Punching yourself repeatedly in the face

By 8 November, 2015August 3rd, 2018Newsletters

Can you smell it?  Change is in the air.  Go on, open the window, and take a deep inhale.  It’s there, it’s so there you can almost taste it.  I am of course talking about the GDC.  If you have been reading their charge sheets recently, you will have noticed some pretty bizarre charges coming through.  For example

  • “Failed to keep your air out of your face”
  • “took too long to take a tooth out”
  • “You took a child to work without permission”
  • “You didn’t keep your LA in their blister packs”
  • “You carried out complex treatment in the anterior region without first providing adequate posterior support” 

Etc etc etc

Of course non of those are misconduct.  At best some might be employment issues, others may be negligence based.  But negligence isn’t misconduct.  Negligence is, in most cases, when something goes wrong.  Oh and most of those were heads of charges, meaning they were the most serious matter.

So how does this happen.  Well the GDC solicitors are the ones that write up the charge sheets, and for some reason some of them seem to be throwing everything they can find, plus the kitchen sink into the charges.  But they base their reports on the information given them by the experts, and the experts are supposed to base their reports on what the reasonable standard is.  Let’s just remind ourselves of the role of an Expert Witness

 

  • should give independent, objective and unbiased evidence which is not influenced by the demands of litigation;
  • should state the facts and assumptions which form the basis of his evidence;
  • should consider facts which do or may detract from his opinion;
  • should indicate when an issue does not fall within the ambit of his expertise;(where this is so), should indicate that he possessed insufficient information to form more than a provisional opinion; (where this is so), should indicate that his opinion is qualified in some respect or respects

 

So it appears (and I may well be wrong) that some of the clinical advisors are exceeding their remit, and I quote

“?A clinical advisor provides clinical advice at the early stages of our fitness to practise process. They produce reports which help us to decide whether information referred to our Fitness to Practise (FtP) team amounts to an allegation that a registrant’s fitness to practise may be impaired.”

 

And I quote again

“In cases relating to clinical treatment, if the GDC finds that the registrant operated at the level of professional practice reasonably expected of a dentist working in the same discipline, the case will not be continued.”

 

Now does this sound like what is happening at present?  Some of our fellow professionals think that their remit is to be an advocate for the patient, or to write their report for the GDC, and that is anything but the case.  Something is going wrong with the process, and I think the GDC will admit this if they are honest.  And it will change, because this kind of thing can’t go on because it is quite simply embarrassing for the GDC.  They have already been before the Health Select Committee once.  To appear again, with this kind of ridiculousness hanging over them would destroy careers.  When an organisation such as the GDC becomes Kafkaesque, when it starts to resemble a kangaroo court (I am not for one minute saying that it is by the way, just that it could face that accusation) then it loses its effectiveness.

The GDC FTP system is flawed and is now damaging patients because the profession is so in fear of them that defensive dentistry is now the norm.  Not only that, good, ethical dentists are leaving the profession in droves.  Practices are being sold to sub optimal corporates and innovation is being stifled.  Why invest heavily in a business when it is now so easy to lose your livelihood.  Whilst I’m sure the GDC came at this all with good intentions, we all know what the road to hell is paved with.

But I don’t even think the GDC are the main problem.  The main problem is us.  Now there are many dentists who will see the work of another and feel compelled to comment.  You see it on Facebook all the time.  For example the best dentist I know posted a picture of one of his amalgams, and several dentists decided to slate it.  It was a beautiful amalgam, but not to some.  Another posted a cerec crown he did and again criticism flowed freely.

May I remind you there are over 40 ways to fill a fecking occlusal cavity. 

Just because you don’t agree with a treatment modality, doesn’t mean the other dentist was wrong.  And yes, OK, you might see something with a dodgy margin, with a large ledge, with a shade that isn’t ideal.  But until you have sat and treated that patient yourself, until you have sat in that dentists shoes and know what he was experiencing at that moment in time, you can’t say a word.  There are many dentists, in this country, who feel it is their duty to slag off other dentists work….. and then give the patient an estimate to sort it all out.

And whilst I will admit there is horrible dentistry being done, there are also patients who are a nightmare to treat, dentists who need help and guidance rather than condemnation and dentists who just had a bad day.  There are also patients who lie through their teeth about the “sinus they never knew about” even though the last dentists clinical notes clearly show the patient was aware and point blank refused any treatment.

There are ways to raise concerns that are effective and which do not involve massaging your ego and do not involve throwing your fellow practitioners under a bus.  There is also a marvellous invention called the telephone that can use to ring up the patient’s last dentist and go “I just saw this patient of yours and I noticed a few things that concerned me.  Would it be ok to have a chat so that I have the full picture?”

Poor performance needs addressing.  Poor practice needs to change, and there are dentists working today that perhaps would be better off changing career.  But there are also dentists with families, struggling with addiction, with illness and with depression that can be helped, mentored and guided.  But some of us don’t see that.  We see an opportunity to somehow prove we are better, that we are superior and hear the ring of the cash till.  Some of us even go so far as recommending the patient sue their previous dentist to pay for it.  Do you want to be the one that tips that dentist over the edge into suicide?

But you know what, there’s a funny thing about all this.  It’s becoming more and more common for the second dentist to get sued also, when it turns out that what they said wasn’t in the best interest of the patients after all.  And the expert witnesses working for the GDC need to remember that very competent barristers will be examining their words and testing their metal, and all of that will be written up and put on the WWW.  More and more dentists are embarrassing themselves because they think they knew it all and, when push came to shove, it turned out they didn’t.

Patients need to be protected, and there are ways to do that.  But show some humanity and some humility for Gods sake, because the actions of some of you are basically punching the profession in the face.