the apex.
I can’t be the only dental professional who has considered that attention has been diverted away from what’s actually being done in the patient’s mouth, to writing up thoroughly what you THINK has been done in the patient’s mouth.
Even the introduction of the Care Quality Commission to dentistry did little to dam up the tidal wave of litigation that dentistry was about to be swamped with.
Yes, the little cottage industry of dental litigation has now grown into a beast and there seems to be little we can do to tame it.
The pressures on dentists now, particularly under the NHS and the bizarre UDA system, are overwhelming, and it’s no wonder mistakes are made, or things are overlooked.
But the fact is, as a profession, we need to make things watertight – I’ll fess up now – my practice was quite leaky, – especially with regard to my notes.
In my opinion, if we still had a system where a dentist with a name and a physical presence was likely to be directly examining random patients after treatment, AND looked at notes, there would be fewer instances of legal and GDC proceedings being taken.
I just think the reintroduction of the RDO examination to NHS general dental practice would help sharpen practitioners up and help them raise their game, as well as improve access to invaluable RDO advice.
Also, being able to produce favourable RDO reports on your treatments would surely potentially go a long way in your favour, if you faced action by the GDC.
But until the RDO is brought back, all you’ve got for protection is a yellow plastic apron and an astronaut suit.
We still have RDO's in Scotland. Unfathomably now called DROs. I reckon them looking at big cases is not so fruitful. For my point of view, they find breaches of rules which have little impact on patient care, but are red tape quibbles which are used not to pay up. If they wanted to find the bad lads, they would look at patients with lots of work in the past who changed dentists and went into years of no NHS restoration. I seen lots of emergencies with shed-loads of caries and perio disease who have regular dentist who seem to be focused on huge private posterior composites, but couldn't diagnose their way out a paper bag and are incapable of bonding the base of the boxes.
I qualified in 1967. Back then we had DROs which origionally stood for Dental Reference Officers.
Some "Items of Service" within the NHS Dental regulations at the time required Prior Approval. By submitting a treatment plan for the DRO's approval. He (I don't think there were any lady DROs in those days) would examine the patient either in the surgery or the local community surgery. If the treatment plan was deemed too ambitious, it would not be approved, especially if there was there was an Item of Service within the Statement of Dental Remuneration, (part of one of the many StatutoryInstruments), available at a more economic cost to the NHS, say an amalgam rather than a gold restoration, or a resin partial denture rather than a bridge. One could appeal the decision, but that another story!
The Dental Estimates Board, (employing thousands of the population of Eastbourne), randomly or otherwise, picked a few cases of each GDP's patients FP17s sent to them for payment, to be checked by the DRO first.
He might also be present at a Dental Service Committee hearing if he was concerned about the standard of treatment, or premises provided by a GDP, who would be present to "defend" himself or be represented by a "friend". again another story.