Claire Nightingale, a consultant orthodontist and former practice owner, shares her remarkable journey through dentistry spanning over three decades. 

From her early experiences as a patient that sparked her interest in dentistry, through to her recent venture into stand-up comedy, Claire offers candid insights into practice ownership, clinical excellence, and embracing change in orthodontics. 

She discusses her transition from NHS to private practice, her pioneering adoption of Invisalign and digital dentistry, and her recent experience selling to a corporate group. 

 

In This Episode

00:01:45 – Early career influences and becoming an orthodontist
00:04:15 – Digital dentistry adoption and Invisalign journey
00:09:35 – Evolution of aligner treatment
00:12:15 – NHS training challenges and future of orthodontics
00:33:25 – Practice ownership journey
00:42:10 – Keys to running a successful business
00:49:55 – Selling to a corporate group
01:04:35 – Women’s Dentist Network
01:21:55 – Blackbox thinking
01:24:00 – Life after practice sale
01:57:15 – Stand-up comedy venture
02:02:15 – Fantasy dinner party guests
02:03:50 – Last days and legacy

 

About Claire Nightingale

Claire Nightingale is a consultant orthodontist at Watford General Hospital and private practitioner with over 25 years of specialist experience. 

A pioneer in digital orthodontics and remote monitoring, she successfully built and sold Queensgate Orthodontics while maintaining her NHS consultant role.

Claire is actively involved in the Women’s Dentist Network and recently embarked on a new chapter combining expert witness work with stand-up comedy.

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

Payman Langroudi: It gives me great pleasure to welcome Claire [00:00:50] Nightingale onto the podcast. Claire is a consultant orthodontist at [00:00:55] the Watford General for over 20 years, now a private practitioner. [00:01:00] A principal at the famous Queensgate Orthodontics, [00:01:05] which she recently exited from as well or.

Claire Nightingale: Exited [00:01:10] in ownership, exited.

Payman Langroudi: Ownership there.

Claire Nightingale: In body and spirit.

Payman Langroudi: Yep. Absolutely. [00:01:15] A great proponent of digital dentistry. Um, remote [00:01:20] monitoring. Um, for me, uh, you know, I’ve got a closer connection. Claire [00:01:25] is the orthodontist for my daughter. Yes.

Claire Nightingale: A great privilege. Thank you for trusting her [00:01:30] to me.

Payman Langroudi: We’re in the middle of it right now, and she’s having a wonderful experience. So thank you very much for that. Um, [00:01:35] Claire, uh, we tend to start with the backstory and all that, but sometimes I’ve got a burning [00:01:40] question. And for me, you know, I’ve had some contact with you. And more interesting [00:01:45] than that, every single person I talk to has great things to say about you both, [00:01:50] both socially and clinically particularly. People really talk about what a great clinician you [00:01:55] are. Just does it come very naturally to you to to [00:02:00] assess something? Are your instincts brilliant or are you just a brilliant operator? [00:02:05] And I know those things are connected, but.

Claire Nightingale: You know, it’s very flattering and [00:02:10] wonderful to hear that feedback. I don’t see myself as brilliant, you know, and [00:02:15] I wouldn’t describe myself as an expert. I think those are adjectives that other people [00:02:20] should use on judging my work and performance. Um, [00:02:25] I mean, inevitably, I’ve been a specialist orthodontist since 1996 [00:02:30] and a dentist since 1989. So given that all [00:02:35] day long I do nothing but look at occlusion. I guess I can [00:02:40] pretty much summarise where I’m heading, you know? But I wouldn’t say I’m brilliant [00:02:45] at recognising restorative need. So? So, yes, [00:02:50] I might be brilliant in one facet of dentistry in the eyes of other people, but I’ve still got [00:02:55] learning development needs in other areas of dentistry. So I think that’s you know, I think [00:03:00] that’s.

Payman Langroudi: Something the question do you work extremely hard or does it come naturally or both?

Claire Nightingale: Oh, I [00:03:05] mean I work extremely hard, but but the whole package now comes naturally [00:03:10] to me. You know, I work extremely hard in the volume of people I look after, the outcomes [00:03:15] I’m trying to deliver for them, how I want the business to run and endure, and [00:03:20] also in the wider Dental networks and education and supporting networking and having [00:03:25] fun. So I work extremely hard, but I don’t have to work at being [00:03:30] an orthodontist.

Payman Langroudi: And then over the years, things have [00:03:35] come along, I’m sure, a million times, and, you know, ended up being rubbish. [00:03:40] And, you know, we’re one of the manufacturers, right? So we get this a lot from dentists where, [00:03:45] you know, we’re trained as dentists. We’re trained to be sceptical about new things. [00:03:50] And you must have seen lots of new things come along. At what point do you jump [00:03:55] in on a trend? Call it a trend. Um, you know how how do you do you wait for others [00:04:00] to try things first. I mean, you seem to be quite an early adopter. For instance, on the digital side.

Claire Nightingale: Yeah, I have been an early [00:04:05] adopter.

Payman Langroudi: So have you found sometimes you’ve been an early adopter and the thing hasn’t worked out? [00:04:10]

Claire Nightingale: Um, I think so. When I think back to my career, I [00:04:15] mean, essentially I use fixed braces and now I’m a majority Invisalign practice. Okay. So [00:04:20] and of course, since the pandemic, I’ve really embraced dental monitoring. So [00:04:25] I have very much been an early adopter on that. But that was catalysed by the pandemic, and I had the good [00:04:30] fortune to set up my first five cases on dental monitoring on January the 20th, 2020. [00:04:35] So the only people I knew how they were doing were those five during the pandemic. So I was [00:04:40] sold on understanding that we should be moving towards an aligner based practice supported by remote [00:04:45] monitoring. Prior to that, my fixed base experience was using the [00:04:50] MBT Prescription, Victory and Clarity series brackets from [00:04:55] three immunotech. And the reason I used those was because R.E.M. were the hottest thing around [00:05:00] when I was doing my training. You know, they were very they really put a lot of marketing and [00:05:05] support into young Post-graduates in the in the 90s. And the B in MBT [00:05:10] was a man called John Bennett, who used to come down and teach us once a month at Bristol and then [00:05:15] became a professional mentor.

Claire Nightingale: And then he in fact, gosh, it’s so interesting [00:05:20] how it all connects. So John wanted to nurture me as a clinician and as an individual. [00:05:25] So he so he put a lot of opportunity my way, including when I was a [00:05:30] senior registrar and the three M Unitec wanted to take a group of rising [00:05:35] stars in orthodontics off to the American Orthodontic Conference in. This was in the millennium [00:05:40] 2000, and I was selected by John to be one of that group. [00:05:45] So off we went for about a ten day break and at the American Orthodontic [00:05:50] Conference was the launch of Invisalign, and at the time, I had a [00:05:55] former lab technician chap called Andy Price, who had just become a sales manager for Armco. I [00:06:00] think it was Armco. Yes. So he was there too, and he came over to me and said, Clare. Clare, come and [00:06:05] look at this. This is really exciting and took me off to the Invisalign stand and showed me this, you [00:06:10] know, digital computer I set up with aligners. And of course I was enormously sceptical, but [00:06:15] he Andy brought it to my attention. So, you know, you know, the sequence being.

Payman Langroudi: If your attention. [00:06:20]

Claire Nightingale: Yeah. If John Bennett hadn’t liked me and valued me and wanted to nurture me, I wouldn’t [00:06:25] have been taken to the conference in 2000. Where? Yeah, where Andy happened to be there, and [00:06:30] he took me off to look at Invisalign. So I came back and I accredited [00:06:35] as an Invisalign provider really quite early on. But what was the attraction for me was not the product, [00:06:40] it was the doctor locator function, because I was just starting to build a practice in Harley [00:06:45] Street as an in-house orthodontist, test. And the internet was still quite early on, you know. You [00:06:50] know. You know, it was still dial up, probably. And the smart phones hadn’t been invented. But I saw [00:06:55] that the doctor function being found as search engine optimisation [00:07:00] with my name on it, was clearly going to be a good thing. So that’s actually why I [00:07:05] accredited as an Invisalign provider. Um, but of course, I [00:07:10] didn’t really get flying with Invisalign until digital scanning technology came along. And the [00:07:15] other thing was they also dropped the case pack and they also dropped, uh, fat. [00:07:20] So instead, you know, VAT, you know, from the lab bill. So all of a sudden it became [00:07:25] a lot more cost effective as a low volume person to start using it. And as [00:07:30] a personality, I’m definitely somebody that is, I guess I’m not alone in this being [00:07:35] inspired by reward instead of threatened by punishment. So I wasn’t ever going to be someone that [00:07:40] bought a case pack and didn’t hit the target and then had a big financial penalty, but I am somebody [00:07:45] given a target and said, oh, you know, just do two more cases.

Claire Nightingale: You might get that extra percentage off your lab bill. So, [00:07:50] so the way their business operated suited my personality. [00:07:55] So I then started using Invisalign and and I am fundamentally a very loyal person. [00:08:00] So I remain very loyal to three Immunotech even though since they’ve become solvent, [00:08:05] um, their customer service has really gone downhill. And I’m very loyal to Invisalign, [00:08:10] despite the fact that there are now other providers on the market. And I’ll come back to all of that later, I’m sure. [00:08:15] Um, so I have and the thing that sets Invisalign align technology aside for me is their investment [00:08:20] in their software. You know, their clincheck process is is outstanding, their scanning [00:08:25] technology now with the interface visualisation outstanding. And [00:08:30] so I don’t have a reason to change provider. I’m in every sense satisfied. Yeah. [00:08:35] So so but coming back to your question so have I. I of course have had tries [00:08:40] at other aligner brands but Spot their clincheck the equivalent, their clincheck [00:08:45] process seems so Mickey Mouse to me. You know, they just didn’t cut the mustard, so I wouldn’t say I’ve had [00:08:50] any. And Damon. Yes, okay, I’ve tried a couple of Damon cases, but [00:08:55] but really, I’ve gone back. Nothing’s been disastrous, but nothing’s persuaded me that [00:09:00] they offer anything better to what I’m already using.

Payman Langroudi: And now. I mean, you’ve really thrown [00:09:05] your weight behind aligners. Yes, which is rare for orthodontists. I [00:09:10] mean, I know a few. I know a few like that. Yes, but the limitations of aligners, have [00:09:15] they now gotten better? I don’t know, intrusion extrusion.

Claire Nightingale: The [00:09:20] extrusion is still a bit tricky. I mean, I think the answer to the question is that I’m [00:09:25] treating some phenomenally difficult malocclusions really nicely with aligners, and [00:09:30] they come with a whole shed of advantages, which, you know, you know, the aesthetics, [00:09:35] the convenience, the lack of breakages, you know, the computerised treatment planning, actually, [00:09:40] the fact that when I when I submit a case, I can look at the tooth movements analysis table and see in multiple [00:09:45] dimensions where that tooth is going to move, and consider whether or not that’s what I want, you know, [00:09:50] and to to inhibit it from the outset. If I don’t want it, you know, to choose what type of attachment [00:09:55] I want to deliver a certain degree of rotation, for example. So and of course, really [00:10:00] when you use fixed appliances, on the whole you’re flying by the seat of your pants. You know, you don’t you think.

Payman Langroudi: Do you [00:10:05] think if the investment was made in fixed appliances, which I’m sure it will be or is now to [00:10:10] digitise fixed appliances as well, some sort of what’s that light force thing [00:10:15] they’re doing where they’re printing the brackets or whatever.

Claire Nightingale: Yeah. Well yes, I mean there have been customised brackets [00:10:20] for a while. I haven’t, I haven’t tried those. I mean I obviously I tried lingual orthodontics [00:10:25] as well, which of course are the ultimate digitised bracket system with [00:10:30] of course personalised bases and all of that. But I found it such a fiddle. Yeah. You know, [00:10:35] as the operator. As the operator? Yeah. A fiddle.

Payman Langroudi: And as a.

Claire Nightingale: Patient. Yeah. The whole [00:10:40] thing is so difficult, you know. And given that aligners can deliver equivalent, why would you. [00:10:45] Why? Why put yourself through that torture when we’ve got a good alternative [00:10:50] while we’re on it?

Payman Langroudi: Is there a percentage of your cases that come out of aligners and into fixed? [00:10:55]

Claire Nightingale: Very few. Very few. Yeah. I think I’m an 80% aligner practice [00:11:00] now. Really? Yeah. So I mean, I offer aligners pretty much to everybody. The only I [00:11:05] don’t treat many patients on an extraction basis, not because philosophically I’m [00:11:10] opposed to it, but I just don’t see that many people with a lot of crowding. And [00:11:15] for example, I have committed to a case for extractions yesterday, [00:11:20] but it was a child with hypodontia, you know. So. So I’m not seeing, you know, if people [00:11:25] maintain their dental health well and so they maintain their primary dentition, many cases [00:11:30] are treated on a non extraction basis, the majority. So uh, um, [00:11:35] however if I had to take out full four premolars. I probably am more comfortable [00:11:40] committing to fixed appliances than aligners. That said, I’ve got a couple of cases on the go, but of course I’ve got the [00:11:45] skill set to be able to switch between the systems if that turns out to be necessary. But [00:11:50] I can think of one. I can think of one adult and one child that I’ve started with [00:11:55] aligners that I’m clearly going to switch to fixed appliances for the adult already the child to come one. [00:12:00] Yeah. And it’s compliance. You know, they’re just not wearing their aligners. So it’s [00:12:05] not it’s not it’s not because the aligners themselves have failed. It’s patient compliance.

Payman Langroudi: And on your [00:12:10] NHS side I guess there’s no aligners available.

Claire Nightingale: Is that right. There aren’t. No. That’s right. Um, [00:12:15] however, I mean, my one of my bugbears is that we are still training [00:12:20] young orthodontists in the way I was trained 35 years ago, and I think this is a [00:12:25] big issue, you know, because of course, in my NHS post, we’re still taking alginate impressions and [00:12:30] we’re using fixed metal braces and that’s about it. And I feel that [00:12:35] given the the complexity of well, not even is it complexity. But given [00:12:40] how I’ve been able to embrace digital technology in private practice, I feel increasingly [00:12:45] the gulf between what we’re delivering on the NHS, but what the rest of the world is doing. [00:12:50] And I and as a people involved with training, we’re we’re not doing [00:12:55] the best by our trainees if we can’t introduce them to all this technology. So what I’ve [00:13:00] done, I mean getting it. Trying to get it through the NHS, particularly in District General Hospital, [00:13:05] is nigh on impossible. It’s impossible. It’s such a battle. So what I’ve done [00:13:10] is I have reached out to align technology and they have something called the Arc programme, [00:13:15] which is acts of random kindness. And, and, and basically each [00:13:20] doctor, you know, dentist has the opportunity to do two cases a year pro bono [00:13:25] on the lab bill. Yeah. For, for cases with a particular need. So for [00:13:30] and so what I’ve done is I’ve managed to get my registrar in my NHS post. I managed to get [00:13:35] her doing two Invisalign cases under my supervision, which I’ve put through the private practice. One of which [00:13:40] has come from this Arc programme and it was a child with such severe hypoplasia [00:13:45] of his enamel, it was unlikely we were going to treat him out with fixed braces because of breakages. [00:13:50] So I reached out to a line and they gave him a free, free, a [00:13:55] free treatment, which of course we are doing for him in the NHS.

Payman Langroudi: Where are we in orthodontics [00:14:00] compared to world leaders? I mean, is the NHS holding us back? It must [00:14:05] be right if our orthodontics are being retained.

Claire Nightingale: I’m sure it is. I’m sure it is because, [00:14:10] you know, you know, of course we should be using scanning technology, you know, not because [00:14:15] it’s just a simple way of generating a study model or sending lab work, but because when [00:14:20] you can look at the screen and you can draw up the occlusal features, you learn so much about the [00:14:25] case, you know, you know, the diagnostic value of and [00:14:30] record keeping as well Of digital technology is phenomenal. But how do we quantify that in a business [00:14:35] case? When an NHS trust that is bankrupt is only looking at cost savings, [00:14:40] you know, and you say, look, we can get a scanner for 20 grand, but alginate is pennies, [00:14:45] you know that. That’s the. That’s the challenge.

Payman Langroudi: I don’t know young orthodontic trainees. [00:14:50] Now, they know that once they get out, they’ve got a whole lot of other education that they need to [00:14:55] to do to get anywhere near, you know, what’s what’s the sort of standard [00:15:00] of of care.

Claire Nightingale: Well, they’ll come out as good orthodontists, [00:15:05] you know. And let’s not forget, what underpins good orthodontic treatment is going to be good [00:15:10] knowledge of tooth movement growth, sensible treatment planning. So [00:15:15] the skills that are required to treat people well with aligners are going to be absolutely transferrable [00:15:20] skills, aren’t they. They’re going to come out of that training programme and diagnosis and treatment planning, as [00:15:25] we were talking about briefly, is going to be essential for that. I mean, it’s not difficult to [00:15:30] learn how to scan. You know, it’s not difficult to learn how to plan with aligners [00:15:35] particularly. But I mean, what’s so interesting, of course, is that people who are leading the way [00:15:40] with training and aligners are. What do you think of that? So let’s be pragmatic about [00:15:45] that. And remember that GP’s have always carried the lion’s share of [00:15:50] orthodontic provision in the UK, you know, either fixed braces or more latterly [00:15:55] aligners. So GDP also is nothing new. Um, and [00:16:00] with the size of the population that we have in the UK, the relatively small number of specialists [00:16:05] we have, which I believe are less than 1500, although you’d have to fact check, [00:16:10] you know, we couldn’t possibly cater for the demand. So GDP although is a good thing. [00:16:15] You know, when I was listening to Marina talking about elective devitalisation of teeth [00:16:20] to provide veneers, that persuaded me even more that GDP ortho is a good thing because at [00:16:25] least that kind of work isn’t being done being done anymore. I would hope, but [00:16:30] I think that. What? And of course, when I went into orthodontics, the only way [00:16:35] you could get any education at all was to enrol on a formal master’s programme, of which there was very little opportunity [00:16:40] and hotly competed for.

Claire Nightingale: Now, with the advent of the internet, there’s [00:16:45] so much, so many different ways that people can access education and and be trained. [00:16:50] And I’ve been very impressed by listening to some of the GP’s who are doing clear aligner therapy [00:16:55] as to the level of their orthodontic knowledge. Um, where I think [00:17:00] the problem lies is that I think specialist orthodontists are probably [00:17:05] on their way out as a speciality. Now I might well be regarded [00:17:10] as a doomsayer a doom monger, if that’s the right phrase and [00:17:15] I. But I don’t think I’m alone in thinking like this, [00:17:20] which is that what is going to be attractive for young [00:17:25] people to want to go through competitive entry with national recruitment, [00:17:30] to do a three year year master’s program, or maybe not a master’s degree, because that [00:17:35] the the project element has been is no longer compulsory to [00:17:40] be trained currently in doing orthodontics in exactly the same way that I was trained 30 years ago, [00:17:45] which is fixed metal braces or functional appliances with no real access to technology. [00:17:50] And then they come out of it. And then what are their choices? To go and work in specialist orthodontic [00:17:55] practice, where the fees are about £1,500. Now, remember when I qualified as a specialist, they were probably [00:18:00] about £1,200. And that’s like about almost 30 years ago. So the fees [00:18:05] have really dropped in real terms. You know they get a small percentage of that [00:18:10] while their mates who’ve come out of BDA, you know, BDS have gone on a few aligner courses [00:18:15] and are doing a line bleach and bond and charging 3000 a case or whatever, you know, so I [00:18:20] struggle to see how Orthodontics as a speciality [00:18:25] is going to continue to attract the type of calibre people that we would like to attract [00:18:30] for the long term.

Claire Nightingale: When that’s the reality of what they are facing [00:18:35] when they come out. So if I ruled the world, you know what [00:18:40] I you know, there are various changes that I think I would make. And, you know, within training [00:18:45] I would like to introduce more technology. So, you know, I think, you know, scanners, possibly [00:18:50] dental monitoring, although I’ve not had any experience of it in high volume NHS settings. [00:18:55] Um, we need to try and train people in clear aligner therapy [00:19:00] using clear aligners as a way of delivering great care. But [00:19:05] I also think that we have to make sure that what people are coming out for is attractive, and [00:19:10] that means either vastly increasing the NHS fees. No, because I think [00:19:15] to expect people to treat palatal canines, that is a treatment that might take three years, [00:19:20] you know, for £1,500. Gross. I think that’s an absolute disgrace. And [00:19:25] I think that I can’t see why people are going to want to do that. And I understand that a lot [00:19:30] of young orthodontists, their ambition is to go into speciality, into go into private practice. But, [00:19:35] you know, I don’t think it’s an attractive week to work in 5 or 6 different places, [00:19:40] you know, pick up a day as an in house.

Payman Langroudi: Some people like it.

Claire Nightingale: But I mean, my head spins [00:19:45] if I work in two places predictably every week. Rigid routine. [00:19:50] But if I step out of my routine, I just fall over, you know? I can’t remember where I’m meant to be. [00:19:55] And how can you be confident that you’ve got the right brackets or the lab work being delivered? So actually, [00:20:00] if I ran the world, I would now be looking at restricted practice. You know, I’d be looking at [00:20:05] and what I mean, I don’t mean that restricting GP’s from doing orthodontics, [00:20:10] but I might restrict the complexity of cases that it is reasonable for a GDP [00:20:15] to treat. But I think I would be looking at saying that orthodontics as a As a specialist [00:20:20] should. Care should be delivered within a specialist practice setting so [00:20:25] that rather than. And I think that would be better for patients and it would be [00:20:30] better for clinicians all round if orthodontics was you know, so for example, you would have a hub and spoke arrangement, [00:20:35] you know. So when I joined dentists, I said my ambition, what I would love would [00:20:40] be if Queensgate Orthodontics became the orthodontic hub for the dentists practices [00:20:45] around it.

Claire Nightingale: And so rather than have in-house specialists where patients were able to go [00:20:50] one morning a week or a day a month, five days a week, six days, seven days a week, [00:20:55] they could come and access care at Queensgate Orthodontics. There would be a team of people there. The [00:21:00] emergencies would be covered. We’d have the bespoke software, we’d have all the scanners. We’d be able to do [00:21:05] audit, you know, peer review, turn to each other for specialist second opinions, you know, that [00:21:10] sort of thing. And unfortunately, that won’t ever happen because [00:21:15] one thing that corporates are very hot on is not restricting clinical freedom. [00:21:20] So they’re very strong on clinical freedom. And that is on the whole led by HMRC [00:21:25] and not wanting to run the risk of an associate being seen as an employed person. [00:21:30] Okay. So it’s not going to be led within the corporates to have a specialist [00:21:35] hub. Um, but I do believe that that’s the best place for patients to be [00:21:40] cared for properly. Let’s go back.

Payman Langroudi: What made you become a dentist?

Claire Nightingale: Right. So [00:21:45] how old were you? Go back a long, long time. So I was [00:21:50] about seven years old, growing up in Durham. And one day I noticed that I [00:21:55] had what I called a gumboil. So we go off to the dentist, and the dentist says, oh, she needs some teeth out. [00:22:00] And in those days, there were two things common running through the 1970s dentistry. [00:22:05] Serial extractions and gaps in the dental chair. Yeah. So? [00:22:10] So my mother was instructed to bring me back to the dental practice. Starved. And she was to bring a scarf. [00:22:15] Those were the were the instructions. So we get there and I ended up having gas [00:22:20] in the dental chair. A number of deciduous teeth removed. To this day, I remember the dream [00:22:25] I had, and I woke up crying and I was still in the dental surgery. [00:22:30] They slapped a bit of gauze in front of my mouth, tied it around my head with a scarf, and off I [00:22:35] went with my mom on the bus back home anyway. Amazingly, a year later she got me back to go through [00:22:40] the whole experience again. So it’s been deeply traumatic. But somehow I went back and did it all again anyway. A [00:22:45] couple of years later we moved down to London and the first family we met. The mother was a dental [00:22:50] nurse and she said, you must come and register with my dentist. Mr. Wilson. And Mr. Wilson looked in my mouth and [00:22:55] said, you need to see a specialist orthodontist.

Claire Nightingale: So I was about 12, probably by this [00:23:00] stage, and I thought that was really exciting. I felt special that I had to go and see a specialist. [00:23:05] So we go off to Watford and see this chap called Mr. Marks who said, yep, four [00:23:10] fours. So I’d obviously just had cereal extractions, four sees, four DS, four for fours. But [00:23:15] Mr. Wilson used local anaesthetic, and it was revelatory because I had such [00:23:20] a positive experience, you know, and I thought, and I must have thought at 12, this is [00:23:25] what dentistry is like, you know. I mean, these men became heroes to me, really, you know, to my [00:23:30] childish, in my childish world. So and the other factor was, I think there were two other [00:23:35] things. So I became aware of going to the dentist early. I became aware of how differently [00:23:40] dental treatment could be delivered. I was always very creative. I was always [00:23:45] modelling and making clothes for my Barbie dolls and making furniture out of Kellogg’s boxes, [00:23:50] this sort of thing. And I come from a very caring family. So my father is a priest, [00:23:55] an Anglican priest, and my mother was a social worker. So human care, looking [00:24:00] after people was very much a theme that ran in family life. So you put all those factors together. [00:24:05] And also I was interested in science and good at biology, and I just thought, you know what? Dentistry [00:24:10] looks like a good career option. So I made.

Payman Langroudi: A good student at school as well.

Claire Nightingale: Come [00:24:15] on, head girl.

Payman Langroudi: Where are you? Of course.

Claire Nightingale: What do you think? So. Yeah. [00:24:20] So, you know, so the advantage of saying at the age of 12, I am going to be a dentist. [00:24:25] It’s just brilliant. Because then you know what I mean? In my day, O-levels, A-levels, [00:24:30] what you had to do a bit of work experience. Et cetera. Et cetera. You know, and and so I [00:24:35] did wobble between dentistry and medicine when I was, you know, particularly during my A-levels. [00:24:40] My grandfather was very ill and subsequently died of cancer. So I kind of had that. Oh, should have been [00:24:45] a doctor. But I really don’t regret sticking with plan A, you know, [00:24:50] so that so basically that was why. And I think what’s interesting about this story is [00:24:55] that I say, you know, you know, when I reflect on, you know, the learning of this story [00:25:00] because it’s very weird for a child of seven not to be deeply traumatised by the experience [00:25:05] I had. And you question, you know, what was it in my either my own personality [00:25:10] or my my my mother’s parenting skills and also the attitude of. In the 1970s, [00:25:15] you know, we took the doctor’s advice, didn’t we? You know, we we went with professional [00:25:20] advice. We didn’t question professional advice. And now when I say to families, oh, your child needs a [00:25:25] baby tooth out, you know, they look at me, I couldn’t possibly put my child through that trauma. I think, well, it [00:25:30] changed the course of my life. What are you talking about? Get yourself down there. Um, so.

Payman Langroudi: You’ve got that responsibility [00:25:35] with my daughter now because she went in to, uh, your treatment [00:25:40] with you saying, I know I don’t want to be a dentist, so it’s up to you. [00:25:45] Well, it’s up to you to change that.

Claire Nightingale: Well, I think I think, I mean, she has. [00:25:50] She’s out perfection. Me, as I think you might know and you know. And now she draws micro [00:25:55] imperfections to my attention. And I’ve told Carla quite clearly, I’m only taking on patients [00:26:00] for treatment who are long sighted from now on. I’ve had enough of this close examination, [00:26:05] but, you know, but when I come back to my own childhood, I think what I learned as a child, clearly I [00:26:10] was resilient, you know. So resilience has carried me through life. You know, I also [00:26:15] made a positive from a negative, which is the best way to look at negative experiences [00:26:20] for sure, you know. So so those two lessons from that story are very, very important. [00:26:25] So that’s how I became a dentist. And when all along.

Payman Langroudi: You knew you wanted to be an orthodontist.

Claire Nightingale: So [00:26:30] did I know throughout uni. Well, I guess yes, because, I mean, I made that decision when I met [00:26:35] Mr. Marks in Watford when I was like 12 years old. Really? It wasn’t even just that I wanted to be a dentist. It was I’m [00:26:40] going to be an orthodontist. But of course, um, you know, we were hardly exposed [00:26:45] to orthodontics as undergraduates. And I do think I mean, I have had I’m [00:26:50] now we have this wonderful WhatsApp group of my year group, and in many ways, we’re closer [00:26:55] 40 years from because I started dental school 40 years ago, which is unbelievable. [00:27:00] And we’re closer now as a group of people than we were as dental students. [00:27:05] And we were recently reflecting on our time and I said, I thought we were all bullied. [00:27:10] We, you know, we were equally bullied irrespective of gender, you know, and we were there was a there was what we [00:27:15] would now call it bullying for sure. And particularly amongst the restorative, the staff and, [00:27:20] and of course, it’s terribly undermining of your confidence. And I never [00:27:25] thought I was any good as a dental student.

Claire Nightingale: I knew I was good academically because, you know, every [00:27:30] exam, you know, we were examined so frequently and I was always getting great marks, but I didn’t know how [00:27:35] good I was as a pair of hands because nobody ever told me. And I didn’t know until the fourth year out of [00:27:40] five that we were being graded on our on our clinical performance. And you had to go down to [00:27:45] the dean’s office and ask the secretary to see your personal file. And then I got my file and discovered [00:27:50] I had like A’s and B’s. And of course, the students were underperforming, were being hauled up in [00:27:55] front of the dean and told to go off and read textbooks. Not also very helpful, but but of course, no one ever [00:28:00] said I’ve been to the Dean’s today to be told I’m rubbish, you know? So, you know, I just had no idea [00:28:05] what I was like as a clinician. And, you know, I think when you’re undermined and bullied and not [00:28:10] told that you’ve done well.

Payman Langroudi: The curriculum was to bully the students. Right.

Claire Nightingale: But then it’s hardly very [00:28:15] nurturing to then decide that you’re going to become a restorative dentist. Yeah.

Payman Langroudi: But I think [00:28:20] I spoke to once I became a dentist, I finally spoke to one of the cons guys as [00:28:25] it was, and he was saying, yeah, you know, dentistry is a pressure job. So we put pressure on [00:28:30] the students to see how well they’ll take it. And it’s a very unhealthy dynamic. Yes. [00:28:35]

Claire Nightingale: Well that’s true, that’s true. Um, and it is a high stress. It is a highly [00:28:40] stressful job, of course. And I you know, it’s taken me almost my entire career to realise how different [00:28:45] it is from other, other jobs and how we are. I always say that every day [00:28:50] is a triumph in the face of adversity. Yeah, there is never a day when you [00:28:55] have every member of staff are there, you don’t have equipment. You know, every day there’s people off [00:29:00] equipment failure, it failure, all.

Payman Langroudi: Of that having left it. Yeah, yeah. I mean, [00:29:05] number one leaving you really crystallise what you loved about it and [00:29:10] what you didn’t love about it. Yeah. So that’s one point. But the question of is [00:29:15] it a simple job or easy job or not? It clearly isn’t an easy job. It’s a difficult job. But [00:29:20] I would say it’s easy money. Being a dentist. Now, why do I say that? You [00:29:25] can get an average person, not an extraordinary person like you or someone else. [00:29:30] An average person who doesn’t push the boundaries, doesn’t do anything out of the ordinary. [00:29:35] And he could make, I don’t know, let’s just throw a number out £250,000 a year. Owning his own [00:29:40] general practice. Yeah. In any other field, that average [00:29:45] person would not be doing that would not be doing that. It would be an extraordinary. People [00:29:50] in other fields make good money, you know. But let’s say that same [00:29:55] character said, oh, I’m interested in marketing. Yes. You’d have to be. You’d have to be head of marketing [00:30:00] for marketing for some major conglomerate to make £250,000. And so it’s not an easy job [00:30:05] at all. It’s a difficult job. It’s a backbreaking job. It’s a stressful job. You’ve got the legal side. You’ve [00:30:10] got the patience. You’re on the stage all the time. All of those things are true.

Claire Nightingale: Yes, but.

Payman Langroudi: It pays. [00:30:15]

Claire Nightingale: Well. And I mean, I think that that’s the point which [00:30:20] we can extrapolate from that is about the selection criteria for Dental students. [00:30:25] Perhaps, you know, because when I went to dental school, the the offer was a B and [00:30:30] two C’s. Yeah. Me too. And the, the academic staff said that dental students, since [00:30:35] they, since they’d raised the entry requirements from like two E’s. Dental [00:30:40] students were not so much fun anymore. You know, they’d had a lot more laughs with the rugby playing [00:30:45] men who got who got in on two E’s. And now, of course, it’s extraordinary, [00:30:50] you know? And the problem is, is that I believe that actually what you need to be to be a [00:30:55] good dentist is you need to have emotional intelligence and a good pair of hands [00:31:00] and be resilient. And you don’t have to remember the Krebs cycle. You know, and so I [00:31:05] do think we are we’ve set the bar way too high to get [00:31:10] the right people in for dentistry. And and I do [00:31:15] also, again, you know, one of my worries is about the geographic variation, because I understand that now [00:31:20] 50% of undergraduates for dentistry and medicine come from London, you know, and apparently [00:31:25] so.

Claire Nightingale: And of course, London has great schools, you know, nationally, you know, [00:31:30] outperforms in academic performance compared to the rest of the country. But as people gravitate back to where they [00:31:35] grew up and where their families are, how how are the mining communities of the North East going to [00:31:40] be served? You know, where this is the problem. And I think that, you know, if I [00:31:45] could rule the world, then I would be selecting people on the basis of emotional [00:31:50] intelligence, empathy, being, wanting to care for people [00:31:55] and geographically appropriate as well. You know, because when I was at dental school, we had at least three [00:32:00] young lads who were from mining communities who had come and done really well and got their B [00:32:05] in two CS and then went back and served their mining communities. And that’s what we [00:32:10] need. We need people like them to be good dentists. So you’re right, you know, you’re right in [00:32:15] this in the sense that we don’t need academic geniuses to be dentists, but we do need some really solid, [00:32:20] grounded people who have got big hearts.

Payman Langroudi: I think the emotional intelligence [00:32:25] piece is super important. And you’re involved in training orthodontists. There isn’t [00:32:30] any training in it. Or is it something that can’t be trained?

Claire Nightingale: Oh, that’s [00:32:35] a big question.

Payman Langroudi: It’s so important. I mean, the way you handle your patients [00:32:40] and staff and call it suppliers or your stakeholders emotionally, [00:32:45] really, I think is the key difference between successful or maybe a great dentist and a [00:32:50] good dentist. You know, it’s that extra piece. Yeah. And there wasn’t a wasn’t a mention of [00:32:55] it in dental school.

Claire Nightingale: No no, no. I’m not the right person to answer [00:33:00] the question about whether you can train people to be empathetic and have emotional intelligence. Clearly people [00:33:05] in training. But I need to need to know that. But it’s certainly an essential. I mean, you know, [00:33:10] I certainly don’t get it right all the time. And sometimes I just don’t have the stamina to get it right all the [00:33:15] time. But fundamentally, it’s one of the core skills for, for for life [00:33:20] for life in general, isn’t it? Dealing with people, you know. Full stop.

Payman Langroudi: Yeah, yeah. [00:33:25] Let’s talk about private practice. So when you decided to make the leap, and that was [00:33:30] kind of a little later on for you, right? In your 40s.

Claire Nightingale: You mean in terms of ownership? [00:33:35] Yeah. Oh, really? Late in life.

Payman Langroudi: Why did you leave it so long?

Claire Nightingale: Oh, because the right [00:33:40] deal didn’t come across my timeline. So, you know, did you have.

Payman Langroudi: A very clear understanding [00:33:45] of what the right deal was?

Claire Nightingale: Well, I quickly learned what the wrong deal was.

Payman Langroudi: Tell [00:33:50] the story. Tell the.

Claire Nightingale: Stories. Okay, so I mean, I think [00:33:55] that there’s so much that’s interesting about practice, ownership and ambition. [00:34:00] Actually, you know, so if we go back 40 years ago and what was the Dental landscape? Well, [00:34:05] dentists tended to be single handed individuals working from the front room of their own home. [00:34:10] You know, we weren’t allowed to advertise. Um, you know, [00:34:15] I know there were those sorts of restrictions anyway. And, of course, anybody [00:34:20] could. Anybody could set up a practice anywhere under the NHS. Right. [00:34:25] So people were used to working by themselves. They just worked out of residential properties [00:34:30] that we didn’t have high street dentists. And remember that NHS that goodwill [00:34:35] sold for a pound. So you know so I have been chuckling to myself at [00:34:40] remembering my two closest friends from dental school when they bought their first practice. Well, their [00:34:45] only practice, actually. They bought a practice in a fabulous location in Jesmond in Newcastle. [00:34:50] They bought it bought it for a pound and the building cost like, say 60,000. Right. [00:34:55] And and of course, they lived above the shop for a while and they, they made, made they converted [00:35:00] it into a beautiful private practice in the end. But when they took me round to view it, it was an old standard NHS [00:35:05] practice. And the waiting area was the corridor by the staircase. A few old [00:35:10] dining chairs shoved in a row, and the only thing that was on the wall to [00:35:15] welcome the patients was a skull with a fag hanging out of its mouth. That said, smoking kills, [00:35:20] you know. And I can contrast that now to, you [00:35:25] know, I was the judge at the private dentistry awards where the the winning, the winning practice. [00:35:30] His mission was to make it look like a high quality hotel from Dubai.

Payman Langroudi: The [00:35:35] Black Swan.

Claire Nightingale: Yes, I think I think that would be it, you know, up in Glasgow.

Payman Langroudi: Or Glasgow.

Claire Nightingale: Or [00:35:40] Scotland, certainly. Anyway, unfortunately, I can’t remember the name. That’s embarrassing. But, you know, I [00:35:45] do remember being hugely impressed. But when you look where dentistry has gone. It’s phenomenal. [00:35:50] And so at the point I’m and you know, no one until 2006, Corporatisation didn’t [00:35:55] really exist. You know, the changes in the regulations. And now, of course, you know, we [00:36:00] all expected to make money from treating patients, didn’t we? So, you know, it was high volume churn [00:36:05] or low volume churn and high prices. Yeah. That’s how we made our money as dentists. Nobody [00:36:10] expected when they came out of dental school in the 80s, that you’d make money from the value [00:36:15] of your business, you know, you know, and now, you know, the thought of buying and selling practices to make a [00:36:20] margin. I mean, you know, that is just alien to my way of thinking, because I came out [00:36:25] of a generation that expected dentists to be single handed operators working out [00:36:30] of a front room of a house. So why I’m telling you, all this is talking about my ambition, [00:36:35] I suppose, because of course, I never had the [00:36:40] imagination that people would own more than one practice, or that you would build up a chain of [00:36:45] practices.

Claire Nightingale: It was Unimaginable to me. And so when I qualified, you know, [00:36:50] what my landscape looked like was a hospital career or going into [00:36:55] private, going into practice and being. I am ambitious, and [00:37:00] I wanted a foot in both camps, you know, and, and, and and of course, quite a lot of people [00:37:05] now have a foot in both camps, but at the time people tend to be full time either way. Yeah. So [00:37:10] I always and so if we come back to Mr. Wilson, my very first dentist, he, he owned his own [00:37:15] practice. So yes, I always saw practice ownership as something that I wanted to do. Um, but of course, [00:37:20] when you do a long period of extended training, as I did, I didn’t come out as a specialist [00:37:25] orthodontist until over the age of 30, you know, and I did my senior registrar training, which [00:37:30] was four years after that. So I managed to time my first child with the [00:37:35] good fortune of being about 6 or 7 months pregnant as I as I.

Payman Langroudi: Set my.

Claire Nightingale: Time. [00:37:40] No, no, I met my future husband in Bristol, and then we moved back to London because we [00:37:45] felt he’s not a dentist. He’s a surveyor. Okay. But we felt that London was the best place that [00:37:50] we could have an equal shot at a career. So we gravitated back to the South East, and it was difficult. It was difficult [00:37:55] for me to get a job, actually, because I wasn’t a London girl. I wasn’t a London undergraduate, I wasn’t a London postgraduate. [00:38:00] And that’s where national recruitment really comes into its own, eliminating those prejudices. [00:38:05] Anyway, on my third attempt, I got a senior registrar post, so I had [00:38:10] to wait a couple of years to get that. So by the time I had my first child, it was a [00:38:15] week before my 35th birthday, you know? And in fact, I’m going to jump [00:38:20] ahead because, you know, at the end of this you’ll ask me about advice. But, you know, one of my pieces [00:38:25] of advice as a woman is to and not so different for [00:38:30] men. Men have obviously a bit more time on their side, but I would say time your family on the [00:38:35] age you want to be when you have your last child, not your first. I mean, your first is important, but we you know, if you leave the first [00:38:40] too late, you may not get the second, you know, and I was very lucky that I managed [00:38:45] to have three children. So what it means, what I’m trying to say by all of this is that, you know, as a professional [00:38:50] woman, if you are, you know, you’ve got an extended period of training, then you want, [00:38:55] you know, you’re competitive and you want a foot in two camps, you know, and then you want a family and you want more than one [00:39:00] child.

Claire Nightingale: You know, all of a sudden you’re in your 40s before [00:39:05] you are and not having a Dental spouse as well. So I didn’t have a [00:39:10] partner that was securing a practice on my behalf, so I had to do it by myself, you [00:39:15] know. So yes. And then my ambition, you see, because I’d met John [00:39:20] Bennett, the B and m t at Bristol. My ambition he had said to me that with my [00:39:25] he said, you’ve got a great pair of hands. And by the way, you speak with patients and their parents, you’d do really [00:39:30] well in private practice. So, so the bar got raised again because I would have come out thinking [00:39:35] NHS practice was fine, but all of a sudden I had this West End practitioner suggesting to me that [00:39:40] I would be good in the in the West End. So I kind of thought, oh, well, Harley Street, you know, sounds all right. So [00:39:45] I had an ambition to follow John and um, and then, of course, you know, you [00:39:50] look at partnerships and anyway, it’s very difficult. So what I’m saying [00:39:55] is, is that I had eggs in a lot of baskets, and I was waiting to see which one came up [00:40:00] first. And ironically, the first opportunity that came my way, [00:40:05] um, I was working in an NHS practice in North London, and it was just as the contracts [00:40:10] were about to change. We were told in 2003 that the contracts were changing in 2006. [00:40:15] So I thought, oh, right, I need to get my own practice really quickly because I could see that the valuations would [00:40:20] rocket.

Payman Langroudi: Why? Why were you so sure? Because of the change in my business [00:40:25] instinct.

Claire Nightingale: So yeah.

Payman Langroudi: Of course.

Claire Nightingale: Okay. So you know, prior, [00:40:30] remember that prior to 2006, NHS dentistry was an absolute [00:40:35] gold mine. You know, you could and particularly orthodontics and you know, there’s a there’s a whole host of young men [00:40:40] that built up fabulous, you know, large grossing practices very quickly [00:40:45] after coming out of specialist training. Yeah. So anyone under the NHS under the [00:40:50] age of 18 could have treatment for free. You know, there was no limit to how much you could gross. [00:40:55] Um, and you could work 6 or 7 days a week, you know, and [00:41:00] of course. So of course. And it was the explosion in the NHS orthodontic spend that [00:41:05] brought this to the attention of the government. And I thought they’ve got a cash limit this we’ve got, we’ve got to limit our liability. So [00:41:10] that’s when they introduced there were so many changes, you know they introduced ITN, [00:41:15] they introduced contracts and contracts then had to be competitive. You had to bid for them, you know, and they [00:41:20] also changed the ownership of practices and said anybody could own a practice. You didn’t have to be a dentist. So there [00:41:25] were massive changes happened that then changed the landscape of dentistry [00:41:30] to what it is now. Now, you know. So there I was thinking, right, [00:41:35] okay, so it’s 2003.

Payman Langroudi: Get on with.

Claire Nightingale: It. Yeah, I’ve got three years before I. [00:41:40] The opportunity is lost. And then, of course, when you’ve got more demand than supply, [00:41:45] you know, so more purchases for less for the same number of practices. Of course the valuation is going [00:41:50] to go up and then you can’t just go off and set up a squat under the NHS, you know. [00:41:55] So, you know, it was a no brainer to see that we, you know, that if you didn’t have a practice, you were [00:42:00] going to be potentially really screwed over, you know, so so I said [00:42:05] to the principal of the practice I was in that I would like to buy, buy his practice. And also [00:42:10] he was at this point all of 50. And as far as I was concerned, he was over the hill. You know, he [00:42:15] must be looking to retire. You know, that’s what I thought happened at 50. Anyway. [00:42:20] I said, look, I’d really like to buy your practice. And at the time I was pregnant with child number two. [00:42:25] And he said, okay, well, when you come back from your maternity leave, we’ll set it to a timetable. [00:42:30] And a week later, he was killed in a motorcycle accident. So it was a terrible, [00:42:35] terrible experience for me. Awful. You can imagine [00:42:40] a heavily pregnant woman with a toddler trying to negotiate with a grieving widow. Neither [00:42:45] of us have had any experience of buying or selling practices before. Ended in complete disaster. [00:42:50] Terrible. I had to walk away massively distressed. Really [00:42:55] ill. I mean, you know, which again, all of these things feed into the life’s learning. Um, [00:43:00] but in the end, it was one of the best things that happened to me, [00:43:05] bizarrely, because had I bought that practice, um, I would have been in a [00:43:10] part of an area of London I didn’t particularly want to be anyway, you know, as you as, you know, I mean, anyway, that was my first [00:43:15] attempt at buying a practice. And then after that, you know, I realised I looked at [00:43:20] partnerships, you know, really, really difficult to go into partnerships with people. The valuations of practices [00:43:25] were rocketing and on the partnership point.

Payman Langroudi: Yeah. Is it that you’re a lone wolf? Is that what you mean? [00:43:30] Or is it that you didn’t find someone that you would want to partner with or.

Claire Nightingale: No, I just, I just, you know, are [00:43:35] you a lone wolf.

Payman Langroudi: Very scared to go into a business without a partner?

Claire Nightingale: Oh, [00:43:40] that’s an interesting. Yeah. Well, I mean, I have rarely observed a [00:43:45] really happy partnership in dentistry. Um, no, I explored two [00:43:50] partnerships out of circumstance. Um, neither of them turned out to be [00:43:55] right. Are you a lone wolf?

Payman Langroudi: Am I a lone person who wants to make an immediate decision? And it happens. [00:44:00] And you don’t want to run it by someone else? Is that all you’ve ever known or. Oh, well, I.

Claire Nightingale: Mean, I’m [00:44:05] certainly a decision maker. I’m definitely not a procrastinator. And the moment I’ve made a decision, [00:44:10] I want it just enacted there and then.

Payman Langroudi: Claire, what are you bad at?

Claire Nightingale: So that’s [00:44:15] an interesting question. Payman. Because I will tell you off the, you know, off the cuff that I’m bad [00:44:20] at clay pigeon shooting and handwriting, but I suspect that the gist of your question is [00:44:25] either what are my weaknesses? Or why did I never have a business partner? And [00:44:30] where would my business deficiencies be? Is that really what you.

Payman Langroudi: Want to.

Claire Nightingale: Drill down to? So [00:44:35] I’ll say to you, I mean, you know, the standard way of responding to what are your weaknesses? We’ve always been trained to portray [00:44:40] them as as a hidden strength. So I would say to you that my weaknesses [00:44:45] are that I am impatient and I have a low boredom threshold, both of which are very true, [00:44:50] but it drives me to do multiple things and be an effective [00:44:55] completer of tasks. So, you know, I’m always looking for the next project. I’m never happy unless I have [00:45:00] a project to work on. Um, but you don’t you don’t.

Payman Langroudi: You don’t strike me as the kind of person [00:45:05] who I’m like, I love a new idea, but the follow through [00:45:10] of it, I don’t enjoy it at all. So it’s like, well.

Claire Nightingale: We need to.

Payman Langroudi: We need to do a.

Claire Nightingale: Test [00:45:15] on you, Payman, and see what where you are. Where you.

Payman Langroudi: Are. When you say when you say boredom, [00:45:20] boredom. So you get bored quickly. Does that does that affect you negatively [00:45:25] as well as positively?

Claire Nightingale: Negatively? I mean, it’s a funny thing to say, isn’t it? As an orthodontist whose treatment plans [00:45:30] take forever to say you’ve got a low boredom threshold. No, it just means that, [00:45:35] you know, that’s why I will go off and do the comedy or do my expert witness course or, you [00:45:40] know, start preparing the next conference for the Women’s Dentist network. Think of the next idea.

Payman Langroudi: What [00:45:45] about you? Don’t live in the moment enough.

Claire Nightingale: Yeah, yeah. I think that is very [00:45:50] I think that that is planning.

Payman Langroudi: Ahead a lot.

Claire Nightingale: I think you have got a very good point, actually, and [00:45:55] I think certainly in my early 20s, I was very guilty of [00:46:00] living too much in the future. You know, it was all about, you know, doing the primary [00:46:05] and the secondary PhDs. And then which job did I have to do to get on an ortho course? All of that. You’re absolutely right. [00:46:10] And actually, very, very recently, I have summed up, I [00:46:15] do make a conscious effort to live in the moment. I do, despite the fact that I’ve got all these projects. [00:46:20] And I would say that my philosophy now is, you know, look to the future, [00:46:25] learn from the past, but live in the live in the moment. Yeah, I think that’s a good encapsulation [00:46:30] of what’s a muscle.

Payman Langroudi: In a way. You have to train that muscle. Yeah, you have to you have [00:46:35] to actually think. Yeah.

Claire Nightingale: And I tell.

Payman Langroudi: You what, on the seat almost, you know, what is the.

Claire Nightingale: Biggest prompt? [00:46:40] It is the death of a friend, isn’t it? Or, you know, a terrible diagnosis as [00:46:45] unfortunately, I’m at that stage of life, you know, of our of friends. So there is nothing like a bit of bad [00:46:50] news to really make you live in the moment. Yeah. Um, but, you know, if we come back [00:46:55] to business, you know. And why at Queensgate Orthodontics did I never have a business [00:47:00] partner, which is what we’ve touched upon. And the answer would be that a mono [00:47:05] speciality private referral practice is like living in a leaking [00:47:10] bucket. You know, whenever you’ve got a new referrer appearing at the top or a new source [00:47:15] of patients at the top, another one drops out at the bottom and that bucket is constantly [00:47:20] leaking. And therefore I just say it’s very simple. You know, the practice never had has never had [00:47:25] enough churn to really support 2 to 2 people, you know. [00:47:30] And of course, you could argue that if I had and then, of course, I’d had two [00:47:35] attempts at partnership before, which had failed and had been a bit scarring. Um, [00:47:40] but and of course I wouldn’t. I’m pretty representative of people of my age [00:47:45] group who have continued to run single handed practices, you know, like Moira Wong, Asif Chattoo [00:47:50] and, you know, we’ve all been running single handed practices for four [00:47:55] years. Um, and you could say that where I have been time [00:48:00] poor has been focusing on marketing. You know, marketing is an alien concept [00:48:05] to me. And also on the finances, you know, things like fee setting, [00:48:10] um, realistic fee setting. I think my fees are realistic, but I kind of do them [00:48:15] on the back of an envelope, and I’m sure someone with an accountancy background would do something [00:48:20] a little bit more scientific. Um, and if I had brought [00:48:25] in another partner who had those skill sets, they might have been able to drive their books sufficiently [00:48:30] to serve two people within the practice. You know, but what. [00:48:35]

Payman Langroudi: I said about partners. Yeah, the thing that would bother me the most about not having a [00:48:40] partner is almost the loneliness of when there are moments in any, even [00:48:45] in the happiest business, there are moments where I wouldn’t say the team turn [00:48:50] on you, but there’s there are moments where it’s an us and them yes moment. Yes. And [00:48:55] in those moments, I find having partners be the most important.

Claire Nightingale: And that’s.

Payman Langroudi: Why you [00:49:00] found yourself lonely in.

Claire Nightingale: Those moments? Yeah, absolutely. I think I’ve referred to the fact that [00:49:05] it’s lonely at the top of the pyramid, irrespective of how small or high that pyramid is. So you [00:49:10] build your net. If you’re a single handed person, you build your network outside of the business. [00:49:15] So even though I was single handed as the practice owner, you know, I had [00:49:20] my school mum friend who was a top notch corporate lawyer. You know, I bought [00:49:25] in external practice management services. I had someone else who I employed for HR [00:49:30] advice, that sort of thing, you know. And I had various shoulders to cry on, you know. [00:49:35] So, um, so you could say. You could say that I was I wasn’t a single, [00:49:40] you know, in effect, I put it like this. I didn’t have a paid partner that had an ownership [00:49:45] of the business, but I had plenty of people around me supporting me every [00:49:50] step of the way. Because you can’t survive unless you’ve got your safety blanket.

Payman Langroudi: Coach and all that, right? [00:49:55]

Claire Nightingale: Well, I never had proper coaching, actually. No, I mean, I’ve mentioned before my fondness for Chris [00:50:00] Barrow. Um, and I would always listen to [00:50:05] him when he was talking at any kind of business meeting. Um, and I did join his [00:50:10] coaching program in Covid. He had that wonderful, uh, you know, virtual [00:50:15] program. But when I had a 1 to 1 with him, he actually said I didn’t need him because he said [00:50:20] I, I he, I asked him what was the difference, why would I not [00:50:25] need him? And he said, because you. He said his coaching was a lot about people who just simply didn’t know where to start. [00:50:30] And I always have a very clear idea of where I’m starting and where I’m going and what I’m [00:50:35] doing.

Payman Langroudi: We were discussing before. Yeah. Can a great clinician be a great business person as [00:50:40] well? And and there are skills that both need, you know, and you seem to [00:50:45] have access to those skills.

Claire Nightingale: Well, I think I do, but I’ve only done it on a small scale. Yeah, yeah. [00:50:50] And I mean, you know, to scale up, I would have to stop being a clinician, you know.

Payman Langroudi: Yeah. [00:50:55] But, you know, I had I had the CEO of Bupa. Yeah. Sitting where you’re sitting. Yeah. And he [00:51:00] said when he said 8000 employees. And I can’t even fathom what that [00:51:05] means. But then when we drill down, there’s really there’s 30, 40 [00:51:10] people he’s in touch with. Yes. You know, so yeah. Even in an 8000 person [00:51:15] business, it’s not an 8000 relationship. Because you’ve got a small business, [00:51:20] you feel like it would be just that scaled. But it’s not necessarily, [00:51:25] you know, a Payman.

Claire Nightingale: I’m going to suggest to you that actually, business principles are pretty simple, and I’m [00:51:30] going to see if you would agree with me. And I think, I mean, essentially, I think it’s kind of like for, [00:51:35] for things, you know, it’s money in, money out. You’ve got to make sure that more money comes in than goes [00:51:40] out. You’ve got to pay really careful pay, great care for your customers, stroke [00:51:45] patients and paying attention to detail. I think that’s it. Yeah. [00:51:50]

Payman Langroudi: It’s tough.

Claire Nightingale: In managing staff is difficult, which is I.

Payman Langroudi: Always think of it as keep your [00:51:55] three three constituents happy, which is your your customers, your staff and your suppliers. [00:52:00] Yes.

Claire Nightingale: And I and.

Payman Langroudi: I in my world, suppliers make a big difference, you know, because there’s a lot [00:52:05] of trust in it. Um, there’s IP involved in it. You know, [00:52:10] I’m getting my particular desensitising gel from a particular factory where we’re [00:52:15] signing off to say, you know, you’re not going to sell that somewhere else. Things like that. Yes. Um, [00:52:20] but those three things. You’re right. It’s not people. People make it more complex than than it has [00:52:25] to be.

Claire Nightingale: And I say to my staff that it’s a triad, you know, it’s the patients, [00:52:30] it’s the business and it’s the team. And we have to pay attention to all of those to stop [00:52:35] the pyramid, the triad falling over. But we don’t have to pay attention in the same amount. [00:52:40] And also at the same time. But we can’t neglect one because the whole thing comes down. [00:52:45] And, you know, and I still can’t read a PNL. She actually, you know, [00:52:50] and actually, I don’t care because it’s still money in, money out. It doesn’t matter quite how an accountant dresses [00:52:55] it up. It’s just no more difficult than your domestic finances.

Payman Langroudi: If I could be bored of [00:53:00] YouTube videos.

Claire Nightingale: If you chose to, if my low boredom threshold allowed me to [00:53:05] try and remember what a bracket meant. And what variance [00:53:10] from the budget did it matter? You know, cash flow. Cash flow. That’s the [00:53:15] other critical thing I would say that I’ve always enjoyed taking listening to people. And [00:53:20] you learn one thing from most people you listen to. So, for example, a chap who was a management [00:53:25] consultant in the NHS trust I was working in who became a personal friend for a while. [00:53:30] He said to me when I was looking at going into partnership and into practice, that wasn’t [00:53:35] very profitable. He said the thing that brings successful businesses down is not lack [00:53:40] of profit, but lack of cash flow. And so when I did run Queensgate Orthodontics, [00:53:45] I always kept a very substantial sum of money in the bank because all of my loads [00:53:50] of my patients paid in advance. And, you know, and I thought, well, I actually don’t really know what’s due to me. And if [00:53:55] they ask for their money back, like northern Rock, you know, I could have had a run on Clare Nightingale [00:54:00] Limited and gone under. So, you know, why did it take me so long to buy a practice? Because I looked at five [00:54:05] before I found the right deal, and I walked away from five opportunities that [00:54:10] were Go through.

Payman Langroudi: Some of the issues with those five deals. So, you know, there’s people who’ve never, ever [00:54:15] bought a practice and now are about to embark on that. What kinds of things did you come across that [00:54:20] put you off those other five?

Claire Nightingale: Um, well, okay. So I mean, ultimately the first [00:54:25] one that I had to walk away from in grief, ultimately, the [00:54:30] opportunity was offered to me as a partnership by the person that did buy, but [00:54:35] she, her husband wanted to be was going to be the practice manager. And I realised I’d be in a husband [00:54:40] and wife partnership and then I wouldn’t have a voice. Good decision. So I [00:54:45] walked. Okay. So that so that was one. So you could say incompatibility in partnership. You know, [00:54:50] not sharing, not having the same shared values um, and aspirations and modus [00:54:55] operandi. You know, as I said, I just like to make decisions and implement them quickly, uh, [00:55:00] because on the whole, most decisions you can retake, you know, um, not [00:55:05] every decision has to be right, but you do have to make one do it.

Payman Langroudi: No, you’re absolutely right. A quick [00:55:10] decision is much better than the right decision. I completely agree with that.

Claire Nightingale: Um. Next one [00:55:15] practice massively overvalued. You know, and back up against the wall in a bad [00:55:20] partnership. You know, being told one thing and then the reality in writing was another. [00:55:25] This sort of thing, you know. Um, next practice I looked at was a [00:55:30] sublet on, on a in a health centre, and the head lease was coming up [00:55:35] for renewal in 18 months after the purchase, and also because the contracting [00:55:40] changed that the vendor was not actually working on the premises. And when I asked the woman [00:55:45] in public mental health, who to whom is this contract? Who will own this contract? [00:55:50] She said it’s going to be owned by the associate, not the principal, because the principal didn’t work there. So? [00:55:55] So I realised that I could end up buying a practice, but within 18 [00:56:00] months, the associate could walk off with the contract value and the head lease could expire and I could be kicked out. [00:56:05]

Payman Langroudi: Did you get into the sort of the weeds of that? Or did you have a lawyer or something?

Claire Nightingale: I [00:56:10] believe you, me? I’ve haemorrhaged cash to Russell. My lovely friend, Russell Abrahams. In [00:56:15] fact, I go out to eat with him so often, I kind of think I’m just eating my way back [00:56:20] through my credit. Anyway, I mean, you know, I mean, out of the silver lining, I [00:56:25] mean, you know, I, you know, again, you know, be resilient. You know, I was on I was floored [00:56:30] by my first experience. I mean, it was terrible. And in fact, you know, I know I’m jumping ahead to deathbed [00:56:35] advice, but I genuinely got deathbed advice from my grandmother at the time, who died within 12 months [00:56:40] of that also. And she looked at me and she said, Claire, is it really worth making yourself [00:56:45] ill over? And I was profoundly ill. I just I had developed Graves disease, [00:56:50] but I didn’t become clinically identifiable as having graves disease [00:56:55] for another ten years. Was I a hypothyroidism? High hypothyroidism. But [00:57:00] my weight dropped to seven stone. Five. Wow. Yeah. And I. That was after two So. [00:57:05] Yeah. So so actually I listened to my grandmother. It was my grandmother saying, is [00:57:10] it worth getting ill over? And I just realised that I was listening to wise Words. So [00:57:15] I walked. So. Yes. So where are we at? What were the what was the next one? Okay. [00:57:20] Next one. Okay. So the next one, I mean basically overvalued [00:57:25] goodwill, you know, because as I said, I’d missed the boat, although I had had an ambition to buy [00:57:30] a practice by 2006, I’d missed the boat.

Claire Nightingale: And indeed, I was absolutely [00:57:35] right. Valuations rocketed, you know. So one practice I was offered, the [00:57:40] NHS goodwill was, let’s call it a I think it was £1 million. And I thought, [00:57:45] you know, if I invest £1 million in goodwill, bearing in mind [00:57:50] that 15 years earlier practices were selling for a quid, you know, [00:57:55] you know, you think, yeah. Well so I spent £1 million on NHS goodwill. I can’t [00:58:00] live in it. I can’t eat it. And when I come to retire, is the Is the NHS going to exist? [00:58:05] Can I? It’s going to be an awful lot of earning back to earn £1 million. [00:58:10] Be down £1 million. Yeah. Right. So I walked away from I walked away from that [00:58:15] one. Another one I was offered was, um, you know, again, a [00:58:20] tragedy. You know, somebody was dying and they wanted and he had a share in three [00:58:25] orthodontic practices. And would I come into a partnership and take on his share [00:58:30] of three practices? And again, I thought, well, you know, it’s expensive. I, [00:58:35] you know, the chap who I would have been in partnership with is a delightful man. We didn’t explore [00:58:40] whether or not our values and aspirations were going to be the same, but on the surface of [00:58:45] it, I was going to spend almost £1 million, and then I was going to run ragged between three different settings. [00:58:50] So I thought, you know, unfortunately that’s not for me either. You know, I tried to figure out a way the.

Payman Langroudi: Fact that [00:58:55] it was three, that was the.

Claire Nightingale: Issue. Well, the value, the valuation. Well, valuation, it was going [00:59:00] to be the I mean, I had three small children, you know. Could I run around between three practices [00:59:05] and service a £700,000 debt? I tried to. I did propose a way [00:59:10] where they amalgamate. I bought one of the practices and they kept two, but it wasn’t palatable [00:59:15] to the vendors, so that didn’t float. So I had got to the point. So [00:59:20] basically I felt like I the analogy was that I was a refusing horse. You know, I had [00:59:25] this ambition, really burning ambition to have my own practice, [00:59:30] you know, have it all. I, you know, I had the three children, I had the part time consultant post, I wanted [00:59:35] the business, but I’d looked at 5 or 6 different businesses and explored [00:59:40] them and spent money on legal fees, getting down to the nitty gritty and then walked [00:59:45] away over a long period of time. And I got really, really despondent. And I really thought [00:59:50] that it was never going to happen for me and I.

Payman Langroudi: Questioning yourself.

Claire Nightingale: Of course, you [00:59:55] say, what’s the common denominator here? Hello, it’s Clare Nightingale. It’s [01:00:00] my problem, you know. But actually and I did say to I had this really lovely [01:00:05] Irish nurse and I said to her, oh, I know I wouldn’t recognise the right opportunity [01:00:10] if it hit me in the face. And she said he will, Clare. You will. And then one day, when I was [01:00:15] absolutely miserable because of my dream, had imploded in the West End, you know, his partnership [01:00:20] hadn’t worked out and I’d been kicked out. Actually, that was another story. Um, [01:00:25] and and I was and I was working as an in-house specialist in a practice in [01:00:30] Harley Street. And I had my consultant job. So in many ways that should have been enough. But [01:00:35] I wasn’t an owner, you see. And and after three months of feeling utterly [01:00:40] miserable and despondent, all of a sudden it was like for no reason whatsoever, a [01:00:45] cloud had suddenly been lifted from my shoulders and I just thought, I’m content. And it was [01:00:50] the first time in about a decade that I hadn’t been pursuing [01:00:55] a dream or an opportunity. And and I still had that dream, [01:01:00] but I wasn’t chasing something for the first time forever. And I just thought, [01:01:05] oh, actually, I’m content. And then this period of content, of just thinking, [01:01:10] not trying to manipulate the future, not trying to create an opportunity, just live in the moment [01:01:15] for a brief time, which maybe that’s what I’m bad at, is living in the moment.

Claire Nightingale: Um, [01:01:20] and I recognised I could articulate, you know, someone said to me, how’s it going? [01:01:25] And I said, I am content. And then a few months later, out of the blue, [01:01:30] I suddenly got this text. And it was from this wonderful chap called Rod Edwards, who had [01:01:35] a practice called Queensgate Orthodontics, and he was looking to retire. And I just got this text. And [01:01:40] the connection again, it comes back to John Bennett. So the connection was that John had [01:01:45] looked out for me, but he also had looked out for rod. So we were all about 15 [01:01:50] years apart in age 10 to 15 years apart. And rod was looking for a safe pair of hands that he could hand his [01:01:55] business over to. Too. So he just texted. Would you like to come and meet me? Come to the practice. [01:02:00] So off I went. And I arrived at Queen’s Gate, and he opened [01:02:05] the door of this basement flat with a big smile on his face. And I stepped across the threshold and I [01:02:10] was like, this is the one. This is the one that I’ve been waiting for. This. It hit me. [01:02:15] And, you know, straight away I recognised it. It didn’t have to hit me in the face, and I just. Rod gave me this [01:02:20] big smile and I walked, stepped across the threshold, and I thought, this is the. This is the one.

Claire Nightingale: And what [01:02:25] made it so different was that, um, it was purely a [01:02:30] private practice so I could thrive or fail on my own merits. You know, [01:02:35] I wasn’t going there wasn’t an NHS contract that was going to be removed from [01:02:40] me. Okay. So it was really up to me to sink or swim. [01:02:45] The second thing was that it was the share of a freehold of a building. So I wasn’t going to be locked [01:02:50] into an upward only rent, you know, full rent, you know. Full rent, you [01:02:55] know, upward. Only rent review and full repairing and insuring lease. It was share of three freehold. [01:03:00] Okay, so it was bricks. I was investing in bricks and mortar that I could [01:03:05] live in. And rod didn’t want a huge amount of money for it. He wanted a reasonable sum for it. [01:03:10] And I think that given that he would have ultimately taken out quite a lot of work in progress, and I had [01:03:15] to completely ultimately over the next four years, I completely refurbished and brought it into the modern [01:03:20] age. I think the price I paid for it was appropriate. I don’t think it was inflated. [01:03:25] So those so it was like, right, this is it. And although it was the most expensive [01:03:30] opportunity, um, it was so obviously the right opportunity and with [01:03:35] least risk actually, because although I borrowed an enormous sum of money, it was largely [01:03:40] tied up in bricks and mortar.

Payman Langroudi: So when you’re when you’re buying that sort [01:03:45] of business, a lot of times you’re kind of reliant on referrals. [01:03:50]

Claire Nightingale: Yes.

Payman Langroudi: And the question of will you continue to get the referrals that he was? [01:03:55] Yeah. How do you deal with that? Was there a was there a period where he was sort of handing over and introducing [01:04:00] you to his referrals?

Claire Nightingale: Yes, he did that very nicely. Yeah. Yeah, I went I mean, the whole [01:04:05] I mean, as a specialist author, you know, as a particularly a mono [01:04:10] speciality private practitioner, you, you never stop worrying about [01:04:15] will.

Payman Langroudi: It dry up.

Claire Nightingale: And it always does, you know. I mean, you know, it’s just it’s a very it’s a difficult [01:04:20] game to play. And particularly in London. So yes. So for that first [01:04:25] year I mean basically what happened was I, we completed on the 31st [01:04:30] of August 2012 and rod was out the door by the 14th of December 2012. [01:04:35] You know, we had you know, and what he did was he took me out for dinner with his core referrers. [01:04:40] He really charged me up to all the patients, told them they were so lucky that finally a decent [01:04:45] orthodontist was going to be taking care of them. And that wasn’t him, you know. And [01:04:50] I went through that first year. I mean, again, very interesting learning. You know, I didn’t [01:04:55] lose a single patient or a single referral. Excellent. You know, so there we go. Emotional [01:05:00] intelligence, you know, not sweating the small stuff. So, you know, treating I did treat. [01:05:05] And I remember I took on I had to change the treatment plan for one patient. And I [01:05:10] ended up treating her out in lingual braces. And I carried all the costs of that. But that was part [01:05:15] of the purchase cost. You know, just keep everybody on side, you know, don’t worry about the small beer, [01:05:20] you know. But I did have challenges with staff who who were used to a very [01:05:25] different way of working.

Payman Langroudi: And just sorry to interrupt, but, you [01:05:30] know, the way he handed it to you and and it was a different time. [01:05:35] Yeah. But and and everyone hands their business over hoping that the [01:05:40] person who takes over is going to look after the staff and the patients and all that. But, you [01:05:45] know, in a way, it sounds like he handed it to you in a very personal all sense. And [01:05:50] then you sold to a corporate? Yes. And it’s changing times. [01:05:55] It’s changing times in a corporate may be the right, the right entity to look after your patients. [01:06:00] But do you reflect on that? Did you not did you not want to sort of pay it forward the [01:06:05] same way as he did?

Claire Nightingale: Absolutely I did. So so so so let’s look at how [01:06:10] the landscape changed over the nine years. Because I only owned a practice. It was only nine [01:06:15] years. Yeah I know. Which which in some ways is a source of disappointment [01:06:20] in some ways disappoint.

Payman Langroudi: Well, just because you didn’t.

Claire Nightingale: I kind of [01:06:25] think I was a bit of a lightweight. You know, I’ve only run a business for nine years.

Payman Langroudi: Resilient, [01:06:30] bones.

Claire Nightingale: You know, should have flogged myself for longer. No, I mean, obviously, because [01:06:35] I came to ownership a little bit late. Later than average. Um, I didn’t run it for very [01:06:40] long. But on the other hand, you know, the other way of looking at it is what a what a wonderful [01:06:45] thing to have bought a business and then sold it on again within nine years, you know. [01:06:50] I mean, you know, so it feels.

Payman Langroudi: Like I lost money for the first nine years, I didn’t. [01:06:55] Well, definitely the first five years. I mean, yeah, you have to the fact that you managed to do that is an [01:07:00] accomplishment in itself.

Claire Nightingale: But but the landscape, you know, one of the many reasons why [01:07:05] I brought it to market when I did was because of the changing landscape in the referral base. [01:07:10] So, yes. So I sustained those referral relationships for, let’s say, two years. [01:07:15] And then what happened was my two principal referrals. Got an in-house orthodontist. Yep. [01:07:20] So I lost those. You know, what.

Payman Langroudi: Do you mean by a principal referral. How many patients does someone have to [01:07:25] refer to you to feel like? Well, they were.

Claire Nightingale: Probably sending 20 to 30 patients a year, most of [01:07:30] whom would convert to treatment, you know, so, I mean, you know.

Payman Langroudi: Can, can, can that sort of 60, [01:07:35] 70, 90 patients referred a year to an orthodontist, can that sustain an orthodontist? [01:07:40]

Claire Nightingale: Yeah, I think that you can. I think I think you need about 80 [01:07:45] active patients to keep you going for a couple of days a week. Oh, really? Yeah, I think [01:07:50] I mean, my caseload, I haven’t it probably runs around about 190 active patients, [01:07:55] which is quite.

Payman Langroudi: Small. It’s not many humans to keep to keep a business going.

Claire Nightingale: It feels [01:08:00] like a it feels like thousands Payman thousands. No, you’re right, because [01:08:05] I’m a high, you know, I’m a high end practitioner, you know, that charges significant sums [01:08:10] of money. I’m not a high, you know, pile of high selling cheap operator.

Payman Langroudi: And then sorry, word of mouth [01:08:15] from existing patients must be a big factor. Yes it.

Claire Nightingale: Does. And yes, [01:08:20] of course. I mean, the landscape has changed, without a doubt. So you know what [01:08:25] happens when you’re a specialist in my specialist journey? Of course. Rod retired [01:08:30] slightly earlier than his peers who supported me. But then they retired, you know, and, you know, [01:08:35] people get ill, people have crises. You know, when you’re a referral practice, [01:08:40] your your fortune rises and falls with [01:08:45] the good fortune of your referrers as well, you know. And, um. [01:08:50] And of course, I mean, uh, GDP, Invisalign. You know, we know [01:08:55] that the majority of Invisalign is provided by GDP. And of [01:09:00] course, the volume of work that’s being done in tooth straightening is, is, is is enormous, you know, and of course, lots [01:09:05] of those adults would never have had treatment full stop anyway. So it’s not that I’m missing the business but [01:09:10] but people but but but yeah of course you know dental referrals have [01:09:15] dropped off a lot anyway. So I would say so. The reasons [01:09:20] why I sold my practice were I felt, well, there were all sorts of reasons. You [01:09:25] know, we’ll start with the fact that I felt as an individual, I had achieved everything [01:09:30] with it in those nine years that I really wanted to, you know, and I would say that, you know, those achievements [01:09:35] were I’d taken a business from a very old fashioned business, that the computer was only [01:09:40] used for word processing, and it was otherwise a pen and paper outfit, and the Dental chairs [01:09:45] didn’t go up and down and back.

Claire Nightingale: You know, I just I take it I’ve taken it. Yeah, [01:09:50] but I did it in a very sensible way. I did it out of cash flow. I didn’t want to increase my debt. [01:09:55] And I did it in, in bits. I didn’t, I mean, you know, turn the clock back. I would have had the [01:10:00] confidence to gut it and make something lovely and put in a really decent computer network [01:10:05] from the beginning. But we did it in dribs and drabs. And my husband and I, we used to drop the kids off at Stagecoach, [01:10:10] and that would give us three hours of a Saturday afternoon, where we’d whizz into the practice to put together a [01:10:15] computer network or assemble a cupboard. You know, that’s the sort of stuff you do when you’re [01:10:20] on a shoestring, when you’re on a shoot, when you’re not thinking big. Actually, you know, when you’re doing something for the first time on [01:10:25] a shoestring. But but I’d transformed it from what I’d bought with one best [01:10:30] practice in the UK in the dentistry wards in 2020, I doubled the turnover and my little boy had [01:10:35] done the practice website video that I had written, and we’d done it as a little family project, [01:10:40] and it’s still up there, and I’m still proud of it.

Claire Nightingale: And I still laugh every time I watch it. And I thought, [01:10:45] okay, so I’ve done everything that I really want to do. I’d [01:10:50] learned from this experience remember my very first attempt at buying a practice. The owner had been killed [01:10:55] a week after he had effectively agreed that I would buy it from him at some point. [01:11:00] So I was very much aware that as a single handed operator and having a non [01:11:05] Dental spouse, that if something happened to me, it would be an absolute [01:11:10] disaster for my family. I had had it valued three times in four years and the valuation [01:11:15] was on such a steep trajectory, I didn’t think it was possible that it could get any more valuable [01:11:20] than it was at that moment in time. And a very good friend of [01:11:25] mine had sold his practice to dentists 18 months before, and [01:11:30] and had was happy. It was very happy, and also had told me he was [01:11:35] in a five year earnout, you see. So. Yes. So I was thinking projected forward. Yeah, exactly. [01:11:40] I was thinking, okay, so I’ve done everything I want. I’m [01:11:45] vulnerable because I’m single handed. And when you hit your 50s, [01:11:50] your peers start getting sick.

Claire Nightingale: Yeah. Yeah, yeah. And, um, so [01:11:55] without wanting to sound doom and gloom, you know, you need part of the entrepreneurial [01:12:00] cycle is cashing in your asset. And I think it’s a big mistake to [01:12:05] think of cashing in an asset as a stage of life thing as opposed to a valuation [01:12:10] thing. Yeah. So, you know, I think, you know, and I do and so [01:12:15] I just so I thought well okay so I’ve got an I’ve got, I’ve got a really valuable asset. [01:12:20] But the value is all about personal to me. It’s all about me. So if anything happens [01:12:25] to me, my husband has to pick up the pieces in a terrible situation and the family lose [01:12:30] all this value too. So cash it in. And of course, I was thinking, would I like [01:12:35] to give? I did offer it to an individual orthodontist first, actually, but she couldn’t raise the [01:12:40] funds and, you know, so. And the second thing is I was worried, I, [01:12:45] I was worried that whoever came and took it on after me would be in this very, very difficult marketplace of [01:12:50] having to maintain referrals and all the rest of it. I don’t think, actually that private [01:12:55] or small private orthodontic practices have legs for the long term. And I, [01:13:00] rod and I are still in touch, you know, sporadically and [01:13:05] rod and I and and I just thought I would worry for that person.

Claire Nightingale: You know, I know you [01:13:10] could say caveat emptor, but I would worry if someone bought it from me for a large [01:13:15] sum of money and then went bankrupt or were unable to make it work. So [01:13:20] on balance, I thought it was better to bring it into the umbrella of a bigger organisation [01:13:25] where I thought that we would all be more protected. Really. Um, [01:13:30] so. And I was just, I was very fortunate that I fortunate that I’d managed to hit the right threshold of turnover [01:13:35] for a corporate to be interested. And of course, the other thing about selling to a corporate is that there’s no [01:13:40] messing about. You know, once you’ve signed heads of terms, you go forwards, you know, there’s they’re [01:13:45] not going to mess you about, you know, the the vendor might mess about. Whereas an individual, you [01:13:50] know, it’s like buying a house. You’ll get lots of people who will pull out. And I just thought and [01:13:55] I just would as I said, you know, I don’t procrastinate and I like decisions I make to be effected [01:14:00] quickly. So actually doing doing what rod had done, which was to [01:14:05] sell it on relatively cheaply for someone to be nurtured, I just thought it I was [01:14:10] perhaps setting someone up for failure if I did that.

Payman Langroudi: And then they’ve known for [01:14:15] was it dentex? Dentex dentex are known for leaving you alone afterwards? [01:14:20] Yes. It’s terrible. It’s a real problem for us suppliers because you said, [01:14:25] you know, you do a deal with dentex. You’re like, hey, put it through your 70 practices or whatever it is, [01:14:30] and now it’s Portland. Yes. And they’re like, oh, we’re not allowed to say anything to our practices. [01:14:35]

Claire Nightingale: Oh yes. That’s right.

Payman Langroudi: From outside.

Claire Nightingale: You mean in terms of political freedom? Yeah.

Payman Langroudi: And [01:14:40] well, was that part of it? I mean, did you did you look at other corporates? Well, I had.

Claire Nightingale: I had, I had [01:14:45] offers from Dental and Portman.

Payman Langroudi: Before they. Yeah.

Claire Nightingale: Before they merged. Yes. And the [01:14:50] deal from dentex was better. And, and also my friends were very extraordinarily [01:14:55] happy with dentex. So yeah we had you know we had 18 months of working [01:15:00] with dentex. And now we’re part of the Portman Dentex group.

Payman Langroudi: I’m quite interested in the question of, you know, [01:15:05] why is it someone who’s, you know, known as a brilliant clinician can’t be known [01:15:10] as a brilliant business person? I mean, I know you can, but we kind [01:15:15] of feel like those two things are in tension. And when I listen to the way you talk, it’s [01:15:20] like you almost put the same outlook on the way you look [01:15:25] at a case as you do looking at a at a business?

Claire Nightingale: Yes. [01:15:30] Is that right? Yes, I think I think you’ve hit the nail on the head. And, you know, [01:15:35] it’s about I mean, I you know, I actually really love data. I love looking at spreadsheets. [01:15:40] You know, when I sold my practice, the bit I really enjoyed was looking at spreadsheets. The bit that I found really [01:15:45] tedious was reading legal agreements. You know. So. So I love looking at KPIs. [01:15:50] I love looking at trends. I find it fascinating. But I think and [01:15:55] I have done business courses, you know, I mean, not not [01:16:00] in any enormously extensive fashion, but I went to a day on setting up [01:16:05] in practice that was probably run by the BDA years ago and listened. I you [01:16:10] know, you always learn something, don’t you, boss? Yeah. Or, you know, one young man [01:16:15] said he’d set up a practice almost on leaving dental school so very young and he disregarded [01:16:20] everybody’s undermining him about his age, saying, oh, you’re way too young to do practice. You know, he went off and did it anyway, [01:16:25] you know, so feel the fear and do it do it anyway. And he said something like, [01:16:30] look, go and set up where they’re setting up a Waitrose, not a Lidl, you know, that sort of thing. You [01:16:35] know, there was a tip, you know, someone else said when something you know, when you’re an associate [01:16:40] and something breaks in the practice, go and watch what the principal does to mend [01:16:45] it, you know.

Claire Nightingale: So I am the only one, really, who gets on my hands and knees to try and identify where [01:16:50] the leak is coming from, you know, or opens the door and fiddles around with [01:16:55] the float, the float of the spittoon, or notices that a light bulb is out, or notices [01:17:00] that the steps need to be swept of leaves, because otherwise the patients are going to slip and everyone’s oblivious [01:17:05] to that. Okay, so that’s the difference between being an associate and a principal. And you’ve got to start looking [01:17:10] through the eyes of the principal. Um, so another course I did was run by Fiona [01:17:15] Stewart-wilson, who I think is fabulous, and it was a practice managers course, basically. And interestingly, [01:17:20] she said when she goes into a practice, the first thing that she asks of the owner is what’s your [01:17:25] What’s your exit strategy? Yeah. So coming back to when my friend said he was in a five year earnout, I [01:17:30] thought, okay, so what does my life look like in five years time? In five years time. My youngest child would be at [01:17:35] university. My parents will be in their mid 80s.

Claire Nightingale: They might need me to take them off to hospital appointments, [01:17:40] you know. Um, and I thought, so if that’s my obligation is going to be different. [01:17:45] So I need to be freed up of obligation in order to then [01:17:50] take, you know, to serve that need if it’s there, you know, and of course, I’ll be 61 [01:17:55] as well. Amazingly. I can’t believe that. So so that’s what I did. So I looked [01:18:00] ahead and I. So those were the multiple reasons why the timing of that sale, the [01:18:05] decision I made. And it turned out to be perfect. It was I nailed [01:18:10] it. It was perfect timing. So I’m so happy for that. Um, [01:18:15] but so so I’ve done two of Fiona’s courses. And then, of course, I adore Chris Barrow, and I love listening to, [01:18:20] you know, the things that he says. Um, but I think. But why? But but [01:18:25] perhaps being a good clinician has held me back from being a good business person, because I’ve ended up doing [01:18:30] it on a very small scale. And had I not been [01:18:35] so committed to clinical care, and had I [01:18:40] been had I gone to dental school 20 years later, when the dental landscape is as it [01:18:45] is now, maybe I’d have been a micro corporate owner.

Payman Langroudi: You could you could have pulled that off.

Claire Nightingale: No, probably. [01:18:50] Probably probably. But but I am, I am I have been held, [01:18:55] I have been in I have not done that because a I didn’t have the vision. And secondly, [01:19:00] I came to it too old, you know, and I’m too entrenched in clinical care. [01:19:05] Anyway, I did what I did and I achieved my goals.

Payman Langroudi: I’m interested in in your [01:19:10] day to day, insomuch as in the hospital job, you must come [01:19:15] across very complex orthognathic type cases. Yes. Different socioeconomic [01:19:20] Economic groups. Yes to you. No to Queen’s gate. No. Queen’s gate. Right. That’s where. [01:19:25] That’s where my kids go to school and all that. Yeah. And, you know, I’m sure you know, you’re saying my daughter’s [01:19:30] one of them, but that you must get these exacting parents. Yes. You know, over [01:19:35] over a millimetre or something. Discrepancy. Well, how does that play out? [01:19:40] How does it play out? Is it is it a healthy thing? Is it a nice thing to have both?

Claire Nightingale: It’s very nice to have both. It’s [01:19:45] very nice to have both. It’s. I couldn’t cope with having more than two places of [01:19:50] work in a week. Um, but, um, so having [01:19:55] having two working places is good. One definitely complements the other. I mean, from a clinical [01:20:00] perspective, actually, I get very challenging cases at Queensgate because I have quite a large private [01:20:05] orthognathic practice there. Yeah. Um, the clinical work as a consultant [01:20:10] has become less interesting over 20 years because I think the specialists are doing [01:20:15] more complex cases because of the changes in iotn Yen. And mostly [01:20:20] what I do is impacted teeth actually, which is a bit dullsville really. Um, in [01:20:25] terms of the demands of the families I look after, actually, it’s not so much [01:20:30] the clinical demands, it’s the social demands. So, you know, I might have a child who lives [01:20:35] in Scotland and is at boarding school in London and then goes abroad every holiday, that kind of [01:20:40] thing. And dancing around somebody’s social needs, you know, I have on a few occasions, [01:20:45] you know, had to do an adjustment whilst a taxi is waiting outside [01:20:50] to take the kid off to Heathrow Airport, that sort of thing. Or, you know, occasionally you’ve.

Payman Langroudi: Private jet order.

Claire Nightingale: You [01:20:55] know. I mean, look, I think you’re kind of I think I suspect you, you lay out your [01:21:00] stall as a clinician without quite realising it, and then you attract people that are [01:21:05] like you. So actually, I don’t look after well, to my knowledge, [01:21:10] I don’t look after enormously mega rich people or celebrities. I’m [01:21:15] just looking after affluent middle class families on the whole, which is a good thing because I can [01:21:20] relate to them and they can relate to me.

Payman Langroudi: Well, I asked my wife this morning. I said, why do you refer [01:21:25] to Claire? Why? And she said, the main thing is that several times [01:21:30] you’ve said, no, this person doesn’t need treatment or yes, this person can wait another two [01:21:35] years. And yes, you know, you’re not led by the finances.

Claire Nightingale: Yeah, that’s true.

Payman Langroudi: And it’s [01:21:40] a nice thing because it’s easy to be led by.

Claire Nightingale: Yeah, I am the master [01:21:45] of the undersell. Patients have to get on their hands and knees and beg for treatment. [01:21:50]

Payman Langroudi: So, Claire, tell me about life after selling your practice.

Claire Nightingale: Well, it’s been an interesting [01:21:55] experience. I think the most important thing to remember is that when you sell, you sell. [01:22:00] And then you have to accept that changes will happen, that will be beyond your control, and you really can’t [01:22:05] have your cake and eat it, you know? So I am eternally grateful every day that somebody [01:22:10] was interested in acquiring my practice and the money’s in the bank and my exit strategy [01:22:15] is secured and everything beyond that is a win, you know? So if I’d sold to an individual, [01:22:20] I’m sure they would have had me out of the practice pretty quickly because they would have needed to earn the money. But [01:22:25] selling to a corporate has meant that I continue, really to run the practice many ways, and [01:22:30] the style it always was. But of course there are external factors that my practice managers [01:22:35] have to get used to that makes his life more difficult. But in the big picture, I think the only way [01:22:40] to embrace the change is to do it positively and accept that you’re just not the owner anymore. You’re [01:22:45] back to being an associate.

Payman Langroudi: So does it grate with you that you have to ask for permission [01:22:50] when you want to change something?

Claire Nightingale: Well, I mean, as you’ll appreciate, I initially sold to dentex [01:22:55] and then of course dentex partnered or were acquired by Portmann. And so there have been constant changes [01:23:00] over the three years since I sold it. They’ve [01:23:05] both both corporates are really like the people that I’ve come into contact with. And a whole new world of opportunity [01:23:10] has opened up to me as a consequence of becoming part of a of a bigger organisation. Well, for example, [01:23:15] I met me, so I became part of a big WhatsApp group of the partners that had sold [01:23:20] and I and do you know, Mitesh. So Mitesh runs [01:23:25] a fantastic charity called Smile Star, and he does multiple visits [01:23:30] to African countries doing extractions for poor people in peculiar places. [01:23:35] And he posted on the group a question about feeding a neonatal [01:23:40] cleft baby that had just walked into his clinic in Sierra Leone. And I responded [01:23:45] with some completely useless information dredged up from my time as a senior registrar. But as a consequence [01:23:50] of him asking the question, me replying, we struck up a text conversation that [01:23:55] culminated in my saying, oh well, one day maybe I’ll come with you. And then finding myself [01:24:00] in Jamaica last Christmas, together with three of my family members taking teeth [01:24:05] out, which I haven’t, which I haven’t done for 30 years. Yeah, yeah. You know, so, I mean, I got a bit hoist by my [01:24:10] own petard Because I think I was a bit insincere when I first said, yeah, [01:24:15] I’d love to do that, you know? And then I found myself in this WhatsApp group and before I could say, [01:24:20] actually, I’m a complete fraud and I never intended to really commit to coming along. [01:24:25]

Claire Nightingale: Um, the first person who confirmed that she was going was a woman who I knew was in marketing. [01:24:30] And I thought, frankly, if a marketeer thinks she can be useful, then so [01:24:35] can a rusty DS. And then when. And then it was two weeks over Christmas. I didn’t [01:24:40] want to leave my husband for that long, so he came along as a dental nurse. And [01:24:45] then when our daughter heard the words of all inclusive three star hotel in Jamaica, she [01:24:50] invited herself. And then we told the youngest he was coming, too. So we had a great trip. We were away [01:24:55] for 14 days, seven days. We did clinics seven days. We were off having fun. [01:25:00] There were 22 of us. We were dubbed the Honorary Gujarat. Um, and of [01:25:05] course, because it was over the Christmas period, you know, I introduced Secret Santa and we And we celebrated the [01:25:10] new year together. But but I mean, most importantly for me, I got back on that horse, you [01:25:15] know, and my hand was shaking like a leaf when I gave my first buccal infiltration. Yeah. [01:25:20] And I was only given the periodontally involved teeth to take out to begin with. But after [01:25:25] seven days, I put in a block, elevated nine roots from the lower left quadrant and stuck in four sutures. [01:25:30] So you know it came back.

Payman Langroudi: What did it do for you? Did it feed you somehow? Well, [01:25:35] I expect I expect that my daughter’s one of your patients, right? Yes. I’m we’re talking about the [01:25:40] kind of people my daughter and her friends might be. Or parents might be very exacting [01:25:45] on the odd millimetre rotation or whatever it is, and balancing that [01:25:50] off with someone who’s just in pain and wants their tooth taken out. Does it keep it real? Did it [01:25:55] keep it real for you?

Claire Nightingale: You know, I really loved getting back to, I mean, going to make a terrible [01:26:00] pun, aren’t I? Inadvertently. But getting back to my roots. You know, I loved oral surgery. In fact, [01:26:05] you know, there was a moment when I considered doing all going off and doing medicine and becoming a career [01:26:10] surgeon. But of course, I’m perfectly happy with the choice that I made to stick with ortho. But [01:26:15] but I would embrace the opportunity to get back to doing some general dentistry. It’s [01:26:20] just that I’m unlikely to ever do it in the UK, you know, because I’m way too out of touch and out of practice. But [01:26:25] I mean, certainly I didn’t mess up, you know, these people benefited from my care. [01:26:30] And in fact, I’m off again in the beginning of February. I’m going to Mozambique, this time.

Payman Langroudi: Effective [01:26:35] altruism.

Claire Nightingale: No, I haven’t tell me what’s that?

Payman Langroudi: So the question is, it’s [01:26:40] a bit of a contrarian way of looking at it. Yeah. But it’s it says if your interest [01:26:45] is to alleviate pain, stay in South Canton, [01:26:50] charge people top dollar, make that money and send it over and pay [01:26:55] locally for local dentists. Yes. You know what I mean? Yeah. As the first question [01:27:00] I asked was does it feed you. Yes. Okay. So it does feed you obviously to to go and help people. Yeah. [01:27:05] Yeah. But that question of do we do charity for ourselves to some extent?

Claire Nightingale: Yeah. No, that’s a [01:27:10] very good question. And the answer is I do both. Payman.

Payman Langroudi: Yeah.

Claire Nightingale: You know, so, um, and [01:27:15] in fact, I. So another consequence of selling my practice, I mean, there’s all sorts of consequences [01:27:20] that were unexpected. So Barry Lanzmann was the chief executive of dentex when [01:27:25] I was acquired. And he introduced me to his partner Nicola, firstly as a patient. And then she and I have become [01:27:30] great friends. And when she knew that as a family, we liked scuba diving, [01:27:35] she suggested to us that we should go to Mozambique, to a place called Vilanculos, [01:27:40] which the scuba diving is awesome. I mean, it’s comparable to the Red sea and and basically [01:27:45] you go kite surfing when the wind is up and scuba diving when it’s calm. And, [01:27:50] you know, I tried flying a kite. It’s really hard. And I found it incredibly painful because I spend my [01:27:55] day looking down. I don’t spend my day looking up, you know? So the muscles on the back of my neck were [01:28:00] screaming out in excruciating pain within five minutes. So I never got on to [01:28:05] the water, but I gave it a go. You know, we all gave it a go. Um, but more importantly, [01:28:10] the kite. So the place that Nicola and Barry. Well, Nicola recommended us to stay in Vilanculos [01:28:15] and use a kite surfing outfit which is a non for profit, [01:28:20] not for profit.

Claire Nightingale: And this incredibly generous Swiss couple have set up a kite surf [01:28:25] school with accommodation and they apply. They plough all the profits back into the local community [01:28:30] and they support schools and an old people’s home and water, which is much more effective than [01:28:35] me dipping my hand in my pocket from South Kensington or going and taking a few teeth out. But [01:28:40] but the laugh was that this young man, who’s the kite surf instructor, naturally [01:28:45] assumed that I was a relative of Nicola and Barry Landsman, and [01:28:50] it was way too complicated to explain. So I sold my practice and she was a patient, and then she [01:28:55] said, come on holiday, you know. So I just said, yes, she’s my cousin, you know. So he, in the way that they [01:29:00] had embraced the local community nurses took me out to meet all the kids that he’s caring [01:29:05] for, because a lot of these kids have been abandoned by their parents. And this young man, Nursia, who’s one of the few with [01:29:10] a regular income as a kite surf instructor, is looking after now no fewer than 17 [01:29:15] children. Wow. Yeah. So I found myself putting my hand in my pocket when I was out there as well. [01:29:20] And he needed to build a house for a fisherman, a disabled fisherman who had lost it [01:29:25] in a cyclone.

Claire Nightingale: You know, so on my last day of holiday, I went off with him to buy [01:29:30] some cement, and we bought roofing materials for a house that he was building. Anyway, I’m digressing, [01:29:35] but the point is, as a consequence of selling my practice, I ended up going to Mozambique. [01:29:40] I ended up becoming part of this community with this kitesurfing instructor. [01:29:45] And now I find myself in a WhatsApp group with Barry Landsman, Nicola Nursia and some [01:29:50] of the kids trying to support them in learning English. So when I go out to Mozambique. So I [01:29:55] went out to Mozambique, also on the request of Barry, and he’s going out for a for a second trip. [01:30:00] This time I’m going along, and not only will I go out and be taking teeth out in incredibly [01:30:05] remote places, that will involve us taking a boat to go to remote islands to provide care. [01:30:10] But I’ll also be hanging out with the kids and going shopping to buy them school materials and all this sort [01:30:15] of stuff. It’s fine. But of course, you know, if you go on a if you if you’re open [01:30:20] to opportunity, life has some incredible journeys. Right. Yeah.

Payman Langroudi: Of course. So surely [01:30:25] you’ve been in the clinic now that there’s the corporate overlord? Yes. [01:30:30] I should call them. You’re saving time.

Claire Nightingale: Oh, I wish that [01:30:35] were true. I’m not. Actually, there must be.

Payman Langroudi: Stuff that you used to have to do. Payroll that [01:30:40] you don’t have to do.

Claire Nightingale: I don’t have to do payroll. I don’t have to manage annual leave. I don’t have to pay the bills. [01:30:45] Yeah. So. So what was going on?

Payman Langroudi: Have you found yourself now broadening [01:30:50] in other ways because you’re not spending the time worrying about running the practice itself? Running the [01:30:55] practice?

Claire Nightingale: Uh, well, I’m not palpably noticing that [01:31:00] my day is much different, to be honest. Yeah, I mean, in many ways, you know, give a busy person if [01:31:05] you want something done, give it to a busy person. So in some ways, I’m a bit frustrated about the [01:31:10] time it takes to achieve things. You know, so I’ll give you an example. Refurbishment. You know, [01:31:15] I would habitually refurbish the practice when it was necessary over the two week period of time that [01:31:20] were closed over Christmas, you know, and I would quickly, you know, commit to a builder, sort [01:31:25] out the flooring, bang. It would all be done. You know, now we have to go through multiple tiers of sign [01:31:30] off, multiple quotes. Et cetera, et cetera. And because I’m not driving that, it just drags. So those are [01:31:35] the sorts of frustrations that come up. But I seem but I seem to be [01:31:40] busy clinically. Um, I don’t think that I’m finding the time professionally [01:31:45] to to do anything that’s obvious in that time that I’m not [01:31:50] paying the bills. I was just obviously quite efficient.

Payman Langroudi: Dental network? Yes. Has that not come about [01:31:55] because you’ve had sort of some bandwidth to think about.

Claire Nightingale: Um, possibly. So, I mean, [01:32:00] I was involved with it to an extent before. So, yeah. So let’s talk about the women’s Dentist network. So [01:32:05] the Women’s Dentist Network is a group of, of of female [01:32:10] dentists. Clearly. Although I must emphasise at this time that men are very welcome to join us as friends [01:32:15] and people in the Allied dental professionals are welcome to join us as friends. It’s effectively the same benefit. [01:32:20] It’s just we don’t pop them in the main WhatsApp group, that’s all. And it was set [01:32:25] up as a consequence of, you know, the beloved Uchenna having a conversation with Linda [01:32:30] Greenwald before the pandemic, actually probably 2018, 2019, saying, come on, Linda, [01:32:35] it’s time to do something again, because Linda, of course, together with Jennifer Pinder and a few others, [01:32:40] had been instrumental in setting up women in dentistry 40 years ago, 40 years ago. So [01:32:45] it started off a few of us just meeting for afternoon tea in a hotel in [01:32:50] Soho, and we would just sort of just discuss what our purpose might be. And [01:32:55] it’s kind of evolved now into something a bit more formal. So our purpose is to showcase women [01:33:00] as speakers and to be supportive as a group of women dentists [01:33:05] and offer mentoring and tips and advice, and generally just be nice to [01:33:10] one another. You know, it’s a network because so often women are overlooked as speakers at [01:33:15] events, and that’s either because they don’t get asked, or it’s because they feel that they’re not worthy [01:33:20] of the in the invitation and they refuse, you know, which we call imposter syndrome. [01:33:25] So the way.

Payman Langroudi: That they don’t put themselves up.

Claire Nightingale: Or. Yes, I think that’s very, very true. No, [01:33:30] you’re absolutely right. Because we do wait to be asked as, as as a gender. We, [01:33:35] you know, we are not active in putting. In fact, I have to say, I didn’t even know that that was a thing. I [01:33:40] didn’t know that people put themselves forwards. I’ve always waited to be asked. It was only Linda who said, oh, well, actually, [01:33:45] the men just asked to speak. Oh, that was news to me. Um, so we are now [01:33:50] a group of over 100 people. It’s only £100 a year to to join. [01:33:55] And for that we host three virtual conferences on a Sunday [01:34:00] morning. So three hours of CPD. So we’ve covered business. We’ve [01:34:05] covered various clinical matters. We have done menopause because of course that’s our age, some of our [01:34:10] age group. But actually we’re doing one in on January the 19th on fertility. And we have our [01:34:15] second in-person conference at the Belfry Golf and Spa Hotel on Saturday, the [01:34:20] 22nd of March. And I’ve got a fantastic programme lined up, lots [01:34:25] of volunteers from within the group speaking, and hopefully one keynote speaker will be joining [01:34:30] us all to be confirmed, but we’ll be posting information on our various social media [01:34:35] channels about that. And if anybody wants to join us, please, you’re very welcome. Just go to Women [01:34:40] Dentist Network.com and join us through a link on our website.

Payman Langroudi: So you said, [01:34:45] look, the goal is to get more women speaking. Yes, which I understand. That. [01:34:50] Um, I’ve got a question. Have you found something out unexpectedly [01:34:55] by being part of this group that you didn’t know before?

Claire Nightingale: Well, [01:35:00] I’m really impressed by the talent that, you know, that that that shouldn’t be a surprise. But, [01:35:05] you know, we so often go to conferences and we hear the same people talking time after time. And, [01:35:10] and it tends to be academics that tend to get asked. But actually the talent within the group [01:35:15] is phenomenal. And the enthusiasm to be kind to one another is just [01:35:20] wonderful. Also. And you know, when I ask for volunteers to do things [01:35:25] or to speak, actually quite quickly, people come back. So at the conference we have an imposter [01:35:30] slot. We have a deliberate half hour where we invite people to do a ten minute presentation [01:35:35] who have never presented before within a friendly audience, you know, knowing that [01:35:40] they would be well supported and applauded for their efforts.

Payman Langroudi: So is [01:35:45] there an experience that women dentists have been through That’s more common [01:35:50] than you thought. I don’t know. Sexual harassment. Not getting a job. A [01:35:55] patient thinking they’re not up to taking a tooth out. Was there anything that any [01:36:00] insight that you gained from talking to? Lots of talking to lots of people.

Claire Nightingale: I [01:36:05] think those sorts of conversations come out more 1 to 1 in small groups. So, for example, [01:36:10] there was quite a lot of sharing that I won’t talk about, but [01:36:15] at the Women’s Dentist Network, you know, because at the meeting at The Belfry. So the reason we [01:36:20] go to the belfry is that they offer a fantastic package. You know, they offer an incredible day rate for [01:36:25] dinner, bed and breakfast and use of the facilities. So but the but the weekend expanded. [01:36:30] So what what happened was those who committed, someone said, oh, if we go on secret escapes, we can [01:36:35] get the Friday night really cheap, you know? So a number of us then committed to the Friday and then somebody else said, and if [01:36:40] we go on this website, we can get a cheap deal on the spa. So a number of us went to the spa on the Friday [01:36:45] afternoon that gave us Friday dinner to chat. And then on the Sunday morning, I organised [01:36:50] a golf lesson. You know, for some of the women staying over. So within those small groups, confidences [01:36:55] were shared. And I think it is quite interesting to discover what [01:37:00] has gone on in people’s lives, both professionally and personally. That was [01:37:05] surprising, actually, and I’m sure more of that sharing will happen when we get together again.

Payman Langroudi: But [01:37:10] I’m interested in one aspect that I don’t know has been talked about enough or not, [01:37:15] but many women dentists are the primary earners. [01:37:20]

Claire Nightingale: In their.

Payman Langroudi: Relationship. In their relationship. Yeah. And that [01:37:25] puts an extra responsibility that many women don’t have [01:37:30] onto them. And an extra stress, I say, on the relationship, because [01:37:35] my advice to any woman who earns more than her man [01:37:40] is not to bring that up. Yes. Yeah. Yeah, it’s really important [01:37:45] for for a man to hear that. It’s very emasculating. Um, [01:37:50] and at the same time, it’s a fact, right? So why shouldn’t you bring it up? Yeah. [01:37:55] Um, but but not to bring it up as a power play. Yeah. And I think [01:38:00] in my, in my own friend circle, there’s, there’s, there’s examples of, of [01:38:05] it where it’s worked really well, but often it hasn’t worked very well. And I think many [01:38:10] hygienists are primary earners as well. Interesting. And I’d be interested to know [01:38:15] I’d be interested to hear stories of, you know, has it been an issue?

Claire Nightingale: Well, I mean, it’s [01:38:20] interesting. Um, nobody shared at that level. I mean, you know, people have talked [01:38:25] about supporting their husbands doing higher education, you know, so I know a number of women [01:38:30] whose husbands have gone off and done medicine, and the wife who has carried on being the breadwinner [01:38:35] during that period, or somebody has gone off to do an MBA and the wife has carried on. [01:38:40] And but you kind of expect that ultimately there’s going to be a rebalance in the [01:38:45] earning potential of that partner later on.

Payman Langroudi: But recently, there was a post, I don’t know if you saw it, and she said, [01:38:50] I’m an associate earning 17,000 a month, and my partner is [01:38:55] a man earning £1,000 a month. Yeah. And it’s all good. [01:39:00] And I was aware of it, but he doesn’t seem interested in increasing that. [01:39:05] And that lack of ambition was something around that. Yes. Okay.

Claire Nightingale: Well I that [01:39:10] sounds to me like the woman has an issue, not the man, if you see what I mean. You know, it’s for her to reconcile it. Really? [01:39:15] I mean.

Payman Langroudi: The other interesting question I’m interested in is women in dentistry get [01:39:20] a bad deal, but for me, not necessarily the dentist. [01:39:25]

Claire Nightingale: In what regard do you mean? And in [01:39:30] what way do you think the deal is bad?

Payman Langroudi: If you if you read, if you go on their on their on their [01:39:35] groups, sometimes they get some really awful treatment by their bosses. [01:39:40]

Claire Nightingale: Okay.

Payman Langroudi: The career prospects are limited in terms of progression [01:39:45] and that cohort, you know it. And you said, you know, [01:39:50] DBS are welcomed as friends or whatever it was. And you’re right. Look, [01:39:55] the women putting themselves up as speakers is an absolute issue that needs addressing. But I think this issue [01:40:00] also needs addressing. If only some of the hygienist stories I’ve heard, some of the nurse stories, I’ve heard terrible [01:40:05] stories.

Claire Nightingale: Okay, well, I’m sorry to hear that, obviously, but I think there are a few points [01:40:10] that I would make in response. I mean, I think that throughout dentistry, throughout the history of dentistry, [01:40:15] men have been treated badly as associates in circumstances. I have been treated [01:40:20] badly as an associate. You know, bad behaviour is rife, [01:40:25] if you like, throughout the profession and always has been in certain circumstances. [01:40:30]

Payman Langroudi: Overwhelmingly female if.

Claire Nightingale: You count.

Payman Langroudi: Everyone.

Claire Nightingale: Right. It is. And well, I think the other two things I’d say [01:40:35] is that if we go back, you know, DC are now paid considerably [01:40:40] more than they were paid 30 years ago. You know, before regulation, before, [01:40:45] you know, dentists, dental nurses had to be regulated, you know, and registered. I [01:40:50] mean, registrants, of course, is what I’m trying to say. You know, like, you know, 40 years ago, [01:40:55] it was very common that a woman would start working in dental practice, having had her kids, [01:41:00] you know, and it was an easy way to get back into work. And they were unbelievably valuable contributor [01:41:05] to the workforce. I mean, the days where a woman could come back, learn how to mix some [01:41:10] cement and hold an aspirator and cover reception and take a telephone message as well, meant [01:41:15] that the workforce was phenomenally versatile. And I miss those days, to be frank. [01:41:20] You know, the registration has really limited flexibility within the workforce, [01:41:25] but they also used to get paid a pittance, you know, and there were no pensions, you [01:41:30] know, so clearly there have been some massively important changes. But we now know that dental nurses [01:41:35] are extremely valuable, you know, and can command really quite a high hourly rate. [01:41:40] And if you look how much an orthodontic therapist is paid. So I don’t I don’t agree that [01:41:45] women are being underpaid in dentistry. And I would also [01:41:50] say that there is and I see this in the various WhatsApp groups that I belong to, that there is a tendency [01:41:55] for those who feel most hard done by to be the ones that are speaking out. You know, nobody, [01:42:00] you know, rare. Well, I mean, those who are in a good place don’t tend to shout about [01:42:05] it. True. And might be boasting if they are, you know. So so I think we just have to keep [01:42:10] take a, you know, look at it with a sense of perspective.

Payman Langroudi: Let’s get to the darker part. [01:42:15] Yeah. We like to talk about errors.

Claire Nightingale: Clinical errors. Yeah. Okay.

Payman Langroudi: So that we can learn from each [01:42:20] other’s clinical errors comes to mind.

Claire Nightingale: Well, the worst [01:42:25] thing I have done as an orthodontist is failed to. Okay. [01:42:30] So an impacted canine. Okay. And in a In a young person, [01:42:35] young man who was crowding crowded. He had a two for contact. [01:42:40] So in one quadrant, upper left quadrant he had a two and an upper lateral was and an [01:42:45] upper first premolar were in contact. And he had a difficult canine and he was crowded [01:42:50] everywhere else. So the treatment plan was take out three premolars in and [01:42:55] align the impacted tooth, but leave the premolar in situ [01:43:00] until I was confident that the canine was shifting. Okay, so you’d think that was all totally sensible. [01:43:05] Anyway, so I made I observed how his treatment was progressing by how quickly [01:43:10] the gold chain was lengthening. I was counting the links of gold chain as they came out from the mucosa. [01:43:15] I hope I took a check X-ray, but I can’t be 100% [01:43:20] certain from memory that I did. Anyway, I got to the point where I was confident to prescribe the [01:43:25] loss of the first premolar. So off he went and had the tooth extracted. And [01:43:30] then we discovered a few months down the line that the canine was enclosed. And [01:43:35] so why was the change? Well, this is the retrospect, you know, with [01:43:40] hindsight. So I went back and looked at the radiographs. And what I saw was that when the surgeon [01:43:45] had done the exposure, she hadn’t pulled the gold chain out under tension. [01:43:50] And what what had happened was that the gold chain was actually coiled up underneath the flap, and I [01:43:55] was just pulling out the gold chain, and I wasn’t putting any tension on the tooth at all. And that [01:44:00] was a bad, a bad, bad call on my behalf, you know, because, um, [01:44:05] he ended up with an implant, you know, so that’s how that one played out.

Payman Langroudi: We’re [01:44:10] lucky to be small. The most difficult sort of patient parent nightmare. There [01:44:15] must have been.

Claire Nightingale: One of those. Yeah. Okay, so I think the best thing I can do is share a few stories. [01:44:20] Okay. So, uh, recently I had a child [01:44:25] who was who had come in from to have Invisalign fitted. So child at boarding [01:44:30] school. Very difficult, you know, to find the time in the diary to come. Came in to have her Invisalign [01:44:35] fitted. And when we opened the box, the Invisalign had been manufactured to completely the wrong scan. [01:44:40] It wasn’t her. It wasn’t her aligners. Right? So we said, oh, look, really terribly sorry. [01:44:45] You know, manufacturing issue. Clearly not your aligners. You know, mum’s put out. I [01:44:50] said, look, if you like, I can quickly put fixed braces on. No, that wasn’t the plan. We weren’t like, okay, terribly [01:44:55] sorry. You know, sent off a fresh, raised it as an error with Invisalign, set them to [01:45:00] come back for a second time. They come back second time. Guess what? We open the box. Same bloody thing. Same thing. [01:45:05]

Payman Langroudi: How often does that happen?

Claire Nightingale: Never. Oh, well. One. Only one. Only, you know and you know. [01:45:10] And so of course, what you know. And I was absolutely mortified, you know, what can you say? A complete [01:45:15] mess up in every regard on their, you know, on Aline’s behalf, on our [01:45:20] behalf.

Payman Langroudi: It falls on you, doesn’t it? Well, you know.

Claire Nightingale: You know, so what happens? You know, you get a delivery [01:45:25] and the staff tick, you know, so and so’s aligners have arrived, but nobody opens the box [01:45:30] to check that the aligners matched the scan. Because you know what? It never happens. It’s a never event. [01:45:35] Apart from it did happen. Okay, it happened twice to this to [01:45:40] to a boarding school family. And I just looked at the mum and I said, look, I don’t know [01:45:45] what to say. I am so sorry. You know, this shouldn’t have happened. [01:45:50] I should take taken personal responsibility myself to check the aligners, you know. [01:45:55] So how did I manage it? You know, you fess up, you know, my, you know, our [01:46:00] error. You know how. I’m very sorry. You know, let me reduce your [01:46:05] fee, you know, not 10% off the overall cost of treatment as a gesture of apology. [01:46:10] How are we going to make sure it’s better next time? Well, I will take personal responsibility to [01:46:15] check that when that lab work comes back, it’s the appropriate one for your daughter. Okay, so what happens [01:46:20] next? She recommends us to her whole family, you know, so.

Payman Langroudi: The way wrong, [01:46:25] then did it. I mean, I’m talking about something that something that went wrong. Well, I.

Claire Nightingale: Mean, all I’m saying is I’m talking about how do you manage adverse situations, [01:46:30] and it has nothing.

Payman Langroudi: To do with your relationship with the patient was excellent there. It [01:46:35] wasn’t.

Claire Nightingale: On the second time they came and they said.

Payman Langroudi: Well, maybe, maybe if that person said, no, [01:46:40] I don’t want to go ahead and left, that would be a good story.

Claire Nightingale: Yes.

Payman Langroudi: Okay.

Claire Nightingale: All right. Okay. [01:46:45] So I’ll tell you another story. So this one will float your boat. Uh, so I [01:46:50] had a kid who was a transfer case from America, and they [01:46:55] had a palatal expander. Right. And I said, oh, well, you know, it looks like it’s done [01:47:00] the job. I mean, I’ll show you another story. Well, anyway, it looks like it’s done the job, so I’ll [01:47:05] tell you what. Why don’t I take it off for you and you can be really comfortable, so. Yeah. Yeah, yeah. So [01:47:10] kid does that. Now, the slight twist to this story is my own daughter was on work experience [01:47:15] at the time, and she was sitting on the reception desk with my receptionist, and all I could hear [01:47:20] was gales of laughter coming from reception. Right. All seemed all very [01:47:25] everything at that moment in time was very jolly and happy. Anyway, I put some band removing pliers [01:47:30] onto this TPA, not realising that unlike in the UK, everything [01:47:35] is soldered, you see. So you know, you pop off one side, it remains intact, you pop off the other, [01:47:40] out it comes. On this occasion, the orthodontist had used palatal sheaths and [01:47:45] the the expander was inserted into a sheath. So when I took off the band, it wasn’t attached [01:47:50] to the expander and the patient promptly swallowed it. Oh, yeah. So there [01:47:55] I am, sort of thinking, oh, God, you know, let’s hope it’s I mean, it wouldn’t be inhaled, but how [01:48:00] do how am I going to tell the mum that her child has just swallowed half of his orthodontic appliance? [01:48:05] I’m sort of like in the meantime, hearing my daughter regaling the practice [01:48:10] manager with this completely inappropriate stories about toilet malfunction on a coach [01:48:15] in New York on her scout trip.

Claire Nightingale: And I’m thinking, I need some help here. Please stop all this hilarity. [01:48:20] Anyway, so of course, I have to say to the to the mum, look, you know, I think I’ve just dropped half [01:48:25] of the appliance down your child’s throat and I’m now going to have to write a referral letter to [01:48:30] A&E at Chelsea and Westminster, and you’re going to have to go off and be x rayed. You know, so off they [01:48:35] go. Um, yes. And I phoned them up the following day to find out how it had went. And mum says, [01:48:40] oh, it was quite funny actually. And I thought phew, I’ve turned this one around. [01:48:45] And what she was referring to was that her humour at seeing her child’s orthodontic appliance in her child’s [01:48:50] stomach on the x ray. Wow. So, you know, so you know, they didn’t I mean, [01:48:55] they’ve been lost to follow up. So they haven’t come back. But you know, is that the kind of, you know, is that a disaster? [01:49:00] It you know, it’s it’s one.

Payman Langroudi: You’re still looking.

Claire Nightingale: For, right? Payman. Let [01:49:05] me think of another one.

Payman Langroudi: That’s just, you know, I dropped something. I, you know, there’s plenty of those [01:49:10] I’m talking about where the confidence of the patient or the or the parent. And the reason why I’m asking is [01:49:15] because there’s a parent patient, you know, that that sort of triangle situation. There [01:49:20] must have been a worse situation than those two.

Claire Nightingale: Well, I’ll just keep talking and then I’ll share. I’ll [01:49:25] share. Let me tell you the other things. So, um. Okay, another, uh, [01:49:30] I mean, you know, I had, um, another difficult moment, [01:49:35] a young man who had been in braces for a long time and, um, uh, [01:49:40] decided not to complete his treatment. I took him out of my orthodontic therapist, was actually de-bonding [01:49:45] him again. We had a young work experience student watching in the surgery. Anyway, I get [01:49:50] the call to go in because this young man had dislocated his mandible while she was [01:49:55] taking off his brace. Now, I’ve never had I’ve never seen a dislocated mandible. Right. So [01:50:00] I walk into this room, and the patient himself had actually apparently had a history of [01:50:05] dislocating his mandible. So I wasn’t particularly alarmed because this had happened before, and, [01:50:10] um, but couldn’t talk to me. I didn’t know, you know, you can’t talk, you know? [01:50:15] So I’ve got this orthodontic therapist in a bit of a flap. I’ve got a young work experience [01:50:20] student, a dog and a man and a patient whose mouth is propped open. And [01:50:25] and it was probably a Friday. You know, it was probably a Friday afternoon. And it’s my peak [01:50:30] time.

Payman Langroudi: Did you have a go at repositioning? Well, I.

Claire Nightingale: Went and phoned a friend. Right. So fortunately my [01:50:35] surgeon picked up the phone and I was like, what do I do? And he said, right, [01:50:40] what you do, you know, put your thumbs on the external oblique ridge, get the patient to cough. And when he coughs, you [01:50:45] push down and back. Okay. So I go back do that. Coughs down and back. And there [01:50:50] was this gratifying pop and the condyles re-seated in the appropriate place and the pay [01:50:55] and we all high fived. You know, this is great, you know. Anyway, a week later, this young man came back [01:51:00] a complete wreck and clearly hadn’t slept because I said, right, we won’t take off your [01:51:05] top brace. You know you’ll do that next week. Came back, was in great distress, [01:51:10] clearly hadn’t slept and had developed extreme pain. Oh, I tell you before he’d left, what [01:51:15] I’d said was I’ll just put on a little bit of bit of power chain. You’ve got like a millimetre of space. So I’ll [01:51:20] just close down this little bit of space. Come back next week, we’ll take your top brace off. Anyway. Came back, wouldn’t let me touch [01:51:25] him. Um, the relationship had completely flipped. Um, and [01:51:30] he left. And then a few weeks later, I got the solicitor’s letter. [01:51:35] Right. This is a meaty story for your pain. This is what you want to hear, isn’t it? Right. Okay. Right. [01:51:40] So I got this solicitor’s letter saying that I had caused this man acute [01:51:45] pain, and he was now taking legal action, so I kind of was slightly puzzled. [01:51:50] Um, and, um, anyway, and this, this went on [01:51:55] for years, actually, you know, because it all goes quiet and I was and I didn’t actually know [01:52:00] what I was potentially being sued for, you see.

Claire Nightingale: And after three [01:52:05] years, I get the letter from my solicitor saying that they had been unable [01:52:10] to find any clinical expert witness to support their case. [01:52:15] So would I be inclined to give them another six months to go hunting? So naturally, [01:52:20] because apparently that’s what you can do. You know, you’ve got three years to bring a case, and then you can ask for an extension [01:52:25] of six months if the person you’re suing, if the person you’re suing is an agreement. So [01:52:30] like, well, that was the quickest decision I’ve ever made, I can tell you. Let me really think [01:52:35] about that one. Long and hard. No, but this was the only point [01:52:40] that I was told what I was actually being sued for. And amazingly, I was being sued [01:52:45] for the careless application of power chain. Okay, now this absolutely [01:52:50] made me laugh out loud for the simple reason that I did my whole thesis on the application of power [01:52:55] chain and the forced decay of power chain. So I replied to my solicitor. I said, oh, [01:53:00] interesting that I’m being sued on the application of power chain, because can I refer you to the five [01:53:05] publications I have on the four stroke of power chain? You know, do you think [01:53:10] it was malicious intent? No. I mean, there were deeper things going on with that [01:53:15] case, which I won’t go into. So it wasn’t malicious. It was, you know, it was just [01:53:20] one of those.

Payman Langroudi: And what can we learn from.

Claire Nightingale: Patient [01:53:25] selection. I’ll use an analogy which, um, [01:53:30] so my my oldest son, his first love when [01:53:35] he was 17, and his, his and the girlfriend’s mother never [01:53:40] allowed her daughter to be unchaperoned. Right. And never wanted my son to [01:53:45] be there in their house with her, without the mom being around anyway. My son was naughty. They were naughty. They. [01:53:50] They hung out together one morning and stupidly posted a photograph [01:53:55] on social media. And there was some phenomenon called maintaining your streaks. Do you know what that means? I don’t [01:54:00] know, I think it was about posting every.

Payman Langroudi: Day or every day having to. Yeah.

Claire Nightingale: Yeah, yeah. So? So [01:54:05] the girl was found out because her mum looked at her phone and found the photo and, you know, [01:54:10] and all hell kicked off and and I was walking to school with my youngest [01:54:15] son, who at the time must have been about ten years old, and I was sharing [01:54:20] this story with him, you know, and my message was really about respect. You know, I wanted my young [01:54:25] son to recognise that people have you have to respect people’s rules and, [01:54:30] you know, and you pay respect to people and observe their requests. So I said to [01:54:35] Harvey, so what do you think the learning outcome of this story is, Harvey? Meaning [01:54:40] I’ll respect the rules, ma’am. And he said, don’t date a girl with a psycho mom.

Payman Langroudi: So [01:54:45] true.

Claire Nightingale: So we come back to case selection by [01:54:50] that analogy.

Payman Langroudi: Tell me about comedy.

Claire Nightingale: Yes. Okay. So this kind of [01:54:55] moves on to the next stage. Looking ahead, you know, what am I doing? So, you [01:55:00] know, I’m three years into my earnout. So I’ve got two years before I am freed of obligation. That [01:55:05] doesn’t mean I’m going to stop working, of course, but I would like to do less clinical work, So I [01:55:10] got to the start of this academic term, September time. And I thought, well, what am I going to do? [01:55:15] So I did two courses. So the first I did a course, the Bond Solon course in expert witness [01:55:20] work so I can start to build a Dental legal career. And the second was stand up comedy. [01:55:25] And did that come from where did it come from? Well, I am someone that’s always enjoyed performance. [01:55:30] You know, I’ve always it’s been difficult in the sense that I’ve worked [01:55:35] so hard professionally that I haven’t committed to any form of amateur operatics or anything like [01:55:40] that for decades. But when I was at university, I was very involved with the Gilbert and Sullivan Society, [01:55:45] and I used to play in various swing bands, that sort of thing. And I went to a stand [01:55:50] up gig at the Museum of Comedy, and I happened to notice a sign on the wall that said Comedy [01:55:55] Course This Way, and I clocked it for future use. And and in [01:56:00] the summer I signed up to do the course. So it was so much fun. So between September and [01:56:05] November, I did a ten week course three hours a night on a Monday at the Museum of Comedy, [01:56:10] run by a stand up comic called Logan Murray.

Claire Nightingale: And there were about 15 of us that started on the course, [01:56:15] 12 completed. And the first five weeks we just did improvisation games, [01:56:20] which was great fun. So I would be asked, I’d be given a microphone [01:56:25] and told to stand up in front of the group and discuss whether doors or windows were better, you know? [01:56:30] And the obvious answer is, well, it depends whether you’re a cat or a burglar, you know? So we larked about [01:56:35] for five weeks, and then we started doing five minute sets. And [01:56:40] I decided I would just try a different set every week and see where the laughs landed. [01:56:45] And after about three weeks, we were told we had our homework was to go and start gigging. Wow. [01:56:50] So there’s a pub up in Highgate called The Boogaloo. So a number of us started [01:56:55] a few sets up there of a Thursday night. So again, you know, the laugh was [01:57:00] so and in order to do a set at this particular venue requires you to [01:57:05] you to bring a paying guest. Right. So you can’t stand up and perform if you don’t have a [01:57:10] guest in the audience. So bless him. My oldest son agreed. My husband was [01:57:15] busy, so my oldest son agreed to come along. But so funnily did Nicola and Barry. [01:57:20] So there’s another twist in the tale of my practice that my. At my first ever stand up gig, [01:57:25] there was Barry supporting me in the audience, and he did laugh and say, Clare, please remember [01:57:30] that the sale agreement only required me to come once anyway. So [01:57:35] yes, so I did like.

Payman Langroudi: Is it very scary?

Claire Nightingale: Um, well, I suppose because I am clearly a bit [01:57:40] of a show off, and I am so used to lecturing and [01:57:45] performing that it was an extension of that. Anyway, you know, and my comedy [01:57:50] is talking about my life. I’m just looking at the humour in my life [01:57:55] and exaggerating it. You know, it’s.

Payman Langroudi: Not Invisalign humour like.

Claire Nightingale: Invisalign, [01:58:00] Invisalign humour, what would be? So tell me a knock knock joke about a clear aligner. Yeah, [01:58:05] no, I have a anyway, so. And of course, when you start off doing something for the first time, you [01:58:10] start to understand the ropes. So just to enlighten you, enlighten. Um, [01:58:15] the industry standard is five minutes. So when you’re starting out in comedy, you do a five minute [01:58:20] set and no more, you know, and that’s really difficult to time it because [01:58:25] when you’re listening, five minutes is an eternity. But when you’re performing, five minutes goes by in a flash. [01:58:30] So I now have and so I mean, so I did my first [01:58:35] comedy set, um, at the Boogaloo. And then a week later I went back and did [01:58:40] a second set. And what was interesting for me is that the audience demographic was totally [01:58:45] different between the first two occasions. So the first occasion it was me, my comedy [01:58:50] group, who were, you know, largely late 40s 50s, um, [01:58:55] and the second week it was all young people in their 20s. And of course, my life experience, [01:59:00] I’m talking from being a being a middle class, middle aged white woman about my life experiences. So [01:59:05] my sets are about childbirth, they’re about dentistry. They’re about going on Mark Warner [01:59:10] Holidays and I opened the set saying, well, not opened it. But at one point [01:59:15] I said, I’ve just come back from a mark Warner holiday. And everybody looked totally blank. I didn’t know what it was. And I [01:59:20] and I sort of managed to sort of carry it through. But I realised that if you if you’re [01:59:25] wanting to be successful in comedy, you’ve got to be really fleet of foot. And you look at your audience and you think, well, [01:59:30] if I’ve got a choice of six sets to pull out of the bag, which one is going to suit [01:59:35] this 20 year old demographic and which is going to suit this 70 year old demographic, depending [01:59:40] on where you’re at?

Payman Langroudi: I mean, you say it’s similar to lecturing, but, you know, you don’t bomb [01:59:45] in the same way when you’re lecturing, even if people don’t like your lecture.

Claire Nightingale: Well, [01:59:50] I mean, you know.

Payman Langroudi: People sort of sort of sit on their hands, but if people aren’t laughing. Yeah. [01:59:55] I mean, how does that feel when you tell a joke and people don’t laugh?

Claire Nightingale: I’m yet to bomb. But, you know, [02:00:00] I’m sounding like I’m an expert. Can I just put it into the context? I’ve done three gigs, you [02:00:05] know, I’ve done two at the Boogaloo and the end of term. End, of course show. [02:00:10] Now, fortunately, in the in the boogaloo, everybody, the. [02:00:15]

Payman Langroudi: Friendly audience, it’s.

Claire Nightingale: A friendly audience. You know, everybody was either a gigging themselves or they were [02:00:20] a bring e there to support. So it was two friendly audiences at the the end of [02:00:25] course show, we performed on the stage at the Museum of Comedy, which is a crypt in a church [02:00:30] off the Tottenham Court Road. And of course, the whole audience were family and friends. So [02:00:35] I’ve yet to have that utterly humiliating.

Payman Langroudi: In an audience where the guy was bombing. [02:00:40] Yeah, it was awful just being in the audience, let alone being on stage [02:00:45] being bombed.

Claire Nightingale: I mean.

Payman Langroudi: Who’s your favourite comedian, by the way?

Claire Nightingale: Oh, well, it has to be Michael McIntyre, doesn’t it? [02:00:50] You know. Well, I mean, you know, I don’t watch a huge amount of comedy in truth, because I’m just very busy in the way I don’t [02:00:55] really read social media posts either. I’m just busy doing my own thing. But I love the Michael [02:01:00] McIntyre sketch about having his failed extraction on the Finchley Road. He must be [02:01:05] familiar with that one. It’s it’s a joy. Um, so, you know, so the question is, [02:01:10] you know, is the you know, I’ve done this to enhance my life when I have more time. And [02:01:15] the thing that’s holding me back at the moment is I have no time. You know, I’m still running at top pace [02:01:20] professionally. Um, but today, in fact, just before I came here, I have booked the [02:01:25] Fiddler’s Elbow for the 9th of March. Uh, no. 12th of March for us to redo [02:01:30] our end of term end of course gig, because we forgot to get it professionally. Professionally [02:01:35] videoed. You know, there we were. We were all doing the culmination of a ten week course, and we forgot [02:01:40] to capture our finest moment. So tell us a joke. I can’t tell you a joke for the simple reason. [02:01:45] If I start doing comedy, you’ve got to warm up. You’ve got to be the compere. You’ve got to warm [02:01:50] up the listeners. And then I’ll tell you my the best ever joke. But it is very dark [02:01:55] and not appropriate for a Dental Leaders podcast.

Payman Langroudi: Definitely this podcast does get dark. [02:02:00]

Claire Nightingale: Yeah, yeah, you probably don’t want to hear about paedophile English tutors. Okay, [02:02:05] but there is comedy even there.

Payman Langroudi: Yeah, it’s been a massive, massive pleasure talking [02:02:10] to you. Let’s get to the final question. Fantasy dinner party.

Claire Nightingale: Okay.

Payman Langroudi: Fantasy [02:02:15] dinner party.

Claire Nightingale: Now, interestingly, I was discussing this with my daughter on Saturday as I was driving a [02:02:20] picking up from university, and we both chose the same first guest, Ella Fitzgerald. Oh, [02:02:25] lovely. Yeah. And not only would I eat with her, but I’d ask if I could sing with [02:02:30] her too.

Payman Langroudi: Are you a singer?

Claire Nightingale: That’s something I’m bad at. Yeah, [02:02:35] I’d like to be. Yeah. Okay, so, Ella Fitzgerald, inevitably, I have to go for Mrs. Pankhurst. [02:02:40] Oh, lovely. And then the third interesting story. Somebody [02:02:45] called James Miranda. Barry. Yeah. Now, James. Miranda. Barry. I [02:02:50] discovered this person when I was looking at. I was in the old operating theatre, which is near Guy’s Hospital. [02:02:55] Really interesting place to visit. And I just stumbled across a photograph on a wall and then read about [02:03:00] this person. So James Miranda Barry was a military surgeon, so born [02:03:05] in 1795, died in 1865. And she he [02:03:10] performed the first recorded caesarean section in which both the mother and the child survived. [02:03:15] Okay. It went off to medical school at 14 up in Edinburgh, learnt [02:03:20] in Latin, had a stand up row with Florence Nightingale during the Crimean War. [02:03:25] Very very interesting person. Lived a very interesting life. But when the body was laid [02:03:30] out for burial turned out to be a woman.

Payman Langroudi: Whoa!

Claire Nightingale: Yeah. Lived a life as a man to [02:03:35] fulfil professional objectives. Wow. Yeah. So [02:03:40] fascinating. Fascinating story. That one. Next question.

Payman Langroudi: Yeah. Good choices. Good [02:03:45] choices. Our final question. It’s a deathbed. Yes. We’ve kind [02:03:50] of alluded to some of them, but let’s see what you got. Deathbed. Deathbed. Pieces of advice [02:03:55] for your friends and family? Loved ones. Right? For the world.

Claire Nightingale: Okay, so I’m not obviously [02:04:00] waiting till my deathbed to give the advice, right? So, um, you know, based [02:04:05] on. So based on my personal experience. So stress is pathological. [02:04:10] So get out of stressful situations early. So one thing I’ve been bad [02:04:15] at is not cutting loose. You know, just recognising [02:04:20] that I was going down a dead.

Payman Langroudi: End with your other thing about resilience, though, you know, it’s problematic because, [02:04:25] you know, on one side, you want to be resilient. Yeah. So that takes a little bit of stress.

Claire Nightingale: So [02:04:30] resilience led me to grave’s disease. What a fabulous reward. Yeah. So cut your losses [02:04:35] early. You know, if it’s quite obviously things are not going to work out. Just get out of the situation [02:04:40] and respect your health. You know, respect that your mental wellbeing, your physical wellbeing [02:04:45] trumps everything else. You know, get out of it. There’s always going to be another alternative. But I mean another [02:04:50] opportunity. But you can’t often see the wood for the trees, can you? So that would be one thing. Um, [02:04:55] I have talked about, um, planning your family around [02:05:00] the age you want to be when you have your last child? Yeah. Hugely important, actually. And the other [02:05:05] one, I would say speak up. Speak up. You know, I have spent my life speaking up. [02:05:10] Um, and I would like to tell you a story, and it comes. So, I [02:05:15] mean, when I was at orthodontic, um, on my orthodontic course, Jonathan Sandy, who was our course [02:05:20] leader, dubbed me the Jemmy Knapp of the orthodontic course because Jemmy Knapp at the time [02:05:25] was quite an aggressive trade union leader, you know, in the 1990s. So that’s what he called [02:05:30] me. Um, but recently I spoke up at [02:05:35] the Invisalign Summit in 2023. And the reason why there [02:05:40] were two, there was the reason why I was a bit, um, enraged was because about two weeks [02:05:45] before Invisalign had invited me to a women’s and dentist networking [02:05:50] event where we’re all women around the table, and they were talking.

Claire Nightingale: It was led by a woman, and the idea was, how can [02:05:55] they support and nurture and mentor women, blah, blah, blah. And we all had this lovely touchy feely evening. [02:06:00] And then two weeks later, I went to the Invisalign summit [02:06:05] to discover that of 12 speakers, ten of them were men. And the two women that were [02:06:10] speaking were dental nurses talking about being treatment coordinators. Right. So, [02:06:15] you know, I thought, how does this marry up? You’ve just hosted this occasion of 15 [02:06:20] female dentists and not a single. Anyway, so I thought, right. And [02:06:25] the laugh was, is that at this meeting we’d been talking about how do we get more women speaking at [02:06:30] events? And I said, well, we have to call it out. You know, whenever there is an event where [02:06:35] less than a third of the speakers are women, we have to call it out little, [02:06:40] knowing that the first event I was going to call it out at was their own. Right. So [02:06:45] you called it out?

Payman Langroudi: Yeah.

Claire Nightingale: So what happened? Yeah, I did. So I was in a room. Let’s [02:06:50] say there were 400 people there, and I thought, okay, so I’ve said, I’m going to call it out. I’ve told them that [02:06:55] I’m going to do it, but when am I going to do it? Because I thought, I don’t want to do it at the beginning of the day, because I [02:07:00] don’t want to take the dampen the mood of the day. But if I leave it too late, everybody [02:07:05] was going out to get their hair done for the party, you see. So anyway, I was gifted this wonderful [02:07:10] moment where they were wrapping up with a panel discussion. So picture ten [02:07:15] men on stage and one man leading the discussion, and he turned [02:07:20] to the panel and said, where would you like a line technology to go in the next 12 months? So [02:07:25] I thought, this is the moment. So I leapt to my feet because I’m so short I [02:07:30] had to stand up and be visible. Pardon? I was a participant. You were a participant, a participant. [02:07:35] So I was their worst nightmare. So yeah, I leapt to my feet, sort of shouting David! David! [02:07:40] Because it was the wonderful David Rajkovic was the chair. Yeah, I know where I would [02:07:45] like a line technology to go in the next 12 months. So at that moment, a micra, a young woman came up to me and thrust [02:07:50] a microphone into my hand. So I said, right, I would like first of all, I would like you to reduce your packaging [02:07:55] because we can’t and also talk about recycling.

Claire Nightingale: I want you to become more environmentally sustainable [02:08:00] because we can’t talk about the best care of teenagers and at the same time simultaneously trash [02:08:05] their world. Right. So there’s a round of applause. Okay. And then I said, and then [02:08:10] secondly, you know, whilst I don’t want to discredit [02:08:15] the gentleman who’ve been speaking, many of whom have been speaking their second language, and it’s been hugely impressive. [02:08:20] Nevertheless, I sincerely hope that this is the last event, Invisalign summit [02:08:25] I ever come to, where there isn’t a single female orthodontist or a single female executive from a line. Technology [02:08:30] speaking. And at this point, the room erupted into cheers, you see. So there were whoops and cheers [02:08:35] and it had a big impact. Anyway, you know, after the adrenaline had settled, I was kind [02:08:40] of waiting for, you know, in a line to reach out to me. And nothing happened for six months. [02:08:45] And then I bumped into Evren Köksal at the Portman Dentex conference last December, [02:08:50] and he came up to me and said, oh, thank you very much for that feedback. You’ll be really delighted, because this [02:08:55] year I’ve made sure that we have 50 over 50 male and female speakers. [02:09:00] I said, that’s brilliant, Evren, because I was really worried, of course, that you would feel [02:09:05] negatively about me. No, no, no, we’re really welcomed. It really glad you spoke up. Next [02:09:10] thing that happens in the in February this year, I get an invitation from Align Technology [02:09:15] to become their UK specialist on their Emir advisory panel.

Claire Nightingale: So I’ve now been to [02:09:20] two meetings with them, one in Poland and one in Madrid. And at the Madrid meeting [02:09:25] they had all of the senior executive team there, so they had Joe Hagan, Simon [02:09:30] Beard, they had their chief financial person and we had been primed. So I’m now part [02:09:35] of this committee of international orthodontists that meet twice a twice a year, [02:09:40] and they run ideas past us and get feedback. And we’d all been [02:09:45] asked to bring a question, you know, what would we like to ask executive team? And I was told afterwards that the one question [02:09:50] they were certain would come up was sustainability. That was the one they had prepared for. But [02:09:55] actually since then they have reduced their packaging. So I can’t tell you that it’s [02:10:00] cause and effect. But I but I’m delighted, of course, that they’ve now got more discreet [02:10:05] packaging. It’s smaller in volume. It’s made out of recyclable materials. Um, but they’ve [02:10:10] asked me to do something for them, and I didn’t like aspects of the contract, so I flagged [02:10:15] it up to Joe Hagan and said, um, you know, I’m not a lawyer, [02:10:20] but these clauses don’t look very favourable to me. And they’ve sent [02:10:25] me a rewrite of the contract. And I think that all of that is incredible [02:10:30] that I, as a single voice, was [02:10:35] willing to stand up and speak out. And they, a big American [02:10:40] corporate, have been big enough to welcome the feedback, to make some changes and [02:10:45] and welcome me in.

Payman Langroudi: Do you think women don’t speak up? Do you think [02:10:50] it’s a woman thing?

Claire Nightingale: I think it’s a I do think it’s a woman thing, [02:10:55] and I think it’s a shy man thing as well. But people should speak up because [02:11:00] you need to be heard, and you can do so in a way that is positive. You [02:11:05] know, I speak up a lot, but, you know, but when I do, it comes from a place [02:11:10] of wanting to make things better. I’m not trying to be complaining or critical or aggressive. [02:11:15] My stance is, can we do this differently? Can we [02:11:20] make it better? And you know, in my own professional life, negative feedback is [02:11:25] painful, but actually it’s more beneficial if you want to move forwards and make [02:11:30] things better than being told you’re doing great, you know? But of course, um, a [02:11:35] negative feedback delivered in an aggressive way is just a terrible experience. [02:11:40]

Payman Langroudi: Claire Nightingale. It’s been a massive, massive pleasure. Thank you so [02:11:45] much for coming all the way here.

Claire Nightingale: It’s been my pleasure to Payman. Thank you for inviting [02:11:50] me.

[VOICE]: This is Dental Leaders, the [02:11:55] podcast where you get to go one on one with emerging leaders in dentistry. [02:12:00] Your hosts Payman Langroudi [02:12:05] and Prav Solanki.

Prav Solanki: Thanks for listening, guys. If you got [02:12:10] this far, you must have listened to the whole thing. And just a huge thank you both from me and pay [02:12:15] for actually sticking through and listening to what we had to say and what our guests has had to say, because [02:12:20] I’m assuming you got some value out of it.

Payman Langroudi: If you did get some value out of it, think about subscribing. [02:12:25] And if you would share this with a friend who you think might get some value out [02:12:30] of it too. Thank you so so so much for listening.

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

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