And also inspiration. And we’ve not done this before, but it is the only way I can see for us to get around this problem and if nothing else will have a plan B and then we’ll have a plan C and that tends to be enough for them. But as said before, you know, to do that, you need to be bold sometimes. And the current climate in clinical dentistry doesn’t allow for that. It doesn’t allow for people to just I don’t like to use the phrase have a go dentistry because having a go suggests a bit of recklessness. But you need to be bold and you need to be able to say, okay, I’m going to give myself the kit. I’m going to give myself the time. I’m going to choose the right patient and I’m going to just go beyond that comfort zone, because the alternative is you’re going to be practising the same way in your 25th year as you were in your in your in your first year. And that’s a real shame.
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.
It gives me great pleasure to welcome Amin Aminian onto the podcast, one of my heroes in dentistry for lots of reasons. The main one is that lots of people don’t know Amin Armenian and the people who do know him think he’s the best. He’s amazing. And I often think what would have happened if you had a big Instagram presence and you were out there, but but one of the reasons I was so so look up to you is a very modest person who’s one of the nicest guys I’ve come across in dentistry. And yet his reputation precedes him. Like people really, really around the Manchester area. People really, really do respect your work. So it’s a pleasure to have you. Amin Payman.
Thank you so much. I appreciate the invite. Now we met. Whatever I tell you, when it was, it was about 12 years ago, I think we’d been in our practice a year when you when we worked together at the composite course for the Masters. Manchester? Yeah. 70 odd people in the room. It was. It was bonkers. But thank you so much. Thank you. I really do appreciate this invite.
So, I mean, you’ve you’re the principal and the founder of Clinic 334, which is a purely referral based practice. Is that right? What percentage of your work is referral based?
Oh, man. Nowadays I think we’ve whittled it down to about 99.9% now. The I inherited a very small group from one of my predecessors who I’ll probably mention at some point over our chat, David Eldridge, and there were probably a handful that followed me from other practices, but it’s all pretty much referral now. The systems, believe it or not, are quite different between a referral setup and a general setup. In a general setup, we need the recall program. We need the on call service. That’s quite different to a referral setup. So the two I find don’t mix particularly well. So over time we’ve asked our general patients to join local practices that we’ve been able to recommend and focus more on the referral cases.
So look, this show we tend to talk about sort of from the beginning to the end, where did you grow up and all of that? But sometimes I find I don’t end up asking the key question I want to ask. So I tend to now start with a key question I want to ask. And it really is around that question of why are you so low profile? Is it on purpose or by mistake? I mean.
Do you know what? It’s funny. I think you’ll probably find that as we chat, I’m so contradicted over so many, contradict myself in so many things. And one of those things is my approach to social media. And I honestly think if we were setting up now, I’d have to we’d have to embrace it. There’s no way of developing any kind of referral base. But, you know, we were lucky. We’re low profile because we appeal to local practitioners. We do it through the courses. We run through study clubs of the practice, through word of mouth. So we’ve not spent a penny on marketing over the 15 years. And, you know, I can’t say to you and say our model works. All I look at is not not don’t look at turnover. All I look at is, is number of referrals. And if they are increasing, that’s a good sign. If they are decreasing, then obviously that’s something to look at whether take patients, take up treatments or not. You can’t control that. You can’t control what’s happening in the wider economy. But for me, the marker is referrals and as we’ve included more colleagues and more specialities and, you know, none of us have any kind of presence. I mean, James D’Arcy, a brilliant guy at our place, I think he does a bit on Instagram, but we rely on word of mouth. For me, there’s nothing better than a patient who’s had treatments, who will then talk to one of their friends and their friends will want to be seen by us and we won’t see anyone unless they’ve been referred. And that friend will have to go to their dentist and ask for a referral. Well, get referred in. We hopefully do the treatment to a really good standard. And then if we’ve kind of every step really looked after that patient, then we’ll hopefully get another referral. So it’s slow, man, It’s slow. And you know, there are times where we drop the ball, but on the whole I think we’re, we’re pretty good at it.
Yeah. As I say, your, your reputation is really beautiful. I mean, it’s golden and I spend quite a lot of time in that way with the course. The mini spa maker and I obviously meet dentists from there and yeah, it sounds like it sounds like. Sounds like you’re doing something right.
That’s very kind. But I’m also hoping the reputation is of the practice. You know, it’s not just just of myself. And and if it’s the practice, it’s one of the reasons I was keen to have this kind of chat with you is that I don’t often get the chance to talk about the team that we have at our place. They are just incredible across the board, clinical, non-clinical, but I’d like to think we all, we all try and do the same thing. We all try and look after our patients to the to the nth degree. Sometimes it works. Occasionally it doesn’t. But I’d like to think that if anyone is talking about our setup, it’s because they know their patients are going to be well looked after. And if that means, you know, if that’s the the bar that I set at the beginning, then yeah, I’ll take credit for that. But then everyone else has to kind of work to maintain that.
Amazing. Take me back. Take me back to the first time you thought I want to be a dentist.
Oh, man. I was 14, 15 and a family friend. So similar to a group of my group of friends that I hung around with at dental school. You know, we didn’t follow the the family line. We didn’t, you know, there was no one in our family that had done dentistry. I was kind of clueless, went and spent some time observing at a local practice and thought, this is Ace, this is good. Where were you?
Which town were you in as a kid? Sheffield.
Sheffield, Yeah. Yeah. Went to school in Sheffield at the time. Still would have given anything up until a couple of years ago. Would have given anything to play football. But yeah, so it was it was a it was an aim. I didn’t know much about it. It was only a week that I spent there and didn’t really pay. You know, you don’t realise that at that time, you know, as much as you’re observing. I wasn’t particularly looking into how that that practice was working, how what dentistry really involved was. I was sat there observing and just loved, loved the dynamic in the, in the practice, in the surgery between the dentist, the patient and the dental nurse. And then that was it. They did the we were the very last year of the O-levels. So did that and did pretty well, went to did my A-levels and failed abysmally. And you know, you talk about kind of moments in your life that you learn lessons. Try going with your dad to pick up your A-level results when he’s kind of paid for you to go through independent schools and had to kind of make some unbelievable sacrifices. It’s going to pick up your A-level results and find that you’ve got a C, D and an N, you know, an N an year passed and you can’t get any more humiliating, really. Um, but, you know, and so obviously that was I wasn’t going to get into anything with those results. And you look back and, you know, in the lead up to our chat today, it has made me kind of look back and reflect and, and at that stage I could have gone for recess or gone for I think it was biological sciences or biomedical sciences. And for whatever reason, I thought I’d do a reset and did the resets. Really lucky in that, got the grades, get into Liverpool and then moved on from there.
So Sheffield of late 80s, early 90s I guess, right. Is that what it was. Yeah. Different place to what it is today. What was the reason. Were you were you were you like an early early party animal like what was the reason that you didn’t study and I guess you learnt your lesson and then going forward in dental school, did you end up being the serious student or what were you like?
So I think as with a lot of kids experience more perhaps with GCSEs where you don’t have to work particularly hard. I didn’t feel I mean, it’s different now, I know, but for, for O-levels, you know, I had a particular work ethic that obviously got me through and that work ethic is nowhere near what you need for A-levels. You know, just sitting in a library for six hours staring at a book doesn’t mean you’re revising, you know? So my my revision method was poor at best. And I look back and I actually think I probably went into those exams confident. But how misplaced must that confidence have been just because you’ve sat there looking at the book, you know, and you transfer that forward, you know, a couple of months and would have been going to those pick those results up, hoping that I’d got decent grades. So you can imagine, you know, the world falls from under you. You’ve got, you know, with my dad, we’ve gone to get the results and I take my hat off to him. How he didn’t wipe the floor with me on that day, you know? Um, but is the testament to the man is incredibly patient man in him. And he said, that’s fine you know we’ll we’ll find a way around it. But it was, it was that it was it was a bit of parting and it was a bit of just lack of focus, lack of focus as a city. It was a, you know, it was a fantastic city. And I’d recommend anyone who’s not been there to go there. But it’s it was it was more down to me being, yeah, losing focus.
Tell me about dental school then. So you got to Liverpool was it Got Liverpool?
Yeah. A year older than a year later than I should have done. Expecting to be the. Lived on my own there for a year, expecting to turn up for Liverpool and and be the mature head. But you know most guys I spoke to had had had resat or taken a year out and yeah I was, I was lucky it just fell in with just what I consider still a good group of mates. I didn’t live in halls because I’d lived on my own for a year and I’d kind of lived independently, so I was basically skint. So I was living on. On the grants you had at the time. So lived in a house share in Toxteth and if you want a kind of a baptism of fire. So the I lived in a, in a, in a house next to a Jamaica house, which was a nightclub next door. And on the day that I moved in, there was a police cordon outside with a white chalk mark of someone who’d been stabbed outside the night before. So it was like, welcome to to Liverpool. But it was it was the most fabulous four and a half years.
Such a great city for university. Right. It’s just the just the right size for a university.
It is just the right size. And it’s and it’s.
And the people are just amazing. It must I don’t know. I’ve obviously never been a student there, but I’ve spent a lot of time in Liverpool and I’m actually trying to persuade my son to go to Liverpool now because there’s a size of town, isn’t there, where it’s just big enough that there’s enough going on, you know, whatever you’re into, whether it’s sports or music or whatever. But then it’s just small enough that you’re going to bump into people, you know, like in London, if we ever bump into someone, you know, you’re never going to bump into them again.
That’s exactly it. And I’m not sure what’s happened. You know, I’ve not been to Liverpool for for a few years, but I know it’s obviously kind of blossomed and grown. But, you know, but that it’s also the pulse of the place is quite unique. And I think that is something that anyone who goes there will pick up on in it. And the people are amazing and it was a wonderful place to be a student. For me, it was quite a cheap place to be a student. That was great and we had the most amazing time and not and it’s not necessarily just going to, you know, the typical student places. You know, we we also used to work in a bar in Liverpool. Kirkland’s some people might know. So there was a social circle that came with that as well. That was on a Friday, Saturday night, all through the holidays, I’d work in the bar and manage the bar occasionally, and that in itself was just added another sphere in social life. Yeah, it was amazing. It was amazing. It was amazing. I learnt a lot. So were you.
Top of your class in dental school?
No, no, no, not at all. Oh, man. No, no, not at all. I was just that bang average guy in the middle. And then the came to finals and I had a pass fail Viva in Pedes. And was it Paediatrics and Orthodontics? So, yes, again, on the day of the results coming in, my brother came up with his wife Sarah, expecting me to pass. And obviously if you remember when they put the names on the notice board and if your name’s not on the list you’ve passed, if it’s on the list, you’ve got a viva. So they’re there expecting to celebrate. But I had to go for a viva, so.
I don’t know why. It makes me happy to hear that. You know, it’s interesting. Yeah, because we had Basil Mizrahi. He was saying he was, you know, middle middle of the road. Dental student Andrew Darwood, one of my heroes, He was saying he was almost didn’t get through dental school either. And it goes to show, doesn’t it, that you can you can get serious at any point in dentistry or, you know, it’s not necessarily dental school. That’s what can define your career.
Absolutely. You know, and it kind of and it’s I was talking to we often have young graduates who sit in and observe. And that’s one thing that I’m going to try and push more and more over the next few years is trying to get young graduates in. And we had one in last week. And she was saying, you know, there were being asked to choose a career or choose their specialities as quickly as possible because they’ve been told that time is of the essence and just don’t get that. I honestly don’t get that because if you’d asked me within a year or two of qualifying, what would I have wanted to do? I’d be been on a completely different trajectory to what followed because it did take me three, 4 or 5 years to work out. So yeah, middle, middle of the road.
That’s funny because the I give that advice to young dentists, pick something and go for it, which is opposite to what you’re saying. Don’t you think? If you had done that, if, let’s say you’d by chance picked Endo and gone for it, don’t you think you’d now be one of the top end of dentists in the country as well?
Um, I just can’t imagine I’d get I’d find another specialities fulfilling. I honestly can’t. The variety that I get from my working day in Prosthodontics is just insane. And again, that’s the other reason I try and encourage young graduates to come and observe, because unless you’ve seen it, you’ll assume it’s all tooth wear or you’ll assume it’s all implants and it isn’t. You know, there is so much to prosthodontics and I’m more than happy to bang that drum. From what I’ve seen of Andover, it’s the one thing that I couldn’t I couldn’t do. I don’t think maybe, you know, you can’t maybe I can’t be accurate in saying that now. But in my choice that I made in Prosthodontics, I think I made it at the right time. And that was kind of a good three, four years after qualifying. And I think if I’d made a choice any earlier, I’m not convinced it would have been the right one.
Fair enough. So what did you do after you qualified? What was your first job?
Oh, man. So, you know, I always think kind of blessings are either the people you come across or the circumstances that happen. And so you know, I’m going to go back a stage. So, you know, just before we sat finals, I need to Eileen Thiele, lovely lady, head of perio and she said, you know, if you carry on the way you’re doing, you’re going to fail. There’s no chance. So you come in. Coming to sit in one of my consult sessions for Over your Christmas, I think it must have been summer holidays, actually, because we sat our finals in December just as you come in and went to all the consult clinics throughout the whole of the summer and that was a massive game changer. And then when it came to at the time, it was it was again late for applying for positions and didn’t have anything lined up at all. But a good one of my best mates, Hugh, he found he got a job in North Wales thinking that he wouldn’t get a house officer’s job. He’d signed the contract for the position and then found he had a house officer job. So he then he tried to he wanted to do the house officer job, but he already signed the contract. So Tim, who was who was going to be his trainer, was obviously not happy because he was going to lose out on a trainee.
So obviously Hugh and myself see it differently. He sees it as he gifted me a job. I see it as me saving his ass by taking the job. But either way, it was a match made in heaven. He he did his job and now was a successful consultant. In fact, I had the most amazing year and a half. And that first year in in North Wales was amazing. You know, we said to you, we talked about Liverpool being a brilliant place and everyone wanted to stay there when they qualified. You know, everyone was trying to get to the practices that were within Liverpool. We myself, Greg and Indi ended up in North Wales and in hindsight it was the best thing to get away from Liverpool to to fresh surroundings. And, and Tim was my trainer and between him and Rob Shaw, who was the course organiser for the North North Wales scheme and I know everyone on that scheme had had an amazing program. I myself had a brilliant introduction to dentistry. So at the end of that year you’re kind of going into to your associateship, you know, flying because you’ve had you’re going in with optimism and having had a good laugh and having having had a good grounding, did that for a year, year and a half.
It’s like a launch the launch pad, isn’t it? Like your early jobs, particularly your first job, I find your first boss can really set a trajectory in terms of mindset for you.
There’s there’s so many aspects to that first job and and it really saddens me when I speak to the foundation trainees and they’ll talk about how they don’t get on with their trainer, how, you know, even if you don’t learn a lot, just finish that year. Enthusiastic, feel enthused where the moment you’re thinking you’ve chosen the wrong career. It’s just so sad because to try and turn that around on your own terms or in your associate is, you know, of course all you need is one poor job choice as an associate. And then that’s that’s, that’s you, you know, you’re, you’re spiralling and, and I hope and I do hope that trainers do do kind of spend as much time not just in the clinic but outside the clinic just trying to remind these young graduates, you know, they made a great choice. It’s a brilliant career. It’s got lots of avenues where they can they can follow, but it may not be general practice, but there’s so many other things they can do. It’s and Tim and Rob were really supportive in that. And I remember when I said to Tim, you know, Tim, you know, Tim, I’m going to leave. It was gutted, but it was it was incredibly supportive at the same time.
Did you leave straight after the first year?
That one year did an extra six months. And then I we moved to Manchester. Greg and I shared a house and and then went to the Falklands for a year. That was always interesting.
Yeah. So I read, I read you became the clinical director of the fork. The, what was it? The head of the head of the. History at the.
Sioux people there. So the first one there is the head of the clinic. Yeah. So so.
The actual the job role called.
Clinic. What was it?
Chief Dental Officer. Chief Dental.
Officer. Yeah. Dental office Officer. Yeah. So to apply for their masters. So realised that, you know, straight away there was, there was, there was a hole in my kind of understanding of bridgework and fixed pros. So applied for the MSC Sir Manchester met Prof now Sir Nathan Wilson again another blessing. Great. And he and he said, you know, you’ve just missed your cut off so we can’t take you on for this year, but you know, you’re in for next year. So add a year to kill. So I thought, you know, what do I do in this advert came with for the Falkland Islands. And I remember thinking, oh, you know, apply just to see what it’s about. Went down for interview, did the questions and, you know, came to the end of the interview and they asked me, you know, what do you have any questions? And I said, Yeah, yeah, I’m intrigued. Why? Why do you want someone just for three months? Because I thought it was a short term locum. And they said, Well, no, no, this interview is for the two year post. Sorry, I can’t, I can’t. I can’t commit to that. I’ve got I’ve got a programme lined up in 12 months time. So we called it an end. And a week later they rang up and said, you know, we’d still like to offer it to you for a year if you fancy it. And there’s me thinking, obviously there’s not many. There’s not been many applicants. That’s the reason why. So but yeah, that’s fine. You know, it’s a year to save some money expecting not to spend anything and, you know, just so naive about it, about where it was and what the job would entail. Took the job. I remember just, you know, getting on the Tristar, Brize Norton, stopping at Ascension, getting off to stretch your legs, getting back on again, flying into Stanley and, you know, being escorted by the tornados. They always do that when you get into the Falkland airspace and then just getting on the drive into Stanley itself and just thinking, what have I done? What have I done?
Was it a military role?
No, no, no. That’s the thing. So the nothing to do with the dentist? No. No. So you’re employed by the government?
Employed.
So you’re purely looking after the inhabitants of the island. So the military.
Like if let’s say let’s say someone touched me down in the Falkland Islands or dropped me in the Falkland Islands, would I think I’m in North Wales or something or is it completely different?
It’s quite nothing. Nothing like it. I remember on the way down there I’m going to show how borderline idiotic I am. So on the way down there, we we popped into Costco to pick up some things, you know, things like thick winter socks and things. And I thought, you know, just there was a massive, you know, Costco have everything on the mega scale. They had this massive atlas. So I opened the atlas to find out exactly where it was. And I kept turning the page to go further and further south. And in the end, you can see this very you know, it’s on the same page of Antarctica, south Georgia, on the same page. And and what you have.
Is freezing.
It. You know, the winters were cold but crisp. You know, it’s for me it was reminded me of Sheffield. Cold, crisp winters, beautiful, warm but windy summers. The landscape is barren, but in a beautiful way. When the when the gorse is blossoming, you know, it’s this amazing, vibrant yellow. Yeah. It’s, you know, it’s got mountains. It’s got, you know, for me as a kid who, you know, I was 12 in the Falklands War, so I remember, you know, there was a lot of those a lot of that geography was imprinted on your mind and you were seeing it in real life. You know, you you’d go on on little treks across the mountains and you’d see this these plastic carrier bags that were dug into the mud that had Spanish writing on, you know, this is what was left by the Argentinians. This is the kind of real life. But it was as far as you know, it was it was a year that you dropped into the deep end, you know, on every level. You had developed social skills Clinically. It made a massive difference for me because, you know, there was no lab on site. So your lab is in was near Oxford, so he would get picked up once a week. The lamp still insisted on the two week turnaround. So it was, you know, you were getting back on the third week and I think back back now and just think, why didn’t I not just ring him up and say, do you mind just doing this on a week turnaround? Because, you know, and he had to make sure the impression was good because if it came back and it didn’t fit, then you’d have to do the whole thing again. But what you did, have you had the time? If you wanted to spend three hours on a prep, you spend three hours on a prep, you want to spend half a day on a case, you spend half a day. So it was a it was a time where you kind of hone your skills. I think clinically.
Was there no question of sending it to a lab in Argentina or something that was that completely out of the question?
No, no, no, no, no. How about.
Visiting? Did you did you think about visiting South America at that point?
So it is so yeah. So I’ve not been back since, but the, the they still had the sentiments toward towards Argentina was still very raw. So, you know, at the time they were trying the Argentinians were trying to send their family over to visit the war graves in the Falklands. And there was a lot of resistance in the Falklands still because of of it’s it’s an amazingly unique place. It is the most British place I’ve I’ve ever been to. You know, they will take they will take a holiday for the queens at the time the queen’s birthday. They will celebrate every British event to the nth degree. And it is beautiful, beautiful for that. But the negative of that was that there was a there was a definite reaction to anything Argentinian. So yeah, if you if I mentioned that I was going to go and visit Argentina on my way back, you know, that was my card marked. But I’ve visited Chile. Chile was amazing. We represented the Falkland Islands in football. That was amazing. We went on a tour to South to Chile. Yeah, it was. We made the, the local press there. Mr. Penalty So yeah, so it was so you look, you know, you look back and it was an amazing 12 months.
And the work, the work was, you know, were you up to the work at the time or did you feel like you didn’t you didn’t know what you were up to? You didn’t you didn’t know.
What they asked for on the way out is, you know, as part of the job description, was to have someone who had good experience in everything. And that included or included oral surgery. That’s the one thing I hadn’t done. I hadn’t done a hospital job. So, you know, management of acute surgical cases, trauma, I hadn’t done it at all, but I kind of winged it, got there and expecting to hopefully as you do, as you do, and, you know, you look back and just so lucky and there’s a lot of fishing on big, big trawler ships in the Falkland Islands waters. And these huge, huge ships do everything from the fishing to the processing to the canning of the fish. So these are and these these guys are away from home. These they were mostly Koreans and Vietnamese guys were away from home for months and months on end. But, you know, health and safety isn’t wasn’t a big thing. And when you had an accident, it was a big accident. So they had you know, they had guys coming on with these, you know, quite serious injuries. And the one thing I could call on was the guys from Mount Pleasant, the Army base. So there was always a military surgeon, whether it be a dentally qualified or ENT. And there was one case that we we treated jointly where I was way out of my depth and they had thankfully helped me through. But it could have been a lot worse.
And it was soon after you got back that you decided you weren’t to specialise because I know you’d already had your place. You had your place, right? So, so, yeah.
So I came back to this. Yeah, came back and did the two year. So it was a two year part time program. Yeah. And so. Prof. Wilson And again, it was a time when we had. Paul Brunton He wasn’t a professor at that time who, who took on the program. And then the second year it was taken over by Fraser McCord and you know, it was an introduction to a team that included David Eldridge and Gordon Smith on the side, just the most generous individuals, both in personality and in their kind of willingness to share their knowledge. These these are guys who have been doing implants from the right of their very inception they brought into the northwest. And I, I promise you, I still see cases now that these guys treated in the 80s that are working beautifully. Well, amazing. And, you know, it amazes me, you know, they were doing this with five years knowledge, full arch cases that are still working. And it’s down to the testament of these guys who just knew their stuff, you know. And so we did the two years MSC program and Fraser, he realised that there was perhaps a demand for a specialist training program. And then myself and Neil, Neil Wilson and Anthony McCullough, we signed up for them for the four years part time program.
So, you know, you’re talking about six years, part time self-funded training. You know, it ain’t cheap. It ain’t cheap. But that’s why, you know, most of us kind of had to park the personal life. You know, we didn’t get married until quite late on because your commitments were towards your training. So it was, yeah, six years of part time, self-funded. And then at the end that’s when we got the specialist training post completed. I was working then with Robin Grey, who sadly passed, but again, another amazing mentor. And then these things, the difference now is that at that time it was it was a complete unknown. You know, there weren’t many, if any, specialist referral practices. So it could have worked. It could have thankfully worked out well, but it could have been. A complete duff where you kind of you’re still working it as a very experienced general practitioner, having, you know, spent a fortune putting yourself through these training programs. So it’s quite lucky to be at the right place at the right time. You know, it was different, different in London at the time. I think the referral practices were thriving there. But I think in the north west there was probably 1 or 2. Poor Tipton’s was probably the only one at the time. Yeah.
And so how long after you finished the six years did you open your own place?
As that was 2009, 2010.
And which year did you finish?
So I finished in 2004, worked with Robin Grey for probably about four years. Then Robin sold up. So myself and a couple of other guys, we kind of decided to go our separate ways. And then it was the same time that David David Eldridge asked me to step in and help him his place. And then we kind of inherited his referral base and then extended that into the clinic. And then at the beginning we rented premises, you know, again, because you couldn’t really commit. And then it was we were just renting on a sessional basis. As And when we were there before, you know, we were there Saturdays and Sundays. And that’s when the accountant said, you know, have you kind of thought about buying somewhere, you know, and when he puts the numbers in front of you, you’re thinking, well, this completely makes sense. And then we moved into the building that you’ve been to in 2011. Yeah. Yeah.
So those early years must have been quite hard in terms of getting the business on its feet. And, you know, you kind of had a huge referral base already at that point.
No, there weren’t, you know, there weren’t. It wasn’t. But that was the time where I’d work. You know, I was still working partly in the hospital. If anyone wanted sessions, you’d say yes. I worked at the Blackburn Royal as a locum consultant there for a couple of days, a week or a day. A week. The practice in Blackburn, I’d worked there probably an evening, if not a day a week. So you’d go anywhere and everywhere because you’d have to do the hard miles, you know, And it’s not about kind of making your week busy. It’s about doing the complex cases, doing the, you know, the only way you’re going to learn. But we had a good leg up with the MSC. You know, we did lots of treatments on the MSC were again, as I said, you know, the guys were really generous in giving us really nice cases. We and the specialist training programme hit the ground running from the first moment you’re doing a really nice big cases, so you’re going into practice with with a bit of confidence. And because we hadn’t committed to a property, you know, you’re only paying for the sessions that you’re there. It was, it was I couldn’t really lose.
Yeah. But you know, back then there wasn’t much in the way of education. I remember saying, I want to be a cosmetic dentist and looking and finding those one course in in London. I don’t know if you remember Howard Steen. Yeah, it was. He used to have this thing. He used to test test products adapt it was called or something and that was it. That was there was, you know, with the name aesthetic or cosmetic on it. That was the one course there was. Now today there’s almost the opposite situation, right? There’s courses on every single aspect of dentistry. I mean, even sometimes it becomes very, very specialised, you know, injection moulded composite course, you know, what’s your advice? And I know to become you a purely specialist referral based practice, it makes sense just from the marketing perspective to to be called the specialist and, and so forth. But but what’s your what’s your advice to a young gun who wants to get really good at fixed? Is it to do a specialist program? Is it to do both? Do you do lots of, you know, go away somewhere across the world and do a, I don’t know, spear or choice or whatever? What’s your advice?
Well, you know, it’s one of it gives you the theoretical background and the ability to kind of apply it practically. And unfortunately, there aren’t that many courses that do that. I’m not a massive fan of the specialist title. You know, there are lots of specialists. I wouldn’t go anywhere near. There are lots of general dentists out there that are amazing. And to see that work all the time. Depeche, you know, these guys there, but go to them before I’d go to a lot of other colleagues for for a lot of work. So the specialist title was was useful at the time from a marketing point of view. But if you look at our practice, you know, we’re not all specialists because we’ve got two guys there who just do surgical dentistry and they’re very good at that. So if I if I had the chance to run a course and and I think this is where dental education should hopefully move towards and it is kind of going that way with implant dentistry, but also it should be doing it with other aspects of dentistry as this kind of theory, then practical, practical on Phantom head and then move on to the practical onto patients. So I mean, what, what we’re, we’re trying to what we’re going to try and do at our at our place is, is do this blended learning, whatever you want to call it, where we do the theory, then we do the hands on on phantom heads. Then you come and observe. When you’ve done that a few times, you come and bring your patients to our practice.
Treat them there because we’ve got the kit. You don’t have to invest in the kit and then you’ll be mentored on site. Do that 2 or 3 times and then you’ve got the chance to you’ve got the confidence of taking it back to your own practice and taking it from there. But you know, that that ain’t that ain’t a quick fix That takes time that. Kind of commitment from the person who wants to join that pathway. But that’s the only way I see where we can provide that structure. And I think to be able to get better at something, you need to be bold. You need to kind of but not arrogant, not not complacent. Yeah, you need to be bold in taking these cases on. And unfortunately, I think the courses maybe make you a little bit overconfident sometimes. And patients don’t allow for that boldness. They expect everything, whether it’s the first time we’ve done that treatment or the hundredth time. And I think this is where we need to kind of just maybe go for this phased learning and do it bit by bit. And and you know, I think anyone can do a big complex case. If you’ve done it 20 times, it’s a lot easier than if you’re doing it for the first time. So that’s what we’re going to try. And I think that’s that’s and I hear implant courses where you can treat patients on the course. I think that’s that’s the way to go.
So what’s your own scope of practice? Do you do implants and do the complicated implants or or are you purely. Yeah.
It’s.
You know, it’s funny, years ago it was 20 years ago it was mostly a lot of implants failing dentitions Now it’s a implants failing Dentitions But say it’s 2,030% of the working week is tooth wear. And I do think, you know, that can’t just be by chance that we’re seeing that. And that’s why I’m I’m really keen on getting the treatment to these cases done in practice by by the referring dentists because you know man alive, you’re using that material day in, day out. You know, you’re using this direct composite day in and day out. It’s just applying it in a different kind of way with a tooth wear case. And the guys who’ve kind of followed our structure and been and see now be observed at the practice. I’ve now seen them do wear cases in the practice at their own practices and it works. And you know, and you’re adding a real benefit to your treatment profile if you can manage these cases in house. And it’s brilliant. The kind of really the financially rewarding, the professional rewarding, you’re making a huge difference to that without prepping teeth at all.
So I mean with with a tooth wear scenario, right? The there’s one aspect of it nowadays where we are more aware of it than we were as a general dentist, right? I think as a general dentist, you can see a tooth wear case and say nothing or, you know, you could be reactive to a patient comes in and says, Now I can’t see my teeth or whatever. Do you have a process you teach or that you use yourself for? You know, breaking it to a patient that, you know, although nothing’s hurting, although you haven’t come and told me I’m unhappy with the way I look, now’s the time to act. And then sometimes acting can be quite a massive plan. And how do you how do you manage that process?
Well, I’m going to go back a stage because I think it’s still surprising how many patients who are regular attenders are referred in to later stage. And I do think there’s an age thing. I think I think, you know, I’m trying to see if there is a pattern where the younger graduates are looking at six year olds and seeing them as being written off. You know, are you of course, you’ve got warm teeth. You’re six year old, you’re 60 years old. You know, you’re bound to have warranty. But actually, that level of wear is significant and you’re not seeing the fact that that patient is going to hopefully live on for another 20, 30 years. Yeah, and that’s so moving, moving on, you know, what’s what’s the process? And we cover it in our courses and and it’s a typical kind of speech I come out with you know tooth wear is teeth becoming thinner and shorter. But really that isn’t enough to explain to you what’s going on in your mouth. I need to explain to you with regards to what’s caused it, which teeth have been affected and how severe it is. And then I try and use that severe category as the as the is the most important aspect of that classification. Because if you if they fall into the mild category, we monitor it, we put in some preventative regime.
If it’s severe, we recommend treatments. And if it’s moderate, we treat someone, we treat and we monitor others. And it’s very arbitrary. You know, I say to patients, this is nothing scientific about this. This is very subjective, but I will put you into a severe category. If teeth were in a 70 year old, you might be moderate and you kind of every single time you see the penny drop. Right. I get it. I get it. You know, I’m even if I’m a healthy six year old, you can have severe tooth wear. If you’re fit and healthy, you’re going to be around for another 20, 30 years. And also follow that up with. But please, please, please don’t lose sleep over this. You know, this is not happened overnight, but just be aware. And it’s about making them walk out. One, being aware of what’s going on in their mouth and also being aware of the consequences of carrying on with a non interceptive approach, whether it be that that that’s been something that’s suggested by their dentist or by them. But they need to kind of. Often take ownership of what’s going on. And, you know, and I think that process works because the treatments uptake for our tooth wear cases is really, really good.
Although with you, they’ve been.
Already referred to you. So already the dentist has said something. What about the dentist themselves? Are dentists referring to late when you said you said that, right? You said they’re referring to. Is it because you haven’t got enough tooth to play with now?
Yeah. Yeah. I think it’s got to the point where and you’ll never know whether, you know, we’ll have patients who came in and said, Yeah, I was given a mouth guard ten years ago. Well, you know, straight away if someone’s had that conversation with them ten years ago to say you’re grinding your teeth, perhaps wasn’t explained to them at that time was that if you don’t wear this mouth guard, it will have a significant effect on your teeth. And I’m going to make a presumption and it might be wrong, but I’ll assume that most patients who are fully or mostly dentate in their 60s do not want to be wearing dentures in their 70s, 80s and 90s. And what you’re saying to them is that if you don’t do anything, as long as you’re aware of the probability of the fact that you will lose more teeth and you’re going to have to wear a denture. If you’re if you’re fine with that, great. You know, you can you can be more passive about it. But if you want to avoid that happening, we need to do something. And thankfully there is a treatment in most cases. We had one last week where we couldn’t treat because it was too advanced. But in most cases there is a treatment that’s really conservative and involves no drilling where we can build the teeth up.
Well, what you’re not saying you’re not telling me in every case you can do additive or are you?
Unless it’s really. Really. I mean, there was one case last week that was so advanced that there was very little to work with, you know, pretty much route faces. But we’ve, you know, we’ve we’ve pushed the boundaries so much where I’ve expected expected things to fall apart and they’ve come back and they’ve behaved you know the build ups they they will they may chip they’ll wear. But it’s very rare for them to just fall apart.
So then but then is it a transitional thing? And then eventually you’re going to go into indirect.
So, yeah. So what we say to them is we’ll do this build ups. And historically what we also did was give them a mouth guard at the end and the patients would come back at a review at six months with this pristine, fresh mouth guard that had never been worn one night. And and you’d say to them, you know, you’re not worn this, have you? And they said, No. And you’re looking at the mouth and the composites were wearing really well. So rather than charging them for the mouth guard, for most cases, what we tend to do is is not give them a mouth guard. And then if we get unexpected chipping or breaking in that first 12 to 18 months, then we’ll suggest a mouth guard. But I’ve not you know, you talk about transitionals. I can’t think of a case where we’ve gone from composites to indirects. We’ve got one lined up because the teeth are so heavily restored that we’ll need indirects. But if you’re talking about largely virgin unrestored teeth, we will go with a direct approach. And as long as there’s something to bond onto that will be hopefully predictable for years.
Well, but. Okay. So when when are you doing the full mouth rehabs then? When? When there’s lots of fillings.
Yeah. So full mouth rehabs, it tends to be lots of failing dentitions where lots of failing teeth, teeth that are heavily restored. So teeth with failing crown and bridgework teeth with failing direct restorations. If we’re looking to reorganise and change the occlusion in the tooth’s got a large amalgam or a large composite can bond onto but large amalgam or a failing crown that tends to be and that’s the messy work, that’s the, you know, dismantling old dentistry, you know, is is time intensive and that, you know, that’s that’s the that’s the kind of stuff that takes two three hours of your of your week. So the the direct composite cases are are relatively straightforward.
I mean how do you charge for that? I mean hopefully.
I’m.
Sure you’ve got an hourly hourly rate sort of story going on. Right. But you know, somehow we end up charging less for direct than we do for indirect. Even once you take into account the lab work element and we all know direct is a lot harder.
Yeah, absolutely. So it becomes, you know, I’m still, believe it or not, still feeling my way with it and I’ll look I think I’ve got on top of it now where where with localised where if it’s lowers there’ll be a particular fee uppers and lowers and additional increments. And then if it’s an aesthetic component where at the end of it all, if, if the patient is lost and incisal third where the composite that you’ve added on might be an aesthetic compromise, then you may have to then plan a third phase of layering the facial aspect with composite then, and if it’s the highest that’s at risk, then that adds another tier. So it tends to be and it is it sounds, you know, the guys who come and observe there must be walking away thinking he’s made a number up.
But it’s not.
But it’s not far off that as long and it is a significant number. But there’s a lot of time in Chairside and also reviews, you know, and you’re factoring in any kind of repairs for the first 12 months.
So what are we talking.
Yeah, I don’t mind sharing that with you if we’re talking kind of a very localised wear case, lower 3 to 3, upper 3 to 3. Um, typical dowel pro about 2000. If you’re doing both arches upper and lower anteriors, then you’re probably going about 3 to 3 and a half. And then if you’re talking about the facial aspects of teeth as well, you know, the high end aesthetic, talking about four, four and a half.
Doesn’t seem high enough.
I completely agree with you. I agree with you. And I think.
It doesn’t.
It doesn’t bearing in mind the time it takes and the time it’s going to take in any chips or whatever, you know, I’m sure you’re not going to charge them straight away. And the experience doesn’t seem high enough.
Yeah, but, you know, I think the reason I’m comfortable with that figure and I think I look at our kind of our implant fees, I would argue a less than a lot of practices in our area. General and referral is I’d like to think we’re quite slick in that, you know, we’re, I’m hoping we’re quite efficient. There’s no downtime in the things. The clinical time is pretty quick. So the wear cases they’re being done, you know in 2.5 hours, maybe in one arch. Yeah. So we’re not talking kind of 4 or 5, 4 or 5 hours, maybe 4 or 5 hours if, if in both arches over two visits. But it’s, it’s not we’re not talking about, you know, eight, ten hours it’s efficient workflow.
Yeah. But is that have you done this on purpose as in you’ve worked on the efficiency rather than on the price. No, it’s just the way it’s evolved.
It’s just the way it’s evolved. And it is just it got to the point where I was thinking what we’re charging is not enough based on what we’re providing. Yeah. So a couple, you know, a couple of years, I look back on some of our reports on the tooth wear cases we were doing kind of eight, ten years ago and you know, we were giving it away, you know, it was £1,500 for and I’m looking in those cases I’m seeing now, you know, the things are still behaving really, really well, performing really well. We had a patient who came in last week who should bust a screw in an implant crown that we fitted eight years ago, and our fees have gone up for for our implant crowns by £300.
Wow.
You know. Yeah.
You know, you haven’t done.
You haven’t done the annual increase that you should have done. Basically.
You know.
If you come to ours, you’ll hopefully pick up some clinical stuff. But don’t expect anything on the business side of things. You know, we’ve, we’ve, we’ve winged it so much because yeah, it’s the way we’ve operated. You know, as long as everyone gets paid and patients are happy and bills get paid and, you know, get paid what I do, I’m quite happy with it. I’ve never looked at hourly rates. We’ve never looked at any of that productivity. It’s yeah. Didn’t didn’t have the headspace for that.
A couple of questions for you. I mean if you’re at the tip of the spear like you are. I mean, you alluded to it before. Sometimes you’re pushing the envelope, like you were saying about the bondage bit piece, that you’ve done things that are slightly outside of let’s call it the evidence base for the sake of the argument. Yeah, I see that as your duty as people who are really at the top of their game have to do that. And also the evidence base is always years behind anyway, right? What’s actually going on? But how do you square that with the worry that something’s going to go wrong and then someone someone’s going to say, hey, this isn’t you know, people are acting a lot more defensively now. And I worry about it. I worry about, you know, we’re not going to get any movement forward because all of us are so defensive.
Well, you know, this is where, you know, I’m in that ivory tower, I’m afraid, because you come at things from a slightly different angle. You know, patients are more willing, I think, to take on treatments. And I think a lot of that is in the communication. If you’re if you’re you know, again, I say it’s guys who sit and observe. Don’t just come in and watch the treatments, come in and observe one of our first appointments because you’ve got 45 minutes to take your information, do your examination, present it to a patient. Patients in a really concise, clear way. And for them to walk out thinking this guy knows what he’s doing and with a bit of confidence, but also with a realistic expectation of what’s going to happen. It was really nice. Last week we had a patient who came in and I was saying to him how difficult it was and he said, Will you just do your best? And it’s been such a long time because patients often their expectations are so way off. What might be possible. It was just really heartening to hear someone say, Well, as long as you just do your best, I’m going to be happy. And that should be the starting point, you know, and and we we will say to patients, you know, there’d be a lot of stuff we’ll do now that we’ve not done before.
And I’ll say to patients, we’ve not done this before, but it is the only way I can see for us to get around this problem. And if nothing else, we’ll have a plan B and then we’ll have a plan C and that tends to be enough for them. But I’ve said before, you know, to do that you need to be bold sometimes. And the current climate in clinical dentistry doesn’t allow for that, doesn’t allow for people to just I don’t like to use the phrase have a go dentistry because having a go suggests a bit of recklessness. But you need to be bold and you need to be able to say, okay, I’m going to give myself the kit, I’m going to give myself the time. I’m going to choose the right patient and I’m going to just go beyond that comfort zone, because the alternative is you’re going to be practising the same way in your 25th year as you were in your in your in your first year. And that’s a real shame.
But do you see that with younger colleagues? They’re more worried than than, let’s say, our generation regarding this issue.
What I see with the younger colleagues, we had a young undergraduate in not that long ago and he’s doing a facial aesthetic clinics nice you know as an undergraduate to make money like I never even thought of that you know and I actually don’t you know you look at restorative dentistry when when we qualified you did amalgams you prepped teeth for crowns or veneers, bridges. There wasn’t a whole lot else. Perio, obviously. And even then we didn’t do that particularly well. We didn’t move teeth. We didn’t bond onto teeth, particularly apart from unless there was a filling. Nowadays, you know, the difficulty or the the massive bonus for these guys is they can take it anywhere, anywhere they want. Unfortunately, I think too often they’re going I would argue they’re going down the wrong path first. You know, they’re going for the Invisalign courses within the first year of qualifying rather than looking at an occlusion course rather than looking at a restorative course, looking at perio course, looking at the endo course. Because I think if you’re going to have a hierarchy of what you need to be good at to be successful, diagnosis of endo or perio, I think is more important than diagnosis of crowded teeth. Yeah.
For sure. I mean, your humility is what’s amazing to me. You you turn up to Mini Smile Makeover. You paid for the course. You didn’t contact me or anything. You just turned up as a delegate. And at the time when you came twice. But the first time you came pitch was 26 or something and you were a consultant. Restorative referral only fixed price guy. And the humility to do that, to turn up and be taught by a 26 year old. I found it amazing. I found it. And look Dipesh he’s extraordinary and all that. But you weren’t to know that for sure before you turned up. Are you. Are you that cat? Are you. Do you. Do you go on loads and loads of courses? And what do you do? What’s what’s your story.
I’d go I think people need to park that you know there’s as I said before, there will be people out there doing way better implant work. We’re so primitive with our approach to digital dentistry. Why wouldn’t I go to someone who’s maybe two years qualified, who can teach me on how to work on scanners, who can work on how to embrace digital dentistry? So you’re going to learn from anyone and everyone and, you know, depression, great guy, brilliant at what he does. The fact that he was, you know, whatever number of years younger than me is is irrelevant. I think it’s nothing to do with humility. I think it’s just recognising the fact that there are better people out there that you can learn from. If you’re if you’re not prepared to do that, then it’s your loss.
But back then, we used to get a fair amount of stress from people saying, Hey, who’s this kid you’re trying to get to teach us? And now I get it. I do get it. And I understand why someone might think that. But, you know, a few times and you’re definitely one of them where people have turned up who you wouldn’t expect to want to be taught by a younger person. What is it about you that you know that you’re that cat? I mean.
I’ll tell you what it is. Part of it is because you’re constantly full of self doubt. That’s probably a good start. You know, it’s always nice when someone says, you know, your introduction was really quite lovely, really nice to hear, but we’ll get the odd locum nursing or we’ll get the odd young graduate in. He’ll come in and be very complimentary about the practice or what would I do in it. And it’s kind of it’s at a complete conflict with with what’s going on in my mind because again, you know, what do you want to call it? Imposter syndrome or what? There is always self doubt there, but I think you need that. You need that self doubt to have that comfort zone because then you need to be working just beyond that comfort zone. You don’t want that self doubt to paralyse you to the point where you don’t do anything. So your whole career is spent about defining where that line is and just hopping just either side of it. And if that means going to listen to someone who can, who, you know, is going to, you know, and you might walk away from a course thinking didn’t pick up much from that. But there’s always something someone’s doing better somewhere, you know?
Yeah, I get that. So then tell me about your sort of pursuit of excellence now, because, you know, it’s a funny thing, the way one positions oneself. I mean, I don’t know. When I was a young dentist, I didn’t think to study any further until then. We started Enlightened and that was that. And then some people do what you do and go and study and. And have you found a sort of an ikigai kind of idea of, you know, you found your zone and you’re now just following excellence, trying to get better and better and better at that at that thing. And does that is that what gives you the pleasure in, in the job?
Um, it is one aspect of what gives them the pleasure. I’ve got to say the, the pursuit of excellence is, is in the effort that we all put in as a team. It’s not just clinical, you know, I think there are other people in the Northwest, definitely in the country who are doing better clinical work outcomes than we are, I’m sure of it, but I think we are brilliant at what we do as a practice. On the caring side, I can’t imagine there is another team that puts as much effort into the care of their patients as much as we do with brilliant of that.
Explain it to me. What’s what is it? What is it? When you say care of your patients, do you mean the patient journey?
Yeah, the patient journey. Yeah. You know, from the moment we’ve got a team that, you know, if you’re talking about kind of what I’m so most proud of, it’s where we are at now, at the practice where we’ve got and it’s on the back of lots of other colleagues that have helped us get to this point, you know, from back 12, 13 years ago. But we’ve got a team that are just so committed to everything that is the practice is about getting this patient on a journey where they will invariably start in a compromised, challenged, really potentially awful place. And you take them to a to an end point where they walk out and. They will sing your praises. They will bring you know, they’re paying for their treatment, but they’ll bring gifts and there’s thank yous. The the everything about it is is about that patient journey. You know, we’ll go back to the fact that, you know, the pandemic, you know, you’re asking guys to go back into the firing line of practice and not one of our members of staff who every one of them would have lost a member of either a family or someone they knew. They got back into it without any hesitation. You know, they they embraced everything we were about. They were confident in the systems that we had set up. And I think that takes a huge amount of respect. So the driving force behind everything we do is is respect for each other, respect for our patients. And we get we expect respect back from our patients. So, you know, if you want to get my goat, you can have a winter reception, be nice, be nice in the surgery, but have a whinge in reception and I’ll be the first to kind of call the patient up afterwards and and just call them up on it because it’s not acceptable.
Really? You’ve done that.
Before. Oh, yeah.
Yeah, absolutely.
Yeah. What do you say?
Talk me through that conversation.
Well, you know, you’ve got to be real.
Idiot to want to cause offence. So invariably patients who cause offence don’t want to cause offence, but if they’ve caused offence then you need to be called up on it because if you, if you let that run they’ll potentially cause offence again. They just need to know that within our four walls, that thing that you said before is not acceptable. So giving an example, we had a saw a patient for a new console on his way out when he went to pay his his fee, he just made a passing comment about I bet he pays better. He pays you less than that per day or per week, referring to our console fee. And he left and I forget who was on the on the desk and said, you know, he just said that that’s quite offensive. So he either let that ride or give it a couple of days and ring the gentleman up and he’s and he’s lovely. And and it was and it’s just a quip. I’m sure he was trying to be funny. But I’d say I hope you don’t mind me saying, but you know, our staff took offence to that and if it was me that had said something that was cause that caused offence, I’d like to know about it. So just to let you know and if you feel that that makes you too uncomfortable to come back. I completely accept that but would be delighted to see you and carry on where we left off. And he was so apologetic and he came back and a lot of it is anxiety. You know, patients are anxious about being there. So they’ll they’ll they may say things that they might think are offensive, but it just means that you need to moderate your you need to moderate what you say when you’re in our four walls. You know, you can’t be rude, you know. And so, yeah, it happens every now and again. It’s about having having each other’s backs, you know, and can have the other dentist back. But you also have to have the receptionist back and the nurses back and they’ll have mine.
I’d like to talk about the practice and you know, it’s not by mistake that a practice does well or that people people respect each other. So how much of that is you and how much of that is someone else who’s who’s like, have you got a practice manager who’s really taking care of the staff side or are you setting the tone to expand a bit on the side? So how many people are we talking?
So we’ve got.
About nine clinicians now. Nine clinicians all do different numbers of numbers of sessions, but it all starts off with kind of myself and Neil, Neil Wilson, a really good friend who again put a lot of time and effort in setting up when we first started and you know, it was just a one surgery setup pretty much. But once you have that core is one of respect and being civil to each other and, you know, just looking after that caring process, it means like attracts like, you know, we start off with with the Louisa practice manager, then Nikki, who was with us for over 11, 12, 13 years. And I can honestly say bar bar, a couple of appointments, all our clinicians, all our nursing staff have bought in, into this, into this. And because if, if you don’t, you’re very quickly get found out because it’s reflected in your work ethic. If you don’t respect your people you work with, invariably it’ll affect the work you’re doing, whether it be on the nursing side, on the admin side or on the as a as a clinician. So I think if we want to take credit for anything, it’s perhaps that bit at the very beginning is that you treat people how you like to be treated. You know, you’re no one’s precious in our place. No one’s no one is above how to make a cup of tea for someone else, you know, to washing up. Lovely. It’s the little things, isn’t it? You know.
I noticed that with you, with our hands on. You came and helped us clear up at the end. You were the teacher. You were the teacher at it. And I remember I’d never seen a teacher do that before.
Yeah.
But, you know, it’s kind of. You know, you see you see your staff and on any given day running around really, really busy. And let’s say, you know, I’ve got a 20 minute gap. It’s either I go up and look at Facebook or read the football or just put the kettle on and just or just wash up. You know, it’s just the right thing to do, isn’t it? And I think it does send out a message. Now, if it means that I keep having to wash up, it means someone else isn’t washing up. And we need to we need to bring that up. But I think it’s you. And, you know, I think words are really, really important. If you if you want me to bring a bit of vomit into my mouth and start referring to your practice manager, you know, my practice manager, my nurse, my treatment plan coordinator, my accountant, that I just find that so offensive. You know, it’s our practice manager. It’s, you know, our training plan coordinator is everything. Because if you use that other possessive, if you’re in the room and you hear that, I think it just it means there’s a hierarchy and there really shouldn’t be one.
I mean, what kind of leader are you? I mean, sometimes, you know, one errs too much on the overfriendly side. Some some people are too much on the, I don’t know, bit strict. Are you strict? Are you friendly? Who are.
You? You know.
I try and be supportive. You lead from the middle, not from the front. Because if you’re in the middle, you’ve surrounded yourself with leaders. So I think the every one of us at the practice has got responsibility that they carry. If you’re in the middle, then the newest additions, you can keep an eye out for them because they’re the ones at the back. I don’t tend to shout and rave too much, but I think when I do, I think the staff know that there’s a reason for it or there’s a reason behind it. But it’s really rare, you know? And the days have gone where I used to kind of throw stuff, you just know it’s completely ineffective and you just come across as a complete fool, you know? So most, most a lot, a lot more can be achieved by just quiet conversations. And that’s the one thing I think I’ve got better at over the last 3 or 4 years is just, you know, just letting it settle and then just having that quiet conversation.
So, I mean, you’ve got this amazing reputation for, you know, knowing your stuff, but also for making patients happy. If you had to distil it down for a young dentist or someone who’s sort of just wants to get into this area, 2 or 3 key things that that you need to look out for to get, you know, patient satisfaction. People, people, people happy at the end of treatment. What comes to mind when I say that?
I think looking it looking at it from the other side, it’s about trying to protect yourself from patients who may have a reason to take it. Anything from a friend to a complaint to the practice or even higher up the ladder. So, you know, in my mind, I think there’s we’re trying to there’s three things you’re looking at. One is getting a successful outcome in your treatments. And obviously that’s the subjective thing. That’s largely down to what the patient perceives as as as successful based on their expectations. The second issue is choosing the right treatment plan. And again, we can discuss that at length. It can be subjective. We can have differences between clinicians as to what is the right treatment and what’s the wrong treatment. One person would do what bonding, One person might veneer a bunch of teeth, but it’s ultimately what is the right treatment for that patient. And the third thing is carrying out that treatment with with an element of care. And I think if you if you can do two out of those three, I feel you’re pretty much protected. You’re protected yourself from a patient having a grievance that may spiral into something that can be really quite stressful in your career. So you can’t you know, a successful outcome isn’t always predictable. There’s variations between what we might choose as a correct treatment choice, but if at least if we can provide a level of care, if that patient feels that they’re being well looked after through that journey, you’ve ticked off one of the three. And if you do tick off two of the three.
You’re safe.
I think you’re safe. I think you’re safe. So so even though we’ve spoken about when, you know it’s exhausting, you’ve got things going in your life and the patient comes and they’re demanding and you’ve really been pushed to your limits. And that’s when you’ve really got to pull it out the bag and show that empathy and that care and that understanding. And if you can do that, and if it’s a lengthy treatment process, it’s multiple appointments, it might be a patient that you may not particularly like as a personality, but you’ve still got to face up. But if you can do that consistently and then either provide a successful outcome or make sure you choose the right treatment in their eyes, I think you can be relaxed and comfortable.
So in a way, you’re saying if if your rapport with the patient is good. And on paper you chose the right treatment plan. If things go wrong, if you don’t get that third one, it’s not going to spiral out of control.
And you look at it the other way, you know, you’ll have patients who’ll go to dentists who can be really prickly characters who who, who are, you know, snappy, short, you know, rude to their staff, but they provide really good treatment with a successful outcome. So they’ll put up with it.
Yeah. Yeah. And what about when you say if you haven’t got that natural rapport with a patient, have you got any tactics that you use in order to, you know, at least make him feel that you’ve got some rapport?
Yeah. You know.
It’s about kind of making that connection and it is different. It is different in a in a referral practice setting because, you know, in a general practice, you’ll see the patient once every six months. And over the course of years you’ll get to know them and their circumstances and their family referral setup. Often you’ll see them over a short period of time, but you’ll see a lot of them. Yeah, yeah, you’ll see. And you’ll get to know them really well. And I think that is the difference. So it’s about trying to get that relationship built up in a, in a, in a general practice setting. And it’s, it’s, it’s a, it’s a soft skill isn’t it. It’s a soft skill that you need to develop. I think unfortunately, I think there was a study that shows that our level of empathy actually decreases the more patient exposure we get. Yeah. So you’ve got to kind of it’s something you work at because it’s human nature. You know, you’re tired, you’re you’re running late and you’ve got to just face up and, and work with that patient as if they are the only patient you’re seeing that day. And they’ve got their full, undivided attention.
I mean, have you had moments where your spidey sense has kicked in and you’ve thought, you know, for whatever sort of sixth sense feeling, I don’t want to treat this patient. How do you break that to them?
Yeah. And and it.
Is what.
Are those times? Are those times where you can’t see what the patient sees when he’s saying, I’m not happy with the way these look and you can’t see it or.
It’s it’s it’s it’s often a non-clinical issue and it’s often it is a spider sense where you you’ve got to have an element of compatibility. You’ve got to you’ve got to they’ve got to have an element of trust. You’ve got to have an element of respect. I’ve got to see I’ve got to say, more often than not, it’s it’s not the expectations that set off his senses. It’s the fact that the patient as a personality you think is not suited to working, to fitting in your environment. And it does then get to the point where you’ll never get a day list where every patient that’s coming in is going to be like your best friend. But you’ve definitely whittled it down to just the odd patient, and that’s okay in an ideal. So what do you say?
What do you say if a young, young dentist is faced with that situation? What’s a nice way of saying.
Well, the first and thanks.
You know, the warning signs are someone who’s been to see lots of dentists in a short period of time. They’ll often present and they’re looking for another opinion or asking to offer an opinion on someone else’s work once they’re in you know, once the moment you’ve picked up that handpiece or you’ve done anything remotely invasive, they are your patient. So it’s about making that call early and just it is awkward conversations, You know, I really don’t feel that what you’re what you’re what you need and what you’re trying to get fits into. What we can provide here as a team, we can recommend practices for you.
Simple as that.
Simple as that. And it’s not a conversation you have too often, but once you’ve had it, you know, through the sense of relief that you get, that you’ve done the right thing.
And how about the fact that you’re probably the lowest ego high level dentist I’ve ever come across, but there are times where your ego kind of gets the better of you insomuch as you know, You know you’re good. You know, you’ve done things well in the past and the patient might be picking you up and that can get you into trouble, right? Yeah. Where you think I can do this? Right. And then. And then you’re. You’re halfway through and you realise that this patient’s not. Not a reasonable person. That must have happened.
Yeah, but.
It’s also every. Every time I’ve kind of genuinely, every time I’ve either got carried away with myself, any time I’ve taken a shortcut, any time I’ve thought, this will do, I’m sure it’ll be fine. I’ve got caught out every time.
It’s the stone in the shoe, isn’t it?
It it is. And you kind of. And it does happen where you think. I’m sure it’ll be fine this time. And the patient comes in six months later with a broken crown. And then you. And that’s, you know, after that initial moment of that, you’re so disheartened, you remind yourself, well, actually, that’s a lesson. I’m not going to make that mistake again for the next two, three years, because it’s human nature that mistakes and, you know, shortcuts and things crawl in. You can’t you can’t be in a spotless for the whole for your whole career. So you’ve got to accept it when when things do happen and you just, you know, and if if you’re a young clinician and you’ve taken on a case that’s out of your depth, just call in more senior colleagues to offer advice. It’s I think too often I think there’s that tendency to try and go through the whole journey on your own when you shouldn’t be on your own, you know, And sometimes it’s just calling on on advice of of someone within the practice or in that area to, to offer an opinion.
I must say it’s comforting to know that even you have that problem.
It’s inevitable.
It’s inevitable, isn’t it? It’s part of our work. And it’s it’s I think by working on a referral system, it’s easier. But it’s. Yeah, everyone wants to be busy, don’t they? You know, we do rather busy with difficult cases or have an empty diary. You want to be again nature is that you want to be busy. It’s it’s a tough one. It’s a lesson you’ll keep learning. And I think and that thing I said to you before, you know girls coming to to observe, I think they get as much out of a consult session as they do a treatment session just for how we set our stall out. You know, You know, you set your stall out first off, and the patient doesn’t like the way we act and behave. Then they also have the option of saying they don’t want to come back. And we have patients who who had one, you know, recently had a report who said that they don’t like the report. They’re going to go elsewhere. That’s completely fine. I’m completely happy with that.
I mean, what about the treatment? Acceptance rate must be quite high. But then inevitably, all of us have some patients who don’t go ahead, but maybe not with, you know, someone might not be as direct as that. I’m going somewhere else. You just. Someone might just not get back to you. Do you guys then chase that patient or not at all?
Yeah. So we have a referral log.
Which it requires manpower to run, you know, so you’ll have a new patient referred there would have been contacted for an initial meeting. They might have not answered the phone or they may have decided to defer it for a while. We’ll put the reason in, then we’ll contact them. Once they’ve had that initial assessment and the report, we’ll contact them. Maybe we should be contacting them within a few weeks. Often once they’ve received the report, it’s all by email. Now they’ll often reply and say, Yeah, please kind of go ahead. How do I proceed? And that makes it a little bit easier. Nice.
Let’s get on to the darker part of the interview. We like to talk about mistakes.
Yeah.
From that sort of black box, thinking that, you know, the guy says that, you know, when a plane goes down, they share the mistakes. And so the mistakes never happen again. But in medical, we tend to hide them and we tend to blame people. And so, you know, the it’s not the system isn’t isn’t ever exercised and people get blamed and we don’t learn from each other’s mistakes. I’d like you to give me a couple of clinical one clinical error, one management error, patient management error, and then one business error.
A clinical.
Error. That’s the beauty of composites, is that I’m going to look at it from a different level angle is that, you know, with with direct composites and tooth wear cases, you can very rarely make it look worse. And that’s the other reason why I’m a big advocate of composites. So for me, the clinical areas tend to be the implant cases. And we’ve got a couple where and it tends to be under treatment where you’ve not been as radical as you should have been. So you’ve kept teeth that should have come out and it’s come back and bitten you. And with all these cases, you look back and think, you know, in hindsight we should have included that tooth or those teeth or gone full arch. But got to say, every single time you also put yourself back in and think, if I had to see that case again, would I do it again? You probably would do you still would. Probably. I would like to think would practice more conservatively and give teeth the benefit of the doubt. And if it means I’m the odd case, you get caught out, you’ve got to you’ve just got to roll with the punches on that. So it tends to be the not being as as aggressive with the treatment planning. Sometimes that’s caught me out and invariably it’s always occlusion. It’s always something that’s occlusal that will smash something or break something that I didn’t expect. So we’ve got a case at the moment where a lady’s broken her implant because we assumed that she would wear a splint and she didn’t, and the thing snapped and trying to unravel that. And we have no.
The fixture itself.
Yeah, very much so. Yeah. Yeah, yeah. So, you know, and you know, Corey is really good at kind of giving that structure to his, to his fees as to, you know, how much they, how much the practice will cover with failures year 135I think. And we need to implement that. We don’t get many of them. So it is very much, you know, like anything you’re putting up in the air and just making it fair. But as long as it’s it’s a fair arrangement, we go with it, really. So that’s, that’s the clinical one. Um, patient management. Um, my biggest mistake is reports I’m not quick enough in getting the reports out. It sounds very pathetic, but I think if I could give any advice to anyone who’s starting out, whether it be general practice, specialist practice, get your reports out and get the reports out quickly. I will guarantee you treatment uptake will be way much better than if you leave it a week or two for lots of reasons. But for from a patient management point of view, it would be great if I could get my reports out. And I’ve got I’ve got probably about 15 to do after we finish here. Um, 55 zero no, 1515 from the last couple. Yeah, 15 for the last couple of weeks and you know, I still dictate them and check them. So it takes, it takes forever from a business point of view.
I’ve had with.
Being so clueless. I’ve probably made so many that I’m just unaware of that. I’m just going to live in blissful ignorance. Pay honestly, because if someone kind of scratched the surface of how the place is run and he spoke earlier before about me kind of selling the practice in October last year and it was with a full knowledge that whoever took over it, all they had to do was look at the finances and would realise that with a tiny bit of tweaking, this place could be so much more productive because this, this buffoon has been running it for so long without even looking at the numbers. So I’m sure there’s been plenty of plenty of mistakes on the business side.
But you never, like, I don’t know, lost someone where you didn’t realise that that person was unhappy or.
No, I think.
We’ve had staff leave. Then I’ve got to say.
And.
You might look at this in a kind of a negative way, but whenever someone leaves, there’s always a drive in me to push the practice to a point where they regret leaving.
Yeah, I know what you mean. I know exactly.
It gives me a bit of a push to think. Right. And we’ve lost some amazing staff. You know, I can namecheck them in. Done. You know we can. Nikki. Our practice manageress, who was with us for 12 years. Amazing individuals, brilliant, amazing friends. But you know, there’s part of me that thinks, right you know, let’s use this now as a kind of an impetus to get this place, get this practice. Not that they’re going to come back where they think, you know, Crikey, that place has got better. Maybe I shouldn’t have.
Left.
Like that. I know exactly what you’re talking about.
But when I say when I come out with it, it just sounds a bit sinister. It doesn’t mean.
To.
In a positive way.
Tell me about digital, for instance. I had the same conversation with Basil, right? We said, you know the guy the guy knows his stuff, right? When it comes to analogue dentistry and then digital, it presents a bunch of new sort of unpredictabilities, if you like. And for someone, you know, I can understand if someone like you, sometimes the patients coming in as sort of last chance saloon. And so you know what you know and you know you know that you can sort them out in the in the traditional way and yet you wouldn’t be I mean Armenian if you hadn’t have jumped onto all the all the developments. How do you how do you how do you time it? How do you square the circle? I mean, classically. Okay. You’re not the first person to get it. You’re not the last person. But but tell me tell me about it.
Well, this is this is where I feel a.
Bit dirty before I’ll kind of feel conflicted sometimes. And I do sometimes see myself now, as I saw my previous mentors, you know, 20 years ago, where you looked at them, think we shouldn’t be doing that. We do things differently. I’ve been to this conference where you can do this, this way or that way and remember bringing it to them and them looking at me thinking, But yeah, but what you’re doing now has worked and worked really, really well. Yeah. So, you know, there’s a reason why we I personally haven’t embraced digital because a lot of the case we do our bigger case with lots of implants and think it’s one of those aspects of dentistry that’s very much technical driven, technician driven. That’s what’s been the driving force. It’s giving an example. One of the labs we use is thinking of going digital only. Yeah, well you’re going, you’re going to force the hand of clinical dentistry, you’re going to force you’re at a major crossroads in clinical dentistry. Then if you can only then just do digital honestly on a day to day basis, I’m taking analogue impressions and I’m thinking, could I have done this digitally? And it’s not just the fact that I don’t have the experience with it, but with my knowledge, with what I know of, of scanning, I look at very few cases and think, yes, I think I would have been as confident about as doing this with an analogue, as digital, as with an analogue.
And until I lose that, that’s that comfort zone and I need to step over that line and put my toe on the on the out of my comfort zone because it shouldn’t be the learning curve. They should put you off. It’s the end result. But, you know, we’ve gone for, you know, we’re doing the digital you know, we’re doing digital stuff on the lab side. We’re getting kind of, you know, the models and, and the, the, the frame checks and stuff. And I don’t think is as good as the old technique, you know, for, for accuracy of fit. I honestly think the gold standard is still a custom abutments With a cast framework you don’t get any better. But also no insane that I’m going to come across as a complete dinosaur.
Which is fine. I don’t mind it. I don’t mind it.
What about. Okay, so the other aspects of digital, I mean, there’s there’s the communication side, which is a lot easier with digital. There’s some people some people even say that they use it for diagnosis. For instance, tooth wear. Right? You can you can take a scan with the old trios and then in three years time, take another scan and see the exact amount of tooth loss between the two.
So. So something like Beautiful things.
Yeah. Yeah. No, for something like that. And that’s the shame of it is that, you know, that’s becoming so, you know scanners are so became so much more prevalent now. Yeah. But the thing they should be used for is something like that. They’re not being useful. Someone will, will do more Invisalign cases than they’ll do wear monitoring cases, you know. So for management of tooth wear, quantifying the amount of tooth structure lost over a period of time, it is going to be brilliant and it should be it should be feeding into research now because it’s been around for long enough for people in practice, for colleagues in practice to be able to put forward cases where they show the rate of. Where on fully dentate, partially dentate cases, different occlusions, different aetiologies and get a body of work that can be can be really useful. Taking it on. But again, you know from on a digital side, I’m just I come from a very naive. We’ve had a scanner for 12 months.
Have you.
Have you not used it? Yeah, I’ve not used it. Did you get.
I’m embarrassed to say that, you know.
Well, you know, it is what it is. It is what it is. What about your younger colleagues? Do they not want to?
Well, that’s the thing. That’s the beauty. So we’ve kind of asked the team that we’ve got. It is, you know, there is some thought that’s put into it. So we’re getting gutted. The guys who have joined us, Calum, James, Gavin, these guys are all the guys who have shown an interest in the digital side who can now and I’m going to ride on their coattails if there’s going to be any if there’s going to be any benefit of being at this stage of your career is that you get the younger guys in who’ve got the the, the nous, the the the dedication to be able to take this. And this is where, you know, our practice has got a there’s a there’s a journey still left. You know, we’ve still got areas where we can progress clinically, non, clinically. And I think the the guys who are going to take it on the digital side are going to be the other guys. And I’ll just hang on and and pick up what I can.
So you said we talked about you sold it last year. What was the sort of decision making process that led to that and when did you think I’ve had enough or what was it?
Oh, you.
Know, I’ll go back probably, probably about five years ago where I thought, well, at some point I’m going to have to sell it. So let’s get a value in, get it valued, and if nothing else, use it as a way of somebody else independently going through the forensics of the of the practice and seeing where I can then spend the next ten years trying to look at some of the figures and look at how we can improve things and make it a more sellable project. And offer came in just and just before the pandemic. And then for lots of reasons, it fell apart. And then straight after the pandemic, we bounced back really quickly because I think the nature of the work that we would do had lots of cases that we that were ready for restoration, lots of cases that were ready for placements than we had the backlog of cases that obviously built up over the pandemic together.
With the fact that we had.
Private entity went through the roof. Right. At that point.
You didn’t plan it.
Did you know everything about it? Whether and I think it goes beyond, you know, everyone talking about kind of patients were looking at their teeth and zooms or they were sat on furlough money. I think I think it was people were more available, you know, working from home. You weren’t you couldn’t use a distraction of a business trip or a holiday. You were around so you could come in any time of the day to have your treatment. So you weren’t waiting and, you know, go back. You know, we had a workforce that were willing to put the shift in, put the put the hours in. And we we caught up quickly and we so the rebound was was really good. So they came back and said, you know, we’re still interested did the numbers again and you know a few things both clinical and both family wages thinking now is the right time, now is the right time. In hindsight, I think it was the right time because the only thing, the only advice I’d give to anyone who’s looking to to to sell up is don’t do it when you’re looking to retire. Do it when you when you feel your journey is not quite finished because you want to be there. You want to be there. You want, you know, you’ve trusted your staff to take it to that endpoint. You want to you want to be with them while the practice then goes through the next phase of of getting better. And if you just sell up and disappear, I think it’s a real shame.
And you sold to Dentex, which is a unique kind of model. It’s less unique now, but they kind of introduced this model of kind of a partnership process where you they don’t pay you the full price and then they get you to stay for four years or something. Is it four years?
You say three and a half? Yeah, three and a half.
Three and a half, yeah. So did you did you have other offers on the table and you decided to go with Dentex or what was it, what was the story with the sale?
Um, you know, the thing with Dentex it was, it was I go with gut feeling. You know, for me, it’s a lot to do with gut feeling. It’s a lot to do with the people you’re dealing with. And, you know, one of the nice things about dentistry is kind of meeting, you know, 12 years ago, lovely guy, get on really well, don’t see enough of you. And it was the same with, you know Chris who represented Dentex. He was just you want someone who gets your practice, who gets the people who work there who who you have confidence will look after your set up in that incredibly turbulent period from where before, during and after a sale? You know, if you have if I had any doubts that the staff weren’t going to get looked after or that the new buyers didn’t get what the practice was about, it would have been horrendous. But did that happen?
Did you have other buyers? Did you have other buyers that you felt didn’t?
No, no, no.
There was just the one. There were the there was another buyer who I think was going to come back to us. But then we went with just the dentex.
Do you envisage that in three and a half years time you are going to leave or you don’t know?
Um.
No, I don’t know. Don’t know. The work life balance has been so bad for so long and I’m going to try and get the next three years to correct that where you can kind of truly, you know, not do your too late nights a week and you’re, you know, historically we’ve done Saturdays and Sundays and, you know, you look back and think that’s that’s ridiculous. But you know things like that digital journey. Yeah that should enthuse that should enthuse me and that should kind of add some energy and so things like that. I look forward to embracing and spending and it’s such a weak excuse the reason it’s just time you know, these these learning curves take time to you to invest. And if you’re working five days a week and you’re doing reports in the evenings, you haven’t got the time to be doing these things.
So dentistry is.
Tiring. Look, dentistry is tiring at any level here, but but at your level, it’s going to be double tiring, right? Because you can’t make a small mistake in the report or whatever. It’s a it’s a tiring thing. I’m surprised you worked five days a week all this time. Did you not think of dropping a day earlier?
No. You know, I blamed Robin Grey for this. You know, he built this work ethic in us where I don’t ever leave people waiting. You know, if someone if someone is agreed to have their treatment, it’s criminal to leave them. So the drive for us has always been get them, get them seen quickly for their first consult. Try not to let them wait more than kind of six weeks. And then, you know, you get someone coming in who’s kind of front teeth have fallen out. You have to be pretty heartless to say, well, our next appointment is going to be three months down the line. You’re going to find a window. So we’ve got kind of the group that we’ve got, you know, the guys we’re working with now, they’re all the same mindset. You know, if it means coming in an extra session just to get that person out of pain, to get that person out of trouble, then they’ll go through it. But so because of that and because, you know, my time was always I think was best spent. Chair Side wrap ports were always done on an evening lectures were always written late evening you know, emails were always reply to after a working day. So it wasn’t that unusual to finish really, really late, really late clinically and then have to do two, three hours. That will take you into the early hours and then you drive home and then be back again. And that was like two a couple of nights a week, you know? So I think I think, you know, I’ve done my time with that. Now is the time to try and get a balance and do things like this.
You know, it’s a massive sacrifice. Right. What you’ve just described there, a massive sacrifice. I mean, you’ve got kids, right? Young kids. I saw the picture on your on your WhatsApp. Yeah. Do you wish do you wish you’d done it differently now in retrospect or not?
Um. I.
It was out of my control. You know, I honestly couldn’t have done. The only thing I could have done is maybe have got someone else in that did the kind of work that I do earlier. And, you know, I’m trying to find someone now. And it’s difficult because it’s not about the clinical skill set. It’s the personality that needs to fit in. And, you know, we’re incredibly lucky with the the group that we we are. I’d like, again, I would argue the most conscientious group clinicians. And it’s getting someone else that fits into that profile. So the choice was taken away from me, an unbelievably kind of supportive and understanding wife who put up with it an amazing support team with the practice, the kids, you know, the time that are dedicated to them was was at the weekends. And I try and be home a couple of times a week before bedtime. Of course, you know, if I could turn back time, you know, you’d be you’d be at home for 5:00. You’d be you’d be at a dinner every night. You’d be. But it’s just what the you know, the kids realise that, you know, that the reason they can go on nice holidays and what they have is down to dad working. Would I ask them to do it? Would I encourage them to put that work ethic in? No, no. You do this to stop them having to do to make the same sacrifices, is that right?
Because I think I think it kind of works out that if they see that that’s the way their dad’s acted, they’re more likely to act that way. Like you learn that work ethic by osmosis.
Yeah, the work ethic is really important.
I mean.
Where did you get it from? Where did you get it from?
Is your dad was.
Your dad that that guy to.
You know, our culture is is similar. I think the Iranian culture is is one that works. Guilt is a big part of it. You know, guilt is a big part of it. And and the again, we’re we’re I’m a few years older than you.
But.
But I think going back to kind of childhoods and when you’re of our age you know when Iran that went through a revolution and a war you got a period of time where everyone every single person would have been affected by it to some level, whether they lived in Iran or outside of Iran. It affected people in different ways, the way it fed to them. My my family is that, you know, my brother and I left Iran when I was seven. He was 11 to move away to a foreign country where, you know, the only words in the year were, yes, no fork, spoon and knife. And and you kind of you’ve got to work to make openings. And then you find that, as I think I said to you before, you know, your blessings come from the people you come across or the opportunities that come across that you come across. And the the what makes the opportunities a certainty is the hard work, you know, And it didn’t take long before you realise that actually the more work I put into something, the more chance it has of, of being something that’s going to work in my favour. And it didn’t work for me for A-levels, it didn’t work for me for the, you know, finals, Pedes and Ortho exam. But you know, those are the things you pick up. But, but yeah, you know, work ethic. Absolutely. I think, I think they’ve got it. But I wouldn’t want them to miss out on the, you know, younger years of their kids the way the.
Way I did. Well, they’re young enough.
They’re young enough from the picture. I don’t know if that picture is a current picture that I’m looking at, but. But looking at the picture. Yeah. They’re young enough that you’ve still got some time.
Yeah.
13 and 13 and 11 and, you know, but I spent, you know, we spend all we, you know, wherever, whenever I’m not working it is we, we spend the four of us, you know, they, they can’t get rid of me basically, you know. You know, if they want to play football in the park, I’ll go and play football with them. We’ll spend time doing everything together. So, you know, maybe an absent for parts of it, but when you’re present, you’re present 100%, you know.
Are you dialling it down now with with the sale? Are you doing fewer hours?
Yeah. So, you know, Mondays I don’t work Mondays. Not because of the sale because I’ve had to give up my surgery to Martin Periodontist, who has recently joined us. And there’s only three surgeries. So Martin’s there now. So Mondays I tend to have off. So, you know, I can pick our boy up from school, which I’ve not been able to do for for a long, long time. So yeah, I’m dialling it down a little bit and it’s, it’s, it’s great. I love it.
I mean, what if I know this is going to sound like an alien concept to you? What if you had half a day to yourself? No practice, no kids, no wife, no just yourself. What would you do.
That you know.
Hasn’t happened in 40.
Years?
Generally it doesn’t have happen.
You know, I find the only time you have to yourself now is that, you know, there are times where I’ll take the longer drive home. Yeah. Not but I’m talking about like 3 or 4 minutes just to give yourself that kind of extra few minutes before you kind of get.
Get up super early.
Or go to bed super late. Well, you must have some me time somewhere.
It gets better.
Super late. Yeah, super, super late. But yeah, no, honestly, if someone could give me that. The one. Think I’ve missed out on is reading books. So, you know, you’ll find that I’ll have no opinion on so many things that are so important because I think to have an opinion on something, you need to you need to you need to be well, read about it. Whether it be AI, Brexit, whatever. And unless you read up about it, it’s pointless having an opinion. So all these things have kind of gone, gone by me because I’ve just not had the chance to kind of read a book and listen to music.
How long is your drive?
It’s 20 minutes. It’s 20 minutes. Not long at all.
Yeah, I was going to say podcast. Podcast. There’s so much on AI in podcasts, you know, I can recommend.
Well, that’s the thing.
But you know, but, but that’s that stuff you still have to zone into, you know. So, so for me, it’s the kind of zone out listen to some music and just zone out and do that 2020 five minutes and then you can kind of phase.
So what was the answer to the question?
If you had half a day, what would you do? What would you do?
I would read and listen to music all the all the. Yeah, so many things. I want to listen to. So many things I want to read that, you know, it’ll take a long, long time to retirement before I’ve had my fill.
So you wouldn’t you’re not a golf guy. You’re not a like a call up Marius and go and party in Liverpool guy.
And that’s of the order actually that’s probably the the order I’ve taken up the golf.
I’ve got the golf lessons but it’s the same thing. I think if I had that half a day, if, if I had that half a day it’d be, you know, in a cafe with a book and the earphones in and just it’s, it’s just the simplest of luxuries that that are amazing. It’s amazing.
So then tell me, what time do you go to bed and what time do you wake up?
Oh, man. You know, you won’t believe this, but you know, when when not it wasn’t that long ago that we would do our long sessions in the clinic. So we’d finish at nine with the last patient, maybe even later. And then we’d catch up with paperwork. So I’d be getting home for maybe two in the morning and then get up at six, 630. Wow. Yeah, 2 to 3 times a week. So, yeah. Yeah. So I tend to kind of go to bed probably about one one ish and then get up. It’s half six to be ready for the kids.
God, you’re like in max fax kind of time. Timing. That’s proper. That’s proper. My goodness. Slow down. Slow down for sure.
Well.
But you know, it’s but you look at look back at it now and just think, you know, there is no way I could have gone back. I could go back and do that now, not not the five days a week with two late nights that we were doing there. It’s and that’s what I’d say. You know, you wouldn’t do it again. And I wouldn’t encourage anyone when we have the the young graduates coming around now and say know if I could give myself some advice. Give yourself that half a day and protect it. If you can protect it. If you can, you know, don’t do admin, don’t do, just do.
I’d say a whole day.
I’d say a whole day. You know, there would be no enlighten if I was a five day a week guy I would, I was a four day a week guy. And on the, on the fifth day you’re right, it wasn’t a weekend. So I wasn’t I didn’t have to do anything with at the time. I wasn’t married, but kids. Sorry. Family? Yeah. And it wasn’t a work day. So, you know, I always encourage people, but you’re right. You need something. Dentistry’s hard. Dentistry’s hard. That’s the thing about it. It’s hard mentally and it’s hard physically.
It’s hard mentally, you know, because and it doesn’t matter what realm of practice you work in, you know, that patient that’s there in your chair at that time assumes they’re the only person you’re treating that day. And, you know, if it’s 8:00 at night, if it’s a nine in the morning, if you’ve had a child that’s hardly slept the night before, if you’re going through kind of personal issues, it that’s the hard part. And you know, for it doesn’t necessarily affect your treatment. It affects your empathy. And I think the one thing you need to have in if if if you’re asking me kind.
Of.
What’s the you know, the respect is one thing that we have running through us. And I think we we all in our practice are very empathetic of what’s coming through our through our door. And that’s that’s the one thing you can go into autopilot with your impressions, with your composite build-ups. But it’s really difficult to be empathetic if you are angry, if you’re exhausted, if you are in emotional distress, if you’ve got stuff going on. But you’ve got to you know, you’ve got to put the face on and and deliver. And that’s that’s that’s that’s what’s tiring. You know.
What would you say.
If I say, what was your darkest day? What would you say? What comes to mind?
In practice. Your talk.
Your talk is staying dentistry. Outside of dentistry, it’s another thing.
Darkest day in dentistry. I. Uh, let me think. There’s a period where I didn’t know what I wanted to do, and there was the option of either the the MSC or going to going to America. And I was I was just absolutely clueless. And and then just opted for the MSC. And it was either the choice of being with family or just being carrying on, being this kind of working solo with no very little family around and and chose that. That was a stressful time. There was a time when, you know, finished specialist training and there was no practice, there was nothing you’re finishing and you had given up my job at the university. So you, you, yeah, you have a mortgage. You have no idea where you’re going to work, but you hope that something is going to come around the corner. And it did. Um, they tend to be the darkest times. Yeah.
What about if I say happiest day? What comes to mind?
Um, happiest day in dentistry. Let me think. Let me think.
Dear. You know, I spent.
I spent most of the time being really happy in work. I honestly do.
And happiest.
Happiest day in dentistry. Um, probably getting the specialist training mid exam.
Getting that in Edinburgh.
Getting that exam. Bear in mind, at that time we had no idea, but it was the one time where it was, it was a culmination of four years of the one time where you’d actually the exam that worked hardest for that you made the biggest sacrifices for. You had no idea it was going to be a ticket to anything else. It was you know, it was it was a bit of a gamble, but it was it was the one time we thought, yeah, you know, this is something I’ve worked hard for and deserve.
Nice. I want to I want to ask you about courses abroad. If you what comes to mind? Like if a young guy wants to look outside the UK for a course. What have you done that that, you know, you say to people. Yeah, go see him. He’s great.
So quintessence do a course every 2 or 3 years and it was on this year and it’s a ceramics symposium and um a zing. I kid you not it is I went to it in the US just yeah. San Francisco. Los Angeles was the one I went to, I think six years ago. And we just look at the timetable, look at the programme, look at the speakers. There’s a reason why it’s not on every year because to get that quality is, you know, you need that kind of course. And it’s I think they do themselves a disservice by calling it ceramic symposium because it’s so much more than that. But yeah, and it was only because we had other things going on this year that I couldn’t go and I just found out about it too late. But it’s something if I had to kind of put something in the diary, I would suggest you go to that. It’s it’s brilliant. It’s one of those things where when you’re there, you know, you know, it goes to these things and you think, well, okay, I’ll find a little window where I can go out for a coffee and explore the local area. None of that happening. You’re there from nine till five, three, four days because because it is that good. You know, the European Academy of Aesthetic Dentistry, they’re doing an amazing programme every couple of years. That’s that’s also similar. Very good.
If if you were giving me some advice regarding guests for this podcast, who would you like to see? Whose story would you most like to hear?
Oh wow.
People in dentistry.
Yeah. Bearing in mind it’s called Dental. Leaders.
Yeah, yeah.
That’s good. You know, honestly now, Wilson.
I’ve had him on. I’ve had him on.
Amazing, right? Amazing. Amazing. Just amazing.
Guy.
Just one of my favourites. One of my favourite interviews.
Just, you know, think again. Look back and think, you know, we’re talking about this giant of dentistry that has got this amazing ability to keep in touch with, you know, this idiot of an MSC student that started in 1997. And, you know, he’s been able to kind of drag people like myself and obviously hundreds of other people, never mind the profession along with him. I think it’s just amazing. Who else, who else I’m going to speak to this person experiencing Stephen Davis, who works at our place. Lovely guy. He’s got so many good stories and he’s been doing it long enough to give you a true sense of what dentistry is like and both in general and and referral practice and is is is a very charismatic guy. I’m going to bang the drum of guys at our place. James D’Arcy. He is way more articulate and eloquent than I would ever be. I spend most of my time just jealous of that man he is.
Let’s get him on.
Let’s get him on sounds. Get him on. Anyone? Anyone you say, Will.
James.
D’arcy get him on? You know, and he. He is an old head on relatively young shoulders. He won’t mind me saying that.
It’s amazing. We’ve come to the end of our time. We’re going to end it with the usual questions. So the the fantasy dinner party, three guests, dead or alive? Who would you have?
I said to you before we started that intentionally, I didn’t look at these because I wanted to think of them off the hoof. Um, I will go for my mum who passed when I was very young. My dad and my brother.
Oh, amazing. Amazing. I mean, how old were you when your mom passed?
Six months.
Oh, my goodness. Yeah. Oh, my goodness. So then was there someone else that you call mom or not?
Well, no. You know.
If you could extend that invitation to other people, it would be my aunties and my grandma and granddad. They were kind of. They were massive. So ideally, it’d be like 6 or 7, eight people.
Okay. And just for you.
Just for you. This. This fancy dinner party can be.
Bless you. Bless you.
It could be three pieces of advice mean that you would leave for your friends and and loved ones on your deathbed. What would you what would you give?
I think friends and loved ones if you if you’re if you’re old enough, you’ve kind of learnt your life lessons. You don’t need advice. I think it’s more for the kids. Spend as much time in flip flops as you can. Invariably, you get as long as you kind of got a roof over your head, I think. Life just is generally more relaxed when you got flip flops on. So if you can find a job that they can do that, that’s great.
It’s the first time I’ve heard that one. Excellent.
Yeah.
Treat people with the respect they deserve. And some people deserve more respect than others. I think that’s probably the other one. And it’s something I did hear on a podcast not that long ago, which is kind of it was a psychologist who was saying that, you know, we’re teaching kids all these all this academic stuff at schools, but important life lessons we’re just missing out on. And one of the most important life lessons is that actually what you what you think about an issue, what you think might happen, what your thoughts are, what your feelings are about an issue, are very rarely the same as the reality of it.
Yeah.
So, you know, just just things are very rarely as bad as you might think, you know.
Absolutely. Absolutely. It’s been such a massive pleasure to have you, buddy. And, you know, knowing you this long and not knowing your story goes to show you that like how much how much people people should sit and talk to each other more. You know, we do it. We do it on this podcast. Right. But, you know, I know we don’t see each other enough, but such a massive inspiration. And, you know, it’s one of the privileges of my job, right, is where I get to hang out with some of my Dental heroes. So really, really lovely to have you, buddy. Thank you so much for doing this today.
Hey, thank you so much for this because it’s giving me a chance to kind of reflect on on kind of life and and what’s kind of brought you here. And, you know, I’m kind of name dropped just a few people but it’s it’s been lovely and and you know the reason I’ve done this is you know as I said I didn’t want to do it. Vanessa, my wife said, do you think you should? But it’s that comfort zone thing I said to you before, you know, sometimes you’ve got to dip your toe on the other side of the line and it’s because of that that that I thought was a good idea. And it’s been lovely getting in touch with, you know, being in touch with you and chatting, chatting away has been really enjoyed it. Thanks very much.
Thank you so much. Philly.
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.
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