Speaker1: The lesson is that, you know, if something sounds number one, if something sounds too good to be true, it probably is. And the second thing more importantly is, you know, it’s okay to not know the answers. It’s okay to not have the information. You know, that’s fine. Not knowing is never a problem. The problem is not seeking the knowledge. So seek the knowledge, seek help, and then and then go for it because you’ve done the right thing.

Speaker2: This [00:00:30] 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.

Speaker3: It gives me great pleasure to welcome Doctor Hesham Ali onto the podcast. Hesham is a specialist orthodontist who works in Manchester, a [00:01:00] consultant at the Royal Bolton Hospital in author obviously, and has a course teaching GP’s Orthodontia. Is that right? Did I say that right?

Speaker1: Yeah. Orthodontia which essentially just means orthodontics. Yeah. Um, but I couldn’t call. Of course. Orthodontics.

Speaker3: Yeah. Reminds me of dentistry magazine. Such a brilliant name, isn’t it? Well it.

Speaker1: Is. It does exactly what it says on the tin, doesn’t it? So maybe. I mean, there are other courses with really, [00:01:30] um, sort of obvious names and, you know, maybe, maybe I should have gone with that. But, um, I tend to be someone who overcomplicates things a lot of the times anyway. So anyway, Orthodontia was the next best thing to orthodontics or, you know, orthodontics course. Um, I suppose these days maybe it’s better to pick something which is dead obvious that someone might Google and is really a Google terms or an SEO friendly terms, I suppose. But no, Orthodontia is what we went for. And it’s it’s kind of reflects where I am, which is everything orthodontics.

Speaker3: So, [00:02:00] Hisham, listen, I’m interested in one particular question. Right. And we used to happen is I used to start with where were you born? And then I’d be chasing that question and not, you know, like so I’m just going to ask it straight away so that we can get it out of the way. And then we can then we can do whatever we want after that. Of course. Do you mind?

Speaker1: I don’t mind ask for that question. I was born in Pakistan.

Speaker3: That wasn’t the question that was. I’m gonna ask the question that I was going to ask. So the key question is, at what point did you say you [00:02:30] decided to be a specialist? Was it from from when, you know, before you got into university or at what point, at what point was it that made what was the thing that made you switch into, I’m going to be a specialist, not a not a generalist.

Speaker1: Um, I’m going to give you the honest answer, which is that there was never one single time point where I decided to be a specialist, and truthfully, I flip flopped more times than I can count. And when I was an undergraduate, I said, I want to be an orthodontist because I thought they were cool. And [00:03:00] I don’t know, I think I’d seen one as a child, and they had a nice practice and they had a good way of life, good quality of life as well. And when I was, when I was in practice in, in Manchester, which is where I spent my entire career, I, you know, I enjoyed the lifestyles and associate, which is, you know, you’re young. I was 20, 22 when I finished university. You enjoyed that lifestyle. And I thought, you know what? Who needs to be a specialist? This is great. I’m working hard and I’m playing hard as well. So what’s the point? But [00:03:30] I was this is back in 2010, 2011. I qualified in 2009. And I got to a point where I was doing these udas and I was getting really fed up and the lifestyle wasn’t enough for me to say, actually, this is the lifestyle which is going to justify me on this treadmill. And, um, I have to be honest, you know, I trained as, as a, as a dentist in Ireland in, uh, in University [00:04:00] College Cork in south of Ireland. Beautiful. And the standard training, I have to say I’m lucky to have received that standard of training. It’s very, very high. And so when I came here, I began to practice within the NHS, and I felt that really my skills weren’t really being utilised and I really felt myself being actively de-skilled at all those techniques, all those special things that I’d learnt as an undergraduate were just being lost, and I never did face those four crowns.

Speaker1: I really wasn’t using retraction cord that much. I wasn’t really doing anything, uh, like [00:04:30] what I was trained. And that was really depressing for me as a from a professional standpoint. So I had to think to myself, well, what is my way out of this? How can I deliver high quality care? How can I do what I want to do, which is just perform and and do whatever I can to the best of my ability? Because I wasn’t at that time. In 2010, 2011, the main route that I could see was specialist practice. And from the [00:05:00] various specialities, orthodontics was the one which sort of appealed to me for a variety of reasons, which maybe will speak about. So really ultimately it was it was that I didn’t really see how to move away from that UDA treadmill, other than to go down that specialist training pathway. And it was a very clear pathway. You know, you leave, uh, primary care, you do a hospital job or two, then you’re into specialist training as long as you are competitive. Enough in the interviews, and then [00:05:30] you are a specialist and you have a different way of working. So that’s kind of the story of how I ended up being a specialist, I suppose.

Speaker3: Yeah. But why? I mean, I had, you know, a lot of people come across that, that problem, I had that problem as well. But I didn’t think I’m going to become an orthodontist. I thought, I’m going to become a private dentist, you know, because I don’t know, I straight off the tee, I thought, I’m never going to do NHS ever again and went, did whatever it took to get a private [00:06:00] job. Why did you think, specialist? Why didn’t you think you could become a private dentist?

Speaker1: I didn’t see the roots that are now existent, you know. Remember, social media was wasn’t really a massive thing. We had Facebook, but you know, that was kind of it. It wasn’t as big as it is now. I didn’t see a clear pathway as to how I could get into one of these amazing, you know, in, in, in commerce, um, uh, practices. How can I actually get into that sort of a role where I can deliver that [00:06:30] high quality dentistry? I just didn’t know how I how I could do it. I didn’t have the connections. I wasn’t born and raised in Manchester in the UK. Um, I didn’t have friends. Really, uh, here that went back generations or contacts in that way. I just felt a little bit trapped within. You wanted guarantees.

Speaker3: You wanted guarantees, right? That’s what you want. No.

Speaker1: I don’t even think, uh Payman. That it was. It was a case of guarantees. It was a case of when you. When I looked online at what what jobs were available at that time, [00:07:00] there was no sort of advertising for private jobs. There was none of this sort of going on that I can remember in my area or in most of Greater Manchester, to say we’re a practice that focus on high quality private care. If you’re an ambitious associate or you’re an ambitious young dentist who wants to learn or who has a good skill set, come and work for us. Come and speak to us. And now if you go online, you will see practices who are advertising in exactly that way to say, if you’ve done such and such [00:07:30] course, come and speak to us. If you are a high level aligner provider, come and work for us. You know, people are looking for skilled practitioners to come and work in their premises. At that time, it just really wasn’t the case. Um, it, it might have been that actually maybe, perhaps in London or down south, things were evolving faster back then. But I guess maybe in my little bubble in Manchester I just didn’t see it. Um, and I’m sure there were some nice practices in Manchester at that time as they are now. Maybe [00:08:00] I was a little bit naive. I didn’t know how to make those right connections and how to, you.

Speaker3: Know, how many years before dental school did you get to UK?

Speaker1: So I, I didn’t I was.

Speaker3: Straight from Pakistan to Cork.

Speaker1: No, no. So I grew up in Pakistan when I was until the age of about four. Yeah. After that we lived in Ireland okay, for a few years. And when I was about eight, this is, I think 1995, we went to live in, in Saudi Arabia. So I was in Riyadh for three and a half years.

Speaker3: Okay. [00:08:30]

Speaker1: Then back to Ireland. And I stayed there from the age of 11 until I qualified as a dentist, which was 22. So that’s from 98 till 2009.

Speaker3: Okay, I get it.

Speaker1: Um, and 2009, I qualified and I came straight to Manchester for this year. I was in for that one year. It was interesting actually, because when you qualify from Ireland, you don’t have to do when you come here you exempt from I did it anyway because I thought it might be a good thing and I sort of stepping stone and in retrospect, probably the worst [00:09:00] thing I ever did was to do that year. Why? Because clinically, uh, as I said, you know, the standard practice which they give you in Ireland is very high. I didn’t really need that support or training, uh, in that sort of hand-holding way that we associated with vocational training in this country, there was a lot more independent as a practitioner at that point. Of course, you need someone to look over your cases and have someone to bounce off. I’m not saying I’m some sort of Dental superhero, far from it. But what happened in that year was that [00:09:30] that’s when my standards changed and I was just seeing the NHS stuff. Yeah, actually, if you take someone with a good skill set and put them into a high performing environment, that’s where they’re going to do well. That’s where they’ll excel. That’s where they where they will grow. Yeah, but if you take some of those high performing and put them into an underperforming environment, they will lose their skills because those skills are not being asked of them. They’re not being delivered or utilised. Yeah. And so actually in retrospect it was demotivating [00:10:00] for a year.

Speaker3: Sorry. It was demotivating for you.

Speaker1: Completely demotivating and de-skilling as I said. So actually going into uh, a supportive private practice, either staying in Ireland for a year or two or moving here to a supportive private practice, that would have been the best move, because it would maintain your skills and it would open your eyes as to what else is possible, what is out there, what is the next step in your development? What is the cutting edge in dentistry?

Speaker3: Yeah, I get them. I mean, look, going [00:10:30] back to what you said about jobs and you couldn’t see the the private jobs being advertised, what I understand nowadays is people ask for jobs that aren’t there. You know, they put out CVS and the practices they want to work at and go shadow those guys and until the job comes from those particular places. So interesting difference. So I used to do it the way that you’re saying, you know like look at the job section of the magazine. Yeah, but but now the best way to get a very good [00:11:00] job is to definitely come to things like packed bar, those, those things, I guess in your world it would be boss or whatever it is boss, isn’t it? Yeah.

Speaker1: Yeah.

Speaker3: That’s right. That’s where you meet the, you know, the movers and shakers, isn’t it?

Speaker1: You’re right. Payman, um, I mean, the industry, the job market is entirely changed, as you know, in dentistry, but I still think that at the top end of of performers, things haven’t changed massively and neither [00:11:30] have the change at the bottom. But you have a lot greater number of people trying to be more towards, uh, the upper end or at least trying to emulate what’s going on at the upper end, which is good. It’s good to see in dentistry. And you’re right, actually, now the way to get a good job is it’s kind of becoming a lot more commercial or I hesitantly say Americanised, where, you know, you need to sort of, uh, spend the time, um, and have a drink or [00:12:00] socialise or be in those events, you know, like, like you say in the various forums that exist, various societies which exist and that might, that might help you along the way. And again, that’s something I am horrible at, you know. Yeah, it.

Speaker3: Doesn’t come naturally.

Speaker1: And networking and socialising, in fact when I, when I met you Payman it was at one of the dental tubules events. Yeah. And it was now you were clearly someone, for example, who’s great, amazing. A master networking.

Speaker3: Networking. No, I’m not very good at networking. I don’t, I [00:12:30] don’t like it.

Speaker1: You could have fooled me because, you know, when I met you, you had a cup of coffee in your hand and you just said, hey, you know, how are you? I’m Payman. What’s your name? And we just got talking. That’s what you know. That is what networking is, right? It’s just being able to make that connection with someone that that link. And, uh, I think you’re very good at it. And equally, that’s probably something which I’m, I’m, I’m equally as bad at as you are. Good.

Speaker3: So listen, man, you know, you’re saying networking okay. Yes. Networking. Because what I said was networking, I guess. Yeah, but but the [00:13:00] other thing, you know, we have people on our course, on our composite course, and a lot of them are there to put it on their CV so that they can get that private job or whatever it is. Yeah. But I’ll tell you what. My advice to them is. Yeah, that, you know, people want bosses want three things from high performing associates. Yeah. Number one photos, photography. And by inference it’s like Instagram. Yeah. And and following and community for sure that for sure that [00:13:30] number two communications courses you know like they’re they’re more interested in the communication of the the associate than his skill because they feel like that they can they can learn the skill later on. Um did I say three? Well, one was Instagram, one was photography. Um, but you know what I mean? It’s weird. The weird thing is that none of that has anything to do with actual clinical, but that’s what’ll get you, you know, get you seen and noticed by the bosses. Interesting [00:14:00] time.

Speaker1: It is interesting time. And I mean, I wonder why do you think that is?

Speaker3: Because that stuff’s super important. Yeah. You know, it’s it’s the you know, we can we can moan about it. But it is super important, you know?

Speaker1: I agree, I mean, I think, you know, on the communication side, 100% agree and you’ll be a lot more successful as a person, whether it’s in life or in dentistry, if those communication skills are harnessed and [00:14:30] refined and all of that, I have no doubt. But on the on the photography Instagram side, you know, yes, having nice or photography skills and being able to produce a good set of images is important from a documentary point of view, from a patient communication point of view, just to display your skill set. But but equally, I think there’s a lot of fudgery that goes on with photo with photographs as well. And you know, I am a cynic, 100% self-proclaimed cynic. And [00:15:00] you know, when I do see photographs, I always wonder why, um, we don’t see complete sets of photographs, why we don’t see photos of the teeth in the proper occlusion, why we don’t see photos of twins in guidance and things like that. And, you know, I think while it’s great to be able to post this up on Instagram, and I understand that maybe the the point of posting is attracting customers or attracting attracting.

Speaker3: That’s the answer. The patient facing the [00:15:30] dentist facing. And there’s plenty of wonderful dentist facing stuff. Yeah. By the way I see I see your Instagram games quite strong, but I don’t know if it is. Yeah it is, it is. But what what being strong isn’t necessarily is being strong is turning up. Yeah. Yeah. And you’re turning up you know you’re doing consistent stuff. Consistent stuff brings in its own audience. You know, it’s like this podcast, dude, we didn’t sit and sort of masterclass it out and say, what would be the most compelling format to to attract [00:16:00] listeners. We just do it. We do it and we do it every week, and it finds its own audience that way. You know, turning up so important in social. No, I think you play a good social game, dude. Have you got like a guy with a camera, you know, comes in every Thursday? How how do you do it? Just let’s talk about that. What’s your execution on.

Speaker1: All my all my social stuff, number one. I mean, I think you’re paying me a compliment, but the compliment, which is not due. But, you know, my my social stuff, you know, if you have a look at my Instagram, I don’t. [00:16:30] I’ve posted a bit in the last couple of months, but not nearly consistently enough. I was much better earlier on this year, but I think that’s the way sometimes, you know, you get distracted by things, and I was distracted by renovating my house, having a second child and so many other things. And that’s not an excuse. I suppose you still got to turn up. You got to turn up, as you say. But no, um, you know, we obviously have different kinds of posts, and obviously I’ve got the patient images, then I’ve got a couple of, um, but what’s your process?

Speaker3: What’s your process? What’s your process?

Speaker1: I [00:17:00] don’t have a process, a process.

Speaker3: You got a process. You’re posting. So. So do you. Just do you just process?

Speaker1: I think of what post am I okay I have a patient images. So I find a case that I finished and I and I just edit the images as I need to crop them whatever. And then I post them the other videos which are of me with talking.

Speaker3: To people and stuff.

Speaker1: Yeah, yeah, with me with this, uh, dentist called Doctor Arnold. Louis. Nice guy. He’s up in Lancashire and he’s he’s got his own little podcast going top guy. He he invited [00:17:30] me onto his podcast. And so they came to the practice, uh, and they recorded it. And actually some of my posts are from me speaking to Arnold. Are that there? That’s his footage which I’ve edited and put onto my own, which I thought was a great usage. You know, uh, and people like this kind of conversation is and it’s much easier for me to have a conversation with someone than with a camera. Yeah. Me too. I find that much easier. And then the last kind of post is basically my stuff from my courses and some stuff that my delegates have sent, something educational, [00:18:00] um, that I’ve recorded, and I’ll put that up. And so I try to maintain those three types of content over, over my page. And, uh, you’re right, it is about consistency. I think, you know, I will try to get into doing more videos, speaking to the camera type of videos. I don’t know if anybody really wants to hear my voice that much or wants to see my face even less, but my I have an ambition to start doing more orthodontic posts like information [00:18:30] posts to say this is a body retainer, not for patients, but for dentists to say these are the considerations you need to have a body retainer. How do you do a best bonded retainer? What are my tips and tricks? So I have an ambition to do that kind of stuff more regularly. But do you have any team working?

Speaker3: Do you have any team working on it at all other than yourself?

Speaker1: No whatsoever.

Speaker3: Well, that’s your area. You know, that’s your area. Um, you’re probably right. I’m not saying go higher right now. A social media ninja, if I am saying that actually if you’re if you are if [00:19:00] you’re if you’re man enough, if you’re man enough. Right. But let’s say you’re not man enough, right. You know, Upwork or people per hour put an ad out saying I need someone to edit videos. I need someone to make posts. I need someone to, you know, you can get someone doing that for you for almost nothing. Like it’s very little about money. People want to do that sort of work. You know your time, your orthodontist per hour time shouldn’t be wasted on this now. Yeah, not not as much 100%.

Speaker1: But at the same time, you know, to.

Speaker3: Learn it, you [00:19:30] need to learn it so that you’ve got the the right words and vocabulary. That’s what I take care of the post for this podcast specifically to feel the pain of a social media person. Yeah, but we’ve got four full time social, you know, people doing all the all the stuff. But you know, dude, my point when I say you’re good at it is, I don’t know many other consultant specialists posting regularly on Instagram very well. So added in that category, you’re like, number one.

Speaker1: You don’t have to leave a [00:20:00] strong point. It’s a really strong point. And I think, you know, historically there’s been a divide between the consultant group or the academics versus, you know, people in primary care. Yeah, there has been a big divide. But now actually and I think it happened over lockdown a little bit more, I think that divide is is becoming a lot narrower. And we’re beginning to converge. And we don’t have that chasm, that canyon between us as much anymore. And I do. There’s a couple of colleagues now, orthodontists, [00:20:30] very well known academics as well, who are posting very regularly now, in fact, far more regularly than I am. So I think they they have also recognised, you know, the power of this, both in terms of reaching the profession and also reaching patients. So I think it’s great. I think we need to have that variety across social media, and I follow those pages. I follow those academics to say, you know, this is really good work. This is a great post. I’m learning from them as well. So I like having that variation of maybe [00:21:00] some posts and some posters who just have cool cases or cool mechanics. Orthodontically. And then you’ve got sort of the Kevin O’Brien’s and Patrick Flemings of this world, the academics who are posting more orthodontic geeky, you know, scientific research and evidence. And I want to read that stuff as well. So actually having that variation is amazing. And I probably somewhere in the middle, uh, I want to show some nice cases. I want to reach the dentists. I still want to be evidence based. And I’m [00:21:30] trying to, like, capture all of that within my sphere of Instagram and Facebook or whatever. So, I mean, that happy zone somewhere. But you’re right. I’ve got to show up. Maybe I should get someone to do it for me. But I also think, you know, like, it’s not that hard. You know, editing photos and cropping them isn’t hard. And, you know, that takes me five minutes to do what takes me ages. And what I still haven’t really mastered is speaking to a camera.

Speaker3: Yeah, but you don’t have to do like, you know, I can’t speak to a camera, so I just don’t.

Speaker1: That’s a really [00:22:00] strong feeling. Yeah.

Speaker3: So look, the thing is, you know, do you know, I don’t know if you know Matty. Um, Parsons, he’s a he’s a he’s a general dentist, does a lot of composite bonding up in Liverpool. And he this guy, his Instagrams fantastically strong because he did a couple of competitions. He’s a he’s a great, great guy. You know could talk to camera if he wanted to. Maybe. Yeah probably. But all he has is before and after. Before. After before. After. [00:22:30] Before. After before after. That’s all he has on his Instagram. Um, yeah. 90,000 followers. Yeah. Like what I’m saying is you just whatever, whatever is comfortable is the thing you should do. And and you know, enough, you know, enough stuff, right? To, to have it without having to talk to the camera. Although it would be good if you could. I can’t. I much prefer this format.

Speaker1: This is a nice format and I mean, I enjoyed the conversational style of it. I think with Matty, um, I’m not familiar with this. I think I’ve heard the name for sure, but, you know, with someone who has [00:23:00] serial before and after photos and it’s just a chronic post-stroke before and after photo. That’s amazing. And obviously his work is, I’m assuming, is primarily clinical. And so the purpose of his social media is just to attract new clientele, I’m assuming. Yeah. Whereas mine is, uh, and maybe for the academics, it’s a little bit more nuanced or a bit more niche in that my posts also need to cover some of the educational stuff. And what that means is, I mean, I’m I’m so aware [00:23:30] that he, myself included, I prefer to listen or watch something than to have to read the information. You know, you might be in the car, you stick on a podcast. Yeah, um, or put on a book or something. So I guess the consumers of this information or of the content or my content probably wants some videos, and that’s where I’m a little bit stuck. You know, maybe I should, maybe I can just try some random posts and see if that works. But I really want to make the videos. I just feel like that’s that’s what I need to do. That’s what I, that’s [00:24:00] my engagement is with videos. You know, I’m so passionate about teaching. I love it more than orthodontics. I love teaching, really. And I think that when you have a passionate teacher, that’s when you learn best. And I really, really want that to come across in my social media and all my contacts and my emails. I want people to know that this is his actual passion is actually the teaching. Um, and I don’t think I get that from the static post. I think I get that from from voice, from video, from facial expression. Yeah.

Speaker3: Um, or, you know, from an online course that would be the ultimate, [00:24:30] right? You just buy buy the online course and sell it all over the world, by the way. Dude. Yeah.

Speaker1: So why not, though? You’re right, you’re right. Yeah. Because what I need to do now is hire a film crew and get them to do it for me.

Speaker3: Don’t worry. I’ll do it for you. And we’ll do, like, a revenue share model.

Speaker1: Why not? Why not? Let’s talk about it. Let’s talk about it.

Speaker3: The wrong meeting? No. After the. No, [00:25:00] no. Um. No. Dude, that. Really. That is a good, good, good thing to do for someone who who adores teaching so much. But the thing about teaching what you adore about it, yeah, is the interesting point, I find, because, you know, like, let’s, let’s, for the sake of the argument, say you want to feed the hungry. Yeah. Or you could be the guy driving the the truck to the village and literally feeding the hungry, you know, because that the buzz of the person grabbing the food, you know, that might be the [00:25:30] thing that drives you. Yeah. But if, if actually you want to feed the most people, go be an orthodontist and pay 50 of those guys to. Yeah, hand out the food. Yeah. And with teaching it’s a similar story. Yeah. Because if you want the maximum number of dentists to learn from you, an online course would be the best way. You know, thousands could learn from you that way. But it’s the fun of teaching is actually watching the person when they suddenly realise light bulb moments in students. Yeah, and [00:26:00] that’s the actual fun of it. It’s not, you know, so the fun doesn’t align to the impact sort of thing.

Speaker1: Yeah, that’s really true. That is very true. It’s that, um, you know, when you see them becoming cognisant of something, you see the penny drop. Yeah. Uh, you’re right that that is the fun of it. And actually, you know, um, I think the thing with teaching is it’s a very social activity when you talk about adult education, you know, it’s not like we’re talking about teaching kids in a room, which is sort of didactic. Adult education and postgraduate education is all about the [00:26:30] interaction. Yeah. It’s a very social activity. Um, and there’s a lot of fun in that. And I think one of the nicer things about it is apart from, you know, watching the penny dropped in front of you. Yeah, it’s, it’s, you know, it’s how it’s building those relationships. Yeah. Uh, and it’s kind of you make new friends out of it. And a lot of the people come to my course, I end up sort of mentoring them. I get to know them over a much longer period. So you’re right that, you know, the the value that I see from it or the fun of it doesn’t really align with, [00:27:00] you know, the financial impact or the delivery of teaching on a wider scale. Yeah.

Speaker3: In fact, you know, I for me, the fun of it is the brilliance of the event. Yeah. And the brilliance of the event in many ways is dictated by how much money you spend on making it a brilliant event. Yeah. And so that the better the event is, the less money you’re making. But but you know, it’s that balance where you just because if it’s not a brilliant event, why even be there that weekend. You know what I mean. Definitely yourself.

Speaker1: 100%. [00:27:30] I mean there is you’re right. Because, you know, I was thinking about the last event. I’m like, I want to do it. Last time I didn’t do a delegate meal like two, two courses ago. And this was like, look, I need to really do a delegate meal this time. It’s got to be nice. And, you know, by the end of the two days, we couldn’t physically eat anymore because the main thing that I’d done in, in true sort of Asian capacity was made sure everyone was well fed at all times and we were [00:28:00] rolling down the stairs at the end of the event. Did you get way too much food? Did you get the.

Speaker3: Wedding caterers in?

Speaker1: I might as well use the banquet. It really was from start to finish. It was just there was just no space at all. But you know, that made the event for me. You know, I want I want people to go back and have a smile on their face and say, remember that time that course we went on, we ate so much. Oh, yeah. And there was something about aligners as well.

Speaker3: But okay, dude, you [00:28:30] know, you say you want people to feel that about you. Yeah. Tell me this dude, how does a how does it align. Right. The, the growing up in three different countries changing school that many times having to make new friends. And were you on one of those US military bases in Saudi. Is your dad a doctor?

Speaker1: No, no. Um, uh, my dad was an anaesthetist, so he was a doctor out there. And, uh, we were in, in, in Riyadh at that time. He used to live in sort of hospital compounds. So and the hospital had housing [00:29:00] associations of compounds all over the city. And you were in one of those. Um, and there were other people that were employed by the hospital in the same compound and an.

Speaker3: International school full of expat types.

Speaker1: That’s right. So there was two main international schools. One was the American and one was the British school. And we went to the British School, which was amazing, by the way. You know, um, a good school. Oh, I mean, the school was fantastic. And the facilities were I mean, we’re talking we know we think about the Saudis these days. [00:29:30] These days we talk, we think about they’re buying Newcastle. You know, AJ and Tyson are going over to fight in Jeddah or Riyadh, you know, but even at that time, you know, life in Saudi was amazing, amazing. As kids growing up, we went to this amazing school with really high quality education. The. Teachers were fantastic. The school was so well decked out. At such good facilities. You know, I can’t even begin to tell you, you know. So it was a great time growing [00:30:00] up in the, in the Middle East at that time, you know, the in your in your house in compound, you had swimming pool, you had tennis court or basketball court, you had friends your age. It was totally safe. You know, they were talking about 15 or 20 houses in a within four walls, locked gates, completely safe. You knew absolutely everybody. Um, and as soon as you got home, there was a race to the swimming pool. And then in the evening, there was a race to the courts. Uh, and so as sort of an eight, [00:30:30] 11 year old, you know, you couldn’t ask for more than that or you wanted to do was get home and start swimming or playing football or doing something with your friends.

Speaker3: What kind of a kid were you? Top of your class?

Speaker1: Um, yeah, they were thereabouts most of the time. Um, yeah. Was it that was it that.

Speaker3: Kind of house where the parents just incentivised study more than everything else? Or was it?

Speaker1: I think they.

Speaker3: More rounded than the.

Speaker1: I think they de incentivised underperformance is probably the way to put [00:31:00] it. And you have to and you have to read between the lines on that one. So yeah so and that’s it’s interesting actually because that mean in, in any, in any walk of life, there’s two ways to get the job done right. Either you incentivise carrot stick or carrots or the other way around. Yeah. And we weren’t really kids who were incentivised for performing. Well, that was just, uh, an expectation. That [00:31:30] was an expectation to say, well, you know, these are the grades you need to get, and if you get them and it was even a thumbs up, it was like, uh, you hit the mark now. Yeah. Stay there. Yeah, yeah, yeah, yeah. But God forbid the thumb starts pointing down. And it did, it did on occasion. So, you know, you have to be careful. Um, but yeah, our household was like that, you know, you had to sort of achieve the grades. And I suppose it’s that classic, uh, you know, South Asian or Asian type of pressure that we [00:32:00] all have spoken about and probably within our friends or elsewhere to say, oh, yeah, my parents expected me to get ten A’s or whatever it was. And we were we were no different. Uh, and from that point of view. Yeah.

Speaker3: Um, so then the thing I said about changing schools, meeting new people. Yeah. Yeah, you it probably means that you’re quite good at that, you know, like meeting new people. I’m obviously can go in one of two directions. Right. But but. You know. What are your [00:32:30] reflections on that? Like how it how it transfers to you today?

Speaker1: Um, I think as a, as a child, it’s very unsettling because you do have to build those relationships every couple of years. You know, there was times when I moved school, so every nine months or something for a couple of years. Um, so yeah. So that’s very difficult to do. So you don’t really build those long time bonds. Having said that, some of my some of the people that I’ve known the longest time in my life are from that three year stint in Saudi from [00:33:00] 20 years ago. Yeah. So you made some really good connections and you can build them over years. I suppose the nice part of it is that, you know, number one, having moved around so much, but also having moved around internationally, um, you get exposed to a lot of different types of people and different cultures, different race, ethnicity, different religions, particularly in Saudi. You know, in an expat school, you have the Muslims, you have the white British expats. Um, you have people from Africa, you have people from everywhere. [00:33:30] Yeah. And it’s really nice to have that because you don’t really get that everywhere. And now in this country, we’re very, you know, sort of cosmopolitan. We have different, different exposures and depending on where you are in the country. But it was great to have it at that time. And I think that makes you a much more rounded person for sure. I and, you know, you you do also then get a sense of what it’s like to have to build those relationships again and again. So there is that benefit when you grow up that maybe you can do that. But I do [00:34:00] feel like it’s a little bit of faking it and that you sort of almost have to you have to be confident and you have to feel or tell yourself that you feel okay with constantly meeting new people, constantly making new friends.

Speaker1: And as an adult, you sort of you’re still doing that a little bit. You’re still saying, look, it’s okay to go and meet a stranger at a conference and say, hey, what’s up? Hey, man. You know, um, uh, so it’s it’s it does give you that something to fall back on and say, I’ve done this as a child. I can [00:34:30] do this as an adult. Almost. Yeah, but I still feel internally like I’m still I’m still moving to a new school. Every time I go to a conference and I meet somebody new. Yeah. And, you know, I’m going to have to introduce myself and develop that relationship with them. And the funny thing is, you know, Payman like, you know, with conferences, uh, most people know a lot of people at various conferences. Um, orthodontists don’t know that many people at conferences because our speciality has historically been [00:35:00] quite isolated. And whether that’s self-imposed or not, I don’t know. But it is relatively isolated, and we don’t share that many conferences with the General Dental Forum. And so when I come to dental tubules or I go to somewhere else, there won’t be I might find 1 or 2 other orthodontists at the most, but everybody else is a prosthodontist, or an oral surgeon, or a general dentist or a marketing guy or something like that and don’t really know anybody. So when I do go to these conferences, I’m in that I’m in, I’m at another new school. [00:35:30] Ah. And, and I have to find some more new friends.

Speaker3: Though I know the feeling, but I know the feeling because I’m painfully shy, you know, I know what you said, what you said. But I’m. I’m painfully shy, I hate it. I’m really, really shy. There are people enlightened here that I haven’t introduced myself to. Employees of mine, you know, because. Because no one’s sort of introduced me to them. I’m really, really shy person as well, man. Um, you know, [00:36:00] it’s just one of those things, man.

Speaker1: Yeah, I guess, I mean, it’s got to be careful with your employees that it doesn’t get to a point where, you know, when you’ve met someone or you know them, and then you’ve had interaction with them. You’ve now known them for 3 or 4 years, but actually you still don’t know their name. You probably get to that point.

Speaker3: That’s happened to me as well. That’s happened to me as well, because we’re on different sites as well. Yeah. There’s um, you know, like I might see our warehouse maybe once every two years. I just don’t go there. It’s like it’s [00:36:30] not where I go. Um, yeah. So listen, man, how do.

Speaker1: You get around that? How do you get around that sort of feeling of, I.

Speaker3: Don’t like it.

Speaker1: Or shyness.

Speaker3: I don’t like it, dude. I’m really bad at it. I mean, now in a Dental environment, it’s it’s, you know, we’re I’m getting a bit senior, right? But I still don’t like it. I still don’t like it. And I find it really weird to hear people come to me and say, hey, I listen to your podcast. I’ve listened to 100 episodes. Yeah. And I like it’s a nice feeling, of course, [00:37:00] when someone says that, right. But I feel really, like really weak in that situation because I feel like they know me really well. I don’t know them. I’m pretty shy again. You know, it’s weird, man. It’s nice. A little bit of therapy for both of us. Uh, the new school therapy. Tell me this, but let’s get to a little bit of author. Let’s get to a little bit of author. I’m interested in this, you know, question of your average GDP is a funny, funny thing to say, right? A relatively junior GDP. Yeah. Coming. Your course for two [00:37:30] days. Is it a two day course?

Speaker1: It is? Yes.

Speaker3: Okay, so that guy or someone who’s done 100 Invisalign cases. Comes to you? Of course. Do you, do you start from the beginning and people get from it what they get from it? Or how do you manage that, the difference between those two? Or do you get a typical avatar type that comes and they’re all similar, similar bit of their of their career?

Speaker1: You know, I, uh, we get a full range. And one of the courses that I did, [00:38:00] I had a newbie I mean, I think sort of one year qualified. Yeah. Anna had a consultant orthodontist in the same room.

Speaker3: Well.

Speaker1: So you can imagine the spectrum that was there. Yeah. And the truth of the matter is that the majority of people who do aligners, I mean, the vast majority were above 90%, I would say haven’t spent the time to investigate and understand what it is [00:38:30] they’re actually doing. And that encompasses the materials, you know, the attachments, the biology of tooth movement, the mechanics of tooth movement. And not. And we haven’t even started talking about the aligners and how they move the teeth and how to stage treatment and IPR and also other things just yet. We were just talking about the basic scientists, a bit like when you go down to school and you have to learn the anatomy, you have to learn some physiology, you have to learn the histology, you have to understand what enamel prisms [00:39:00] are and what the hybrid layer is. If you’re going to do company, you have to set all these things. Yeah. And until you do well, you’re probably going to do pretty rubbish dentistry. Now. It’s not it’s not knowledge that you might need when you’re doing that filling. But if you don’t have that knowledge, you probably won’t know why you’re doing a good filling or why your fillings keep failing, for example. And in the same way, it’s the same with with with aligners. If you’ve done a hundred cases, hopefully you’re you’re you’re very good at managing your workflow. You might have done a bit of trial and error [00:39:30] and figured out what works and what doesn’t work.

Speaker1: But your approach to case management or clinical care is unlikely to be scientific, because you haven’t taken a scientific approach to your learning. You haven’t understood what the principles are and what the steps are in approaching your case in a systematic and scientific manner. So that was the problem. And I remember when I was at GDP, that was GDP for two years before I left and went to hospital, uh, into speciality training, I [00:40:00] did I did two aligner cases when I was a GDP back then. It was a company called Clear Step who went bankrupt. I’m sure everybody remembers. And um, and I spoke to Arnold about this, actually. And, you know, I did these two cases and they, they just they just were they were awful. They were awful. Horrible. And, you know, I remember the training. It was here, take a silicone impression and we’ll send you back a plan. Here’s a great consent form you can use. But that’s not treatment planning is it. [00:40:30] That’s taking an impression and signing a form. That’s what that is. And so the idea of the course came from this concept that actually I was GDP, I wasn’t appropriately trained to do something and actually something went wrong in those cases. So when I saw that happen, I thought at that time, this is not for me. I can’t do more alignment.

Speaker1: So I know what I’m doing. And that was one of the triggers that led me down the specialist pathway. Um, and then when I was in the last couple of years, when I decided to do [00:41:00] this course, I was, I tried to capture that feeling of what was it that I didn’t know? And I realised that what I didn’t know was everything in orthodontics, everything got to do with material science, everything got to do with biology and mechanics of tooth movement. So the course then basically was designed to answer all those questions and give people the building blocks they need to actually deliver proper treatment, not just focus on a brand of aligner treatment. So actually, you know, you can have a consultant in the same room [00:41:30] as a year one GDP or year two GDP. And a lot of the material is relevant to everybody. Um, because, you know, they haven’t covered it before. And yes, there will be some stuff which is irrelevant to the consultant or to somebody a bit more experienced. But unless you are that consultant, most people aren’t. They’ll just be more experienced GDP or even some specialists. Um, then that knowledge will will apply to you equally as much as it will to, uh, that junior colleague. But the one thing I’d say is kudos to the junior colleague for coming on on [00:42:00] year one and two rather than waiting for 100 cases.

Speaker3: Yeah, I agree with that. I agree with that. But the first time I did an Invisalign case, I could not believe I was doing an Invisalign case after the two days. They basically it was a one day course, one day course where they were basically showing you how to use the software. There was. There was nothing I couldn’t believe I was doing. Ortho. I mean, it was a long time ago. It was, I don’t know. Yeah. Before you qualified even. But now, [00:42:30] nowadays. Right. The the number of cases that are going through the importance of it, dude, like if you had to sort of put your finger on the very important critical difference between someone who understands materials, biology, tooth movement, what’s the critical point? I mean, you know, the way a line are talking about it is that, you know, that their supercomputer, AI is has analysed 5 million cases and [00:43:00] just knows where to put everything. So there it is.

Speaker1: You’re right there. But then why do we do refinements?

Speaker3: Yeah. True. True.

Speaker1: Why would you refinements if they’ve got, you know, 1,000,000,000 million cases and they’ve got the scans at the beginning, they’ve got the scans at the end. So surely, you know, uh, their supercomputer can work out what has gone wrong, what has gone. Well, yeah. What attachments were there and [00:43:30] what do we need to to modify here? Surely. Now, what’s really interesting is that I’m sure you’ve heard the line, you know, that you know, the the lie is halfway down the street before the truth is out of bed. Yeah, yeah. And it’s it’s true in every walk of life in dentistry is no different. And so with aligners, you know, if you, if you, if we say that we’re going to get a certain amount of tooth movement or they can do this or they can do that, it’s not really true. The evidence is now coming out to say, well, the predictability of treatment is actually [00:44:00] quite poor, and we can now begin to grade how effective or how predictable individual tooth movements are. So is overbite reduction going to be 100% of what we’re seeing on the treatment simulation? It’s not it’s going to be, you know, roughly half of what we’re seeing or so on and so forth.

Speaker1: What about rotations, what about angulation etc., etc.. So we know that that’s not true because the science is actually now there. The the thing that aligner companies had was they had the benefit of a lack of science so they could say [00:44:30] whatever they wanted. Um, but now the science is there, so you can’t just say whatever you want because the science is, is, is obviously existing. Anyone can go and research it. Um, and as clinicians, you know, we shouldn’t be, um, hesitant to apply the science. We shouldn’t say, well, aligner is saying this or clear corrector saying that, and spark is saying this, so it must be true. And the last thing I’d say is that, you know, AI doesn’t have an understanding of the biological limitations [00:45:00] or the biological parameters around treatment. It doesn’t have an understanding of patient compliance. It doesn’t have an understanding of the various failures that can happen during treatment, doesn’t have understanding of any of this. And all of these are massive factors when you consider what kind of treatment we want to deliver and how we want to plan to deliver that movement. So give me that example.

Speaker3: Give me that example here where knowing the just an example, one of many right, where knowing about the materials, about the bone with something, [00:45:30] what goes wrong, what’s the what do dentists commonly do wrong that they shouldn’t with aligners? And if they knew what they know with your bit, they wouldn’t do? Go on, give us an example.

Speaker1: Well, you have to come to my course to find out. No, I’m only joking. No, no, I’ll tell you. I’ll tell you what it is. The number one thing I see is overexpansion of the upper and lower arches, which we know is unsafe because you’re you’re violating the biological and periodontal parameters. That’s the number one thing. Yeah. And the second thing I see is really [00:46:00] poor finish or really poor occlusion. And the caveat is, well, the patient was okay with it. Um, and I feel that that is a get out of jail card that a lot of us are using. And it’s not really justified to say, well, the patient didn’t say anything. The patient didn’t complain because you’re actually the health care provider. You should be providing the optimal level of care and to say, well, the patient didn’t really care what the patient wasn’t too bothered. So I left it high in the occlusion or whatever. That’s not really a satisfactory outcome for me. I think [00:46:30] that’s a cop out. I think it’s really a poor standard of care to be delivered in that kind of service. And I think that that’s where you want to deliver. Then you shouldn’t you shouldn’t do the treatment. Let someone do the treatment. You can actually deliver it to a to the right standard. And who holds themselves to a higher authority than patient? Not complaining.

Speaker3: Agreed. I mean patient not complaining is is is you know down here and patient delighted. And sending you another patient is a long way away from there’s a big space between those two.

Speaker1: Payman isn’t it. I mean you can straighten [00:47:00] someone’s teeth, but if you leave them with a lip trap that they’re not complaining about, they may not even realise it. You know, they might just accept that, you know, or sometimes, you know, they dentists or people will say, well, I told them they’re going to have a lip trap. It doesn’t mean it doesn’t mean it’s okay in my book doesn’t mean it’s okay. So a negative outcome.

Speaker3: So dude, you know, it’s kind of similar to. To Indo, isn’t it? Right. So, you know, some general dentists can do Indo and want to do Indo. And then there is a point where they feel like referring. Yeah. But [00:47:30] with, with ortho you’ve got, you know, you’ve got the kind of dentist who doesn’t do any ortho and he’s going to have to refer, you know, earlier, but then you’ve got the kind of a whole spectrum of dentists who do ortho. What do you tell them. What do you tell them is the time that they should be referring to a specialist, or is it different for each person? I mean.

Speaker1: Yeah, it’s different for each person, their experience level. Some people have mentors that help them along. So I mentor a lot of dentists, for example. So maybe they’re tackling an increased complexity of case as their skill level increases. Yeah, I think the [00:48:00] difference, for example, is that with endodontics, you know, the outcome even with a specialist is not necessarily guaranteed. You know, even if you go and see one of those, you know, if we see Sanjiv down in Manchester and he’ll still tell you there’s I’m sure there’s a risk of failure here because it will eventually fail. The thing with orthodontic treatment, though, is that generally speaking, it’s a fairly traditionally a predictable treatment. You kind of know what to movements are going to occur, what kind [00:48:30] of tooth movements need to occur, what’s the final overjet going to be like? What’s the final overbite going to be like? If there’s any spaces left, you kind of know where they’re going to be and how big they’re going to be as well. And if you can’t, you know, really plan in that way. And if you’re saying, well, let’s give you some aligners and let’s see what it looks like, let’s see what it looks like, and then we’ll see if we need some more aligners. And and then we’ll see if maybe we need some composite afterwards. That’s not really a roadmap to success. Really. That’s a hidden hope. You [00:49:00] know, when you go to London from Manchester, you you have your satnav on and satnav tells you the route that you need to go on.

Speaker1: And yeah, you might encounter a problem in accident. You might take a little detour to get to the same end point, but you still have an overall route. And a lot of the times with aligners, the mentality seems to be, well, we’ll see how much we get done and then the rest of it we’ll see. You might need some veneers, you know, we might might need some full coverage crowns, you might need some composite. And for me that’s not really a satisfactory way of planning. I think that you can plan with a [00:49:30] much higher degree of predictability, because orthodontic tooth movement is generally quite predictable in terms of what moves are going to occur. So why can’t we do that? Why can’t all dentists plan in that way and say, actually, we know what the final occlusion is going to be like because we planned it. We didn’t just align the teeth and hope for the best. We planned it. We told the patient in advance exactly what it’s going to be like, or almost what it’s going to be like, and we plan the restorative face as well. And that to me is high quality [00:50:00] treatment. That to me is informed consent that really ticks all the boxes of communication and everything else. So I guess that’s my my inflection point. Yes. Well said.

Speaker3: That’s lovely man. Um, so when they come on this two day course. What do you teach them? How long does it take you to teach them the, you know, the basic science bit? I mean, it doesn’t seem long enough. Does it do that?

Speaker1: Oh.

Speaker3: Is there a continuum? Is there a continuum, by [00:50:30] the way? We do ours is our composite course is a two day course, but there should be a continuum. We haven’t got round to, you know. Yes. Is there more than two days.

Speaker1: My, my my course is two days. And what I, what I always say to anybody, whether they’re mentoring or whether they’re coming onto courses to say, look, I can’t, you know, Rome was built in a day and I can’t teach you orthodontics in two days. What I can do is give you the essential building blocks. You need the essential. And I’ve got this picture of a of a of [00:51:00] a of a road map, uh, much like our London to Manchester or vice versa analogy. I know there’s a car and it’s going from point A, and it’s got a marker and point B where it’s going and, and actually what I say is actually what I started saying now is that point B shouldn’t really be there. It should just be a road. And the point is, isn’t it? Is an infinity somewhere. Yeah. Because even for me, as the person providing the teaching, I’m still on that road. I’m just further along the road. Yeah, [00:51:30] yeah, yeah, yeah. So the continuum is there, I think, you know, so when you say how long does it take to teach you. How long does it take to teach the basics? I’d say the two days. The two days is what it takes to teach the basics. Because, yeah, each topic or each lecture or each part of the conversation that we have is about something different.

Speaker1: And all of those things are essential. They are absolutely essential to dilute, to do any of the Leaders. So I would say the two days is what you need to learn the basics. And actually, [00:52:00] um, more recently I’ve had a thought to do a second course which is going to be aiming to cater for those people who have grabbed the basics, who understand the right way to do the treatment, who understand the biological and orthodontic limits and parameters that you should be working to understand the importance of not, you know, insulting the periodontium and and then going through a more advanced type, of course, where actually we’re showing you more specifically how to use the 3D controls, how to do things in [00:52:30] greater detail to really refine your cases, minimise the number of treatment phases that you need, making them more comfortable with the software. Because truthfully, most of the planning they need for orthodontics is done in your mind. Most of its mind is mind work. The rest of it is just a bit of clicking on the computer. Once you’ve mastered the mind work, starting the second course will be great for people who want to really master the software as well.

Speaker3: So do you do things like massive over corrections, change the shape of the attachments, all of that sort of stuff?

Speaker1: Yeah, absolutely. [00:53:00] Absolutely. And that that part is key because we know in the same way with with braces, you know, braces, under-deliver fixed braces, they under-deliver on what we want them to do. So it’s up to the clinician to understand where their underperformance is going to be and to manage that appropriately. And aligners are no different. They underperform massively, far more than fixed braces. So again, it’s just a matter of understanding how, when and why the underperformance is going to occur and then [00:53:30] build in the mechanisms to try and account for that during your treatment. So, you know, modification of attachments and adjustment of the tooth positions. All of these things account for the underperformance within the appliance system itself. And it’s no difference whether you use Invisalign or clear, correct or spark. It doesn’t matter. Or sure, smile and forget or say all the big boys and no one feels left out. They all underperform in a similar way. And so if you understood the science behind why you’re doing what you’re doing, well, what [00:54:00] I say to everyone is every case becomes the same case because all you’re doing is applying your knowledge to that particular case. You’re you’re doing things in a systematic way to account for underperformance. And so my aim is to give you tell me this, tell me.

Speaker3: This, dude, if you’re saying you can be so sure about the outcome at the outset, that’s what you’re saying. Yeah.

Speaker1: Notice I’m saying, oh, you know, now, what I’m saying is that, you know, that there’s going to be underperformance. Yeah. Because the science [00:54:30] is now telling us where the underperformance actually is. There’s research out there to tell us where it is. So you can try and build in mechanisms to correct that. Yeah. Because there’s biological variation between you and I for example. Payman. Yeah. That overcorrection or that that mechanism to address underperformance may not be expressed in the same way between you and I. So I’m still going to introduce some refinements. I’m still going to have to do some of some corrections later on, but I should know where the outcome is going to be. I should know what my overjet overbite are going to be at the end of treatment.

Speaker3: So do you do? [00:55:00] Do you do that service where you do the treatment planning for the dentist?

Speaker1: No, I don’t believe in that whatsoever. Why not? I think that I think that’s, uh, that’s a that’s a quick ticket to litigation. Um, I’ll tell you why. It’s because, number one, you know, as a dentist who’s providing treatment, you need to be in control of your treatment. And if you’ve got someone else to do your plan for you, and you don’t understand why they’ve put in those attachments, or why you might need to use elastics at a particular point, then [00:55:30] when it comes to using those elastics and when it comes to monitoring the treatment progress, um, how will you do that if you don’t know why you did it in the first place and what to look for? And so I don’t think it’s a good service to as an educator, as a consultant, as someone who teaches Post-grads and everybody else. I don’t think it’s the right service to offer our profession to say, here’s a quick plan that I did. Hopefully it works for you. If it doesn’t really sorry, scan it again. I’ll charge you another [00:56:00] £200 to do another plan for you. I’ll only take 20 minutes to do the plan. Hopefully it’ll work if not refined in three. Comeback. I’ll charge you another £200 or whatever my fee is. And I don’t think it’s teaching the dentists or teaching the users of that service to be better clinicians. I don’t think it’s good necessarily achieve better outcomes, so I don’t really believe in that as an approach to education or approach to care. I think clinicians still retain legal responsibility for that. So if I did a plan for you and it doesn’t go doesn’t [00:56:30] go well, well, the patient’s going to come after you. I’m going to have my, you know, contracts in place to make sure that I’m fine. You’re the one that clicked the approve button. Yeah.

Speaker3: But still I’m still more confident with your plan than mine, so I’ll take that risk.

Speaker1: Well, you might, but, uh, I suppose that’s a philosophical divide, isn’t it? Yeah, I just, I feel that I get it. There’s a business and there’s a market for that. I totally understand that. I just, I think, [00:57:00] I think I disagree with it from an educational standpoint or from from a, from a clinical standpoint, from a patient care standpoint that you don’t know what you’re doing with your patient. And I don’t really want to be part of that. You know, my my whole ethos is on providing high quality care, high quality education that’s ethically driven, that does the right thing, you know, say no to drugs. That’s my thing. So I don’t want to be even perceived as someone that thinks that there’s a shortcut [00:57:30] to doing good treatment, because there isn’t. And I think everyone should be responsible for their own care.

Speaker3: That’s a good point, man. Let’s talk about darker times. We have a thing on this pod where we talk about errors. Clinical errors? Yes. In the hope that we can all learn from each others a little bit rather than hiding our errors like that black box thinking idea. Yeah. What comes to mind when I say clinical errors?

Speaker1: You know what? I only have two [00:58:00] that stick in my mind over my career. Really? I’m sure I’ve made plenty of errors, though, and. But there are only two which stick to mind. And I guess it’s because part of those are the two cases, or the two examples that led me to where I am, and they’re the two aligner cases. I mean, nothing crazy. I mean, um, you know, so please, I don’t want there to be a suspense around what I’m going to say, but clinical errors, you know, it was those two early aligner cases that I did. And, um, I’ll tell you about them, should [00:58:30] you wish. Yeah. Um, you know, it was one. I think the first case I did was this, uh, Middle-Aged, uh, lady. And, um, uh, she had some periodontal disease historically, and I, I was a happy go lucky associate, uh, you know, and I said, yeah, pull the trigger, get the aligners done. Uh, bonded her up with the attachments, and I think, I don’t know how many number of aligners in, you know, the upper lateral incisor was mobile. Oh, and I thought, oh, God. And, you know, I was, [00:59:00] you know, I’m not sure you allow swearing on this, but, uh, you know, I was yeah, I was shit scared. I thought, what have I done? I was a year 1 or 2 associate after, I mean, very junior. Not a clue why these tuples mobile. And, you know, thinking back, I’m thinking, was it a problem because teeth are actually mobile during orthodontic treatment. Anyway, that’s how foolish was I to number one to panic. I mean, teeth are meant to be mobile during orthodontic treatment, right? But I think this was a bit more mobile than I wanted it to be [00:59:30] because she had a bit of perio or whatever in the past. And even now, I think thinking back, I probably wasn’t a problem, but I panicked and I sort of froze. The treatment referred her on to a specialist orthodontist, referring to a special.

Speaker3: Expansion like you just said. Is that what it was?

Speaker1: No, it was it was expansion. I was rotating a lateral. It was rotating a lateral. Um, but it might have proclaimed a bit, you know, outside the bone. I don’t know, I don’t know because I didn’t have a cone beam. So what what massive thing happened?

Speaker3: Did you say what [01:00:00] happened with the patient?

Speaker1: I stopped the treatment. Yeah, but I stopped confidence and I. And sorry.

Speaker3: Patient confidence. Did they sort of twig that you’d made an error or what happened? Did you tell them I’ve made an error?

Speaker1: What happened? I think I’m so, like, blinded by my sheer panic that time. And I’m managing my own feelings. I don’t even remember how the patient handled it. I think we could have been good. Yeah, I think I think we said, look, I did, I did that thing which I tell dentist not to do, of course, which is tell the patient it’s okay. Yeah, we’ve got a good improvement [01:00:30] and we can manage the rest with a bit of restorative work, but go and see a periodontist first. Something along those lines. Um, and yeah, we aligned the rest of the other incisors. There was an improvement, but that’s not a good outcome. No. And anyway, I stopped doing the aligners for a little while. After a few months, I saw another case, and this one was a crowded case, and I sort of got my confidence back and I said, okay, there’s no perio here. This is a this is a go. Um, and uh, again, I took the took the impressions and got the aligners [01:01:00] made. And again, lateral incisor, which are the bane of aligners, but it just would not align. It would not align no matter what I did, no matter how many elastics I used and bootstrapped and informs that I went on it, I couldn’t get it to go.

Speaker1: And in the end, you know, the patient needed to have fixed. So it’s a failed at that point, isn’t it? Financially, it’s a fail. Clinically it’s a failed patient with losing confidence in you. It’s just not a win or whatsoever. Yeah. And you know, if you think about it, you know, [01:01:30] those failures uh, those cases, you know, led you to become an orthodontist. Yeah. Now I’m a consultant. At that time, I was a GDP. I didn’t know any better. And, you know, there’s failures in diagnosis. There’s failures in understanding how teeth move. There’s failures in understanding the physiology. You know, understand that the teeth are going to become mobile. There’s failures in monitoring the treatment. There’s failures at every single stage, the Payman. So I don’t think it gets any bigger than that. And you know [01:02:00] what both cases they didn’t end up, you know, with, with uh, any sort of, uh, claims or anything like that. Both patients had decent outcomes at the end of it. But from my point of view, you know, that’s that wasn’t where I wanted to be as a clinician, certainly not as a young, enthusiastic practitioner. That’s not what you want.

Speaker3: And the lesson we have to learn from this is know your shit before getting into stuff. Is that the lesson or.

Speaker1: Yeah, the lesson is that, you know, if if something sounds number one, if something sounds too good to be true, [01:02:30] it probably is. Yeah. And the second thing more importantly is, you know, it’s okay to not know the answers. It’s okay to not have the information, you know. That’s fine. Not knowing is never a problem. The problem is not seeking the knowledge. So seek the knowledge. Seek help. And then. And then go for it. Because you’ve done the right thing.

Speaker3: So interesting man. When I talk to whoever I’m talking to, it could be a lawyer. It could be whoever. I’m talking to a marketing guy. [01:03:00] And if I ask a question and they say, I don’t know, yeah, my respect for them goes straight up instead of instead of what we think is that, you know, if you say you don’t know, the patient’s going to feel, why doesn’t why don’t you know? Yeah. That’s you know, your instinct says, I can’t say I don’t know. But from the other side of it, I’ve personally when someone says, I don’t know, I just, I like that. Yeah. Um, it’s a bit like Andrew Darwood was saying, uh, when I spoke to him, he said, if you’re going through [01:03:30] all the things that could go wrong during treatment, and you’re saying it with some authority, and you’re saying this could happen, that you’re not putting the patient off, you’re actually giving the patient confidence because they think, you know, this guy’s been around the block, knows what he’s doing, knows what’s possible, what can go wrong. You know, it’s a bit like that.

Speaker1: Absolutely, absolutely. I think I think you’re right on that. And actually, I mean, the thing is. Right. If how would you feel if your dentist somehow was delivering health care to you? Dad, I don’t [01:04:00] know. Appetising is one thing, marketing is one thing. But what if they said, I don’t know if I asked.

Speaker3: Him a question and he said, I don’t know, I I’d be totally cool. Um, you’d be cool if you said, I don’t know, but I’ll find out. Right? That’s the the kind of thing you want from them. Um, I’d much rather that than think he just made it up on the spot, which I guess people, for sure. People are good. People are good at hiding that, right? They are good at hiding that. But like I say, I I’m, I like it, I like hearing I don’t know from professionals personally. [01:04:30]

Speaker1: Um, no, I do think it’s a good thing I yeah, I do, and you’re right. You know, when you do tell your patients, you know, what is the difference between it’s a difference.

Speaker3: Between knowing your stuff and saying, I don’t know. It’s very different to not knowing your stuff and saying, I don’t know.

Speaker1: Isn’t it? I love that, I love that. That’s very well put because you.

Speaker3: Know your stuff, dude. You’re so when you’re saying, I don’t know, you’re telling the guy, you know.

Speaker1: As someone who knows a lot.

Speaker3: I don’t know. It’s a totally different [01:05:00] story, you know?

Speaker1: Yeah. I suppose it’s like that concept of, you know, for example, when I send my patients, I tell them, look, one of the risks is tooth loss. Yeah. Right. I say it, I say that’s the worst thing that can happen is tooth loss. And it’s never happened in any of my cases. But it’s a theoretical risk. I always say, you know what the risk is root resorption. And they say, what are the chances? I say in your specific case, I don’t know. But here’s what the evidence says about it generally. What is it? It’s it’s 100% of cases [01:05:30] will get root resorption really 100%. Um, and very, very, very small minority will get severe resorption. In other words, 50% of root loss or more.

Speaker3: How many?

Speaker1: I don’t know. Well done, well done.

Speaker3: Well, I love that dude. I love having just with what I just said. Well done man.

Speaker1: I think it’s I think it’s less I don’t I don’t want to quote it, but I think it’s less than 2%. It’s less than 2%. But I don’t want to I don’t want to because people are listening to this. I don’t want to say, [01:06:00] like Sean said it and he’s a consultant. So so I’m going to say, I don’t know, but it’s around by less than 2%.

Speaker3: Sure, man. Sure. You know, I always find it interesting your author has this wonderful position in our profession. Yeah. Oh, refer the kid for ortho. Ortho this, ortho that. And in a way, like, as if it’s not cosmetics. Yeah, you know, it’s not Payman. Ortho is cosmetics, buddy. Yeah, ortho is cosmetics. Yeah. If the cosmetic benefits of ortho weren’t there, we would send their kid to have a 2% risk [01:06:30] of root resorption.

Speaker1: You’re right. I mean, look, look, what I’m saying is.

Speaker3: I’m very happy with ortho being cosmetic studio, but but there’s a there’s a bunch of people in our profession who refer to authors with some sort of wonderful thing. And then you say, hey, how did you ask about teeth whitening? They’re like, oh, it’s like a massive shark or something to that. We’re talking about cosmetics outside, for sure.

Speaker1: I think I know, I agree with you. Look, a lot of adult orthodontics in primary care is cosmetically [01:07:00] driven. The huge, huge child and.

Speaker3: Child and child. Let’s not be.

Speaker1: Silly and child look for the children. You know there is there are there is some psychosocial benefits. It’s not to say that that’s the primary factor, but you know, kids who have their teeth straightened are a lot more confident, seem to be generally a lot happier and probably have less teasing as well. So there is some clear societal or psychosocial benefits there. That’s the first thing. And then if we talk about orthodontics as a speciality, [01:07:30] I think what most of the profession are exposed to is, uh, you know, referring the kids at the age of 10 or 11, you know, for an orthodontic assessment, they come back with braces, maybe some teeth out straight teeth, or the adults have a bit of ceramic or aligners or whatever, or incognito and, you know, they have their teeth done. It’s it’s cosmetic. But don’t forget that a lot of the cases that consultants are treating are in secondary care or even in private practice, we see a huge amount of multidisciplinary cases. Huge. [01:08:00] Let’s not forget cleft care. Let’s not forget the craniofacial centres. Let’s not forget hypodontia patients.

Speaker1: Let’s not forget multidisciplinary patients. Otherwise, you know, all of that is orthodontics. And you know, privately I see so many referrals for just even routine secondary care NHS patients who don’t want to wait in the waiting list. Now they’ve got hypodontia or they need orthognathic surgery. Um, these are patients with proper functional deficit or facial deformity. And particularly as consultants, we treat a huge number of [01:08:30] those patients. So yeah, I think from the broad spectrum that the most of the profession sees, there is a significant component of cosmetic orthodontics. And that is that is what’s led to aligner explosion. But as a speciality, you know, we have a huge portion of our time dedicated to complex malocclusion, multidisciplinary treatment or just complex dental alveolar stuff. I mean, the amount of central incisors that I have to align every year or every couple of years is massive, you know, and, [01:09:00] uh, and I suppose that, you know, no one should say, well, that central incisor for that kid, it shouldn’t be done or is purely cosmetic. I mean, the kid hasn’t got a front tooth. Yeah, okay.

Speaker3: But I get it.

Speaker1: And yeah, that is cosmetic. Right. But but that is cosmetic. But but it’s, it’s but it’s, it’s outside the norm of what society expects for that kid.

Speaker3: I get it. Look, I’m just bitter, that’s all. I’m just bitter about my my bleaching.

Speaker1: My bleaching thing. I’m an orthodontist. I mean.

Speaker3: You know, they should have just said, you know, [01:09:30] as part of an examination, take shade, and then everyone would be doing that and that’d be the end of it. But and Pei Pei wouldn’t have to sit here and bitch on the podcast.

Speaker1: I don’t think I don’t think anyone is, you know, you know, I’m voting for people who can’t see me, but I’m currently twitching the world’s smallest violin between my index finger and my thumb. So can you imagine? But you know what? You should be happy. You should be happy. Because the explosion in aligner treatment has led to even more patients having their teeth whitened. What, the free [01:10:00] whitening.

Speaker3: Yeah, the free whitening. Yeah, but they’re.

Speaker1: Paying you for it. No they don’t, they don’t.

Speaker3: They go for the cheapest, crappiest one they can find. Yeah that’s true. There is a, there is a thing called the upgrade conversation which is hey start with free whitening. And then at the end say, hey, do you want to upgrade to, you know, vivera and light and that combination. Yeah. Um.

Speaker1: Very enlightened. Yeah. Why not? Because when you start doing is start giving those little, you know, those little tiny toothpaste tubes you get on aeroplanes, like the time they cost.

Speaker3: Money to make those, you know, people think they just they.

Speaker1: They can just do a couple of teeth, [01:10:30] you know, and.

Speaker3: The number of times people have asked for those. Yeah. And you know that that just costs extra money on top of all the other money. You have to make those on top now. Yeah. It’s tell me about I quite enjoyed your dark period there. So tell me something else. You know, career wise I mean okay that was patient error. Yeah. When was the darkest day in your career? Because a lot of ups and downs, dude. Yeah, I’m looking at your CV here on my other screen Masters [01:11:00] in dental public health.

Speaker1: Those were dark days. And you’ve done.

Speaker3: Three different ortho like an MSC, an ortho an morth and then a fellowship as well. Yes. Um, there must have been some dark days in this, in this little career.

Speaker1: Yeah. Look, I think academically, yeah, I think the Masters at Dental Public Health was I did that while I was an associate, and I did that. Yeah. In my second year of associateship [01:11:30] and. My first year as show and Max Fox. I did that Masters and it was good because it gave me a really good academic grounding in research methods and biostatistics and all this kind of stuff. And it also bolstered my CV because I needed to do that to get into orthodontics, which is obviously competitive recruitment process. It’s highly competitive writing. Mhm. Um, so I had to do that. I mean, the other stuff is kind of more routine, you know, now that actually taking it out. But historically you had to do a master’s [01:12:00] as part of your uh, your speciality training in orthodontics. And you also then had to do the membership exam from the Royal College as an exit exam, essentially. And then the FDS is the fellowship. That’s sort of your consultant examination.

Speaker3: What about your advice to someone who wants to get into ortho?

Speaker1: I mean, um, I think how hard is it?

Speaker3: How hard is it? Like.

Speaker1: You start working as hard as you can as early as possible and make sure it is something that you really want. You really want. Because I have [01:12:30] to admit to you that, you know, I do have colleagues, you know, consultants, colleagues. And sometimes, you know, we’ll chat and we’ll say, guys, was it worth it? Because it’s a long time Payman it’s a long time. And the opportunity cost of specialist training in orthodontics is massive. Yeah, it’s huge, particularly if you’re a hard working, enthusiastic, highly skilled associate. Yeah. Who has really good work ethic. The opportunity [01:13:00] cost is massive. The life afterwards is really good, I have to tell you. And in terms of dark days, you know, just going back to your first question, you know, the dark days in my career don’t really relate to. I mean, I talked about the two clinical cases, but the rest of it doesn’t really relate to cases or clinical care. It relates more to, uh, how should we say? I think. Relationship management. Um. [01:13:30] Go on. And and, you know, when you’re when you are someone junior in your career, when you’re, uh, when you’re answerable to trainers and, and supervisors and stuff like that, I think, you know, and particularly as an adult, you know, uh, when we go to university, we’re still kind of kids, aren’t we? We’ve just left school. We don’t mind someone telling us what to do and where to be. We almost need it because we’re still kids. Yeah. As an adult, you know, it’s sort of someone in [01:14:00] their late 20s, early 30s, and it can be difficult to to absorb instruction in the same way.

Speaker3: Are you are you are you telling me you have a problem with authority?

Speaker1: I’m not saying that. But look, I know I don’t think it’s a problem with authority, but I know what I’m saying. I have difficulty absorbing instruction is what I expect. No, no, look, look, I think I think, um, uh, [01:14:30] spit it out.

Speaker3: We’ll cut it out. We’ll cut it out. What happened? What happened? Just say it. No, no, I think I’ll cut it out.

Speaker1: Just say it and we’ll cut everywhere. I’ve lived around the world. Right? A little bit. Not around the world, but I lived in different places. British society has a very sort of unique structure. And they we still have a very hierarchical society that’s reflected within the academic institutions. Yeah. And there isn’t much place for individualism.

Speaker3: Well, you say that, dude. Yeah. But I mean, I don’t know if [01:15:00] you’ve ever been come across like the French. Right. The very, very, very conservative man. I mean, you know, at least in London, you see the odd people with, you know, a punk or a skinhead or something. The French are just homogenous from what I’ve seen.

Speaker1: You know, that’s interesting. You know, I think, yeah. You’re right. Maybe, maybe I maybe I’m sort of generalising, but I society I hear what.

Speaker3: You say, I hear what you say. And the problem that I see with it is almost like there’s no middle. Um, yeah, there’s the best restaurants in the world are in London. Yeah, but if you randomly [01:15:30] walk into a restaurant, you probably have a terrible experience, you know, like this. Or the best universities we have or the best, uh, you know, we do have the best of a lot of things. Best healthcare. Yeah, but then a big middle bit, which isn’t very, very, very good. And it’s just reflected in every part of society. So, you know, I don’t know whether you’re thinking about the, you know, the class system and all of that stuff. I find it’s so interesting after 40 [01:16:00] years, 50 years, however long I’ve been living here. Yeah. That like only recently understanding properly, understanding that people are more interested in the school you went to than the university you went to. And it’s like it’s it’s a that’s the biggest divide here, you know, of course you have the people who go to university and the people who never, never go and haven’t been yet, but go on the dark day. What happened? What happened? You did you.

Speaker1: Get a job.

Speaker3: You didn’t get a promotion. You didn’t get a [01:16:30] recommendation.

Speaker1: I don’t think any of that. I think I think sometimes in in institutions and you know, and the NHS is not immune to this because it is a huge institution. Yeah. You know, you get institutional bias. Yeah. And that can be if you’re not tough skinned that can be very, very difficult to to swallow. And bias occurs in many different ways as you know. Yeah. Uh, whether that’s gender, whether that’s race, whether that’s just the way you do [01:17:00] things that, you know, you’re not following a set guideline or a set pathway or a set style of behaviour or a set style of communication or whatever it is. Okay. But what happened? There’s a there’s a, there’s a bias there which, you know, which is, which is difficult to to get around. I think, you know, I just I think that in some ways I struggle to fit in in, in certain scenarios and certain situations. And when you don’t fit in, then, um, you know, you start [01:17:30] questioning whether this is the right job for you, whether this is the right place for you, whether this is the right training for you. And I think in some circumstances, you know, without getting too deep into it or giving away too much because I think, uh, a lot of people are still working. I think that there are there are I think there are times when you have to just stand up for yourself. And those are the darkest days, because actually you’re challenging behaviours that are unacceptable or you’re challenging people or personalities [01:18:00] that are or biases that are unacceptable. And those were the darkest days where as someone who is maybe come from Ireland or come from elsewhere, and if you’re being treated differently to other people within the same environment, within the same context, and you know what that different treatment means, it doesn’t make a difference. It doesn’t mean you weren’t given an audit project or you weren’t given the same type of patience. You weren’t given the same type of training, or you weren’t given access to, uh, to education or access to consultants or whatever it is that could come.

Speaker3: Down to anything.

Speaker1: Tonality [01:18:30] if you come out and reality is, uh Payman that it comes down to everything, not anything. It comes out to everything, doesn’t it? Because bias affects everything. And so I think those were the dark days. And that really is, is a test of character actually. Because what’s your reflection on that.

Speaker3: What’s your reflection on that. Is your reflection on that. That’s the way it was. And I just, you know, I lived it. And as a Pakistani guy in Saudi, for instance, I’m sure there was some some bias there too, right. Yeah. Or, or is it that you got bitter about it because, you know, it’s interesting talking to [01:19:00] you now I see you’ve got like very clear sort of right and wrong thing that you’re putting out or you’re feeling I guess. Yeah. And you know, almost like very sort of binary sort of black and white about things in your, in your and I don’t think you are that but in your, the way your delivery is, you know, your delivery is that, you know, because talking to you, you’re very nuanced. And does that maybe rub people up the wrong way or something? I don’t know.

Speaker1: No, I think you’re right. I think there’s, there’s I probably am speaking in that black and white way. I think, um, I’m [01:19:30] also being, uh, intentionally careful.

Speaker3: Incredibly sensitive boy as well. Uh, sorry. Incredibly sensitive as well. I feel like you’re quite sensitive.

Speaker1: I think I am, um, uh, and I think I’m being very intentionally careful with my choice of words as well. Sure. Um, I think my reflection on it is this. It’s that sometimes you’re in a situation in which you don’t see a way out, and you have to just you have to accept where you are, whether whatever bias you’re facing, whatever [01:20:00] negative personality you’re dealing with, you don’t see a way out of it. Yeah. Uh, but ultimately, I think the nice part of where we live in the UK, the nice part of the society we’re in, is that you? You there are ways out of it, you know, and actually dealing with those biases makes you who you are. Um, uh, and figuring out how to manage those personalities around you, uh, is what builds your character. And in a way, I’m grateful for it. I’m grateful for it. Because [01:20:30] where I am now is, you know, I have my own trainees, you know, whether the dcts or whatever. And I’m so hypersensitive about how I speak to them, how I come across to them, how I deal with them, making sure I’m fair with everybody, whether they’re male or female or how I speak to my colleagues within the department or whatever. You know, I’m very I’m much more sensitive about that now than I was earlier on. So it’s been an education for me to say, actually, this is I’ve been faced with things and it’s been an example [01:21:00] to me on how not to behave. Absolutely. So my, my, I think when you’re in that situation, sometimes it’s hard to see the wood from the trees, but on the other end of it, you know, it makes you a better person and makes you a more sensitive person and probably means that you’re you’re better as a dentist, you’re better as a father, you’re better as a as a as a member of society. I’m sorry. I’m not being more specific.

Speaker3: No, no, I get it, I get it. Um, what would you have done differently if I could rewind you 20 years, 15 years, career wise? What would you have done [01:21:30] differently? Or earlier or later or not at all? Or.

Speaker1: I’m not sure. Knowing what I know now, retrospect, is such a beautiful thing, isn’t it? Yeah. I think, um, I would have I don’t know if I would have. I may have, uh, um, maybe gone into that private practice. I may have learned how to do the networking that I didn’t know earlier on, and that would have changed my career path and my life path. So that’s the one thing. The second thing is, I would probably say, [01:22:00] and this is probably in part answering one of the later questions you might come to, but I’d probably ask for help. Sooner and faster. And part of that is being more self-aware and self-critical about what you’re good at, what you’re not good at, and where you need to develop. So I wasn’t really self-aware early on my career, and that was both in terms of my behaviour, in terms of my own development. So I want to be more self-aware and ask for help on those things [01:22:30] a lot sooner. That’s those are the two things I would say, um, I would have done differently. Everything else, you know, I think I made my mistakes, but, uh, I stand by them as well. I do stand by them. Uh, I don’t think there’s a major things. I think those two things are really important, you know, build those relationships early and look inside and figure out what you need to develop yourself. So look.

Speaker3: You’ve got a five month old and a six and a half [01:23:00] year. Is that right? Six and a half year old.

Speaker1: Yeah. Well, the, uh, just over six. Yeah.

Speaker3: So do you get any time to do anything other than teeth and kids?

Speaker1: While we’re doing this podcast on a Monday.

Speaker3: This is teeth. This is teeth. Yeah. So like, you know, like what if you had if let’s say I know this will sound really strange, but if you had half a day to yourself. Oh, man.

Speaker1: That’s impossible.

Speaker3: Let’s say you had half a day to yourself. I don’t know, wife and kids were in another city and [01:23:30] you could do whatever. You weren’t working. Do whatever you want. What would you do?

Speaker1: I’d probably tidy the garage. It’s a mess. But you know. You know what?

Speaker3: Let’s say? Let’s say the garage was clean as well. Like. No, no.

Speaker1: Joking. Of course. Um, you know what? I probably go see some friends because, uh, all of my friends are pretty much all of them are married. They’ve all got kids. And we as a group don’t spend enough time together. Um, I know some of our wives are friends and stuff, and they actually have social and we don’t, [01:24:00] you know, and part of that is actually just spending some time with your with your friends. It’s not it’s not actually therapy, but it kind of turns into it by, you know, by by design or just by default. And, um, it’s fun to do that. So number one thing I do is I, you know, I see my friends and in February my wife is going to be away while I’m here. And, you know, I’m already thinking about, okay, how many times can I see the boys? So I need to put the feelers out there. But, you know, if, if, if [01:24:30] time allowed, you know, in the garage actually is is, uh, is is a motorcycle.

Speaker4: Oh, okay.

Speaker1: And, uh, it’s just gathering dust. It’s gathering dust and my brother and I have a twin brother sports bike, so it’s a Ducati monster. So it’s like, uh, it’s like it’s kind of like a more comfortable type of bike, but quick enough. Um, and, um, I have a twin brother, Zohaib. He’s a he’s a specialist. Prosthodontist.

Speaker4: Oh.

Speaker1: And, um, [01:25:00] so he got me into the motorcycles because he was on them first. So what I’d love to do is, you know, half a day or ideally a week, and I’d love to just I would love to just ride over to Scotland and just go and see Scotland for a few days or go and do Europe, because that’s something that I wanted to do for so long, is on a bike to a bit of touring, and I never get the time to do it, so that would be my sort of my wish list.

Speaker3: Amazing. Um, is your brother does your brother work with Costas?

Speaker4: He does. Oh. [01:25:30]

Speaker3: It’s amazing. Amazing. That’s your brother?

Speaker1: That’s my twin brother.

Speaker3: Yes. Amazing man. Well, we had Costas on just two episodes ago. Or 1 or 2 episodes ago. Yeah, yeah yeah, yeah, yeah.

Speaker1: Costas is such a nice guy. Zoheb is all right. Yeah, yeah. No no, no. I’m kidding. Yeah, they do. Obviously they do their injection moulding course together.

Speaker4: Yeah yeah yeah yeah.

Speaker3: Oh wow. I didn’t realise I said well you look exactly the same.

Speaker1: Yeah I mean when I go to conferences I’m, I’m constantly [01:26:00] being stopped and people sort of saying hey how’s it going? I sort of have to say, do I know you? And then after, oh yeah, it’s a twin thing. And then, then I have to get my phone out and show them the photographs and then and then at that point, they’re no longer offended that Zoheb or my twin brother doesn’t recognise them. So it happens all the time. I mean, it’s happened in different cities. I won’t I don’t remember which city I was in. Someone came up to me randomly in a European city, said, hey, you know, I said, I said, yeah, honestly, I can’t remember where it was. Did he. [01:26:30]

Speaker4: Did he study.

Speaker3: In Cork as well?

Speaker1: No, he studied in Dublin.

Speaker3: Oh. So that’s when you split?

Speaker1: Yes. That’s where we split. And he I can’t imagine just straight away he came after a year. So he followed me over at that point.

Speaker3: How did it feel splitting were you like trying to sort of establish yourself as an individual?

Speaker4: No, I think it’s a good thing because.

Speaker1: I definitely think it’s a good thing because as twins, you, you know, you share a room, you share a room, man, and then a room, and then you share friends and your life for the next 18 years.

Speaker4: Yeah.

Speaker1: Uh, [01:27:00] you share the same teachers, you know, you have. It literally is like a side by side experience. Um, so I think it’s good for everyone to have some of their own space, some of their own friends, and just to develop independently.

Speaker3: And what’s what is he like you? Is he is he similar to you or is he different to you?

Speaker1: I think in many ways it’s similar and in some ways is different. Yeah, it’s hard. And I think as the years have gone on, we’ve probably become a slightly more different. But we share a lot of the [01:27:30] same personality traits. And yeah, I think it I mean, you should do a podcast with him and then you should tell me.

Speaker3: Yeah, I think I will. I had Kostas, I didn’t have him, but he was talking about him. So listen man, it’s been an hour and a half. That went quick. Let’s get to the final questions. Fantasy dinner party. Three guests, dead or alive. Who would you. Who do you want to chat to? [01:28:00]

Speaker1: I think that’s such a. Difficult question because. I don’t know, I sometimes I feel like with these questions it will be a case of never meet your heroes, but now we can only go on the information that that we kind of have about various people. And, you know, to be honest, I could really only think of one person really, that would really care to. I would love, and I think it’s unparalleled to listen [01:28:30] to or to speak to or to learn from. And that, of course, you know, being a muslim for me would be our Prophet Muhammad. Peace be upon him by knowing. His biography is obviously well written by various authors. You know, whether that was his organisational ability or his motivational abilities or his military abilities or whatever abilities you have. I think as someone in history that is well documented and highly respected. So I think when I thought about, you know, the various characters throughout history, [01:29:00] whether it’s the Mother Teresa’s or the Nelson Mandela’s, I mean, Nelson was up there as well. Hi. You know, um, just I think for someone who has faced massive bias himself and for what he represented, um, but then, you know, I guess I am a muslim, and that is my primary identity is not an orthodontist. It’s not an Irish person or a Pakistani person. My primary identity is as a muslim. And then I thought, well, you know, I am a muslim, and who do I hold in the [01:29:30] highest regard? And by no means am I the perfect Muslim. By no means, but that is the person I hold in the highest regard. And so I know I was asked to pick three, but then I said, well, I can’t really draw parallels here. So that is the one that I picked. Um, and I suppose to justify that, surely.

Speaker3: You want some loved ones with you on that day, you know, why do you want to be one one on one?

Speaker1: Well, I think the loved ones I have with me are the ones I have already. [01:30:00] And really, what I would want from a fancy dinner party. This is a hypothetical situation, is I would want to meet people who have not met before and gain from them. You know, having their loved ones there is.

Speaker4: Well know your your grandfather’s.

Speaker3: Grandfather or whatever, you know. You know what I mean?

Speaker1: No, I do know what you mean. Payman, uh, and in fact, my grandfather was up there because he was somebody that I never really got to spend time with. Super intelligent man, a scientist emeritus. Uh, your dad’s dad. My my father’s [01:30:30] father? Yeah.

Speaker3: Was he a doctor as well? The scientist?

Speaker1: No, he was he was a geneticist. He was essentially an agricultural scientist who became a geneticist.

Speaker4: Whoa.

Speaker1: Um. And he developed this, uh, he needed the vaccine most of his life. He did his PhD in the US in the 50s and 60s. And, uh, he developed this cotton seed, which didn’t require pesticide, and put the pesticide companies out of business through genetic modification. And he became a scientist emeritus. So and I never got to spend much time with him. And he was I [01:31:00] really respected him, but he was highly respected within the country. So my grandfather was was up there just because I really loved and respected him. And my mother says I looked a lot like him. And and he died before I really got to have that connection with him. And that was one of the the downsides of moving around so much is that we lost touch with our grandparents and with our extended families who were still there. So, you know, obviously the prophet’s up there, but beyond that, I think, as I said, Nelson, [01:31:30] for what he did or what he stood for for so many years and the lasting legacy of that, whether that’s. You know, what is his his assets, what his successes are now talking about in Palestine or elsewhere. And my grandfather’s up there just because someone that I just aspired to be like, and I never really got to spend some time with it. And I think, you know, I am this. Like you said earlier, I seem to speak about ethics in black and white and the right and wrong and black and white, and he was someone who was extremely intelligent and [01:32:00] could have had a lavish life and set me up quite nicely. But he didn’t. And I came down to him, you know, refusing the commercial aspects of his, of of his invention and giving that to the people. So he lived a very, you know, modest life for his until his death. And that’s something I find really inspirational, you know.

Speaker3: Absolutely, man. So, look, you know, your grandfather was a, you know, was a geneticist, agricultural geneticist. Your dad was an anaesthetist. You guys both specialists, [01:32:30] you and your brother. Is that is that expectation of doing something, you know, massively significant? Is that is that are you pushing that now to your kids as well? I know they’re too young. I know they’re too young.

Speaker1: No, no, I think, you know, um, I don’t think what I do is significant is the truth of the matter.

Speaker3: It’s quite significant.

Speaker1: No it’s not I mean, I do.

Speaker4: I do.

Speaker1: I do some cleft care and a little bit of it, you know, that’s referred into me locally. Not much. That [01:33:00] stuff is really important. But the rest of it, it’s teeth. I don’t think, in the grand scheme of things.

Speaker3: But I’m in kind of the pursuit of excellence, if you like. Yeah. I mean, as far as.

Speaker4: I think that the kids, as far as I’m concerned, you.

Speaker3: Could be you could be the best shoemaker in Karachi. As long as you’re the one who’s trying to be the best, you know, whatever, whatever you do. What do you think the reflections on kids, what would you what would you encourage them to do?

Speaker1: I think I want the kids to be [01:33:30] at the top of their game in whatever they want to do, but I’m not going to force them into dentistry or science or medicine or anything like that. But I do believe that they have to be at the top of whatever they do. I think every every parent wants to believe their child is special and intelligent and whatever. And I think my children are intelligent and they’re performing at an above average level. At least the six year old is at the moment, uh, thank God. So so that kind of pressure coming together.

Speaker4: Yeah. Is it going to be said that. Did I say that out loud I did.

Speaker1: So [01:34:00] so so whatever they want to do is it’s cool. It’s cool, but be a success. Make sure you can take care of your family and be the best at at that. And that’s good enough for me. That’s good enough for me. What’s not good enough for me is that you achieve less than what you are able to do. Okay. Yeah.

Speaker3: But does it resonate with you that there were times where when your dad was being the best he could be, he wasn’t around with you, and you know, the sacrifice. You know, I’ve got, uh, Depeche on my course here. [01:34:30] The guy wants to be the best in the world at teaching composite, right? There’s massive sacrifice in that massive sacrifice. And often the sacrifice ends up being one of the family, right? Whether it’s your wife or kids or, you know, because you don’t let work go or yourself, of course, that’s, that’s that ends up being the biggest sacrifice sometimes. Do you recognise that. And and are you going to adjust for that.

Speaker1: Yeah, I think that’s a very, very valid point. And um, and like you say, I don’t think I’m [01:35:00] the best orthodontist in the world or the best educator in the world, and I’m probably have found a balance in looking at family life and all those things. Yeah, I think I think we can we can always adjust our compass a little bit, accounting for those sorts of parameters and accounting for family life. And that probably is important because, you know, you can look at you can look at Steve Jobs, um, and what he said on his deathbed, and you can look at all these people. And actually, what do they talk about in those final moments is not really developing [01:35:30] the iPhone or MacBook or being a trillionaire. Uh, it’s probably the other things in their life, uh, which they have missed.

Speaker4: Um, apparently.

Speaker3: Apparently he apparently he never said that stuff, but but but it’s still it’s still relevant, man. It’s still relevant.

Speaker4: He he should have said it.

Speaker3: He should have said it. Even if he didn’t, he didn’t.

Speaker4: Then he should.

Speaker3: Have. Yeah. Yeah, yeah. Let’s get let’s get to our, um. Final. Final. Yeah, it’s a deathbed question. It’s difficult with someone so young to talk about deathbed, but. But let’s just [01:36:00] go there on your deathbed. Surrounded by your loved ones. Hopefully your kids will be very old by that time. Your friends and family and loved ones. Three pieces of advice you’d leave to them or the world.

Speaker4: I had to.

Speaker1: Really think about this as well. I mean, uh, you forced me to go into deep places, and I think the three things that I would say, I think that probably moulded partly by your own experience, I think naturally. And [01:36:30] I’m sure if you ask me this question, in 20 years time, I might give you a different answer. I don’t know, but I might. Um, I think the first thing I’d say is that it ask for ask for help sooner. Whatever that means to you, whether that’s professionally, whether that’s something you’re struggling with, you’re not feeling well mentally. Whatever it is that you need help with is to ask for that help as soon as possible. That’s the first thing. And [01:37:00] because, you know, if you can’t do anything without that support, without that network around you, without feeling well, you can’t. So the first thing is to ask for that help. And then, um, the second thing is to be probably more vigilant or pay more attention to the people around you and maybe your impact on them. So, you know, how are they feeling? What are they actually asking, asking you for? You know, when you’re when you’re a six year old is crying [01:37:30] or she’s upset or, you know, understanding why that is that she’s really happy, really understand why that is. Don’t just know that she’s happy or upset.

Speaker1: Figure out what it is that’s driving that emotion. So be attentive to people so you can help them, or you can support them, or you can just connect with them, um, and just build your bonds. And then the last thing is, once you build that bond is, is to remind each other of of those bonds that you’ve built, you know, whether it’s your friends, whether it’s your brother. Whomever [01:38:00] it is, because I think a lot of the time we kind of just forget to remind each other of. Our relationships or the love you have for each other or whatever you’ve been through. You know, I’ve got friends who’ve who I’ve known for 20 years or and I’m sure you have as well, for even longer. And you kind of just take it for granted after a while, where it’s good to sometimes sit down. And I don’t think you have to get emotional every time or sentimental, but it’s good to maybe look back and remind each other where you came [01:38:30] from and why you were like, and what those bonds actually mean to you. Ah, yeah. And I think that’s sort of that probably would give, I think if I did that earlier and sooner, I knew these things that bit faster in my life, maybe I’d have greater satisfaction or, you know, before or achieve that happiness sooner.

Speaker3: That’s nice, man. I could stay in touch with your buddies. Kind of one. Right? And family and all that. Yeah.

Speaker1: Yeah. Yeah, absolutely.

Speaker3: It’s an interesting [01:39:00] question. That one. Yeah. Because it’s perhaps question perhaps my other my my co-host. Right. And uh, you can either answer that question with I did this and you should too. Or you could answer it in I think you’re more skewed this way. I didn’t do this, but you should.

Speaker4: Yeah. Which is which is the way.

Speaker3: I would answer this question as well. I’d be like, yeah, go right to the gym.

Speaker4: Because that’s the thing, right?

Speaker1: I mean, it’s and that’s [01:39:30] what I was thinking, like, this is what I haven’t done. And it would be better. I mean, I don’t know, I assume a little self-deprecating. Uh, you.

Speaker4: Say you are.

Speaker3: You are, buddy. You are. Um. It’s nice. It’s a nice thing. It’s a nice thing. Because, again, much better than. Much better this way than the other way. But, um, you know, dude, a lot of times I feel like, uh, punishing yourself sometimes. Not you. One one punishes oneself, sometimes a bit too much. Life’s too short to punish yourself too much. But you know that [01:40:00] just amount of. I’m looking back on it. Yeah. Looking back and thinking the things that you were thinking 15 years ago and you realise, God, all of that was wrong.

Speaker4: Yeah. I mean, uh, not just that.

Speaker1: I mean, sometimes you look back and you cringe on some of the stuff you’ve.

Speaker4: Done or thought about.

Speaker1: You know, and I really sort of try to shake some memories. I thought, what were you doing.

Speaker4: Or what.

Speaker1: What did you do that for? What were [01:40:30] you thinking? And I just I sort of just had to almost shake the cringe off my back.

Speaker4: Shake the.

Speaker3: Cringe. Oh, nice way to end it, my buddy love. Lovely conversation. I really, really enjoyed that. Man. Really did know that.

Speaker1: Was amazing man. I think, um, I think there’s there’s so much scope for more of this. And I to be honest, I enjoyed this way more than I thought I would. So I thank.

Speaker4: You for having me on.

Speaker3: You’re a natural. You’re a natural talker, buddy. You are a natural teacher. Thanks a lot for taking time. Cheers, man.

Speaker2: This [01:41:00] 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.

Speaker5: Thanks for listening, guys. If you got this far, you must have listened to the whole thing. And just a huge thank you both from me and pay for actually sticking through and listening to what we’ve had to say and what our guest has had to say, because I’m assuming you got some value [01:41:30] out of it.

Speaker3: If you did get some value out of it, think about subscribing. And if you would share this with a friend who you think might get some value out of it too. Thank you so so, so much for listening.

Speaker4: Thanks.

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