45 Years in Dentistry: What I have learned
It seems inconceivable to me that I graduated as a dentist some 45 years ago, way way back in the mid-1970s. That largely forgotten crooner Eric Carmen was number one in the UK charts with ‘All by myself’ a rather apt title given that for many colleagues dentistry can be a somewhat solitary endeavour—where did all that time go!
The professional landscape has changed so much over those years it seems inconceivable that it won’t continue to evolve and develop in the years to come. It has been said that studying the past is the only way we can try to predict the future and I do think that we can learn from history, learn how to approach many of the challenges that lay ahead, expected or otherwise. One thing I certainly do believe in very strongly after some five decades in the profession is that being a successful dentist will always entail following certain constant, core principles.
And so in this article I will provide an overview of these principles, drawing on my own experiences and those of the countless dentists I have had the great privilege and pleasure of working with down the years. Before I do, I must stress that nothing in life is ever black and white and time has taught me that each one of these principles comes with a caveat. I appreciate that as a result of this, what I say might be brushed off as the musings of a cynical dinosaur. I will leave that, dear reader, up to you to decide.
Principle #1: Be interested in what you do…but don’t confuse passion with commitment.
Passion is a much overused word. It seems to me that these days one must not only be interested in one’s work one must also be passionate about it, must love what we do. I’m not sure that this is entirely healthy. Take for example ‘passion project’ the name given to something that excites and inspires you. You do it for your own satisfaction, not for anybody else's. It may sound like heresy but I know very few dentists who are truly passionate about what they do to the extent that they would continue to do it even if it could not provide them with a living. We all think we know dentists like that but I have my doubts.
It may sound like heresy but I know very few dentists who are truly passionate about what they do. . .
My view is that dentistry is a profession which demands total commitment but in a sensible, level-headed, rational way, not some head in the clouds romanticised way. You owe it to your patients, your staff but most of all to yourself to invest your own personal and professional development, in other words to keep up-to-date and to be aware of changing trends within the profession. I strongly believe that you should aim to become really good at something, not necessarily to the extent of becoming a specialist but rather that you become known and respected for a particular skill, to become the dentist that people actively seek out when they they require this skill set. Being good at something, being an opinion leader undoubtedly improves one’s job satisfaction. It also means that you can charge a premium for your services. All of this demands commitment, not trite platitudes about passion.
Principle #2: Work out what your values are…but don’t expect everyone else to share them.
Basically, think about how you are going to behave and stick to it. We all like to think of ourselves as honest, always acting with integrity, hard working, fair, open-minded and so on. As with the dreaded passion word though, these are rather woolly, how do they actually translate into our everyday behaviour? Take honesty for example. At one extreme this can mean we aren’t going to rob a bank but it becomes a little more blurry if, say, we are discussing likely treatment longevity with a patient. Do you always tell a patient honestly how long you truly believe a particular treatment you are providing is likely to last? We have all been guilty of sugar coating what we do but dental practice is changing and it is now your legal duty to be truthful in terms of the treatment options available as well as their likely prognosis. So it behoves us all to sit down and consider our values much more thoroughly than we tend to do and as much as we would like the people around us to share the same values it is unreasonable to expect them to do so.
We have all been guilty of sugar coating what we do but dental practice is changing and it is now your legal duty to be truthful . . .
Such things as responsiveness, reliability and courtesy mean different things to different people. So by all means, discuss these with your staff but don’t expect them to always buy into everything the way you do. Their life situations, goals and commitment (that word again) will vary enormously. I was recently speaking with an estate agent who strongly believed that all his staff bought into the same business ideals that he did, that they were all extremely happy and fulfilled at work and would never ever moan about their jobs. The point is that his name is above the door, it is his business, we simply cannot expect employees to hold the same degree of enthusiasm for the business. The best you can hope for is to lead by example and hope some of it rubs off on those around you. Remember that staff are employees first, friends second. It's ok to ask them to work.
Principle #3: Have a plan…but don’t expect it to work out 100% all the time.
Or as Taylor Swift put it “Just because you made a good plan, doesn’t mean that’s what’s gonna happen.” Clearly nobody saw Covid 19 coming but equally those dental practices that had already implemented considered state-of-the-art cross infection control measures were clearly always going to be in a better position to deal with the clinical implications of the virus than those in which cross-infection control was something of an irritating afterthought.
One thing is for certain and that is plans are better than no plans, be they at a personal or a business level. There are so many clichés surrounding the art and science of planning but truisms exist simply because, by and large they true! So “Someone’s sitting in the shade today because someone planted a tree a long time ago” and “If you don’t know where you are going, you’ll end up someplace else” may sound rather trite but ignore them at your peril.
Principle #4: Embrace new technology…but realise that many traditional ways of doing things have stood the test of time for a reason.
Clearly, I’m not advocating that we all go back to taking compound and copper ring impressions (most you won‘t have a clue what I am talking about!). It is vital that we embrace new technologies that are scientifically verified and evidence-based. I sometimes shudder at the way we practised dentistry back in the time I qualified. It looks almost brutal when compared with modern approaches which conserve tooth tissue and inflict less damage to fragile supporting structures. We also understand much more these days about disease causality and progression and as I stated in the first principle, it is our responsibility to be up to date in our understanding of these areas.
I sometimes shudder at the way we practised dentistry back in the time I qualified. It looks almost brutal when compared with modern approaches . . .
Our patients expect it as do our governing bodies—how can we expect to present all the possible treatment options if we don’t even know what they are? Beware though, of throwing the baby out with the bath water. Some treatment modalities and principles are just as valid today as they were half a century ago. So whether you are placing a single surface composite, fitting extensive implant-retained prosthesis or embarking on life changing surgery or orthodontic treatment, the principle of thorough diagnosis and treatment planning still apply, now more so than ever.
It is also true that just about every modern treatment is more technique sensitive than older, more ‘conventional’ ones. Take amalgams versus composites. Of course composites are virtually always preferable to amalgams but they come with the need to be scrupulous in terms of adherence to treatment protocols, understanding material science, strict moisture control and placement techniques. Modern composites yield incredible results when done correctly but their use dictates the need for one of the oldest treatment adjuncts around—rubber dam. The point is that one has to be open to mixing old and new ideas, just because something is new doesn’t necessarily make it better.
Principle #5: Keep a tight reign on finances…but don’t let money dominate your decision-making.
This applies to life in general just as much as it does to your professional activities. Remember what I said earlier about your work being a commitment not a passion? You must charge appropriately for what you and you must collect payments efficiently if you are to be clinically and professionally successful. Think carefully too about what you spend. So many dentists I have met down the years are convinced that a certain piece of equipment is going to transform their practice and while yes, such things are nice to have seldom are they as transformative as one might think.
hardly ever hear patients getting excited about a new piece of equipment, instead they focus on the raft of intangible factors that go to create a successful dentist-patient relationship.
Clearly, some items of equipment are essential if we are to practice high quality dentistry but just, if not more important, are softer skills such as empathy, an ability to listen and to explain. I hardly ever hear patients getting excited about a new piece of equipment, instead they focus on the raft of intangible factors that go to create a successful dentist-patient relationship. Treatment planning should never be about what is best for the dentist’s bank balance, rather what is most beneficial to the patient. The number one goal should be to build a strong long-term, mutually trusting, relationship between the two parties and in turn this will bear fruits for years to come.
Principle #6: Marketing is essential…but be highly cautious of social media!
Many years ago dentists were strongly discouraged from ‘marketing’ their practices, to such an extent that in some jurisdictions it was considered a breach of professional standards to do anything that smacked of telling the world who you were and what services you provided. Marketing was often confused with selling. In truth, every business and everyone in every business engages in marketing even if they don’t know it. We market ourselves in every interaction with patients, actual or otherwise. The way we project ourselves to others in the way we communicate, dress, the style and nature of signage, interior décor, external appearance of the practice.
In truth, every business and everyone in every business engages in marketing even if they don’t know it.
Nowadays all this is magnified by our online presence, our website and dare I say it our social media presence. In truth, patients have formed a pretty comprehensive opinion of you in their mind before they even step foot into the practice. Whether or not this reflects the truth is down to how you, your staff present yourselves and your practice. At the end of the day perception is everything. It goes without saying that social media in all its forms is here to stay. Used properly it can be a useful adjunct to your overall marketing effort. But don’t let it dominate and certainly don’t let it transcend the ill-defined boundaries between what is acceptable and what isn’t. As with staff, patients by and large aren’t your friends, they are participants in a mutually beneficial professional relationship. And yet I am always reading advice from so-called social media consultants and gurus that as dentists we should be sharing more about ourselves via or social media channels so that patients can find out more about us and discover the real ‘us’.
As with staff, patients by and large aren’t your friends, they are participants in a mutually beneficial professional relationship.
Of course, over time some patients do become friends but in general I think that we need to keep a distance and not open up our lives in this way. What patients are really interested in is what happens when they are with us, how we treat them as people and how we manage their problems and concerns. How do we respond when they are in pain or something has broken or fallen out? Put simply, they want to feel that they are in the right place and that we are giving them 100% of our efforts and concern. This applies just as much now as it did back in the dark ages when I graduated.
Philip Newsome graduated with Honours from Leeds Dental School in 1976. He is a retired Specialist Prosthodontist having spent most of his career at the University of Hong Kong Faculty of Dentistry. He now lives in England’s beautiful Cotswolds where he writes and publishes on a wide range of topics from motorsport to, of course, dentistry.