Month: March 2021

[00:00:00] And I would say to my students, this is a service in our culture, to bow your head and serve someone is not to demean yourself. It’s like the highest form of love. And so I believe that I really believe them. And so for me, that’s what the ethos of this clinic is about.

[00:00:22] This is dental leaders, the podcast where you get to go one on one with emerging leaders in dentistry.

[00:00:34] Your hosts Payman Langroudi and Prav Solanki, it gives me great pleasure to welcome Fazeela Khan-Osborne to the podcast because he has become a household name in the area of employment policy and teaching of Implantology. It’s lovely to have you on the on the show Fazeela. This podcast really about getting to the person behind the persona. And we always kind of start with the same question. Where were you born? How did you end up in dentistry? What kind of childhood did you have?

[00:01:06] Thanks for having me, guys. Real pleasure and privilege. I’m a West Indian kid. I was born in Guyana, in Georgetown in the 60s, mid 60s, and I was born to two parents that were human rights judges. And we traveled around based on wherever that was predominantly sent to. So we were a British Empire. Kids really in that sense, grew up in the sunshine, walked on the seawall every day after work. You can imagine mum and dad in the front and the rest of us trailing behind. Really happy childhood, as I was saying, to prevail here. I’ve got five brothers, so I’m No. Five of six and technically I’m the shortest. So, you know, I’m not the youngest, but I’m the shortest. So, you know, we just grew up with very simple, no TV, no phones, nothing like that. If we if we were having a birthday and we were having a movie that we’d fire the projector and the Disney movie would come out. It was that kind of thing, very outdoor life. So we’re really happy. Life came here, came here every year, actually, because when you were in that service, my parents were diplomats. You had to come to the UK as well as somewhere else, wherever you wanted to go. So we came here a lot. And then we finally my father was very British, obviously, and was educated here as well as my mum. So we came here in the late seventies. Seventy five, seventy six. And we came here for education. The political situation at home had got to the point where it was very dangerous for us. My dad was chief justice at the time our mail was opened. Every other phone call was a bit hard for one. And when you’re 10, 12 year old kids, that’s quiet. You look out the window and you see kids walking around and you you wonder what made you be behind the door and they’d be the other side of it. So, you know, I was very grateful, but my parents really came here to give us a better life.

[00:03:12] You remember actually the moment of arriving in New York, I remember.

[00:03:17] Yeah, absolutely. And I remember you. I was just coming up to 12. But what I remembered more was because National Service was becoming a conscription for women as well as men.

[00:03:30] I was coming up to 11 was the age and I was coming up to 12. So I was even past my sell by date on that one. And I remember being woken up one morning and bundled into a car with my brothers and looking out the window at the help, because obviously in that part of the world, you have a cook and a gardener people to help you. And then just part of your family, really. And I remember looking at them and thinking, I’m never going to see you again, but I didn’t know where we were going and I didn’t know if we were ever coming back.

[00:04:00] So I remember that vividly arriving arriving in the late 70s. You came, right? That was the winter of discontent. Yeah. So from all the bright colors to that sort of gray ju ju ju ju ju remember thinking you’ve downgraded.

[00:04:18] I remember thinking was the sun you know, why people why don’t people understand my English with my twang. And it was very it was, it was still the days of all the signage where you were the only colored kid in school. You were the only. I grew up in Richmond, so it was a very white middle class area. Very nice, but very, you know, a lonely place. If you didn’t have people that were like nice school. But, you know, it was tough. It was tough in the first days. And people would say, you know, when you go in home or, you know, that was when I was first introduced to the word walk, which I didn’t really know what that meant. I remember going home and saying to my mom, what’s the word she was? And she would say, oh, was that started already? But it sounds silly to say, but I didn’t really realize that I was a color till I got here. We were just kids. We just loved life. And that didn’t really come into our consciousness at all.

[00:05:20] So it was a bit of a rough start from that point of view due to the name calling and the and the the racism, so to speak. How did that manifest on you?

[00:05:31] At the beginning? It was just, you know, a little bit of it was a lot of names and it was a little I was the kid with long hair, pigtails and glasses, so, you know. Mm. Not fun. I got to five foot five when I was about twelve and didn’t go much after that. So I mean, you know, it was just and the thing is because I always had a brother in the school, it helped. But you did feel it was something you had to get used to and you did get used to it because the signs were still out in restaurants saying that you couldn’t go in or whatever, it was getting better, but it wasn’t done yet. And you were very aware of being in the minority in that society, let’s put it that way. But you were also very aware that your parents are working, but don’t, you know, work, working all day and you got to pull together. And and we just we’re very tight because apparently the lawyers my dad was was a human rights judge and my mum was appointed as a first female human rights judge, literally three months before we left. And so she didn’t take up post, but they were both barristers, essentially what they were doing here as well. Yeah, yeah. Although when we when we came here, you see my dad was fifty three when I was born well so but he was like forty, he was running around like baby and very, very active with his kids and my mum was sixteen years younger than him so we wouldn’t have to, I mean he was definitely, she was definitely the, the cool, calm, collected one. So we were really lucky. But he was already semi retired and still putting three kids through school because the kids had gone, but the bottom kids weren’t so. So it was tough for them because we had when you left a situation like that, all your money was there. So you kind of had to start again a little bit. So, yeah.

[00:07:31] When did dentistry come on to you? Oh, not for radar.

[00:07:35] I mean, why dentistry when you have both parents and in the US, I often wonder that I was the kid that brought the dog with the label like home with the kids that brought the kid home who who didn’t have didn’t have a nice home to go home to and they’d sit and eat with us. I’ve always been a caring person. I’ve always loved looking after people. I’ve always wanted to look after people. So I always knew that I would be interested or want to spend a decent part of my life doing that. So obviously, medicine would be. The thing that we turn to and I had also a member of my family who is a radiologist, so that was kind of going that way and I actually ended up starting there and then deciding, funnily enough, now that I’m out of surgery, funnily enough, deciding I don’t want to do medicine because I don’t want to do surgery. So I ended up with a medical biochemistry physiology degree and it kind of got very interested in genetics and that kind of thing. And I ended up working for Paul Nurse actually ICRA for a year to do my PhD and then decided I didn’t really want to kill animals for a living. So I fell into it really because I went to do my PhD at the Royal London with a guy who you guys are probably too young to know is a guy called Spears, who was a professor of physiology in relation to saliva.

[00:09:01] And I started my study with him and he said, why are you here? Why why are you in this lab when you should be out with people? And and it was you know, research is a hard taskmaster, really. And he said to me, go to dentistry. You love people, you’re good with your hands, go to the tree and you’ve only got to do anatomy. It’s only a term. And that was the time when you could do that and go straight into clinical, you know, the three, the full year. And so that’s what I did. What was your deal? It was on the saliva and there were a couple of genes in saliva and couple of proteins that we were looking at. The what how did that give you protection against dental disease? And I only did it for six months. So it didn’t amount to a lot. But it taught me to be really focused and to be really disciplined about what I did. And that, you know, I come from a very science background. So that that helped me a lot with dentistry, because dentistry for me is apart from the lovely bit of actually caring about someone, it’s really about the protocol and making sure that you do it in the right way. And I sort of get that quite easily.

[00:10:20] So I’m from there. Obviously, you went through dental school, and how did you find that? Were you sort of somebody who was sort of top of your class and all that sort of thing?

[00:10:31] No, I had a great time in dental school, so I wasn’t. But I was kind of in the middle. We had thirty three in my year and I was always around number eight, nine, that kind of thing. And I wasn’t I could do it. But there was nothing special on the hospital. Yeah, it was when it was actually the London hospital. So there was a big and I was really lucky because I had a great year and you know, we had a laugh and we had a good social life and and we worked hard, too, but we played hard as well.

[00:11:08] So which did you qualify as a dentist? Nineteen ninety four. OK, same same time. Yeah.

[00:11:16] I mean what did you think then would you did you go like did you have it in those days?

[00:11:22] Yeah, it was just coming in and I basically decided to run for you. Yeah. And I didn’t, I didn’t really want to do it and I really didn’t because I didn’t want to be sent to Colchester to do it. And I really got that year, the final year the Royal London or the London was really good at, you know, different hospitals are good at stuff. We were good at oral surgery. We wanted to get a tons of conservation, but guys were. So I really started to to to go towards oral surgeon because it was something I was really barbershops, basically, and I wanted to be better. And then I won the surgical prize and something happened that year because normally you’d get housetop when you’re in hospital, you know, and if you didn’t get it, then you wouldn’t get it anywhere else. And I remember walking past the the staff room of the oral surgeon room and overhearing a member of staff saying, well, I’m not giving her the job. And it really pissed me off. And I thought, right. And I’ve done a really good rotation and everybody was fine and I had a good time and did the job well. And the remarks that came back were really good. And I thought, I’m not going to give you the satisfaction of turning me down.

[00:12:37] So I didn’t apply. And I applied instead with John Langdon, who had done a bit of research with and I got an interview and I got a house job at Jorges instead, which was great. So I left and I just thought, I’m not doing that, not playing that game. And I just found that there was a little bit of that kind of thing going on in hospital. Even though I loved hospital, I didn’t like the politics at all. So I went to Georgia, do my husband job, and then I went to Keen’s to do the second bit. And then I decided to go back to London now on my own terms. But this time I was seeing one of the staff members married to him. So that was a bit awkward. But he was in restorative and I was in surgery, so it didn’t matter. And I spent another 12 to 18 months there doing right up to locum registrar. And then I went and did great woman straight in Newcastle. So I did the whole law in about six years, had a great time. But it kind of kills your life when because in those days we didn’t have you know, there was no contract. You worked 90 hours a week for duty.

[00:13:47] Did you have a plan from the career perspective that you were going to be a surgeon?

[00:13:51] Yes, I but I did. The one thing I didn’t want to do after having done all of that time was I didn’t know. I didn’t you could have got away with not doing it at that point. Just about, actually. But I didn’t want to do cancer patients because they all died. And that really hurt me. I mean, despite my tough appearance, I’m actually a bit soft and I get to know these people and then we would dehumanize the hell out of them and then they die. And that really bothered me. So I kind of made this decision that I wasn’t doing my space. And the other thing that happened was I looked at the list of consultants at the time and they were six hundred of them and two were women and both were unmarried and both were miserable sods. And I thought, I don’t want to be like you. I want a family, I want a life, but I want to do my surgery, you know? So I made a choice to bring surgery into practice and do it my own way.

[00:14:50] I mean, even even surgery at practice wasn’t really done much by women time.

[00:14:55] No, not at all. I think I know. I know. Well, that’s part of the problem. And I think, you know, in those days and it’s our own fault a little bit, you know, it’s funny. Lately, women in dentistry, she’s become a real topic again. Again. Right. And I tried to almost distance myself from that because I don’t think that we we are a special case. I think if you want to do something, you get you get off your arse, you do it. And if it takes you 10 years, it takes 10 years. And it’s persistence to actually get to where you want to go. And I had listened I when I built my practice that week, I had a kid, I bought my practice and I sent my master’s exam by myself at the time. I remember getting I’m in the breast feeding my son and giving that kid to my husband and saying, can I just go in the pub for a quick bite with the boys just before I go home again? And he said, Yeah, OK, no problem. And you know what? I’ve always been one of the boys because I grew up with boys, go out with boys. There was no concern about, you know, if you’re going to do it on your own, you know what I mean? So it was tough, but it was. All right.

[00:16:10] So then let’s let’s get this out of the way right now. So the women in dentistry thing that’s come back now, do you have some sort of sympathy with why that happened?

[00:16:22] I don’t genuinely I find I think there are a lot of talented women around, but I think they’re talented because they’re talented, not because the women. So that’s one thing. I think this the one about what we’ve got kids. But I had two kids. I had two kids. I have parents to look after, to practice, to look after the education to do you know, it’s about being well organized. It’s about my moms. I was very lucky. I moved back to West London so my mom could help me help us. I also had to even though we’re divorced now, you know, my ex-husband was the most supportive, fantastic person on the planet. And frankly, any education I wanted to do, he would say, you go do it and I’ll stay home and look after the kids. So I was super lucky. So between that, my nanny and my parents, I got it done. And it was just a question of organizing. And for a while, for about three or four years, I took, took, took, took, took the whole time. And because that’s what it required. But, you know, I was just very lucky. But they were supportive 100 percent. And of course, I got in with people like Koroit with Zacky, and I’ve been friends for twenty three years. He’s one of my best mates.

[00:17:39] So at what point do you remember it’s switching from, you know, you qualified as a dentist, you did this all surgery route and bought a practice. At what point did that change to West End high end teaching and all?

[00:17:55] Ok, well, I go to the University London practice, so that was based in Gower Street anyway. So it was already in slightly Western. But when I was a kid, we used to walk up and down High Street and you’d see all the little prince, typical immigrant story. And my dad would point out all these little gold plates. And I thought to myself, if I ever get good enough, I would love to have a plate. And for me, it was about achieving being good enough, not just arriving there, because you can. So it was an important thing for me. And the reason I wanted to be there was because if you go anywhere in the world and you say that you practiced there, there is an understanding or at least a belief that some of the best people in the world practiced there, that there is this collection of knowledge and expertise. And I wanted to be at least part of something that meant something. I think certainly when I was twenty five years old, I’m not sure I feel the same way right now, but because it is a very hard task.

[00:18:58] Master the West Westend could expand on that a little bit for me. Well, there’s the obvious things, right? You haven’t got walk by traffic. Yeah.

[00:19:08] You know, you have you know, there’s no really business in the West and it’s a it’s a boys club. There’s no question about that. When I, I still get mail saying, Mr. Osborne there, it makes me laugh. Actually, the whole the whole thing makes me laugh. But when I up in practice, I had done my and restorative and I done the top, my special area was Dehradun it and I think because my parents were a bit older, certainly my dad, I was really interested in this concept that, oh, they’re old, so they really deserve dentures. Why would they want nice teeth? And that whole thing disturbed me a lot because I have treated people who are ninety six years old with implants because they say in my chair, I want to eat my steak just like you, and why shouldn’t they. And I feel really strongly about that. And I think your ability to be the best part of yourself, to look in the mirror and think I’m still here, I’m still, I’m still great, I can still eat, I can still socialise with my friends. All of those things is what keeps you living. And so I wanted to create a place that wanted to look after everyone. And the whole idea of one to one was the care that I give you one to one is custom. It’s between me and you. And so that’s how the idea came. And in fact, the one to one name came because just before my dad passed away, he gave me a sculpture with a man and a woman looking at each other. And for me that was one to one. And so I used that as my logo. And I you know, I signed my lease on the 14th of November, the year my dad passed away.

[00:20:53] You never saw it, but he knew about it. And the ethos has always been when you come in this clinic, we sit down with you and we listen to you. And we we we look and we examine I really believe in the concept of sitting down for an hour and a half trying to gather as much info as I can. And also for me, I always say to people, how can I help? You know, for me, it’s and I always say to my students, this is a. In our culture, to bow your head and serve someone is not to demean yourself, it’s like the highest form of love. And so I believe that. I really believe that. And so for me, that’s what the ethos of this clinic is about. And when I did my education, I have to say, and this is where I think it’s changed massively for women, you know, most of the time that I went to a course, most people thought I was there to make coffee or I was going to clean the premises because they actually suggested it to me a few times. And that was just how it was, you know, and the day my life changed was a damn upsetting. So I said this was my first real mentor. I mean, I was with him for 15 years, very long time. And the day I spent that day and I remember coming back out of thirty three Harley Street and opening the front door, the sun was shining and I walked out into the street and I thought, now I know what I’m going to do. So that was my one of my moments of grace, I think.

[00:22:25] Do you see the kind of person to rise out of the witness, you know, like the next person when they thought when they heard that overheard the person in the corridor saying, I’m not giving the job to her, would have melted under or you felt you like you enjoy being mistaken for the cleaner because you’re going to teach them what is known.

[00:22:49] But I think when I was younger, you get used to being you get used to people expecting a little bit. And in my family, it was totally the opposite. My father was very pro women. I’m a Muslim girl. And he he expected more from me than even said to the boys, No, it’s not that I find that quite sad. I find it sad that people don’t have good expectations of you, you know, and I think that’s something I’ve tried to change when I teach because I really, really believe that anybody can be taught anything. And I think that teaching is about the acquisition of skills. It’s about change. And I really think if you believe in something, anything’s possible. And I was and that’s what my parents gave us. They gave us that belief. And it’s not so much the I I respect it. I certainly when I was younger, I expected it and I got it. And I just thought, OK, here we go. Here we go again.

[00:23:47] Does that drive you and motivate you? Does it does it make you think, you know what that person thinks I’m the lady. This person is not going to give me the job. I’ll show. And that give you more drive.

[00:24:00] Yeah, it does. It did at the time. Without question. I definitely had a much more feisty I think it mellow with age. I definitely had a much more feisty. Well, you put the barrier down. You know, I’m I’m a great believer. When people talk to me about barriers, I say to them that barriers in reality and the barriers in your head and I think more barriers of it sometimes than reality. And I am a person that if I want to do something, I’m either going through it, around it or over it, but I’m not going to go under it. And I fall down all the time. I fall down all the time. But the thing is, I am surrounded by a family that loved me. Come what may. They are unconditionally at my side. I’m supported in by my friends. You know, I said about even Asher and I have friends I’ve had for thirty years. And even when I fell down in the sense that I don’t know whether you will bring this up, so I’ll bring it up. When I got my letter right, that was four years of hell. Hell, because you suddenly feel that everything has been swept from under you and you suddenly start to believe that you’ve done something terrible. You’ve really that you’ve hurt someone. And it’s appalling. And I remember Corey and Zachy coming to my practice of the day and they sat down and read the letter and said, write, what are we going to do? And it was always we it was always the Three Musketeers, you know. And and I and I hugely remember Corey saying, if they come for you, they’ll come for me, too. And so I was always really lucky because loyalty to my friends is any of my friends call me anytime of the day or night. I will get in my car or walk there if I have to to get to them, because that’s what friendship means to me. And I think that’s why I’ve survived this long, really fiscella.

[00:26:03] Tell me about your patient experience, because from what I’m hearing right now, your whole life and everything is about loyalty, love, care and all of that. And so how do you how do you wrap that up in your in your patient experience? It seems to me you’re less of a businesswoman and more of someone. Is that, as you mentioned, to serve to give that ninety six year old the ability to bite into a steak for the first time in 20, 30 years solely through your patient experience, what happens? A walk through the door? Who do I meet if I pick up the phone? Who do I speak to? What is the experience like in your clinic?

[00:26:41] So usually a lot of my work is referrals, so it’s not the referral from in-house patients. So I think that’s a big plus for us and also a lot of my students and work. But although we’re doing that work together a lot of the time or is just direct referrals. So for example, I have referrals from each other and of the people in the area that I work with. So they will ring and we will have normally had a letter before. So we’ll be aware some white front of House will know straight away that someone’s called and they will be welcomed and say, yes, we’ve got the referral. We’re going to send you an email. Would you like to send us back to your availability? And we would normally say to them, we’ll call you by the end of today to get this sorted for you. Then they’ll come to me and show me that. And if I don’t know about it already, we’ll try to find the appropriate time. So, for example, if the patient is 90, I’m not going to offer them a nine o’clock appointment. I’m going to offer them at 11:00 to do a fourth appointment because they’re not going to get out of bed at 7:00. So things like that I’m fairly attuned to then depending on what it is, they will be called by my head nurse who looks after my patients and she will get to know them. She will ask them if there’s anything they’re particularly concerned about. She’ll ask them how they’re getting to us, you know, just in case there’s any delays, all that kind of thing. And then she’ll follow up on an email saying, I’ll call you the day before your appointment. If you have any concerns, please contact me before.

[00:28:14] So that happens when you walk in. We’re ready. We know you’re coming. So my head nurse will welcome you three covid. We would have known. We will have you a cup of coffee, whatever you want. You will sit down and then they’ll tell me straight away and I will go to to the waiting room or the waiting area and pick up the patient myself. I’ll then take them through and we sit in like a little coffee an area and sit down and have a chat. So the first thing I do with my patient in that scenario is to sit down and learn something about them, learn what makes them tick, why they’re there, what their experience has been, what worries them, what makes them happy. What they’re concerned about today is that away from the dental chair? Yeah. So we have a couple of armchairs. We have a coffee table, that kind of thing. Very simple. They might have a cup of coffee still in their hand. And then we’ll move towards the dental chair and I’ll say to them, this is what I’d like to achieve in the next forty five minutes. We’re going to go through it in this way so they know exactly what’s going to happen before we move to the chair and then we get to the chair. So I will do a full exam photographs. I tend to ask them what are the three or four things that they want to achieve? And I write them down in their own words. And I say to the if you decide that I’m the person who’s going to help you, we’re going to come back and look at this at the end when I fit. So I know whether I did this right.

[00:29:43] You look at just what’s really important about what you just said there is. You’ll know this payment because there’s so many people on Facebook who will advise you during a consultation to say, you know, you’ve just said if you decide that you’re the right way, I’m the right person for you, which is far more humble than some of the advice put out there, which they say, if I think you’re the right patient today and I decide. And so that puts that idea of scarcity in the patient to make them more likely to convert. Yeah. Or as you’ve just flipped that on its head and actually put the choice in the patient’s hands.

[00:30:25] Well, I think it is their choice. I think it’s also our choice. Yeah. I think, you know, if I feel and I’m I’m wrong sometimes about this, but I feel that most of the time I have some connection to people. And I think you have to have an alignment or a connection with the person you’re going to serve in that way, because it’s going to take 12 months sometimes. And it’s not just about the technical. Let’s get through the technical bit of the work that you’re doing. My area is is full mastery, but I don’t do all I’m for. I tend to do all on eight. So I’m actually trying to do the bone grafting of the gum grafting and put everything back so I don’t make units bigger than three. The biggest unit I’ve got is a three unit bridge. So I’m actually spending a lot of time, maybe 12, 18 months doing this. But make and the other thing I don’t do is I don’t do dentures ever. So for me, adventure is like in my hand of. Do you immediately load about 90 percent of what I do is immediately like, yeah, so obviously we have all the fancy stuff now with all the planning, the digital planning. We’ve got a lab here now and all of that and all the city and all of that. But for me, I want the technical side of things to be behind the patient care. And for me, that’s really important. I don’t want the patients, so I’m just going to have a impulsivity. I want them to feel that they’re coming here and we’re going to change one set of teeth to work for another set of teeth to do. And that’s a real responsibility because you can’t really afford to get that wrong, not to mention the financial investment they’re making. But it’s the fact that once you’ve taken all that away, you can’t put it back if you like. So you have to take that really seriously.

[00:32:13] What I find about the whole teeth in a day process procedure, out of all the treatments that we provide in our own clinic is the one that has, I would say, the biggest life impact. Absolutely. Above and beyond that is cosmetic dentistry, teeth whitening, even payment and orthodontics. Right. Is that you’re actually giving these patients back, Cruickshank’s and yeah. The ability to not worry about something falling out of their mouth. Absolutely. Or just a whole new menu of food, right? Yeah. Have you got any stories you can share with those of patients whose lives have changed? And what is the one that sticks out that’s had the biggest impact on you?

[00:33:00] I remember the first one I did, the first one I did was a lady who came and everything was moving to the point where she brought her models and said, you can’t take an impression because everything will come out. So I was already shit scared about what I was going to be doing if I was going to be doing it. So. So that was a big thing. And she was only sixty seven. So for me that wasn’t that old. And I sat down and I remember saying to her, and I’ve done lots of versions of this a lot, but I’d never actually done it all in one go. And I always made sure I surrounded myself with people that were a bit better or a lot better. So that wasn’t very difficult. And I made sure and I said to her, OK, so we used these two models, which were OK, and we kind of guesstimated what we were going to do. And I had everybody there on the day and I knew I could do the surgery. And my ex-husband was a prosthodontics, so I knew I had him as a backup. And he we did this as a double act for nearly two years.

[00:34:01] And at the end of it and I’m not joking, have we finished a 10 to one in the morning? It was about ten hours apart. A whole lot. And I remember her daughter coming to get her and everything was fine. I did it under sedation, so everything was cool. She went home and the next day she sent me a photo of her eating and she said, today is the beginning of the rest of my life. And I still have the photo and I still have the text to remind me of how fallible I am and how, yes, this can go well, but how lucky I am and how grateful I am to be surrounded by all those people to pick me up. And they do. They operate for eight hours is no joke. And I was really lucky. And I and I said to myself, I’m going to do five hundred and then I’m going to go and I’ve done five hundred and three. But but I also decided the last one I’m going to do for free because that would be my best one. Nice.

[00:35:06] Do you remember your first implant fame if.

[00:35:08] Oh yeah. I’ll tell you something, it’s funny, we were talking about it yesterday. I have it in my drawer because I do have it to look at. So every time I open the door, the surgery is looking at me. Yeah, it happened after 18 months. And I remember saying to me, I’m so glad because I was beginning to worry that you’d think they weren’t. Yeah. I remember every single day, every time I pick up an infant, I remember that you’re only as good as the last one. Really? Really. And, you know, I learned a lot from that. And I don’t worry that the implants will fail because after twenty six years later, you know what to do, because you’ve actually made all the mistakes and you’ve mostly made all the corrections. So by now, you should you should know something.

[00:35:58] If we ask if you want to say this question about mistakes. Because from from I don’t know if you’ve seen black black box thinking. Yeah, yeah. It’s about it’s about we can learn from mistakes and how in medicine we don’t sort of learn from our mistakes. What we don’t learn from each other’s mistakes because everyone hides their mistakes.

[00:36:20] If you had to think back, what would you say is your biggest mistake and what have you learned from it?

[00:36:25] My first big mistake was I was doing a placement with an oral surgeon, actually, and she put this implant in and I said, is it sound? And I wiggled it and it went into sinus. All right. And I remember thinking, holy bleep, what am I going to do now? And so my choice was right. Well, let’s go back to oral surgeon, open it up. We take it out. I remember saying to us that when it happened to him that you’re fishing around in this sinus doing this Cordella procedure, you’re fishing around. And then he literally set up the patient and the implant fell out onto the floor. And I remember thinking, yeah, OK, so after an hour of fishing around, I suddenly wised up and I said to the patient, can we just sit you up for a sec? And it fell on the floor. And in that moment, I literally looked up at the sky at the window and said, thank you so much. So there’s that. I’ve learnt a lot from that. I think putting implants in the wrong place, I think almost every kind of mistake you can imagine, nothing life threatening, nothing major, but every kind of thing that is not perfect.

[00:37:40] I have at least done once, if not more than that. And I think the difference is that when I go to surgery now, I don’t go with a plan. I go with 10 plans. So I always assume, well, if it goes to plan, we don’t need to talk about it and nobody does. You don’t learn anything either. But if it doesn’t go to plan, what are you going to do? What happens if this happens and this happens and this happens? And if I’m nervous, I will have spoken to cry about it or I will have spoken to six or seven of my colleagues and we have a club for failures. You can’t bring successes to this club. You only bring failures. And that is the best seminar we have. And there’s only four of us. But we bring the failures because we’ve all got the two, three cases that if you touch it, it goes wrong. And I still have a couple of those.

[00:38:30] Yeah, I mean, it’s it’s nice. It’s become much more fashionable to talk about in lectures. So you’ve been surrounded by some of the you know, the great looks at the flea and Koroit. What would you say? We just we just did a podcast with Paul Polman. Yeah. And the question of does it take to be a great implant surgeon because it’s not about drilling the hole, is it?

[00:38:57] No, it’s about knowing where to drill it. No. For me, the people my mentors are people like the two people you’ve mentioned, but also how Goodman, the Christian I went abroad and the thing that I learned the most was plan, plan, plan, collect as much information plan. Listen, go back, check it again and try to get some skills. You know, what I find hard is that you tend to sell what you do. And the problem is that if you when you’re younger, you’ve only got a few skills. So you’re trying to push those. And I keep saying to my students, life is this tool box of us every month, get a skill, get a tip, get a break and put it in there, because you might not use it more than once a year, but at least it’s in there. And I think for me, I have been on every major course going. I’m still learning. I’m still excited about what I don’t know, although it can be frustrating. But I find it for me it’s about trying to learn what I don’t know so I can do more and do better because I can always do better.

[00:40:07] So typically, this patient that you mentioned, the one that the new patient comes in my referral, let’s call it a full mouth rehab, how much time is spent away from that patient planning the case?

[00:40:20] If it’s a full full, I’ll spend an hour to one and a half hour sessions with them and then I’ll spend probably four or five hours writing the treatment plan and another three or four hours planning on the scan with the lab. Looking at the the stuff that comes is probably a good 15 hours of work before you get to the surgery.

[00:40:39] Well, easily. And the process of presenting your plan to the patient. Yes. They construe that by now we’ve got a lot of rapport. Yeah. No way we’re all going. Yeah, but I take it your prices are on the upper end.

[00:40:57] I think I’m in the middle. I remember once somebody said I was the most reasonable dentist in Piss Me Off that way.

[00:41:04] But I mean, I guess sometimes it runs to tens of thousands of pounds.

[00:41:08] I mean, a full month rehab is is definitely in the in the rebate of 50 plus years.

[00:41:14] So you’ve got to break that news to the patients because. Sixty thousand pound plan take us through it and the follow up process as well. I mean, so everyone’s straight away.

[00:41:25] No, but the thing is, when I do my consultation, the first one we measure, how many people come I don’t have 20 consults a month. I have three or four. So when you sit with me, there’s a good chance you want to be there. I’m not as expensive as Karibe, but, you know, I charge two fifty three hundred quid to sit in my chair. And it’s really for me to listen to what you want, what you want and also what you think you need. We’re very good at telling people what they need, and I’m not one of those people. I remember somebody saying people buy what they want, not what you tell them they need. So I’m very mindful of that. I sit down and I also learned a long time ago that people hold this notion of what they want in their heads for five days. And after that they’re off somewhere else, buying a car, buying a diamond, whatever it is. So we have a rule in the clinic, certainly for me, that when I see a consult from implant dentistry, you get by email and post a full treatment plan within five days, you’re then invited to come and talk to me. If it’s a simple single, most people will do that, but they will come to consult to do the rest of the investigations and then we would go to surgery.

[00:42:40] And if they need to see the therapist or the hygienist or or if they need to have a workup, some of the boys that I work with, they will I will segment the case into if they need. We can work that I do right now. I will send it to Tomko for Clark or somebody like that who’s been in my practice, and he will do all of that.

[00:42:58] They’ll remove all the carries the build the tools and we will set up the occlusal scag because that patient is having a fixed provision or whether it’s a rocket or whatever it is, even if they had a dentist to start with, because I find it a bit crazy that you’re selling this. And if it is not was 50 quid, we wouldn’t be talking about it by the crew. So you’re selling the most expensive thing in dentistry and you’re taking it to thousand and the first thing you do is put a disgusting flipper in their mouth. Well, what I what a great guy. What a great girl you are. So for me, that is the work you have just dehumanised that person. So for me, I would say to my students, if you do that, please let me know and please don’t ever come back, because it is the exact opposite of what I’m about. So the patient will come, we’ll talk it through at the end of the first ponza. I say to the patient, you have two decisions to make. One, are we doing this together? And two, how are we going to pay for it? And they are two distinct decisions. And in a sense, it’s like the jargony word is the call to action, if you like. So then I repeat that in my email and I say to them, if you want to do this, but you haven’t worked, it might be finance, it might be stage payments, it might be some of it’s on the course. Some of it is there are lots of ways to skin the cat. But if you decided that we are the people who you want to help you, then we can help you with the other side as well. And that’s really important to me. I don’t want to treat people who just have a stack of cash in the boot. I want to treat people who we’re going to make a difference to.

[00:44:40] But you tell the guy fifty thousand pounds, I bet you get a few shocked people, right?

[00:44:45] Yeah. But to be honest, maybe years ago. But I think nowadays people who are at the terminal dentition stage and they do not want dentures. And to be honest, I don’t have a single dental care in my practice because our practice demographic is from 18 to about, well, ninety six. But the point is the majority of people are within working age. So I’m going to get the middle ranking.

[00:45:11] I used to get a lot of everyday people that have just saved up and you just feel a huge responsibility for taking their savings, you know, so they know it’s going to be a fair amount. The one thing about media nowadays, find out whatever you want to find out so they know this already if they’re being referred. And a lot of my work is referred to the person. It’s a warm leave, isn’t it? Because the person sending Bulatovic.

[00:45:39] Tell me about the practice and you said you mentioned Tomko footlong. Yeah. How many associates are there? What’s the setup?

[00:45:46] Well, I don’t do associates, you know, so I kind of do I’m a pretend associate. So what I like to do, what I’ve always wanted to do is for each one of these guys to have their own little practice. OK, so they do do some associate work for me, but each one of them has their own bank of patients that belongs to them.

[00:46:10] So they rent the space, they take their own money, they do their own shit. And slowly over the time they are building their own little practices. And we essentially they pay a flat rate because obviously they’re young and they and they want to keep their expenses down. And I send the work on an associate 50 50 basis as well.

[00:46:29] But each one of them has their own little practice. And the idea is that eventually, hopefully three or four of them will get together and they’ll do it together as an expense share, but they’ll take their own money, have their own independence, have their own philosophy. But they will also have an ethos that is together. So how many of them are that? There’s four of them. And and obviously I have a therapist as well who looks after all of us. So so they all do a day, two days, three days. That is a full surgery practice. And they have gone through all of the courses that I’ve done. So I’ve kind of picked them based on I haven’t just picked on skill, actually. I’ve picked on that headspace, how kind they are, how honest they are, because I think if you have the right person, you know, me and Alphons are pretty cool friends. I love the guys. I love the way he does things. I believe in the same thing as he does. I think if you pick the right person, you can change anything. So same thing.

[00:47:31] A lot of time for our fans of such a lovely guy. And tell me about the vibe if you practice, Fazeela, what’s it like when you go there in terms of just the environment, the general buzz, the feel that you get when you walk in there with your team?

[00:47:47] Laughter I’m saying to the girls today, we love too much. There’s always we we were family. We’re not that big. Everybody’s part time except me. We look out for each other. We know what’s going on in each other’s lives. We care about each other. We also believe work is work. So when that switch flips, it’s time to put your game face on, you know? But the other thing is, I’ve been looking after probably 70 percent of my patients for at least 20 plus years. So they’re friends now. They’re people that we very sociable with quite often before pandemic. If a patient had said, oh, I’m not going to my husband’s not picking me up for another hour, I said, what? Don’t you pop upstairs with me, sit down and have a cup of coffee, have a chat. You know, it’s a very sociable place. It’s a very warm place. It’s very Western kind of feel. I love that vibe. There’s always fruit on the table. There’s always food in the fridge. You know, on a Friday night, we sit down. Even now, we try to have our practice meetings around, you know, an Indian takeout round, the one on the conference table. And I think I would like that family. I hope the big family I had at home, I brought to work. So from that point of view, it’s a warm, happy place. I’m not saying we don’t have moments when we’re I’m a grumpy soldier or somebody else else’s, but by and large, people are really great at their jobs. They love what they do. They believe in what they do. And I’m really proud of them.

[00:49:18] Sort so bossy. You so imagine. Well, first of all, what sort of bossy you when when you need to sort of batten down the hatches and tell someone they’ve done something wrong or really straight talking pain in the ass, you know?

[00:49:33] Well, if somebody comes to me, it depends on the mood. But I’m a very kind, caring person. If you need me, I’ll be there and I will help you. If you come and say it and say to me, can we have a coffee? And I sit down with you and I say, what’s the problem? I’m really don’t. OK, let’s do it. Let’s do it again. And I will be there and I will help and all the rest of it. But I’m also the person if I’m really stressed about something. Yeah, I’ll have a little swear occasionally. And I think I’m, I’m not tough, but I’m very straight talking. I don’t get what you say. Yeah. What you see is what you get and I don’t change. And the thing is but when I’ve said it, I’ve said it. I’m not somebody who doesn’t talk to you for days and all that kind of nonsense. I’ll say it and I’ll go. Are we good? Yeah, right. Should put the kettle on then. That’s kind of who I am. Mood everybody makes mistakes.

[00:50:30] What about your teaching? So you teach them on the course. Does that Crucell going with and.

[00:50:37] We suspended it. We did a couple of years, part of the reason we did that course was that we kind of grew up in an industry together and we actually wanted to share what we knew. So we did a couple of years and I was still at the royal colleges that as the lead to to. Yes, it. Yeah. And I had it. I’m not anymore. But I had a gig. I was associate professor at Stony Brook, so I had a gig there and I was just traveling a lot. And I was also running my own year courses, my own advanced courses for when I go. Yeah. So I’ve got a connection with how equipment in South Africa. I’ve got one question in Romania and all the rest of it. And so what I decided in the pandemic was to bring it all together under one umbrella and to just open it up. So now we’ve got an 18 month program which allows you to say diploma. We cover the curriculum, but we’ve got speakers and tutors. So the guys who have been through the course, taking the time and now tutors and they look after the general practices that come in and obviously the speakers like each other come and speak. And Alphons is one of my speakers as well, actually. But but what I wanted to do with the education is I wanted to create a place where people, young people could come see you in town and you got an hour to kill and you just want to come in almost like a like in the old common room school, you know, and you come in, make a coffee, sit down, somebody looking at a case and you just take part and it’s an open door policy and it’s a place where you can feel at home and welcome. And there’s always something going on. And the ones who are slightly older are teaching, the ones that are slightly younger, that kind of thing. And we’re doing that. We’re doing that. And we’re loving it, actually.

[00:52:24] And I just want to touch upon you, really, Fazeela and just sort of you mentioned ex husband. You happy to talk about that and.

[00:52:35] Oh yeah, he’s one of my best friends, actually. So I was married to a Welshman called David Osborne, who’s a senior lecturer at the Royal London and Restorative kind of came about a couple of weeks before I graduated and left. So when I came back, he was there and we eventually got married 18 months later. So he was still teaching in hospital, partly in practice. We had a couple of kids. And, you know, I think the stresses of life, we bought a free held in holosuite, bought 50 to that, nearly killed us. I’ve lived in Harley Street for about eight years. And I think, you know, I really knew where I wanted to go. And he was incredibly supportive. And I think maybe sometimes I wonder if I’m pushy. When I’m ready to go, I’m going, you know? And I think it was just the tough it was a tough we went through. So, you know, 2010 was a great recession even before that. And we ended up thinking that we were better separate than we were together. But we had one thing in common, other than the fact that we were both decent people.

[00:53:46] I was very, very lucky in that we both absolutely adored our children and we didn’t want to hurt them. So we had a very amicable divorce. I mean, obviously there were days where we wanted to kill each other, but very few. And even to this day, our kids say we didn’t really feel like you were divorced because you were just so nice to each other. And I worked with David three or four years after we were divorced because I’d worked with him all the way through before. So I was very fortunate. And I have happy children. And even though David is in Singapore, remarried to a very nice lady, you know, he is one person. If I needed some advice, if I was selling tomorrow and I wanted a really straight up, loyal, decent guy to give me a really good opinion, he would be the one I would go to. Mason. How old are your kids, Fazil? My daughter is twenty three to be twenty four this year and my son is twenty two this year.

[00:54:49] To either of them. Look at dentistry to be daft.

[00:54:52] One of them is, one of them is an architect in the making. So she’s going back to Cambridge to do her master’s in real estate, finance and architecture. So she’s fine, she’s fine if you like, of that seven, eight year road. And my son went into the family business of politics, philosophy and law. So so. Yeah. So I did one go to Cambridge and one go to Oxford, know what he’s thinking about going to do. His master’s there, but he went to work and he’s now in Austria this year just doing philosophy. He’s another one that wants to bring all the animals home and mend them. But I think he wants to do that with humans. So yeah.

[00:55:34] Did you guys not one of them to be a dentist?

[00:55:36] No, we didn’t. You know what we did? We kind of said when they’re ready for the career, we’ll open the door and have the chat with them. And they came to us and said, we want to do this. So we said, fine, off you go. And we basically said our job was to open all the opportunities to them and let them decide. But I can’t say I wouldn’t. I think dentistry is really amazing and exciting in twenty, twenty one, but really hard. I think the people, the the generation, the are the social media generation are much faster with each other than my generation was. You know, I’m fifty five years old. If I don’t like someone I just don’t go to the pub with them. It’s really simple. I feel the need to slag everywhere that I can find. And I think that harshness and the lack of grace is something that I’m glad that my kids would never be part of in my profession. And it’s this I’m better than you syndrome that I find really hard. And I say to the I treat the guys on my courses, the guys and the girls, they’re all twenty five to thirty five or even older. And I just say to them, you know, if everyone makes a mistake, everybody has got skills and everybody is learning skills and we need to be a bit kinder to each other.

[00:57:00] I think physically, you know, sometimes under the guise of what’s best for the patient, we can be quite cruel to each other. Yeah. And it’s it’s one of those things. It’s almost like you have licence when you’re talking about the patient. You’ve got licence to be cruel to each other. And and I see that quite a lot, you know, at the same time. Do you think Forstchen. The reason that they’ve been brought up on social media got massive advantages over huge.

[00:57:31] Yeah, but you know what I find, you know, for me, I would much rather pick up the phone and have a conversation with you about the fact that it saves all the twenty seven texts. And I’m Tony and you and you misunderstand me. And then we fall at the end of it anyway, whereas you pick up the phone and get what I mean is this and that’s the end of that conversation. So for me, what I find sad is it feels sometimes like the art of conversation is going all right. And I have to say, we grew up, especially on a Friday night, where we all sat around the table together. I lived with five boys through uni. Half of them would come home to mum and dad and we’d sit there, eat endless amounts of food, having a whisky and a cigar at the end of the night and just put it in the whole world to write, you know, that that conversation, that banter. And we still have it in the practice. But that notion of why don’t we just have a conversation? And in fact, when people come to me and say, how is it you get the conversion on your consults? And I say to the just have a channel for me when I consult a patient, if they buy, they buy. If they don’t, they don’t.

[00:58:42] I’m just having a conversation like I don’t know why, but I get the feeling I want to come to a party hosted by you. Why? I just feel like you’re one of those hostess with the most this kind of I love the food will definitely be good.

[00:59:00] You know, I’m not crazy, but I get on the summer. But you know what? There’s only like one or two things I really do. Well, everything else I just try hard. But, you know, I think. Well, you must kind. Thank you. Know what my dinner parties are like. You come, you have loads to drink at the beginning. We have really lovely food. And then I put some lovely Spotify and start singing or gets his guitar. That’s it. That’s what happens.

[00:59:32] It’s all downhill from there because I wanted to touch base on you if you were speaking about your dad in the sculpture earlier. Yeah. You mentioned to me before this podcast that your mom passed away not too long ago. Tell us a little bit about your mom and the daily conversations you used to have to have with you. Say your routine would be at some point during the day she was on speed dial, right?

[00:59:59] Yeah, always. You know what I loved about her? I wish I was anything like as like my dad, but crazy. She was calm and cool. And when she had something to say, you didn’t speak. But her entire life was her family, even though she was a very, very well respected senior lawyer. But she found the humor in everything. So if I was going out for dinner with anybody, I would get on the phone. I said, I’m going to need to tell you I’m not ringing you, but we’re going here and we’re going we’re going to do that. She knew everybody. She knew all my friends because she always encouraged us to bring our friends home. She always said, show me show me your company and I’ll tell you who you are. You know, it’s really old fashioned, but it is what it is. We had a bar in our house and, you know, my parents were you want to you want to have your your your cocktails till 3:00 in the morning. No problem at all of you come in the garden, whatever. And we’re just off to bed.

[01:00:50] So I was really lucky that I didn’t have to hide. I didn’t have to be the girl that had to put her face on in the in the bathroom before I went to school. I could do that at home. You know, I was very lucky. But my mom was the glue. She was the one who showed us how to love and and she loved us every single day. And she was our best friend. And she loved to laugh with us and at us at all the silly things we did. And now we miss we I miss her every day. I miss my dad every day. And with mom, it’s food. So even yesterday I said to my daughter, yes, let’s just cook that one thing that mom did. And, you know, we remember her story thinking about her every day and and just remembering the humor. But it’s something that is still very, very it’ll be there at my father’s been dead twenty years. It’s the first person I think of when I wake up in the morning. It is just one of those things.

[01:01:52] I’m fortunate not to be in that position. Right. But I know Songe lost both his parents. Yes. I mean, you were saying that it almost felt like the ground from under his feet disappeared, right. When when you’ve got that support, as you spoke to it, spoke about it like glue.

[01:02:10] And how did you cope initially when?

[01:02:14] Well, with mom, it was really difficult because she came home to pass away, you know, this old West Indian. And it’s not even. What’s the old saying? My mom was like.

[01:02:23] Four years old, she wanted to die at home and we managed to do that, and it was all of us, the grandchildren, everything. And I thought to myself, you just passed away, passed on with everybody that’s nearest and dearest, close to you, who love you quietly, not in pain. And we will remember you every single day. It was hard. It was hell, because both funnily enough, both my parents died on the same day, 17 years apart, which is weird. And they were buried on Christmas Eve. So Christmas is a tough time for us, but now that it’s getting less painful. I choose to you know, I’m I have both my parents photos of my surgery and my patients always say we’ve got the level they like here. And I say that’s to protect me against you. And we have a bit of a laugh about that. But is it cute because it makes you face your own mortality? Yeah, it does. And it’s a very good question that you ask that, because when your parents passed away, certainly for me, you suddenly feel like that golden cloak isn’t there anymore and you’re kind of on your own, even though I’m not on my own. And you will next year, the next generation. So even though I’m fifty five, I’m not seventy five. You think hang on a minute. I’m going to make the next X number of years count. So you start to. It’s not so much the exiting but is what am I going to do in the next five years because I don’t really want to do much more than that. I want to go back to it is a walk on the beach every day. But what am I going to do that’s going to make the last five years be the best five years in your life? So it does make you a bit nervous, but I’m not frightened in the middle of my career.

[01:04:12] It’s not something that I particularly talk about, but it’s not a secret either. I was very, very ill. I had a very good cancer when I was thirty eight and I lost two children and went through 12 years of surgeries and chemo and and a lot of people didn’t know. I just got on with it. And you know, it was quite nice just getting on with it. But when I needed them they were there and and my kids were there particularly. So I know what it’s like to wonder if I’m going to survive because they gave me three and I go, I’m already 13. And so, you know, I’m going to die when I’m good and ready.

[01:04:47] But again, a little bit of bloody mindedness. Yeah, I’m not ready. I’ve got still things I don’t want to do. But it does make you think every day is going to count, even if it’s just to have a coffee with a man.

[01:05:03] So what are you thinking for the next five years?

[01:05:06] Well, I want to grow this education thing that’s been going on for twenty odd years into something solid. So finally, I’ve put it into a company and I’m going to I would like the course to be less about me and more about them, more about the boys that are going to be the payments, Barney’s and the Toms and the Scott Phillips and all those guys trip and all the people that are going to take it forward. And, you know, I want to leave it to them. I want to leave that to them so that they can look after it and carry it. I want to do my best five years. I want to learn all the things I still can’t do and be a bit better. And I want to spend I promised myself before lockdown that I would work for six weeks and go home to or work for eight to go home for three. And it hasn’t happened because of this. But I’m definitely going to do that. I’m going to take the time to look at the way some more and to trek some more and to spend the time with the people that are getting old, because I don’t want to be that guy who says I wish I had because a lot of my family were in the seventies and I want to be there to live with the because dentistry can wait, you know, and the young ones can do it. And, you know, I want to have more balance in that sense.

[01:06:30] What would you do if you had half a day to yourself would be Fazeela? Sort of?

[01:06:36] Well, it depends who I could do it with. If I had the kids, we’d probably go for a really cool breakfast and then go for a long walk in Box Hill and just chat away. You live around there? No, but we go there quite often. I live in I live in music. Oh, well, we it depends. If I was in the Caribbean, it would be a different thing, but I would spend it with people I love. I would cook if it was not an activity, I would or I’d be on a horse somewhere or something like that. They would always be food around. But for me, life is people. Life is my family, my friends and the people I work with predominantly.

[01:07:19] Fazeela, that sort of takes us on too nicely on Suazo. Final question. Going back to what your mom and dad passed on to you, the sculpture and the daily conversations with mom. I imagine it’s your last day on the planet and you’ve got your kids around you. What would be the things that you pass on to them? Three pieces of advice that you’d want to leave them with the equivalent of the sculpture or whatever it is. What would you say to them?

[01:07:56] I would say to my kids, don’t forget where we come from so that you know where you’re going. That’s really important to me that we keep our food and our culture and all the things that glue us together from the from the elders to the to the next, I think I would say in everything you do look for a win win. Don’t do deals of any kind where someone has to lose, look for a win because it’s a much better deal. It makes you sleep at night. And the final thing is live every day, live every day as if it’s your last laugh, cry, love, do whatever you do and do it really well. And if you mess up when you put your head on your pillow, tomorrow is a better day. Always. It’s just simple stuff, you know, simple stuff. Look out for each other and be true to what you believe in, you know. And if it doesn’t work, if people don’t like that, well, keep quiet about it then.

[01:08:56] And if you could finish the following sentence and the topic is legacy write Fazila was dot, dot, dot a crazy, but he was kind, tough, loyal, persistent.

[01:09:15] And who never gave up?

[01:09:17] If I don’t to want a more positive one, imagine you’ve got a month left. Oh.

[01:09:25] Are you going to do your time, I would pretty much give up work if I had a month, I do a week of work. You lost three case, yeah. Yep. I can’t finish at the month.

[01:09:39] I do as much as I could do a week of work if you had a month.

[01:09:43] Yeah, I do a week of work. I love. I love. I love knowing the. Somewhere down the line, it might make a difference or might help. I know that sounds a bit. It sounds a bit highfalutin, but it’s not so I do a do a few days at work, I would try to I have a bucket list of one hundred and fourteen things. I’ve only got 12 left. So what do they want it? I can’t tell you that it was everything from. I still have to do Machu Picchu. I haven’t done that. It’s simple stuff. It’s like I have a walk on Nelson Mandela did that, you know, simple things. I would spend most of it with my kids in the bush in Guyana, in the Amazon, trekking for at least two weeks. And then I’d probably have my five favorite foods in the world and just chill with the people I love. I won’t do anything too fancy for me.

[01:10:42] That’s fancy, will you? Five favorite foods. Well, you probably should. Did you what’s your final meal? Yes, just to keep things really positive.

[01:10:56] Curry the execution meal from Kenya. I want to bring and aubergine curry with some callaloo which is like a spinach and some roti and some doel. Nice. Nice.

[01:11:13] It’s been absolutely lovely. Oh, it’s been a joy to continue. I really enjoyed it.

[01:11:17] Yeah, me too. I really, really enjoyed that. And I think the thanks a lot for being so open. Really well.

[01:11:25] I’ll probably come across as a lunatic, but it is really enjoyable when you are in the West then. I have listened to a few of them actually. And you know, I trained Sanjay and I, Sanjay and I, I taught Sanjay on his first the kidney. So I know I know Nick. I know them. All right. That’s the problem. We’ve been around so long and we eat again. That’s what we did.

[01:11:54] So whenever you’re in the in the West End number eight, the door’s always open.

[01:11:58] Thank you for food.

[01:12:02] It’s been lovely to see. Definitely. Definitely. Thank you so much for having me. I really appreciate it.

[01:12:09] Thank you for doing this. Acento leaders the podcast where you get to go one on one with emerging leaders and dentistry.

[01:12:23] Your house payment, then Groody and perhaps Celenk. Thanks for listening, guys. If you got this far, you must have listened to the whole thing and just a huge thank you both from me and pay for actually sticking through and listening to what we had to say and what our guest has had to say, because I’m assuming you got some value out of it if you did get some value out of it.

[01:12:44] Think about subscribing and if you would share this with a friend who you think might get some value out of it, too. Thank you so, so, so much for listening. Thanks. And don’t forget our six star rating.

Dental Leaders – Paul Palmer.mp3

[00:00:00] We always try and not treat patients to a budget. So if it means not treating a patient, I know it sounds mean, but we’d rather not treat a patient than try and treat them on the cheap.

[00:00:17] This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts Paymen Langroudi and Prav Solanki, it gives me great pleasure to welcome Paul Palmer onto the podcast.

[00:00:40] Paul is a consultant periodontist from Guys Hospital, works in the West and has many papers and a book on employment policy and works in the South End practice. Pleasure to have you, Paul.

[00:00:58] Thank you very much. Nice to be on this podcast.

[00:01:01] It’s about kind of the person behind the persona. And we kind of we tend to start with the same question and end with the same question. So the first question always is, where were you born? How do you sort of grow up? What kind of childhood did you have?

[00:01:15] When did dentistry come onto your agenda? OK, so that’s what leads to her. You actually confused me with my brother in a setting up of the expected third year and one of a family of five boys, and our father was a furrier. Grandmother was in the fur trade as well. So a lot of my extended family were in the fur trade, which is obviously quite a high, highly technical manual job. Now, that’s partly where we go now, dexterity from so two my brothers, when it’s the fur trade we’re actually dying and they went on to other things. So one of them became a paramedic, another one which I went into a sale loft because we’re sort of major family sporting activity growing up with society. And then one, the middle one’s an accountant. And then so my eldest brother, Richard, who is a twin, he had the closest relationship and the five of us. So we were very close, all my three brothers, nine years between us. So he had a big influence on my choices, I suppose. So the classic story I tell is where my teacher at the age of nine asked me what I wanted to be and I was proud when I got home to tell my mother I’d had this conversation. And the answer I gave is all I want to be a gynaecologist. And she just basically just raised your eyebrows and just sort of took it as why would that be a surprise when he’s got four older brothers just influencing him.

[00:02:53] And so they had a massive influence. You know, when you got brothers who were that much older than you, they influence you. But then it’s always had a sort of medical balance, I suppose. But medicine saved a bit of a a far stretch. So rich nobody I who went to grammar school after eleven plus our middle brother joined us. So I went to grammar school on the same day he went to sixth form and I went into the first one. Did you grow up in Essex? Yeah. So we’re all born and bred in Essex by three of us live in our own lives and cultures. London, so by the time I was of deciding what to do, Richard was already just about to qualify as a dentist. And so then when I was at school, I nursed him a couple of times when you say periodontal surgery. So he started the practice we’re in now that started on Saturday mornings in our small surgery a mile away from me now. Well, what year did you start, though? So he started that a little bit, about nineteen seventy seven, something like that. Well, that’s that’s the one you just sold. Yeah. So that they evolved from. So that went from a Saturday morning to by the time I qualified and a year and a half in, in hospitals.

[00:04:21] So I thought that time I was about eighty nine and then joined Richard. So Richard basically phoned me up and said, do you want a job. But if you want a job you need to do a masters. So I joined him as his apprentice really went to work. So I said Friday night I got to work at Food Drive to Essex and then Friday evening I could work day surgery. So goddamn 10 o’clock at night people would come along and have it done. And then so that was he was doing Saturdays, as I was saying Friday evenings and now. It’s through surgery, nearly a five day a week practice, that’s those built on perio. And they very much built on implants because implants became a large part of perio activity and we were right at the beginning of that, but and that is a big thing.

[00:05:20] I started implants before he did. All right. So I was really fortunate. My second job was in Pecking, so I’d say more than anything. So we had fantastic consultants there and we had a brilliant senior registrar called Brian Littler, and he was putting in the implants for John Basford and the London. So we were taking pictures out of the London hospital and putting implanted in. And then John Basford was in the process. So that was we were really early on the activity that was in 1988. Well, so I go back along along with the prime system. And are you still using the wrong system now? So. So the thing to do, the things you learn as you go through life, at one point we were running five implant systems and partly that was because we were running a program at guys and we thought there were benefits to immersing people in a lot of systems. And what you learn from that is you actually confuse people a bit in some respects. It’s like, you know, you’re going to play golf, play with one set of clubs, don’t keep giving someone a different set of clubs every day as they were. Just just get confused. So we condensed it down, guys, and we also then condensed it down in our practice because we were running we’re running a mirror image so that we we were doing things in practice that we were then teaching in the hospital.

[00:06:57] And we’re familiar with all those systems. But then you have all the trials and tribulations of trying to run different kids, different spare’s different implants, and then as patients then come back to you for problems, which they always do, you’re trying to remember what went in or what the components were.

[00:07:17] Screwdrivers were what the top levels were just becomes a whole complete nightmare.

[00:07:23] So now actually we’ve basically use Astra and we use the Astra TX, so I’ve been resistant to changing that. So they evolved for the last five years, I suppose, introducing some of the research on the bone loss around Astraea implants.

[00:07:43] So we were very early on. We were very lucky that we were looking for people to run trials for the Astra ST. Once I remember the first I met Michael, nor have you interviewed him yet?

[00:07:55] No one to as a recommendation, say he’s a good raconteur and you know that he he sold the system incredibly well. So it was a very good system. It was very innovative and it’s in the way you could handle it. It’s quite user friendly.

[00:08:13] But then we were given the the early trial of the assay, which was the first Astra implants that had a.. Rotation indexing. So we did a small trial and they asked us to play and restoration, and that was with Brian Smith, who was the prosthodontics they got guys and what was it was to do up to that point?

[00:08:35] It was sort of standard thinking that you would always lose some bone up to the first thread.

[00:08:40] Yeah, that’s that’s a pretty. So we can literally print them out. And it has its good things and its bad things. But what we knew was that it would always lose power to the first strike and that’s part of the design of it. And it’s probably largely relates to it being a peripheral fit implant with an external fit. So where the implant meets you have a big biological insult coming through the stack of componentry. So it’s almost like a biological waste of that implant. And that’s why it goes to the first side is largely, I think, of, well, health there. And then so the Astra by almost by accident, was one of the early platforms, which is a platform switching implant with a really good seal. It’s called the conical. So it’s not it’s not a perfect seal, but it’s it just reduces that biological insult from the implant abutment junction. And so that really did hold the bone very well. And also the other component of that system at that point was the. So we’re using a single teeth. So that’s a sealed system. You’ve got a semantic crown. There’s not much leakage. And then their abutments were solid and they certainly are a lot of them still all. So the uniform is a solid column of titanium. So you don’t get a biological leak from the stack of componentry, so you don’t get a insole bone level. So it delivered on two levels. So it was platform switching and there wasn’t much in the way of biofilm within the stack of components. And that’s what made the big difference. So they always thought or promoted the concept of the micro threading and in the Corona portion of that implant, but that’s probably not the most important thing and it’s also one of the early surface traceroute implants. Yeah, it was. And that was really making a difference of.

[00:10:53] What’s changed in that period of time when it comes to implant dentistry? My involvement with dentists is primarily having conversations with them about the type of patients that are coming through the door, but also the interaction. And I’ll just give you my take on things. There’s this whole new and I know it’s not new people. There’s been this upsurge in the market of people promoting and offering immediate loaded S.A.T. solutions. And I’ve come across clinicians who are for or against that and various various arguments. And then there’s been, I would say, a growth of the interaction between the clinical dental technician and the implant dentist. And that how many of those two types of clinicians and I don’t know if you if you worked in that sort of collaboration before and if you got any thoughts on that, the answer would come to this as well.

[00:11:45] So the most important thing that the golden thing to remember in whatever you do, it’s all about case selection and in case selection, the first thing is patient selection. And the next thing is what are you going to do in that patient? So it’s the case selection within the patient selection. If you can stack up or you’ll get all your ducks in a row, then you’re going to have a quiet time. And I think our philosophy has always been to keep it simple. But obviously over decades of working, you inevitably have to take up certain new techniques and certain new philosophies.

[00:12:26] So as we spoke about earlier, there isn’t anything we haven’t done or tried in the past. And I always say with so logic, my philosophy, I suppose because I’m the one who is doing most of it, is you don’t push the envelope too far. So we don’t actively promote our business based on taking a day or immediate loading. But again, I’m not averse to it in the right situation. And the best example I could suggest is that immediate placement is that easy. If you got a small route and a big employer, an immediate load is that easy. If you’ve got a big problem and the occlusion is you just stack up all the right base to enable you to get to the end result. But our philosophy and that it’s not an uncommon one is that every time you lose an employer, it might be a small percentage of your activity, but it’s one hundred percent of the patient. And you’ve you’ve got to be very brave to actually put yourself in a position where you will either encouraging or allowing a patient to take your choice, where they’re taking out and then ultimately high risk for what effectively is a great gain in the scheme of things.

[00:13:50] If you can just delay things for a few months and be much nearer to one hundred percent, why would you make life so much more complicated for everyone and the added expense of it as well? So it’s always and obviously not always. So I always say always, but by and large, you add expense and complexity to the whole situation. And if you add expense and complexity and it fails, you failed on a higher level. Yeah, and that’s where you can really struggle with patients happy so that our overall philosophy really is that we still do immediate loading. We’ve done some really quite significant cases of patients walking in with periodontal involved, not particularly well kept teeth, but for their psychological well-being to actually give them a clearance and then give them full foot bridges in a day. Don’t don’t enjoy. I don’t I don’t feel any kudo’s doing it. I’ve done it to help the patient more than anything.

[00:15:10] So are there any, shall we say, sort of clinical biological benefits and in certain cases of giving, e.g. Lodin or if you were given choice and is the always patient driven in the sense that it’s more lifestyle? And if you would say, I don’t know, extrapolate out one year, two years, five years down the line, are there any benefits of immediate loading versus delayed loading apart from the inconvenience to the patient during the integration side?

[00:15:41] I think that most the evidence would suggest that other than the old millimeter of bone here or there, the differences aren’t great. So that it helps you argue it both ways, doesn’t it, that there’s no harm in doing it, but that the risks can be a little bit higher?

[00:15:59] Is there any any evidence pointing towards sort of failure rates and things like that with respect to immediate verses and then the whole argument that some people say, well, you only need four implants and some clinicians I speak to say, you know what, even if I’m immediately then I’m not going I’m not going to let it all hang on or I’ll put in five or six for the amount of time it takes me to stick in another one or two. It’s not worth the risk. But just on that front, is there any evidence that the risk of failure is higher with immediate loading?

[00:16:32] Yeah, there’s definitely slightly higher risk, but there’s there’s evidence to show it both ways. But overall, you have to accept there is a slightly higher risk. And again, because we grew up with Branum and we grew up with that in the back of our minds, that it was in the maxilla like a 15 percent failure rate over 10 years will be. When you look at all the stocks that you look at now, that’s that’s a completely different way of looking at implants. So we were we were in early and we had to accept that we were having to build a quite a high failure rate. And part of the reason the implants were so expensive from the get go wasn’t so much that it was expensive to actually start at the start up costs was significant. So the kids were really expensive. The drone attacks were expensive, but also in the background, the the fees were building in a degree of failure because we thought we were going to have to retreat more patients than we ever did. Not never got a refund. But that was it was a it was a philosophy and it was it was the right philosophy.

[00:17:40] And so we also had a protocol where we’ve never. Never say never, never say never, but we always try and not treat patients on to a budget. So if it means not treating a patient, I know it sounds mean, but we’d rather not treat a patient than try and treat them on the cheap and compromise what you do. So the other way looking that is when we when we had significant say about it that would accommodate three implants.

[00:18:17] You’d rather it’s in the early days, put three in and expect one of them to fail rather than put two in for the same things and then hope and pray that you didn’t lose one because then that’s catastrophic. So we fail. Team failure in lots and lots of our case is still part of our philosophy now that you should try and accommodate some degree of failure within within what you’re trying to do.

[00:18:47] We also know that we are really, really bad at predicting failure of a person’s dentition, whether it’s restorative. We operate on flavor. You know, anything. You’re probably a bit more certain we’ll treat you well by time period. But, you know, some of the bigger classes, you try and choose a path where you’ve got a parachute at some point down the line, but the truth will out and they never fight in the way you think.

[00:19:17] You remember any cases where either failure had a big impact on you clinically or just emotionally or perhaps the first time an implant failed. And how that felt and how you how you dealt with it obviously happens to everyone. And many implant surgeons I’ve spoken to, it’s you know, it’s like getting a letter from the GDC, not quite as bad as that is. That’s heart sinking feeling where they feel like, you know, what could have they done differently?

[00:19:47] And have there been any situations like that for you with patients know again, we’ve had it, there isn’t anything we are thinking we’ve not experienced. So with a failure to say so. We had a big legal case years ago where someone sued both Richard and I. Well, I filed a case back that went all the way. So we were ten days out of court. Wow, and that was stressing to the point where you would not believe. And so I think the end is very, you know, this this kind of stuff, it’s good to let people know that you share in the same experiences. And I was very lucky in that case in the rich and I were being so together. And he’s a man who is very driven and he’s classic. Is OneTouch a piece of paper once. So something comes in, lands on his desk. He comes out the next day.

[00:20:56] And I very much try and do that because if you want a quiet life to do so, that litigation was, I think, quite remarkable because what I had in the two of us was two people actually willing to take the fight and get stuff back super fast. So the other side never really had a chance to have anything over on us because every time they said something, it was back delivered robust defense and it was you know, we had more control of it because what did you learn from that process?

[00:21:41] You learn something that’s not the nicest places. The ones you get on best with can still bite you.

[00:21:48] And so you never assume that your relationship with a patient is always going to go the right way because we have a very good relationship with him and it just turned what was what do you think you must have reflected on?

[00:22:03] What was the pivotal moment when it turned? Why did it turn?

[00:22:09] You got a second opinion that probably wasn’t. Completely supportive of us. We didn’t expect it to be here. We had some kind of an implant that was that was the big problem that can be very, very difficult to manage. And so the management of him became someone else’s problem, and then that became our problem. And then when he decided to litigate, the expert was not impartial. So they forgot their duty to the call and they just felt I had a duty to the patient and they weren’t particularly careful.

[00:22:53] But so they had an axe to grind with at least one of us. And it wasn’t until very late in the day where our side said to the other side, if you got any idea who you’re trying to say, and I said, you don’t know what you mean, because the experts said that Richard and I were actually not trained fully what we provided. And then what? Well. He’s the first professor of implant industry in this country and I was a specialist associate, and so at that point they had to then go back to their expert and say, you know, why have you said? So he lost his credibility very, very quickly.

[00:23:44] Do you feel do you feel the weight of being at the leading edge?

[00:23:51] You know what I mean by that?

[00:23:53] I mean, I’ve talked to some dentists who say, you know, they’re well known lecturers or whatever. And when they’re doing the work, yes, they’re doing it for the patient. Yes, they’re doing it for their own self-respect and all of that. But the idea that at any point in the future, that patient could be seen by another dentist who then says, I was treated by Paul Palmer.

[00:24:12] And, you know, your reputation is is up there. So you can’t you feel the weight of that.

[00:24:18] I think we all feel the way I think I think that’s dentistry that, you know, I think my wife has always said that, you know, whenever you say a patient, a scene that someone else is going to say this.

[00:24:30] And I think that’s I suppose I suppose that a lot of your work has been by referral by for such a long time that that’s like just second nature to you.

[00:24:38] Yeah, I think that that’s implicit in a lot of our activity, that’s for sure. But I think it has I think that’s part of the stress of dentistry anyway, is that inevitably someone else will actually say your work is sort it’s almost a given and that should be your driving force to do your best, obviously. But it’s a good thing to remember that. And we’ve always tried to do our best by our patients. Sometimes it doesn’t you know, it’s not always going to go 100 percent, only if you’ve trained so many implant.

[00:25:16] So, I mean, you did you trained most of the people who went through that guy’s M.S. right now.

[00:25:21] And you’ve come at it yourself from the perio angle. But the plenty of people go go with implants from the restorative and then some come in from the oral surgery kind of angle for today. Now, I know that M.S. is not running anymore. Right.

[00:25:36] So we we them Clinton now. So that basically what happened was that in running a masters in implant industry, you get through a lot of clinical cases. So for four people on that course can just get through so much clinical activity on their own that it was not really allowing a good throughput into programs that were perio pros that were leading to a specialist certification. So it just made sense to come back from the the MSA and implants, which wasn’t it was delivering a very, very good degree and fantastic that they had an awful lot of clinical input on their clinical surgeries. But we had a lot of parents and students who were not benefiting so much. So it was better to drive a bigger and better implant.

[00:26:44] So those two degrees than if someone was thinking of if a young young dentist was thinking of going into implants now, what would be your advice as the best pathway to follow?

[00:27:00] Not not only from the educational perspective, but what to do, you know, get a mentor before I think that every now and again are some of the mentoring is good.

[00:27:13] But if, you know, all the programs will be driven by someone with more than one aspect or another. So getting a broad base I think can be difficult. But within an academic environment, I think you’re more likely to get a broader base. So, again, I think programs and certainly we’re very proud of because they get an input from and consultants or surgery and restorative. So they’re both broad based. So I think you’d still have to say that they are probably the gold standard. So an intern program. But the commitment that is is massive and you can’t deny that.

[00:28:02] How long does that take? How much does it cost? How hard is it to get onto these four years?

[00:28:07] The cost? Now there are about 20 grand a year. I think people would have to just check that. And the commitment is three days away. So it’s massive. And I feel really sorry for this. Last year has just been too painful for every one of our undergrads postgrads. It’s just been inconceivable. But is it hard to get on to that program? I think it’s really hard. It’s probably got a little bit easier. I think the numbers of the.

[00:28:43] Probably number of it might have gone down a bit, but I’ll pay you 20 grand and then you stay out of all the students you’ve told. Is it quite easy to spot talent I know Payman always talks about refers back to Dipesh and says when he first saw the passion to his work on the composite side of things, you could spot the talent straight away. And he was it was leagues ahead when you were teaching students. Can you pick the talent out pretty quickly? And if so, what are those what are those key indicators you look at and say, this guy’s going to be a good surgeon, he knows how to treatment plan, case selection, etc., etc. all of the skills of a good implant ologist because it’s not about drilling.

[00:29:33] The implant is not the key point now.

[00:29:36] So I thought we sort of drifted off a bit early because I was I was incredibly lucky that I had our training is undergraduate’s was very, very, very good. So we had a big surgical program. So we had probably at the London and the old surgery department that was actually amazing. So we took hundreds of teeth out. We could load the search crews out finals. You could end up doing an impacted wisdom, tooth surgical removal as part of your final exam rather than just doing something in concert. And then I did a house job and then a schedule, and that gave me a really good grounding in surgery. And then the NSA guys is obviously very surgically orientated. But I had a big restorative component to it. So we were it wasn’t just about perio. There was considerable process input. So that then gives you a really good basis to start your influence with an obviously, again, been exposed very early on to the Brenham protocol, which was so based on dictum that you can yeah, he’s a bit like playing golf.

[00:30:55] There’s a point where putting the implant in, as you say, is just the drilling the whole bit and when you can forget worrying about that.

[00:31:03] But that’s the point at which you raise your bit where you are trying to point where you’re going to be optimizing all the other bits, because all the stress for the students is, oh, God, I’ve got to drill this hole. But actually. It’s not quite that, but it’s the bit around it so is being restored to be driven and being able to think about all those facets rather than getting the implanted.

[00:31:34] So just going back to that question, when it comes to spotting talent, we’ve spoke to numerous educators, Payman himself, when he spotted Dipesh’s talent from a mile away. Do you spot that talent? I mean, is it obvious to you when you’ve got a cohort of students who’s going to be flying ahead? And if so, why?

[00:31:55] I think it’s you also have some that are academically very good and some are potentially very good with their hands. Yeah. And that’s obviously a bit like the most obviously is the practical side of things. So when you get someone who’s very confident in their soft tissue handling, that’s the point at which, you know, you’ve got someone who is probably going to excel. But there are plenty of times in the rough where you start and you think we’re going to have some problems here. But again, their exposure at that point just hasn’t been enough. And it’s part of the problem with undergraduates now and the reliance on what appears to be a lot in practice. Learning in practice is your exposure to enough surgery as an undergraduate and as a as a trainee that gets you to a point where you’re able to do that. So that’s how I was learning implants. The soft tissue handling and bone manipulation was sort of second nature. And that makes a big, big difference. But you can certainly take the good ones and you get most most students a very good standard.

[00:33:11] You must I mean, I said you must do you do charge more than an average guy for an implant?

[00:33:20] No, you do not know how much how much is a single unit restored in the back of the mouth if you’re in two thousand five hundred.

[00:33:30] For us, and that’s that would be standard. And that’s how you just got to. So things I remember about myself, my brother, is that we are quite good at what we do and we’re very efficient. So if you look to our hourly rate, it’s probably better by virtue of the fact that we are incredibly efficient at what we do.

[00:33:53] So how fast, how fast are you how how fast you can go and you are still the still actually mostly a few minutes.

[00:34:04] Well, he’s about 15 minutes. But that so it’s all the stuff around isn’t it. So it’s patient, a local analgesics also stuff.

[00:34:15] So I still largely book out an alpha for one between one and four implants will probably still be an hour. And if it’s a single then I’m going to finish well within the hour if it’s full and it’s going to be a little bit of time.

[00:34:32] But that that makes me, you know, I think a highly efficient individual. Whereas other people that’s a classic, you know, some of the most expensive things, they’re are being used to spend an entire afternoon putting one in on it now. Yeah, that’s fine. I don’t know how you do that.

[00:34:55] It reminds you that they’re not making any more money.

[00:34:59] That’s not something, isn’t it? It’s what charges it is. We want wanted to be comfortable with what we charge as well. So, you know, we hate proctoring. So we try and sort of apply a middle line in the West and we’re not wildly expensive either. We can always kept at a reasonable level.

[00:35:21] I was right here on the show and I was saying to him that every time he’s in the mouth, he’s probably doing something outside of the ordinary. And, you know, dentists know him as a sort of top restorative guy. But every time he meets a patient, he has to sort of justify himself to the patient because the patient doesn’t know who he is. And he said there’s an element of the referral then to sort of saying it.

[00:35:49] But do you find that problem? I mean, amongst dentists, you’re so highly regarded, but you have to keep telling yourself to patients every time you meet them and if you become good at that as well.

[00:35:59] No, don’t know if you even bother with that, you know, because I trust the dentist in all good faith and I think that is that’s the biggest thing that’s going to put you in the right place for the patient. So we’re quite straight talking.

[00:36:21] We don’t we don’t try to promote ourselves massively. We try to talk to patients on their level. So I think I hope we come over as trustworthy and we thrown back as many as we come through the door. There’s lots of places we won’t treat or don’t treat. Also to have something else we give them. We try to give them all the options they have.

[00:36:42] So I don’t I don’t sell implants. I don’t I don’t need to. And I often say to patients that I’m busy enough. I don’t need to trade you. So if I take it or leave it with us, I don’t mind patients. Some patients won’t like won’t like me. And that’s the way some patients will either gel with you or they won’t. I think we’re very lucky in Essex where you have a broad church of patients coming in, but you’re all on the same sort of level.

[00:37:20] Yeah, I like that. About a 16.

[00:37:24] Yeah, but they all live in the place that we have a very, very high tech, smart practice and it was purpose-built and we’re very proud of it and our staff are very proud of it. And they all they’re not driving it to create an income for their driving it. So you give patients the treatment and that comes over so we don’t have to sell anything. The site has been done. If someone sits in our chair, the chances of me not being you know, if I had the mind to do it, I could probably put an implant in just about every patient to walk through the door. But that’s not never been our philosophy. It’s always be that they need it to explode all the other possibilities.

[00:38:09] You know, is there something else that I could have done just just on that conversation of budget? Because if we look at implant, dentistry is probably one of the most expensive treatments that you can invest in, especially if you’re going for so full natural mouthfeel, need full mouth to sort of implant dentistry. And you mentioned earlier that one of your philosophies is you don’t let budget drive the treatment plan because that that could compromise your treatment plan, I guess. Do you ever speak to patients about the replacement of so how long this bridge is going to last, what the future cost of that could be? You know, when you when you get patients in clinics and a bridge is going to be several thousand pounds, and when we know it’s not going to last forever, is that a conversation that comes up or that you ask if we have with your patients?

[00:39:00] Yes. So I try and I try and impress on our students as well.

[00:39:05] So it’s quite good with being in practice and in the academic environment because you’re trying to teach people, but you’re also trying to teach them how to behave in practice and how best to look after their patients and how best to keep yourself out of court and out of the way of the GDC, and that he’s about giving them the information they need. So one of my go to things is looking at ten year data, which is the pool data. So it doesn’t have to be specific to your own activity necessarily. But if you pull data and tell them about ten year data that usually they can cope with that and get their heads around that.

[00:39:51] And what I often say to patients is if I didn’t think this would last ten years, I would be telling you not to have it done. It doesn’t mean it’s going to last ten years. But on balance and on average, I would expect this to be that in ten years time. And if I don’t believe that, then I shouldn’t do it. And I shouldn’t be encouraging you to have it done. And your patients, fortunately, do see ten years as a reasonable time frame and a good time frame for things to last. But that’s I think that’s the best way in the fairest way to do that as pool.

[00:40:30] How much of your work is classic perio work?

[00:40:35] How much is implant or none? But there’s not none. But it’s tiny so. But do we implant itis? Is that something you’re looking at? Someone’s accused of being a one trick pony. You had some while ago, which was stuck in my craw for a long time. So I’ve never given up perio and I’m happy to hear. But I’m surrounded by. Some very, very good periodontist in our practices, so unfortunate that they pick up that stuff, I’ll pick up on items, the take up on that is not quite so, so good. So I tend to do a reasonable amount. But again, I don’t dress it up in any great way.

[00:41:19] I don’t make it too technical. But overall, we have fairly good results with that, actually. So I’m very pleased that today they’re not they’re not great today. So it’s not it’s not a good place to start your relationship with a patient or in your relationship with a patient, because obviously things are going awry and we are looking at an avalanche of very important items that’s going to hit us.

[00:41:45] What’s your position like? What do you think is going to happen?

[00:41:48] I think we all agree that it is an inevitability, I’m afraid, fortunately out and we don’t have a huge amount of coming in that is of our doing. But obviously there is some I think we probably become a bit more cautious as well. So, again, in that case, selection. So where patients don’t have a great deal of attached Sokoya and stuff like that, again, you’re trying to do your best to not pay yourself to corner some point down the line. So I hope in our activities we’re reducing the chances of it happening, but we’re also more aggressive. And so when we identify it, we tend to be more aggressive early on.

[00:42:30] So it’s like a like a flat procedure.

[00:42:33] Yeah, definitely. So if you see it as an active, I’d say he’s only saying time to openly debride it. And I I’m one of the people who doesn’t I’m not concerned about using state instruments on implants, but I think they’re still the best. You’ve got contaminated surface. It’s a wrecked surface. There’s nothing you can do that’s going to preserve the surface. So you might as well get in debride aggressive way as you can. Again, your respective. So you’ll mostly effectively. Are you repositioning as much as you dare? Or you can give the aesthetic, though using adjectives like azithromycin seems to have an effect. But fortunately, overall, I think I get some good, good results. But they are the expensive, sometimes showing more metal, having more space on them. Is this going back to good old fashioned perio surgery? Unfortunately.

[00:43:36] Who are frustrated? I mean, I’m frustrated by how little perio has moved. Well, I don’t know if it’s partly partly periodontist or whatever the new thing comes along I’ll miss. So many fans have come and gone. The periodontist are so anti anything other than debridement.

[00:43:55] No, like is renaming everything from reclassifying it.

[00:44:02] I mean, every dentist must lie, lie back and try and try and invent the cure. It’s just amazing.

[00:44:10] Maybe it’s just I find it totally frustrating that a lot of people are out there.

[00:44:18] You’re just trying to muck around with it on an academic level where in some respects know for the most part the patients is actually a simple disease to treat.

[00:44:30] But it has complexities because you are evolving so often, so many take. And with Ruggie support, so, you know, that’s frustrating. They’re all places that do appear from nowhere, obviously, but I think one of the good things about her is that if you do actually deployed and so what is it now? Some changeable professional mechanical platform is the pmrp.

[00:45:07] Penalty is nearly palmitate fire, so it’s. That’s why they’re coming down and it’s just it’s good to realize that that is the number perio, but it’s also the biggest thing. And that is often the is the home care.

[00:45:25] So if you can’t drive very early on into the patient, but the bulk of periodontal treatment is home care, if you don’t get that message through early on, you’re probably onto a loser.

[00:45:40] I won’t be frustrated by that. I think some of the techniques are fantastic. And unfortunately, some of the most widely propagated and promoted techniques are actually all about recession that no one sees or cares about as far as I’m concerned, for the most part. And I find that frustrating. But, you know, that’s that’s the world we live in.

[00:45:59] So a couple of things when it comes to the peril that I see shopped around, one of the mizin repeated treatment with whatever laser it is for several thousand, if not tens of thousands of pounds marketed as the as the sort of cure. I’d like to get your take on that.

[00:46:19] And then and then the stuff you talking about propagates. And he talked about stuff like pinhole, surgical technique and stuff like that.

[00:46:25] Yes, I see techniques that recession and things like that. But for the most part of the country now he’s proper perio, but largely is is not required. Yeah. Cosmetic, which is truly cosmetic. And that’s a great thing. But yes, around four fives and sixes, that’s where I start to struggle. So I think again, after a little bit careful.

[00:46:52] But the last time I saw it shown in a lecture and shown as this is laser therapy, it was the closest thing to subdural Curatola and I mean curtilage, which is now with the new classification, an obsolete term because you shouldn’t do it unless it’s a periodontal lateral prophylaxis. It was the closest thing to that I have seen in 20 years being shown as this is laser therapy and it blatantly isn’t. So I think some of the people who try and promote it are not actually delivering it, as you would describe it. So if it was waving a laser down a pocket and it worked well, you know, who wouldn’t want that and who wouldn’t love that to be the case? And if it was that, why isn’t it really cheap? But they obviously isn’t.

[00:47:43] And it’s there’s no research or evidence that points to that being the trouble is there is there is supporting evidence.

[00:47:53] But the problem is then when you look at you’re not looking at like for like so if do laser treatment and you’ll know mechanically removing plaque, then you’re probably not going to get much of a result. But the minute you start to mechanically remove plaque professionally, then the level of what you do that is very much under the control of the operator. And it’s to set up a controlled study which is truly blind. And where you truly deliver an equivalent treatment can also be very difficult. What are your memories of the surgery and the data that came from that? The level of scaling root plating that the Swedes did in the good old days was phenomenal. Now, like over an hour on a one motivated to just heart such high end intervention that it doesn’t even compare to what you can deliver. And so if you introduce that into a study where you’re introducing a laser and you have the ability to manipulate the tissues outside of that, then there’s an opening to show more effect than maybe there is in the true world. But that’s the biggest problem.

[00:49:16] Would you do such a sort of variation of different things that you teach you research?

[00:49:25] And then you treat patients and and you know this on the patient side, this kind of mccolm on every side, and there’s the sort of treatment planning side and you write books and all that.

[00:49:36] What’s your favorite of those? Is it the mix? You like what you like the most? I mean, the university environment.

[00:49:44] So I have been blessed with with my career because once I started working in a practice that gave me another home outside of general practice and then very quickly became exclusively in perio practice, privately and in the academia. I’ve had a great mix of places I work. So for the last 20 years I worked in three practices and that guys. And that gives you a really nice it’s a complex world, but it’s also really nice because you’re in a different room every day. You have a different nurse. Most days often say, if I got into practice, I’ll probably be dead by now. I don’t think I could have coped with it. One room, one nurse. It wouldn’t have been good for me. So I had been really fortunate. So, you know, I think you can love and hate them equally, but a bad day in practice just, you know, can be really, really bad on be a good day. Practice, it’s very fulfilling, but having the mix and having a good group of colleagues and a network of friends are probably the reason I’m talking to you, was one of our students and he’s now my boss. And we have a great network of friends, colleagues who work for a lot of the time. We all like minded, but we all have different opinions and we have different ways of working, but we all bounce off each other as well. So when we get frustrated or we’re a bad case, we have a WhatsApp group and we share stuff online. So I think we’re lucky. And now it’s a different world, isn’t it? Twenty years ago, you could have been in practice and never you might never speak to another dentist, let alone a whole group of them.

[00:51:52] So are you on Instagram?

[00:51:54] No, I’m not. Tell us to go on Instagram. I’ll choose my hat or choose my hairdresser, my optician. My this is on the Instagram is a map top up on top of an idea on my way.

[00:52:16] And Paul’s outside would go so out of hand to us.

[00:52:20] The same question. Go for me. Yeah. So your favorite at eBay, you mentioned outside of work, what do you do for fun? So when you mentioned comparing golf clubs to implement tools, it’s I’m guessing not that features somewhere and.

[00:52:36] But tell us what tell us what you do outside of academia and practice to relax.

[00:52:44] If you Times is watching this game, you play golf and it’s not pretty. Basically once a year and it’s usually a charity thing or something gets me to dust the clubs off. So but I appreciate the technicalities of that and how difficult that is and more by the time you need to play such a key hole that they should go for it.

[00:53:08] That’s a use as an analogy. I love my rugby, but so I’m a bit sad today. And so I’ve used that sometimes in my teaching where you’re trying to get people to look at a perspective and you can say is sometimes like, you know, Jonny Wilkinson is lining up a kick. You’ve got to look at it in such a way. You’ve you’ve got to visualize it and you’ve got to put it in plain view as you can and break it down to that point. So it’s the machinations of those things. So, yeah, I’m not quite a sport, but my biggest activity was exciting stuff, saying if you had a week to sell, what would you be doing outside of work?

[00:53:56] So we recycle a lot. So we’re going down the coast to coast in May. We just we snuck in before Boris’s announcement. So we we booked a welcome to Bridlington cycle. Right. Actually, my brother Richard and his wife, my wife and our daughter. So we’re doing that. So that sort of thing. If we got a holiday, it’s an active one. We I can’t I cannot sit on the beach. I mean, look at the look at the colour of my guys. So I’m pale and pasty. I still have the sun off on the beach, the most uncomfortable place on Earth. So I’ll have to sit in the warm shade and read a book or cycle sail to all that stuff.

[00:54:43] It’s been a great honor to meet you. But having heard so many stories about you from a lot of your students, and and we got some great laughs over the years of that lately.

[00:54:58] Yeah. My good friend to all of them worked under Paul and his brother and Pete friend, who I’ve known for years and years and years, always used to tell me about it. So it’s been lovely to meet you, but always ends it on the same question.

[00:55:14] I do. I do. I’ve got I’ve actually got one more question if that’s OK. Know, we’ll kick off with that. And it’s just because it comes up a lot with people I speak to and that’s zygomatic implant’s.

[00:55:26] And you’ll I just want I just want your thoughts on it, because you know what? I’ve come across some dentists who jump on a weekend course to learn zygomatic implants.

[00:55:35] I personally think that’s bonkers.

[00:55:37] And then whatever your philosophy is on it, what sort of training and qualifications do you think somebody should have to be doing that, that level of surgery?

[00:55:49] That’s always a tricky one. I’m not staying at the door letting people in and excluding people. So I think it’s dangerous to even stranger than the line of who who should or shouldn’t, because at the end of the day, the person holding the drill is the one who has to answer so self and the gdc. So it not how much training you’ve had and what courses you’ve done. At the end of the day, you’ve got to be able to be confident in your own ability and working within your own ability. That again, is what we try and instill in our students and our the people we work with. Because once you lose that insight, life gets difficult and dangerous for all of us. But it’s automatic imprisonment. So you have a good enough record and in the right hands they certainly have a place. But what they actually can deliver again is another one. It’s a common philosophy, isn’t it? And one used by by Boris of Light, which is under promise and over deliver. And I think once you’re at the level where you’re starting zygomatic in your stance across the lines where delivery could prove very problematic. So just proceed with caution would be my word with it. It’s not something again, we know well our level of expertise. And when it comes to that, we’ll we’d found that out if we felt it appropriate to have anyone within our practices to actually provide some interest.

[00:57:31] And so on to my final question, Paul. So much in it’s your last day on the planet.

[00:57:40] You’ve got all your loved ones around you, and you need to leave them with three pieces of wisdom, obstructer of advice.

[00:57:49] If I did this one, three, I think you know that. Don’t don’t forget overpromise under promise and over deliver a good one, but you choose yourself and always try and work within your own capabilities because otherwise life is going to be difficult. Now I look after each other really nothing, nothing, nothing groundbreaking there is that it comes down to what your values are really.

[00:58:20] And you have to ride it out. Don’t what you’re also like broken glass.

[00:58:23] But let’s leave.

[00:58:26] I may you might save some people’s backsides. They’re finally available. And how would you like to be remembered, Paul, if if that upset, then this sense and it was Paul loss, how would you like to be remembered for good company?

[00:58:49] I like making people laugh and I think, OK, most most I can do that without causing offence. I hope people think that I do bring about humor into their lives more than anything I do. And I’ve spent my whole life pissing about expense out of classrooms and detention. And I’ve read one of my reports the other day which was post preoccupied with, you know, amusing the rest of the class. Everyone’s expense, not just his own, but erm I suppose is one of my traits. I’m disruptive, I’m a disruptor I think. But no, I don’t do it maliciously, but I can’t, I can’t resist the old gag and luckily actually you know today of not being pulled out of a. Professionally, it must have been close a few times, and I know that Richard would have would have been close a few times as well when one of your students told me he was one of the lads, always one of the lads.

[00:59:58] And that could be that could be your undoing as well. So, yeah, we really like to be a part of that.

[01:00:05] It’s good to have a good relationship. You know, I think the best of the British society, period, period, ontologies always had a good image of being in a place where you can go and learn a bit, but also have some fun, have some fun and hopefully we’ll get some of that sometime soon.

[01:00:28] And the last question for you, about a month left.

[01:00:32] What do you do in that month?

[01:00:34] Isn’t that what amazes me is that people who go back to work, I seriously, I.

[01:00:45] But yeah, I would not be doing that, that’s for sure. What do you think? I didn’t go particularly mad. A party which is spending time, you know, very, very nice life. No. Where we walk away so I can only do stuff. Let’s spend it with our our children are everything to us and we want to spend it with them.

[01:01:11] Are they going to need some nice stuff. How old are your kids? Twenty nine. Twenty six. I loved talking to you made it actually it was terrifying, as I expected it to be, just to chat down the people, you know.

[01:01:34] Yeah. Yeah, I know. Thank you so much for doing it.

[01:01:38] You know, welcome. This is Dental Leaders. The podcast where you get to go one on one with emerging leaders in dentistry.

[01:01:52] Your hosts Paymen Langroudi and Prav Solanki. Thanks for listening, guys. If you got this far, you must have listened to the whole thing and just a huge thank you both from me and pay for actually sticking through and listening to what we had to say and what our guest has had to say, because I’m assuming you got some value out of it if you did get some value out of it.

[01:02:13] Think about subscribing and if you would share this with a friend who you think might get some value out of it, too. Thank you so, so, so much for listening. Thanks. And don’t forget our six star rating.

Prav Soulanki: You know, I think what’s really important here is that they have that true moment of realisation themselves that if this is their dream and this is their ambition and this is what they want to do with their business then switch that bloody aggression on and give it 110% and I’ve always been one of these people who believes that if you really want to succeed, you really want to do it, you need that pig-headed discipline and aggression to attack it with and if that is distracted with two thirds of your week, or whatever it is, somewhere else, being told what to do, working in a way that you don’t want to work, it’s just going to kill your energy for growth.

Speaker 2: This is Dental Leaders, the podcast where you get to go one-on-one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Soulanki.

Prav Soulanki: Gives me great pleasure to introduce David Hossein to the Dental Leaders podcast. Me and David have had a few conversations over the last year or two, just sharing mutual clients and we just started talking about treatment of dental accountancy and I’ve spoke to a lot of dental accountants over the years and on the whole, they tend to bamboozle me with the language and I’ve found that speaking to David, he seems to break everything down really simply to understand and just full transparency here, David’s not my accountant, but I do respect him and the advice he gives out there. So David, if we just kick it off with just a brief history of where you grew up, what your upbringing was like, and then how you then got into your passion, which is crunching numbers for dentists.

David Hossein: Thanks Prav and thanks Payman. So Manchester lad, grew up in Stretford.

Prav Soulanki: Red or a blue mate?

David Hossein: I am a blue, even though I grew up round the corner from Manchester United. I think for me when the Glazers came in, it became less about football and more about money. Yeah, I think at that time, I was just quite impressed by the loyalty of City fans, how crap their team was but they still stuck by them. So that won me over and it worked out well in the end, so not a bad story. Yeah, grew up in Manchester, never really lived anywhere else apart from a short stint in London and did a bit of travelling, like you do in your youth. How did I get into accountancy? Well, my father encouraged me to take it up, it was something he did as well. So yeah, I think it helped me make my decision because it wasn’t something I would have ever chosen if I’m honest with you, but it turns out I’m actually good at it, so I’m happy for that.

Prav Soulanki: When you were at school, were you one of these numbers guys? Like top of your class at maths and maths geek, not great at English, sort of thing and just accelerating in one subject? Was that your strength?

David Hossein: No, no, not at all, not at all.

Prav Soulanki: No?

David Hossein: I don’t see accountancy necessarily about numbers. I think the software and a calculator will do a lot of the maths for you, I think to be a good accountant, you should be [inaudible] minded and that comes with experience.

Prav Soulanki: So what was the pathway? What was the pathway for you? Did you do GCSEs, A Levels or O Level, whatever the equivalents were back then and then …

David Hossein: Yeah, did GCSEs, did business studies at A Level and as I say, my father guided me into that. Passed my exams, got a training contract and the rest is history and here I am today.

Payman Langroud…: So are you a chartered accountant?

Prav Soulanki: So after you became a qualified accountant?

David Hossein: Yes, I’m a qualified accountant and I also sat my chartered taxation exams as well. That was really helpful for a lot of what I do now, because being an accountant and being a tax advisor is … they’re similar but different. A lot of the transactional tax advisory work, you’ll only get that if you’ve done the tax exams. So that does help in a lot of my work, yeah.

Prav Soulanki: How did you get into dentistry?

David Hossein: Funnily enough, I was at uni, I’ve always had friends who are dentists and naturally they became clients and just did more and more of it until that’s pretty much 95% of what I do now.

Payman Langroud…: So David, there’s more to it than just working out accounts for associates and practises. I mean, tell me about the scope of business. I guess you’ve got that self-employed bit, you’ve got the business owner bit, what else?

David Hossein: Well, most of my work is in the transactional side. So I call myself a commercial dental accountant, which is somebody who … There’s accountants who will say, “Well, here’s your accountant, here’s your tax bill and here’s my fee for the bad news.” Or there’s someone who’s like, “Well actually, where are you in your business and where’s it going to go, and how do I fit into that and how can I support you in that?” So it’s things like business plans and cashflows for new start ups, helping a first time buyer appraise the practise and helping them through to completion really and helping mini groups with their acquisition programmes and helping them through to sales. So that’s really the majority of my work. I can do accounts and tax because obviously I’m a qualified accountant, but my main focus is working closely with my clients.

Payman Langroud…: So give some examples David, of big mistakes you’ve seen clients making that you’ve had to fix?

David Hossein: Yeah, having no accounts, not done by a dental account and it can cause problems further down the line, I think as … So dentistry performs to a very predictable format in terms of fee [inaudible], cost of sales, gross margins and KPIs. Just the accounts I’ve seen, I’ve just been like, “Well actually, this doesn’t make any sense.” In some ways, you have to start again, really then to start to understand how the business is actually performing. That can be more common than it should be. Things like flawed incorporations, so people saying, “Well, I want to have a limited company because it’s going to save on tax.” But then it’s not done by a dental accountant, they don’t understand that you need to have the contracts [inaudible] properly, otherwise the tax man will just cut through it and say, “Well actually, you’ve not done it properly, therefore no you’re not having these tax savings.” Then when you’re coming to sell, that’s another problem that then the buyers can’t understand the structure because it’s not done properly. So I think having somebody who understands the specifics of your area and your business and dentistry, I think is valuable.

Prav Soulanki: David, I’ve got a situation where I co-own a group of practises. I was advised by an accountant, non-dental, or we were as co-owners, of how to structure our company and then how to extract those funds personally, appropriate times and when we declare our divs and whatnot and just maximise on that position, right?

David Hossein: Yes.

Prav Soulanki: However our accountant advises us. Anyway, time went on, the practise moved to another accountant. We got the news that had we had a different structure, i.e. and I’ll just give you an overview, we’ve got a holding company, an LLP and two limited companies that sit under the hodling company because when profits get pushed up to the LLP, we’re paying tax at source, rather than deciding what we’re going to do and how we’re going to plan that. We’ve got no control over that, it’s like, boom, it goes straight onto your-

David Hossein: Tax return.

Prav Soulanki: … you know, your personal-

David Hossein: Yeah.

Prav Soulanki: … and you get leathered by it, you haven’t got as much control. That cost us a lot, a lot of money over the years, but as somebody who’s not accountancy-minded, or clueless about that, we trusted our advisors and we ended up going that and it was very clearly explained to us by the other accountant that, “Look, we could have saved you … ” it was in the region of multiple hundreds of thousands over years, right?

David Hossein: Yeah, yeah.

Prav Soulanki: Can you give me your insight into … Well, do you come across things like this in terms of flawed structures? Also, just a bit of advice out there, imagine you’re starting up a squat, or you’re thinking of growing a group, or whatever that is. Is there an ideal structure to operate under, depending on, I’m assuming what your goals are, whether it’s growth, where it’s acquisition by other people, or acquisition for yourself. Do you want to just run us through structure?

David Hossein: Yeah, absolutely and 100%, that’s a problem. The problem you’re talking about is where does the money go? When it comes to tax, the first thing you always have to answer is start with the end in mind, so what are we trying to achieve by this? Where does the money go? Where does the profits go and where does the capital go? Once you can pinpoint those two things, then from there, you can then map back, well how should the structure work to achieve the income distributions and the capital distributions in the future? You’re quite different Prav, because you’ve got LLP with a company, it’s probably more common where you see, say an associate first time buyer who’s buying a limited company and they have the debt held personally and the company is repaying the loan repayments and they just get hammered for that capital repayment as a dividend. So heavily taxed on it, they’ve got massive bank repayment, and they’re just left very poor from the actual residual profits. It’s entirely avoidable by having a hodling company above the practise that you’re buying, so the debt is held in there, dividends are paid up but the cash stays within the corporate structure to repay the debt and then you’re not having to pay tax on the distributions, it’s only after the bank has been repaid, so lots of structural issues to be very careful of in that scenario.

Prav Soulanki: Is there anything that you guys can to do almost unwind this?

David Hossein: It’s difficult with the bank.

Prav Soulanki: Let’s say something’s happened and you think, “Do you know what? If only the structure was like this.” Is there any point where it becomes too late, or is there a point where you say, “Actually, come and speak to … ” yourself, or somebody like yourself, who’s a commercially-minded accountant, ” … and we may be able to improve your position.” Even if something’s happened in the past the A was either structurally wrong or accounting, cost centres have been done differently, or like you said, the debts going in the wrong direction?

David Hossein: Yeah, it’s harder to fix once it’s in place. First of all, if the debts in the wrong place, then to move it, the banks have to be onboard with refinance and if you lock in at a very good rate, that’s a problem because they’d want a new rate. On other structural issues, yes, it’s possible but you just have to mindful of HMRC’s transactions and securities legislation which is designed for an entirely different purpose, but can tarnish other things when they have unintended consequences, but it has to be looked at on a case by case basis.

Prav Soulanki: What are the main things that you’ve noticed when speaking to clients during this whole lockdown COVID situation at the moment, in terms of the support they’ve needed? Obviously there’s been loans and things like that, cashflow forecasts and things like that, I’m assuming you’ve had to be working on, but what’s your general sense of the market now in dentistry, especially you say you help with people who are starting up new practises and you also help with acquisitions and sales and stuff like that. Can you just give us a temperature check of what’s going on in the market at the moment at both ends of the spectrum?

David Hossein: Yeah, sure. So on new side, I am seeing a lot more interest. I think associates are questioning where they are with life generally, it’s obviously been a mad time we’ve been through so people are saying, “Well, actually you know what? I’ve been through this, I’d like a bit more independence, is this quite right for me?” So I’m getting a lot more inquiries and I’ve seen a lot of people going down the squat route. I think if it’s executed correctly, I think it is a very good return on your money. So I’m seeing more on that side. On the private side, I think the first three months are quite scary for private practises, there’s a lot of uncertainty, so there was a need for, “Well, let’s have a look at the cashflow, let’s see what the situation is.” I’m very lucky that none of my clients had to close because of it, they’ve had to come through and are probably having now, couple of months, best months they’ve ever had because it’s quite difficult to get an NHS dental appointment.

David Hossein: On the selling side, there was, I think it’s fair to say, a lot of acquisitions were paused, so some of the corporates just slowed things down a bit, saying, “Well, hang on a second, let’s let the dust settle and let’s see where we are.” But that’s picking up now. So I think we’re moving towards normality now.

Payman Langroud…: Okay, how long have you been just working with dentists?

David Hossein: With just dentists, about 10 years, 10 years.

Payman Langroud…: So how would you rate the industry compared to other industries, as far as the health of the businesses that you see? Would you say it’s an easier business overall than others, or more difficult?

David Hossein: I’d say it’s actually more difficult because you’ve got the challenge of in many … Well, most of my clients anyway, are bringing in the income. So you’re having to work in the business and be responsible for all your admin and be responsible for all your marketing, and be responsible for all your team training. It’s very different, whereas other people who’ve got a business, they’ve got a corporate structure, where managing director manages the business and that’s not the case with dentistry, I think … Yeah, I don’t envy a lot of my clients. I think it’s quite a hard sector to be in, the hours they do, the responsibility they’ve got, the constant threat of litigation, so something going wrong. It’s a difficult business to be in.

David Hossein: I think that on the other side, if you get past that and you’re commercially minded and you want to go and grow something for creating value, well as a sector, healthcare, but dentistry in general is a great way to grow and build something that can generate future value but in the meantime, be careful of your mental health. Have the right people behind you, it’s a lonely, lonely sector.

Prav Soulanki: You spoke about starting a squat and it being a profitable thing if you do it right and I guess the flip side, if you’re somebody who’s just staring out and you think, “Okay, do I buy in on going concern and buy into cashflow so I hit the ground running? Or do I set up a squat and just set up a business from scratch and I’m not whacking a load of money in,” and bank finance might be easier if you’re buying a business that’s already got a proven cashflow. What would you say are the pros and cons from your perspective of saying, “Right, okay I’m going buy a practise and just … ” shall we say, hit the ground running, but I’m sure you’ve seen all the problems that come with that and then stand squat?

David Hossein: I look at it slightly differently in that what’s your natural … I think people should do what they’re naturally inclined towards. I think you’ve got natural personality times, some people are entrepreneurial and really enjoy rolling their sleeves up and doing things themself. I think that type of personality should go for a squat because if you’re buying a practise and you’re coming in and you roll your sleeves up and try and change everything, everyone’s going to be pissed off at you, and you’d have no friends and it’s going to cause you problems. And then you’ve got the other type of personality which isn’t like that and just wants to come in get started from day one with regular cashflow.

David Hossein: So I think I always look at the personality type first, but to answer your question, I think it’s less cash intensive on a squat but you’ve got to get your marketing right, you’ve got to have that right. So there’s more risk with potentially more return if it does pick up. On the acquisition side, you’ve got the benefit of walking into something that has got a cashflow, a regular income, so you’re not having to work in two places while it’s picking up. I do spend a lot of time convince people not to buy practises.

David Hossein: I think that I’ve had clients and they’ve paid too much for something that it just wasn’t right and after you’ve paid the bank back any tax, you can be actually worse off and the first thing I do when an associate’s looking to buy a practise is well, let’s please look at the numbers closely, let’s compare the post-loan repayments cashflow to what you had before and are you better off or are you worse off? If you’re 10 grand worse off, you’re comfortable with that, you’re happy that it’s tied up in the equity of the practise and as long as you’re going into it with your eyes wide open and you’ve understood, I’ll support you but if then it’s like, well it’s going to be worse off for you, I will try and get that across. The last thing I want is a client that’s miserable because if the client’s miserable then I’ll be miserable and it won’t be a healthy relationship.

Prav Soulanki: Does your role extend above and beyond business and stuff like that? I often find that when I’m speaking to clients, often bleeds into a conversation more than just marketing and you talk about work/life balance and stuff like that and sometimes I’ll have people approach me and say, “I’m thinking of buying practise two.” Because practise one is going really well and I’ve just [inaudible]. We all know that’s not reality, not for most people anyway, or somebody who’s grossing really well as an associate and they think, “Hold on a minute, the practise that I’m working for is taking 60% of the dough, I want it all.” So then they go down that route. Do you find yourself in those situations? Do you find your role extending above and beyond commercial dental accountant? Have you got any stories that you can share with us?

David Hossein: Yeah, sure. I mean, to answer the first question, absolutely, it’s not just about your numbers, it’s about where you are and where you’re going and how you feel and what’s driving you. Yeah, absolutely I think … Yeah, the second thing you mentioned there about the associates not happy about the 60% going, that’s very common and what I always say to people who are thinking of buying is just let’s talk it through beforehand to be clear on what your reasons are for doing it. Do something like that for the right reasons because it is a very big thing to take on and if you’ve not done it for the right reasons, it will make you unhappy. Any stories? What would you like to know?

Prav Soulanki: Summat juicy, mate.

David Hossein: Summat juicy.

Prav Soulanki: Any big names in dentistry who mucked it all up? No, I’m only kidding. Do you know what? Just something out there where you’ve seen perhaps something go wrong or that could have gone the right way, or just stories of where for example, people have bitten off more than they can chew because they didn’t quite know what they were getting into. I often find that, especially with a lot of associates, a lot of them don’t know what they’re getting into and they think grass is greener on the other side and then they realise, “Hold on a minute, I could wake up, stroll into work at 9:30, go home at half five, have my tea, watch a bit of Netflix and go to bed and now I’m doing the 14, 15, 16 hour shift and the majority of that shift is at home, stressing and thinking, or dealing with someone’s going to be off sick or whatever.” Have you had any of those scenarios perhaps, or stories where someone’s bought in and they think, “Oh my God, I can’t do this any more.” Or someone who’s been even braver and said, “Do you know what? I’ve made a massive mistake, I’m getting out of this.”

David Hossein: I have, many years ago, I do try and avoid my clients putting themselves in that situation because I’ve been through it before and I’ve had a client who really overpaid for what this practise was worth. It wasn’t my client at the time, so he came to me after he’d bought it because I would have stopped him doing that but every year, every January, it’d come to, “Here’s your tax bill,” and I won’t mention any names but it was soul destroying for him, said, “Where am I going to find this money from? I’m being taxed on this.” Don’t forget you’re taxed on your pre-bank loan profits. So if you’ve got 100 grand profits but you’re paying the bank 50, you’re only seeing 50 of that, but you’re being taxed on 100. Then if you’ve got a 40 grand tax bill on the 100, then there’s 10 grand left for you and your family. So you’ve got to really make sure you can avoid those capital repayments and yeah, he did come out, he had to cut his losses, but it’s like you say, you don’t throw good money after bad, there is a bad where actually this is not working and luckily, he could sell. He didn’t make a massive loss on it but compare that to where he is now, he’s an associate earning 100 grand, so it’s-

Prav Soulanki: A month?

David Hossein: No, not 100 grand a month, 100 grand a year.

Payman Langroud…: David, you know it’s a good exercise, yeah? Because a lot of dentists, like Prav said, want to open their second or third, or fourth sites, and in those sites they’re not going to be there, right?

David Hossein: Yes, yeah.

Payman Langroud…: In the end, they’re not going be the fee earners. So as a thought exercise, if you were going to open a dental practise, bearing in mind you’re not going to be there earning as a dentist, what would be things you would look for? Let’s say, begin with the end in mind, you want a three practise group, what would you do?

David Hossein: Man, that’s a really good question. I think it’s easier if your first practise is an NHS practise that doesn’t need to do a lot of marketing. If you can convert practise, an associate-led practise, sorry build it into an associate practise that doesn’t need you there, they often say the shift from one to two is harder than the shift from three to 10 because once you’ve three, you’ve got the seeds in place and it’s replicating the business model and the business isn’t contingent on you at three. But going from one to two is where you get cut down the middle, so you really want to make sure that practise number one is very, very self-sufficient and it’s the least of your time. It’s great if you’re not then working in it at that point and then it’s great that you can then work in the new site. Somewhere not too far, so your practise manager from site one can help and come over but yeah, it takes time and I think that’s … I think if I was giving … Go on.

Payman Langroud…: First one’s the NHS, what would your second one be? NHS too?

David Hossein: Well, if it was me, I think that it depends on the location, but a second one that’s private, is a private squat, would be attractive to me because I think your investment at that point is less but at the same time, if the cashflows work to buying another practise, then obviously go for that, but as you know, valuations aren’t very high, so you’ve got to make sure that cashflow works and then when you’ve got two and you’ve got a third one, then you add in then, do you need centralization of your processes and that’s another headache. Do we need a head office?

Prav Soulanki: Do you know, what I find about that, you say practise one NHS, practise two private, but systems and processes in place for expansion-

Payman Langroud…: They’re different types of practises aren’t they?

Prav Soulanki: Yeah, so surely in my … I’ve only ever known, in terms of ownership, private and I’ve worked with practises who are mixed and the processes and the systems are entirely different. I mean, NHS dentistry and the way that’s handled and stuff, it’s a whole world I don’t really understand but when I do get let into it, it feels like chaos. The only reason I say that is because when I communicate with the team members there, it is like they’re going 110 miles an hour and when you’re in a private practise, it feels like the music levels just toned down and you’re just coasting along and it’s smoother, do you know what I mean? Because you’re more in control of everything, rather than being dictated, so the systems and processes will be different. But is the logic NHS first, private squat second?

Payman Langroud…: Well, it’s a very common way of doing it Prav, because you’ve got the guaranteed income first.

Prav Soulanki: Not so much guaranteed moving forward though maybe?

David Hossein: Yeah the question was only two sites and I’m just going off what I see as most common for what I see but I think start with the end in mind. If your goal is to have one and two, then having one that’s self-sufficient and the second is your private where you generate high level returns, that can work. If your goal is, “Actually you know what? I’m going for 10 practises here.” Then yes, acquire several ones, acquire similar ones.

Payman Langroud…: Let’s take it forward then. Yeah, let’s saying we’re going for 10 practises, now you’re at three and you’re saying we’re now looking at some head office staff. Let’s walk through it. How do we get more money? How does it work? Are you in the cash raising side of these businesses too, or not?

David Hossein: I work with the lenders on behalf of the clients but the banks love dentistry. They will give you money.

Payman Langroud…: All right.

David Hossein: So it’s entirely up to you whether you take that on. Yeah, have that now very large debt above your head.

Payman Langroud…: Let’s talk systems then, go on. Let’s say you want to go from three to 10, what should be our systems? Who should we be looking to hire? How much money should we be looking to borrow and then what’s going to be our exit story? From your perspective?

Prav Soulanki: One at a time mate?

Payman Langroud…: Yeah, yeah, yeah, I know.

David Hossein: I have to say, there’s a line that I don’t cross. I don’t step into the business and put an operations person in and there’s a line I can’t go past. Prav’s probably better placed to answer that side, being on the inside, but from the outside, from what I see with my clients, then you want to have your accountancy function centralised. Associate pay, have your payroll, your associate pay centralised so take as much off your practises, have it all centralised. What else? Do you need a HR person at that point? I don’t think so, I think that having an external company can still help, you don’t need to have a HR person centralised. So when people talk about head office, we often make that into a really big thing, when in reality, it doesn’t have to be. I’ve got a client who’s just sold for a very, very good sum and their head office was very loosely put together with laptops and people working from home. It’s how you design it and what the point of the head office is. So if you can take off the payroll, take off the associate pay, paying of bills, having your accountancy function, your purchase ledger, if that can be centralised, great. Doesn’t have to be.

David Hossein: I think it also, again, going back to structures, it depends who you’ve got in the business. If it’s just you, and you want that all in once place and you pay the bills then yeah, centralise it. If you’ve got partners involved, and I think partnership models will become a lot more common going forward then you might … It depends what you agree with the partners and what you want to do, what they want to do and they might say, “Well actually, you know what? I want to pay the bills and I’ve got visibility on that.” I don’t think there’s one size fit all, I think there’s flexibility to what it actually needs. Obviously a big corporate would need to have purpose built offices and an in-house legal person and so on but I think for the smaller size clients, you don’t need something like that.

Prav Soulanki: When people are looking to set up a squat, I’m sure loads of mistakes are made, just the treatment of things financially I’m thinking about, rather than other operational business-type stuff. Are there three big tips you can give from a financial perspective? For example when people have questions like, “Buy equipment outright or lease,” for example. Can you tap into that but also maybe a couple of other for examples where you can just give some advice of what are the best ways to treat different areas of your business from an accounts issue, a tax perspective, to maximise things for you moving forward?

David Hossein: Well, for a squat, the absolute priority is not to spend all your cash and be as pessimistic as you can on how long it will take you to get new patients. If you’re over-confident with it, “You know what? I’m going to have 20 grand a month from day one,” then you’ll base your decisions on that and over commit your cash. Cash is the blood of any business. When it comes to a squat, I always say well, “Well, do you need to do two surgeries from day one?” If you’ve got a certain amount of cash, let’s do one surgery, wait for that to be full before committing to the second and third and so on. So doing things in a staged process if very common, so should I buy something on hire purchase or cash? If you’ve got the cash and you’re 100% certain you don’t need it, and you’ve got a bit in reserve after that, because always have something for a rainy day, then if you’re buy it cash, then you won’t have to pay the interest charge, which although it is tax deductible, then if you’re a company, let’s say it’s 19%, 81% is still a real cost to you, so that’s worth considering.

David Hossein: However, from a tax point of view, doesn’t make a difference. Whether you buy it cash, or whether you buy it on hire purchase, let’s say your year end is the 31st of March and you sign the contract on the 31st of March, you will get the full tax relief on that asset in that financial year. So if there’s no real tax, it’s more about, well can afford to lose that-

Prav Soulanki: Cashflow.

David Hossein: … yeah, cashflow and the extra cost of the interest. It’s what’s the best use of your money.

Prav Soulanki: Any other sort of … So, that’s many one example where I’ve definitely heard questions in Facebook forums and groups where people say, “Should I buy, should I lease … ” are there any other examples of those type of scenarios?

Payman Langroud…: Very commonly people overestimate how quickly business is going to come in, right David? But it’s interesting because if you’re an associate and you’re going to do your first squat, I mean, how you going to even get anything accurate on how quickly you’re going to get patients in? I mean, you’ve never run a marketing campaign, what would you say? If someone says to you, “Look, I’m going to open in Manchester, how many patients a week can I expect?” I don’t know, I’ve never done it before, so what do you do? You say pessimistic, what’s pessimistic?

David Hossein: The way I work my financial models are how many surgeries are you going to put in and what’s the capacity? So I know the question you’re asking, is it five patients per week, or is it 10. I tend to work on the high level perspective, so if that surgery can generate £200,000 worth of revenue, then in month one I would assume zero percent, month two, maybe 5% and then 10% and so you build it up so to the end of year one, hopefully we’re 30% capacity, so 30% of £200,000, 60 grand income. So it’s a staged over. I think I would start with a really pessimistic perspective because if we beat it, that’s great, but if we’ve over egged it, we’ve all got egg on our face. I think it’s very important to have the right marketing team behind you and I think people like yourselves are very valuable to a new squat. I think that like you say, as an associate, you’ve probably never done marketing, you’ve never done an SEO campaign, and I certainly don’t, if I need doing, I’ll go to an expert. I think that’s where you and I probably worked a bit closely Prav, where clients have needed the help and you’ve been very helpful.

Prav Soulanki: Do you know what David? The one thing that I come across a lot is I run, call it a clinic or whatever, but I give up say 15 minutes of my time to speak to people, they can book that through my website and one of the most common inquiries, or let’s say conversations rather than inquired because they generally tend not to lead to me being able to represent them, but it’s somebody who’s a practise owner who’s working at his own practise two days a work, working as an associate three days a week and then comes to me and says, “I want to grow my practise and blow it out the water.” And they have these massive ambitions. The one thing that I find is fundamentally broken there is that job that they’ve got three days a week because that’s holding their practise back from growing, 100%-

Payman Langroud…: You mean their attention, Prav?

Prav Soulanki: Pardon?

Payman Langroud…: You mean their attention isn’t 100% on the practise?

Prav Soulanki: Well, there’s a few things. One of them is the reason they’ve got that three day a week job is they need to put food on the table. Now, the majority of people I speak to about this, they will say to me, “Oh well I’m grossing big numbers at the other practise but I want to grow this so I can do it for myself.” So then I break that down and say, “Okay, you’ve got an associate in your practise, let’s assume you change your two days to three days and gave one day up there, do you think you could make that income that you’re making there in your practise? “Oh yeah, yeah, yeah, I think I could do that.” All right, so we’re moving this conversation along, but I think it’s almost like that comfort blanket, in order for them to do that, there needs to be a point where you just say, “Do you know what? I’m going to tuck my balls in and go for it?” Like an element of risk. I find in that situation, I’ve come across so many dentists who’ve got that associate job, in order for them to get to the next level, they need to commit with 100% aggression and-

Payman Langroud…: Prav, it’s like every moment of growth in a business though, yeah? It’s scary.

Prav Soulanki: Yeah, course it is. Course it is.

Payman Langroud…: We’ve both been in the same situation ourselves. Not from a two days a week perspective but there are things we could both do which scare us and I hear what you’re saying about … skin in the game you’re basically saying. If your life depended on it, you’d really go for it, but you’re almost too comfortable in the associate job, is what you’re saying.

Prav Soulanki: Like cutting your lifeline off isn’t it?

Payman Langroud…: Yeah.

Prav Soulanki: So often the conversation we have is around life, so I will ask that dentist, look-

Payman Langroud…: It takes a personality type though Prav?

Prav Soulanki: Yeah, no, 100% mate, 100%. But if you think, if you lost that job tomorrow, is it going to change what you eat for your next meal? Is it going to change the roof over your head and is it going to change how you commute? If the answer to that question is no, and you’ve got enough ambition, just cut the cord. But if you’re depending on it for survival it becomes more difficult but those two things, the associate job and growing your practise to your dreams, they’re just incompatible. Do you come across any clients, or have you got any clients who are in that scenario or situation, where they’re just ball and chain with the job?

David Hossein: Yes, yeah I do and I think the point you’re making is valid, that it’s to the detriment of future growth in the practise. I think that there can be multiple reasons for it, if the associate’s got a small family, sorry, I beg your pardon, young kids, has got very young kids, then that situation’s giving them flexibility to spend time at home while the kids are young, then that can be one reason for it but I do agree, you look at it, that’s really frustrating because you’ve got this potential here that you could be developing and-

Payman Langroud…: It’s almost by definition the kind of associate who’s going to set up a squat has had to be quite successful as an associate to save up this money and all that, so that job then by definition is quite a good job that they had and breaking away from that is quite hard, I can see how it’s going to come up a lot actually Prav, you’re right.

Prav Soulanki: Yeah, no totally, totally and it’s hard to kiss goodbye to a regular, healthy, fat income right? That you’re used it. Whether you’re spending it or not is a different matter, what you do with it, invest it or whatever but to just cut that cord and then say, “Right, I’m going to … ” We spoke about this earlier, it’s up-climatizing is a lot easier than down-climatizing, right?

Payman Langroud…: Yeah.

Prav Soulanki: It’s much more comfortable and easier to go from a one bedroom flat to a three bedroom house but going in the other direction it’s a lot harder and the same thing, if you’re used to a juicy monthly income, no matter what you do with it, and all of a sudden you cut the cord, it’s got to be a hard pill to swallow.

Payman Langroud…: It’s interesting Prav that they’re coming to you at that point and not at the beginning. Maybe they think they can’t afford you at the beginning or something, yeah?

Prav Soulanki: I think it’s a combination a few things. A lot of people I speak to have said that they’ve been following me or blah, blah, blah, whatever, call it the long-term marketing game, where I’ll put a bit of content out there, I might resonate with some people and I’ll definitely turn a lot of people off as well. I’ll polarise people and so some people feel that I’m approachable and they can just book a 15 minute call with me, have a conversation, we have a nice chat and then going our separate ways and hopefully they walk away with some guidance or some advice or have one or two little ah-ha moments.

Prav Soulanki: Why didn’t they get in touch with me in the beginning? Maybe they didn’t know about me, who knows? But I think what’s really important here is that they have that true moment of realisation themselves, that if this their dream and this is their ambition and this is what they want to do with business, then switch that bloody aggression on and give it 110% and I’ve always been one of these people who believes that if you really want to succeed, you really want to do it, you need that pig-headed discipline and aggression to attack it with. If that is distracted with two thirds of your week, or whatever it is, somewhere else, being told what to do, working in a way that you don’t want to work, it’s just going to kill your energy for growth.

Payman Langroud…: Yeah, true. David what are the few things you wish dentists knew better?

David Hossein: Oh, good question.

Payman Langroud…: Apart from root canal.

David Hossein: We know they know that very well. What they knew better? I tell my team that if you’re waiting for someone to come back to you that’s probably because they’ve had a phone call that day with somebody in a lot of pain and they’ve had to rearrange their whole day for that, so you have to be patient with people, and try them on their lunch, that’s usually a good one.

David Hossein: I think that the benefit of being very disciplined and organised, I think that a lot of the problems that I see are rooted in … I mean, a client at the moment has set up a squat, used to have an associate limited company and it just needs closing down because he doesn’t need that company any more but it’s not been done and it’s racking up £100 a month late penalties and I keep saying, “Well look, we really just need to get rid of that because that is costing you a lot of money and you need that right now.” I think it’s very focused on, “Well, I’m in a squat now, I’ve got to focus on this.” But in the back of his mind, I know that that’ll be grinding him down. When he goes to bed at night, it’s there in the back of his head that, “I’ve still not dealt with that damn thing.” And that’ll be grinding him down. But I think the 15 minute phone call to me to sort it out for him would pay dividends mentally. So, having things that are bothering you and it’s not fun dealing with them, but not dealing with them, will cause you a lot more stress when you go home and you’re trying to relax.

Prav Soulanki: I’ve seen that and it’s something I’ve picked up on, definitely in the last few years, it’s the who not the how and I think there was a big Dan Sullivan thing that rather than trying to figure out how to do it and figure out, “Right, so I’m going to close this company down and I need to fill out this form at Companies House, blah, blah, blah, this, that and the other.” It’s like, “Who can just take this problem away from me and do it and does it every day?” And it’s that 15 minute phone call with you, is that you can take that pain away and that thing that’s holding them back from maybe just accelerating away.

David Hossein: And becoming a bigger problem because the penalties are still being … it’s more expensive not to deal with it, if it’s … You must come across that, Prav. Advice for people, one question I’ve got [inaudible] what advice would you give to dentists to make themself more, I don’t want to use the word organised because that’s condescending but as a dentist, you go into your practise and you’ve got patients, you’ve got responsibilities and there’s all this admin stuff and it’s of no value other than you have to get it done but you still have to deal with it, so switching your mindset into, “Got to get that done because it’ll just grind me down and become a problem if I don’t deal with it.” How do you coach people like that?

Prav Soulanki: I think my advice is, and I can’t remember the guy who came up … because I do a lot of reading, a lot of listening, a lot of watching and stuff and there’s this concept, it’ll come to me who the name of the guy is, there’s this concept called the three alarms and you don’t be restricted to three alarms, it could be as many alarms as you want but just think about, “Okay, this is what I’m going to do today, I’m going to wake up in the morning and I’m going to exercise. I’m going to spend some with my kids between this time and this time and I’m going to go into the office and I’m going to work efficiently like a ninja with no distractions.” Let’s imagine those are the three activities that you want to smash that day.

Prav Soulanki: So your first alarm goes off at 6:00 in the morning, call it a mental alarm, or you can just set the alarm on your phone and have a notification with it and that first alarm says, “Linford Christie, Usain Bolt, I am a world class athlete.” So you wake up, call it positive affirmations or whatever, but you say, “When I’m going into that gym, there’s no distractions, no nothing, I’m a world class athlete.” You may not, million miles away from there but you’re positively telling yourself, “This is all I’m doing.”

Payman Langroud…: Bud, bud, bud the alarm goes off on your phone and you say to yourself, “I am Linford Christie. I am Linford Christie.”

Prav Soulanki: 100% mate.

Payman Langroud…: Is that what you’re saying? Okay, okay, go on.

Prav Soulanki: Right okay, but the point I’m trying to make is you put yourself in the shoes of-

Payman Langroud…: Linford Christie.

Prav Soulanki: Or I’m a world class athlete or whatever, but I’m going to approach this like one of the top professionals in the world

Payman Langroud…: Okay, go on, go on.

Prav Soulanki: So you’ve got that mental attitude where your next alarm goes off and it’s time with your kids, best dad in the world. So what does the best dad in the world do? He takes this thing and leaves it somewhere else, because that’s the thing that’s going to distract you and I’ve got my phone in my hand and then you give 100% attention, and you do whatever the best dad in the world does. Next alarm goes off, Elon Musk, you’re in the office so you sit down and buy loads of bitcoin, I’m kidding. But do you understand what I’m saying.

Payman Langroud…: It’s the alarm, so the alarm goes off at 6:00, you go for your run and then the alarm goes off at 10:00 you look after your kids, is that what you mean?

Prav Soulanki: I’ve got a schedule to my life, I’ve got a diary which says between these hours I’m working, between these hours, I’m spending time with my kids.

Payman Langroud…: [crosstalk] alarms are going off.

Prav Soulanki: Absolutely, yeah, it’s not random mate.

Payman Langroud…: Because I was thinking snooze when you said it, because I snooze my alarm three times.

Prav Soulanki: Yeah, yeah, yeah, I’ll give you some words after this call that will reinforce those habits mate.

Payman Langroud…: David, tell me about the structure of your organisation, how many people are you, how many clients do you have?

David Hossein: So I have about 90 to 100 dentists associate practise groups. My team is five people. We’re a unit inside a bigger unit, currently Bennett Brooks is a top 80 accounting firm so we can provide a very high level tax client where needed and some of the stuff that isn’t the general side, so if you need inheritance tax or … When it comes to the exiting side, there’s a lot of work that’s needed on the tax side, so that’s set. On a day-to-day basis, most of my clients don’t need that, they just need an accountant who can understand their accounts and talk to them about their accounts and their situation.

Payman Langroud…: How do you get over … Dentists are always coming up with crazy accountancy schemes to get out of paying tax.

David Hossein: Well, I think they’ve got a lot of help from people who want to target them and that’s the frustrating thing. If I take on a new client, it’s is there anything I should know and oftentimes, “Yeah, I’ve got this thing hanging over my head and how do I deal with it?”

Payman Langroud…: Is it always BS or are there some things that you could look at? I mean, I don’t know, there was the film schemes and there was this, that and loan yourself that much and pay it back. Is it always BS, should you just avoid?

David Hossein: Anything that has the word scheme in it, yeah, I would pretty much say, “No, no please don’t do that.”

Prav Soulanki: Scheme equals scam.

David Hossein: Scheme equals scam and I do feel for dentists because one, I think they are targeted on purpose, we’ve got very unscrupulous people out there who sit down and make a list of who are the people with money that I want to go after? That’s an unfortunate part of life. I also think that practise owners have this particular problem where if you took out a loan to buy a practise, you can on paper look very rich, but sometimes be cash poor because you’re having to pay the bank back so much and you only realise that value when you sell your business and you go, “Oh thank God for that, I’m out of this now and I’ve got my million pound in the bank,” or whatever it is. So it’s a combination of the two that puts people in that situation as well, “What can I do to get this tax down?”

David Hossein: First thing is, look for the structural things that you can do to make sure everything’s structured tax efficiently, without any schemes, and there’s lots that can be done. If it’s a company, having your wife as a shareholder, just seeing how the family’s income package looks like, to have income distributed in a tax efficient way. Do those things, but when it comes to somebody calling you and saying, “Oh I’ve got a way to get your tax disappear,” just don’t do it. If you really have to do it and you’re that way inclined, let’s say it’s going to save you 200 grand, you use that money and buy a house, don’t go to Las Vegas and blow it all. So if it ever does go wrong, you’ve got the house to fall back on, then you can sell and really pay the tax and interest that they’re going to come for you for.

Payman Langroud…: Yeah, I spoke to a dentist, that’s what he was saying. He was saying, “Take up as many of these schemes as you can and invest the cash and when they come for you, at least you invested the cash.”

David Hossein: Well, they’ll come for you plus interest and penalties and the penalties can be 100% of the tax sometimes, so it has to be a really good investment, put it that way.

Prav Soulanki: You just touched upon, I think Payman asked the question, is what one thing do you wish a dentist could do and the one thing that I often come across is a dentist will get their year end accounts, they’ll glaze over it and they won’t understand it and they’ll nod their heads and they’ll say, “Just give me the bad news, how much tax do I have to pay?” But they really don’t understand the numbers and whatnot and I think a lot of it comes down to the way it’s explained by a lot of people in your position, who just assume terminology is commonplace across borders and whatnot, do you know what I mean?

Prav Soulanki: So I think that’s one thing that I think certainly from your perspective, when I’ve been speaking to you, I have found that you dumb things down for me and that’s helped me understand things better for sure, and I think that’s key but then just one other thing you touched upon when you said practise owners when they dispose of a practise and they realise that the fruits of their hard work over the years, is how do they deal with that huge injection of money, that lump sum? Especially if they’re later on in life, coming towards last 20 years of their life and whatnot and maybe they’ve been the sort of people who don’t spend money and are not going to spend that money in their lifetime. Any tips for inheritance tax and structures and things like that? I know you’re not an IFA or whatever, but just some general sort of things that people often, once again, have conversations, we’ve said this. I can’t advise them on this sort of stuff, so point them in various directions but is there anything you can do from that point of view? I look at it from this point of view and think, “I’ve been working all my life, I’ve paid tax on all that income,” you sell your business, you pay tax again and then you pop your clogs and they get another-

David Hossein: They take 40%, yeah.

Prav Soulanki: … they get another stab at it as well, and well, I don’t want that to happen. Are there any bits of advice you can give?

David Hossein: Advice that it has to be very specific to first of all, do you have kids in the first place? Are you married? How much do you need for yourself? You’re right, passing on … In some ways you look at it and suddenly, you’re 60, 60, 65, you’ve just sold your practise for £2 million, now you’ve got £2 million cash. If you die the next day, you’re going to get 40% bill on it, whereas if you would have held and passed it down to your kids and if they were dentists, let’s say, there would have been zero tax on it because it was a business that you passed on.

David Hossein: So you really have to map back and say, “Well, okay, how much do I need for my retirement? What do I want to do with that money?” I’ve got clients who’ve gone and bought a golf course and if that’s what you want to do, go and do that but once you know how much you need then it’s, “Okay, the rest, where do I want it to go?” Then you’re into thinking about your kids, if your kid is a dentist as well, “Should I help them buy a dental practise?” That’s a business to have, so it’s just seeing what’s right for your circumstances, or is it grandkids, “Do I want to put money into a trust for my grandkids?” There’s so much involved in that situation, it’s very hard to give one answer for it.

Prav Soulanki: Let’s assume it was just cash, let’s assume you haven’t got a business, you’re a training company or something like that, and you’ve just got cash for example, like you just mentioned, that dentists who’s got £2 million with cash or whatever, what would you advise them to do? Seek advice from a … who? What type of person?

David Hossein: I think your IFA, if you’re not interested … I think first question is, have you had enough? Are you out of it now? Have you got any energy left to do a business? If the answer is no, then it’s, well if it’s not going to be a business, could it be an investment in another business, because that’s the halfway point between well actually now I’ve got something that’s fully an investment. So fully-owned business, partially-owned investment in an unlisted company, because that qualifies for business property relief, or am I sick of all that and I’m going to go into properties, investments and trust. Depending on which category you fall in, if you’re in the category of investments, then have your accountant talk with your IFA, and see what they are advising you in the returns involved there and how that impacts on your estate.

Payman Langroud…: Cash, no? You can gift cash seven years before you die.

David Hossein: You can yeah, you’ve got lifetime gifts you can make.

Payman Langroud…: Yeah, I’ll set my alarm for that date. It’s been an interesting chat man, what do you do outside of accountancy?

David Hossein: Well, I’ve got three kids so I spend a lot of time with the family, enjoy that. We try and get out, we’re very lucky to live near some fields here so we try and get out as much as we can, walking. I like to hike when I can, when I can get away, like to go for a hike and that sort of stuff. And food, I like my food.

Payman Langroud…: Do you cook?

David Hossein: Yeah. Yeah, yeah I cook. My wife’s a good cook but I like cooking as well.

Prav Soulanki: What’s your favourite cuisine?

David Hossein: Steak.

Payman Langroud…: Me too, man. Prav likes to end it on his traditional questions, I don’t know if you’ve ever heard this podcast before David, but Prav likes to make our guest cry.

Prav Soulanki: [crosstalk] David, but look, I’ve got a few questions and it just taps into the person behind the voice really, so imagine it was your last day on the planet, you had your kids around you and you had to leave them with three pieces of wisdom, words of advice, call it what you want, what would they be?

David Hossein: Be honest, truth is important, work hard, because anything worth doing is usually hard work and find something that you enjoy, to make it worthwhile.

Payman Langroud…: Nice.

Prav Soulanki: Very nice. How would you like to be remembered? So, “David was … ”

David Hossein: I suppose, “There for me when I needed him.”

Prav Soulanki: Nice. Now, imagine you got a month left to live and you know you’ve got a month left, you’ve got your health and everything in place but you know you’ve got 30 days, what you going to do with that 30 days? Please don’t say, “Look at another spreadsheet.”

Payman Langroud…: He’s going to first of all look at his inheritance tax situation.

David Hossein: Well yeah, I’d do that quickly. I’d probably go to Everest mate, probably try and-

Prav Soulanki: Would you?

David Hossein: Yeah, I’d want to go and … I’ve never been, I’d love to go see the end of the world, that’d be nice.

Prav Soulanki: Nice. David, it’s been an absolute pleasure, I think there’s lots of advice and that’s come out there. If people want to get in touch with you after this and just maybe speak to you and get some advice, is there an easy way to connect with you?

David Hossein: Yeah, so my email address, my website, bennettbrooks.co.uk. I’m on Facebook, I’m on LinkedIn. Yeah, google me.

Payman Langroud…: All right mate, thanks a lot, lovely to meet you.

Prav Soulanki: Thanks David.

David Hossein: All right, cheers guys.

Speaker 2: This is Dental Leaders, the podcast where you get to go one-one-one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Soulanki.

Prav Soulanki: Thanks for listening guys. If you’ve got this far, you must have listened to the whole thing and just a huge thank you, both from me and Pay, for actually sticking through and listening to what we’ve had to say and what our guest has had to say because I’m assuming that you got some value out of it.

Payman Langroud…: If you did get some value out of it, think about subscribing and if you would share this with a friend, who you think might get some value out of it too. Thank you so, so, so much for listening, thanks.

Prav Soulanki: And don’t forget our six star rating.

Jaz Gulati: And I’ll never forget that moment I got my first gold star at age six, and from there, I was addicted to achievement, and that’s been a big driver for me, I just want to constantly do things. I’m one of these guys who has this massive to do list, I’m like, tick, tick, tick, tick. If I’ve done something that wasn’t on the to-do list, I’ll put it on the to-do list just to tick it off, just to get that feeling, yes, I’ve done something.

Intro Voice: This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.

Payman: Jaz Gulati, real honour to have you on the podcast today, buddy. Jaz has been to, qualified, what, seven years? And for a dentist of your pedigree, Jaz, you really have made a massive difference to what I would call sort of the educational landscape, and I’m really interested in what you’ve achieved with this Protrusive Dental podcast, and particularly the Protrusive Dental community that’s come from it. And for me, as a dentist who’s not wet-fingered anymore, it’s now become my link to the wet-fingered world, and I don’t miss an episode. I’m definitely one of the Protruserati. Lovely to have you on the show, bud.

Jaz Gulati: Oh, thank you so much, Pay. It’s great to be on your fantastic podcast, shame Prav’s not here today, but I listen to you guys all the time, the journeys that you guys have. But it’s all the things you said between my sort of podcasts and educational stuff I’m doing, very kind of you, really appreciate it. And you touched on the Protrusive Dental community or the Protruserati, and that’s something a lot of these things that you’ll discover in this episode today came by accident, grew organically, and I just love it, I just love what it’s become, and it’s so exciting to be part of this movement. So yeah, it’s great. It’s moving at a very fast pace, but it’s great to be part of, and I’m very excited for what’s to come with this.

Payman: I mean, traditionally on this podcast we start with where were you born and all that, but now that we’re on it, let’s talk about this. Did you go out to make your podcast, I remember when I was thinking of starting a podcast, and I’ve got Prav on the other side who’s very technical, knows a lot about a lot, or if he doesn’t, he goes-

Jaz Gulati: Marketing genius.

Payman: Marketing genius, he goes and finds out. And he contacted one of the world’s top podcast coach, and we had a session with him. And with me, I know that if I say to Prav, “What’s going to happen, what’s the technical side?” He’s going to fix it. But for you, when you were thinking of doing your podcast, take me through the thought process, first of all, of that, and then the steps you took-

Jaz Gulati: It’s a unique and strange one. Yeah, absolutely, it’s a strange one. Like when I look at origin stories of other podcasts, they had this goal and they had this overarching sort of theme that they want to explore, take everyone for a journey. For me, it was just one simple thing, and it was me and my wife, we went to Singapore. And we had a great time there, we were both working for the same corporate called Q&M as dentists there, and we had a fantastic time. I wanted to stay there forever, but she wanted to come back, she’s a very homely girl and she was missing family life.

Jaz Gulati: So we came back to the UK, and then word got around, on the forums, on Facebook and stuff, any time someone talked about Singapore, they’d tag me in it. And I go to a stage where I was commuting from London to Oxford every day, so an hour each way, and usually that evening commute home was always occupied by me on the phone to a dentist telling them the same thing about, oh, well what’s it like in Singapore, how much money do you earn, what’s the situation like, what’s the Singapore Dental Council like compared to the GDC? The usual questions that you get.

Jaz Gulati: I kind of got sick of it. I thought, “Okay, I wish there was a way to record this in audio format and just get it out everyone so I don’t” … It was a fun thing to do the first eight people I spoke to, but then it got very repetitive. It’s like, okay, maybe there’s something I can blog about this, but blogging, writing is fun and stuff, but I’m very much more into audio and now video. So that was the actual muse, if you like, to start the podcast. Episode number one was expat dentists in Singapore, I had no real plan about how it was going to continue. And the first few was Singapore, then USA, then eventually Australia, and I just ran with it. And what it’s become now is just [crosstalk]-

Payman: Was it Protrusive at that point as well?

Jaz Gulati: Yeah, from the beginning. And to fair, I was toying with the names. I wanted to be a forward-thinking podcast, and I already have an interest occlusion, so forward-thinking, protrusive, to thrust forward. So that’s how that came, marrying up my interest in occlusion, but also something that represents forward-thinking, so that’s why I came up with protrusive.

Payman: What about this sort of infectious enthusiasm that you’ve got for dentistry? I mean, were you a good speaker before, did people come to you for advice? I mean, you seem to take it so naturally. You talk to people and the enthusiasm you have. Where did this start? I mean, were you one of these people … I was talking to Basil, he was saying that he wasn’t top of his class in dental school. What was your story?

Jaz Gulati: Well, I was president of SUDSS, Sheffield University Dental Student Society, so I was very active in that. I was very used to speaking, and something that I was very much involved in. I don’t do the whole, I was listening to Basil’s episode, and I stay away from politics. So the only two things I don’t talk about in my podcast is religion and politics, I stay away from that stuff, everything else goes, and the [inaudible]. But I guess so.

Jaz Gulati: I was also, without blowing my own horn, I was top of the class. I was the first person … Before, I was very embarrassed, in a way, to say this. I was like, “Ah, it’s very egotistical.” But I’ve since had some sort of mind training to change thew way I perceive it, which is basically, I was the first person in the university to get 100% in a finals clinical exam, and now I’m proud to say that, and it was something I really worked towards. So I was always aiming to be competitive and top of the class, and aiming to be one with the community, and a voice, a leader of some sort.

Payman: Where did you qualify? In Sheffield?

Jaz Gulati: Sheffield, 2013

Payman: Sheffield. So were you top of your class in school as well?

Jaz Gulati: Like before …

Payman: Yeah.

Jaz Gulati: Before Sheffield, like sixth form and stuff?

Payman: Yeah.

Jaz Gulati: Yeah, yeah, that was always … And I was thinking about the origin, because I knew I was going to come on the podcast, like where does it all originate from? And I can pinpoint it to when I was six years old. So if you go back far enough, I’m sure we’ll come to it. I’m a refugee, I was born in Jalalabad, Afghanistan. I came here when I was six years old, didn’t know a word of English, and my earliest memory of achievement was sat in year two at the time, and there was this massive board at the front of the class with everyone’s name on it and who got 100% in their spelling test. So everyone had all these stars. So every time you get 100% on the spelling test, you get a gold star.

Jaz Gulati: So obviously everyone had all these stars, and I was the only one without a star. And it went on week by week by week, I never had a star. And I just made it my mission that one evening to practise writing these three and four letter words, cat, home, ball, that kind of stuff. Practise, practise, practise all night. And I’ll never forget that moment I got my first gold star at age six, and from there, it was like addicted. I was addicted to achievement, and that’s been a big driver for me, I just want to constantly do things, I’m one of these guys who has this massive to do list, I’m like, tick, tick, tick, tick. If I’ve done something that wasn’t on the to-do list, I’ll put it on the to-do list just to tick it off, just to get that feeling, yes, I’ve done something.

Payman: So take me back, do you remember when you arrived in the UK? Do you remember that feeling?

Jaz Gulati: I do, I do. It was a strange time, I didn’t really know what was going on. I remember the way to get here was, travelling and whatnot. I was like, “Mom and dad, what’s happening, where are we going?” They’re like, “Don’t worry, we’re going to a better place.” And there we are, I was in England, didn’t know a word of English. And my mom spoke a bit of English, and my dad still … He’s okay now, he’s a shopkeeper, so he can speak English, but he doesn’t read or write.

Jaz Gulati: So I’ve always come from that background of … Which was important for me, because it ended up meaning that age nine, 10, 11, I was doing all the letter reading at home, and it made me very independent. So that was a very steep learning curve, just learning a new culture, a new language at that point.

Payman: And then what point do you remember thinking, “I’m going to be a dentist?” What was the driver for that? I mean, did you have any dentists in the family, or …

Jaz Gulati: Oh, no, no. I was the first person to go to uni, I was the first person to … I mean, with all my cousins and family members, we’re not very educationally-minded. And they won’t mind me saying this, I’m the most studious by far. There’s no one else who even reads in my family, let alone anything. So for me, it was my own experiences. I used to have terrible teeth, really goofy, I was very embarrassed. My upper left one was like a nine millimetre overjut, almost 90 degrees, and I went from being this very shy 11 year old to wanting, I was desperate for braces, because bullying, and [inaudible] wasn’t nice, I would always hide when I’m speaking.

Jaz Gulati: And then when I got braces, it completely changed me as a person. So that’s important in my journey, not only wanting to do dentistry, but also coming out of my shell and being someone who’s now outspoken, in a way.

Payman: Yeah, it’s funny, you hear quite a lot of dentists, and I’ve asked quite a lot of dentists this question, right, quite a lot of dentists actually relate the reason they became a dentist to an experience they had at the dentist. For me it was my brother, he had amelogenesis imperfecta, and he went through a lot of dental work, and one day came back totally beautiful. All my life, when my brother was this kid with teeth falling apart, and then it felt like pure magic as a kid, seeing him, and what it did to him, having that, like you said, bullying and all that, having the confidence to … Like he suddenly had a wonderful smile, and he went through two, three years of work at the Eastman, full mouth rehab for a 14 year old, whatever he was. And it’s still there by today, he’s-

Jaz Gulati: Wow.

Payman: … 50 years old, and it’s still all there. I mean, he gets the odd chip-

Jaz Gulati: That same rehab without any revisions, or …

Payman: The odd chip, the odd chip here and there, yeah. I mean, they put [inaudible] up the back, so probably a good idea. But it’s interesting that that’s what sometimes gets people into dentistry.

Payman: So then, you said you were excelling in dental school. Were you one of these who was making plans early on as to the kind of dentist you were going to be, or did you always think you were going to be in general practise? Why didn’t you specialise, if you were top of your class? Was that on your mind, or not?

Jaz Gulati: Yeah, it was definitely on mind. Initially, first year, if you asked me, I would’ve said, “I want to be an orthodontist,” because it was an orthodontist that inspired me in a way, had straight teeth. But then as I moved along, I had this affinity and enjoyment of endodontics, actually, so there was a tutor called Steven Godfrey, fantastic endodontist, who sort of, who’s just a lovely person and a great tutor, and sort of, sometimes you have that meeting with someone, they inspire you in a way, they take you under their wing a little bit. So I started getting into a bit of endo.

Jaz Gulati: Then I actually met someone on the train, and I was reading a book, it was like, Understanding Partial Dentures, right, I was like a third year student. And the guy on the train was a dentist. I still don’t know his name, so I want to thank the guy who’s listening, if you remember me, from reading this Understanding Partial Denture book. And he said to me, “Hey, you’re reading this book, are you a dental student?” I’m like, “Yeah,” we started talking, and I started telling him, “Yeah, endodontist sounds good, I like root canals and stuff.”

Jaz Gulati: And he said to me, “Are you sure you want to specialise in something that’s about this tall and about this thin?” And I considered that, and I was like, “Crap, he’s right.” It’s like, do I really want to specialise in such a such a tiny environment? And then eventually one thing led to another, and I sort of set my sights on restorative, [inaudible] training, specialty training, because I thought, “Okay, if I can be a restorative specialist, I can potentially be a specialist in endo, prostho, and perio. I can be the don, I can be the king.”

Jaz Gulati: And then eventually, my experience in hospital and stuff said that, okay, if I have to endure through this many years of hospital training with these egos, with this sort of slow pace and … So eventually I went private, and I’ve never looked back, and I’m enjoying my ortho restorative dentistry now, I’ve got a diploma in orthodontics. I’m very much someone who’s happy to travel around thew world, to go to the best courses to learn from the best people, and not having to worry about the letters after my name. Although I have some of those, they don’t define you as a clinician, is what I strongly believe.

Payman: Definitely not. And what about endo, do you do endo? Having said all that?

Jaz Gulati: I still do. But the thing is, the more you learn endo, and it’s one of the reasons why I felt compelled to leave the NHS, because the more you learn something, especially in endo, I mean, when you learn to use EDTA 17%, when you learn to use certain files, you can’t then cut corners, it’s very difficult to. So the more you learn, the more it becomes impossible to do it to the standard you want to in a limited time environment, and then the more you appreciate the complexities, so now I’m in a situation where a lot of the molars I’ll refer. Simple ones I’ll do, I’ll do five to five, I’ll do, but I think about 80% of the root canals now, I refer. Because they’re complex cracks, I feel as though the patient deserves to see someone who will do it the best, under a microscope, and not my five or 7.5 times magnification. Even though that’s good, I feel as though the patient deserves better. So I do some endo still, but not as much as I thought I would do.

Payman: And then this move into occlusion, and sort of … You’re definitely the person I like to listen the most to on this subject, yeah. You’re a bit young for someone who gets into that, usually it takes people a bit longer, like you end up with a few failures, maybe, and sometimes that wakes people up. Or I guess another way is mentor or something. I mean, what made you go that direction so early?

Jaz Gulati: I think definitely mentorship. So one of my principals, I work Fridays at the Richmond Dentist, so [Hap Gill], I actually [inaudible]-

Payman: Oh, is he your principal?

Jaz Gulati: Yeah, he’s my principal on Friday, so he’s [inaudible]-trained. And I met him on Twitter, right? So we used to tweet each other, I was a second or third-year student, and he was this amazing dentist, like celebrity dentist. And it was like, “Wow, we’re tweeting each other,” it was so cool. And I found out he’s from Hounslow, I’m from Hounslow, in West London, we’re the Hounslow Massive. So we had these similarities, and one day I went to shadow him as a student, and then a few years later I went to see him again as a dentist, and we were toying with the idea that one day he might take me under his wing, and he did. So he was a massive influence, because he sort of sat me down in the pub next door, he was [inaudible] letters, and he was teaching me these things about how the lower incisors must meet the upper incisor in a certain way to prevent chipping and stuff, and I was like, “Wow, we don’t get taught this at dental school.”

Jaz Gulati: So he was a massive inspiration, so was Michael Melkers, so was just consuming content by Frank [Spearings] online and stuff, so it’s not the occlusion that excites me, it’s what occlusion can give you, which is how can I do bigger cases? And it’s the knowledge of how it all works together that you can plan the blueprint to how to treat bigger cases. So it’s more the excitement for the bigger cases.

Jaz Gulati: And I guess, you’re totally right, I’m so young, so I haven’t done many full mouth rehabilitations. I know when they come through, I know how to plan one, I know how to sort of send it to which specialist to do to get the best out of them and work as a team and to plan overall, but I still see myself as someone who’s got another 10 years to get more failures, to get more rehabs under my belt. I mean, I’m getting more and more teaching, I don’t teach rehabs. I teach the basics of occlusion, I’m very good at splints and stuff, so I teach that, but I know my limits. I know that I’ve so much more still to learn, but I’ve got a good grasp of in which patients occlusion is important, and which patients it just doesn’t matter and we’re overplaying it.

Payman: Yeah, well, I mean, those decisions, and these are the questions you ask in your podcast. Sometimes they could be even seen as a very basic question, but it’s a question that needs asking. So I was listening to Nick Sethi’s one, and it’s a very simple question. When do you go indirect, when do you go direct? And you’d imagine these things are all set out, and I know you’ve got your traditional teaching, but we’re at that sort of inflexion point, aren’t we, between traditional dentistry, adhesive, traditional minimally invasive, and the rules are changing, and that’s why it’s so interesting. You can ask the question that’s sort of so simple but so important. Same thing with your podcast with Finn, the partial denture … Some simple things that someone who’s at the top of their game to answer. What do you think, when you’ve been to lectures, what was one, or an event, or a conference, one that enthused you the most?

Payman: Like if I was a young dentist now, who would you tell me, “Look, make sure you go and see this guy?” For me, back in my day, Mike Wise, Galip Gurel totally changed my understanding of how to prep within enamel and all that. What about you? Who were the people who-

Jaz Gulati: I can easily pinpoint it to 2014, probably January, February. I was in my DF1 year, it was Koray Feran. Koray’s been on the podcast, and I was in my DF1 at the time, I was in this NHS environment. I just was never exposed to … Yes, as a student, and nowadays, being a student, with the dentistry, the presence it has on Instagram, with Facebook and these groups and stuff, as a student, you can easily get exposed to the highest level of dentistry.

Jaz Gulati: Back then, 2014, it wasn’t as prevalent, it was still, you had to seek it out, and I was seeking it out. But for me, that lecture of Koray’s two hours, the title of the lecture was excellence in restorative dentistry, and I just hadn’t been exposed to that level. So when I saw that, I was like, “Wow, how can I be more like Koray? How can I do bigger cases, how can I be really good at restorative dentistry?” So that’s an easy one for me, that really sparked my interest. And then as the years went by, I started to seek courses, mentors to try and learn about that. But now, it’s so easy and accessible and affordable, with online and the presence that it has everywhere. So it’s never been a better time to be a dentist than how. A dentist who wants to learn, this is a great time.

Payman: So then you did this originally, an NHS job, you said, yeah?

Jaz Gulati: Well, DF1 was NHS, and then I was doing DCT post in oral surgery and restorative at [inaudible]. Their oral surgery was okay, was all right. The restorative was not so good. Because when you’re a restorative DCT at Guy’s, you’re this tiny tadpole in this massive ocean and there’s all these sharks, these guys paying 20 grand a year to do their postgrad, they’re getting all the cases, they’re getting all the amelogenesis imperfectas, they’re getting all the fun stuff. You’re getting the fifth complete denture set on someone who doesn’t attempt to attend, or you get the sort of not so exciting cases.

Jaz Gulati: So that was a bit sad, but I made my time valuable there, I valued my time. I wrote the reservoir and bridge paper, two part paper in Dental Update. So I really worked hard to do that, because I thought while I had the spare time, let me make an impact, let me do something. So that was really valuable, and a journey of eventually getting into education, doing that. I then did restorative DCT, so you get the theme, right? I was gearing my CV up for restorative [inaudible] training. So I was at Sheffield, DCT and restorative, which was a phenomenal post. That was like microscope, [inaudible], that was everything I wanted, and I really loved that.

Jaz Gulati: And then after that, it was like, what next? Because I don’t think my portfolio and my CV and my timing was right me to be able to land a private job, and I was already doing a Saturday NHS job, and I’d wake up and I’d say to my wife, “I feel really anxious about going in today.” Because those kind of conversations pay like, you can have a root canal with hand files, or you can have a root canal with rotary, and there’s a fee difference. Or you can have a metal filling or a tooth colour filling. I absolutely hated those conversations, I was a slow dentist, because if I knew how to do something properly, I just felt like a liar and a cheat if I was cutting corners. So I knew I couldn’t do that.

Jaz Gulati: So yes, it was the adventure of Singapore, yes it was the being able to travel, yes it was the experiencing a new society and a culture, but it’s also not settling for the NHS at the time. And I mean no offence to anyone listening to this, because I think those NHS dentists do a fantastic service, and we need lots of good NHS dentists who work fast, who work ethically, and that’s amazing. But I couldn’t do it. So that was [crosstalk]-

Payman: I mean, those are the conversations they’re having every day, right? I mean, that’s part of the thing that grates you, wears you down in the NHS, having to pretend that it’s all top notch treatment and then not being able to deliver it. It’s a sad story. So why Singapore? Did you do some research and decide that’s the place to go, or what? What was the reason?

Jaz Gulati: Yeah, I mean, like most stories, you usually just know one person that did it, and then you sort of contact them. And with social media, like I say, it’s never been a better time, you can connect with anyone in the world. So it was [Sirindha Poonian] who was there who was two years above me at dental school. So I just realised that, “Hey, she went to Hong Kong then, now she’s in Singapore,” I just sent her a Facebook message.

Jaz Gulati: And sort of like how people were calling me and messaging me when I came back from Singapore to England, it was also hitting [inaudible] as well, who’s now a periodontist, he helped me a lot, he told me about which practise to apply for and stuff. So there are some UK grades out there who were so helpful, and me and my wife decided, if we don’t do it now, when will we do it? How can we break away, how can we have that … We never had gap years, me and my wife. So we thought, “Why not?” There’s never going to be a better time than now. We didn’t have a mortgage, no children. It was just a perfect time.

Payman: So I know you’ve had to do this many times before, but walk us through the process. What was it? Okay, you decided Singapore, then?

Jaz Gulati: Yeah. Decided Singapore, and then you have to find someone who’s going to employ you. So at the time, it was Q&M, was a corporate. They’re still there now, but nowadays they’re so much more difficult to, as a foreign dentist, to get your licence there. So you get like a conditional registration. And the bad point is that even if you’re a specialist in the UK, as far as I know, I might be wrong now, because not current knowledge, but you still have to be conditionally registered with the Singapore Dental Council. What that means is essentially you’d need like a VT trainer. So you need a dentist there who is going to be your supervisor, and that was when it becomes messy, because at any one time, your supervisor had to be there. But the problem is, a lot of these clinics in Singapore, they’re a one surgery clinic. So how does that work?

Jaz Gulati: So that becomes difficult, there are inspections, there were issues like that. I’m not going to get into the messy details of that, but it’s not an easy place, now, as it was back then. But basically, you find someone to hire you, so it would be a corporate. We flew to Singapore, had a nice lunch with them, they had many UK dentists before who had worked for them, so they knew how it worked. They sort of almost equivalent sponsor you in a way, they sort of said, “Yes, we’ll take this dentist on, we’ll fill in their paperwork.” You have your blood tests, and eventually you just send some paperwork for the Singapore Dental Council and it gets approved, that takes a few months.

Jaz Gulati: In that few months, we went to Malaysia and all these countries, travelling while all the paperwork was getting processed, and then eventually it was quite easy to get started.

Payman: Singapore has, I mean, it’s famous for its high standards of pretty much everything, but particularly healthcare, the standards are very, very high. Were patient expectations high there? I mean, what’s the culture of a patient there? Were they highly educated in dentistry and expected everything from you? What was the story?

Jaz Gulati: It’s fascinating, Pay, honestly, it’s so fascinating. Because I went there thinking exactly what you thought, but I worked in two locations. One was in, it’s called [inaudible]. It was like a suburb area in Singapore. The other one was called [Somerset]. This is right by Orchard Road. Have you been to Singapore?

Payman: No.

Jaz Gulati: So it’s like by Oxford Street, basically, of Singapore, just off there. So I worked in these two locations, and they were really different. So in one, I was seeing all these expats, and the domestic helpers of the expats, which was always a weird thing, because it was the expat who was funding the treatment, but we sort of had to negotiate, okay, what’s a fair thing here? Which was just the craziest thing ever.

Jaz Gulati: But then in this other suburban place, I was just seeing what we call uncles and aunties. So anyone who was old enough, we just call them uncle and auntie. And the standard of work there was, it was like fee per item NHS, I was shocked. You see all these big RMGIC restorations, they charge $70 for like a filling there. So I came to a practise, I was like, “We need to get rubber dam, we need to get composites, we need to actually do everything the way I want to do it,” and the culture in Singapore is such that patients come in to dentists to get a clean, so I was doing all the [inaudible] polishes. And it was weird, you were almost doing an exam secretly, like going around doing the charting secretly, because what they wanted from you was like a hairdresser, they wanted to come to you to get their teeth cleaned. They don’t want to hear about a diagnosis and whatnot.

Jaz Gulati: So it was a big challenge for me to actually get the practise geared up for routine bitewings, like most of our patients had never had a bitewing before. So it was really strange, Pay, in that one practise, to answer to you, and that was the bog standard average practise in Singapore. Yes, you got the high end ones, and I went to shadow them and stuff, because I was hungry, I wanted to learn, I want to see these top dog clinicians, and I did, and it was amazing. But the average dentistry was fee per item NHS, I’d say.

Payman: Wow. That really does surprise me. I mean, I’ve talked to a couple of dentists from there, and they showed … Well, they’re trying to be enlightened users and distributors out there, and have shown me their clinics and it just sort of blew me away, something out of this world. Maybe they were the top ones. [crosstalk] that surprised me-

Jaz Gulati: I think so, I think there are loads of really independent practises, but a lot of the corporate ones, they’re there just to give a service like the NHS, is just, people come in, they’ve got missing teeth, they want dentures, very disease-orientated, and that was fine. I was there to upskill, but also to travel as well.

Payman: Of course. As far as language and that sort of thing, did you have to learn anything? [crosstalk]-

Jaz Gulati: No, I mean, everybody speaks English. I mean, your uncle and aunties, they either speak Bahasa Malay or they speak Mandarin, but my nurses were so brilliant, they were fantastic ladies, they would speak everything. English, Bahasa, Mandarin. I started learning Chinese while I was there a little bit, on this phone, like a HelloChinese app, and I can say root canal in Chinese. [Chinese]. So, the thing about that, so it was pretty cool. But no, language wasn’t as big of an issue as you might think.

Payman: What about Singapore as a town to live in?

Jaz Gulati: Amazing. Wow, it’s Asia-lite. It’s like, it’s so good. It was just clean, and the food culture, these hawker centres. I can get like, a plate of chicken rice for like $2.80, and it was bliss, right? It was food everywhere, Singapore’s crazy about food. Everywhere you look, it was food, food, food, food, food, and that was great. Alcohol was really expensive, the culture there, because they want to tax everything, to drive is almost impossible. To have a house is like, whoa, if you have a house there? You’re richer than rich. So most people live in apartments, so we had this condo, had a rooftop swimming pool. It was just the life, it was beautiful. What can I say? It was just a lovely country, great weather, great people, just a great buzz about Singapore, really miss it.

Payman: Did you do a little stint in Australia while you were there as well? Or did you travel to Australia?

Jaz Gulati: We went travelling for about three or four weeks, just [inaudible] the end, we know we were coming back to England now, so we thought, “Right, better go Australia.” As you do, I went to a Tif Qureshi course while I was in Sydney, and I went to a Lincoln Harris course as well while I was there. So I thought, “Okay, let me make the most of it while I’m there.”

Payman: How many hours of education do you think you’ve done, then? You’ve done a lot.

Jaz Gulati: Yeah, I mean, too much, too much. So now, I mean, the CPD, [inaudible], they don’t excite me at all. I don’t think they excite anyone. It’s funny, Pay, you’re a provider of education. Some people get really anal about that, and they’re really, the certificate’s really important, “Can you send it to me ASAP,” kind of thing, whereas I’m like, I’ve got CPD coming out of my ears. I don’t need the certificate, it’s fine. I’ll waive the certificate, it’s okay. So it’s not about the certificate.

Payman: Yeah, you’re right about that, though, you’re right. Some people really do panic about that item. So now we’ve got, look, I’ve got you down definitely as an educator, yeah? I mean I really mean that. Was that a goal? As a high-flying student, and then as someone who’s going on a load of courses and all that, and you were talking about the restorative sort of specialising and restorative … Were you thinking, “I want to be a teacher?”

Jaz Gulati: Yes, to the extent that as soon as I qualified, 2013, I entered the PG cert for dental education. So I knew that, “Okay, I want to do this. Let me set myself up, what do I need to do?” So although I didn’t have enough knowledge to teach, I was always thinking, “How can I become a better educator?” So once I’ve amassed enough knowledge, once I’ve had enough failures, once I’ve really given it my all and I have something valuable to share, then I’ll be ready. So I was gearing myself up to it for many years, I was analysing lecturers, which lecturers really engaged me, excited me, the kind of traits they had. Which ones, although they had all the accolades and letters next to their name, which ones just bored me? I never wanted to be someone who was going to be boring. I always want engaging, like, I always paid real attention to Raj Rattan’s lectures, or stories. Such an amazing storyteller, so that becomes a very important part of me trying to make it through as an educator, so that was important.

Jaz Gulati: And funnily enough, I can go back to first year of dental school, where my buddy Eric, who was a dental student from Korea, and he failed his first year exams. And he said to me, “Jaz, if you can help me pass my first year exams, I’ll take you to Korea, all expenses paid,” right? So I stayed back with him two weeks, I tutored him, we got him to pass his first BDS exams, and that was me like, “Okay, I’m trying to teach someone here,” that was a important part of it, I think. And then two years later he took me to Korea and Tokyo and we had a blast, so there’s a little fun story for you there as well.

Payman: I mean Jaz, you’ve obviously got a talent here. There’s no doubt, in my head, no doubts about it, yeah, that you can-

Jaz Gulati: I appreciate it.

Payman: Being a teacher really is the right move for you. And it’s interesting that it’s come out in this Protrusive Dental podcast way, and who knows where else it’s going to go? I’m sure you’re going to spin off events and all that from it. You have, haven’t you? Or, COVID got in the way of that. Do you recognise this thing that I’m thinking of young dentists who want to be teachers? In my day, that wasn’t a thing, yeah? I don’t know, maybe it’s the ones I’m talking to. But almost every single young dentist I’m talking to is banging on about becoming a teacher. Why? I mean-

Jaz Gulati: [crosstalk]-

Payman: … what’s happened? I mean, why teacher? Why not rich? Why not multiple … You know what I mean? Teacher seems like kind of a left field thing. As I say, you definitely do have a talent there. For sure, it’s the right thing for you. But I hear it a lot, man. Do you hear that?

Jaz Gulati: Yeah, I see it a lot. And I think you’re right, back then it wasn’t the case. But thinking, even as far back to someone like Richard Field, remember when he was like one or two years’ qualified, and he was teaching composites? And to be fair, at that stage, he was doing way better composites than most dentists, right? Like, amazing, and I thought he had every right. But I remember him getting bashed on Facebook about it like, “Who is he? He hasn’t got any experience,” whatnot. And after … He definitely has a place, and he’s done amazing things, and I really respect him for that. But nowadays you see it more and more because people are able to use and leverage the platform of social media to show that, “Hey, I have something to share.”

Jaz Gulati: But I think to answer your question, though, why are young dentists attracted to education? Is, I think, we have such great people like Tif Qureshi and people like him, who, just such inspirational people that we want to be like them, so we try and model them. So I think it’s because some of the most influential person we know in dentistry are educators. I mean, look at the, not that I’ve ever voted or taken part in it, but the top 50 stuff, so many of those are educators. So we look up to these people as educators, and we see that yes, they’ve got their practise and clinical career, but they’re also educating. So I think young dentists naturally just want to model themselves, so that’s my best answer. What do you think?

Payman: I don’t know, dude. By the way, the blowback that you’re talking about with Richard, we got a lot of that with Dipesh at the beginning, because Dipesh was very young. I think he was 26 when he first started lectures with him. And we got lots and lots of that same blowback. And at the time I felt it was really unfair, because he really is a talent above ones I’ve ever seen, he really could be one of the greats in minimally invasive-

Jaz Gulati: Oh, absolutely.

Payman: But, for me, this thing about, “I want to be a teacher,” I hear where you’re coming from as far as a bit of modelling on other teachers, but I think you’ve got to examine the reasons why you want to be a teacher. Like there’s an element of want to be famous in it, and then you’ve got to go, okay, why do you want to be famous? There’s an element of … I don’t know, man, I mean, I can’t put my finger right on it. But it’s like, PG cert, that thing, it’s like, everyone wants to do that now. It’s an amazing thing.

Jaz Gulati: Yeah. It’s interesting, initially a lot of people were doing it because it was something you needed to be a DF1 trainer, so all these people were jumping onboard and whatnot. But you’re right, a lot of people are doing it with a view to that. So they are mapping out their careers in five, 10 years’ time, and they’re thinking, sort of like I did, and my-

Payman: I was on a Instagram profile yesterday, and it said, “Second year dental student and mentor.” But I get it, I get it. I’m not the type to say, “Hey, screw you, why are you a mentor?” But in our day, you had to get out of dental school, do a couple of degrees, teach at university before anyone paid any attention to you. And that was wrong too, that was wrong too, because look at you. You’re giving out this valuable, super accessible, amazing information out, and you haven’t had to go and get it from a piece of paper from a university in order to do that. So I’m not harking back to those days at all, but it does fascinate me that being a teacher’s become a really … It’s almost like being an entrepreneur has become cool, isn’t it? That sort of thing.

Payman: All right, let’s get to the main subject, dude. Protrusive, yeah? I don’t mind admitting that I’m a little bit jealous of what you-

Jaz Gulati: Nothing to be jealous about, man, come on.

Payman: … what you’ve achieved, dude. It’s not to do with downloads, it’s nothing to do with that. It’s to do with, this love, yeah? I feel like, yeah, people will listen to our podcasts because they’re interested in other people’s lives, and it’s kind of a cheat, it’s an easy win, yeah? But with you, you’ve managed to harness kind of the dentist that’s really, I’d call it the geeky tendency in people’s brains, and not just harness it, expand it. Like I’m no geek, dude, I’m really not. I am not a geek. I mean, on that one little subject of bleaching trays, maybe, but I listen to yours, I just want to know more, I want to learn more. And so you say it’s happened by mistake, for instance, yeah, but where do you think it’s going to go now? I mean, okay, what are we going to do? Just wait until other things happen by mistake, or what have you got in the pipeline?

Jaz Gulati: So definitely the biggest thing I have now is making time for the things I enjoy. So I love the podcasting, and very early on, I knew that the editing. So as you know, or as your team might know, one hour of podcasting takes five hours of editing to actually produce and get ready, especially when I moved to video as well, because I saw the power in video. And before, when I was like, the first 20 episodes were audio-only, and people were saying, “Jaz, why don’t you make videos and stuff?”

Jaz Gulati: At the time, it was like those normal insecurities everyone has, like, “I don’t know if I can present myself on video,” and I actually ended up doing this Toastmasters training as well, I was like, “Okay, if I’m going to be on video, I need to get some more training to public speaking,” and stuff. Even though I had a bit of history of speaking on stage and that kind of stuff, but you still doubt yourself. And going forward, I’ve got some people working on the team now, so I’ve got other people editing and stuff, so it frees me up to still be a father, be a husband, be a dentist. I’ve still got all the normal dentistry things to do. So to find time and systemize things so I can still get these episodes out, which I love doing. I sometimes open my phone, I got a message today of someone saying that they had this crappy 2020 and they were not in a good place, but now, from discovering the podcast, they’re now feeling positivity and enthusiasm towards dentistry. And that’s the most common sort of theme I get, and that just [crosstalk]-

Payman: The one you read out, the guy who’s doing the MSC now?

Jaz Gulati: No, this is a new one. This is a new one, I just literally got it before, 20 minutes ago. I checked, I was like, “Wow.” And these are the kind of messages I’m getting more and more frequently about reigniting people’s passion. So I think the future is to keep going for as long as I’m having fun, for as long as I can still balance all my duties, and I intend to. Just keep going and see what comes of it. If I can help more people with the education site, because I’m enjoying that as well, then great. But the main thing is I’m still learning as well.

Jaz Gulati: Because every time I bring on a guest, like tonight, I’m doing a live with someone called Robin Bethel from the USA, and I don’t know that much about elastics with aligners, and now I know which aligners to use, how to use them. So I’m learning as well, and I’m just selflessly sharing that with everyone else. Because I think one thing I am good at is figuring out the pains that we have as dentists and really making them public, and be like, “You know what, it’s okay not to know, but why don’t we just learn together so we can all grow together?”

Payman: Yeah. And what about courses? Tell me about this, what was it called? Occlusion … [crosstalk]-

Jaz Gulati: We had Occlusion 2020, so-

Payman: Occlusion 2020.

Jaz Gulati: … I had Michael Melkers, it was like a joint partnership where I had him. I was going to, well, fly him over to teach at Heathrow and put on this really cool event and stuff, but obviously COVID happened. So we did something crazy, made it a two day Zoom virtual event and stuff. So it was a very stressful period at the time as well, because at one stage I was looking at losing thousands here, basically, from going to a position where I was going to put on this wonderful event, it was going to be so … all this positivity and excitement towards it, to then suddenly making a big financial loss, which I hadn’t really planned for, but then suddenly it came through virtually, it was amazing.

Jaz Gulati: Now, my big focus now is I did the reservoir and bridge master class, which is like … And in a way, Pay, that was me shoving myself as an educator. So I saw the reservoir and bridge master class as a way for me to be able to show people that, hey, you know what? I think I can teach, let’s test the waters. And wow, the feedback I’ve had from that has been phenomenal. Like people, dentists messaging me saying, “You need to charge more for this.” I’ve had dentists send me their cases like, “Wow, I couldn’t do this before, and now you taught me.”

Jaz Gulati: And then one dentist said, “This is the best education I’ve done during lockdown.” So if you think about all the different events and webinars they’re having during lockdown, that kind of feedback, it really gave me the confidence to now being able to position to put together this splint course. So splint course is my baby, this is my flagship thing coming soon, very excited. It’s been four years of content creation coming up to this. Now, back when I was making videos of my first splints, and even in like 201, I didn’t know that it’d have a use one day. That was mostly my failures I was recording.

Jaz Gulati: But now I can put it together, because an area that everyone finds confusing is bruxism, occlusion, splints and stuff. And I feel as though I’ve got a formula to help dentists just simplify it, and that’s what I’m really excited for.

Payman: You know, bud, I don’t think you should worry about sort of monetizing this thing. I mean, I don’t think it should be your focus, by the way. Just like dentistry, you should do the best for your patient, and the money will come, that way of thinking. But at the same time, the amount of free resource that you’re putting out, the value for money of being connected to Jaz Gulati is probably extraordinary, because there’s all that resource that’s coming for free, free, free, free, free, free, free, and as the [inaudible] about the left hook, whatever it was [crosstalk]-

Jaz Gulati: Jab right, I was just going to say that, Pay, I was just going to say that.

Payman: From that perspective, if you come to charge for it, it’s absolutely correct. And by the way, by the way, sometimes you’ve got a purpose-led … I mean, the way I see your Protrusive is a purpose-led thing. You’ve got a situation where everything’s right, and still it’s a nightmare to make money. Look at Drew and what he’s been through. I think of Drew as, well, there’s such a halo around Drew’s head, but he’s such a Godlike figure, such a saint that it should be easy for him to monetize, scale, and grow the [inaudible]. But he’s been through so many ups and downs. And so I don’t think you should feel any guilt about it at all, and I think you should value yourself and charge correctly.

Jaz Gulati: I appreciate that. Initially, I think during the reservoir and bridge course, I had that. Which is why, if I look back, I charged, initially, $22 for it, can you believe it? $22, okay, can you believe it, right? And then now, the price is now $90, which was like the discount thing. But I could easily charge 400, $500 for it, and people still would have bought it and stuff. And that’s okay, because that was part of me … Like you said, I was worried about it. I was like, “Oh my God, I don’t want to be seen as I’m doing this thing to monetize,” but now I’ve gotten to a stage, and with the amount of hours I’ve spent, the amount of sleep I’ve sacrificed to be able to make this next course, I’m totally happy to charge what it’s worth, because I know the amount of value it’ll bring to the dentists, and you’re completely right, I’ve got-

Payman: [crosstalk] value, that’s the point, the value, yeah? If I do this course, I’m going to get value, I’m going to make money myself from it, [crosstalk]-

Jaz Gulati: Absolutely.

Payman: … with the information.

Jaz Gulati: Definitely in that mindset now.

Payman: Yeah. I mean, look, the podcast, it should just keep on going and getting bigger and better, I really think. And when I came to sponsor your podcast, there was nothing, other than, “I completely trust this guy.” And so, you were using our products, and [inaudible] well, there it is. I trust you, you can talk about it, and people trust you too. I think you should keep that going, and I think you should spin off as many things as possible from it. I hope people get inspired by your story, and other forms of education like this, come out. Because we have sort of the university of Facebook, university of Instagram, but the university of podcasts, it’s much deeper learning. What you do, you go in and focus on one small bit of dentistry, and ask those questions of these experts. I really hope that happens.

Payman: And it’s interesting, in podcasting, I don’t feel like there’s a competitive environment. I do feel that in products and courses, but not in … In podcasting, your podcast finds a certain audience, in a way, you know what I mean? Like yours is my favourite podcast, that’s it. If it was this competitive situation, I wouldn’t be feeling that, wouldn’t be thinking that. So I’m really, really happy to see that.

Jaz Gulati: Well, I really appreciate all those things said, and I really appreciate that you guys sponsored my podcast. And for those who don’t know, it was the best conversation ever. It was like, “I trust you, just do what you want.” I was like, “But how do you want me to, you’re my first sponsor, how do I actually pitch it? What do you want me to say, is there a script?” You’re like, “Nah, I trust you.” And I just ran with it. And I love making those videos, some little tips that Dipesh had taught me. I then passed them on, and I credited Dipesh, like, “Look, you guys need to check out the [inaudible] course, because it helped me a lot,” and that was my way of sort of fulfilling that sponsorship, but at the same time, in my usual way, making it a Protrusive Dental Pearl, or making it educational and making it fun and funny, I hope I made it funny with the Maybelline, my wife’s makeup I was using, eyeliner, that’s what it was. But yeah, that’s all been really fun too, so really appreciate your support with the podcast, it’s really helped massively.

Payman: Tell me about your practising situation, how many days are you where, and how many practises are you in?

Jaz Gulati: So two practises now, I’m in Reading most of the week, and Fridays with Hap Gill at Richmond. And actually, the working hours I have now are very conducive to my life. So the most common question I get on social media is, “Jaz, how do you have time to be a father, to be a dentist, to do podcasting stuff?” That’s the most common question of all the questions I get, clinical, nonclinical, that’s the most common question I get.

Jaz Gulati: And one is I’ve got such a supportive family in my wife, and since we came back from Singapore, we’re moving out soon, by the way, but we still live with my parents. So came back from Singapore, living with my parents, and my sister all live … so there’s loads of us in this house, I’ve got loads of support with [Ishaan], my son, and that’s great. So in six weeks’ time, we’re moving out. So that’s going to be a bit more different, it’s going to bring its own unique challenges.

Jaz Gulati: But when I accepted this new position in Reading, this follow this 2:00 until 8:00, 8:00 until 2:00 sort of a shift pattern, so one week I’m working mornings, the other weeks I’m working the afternoon, and that’s why I’m able to be sat here on a Thursday afternoon to have this podcast episode with you, because it landed on that week where I could. So it’s given me a lot of freedom, and it’s not because of COVID, it’s been doing it for 30 odd years. So patients are used to it, the staff are used to it, and I believe it’s why this practise in a little village in Reading has got such a great staff retention. Like, there’s a leaderboard of how many years the nurses and receptionists have been there, 28 years, 25 years, 24 years, 23 years. When you come to work there, you don’t leave. Because no matter how bad of a day you have, it’s just half a day, right? It’s like, 8:00 until 2:00, you’re done. I just feel like for work-life balance, it’s amazing. So that’s actually been really important as well.

Payman: What’s the name of the practise? Who’s the principal?

Jaz Gulati: Principal, it’s actually my buddy from dental school, we were in the same years, John [Cowie] and Chris Reed, it’s Triangle Dental. So these are two young guys, the other associates are young as well. So actually a very young team, and our sort of support network of the nurses and receptionists, they’ve all been here longer than us, so they’re almost like mother figures. And my nurse is almost like a mother figure to me in a way, I hope she won’t mind me saying that. So Zoe, shout out to you, thanks so much. So it’s amazing, the culture of this practise is brilliant.

Jaz Gulati: Now, when I was working in Oxford, it got taken over by a corporate, and the values, the culture just went. And one of my mantras is that successful people are quick to make decisions and slow to change them. So I was very quick to say, “Okay, I’m jumping ship, and that’s it.” So I picked up the phone, and randomly I was speaking to my friend John, I was like, “Hey, I’m looking for a job.” And he’s like, “Oh, no way, I’m hiring.” So it’s funny, when you ask something of the universe, universe gives it to you.

Payman: Yeah, very true, man. Very true. So tell me some of the lessons you’ve learned, you’ve been exposed to quite a lot of different setups now, the NHS, the hospital setup, Singapore, now these two practises, Hap Gill, one of the greats, one of the good guys when it comes to comprehensive dentistry. Tell me some of the lessons you’ve learned from your perspective, from the practise management, patient management, some of the lessons you’ve learned from the best of these guys.

Jaz Gulati: I think, go out there, and shadow, and gain exposure. Had I not seen that Koray Feran lecture, I wouldn’t have been inspired. Had I not met Hap [inaudible] next to the practise in Richmond that one night over a beer. It’s so important to reach out.

Jaz Gulati: So if I wasn’t on Twitter, just reaching out to these guys for no reason, or going to these events, I think you have to make time for that as part of your professional development. So what happens outside of work with these people, the conversations that you have at the funny hours … These are just so important. So things like tubules and stuff, the congresses, the fun that we have.

Jaz Gulati: Drew has, by the way, been such a huge influence to me, I feel as though sometimes that I’m just an extension of him in a way, and continuing on his good work that he set the momentum for, getting dentists passionate again about dentistry. So connect with like-minded people, and that all begins with starting a conversation. So I think seek mentors, and sometimes you just can’t wait for these things to happen. I think my biggest lesson is be proactive. Send those emails, send those messages, and all the people who are just amazing, like I mentioned Tif Qureshi’s name earlier. I remember my first ortho case, 2017. I was messaging him on a Sunday, and he was replying to me. I was like, “What the” … Tif Qureshi’s replying to me on a Sunday afternoon, because these guys are so, so giving like that. I find the people who are most successful that we all know and love in our profession, they are always going to be there for you to give you the time.

Jaz Gulati: So don’t be afraid to think, “Ah, this guy’s really busy, I’m not going to reach out.” Reach out and beautiful things will happen. So I think get out your shell and reach out to more people.

Payman: I don’t know where I heard it, but it’s definitely true, the idea that if you’re going to a course, if you message the course organiser or the lecturer before you get there, and just say, “Hey, I’m coming to the course,” simple as that, yeah? Then you’re going to get more attention in that course, aren’t you? It’s just the way it is, it’s human nature.

Payman: But when I asked you the question, I was talking about, you must’ve seen the way that these practises are run. I mean, I’m sure Hap’s practise is run very differently to your Reading practise, yeah?

Jaz Gulati: Big time.

Payman: But what is it about one that you’ve learned? What are the things you’ve learned? Like for instance, my next question after this was going to be, “Do you want to set up your own practise?” And what’s that going to look like?

Jaz Gulati: I see. Well, I think there’s a lot to be learned. Hap’s way of doing things is very systematised, and everything’s got a flowchart to follow in a way. The staff are highly trained, but the vibe and the trust amongst everyone, it’s a small practise, is amazing. In a bigger practise like the one in Reading, it’s a bit more haphazard sometimes, you’re still working out all the systems and stuff.

Jaz Gulati: I guess at the end of the day, the culture is right. So I feel as though anything can happen in terms of systems, or to automations practise, but I feel as though what these two practises have nailed is the culture, and that all begins with the staff, and brewing a culture of trust with each other. So I think that’s the best I can come up with then, and to answer your next question about would I want my own practise?

Jaz Gulati: If I had my own practise, I’m someone who would give it my everything. Like when I was president of SUDSS, Sheffield University Dental Students Society, it was my baby, I gave it my everything. I feel as though if I had a practise, I’d give it my everything. I believe in myself that I’d make it amazing. You have to have that belief when you do something like that. But if I did that, I know that I wouldn’t have time for the other things, education, the podcasting, that kind of stuff. So I have actually made a conscious decision not to have my own baby in that way, because I do feel I can touch more people’s lives, I can get my message across more through all the other things I’m doing in education than I can by serving a population in a town through a practise, and that’s just the way I see the world.

Payman: Never say never, though, right? Or have you decided?

Jaz Gulati: Never say never, if the Reading practise gets taken over by a corporate, so John and Chris, if you’re listening to this, if that happens, I’ll be the first one out.

Payman: No, but are you really saying that you’re planning never to open a practise, or you’re just saying not yet?

Jaz Gulati: Definitely not yet, and I don’t have any vision in the next five years either. It’s just, I know what I’m like. It’s like a limitation, I’m a perfectionist in a kind of way as well, and I know that I’d have to really throw myself in the deep end for that, and I would, and I’d be totally up for it. But I just don’t see that as the right move for me. Because at the moment, the associate life allows me other luxuries, and time to do other things that I’m not having to think about staffing and CQC and stuff, so I can do all these wonderful, beautiful things I’m enjoying so much. So not now, but never say never.

Payman: I don’t know if you heard our interview with Jason Smithson, but he said something like that. Something like, “It’s possible, but not possible to do well,” a practise and an intellectual, lecture career, and a family life. He was saying two out of three, or one of the … I think there was a fourth one, yourself, taking care of yourself. And he was saying you can’t have them all, you’ve got to decide which one of those is going to take a backseat.

Jaz Gulati: I’m with Jason on this one, for sure.

Payman: Yeah. I think it would definitely be the wrong time now, because I feel like your protrusive thing, you may not even see it from the inside, yeah, but form the outside, your protrusive thing’s in an inflexion point, it’s about to really take off.

Jaz Gulati: It’s like a tipping point. I can sense it, I can sense it at the moment. It’s not just about the metrics and downloads, it’s about the vibe. It’s about the connections, it’s about the message, it’s about the love I’m feeling through the Protruserati, the Facebook group itself has gone more international, and people are just connecting from all over the world and it’s just a beautiful thing to be part of. So I totally agree, I think now would be a terrible time to sort of step away from Protrusive. I want to give it more energy, give it more time. It’s like a baby.

Payman: And so what is the international nature of it? I mean, I notice when you’re talking, a lot of times you sort of translate into American what you’re saying. Do you have a lot of US listeners, or members, or-

Jaz Gulati: So number one is UK, number two is US. It used to be Australia, now it’s US. So US is, month by month the biggest growth is US, and I feel as though that’s … It’s an interesting market. I mean, US has always been like almost like isolationist, right? They always, they have their own sports, baseball and stuff, they always do their own thing, they have their own conference and stuff. So I think to make it in USA, it’s going to be a big deal. So it’s something, I think there’s so many great dentists that we can learn form US as well, so to get them on the podcast, to help, to sort of grow an international community is fine, but ultimately, that’s not what it’s about. It’s about just getting that everyone learning, everyone engaging, everyone just feeling reignited in passion.

Jaz Gulati: And my connections are mostly in UK, that’s why most of the guests are in the UK, that’s why most of the listeners are in the UK, but it’s listened to in over 110 countries now, I’m sure Dental Leaders has got hundreds of countries as well. It’s one of those things that with the medium of podcast, it’s so easy just for people to connect with you, and that’s the beauty of it. So yeah, it’s growing in USA, Australia, and all the other countries, even Germany and stuff is probably number four, I think, which is just exciting. When I open up my podcasting platform and I see all the different countries, it just, wow, it really gets me going.

Payman: If I were you, though, Jaz, our goals are slightly different with why we’re doing it, why you’re doing it, and all of that. If I were you, I would focus on US. Because you know Michael Melkers quite well and all that, and because I think that [inaudible] career in the US is, you’ve got to remember, California is the ninth biggest country in the world, in economy terms, yeah? And so it’s not like here. If you can get yourself … And if I were you, I would do some paid ads and focus them on the US, on the major cities.

Payman: Because when the product’s good, it makes sense to put money behind it and put resource behind it and effort, which is what you’re doing. You’re putting sweat equity behind it, and I know you’ve hired these two guys. But if I were, strategically talking now, now we get away from the passion a little bit, strategically talking, that’s what I would do, man. Because you can track it really quite well, quite easily, and you don’t have to spend loads of money-

Jaz Gulati: I appreciate that. This is great coaching I’m getting, and I agree with you. I think that’s the next step. Right now all my attention, because I’m literally weeks away form the launch of the course, but-

Payman: The splint.

Jaz Gulati: … I think the next step … the splint course. The next step will be to then focus on getting my podcast, which I’m so proud of and what it’s become, to more audiences so that they can feel that connection and it can grow, and I completely agree with you that at some point, paid ads may be the next step forward.

Payman: So let me ask you some of the questions that we ask all our guests. You probably know about a question which is from Black Box Thinking, about errors, clinical errors. What have been some of your clinical errors, and what did you learn from them?

Jaz Gulati: They’re many. The one that always springs to mind in this case is two years out of dental school, just doing a root canal, lower premolar. Now, this patient happened to be an auntie of someone who was a couple years below me in dental school, and I was doing this root canal, and struggling to find this canal. And suddenly, I thought this tooth was necrotic, but I see a bit of bleeding. I put the file inside, take an X-ray, and here’s the premolar, and the file’s just coming out the complete other way, it’s the most shocking radiograph you’ll ever see. Literally, my heart was pounding, I was like, “What the hell have I just done?” I felt so bad.

Jaz Gulati: But whenever a mistake happens like that, my nature is to be very warm and friendly, and so the patient was very understanding about it. I was profusely apologetic about this, and I wanted to just make it right. So we took the tooth out, because it was just buggered, and I did what I knew, was my expertise at the time was reservoir and bridge. I did that, she was happy, I dodged a crazy situation there. I’ve never spoken to that dentist two years below me, because I’m just embarrassed to speak to her. So it’s one of those things, isn’t it?

Jaz Gulati: So that’s one of them, a perforation, and I think that the whole point of Black Box Thinking is what can we learn from that? So I would say to any dentist is don’t be afraid to make an access into a tooth without rubber dam initially, just so you can get your orientation, and always follow the long axis, and even could use a perio probe around to see exactly the angulation, the roots going in, that’s always going to be very helpful.

Payman: Yeah, I made that mistake in dental school. Well, yours was necrotic, but you try and convince yourself it’s pulp, and at one point you realise that ain’t pulp.

Jaz Gulati: You struck oil.

Payman: Yeah. And the you say about long axis, it’s very true, because you cam zoom in so much, with dentistry you can over-focus, can’t you? You over-focus on that crown, and sometimes lose the long axis focus, obviously with a rubber dam as well, I don’t think we were using rubber dams back then. But yeah, I think I’ve done that before.

Jaz Gulati: Very much in fashion, that rubber dam. Rubber dam fam, #rubberdamology, all that sort of stuff.

Payman: Thank God, man. Thank God. I mean, I tell you what, I’m amazed that everyone’s doing like cementing in with rubber dam. I never thought that would catch on. Because back in my day, that was like a crazy situation. But now it’s almost standard, in terms of bonding protocol.

Jaz Gulati: I think that’s a necessity, because you’re seeing these flat preps, essentially tabletop, the margin of error is so fine. You can’t have any sort of saliva contamination. So I think that’s a big thing about it. But I’m so proud of seeing our dental community using more and more dam. I always say, five years ago, I wish I bought shares in rubber dam, because I’m sure that’s climbing, climbing, climbing all the time, [inaudible]. And still climbing. So I think it’s great that we’re using it, it’s definitely, it results in a stress-free dentist.

Jaz Gulati: I think I use rubber dam selfishly, if it’s a simple occlusal, I’ll do it, because I’m less stressed. I just find it reduces my stress.

Payman: Are you tough on your nurse? Are you a tough guy to work for? Because I’ve got a feeling, you’re a lovely guy, lovely person, I get that, you’re very warm, but very high standards. So does that … Which side of you kind of wins?

Jaz Gulati: Sure. I think with nurses, I always believe in making a nurse a cup of tea and looking after them, and gifts and stuff, I’m very much in that kind of nature. When it comes to clinical, one thing I hate, and I’ve had this experience before with nurses, is when I’m not happy with my matrix seal, like the matrix [inaudible]’s there, and the seal’s not 100%? I always say, “Okay I’m going to change this wedge for a different one,” and then she or he will get me a different one,” and you’re like, “Nope, now I choose this matrix,” right? And my nurse Zoe now, she’s used to it, and she knows, she gets why I’m doing it.

Payman: She knows why you’re doing it.

Jaz Gulati: She knows I just want to get a perfect result. But then there are the nurses who just want to have lunch, who just want to give the first matrix [inaudible] to you and they want it to work, and I’ll never get along with that nurse, because that nurse is not in there for the patient.

Jaz Gulati: So I think, as long as you’re on the same team, and the same team is we’re there for the patient, then I think I will always get along with that nurse. So yes, some nurses will struggle to work with me because I will change my mind. And here’s the thing. Nurses, they want consistency and they want protocol. But when you’re trying to do everything to the best of your ability, and every tooth has its own challenges, its own curves. There’s no recipe book for how to treat that patient in that scenario in that quadrant. So my nurse has learnt very quickly with me that actually, although there’s some general things I will like to do, I’ll always like to put a little bit of [inaudible] first before I put the restorative composite, but sometimes I’ll change it up, and there’s a reason for it.

Jaz Gulati: And I love it when my nurses ask me why, I love that. Because I think it’s a great opportunity, it shows me that the nurse cares and she wants to learn. So I always, at the start of a relationship with a nurse, I’ll always say, “I want you to ask me questions. I don’t care if it’s in front of the patient,” because I think it actually makes you look cool in front of the patient as well, because you’re educating your nurse, your patient’s listening, they’re getting value. Like, “Wow, so this is what he’s doing,” it’s not just squirting some filling in, there’s some science behind it. So I think everyone wins.

Payman: It’s one of the hardest jobs in the world, I think, dental nurse, man. Because even the very engaged dental nurse can’t see what you see, yeah? They can’t see there’s no seal there. I mean, if you imagine it, try and change the angle and no mirror, you’re looking like that, and now that’s not right. And then not having control at all over what’s going to happen next, that’s hard itself.

Jaz Gulati: That is so tough, that is so tough. But one way to overcome that, what I do now, when I’ve got a rubbish situation with the matrix, I take a photo, internal camera, just pull it out, and I’ve got in the habit of showing my nurse, “Okay, this is the problem we have, let’s fix it.” So then if you start doing that, if you’ve got a nurse who just doesn’t get it, when you start doing that, and you’re completely right, Pay, they don’t see those issues. But when you show it to them, and then suddenly you’re on the same team, they see why, and that’s made a huge difference in the last three, four years, when I started doing that.

Payman: I don’t know how … I mean, I stopped practising 10 years ago, so I don’t know how correct this is nowadays, but back in the day I used to try and let the nurse do a lot more, whatever it was, whatever the thing was. I was taught four handed in Cardiff, kind of by mistake. There was this bit of the clinic that was four handed, and my favourite nurse was … So I remember one day I came to my first job and I just put my hands up like this, and the nurses looked at me, and she said, “What are you doing?”

Jaz Gulati: Oh, that’s brilliant.

Payman: And I said, “Give me my instruments,” right, and she walked out of the practise, she quit her job that day. Not only because of me, I think, I think there was some history to-

Jaz Gulati: You were the scapegoat.

Payman: Yeah, yeah. But the question of the nurse choosing the shade, for instance, or helping with the shade taking, I had a nurse that was really good at that. The nurse calling the patient afterwards and saying, “Dr. Gulati wants to know how you’re doing,” and all that. Involving your nurse in the treatment really makes a lot, a lot of sense. Because as I say, there’s no control in their day to day. And at the moment when we go … and it’s time to get finished, then they’ve got to start working cleanup again, yeah? And they’re running the whole place, really, right? In the end, they’re the ones running the business. I don’t think they get enough career progression, I don’t think they get paid enough, and they get abused a lot. It’s a tough job, man.

Payman: And now in COVID, I think that’s why we’ve got this sort of movement away from dental nursing, because it’s always the final straw that’s broken the camel’s back. So shout out to all the nurses.

Jaz Gulati: Absolutely, shout out the nurses. Interestingly, I’m starting to see some virtual assistants for dentists pop up now who used to be nurses, because they got the know-how and stuff, so I’ve recently seen this, and that’s a great niche for them, but it’s a shame that we’re losing these clinical nurses because of that reason, because maybe they don’t feel valued enough. But I agree with everything you said, and I’d go to the extent to say that the number one thing that’s going to decide your fulfilment and enjoyment for dentistry is the relationship between you and your nurse and how you work together. I think that, so if I’ve got a nurse with bad vibes, I can’t be myself. I can’t do the dentistry and give my patient the best care. Everything else, all the courses you’ve been on, all the knowledge you gain, all your patient communication skills go out the window if you don’t have a great nurse. So that’s the number one thing in all of dentistry, I think.

Payman: I know this is a really unfair question, but which is your favourite episodes of your podcast?

Jaz Gulati: Oh, gosh, all right. So I would say … I can’t, I can’t, Pay. I can’t do it. I almost did it, I can’t do it.

Payman: No, no, come on, man.

Jaz Gulati: I’m not going to do it.

Payman: Not your favourite episode, your favourite episodes.

Jaz Gulati: Okay, sure, sure, fine.

Payman: [crosstalk] seven or 10, whatever you want.

Jaz Gulati: Fine. The type of episodes I like the most, because I gain the most from, and here’s the thing, the beauty of it is, others will find that completely different. But the ones where my guest is just on fire. Every sentence is like a learning point, and you want to make notes, you want to make notes and notes and notes. So Prof Tipton on fixed-movable bridges, everything he was saying was to the detail, we’re a very detail-oriented profession. Nick Sethi, oh my God, everything he was saying, I’ve got so many WhatsApp messages and Instagram stories of people just showing me their notes of how much they’re learning from that one episode. They’ve been to all these courses for it and stuff, but that one free episode with Nick Sethi who’s a phenomenal educator-

Payman: Excellent episode.

Jaz Gulati: I didn’t appreciate how good he was until I actually had him on. So any episode which is more clinically oriented, which just gives out so many gems, verti preps [inaudible], we talked about with Smithson as well. Anything like that is what I love the most, because I’m just [crosstalk]-

Payman: You don’t have to worry about it. Because look, I get messages about this podcast, there are some that I don’t rate, and I get messages saying, “That was an amazing episode.”

Jaz Gulati: Same, same. [crosstalk] that’s great, cool.

Payman: And then the opposite, the opposite as well, right? The ones that do rate-

Jaz Gulati: I’ve got some people who hate my occlusion episodes. Like I live for those, right? And I’ve got my core group of people who I’d say who are really into it, and that’s why they listen to podcast, because it’s got this bias towards occlusion. But I went to the Smithson course in Glasgow, and I met this one guy, and he was like, “Yeah, I listen to your episodes about, Richard Porter episode about how to win at life and be successful in dentistry and stuff, but all the occlusion stuff, gosh, that doesn’t interest me.”

Jaz Gulati: So everyone’s different, and it goes back to what you said earlier. I think when I was starting to put myself out there more, the thing I was worried about is that I’d get shot down. You stick your head above the parapet, you know that people are going to be there gunning you on social media, “Who the hell is he?” Kind of thing. But the beauty of podcasting is that they have to find you, they have to seek you out on this app, then they have to press play and sit there and listen. Unless they already have some sort of good connection or the desire to learn, then the people who are there to badmouth, the trolls, it’s too much of a step for them to get to. So it’s self-selecting, like you said. You make your own audience, and that’s why I think it’s been successful, because I think it tracks the right people and it retains my tribe.

Payman: I mean, I don’t think that you are an impostor, dude, but do you suffer with imposter syndrome?

Jaz Gulati: I spoke about it with the episode with Drew very early on.

Payman: What I mean is, you must have had thoughts of, “I’m going to do this podcast,” which is a very clinical podcast, right? I mean, do you worry about getting something wrong? Like-

Jaz Gulati: Yeah, I do worry about it. Just, it’s human nature, I do worry about getting something wrong, so I’ll always fact-check. But more and more, now that I’m getting a bit more comfortable with the podcasting, and sometimes I’m happy to say … There was an episode I had with Barry Glassman, he taught me that it’s okay to say, “I don’t know.” It’s such a liberating thing to say, “I don’t know.” So a lot of the time I don’t know something, I’m so much happier to say, “I don’t know,” from people like him. And I think you don’t have to have all the answers, and a lot of the time I’m learning as much as you guys are when you’re listening to a podcast. And that’s the beauty of it, you’re just part of my journey when I’m learning, so it’s okay.

Jaz Gulati: And with the whole imposter syndrome, I felt it a lot when I was going into private practise, like moving into fully private practise in the UK. Not in Singapore, because I felt like it was so much more relaxing to practise in Singapore, because there was no GDC. SDC, if you’re a dentist in Singapore and you’ve been sued? There’s no such thing. Whereas here, the fear is real. So when I was going into private practise, I was doubting my abilities and stuff, and I spoke to Drew about that, and he helped me a lot and got my confidence up.

Jaz Gulati: But I never had it initially with the podcast because I wasn’t really talking about the clinical things initially. It was more about how to move to Australia, how to do this, and when I started to talk more and more clinical, it was just an organic, it was just me being me and the geeky stuff coming out to be honest with you.

Payman: Yeah, because I don’t know, man. I’d worry about it if I was you. I’m not you. It’s a lot easier to say, “Hey, what’s your biggest clinical mistake?” Than to go deep into deep margin elevation, right? I mean, you could-

Jaz Gulati: But one episode I was worried about, Pay, actually, to mention it, is episode 40, which has been such a huge episode for me, is Michigan splints are overrated. Here I am cussing the appliance of the last millennium in terms of dentistry, the Eastman [inaudible], the [inaudible], the holy grail of the occlusal appliance, and I just went and I just cussed the life out of it.

Jaz Gulati: No, I did it in a respectful way, and I sort of hopefully took you through the pros and cons of it-

Payman: It was kind of tongue in cheek, in a way. I mean, it wasn’t-

Jaz Gulati: It was, it was. Yeah, it wasn’t that negative towards it, but I wanted people to realise that when it comes to appliances, there’s more to it than just a Michigan splint. I was nervous about that one, because I was thinking like, “I’m going to get messages from all these professors at Eastman and stuff like, ‘Who the hell are you? Take it down’ kind of stuff,” but no, people just enjoyed it and it’s been good.

Payman: No, I don’t think we need to worry in podcasting, dude. Like you said, the barriers too high, and it’s the reason you can swear on a podcast, right? If you don’t want to listen, don’t listen, yeah? End of story.

Jaz Gulati: It’s true. I’ve started bleeping more and swearing less and whatnot, because when you are explicit on Apple and Spotify stuff, your content doesn’t reach UAE. So I still haven’t had time to do it-

Payman: Oh, really?

Jaz Gulati: But I’ve got to go back in my episodes and remove the explicit label, because I had this one person message me saying, “You content is coming up as too explicit to listen to in my country, can you do something about this?” I’m like, “Oh, I’m so sorry, let me sort it out.” So yeah, careful.

Payman: The AI thing just hears the words, does it? Is that how it works?

Jaz Gulati: No, it’s something that within your settings that you set. Because one time I said a swear word, I was like, “Okay, I better be safe, legal, yes, I’m going to mark it as explicit,” but really I think it’s a bad move. Because a lot of countries, it won’t be allowed so I’m probably going to remove that.

Payman: Yes, I’ve seen it on ours, I’m going to have to remove that myself.

Jaz Gulati: You should.

Payman: So, man, I mean, Prav’s not with us, but I going to ask you his final questions. You are on your deathbed, you’ve got the five or 10 closest people to you, with you. What’s three pieces of advice you leave to them and to the world?

Jaz Gulati: I just think of my son the most when it comes to something like this, and I would say, you can do anything you put your mind to. You can become anything, do anything you put your mind to. That’s number one. But in the same world where you can do anything and become anything, be kind. That’s always been my style, I always hated working environments where the professor was just angry and mean to everyone. I just want everyone to be kind and courteous, I think there’s a certain charisma that is just beautiful about people who are just nice, that’s my favourite. Because there’s some different types of charisma, my favourite type is people who are just kind and polite, and there’s something that’s so much to be said for that.

Jaz Gulati: And I guess another thing I’d say is, like I said earlier, successful people are quick to make decisions and slow to change them. I think nowadays people meander and they think and they think and they think, and they finally come up with a decision, and then the next thing comes up, they completely change it. That’s completely the wrong way to go. Work hard, and make sure that you are the hardest-working person in any room. That’s my sort of, the things I live by.

Payman: Having your son, has it changed your relationship with your parents? For me, I thought that cliché, it’s a cliché, right, but I did feel that, I did feel that. Tell me about how you felt being a father?

Jaz Gulati: Oh, it’s just the greatest feeling on earth for me, there’s nothing better. I feel so blessed to be a father, it’s amazing. So yes, it did change my relationship with my parents, I sort of started to value them a little bit more, in a way. You always value your parents, but you kind of think, “Oh gosh, they changed my nappies for so many years.” Those sorts of little things, and now when my son has a fever or something and I’m like, “What’s going to happen?” Kind of thing, and I think, “Gosh, this is parenthood, it’s real.”

Jaz Gulati: But it’s interesting, I was never that close with my parents. It’s a funny thing to say, because I was always … Once I came here I became very independent, so I’d learn English, I started to speak English outside, at home I speak Punjabi, but then that was less and less and less. My parents never really knew what was happening in my life. Like I remember in A levels, I was in A2, right? So my final year of A levels, and my mom sat there, watching telly, and she goes to me, “Jaz, what do you do in school? What are you doing?” Well I was like, “Mum, I’m doing biology, chemistry, maths, and physics.” And bless her, she said, “Oh, so you’re not doing science, are you?” Because she doesn’t know all that stuff, right? So there was always a bit of disconnect in terms of my world and their world. Through having my son, I feel it’s made us a bit closer, and I’m trying to include them as part of my world, is what I’m trying to tell them, “Okay, I do this podcasting stuff, it’s pretty cool and stuff.” So I’m trying to be more expressive, because I feel as though I’d want my son to be like that as well.

Payman: But Jaz, I don’t know, your son’s so young right now, but I don’t know if you think of it this way, as far as what can you do for your kid that in the end, outside of shelter and health, confidence is what I’d say. And you’re a confident cat, man. Is there something that comes from your parents that made you this, or what?

Jaz Gulati: I think my parents are, within the Afghani Sikh community that we have, they are socialites, I guess, so maybe I got it from that, maybe. I couldn’t tell you. I was always into drama. GCSE drama, I used to love doing the school production, I used to live for that, I used to do all the drama kind of stuff. So I always find that people who did drama at university and stuff, they’re always very exuberant characters, so I sometimes think that maybe it’s because I liked drama and I wasn’t afraid to stand up on stage and do crossdressing at that time, a play in year eight, we did Midsummer Night’s Dream and I was the guy who had to dress up as a girl, funny things like that. So maybe that’s where it comes from, actually, my interest in drama.

Payman: That’s interesting. But for me, with kids, right, I’m always thinking, “Ah, got to make them confident, but I don’t want to make them arrogant.” And it’s like, almost is a thin line. But it’s not a thin line, yeah, because look at you. I’d give you 12 out of 10 for confidence and one out of 10 for arrogance. You really are, and that’s that sort of non-arrogant, non-judgmental way that you talk about things that brings so many people to you. And I’ve heard it 100 times now about you, infectious enthusiasm. It really is, man. It really is. And you’re a credit to the profession, buddy. You really are.

Jaz Gulati: Wow. I mean, thank you so much [crosstalk]-

Payman: You really are [crosstalk]-

Jaz Gulati: … one thing I say, one person who’s inspired me as well is Gary [Vee], we mentioned him earlier. And what you said was, it reminded me of one of his sayings, which are the two most important things which I would love to pass onto Ishaan, my son, and I think what we can teach young people is the two things that his mother instilled in him was self-esteem and self-awareness, right? So have the self-esteem to make sure that when people say bad things about you and people will gun you down, just have that confidence in yourself that you’re doing the right thing, but self-awareness so you know your limitations, and you know that, you stay in your lane, in a way, that you can actually make the biggest impact in things that you actually know about and you can influence, rather than doing things that, a bit ambitious in and away, if you know what I mean. So self-esteem and self-awareness, I always try and think about that as well.

Payman: Let’s move on with Prav’s further questions. How would you like to be remembered? [crosstalk]-

Jaz Gulati: As that really enthusiastic, nutty dentist who just wanted everyone to learn and place better onlays and do better dentistry, and make splints, and get rid of headaches, and just [crosstalk]-

Payman: Proper geeky answer there.

Jaz Gulati: Yeah, I know. It’s true. Just that enthusiastic dentist who just was always happy to help and share.

Payman: And then he’s got this final one that he’s doing now, and I know it all sounds very death-orientated, yeah. You’ve got a month to live, you’re healthy, you’re not in bed or anything. What would you do with the month?

Jaz Gulati: I would go to most magical place on Earth.

Payman: Where is that?

Jaz Gulati: Disney World. I’d go to Disney World, Florida-

Payman: [crosstalk]-

Jaz Gulati: … me, and my wife, my son. We would just go to Disney World Florida, and we’d just have the best month ever. That’s what I’d do.

Payman: The last place I thought you were going to say was Disney World, dude.

Jaz Gulati: That place is amazing.

Payman: Well, it’s been lovely having you, and it feels like we just [inaudible], man. I’m sure we’ll have you again, and I just feel like this little train that you’ve started is going to keep going on and on and on, and I really wish you the best, man, because you really-

Jaz Gulati: All plans [crosstalk], honestly.

Payman: … you’re changing the landscape, buddy, and it’s good to see that. It’s good to see that, really is.

Jaz Gulati: Thank you so much for having me on. I love what you’re doing with Dental Leaders. Keep getting these stories, because so good to connect to everyone’s story, and thank you for having me to share my story, I really appreciate it. And all your support from Enlighten and MSM for the Protrusive, I really appreciate that.

Payman: Of course, of course buddy. Thanks a lot, man.

Jaz Gulati: Thank you.

Outro Voice: is is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.

Prav Solanki: Thanks for listening, guys. If you got this far, you must have listened to the whole thing, and just a huge thank you, both from me and Pay for actually sticking through and listening to what we had to say, and what our guest has had to say, because I’m assuming you got some value out of it.

Payman: if you did get some value out of it, think about subscribing, and if you would share this with a friend who you think might get some value out of it too, thank you so, so, so much for listening, thanks.

Prav Solanki: And don’t forget our six star rating.

Elaine Halley: And realised very quickly I wasn’t going to survive in an NHS environment, because I wanted to be able to offer my patients the best that dentistry had to offer. That’s always been, I want my patients to have the choice of the best. Not to say that I’m the best, clinically, that was never my goal, but to make sure that I understood all the different options and to be sure that people had choice, that’s what was important to me.

Speaker 2: This is Dental Leaders, the podcast where you get to go one-on-one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.

Payman: It’s my great pleasure to welcome Elaine Halley on to the podcast, one of the pioneers of cosmetic dentistry in the UK and definitely one from Scotland. Were you the first lady to be accredited by the BACD as well?

Elaine Halley: Yes, I was. First, and so far only president and yeah. I’m the first female, yeah.

Payman: Welcome to the show, Elaine, you’ve been teaching all over the world, I think, the recent DSD thing that you’ve been doing as well, right? Shall we just get this lady thing out of the way before we go any further? Because it grates with me a little bit that we have to talk about it, but what’s your position on this balancing the boards, is it harder for women? You’ve been there. You’ve been the one on the boards, president of the board. Was it harder?

Elaine Halley: It’s such a complex question, this. I think in my younger days, I didn’t pay much attention to it, so I think in my younger days I considered myself a dentist, the same as my colleagues. I’ve got two brothers, I’ve always been pretty comfortable in male company. And I was fortunate, I think, when we were starting the BACD, my good friends David Bloom and Chris Orr, we all were equal. Certainly in my eyes, we were peers, colleagues, friends. So, I didn’t feel that being female was either up nor down, at that time.

Elaine Halley: I think, as I’ve got older, and certainly maybe in the last five or 10 years, I have reflected on why are there not more versions of me? I mean, there are some brilliant females in the teaching of dentistry, but not many. And actually, when I think back now, I’ve been in this practise for over 25 years. I have been around for a while and nothing has really changed in that perspective, I would say. And it was at one of the anniversary talks at the BACD, a young female dentist came up to me and said, “Are you going to say anything about the fact that you’re the only female president of the BACD in all of this time?” And I suddenly felt that uncomfortable shift of responsibility, which I’d never really… I never felt it was my job to campaign on behalf of women, I was just me doing what I did.

Elaine Halley: But then I did think yeah, you know what? Maybe I do have to say something here. And so, a few times in my career I’ve felt that the balance and the representation is uneven. That’s the bit that frustrates me, is if the audience are 50/50 male, female or in some countries where I’ve been to conferences, it’s mostly women in the audience. And if the people talking to those women are all male, then there’s something out of balance. You are not representing your audience. And the more I’ve looked in to this, I think that’s the imbalance in dentistry. I think that for all sorts of deep rooted cultural, circumstantial reasons, there just is a tendency for men to ask their friends, for it to become almost without intention, but for some of the boards and the panels to become male dominated. And I think that doesn’t represent the profession.

Elaine Halley: I think any time you have an imbalance in representation, there will be blind spots and there will be bias, you can’t help it.

Payman: What do you reckon should happen about it?

Elaine Halley: I think we need more conversations about it, and I think women can’t do it. I think it is very difficult for the minority to elbow their way in. I think men need to turn around and go, “Wait a minute, we are missing the other side of the conversation,” and need to talk about my colleagues that invited me and stood aside to let me come through. And that’s how I think about it, is stand beside us, not in front of us. Let us in, give us a hand up, men and women. I try to do the same thing myself, and I don’t know that I necessarily did when I was younger, because I didn’t particularly recognise that there was an issue. But I think there obviously are issues.

Elaine Halley: I also get a bit frustrated when people ask me what should be done, like when men say, “Well, Elaine, you’re a female that’s speaking. What should we do to try and get more females?” And I get a bit frustrated with that, because I don’t know any more than anyone else does. I think we all have to look around and it’s not the women’s responsibility only.

Payman: Yeah, one side says… I mean, I don’t want to put it in to a side debate like that, but one side says, “You should do nothing,” and then you’re saying, “There’s misrepresentation and we have to do something.” And so the something, what should we do question is really the problem, because it’s that sort of… No one wants to really give positive discrimination, no one wants to feel like they’ve got a role that they didn’t deserve, and that’s always going to be level, that way of working. And so, maybe, you’re right, thinking about it does help, because since this conversation’s come up, now I’m thinking about it more and so next time I have an event I’ll be thinking about it.

Payman: It’s just strange, man. Yesterday I interviewed Basil [Misrahay]. I didn’t start by saying, “Hey, you’re a man, what’s it like being a man?” And yet today, I’m feeling like I have to ask that question. And I wouldn’t have felt that I would have to ask that question before this debate came up, but there we are.

Payman: Let’s move on. We normally start with this thing with, where were you born? How did you grow up? When did you decide to become a dentist? Why?

Elaine Halley: So I was born in St. Andrews in Fife, which is the home of golf. So, I was born there. My parents had a shop, so they were in retail. My father was quite entrepreneurial. He did a degree in physics at St. Andrews University and then he had an exchange to MIT in Boston, worked as a consultant in the States for a while, which kind of gave me my love of travel to the States. He then came back to London and then saw an opportunity to open a shop on… Well, he was taking tartan scarves from Scotland to the States, and selling them to students at MIT in Boston, and that gave him that insight that there’s a tourist market for Scottish goods. He opened a shop on the 18th green of the golf course in St. Andrews, selling cashmere jumpers, tartan golf balls, kilts… And so, that was the business that I was born in to. So, self employed, he used to give away free tea and coffee when nobody did that, to encourage coach loads of people. So, a very quirky entrepreneurial business.

Elaine Halley: My mother was from London, he’d met her when he was working in London. We were a self employed household, I guess. I’ve got two younger brothers. I was a good student, a good girl at school, did well and enjoyed studying and actually, it probably is a cliché, but wanted to be a vet. That was my absolute ambition. I get annoyed when people say, “Dentists are failed medics and vets.” We used to get that at uni all the time, but the truth was, I wanted to be a vet. Of course, It was really difficult to get in to veterinary school, that was in the 80s, and I just didn’t get the grade in [physics]. I needed an A and I got a C, and I had tried, that was my best.

Elaine Halley: So, I started off doing biology at university because I didn’t know what else to do when I couldn’t get in to be a vet. I had a thought in my mind of trying to get in in second year and I tried really hard, but there was no way in for me. And then I met some dental students. So, while we were just sitting in the student union I met some dental students and I’d always known I didn’t want to do medicine. I don’t know why, but I just knew, for sure, that medicine wasn’t for me, but I was a little bit lost with biology because I was so, had in my mind to be a… And I think again, that was a sign of the times in the 80s, to be a thing, like an accountant or a lawyer… So there was an expectation you were going to be a something.

Elaine Halley: So, I met dental students and then was hearing about them actually doing the dissection on the head, neck and I thought, “Oh, that sounds actually really interesting,” and sort of a half way to medicine but still fulfilling my interest in biological sciences. I applied to transfer after first year at uni, I did a bit of shadowing with my own dentist at home, applied to transfer and that was me.

Payman: Did you enjoy dental school? Were you one of the top in your class?

Elaine Halley: No, I was painfully shy growing up, painfully shy at dental school. Because I hadn’t come in in first year, most of my friends at uni were not studying dentistry, so I quite enjoyed that. Dentistry is, as you know, can become quite insular. I never shared flats predominately with dentists, and those guys are still my friends to this day, those first year friends that I made. I just kept my head down, did the work and got through dental school. I made some great friends, but I wouldn’t say it was the most comfortable experience for me.

Payman: So then Elaine, most people who qualify in dentistry, go and do a regular job. Back in the day, when me and you qualified, a lot of that being NHS practise. When did it switch from being a regular dentist to looking into this cosmetic world? What was the moment? Do you remember the moment when you kind of switched your thinking? Or were you always a bit different?

Elaine Halley: I think, looking back, the fact that my parents were self employed and ran their own business and had to bend with the economic situations and come up with new ideas, I think that was a big influence. So, I already knew as I was graduating from dental school, that I was going to go into general practise. I had no interest in playing the political house officer game. And I also had had, as lots of people had, had a bad experience as a child, where my dentist tried to extract a lower molar I was having taken out for ortho reasons, and I now know that the [ID] block hadn’t worked. But my tongue was numb, my lip was numb, but the tooth was not numb, and she didn’t believe me and carried on trying to extract a lower seven.

Elaine Halley: So, I had been… I kind of bounced back from that no problem, but it was in my head that people can be very nervous for good reason, and believe people, whether you think they can feel it or not feel it, if they think they can feel it, believe them. So, I had those two things in my head. I also travelled to the States, as we had to do our elective period of study, which myself and my two girlfriends, we travelled to California and had a beach/elective experience. But when I was there, I actually heard Larry [Rosenthold] speaking. We got invited to a conference of students, we didn’t know anything about anything, we were fourth year dental students, but I don’t remember anyone else at that conference, but I remember him. And we also visited various different dental practises and they had Nintendo’s, in those days, in the waiting rooms and they had coffee in the… Again, I graduated in 1992, in the early 90s, in this country, there was very little in the way of customer service going on with dentistry.

Elaine Halley: So I had that idea that there’s a different way to be, and that to really help work with nervous patients, that there’s a way of making dentistry not as clinical and not as regimental as it was. I already had that in my head when I graduated, that I had a vision of… It wasn’t particularly on the cosmetic, it was more on the looking after nervous patients. And then, in my first job, I worked in a big NHS practise in Cambridgeshire when I first graduated, and a lady there had spaces between her front teeth and pretty misshapen front teeth, and she came and asked for veneers which, again, I hadn’t done any real training, other than what I’d learned at uni. But I remember her saying she’d been asking for years and all she’d kept being told was that there’s nothing wrong with her teeth and it was character, she should just get on without, her teeth were healthy, it was character.

Elaine Halley: And I can remember thinking, “Well, if my teeth looked like that, I would certainly want something done about it.” So, that kind of put a switch in my head. But cosmetic is, it can be life changing for people and it’s not for us to judge what is character and what isn’t. If you don’t like the way your teeth are, you should be able to explore the pros and cons of doing something about it. So, those two things, I think, are what inspired me at that time.

Prav: And so, moving from that job to owning your business, obviously your father was entrepreneurial and I guess, it was probably written in your life or in your blood, so to speak, that you were going to own your own business. At what point did you say, “Well, I’m going to create my own practise, have my own patient journey and my own vision.” Because I remember when I first got in to dentistry, probably 13 years ago, 14 years ago now, Cherrybank was that practise that you just looked up at and everyone spoke about the experience there, the service there. To me, I don’t know whether they did speak about the actual dentistry itself, but the one big stand out thing that was on everyone’s radar, was the service and the level of service, and people who went there to visit… And I think, at the time, you were doing some kind of training programme with Jameson Management, going round practises and almost injecting Cherrybank in to multiple practises.

Prav: How did that evolution come about? From obviously working as a dentist for someone else, to saying, “I want to own my business and create this experience for patients.”

Elaine Halley: Yeah, I didn’t last very long working for anyone else. I think I have learned that about myself, that there’s a certain… would you say control freak? I don’t know what it is, but there’s a certain… I have ideas and for me, freedom is really, really important. The freedom to be able to put my own ideas in to practise. I was very young when I started my practise, and my first job as an associate was great. Big NHS practise. I learned a lot, but I went on a course and I can’t even remember the name of the course, and there’s a few key dentists that we all know that were on that as well. But it was basically an accountant, but he was almost running a course for associates, saying, “You can do this by yourself.” And I hadn’t actually considered, at that time, that I would be able to open a practise of my own. I was just kind of going with the flow.

Elaine Halley: There wasn’t VT, I was just ahead of the VT curve. My first two, two and a half years in practise, I was self taught. I realised very quickly, I didn’t know enough, so I immediately enrolled in the FGDP programme. I went on a lot of courses and then I was working down south in England, and decided I wanted to come back to Scotland and I just couldn’t face the thought of signing on as an associate, again, for another practise. Fortunately, I had the support of my parents, but I just decided to open a squat practise. I did a fair amount of research into where would I want to live, and where did I think there would be space at that time, but yeah, I was only two and a half years out of uni and I opened a squat practise.

Payman: Is that your Edinburgh one?

Elaine Halley: Perth, that’s where I’m setting up [crosstalk].

Payman: Oh Perth was your first one.

Elaine Halley: Yeah, this is my [crosstalk].

Payman: The one you’re sitting in right now.

Elaine Halley: Yeah.

Payman: Amazing. So, take us through… Opening a squat was quite an innovative thing to do back then. People didn’t really open squats. I mean, of course some did, but take us through that. Are you the kind of person who jumps into things with full confidence? Or did you have anxiety about it? Were you using your parents money? That must have been stressful.

Elaine Halley: No, I didn’t use my parents money, not that they offered, but what they did have to do was guarantee. They guaranteed, they had to act as the guarantee for the loans from the bank. Do I jump in to things? I think I logically look at the pros and cons. I had a plan and I just took it step by step and I’ve never particularly worried too much about what other people think, although then sometimes it comes as a shock when I realise people do think things. So, I got a lot of stick for opening a practise in a city where I wasn’t known, and I actually got some quite nasty letters from some of the dentists. I was quite naïve, I suppose. I did write to everyone saying I was opening a practise, single handed squat practise, I was going to be charging privately for the first examination. It was just, the contracts all changed the year that I graduated, so there was a big move in England, where I had worked initially, for dentists coming out of the NHS. Scotland wasn’t moving in that way.

Elaine Halley: Before that, you weren’t allowed to mix private and NHS, and I started by charging for the full examination and then giving people options, and that was practically… I really angered a lot of people by doing that, but I just kept my head down and stuck to my guns and realised very quickly I wasn’t going to survive in an NHS environment, because I wanted to be able to offer my patients the best that dentistry had to offer. That’s always been, I want my patients to have the choice of the best, not to say that I’m the best clinically, that was never my goal, but to make sure that I understood all the different options and to be sure that people had choice, that’s what was important to me.

Prav: Do you know back then, I mean, you spoke about your dad having this shop and it was unheard of back then to offer tea and coffee. Did you sit down and map out your patient journey and what that would look like? Was there some inspiration in there, in terms of trying to be different and it being about the experience, or did that evolve over time?

Elaine Halley: A bit of both. I used to dream about how could you make the environment not like a dentist. I think I was a bit influenced by not enjoying my childhood experience of dentistry. I used to think, how could you make it more friendly? Could you have yellow paint on the walls instead of white? And then I was very influenced by what I saw in the States, in terms of customer service. And then more and more influenced, because right at that time, spa dentistry, which has probably been done to death now, right at the time I think we were the first in the UK and that was influenced by the States, what we saw in the States.

Payman: What did spa dentistry mean back then, and what does it mean now?

Elaine Halley: Spa dentistry back then absolutely was about making everyone around the dentistry as comfortable as possible, so that people forgot that they were somewhere where they didn’t want to be. That’s what it was about. I think that’s still what it’s about, it’s just like everything, the term’s been overused and it’s easy to call yourself something that doesn’t mean you actually follow through with the ethos behind it. To start with, I was Cherrybank Family Dental Health Centre, that’s what I was for years, and then as my interest in aesthetic cosmetic dentistry grew, I decided that yeah, I’m not really a family dental health centre, that’s not really my market anymore, so we decided to change the name. But definitely influenced by just trying to be different. What can we do that’s different? Why would people come to see us? We need to have something different that we can offer. There’s no point being the same as everybody else.

Prav: Elaine, when you first opened your practise, I remember having conversations with my brother when he first opened his in 2005, he was having two to three hour lunch breaks and I remember getting a phone call from him, saying, “Can you help me sort this out?” Did you have any moments like that at the beginning? What were the earlier marketing campaigns? What were the things… You’ve got this building, nobody knows about you, you’re offering a service that’s totally alien, especially other dentists saying they’re angry about what you’re doing. What did you do to get the initial people through the door? And just talk me through the progression of how it was, say, in the first year, and how you grew the business, and what were the key things that you… strategies you used to get patients through the door.

Elaine Halley: So, it was different times, Prav. One of the biggest things that we did was Yellow Pages, if you remember that.

Prav: Oh yeah.

Elaine Halley: At the time, Yellow Pages was lists, and the dentists were called Mr. Smith and Associates. I’d start with the Yellow Pages and I thought, right, this I guess is where my family helped, because my dad had been a big advert print advertiser with his shop, he had a famous sale every new year and he used newspaper, Yellow Pages, TV ads… And my brother, one of my brothers got involved with advertising. So, we were the first in our area to put an ad in the Yellow Pages that actually… we had a logo, which Pronto Printers came up with our cherries, Cherrybank Family Dental Health Centre and my strap line was, “Caring dentistry with a gentle touch.” And I guess we built a story, at a time when people were just putting lists and their names and numbers. We started off with a box ad, and then we moved to a column, and then we got bigger. And then other practises started to follow suit, so we had to do other things.

Elaine Halley: We also did leaflet. I mean, I went round with leaflets, myself, and put them through doors. I joined the Chamber of Commerce. I joined the business network. I made myself, and as I said, I explained… I talk and teach now, but that never came easily to me, so I made myself join business networking groups and have to stand up and vouch for what I was doing. I remember people saying most new businesses fold within the first 12 months, so I’d get to 12 months saying, “Right, phew.” And then it would be, but most businesses fold within the first three years, and then most don’t make it to five years. I remember each of those milestones, thinking, “Oh my God, when can I feel like I’ve made it?” And then you learn.

Payman: You have three practises now, Elaine, right?

Elaine Halley: No, not quite. So, I did open a second practise in Edinburgh, and I have sold the majority stake in that practise to a group of practises in Scotland, the Pain Free Dentistry Group, and I work for them as a clinical director, so helping to mentor the associates. I still have some ownership of Edinburgh, but I don’t work there anymore.

Elaine Halley: I had a brief dalliance with corporate, which didn’t go well, which I could have probably… A bit like, I need to work for myself. I realised this isn’t going to work, managed to get myself out of that by then selling to a dentist, who understands what it is to be a dentist. I really enjoy balance in my working life, so I work clinically part of the time in my own practise in Perth, which is now back to being just mine, which is brilliant, and then I work mentoring associates for Pain Free Dentistry Group, and then I also teach as well. I love the balance.

Payman: You said you’re a bit of a control freak. What are you like as a boss? Are you a touchy feely, caring, sharing boss? Or are you a bit stricter than that?

Elaine Halley: I’m probably not the one to ask. I have three team members who worked with me for over 20 years, so I can’t-

Payman: That’s a good sign.

Elaine Halley: I can’t be that bad. Yeah, I think, I don’t know. I try and be kind, I try and respect my colleagues but I also know how I want things to be, and I think, sometimes, I have to remember to do the touchy feely stuff. I think most business owners have a mindset of getting the job done and making decisions, and sometimes you have to remember that people aren’t just… they can’t read your mind and they’re not necessarily just going to come with you, you might have to check on them occasionally.

Elaine Halley: But my core team, my team here in Perth, as I say, most of them have been with me for a long time, so they’ve figured out how to manage me, probably, more than-

Payman: You must have had some periods of overwhelm, though, because before you had more practises, more associates, more staff, the whole BACD commitment, you’ve got how many kids?

Elaine Halley: Three.

Payman: Three kids. There must have been moments where it was just too much. What’s your darkest days in your professional life?

Elaine Halley: I’ve had lots of moments where it’s been too much. I mean, I don’t think you get through life without ups and downs. I think that I’m very fortunate that I’ve been able to maintain ownership of my first practise, and I think anyone who’s started a squat practise, not anyone, because some people are very good at starting businesses and selling them and letting them go. But for me, this building, these people, these patients I’ve been looking after for 25 years have been my rock, throughout some of the other ups and downs of life, absolutely.

Elaine Halley: I mean, starting Edinburgh was an ambitious move. I try not to have regrets in life, but there were some pretty big moments where I really did regret stretching myself financially and emotionally, and I have massive respect for people that can manage multi-site practises. I struggled with two, so I don’t know how these people do it that have multiple sites. I realised that that’s not… That was possibly an ego driven situation, I’m doing so well in Perth, I can certainly do it somewhere else. I think what I learnt about myself was, I’m good at what I do, but growing, scaling, that’s not what drives me.

Elaine Halley: So yeah, I have three children. My first pregnancy, I had appendicitis in the middle of that pregnancy and was suddenly off, like suddenly off, for six weeks with a new practise and no associates. Lots of ups and downs that life throws at you. I certainly don’t take any of it for granted, that’s for sure.

Prav: Elaine, what are your strengths, when it comes to running or managing owning a practise? As business owners, we all have different strengths and then there’s probably areas which you absolutely hate. Can you just run us through, during this time, what do you absolutely love about being a practise owner and what do you not like so much?

Elaine Halley: What I love about it, is that ability to think through the patient journey and make that better and better and better. So, what I absolutely love is meeting a new patient for the time, who’s nervous, often here we have people who haven’t been to the dentist for a long time, or they have been but they’ve been made to feel bad for whatever reasons. So, I absolutely love that, “What can we do for you?” Let’s gather the information. Let me analyse it and think about it and let me work out how to best tell that story back to the patient in a way that they can engage with. That’s what I love to do.

Elaine Halley: And part of that is that constant learning about psychology of people, psychology of decision making, psychology of our own biases, how we analyse what’s happened to somebody’s mouth, how we figure out what their options are. In terms of delivery of dentistry, I love that journey, the problem solving, solution finding. And so, I guess my strengths are just always making that better and always being flexible. Always thinking, like introducing the DSD workflow, okay, I like some of what’s being said there by Christian, let’s think about it, let’s bring it back, let’s put it in to practise, let’s try it, let’s adapt it. What else, what’s anyone else doing? Let’s see, is that going to fit with the way that we work.

Elaine Halley: I think sometimes for my team, that’s very frustrating, because we don’t do things the same for very long. So, I think, for some of those personalities that don’t like change, they don’t last long working for me because we’re always trying to change and innovate and do things differently. I think the areas that I hate are financial management, and I’m lucky I’ve got two brothers. One works with me and does the marketing, business development, the other one has taken control of speaking to the banks, doing the cashflow, managing the stock. I’m not a numbers person, I’m an experience, creative person, not a numbers person.

Prav: What about the people side of things? You just mentioned that, obviously those that don’t like change, don’t last. Is it you that does the hiring and firing?

Elaine Halley: No, not particularly. I’m quite a good delegator. I have a brilliant practise manager, she’s one of the members that’s been with me for over 20 years. She started with me as a dental nurse when she was 19, so we’ve been through a lot together. I leave a lot of the hiring, I get involved but my team, our culture here is so well established after all this time, that it’s usually obvious pretty quickly, who fits and who doesn’t. I like the… done a lot of reading, as we all have, on business books and how to develop culture, and that was the hardest thing I felt when trying to replicate, that’s the bit that was hard. But in a small, contained area where I’m here most of the time, it’s easier to influence. Blame a system, not a person. Treat your team members how you want them to treat your best customers, making sure you say, “Please,” and, “Thank you,” and treat everybody with respect.

Elaine Halley: And I do believe, and always have believed, that every member of the team is as important as every other member, so I don’t believe in the sort of hierarchy. I think we’re a team, and we all need each other.

Payman: Elaine, give me one book you’ve read on the personal development business side, that really resonated with you, that you keep referring back to.

Elaine Halley: The Seven Habits of Highly Effective People, Stephen Covey. And that habit four, and I drive my kids mad trying to teach them these habits, but that habit four, seek first to understand and then to be understood. I think that, in itself, if we can just go through life trying to understand and ask questions before we jump to judgements and assumptions. I think the world would be a happier place when we can all remember to try and see things from someone else’s perspective before jumping in with our own thoughts.

Payman: [inaudible] but first principles man, you can’t beat first principles. And then what about, as far as dentistry lectures, you said early on that Rosenthal lecture grabbed you. What about later, when you’ve had the opportunity to meet a lot of these guys and from the lecture perspective, which lecture do you think, you sat in it and it blew you away more recently? Would it be [inaudible]?

Elaine Halley: Yeah, well obviously I think Christian is an amazing visionary, thinker and I’ve really embraced the digital workflow. I think before that, one of the key moments was going to the States, and the very first AACD that I went to after a group of us had got together in the UK and thought, “Right, let’s go.”

Payman: Which one was that? Where was it?

Elaine Halley: Orlando. [Carinda Hundel] was there, Chris Orr, David Bloom, few dental technicians that I know from London. And sitting in those lectures and just thinking, “I don’t know how to do dentistry like this, I’ve never seen composite dentistry that looks like that. I haven’t been taught how to do that.” That kind of wow, there is a whole other world that exists outside of Section 63, that existed at the time. So, that, and then I think, I’ve also always been interested in the clinical, chemical side of things.

Elaine Halley: So, [Pascal Manieu] was another huge influence, and Newton Fall was the other one. I went to [inaudible] and did his-

Payman: Oh did you?

Elaine Halley: Yeah, that really was life changing. And then Pascal Manieu, I followed around like a little groupie for a while. Just that merge of the science and the evidence. And then, the art and Michelle Manieu, his brother, as well, was the first, I guess, insight for me that art is related to dentistry. I hadn’t got that before, but I used to just sit in his lectures and not write a single note down and think that was amazing, and other dentists would be complaining that they hadn’t written a single note down. He was saying, “Go to art galleries, study form, open your eyes to that aesthetic world.” And I think dentists often were science based, that’s how we managed to get in to dental school, we’re very heavily influenced by science and I think it’s so important to be able to open that other side of your…

Payman: You know what, my kids are in french school now, and the system there, you don’t shut art out when you go into science. But the system here, we do. In a way, you’re taught, all three of us, we’re zoomed in on, I don’t know, you guys probably did biology, I did maths, physics, chemistry. Zoomed in on those and there wasn’t even a question of a, what about design and art and these sort of… those subjects, in our world, were considered just bullshit. Don’t go near those subjects. And then now, I don’t know about you, Elaine, but for me, I’m thinking my natural position might be in art. Not drawing art, but the arts rather than the sciences.

Elaine Halley: And interestingly, my son, my eldest, is studying fine art, fine art with history of art, and I have so encouraged him because from an early age it was obviously his thing. But I have learned so much from him because like you, art was shut down. If you couldn’t do science, you could do art. My knowledge in art was so limited and so, yeah, you experience the world again through your children, often, don’t you?

Payman: Yeah.

Elaine Halley: I’ve really-

Payman: Tell me about the world of, I don’t want to call it politics, because BACD’s not really like that, but that world, the world of getting… starting an organisation. You were really there, right at the beginning, and then getting members and meetings and who’s the president and that whole world.

Elaine Halley: Yeah, so BACD came about from that first AACD meeting that we were at, and we were sitting there, David, Chris and [Surrendra] and actually myself, at the time, and we were saying, “Do you know what? For all of the versions of us that have come here, and travelled to the States, there must be so many people back home that wouldn’t make this journey.” And again, it was before internet learning, there was none. The only way, in those days, to find out was to travel. So, we decided to come back and invite all of the Britain members of the AACD to a meeting, to see would they be interested in a British version.

Elaine Halley: And we held that meeting in London, and there was me, Chris and David, because we’d literally written it down on the back of an envelope what we thought a good organisation would be. We were blown away at that first meeting. I was the secretary, of course, naturally [inaudible]. Delegated, David and Chris. [inaudible]. Yeah, so we signed up, I think something like 70 odd members on that first meeting, not knowing what we were doing. And Chris, luckily, was a natural. He knew about constitutions and he knew about-

Payman: As a student, he’d done something, didn’t he? European dental student.

Elaine Halley: Yeah, he’d been heavily involved with the [IFID], the international student thing, so he knew, he understood. David and I had not been able to get in to another aesthetic organisation. That was-

Payman: Because it was at the golf club, wasn’t it, back then?

Elaine Halley: Yeah. So, I didn’t know anybody in it, and you had to be nominated, and I didn’t know anybody. We very much from the beginning wanted BACD to be inclusive, because I never was any good at playing the boys network thing, surprisingly. It didn’t interest me and I wasn’t going to know anybody.

Payman: But then when you fast forward to, I don’t know, the 15th meeting, where you’ve got 400 people turn up and you’ve got international speakers, there must have been some satisfaction, seeing that thing that it become, how big it came.

Elaine Halley: Massively proud of that, I mean I think we did a good thing. When I look back at my career, what is the thing you’re most proud of, being there, it was the three of us, that we did that. And these things then rely on everybody else, and there are amazing members and the people that came after us. We didn’t do it perfectly, by any means. We were finding our way, but the buzz and the camaraderie and the, I think, the education, the benchmarking of standards, all of those things that came with the BACD is a good thing. So yeah, I mean, at the time it was quite overwhelming. We didn’t know it was going to be such a success when we started it.

Payman: Yeah, you never do, do you?

Elaine Halley: But very proud, very proud to have been part of that.

Payman: And what about the accreditation process? I mean, if I’m a young dentist, ambitious, whatever, would you recommend that to someone?

Elaine Halley: Yeah, so the accreditation is about benchmarking yourself, so the point of having an accreditation process is to say, these are examples of doing dentistry to a high standard. It’s not… We can all study and pass academic qualifications, but accreditation is about practical. Here’s your cases, your justification, but it’s actually your clinical dentistry. So, nobody has to do accreditation, but I think if you’re brave and you want to benchmark your clinical dentistry against a high standard that’s not easy to attain, there’s massive professional growth and personal satisfaction from doing that.

Elaine Halley: It’s also a very vulnerable thing to do, because you might not pass every case first time. Anything that’s judged by your peers, you have to put your ego to one side and you have to go, “Here’s the best that I did, can I have feedback? How could I do it better?” But that’s how you grow, isn’t it? That’s how… You have to tuck your ego away and go, “Okay, this is it.” Bare your soul and learn.

Payman: It’s a good time to talk about our ego breaking moment of our podcast, that we ask every guest about mistakes. In medical dental, we don’t tend to talk about them enough, but we’ve decided to try and buck that trend and discuss clinical errors or different people answer in different ways. Answer any way you like. What have been your biggest mistakes?

Elaine Halley: Yeah, I think, I mean that book, Black Box Thinking, Matthew Syed, I think we should be talking about our mistakes, because to pretend that we don’t make any is ridiculous. We’re humans, often working under time pressure stresses, and one thing about being in the same practise for the length of time that I have, is you see the things that go right as well as the things that go wrong. I’ve made… I’ve drilled the wrong tooth once. When I had a visiting oral surgeon, and I looked at him and he looked at me, and it was taking off a crown. I had drilled through the wrong crown and because we were both there together, I had to say to the patient, I just had to say, “I’m so sorry, I was looking at the wrong side and I drilled through the wrong crown, and I will replace it.” She wasn’t very happy at all, I think she did write and complain and luckily the oral surgeon backed me up with the… You know, we were doing a difficult procedure and these mistakes can happen. That wasn’t very comfortable.

Elaine Halley: I’ve had a complaint against me to the GDC, like most of us have, when you’ve been around for as long as I have. It wasn’t my patient, it was a patient of one of my associates that I saw for one appointment. But what that highlighted was that I hadn’t re-consented the patient to be treated by me, and as usual, what she was complaining about was not the thing that we all then got in to trouble with from the GDC, it was record [inaudible]. And so, I had thought that I was taking photos of everything, I thought I had a very well documented consent process, but it didn’t conform to the GDC’s idea. Taking a photograph isn’t enough, you have to write down what’s in the photograph, even although my thinking was, you can see, the photograph’s there.

Payman: We can talk about what you learned from that was, whatever, write more notes, but what can you tell someone who’s going through that, or has never been through that process and has just got their first letter?

Elaine Halley: I think, as everyone says, it’s awful. It’s horrible. It certainly made me really close to wanting to say, “Enough.” And I think it’s partly the fitness to practise, is those words, because if it’s fitness to practise then you’re unfit. If you’re found to be wrong, that means you’re unfit to practise and if you really are trying to do your best, which most of us are at all times, but as we’ve said, we are also humans. We won’t do it right all of the time, but our intention is to do it right. I think the thing to do is talk about it. I’m a great believer in talking, and talking probably sometimes to my detriment, sharing too much, but I’m great believer in if you talk something through, a, you feel better because you’ve put it in words and got it out of your head, but also you’ll find that there are other people who’ve been through the same situations. I think, as a profession, we’re getting slightly better. It used to be a thing to be ashamed of, didn’t it? And you would dread that anyone found out that you’d had anything go anywhere near the GDC.

Elaine Halley: And I think there’s been some good, prominent… Colin Campbell and the likes that have really spoken up about a, the fact that it happens to most of us. I think that is just a given, it will happen, and the fact that it happens to good people. It doesn’t mean you did anything wrong, but you do have to take it seriously and reflect. You do have to take it seriously. There’s no point getting angry about the injustice of it, you’re in the system that we’re in. I do think there’s some reform that could be made to that whole process.

Payman: There’s been some reform, hopefully, and they say it’s getting better. When we qualified, it really was the bad people, wasn’t it? It was about fraud and stuff like that. That’s why it was shameful, because it was a bad-

Elaine Halley: It was the people that’d done something wrong.

Payman: Yeah, you put your fear on it. Before I said to you, what’s the thing that drives you the most, and you were like, “Solving a problem for my patient,” is what drives you the most, and then you see this things that says you’re not fit to practise, that’s the question. And those two things, the thing that drives you the most is being put in question. I see you getting some flashbacks there. What about in your personal life, if you had half a day to yourself, what would you do? I know you don’t.

Elaine Halley: I go walking with my dogs up in the hills. My friends and my dogs. Nature, looking away from your hands, like looking…

Payman: And your kids, I know you said you don’t want to tell them what to do, but one of them should be a dentist, right?

Elaine Halley: No.

Payman: It makes sense, doesn’t it?

Elaine Halley: Well, I would be very delighted if any of them wanted to be a dentist. I’ve still got, one of my youngest is 13, so there’s still hope. So, I would be delighted but my son was so obviously art, I mean it just was going to be art or musical theatre. And what I want for all three of my children is for them to study the thing that interests them, not necessarily the… Whereas my generation, I think it was about the job and the career, whereas I think if you’ve got any creative bone in you, follow that because that will serve you well in later life. And all the business books you read, find what you’re passionate about and follow that. Yeah, my son’s fine art, my next daughter, she’s at uni doing animal sciences but she’s probably going to do some type of farming, horses, something like that. And the little one, who knows? She’s only 13.

Payman: What about teaching, Elaine. I’ve watched one of your lectures that really actually turned my idea of potential smile design. I studied [inaudible]. I thought I could smile design myself, and the people that didn’t know how to do it had to digitally smile design, until I watched your lecture and you really explained it well, especially the video before and after that really resonated with me. And it suddenly makes you realise, out of all these years we’ve been doing the [inaudible] for them, there’s no video on this podcast, but [crosstalk].

Elaine Halley: Perfect smile.

Payman: Yeah, why [inaudible] that’s not how we see each other? But with the teaching, do you prefer the practise side, the management side of the practise, the treatment planning like you were saying, the empathy side with your patients? Or do you prefer the teaching side?

Elaine Halley: Do you know, I really love the balance. I’ve asked myself that question a lot. I think I wouldn’t be as good a teacher if I wasn’t working with live patients and facing the same challenges that people do in practise. But what I’ve always loved is sharing. “Look, I’ve tried this out and I’ve been through this sequence and I’m putting it in practise and it’s working. I’m getting good results, so let me explain how I’m doing that.” That’s the bit of teaching that I’ve always loved. “This is how I do it, and I know it’s worth telling you about because it’s working well for us.”

Elaine Halley: I really love the clinical director job that I’m doing with Pain Free Dentistry Group, because I’m there as a sounding board for all of the… they’re all associate run practises, and so I really love… They send me their difficult treatment plans and we look at things together and I’m trying to tell them to slow down, you don’t have to have all that answers, and when the patient’s in the chair, gather the information and then take your time. And then when I hear them coming back with my words, it’s like your children, coming back saying, “You’ve always said, I did this.” And you think, “Oh, that’s great, that’s making a difference.” And ultimately, for patients, that’s making a difference. Everyone’s winning out of that scenario.

Elaine Halley: I enjoy the teaching from a, not look at me, this is how great I am, but from a let’s all get better together, this is a collaborative process.

Prav: Because Pain Free Dentistry, how big is that group?

Elaine Halley: They’ve got seven practises now.

Payman: It’s a bold name, isn’t it?

Elaine Halley: Yeah, very bold, very, very clever. Very clever dentists. Again, not frightened about what people think, just set a value and going for it.

Payman: What are they like? Are they all private?

Elaine Halley: Some of them are a mix, but with an emphasis on private. Again, it’s a bit like the dental spa, but just taken to another extreme. It’s about doing everything we can. If you’re going to say you’re going to be pain free, you better make sure that you’re doing everything you can to make that patient journey as comfortable as possible. It’s again, speaking to the patient rather than-

Payman: Do they have all those sort of machines to give [inaudible] and stuff?

Elaine Halley: Yeah, the electronic anaesthetic, yeah. [crosstalk]

Prav: Is the whole pain free group around, is a big part of it focused around emergency dentistry? Is the whole point is it’s focused around dental phobia, is what you spoke about earlier, just providing the whole range of treatments but attracting those patients who are more anxious and concerned about pain.

Elaine Halley: Yeah, it’s about what are the barriers to patients seeking dental care? We’ve known those four barriers forever, haven’t we? And fear of pain is still one of the major-

Payman: It’s number one.

Elaine Halley: Yeah, fear of pain, fear of cost, no perceived need, and lack of time. So, pain free is about, let’s break down that barrier, let’s do everything that we can to make dentistry accessible. That’s the value set behind that.

Payman: I don’t know if you’re a fan of this podcast, Elaine, but Prav always ends it with the same question.

Prav: Do you know what you’re about to let yourself in for, Elaine?

Elaine Halley: I listened to [inaudible] one last night.

Prav: So, Elaine, imagine it’s your last day on the planet. You’ve got your kids around you, your loved ones around you and you need to part, leaving them with three pieces of wisdom, advice. What would they be?

Elaine Halley: So, my children, we do talk about this some times. My number one thing is be kind, that’s always my number one bit of advice. Just be kind to each other, be kind to yourself, just be kind. The second thing I always say, is get a good nights sleep. Whatever is going wrong, whatever you’re worrying about, just try and get a good nights sleep and things always feel better in the morning. I guess the last one is, just be open to new experiences. Say, “Yes,” to things. It’s okay to be afraid, it’s okay, it’s that feel the fear and do it anyway. It’s okay to be nervous, but say, “Yes.” Experience life. Don’t not do things, take the opportunities.

Payman: Good ones.

Prav: Excellent. And what would you like your legacy to be, Elaine? Elaine was, complete the sentence. How would you like to be remembered?

Elaine Halley: That’s a tough one, isn’t it? I guess, that I lived, I said, “Yes,” to opportunities, I made the most of life. I think that’s all any of us can do, isn’t it? But appreciate every day that you have and be happy.

Prav: And imagine you were given the news that you had a month to live, so you’ve got 30 days. What would you do for those 30 days? Let’s say you had your health and everything all intact, not 30 days in bed and ill or whatnot, but you had 30 days to do whatever you wanted. How would you spend them?

Elaine Halley: The thing that comes to mind is stand on top of mountains and walk on beaches, just get out into nature with friends, with people that you love. Laugh, just really enjoy the physical being. I think I would very quickly hand my practise over to my associate. I don’t think I would spend 30 days treatment planning.

Payman: What’s your favourite place you’ve been to, Elaine?

Elaine Halley: I love the north west of Scotland. There’s a beach, [Clachtoll] Bay, up in the north west of Scotland. White sands, clear water, freezing cold but stunning. And yeah. I’m more drawn towards the north, also the Lofoten islands off Norway, I loved it up there, beautiful. So, I’m more a cold person than I sun seeker. The sea, but yeah.

Payman: The cold sea.

Elaine Halley: The cold sea.

Prav: Ice baths and cold showers, Elaine?

Elaine Halley: No, not quite, I’m not that [crosstalk]. I know that’s good for you, but no.

Payman: Well, it’s been a lovely conversation. Thank you so much for doing it, Elaine.

Prav: Thank you, Elaine.

Elaine Halley: You’re welcome.

Payman: So nice for someone listening to this, to see that someone who has gone as far as you have, can be so open and honest. There’s no magic answer, is there? Behind work hard. [inaudible]. Thank you so much, Elaine. We loved it.

Elaine Halley: Thanks for having me, I appreciate it, thank you, bye.

Speaker 2: This is Dental Leaders, the podcast where you get to go one-on-one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.

Prav: Thanks for listening, guys. If you got this far, you must have listened to the whole thing and just a huge thank you, both from me and Pay, for actually sticking through and listening to what we’ve had to say and what our guest has had to say, because I’m assuming you’ve got some value out of it.

Payman: If you did get some value out of it, think about subscribing and, if you would, share this with a friend who you think might get some value out of it, too. Thank you so, so, so much for listening. Thanks.

Prav: And don’t forget our six star rating.