If your patients feel more confident using a bit of glue on your superb denture, do you despair? Well you shouldn't. It's all cool according to a new white paper.
Meeting A Sticky End
Why Dental Fixatives Are No Longer Taboo
By @DentistGoneBadd
If you check out the word fortitude you get a sense of the characteristics necessary to campaign on Public Health. Resilience, endurance, perseverance, patience, tenacity, resolve, determination, grit and pluck. I wish we’d looked this up in 2012 when we started all of this – we may have decided to duck the challenge. We didn’t, and now we know why fortitude is essential, necessary, imperative, obligatory paramount, courage over a long period, plucky………
Back to 2012 then - let’s fire up the De Lorean although for the petrol heads it’s a metaphorical one as we know they stopped making them in 1983 which coincidentally was the same year that McColl v Strathclyde set a 201 day record for any legal case in Scotland over you guessed it Community Water Fluoridation. Manchester City win their first league title in 44 years, the Olympics come to London, Bruce Springsteen releases Land of Hope and Dreams and Hull LDC wake up.
Hull LDC met at the Ionians Rugby Club back then and that evening we meant business. Ionians were known for their love of democracy, philosophy the arts and pleasure. We were more in to treating our patients and staying healthy and solvent as NHS Practitioners but we did enjoy a beer. That night we were fed up as usual. Fed up with the tsunami of decay and the human consequences, the pain, the extractions the relentless tide of poor dental health. We were all very committed to prevention. We were all very committed to our patients and to the community of Hull. But we felt powerless and we knew we needed change. Hull has very poor oral health and is one of the most deprived areas in England. We understand the social health gradient now, but we were embedded in it in 2012 (as we still are) and we finally decided to do something. This isn’t surprising. People from Hull have a track record of standing up. In 1642 Hull refused the King entry to the City even though he turned up personally, endured a long siege militarily outnumbered by 2:1 and finally saw off the threat. That definitely takes pluck, grit, and fortitude.
Over a pint of bitter and a sandwich we voted to try and drive a Fluoridation agenda. We would start with a letter to the BDJ and publish an e – petition. So we did, convinced in our own minds that by the next AGM we would have cracked it.
We even developed a QR code link to the e- petition on the Petition Parliament site. Like a deluded punter down the bookies – we couldn’t lose could we?
The BDJ printed the letter and we waited for the e-petition to take off, soar,go viral. But it didn’t and in October six months after our rallying call for something to happen, it closed on 315 signatures.
So in October 2012 it seemed like Hull LDC were standing at the Fluoridation barricades alone or at least there were only 315 of us. Then the phone rang in Reception and my Nurse whispered in my ear – “there’s a Prof on the phone who wants to speak to you about your letter in the Journal.” I finished my fifth extraction on a child that morning and took the call.
To be continued...
Domiciliary dental care was in the news the other day — or rather a lack of it. Hopefully there may be some discussion now on adequate funding for treating the housebound. "Sorry. Don't Do House Visits"
I was initially quite scathing of the Tory Leadership selection process, but when I looked back critically at the way that I chose members of practice staff, I thought better of it. "You'll Do" How NOT To Choose Practice Staff By @DentistGoneBadd
The phrase “Existential Crisis” has been used a lot recently. In an individual it is defined as, “a moment at which one questions if their life has meaning, purpose or value”. Often it occurs at a point of depression or negative speculations on ones purpose in life.
Extrapolate that to a country and you have UK 2019 where political leaders in both government and opposition seem to have lost their perspective on many things, not least the word beginning “Brex”.
Dentistry like much of healthcare, is no exception. There are many dentists examining themselves and their motivations, trying to make sense of the direction they thought they were heading and the reality. Are these individuals really symptoms of a far bigger crisis or crossroads within the profession? And is it limited to the UK?
Examine the traditional career pathway. Dental student, FD, perhaps a little hospital work then an associateship or three, find a place that suits you and either buy into a partnership or buy a practice of your own. The financial pressures of ownership led to a focus on the reality of running a tight ship making the years of relative sufficiency and comfortable associateship feel like a dream. It all seems so simple.
With hindsight 2006 was a far greater watershed than we could have imagined. Fixed contracts have brought associates to the verge of employed status. Scarcity of contracts has led to massive inflation of their value. Most agree that the contract remains bad for everyone involved excepting those who hold the purse strings and make the rules. Yet there are no shortage of takers.
Looking at it from more than a decade and a half, the one outstanding thing was the independence of practitioners. Even those who chose to be “career” associates (including those who worked part time with family commitments) had stability with their own contracts and patients. The DoH write the rules, they wanted control and they have taken it.
Add to the mix the onus on universities to produce graduates to work in the NHS as opposed to being safe to provide care under any arrangement. The change in emphasis appears small, but is significant.
The fall out from Shipman has brought about a broad brush approach to the need for compliance, adding yet another contribution to the erosion of morale. The Care Quality Commission was never suited to Dentistry and remains a poor fit. Yet the tank trundles ever onward, distracting and crushing dental teams under its tracks.
There has been a growth of larger practices and the pervasive influence of corporates, some, not all, with a culture of command and control management which puts the investors’ interests above those of the patients and workforce. New graduates, taken in by piecrust promises and unable to find other posts are discovering that there is no line on a spreadsheet for empathy and care.
The commoditisation of orthodontics, led by the Align corporation, far from increasing individual skills is leading to an A.I. world. How many steps away are we from photographs taken with an app on an iPhone transmitted to a central hub for diagnosis, treatment planning and subsequent appliance delivery direct to the consumer. Why bother with those pesky dentists with their expectations and sense of entitlement?
Diagnosis of disease will be done more accurately using computers, treatments that can’t be carried out by robots will be performed by Dental Therapists. The headlong rush to being “Dental Beauticians” opens the market to many. Just because something has always been safe and controlled doesn’t mean that it will remain so. Remember coal, steel and newspaper typesetters.
In their book “The Future of the Professions”, Richard and Daniel Susskind predict the decline of today's professions and introduces the people and systems that will replace them. In an internet-enhanced society, we will neither need nor want doctors, teachers, accountants, architects, the clergy, consultants, lawyers, and many others, to work as they did in the 20th century.
The authors challenge the 'grand bargain' - the arrangement that grants various monopolies to today's professionals. They argue that our current professions are antiquated, opaque and no longer affordable, and that the expertise of their best is enjoyed only by a few.
Perhaps we should all embrace Dentistry’s Existential Crisis and plan for our futures.
