Payman Langroudi: One of the most common questions I get is how do I do more teeth whitening? The basis of that is to really [00:00:05] believe in it, and the basis of that is to fully understand it. Join us for enlightened online training on [00:00:10] enlightened Online training.com to understand how to assess a case quickly, how to deliver [00:00:15] brilliant results every time. Next time. Whitening Underwhelms try and lighten. Now let’s get to the [00:00:20] pod.

VOICE: This [00:00:25] is Dental Leaders. The podcast where [00:00:30] you get to go one on one with emerging leaders in dentistry. Your [00:00:35] hosts Payman Langroudi and [00:00:40] Prav Solanki.

Payman Langroudi: It gives me great pleasure to welcome Afzal [00:00:45] Haq onto the podcast. Afzal was an endodontist interesting [00:00:50] road to endodontics. It’s a full on practice owner, ten [00:00:55] years of general practice before deciding to go down that route in South Manchester. Indo [00:01:00] 41 is the name of the Indo branch.

Afzal Haque: Yeah. M41 [00:01:05] Indo.

Payman Langroudi: M41.

Afzal Haque: Is the postcode of where we are. Yeah.

Payman Langroudi: And the practice squad. [00:01:10]

Afzal Haque: What’s the practice is Stretford Road Dental practice. That’s my main practice. But I have a little Indo [00:01:15] branch in there. Call M41 Indo.

Payman Langroudi: And you trained with some of the people I’ve had on the show already.

Afzal Haque: Yeah. So [00:01:20] shout out to uh Amal Hourani. He was in my in my group. So [00:01:25] when we did our specialist training, there was four of us. Um, and he was one, he was one of the four. So I [00:01:30] spent a lot of time with him. Um, Rob Jacobs he was the above me. A good friend of mine lives [00:01:35] locally to me. We, we chat a lot. Um indo and non indo stuff. Um [00:01:40] sanj has he been on your, on your podcast. No, but he’s a good friend of yours isn’t he. Yeah. You know [00:01:45] him well. Yeah. Um he taught me um so a lot of a [00:01:50] lot of the Indo guys, um and then other people as well that I’ve been on kind of, I know quite a few [00:01:55] NASA came on not long ago.

Payman Langroudi: Manchester’s kind of a small place in that sense.

Afzal Haque: Everyone [00:02:00] knows it’s a good place. I’ve been born and bred there, so it’s. I’ve never left it really, apart from just to [00:02:05] go to Liverpool for three years.

Payman Langroudi: Did you not want to leave Manchester for uni?

Afzal Haque: So. So [00:02:10] going back to very, very beginning I was okay. Student average student, [00:02:15] just getting into dentistry was just like everything to me. So I got [00:02:20] an offer from Manchester. It was my first offer given to me not offer interview. [00:02:25] Yeah. Um, and I went along to that and literally the next day I [00:02:30] was given the, the offer. And I think from what I remember, you could only pick one and one, the other one had to [00:02:35] be non dentistry. So as I was applying and the interview started coming, I just cancelled [00:02:40] everything else because my dad said, you know what, you got Manchester, no need for you to go anywhere else. It’s just easier [00:02:45] for us. It’d be easier for you. You’ll thank me for it. Um, and and that was it. So I never [00:02:50] really had a desire to.

Payman Langroudi: To go away. A shadow of regret.

Afzal Haque: I think when I went to Liverpool, [00:02:55] I went as a as a 34 year old and I, [00:03:00] I we’ll come on to it later. But I spent one year there alone and that [00:03:05] was very new to me because I’ve never lived alone.

Payman Langroudi: Did you live at home during university as [00:03:10] well? I did, I lived at home.

Afzal Haque: Well, I only lived two and a half miles down, down from the university. One bus, [00:03:15] 15 minutes and I was there. It made no sense to to live in.

Payman Langroudi: My son [00:03:20] did engineering. Yeah. And the best school for engineering is one of the best is Imperial College. [00:03:25] Yeah, but Royal College is the building next door to his school. Yes. I banned him from even applying.

Afzal Haque: Yeah, [00:03:30] yeah, yeah, yeah. I mean, I’ve got kids now. I mean, what would I advise them, um, if they wanted [00:03:35] to? There’s no problem. But I don’t feel I missed out on university life because [00:03:40] my parents were very trusting, very, you know, modern thinking said, do you know what? As long as you’re back [00:03:45] home for a decent time, do what you want. So my mates lived in halls [00:03:50] and I’d, I’d go to uni and then go and meet them in their halls and spend a lot.

Payman Langroudi: If If you want to come home in an indecent [00:03:55] time.

Afzal Haque: Indecent time, well, I’d have to give him a call before that. I’d have to give him a call just just to warn them where I am. [00:04:00] That happened a few times. And and mothers never sleep. My dad was fast asleep, [00:04:05] but mothers, this.

Payman Langroudi: Was the days before mobile phones were like, yeah, yeah.

Afzal Haque: I think we just got our mobile phone [00:04:10] then. So it would have been what, 2001? Okay, see that one? Yeah. So I had, you know, the typical Nokia [00:04:15] with the big buttons where you step on them to, to, you know, to, to dial, dial the numbers. [00:04:20] Um, but my mum would never sleep. She’d come home, she’d give me a look and she’d just look at me and [00:04:25] she, I think she would just analyse what I looked like at that time of night. And [00:04:30] she said, fine. But yeah, it was, they were very, very good with me. So I never felt like I missed out [00:04:35] on university. Yeah. I didn’t live on my own. I didn’t fend for myself, um, at that time. Um, [00:04:40] but we were brought up to, to do a lot of stuff by ourselves. So even at home, we were kind of doing our own [00:04:45] laundry and just helping out. Mum did help, of course, and dad also helped.

Payman Langroudi: What do your parents do? [00:04:50]

Afzal Haque: So my dad is a retired school teacher. So he came from India, um, [00:04:55] in, in the 70s, a long story, but um, he came over [00:05:00] here, um for medical treatment. So he’s, he’s, he’s the [00:05:05] son of a, of a, of a doctor from India. My grandfather was a surgeon. Um, my [00:05:10] father as a young child, she used to suffer from severe headaches. So my [00:05:15] grandfather used to, used to give him injections. I’m, I’m guessing it was probably morphine at that time. [00:05:20] And he, my dad used to said to me, he goes, your grandfather used to say, oh, either you going to this pain is going to [00:05:25] go or you’re not going to wake up. Because my dad said this. The pain was [00:05:30] that severe. So my grandfather did his postgraduate training in Manchester. [00:05:35] Um, so he did his primary medical degree from India, came over here, his post-grad training, went back [00:05:40] to India. So he knew colleagues in Manchester, my dad’s sister. So my dad’s number [00:05:45] in contact, you know, for context, my dad’s number, seven of eight children.

Payman Langroudi: Whoa.

Afzal Haque: Yeah. Big family, [00:05:50] big Indian family. So his sister, who would have been number four or number five, [00:05:55] was a fair bit older than him. So maybe, maybe ten, 15 years older than him. She [00:06:00] was married to an accountant and had settled in Manchester. So my grandfather knew that [00:06:05] his sister’s there. So he said, well, I’m going to send you over to Manchester and let’s get you fully checked out. So. So that [00:06:10] took years. So my dad came here probably at age 11, enrolled in a school, lived [00:06:15] with his sister and in an area of South Manchester called Worsley. Years [00:06:20] went by and diagnosis came out that everything was fine. I think [00:06:25] the suspicion was he had a brain tumour, but he didn’t. Eventually, as he. As he got older, he grew out of it. But [00:06:30] then he was fully fledged in the local society. He was he was a student. Um, so [00:06:35] my grandfather left him. Um, so he ended up staying here. So during [00:06:40] his, I think 16 or 17 years old, maybe GCSE A levels would have been O-levels [00:06:45] at the time. His sister emigrated to the Middle East with her husband. They got a new job. [00:06:50] So then he became a lodger with one of his class fellows families, an Irish [00:06:55] family.

Afzal Haque: Um, yeah. His friend was called Anthony. And, um, we call him Uncle Anthony today because [00:07:00] he’s actually he’s more my dad’s brother than he is a friend. So they keep him. He’s [00:07:05] moved to Australia now. So my dad lived with them at the time of living with them. He [00:07:10] obviously worked, studied, worked, studied. He didn’t have any family support. So his [00:07:15] dream was to be a doctor. But he lost a few years because of his illness. And then, you know, [00:07:20] um, appointments, this, that and the other. And he, he couldn’t concentrate long for studying [00:07:25] because the headaches would come. So he was very good at biology. And then he said, look, I need to [00:07:30] do something that’s going to be quick. I can get through it. I can get myself a career and move on with it. [00:07:35] So he did. He did zoology as a primary degree and then went on to do a [00:07:40] masters and did a teaching degree and started off as a technician. [00:07:45] A lab technician in a school became a teacher in that same school and 40 years later [00:07:50] retired at that school.

Payman Langroudi: Wow.

Afzal Haque: So that’s how he did it. So he was a he, he was he was self-made. [00:07:55] Pretty much no family support, um, moral support, phone calls, all that kind of [00:08:00] stuff, but not financially. Um, and then in 1979, he went back to [00:08:05] India, married my mother and brought her back over in 81. And I was born 82. [00:08:10]

Payman Langroudi: Did she work?

Afzal Haque: No, my mom didn’t work here. So my mom was, um, a school teacher in India. So [00:08:15] she taught Hindi and she, she was, she had a degree in sociology, so she taught primary school children. So [00:08:20] she was working there. But then, um, after marrying my dad, um, came here housewife [00:08:25] hated it here. Absolutely hated it.

Payman Langroudi: You could imagine. Absolutely.

Afzal Haque: So [00:08:30] my mum um, comes from quite a, a noble background back home. Um, I don’t [00:08:35] know if you’re aware of how the, the Indian um aristocracy, um [00:08:40] kingdoms used to work back in.

Payman Langroudi: The.

Afzal Haque: Maharajahs. Yeah. Uh, Hindus were with Maharajahs [00:08:45] and Muslims were were nawabs. So my mother was a granddaughter [00:08:50] of Nawab. Oh, yeah. So the stories that she tells [00:08:55] us, I can’t imagine that happened. But she was saying that her childhood, they [00:09:00] played with elephants and all that kind of stuff. That was that was the pets that they owned. Um, so she seen quite [00:09:05] a lot. And then she married my father because he, he was, um, family, [00:09:10] friends of her family. He was abroad, he had a good stable job, but she knew [00:09:15] how to do nothing. She didn’t cook, she didn’t clean. And then she came here and realised that I’ve got to [00:09:20] do everything myself. So that was a shock to her. Um, a big cultural shock. So [00:09:25] when I was born, um, she took me back to India. Um, so I was born here in Manchester, but at the age of [00:09:30] about nine months, my father was like, you’re struggling. I’ve got to work. Let’s you go back [00:09:35] home, um, for a year while he’s young and you get all the help. So she went and took me back home. I don’t remember [00:09:40] any of it, but I seen pictures.

Payman Langroudi: You’re the oldest.

Afzal Haque: I’m the eldest. Yeah. Brother and I’ve got one younger brother. [00:09:45]

Payman Langroudi: What does he.

Afzal Haque: Do? He’s a pharmacist. He’s a pharmacist. He actually works for the GDC [00:09:50] equivalent of pharmacy. So he was a clinical pharmacist. He owned his own pharmacy [00:09:55] and did it for years but didn’t quite gel with it. But then he developed his pharmacy [00:10:00] from nothing to a profitable pharmacy and got [00:10:05] very much involved in the admin and the, the politics side of things. And then he got recruited to, [00:10:10] um, be an insulator. Yeah. Regulatory inspector. So very lovely job. Works from home. Um, [00:10:15] managed his own diary, goes a few days a week to do inspections. [00:10:20] He’s back home by two. Great job. So, so that’s what he does. Yeah. So my mum [00:10:25] going back to my mum. So so I went back to India for a while and then [00:10:30] and then then after a year we came back and my dad and my mum just started [00:10:35] a family. My brother was born a couple of years later and that was it. So my dad was the sole owner of the house, [00:10:40] lived in a very humble part of Manchester. And um, it was all about education, [00:10:45] education, education.

Payman Langroudi: It’s interesting. Quite a lot of dentists are children of [00:10:50] teachers.

Afzal Haque: Yeah.

Payman Langroudi: I’ve, you know, I’ve had a few people sit where you’re sitting telling me their parents were teachers. [00:10:55] What’s it like? I mean, being is there like no option [00:11:00] but to study and. Yes. So as a child of a teacher, as an Asian child of a teacher.

Afzal Haque: In my [00:11:05] family, 100%. Um, so, so I’m lucky. I’m very lucky. Fortunate. All my cousins [00:11:10] have done very well in life. They’re either doctors or some sort of medical profession or lawyer. [00:11:15] They’ve got some sort of profession. Um, so my dad’s my dad didn’t make it as a doctor. [00:11:20] He wanted to be a doctor, but through illness, he didn’t. It’s not like he didn’t have the intelligence. He just didn’t have the opportunity. [00:11:25] Um, and time was on on his side. Wasn’t on his side. But my dad lodged when [00:11:30] he was at university. He went to Manchester University and his, two of his best mates were dentists. [00:11:35] And um, he got on with them very, very [00:11:40] well. Um, and to this day he still, still good friends with him. They’ve all got kids similar age as us. So as [00:11:45] young children we used to visit them and.

Payman Langroudi: So you could see what was going on in [00:11:50] their lives.

Afzal Haque: Yeah. And my dad would tell me. So, you know, obviously these, these uncle come uncles [00:11:55] are our dentists, you know, was this something that you’d, you, you know, you might want to be interested [00:12:00] in. So he, they, one of them was a general dentist, one was an orthodontist. And the general dentist was in Manchester. [00:12:05] So we used to go as patients. So he’d do his check-up. And I remember looking at the surgery thinking, [00:12:10] this is cool, you know, you know, that smell that that you have when you when you when you hit a dental [00:12:15] surgery, it hits you straight in the face. Um, I remembered that and I was like, oh, I wonder what [00:12:20] he does. And then his kids were all in private schools. We weren’t, um, they [00:12:25] had nice holidays, you know, they had a nice lifestyle. So I used to ask my dad, I said, dad, what do they do? And he [00:12:30] said dentist. And that’s how I started to get interested in more because [00:12:35] it was Uncle Navin, uh, who was in Manchester. Um. Big respect to him and Uncle [00:12:40] Afzal. I was named after Uncle Obzl. Um, because my dad, um, [00:12:45] really liked him. He was a good man. Um, he’s retired orthodontist about a couple of years ago [00:12:50] now. So then we got familiar with with their families and, um.

Payman Langroudi: Yeah. [00:12:55] Little did you know, that was the Jedi mind trick your dad was playing.

Afzal Haque: Maybe. So I think I [00:13:00] think deep down, he wanted me to be a medic. But then I think he, you know, because he spent a lot of time with these guys, he [00:13:05] was like, these guys were good life.

Payman Langroudi: You could see they were happy.

Afzal Haque: Yeah, they were happy. They were successful. The kids were doing [00:13:10] well. And that’s all you want as a parent, don’t you? You want you know, all fathers, [00:13:15] mothers want them to do better than they’ve done. So that was his.

Payman Langroudi: Traditionally, I just follow the line, [00:13:20] go and say what happened next, what happened next? But I’m interested in the inflection point that took you to [00:13:25] Indo.

Afzal Haque: Oh, right. Yeah, yeah. Here we go.

Payman Langroudi: Let’s go straight there.

Afzal Haque: Let’s go straight there. Right.

Payman Langroudi: So so were you already quite [00:13:30] good at Indo as a general practitioner?

Afzal Haque: As a, as a, um newly qualified dentist. [00:13:35] I hated endo like.

Payman Langroudi: Like all.

Afzal Haque: Of us. Like all of us. No, but seriously hated it.

Payman Langroudi: Had you perforated in college? [00:13:40]

Afzal Haque: I’ve done everything. I’ve done everything.

Payman Langroudi: As a young.

Afzal Haque: Man. As a young man, I hated it. Um. And [00:13:45] when I got married to my wife in 2009, she and her sister, who’s also a dentist, they were doing [00:13:50] their own sort of, they were, um, opening up a practice and they had done and [00:13:55] they were kind of doing their own thing. I was doing.

Payman Langroudi: Qualified in India.

Afzal Haque: No, no no no. Um, my, my [00:14:00] wife, she qualified with me Manchester. She was in my year. Yeah yeah yeah. Sister qualified five years [00:14:05] um ahead of her. So the two of them were setting up a squat practice. So [00:14:10] she had bought all the equipment etc.. So very early on in our marriage, um, I, I just remember [00:14:15] the night before the endo, I just wouldn’t sleep, just wouldn’t, just wouldn’t sleep. And then she’d be like, what [00:14:20] is wrong with you? Why are you panicking? It’s just work. And I was like, I’ve got this endodontic treatment. Um, [00:14:25] I don’t know where to start. I’ve had some problems in the past. And she was like, why [00:14:30] are you so bothered about it? And she’s like, what are you using? And at that time, we weren’t taught rotary instrumentation [00:14:35] at university. Just hand files. I told her I’m using this, and we had this gigantic handpiece that [00:14:40] you put a file in and just does a quarter turn, basically reciprocation at the time. I had no idea [00:14:45] about other stuff. And then she was like, well, I’ve got this new kit, why don’t you use this? And I said, I don’t know about [00:14:50] this. I can’t just take this tomorrow. And she goes, tell you what. Um, I’ll come with [00:14:55] you one day. We’ll do some practice, then I’ll come with you and I’ll watch you do it and I’ll show you how to do. And that’s [00:15:00] how it started. As soon as I started to get used to this rotary stuff, I thought, this is amazing. What is [00:15:05] this? And then one treatment. Next treatment. Next. Start to get better and better. So that’s how [00:15:10] Endo started to get better at it. But then family came and everything came and I thought, right, how can I improve [00:15:15] my skills? So I took on a part time master’s.

Afzal Haque: So it’s 2012. [00:15:20] No start again, 2014. I started my son. Son had been born then. So [00:15:25] did that part time. That was simply a brilliant course. And at that time it was in it [00:15:30] was in South Manchester. So that’s how I started and that’s how I got better. But in 2013, [00:15:35] we got my we we bought our practice. So that was the environment I could start doing. [00:15:40] And so once I started to get know the patients a little bit, you know, we started, I started to do a bit more complex treatment [00:15:45] and started a bit more, you know, being a bit braver. And [00:15:50] that’s how that started initially. But I always were looking for the next stage. And I got [00:15:55] to a point where I said, well, I thought, how do I do this day in, day out? I wasn’t confident enough [00:16:00] at the time to just completely give up general dentistry. I thought that was my safety net and I did enjoy it to [00:16:05] a huge extent, really. But then it was in 2015, so [00:16:10] 2015, there was an endodontic conference in Southampton, and I went there to buy a microscope [00:16:15] because I was like, I’m formalising my education, I’m going to get the right equipment. And I was using Loupes at the time, [00:16:20] which was great, but I wanted to step it up. So we went to Southampton and I was looking for a microscope [00:16:25] and just seeing it like you do, see all the reps, see what the best deal is on the day. But my aim was to come back with a [00:16:30] deal. That was the aim. And I met my very good friend, colleague, [00:16:35] mentor Sanjay.

Payman Langroudi: Sanjay Bhandari for the first time.

Afzal Haque: No, no, I met him. I’ve known him through [00:16:40] the endo circles. He was actually my one of the tutors at undergrad at Manchester. So I [00:16:45] think he was, um, he was, he was relatively new to Manchester at the time and he [00:16:50] was teaching there as well. So I knew him. So he remembered me and he just, we just bumped into each other and said, oh, what [00:16:55] are you, what are you, what are you doing here? And I said, well, I’m interested in endo. I’m doing a little bit of endo. I’m doing the simply [00:17:00] endo course. He said, do you do a lot of it? I said, yeah, I do a fair amount. I said, but I want to get really better. [00:17:05] And he goes, why don’t you why don’t you become a specialist? I’m like, um, [00:17:10] because I’ve got wife, two kids. I live in Manchester and at [00:17:15] the time I only was aware of courses in London. So I live in Manchester. [00:17:20] There’s no way I’m going to, you know, down to London at the time, my brother in law um [00:17:25] is a specialist periodontist. He was doing his specialist training In in [00:17:30] the Eastman. Oh, so he was doing it then. So he was like, I’ve got a flat here. [00:17:35] Just come, come to London. I was like, well, it’s not as simple as that. Um, and recently we just bought [00:17:40] the practice. So 2015 we bought the practice 2013. So I was like, no, this is not [00:17:45] the right thing for me.

Afzal Haque: Then Sam said, um, why don’t you just do it in Liverpool? I’m like, what? Liverpool? [00:17:50] Apart from football, I didn’t know anything else about Liverpool. Um and he said, well they’ve [00:17:55] just started of course 2013. They just started um what we call the doctorate of um [00:18:00] dental science degree in endodontics. And it’s a three year full time specialist training course. He goes, [00:18:05] it’s local to you because I warn you, it’s hard work, but it’s doable because [00:18:10] of where you live. And he said, go and speak to the programme director, um [00:18:15] Prof. Prof. Gerard and just just get [00:18:20] a feel for it. So I came back with a microscope which my wife was absolutely [00:18:25] fuming. She’s like just spent God knows how much money. And this silly idea in her [00:18:30] mind at the time to to do this specialist training. But we thought [00:18:35] about it and then she was like, my wife was my it’s my biggest, biggest support, [00:18:40] biggest fan. And if it weren’t for her, there’s no way this would have happened. So she [00:18:45] was like thinking about this more. And she was like, you’re [00:18:50] good at this. We’ve got our own practice. We’re in our [00:18:55] 30s. Dental career, God willing, can be many, many years. What’s [00:19:00] three years if you can get on to it? And she [00:19:05] said, well, you must try, because I know now. But at [00:19:10] the back of her, she always wanted me to be the best I could be.

Afzal Haque: So she, she had a dream [00:19:15] that, you know, I’ll try and push him as far as he can. If he can make it to specialist level, that would be brilliant. [00:19:20] But she never. She never pushed me. But when this opportunity she got wind of it, she was like, right, okay. Um, [00:19:25] she said, go and meet them. Go to Liverpool, go meet, go meet Faddy. So I made an appointment, [00:19:30] went and saw Faddy and he was lovely. He was very nice. He showed me around [00:19:35] and he just said to me, look, this is really tough. Course it’s going to take over your life. You [00:19:40] cannot work in the in these three years. Um, I know you’ve got a practice. I [00:19:45] know you’ve done postgraduate training. Um, sorry. Um you’ve done postgraduate [00:19:50] master’s already. He goes but it’s very different. Um he goes, have a think about it. [00:19:55] And if you want to do it, my advice would be to make an application. [00:20:00] I was trying to read in between the lines. I was like, okay. And I had no, um, [00:20:05] prior to that, no formal, um, pathway. So I went from straight to [00:20:10] being an associate straight to owner of practice. So did a no show job, no publications, no CV, nothing. [00:20:15] My CV was just practice, practice, practice. I’m thinking I’m the wrong person to do this. Um, anyway, [00:20:20] so I went back and I said.

Payman Langroudi: What was the cost?

Afzal Haque: The cost at the time was about 20 grand a year, 20 [00:20:25] grand.

Payman Langroudi: A year. And the lost income.

Afzal Haque: And the lost income as well.

Payman Langroudi: So just the financial calculation was huge. I mean, [00:20:30] did you have to make changes at home?

Afzal Haque: Yeah. So then when when we came, when I came back and we did all the all the maths, my [00:20:35] wife said to me, she goes, you know what, forget about the money at the moment. Just go and apply. If you get [00:20:40] it, we’ll think about it. If you don’t get it, we’ll draw a line, move on. Nothing lost because I had [00:20:45] no expectation to do it because I’m not the right candidate and well, the right CV. Um, [00:20:50] so when I applied, I got the interview. Interview [00:20:55] went fine. The next day I got an email saying, you’ve [00:21:00] been very successful in the interview. We offer you a place on this course. This is March [00:21:05] 2016. Starting in September. I came, I told Zara, [00:21:10] I told my wife and she was like, well, she goes, well, you’re gonna have to do it, aren’t you? I was like, [00:21:15] what do you mean? I said, Zara, this is not a small amount of money we’ve invested. [00:21:20] We bought a house a few years prior to that. We’ve got a practice. All the money is tied up. [00:21:25] You know, we’ve got kids, we’ve got. How’s this going to happen? I haven’t got 60 grand, [00:21:30] you know, just sat there in my account to go and do this. And she was [00:21:35] like, she looked around and we sat in the house at this time, we sat in the front living room and she looked around and she goes, [00:21:40] this is just bricks and mortar. I was like, what? She [00:21:45] goes, we’re selling the house. I was like, Zara, do you understand what [00:21:50] you’re saying?

Payman Langroudi: Do you have children?

Afzal Haque: Yeah, I had two children. I had a four year old daughter and a two year old boy [00:21:55] at the time.

Payman Langroudi: What a cool chick, man.

Afzal Haque: Yeah, absolutely. She’s legend, absolute legend. So she [00:22:00] said to me, she goes just the way she did it. I remember it vividly. I’ll never forget it. We were sitting in the front room. The kids [00:22:05] were playing around. She goes, this is this is bricks and mortar. She goes, we’ll get rid of this. She goes, what I [00:22:10] don’t want to do is work more to support the house. I’d [00:22:15] rather go into a smaller property. My kids are very young at the moment. I’ll focus on the practice. I’ll do a little bit of work, but focus [00:22:20] on bringing up the kids. You go and do what you need to do. She goes because she [00:22:25] goes, we will. We can buy a house again in the future. She goes. They come [00:22:30] and they go. People upgrade all the time. You know, they move house all the time. She goes, this is setting [00:22:35] us up for the future and getting you to do what you want, [00:22:40] and you’ll be in the happiest place. Because although I like general dentistry, [00:22:45] um, I found it quite challenging, but [00:22:50] it suited me. So what? I couldn’t believe it. And I said, are you serious? So she she [00:22:55] started the process.

Payman Langroudi: She’s a wise person, but very.

Afzal Haque: Wise.

Payman Langroudi: Person. Go into that. Why? Why was [00:23:00] general dentistry challenging? And endo so peaceful. Like what was it? So what is it about endo? [00:23:05]

Afzal Haque: I just find it very relaxing. I find it very relaxing. I find [00:23:10] the fact that you’re treating disease the challenge, and I like that. [00:23:15] Um, I’m not saying the other parts of dentistry aren’t aren’t challenging.

Payman Langroudi: You’re not a salesman?

Afzal Haque: No, [00:23:20] not at all. Not at all. I like treating disease.

Payman Langroudi: That’s the best thing about endo. There’s no selling.

Afzal Haque: There’s no selling. No [00:23:25] selling whatsoever. It’s already sold. Um, and you just got to, when it comes to [00:23:30] me, literally in the most, most respect, I am the end of the line. Either [00:23:35] it’s going to work or it’s not going to work. And the patients really, really trust us. [00:23:40] So I found dentistry. I think dental is much harder than being a specialist. I think being a specialist [00:23:45] is actually very, very easy. My job now is brilliant. Um, general [00:23:50] dentists, you’ve got 15, 20 patients, 30, 40 patients depending on where you work, 40 [00:23:55] different personalities, 40 different problems.

Payman Langroudi: 40 different hellos and goodbyes and.

Afzal Haque: 40 different. [00:24:00]

Payman Langroudi: Solutions that.

Afzal Haque: You got to come up with on the spot. And I think it’s actually my wife do this and I think she’s great. I think [00:24:05] your job is actually harder than mine. It really is. And a lot of my colleagues [00:24:10] and, and people say to me, oh, it’s all right for you now because you only see [00:24:15] three, four patients a day. I said, it’s all right now, but the journey is the problem. It’s the biggest [00:24:20] challenge of the journey. So that’s why I found it challenging. It’s not that I couldn’t do it, and I [00:24:25] do miss aspects of general dentistry. Ten years I did it, I did the NHS, did the uda’s, took [00:24:30] the teeth out, immediate dentures, everything, all the composite stuff. Um, [00:24:35] but I found my niche there. I thought rubber dams on, I can get on with it. It’s nice and relaxing. [00:24:40]

Payman Langroudi: Let’s just get to the but the your in terms of your schedule. Yeah, yeah. How many days a [00:24:45] week are you seeing? Four patients a day.

Afzal Haque: So probably about three days. Yeah.

Payman Langroudi: And the others.

Afzal Haque: The others the one day [00:24:50] a week I work as a senior lecturer at a university in Lancashire. Yeah. Which is.

Payman Langroudi: Formally.

Afzal Haque: Uclan. [00:24:55] Yeah. Yeah. So I teach the they’ve just um started a new specialist [00:25:00] training programme um from, from this last September and it’s a doctorate um indent [00:25:05] where they will go on to become hopefully specialists in endodontics. [00:25:10] So I’m teaching them one day a week.

Payman Langroudi: And did you have anything to do with that syllabus.

Afzal Haque: Oh The [00:25:15] syllabus is all done with a lady called Shalini. She’s lovely. [00:25:20] She qualified at Kings specialist Endodontist. So she invited me to come and join [00:25:25] the team and it’s been brilliant. So I do that one day a week. I love teaching. Teaching is [00:25:30] my.

Payman Langroudi: Nice.

Afzal Haque: Man, I love it. It’s nice the way I think about teaching. My father’s a teacher [00:25:35] and he always said to me, he goes, if you can explain something to somebody, means that you’ve understood [00:25:40] it. Yeah. And and you know what you’re talking about. So that’s how I feel is like, if I can, if my [00:25:45] students can understand where I’m coming from, understand the concepts I’m trying [00:25:50] to, um, show them and, and they implement it, then job [00:25:55] done, job done. And it’s a great, it’s a great day. Um, so yeah, so that’s what I do on a Tuesday, [00:26:00] on a Friday I have, um, it’s officially a day off, but I use it as an [00:26:05] overspill day. So if I need some patients that need to be seen sooner and they can’t wait. [00:26:10] So I try and have a, um, a two week turnaround from referral to seeing [00:26:15] the patient. And if that’s getting busier, which it which it can do, it depends on the season. I’ll throw [00:26:20] in a Friday. Um, I also do a little bit of um. Work [00:26:25] for the CQC as well. So I’m not the inspector but I’m the guy [00:26:30] that goes along with the inspector. So that’s a new role that I took over. Um, and I do that ad [00:26:35] hoc as and when they may need me. So having the odd day here and there.

Payman Langroudi: Tell me about that. Do you [00:26:40] have to get trained to do that?

Afzal Haque: Yeah. You do. So we as a practice got inspected about two and a half, three years ago now. And [00:26:45] um, the inspections now are so much better than they were when we first got inspected. So when [00:26:50] we took over the practice in 2013, literally week eight got a phone call. Right. We’re coming to inspect you [00:26:55] like we’ve just started, you know, what is all this all about? We’re in the middle of doing some building work as well. The [00:27:00] person that came was like an ex-banker and they were more interested on in the fact that, you know, [00:27:05] we couldn’t, you know, get rid of the dust as quick as it settled because we were having building works. We’re having [00:27:10] building work. Didn’t get that. Um, but it went fine. But this time was a proper, [00:27:15] you know, detailed inspection. And we used it as an opportunity to show off, not [00:27:20] as a we didn’t look at it as this is not going to be, um, you know, this [00:27:25] is gonna be bad. So my wife, um, she’s dead positive, dead positive, proper trooper. [00:27:30] She said to her staff, um, said to all of us and said, are we, are we gonna, um, [00:27:35] just pass this or are we, are we going or are we going to smash this? You’ve got two options.

Afzal Haque: I’m [00:27:40] going to go for smashing. We’re gonna smash it. And that’s the mentality [00:27:45] that we had. It was a lovely day and it went really well. So I, I thought to myself, [00:27:50] if this opportunity ever comes up, I’ll give it a go. Because when you’re on your own practice, it’s good to keep up with what’s going [00:27:55] on. It’s good to see what other people are doing. You learn from them. So it came up, I think there [00:28:00] was a there was a job of about 15, what they call s spars, which is specialist advisers, [00:28:05] um in the country. And I applied, I got interviewed. [00:28:10] I went. I got through it. They offered it me and the training for it. So it’s good we do it every so [00:28:15] probably do maybe 1 or 2 a month if I’m if I’m lucky. Um, but it’s nice. It’s [00:28:20] a nice little thing to do and keep up to date with the regulations. So nothing scary at all.

Payman Langroudi: And [00:28:25] the endo itself. Yeah. How much of it is from the referral, from the practice [00:28:30] and how much of it is referred from outside the practice?

Afzal Haque: I’ll be honest, 95% of my work is external. Comes from outside the practice. [00:28:35] Yeah, I get very little from my own practice. I will get some cases, but I actually did an audit [00:28:40] about this last year and I got about about 95% of my patients I saw were were [00:28:45] external referrals. So I’m heavily reliant on external referrals.

Payman Langroudi: That’s that life of being [00:28:50] a referral dentist. Your customer in a way is the general [00:28:55] dentist rather than the patient. The patient comes in under the rubber.

Afzal Haque: Yeah, absolutely. Yeah.

Payman Langroudi: And I [00:29:00] know there’s a general shortage of endodontists. Yeah. Is that the case? Is it?

Afzal Haque: Well um. [00:29:05] Specialists. Yes. Yeah. So registered specialists, I specialist. I don’t think there’s. Last time I looked there’s about 350 [00:29:10] registered.

Payman Langroudi: In the whole country.

Afzal Haque: The whole country. Um, having said that, mono [00:29:15] spec even less. A lot of those people who have got specialist title in endodontics are [00:29:20] restorative consultants. So they’re on all the lists. Uh, or they may have done restorative training [00:29:25] and they’re on prosto and they’re on endo. So the actual pure mono spec is, I don’t think there’s that many. [00:29:30] Um, but because of simply endo, because of uclan and other courses, there are a lot of [00:29:35] dentists who are, who are doing endo, who have got special interests. It’s essentially what I was essentially what [00:29:40] I was. Um, so, so it’s not as, um, what’s the [00:29:45] word I’m looking for now? It’s not as exclusive as it used to be. Um, so you’ve got [00:29:50] to work for your referrals. There’s got to be something special about it.

Payman Langroudi: So what I want to know outside of the clinical.

Afzal Haque: Yeah. [00:29:55]

Payman Langroudi: What do you, what do you if someone wants to be any referral. Referral. [00:30:00] Yeah. Dentist. What are what are tips tricks things that yeah. [00:30:05] Things that things that you should be aware of.

Afzal Haque: Yeah.

Payman Langroudi: So I mean, I guess, am I right that your day teaching [00:30:10] helps bring in some referrals?

Afzal Haque: So my day teaching is I’m, I’m teaching postgraduates, so I’m [00:30:15] teaching my competition. That’s essentially what I’m teaching. But the reason why I do that is because.

Payman Langroudi: Just [00:30:20] to be on top.

Afzal Haque: Yeah, because a lot of stuff that gets referred to the hospital is stuff that generally doesn’t happen [00:30:25] in practice. So it’s good to know and be at the forefront of the, of the knowledge and the research. [00:30:30] But yeah, going back to, um, how, how you.

Payman Langroudi: How you find new referring dentists.

Afzal Haque: Yeah.

Payman Langroudi: So word [00:30:35] of mouth.

Afzal Haque: So I’ve done a few, a few webinars. I do a few. So I’m keeping [00:30:40] in leader for oxidant as I use their, their files agenda. I’ve been using them for last [00:30:45] 2 or 3 years. I’ve used everything, but these are the ones I click with. So I’ve created a relationship with them [00:30:50] and through them I’ve done a few webinars that gets me the odd person.

Payman Langroudi: Did you do that on purpose or did they find [00:30:55] you?

Afzal Haque: So they found me. So, um, they had a rep who was actually Manchester based, and I get [00:31:00] lots of reps that come in and say, oh, do you want to use that? I use everyone’s file because I give everyone a chance. Um, [00:31:05] you don’t know what you don’t know. And there may be something that comes up that that is absolutely amazing. So I’ve [00:31:10] used every system, some systems I gel with, some systems I’ve not gel with and their [00:31:15] system I did gel with. So we created a relationship. Um, [00:31:20] I use them now exclusively. Um, and I, when I do my teaching, I do [00:31:25] teach their system, but other systems are just whatever works for you [00:31:30] is essentially the, the answer to that. But, um, through them, I’ve managed to do a few webinars [00:31:35] and that helps get some interest. Yeah. I’ve done a few, um, webinars [00:31:40] for PhDs as well about career, uh, pathway, like how one has become [00:31:45] an endodontist that’s really helped because that creates interest, but also people [00:31:50] want to come and shadow. So that’s a lot, a lot of things that, um, now [00:31:55] nowadays I’m getting a lot of people coming to shadow. So they’re saying, oh, can we come and watch you? So they’ll spend a whole day [00:32:00] with me. Um, and that really helps because they’ll do endo themselves a little bit better. But then they’ll, it’ll [00:32:05] help them recognise the cases that they feel is beyond them. And a lot of it is about assessment and just knowing [00:32:10] what I can do and what, what the other guy, what, what could be referred [00:32:15] because you should be doing it. In all reality, all dentists are trained to do it, so [00:32:20] they should be doing it. But the um, the clever ones are the ones who can recognise. [00:32:25]

Payman Langroudi: Which cases.

Afzal Haque: Which cases is the one I should be taking on. And sometimes we [00:32:30] just get dentists just phoning me up. So I’m going to treat this case today. Um, if you’ve got [00:32:35] any advice for me and I’d be happy to spend the time with them. Um, and if they, they’ll ask me, [00:32:40] some of them will ask me, should I be doing this? And I’ll just go into a bit more detail and find out, you [00:32:45] know, how much they’ve done, what they’re comfortable with. And then through that, we’ll, we’ll, we’ll work out whether [00:32:50] it’s right for them or not. So yeah. And as soon as I’ve got a new referral, it’s creating [00:32:55] a good relationship with them, like giving them a call, um, have a chat with them. Um. Try [00:33:00] and see the patient quickly and try and get the, the the correspondence [00:33:05] out quickly. And if there’s any issues have free rein range for them [00:33:10] to come and speak to you. I think that’s what builds up, builds up good relationships. You know, we send everybody a little [00:33:15] gift over the over the Christmas and New Year. That always helps. But it’s relationships. [00:33:20] I think when the patients come in, um, from the referring dentist, I think [00:33:25] one of the good things is, is I always like to big up their dentist.

Afzal Haque: And [00:33:30] because I get most, most happen to so many referring dentists, [00:33:35] why can’t my dentist do this? Why have I got to pay you £1,000? And [00:33:40] my dentist does root canal for £75? And why have I got [00:33:45] to pay you? So part of the conversation is the spiel. Yeah. The part of [00:33:50] the conversation is, well, you don’t realise how lucky you are to have that dentist because they’ve spotted [00:33:55] something that is beyond what what they feel comfortable doing [00:34:00] and should they should. Should they have done that? You’d be in a worse off position. So, you know, [00:34:05] I agree. You’ve got to pay to come and see me, but you should be congratulating your dentist because I am. And [00:34:10] they turn around and go, oh wow. And when you show them the radiograph showed them [00:34:15] the extreme curvatures or calcification, you know, point it out and explain [00:34:20] I use a microscope, etc., etc. that that really helps. And I think they go back to because we [00:34:25] have a policy, we don’t, because I’ve got a general practice attached to my referral practice. We don’t take any patients on that. Come [00:34:30] on. That’s that’s a rule.

Payman Langroudi: And you send them back with the only sold no.

Afzal Haque: Yes, 100% [00:34:35] Cuspal coverage. Um, will be sold. Uh, they’ll go back with a course as [00:34:40] little the dentist needs to do. All they do is prep the tooth. That’s my philosophy. Do as much as I [00:34:45] can to help that help the dentist. Uh, and they’ll be getting a crown. Um, [00:34:50] so that is really important to have that relationship to make sure they get something out of it as well. Otherwise you’re not going [00:34:55] to have any anyone referring, but.

Payman Langroudi: Do you want education days at the practice as [00:35:00] well?

Afzal Haque: So have done. Yeah. So I’ve done a few um evening study clubs. So um [00:35:05] we get, we get opted in to help us a little bit and then they, they will help me get [00:35:10] um, all the, all the, you know, flyers out etc. and we, we, we [00:35:15] invite about 10 to 10, ten delegates in and we’ll do, we’ll talk about access [00:35:20] or we’ll talk about some diagnosis, something quite simple that they can go away and, and utilise [00:35:25] the next day and we’ll have a little hands on session as well.

Payman Langroudi: So. And are there some dentists that refer all their endo to you.

Afzal Haque: Yeah, [00:35:30] there are a few.

Payman Langroudi: Just there are a few.

Afzal Haque: So, so there’s some dentists who are excellent [00:35:35] implant dentists. Yeah. So they still do general dentistry, but they will do majority of their [00:35:40] expertise work is implants. So when they’re taking these scans they may find few lesions here [00:35:45] and there. And I’m finding implant dentists um are very good [00:35:50] at kind of wanting to save teeth. They’re not so much wanting to place the implant in unless it’s necessary. [00:35:55] So they will refer those cases. So I love those dentists.

Payman Langroudi: Five years [00:36:00] out to start enlightened. Yeah. And then when I came back, everyone was on rotary. Yeah [00:36:05] yeah yeah yeah yeah yeah. I had never done rotary. Yeah yeah yeah. So when I came back I said I’m not gonna do any more. But [00:36:10] it’s one of the features of referral practice that you’ve got. [00:36:15] I don’t know how many of those like 4 or 5 people like that who have too much power [00:36:20] over you because all it takes is for a couple of them to drop [00:36:25] off, whether they sell their practice.

Afzal Haque: Or they move somewhere, move somewhere. Yeah.

Payman Langroudi: And that’s [00:36:30] a major effect on your business.

Afzal Haque: It does.

Payman Langroudi: Yeah, yeah. And I was surprised to learn that, you know, even [00:36:35] the super famous guys in all specialities have got [00:36:40] a churn rate. I mean, there’s a there’s a rate of people constantly dropping, dropping off.

Afzal Haque: Yeah, yeah.

Payman Langroudi: So you have to constantly [00:36:45] be putting them in. So that’s why.

Afzal Haque: It’s so important to keep doing these things, keep inviting people into the [00:36:50] practice. Because you’re right, either they retire.

Payman Langroudi: Yeah, yeah.

Afzal Haque: Or they go or they do [00:36:55] or they leave NHS practice. Yeah. And they go to private practice and they start doing a bit more themselves. Found that happened [00:37:00] in Covid a lot because the private industry went like that. Yeah, yeah. So everyone [00:37:05] was doing their own endo.

Payman Langroudi: It kind of woke people up.

Afzal Haque: And everyone upskilled everyone upskilled, [00:37:10] which is great, which is great for the, for individuals and, and dentists as a whole. But I [00:37:15] noticed at that time referrals reduced a lot because um, people [00:37:20] were doing their own. And then the cases you would get were all the, the challenging cases because they’ve not gone well [00:37:25] or there’s a problem that’s happened. Yeah. Um, I think that’s levelled out a bit now because now NHS has [00:37:30] gone back to normal and people are back on the um doing their udas. So yeah, you’re right. So it’s [00:37:35] constantly having to, you know, be out there and.

Payman Langroudi: While we’re still on the business [00:37:40] side.

Afzal Haque: Yeah.

Payman Langroudi: What do you charge the same amount for all teeth. You charge [00:37:45] one for back teeth, one for front.

Afzal Haque: So so I’ve kept it very simple. So I know a lot of my colleagues [00:37:50] and friends, they will have an anterior to posterior tooth at one visit fee or two visit fee. So I have [00:37:55] essentially three fees. Fee number one is consultation fee. And I [00:38:00] make sure I consult everybody, as many people as I can. And people ask [00:38:05] me, why do I need to do that? And the reason I do that, because I think it’s [00:38:10] so good to build that rapport with that patient. Yeah it does. You do lose time. It’s not as [00:38:15] financially beneficial, but you’ve won that patient. They know exactly [00:38:20] what their problem is. They need to understand it, and they need to understand it at a time where they can process it and not say, hi, how are you? Yeah, [00:38:25] you’ve got this upper left six and he’s doing your dentist. It needs to be done right. Um, my name is Afzal. These [00:38:30] are the risks. Here we go. Here’s the local get started. That works for a lot of people. And I get that for me doesn’t [00:38:35] I like the, um, the human touch where I’m gonna get to know them, find out [00:38:40] a bit about them.

Afzal Haque: So I spend about 30 minutes to do that. And once they’ve signed [00:38:45] up, the next fee is the treatment fee. So it doesn’t matter whether it’s a front tooth or a back tooth, a primary [00:38:50] treatment or a retreatment. I charge the same fee. And my philosophy behind that is because nothing [00:38:55] that comes to me is going to be easy. So a front tooth is never going to be an easy, uh, [00:39:00] an easy endo or a primo is never gonna be easy. And it’s always going to be a calcified tooth. It’s going [00:39:05] to be strategically very important. It’s going to have some issue. So just to keep it easy, [00:39:10] one fee and the last fee if we do surgical endodontics. And that’s [00:39:15] one thing. So I that’s how I keep it. I don’t there may be some [00:39:20] caveats as well. Like, for example, if they need a post and that dentist asked me, then there might be a little bit here and there, but if they’re [00:39:25] paying close to £1,000, an extra 50, £60 is not going to break the bank for them. So I’ve kept [00:39:30] it very simple. So the Referrers know, three fees, consultation fee, treatment fee and surgery. [00:39:35]

Payman Langroudi: The restorative build up I built that.

Afzal Haque: Can be fee. I built it into the [00:39:40] fee.

Payman Langroudi: But sometimes that’s a big.

Afzal Haque: It can be a.

Payman Langroudi: Deal or no deal at all.

Afzal Haque: The [00:39:45] way I look at it, it’s like udas.

Payman Langroudi: Swings and roundabouts.

Afzal Haque: Swings and roundabouts. Yeah, you’ll get one. That’s very simple. I’ll do in ten minutes [00:39:50] and one I will know I have to spend a bit longer with. So that’s what the consultation is very important.

Payman Langroudi: And [00:39:55] it is you who does that. So deep marginalisation the whole thing.

Afzal Haque: Yeah. I’ll do it as much as I can. [00:40:00] Yeah.

Payman Langroudi: Cutting gum, putting them.

Afzal Haque: Yeah. So I will assess that at the consultation. So [00:40:05] if I looked at.

Payman Langroudi: You.

Afzal Haque: It’s a big deal restoration. So I’ll book my time accordingly. Yeah. So I [00:40:10] might book, you know, for, for the first. So I’ll say the first visit, I might spend 90 minutes. [00:40:15] But the second visit, you know, I might not, I might get to the end or done or majority done [00:40:20] on second visit. I just need time to operate and build up the tooth. So I might not have to book as long or might be the opposite [00:40:25] where I’m after second visit might be longer because I’ve got to control the gingiva. I’ve got to control the bleeding, [00:40:30] all that. So I’ve built that into the fee. Um, I just want referrers to find it easy [00:40:35] to refer. And so I can tell the patients is this and this that’s it. [00:40:40]

Payman Langroudi: And how much of your day is spent filling out like the communication back to the dentist. [00:40:45] So every day you.

Afzal Haque: Have to do everything. But. But I’ve started to use AI.

Payman Langroudi: Have [00:40:50] you?

Afzal Haque: Yeah, yeah. So I use, um, a program called Heidi and it’s, I think it’s [00:40:55] Australian originally designed for medics. But once you play with it, [00:41:00] start, start playing with it. It’s fantastic at writing letters. So I can just dictate into it [00:41:05] and it will devise a letter. And before that patient has left the building, the letters done. [00:41:10] Oh, so I’ve got a very good team. That’s one thing I’ve got that I’m very lucky. And [00:41:15] it’s taken us years to get this, uh, again, with the driving force, she makes sure my [00:41:20] life is as easy as possible because it’s our reputation, it’s referrers that we want [00:41:25] to be happy and we want it all to go smoothly. So she’s recruited the best nurses [00:41:30] to work with me, to be able to make sure that journey is is so smooth from [00:41:35] phone call to discharge. That whole journey has to be bang [00:41:40] on. So even when I’m not there, like I’m, I’m not there today, but we may have an endodontic [00:41:45] emergency or somebody that’s been niggling the tooth niggling the.

Payman Langroudi: Post.

Afzal Haque: Op. [00:41:50] Post op. Yeah. Yeah. Although I’ve mentioned it.

Payman Langroudi: Yeah.

Afzal Haque: But we will. Oh. Everyone gets a courtesy [00:41:55] call. So the staff are on it. And if there’s any problems, they are so well equipped to deal [00:42:00] with that problem that generally we won’t need to see that patient again or we, you know, [00:42:05] they will reassure them and we can sort them out at some point. So having the team, [00:42:10] my work doesn’t become, um, half as good as it can be without the staff. [00:42:15] Yeah, sure. Absolutely. They are like my my left arm, for [00:42:20] example.

Payman Langroudi: Are you the highest earner.

Afzal Haque: In the practice? Yeah.

Payman Langroudi: And it’s weird, man, because you almost [00:42:25] know how much you’re going to earn every day. There’s no.

Afzal Haque: Yeah.

Payman Langroudi: There’s not much variation.

Afzal Haque: There’s not much variation. There [00:42:30] will be the odd one where you open up the tooth and there’s a big crack in it. Yeah. And then you’re like, well, I booked out 90 minutes. [00:42:35] And I’m not only going to get a proportion of the fee, but that’s okay. That again is [00:42:40] swings and roundabouts. You can’t plan for these things. Sometimes it’s very obvious before you even start, but, [00:42:45] um. Oh, am I doing what’s called an investigation? So the patient knows that at this point we might [00:42:50] stop. So might book a shorter appointment and the fees set. So yeah, it can be. [00:42:55] But the hardest thing is just getting that flow of referrals in regularly. And, and [00:43:00] that takes time. So I’ve been on my own for about since 2022. [00:43:05] So I worked a little bit. I, I’ve been on my own for a long time to [00:43:10] be fair, but I really focussed on my own personal referrals from about I just after Covid, [00:43:15] just after Covid. So, um, yeah, but it’s going well, it’s going well.

Payman Langroudi: What’s the kind of goal here? Is [00:43:20] the goal that eventually you’ll have another endodontist, right? Yeah.

Afzal Haque: So, so so I in an ideal world, [00:43:25] I don’t ever want to retire. I mean, I’m saying that at the moment, but I’m [00:43:30] 43, 43. I love my work. Since I’ve become an endodontist, [00:43:35] going to work is just not a problem. I just go, it’s fine. I think with any referral [00:43:40] stuff, You kind of know what’s going, especially with, you know, you know what you’re doing before the patients even [00:43:45] come in and you’ve seen the radiograph, you kind of know what’s going on. You’ve just got to gel with the patient and you get on with [00:43:50] it. So the goal is to have four, five, six days worth [00:43:55] of endodontics. Um at the moment I’ve got about three days and that’s plenty for me. But as [00:44:00] soon as we start moving to day four and day five, I’d love to get a, a colleague to [00:44:05] work with me.

Payman Langroudi: Um, and how does it work associate wise? Is it like 5050? [00:44:10]

Afzal Haque: Yeah, yeah, yeah, yeah. So yeah. So I also, um, do a day, um, a couple of [00:44:15] days a month for my friend who’s, who’s got a practice about 20 miles from where we live. He’s [00:44:20] actually my implant surgeon. So he’s been working for me for about 7 or 8 years. But when he bought his practice [00:44:25] about three years ago, he asked me, would I come over there? So I have an associate agreement with him and it’s [00:44:30] a 50%. And that is I think that’s fair. That’s absolutely fair. I wouldn’t want any more. [00:44:35] I think anything less is is is 50%. It’s just.

Payman Langroudi: Bang on. As [00:44:40] a specialist, you deserve 50%.

Afzal Haque: I think so. I think so. Um, I mean, you hear lots of [00:44:45] things about percentages, but I always say to new graduates, who are they ask me. [00:44:50] Oh, well, they’re giving me 40% or 35%. I said, don’t focus on percentages because [00:44:55] 50, 40% of a big number is better than 50% of a small number. And, you know, look at where [00:45:00] you are, what you’re going to get out of that practice is any mentorship, anyone you can, you can learn from, [00:45:05] um, things that money won’t, won’t buy. Um, and look at your progression. [00:45:10] So I think 50% is fair. Yeah.

Payman Langroudi: Let’s get on to endo. It’s funny, I’ve talked endo [00:45:15] more than I’ve talked to anything else on this podcast, but it is advice I give young dentists. Yeah, that [00:45:20] too many people don’t think of endo as a because it was hard. Yeah. Undergrad.

Afzal Haque: Well, [00:45:25] that’s.

Payman Langroudi: What they just they just think to themselves, you know, they script themselves and thinking, forget endo [00:45:30] kind of implants too, right? Like surgeries and things. People just don’t like blood. Yeah. But [00:45:35] let’s talk about endo.

Afzal Haque: Yeah.

Payman Langroudi: Is there like a. Firstly, I’m [00:45:40] quite interested in like endo porn for you.

Afzal Haque: There’s [00:45:45] lots of it around.

Payman Langroudi: Like what’s what’s your version of that? Is it like, like, who’s [00:45:50] like an endo hero of yours? And why?

Afzal Haque: Why do you know what? I don’t actually know names, but there’s a lot of American [00:45:55] guys out there that have.

Payman Langroudi: What are they doing? Like, what is it that they’re doing?

Afzal Haque: Is it they’re doing the same [00:46:00] thing as us, but they seem to have all these beautiful looking X-rays. [00:46:05] Uh, very nice. Dense white lines, sharp curves, lovely little puffs at the end [00:46:10] of the routes. They look amazing. There’s another chap in in Dublin. Um, [00:46:15] I forget his name at the moment. He’s on Instagram and his stuff is just brilliant. He’s like very minimally prepped and [00:46:20] this beautiful white lines, you can tell he’s filled the whole anatomy and and [00:46:25] you think, oh, how do they do that? But it’s a, it’s another level that it’s um, yeah. [00:46:30] So, so I can’t remember names.

Payman Langroudi: There’s ninja access. You like that, you know.

Afzal Haque: Well, funny [00:46:35] you should say that gave you a webinar about this last week. And, um, I’m not a big fan of ninja [00:46:40] access because it, it restricts what you can do. It’s great for a photograph and if you [00:46:45] can get it done and it all goes well, all well and good, but there’s more chance of [00:46:50] causing problems by doing that. Now, no one’s saying cut a big hole in it that you know you’ve completely destroyed [00:46:55] the truth. Be conservative, be, you know, follow the principles of endodontics, straight [00:47:00] line access. That’s what we want. We want to be able to see what we’re doing. Why do we want to put extra pressure and [00:47:05] stress on, on our files just so that we can have very, very tiny [00:47:10] access for Instagram, for Instagram? Well, essentially what it is. Yeah, there is a theory and I do agree with it that, you [00:47:15] know, it’s going to be better for the tooth long term if you remove less, but not if you if you can’t get all the bugs out. So [00:47:20] it’s a balancing act, isn’t it? So they look great. I’ve done a few. [00:47:25] And let me tell you, at the end it was a lot harder sweating a lot more. Yeah, [00:47:30] sweating a lot more. And then you have to.

Payman Langroudi: You can’t get your irrigant properly, right? There’s things [00:47:35] like that.

Afzal Haque: Things, things like that make a big difference. So endo is not just the files. 50% of it is [00:47:40] is the irrigation and the activation. And if you’ve got very tiny access, how are you going to activate [00:47:45] that irrigant. So you’ve got to ask yourself all these questions.

Payman Langroudi: And do you guys like do you would [00:47:50] do you and Sanj and um, Rob and [00:47:55] Amal do like the same thing? So is there, is there [00:48:00] like one thing you do differently to know?

Afzal Haque: So I would say Amar, Rob and myself, because we’ve all been trained [00:48:05] in the same institution. We’re all a Liverpool grads. Post-grads we probably do something very, very similar. Uh, [00:48:10] and we all talk to each other. We’ve got little a little endo group. It’s more like, you know, PTSD, [00:48:15] DSC, endo group. You know, we still survived like [00:48:20] a kind of group.

Payman Langroudi: It’s a barrel of laughs.

Afzal Haque: A barrel of laughs.

Payman Langroudi: Yeah.

Afzal Haque: So there’s always someone asking about a [00:48:25] sealer or something silly like that. And it’s like, it’s like anyway. Um, so, but Rob and I, [00:48:30] and I, and I, we, we will discuss cases. So we’ve got a very similar sort of way of working. Um [00:48:35] Sanjay I would I have watched him work. I mean, we’re not too dissimilar to him. [00:48:40] The difference is he’s been doing it a lot longer than us. Um, his techniques I’ve [00:48:45] adapted the way I work by watching him. So I watched, you know, um, I’d say growing up, but yeah, [00:48:50] growing up as an endodontist, um, him and there was a, a lovely chap who sadly [00:48:55] passed away called Mark Hunter. He was a very kind and gentle endodontist in [00:49:00] South Manchester. Um, I think he actually taught Sanjay when Sandra was doing his, [00:49:05] his endo training and I watched both of them. And what I learnt was [00:49:10] lovely patient management and the holistic approach from Mark Sanjay [00:49:15] showed me that as well. But he also showed me how to be efficient with endodontics. And I think I’ve adapted [00:49:20] a lot of his efficiency into my daily practice. So it’s because at the end of the day, you’ve got to get it done. [00:49:25]

Payman Langroudi: You can do it faster.

Afzal Haque: You can do it a lot faster. Yeah. Um, so Mark would take, uh, two visits, [00:49:30] pretty much every case, three hours at a time, potentially. Um, which is great. [00:49:35] And that worked for him and that was perfect for him. Sandra’s a lot quicker, a lot more single visit [00:49:40] treatment, um, and getting things done within 90 minutes. Um, so that’s what I learned [00:49:45] from him how to be very efficient. And it’s great having the two contrasts because you can [00:49:50] pick up so much from both. Uh, sandwich is extremely efficient. Uh, and [00:49:55] Mark was, um, he took his time, but I learned that of, you [00:50:00] know, patient care and all that kind of thing. Not saying that sandwich can’t do that. It’s just different. [00:50:05] Yeah. Um, but then you take aspects of both and put it into your practice saying, well, this is [00:50:10] why I do a consultation. So my, um, philosophy of consultation came from [00:50:15] Mark. He consulted everybody where Sandra will do some and not and not others. Um, and that’s [00:50:20] fine, but that’s how I learned. So it’s brilliant.

Payman Langroudi: Um have you done any training in the US [00:50:25] or. No.

Afzal Haque: That’s something I would love to do. Um, so they run courses [00:50:30] in I think in the US, but they take you to South America somewhere weird, Nicaragua [00:50:35] or something like that. And it’s more surgical stuff. And that’s where I want [00:50:40] to really up my game because I do surgery. Um, but the way the Americans do it is, [00:50:45] is a lot different to how we do it. They’re very efficient. It’s something that is part of their daily practice. We’ll [00:50:50] do, uh, maybe the odd 1 or 2 a month, um, maybe a bit more.

Payman Langroudi: But to me, yeah.

Afzal Haque: To [00:50:55] me, but for them, it’s a regular part of the practice. So yeah, if I, if I’m [00:51:00] to do more, I’d love to go America.

Payman Langroudi: Is Apicectomy is less apicectomy happening these [00:51:05] days because more like more and those got better. Yeah, yeah.

Afzal Haque: There is that as well. But there’s always [00:51:10] going to be, uh, an element of it. So we get a lot of cases that are sent to us by very good general dentists [00:51:15] who have done everything under correct protocols, use all the right stuff. And then you think, well, [00:51:20] if they’ve done it so well, you know, what am I actually going to do to, to improve this? It’s, you know, [00:51:25] the X-rays, the root fillings right to the end of the root. Everything looks great. So then having that surgical [00:51:30] skill is quite important because if you can’t retreat it.

Payman Langroudi: There’s nowhere.

Afzal Haque: Else to go. There’s nowhere else to [00:51:35] go. And you know, patient may save it, save some money and you won’t need an implant. You might [00:51:40] get a few more years out of the out of the tooth. So I think it’s a great skill to have, which we do do it. But [00:51:45] in America, they’re very good at doing posterior teeth and things like that. So it’s a bit [00:51:50] more kind of um, it’s a bit more speciality I suppose there um within endodontists.

Payman Langroudi: Something about [00:51:55] endo that most generalists get wrong.

Afzal Haque: I think it’s diagnosis. I think tooth [00:52:00] is TTP it needs endo. Um tooth is sensitive [00:52:05] while I’m doing a crown, a crown prep. Um, can you do endo. It’s [00:52:10] TTP is not a diagnosis for endodontics. It’s, it’s part of the diagnosis. [00:52:15] It might tell you that that tooth then.

Payman Langroudi: Filling.

Afzal Haque: High filling or um, [00:52:20] bruxism, something like that. Yeah. They may have had a little bit of local trauma. Um But [00:52:25] that in itself is not a reason to do endo. Um, I find a lot of general dentists that do [00:52:30] refer to me, um, they’ve learned over the time because I tell them how [00:52:35] to do it, you know, do simple things like cold testing, just do the cold test and do that tooth and do another tooth and do it from [00:52:40] different parts on the tooth, because sometimes they’ll do it too high on the tooth and we should be doing [00:52:45] it a little bit lower down towards the gingival margin, and then you’ll get a bit of a better response. Um, things [00:52:50] like that is quite important. It’s getting the diagnosis right.

Payman Langroudi: So what’s the point. You said.

Afzal Haque: That. Yeah. [00:52:55] I find that because and also um pain management.

Payman Langroudi: Mhm. [00:53:00]

Afzal Haque: It’s hard to get pulpitis tooth numb. And it’s very [00:53:05] easy for us because by the time it comes to us, it’s become necrotic. So I find that, you know, that [00:53:10] is a skill to have. And it’s just being a little bit more, um, aware of the anatomy [00:53:15] and, and just going for it really and just trying to get that patient out of pain. Um. [00:53:20] Reducing the amount of antibiotics used if possible. [00:53:25] Because antibiotics is not the first line. We need to open up these teeth. Release the [00:53:30] pressure. Um, the other thing I find um, should be better taught is [00:53:35] how to deal with emergencies. Um, we don’t need to put files in teeth. Oh no. [00:53:40] So if you’ve got pulpitis tooth, they literally need to open up the pulp chamber, release the pressure. [00:53:45] And essentially, um, if they can do under a rubber dam, brilliant. A little bit of hypochlorite to, [00:53:50] to wash the coronal pulp and just medicate that the minute they put files in the.

Payman Langroudi: Medicate it with.

Afzal Haque: With, [00:53:55] with like leather mix or something like that. Yes. And like an anti-inflammatory steroid, the minute they put files [00:54:00] in the tooth. Now my.

Payman Langroudi: Complicated.

Afzal Haque: To you might complicate it, but the thing is they’ve also got to [00:54:05] remember where did all the bugs live? They live at the top of the tooth. So so if you’re putting a file down [00:54:10] and if you’ve got no intention at that appointment to do the endo, then you’re literally pushing the bugs from the top [00:54:15] to the bottom. And what happens after that? They have patients get a post-operative flare up. And [00:54:20] that’s not a great practice builder.

Payman Langroudi: Because.

Afzal Haque: I came to you in pain and I’m worse pain now. [00:54:25] Some cases will be the exception and there will be ones that we won’t get it right. But [00:54:30] I try and teach um general dentists is is just get the coronal pulp out. Medicate [00:54:35] it, dress it, bring them back another day when you’re ready to do the endodontics or refer it on. Also [00:54:40] alleging the file goes into the tooth can’t get to the apex and keep [00:54:45] tapping tapping tapping. And it’s essentially alleged it. So when it comes to us, it’s becomes much more difficult case. [00:54:50] So the way.

Payman Langroudi: You do about it actually.

Afzal Haque: What to do about the ledge, you have to manage it.

Payman Langroudi: So [00:54:55] you you have to know it’s there.

Afzal Haque: Well, you can’t see it on a radiograph. So you feel [00:55:00] it when you go in and you think this file’s not going anywhere. And then you know, it’s been accessed. So you [00:55:05] kind of, you know.

Payman Langroudi: You do, you kind of pretend.

Afzal Haque: Yeah. [00:55:10] So so I put little sharp bends on the end of my files. And essentially what I’m trying to [00:55:15] do is walk it down the canal and just see if it, if it just, you know, sits past it and just [00:55:20] catches somewhere. If it catches somewhere, you know, you get that warm feeling inside. I’m going [00:55:25] somewhere and you try and smooth that out. Ledges is probably one of the worst things [00:55:30] that we have to deal with. It’s horrible. It can take it can turn a treatment from an hour [00:55:35] to double it. Um, and I might end up just working on that one canal for that session [00:55:40] because it can be that difficult to, you know, to get past it. Once you’re past it and [00:55:45] you smooth it, you’re back to normal again. But that can be avoided a lot of the time. Um, [00:55:50] especially in emergency appointments, I think we’ve got this philosophy that we stick files in teeth. We don’t [00:55:55] not for pulp teeth. We can just medicate it and and you’ll be surprised. Patients will will [00:56:00] get out of pain once that medication starts to work. And just painkillers, you know, giving [00:56:05] the right post-op advice. Tell them it’s going to be sore for a few days. So the expectation is already [00:56:10] there. Um, so they’ll deal with it. And patients tend to tend to not bother you if. [00:56:15]

Payman Langroudi: Look, I know it depends on the dentist. Should generalists ever do re [00:56:20] endo.

Afzal Haque: If they’ve got the skill set for it? Yes.

Payman Langroudi: It depends.

Afzal Haque: It depends on the dentist.

Payman Langroudi: But [00:56:25] yeah should they not.

Afzal Haque: I would say re endo is probably the majority of my work [00:56:30] is re endo. Yeah. Re endo um resorption these sort of cases [00:56:35] calcified canal.

Payman Langroudi: So you look at you look at the first day you kind of say I can see [00:56:40] that’s not a very good endo sometimes. Yeah. Other times you don’t.

Afzal Haque: Other times there’s a brilliant endo. [00:56:45]

Payman Langroudi: But but but the quality of endo is less is not just the X-ray is it 100%. [00:56:50] It could be the way they used irrigant. It could be the salivary.

Afzal Haque: Absolutely. You’ve hit the nail [00:56:55] on the head. So just because it’s a nice, beautiful line, it could have been washed with water. Yeah. Or [00:57:00] nothing. So you’ve got to take into mind. So these are the questions that I kind of will ask the patient. So if it’s [00:57:05] a recent endo they will generally remember if they’ve had rubber dam smell bleach or even tasted it. [00:57:10] Um, but if it’s a really old one, um, then it’s the question is, [00:57:15] AM I going to. Am I going to retreat it now? You’d be surprised if it’s quite [00:57:20] infected. And it’s such. And it looks like a lovely root canal treatment. Sometimes that GP will come out [00:57:25] quite easily because there’s infection around it. Yeah. And it’s not as bad as it looks on the X-ray. So it’s all [00:57:30] about having the right conversation with the patient, you know, giving them the options because not everyone wants to go through surgery. [00:57:35] Yeah. And, and I kind of explained, look, it’s the end of the line here. If we [00:57:40] can do something with this tooth, we will try. And what would you want to do. And [00:57:45] we’ll build in the the fee. So if we on the first visit, if I can’t [00:57:50] remove everything or there’s a problem, we can’t get to length there, the chances are if it’s got a big area on the end of the roots [00:57:55] and I can’t get to the length, it’s not going to heal. So I need surgery or extraction. And then patients [00:58:00] can be quite accepting of that because you’ve given it a go. You’ve explained it all and [00:58:05] they know they’ve got another option. If if um the retreatment doesn’t work. So [00:58:10] there is um it’s all about communication really. It’s like the happiest dentists, [00:58:15] I feel, are the ones who communicate really, really well and the ones who don’t get into trouble. Lots of things can go [00:58:20] wrong, but if you communicated well, generally you don’t have problems. But that’s what experience [00:58:25] is.

Payman Langroudi: Yeah. I mean, it’s so interesting, man, because you could have two dentists, same [00:58:30] treatment, same outcome. Yeah. Two different communications. One, one [00:58:35] patient will adore you and one patient might be suing you.

Afzal Haque: Yeah, absolutely. Absolutely. So I [00:58:40] get that. I get people like, oh, do I need to, you know, should I complain to my dentist? Well, no, you [00:58:45] know, that’s the reason why you’re here. So we have to kind of I have to be very careful [00:58:50] with the language that we use with, with patients, because you don’t want to get your dentist [00:58:55] into, into hot water. Um, and some of the treatments may not be great [00:59:00] and it’s just how you project that to the patient. Um, and I explained [00:59:05] that these teeth are difficult. Root canals are very challenging treatment modality that we do. [00:59:10] Very, very difficult. Um. And that’s why you’re here.

Payman Langroudi: So [00:59:15] how come he hasn’t moved on, man? Like, why isn’t there a different filling material than JP?

Afzal Haque: I don’t know. It works. [00:59:20] It’s been working for years, hasn’t it? So filling materials not worked. Sorry, not changed much. But [00:59:25] the sealers have. So initially GP was our main filling [00:59:30] material. Like just got to get that GP everywhere. Yeah. So it was [00:59:35] a GP based obturation. Now we use these calcium silicate [00:59:40] MTA based what we call bioceramics which have really changed the um the [00:59:45] modern endodontics. So now it’s become.

Payman Langroudi: That’s feeling that all the that’s getting [00:59:50] canals.

Afzal Haque: And that’s getting everywhere and it’s almost come full circle. So we call it now a sealer [00:59:55] based Obturation. Whereas the GP is just the carrier. It’s just a carrier that [01:00:00] takes it to the apex. That’s interesting. That’s all it is. And it’s a medium to, [01:00:05] to be able to remove because bioceramics when it sets, it sets rock hard. Trying to retreat [01:00:10] a bioceramic case is very difficult. I’ve had to retreat some of my own that I did make five years ago, um [01:00:15] or longer. And it’s really difficult because it sets rock hard. But that GP [01:00:20] is the pathway to try and get you.

Payman Langroudi: Antibacterial as well.

Afzal Haque: Yeah. It’s antibacterial, it’s high pH. [01:00:25] It’s very much like like.

Payman Langroudi: Gp isn’t is it.

Afzal Haque: No, no GP is like just rubber. Rubber. Got [01:00:30] eugenol in it. Yeah. Um but the GP is, is, is the carrier. So, so [01:00:35] the philosophy is changed now initially 20, 30 years ago if we saw single cones in, [01:00:40] in as root canal fillings. It’s a single cone obturation. It’s a bad job. We’ve come back to [01:00:45] single root. So it’s gone full circle. So the simpler things now and for single [01:00:50] cone obturation is the way to go. And if you’re doing it with a bioceramic, [01:00:55] it’s even better. And that’s how they how they teach it because they say Bioceramic doesn’t, [01:01:00] you know, um, work well with heat. So, you know, the heating system. So just you make sure [01:01:05] you’ve got enough, um, bioceramic in the canal and gently placed your cone. [01:01:10]

Payman Langroudi: Is it radiopaque?

Afzal Haque: Yeah, very much so. Very much. And if you get a little bit out of the apex, although [01:01:15] not ideal, the body deals with it very well. So it’s not as irritant. So like the, um, [01:01:20] the older ones like the eugenol and the calcium hydroxide based um.

Payman Langroudi: Tubli-seal. [01:01:25]

Afzal Haque: Tube seal. Sealapex. Yeah. Um the resin ones like h plus they [01:01:30] can, they’re very, they flow a lot and they, it’s very easy to get it out at the end and it can be cytotoxic, [01:01:35] it can really make the, make it very uncomfortable for the patient. Uh, but it will settle, but it will [01:01:40] settle with the bioceramic. If I get anything out the end, as long as it’s not near any structure like you don’t want in the mental [01:01:45] nerve, you don’t want it, you know, in the sinus too much. Um, it generally will be fine. Um, [01:01:50] and it’s changed endodontics completely.

Payman Langroudi: You know, that thing that you must be getting asked about? [01:01:55] Oh, every cancer patient has a endo in their mouth. Yeah, yeah. Conspiracy. [01:02:00]

Afzal Haque: Yeah, yeah.

Payman Langroudi: I must come up a lot.

Afzal Haque: I’ve had a few people, um, ask me [01:02:05] that question or does it cause cancer? I’m like, no, you know, where’s the evidence? The evidence is poor. [01:02:10] We’ve been doing root canals for years. You know how many patients are dying of cancer due [01:02:15] to the root canals? It’s it’s it’s not what you read on the internet. [01:02:20] And that’s the problem. People are very well informed these days. Yeah. We’ve got ChatGPT. They’ve [01:02:25] got someone found me on ChatGPT. This is how this is how weird it [01:02:30] is. Oh, who who’s a good endodontist in the Manchester region. And my name came up. [01:02:35] I found you on ChatGPT. This is this is what people are using now to, to get their information. And you’ve [01:02:40] got to be very careful of, of what they read. So that’s why I try and tell, try and educate them a little bit.

Payman Langroudi: So you can [01:02:45] you can nlm optimise.

Afzal Haque: Yeah yeah yeah yeah yeah.

Payman Langroudi: So a couple of dentists contacted me because [01:02:50] we had them in a blog post and the blog post didn’t say so. And [01:02:55] so works in Liverpool.

Afzal Haque: Right.

Payman Langroudi: So can you go into that blog post and change it. Right. So [01:03:00] that when ChatGPT is looking, it knows that I’m a dentist in Liverpool because it really likes third [01:03:05] party, right? Like enlightened thinking about the dentist rather than the dentist talking about himself. [01:03:10]

Afzal Haque: Yeah. That’s interesting. Well, that was that’s new to me. But yeah, it’s just information is just [01:03:15] everywhere. It’s overload, isn’t it? So, um, yeah, you just have to educate [01:03:20] them. Um, but yeah, I remember a few years ago that Netflix movie came out.

Payman Langroudi: It wasn’t [01:03:25] this all the same thing. Yeah.

Afzal Haque: Yeah. Well, that’s what it was all about. Root canals are bad and they cause this cause that [01:03:30] there’s a lot of these.

Payman Langroudi: Are you getting asked all the time?

Afzal Haque: Not now. At the time there were. There was a few people that watch. Oh, did you watch [01:03:35] that movie? To be fair, the people that did come and see me didn’t take much notice of it. Um, but [01:03:40] going speaking to colleagues, you know, a lot, a lot of them have had to deal with people saying, I’m not having [01:03:45] that because it’s, it causes this, this causes that is it.

Payman Langroudi: Every time you take GP out of [01:03:50] a tooth, it’s kind of smelly. Yeah. So there are bacteria.

Afzal Haque: Yeah. Yeah. 100%. [01:03:55]

Payman Langroudi: The idea that there are bacteria hanging out in your in your endo.

Afzal Haque: Absolutely. [01:04:00]

Payman Langroudi: So it’s for real.

Afzal Haque: I make it a point with the patient. So because when you’re taking GP out, there’s [01:04:05] that odour, you know, that endodontic smell, you just know it. Um you smelt it that many [01:04:10] times.

Payman Langroudi: I mean I’m not saying it causes cancer. No, no. But it’s real.

Afzal Haque: It’s real. So I would, I would [01:04:15] I would explain to the patient, I said can you smell that odour there? Like I said, that’s the infection in your [01:04:20] tooth. So this is why why we need to do it. So that builds confidence for the patient I think. Yeah it’s [01:04:25] the right decision. Um but yeah most infected root canals will be like that. Yeah. [01:04:30] They’ll get that odour.

Payman Langroudi: You’re not saying so you don’t think most root [01:04:35] canals.

Afzal Haque: Um infected ones. Yeah. Yeah. Now if I’m removing [01:04:40] GP I’m generally going to be removing for a reason. Yeah. Yeah. So it’s got contaminated somehow. Um [01:04:45] so there will be some malodour from it. Yeah. Generally.

Payman Langroudi: And [01:04:50] if I don’t onlay or crown after rct am [01:04:55] I wasting my time with the city.

Afzal Haque: Yeah. Um.

Payman Langroudi: Or is that old? Is that old information.

Afzal Haque: My doctorate [01:05:00] was on this. Oh yeah. My doctor was on the restoration of root canal treated teeth. And the general consensus [01:05:05] is if it’s if you’ve lost a marginal marginal ridge, um, then that tooth is going to be significantly [01:05:10] weaker than a tooth that hasn’t, uh, and endo with due [01:05:15] to cutting a big hole into the tooth, doing the process of what we do will weaken the tooth further. [01:05:20] So if you’re not going to have comfortable coverage, there’s a higher chance you’re going to get a fracture. Now, some people [01:05:25] might get away with it because their occlusion might be a bit more favourable than others. But as a general rule, on a posterior [01:05:30] tooth, if you’ve lost a marginal ridge, I will be advocating minimal, um, uh, [01:05:35] comfortable coverage. Now that can be with whatever material, but some sort of cuspal [01:05:40] coverage to stop that flexing of, of, of the cusps and causing a fracture. So [01:05:45] yeah, that goes without saying. And that will be discussed at the consultation. So when you go [01:05:50] back to your dentist, because so some people may have heard it but not processed it. So you will need a crown. [01:05:55] So they’ve got to know that because that’s an additional additional cost that they will incur when they’re going [01:06:00] back to their dentist. So I explain how they talked to you about that. Well, I don’t know what they [01:06:05] charge, but this is what they’ll they’ll need to do after it protects what what we do. And [01:06:10] it could range between this and this and generally it’s fine. But yeah, Cuspal coverage. Um, that was my [01:06:15] thing.

Payman Langroudi: And while we’re here internal bleaching.

Afzal Haque: Yes.

Payman Langroudi: What do you do?

Afzal Haque: So, um, [01:06:20] I’ve not done many for a while because I generally prepare the teeth for the general dentist to do. But [01:06:25] when I did do it, I used to. Do, you know the inside outside. Yeah. The walking bleach, walking, the walking bleach.

Payman Langroudi: You close [01:06:30] the access.

Afzal Haque: Um, no. So so.

Payman Langroudi: It’s.

Afzal Haque: Open. Is it inside inside. So not walking. Sorry. The inside [01:06:35] outside. Yeah. It’s where you make them a tray and then and they, they um replenish the, um the [01:06:40] gel every so often. It’s interesting you mentioned that I went to a lecture um not [01:06:45] long ago about incidents of resorption in, in teeth [01:06:50] and obviously bleaching came up as one of them. And the, the person giving the [01:06:55] lecture was saying that, um, you know, the walking bleach is probably higher risk [01:07:00] due to the fact that there’s nowhere for the for the bleach to exhale.

Payman Langroudi: Interestingly, I heard the [01:07:05] incidence has gone down a lot.

Afzal Haque: I’m sure it has.

Payman Langroudi: Because we no longer think heating [01:07:10] the thing. Yeah.

Afzal Haque: And also the percentages have gone down as well.

Payman Langroudi: Yeah.

Afzal Haque: Over the years.

Payman Langroudi: Yeah. But I [01:07:15] remember a time you just took a hot instrument into into bleach.

Afzal Haque: Yeah. [01:07:20]

Payman Langroudi: In the access cavity thinking hot bleach is what you want. And it’s that heat that was causing. [01:07:25] Yeah. Um, so I think Chris did a study, not study the [01:07:30] search on, on.

Afzal Haque: Yeah.

Payman Langroudi: He told me that. Um, but interesting thing, [01:07:35] you know, regression, the best way to handle regression [01:07:40] after internal bleaching is externally. Yeah. Not, not internally. Right. Because [01:07:45] everyone thinks, oh, we’re internal. It’s difficult. You don’t know whether it’s going to regress or not. Yeah. You don’t [01:07:50] even let it regress. You do external one night a month or one night a week or whatever it takes for it [01:07:55] not to regress. Yeah, yeah. With with a tray externally as well.

Afzal Haque: Yeah. No. Um, so [01:08:00] so I get asked, um can you prepare the tooth for internal whitening. So I’ll [01:08:05] make sure the GP has cut the right place. All the barrier is in so the dentist can carry on and do that. But yeah, it’s [01:08:10] a great way. I used to do loads when I was doing my specialist training, so we saw great results. Um, [01:08:15] I mean you correct me if I’m wrong, but the grey, the tooth was, it was a bit more challenging, [01:08:20] but you got some change and it was, it was some of them were remarkable. The way, the way it looked. [01:08:25] I thought what’s happened.

Payman Langroudi: To white.

Afzal Haque: Something something go to white. Yeah. Yeah. And then you’re thinking, well, you’re gonna [01:08:30] have to bleach the rest of them now and not bleach that one. Yeah. So yeah, that’s.

Payman Langroudi: What we do actually. We [01:08:35] bleach everything.

Afzal Haque: Yeah. But it’s a great treatment if. And it can work quite well. [01:08:40] So it’s trauma. Yeah. You see a lot trauma.

Payman Langroudi: What grinds your gears? Like what gets you angry? [01:08:45] Getting mad about the profession.

Afzal Haque: Oh, gosh. Um, this goes back to [01:08:50] my undergraduate days.

Payman Langroudi: So the teaching, the what you’re saying the [01:08:55] teaching.

Afzal Haque: That’s what really winds me up.

Payman Langroudi: Almost like there’s abuse built into it.

Afzal Haque: It’s a level [01:09:00] of abuse, isn’t it? But but it’s not.

Payman Langroudi: I remember, I remember it’s not emotional. It completely [01:09:05] I completely resonated with me when you said what you said, I’m maybe ten years behind [01:09:10] you. Yeah. Like older than you. Yeah. And I remember thinking, [01:09:15] why is this guy being so cruel?

Afzal Haque: Well, that’s, that’s what it was.

Payman Langroudi: But I remember, I remember [01:09:20] that there was this idea that dentistry is tough, and we’re [01:09:25] gonna abuse you to see who can take it and who can’t. It was almost like this excuse [01:09:30] for abuse.

Afzal Haque: Absolutely. And, and looking back on it, I think that nobody nobody [01:09:35] learns from that. Nobody learns from I mean, you’ve got to be constructively, you’ve got to give constructive [01:09:40] criticism, but everything negative is going to bring somebody down. My experience with dental school was I [01:09:45] was the average student, didn’t do anything better than just passed my exam. That’s all I did. And I, and [01:09:50] I never failed an exam, but everything didn’t come, came to me, you know, with some effort. [01:09:55] It’s there was some of my colleagues and friends who just got everything. They just. Yeah, perfect. [01:10:00] But those tutors were, were, were quite harsh on people like us. And they would [01:10:05] say, oh, maybe you should think of another career and things like, you know, things like that. That’s not very helpful when you’re in your third and fourth year. I [01:10:10] remember quite clearly, um, a couple of colleagues, um, on clinic [01:10:15] and they were telling them for a patient, maybe you should think about another career. And I think that is just so not helpful. [01:10:20]

Payman Langroudi: And it’s.

Afzal Haque: Really annoying.

Payman Langroudi: Some people have to decide [01:10:25] age 13. Yeah, they want to be a dentist because of the GCSEs they’re taking. So you’ve [01:10:30] been working at this thing for ten years. Would you like for.

Afzal Haque: Someone.

Payman Langroudi: To tell you that half your life almost at that point?

Afzal Haque: Yeah, absolutely. [01:10:35]

Payman Langroudi: And this guy is a minute. Yeah. Yeah. You know, quite eminent, isn’t he? Because he’s [01:10:40] an academic. Yeah. You’re a student. Yeah. To hear that from him, it’s just heartbreaking. [01:10:45]

Afzal Haque: It’s horrible. It was like people taking impressions. It didn’t look good. Pick it up and throw it in the bin. Do it again. Um, [01:10:50] that really annoyed me. So.

Payman Langroudi: And [01:10:55] you were, you were saying that’s why you like teaching? Teaching?

Afzal Haque: Yeah. I mean, I can’t change the [01:11:00] world, but I can do my my own little bit. And my philosophy was, I’m never going to let anyone feel [01:11:05] like that. If there’s a problem, we’ll have an open and honest conversation, make it constructive and give them [01:11:10] a plan. It’s a bit like the stuff I do. If the practice is not is not great, you [01:11:15] don’t shut them down, address it, give them an action plan, go back, give them a chance. [01:11:20] And that was my thing. I was like, I cannot, um, teach like this. I have [01:11:25] to use a different approach. And, you know, it was horrible [01:11:30] to see that, uh, at the time. And it broke a lot of people. And I had one good tutor. [01:11:35] I will mention his name’s Amin. I’m in a minion. He a legend, absolute [01:11:40] legend.

Payman Langroudi: He loved that guy.

Afzal Haque: Lovely man and fantastic clinician, but just [01:11:45] a realist. And when we were undergrads, I must have be third year [01:11:50] or yeah, it would have been third year. And we were doing the, you know, the op tech where you you cut cavities on plastic teeth [01:11:55] and you passed that exam. Then you go on to see patients and other tutors and other groups. So [01:12:00] he was, I was assigned to his group and other, um, students. They were all getting [01:12:05] A’s and I was in from what I remember, it was a, B, C pass. [01:12:10] D was like cause of concern and would only give me C the [01:12:15] odd B, and I’m looking at my colleagues. I’m looking at obviously different teachers have different ways of marking. [01:12:20] I’m looking at my work. It’s not that bad, but I’m getting B’s and C’s. Well, B if I’m lucky. [01:12:25] And I was like, I had to speak to, I mean, and actually I remember he came [01:12:30] up to me and said, are you all right? I said, I said, look, I mean, I’ve been doing this for like a term. Now I’m [01:12:35] only getting C’s.

Afzal Haque: And he just brought me to the side. I said, look, if you’re gonna [01:12:40] get if you want A’s, you have to do this better than me because I’ve been doing this a long time. And [01:12:45] if you’re getting B’s and C’s, you are safe, you’re adequate, and it gives you room to improve. [01:12:50] And so let me tell you one thing. I did nothing else in my Dental undergraduate career than just [01:12:55] passed my exams. He goes, and that’s all you need to do. You need to be hungry to [01:13:00] keep improving. If you get the A’s, you become complacent. So that [01:13:05] stuck with me. And you know, you know, when you’re an undergrad, you look up to these guys and [01:13:10] they say, oh, prosthodontists, you know, you know, they’re brilliant clinicians. And it [01:13:15] was always like a bit of imposter syndrome. You know, when you come out of university, I will never be like him. But [01:13:20] with time, if you’re hungry and you stay humble, you, you’ll [01:13:25] get there. And I’ve still got lots to do. Yet I’ve nowhere the [01:13:30] finished article, but the journey is there and I’m still continuing.

Payman Langroudi: The things that you’ve got [01:13:35] to do where like, how do you categorise them? Like there’s business goals.

Afzal Haque: Yeah, I think there’s business goals.

Payman Langroudi: Clinical [01:13:40] goals.

Afzal Haque: Clinical goals. Like I told you.

Payman Langroudi: About.

Afzal Haque: Surgery. Yeah. I mean, I do surgery, but I want to be A [01:13:45] liquor and get much, much better at it. And that comes with time, comes with practice. I’m [01:13:50] lucky I’m working at UConn because I work with oral surgery. So we do a lot of cases together and that [01:13:55] will improve my experience and exposure to it. Um, but yeah, there’s the business goals. [01:14:00] Of course, there’s business goals I want to create. Um, so I mentioned [01:14:05] before, I’ve got a general private practice with an offshoot of endo. At the moment it’s all one, [01:14:10] but my, my plan would be to kind of make it to maybe, maybe [01:14:15] take it to a different location. Um, I’d teaching to it because [01:14:20] I love teaching at the moment I’m teaching postgraduates at the university level. Um, the [01:14:25] reason I’m not doing courses at the moment, um, is because not because I have done them in the past, [01:14:30] I focus a lot on my business. I want to get my business right. I want to get my business right. I want [01:14:35] to get that, that flow, um, of endodontic treatment coming well into, into the practice. [01:14:40] And I don’t, didn’t want to do courses too early. A lot of people do courses way too early. [01:14:45] They’ve graduated. They’ve started courses. How can you teach, you know, endodontics [01:14:50] if you’re not doing it regularly every single day? And I want to be that wet finger dentist that teaches a course [01:14:55] that today someone’s going to learn something and tomorrow they’ll, they’ll, they’ll apply it. So that’s my [01:15:00] goal. I want to create one day, I don’t know when, but some sort of like an institution where people [01:15:05] can come and treat under my supervision, because that’s one thing I think endodontics [01:15:10] doesn’t have that implants and other specialities have mentorship. Mhm. They have [01:15:15] um, so if you’re placing an implant, you can get a mentor.

Payman Langroudi: Yeah.

Afzal Haque: But where are your mentors? Where [01:15:20] where are they? No, they don’t exist. Um, why? There must be some logistic [01:15:25] reason, but I’ve got my own practice and I’ve got space, and [01:15:30] I love teaching, so why not try and create something?

Payman Langroudi: Yeah.

Afzal Haque: It’s [01:15:35] it’s a thought, but let’s see what happens. Um, but for that, I need a bit more time. [01:15:40]

Payman Langroudi: Yeah, man. You’re young.

Afzal Haque: Yeah. So so that’s what I mean. I’m not done yet. Yeah, yeah. There’s a lot as long as I’ve got [01:15:45] energy, I’ve got the air in my lungs. An amazing wife who continues to support [01:15:50] me and my family.

Payman Langroudi: She sounds great.

Afzal Haque: She, she is amazing. You need to bring her on a podcast. You don’t need me. So I say to everybody, [01:15:55] I’m not the specialist. She’s the specialist. Because when you do specialist training, they [01:16:00] all do it with you. She does it from a different angle, supporting everything.

Payman Langroudi: Well, at [01:16:05] the Eastman, they call it the marriage break. Well, it’s it’s.

Afzal Haque: It’s it’s it’s the the divorce.

Payman Langroudi: The [01:16:10] divorce course.

Afzal Haque: Reverse course. I mean, it times have been difficult. [01:16:15] I could not say sit there and it’s been, oh, it’s been a rosy time. The times I want to give up because [01:16:20] I’m like, what am I doing this for? You know, I’m away from my family. My wife’s miserable. I’m [01:16:25] miserable. You know.

Payman Langroudi: By the way, it’s terrible. I know of several divorces [01:16:30] because of.

Afzal Haque: So do I. Yeah, so do I. My brother in law, um, who’s a periodontist. [01:16:35] Um, he studied at the Eastman. He was telling me this all the time and he says [01:16:40] it to me. Now he goes. The fact you two made it is a massive testament testament [01:16:45] to to you both, but I hold her solely responsible for everything [01:16:50] because she she she set it all up. But the difference is we both had the same [01:16:55] goal and it did help the fact she’s a dentist. She. She could see the. No one can see the future. But [01:17:00] you can.

Payman Langroudi: Yeah, yeah, yeah.

Afzal Haque: You can aim for the same thing. And that’s what I feel. She has a [01:17:05] great skill in. But, um. Yeah, because I wanted to give up. She, you know, she [01:17:10] see me, she goes, but you’re not here. She’s your present, but you’re not present. So the kids were going swimming [01:17:15] and I’m on my phone trying to answer emails or and she’s like, this is [01:17:20] this is why I moved to Liverpool in my final year. She kicked me out pretty much. She said, you’re not no [01:17:25] use to us here. And you know, you used to yourself over there because I’m falling behind on projects. I’m not getting [01:17:30] deadlines done because I’ve got a commute. I’ve got to see my practice. I’ve got to I wasn’t I wasn’t meant [01:17:35] to work in that in those three years, but I did.

Payman Langroudi: And were you coming home at the weekends. At that point.

Afzal Haque: So [01:17:40] every day I would leave at 6:45. So before the kids were up and I’d come [01:17:45] back about 8:00 after the kids were asleep. So the first two days never saw them. So. And I’d [01:17:50] work on a Saturday.

Payman Langroudi: Even though you weren’t supposed.

Afzal Haque: You weren’t supposed to. So I came back to Manchester [01:17:55] on a Friday night, Saturday morning in my clinic for half a day till about 2:00. Then I saw the family, [01:18:00] and then Sunday I would get back to my books. So they’d be all going swimming lessons and everything. I’d be [01:18:05] missing it. And the odd time I did turn up, she’s like, you’re not here. So in the final year, when [01:18:10] I really needed to tighten everything, she’s like, right, you’re out of here now. She goes, we’re gonna go and find a flat. [01:18:15] So we went to Liverpool. She, um, in the summer, we found a flat where [01:18:20] I’d be self-contained off to share with anybody. Just got somewhere to put your head, eat your food, [01:18:25] get to university. And literally five minutes from the university walk. And she sent me on my way. So I used to go on a Sunday [01:18:30] night and come back on a Saturday morning. I wasn’t even allowed to come home on a Friday [01:18:35] night. Yeah. She was like, get your work done. So she goes, oh, [01:18:40] I don’t think you need to come back on Friday night to see us. I’d rather you come back on Saturday morning, go straight [01:18:45] to the clinic. Do that and then afterwards give us all your time. So Saturday afternoons [01:18:50] and Sunday morning breakfast time, I would be with them. And then on Sunday afternoons, [01:18:55] about three, 3 or 4:00, I’d go back because you want me back. Go to go back early so I can settle in, do [01:19:00] some work and get ready for the week.

Payman Langroudi: So that much work.

Afzal Haque: There’s a lot of work.

Payman Langroudi: So homework. [01:19:05]

Afzal Haque: Yeah. Because the course is at doctorate level. So you’ve got em condense [01:19:10] you’re researching. It’s very research heavy. It’s not it’s not hard. [01:19:15] It’s just a bigger project. So it had multiple things to do. Then there’s the your [01:19:20] own admin. You’ve got to do all your letters. You’ve got to do everything. Then you know, your audits, your, [01:19:25] you know, revising. And my colleagues, the three guys I was with, they’re all Liverpool [01:19:30] based, you know, Amar, Nick and Mustafa, they’re all Liverpool based. I’m the only one in Manchester. [01:19:35] So when they’re going for the exams, I’m not there. And [01:19:40] you learn in a group. It was much more beneficial to learn as a group. So being there was [01:19:45] important. So yeah.

Payman Langroudi: I think we all know bits of the Dental course we change. [01:19:50] Yeah, yeah. Are there bits of the endo training you would change because, you know, I’m sure, I’m [01:19:55] sure you’re a goddamn expert at the your doctorate thing. Yeah, but [01:20:00] is it is it too much? Is it, is it, is it stuff that they don’t teach you that they really should? Yeah. [01:20:05] Like, you know, like in an ortho morph, they don’t teach any clear aligner at all.

Afzal Haque: Yeah, yeah. So [01:20:10] in terms of endodontic, if I was going to change, change the course, I think it’s got, I mean we were very [01:20:15] lucky we got to place implants. Whoa. Yeah. So faddy. Um, I’ve got a lot [01:20:20] of, lot of time for faddy. Um, our program director, he created [01:20:25] the course so we would place implants, and I thought that was very beneficial at the time. Thinking I’m doing endo. What am I doing [01:20:30] implants for? But it was good to understand the other side of it. And I think, I don’t know where that element is still in in. [01:20:35] The course. But some element of that adding to specialist training would be brilliant because [01:20:40] you get to see the other side and also it doubles up your surgery experience as well. So so it was really good. So [01:20:45] he made sure that we did endo surgery and we did implants and we restored our implants. So [01:20:50] endodontics is an offshoot of restorative dentistry. So [01:20:55] to be a good endodontist, I think you need to be a good restorative dentist first. So in Liverpool [01:21:00] we were very lucky. We restored all our teeth. We did a lot of added dentures. I [01:21:05] understood how the, you know, the occlusion works because that was part of the [01:21:10] overall restorative training as well. So we although we did lots of nearly 200 endo cases, um, [01:21:15] maybe more, but a lot of focus was on restorative. So would I change [01:21:20] anything at the moment I keep that, uh, the implant element in um, I doing [01:21:25] a doctorate or doing a master’s. I don’t think it makes much difference [01:21:30] in terms of getting on the specialist list. It just is a bigger project. Um, how? [01:21:35] Having said that, it opens more doors up later.

Payman Langroudi: Mhm.

Afzal Haque: And I think [01:21:40] it has for me, especially because, you know, in terms of teaching and all that kind of stuff, it’s it’s been [01:21:45] very, very beneficial to have it at the time, I hated it. Just, just hated it. Just wanted to just, you [01:21:50] know, rip it up and throw it in the bin. But you don’t realise at the time. But [01:21:55] afterwards when you reflect, you think, yeah, it was a hard three years. Well, nearly four years. [01:22:00] Um, because um I had to take an extension to, to hand in my [01:22:05] doctorate, which is quite common, but it just means you don’t finish on that third year. [01:22:10] You’ve still got to do a bit more work, but then the world of work starts and you come out, you come out without a job.

Payman Langroudi: Um. [01:22:15]

Afzal Haque: Although it’s not like medicine or even the orthodontists, [01:22:20] they come out and there’s awful practices where, you know, they’ve got contract, they can get a job. Who’s going to send [01:22:25] you endo?

Payman Langroudi: From the beginning you weren’t working.

Afzal Haque: So, so I, I obviously I’m the lucky one because I had my own practice. [01:22:30] So I was building a little bit of referral work there, but not a lot. So I came out [01:22:35] and was like, right, I’m a fully fledged endodontist. No work or very little. I’ve got [01:22:40] half a day a week.

Payman Langroudi: Yeah, that’s.

Afzal Haque: Not gonna support the family. So I had to still do a bit of general. I had to carry on doing [01:22:45] a bit of general dentistry. Yeah. And then I managed to work [01:22:50] at another practice not far from where I live, just to kind of, um, help them out. And [01:22:55] that gave me a little bit of more income. I taught at Manchester as well at the university. That wasn’t [01:23:00] great financially, but it was something to do. But you don’t get told all these [01:23:05] things, you know, you think you’re done, you go straight into a job. No.

Payman Langroudi: It’s I was saying.

Afzal Haque: Yeah, [01:23:10] you’ve got to create your own brand essentially. So why would someone refer to me? You [01:23:15] know, what is it about me? So that’s how the journey has come. Now five, six [01:23:20] years on, you start to see the benefit of all that hard work. You don’t see it straight away. And this is why I respect [01:23:25] people like Sanj, because Sanj is 2030 years of [01:23:30] that.

Payman Langroudi: Yeah yeah yeah.

Afzal Haque: So everything is hats off to him. You know he deserves. [01:23:35]

Payman Langroudi: He’s the Don in the North.

Afzal Haque: Yeah. He deserves the utmost respect because he put in the hours. [01:23:40] You know, he left his kids to go and teach and and lecture and etc. [01:23:45] and all that kind of stuff. Um, and that’s how we built a successful business. So [01:23:50] we’re not reinventing the wheel here. It’s like any business [01:23:55] or any sort of, um, entrepreneur, if you like what they [01:24:00] do. Copy it. Yeah.

Payman Langroudi: Yeah.

Afzal Haque: There’s, there’s no, there’s nothing amazing about it.

Payman Langroudi: We [01:24:05] like to talk about mistakes.

Afzal Haque: Yeah, yeah, yeah.

Payman Langroudi: What comes to mind if I say so? Clinical error.

Afzal Haque: So. [01:24:10] Well, do you want to do any mistakes or do you want to do either. Right. We’ll start with random mistakes. [01:24:15] Well there’s not one procedural error that I’ve probably not done.

Payman Langroudi: Yeah.

Afzal Haque: And I think the best endodontists [01:24:20] are made the ones who’ve done the most mistakes because then you know how to fix that. [01:24:25]

Payman Langroudi: Yeah.

Afzal Haque: So broken files. Everyone does it. Everyone does it. I broke a [01:24:30] file. Now, this. This is a true story in a tooth of a patient that I was seeing in my own [01:24:35] practice when I was a general dentist years ago. Patient was nice. Very, very [01:24:40] okay. Okay. And then that tooth over years was [01:24:45] fine. And then eventually started to get problematic. Patient was getting pain. Discomfort [01:24:50] started to get a bit upset. The patient now and everyone looks at, oh, there’s a file broken in that [01:24:55] tooth and in that, in that root. And that’s where the infection is from. Luckily, I [01:25:00] was able to remove it because I had the training. Many, many, many years later. So [01:25:05] I got away with that one. Um, but and I managed to get it out retreated and the patient’s fine, [01:25:10] but that is a common.

Payman Langroudi: Why does a broken file cause pain?

Afzal Haque: It’s not the file. And [01:25:15] this is what I try and get out to people a lot and patients that come in. Oh you broke a tool. Tool. I [01:25:20] left a tool on my tooth. I’m like, let’s take it back a bit. It’s [01:25:25] not the the tool or the file that causes the infection. It’s the bacteria that’s left [01:25:30] around it. So the way.

Payman Langroudi: You can’t fill.

Afzal Haque: You can’t fill around, you can’t clean around it. So the way I describe [01:25:35] it to patients, because that’s part of the consent process is that if especially a particularly curved tooth, we’re going [01:25:40] to mention it. I’m going to mention in most teeth, but I will mention that there’s a chance of separation of [01:25:45] a file and what that may mean it might alter the outcome. And [01:25:50] I’ll explain that if it happens early on in the treatment, it’s more of an issue because I’ve [01:25:55] not had the opportunity to clean. But if it happens towards the end, you can just fill it. And majority of the time it’s not going [01:26:00] to be a problem. So it’s not a negligent, it’s a procedural error. Um, there’s [01:26:05] ways of trying to avoid it by taking your time using small files, bringing, you know, [01:26:10] getting the shape bigger slowly. But if it does happen, first of all, tell your patient. [01:26:15] Second of all, don’t panic. Sometimes if you’ve cleaned it well, it’s [01:26:20] going to be fine. If you can see it, you can retrieve it generally. But if it’s [01:26:25] around a curve, you’ve got to think about is it worth doing that?

Payman Langroudi: You see it with your microscope?

Afzal Haque: Yeah, I can see with microscopes. [01:26:30] Generally, generally the rule is I would definitely attempt to retrieve it, but it’s around a curve. [01:26:35] There’s no chance of getting that out. So it’s not the file, it’s the bacteria around it. I will just try and irrigate as much as I can, [01:26:40] activate the Irrigant try and get as much around that file as possible. Trying to see if I can um if [01:26:45] reduce the bacterial load and eventually hopefully it will settle because it’s [01:26:50] about reducing the overall bacteria and the immune system will do its [01:26:55] bits as well. So I don’t see that as a problem. But that’s one area we talk. Perforations happen a lot. [01:27:00] And I think back in the day I would just get a big, big, um, diamond burr, [01:27:05] take it into the cavity and it’s just sank a bit too far and [01:27:10] you see bleeding. What’s that. You’ve just gone straight through the middle of the tooth. So [01:27:15] that could be avoided now by using these end cutting burs. I didn’t have them at the time. I didn’t have [01:27:20] any sort of, um, understanding of it at the time. So that’s, that’s one error. Um [01:27:25] let’s talk about a non Indo error.

Payman Langroudi: So but what [01:27:30] about an Indo era where it went wrong with the patient.

Afzal Haque: Um I’d be [01:27:35] very lucky I’ve not had that because I feel I communicate quite well. Yeah. And I think that I’ve [01:27:40] had one patient where it went a little bit funny, but we managed to deal with it. I ended up giving [01:27:45] giving them the money back. But let’s talk about that one. So it [01:27:50] was a patient where I did endodontic treatment and it just never settled. Six months [01:27:55] later, he went to see another dentist and it was an upper six. It looked fine on the radiograph and [01:28:00] it was um yeah, they still had a lesion on the tooth. The dentist decided [01:28:05] um I need to take the tooth out, but what the, what the comment that they passed on to the patient [01:28:10] was, oh this tooth has an mm two which it has not been filled.

Payman Langroudi: Mhm. [01:28:15]

Afzal Haque: And I was like fine. And then I was a little bit shocked about that. Got [01:28:20] this big letter from the then from the patient. Um, what are you going to do about it? I’ve had to [01:28:25] endure all this, which is fair enough. Um, when I looked back at the notes I thought, he’s [01:28:30] in here. He was in the letter. He was saying another dentist who has not got the speciality you’ve got [01:28:35] seems to spotted there was missed me too. Why have you not done this? Then I went back to my notes [01:28:40] and I read my notes. I looked at radiographs and I said, there is an MM2 there and I have filled it. So what had [01:28:45] happened? The dentist who made that comment had taken an X-ray at an angle where the [01:28:50] MM2 and mm one superimposed over each other. He’s not seen it. And I’ve seen my [01:28:55] radiograph and I’ve taken different angles. There is an MM2.

Payman Langroudi: Filled.

Afzal Haque: Filled. [01:29:00] There is a slight difference in it because the contrast of the MM2 is slightly [01:29:05] different to the. Mm one because the it was a challenging [01:29:10] one. And um I think the apex was slightly a bit more wider than, than um [01:29:15] I would have expected. So I filled the failed majority of that with Bioceramic. So it’s there, but it’s [01:29:20] got a different contrast. So when I read the notes, I said, well, it has been done. It’s just unfortunate. [01:29:25] It’s one of those what we call 20% that won’t work. I wrote back to the [01:29:30] patient and explained that this this is what’s happened. Um, it has been filled. [01:29:35] Unfortunately, I had to write that, you know, sometimes if you’ve not got a trained eye or you’ve taken [01:29:40] an X-ray, a different angle, you may miss it, but it’s just unfortunate that it hasn’t happened. He started to get [01:29:45] all very, very upset about it. Oh no, no, no, you’re wrong. You’ve not done it [01:29:50] right. And I was like, look what’s going to make you happiest? And he was like I said, if [01:29:55] I gave you all and gave you your money back with that, would that please you? He said, yeah, [01:30:00] that’s the least I want. So we just, we just ended it there. Um, it could have got worse. Um, [01:30:05] but then I think the learning point from that was not to be aggressive [01:30:10] back. Yeah, yeah. It’s like, you know what, if that’s what you want, leave it. You know, you’ve done it right. Um, I [01:30:15] got my indemnity involved and even they took my point on [01:30:20] it because they weren’t an endodontist they, they couldn’t see what I had done when they read the notes like, ah, now [01:30:25] it makes sense. So if you want to fight it, you can fight. I’m not gonna, I don’t want to. Let’s just deal with it. Move on because [01:30:30] yeah, £1,000. It’s it’s not not the end of the world. [01:30:35]

Payman Langroudi: It doesn’t tend to be the money. It’s the point. Yeah.

Afzal Haque: It’s not the money. No you’re right. It’s, [01:30:40] it’s more like, how dare they not, you know, say what they said.

Payman Langroudi: Also [01:30:45] it’s, it’s like, you know, like your intent was absolutely right. 100%. Your treatment ended [01:30:50] up being absolutely right. Yeah, yeah. And the guys kind of said, well, that’s the question that that’s. [01:30:55]

Afzal Haque: The learning point from that is that no matter how well you do the treatment, sometimes things don’t go well. And that [01:31:00] happens a lot. So you call that a mistake? I don’t think it was it was a mistake. But it was it was an an [01:31:05] interesting moment. The more mistakes I’ve had dentistry where patients have actually gone on to take it [01:31:10] further, more when I was a general dentist. So I had a patient, um, This is going back. It was 2008. [01:31:15] It’s going back a while. I got married in 2009 and she was [01:31:20] a new patient. Lots of perio. Um, and had a problem with an upper six [01:31:25] heavily, heavily filled and came in with an abscess, like a big facial [01:31:30] swelling. And we ended up extracting the, the upper six. So the upper six got, got extracted [01:31:35] and then for months I didn’t see her. And then one day [01:31:40] I got a letter from her and the letter said that she’s been in hospital, hospitalised, [01:31:45] have multiple sinus infections, has had to have surgery, etc., [01:31:50] etc.. I was like really shocked at this, like just a routine extraction and this is the way it’s gone. And [01:31:55] I remember at the time I was very cautious, checked for OAC, all that stuff. And it’s been [01:32:00] a long, long time since it happened. And then she got, she, she went further with it. And [01:32:05] this is around the time I was getting married and it really put me off, really [01:32:10] knocked me because I’m not. I’m 2006 graduate. 2008 is happening. I’m thinking, have I got a career now? Yeah, [01:32:15] yeah, I’m getting married literally in a year’s time.

Afzal Haque: Yeah. I’ve got to provide for the family. I’ve got to do this. [01:32:20] What happens at this point anyway? It got resolved through through protection. Dental [01:32:25] protection. Um, but what the outcome was, it was a very rare issue [01:32:30] with a very routine treatment. So they couldn’t they were like, we don’t [01:32:35] even know what’s happened. Anyway, the patient got what they needed. But that [01:32:40] was the, the start of like, let’s become better. Let’s [01:32:45] become better. Let’s learn from it could go the complete opposite way. I remember I got married on the, on, [01:32:50] on the Saturday and on the Monday because I didn’t we didn’t go away on our honeymoon straight away. We [01:32:55] left it a few weeks and on the Monday I was having a meeting with that lady. And [01:33:00] I remember seeing her. I just just got married. And I’m dealing with this. No, it’s your fault. It’s your fault. It’s your fault. We’re [01:33:05] going to take it further anyway, I think it’s important that. And in [01:33:10] many ways I’m so glad it happened. Not not that the patient suffered. That issue happened [01:33:15] with me because it built resilience. Like, do you know what? That’s why we pay our indemnity. [01:33:20] Yeah, yeah. I pay you to deal with the problem. I [01:33:25] think if you have that philosophy, then as long as you know in your heart you’re doing everything right [01:33:30] and you’ve done the best and most of us will will do that. What’s the point [01:33:35] of worrying?

Payman Langroudi: Oh, man. And we’re human. Sometimes we won’t do everything right.

Afzal Haque: Let [01:33:40] the lawyers deal with it.

Payman Langroudi: Let yourself off that. Yeah. That fact. But sometimes in a long career. Yeah, yeah, [01:33:45] there’ll be a mistake somewhere.

Afzal Haque: And you take it so personally.

Payman Langroudi: Yeah.

Afzal Haque: That’s the problem. And I think [01:33:50] I’ve become a little bit more thick skinned as time has gone on. But that’s only experience. That’s not my my nature is to still [01:33:55] be upset if someone doesn’t like you. I don’t like that. Of course I don’t like that. I don’t [01:34:00] fall out with people.

Payman Langroudi: Of course.

Afzal Haque: Um, that’s just my nature.

Payman Langroudi: You’re in high end private where? It’s [01:34:05] a yes business.

Afzal Haque: Yeah.

Payman Langroudi: Trying to make people happy.

Afzal Haque: It’s a show business [01:34:10] in many ways, and we have to make good relations. And if somebody doesn’t like [01:34:15] you, it does bother me. So there is a part of that where I still probably will be bothered to a certain degree, [01:34:20] but then I’ll be like, well, this is why we have this service. And and they do a great job, so [01:34:25] let them deal with it.

Payman Langroudi: Would you be happy for your kids to become dentists?

Afzal Haque: Would I be happy? I wouldn’t have any objection [01:34:30] whatsoever. Um, I mean, it’s a cliche to let them do what they want. That is part of it as [01:34:35] well. But some of my kids may not be cut out for it.

Payman Langroudi: Yeah. [01:34:40]

Afzal Haque: So so whatever suits them, if they came to me tomorrow and said, dad, I really want to be a dentist, I said, well, [01:34:45] go as far as you can go. I have no objection. Any career because I honestly believe you’re [01:34:50] in charge of your your destiny. Really, if you want to be the best doctor, [01:34:55] the best marketer, the best banker, best dentist, [01:35:00] just aim for the stars.

Payman Langroudi: Problem is, a lot of times kids don’t know what they want.

Afzal Haque: That’s the problem. [01:35:05]

Payman Langroudi: They come to you.

Afzal Haque: Yeah, yeah. And it’s always you.

Payman Langroudi: Would you, would you advise dentistry?

Afzal Haque: Yeah. I [01:35:10] would say yeah. I say it’s a good profession. It gives you stability. But that’s the problem. [01:35:15] Everybody will only would advise what they know. Yeah. It’s like someone comes up to me [01:35:20] and said um would you be a specialist? Endodontist. Well, yeah, of course. [01:35:25] Yeah.

Payman Langroudi: But I’m asking everyone though. Yeah. How long before robots do dentistry?

Afzal Haque: I [01:35:30] think it will happen, but it’s not going to happen in our lifetime, I don’t think. I [01:35:35] don’t know, I just I just feel there’s that human element of, of, of treating [01:35:40] patients.

Payman Langroudi: The social.

Afzal Haque: Emotional element.

Payman Langroudi: You can have a person [01:35:45] who’s not a dentist.

Afzal Haque: I, I, yeah, no, I see what you’re saying, but I think a lot of patients, I think a lot of patients [01:35:50] may not, may not accept that at this moment in time, having treatment done by a robot. Why? [01:35:55] Because they want to speak to somebody. They want someone to TCO.

Payman Langroudi: Like the TCO could be the [01:36:00] most charming person.

Speaker 4: Yeah, yeah, yeah.

Afzal Haque: I don’t know, I don’t know, I know what you’re trying [01:36:05] to say, but I just I just feel there’s a.

Payman Langroudi: Lot of people, a lot of people think, what do you think?

Afzal Haque: I still think that there’s an element [01:36:10] of a human to do treatment and to speak to people. And would I want that [01:36:15] for myself now? Difficult for me to answer that because I know about the industry, but I wouldn’t.

Payman Langroudi: Speak to him. [01:36:20] There’ll be humans there, just not dentists.

Afzal Haque: But they I don’t know whether they want someone to actually do the treatment [01:36:25] for them or not. I think it could happen. I think it could happen. It’s a difficult one, isn’t it? Um, but [01:36:30] it is going that way. It’s just I would I want a robot to do my leg [01:36:35] surgery, for example.

Payman Langroudi: What if he’s better than the human?

Afzal Haque: Like, how do I know that?

Payman Langroudi: Because he will be by that [01:36:40] time, isn’t he? Yeah.

Afzal Haque: Well, I think until we know that. Yeah, I think I know I’ll reserve my judgement until I know that [01:36:45] if I know they can do multiple procedures perfectly.

Payman Langroudi: Then let’s face [01:36:50] it, then the way they’ll be, the way it’ll be will be that the ender will be done much [01:36:55] better than what you’re doing, because it’ll be the world’s best. Endodontists will train the [01:37:00] model. Yeah, yeah, that’s.

Afzal Haque: Yeah, well, if that happened, I’m out of a job [01:37:05] at that point, and hopefully I’ll be dead before.

Payman Langroudi: My kids saying she was [01:37:10] a dentist. She’s 15. Yeah, that means eight years time she’s going to be a dentist. Yeah, [01:37:15] it is a long time.

Afzal Haque: It is a long time.

Payman Langroudi: Ai and robotics.

Afzal Haque: I know, I know it’s [01:37:20] you know, you’re right. It’s scary how quickly these things are moving on. I suppose I’m not giving it much [01:37:25] thought. And I’ve always kind of maybe may have been maybe.

Payman Langroudi: In a Waymo like a driverless car. [01:37:30] I mean, they’re all over London.

Afzal Haque: At the moment. I wouldn’t I like to drive [01:37:35] my own car though.

Payman Langroudi: But driverless taxi.

Afzal Haque: Yeah. Again I have to be proven [01:37:40] that it’s it works and it’s fine.

Payman Langroudi: But that’s easy to prove.

Afzal Haque: Yeah. I suppose I wouldn’t have [01:37:45] any any problem with that. I suppose I wouldn’t have any problem with that. But I don’t know when it comes to the human, when it comes to. [01:37:50]

Payman Langroudi: What is it, what do you think the magic outside of the social which will take care of. We’re talking [01:37:55] a brain. The brain’s already unbelievable. Yeah, you’re talking AIS. They can sort out X-ray vision. [01:38:00] Amazing AIS. And then you took your hands. Or you don’t think they can improve on hands?

Afzal Haque: Yeah, I suppose they’ll be able to do [01:38:05] it. Well, basically, I may as well give up right now. Let’s end this podcast. I’ll [01:38:10] retrain on something else.

Payman Langroudi: It’s been a pleasure having you, man. We’re gonna end with [01:38:15] the usual question that I asked. It’s been great about a fantasy dinner party.

Afzal Haque: Yeah.

Payman Langroudi: Three [01:38:20] guests.

Afzal Haque: Okay.

Payman Langroudi: Dead or alive, who are you having?

Afzal Haque: So, first of all, I’ll. I’ll always [01:38:25] have my dad. My, my, my dad has been brilliant for me all through my life. Is [01:38:30] he still with us? He’s still with us? Yeah, he’s still with us. You’re not my father. Right? Fine.

Payman Langroudi: If he’s still [01:38:35] with us.

Afzal Haque: He is still with us, actually. But, um. Okay, so we’ll start off with [01:38:40] I.

Payman Langroudi: Your wife or your kids, or.

Afzal Haque: I will start off with Sir [01:38:45] Alex Ferguson. All right, so I’m a big United fan. Yeah. And. [01:38:50] I’d love to know about his man management, how [01:38:55] he.

Payman Langroudi: Have you read the books?

Afzal Haque: I do, I haven’t, but this must be amazing. I actually have one [01:39:00] of my things I would like to do.

Payman Langroudi: I absolutely don’t care about football, but if I did, I would definitely be. I’m thinking [01:39:05] about reading them even though I don’t care about them.

Afzal Haque: You know, it’s something that I probably probably would be a really good.

Payman Langroudi: Business.

Afzal Haque: Book. Yeah. Um, [01:39:10] but it’s just how to manage people because that’s what we do day to day is how has he got the best out of people? [01:39:15] I mean, we have our own ways of getting the best out of people. But this is how Alex Ferguson, you know, [01:39:20] he won so much with United. Um, so I definitely would like to have him there. And I’d like to also know [01:39:25] from him what actually happened with David Beckham, what actually happened. What was the real reason [01:39:30] that you that that you got him out of the club? But yeah, so Alex is definitely one [01:39:35] of them. Um, the next guy I would have, the next person I would have, it would [01:39:40] have to be. And only because I followed this chap as a tennis player, Roger [01:39:45] Federer. Oh yeah. Yeah. So I used to play a lot of tennis when I was, when I was younger. And I played for, [01:39:50] for, for a local club. Just junior level. No no no no nothing. Nothing. Amazing. Um, just [01:39:55] sorry, not junior level club level, But ephedrine would be, what, maybe 18 months, [01:40:00] two years older than I am right now. But at the age of when I was about 12 or 13, [01:40:05] I remember someone in the club talking about, oh, there’s this junior coming out [01:40:10] called Roger, Roger Federer from Switzerland. He was about 14 or 15 at the time. I remember we we saw [01:40:15] we saw some saw, saw some video about him or we heard something about him. And he was in my mind from [01:40:20] that day forward. So a lot of people following him. Yeah. So a lot of people followed him, you know, once he’s become successful [01:40:25] and I knew about him. So that iconic, um, match that he, [01:40:30] he played at Wimbledon in, I think it was the fourth round or quarterfinal [01:40:35] maybe in the fourth round against Tim Henman where he beat him. But that was [01:40:40] the coming of Roger Federer, because I think the next year he came back and he won the tournament. Um, [01:40:45] so I’ve always followed him. What I like about him is just he makes tennis [01:40:50] look so lovely.

Payman Langroudi: Yeah.

Afzal Haque: And if [01:40:55] I would like to be like him in my profession, I was like, I don’t want to make want to be as [01:41:00] finesse and beautiful in my work as as he makes tennis [01:41:05] look and a gentleman family man and reached [01:41:10] the top of his game. So he was he definitely be the the one [01:41:15] that I’d have.

Payman Langroudi: And both of those two have come on dinner parties on this show. [01:41:20]

Afzal Haque: Have they?

Payman Langroudi: Many times.

Afzal Haque: Oh gosh. Um and he would be the last one. Um, [01:41:25] I mean it’s hard, it’s hard to hard to pick, pick the last [01:41:30] one. Um, but I’m gonna, I’m gonna mention [01:41:35] this, this chat and I don’t think anyone probably has mentioned this, but I’m a big United fan and I [01:41:40] grew up in Manchester. I went to school in East Manchester as a, as [01:41:45] a primary school lad, where I went to a predominantly white school working class area, and [01:41:50] I was the only coloured lad in the not in the class in the school. The reason I went [01:41:55] to that school, because my dad taught in the feeder, um, secondary school. So it was easier for him in those days [01:42:00] we got in. But my favourite footballer of all time is not going to be your obvious guy is [01:42:05] Andy Cole. Oh, Andy Cole is my favourite footballer of all time. And [01:42:10] one of the main reasons is, is that when he came on the scene when he signed for United, I think it was 95, he [01:42:15] he’s off colour and he helped [01:42:20] people like us when we were the only coloured lad in the class. We’re all playing football, we were all playing [01:42:25] football and we all want to be a player. We all want to be Eric Cantona or or so on. And [01:42:30] I was Andy Cole, I was Andy Cole and and and I played the striker [01:42:35] like he did. And he did wonders for I wonders for [01:42:40] for United. And I think.

Payman Langroudi: Did you suffer with racism. Yeah. In school.

Afzal Haque: At primary school a [01:42:45] lot a lot. So like like I mentioned, I was the only coloured lad in that school [01:42:50] and my, it was convenient for my father to send me to that school, but I. I’d have assemblies [01:42:55] on who I was because the kids [01:43:00] in the school did not did not understand what why I was brown. I had, [01:43:05] um, kids come and say to me, um, why? Why have you got chocolate on your face? Why don’t [01:43:10] you wipe it off? Or why are you brown? And why are we not and make some [01:43:15] silly remarks. And I remember it wasn’t until my brother joined two years later that [01:43:20] things got a little bit more normal, and then more kids. And there was a local pharmacist whose son [01:43:25] joined, but we would have little scraps at school, my brother and myself. And um, [01:43:30] we would, um, get called and we’d have to have an assembly. Like he is no [01:43:35] different to the rest of you. And that happened a lot in primary. Yeah. I, it didn’t, it didn’t bother me [01:43:40] so much.

Payman Langroudi: In school at that sort of age. All you want is to fit in.

Afzal Haque: Yeah, absolutely.

Payman Langroudi: And if you’ve got this [01:43:45] obvious reason why you’re not fitting in, absolutely. You can put it like a.

Afzal Haque: Massive, massive.

Payman Langroudi: Do [01:43:50] you think do you put your success down to surviving that? I don’t.

Afzal Haque: Know. I suppose at the time I didn’t take much notice [01:43:55] of it. Um, because, because, because my dad worked in a, in a similar environment, he was fine. He [01:44:00] just said, oh, just, just forget about it. But then sporting heroes, like at [01:44:05] the time, Andy Cole for United, there was Paul Ince, they, they played, played for my favourite club. [01:44:10] Um, not long after Prince Naseem Hamed came on the scene in boxing. I’m [01:44:15] a big boxing fan. I love boxing and, and he put us people of a similar colour on the map [01:44:20] and. Yeah. So these things made a difference. But no, it didn’t bother [01:44:25] me that much. But when I went to high school, I went to a very mixed high school. So the high school I [01:44:30] went to was closer to where I lived. So the primary school was further away because that was my dad worked, [01:44:35] but high school was closer to our family home, and we live in a very multicultural area. And [01:44:40] I found that bizarre, how we’re seeing people that look a bit like me and all different [01:44:45] walks of life. It was brilliant. So I don’t think it made much difference [01:44:50] because since then, since leaving that premise, I’ve never had. I can honestly say I’ve never had any problem with this. [01:44:55] Um, I know some people have, but I’ve never been, um, a victim [01:45:00] of that and I don’t think it’s ever held me back. Um, whether I can see it, I don’t [01:45:05] know, but I don’t feel it has.

Payman Langroudi: I mean, I wasn’t a massive fan of him yet, [01:45:10] but, um the Prime Minister was in India. Yeah, absolutely. I didn’t think I’d [01:45:15] see that. Yeah. That was, that was brilliant wasn’t it? Yeah. I did not think I’d see that. Yeah. And [01:45:20] even though I wasn’t a fan of Rishi um his policies.

Afzal Haque: Yeah. Yeah.

Payman Langroudi: I still [01:45:25] thought good on good on Britain for doing. Absolutely.

Speaker 4: Absolutely.

Afzal Haque: And I think.

Payman Langroudi: Pulling that off. [01:45:30]

Speaker 4: Yeah.

Afzal Haque: It’s important. But um yeah it did it bother me. Not [01:45:35] really. I, um, I just, I just got to be put at the front of the class in front of everybody else. [01:45:40] And I was like the sense of retention for a few moments. But yeah, so, so he’d be my [01:45:45] third call And it’s probably no one’s going to sportsmen. Yeah, because I [01:45:50] love sports. I’m a big fan. My son is into. I’m living. My wife says you’re living your childhood through [01:45:55] your son.

Payman Langroudi: Yeah.

Afzal Haque: So which I am doing, I’m not gonna I’m not gonna lie for him. He’s a he’s a really good sportsman. [01:46:00] So football, cricket does everything. And I love going around and, and watching, [01:46:05] watching. Yeah. It’s one thing I was a good cricketer, but my parents [01:46:10] were the limiting factor because what you’re going to do with [01:46:15] it, you know, you’re not going to make it. Uh, I was a good bowler. Um, but I [01:46:20] didn’t have that fan following that my son gets today. Um, and I think it’s [01:46:25] a world of difference makes all the difference. He looks out for me and when he’s done something good, he wants that acknowledgement. [01:46:30] And dad’s watching. Dad’s giving him the thumbs up. I think that’s brilliant. Um, I have no regrets. [01:46:35] And I don’t blame my parents because it’s a different era, different philosophy, different the [01:46:40] different circumstances. But if I had a chance, I would have loved to have progressed [01:46:45] a little bit further in in sports, but hey, we’ve not [01:46:50] done too badly.

Payman Langroudi: Amazing, man. I really enjoyed that. Um, [01:46:55] learnt a lot from you, man. Thank you. Um, you know what I should do? I should put out like a little if [01:47:00] you want to be an endodontist sort of like a highlight reel of yours and emsas and.

Afzal Haque: Yeah, [01:47:05] because they’re all different journeys. Yeah. All different journeys, but ended up in the same place. So [01:47:10] it’s, I mean.

Payman Langroudi: It’s a really, really, really small world. And like, you guys all know, like [01:47:15] everyone in the, in the community.

Afzal Haque: It’s a very small world. Like you said, um, there’s not many of us, but. [01:47:20]

Payman Langroudi: Mm. You know. Mm.

Afzal Haque: Yes. Yeah. Um, but the take [01:47:25] home message is, is that no matter where you started from, [01:47:30] you can do whatever you want. And I’m, I’m living proof of that. Um, you don’t have to [01:47:35] have that perfect CV. Um, you can go this route, that route, that route, whichever. [01:47:40] And life takes different turns.

Payman Langroudi: You’re very, very, very determined and and very ambitious [01:47:45] too. I was, as you were telling the story, I’m sitting here thinking, you know, you don’t have to like [01:47:50] you could have been a dentist with a bit of an interest in anything, but not a bit of endo. Yeah. And [01:47:55] continue to be that. But yeah, I want to get better at this. Yeah. Then, well, want to become a specialist? [01:48:00] Yeah. And I think they have another associate specialist working for you. You know.

Afzal Haque: I think you get one.

Payman Langroudi: Life naturally [01:48:05] to you. I think yeah, the stuff that comes naturally to us, we don’t sort of think of it. [01:48:10] It just comes naturally, isn’t it?

Afzal Haque: Well, I think in life generally you’ll be successful [01:48:15] if if you’re good at something and you take it somewhere, you’ll generally be quite good at it. And [01:48:20] the way I look at it, you’ve got one life.

Payman Langroudi: To.

Afzal Haque: Live up to. You do whatever you can. Um, [01:48:25] it’s like Anthony Joshua says, you know the boxer. Stay hungry, stay humble. Yeah. Always [01:48:30] have to be hungry. And if I was gonna give any advice to anybody is that, you know, the cliche term, don’t give up. [01:48:35] That goes without saying. But you can do whatever you want to do [01:48:40] as long as you have a focus and you know, you try and line up everything so [01:48:45] that so that you reach that goal. And if you don’t reach it, if you don’t become a specialist, you will be the next [01:48:50] level down. And that’s still very, very good. But don’t limit your ambitions. Um, [01:48:55] try to tell my kids this every single day driving when I drive them to school. Say, you’re the best. [01:49:00] You’re you’re brilliant. Touch the sky. Work the hardest you can [01:49:05] do. Just be the best version of yourself and go and win the day. That’s my [01:49:10] line to them. And when they get out of the car, go and win the day. Whatever it is, whether it’s sport, [01:49:15] your studies, you know, being the politest person, being the best mannered, doing something [01:49:20] nice for somebody else.

Payman Langroudi: You accept your dad didn’t say this or.

Afzal Haque: No.

Payman Langroudi: No he.

Afzal Haque: Didn’t. My dad was very tough. [01:49:25]

Payman Langroudi: And yet you, you you did. So maybe. Maybe you’re overcompensating, maybe I am. I [01:49:30] don’t know where I’m going, but my dad, the first time he told me he’s proud of me was when I stuck 16 veneers [01:49:35] on him, aged, aged 30 or something. Yeah. And now I tell my kids I’m proud of them [01:49:40] too much.

Afzal Haque: I think that’s.

Payman Langroudi: True. Meanings gone from it. You know.

Afzal Haque: My dad’s never said that. But but, [01:49:45] you know, he he acknowledges it.

Payman Langroudi: He boasts about it.

Afzal Haque: To other people. Well, he doesn’t even do that. He just, he just [01:49:50] he just goes, he just like, yeah, yeah, it’s fine if he gets silence from me. You [01:49:55] know, you’ve done all right. But you’re right. I think I probably overcomplicate with my kids, but do you know what I [01:50:00] think? You always try and give them what you didn’t have.

Payman Langroudi: Yeah, yeah, yeah.

Afzal Haque: And every walk of life.

Payman Langroudi: Of course it’s natural. [01:50:05]

Afzal Haque: Yeah. I mean, you educate, educate them the best. You give up whatever you can [01:50:10] to make sure they have it. And I think that’s the the circle of life.

Payman Langroudi: Thanks so much for doing this. We [01:50:15] really enjoyed it.

Prav Solanki: Thanks for listening guys. Hope you enjoyed today’s episode. Make sure you tune in for [01:50:20] future episodes. Hit subscribe in iTunes or Google Play or whatever [01:50:25] platform it is. And you know, we really, really appreciate it. If you would, um, give [01:50:30] us.

Payman Langroudi: A six star rating.

Prav Solanki: Six star rating. That’s what I always leave my Uber driver. [01:50:35]

Payman Langroudi: Thanks a lot, guys.

Prav Solanki: Bye.