Payman Langroudi presents part one of a deep conversation with Len D’Cruz, a distinguished figure in dental legal affairs. Len shares his journey from Nairobi to London, his unexpected path into dentistry, and his perspectives on the evolving field of dental law.

Len talks about childhood, academic choices, and his approach to handling dental complaints and claims with empathy, detailed record-keeping, and a cool head in the face of pressure.

In This Episode

02:15 – Backstory

04:10 – Entry into dentistry

07:55 – Character traits

09:00 – Dentistry and academia

11:10 – Whitechapel

12:30 – University

14:10 – Work ethic

17:10 – Dental legal affairs

24:45 – Mistakes and shame

31:20 – The legal landscape

35:10 – Partnerships

38:40 – Defending legal cases

41:05 – Implant and aligner therapy

43:40 – Future trends

45:55 – Record-keeping

About Len D’Cruz

Len D’Cruz is the head of indemnity at the British Dental Association. He heads a mixed NHS/private practice consisting of seven surgeries in Woodford Green, North East London. He also teaches the MA in Dental Law and Ethics program at the University of Bedfordshire.

Speaker1: Dentistry is a fantastic profession. It does not need to be. You do not need to be worried looking [00:00:05] over your shoulder thinking, God, when am I going to get sued? The patient’s going to complain. If they complain, they complain. [00:00:10] But all you need to do is just learn from those complaints and move on. So I think that’s our biggest concern [00:00:15] that we still have this, this, this sword of Damocles, of litigation hanging over people’s [00:00:20] heads thinking it’s going to be me. It’s going to be me today. If I go in and I do something wrong, they’re bound to complain. [00:00:25] And I have that in my own practising. And don’t worry about it. They complain we’ll deal with it. So okay. [00:00:30]

Speaker2: This [00:00:35] is Dental Leaders. The podcast where you get [00:00:40] to go one on one with emerging leaders in dentistry. Your [00:00:45] hosts Payman Langroudi and Prav [00:00:50] Solanki.

Speaker3: It gives me great pleasure to welcome a [00:00:55] dentist whose name is so synonymous with dental legal affairs that [00:01:00] you may think he does nothing else, but because this research that I was [00:01:05] doing for this podcast with Len de Cruz, I’ve come to find that he’s one of the [00:01:10] busiest dentists out there. It took me a full 45 minutes to go through all of your achievements. [00:01:15] Then, uh, practice owner with his wife and a practice they started [00:01:20] 30 odd years ago with two surgeries. Now, up to seven surgeries with specialists. [00:01:25] You know, any any business that’s running for that many years, I’ve got a lot of respect [00:01:30] for. But growing a business like that and, you know, I’ve known of Len de Cruz since the day [00:01:35] I qualified. And yet I never knew that, uh, you’re running a busy practice. Um, [00:01:40] trainer, foundation trainer, long time Dental, legal advisor [00:01:45] at Dental protection and now head of BDA indemnity, [00:01:50] which we’ll get to. But examiner for the aura. [00:01:55] Um, all for lots of journals and book book chapters. [00:02:00] Post-grad tutor. But you’ve done a lot. I’m sure I’ve [00:02:05] missed a bunch. Welcome to the podcast. Lovely.

Speaker1: Thank you very much. It’s a lovely introduction. [00:02:10] You do forget what you’ve been doing, uh, over the years, basically. But. Yeah. Thank you.

Speaker3: So [00:02:15] then I’d love to sort of try and find out sort of the backstory of what what [00:02:20] what were you like as, as a kid? Where did you grow up? Where were you born? [00:02:25] Where did you grow up? What were you like?

Speaker1: What was it like? Um, so I was born in Nairobi [00:02:30] in Kenya, and I lived there till I was 12 or 13 years old. [00:02:35] My parents, my dad was a worked for a company called [00:02:40] East Africa Power and Lighting. Uh, and he had interestingly, my two [00:02:45] elder brothers were came here to private school, public school, boarding school, about [00:02:50] 7 or 8 years before we arrived, because my dad had expatriate terms and they paid for [00:02:55] their education, they paid for their flights back home. But in their wisdom, they decided to keep [00:03:00] me home, uh, as their last son. So we eventually emigrated to England [00:03:05] in 1977. So. And I arrived here [00:03:10] as a schoolboy, walked into school at, well, essentially [00:03:15] arrived in London Heathrow Airport, driving through house [00:03:20] after house, thinking what on earth are I’m doing in this country? Having lived in the wild [00:03:25] wilds of Nairobi, the open spaces. So coming to London was a bit of a shock. [00:03:30] I came arrived in September and I was in school within within a few weeks in [00:03:35] a school in North London, essentially. Um, and that was the start of it. Uh, I, I [00:03:40] enjoyed school, it was a bit of a culture shock the first couple of years, because the [00:03:45] education system in Kenya was actually pretty advanced. I spent the first year not doing a great [00:03:50] deal. I watched TV a lot and Citizen Smith and Selwyn Frog and [00:03:55] complete rubbish and and actually just got on with life. So as a kid [00:04:00] I. I enjoyed sports. I was good at basketball, reasonably good at football, [00:04:05] and then became.

Speaker1: But one of the things I enjoyed doing most of all was [00:04:10] English. I liked, uh, reading books, and I actually did English [00:04:15] A-level, uh, in amongst the three science A-levels you had to do. So I did physics, chemistry, [00:04:20] biology, and I was absolutely hopeless at physics. I don’t understand it now. [00:04:25] Not sure why anybody can understand physics. Maths was just a was a foreign subject [00:04:30] to me. So I actually did English. I did miserably in physics, dropped several grades and because I got [00:04:35] an A in English, I managed to get to do dentistry. So I wouldn’t have done. I wouldn’t have been here right now [00:04:40] had I not done English. And interestingly, I did English, uh, on the sly because [00:04:45] my parents said, uh, you as good Indian parents, you have to concentrate your three subjects [00:04:50] you can’t possibly do English. English is going to is going to be a is a waste of time. It’s a useless subject. Don’t bother [00:04:55] doing it. Um, so I remember coming home and they said to me, have you given up English? I [00:05:00] said, yeah, I’ve given up. Are you sure you’ve given up English? Yes, I have, uh, so I carried on anyway and, and [00:05:05] bizarrely got a, got an A and, and at one point I was considering doing English [00:05:10] at university and my English teacher said, don’t bother. Do sciences do dentistry? [00:05:15] They are the great career. You can do English at any point. So that’s kind of how I got into, uh, writing, [00:05:20] uh, and just really interested in that sort of stuff.

Speaker3: Why dentistry?

Speaker1: The, uh, why [00:05:25] dentistry? Interestingly, I probably the it’s an odd answer, but it’s [00:05:30] a lazy, lazy response to to or lazy lazy reaction to [00:05:35] medicine. My brother, my older brother was was a doctor. He was working incredibly long [00:05:40] hours. He was doing a lot of, uh, a lot of work. Uh, and I just thought, actually, if I did dentistry, [00:05:45] I wouldn’t have to do as much. I just had to learn anatomy of the head and neck wouldn’t be that difficult, [00:05:50] surely. And it’s a 9 to 5 job, so it should be. Okay. So it was kind [00:05:55] of, uh, one of the things I was quite interested at that time was, is I was going to be dentistry, pharmacy [00:06:00] or genetics. Genetics was a major big thing. You read New Scientist at the time, genetics [00:06:05] was a real, real big, big thing. Well, before the Human Genome Project. All the [00:06:10] sort of things that now become quite, quite relevant. Now, back in the days, it was quite a big thing. Every [00:06:15] every article in New Scientist at the time was about genetics. The jobs were about genetics, [00:06:20] um, and that new world. So I was quite interested in that, but ended up in dentistry [00:06:25] and ended up at uh, and again, the the reason I got into dentistry was [00:06:30] no other university other than the Royal London or London Hospital at the time was taking [00:06:35] English, or they took biology, chemistry and one other subject. Everybody else said you had to have [00:06:40] physics, chemistry, biology. So I’m eternally grateful for the London having the [00:06:45] foresight to see that actually it didn’t need physics to do dentistry, frankly. And [00:06:50] and so that was that’s how I got there. Uh, no other university would have accepted me at that time. [00:06:55]

Speaker3: So, I mean, now I know now you have a law qualification. Was was law not on the picture [00:07:00] at that point?

Speaker1: Not really. No. It was it was very much dentistry is going to be English dentistry [00:07:05] science background I wouldn’t the law stuff came a lot later when the opportunity [00:07:10] arose, rather than something that was sort of burning ambition.

Speaker3: But you know what [00:07:15] I mean. Your English teacher could have said, hey, do law.

Speaker1: Could [00:07:20] have done, could have done. Um, uh, because there was there was a couple of people who’d went [00:07:25] off to York University to do English, and I thought, this is just amazing, you know, go to the English to, [00:07:30] you know, do Shakespeare, all that sort of stuff. And I remember, uh, just saying, you know, you can do this [00:07:35] any time you want to, basically, you know, if you’ve got a good career in dentistry, if you’re going to do well, let’s crack [00:07:40] on with that, basically. But yeah, and actually nobody did mention law. Um, I’m probably not [00:07:45] because because I quite like the sciences. And so it would have been, it could [00:07:50] have done it, but uh, it was, wasn’t on my radar at all.

Speaker3: You [00:07:55] know, when, when, when we had a dinner recently at the, um, Dental update thing and [00:08:00] when I left that dinner, the feeling that I got from you. Well, number [00:08:05] one, I spent the whole night talking about me because. Because you’re such a curious person, [00:08:10] you you ask a question and delve deeper into it and then say, what do you really mean [00:08:15] by that? And, you know, an incredibly detail orientated person. [00:08:20] Have you always been that guy?

Speaker1: You surprised me that you’d say, I’m a detail person [00:08:25] because my wife would say to me, uh, you’re a big you’re a big picture person and you never follow through and [00:08:30] stuff. So I think, I think probably conversation I would get into into into [00:08:35] detail stuff. But but as a, it’s a reason why I don’t think I’d be a specialist. [00:08:40] The reason why I couldn’t do something to, you know, so I rely a lot on other people. [00:08:45] I rely a lot on my wife for the detail stuff. I rely on other people for the detail stuff. Conversationally. [00:08:50] I just find fascinating chatting to people and just getting to know other people’s stories. So, [00:08:55] uh. So yeah, I forgive me if I was intrusive.

Speaker3: No no no no no no no no. So [00:09:00] just because, you know, I want to know about you, but you. So [00:09:05] tell me about your university years. Did you take to it? Naturally. [00:09:10] Did you find it difficult? Did you find the studying bit easier or the practical bit?

Speaker1: Uh, [00:09:15] I actually found that academic was very easy. I mean, I realised one [00:09:20] side done the first year. I think actually, it’s not going to get any more difficult than this, and it was pretty straightforward. [00:09:25] It’s just need to learn anatomy, physiology, biochemistry. And it was not particularly difficult. [00:09:30] So academically and I and I and I really strongly believe that it’s not an academic [00:09:35] subject. And we created this, this monster that requires, you know, [00:09:40] uh, four stars to get into dentistry. And it’s just it’s really obviously just, uh, just a filter mechanism. [00:09:45] But actually, academically, you don’t need to be exceptionally bright. You just need to be you need to be good with people. You need to be good [00:09:50] with your hands. And but even the hands thing, you know, I’ve done looked at this a lot and you [00:09:55] can learn those sort of those manual dexterity skills. I think it’s the communication, the liking, people [00:10:00] getting on with people that is actually fundamental to all of it. Being empathetic, um, having those sort of communication [00:10:05] skills and listening to people. And I think that’s you can’t you can’t necessarily teach that it’s got to be [00:10:10] something that you just enjoy doing.

Speaker1: So, I mean, for me, university I enjoyed academically [00:10:15] wasn’t challenging. Um, I wasn’t the best student, but interesting. I started getting [00:10:20] involved, wanting to get involved in politics as the there was the PDSA British Dental Students [00:10:25] Association stood for election. Didn’t get it started seeing okay, this is something that might I might [00:10:30] find interesting but yeah, I probably was uh, I was, I was I was quite keen, I [00:10:35] didn’t I didn’t fail any exams. Lots of people failed all their internal exams because it just couldn’t be bothered to do it. And I thought, [00:10:40] no, I don’t want to fail an exam. So so I did. I worked reasonably hard, uh, was reasonably academic, [00:10:45] but not not, um, not a high flyer by any stretch of the imagination. Just, just just basically [00:10:50] works and work. So. Yeah. So I mean, I enjoyed university. Lots of people didn’t work out. Um, [00:10:55] they lots of people hated university and just wanted to get out [00:11:00] for me and enjoyed it, enjoyed the the fun of it, enjoyed the the camaraderie of it and [00:11:05] and was gone on with the gone on well with the tutors.

Speaker3: And in Whitechapel [00:11:10] did you know what to expect when you, when you got there? Because I remember going for my interview in Whitechapel [00:11:15] and um, I couldn’t believe it, man. When I came out of the the [00:11:20] underground station into Whitechapel market, I’m not sure if it’s still is. [00:11:25] It must be still like that. I haven’t been for a while.

Speaker1: Exactly. It’s exactly the same. It’s a real culture shock. Um, [00:11:30] you know, coming from North London, I’ve lived in north London. And you, you’re always thinking, where am I this [00:11:35] this looks like, you know, West Bengal or something. What is going on here? You know, markets, you know, from, uh. [00:11:40] And you think I’m never going to get on with it. Um, but interestingly, I, my wife went to King’s and she [00:11:45] had the same experience she was from. She was from Ireland. Uh, she lived in Ireland all her life in rural, [00:11:50] rural Fermanagh. And she arrives in Brixton and you’re thinking, oh my goodness [00:11:55] me. And she says, I’m never going to like this place. And she, you know, as you do, you get on with it, you enjoy it, you [00:12:00] get to know the place, you feel reasonably safe in it. You get on with it. Yeah. So it is exactly [00:12:05] the same, but it’s actually a wonderful area.

Speaker3: It’s actually quite cool now.

Speaker1: It is. It is, you know, when [00:12:10] you and when you cross the Whitechapel High Street, you look down and you’re thinking that is the city. You know, you’re so close to city. [00:12:15] And I don’t think I ever realised just how close it was to city, which is why, you know, it is. It is seriously, [00:12:20] um, desirable residential areas now for sure. Um, which is, which [00:12:25] is strange.

Speaker3: Did you did you party or. No.

Speaker1: I did some. I didn’t do [00:12:30] a huge amount of partying at those guys in the year. Above. Above me who, uh, they were serious [00:12:35] party animals, basically. But no, I wouldn’t wouldn’t say we were. We’re out doing, uh, [00:12:40] long, late nights, basically. Um, so. Yeah. No, it was, it was we we had a good time, but it was [00:12:45] and I think and what is interesting, because it’s such a long course, you just got to, you kind of realise you’ve [00:12:50] got to crack on and do this. And I think what drove me both the Dental school and in my [00:12:55] A-levels was this notion that if I don’t do this, I’m going to get left behind. And [00:13:00] I remember the classic sort of feeling at, um, at school at, you know, doing my A-levels, [00:13:05] thinking if I don’t get to do dentistry, if I fail some exams, I’m going to have to go back into [00:13:10] sixth form college. I’m going to hate it. All my mates are going to be moving on. It’s going to be a nightmare. And so [00:13:15] probably this this drive of not being left behind, making sure I didn’t do anything, undermine [00:13:20] my my sort of progress was just sort of the driving force. And it wasn’t, you know, it wasn’t academically [00:13:25] gifted, nor was I, you know, really, really hard working. It was just, you know, put the hours in [00:13:30] and just just make sure you got you got there in the end. And, and I, you know, lots of my friends failed [00:13:35] either prosthetics or they failed finals or fail pathology or dental anatomy [00:13:40] or whatever along the way. And I thought it’s just such a waste of time and effort, basically. So that was kind [00:13:45] of what drove me to make sure at least I got through, got through university.

Speaker3: And [00:13:50] so, you know, to create a kid like you takes a particular [00:13:55] type of parenting. Right. And would you say that the parenting [00:14:00] style of your. Parents compared to your parenting style is very [00:14:05] different or very similar.

Speaker1: I think it’s very different because, well, I think there was the [00:14:10] that it’s a generational thing and I, you know, I don’t think I’d got many, uh, hugs [00:14:15] or cuddles or, you know, that sort of that sort of relationship that, that you probably had with your parents, [00:14:20] I had with my parents. It’s like, you know, and it was it is very much you got to work. You got to work hard. Um, [00:14:25] you know, one of the things, you know, one of the things you know, my dad was very fond of saying in [00:14:30] Kenya was you have to get your caritas. Caritas is Swahili for paper. So I [00:14:35] you’ve got to get your bit of paper, you’ve got to get your qualifications. And I think his he was very scarred [00:14:40] by being an Asian in a, in a largely [00:14:45] white colonial sort of company in Kenya. And he felt this [00:14:50] prejudice, he felt the only thing that kept him, the only thing that set him apart or kept him going [00:14:55] was the fact that he had a proper qualification. He was a chartered electrical engineer. He [00:15:00] had what he called a bit of courtesy, saying, basically, nobody can take that away from you. As long as he got you a bit of [00:15:05] paper, you work hard, you get your qualifications.

Speaker1: And I suppose that’s kind of driven, um, [00:15:10] driven, driven me to get a strings of bits of qualifications, all sorts [00:15:15] of things. And it was, it was kind of just saying, you know, it gives me credibility as one things I did a law degree for, [00:15:20] because by that time I’d joined Dental Protection, and I [00:15:25] was the youngest Dental legal adviser in Dental protection at the time. And I thought, ah, [00:15:30] this is you know, this is not a good look if if I walk in here and I’ve got no real credibility [00:15:35] other than the fact that, you know, I’ve been selected and there’s no massive [00:15:40] interview process back in the days when it was Kevin Lewis and, you know, it was [00:15:45] that sort of that sort of interview where you sort of you had it described as a David [00:15:50] Phillips and Kevin Lewis did a trial by knife and fork. You come in, if we like you, [00:15:55] we’ll give you the job basically at their favourite Italian restaurant, which you can’t do these days at all, basically. [00:16:00] And, and at that point you’re thinking, right, okay, I’m here. It’s fantastic. But you know, how am I going [00:16:05] to demonstrate my credibility? That’s why I end up doing a law degree, the master’s in law down at, um, [00:16:10] Cardiff.

Speaker1: And, you know, and it did well. And on the back of that, [00:16:15] interestingly, I was I was writing a, a couple of articles, written article for Dental update [00:16:20] for Trevor Burke, um, on record keeping. And I said, oh, I’ve just done this, uh, law [00:16:25] degree. I could write something else. He says, oh, what else do you want write about? I said, maybe write some content. He says, tell [00:16:30] you what, don’t do that. Why don’t you write a book? And I said, what do you mean, write a book? Um, well, [00:16:35] just just write a book. Uh, legal aspects of dental practice. I said, what are [00:16:40] you talking about? He says, well, we’ll put you in touch with Elsevier, Churchill, Livingstone, Elsevier, uh, and go [00:16:45] for it. And I’m thinking, what? And so yeah. And it took, it took a while, but [00:16:50] you did it and, and again that gives you confidence, not so much credibility but [00:16:55] confidence to say, actually you know what? I think I know what I’m doing. And that’s kind of then builds builds you up. And [00:17:00] that’s again it’s that sort of notion of confidence because you’ve done you’ve done the hard yards [00:17:05] to get where you want to be.

Speaker3: And now it’s a massive area. I mean, you teach on on [00:17:10] the Ma and university yourself for now. Yeah. But yeah, at the time that [00:17:15] you were getting into it, it wasn’t really. Did you have an inkling that it would be. [00:17:20]

Speaker1: Um, no, I think it was. I think the beauty of Dental protection was [00:17:25] it’s this family of Dental legal advisers. They had the largest number of Dental legal advisers. [00:17:30] Uh, David Phillips was there then. He then obviously retired. Kevin Lewis took over. And he’s [00:17:35] just. If there’s anybody I admire, there’s two people I admire most to be Rajaratnam [00:17:40] and Kevin Lewis. And and they had a real you know, they’re really influential in my life [00:17:45] in terms of, you know, how I thought about things, um, how I conducted myself. But [00:17:50] but it was that sort of it was you knew you were doing something that was really, really interesting [00:17:55] and fascinating, but it wasn’t. It only became it’s [00:18:00] probably become bigger now, partly because people are now we run a course on it. Um, at the University [00:18:05] of Bedfordshire course is the one I actually set up because a lady called Claire Morris was [00:18:10] she ran a masters in postgraduate education, in teaching for, for [00:18:15] trainers. And when the chapter is doing a seminar, she says, I would love to do more stuff with dentists. And I said, well, [00:18:20] I remember, um, it was a conference going to bed, uh, at that night and then wake [00:18:25] up at 3:00 in the morning.

Speaker1: And you know what? We need to do a Dental legal course. Um, and literally 3:00 [00:18:30] in the morning, knocked out a whole curriculum. Said, I’ve got to we’ve got to do this. Basically, it took another two years [00:18:35] to get the curriculum up and running. But it’s great. You know, we’ve had, what, about 110, 120 people [00:18:40] through that. So it’s becoming more academic. Back in the day it wasn’t very academic. You kind of just said, right, [00:18:45] uh, read, uh, read the NHS regulations, the, the SDR, a couple [00:18:50] of GDC gazettes, and here’s the telephone answer, some answer some calls. And now it is. [00:18:55] It is it’s very academic. Um, and it’s also it’s more. [00:19:00] I think that there are higher stakes, probably were higher stakes then, but I think they’re more higher stakes in [00:19:05] terms of the advice you give, you’ve got to be more careful. You can be more, um, more, uh, [00:19:10] you’ve got to understand and, uh, be in tune with a whole lot of other stuff in addition [00:19:15] to the facts of the case.

Speaker3: Well, do you think makes a good Dental legal adviser? [00:19:20] Because, I mean, let’s let’s start with the kind of person who wants [00:19:25] to be a Dental legal adviser. It takes a particular character, doesn’t it? I mean, in [00:19:30] many ways, I’d find, you know, in the same way as I’m very scared of oral surgery. [00:19:35] You know, I just I’m just scared of it. And now you could say, I don’t know what I’m doing. [00:19:40] Right, but I’ve got intrinsic fear of blood, if you like, as a as a as an operator. [00:19:45] I mean, yeah, but it’s a similar kind of you’ve got to be a particular kind of person to. [00:19:50] Sort of. Yeah. Like you say, play in those states, people’s lives [00:19:55] and and sort of their whole livelihoods at stake. What would you say? What are your [00:20:00] thoughts about Dental legal adviser? I mean, what kind of person is it? Okay.

Speaker1: So there’s two types. I [00:20:05] suppose the, the the more recent applicants to become [00:20:10] Dental legal adviser are people who actually don’t want to do dentistry anymore. Okay. They kind of think, [00:20:15] you know, I just want to do something else. I want to find another avenue. I don’t want to do clinical dentistry [00:20:20] day in, day out. And I just want to find another avenue. And they aren’t necessarily the most suitable [00:20:25] people because they’re just finding another, another avenue they could be doing. They could be doing [00:20:30] any other avenue, basically, but they just want to do something other than that. And that’s probably not the best people. [00:20:35] The sort of test now is that you’ve you I think you’re going to be a good listener. [00:20:40] And we’ve interestingly, we’ve just had a we’ve had a round of applications. We’ve just appointed somebody, [00:20:45] a new person to our team about 3 or 4 months ago. And what was interesting was [00:20:50] we did a they did a presentation, they did a group exercise, they did a [00:20:55] written exercise, etc., etc.. And what was interesting was the most the thing that separated the [00:21:00] candidates apart was the group exercise because we gave them a particular scenario. Um, [00:21:05] it’s a, it’s a bit of um, a member has called in, they’ve asked for some help and you give them [00:21:10] the scenario, and then these four people discuss it. And what was interesting was [00:21:15] how the person who is the most likely person to get it was, was, was bright, but also [00:21:20] stopped, listened, managed to, to get all the information from everybody else, weighed [00:21:25] it all up and then weighed in.

Speaker1: And I think that’s one of the skills skill set that [00:21:30] you need to have in you. You need to have a you can’t be egotistical, you can’t be arrogant, [00:21:35] but you can’t be. You’re there to advise, but not over advisers away. You’re there [00:21:40] to listen and you’re there to direct people in in the right way. But [00:21:45] you can’t be the expert. You can’t be the one to say, well, you ought to do it like this because. [00:21:50] Because all you’re doing is advising them. Because ultimately you, as the dentist will say, I’m [00:21:55] not going to listen to your advice. I’m going to do X, Y, and Z. And it it takes a lot of it takes a certain [00:22:00] skill set to say, actually, this is not actually about me. This is about you. Um, I’m putting my [00:22:05] ego, my views, my clinical skill set to one side. [00:22:10] I need to listen to you. I need to listen to your particular perspective. Then I’ll give you my view [00:22:15] and. But but I need to get all the facts from you. And often, you know, dentists like everybody [00:22:20] else, who only give you half the story. You need to tease out that story from them. Simple things, you know, somebody [00:22:25] will say, how long did they keep records card for? We don’t need to give me a ring for that.

Speaker1: It’s pretty obvious. Just look [00:22:30] it up, okay? But you don’t see. Rang me for a reason. Why didn’t you? Why ask [00:22:35] me that role? Because I’m telling the practice. Oh, you’re selling the practice, so why send the practice? Oh, because I’ve had particular [00:22:40] problems. Oh, you have particular problems. And it just goes on and on and thinking. So actually, the question wasn’t about record keeping at all. [00:22:45] The question is about something else. And actually and maybe that’s this, this interrogative sort of approach [00:22:50] that you said at the beginning is I just want to know what what’s going on, what’s going on in your head? [00:22:55] Why do you. Because because my you know, I say to our dental advisors often, [00:23:00] you know, the people have complaints all the time, day in, day [00:23:05] out. They don’t phone us. Okay. So what is it that prompt them to phone us today [00:23:10] about this particular issue? There’s something about this particular issue. These are bright, intelligent people. Um, [00:23:15] they deal with these sort of issues day in, day out. They must have complaints. We, we as [00:23:20] uh, advisors or uh, indemnity organisations probably deal with just the tip of the iceberg in terms [00:23:25] of the calls. We get literally thousands of calls, but there’s plenty of other things that happen. So you’re thinking, [00:23:30] why did you phone me today? What is it that’s actually bugging you? What’s going on? [00:23:35] So there’s there’s a couple of things you’d want.

Speaker1: You either want reassurance about the things [00:23:40] you’re currently doing. You want to go down one route and you want reassurance. Or there is generally flummoxed, [00:23:45] genuinely flummoxed about something. Or actually, there’s there’s something more to this call. [00:23:50] Um, and I need to get to the bottom of why you’ve called me, not giving me the full story. Um, because [00:23:55] you’re embarrassed. Because it’s it’s a it’s worrying you, you’re concerned. And and I think [00:24:00] for us, I think the most challenging emotion that [00:24:05] we ever have to deal with is shame. Okay. Um, because nobody wants [00:24:10] to admit they made a mistake. Nobody ever wants to say I’ve done something wrong. And then to get onto the phone and [00:24:15] say, you know what? I’ve done this. They’re not going to come out and say, I’ve done this because, because, because they’ll [00:24:20] kind of say, you know, they’ve done it. It’ll take a huge amount of effort to to admit [00:24:25] it. And it’s human nature to actually talk to a complete stranger and say, you know [00:24:30] what? I’ve done this. And and I remember one of the most interesting conversations I had with a couple of years [00:24:35] ago with, with a dentist, and he’d done something, uh, there was an error we thought was probably, [00:24:40] uh, worth a claim. Um, there’s probably going to probably going to settle it.

Speaker1: And I said to him and said, you know, you’re worried about this. [00:24:45] Yeah. He says, I’m worried about it. But I said, have you spoken to anybody about it? And he says. [00:24:50] No, I said, do you have anybody, you know, family who’s a dentist? He said, yeah, my brother’s a dentist. [00:24:55] I said, have you spoken to him? Said, no, no. Why haven’t you spoken to him? Because he’d think less of [00:25:00] me. And the family would be very shameful if I said this to to anybody that I actually [00:25:05] made a mistake. And you’re thinking. Yeah, but we all make mistakes. No, no, my family won’t tolerate [00:25:10] it. My brother will think I’m stupid. So I’m not going to say to anyone, I think, well, you’ve [00:25:15] just lost out on a huge opportunity to talk to somebody else about it. Your your your brother is a dentist. Um, [00:25:20] but no. And I think that’s and I think shame is the sort of thing that clouds [00:25:25] a lot of judgements. People become defensive, they pick up, take up a position which [00:25:30] they don’t want to admit to, and they get lost in that particular position. They don’t want to change it. And you’re thinking, you know, [00:25:35] and you realise actually you have done something wrong. Just admit it, you know, well, you’re here to help [00:25:40] you. And I think for us that’s that is the biggest, biggest challenge.

Speaker3: I guess it’s a bit like [00:25:45] patients who are ashamed of their teeth and they think that we’re going to have any problem with [00:25:50] it. Yeah. Yeah. Like that’s right.

Speaker1: Yeah, absolutely. You say, you know how many times you say, [00:25:55] oh, you’re going to be you’re going to be amazed. You’re going to be shocked when you look at my mouth. I’m really embarrassed about it. You [00:26:00] look around, you think, actually there’s only one filling need doing here. What’s what’s the big deal here? Uh, so [00:26:05] so yeah, no I agree.

Speaker3: Yeah, but then. Okay, shame [00:26:10] is one thing. And then. And then you’ve got people who whose whole livelihood is at risk, [00:26:15] right? Are people generally more worried than they should be in [00:26:20] the nature of the thing?

Speaker1: Yeah, I think there is. And I think we sort of, uh, [00:26:25] interestingly, we’ve just done a survey of members, quite a detailed [00:26:30] surveys. It’s it’s our contribution to contract review and [00:26:35] that data and which is looking at the looking at things [00:26:40] like, you know, are you stressed, are you anxious, are you concerned. What is your biggest stresses as a practice [00:26:45] owner? What’s your big stresses and associate? The biggest stress for the practice owners are essentially, um, [00:26:50] overheads, costs and trying to and trying to get uh, staff or keep [00:26:55] and retain staff for associates. Interestingly, 67% of these people are 60 [00:27:00] minutes of the associates said, uh, litigation, fear of litigation was a concern. And [00:27:05] I find that really odd because because that is something that I was [00:27:10] acutely aware of back in 2014, 2015, 2016, when the GDC were just [00:27:15] pretty well, any case that ended up GDC went all the way through the sausage machine of fits to practice, [00:27:20] and people genuinely were concerned about litigation and had had [00:27:25] good reason to be concerned about litigation, particularly for litigation for claims, because [00:27:30] the Dental Law Partnership had set up a few years before and were were very successful [00:27:35] in doing their job at GDC, were running riot and pretty well any any [00:27:40] complaint that went in went all the way through to, to practice. And so there was a general feeling [00:27:45] of unease amongst in 2014, 2015, 2016, there was several hundred [00:27:50] cases that goes through the GDC, but interestingly, over the last 3 or 4 years that things have [00:27:55] changed.

Speaker1: The claims, the, uh, no win, no fee has changed. Uh, the [00:28:00] actual the mechanism for making claims, uh, and for, uh, for [00:28:05] costs, it’s taken the wind out of the sails of, of the claimant solicitors. So there’s less [00:28:10] likelihood of getting a claim, and there’s even less likelihood of getting [00:28:15] a GDC complaint that’s going to go all the way through. So a significant number of cases, uh, [00:28:20] end up at the GDC, but go no further than, uh, case examiners, about 60%, 67% [00:28:25] of cases just stop just there. But we still have this this overwhelming [00:28:30] feeling of of fear of litigation. And I think I believe it’s it’s unfounded [00:28:35] and partly it’s been driven originally by those that caseload, [00:28:40] but it’s also driven to, uh, to greater extent. And I think by [00:28:45] us as indemnity organisations, it was very much this idea. You’d go into a [00:28:50] lecture or given a presentation and you’d you start quoting figures of what the likelihood of [00:28:55] you getting a claim was. And, you know, 1 in 2 or 1 in 3, if you’re going to get a claim, you’re going to get a claim in the next five [00:29:00] years. Uh, so and that was almost your attention seeking device to say, well, you better [00:29:05] listen to my lecture for the next hour or so.

Speaker1: Um, because if you don’t listen, um, in trouble, [00:29:10] you’re in trouble. Uh, and so that was the sort of the normal process. And I remember, uh, [00:29:15] as I left and I think this is crazy. The whole thing has changed. But we don’t need to do [00:29:20] that. We’re actually fuelling this, this anxiety. So why don’t we look at a different [00:29:25] way. And so so my my view is very much you will get complaints. Almost certainly. [00:29:30] There’s no doubt you’re going to get a complaint because we live in a service industry. Patients are paying money. They [00:29:35] experience pain. Something’s bound to go wrong. Um, it’s a complex procedure. So. So actually, [00:29:40] complaints are inevitable part of our life, but not the GDC and not claims. [00:29:45] Um, so we should be a bit more reassured about that. And I think that’s that message [00:29:50] hasn’t got through. We, uh, at MSI, we spent a long time, certainly [00:29:55] in the last 2 or 3 years, all our all our guidance is very much about saying [00:30:00] this. Complaints are inevitable, but don’t worry about litigation or GDC stuff [00:30:05] to the point that even the GDC, their latest pilot, is looking at [00:30:10] starting September October. They are saying that if it’s a single case relating to a single [00:30:15] patient and you have no previous fitness to practice before this particular case arrived, [00:30:20] they’re not going to take any further.

Speaker1: They’ll investigate it, but pretty well. It’s going to end without with no fitness to [00:30:25] practice issues. So we’re not even going to bother going to case examiners fitness practice. So we’ll just end it there [00:30:30] because they reckon that 60% of the cases with a single case, uh, single [00:30:35] patient, it’s not going to go anywhere. Why is somebody wasting their time. So even they are trying to control [00:30:40] this. But the message hasn’t got through. And and what I’d like to say to, [00:30:45] to dentists is dentistry is a fantastic profession. It does not need to be. [00:30:50] You do not need to be worried looking over your shoulder thinking, God, when am I going to get sued? The patient is going to complain. [00:30:55] If they complain, they complain. But all you need to do is just learn from those complaints and move on. So [00:31:00] I think that’s our biggest concern that we still have this, this, this sword of Damocles, [00:31:05] of litigation hanging over. People’s heads thinking, it’s going to be me. It’s going to be me today. If I go in [00:31:10] and I do something wrong, they’re bound to complain. And I have that in my own practice saying, and don’t worry about it. They [00:31:15] complain. We’ll deal with it. So okay.

Speaker3: It’s good to hear that. It’s good to hear. I mean, you’re absolutely right. [00:31:20] I had no idea that things are getting a lot easier or getting easier even. You know, my my feeling [00:31:25] was that things are as bad as ever. But what do you think was the perfect storm that [00:31:30] led to that era of. I mean, you said you alluded a bit to the no win, no [00:31:35] fee. What about GDC itself?

Speaker1: Yeah, [00:31:40] the GDC, I think there was a bit of empire building. We put [00:31:45] it down to the head of fitness practice at the time, wanting to build the empire in [00:31:50] terms of resources, money, income coming into their particular [00:31:55] department to say, you know, fitness to practice is a is a big issue. We have all these cases coming in. [00:32:00] We need more resources. We need more energy applied to it. So as a as [00:32:05] a you become very busy all of a sudden if you essentially if the threshold is very [00:32:10] low, uh, to get across the bar into the GDC and you just put it through the sausage machine, [00:32:15] you know, it’s going to work and then your your department gets really busy. You look [00:32:20] like you need more resources. So you get more get more people. And it just it builds itself. And [00:32:25] we think there was something cynical going on at that time with the particular people at [00:32:30] the GDC. And what is what also needs to be recognised is [00:32:35] the GDC is separate from fitness to practice. I think people just wrap the whole thing up the same as [00:32:40] the same um, organisation. Fitness to practice is independent from [00:32:45] the GDC. The GDC essentially are the prosecutors. They bring their case to [00:32:50] the tribunal, the Fitness to Practice tribunal, and they have to they have to win [00:32:55] their case or successfully win their case in front of that tribunal. And we, as the defence will [00:33:00] present our case, it’s not the GDC who are judge, jury and executioner, which is [00:33:05] what people’s perception are when they say the GDC.

Speaker1: The GDC may be after you, but they’ve still got to [00:33:10] get their case across to the Fitness to Practice panel, and they’ve got to you’ve got to [00:33:15] demonstrate your fitness to practise is impaired and currently currently impaired. [00:33:20] And that is something they have to do, the GDC have to do in front of the tribunal. And [00:33:25] so so which is why if you speak to most Dental legal organisation, Dental legal advisors, [00:33:30] they say the fitness to practice process is actually very, very fair because [00:33:35] they are fair minded people. They will dismiss GDC cases just as quickly as anybody [00:33:40] else because they say there’s no case to answer here, but why is this case being brought and and what [00:33:45] they found when 2016, 2017 was when those cases went through the sausage machine at the end, they [00:33:50] realised actually there was no fitness to practice issues and no impairment was found. And so that that [00:33:55] was why was uh, that was when the bubble burst. And people think, actually, this is there’s something seriously [00:34:00] wrong here. And, and the GDC turned the corner with new personnel [00:34:05] in their fitness to practice and going and actually going out to [00:34:10] the profession and saying, we have got it wrong, we want to change. And the sort of move towards, [00:34:15] um, shifting the balance to prevention rather than cures was, [00:34:20] was, was, was a solution basically.

Speaker3: And as a guy who I mean, in a way, [00:34:25] you’re part of the legal sector now, what do you think of dental [00:34:30] law partnership differently than the way most dentists would think of them as a sort of evil [00:34:35] empire? Um, because I saw [00:34:40] something. I was one of those guys, by the way. I was thinking, I couldn’t understand, how could one law firm [00:34:45] ruin a profession, you know, in effect. And I was looking into them [00:34:50] and I saw on the legal side, you know, in the legal award ceremony [00:34:55] or something, they were picking up awards and there was a gigantic company and and so on. How [00:35:00] how do you feel about them or not? Not them in particular. But, you know, that kind of lawyer. [00:35:05] Yeah.

Speaker1: I mean, I think, well, if we if we pick on Dental partnership, their, [00:35:10] their success was, was based on the fact that they were both dentists and who [00:35:15] they were qualified dentists, they qualified as lawyers and they knew the business. They knew [00:35:20] dentistry inside out. So so their success rate was dramatically higher than anybody else, basically [00:35:25] because they knew which which claims to run. So when they knew there was no base in it, they [00:35:30] could look at themselves and say, this is not a runner. Um, we’re not even going to take this case any further. So their success [00:35:35] rate against us at the time was something like 85, 90%. Most other law firms were at [00:35:40] 45, 50%. So they knew which cases to run, and they did it very well. The problem [00:35:45] that that point was they would dig around looking at pretty well everything else that we’d done by that patient, [00:35:50] on that patient for various people. So that was more problematic. But ultimately, [00:35:55] our view, very much of you now at the indemnity and the DPL was if harm, harm [00:36:00] has come as a result of negligence, that patient deserves compensation. It’s it’s straightforward [00:36:05] as that. And our job is to. Make sure that patient gets compensation because it’s unfair to the patient. [00:36:10] We shouldn’t be dragging out a case when there is a breach of duty.

Speaker1: And and harm [00:36:15] has been caused as a result of that breach of duty. We should be paying out. So we were never [00:36:20] concerned about the concept of a solicitor acting on behalf of the patient, because they’re [00:36:25] absolutely entitled to it. And where harm is done, they should have the money, there’s no doubt about that. The issue [00:36:30] we had was the tactics they’d used, and they were pretty underhand tactics. And the [00:36:35] a significant amount of costs or significant amount of payout related [00:36:40] to the costs of the solicitors, i.e. so we’re having disproportional settlements [00:36:45] where you’d have a five £10,000 settlement to the patient and [00:36:50] you’d get a cost estimate, or the costs would run in from the from the claim solicitors [00:36:55] of 50, 60, 80, 100 grand. And you’re thinking, hang on a second, this can’t be right. So you we’ve settled [00:37:00] on ten grand. Your client has got ten grand. They’ve walked away. And you’ve now put a bill in [00:37:05] of 50, 60, £70,000. So we’d spend a particular spend a lot [00:37:10] of time in, in Chester County Court looking at the costs [00:37:15] draughtsman challenging a lot of these costs because they were inflated costs. And that’s why those [00:37:20] that’s why those, those cases look so horrendously expensive when you settle them. Because the [00:37:25] patient got a small amount. But actually what settled was quite a man.

Speaker1: So so it was a tactic that [00:37:30] and things have changed the way the legal system has changed as as unpick some of those, those situations. [00:37:35] So conceptually that claimants lawyers, they do they do a job, they do a job for [00:37:40] their patients and they do the best they can. And we’re happy for them to do that. Um, [00:37:45] it’s, it’s when they’re when tactics are employed, which I think are, are not actually beneficial [00:37:50] to the patient because sometimes, you know, one of the things that is a concern is, is the patient [00:37:55] who is being offered a settlement, but the lawyers [00:38:00] decide, actually we’re not going to accept the settlement we want more or we’re going to go after the practice [00:38:05] owner, which is what happened. Um, you know, with the liability ended up. And actually the patient [00:38:10] at the settlement was offered. There’s a settlement on the offer on the, [00:38:15] on the table, but the law firm says, actually, no, we’re going to go off to somebody else. Um, and the patient’s [00:38:20] still hanging, waiting for that settlement. You’re thinking, well, uh, you don’t have a settlement. This [00:38:25] patient is still there, you know, several years later, still waiting for something. So I think that that’s that’s our concern [00:38:30] about, uh, some of the tactics, but conceptually, they need they need to be there to do that job.

Speaker3: Which. [00:38:35] What? So would you would you set up a the equivalent.

Speaker1: Uh, [00:38:40] for. No, I think we’d always be on the defence side. Uh, we wouldn’t be on the claimants. We [00:38:45] would always be on the claimants side. That’s we’d never be on the claims. We’d always be on the defence side.

Speaker3: So [00:38:50] because you could write you you’d have the tactics and skill [00:38:55] set.

Speaker1: Yeah. Yeah. Exactly. Yeah. I don’t think you’d be interviewing me if that was the case.

Speaker3: You [00:39:00] never know. But maybe I should get the law guys and see what they’re talking about. Yeah, [00:39:05] exactly. What about what? About the breakdown of claims and complaints? How [00:39:10] does it break down, like, statistically, what’s what’s the areas of dentistry that are most risky. [00:39:15] So I imagine what implants? Hereoh. Yeah. Author.

Speaker4: Yeah. [00:39:20]

Speaker1: It’s interesting. You see, I mean, there is a sort of a legacy of cases [00:39:25] that we might say are really high risk, period, because it’s failed to diagnose. [00:39:30] And then when when a settlement arrives, you’re chucking a lot of implants in and it’s very expensive [00:39:35] implants because they’re quite they’re quite technically difficult. Interestingly, [00:39:40] uh, our own figures over the last four years don’t show that at all. What the, [00:39:45] the most common things are, the most common things that happen. It’s failed root canal treatments or broken instruments. [00:39:50] It’s oestrogenic injury. We’ve had a skew of oestrogenic injuries where people have [00:39:55] got burnt lips from hot handpieces, uh, people have dropped instruments, the classic everyday [00:40:00] stuff, which settles for not a great deal and it’s not as complicated. And I think [00:40:05] the one of the things about the great fallacies about implants is that the reason [00:40:10] why they were loaded so high was because when implants first came on [00:40:15] the scene 20 years ago, or became more popular about 20 years ago, 20, 25 years ago, nobody [00:40:20] knew the risks involved. So they said, this must be a risk. And you’re sticking these metal blades, [00:40:25] these these, this Swedish nails into people’s teeth. This must be risky stuff. Surely [00:40:30] you’re going to hit all sorts of stuff. Um, and so people said, well, it’s going to be we’re just going to have to load these. [00:40:35] We’ve got to increase the premiums for all these people. And Kevin Lewis, when we set up and empty, [00:40:40] Kevin Lewis was a consultant, still is a consultant for us. And he said we’re toying with the idea of being empty, [00:40:45] not to load implants at all, because actually when we look at the actual figures, they [00:40:50] aren’t particularly high at all. Um, and partly because the profession has recognised [00:40:55] that this is pretty scary stuff. And they go on very good courses, um, [00:41:00] the, the I’s and.

Speaker3: Cross the T’s.

Speaker4: Absolutely.

Speaker1: So the consent forms are good. They’ve nobody [00:41:05] now. Nobody’s. To do a weekend course and implants. They might do a weekend course in aligners, [00:41:10] but they’re certainly not going to do it in implants. And so the people who are doing implants are [00:41:15] not people who are doing them, you know, once, once a year, they’re doing them pretty frequently. [00:41:20] They’re pretty skilled. They don’t take risks unless they are calculated risks. And the [00:41:25] patient’s informed at all times. So I think, you know, the GDC have got guidance. [00:41:30] The the Associate Dental Implantologists got implant got guidance. And so people go into [00:41:35] it with their eyes open and they do they are pretty skilled now when they do implants. And so [00:41:40] when something goes wrong, it tends to be because an implant failed. Um, uh, you know, it has an integrated. [00:41:45] So they’re giving the money back. And so it’s it’s never it’s, you know, it’s not hugely [00:41:50] dramatic stuff. Um, so it’s actually just run of the mill stuff. It’s, it’s, you know, um, [00:41:55] you didn’t tell me about the tooth. Might need a crown afterwards. It broken and [00:42:00] that root canal treatment. So it’s really almost mundane stuff. And it’s not the the [00:42:05] stuff you think this is going to cost a lot of money. So. So the perils thing is also, [00:42:10] again, slightly overblown. I don’t think there’s as much peril claims as there might [00:42:15] have been or could have been.

Speaker1: There are a couple of really odd cases. But and the thing about perio [00:42:20] is, interestingly and you know, when I lecture on it, I was in terms of perio, it is [00:42:25] probably the easiest thing to mitigate risk for because all you need to do is [00:42:30] a diagnose it. Take the relevant radiographs, tell the patient [00:42:35] and do some sort of treatment, you’re there. Whereas whereas pretty well every other aspect of [00:42:40] dentistry is, is actually requires a lot of technical skills which can go wrong. So you do [00:42:45] end up it’s pretty obvious you’ve done something wrong because look at the radiograph. Uh, if you if you’ve [00:42:50] missed some calculus on somebody’s teeth, it’s not very easy to pick up. Um, all, [00:42:55] all the uh, the treatment hasn’t succeeded. Well it’s probably down to the [00:43:00] patient. So I think that’s so, so in a sense, the those issues are not, uh, perils. [00:43:05] Easy one to resolve. And I think part of the problem is the reason why is there still claims [00:43:10] knocking around because of the system. It’s the NHS system that people shortcut it. And the [00:43:15] Bsp’s done a fantastic job in trying to address those, uh, with some [00:43:20] excellent advice about phasing, treatment, etc., etc.. So so I think we shouldn’t see [00:43:25] too many cases going forward.

Speaker3: So then what is the problem? Is it is it [00:43:30] where is the current issue? Is it young dentists. Not enough training in ortho [00:43:35] take on, but cases more complicated than.

Speaker1: I think those are. I think the things [00:43:40] that are coming up are the two big things we think are coming up are going to be [00:43:45] aligners, aligner therapy, um, where and is probably consent [00:43:50] patients didn’t know they’re going to end up with having interproximal reduction. They’re going to have their teeth thinned down. [00:43:55] They didn’t. They said it’s going to be six months. It’s actually nine months or 12 months. Didn’t actually didn’t work [00:44:00] out as well as I wanted to. So the expectations are higher. And the other thing we are [00:44:05] a little bit concerned about is, is tooth surface loss, failure to diagnose two surface loss. [00:44:10] And because, you know, when I when I started a [00:44:15] 30 years ago, two surface loss was well based. Just monitor it, take some take some study [00:44:20] models and just keep an eye on it because it’s pretty tricky stuff. Just make a diagnosis, try and work out what’s causing it. [00:44:25] Tell them to stop drinking acidic stuff and you’d be fine. Uh, don’t do anything about it. Now, [00:44:30] you know, we’re moving towards actually some interventive treatment. Um, you can use composite. You don’t have to use, uh, uh, [00:44:35] crown and bridge. Um, and actually, you probably ought to be doing something because those teeth are going to wear [00:44:40] away quite quickly. So. So I’ve been with you for the last 20 years and you’ve done nothing.

Speaker1: Why didn’t [00:44:45] you do anything for me? Well, it wasn’t we wasn’t very. It wasn’t painful. You didn’t want anything done about it. But [00:44:50] you never asked me. You didn’t diagnose it, did you? And I think that’s the potential [00:44:55] for the future. When patients say, right, I now you’ve now diagnosed. I need, um, [00:45:00] this full mouth rehab, uh, lots of anterior build ups of teeth. So I’ve been [00:45:05] seeing this the last ten years. Well, so wasn’t this there before? Well, it was there before, but I didn’t think about [00:45:10] it. So what are you doing about it? So I think those those conversations are going to be harder to manage [00:45:15] when you’ve been in establishing a practice. And I think that’s the challenge. You know, it’s a challenge for me in my own practice. [00:45:20] I’ve been there for 30 years. I see patients and and it’s the it’s the [00:45:25] it’s interesting because, you know, people talk about, you know, when when you retire suddenly somebody the other day [00:45:30] said, oh, you know, what advice would you give me before? You know, I’m thinking about retiring in the next couple of years. What advice would you give me? [00:45:35] And it illegally. And the advice I’d give to them and to everybody else is treat your patient as [00:45:40] though it’s the first time they’ve ever seen them, because you look at it and thinking, oh, God, okay, [00:45:45] um, there’s a whole lot of stuff I haven’t done anything about or should have done something [00:45:50] about or warn the patient about.

Speaker1: Because if I leave, if this is the last time I see the patient, they see somebody else in six months time [00:45:55] or a year’s time, will they know why I left that route there? Will they know why [00:46:00] I haven’t crowned that tooth? Will they know why we’ve decided that we’re going to leave these particular [00:46:05] teeth in the situation they are? Because if I don’t have good notes, the patient not going to remember, and [00:46:10] the next day it’s going to say, oh, no, what? Did you know what Mr. Crews have been doing for you for the last ten years? Because the amounts, the mess [00:46:15] and every one of us will have done, done things for patients where you think, [00:46:20] oh, God, okay, I shouldn’t really have done that. It hasn’t worked out as well as I have. But, you know, it is what [00:46:25] it is. But somebody else looking at it might think, okay, this is a very odd treatment [00:46:30] for this particular patient, but a high risk dentistry, why do they do that. So so I think that’s so, [00:46:35] so I think the big thing there’s no big I think [00:46:40] for us it is probably going to be the the aligners.

Speaker1: Because in the same way [00:46:45] that implants might have been an issue, they they became less an issue because of the training and because [00:46:50] of the involvement of the dentist. Now it’s very much the line is anybody can do it because frankly, [00:46:55] it’s taking impression. Send it off, should be fine. Somebody else is doing it. And I think that’s where if you [00:47:00] lack the and there are, there are better and better courses now which uh go [00:47:05] through run by orthodontists run in a very clinical way. Um, recognising [00:47:10] that actually it’s not just an aligner. There is a other dimensions to this treatment. And knowing [00:47:15] where the limitations are is quite important. But so I think I, you know, I [00:47:20] advise dentists to think quite seriously about doing longer longitudinal [00:47:25] courses if they’re going to pick up those sort of things in the same way they did. They did implants because [00:47:30] there is very much this. Me too. I’ve. To do what everybody else is doing it up. I’m going to be left behind [00:47:35] unless I do the facial aesthetics, unless I do the the the aligners, unless [00:47:40] I do cosmetic dentistry, unless they do build up, unless I do composite vineyards. I’m going [00:47:45] to be left behind. I think that’s that’s the challenge for us.

Speaker3: And I think one, one thing [00:47:50] that a lot of dentists find annoying is when indemnity settles, [00:47:55] even though everyone knows that they’re not at fault. Are we past [00:48:00] the peak of that behaviour, or is that is that I mean, I know probably [00:48:05] boils down to a financial decision of keeping something out of court, you know, as [00:48:10] the priority. But where are we at with that?

Speaker1: Yeah. I mean, I think they [00:48:15] I mean, I know, um, a number of mutuals have been accused of that [00:48:20] in the past, and that was very much my view that we wouldn’t do that when we got to be the indemnity, [00:48:25] because we wanted to make sure that, you know, we wouldn’t settle without your consent. We wouldn’t do [00:48:30] anything without your permission. And we still hold that view, because if you [00:48:35] and often, you know, the member will know, the dentist [00:48:40] will know more about that case than we ever will. They treat that patient. And if they think in their heart [00:48:45] of hearts, they think, you know what? Yeah, I did screw up, basically. Um, you know, let’s just settle it. Other [00:48:50] people say, yeah, I did do something wrong, but actually there was this, this, this, this, this. And there’s a whole other [00:48:55] circumstance now, and Mars is right. Fantastic. Okay, you give me that ammunition, I’ll go straight back to [00:49:00] our claims team and at RSA, and they’ll knock it back. And and interestingly, [00:49:05] our insurers RSA are very much of that view. They, they’re not going to settle, [00:49:10] uh, just because it needs to be settled on good terms because they want the best result [00:49:15] for the member. And with our help and assistance and with [00:49:20] the with the the dentists involvement, we’re more than happy to to defend those cases where the defensible, [00:49:25] um, but you know, but also sometimes you have to take the dentist [00:49:30] to uh, for them to look at it.

Speaker1: And it came back to the same, same issue about, you know, shame. Nobody [00:49:35] wants to admit their mistakes. But if you take them gently through how a lawyer might look [00:49:40] at it, it it opens their eyes to thinking, okay, yeah, a lawyer might [00:49:45] have a different view to this. And therefore there is a a breach of duty. There is a loss [00:49:50] as a result of it, and there’s a causal result, uh, result of it basically. So, so I think that’s [00:49:55] we’re probably past that peak because, because I think mutuals and recognising [00:50:00] that dentists don’t like that, just settling for the sake of settling. But but you know, you do you [00:50:05] do it for pragmatic reasons sometimes because the member themselves says, and [00:50:10] sometimes the other way around. The member says, you know, I want to settle. I want to give the money back. And you’re thinking, why [00:50:15] are you giving the money back? You know, I have a number of sort of existential conversations with people [00:50:20] and you say, well, what are your records? They’re really good. You get consent. Yes, or get consent. [00:50:25] And so the tooth flared up after that root canal treatment. [00:50:30]

Speaker1: Yeah. And they’ve gone somewhere else. Yeah. I want to give the money back so. Well yeah. But you warned them about that didn’t you. [00:50:35] Yeah. The consent form. Perfectly fine. So why are you giving the money back? Oh, because I don’t want any more trouble, I said, but [00:50:40] you’ve done everything right. We lecture hour after hour about consent. You’ve done everything we expect you [00:50:45] to do. And now you say, give the money back. I can understand you want the hassle, but that doesn’t make sense. [00:50:50] So in a sense, you’re kind of almost persuading the member to say, well, I’m happy to do [00:50:55] it, but. But you do so on the basis that you’ve done the right thing. This is just a goodwill gesture. [00:51:00] It’s not because you’ve done anything wrong. And so so I find it equally, uh, equally, [00:51:05] um, frustrating, frustrating and challenging when patients when the member [00:51:10] says, I want to settle, you’re thinking, I’ve looked at your records. They’re perfectly fine. Everything you’ve done [00:51:15] is perfectly reasonable. What a reasonable dentist would do. So why are we settling? And the answer is going to [00:51:20] be, I just don’t want hassle. I just yeah, I’ll give them back the money back. It’ll be done. He said. Okay, [00:51:25] fine, I’m happy to do that. But, um, it wasn’t necessarily my advice to do that.

Speaker2: This [00:51:30] is Dental Leaders, the podcast where you [00:51:35] get to go one on one with emerging leaders in dentistry. Your [00:51:40] hosts. Payman Langroudi and Prav Solanki. [00:51:45]

Speaker5: Thanks for listening, guys. If you got this far, you must have listened [00:51:50] to the whole thing. And just a huge thank you both from me and pay for actually sticking through [00:51:55] and listening to what we’ve had to say and what our guest has had to say, because I’m assuming you got some [00:52:00] value out of it.

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