Dentistry has an inherent problem...

By Dr Dhru Shah
Saturday November 28th 2020

What I am about to write is written in absolute honesty. Of the 30 insight blogs I have written in the last few months (which I am sure you have barely read), this is perhaps one of the most cutting. I am writing what my thoughts and feelings convey with the facts that go with it. Perhaps someone needs to write some explosively honest pieces and take over from Martin Kelleher (although no one would do any justice to his standards of writing). 

No, I am not being honest about veneers and cosmetics, I am being honest about something deeper... 

I was speaking to Dr Sanjay Sethi at the Square Mile Dental practice. One conversation led to another, as we discussed clinical cases, but that pure passion for excellence emanated from what he spoke about. He talked about how he sacrificed income to provide the highest quality of treatments for patients, he spoke about how he had got patients in to do some of his treatments again, or for revision surgeries, as he felt that he could improve things for that patient just that little bit (with no regard to lost time or income in this). In addition to this, without hesitation, he opened his computer and opened up his portfolio of anonymised cases to showcase and discuss the points we were debating. Just enough was not just enough for him. 

Every time I have heard clinicians like Sanjay speak that same search for that elusive perfection repeats. 

Gurvinder Bhirth, Boota Ubhi, Mahul Patel, Koray Feran and many more who teach regularly also emanate this same emotion. You want to see another example of such pursuit of excellence, then check out Gurvinder Bhirth's TubulesTalk at https://www.dentinaltubules.com/videos/the-3rd-dentinaltubules-annual-gl....

Beyond the financial and other material rewards that dentistry may provide, is another reward. This is the payout that truly matters- that payout of fulfilment, and of satisfaction - that settles that never-ending restlessness and that niggling feeling. The fulfilment and satisfaction that comes from the perseverance and pursuit of giving the patient the best that they can possibly deliver no matter how many tries it takes. I call this payout an emotional payout and it is a payout that surpasses anything else. It is an inspiring outcome.

That emotional payout, that continued pursuit of excellence is inspiring to others and serves as an inspiration to them as well.

At this stage, I present a simple quote from myself (so you could say copyright Dhru Shah 2020) - "If you don't care enough, you won't be inspired and if you are not inspired enough, you won't care BUT if you care enough, you will find that inspiration". These guys and gals care for every detail, every little bit, every small improvement that can lead towards that elusive perfection. 

Actually, I will add to that (another copyright Dhru Shah 2020) quote "If you are not inspired, you won't have a yearning to learn, and if you don't have a yearning to learn, to feed your curiosity, how will you be inspired?". These guys and gals care so much, that they continue to learn, every day and in every way. Their education never stops. They invest a lot of time and money in education.

These guys care, they truly deeply care.

One of them truly cared enough to recognise his passion, sell his practice and focus on his delivery of dentistry to the patient. He took the bold leap into the unknown to find the right practice that will support his pursuit of excellence.

Another cared enough to take the bold leap into the world of private, independent dentistry when he didn't know if he would have enough to feed his and his family -  a pure leap of belief and faith in what he believed in and cared about.

Now I go ahead with my profound statement of honesty - "Dentistry lacks that genuine care and inspiration".

Now before the tomato throwing begins, think of some of these thoughts

1. As a periodontist, every patient I see, has an hour's consultation. Many of these have primary periodontal disease. Yet I spend an hour listening to them, educating them and establishing mutual rapport and trust. AN HOUR. Sometimes an hour is not enough. Yet I REFUSE TO COMPROMISE on this. Many years ago, I got frustrated with an NHS system where I could not get enough time with a patient, I got frustrated that I had to rush through treatments that I decided to embark on a painstaking path to specialisation, just to be able to reach a stage where I could deliver that care with the time it deserves. I struggled, I was not perfect. Natural skill was not my forte, but day by day, I have worked to enhance my strengths. If you want to know more, here is my blog entitled Because I care at https://www.dentinaltubules.com/tubules-live/blog/because-i-care .

These patients need good time, patience and quality to be educated on what is happening and time (yes time) to build that trust in me. It is this trust, that builds their knowledge and understanding, and that knowledge and understanding that helps them change their health behaviours. This takes time.

This is NOT just cleaning their teeth or fixing a hole with a filling or moving some teeth - this is making them understand what the problem is, how it happened, why it happened, what are the risks and benefits and enabling them to take ownership of their decisions with your support. This takes time. 

Dentistry has to be slow, has to be specific, has to careful and the skills needed to attain that level of care are not easy. The skills to communicate, the skills to understand, the skills to deliver those treatments to the best of our ability, the skills to reflect (yes that word reflect), the skills to understand people, and the skills to work with a team that includes a valued dental nurse cannot be attained overnight. They need patience, perseverence, regular learning, continous dedication and time with the patients to be able to deliver them for the best possible outcome.

Yet there is a population who are doing this within 15 minutes or maybe 20 because the system will not enable them to do more. A target driven system that enables them to push numbers. For whose benefit may I ask?

To so many, dentistry currently feels like it is not a rewarding profession. I do not mean financially rewarding. That only comes as a consequence of doing the right thing. The true reward, as I alluded earlier is emotional reward. That feel good feeling when we have done an amazing piece of work and truly benefitted our patient. That feel good feeling that hits the spot when what we value has been met.

In a climate of high stress, high risk of complaints, high litigation and frankly poor leadership - how can you gain that emotional reward? 

By truly caring for what you believe in, by truly investing yourself into this and by taking that leap of faith. Aim for excellence because you patient will appreciate it. They see this, you see this, and your growth delivers inspiration that emotionally fulfils you. It makes you happy.

If we truly cared, we would take that leap of faith towards care. We would make the jump collectively. We would create something as a profession that increases patient trust in us.

Until you are not inspired , you cannot care enough to take that leap of faith, and it won't be easy BUT it will be the consequence of what you value and what you aim to deliver.

I don't just talk. I do practice what I preach. In point 2, I relay my example of the  leaps of faith I took to deliver what I truly cared about and what inspired me.

2. Firstly, I was inspired to inspire dentistry and dental professionals. I see too many dental professionals who are unconfident, uncertain, overwhelmed, feel inadequate about what they do (and compare themselves and their work to what they see on social media) and are genuinely scared, uncertain, worried or not sure about their future.

In 2009 I took a leap of faith. With no money, no clue - I started dentinaltubules with a vision to educate and inspire the profession. I truly cared, to a level where I took the hard journey and took the risks on. I made huge financial losses personally for almost a decade, but never ever compromised on excellence. and on my vision. This was excellence at every level:

- Not compromising on the excellence of the educational delivery meant that we paid thousands of pounds for high quality videos and international speakers when a couple of handful of webinars or even simple click through slides to tick boxes would have done and cost us a few hundred pounds.
- Not compromising on the congress experience whether it made a profit or loss in order to inspire the atendees. We invited UK and the world's best speakers, invested in one of the highest quality AV and screen experience and held the most inspiring events. 
- Not compromising on the website - by finding the best team and delivering the best user experience we could.
- Not compromising on my own leadership - by regularly learning what I could do better, by leading by example and by sacrificing my own time, money and even sleep (I slept 2 hours a night at one point) and sacrificing my health to deliver the utmost best for the profession.

Yet I don't do this for fame, glory and all. If I did, I would be jumping to be winning awards and all that. No, true care, true inspiration, true fulfilment comes from within - not someone's recognition from without. I did this because I truly cared, and was inspired by the change I could make to another dental professional's life.

Over the last 12 years, as a result, a fair number of dental professionals have seen their inspiration in dentistry return, accompanied by compounded growth in themselves. They are maximising their potential to thrive. 

3. Our profession is also stuck in continuing to hammer away at the same tried and tested methods. They may work, they may not.

If someone has an article to publish, they think the BDJ is the place to do so. Yet here I am publishing this on Tubules. (yes the BDJ is high quality peer reviewed journal and should be supported but we need to observe that other methods and new avenues exist). 

Look at the current BDA election. Last time I looked, there were circa 42000 dentists on the GDC register of whom ballots were issued to 15000 odd. Only 1300 odd voted. ONLY. That's barely touching the tip of the iceberg.  This is for an organisation that is meant to represent us politically. It is out of touch, irrelevant or people have lost hope or don't care. I don't  know BUT this tells you another thing. So instead of continuing to try the same tested methods, hoping they will change, perhaps we can give the new organisations a chance. (yes the BDA has done some good things and should be supported but we need to observe that other methods and new avenues exist).

However the truth is that we continue with this approach because we lack true leadership in the profession. If we truly cared, if we were truly inspired, we would recognise the leaders who are working damn hard day in, day out and not shouting out, not making noise, not marketing themselves and definitely not displaying awards. 

So often, we point fingers at various organisations or regulators blaming them and blaming their methods. We ask them to change. However their change, their need or want for change is out of our control. 

The only thing within our control is US and what WE DO. If we truly cared, we would take those courageous leaps of faith to make bold changes in what we do, to rise above this. 

If we truly cared, we would be engaging the public at large. Finding ways to educate and inspire them about their oral healthcare. 

True leaders give hope, they give a vision of a better future and true leaders enable things to happen for that future. True leaders make bold decisions (most of the time in the absence of all the available facts) with the genuine intention of serving those who they are supposed to serve.

When the COVID Crisis struck in March 2020 and practices were asked to shut down, dentistry was in disarray, confusion, uncertainty and stress. There was panic about the future and uncertainty about whether businesses that provide dental healthcare will survive.

In this light, a leader was needed to deliver hope, certainty or something to uplift people. 

The regulators who are always so loud, in issuing guidance, didn't issue any statements of hope, or reassurance or even guidance. They asked us to follow the direction of the CDO. The CDO's first webinar, attended by 10000 people was highlighted by most viewers with an emphasis on a telling off of some Facebook post rather than one of positivity, reassurance and hope. So many KOLs who should have stood up to rally the troops were nowhere to be seen.

Where were the leaders?

At Tubules, in our limited capacity, we tried our best. Overnight I called a team meeting and mobilised whatever machinery and infrastructure we had to deliver something of use to the profession.

- Overnight our webteam created a FREE TubulesLive section on the site and a free base membership. 
- Overnight we offer hundreds of people free tubules memberships 
- Overnight and continuously for 6 weeks (42 days - every single day - we ran a webinar , a TubulesLive on some aspect or another to guide the profession). EVERY SINGLE DAY IN THE CRISIS. Only Chris Barrow did the same with his extreme business team. A special thanks to our tubules team, especially Zak Kara, Angela and Tubulites who contributed and engaged.
And through 2020 we have continued to do this.
 Overnight our WhatsApp groups turned in networks of pure support, information and exchange - especially our practice owners groups. 

All this was done irrespective of cost (and in the face of a mass of subscription cancellations) to serve the dental professionals and to give them some light in the darkness. 

We would have done more if we had the influence, resources, numbers and backing.

Yet we got abuse for charging people from August onwards, we got told off for not offering free CPD and we got all kinds of comments of disappreciation. 

Similary, other organisations created documents and reviews to help move forward through this and to get practices going. Without much push, these organisations took the initiative and did whatever they could. Independent practices had NO income and these groups were creating momentum to ensure survivability of people's livelihoods AND care for patients who could not access care.

BUT WHERE WERE THE peoeple who have been called 'leaders' in dentistry?

If dentistry truly care, if dentistry was truly inspired - the abundance of those leaders would have shown doing things overnight that we needed to be done.

4. There is a known fact that dental nurses are getting difficult to recruit for whatever reasons. Many dental nurses are leaving the profession.

While many dentists have been taught technical skills, how many invested themselves into learning true genuine leadership skills that would ensure that the one resource in their team would be inspired? Dental nurses are leaving because they feel devalued, uninspired and not inspired to grow.

We have had practices cancel dentinaltubules practice membership because their teams did not use Tubules enough. With the amount of features, facilities and content, I was baffled as to why some practices truly engaged in our resource and why some practice teams LOVED it and why some of these didn't. 

It is because the Tubules practice owners truly care to inspire their teams. 

Yet this is where we are headed. I have always said - inspiration comes from within, motivation comes from without. We have stopped caring, we have stopped inspiring.

All we care about are how to get on Instagram and the likes, all we care about are those awards, all we care about is how to earn a quick buck over excellence, all we care about is how to hit UDA targets over patient care, and all we care about is quick box-ticking CPD and compliance rather than true detailed in-depth learning.

Having spent 12 years trying to inspire people, trying to convince them to grow and rise above mediocrity - I am tired.

Until true care, HEALTHCARE does not come from within, until that pursuit of perfection and excellence does not appear, until we are not inspired - our problems will continue.

I am sorry if this offends anyone but the truth must be told.

Perhaps it is time for everyone to wake up and smell the coffee, sip it and take that leap of faith. Take personal responsibility.

If you truly care for your patients, your patients too will truly care for you and give you the emotional rewards and the trust your inspired care deserves. We deserve to take the bold leap of faith, because this time dentistry needs it. 

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