This week Prav and Payman connect with dentist and dentolegal professional, Dr Victoria Holden.
Victoria lets us in on life as a moderator on one of the UK’s busiest online dental forums and shares some of her experience working as a senior advisor with Taylor Defence Services – a legal defence company representing the dental profession.
The trio also discusses life under lockdown, women in dentistry and a whole host more.
“What I tell my kids…Treat everybody equally…Don’t just take, take, take, be a giver as well as a taker. And the final thing, always brush your teeth.” – Vikki Holden
In This Episode
00.38 – Life and lockdown
08.52 – Women in dentistry
16.03 – Law
27.29 – Workflows and running a practice
42.49 – Darkest days and silver linings
50.27 – Back to the beginning
01.04 – Regulation and litigation
01.10.18 – Last day and legacy
About Victoria Holden
Victoria graduated from Sheffield University in 1999 and went on to work in general practice. She has been a partner at The Briars Dental Centre in Newbury since 2007.
Victoria holds the MFGDP(UK) Diploma in Implant Dentistry and Fellowship of the Faculty of General Dental Practitioners from the Royal College of Surgeons of England.
She earned an LLM in medical law from Northumbria University and has acted as an expert witness in clinical negligence and fitness to practice cases.
Vikki Holden: What I tell my kids, I probably say to them, just to always make sure that they are fair to everybody. Treat everybody equally. They are very lucky, and I don’t want them to forget that ever. Don’t just take, take, take, be a giver as well as a taker. And the final thing, always brush your teeth.
Intro Voice: This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.
Payman: It gives me great pleasure to have Vikki Holden on the podcast today. Vikki’s had a real varied career extending from general practise to legal. Well, we’ll get into it now, Vikki, but just tell me about lockdown, Vikki. What was lockdown like for someone like you?
Vikki Holden: Well, I really, really enjoyed lockdown actually. After the first bit of drama where we had to very quickly hibernate the practise, I actually really loved being at home with the kids. In a way, it was easier to have the practise shut. I did try quite hard initially to get systems in place so that we could have run an emergency service from here, but there was quite a few barriers put in place, quite a few obstacles, and it was difficult getting things like the PPE sorted out.
Vikki Holden: So when it just became apart that the kids were going to be at home for the foreseeable future, actually it was quite nice just to be able to leave the practise for a little while and spend a bit of time at home with the kids. And actually it’s the longest break from working on teeth that I’ve had since I’ve graduated.
Payman: Did you change something or are you going to change something going forward? Just imagine the virus disappears tomorrow, what will you do differently after lockdown?
Vikki Holden: Now I’m back at the practise, my working pattern is still the same, but the things that I probably would change are little things like the dog walker. She wasn’t able to come and walk the dogs through lockdown, so under the old ways… my husband works in London, so he’d be out most days in London and I’d be racing around between the practise and trying to do work for TDS and picking the kids up from school. So I’d never had really time to walk the dogs apart from [inaudible 00:02:42]. And now I’m out every day with the dogs, and just simple things like that actually. I think we’ll have to find a way that we can always do those things ourselves. Just simple stuff, really. Spending time with the kids, taking them down, out playing at the skate park, that kind of thing. I’ve really, really enjoyed that time.
Prav: And with your husband, saying he’s always away in London and stuff, and a lot of my friends and colleagues travel a lot for work, are things going to change for him? Is that going to change the dynamic in the home as well?
Vikki Holden: Yeah, it’s definitely. It’s been so much nicer having him around a lot more. Previously, he’d be out of the house at half past six in the morning. He wouldn’t get home till half past seven, and by that time the kids are getting ready for bed. He’s been working from home since maybe the beginning of March when I think his office closed. And I think his role is quite a global role, he doesn’t do a lot of travelling, but he does-
Payman: What does he do, Vikki?
Vikki Holden: … what does he do? He’s like a CRO for a company called Willis Towers Watson, and they’re based in London, but well, they’re an American company. They’re a global firm. They’re an actuarial company. Willis is an insurer, so it’s real corporate financial world really, and at the moment he’s heading up a project, overhaul their IT systems and the platform that they use for [inaudible 00:04:10]. So he’s not a fund manager, he’s not got a job like that, he’s really just an operations guy.
Payman: What’s your arrangement at home? You own a practise, you’re partnered in a practise, you’re doing all of this defence stuff with Taylor. You’re one of the moderators on the Dentist UK site, is that right?
Vikki Holden: Yeah.
Payman: You’re a busy person, and you’ve got two young kids. How old are the kids?
Vikki Holden: Well, one’s nearly 10 and the other one is eight.
Payman: So what are the arrangements? What’s your typical week like? How many days do you work?
Vikki Holden: So I’ll be at the practise four days a week, and the way that the hours are structured is that I’ll have a little bit of time doing the clinical stuff in the morning, have a big window in the middle of the day for dealing with work that I’ll be doing for Taylor Defence Services, see patients again in the afternoon, and then pick up the kids. So the kids, they’re quite lucky. They go to a nice school. It’s a private school. I can drop them off just down the road. They get a minibus to school at about half past seven, and then I pick them up at half past five. So the biggest issue, I think, when you’re a working mom, is childcare. So that system, I’m not particularly one of those people who go, oh, my children must go to private school to get the best education. It is really something that’s driven out of a need for childcare because it’s quite difficult actually getting wraparound care when you’re children are at school.
Vikki Holden: And I will say, wanted to be the person who drops the kids off at school, I wanted to pick them up from school. I don’t want to have to rely on nannies. So I live quite close to the practise, that’s great. I’ve also got the job working with Taylor Defence Services where I literally just need my computer and a phone to do that. So those things fit in quite nicely really. I limit the time that I spend on social media to about 15, 20 minutes a day. I don’t spend a lot of time on Facebook for various reasons. So that part of it doesn’t take an awful lot of time really.
Payman: Can you moderate that forum in 15 minutes a day?
Vikki Holden: Well, people might say that it’s not maybe a very well moderated forum. That is one of the criticisms that comes up and that’s maybe the reason why. But I’ve done a lot of moderating since about 10 years ago. Tony Jacobs GDPUK forum. So I’ve been involved in that for quite a while actually and I think generally people behave okay on the forums. There’s not that much stuff that needs moderated. You might get a notification that pops up that somebody’s offended by a post or there’s something that’s inappropriate, somebody that’s self-promoting their own causes a bit too much, or whitening is being promoted and unfair to other companies, et cetera. And we tend to deal with those and then move on really. It doesn’t take a lot of time. I’m not really one for sitting on Facebook, scrolling, scrolling, scrolling, scrolling, scrolling through the threads. I’ll go on, have a quick look, see if anything’s been flagged up on the forums, and then off.
Prav: Do you think that being a woman in dentistry is more difficult, being a mom?
Vikki Holden: No, I don’t think it does actually. I think dentistry is quite a good career choice if you want, because I think the main reason is that you get the option to work normal hours. It is a very nine to five job, and then you might be doing a bit of admin or treatment planning or courses outside of working hours. It’s not as difficult as say, if you were a barrister or something and you’ve got long hours in London or in court, or a doctor where you’re having to work shift patterns. I think those things could be really difficult. But I think dentistry, it does lend itself quite well actually to being a working mom, as long as you can get the childcare issues sorted out around school.
Vikki Holden: And obviously we’re quite lucky in the situation that we can pay to put our kids into a school that helps with that. That might be a bit of a challenge for some people, I’m sure. And there’s been times actually in the past where before I moved the children to that school and they were in the village school, because we didn’t have any childcare, I was literally having to condense my working days into nine till half past two so that I’d be the one that was having to pick them up. And that was where I just thought this is just ridiculous that I’m having to do this. My own staff managed to arrange the childcare, I’m struggling with it, but it’s just living in a little village out in the middle of nowhere. There’s not an awful lot of childcare around really.
Payman: This question of women in dentistry is coming up quite a lot recently. I’ve noticed when it comes up, you’re vocal on the opposite side of the argument, saying, look, I’ve never had any problems as a woman. What you just said, that you think that it’s a good career for women and all that. And why do you think it’s a thing that’s coming up now and where do you think there are the disparities? And certainly I can say myself there aren’t enough women lecturers. But do you think the way to handle that is to positively discriminate or are you one of those who says that’s definitely a no-no?
Vikki Holden: Do you know, I think this topic, it’s…
Vikki Holden: It’s so complex. And I don’t profess to know enough about things, really, to maybe give the right view on this. But from my point of view, I want to be able to be in a position to see my kids grow up. I don’t want to give over my whole life to some of the things that happen in dentistry. I know you’re probably referring to the topic conversations to why are there no females on the executive board of the BAPD. That is something I know that they tried very hard, actually, to positively engage women into those roles, and I was asked. I just said, look, no, I haven’t got the time for this. I didn’t want to do it purely from putting the brakes on how many things I’ve got going on in my life. There has to be a line drawn somewhere. It’s the amount of time that you give up, and these things can be quite time consuming.
Vikki Holden: I personally have never felt discriminated against as a women. I’ve felt as though I’ve been able to everything that I wanted to do in terms of my career, but I do think women are underrepresented in a lot of ways in dentistry. And that’s the question, I think, that needs to be asked, is why aren’t more women putting themselves forward rather than looking at it from the point of view saying, well, these men, they’re pushy, they just take over all these roles. I don’t think that is the case. I think a lot of men do want women to be more engaged and we need to have a look at the reasons why they can’t.
Vikki Holden: And it might be, that same as me, just go, no, I don’t want to spend my whole evening working on committees or preparing lectures. It’s a lot of work that has to go into preparing lectures. I want to be able to work hard. I enjoy being a dentist. I really do enjoy the day job. So I’m not necessarily looking for ways to cut down my clinical time to be able to maybe do more lecturing. I’m pretty happy with the setup that I’ve got, and it might be that that’s the case for a lot of women, maybe feel the same. I don’t know. It’s something that we don’t really talk about very much and it often seems to descend into an argument, whereas there needs to be a bit more of constructive discussion about it.
Payman: I’d agree with that. I’d agree with that.
Prav: I do totally agree with what you say, and I think looking at the whole women in dentistry, and I guess we’ve all got to be careful about what we say, but I’ll just speak my mind anyway, ultimately I’ve never seen discrimination against females. You’ve organised some events, Payman, and you’ve asked lots of female lecturers to come on board and a lot of people said no. And you’ve had some female lecturers as well. And similar to what you just said about the BAPD, it’s not because they’ve not actively gone out there and asked women.
Payman: That’s not the case for me, Prav, actually. In the [inaudible 00:12:33], I approach more men than women. I did. I wasn’t onto this idea, to tell you the truth. I wasn’t. It’s not like I thought about it and decided not to ask women. I thought I want the best people, who are the best people. Started thinking who do I know and all of that, and organically went for the best people. And then it was pointed out to me later, by I think Bertie, someone like that, who said, look, you had nine speakers and eight of them were men. And I don’t know what the actual answer. It’s not that I asked lots of women and they said no. But I feel like there wasn’t the availability of high profile women to ask. That was the feeling I had.
Prav: Let’s say you look in the composite field of implant dentistry or whatever it is that you want somebody to lecture on, who have you got to select from?
Payman: Not from women [inaudible] composites. You know about implants, Vikki?
Vikki Holden: Yeah, I do, and there’s a number of women actually who I think I would love to see do lectures. Anna McDonagh, she would be somebody who’d be great. She did a lot of implant surgical work. Maria Hardman, who is very close to us in Oxford, massive implant dentist. Maybe people don’t think about it enough to maybe do a bit of research. I was having a chat with my husband about these sorts of issues actually over the weekend, and quality and diversity. All this row erupted on the Facebook group about the lack of women in the executive [inaudible 00:14:20]. And he said, these days it’s not just enough that people say, for example, I’m not racist. Nowadays we have to be anti-racist. We have to actually go out of our way, all of us, to stamp it out. And it’s maybe the same with the whole equality thing with women in dentistry. It’s not the same necessarily as positive discrimination, but it’s saying, look, we’ve got a board here, we’re actually just going to make it equal. So it’s going to be 50-50 and we won’t fill those seats until we’ve got enough women come forward to do it. And maybe that’s the same way that we need to be. I don’t know.
Vikki Holden: I don’t know that I know enough about the topic enough. It’s something that maybe I need to… you know, I think I probably will read some books on it and try and learn a bit more and.
Payman: In that particular debate that we were talking about, there wasn’t any technicians on that committee, there weren’t any nurses. And BAPD were saying we represent all these people. There probably weren’t any associates for all I know. It was rapidly put together. But I don’t think it was… I think you’re right, Vikki, that you can’t say that this is not a valid argument because if enough people are feeling it, I guess that turns it into a valid argument. The question is it lots of people, is it a few, minority, vocal minority? And does positive discrimination help women or not?
Vikki Holden: Pass. I don’t…
Payman: Such a difficult question.
Vikki Holden: It is. It’s all very complicated and lots of strings to it I think that…
Payman: Let’s move on.
Vikki Holden: find an easier topic.
Payman: So tell us about when you started looking at law and doing the law degree and all that. What made you start doing that?
Vikki Holden: So when I was thinking about what A levels I was going to do actually, I nearly chose law rather than dentistry. So I was quite interested in law anyway, but I decided to go down the dentistry route instead. I think I decided that I’d be better of doing something that was more science based than something that was more practical. I used to play a lot of instruments when I was younger, so quite liked the idea of doing something that involved that dexterity. But I promised myself that I would probably come back to law at a later date. And I did find that soon after qualifying I was quite interested in the dentolegal side of things. So I had in my head that I would at some point do an LLM. I had to wait until the time was right, I guess, which seemed to be after I had my second baby. So I’m not sure that the timing of that was that brilliant. But I did quite an interesting course actually. There’s quite a few LLMs out there and they’re not all the same. Some of them when I looked at the syllabus seemed to be more to do with medical legal law and those medical legal questions like the rights of the unborn foetus, end of life things, it’s quite topical. Should people have the ability to choose when they’re going to choose to die, et cetera.
Vikki Holden: That wasn’t really, as interesting as it is and important as it is, that wasn’t really what interested me. So the course I ended up doing was very much focused on topics that were quite useful to dentistry. So consent, confidentiality, clinical negligence, et cetera. And it was mainly a distance learning programme as well, which was quite helpful when you’ve got two young children. So I’d spend a lot of the evening reading up on that and had to do quite a few assignments. And it took me two or three years to do that. In the meantime I was also doing quite a bit of expert witness work as well, which was quite interesting, although I don’t do any expert witness work these days. But that was how I got round to it really. It was just one of those things that I had on my long term personal development plan.
Payman: Are you the person on Taylor Defence that’s get the call from a dentist who’s had a compliant or a GDC? Is that you?
Vikki Holden: Yeah, well there are a few advisors. The rest of them are all based up in Scotland. So there’s only me who is actually really down on my own down here. Really, all the calls and complaints will go into a central email system. So they can do a conflict check and see who will be the best person to deal with it. And then some of those complaints will obviously come out for me to deal with. Most of what I do now is helping people deal with complaints at a local resolution stage. If something is a litigation claim or a GDC claim, then typically would be instructed to deal with that, as you would with any organisation really. And then I will still assist those clients and offer support. But I’m there on the end of the phone or emails. A lot of the time just dealing with general queries and complaints.
Payman: Do you often find when people speak to you, or dentists when they’ve had a complaint, that you know what the outcome’s going to be with your experience. I’ve, as a non-legal entity, acted as almost a shoulder to lean on for a lot of my clients who just want to speak about a letter that’s arrived through the post. And what my experience as a previous dentist who’s had similar issues, and the advice is obviously don’t lose too much sleep over it, even though you can’t prevent that. And my experience of what other dentists have been through and what advice they’ve given. Do you often have an idea when someone comes through, something comes through, that the way they’re rationalising it in their mind in terms of how bad it really is in comparison to how bad it really is?
Vikki Holden: Yeah, there can be sometimes a bit of a tendency for people to catastrophize with complaints. So it is often it’s quite obvious when you’ve dealt with a lot of complaints the right ways to resolve it. And it’s not always the case that the patient wants their money back. Sometimes they just want to be given the chance to have remedial treatment, sometimes [inaudible] things being damaged [inaudible 00:20:28]. It’s about sorting out what’s the fair thing to do for both parties, really. And a lot of dentists, they do take your advice on what is going to be the best way out of it, but the majority of what we deal with is just local resolution really, and it can be dealt with at a local level. Not everything needs to escalate, and if you’ve got good complaint systems in place in your practise then most things you can handle without it needing to escalate to the GDC or to litigation.
Prav: I had a conversation with a client even just a couple of days ago late last week, and it revolved around this patient getting a 1,000 quid back. And that particular dentist said to me, well, it’s not fair. There’s nothing wrong with the crown. I don’t believe they should get it, blah, blah, blah. And my advice was listen, just give them the 1,000 quid and forget about it, because if this does escalate, the problems it’ll cause, you’ll have wished you paid that 10 times over. And there’s often this argument that they feel it’s just not fair, but doing the easiest thing is just to give them the 1,000 quid and just forget about it. What’s your thought on that?
Vikki Holden: Well, I don’t know necessarily that all patients are just looking for money back actually. It’s quite interesting. I did some research for a webinar that I did over the lockdown period on complaints. But if you go on the parliamentary [inaudible 00:22:00], so they deal with NHS complaints that haven’t been resolved locally, their research showed that actually most of the complaints that they received were people who didn’t want other people to have the same experience in terms of service. It was not to do with money. And there’s another organisation, ADMA, which is accidents or medical accidents, basically things that shouldn’t have happened. They’re a charity, and they were saying that their research showed that most people litigate because they want an answer as to what happened. Sometimes people just need to have an explanation as to why things have gone wrong because they haven’t understood necessarily what has gone on in the surgery. Sometimes just writing a check and saying, well, have your money back doesn’t always resolve the complaint for the patient because they still don’t really understand why what happened happened.
Payman: Vikki, would you characterise… I remember when I was [inaudible 00:22:56], if there’s something which to go to the GDC or whatever, it was what we would call an obvious situation had happened. Whether it was a fraudulent thing or whether it was an actual clinical mistake or something like that. Whereas nowadays it feels like everyone’s getting problems because of, I don’t know, [inaudible] or whatever. But when you get the calls coming in, how do they break down in terms of the percentages? What percentage are just on dentist issues, what percentage are dentist [inaudible] patient issues, and then what percentage are what we would call actual problems, and what percentage are the ones that we’re also worried about that I know they’re actual problems?
Vikki Holden: So I think the majority of the complaints that we get [and are 00:23:44] patients complaining for one reason or another about treatment that they’ve received. And I’d say the majority of that seems to be, I’d say maybe NHS treatment. That’s just you don’t get as much about private dentistry, but that might just be because we have got more clients who are NHS dentists than private dentists. I don’t think we audit that data yet. Sometimes the patient will come in with a complaint saying, I’ve been to a new dentist and this new dentist suggested this crown isn’t good enough, et cetera. But you haven’t got all the dentist notes to know whether that is the case or whether that’s just how the patient has interpreted the conversation that they’ve had. We did go through a spate where we seemed to get quite a few GDC complaints that were against clients that were anonymous. Not a lot. I’m talking about maybe a dozen or so where there seemed to be an undertone of the complaint had been drafted by another dentist, maybe, who’d left the practise or a disgruntled employee. And those complaints were often made anonymously, so the dentist probably has an idea who it was, but doesn’t necessarily know for sure who it was. And it’s not as many as you might think.
Vikki Holden: And hopefully since the article in the BDJ highlighting the issue with blue on blue complaints, and I’d submitted a [inaudible] request a while ago, actually, to get updated from the GDC to find out how many complaints were made in retaliation by dentists. It’s not loads, and hopefully those numbers will improve now that it’s been aired in public and people [have got 00:25:23] a bit of telling off by the BDJ article about using the GDC as a weapon for airing complaints.
Payman: What about treatment modalities? Which are the treatments that are getting the most attention [inaudible 00:25:33]?
Vikki Holden: I’d say it’s often pain related complaints is probably the big one. So patients who’ve had deep fillings put in and the tooth needed re-treatment or it’s not settled after it’s had a crown put on it, that sort of thing. That’s often a common complaint with patients.
Payman: [They’re] not also [inaudible 00:25:59]?
Vikki Holden: No, not really. I’d say I’ve worked for Taylor Defence Services for, it’ll be coming up to five years I think in February, and we haven’t had a lot of claims that have come in for litigation. The [inaudible 00:26:21].
Prav: A lot of what I hear, and it’s maybe just the practises I work with, tend to be revolving around the cosmetic outcomes and just dissatisfaction around that. Do you see much of that at all?
Vikki Holden: Bonding is one of the things that I’d say we get not a lot of complaints about, but that could be something that patients complain about. Patient expectations, I think, are getting higher, definitely. And these treatments, injection moulded composites, veneers, composite or edge bonding, actually can be quite tricky to do well. And one of the things that sometimes you see with snapshots of the treatment we see on Instagram is that a lot of the dentists who do this amazing work, they make it look really easy because they’re so good at it. And that can be something I think that actually needs quite a lot of training and a lot of practise to be able to do those treatments really, really well.
Vikki Holden: Sorry, somebody’s responding to that question.
Prav: I think you mentioned something about fixed braces or I think, [inaudible 00:27:32], you not wanting to do fixed ortho again. Is that related to this or is it something completely separate?
Vikki Holden: No, just from my own clinical preferences. So the past few years I’ve tried to generally learn a bit about everything through my career. So I learned how to implant. Spent a fortune on implant courses actually and I don’t do even like the number of implants that I should do. I did the FGDP diploma in implant dentistry, which was quite a feat because I had to do all these cases with block grafting in, which I did, and then I just never wanted to do anything that complicated since. So I’m very much just limit the implants that I do to very simple cases. Over the last five, six years, I’ve learned how to do Invisalign treatments, and that’s been quite good. And at some point [longer] on I thought do you know, probably should have a look at fixed braces because I keep hearing about Invisalign’s great but sometimes you just need to put the patient into fixed braces at the end, whatever. That’s not been my experience of it at all actually. And so fixed braces have been the, particularly through lockdown, just thought, God, I’ve got these patients, I can’t see them, I don’t know what’s going on, they’re complaining they’ve got brackets that have fallen off or the elastics are breaking down. So fixed braces, certainly for me, not for me. [crosstalk 00:28:57].
Prav: Is that just because of your lockdown experience or just in terms of you getting better results with removable appliances?
Vikki Holden: I think the way that we’re heading, particularly our practise as well, is very much down a digital workflow. We’ve got two [ICO] scanners that we’ve got in use all the time, and I just like the ability to be able to do the digital planning. And that for me, I think with fixed braces sort of thing, I’m just not sure how that you can visualise that end result in quite the same way as you can with the Invisalign planning or digital planning where you can do it all pre-planned. I just like that. I like that certainty that you get in being able to see what your outcome is that you’re working to before you’ve done anything. I guess it’s like having a [wax] [inaudible 00:29:45], isn’t it, beforehand. Because you can see [inaudible] dimensions, I just find it a bit easier to visualise.
Prav: So you talked about obviously going digital with your practise and stuff. Have you embraced any other changes during lockdown like video consultations or using remote monitoring? I think there’s-
Vikki Holden: I’m looking at remote monitoring. I’ve not got it set up yet, but that’s definitely something to look at. The other thing that we’ve done is we’ve pretty much gone paper free. So looking at ways that we could reduce touchpoints in the [surgery 00:30:19]. I guess like many practises are, waiting rooms are out of action at the moment, but when you start to look at some of the systems that you have in place, some of them are actually quite inefficient and quite expensive, probably, to run in terms of the amount of manpower that you need. So for example, patients arrive at the practise and give them a printed off medical history form and they sit in the waiting room and they fill it out and they hand it back to the receptionist and then somebody loads it onto the computer and gets scanned it and it gets shredded. Look at all the steps that are involved in that.
Vikki Holden: One of the things that we did initially was we made all the forms into digital forms so that people could fill them out using some sort of Adobe Acrobat. But we had problems with that as well, because a lot of our patients were saying, well, actually I can’t save this document and send it back and they were coming back blank and patients complaining they had four different forms to fill out for new medical history and photo form and COVID screening form, et cetera. So one of the things that we did was we just made a load of Google forms and the patients get sent a link, they fill out the form, we save their answers to it, download it, import it into the dental software, and it’s been really good actually. So that’s one of the things that we’ll definitely keep in place.
Vikki Holden: We’re just constantly, at the moment, looking for ways in which we can make things more efficient. We’ve lost two members of the staff naturally, which is good because it means that we’re not in a situation [wherein] potentially we overstaff. So that’s been quite nice that we’ve been able to plan the workforce around a team that’s naturally reduced in size, but obviously that means that we have lost two bodies that would have been able to do some of those jobs. So we’re just looking at a lot of ways that we can speed things up now because now we’ve got five surgeries running today. That’s the most that we’ve had since lockdown. So it’ll be interesting to see how that works with getting patients in and out of the building without them bumping into each other and have we got all the paperwork that we need sorted out beforehand, and taking more payments remotely, that kind of thing.
Payman: How do you manage with partners? Which role do you play? How many partners? Say that again.
Vikki Holden: So there’s four partners at the practise. We did have six initially, but just [with] retirement and people moving on, we’re down to four. I tend to look after most of the compliance side of things, which just seems to be actually where they would have me. And I don’t know, again, we’re coming back to this equality issue, because I’m the only female partner, I seem to be the person that a lot of the staff would naturally gravitate to if they’ve got an issue that needs resolving. And I’m probably just about a little bit more than everybody else [inaudible] practise. So I tend to maybe oversee most of the HR side of things.
Payman: Hiring and firing bit?
Vikki Holden: Well, I’m fortunate not to do much firing, but hiring, we delegate that to the practise manager. She’s much better at interviewing and recruiting, I’d say, than the partners have been in the past. So that’s one thing we don’t do, but looking at maybe the legal aspects if the employment contracts need updating or associate contracts need reviewing, then I would have a look at those sorts of things. We outsource quite a few bits. Like employment law we use FTA Law. So Sarah Buxton’s company. They look after our employment side of things, and that’s something that’s really worthwhile having in place actually.
Payman: What’s the decision-making structure? Is one of you responsible for marketing and you leave it up to him, or do you guys pass all these decisions through each other?
Vikki Holden: Well, in terms of how the practise runs, so two of the partners are actually specialists. So one’s an orthodontist and one’s an endodontist and they have quite solid referral basis, whereas myself and the other partner, Nick, are more general practise dentists. So really, in terms of those decisions with marketing, I’d say mainly it’s down to me and Nick to decide what we do, and that makes it quite easy because it’s just the two of us need to have a conversation with the practise manager. We do a bit of Facebook marketing. We don’t really do any Google marketing. But we just have a look at what sort of things we want to do. It’s mainly Invisalign or implants. Prior to lockdown, we were having Facebook marketing done with Derek. You know Derek?
Vikki Holden: So Derek was, imagine that, we’re just about to get that all up and running again. We tend to be a little bit conservative, I suppose, on marketing things that we can’t measure. So adverts in the paper, that kind of thing, we don’t really get involved in that sort of thing these days. But it’s quite easy in a way to make decisions like that because it’s just two of you, you have a conversation, go, do you think that’s a good idea, and they’ll go, yes or no, and then you move on. So I think the days of sitting around, having long meeting where everything has to be agreed by six people is gone because that can be a bit [inaudible] obviously to get everyone to agree to the same thing at the same time.
Payman: How do you, and obviously you don’t have to answer this question, but how do you figure out the financial split when you’ve got four partners? Just on a higher level, the dentistry you’re doing, the dentistry a specialist is doing, what goes into the central [partners] of business? Let’s say you buy a couple of iTero machines, how does that fit into the mix if, let’s say, a specialist isn’t using it? There must be a lot of complicated conversations when you’ve got numerous people in a partnership. Just curious to learn how that all mixes up.
Vikki Holden: So a lot of those systems, I’ve been here for 13 years, and the practise has always been, when it’s very busy financially, but it’s always been quite well structured financially because I think a lot of those difficult conversations about how things were split were done before I came. And over time, whenever we refine those systems or review some of them, but it’s quite simple actually, and we break it down. Each fee earner who’s a partner, we have our own [inaudible] big [inaudible] management accounts, and our income is our own. So the dentist software allows [to say 00:36:40] if I’ve done a crown, seen a patient for an exam, that payment is allocated to me. So my income is mine. And that’s the same for the other dentists. Where we’ve got associates that we share, that gets split out between those vendors who are looking after that associate.
Vikki Holden: In terms of the expenses, again, it’s quite simple. We either have expenses that we split equally because you need that thing whether you are there one day a week or five days a week, for example, CQC registration. If there was only one partner at the practise, they’d be paying that on their own, so we split that equally. And some things we split on what we call a sessional basis. So we work out how many, say my surgery is available for me 10 sessions a week, so I would pay the portion of those expenses that vary based on how much you’re here, like gloves, for example, local anaesthetics, cotton wool rolls, those things [inaudible] on a sessional basis. And it’s quite simple. We get the invoices in, we look at materials. Well, that went to that surgery, so it just gets all split out. We employ a full-time administrator to do the finances at the practise, as well as a practise manager. When we’re fully operational, we’ve got eight dentists working here, two hygienists, so I think you need that level. So it is recorded in quite a big level of detail, really, but overall it should be pretty fair.
Payman: What’s positioning of the practise? Are you [guys] the most expensive practise in town?
Vikki Holden: Do you know, I don’t know because I don’t really look too much at what other practises are charging. We’re in the same town as the [inaudible 00:38:23]. I’d say we’re probably not as expensive as they might be for things like implants or other specialist work that’s going on. We are a fully private practise. The practise has been going for over a 100 years, I think, but I we don’t set ourselves out necessarily to have a… we’re going to position ourselves as most expensive one, you’ve got to be very wealthy to come here. My upbringing and my view on life is that we should be inclusive of everybody, so I would probably be trying to position the fees to make it affordable for everybody actually.
Payman: Everybody except NHS patients, is that you mean?
Vikki Holden: Well, we don’t have an NHS contract. Actually, you say that, but yesterday I had a patient come in for a consultation because she wanted to find out about Invisalign and she wanted to find out about having an implant replacement but she didn’t want to come here as a general practise patient. And we’ve also, since we’ve reopened after lockdown, we have made quite [inaudible 00:39:20], saying, we are here, we can offer emergency care to everybody. And we’ve had quite a lot of patients who’ve come in just to have something sorted out because their own dentist either hasn’t been ready to do it or couldn’t see them quickly enough or wasn’t able to AGPs at the time. So I try and be inclusive of everybody.
Payman: And then, as somebody who’s involved in a partnership, are you all quite aligned in terms of what the end goal is or where you want to go, what direction you want to go, and whether it’s an exit, a planned exit in X number of years time? Are you all at different stages in your life and how does that all play out?
Vikki Holden: Yeah, so I think I don’t know. That probably is a conversation, at the moment, that we need to have actually, because I am the youngest of all the partners. One of the partners, Nick and I were about to buy him out actually at the start of lockdown, and that’s been thrown up into the air because nobody knows what’s going to happen there. So we were going to go down to three partners. Exit strategy, I don’t know. I’m 44 and I’ve always said I just don’t really fancy working for corporate. I just don’t think I’d be very good at being an associate actually. I don’t know whether the associates here would want to buy the practise. Nick is actually 10 years older than me, and I think he is still fairly young, but equally, I don’t know if he wants to keep going after 10 years time when he’ll be 64. Does he still want to be at the practise seeing patients? I don’t know. I’ll need to see. And I think with a partnership this big, where it probably gets difficult is as you reduce down partners, then the amount of money that you need to borrow to buy people out is getting quite significant. And then I’ll be getting on for 50 maybe when the next one’s wanting to retire.
Vikki Holden: So I don’t know is the answer. But I just feel as though this practise has been an independent practise for over a 100 years, and I just don’t know that I necessarily want to be the one that would hand it over to one of the corporates.
Payman: Corporate. And do you have some kind of rules in terms of deciding who gets to buy [it 00:41:32]? So let’s imagine you’ve got three, four partners, whatever it is, and then one of the partners wants out and goes, do you know what, I’ve found a buyer. I’m assuming you guys have got first refusal, right?
Vikki Holden: Yeah, so that would be something that if you’re going to be in a partnership you need to have a well-drafted partnership agreement. And we have had those agreements written and they do need to be reviewed every so often as well. So I think the clause would be that the sale of the business would be to the people who are within it, and if they didn’t want to exercise that right, then it should be free to go on the open market, really. I don’t know [crosstalk 00:42:08].
Payman: So just that partner share?
Vikki Holden: Yeah.
Vikki Holden: They’re a bit old fashioned, I think, aren’t they now, these partnership agreements or partnership rules. When I bought in 13, 14 years ago now, and I’d not worked for [them 00:42:25], I didn’t know any of the people who were buying in, really it was a bit of a risk at the time because they can be a little bit quite difficult to get out of if you decide that you didn’t want to be in the partnership anymore. Finding a buyer in the open market or getting everybody else to buy you out might be quite tricky. So I’d say it is a bit of a risk, I suppose, going into partnership, but we seem to be doing all right with the ones that we’ve got left.
Payman: So what would you say has been your darkest day from a professional perspective?
Vikki Holden: I think probably I would say that was… When I had children, I’d say that was a pretty stressful time actually, when they were actually born because [particularly] with my first child, I had him at 28 weeks. And I had these plans, I was having a baby and I had no NHS contract so I didn’t have any maternity pay at all. And I had this plan that I had an associate, he was going to come and look after my patients through November when the baby was going to be born and I was going to go off for maternity leave. And actually I went into labour suddenly one day after being in the clinic one day, and ended up the next morning I had a baby and the baby was in hospital.
Vikki Holden: And it was just massively stressful at the time because I felt like the rug had been pulled from under my feet a little bit. I had patients who were still midway through treatment. I didn’t know whether I was going to be able to finish them off or not. [inaudible] having to [trek] back and forth to the practise and financially it was really, really stressful. And I’d say that was probably the darkest day that I had, or darkest days, because it was all very uncertain. I just didn’t know if the baby was going to be all right. Just very difficult because ended up being signed off from work actually for three months, which was great in a way, because the insurance paid out then, but without that being in place, I literally went from earning normal income and I planned to wind down, and that didn’t happen. I had all these bills.
Vikki Holden: and I say that experience probably put me in a better frame of mind for when we suddenly had the Coronavirus and everybody had to stop working actually, because you could see when you looked on the Facebook forums, all this fear and anxiety over money. And I never really felt that at the time in March because I just thought, do you know what, these things sort themselves out. They work out and it was a great learning experience actually, that whole thing. These experiences that you can draw on, I suppose, from the past, where you think, that was awful. Wen I look back on it, it was the most stressful time of my life, and I suppose what doesn’t kill you makes you stronger.
Payman: That little cliché is true.
Vikki Holden: It is a massive cliché, but it is true.
Prav: When you were just speaking about the experience you went through then, getting the rug pulled under and all the rest of it, the first thing that came into my mind before you went into was Coronavirus and how that just took everything. There was no plans, there was no nothing. There was uncertainty and all the rest of it. And obviously you’ve coped with it in a really easy way. What would you say have been the biggest highlights for you, the biggest wins that have come out of this time period?
Vikki Holden: So one big win, obviously, was getting to have all this time with the kids. I’d say it was the longest spell I’d really had off where I wasn’t doing any dentistry. And getting to spend that time with the kids was great, because when I had my kids they were in hospital for most of the time when I was, in theory, on maternity leave. So I didn’t have that nice maternity period at home with a baby.
Vikki Holden: The other big win is having time to just do a lot of life admin. We managed to do so much sorting out of things that we’ve never really had the chance to do at the practise. Getting things sorted out onto spreadsheets and making things efficient, but also at home as well. It’s been great. It has just given us back a few hours each day that we haven’t had.
Prav: And do you feel like you want to go… For me, at the moment, work has just picked up at an astronomical rate. So it went from zero work, panic, stress. So I did have the panic, I had the stress, I had the tears. And then, life became incredibly good. It was almost like getting a snippet of what retirement would be like in the future. And spending loads of great times with the kids, with the family, having those long lie ins in the morning. It’s like what the [fuck 00:47:08]. I’d say in bed-
Vikki Holden: [crosstalk 00:47:10].
Prav: … till half past six in the morning or something like that. And then-
Payman: He sent me a message today at 4:40. 4:40.
Vikki Holden: Oh, [inaudible 00:47:21].
Prav: … I had to get a shift in before the podcasts. So all of that came great, and now my world has imploded and work has gone crazy and it’s almost like I want to steal back that old life, do you know what I mean, and try and get it back. I think what I’m trying to do is design my life so I can lean more towards what the start of lockdown was, rather than reverting back to the old ways.
Payman: [crosstalk] it’s easier for me and you because we literally can work from home. Prav’s told his team he’s not going back till January to the office. And you probably won’t even fully go back at that point.
Prav: It’ll be hybrid.
Payman: Something that’s changed for me, Prav, [inaudible 00:48:06], my marketing manager said, [I want to 00:48:08] do a course, an online course. And it’s every Tuesday at 4:30. So once we go back to the office, every Tuesday at 4:30 to 5:30 I’m not going to be available. Would that be okay? And under normal circumstances before lockdown, we would have said, we’ll try and work it out or whatever. Really? We’ll try and work it out for her to do her course. Now, I said, well, if we ever go back, why don’t you just take the Tuesday afternoons as working from home? Amazing. To give someone an afternoon working from home before would have been a major decision.
Vikki Holden: I think everybody’s realised, haven’t they, that there’s a lot of things that people can do as productively from home-
Payman: More productively.
Vikki Holden: … as they can in the office.
Prav: More productively. I had the same conversation with my team, and Payman, what you’re saying there, we were on a Zoom call the other day and I said to them all, I said, in no uncertain terms, had all of you come to me and said, listen, we want to do half the week from home, I’d have told you which bus to get off. Not in a million years. But now, we’re all having the discussion of what does 2021 look like, and I see it as a hybrid structure where we have a couple of core days in the office, and then people can choose to do what they want. They can either come in and do a five day week in the office, they can do two days in the office, three days from home. And no hard and fast rules for any one individual, but just having the structure there so everyone can just deliver their best. And as long as the stuff gets done, I don’t really care.
Prav: There is no way my mindset would have been in that frame of mind pre COVID. And even that’s a blessing for everyone because everyone’s happier at the moment.
Vikki Holden: My brother works for Google and they’re quite a progressive employer anyway. They [crosstalk] where 20% of the employee’s time can be spent on developing their own projects anyway. And I think they’re still doing it for Google, because out of that have come a lot of things that they’ve developed. But he’s been told they’ll be able to work from home till mid 2021.
Vikki Holden: That’s how [crosstalk 00:50:27].
Payman: Vikki, you talked about your upbringing, saying that because of your upbringing you want your practise to be accessible and inclusive. What do you mean? Tell us about that, your upbringing? Where did you grow up? What kind of family was it? When did you decide to become a dentist?
Vikki Holden: So I grew up in a really tiny village in Northumberland, which nobody will have ever heard of, called Ovington. It’s quite close to a [inaudible] called Hexham, which see, people know that because the racecourse if they’re into horse racing. So it’s not up near Scotland, it’s not in the middle of nowhere, but quite far down in the south of Northumberland. But it was really nice, the old country village, not much to do. Was two pubs in the village and a post office. Very, very rural area. My parents were both teachers. My mom was a deputy head of a primary school in the village, and my dad taught in a bit of a bigger school that was on the outskirts of Newcastle. And they always said to me, be whatever you want when you grow up. We’ve got no expectations as to what you have to do, but don’t be a teacher. So I always knew that I was never going to be a teacher because I see how hard teachers work. It was a really difficult and demanding job, and they were in that era where they started to bring in lead tables and a formal curriculum, et cetera, and that sort of thing.
Vikki Holden: I also had another big influence in my life, which was my aunt. And she was a dentist. And from being quite young, she would say to me, you’re going to come work for me when you’re older. And I think when I was about seven or eight, I thought, I’ll go and work as a receptionist for Auntie June, which probably wasn’t what she meant. She meant come and be a dentist. So when I was going through school and I seemed to have this affinity for science based subjects, I was interested in science, I was interested in medicine, but I always used to do a lot of sport. I was quite a sporty child. And I played three musical instruments, as well, at school. So I did a lot with my hands, and it just, like I say, went down this route thinking well, what am I going to do?
Vikki Holden: If I didn’t have that dental influence, I’d probably dare say I would have gone down the medicine route. It would have been medicine or law. But I think because at the time, a lot of the people I was at dental school with, they seemed to have some link with dentistry. I’m in that age group where it wasn’t necessarily a really popular choice of degree to do. The grades that I needed to get, they weren’t very high. I had quite a few [inaudible] offers, actually, to get into university, because there just wasn’t that level of competition, I don’t think. But that was why I…
Payman: Where did you study? Where did you study?
Vikki Holden: Sheffield.
Payman: How was that? What did that feel like going from rural Northumberland to the big spoke?
Vikki Holden: I know. I applied to universities that were in the north of England. The obvious one would have been to go to Newcastle, but Newcastle [would have been 00:53:27] about  minutes drive from home, so I thought I need to be a bit further away than that. I don’t know why I didn’t really… I didn’t fancy Leeds. I can’t remember why particularly. I went for an interview in Liverpool, but it was just the worst weather I’ve ever experienced. Walking back to the train station, I got literally soaked to the bone walking down from [inaudible] to [Broad Street 00:53:50] station. So I didn’t fancy going there either. And there was this train that took five hours to get home, so that would be a nightmare.
Vikki Holden: So Sheffield, it was two and a half hours drive away. It was a good distance, I suppose, from my parents. It was nice, it was a small dental school with quite a small year group, I think, that came out of there. They didn’t have a lot of students. It was a new dentist school as well when we went. I think we were one of the first years to go through the new dental hospital. And it was nice, it was a nice time. I didn’t want to stay in Sheffield after I finished. I moved back home. It was too obvious to not go back and work at my aunt’s practise after all the influence that I’d had from her.
Payman: You did that, did you?
Vikki Holden: I did, yeah. I did my [inaudible] back in the Northeast, and I worked at my aunt’s practise for four years or so. I liked working there, but I didn’t really like doing NHS dentistry, I think. I found that hard, and I found it was the old contract. And I found the fee pricing system, which was what it was at the time, we used to say it was [the real old 00:54:59] treadmill [this 00:55:00]. And I could see how it was a bit of tread mill and I just felt like I wanted to learn how to do implants and I wanted to learn how to do cosmetic dentistry. And a lot of those things, I just at the time, didn’t think I would necessarily maybe be able to do. I think that’s all changed now because I think there’s such a market for those things everywhere. So I headed off to the South and I learned how to do implants and learned how to do cosmetic dentistry.
Payman: So how did you end up being a Southerner then?
Vikki Holden: [Ended up being 00:55:31] a Southerner. Wow. I moved down. I got a job in the South, and when I landed down here I started to think, well, I’d quite like to buy a practise and I’d like to have my own practise. And actually, this is quite interesting, because one of the things that I did do about this time when I was moving to the South is I got in my head. I didn’t want to work as an NHS dentist, I wanted to develop all these other skills. So I ended up thinking I need to have some sort of coaching or counselling to help me decide what I want to do with this career actually.
Vikki Holden: And as I looked into it, one of the first post graduate courses that I ever did actually was a diploma in life coaching. So I am technically a qualified life coach, although I’ve never really done any coaching. But it was brilliant, that course, actually because part of it, it was you had to really coach yourself through to get the qualification. You had to go through a lot of coaching yourself, and it really did open my eyes to a lot of things. And it was a really good exercise in personal development actually. And it really sparked an interest that has followed me through. I don’t read a lot of books on fiction, I read a lot of books on productivity and self-awareness and personal development books. That’s really my thing. I’ll listen to podcasts on those things when I go out walking with the dogs.
Payman: Vikki, what would you say are a couple of books that have changed your life, changed your direction?
Vikki Holden: The Seven Habits book, I’d say. That was probably the best book I’ve ever read, and I still refer to it now. Those habits, those values, I think are the ones that I would definitely say I try and live my life by and get quite frustrated when I come across people in situations who don’t really live to those [ones 00:57:24]. That’s one. Second book, I don’t know.
Payman: What about podcasts? Which podcasts do you listen?
Vikki Holden: Well, I like your podcast. [crosstalk 00:57:34]. I really like [inaudible 00:57:35]. So the podcasts I like, actually the ones I’ve been listening to most of the summer, I love listening to your Podcast. It’s been brilliant for getting to know people who you feel as though you know them because you see them on social media or they do courses or whatever, but you don’t really know these people because you’ve never met them personally. I’ve never met you guys face-to-face. It’s been really good, actually, these chats that you’ve had with people, getting to know them and seeing what was their upbringing like and how did they end up in dentistry. That’s a good one. And I also like listening to Brad’s podcast. Have you listened to Brad’s podcast?
Vikki Holden: Business type of podcast. I quite like listening to that one.
Payman: Do you listen to anything outside of industry?
Vikki Holden: Yeah, I do, but I’d have to get on my phone, have a look, because I probably just [inaudible 00:58:22]. I’ll see these things, don’t know [if it’d be 00:58:24] a really good… Tim Ferriss, he’s another one. I quite like listening to that podcast.
Payman: So Vikki, you’ve got lots of different hats. You’re a mom, you’re an owner, you’ve got the dentolegal side. You’ve got the Facebook moderator, headmistress role. Which of these are the ones that you like that most? Is clinical dentistry your passion? It sounds like you’re up for volunteering for stuff.
Vikki Holden: I really like to help out with things. I definitely am happy to give up time and knowledge. I did the FGDP career progression. So I did the FFGDP fellowship exam, and one of the things that I said when I was doing the final [inaudible] for that was that I’d spent a lot of time focusing on my own post graduate education, really it’s time to maybe give some of that back. So I’m quite happy to volunteer and help to do things, obviously [inaudible 00:59:27]. I think it’s just a question of time management. I enjoy all the things that I do. I enjoy being a mom and I enjoy clinical dentistry and I enjoy the dentolegal thing. I think I’d be very, very upset if I had to ever give one thing up to focus on one thing alone.
Vikki Holden: But it’s that principle out of the Seven Habits book, isn’t it, putting first things first. At different times of your life you have to be able to do what’s needed. So through lockdown, the thing that needed to come first was sorting the kids out and supporting them through homeschooling. Hibernate the business. People were looked after in the sense that we have the furlough scheme in place. That was the thing that needed to be put first then. There’s been other times where there’s been a massive workload with TDS and that needs to be put first to sort those things out, and other periods of time where the business has needed a lot of attention, particularly when we were getting it back up and running. And I’d said to my husband, it’s nice that we’ve all been at home for the last two months together, but there’s going to come a time when I’m going to have to go back to the surgery and you’re going to have [field] the kids at home on your own. And by that time it was a bit easier because the kids were into the routine of the Teams lessons and Alexa alarms were set all through the house. So they were going off all the time to tell them when the next lesson was.
Vikki Holden: So a lot of it is just about being organised, I think, and making sure that you’ve got your calendars up to date and you’ve got your calendars synced and you know what you’re doing. And just working out what needs to be done when.
Payman: The question that’s been boggling me the most over lockdown has been can we address some of the issues that we’ve got as a profession? And I feel like we were let down left, right and centre. We don’t need to be [mystical 01:01:17], but the GDC reform, no one really knows fee reform. You’ve done a law degree now. Is there a debate in the legal profession that talks about the downsides of things like no win-no fee? I guess there’s an upside to it. People who can’t afford lawyers, are your lawyers working for you properly and all that. But is there a debate about that? That we have debates about polishing composite?
Vikki Holden: I think there’s a bit of a misconception about no win-no fee in that people think it means that solicitors will just take on any case. And the reality of no win-no fee is that the solicitor still has to do a lot of work on a case before they have any chance of getting paid for that case. So they won’t take on a case unless they think it’s got a realistic chance of success. I don’t know-
Payman: [crosstalk 01:02:13]… I guess what I’m alluding to is that claim culture. I have a little [inaudible] in my car, for the next six years I get called by some sort of ambulance chaser saying, haven’t you got whiplash and all of that? If someone has an accident at work there’s adverts on the TV saying, call us claims. And then we’ve got our version of it with the dental law partnership. Then there’s the downside. The downside of that ambulance chasing, maybe I called it no win-no fee, maybe that wasn’t [inaudible 01:02:42].
Vikki Holden: So I think a lot of patients, from the complaints that I see coming in, I think a lot of the general public are wise to the fact that actually sometimes getting a solicitor to sort a problem out doesn’t save them any time, in fact it just prolongs the process. So I think as a profession, that’s where maybe we need to look at accepting that sometimes things don’t go to plan. And there might be times where things go badly wrong. So you might have damaged a tooth beyond repair. I think it’s [inaudible] profession to be professional about it. And that’s the reason why you have indemnity arrangements in place so that you can call on them to sort out those problems if it needs some sort of financial settlement before the patient is necessarily given the opportunity to go to a solicitor. Because if you go to a solicitor everybody loses, really. The dentist or the [inaudible] loses because their costs go up massively because they’re now paying legal fees on often both sides. And the patient loses because they might not get the level of compensation that they would have got if it had just been sorted out amicably with no lawyers involved.
Vikki Holden: And the main reason for that is that part of the no win-no fee arrangement is that solicitors can charge the clients a success fee of up to 25% of the damages. So if say you had some sort of an issue and your dentist is going to compensate you 5,000 pounds, you might be initially 25% down on that at the end of a settlement, and it might have taken the best part of 18 months, two years, to actually get there. So I think taking those opportunities to solve those problems that might involve [inaudible] compensation in-house, that’s one thing that would help get rid of, what we call ambulance chasing solicitors.
Vikki Holden: I can only think of one case, I suppose, where I might have looked at it and gone, do you know what, that is really, really ridiculous. Where a patient was trying to claim for a toothbrush. They said I’ve got to buy a special toothbrush because of what you’ve done. It was like an electric toothbrush. One in five years I’ve seen. I don’t see it as being a bit of a problem or as big of a problem as people do because of the work that I’m doing. But the problem is you’ve got these echo chambers on Facebook, i.e, forums, where there has been a lot of scaremongering about these sorts of issues. And I think what you’ve got to remember when you read the Facebook forums and form an opinion about ambulance chasing solicitors and no win-no fee and GDC compliance, is that you’re only getting one side of the story there. You’re only getting one party’s side of the story. You’re not in a position where you’ve seen what was the complaint that came in from the patient and what really happened. And I think I’ve just learned to take a step back from those sorts of threads and again, I just [crosstalk 01:05:36].
Payman: You’re literally saying there’s no need for reform, it’s all good, everything’s fine?
Vikki Holden: I think we need to reform it by managing things better at a local level. If we’re talking about reforming the GDC by saying, oh, let’s go back to the burden of proof beyond reasonable doubt, it’s not ever going to happen. That’s never going to happen, so it’s a bit of a waste of time. The reform that would be going on at the GDC, right-touch regulation, that’s a really big thing that the regulators are looking at at the moment. And you can see in the communications that they’re sending, to me, I see that they are taking those things quite seriously. Where does the reform need to happen, people not taking screenshots off of social media and reported people to the GDC for making unprofessional comments. We need to look more at ourselves as to why these things are happening and reform it that way as well as just demanding that the regulators maybe don’t open up so many complaint cases. There’s just certain triggers that in place when the GDC get a complaint of such words that needs to be used that will open an investigation.
Vikki Holden: I just don’t buy into the scaremongering as much. I think that there have been some changes that have been at the GDC that are quite positive actually. We need to maybe keep on with the clinical advisor reports a little bit. They can be sometimes a bit irritating that they might not have picked up on or not read things that are blatantly in the notes and it’s triggered their case to go to the case examiner’s. But those cases do get dealt with when the letters are written and the case examiners have a look. So I…
Payman: It’s lovely to hear you say this.
Vikki Holden: [crosstalk] about those thing than…
Payman: It’s really good to hear you say this, it’s really good that you say this because you’re in it, so you’re getting much more information on this than we are. But I don’t-
Vikki Holden: I’m not saying it’s perfect. I’m not saying it’s perfect, but I think the expectations of the profession maybe needs to be managed a little bit. The GDC’s not going to go away. They are there to protect patients. They’re there to do a job to review complaints that come in. And the proof will be in the pudding of looking at the annual reports and seeing how many cases were stopped by the case examiners. The case examiners seem to be doing an amazing job, actually, of dealing with those GDC complaints at a much lower level and not triggering it onto a hearing. So I think from where I sit, things do seem to be moving in a positive direction.
Payman: I think there it was something that we were, in the UK, we had over the Americans, that I thought was that we weren’t so [meticulous 01:08:21], we weren’t so attacking each other. And [inaudible] that’s gone, now we are. I guess if a society’s based on law, it’s one of the side effects of that, isn’t it. Maybe that’s what it is.
Vikki Holden: Yeah, and when I did a webinar recently, again, looking at this issue of complaints, I think understanding the reasons why people complain actually will probably help us to stop a lot of complaints from escalating in the first place. And one of the facts that I’d uncovered was that in the UK, we’ve got a bit of an issue with literacy. So it’s something like one in five adults in the UK has got the literacy skills of an 11-year-old child. That’s actually quite a high proportion of adults who’ve actually got quite poor literacy skills. And are they really understanding the information that’s being imparted to them, and particularly where you might be in a rushed clinical environment.
Vikki Holden: [inaudible] one was something like half or nearly half of adults only have or didn’t have 300 pounds in savings for an unexpected emergency. Well, when you look at, what was it, cost to keep teeth under good repair, it’s quite expensive. And those sorts of factors. And you’ve got a patient who might have paid for a crown on a tooth and all of a sudden the crown needs a root canal treatment, and they’re looking at that tooth being extracted and implant. That’s quite a big deal actually to a lot of the general public. And I’m not saying that there aren’t complainants out there who are vexatious or who are aggressive in the way that they present their complaints, because of course there are. But I think we just need to be able to look at how do we understand things from that other point of view, and that would go a long way, I think, into helping resolve a lot of issues without needing to escalate in the first place.
Payman: Communication [crosstalk 01:10:10].
Vikki Holden: Yeah. Communication, and empathy is another one.
Prav: I’m sorry, you’ve heard this question probably God knows how many episodes you’ve listened to, but if it was your last day on the planet and you had your kids by your side, couple of things, what would be the three pieces of advice you’d leave them with and how would you like to be remembered?
Vikki Holden: Oh gosh. So I’d probably like to be remembered as somebody who was a fair person and somebody who was happy to speak up and say something that needed to be said, even if what needed to be said was unpopular or uncomfortable for other people to hear. What would I tell my kids? I’d probably say to them just to always make sure that they are fair to everybody. Treat everybody equally because they live very privileged lives, my kids, and they are very lucky and I don’t want them to forget that ever. They could have been unlucky to have been in born somewhere that’s [inaudible] war or where people are just not being very nice to them. There’s so many issues with child abuse and things that go on, are just horrible in the world. So I want them to always remember that they are very, very lucky. And pay it forwards. Don’t just take, take, take. Be a giver as well as a taker. And the final thing, always brush your teeth. The only thing I’m not great at actually, which is a bit disappointing as a dentist.
Payman: Vikki, before we go, before we finish it off, how do you keep it real for your kids? They’ve had a much more privileged upbringing than yours, let’s say for the sake of the argument, so how do keep it real? Do you actually try and keep it real for them somehow?
Vikki Holden: I try not to spoil them. At the moment, for example, because they are spending a bit more time than probably I’d like on the Xbox, but they are wanting to constantly buy V-Bucks or whatever they are so they can play on Fortnite. And I’m like, no, it’s a waste of money. I’m not into wasting money. Even though I think we’re quite fortunate, we’re probably a lot better off than my parents were. But they don’t get spoiled. They don’t get everything that they want. They’ll come to be saying, can I get this, and I’ll be like, no, you get it for your birthday.
Payman: Really good point.
Vikki Holden: [crosstalk 01:12:34].
Prav: Hard to say no though, right?
Vikki Holden: I don’t know. I’ve [inaudible 01:12:38].
Prav: I struggle with certain things. I don’t know. You want your kids to have the best, whether it’s education or maybe Fortnite credits and games and things are probably not at the top of the priority list. And in the same respect, deep down, I want them to know what it’s like to struggle as well.
Vikki Holden: Yeah, exactly. I think they just need to have a good perspective of life. And I think I’d also want them to know that we live in the house that we and they have the nice holidays that they have, although obviously nobody’s going on holiday at the moment, because me and their dad have worked really hard. We’ve not [inaudible] on a plate ourselves. And equally, I don’t think that I would be wanting to hand things to a plate on them either. They need to learn how to save up money if they want to buy something, and they need to understand that if they don’t get good school reports then they’re not just going to get rewarded with treats all the same. I think that’s probably a good lesson for them to have, that it doesn’t just all come from nowhere.
Payman: Thank you so much, Vikki.
Vikki Holden: Thank [crosstalk 01:13:49].
Prav: Thank you.
Payman: [crosstalk 01:13:51]. Hopefully we’ll meet up for a real meeting.
Vikki Holden: That would be [inaudible 01:13:56].
Payman: Thanks a lot.
Prav: Thank you so much.
Vikki Holden: No worries.
Prav: Take care.
Vikki Holden: Thanks. Bye.
Outro Voice: This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.
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