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[VOICE]: This [00:00:30] is Dental Leaders. The podcast [00:00:35] where you get to go one on one with emerging leaders in dentistry. Your [00:00:40] hosts Payman Langroudi [00:00:45] and Prav Solanki.
Payman Langroudi: It gives me great pleasure to welcome Claire [00:00:50] Nightingale onto the podcast. Claire is a consultant orthodontist at [00:00:55] the Watford General for over 20 years, now a private practitioner. [00:01:00] A principal at the famous Queensgate Orthodontics, [00:01:05] which she recently exited from as well or.
Claire Nightingale: Exited [00:01:10] in ownership, exited.
Payman Langroudi: Ownership there.
Claire Nightingale: In body and spirit.
Payman Langroudi: Yep. Absolutely. [00:01:15] A great proponent of digital dentistry. Um, remote [00:01:20] monitoring. Um, for me, uh, you know, I’ve got a closer connection. Claire [00:01:25] is the orthodontist for my daughter. Yes.
Claire Nightingale: A great privilege. Thank you for trusting her [00:01:30] to me.
Payman Langroudi: We’re in the middle of it right now, and she’s having a wonderful experience. So thank you very much for that. Um, [00:01:35] Claire, uh, we tend to start with the backstory and all that, but sometimes I’ve got a burning [00:01:40] question. And for me, you know, I’ve had some contact with you. And more interesting [00:01:45] than that, every single person I talk to has great things to say about you both, [00:01:50] both socially and clinically particularly. People really talk about what a great clinician you [00:01:55] are. Just does it come very naturally to you to to [00:02:00] assess something? Are your instincts brilliant or are you just a brilliant operator? [00:02:05] And I know those things are connected, but.
Claire Nightingale: You know, it’s very flattering and [00:02:10] wonderful to hear that feedback. I don’t see myself as brilliant, you know, and [00:02:15] I wouldn’t describe myself as an expert. I think those are adjectives that other people [00:02:20] should use on judging my work and performance. Um, [00:02:25] I mean, inevitably, I’ve been a specialist orthodontist since 1996 [00:02:30] and a dentist since 1989. So given that all [00:02:35] day long I do nothing but look at occlusion. I guess I can [00:02:40] pretty much summarise where I’m heading, you know? But I wouldn’t say I’m brilliant [00:02:45] at recognising restorative need. So? So, yes, [00:02:50] I might be brilliant in one facet of dentistry in the eyes of other people, but I’ve still got [00:02:55] learning development needs in other areas of dentistry. So I think that’s you know, I think [00:03:00] that’s.
Payman Langroudi: Something the question do you work extremely hard or does it come naturally or both?
Claire Nightingale: Oh, I [00:03:05] mean I work extremely hard, but but the whole package now comes naturally [00:03:10] to me. You know, I work extremely hard in the volume of people I look after, the outcomes [00:03:15] I’m trying to deliver for them, how I want the business to run and endure, and [00:03:20] also in the wider Dental networks and education and supporting networking and having [00:03:25] fun. So I work extremely hard, but I don’t have to work at being [00:03:30] an orthodontist.
Payman Langroudi: And then over the years, things have [00:03:35] come along, I’m sure, a million times, and, you know, ended up being rubbish. [00:03:40] And, you know, we’re one of the manufacturers, right? So we get this a lot from dentists where, [00:03:45] you know, we’re trained as dentists. We’re trained to be sceptical about new things. [00:03:50] And you must have seen lots of new things come along. At what point do you jump [00:03:55] in on a trend? Call it a trend. Um, you know how how do you do you wait for others [00:04:00] to try things first. I mean, you seem to be quite an early adopter. For instance, on the digital side.
Claire Nightingale: Yeah, I have been an early [00:04:05] adopter.
Payman Langroudi: So have you found sometimes you’ve been an early adopter and the thing hasn’t worked out? [00:04:10]
Claire Nightingale: Um, I think so. When I think back to my career, I [00:04:15] mean, essentially I use fixed braces and now I’m a majority Invisalign practice. Okay. So [00:04:20] and of course, since the pandemic, I’ve really embraced dental monitoring. So [00:04:25] I have very much been an early adopter on that. But that was catalysed by the pandemic, and I had the good [00:04:30] fortune to set up my first five cases on dental monitoring on January the 20th, 2020. [00:04:35] So the only people I knew how they were doing were those five during the pandemic. So I was [00:04:40] sold on understanding that we should be moving towards an aligner based practice supported by remote [00:04:45] monitoring. Prior to that, my fixed base experience was using the [00:04:50] MBT Prescription, Victory and Clarity series brackets from [00:04:55] three immunotech. And the reason I used those was because R.E.M. were the hottest thing around [00:05:00] when I was doing my training. You know, they were very they really put a lot of marketing and [00:05:05] support into young Post-graduates in the in the 90s. And the B in MBT [00:05:10] was a man called John Bennett, who used to come down and teach us once a month at Bristol and then [00:05:15] became a professional mentor.
Claire Nightingale: And then he in fact, gosh, it’s so interesting [00:05:20] how it all connects. So John wanted to nurture me as a clinician and as an individual. [00:05:25] So he so he put a lot of opportunity my way, including when I was a [00:05:30] senior registrar and the three M Unitec wanted to take a group of rising [00:05:35] stars in orthodontics off to the American Orthodontic Conference in. This was in the millennium [00:05:40] 2000, and I was selected by John to be one of that group. [00:05:45] So off we went for about a ten day break and at the American Orthodontic [00:05:50] Conference was the launch of Invisalign, and at the time, I had a [00:05:55] former lab technician chap called Andy Price, who had just become a sales manager for Armco. I [00:06:00] think it was Armco. Yes. So he was there too, and he came over to me and said, Clare. Clare, come and [00:06:05] look at this. This is really exciting and took me off to the Invisalign stand and showed me this, you [00:06:10] know, digital computer I set up with aligners. And of course I was enormously sceptical, but [00:06:15] he Andy brought it to my attention. So, you know, you know, the sequence being.
Payman Langroudi: If your attention. [00:06:20]
Claire Nightingale: Yeah. If John Bennett hadn’t liked me and valued me and wanted to nurture me, I wouldn’t [00:06:25] have been taken to the conference in 2000. Where? Yeah, where Andy happened to be there, and [00:06:30] he took me off to look at Invisalign. So I came back and I accredited [00:06:35] as an Invisalign provider really quite early on. But what was the attraction for me was not the product, [00:06:40] it was the doctor locator function, because I was just starting to build a practice in Harley [00:06:45] Street as an in-house orthodontist, test. And the internet was still quite early on, you know. You [00:06:50] know. You know, it was still dial up, probably. And the smart phones hadn’t been invented. But I saw [00:06:55] that the doctor function being found as search engine optimisation [00:07:00] with my name on it, was clearly going to be a good thing. So that’s actually why I [00:07:05] accredited as an Invisalign provider. Um, but of course, I [00:07:10] didn’t really get flying with Invisalign until digital scanning technology came along. And the [00:07:15] other thing was they also dropped the case pack and they also dropped, uh, fat. [00:07:20] So instead, you know, VAT, you know, from the lab bill. So all of a sudden it became [00:07:25] a lot more cost effective as a low volume person to start using it. And as [00:07:30] a personality, I’m definitely somebody that is, I guess I’m not alone in this being [00:07:35] inspired by reward instead of threatened by punishment. So I wasn’t ever going to be someone that [00:07:40] bought a case pack and didn’t hit the target and then had a big financial penalty, but I am somebody [00:07:45] given a target and said, oh, you know, just do two more cases.
Claire Nightingale: You might get that extra percentage off your lab bill. So, [00:07:50] so the way their business operated suited my personality. [00:07:55] So I then started using Invisalign and and I am fundamentally a very loyal person. [00:08:00] So I remain very loyal to three Immunotech even though since they’ve become solvent, [00:08:05] um, their customer service has really gone downhill. And I’m very loyal to Invisalign, [00:08:10] despite the fact that there are now other providers on the market. And I’ll come back to all of that later, I’m sure. [00:08:15] Um, so I have and the thing that sets Invisalign align technology aside for me is their investment [00:08:20] in their software. You know, their clincheck process is is outstanding, their scanning [00:08:25] technology now with the interface visualisation outstanding. And [00:08:30] so I don’t have a reason to change provider. I’m in every sense satisfied. Yeah. [00:08:35] So so but coming back to your question so have I. I of course have had tries [00:08:40] at other aligner brands but Spot their clincheck the equivalent, their clincheck [00:08:45] process seems so Mickey Mouse to me. You know, they just didn’t cut the mustard, so I wouldn’t say I’ve had [00:08:50] any. And Damon. Yes, okay, I’ve tried a couple of Damon cases, but [00:08:55] but really, I’ve gone back. Nothing’s been disastrous, but nothing’s persuaded me that [00:09:00] they offer anything better to what I’m already using.
Payman Langroudi: And now. I mean, you’ve really thrown [00:09:05] your weight behind aligners. Yes, which is rare for orthodontists. I [00:09:10] mean, I know a few. I know a few like that. Yes, but the limitations of aligners, have [00:09:15] they now gotten better? I don’t know, intrusion extrusion.
Claire Nightingale: The [00:09:20] extrusion is still a bit tricky. I mean, I think the answer to the question is that I’m [00:09:25] treating some phenomenally difficult malocclusions really nicely with aligners, and [00:09:30] they come with a whole shed of advantages, which, you know, you know, the aesthetics, [00:09:35] the convenience, the lack of breakages, you know, the computerised treatment planning, actually, [00:09:40] the fact that when I when I submit a case, I can look at the tooth movements analysis table and see in multiple [00:09:45] dimensions where that tooth is going to move, and consider whether or not that’s what I want, you know, [00:09:50] and to to inhibit it from the outset. If I don’t want it, you know, to choose what type of attachment [00:09:55] I want to deliver a certain degree of rotation, for example. So and of course, really [00:10:00] when you use fixed appliances, on the whole you’re flying by the seat of your pants. You know, you don’t you think.
Payman Langroudi: Do you [00:10:05] think if the investment was made in fixed appliances, which I’m sure it will be or is now to [00:10:10] digitise fixed appliances as well, some sort of what’s that light force thing [00:10:15] they’re doing where they’re printing the brackets or whatever.
Claire Nightingale: Yeah. Well yes, I mean there have been customised brackets [00:10:20] for a while. I haven’t, I haven’t tried those. I mean I obviously I tried lingual orthodontics [00:10:25] as well, which of course are the ultimate digitised bracket system with [00:10:30] of course personalised bases and all of that. But I found it such a fiddle. Yeah. You know, [00:10:35] as the operator. As the operator? Yeah. A fiddle.
Payman Langroudi: And as a.
Claire Nightingale: Patient. Yeah. The whole [00:10:40] thing is so difficult, you know. And given that aligners can deliver equivalent, why would you. [00:10:45] Why? Why put yourself through that torture when we’ve got a good alternative [00:10:50] while we’re on it?
Payman Langroudi: Is there a percentage of your cases that come out of aligners and into fixed? [00:10:55]
Claire Nightingale: Very few. Very few. Yeah. I think I’m an 80% aligner practice [00:11:00] now. Really? Yeah. So I mean, I offer aligners pretty much to everybody. The only I [00:11:05] don’t treat many patients on an extraction basis, not because philosophically I’m [00:11:10] opposed to it, but I just don’t see that many people with a lot of crowding. And [00:11:15] for example, I have committed to a case for extractions yesterday, [00:11:20] but it was a child with hypodontia, you know. So. So I’m not seeing, you know, if people [00:11:25] maintain their dental health well and so they maintain their primary dentition, many cases [00:11:30] are treated on a non extraction basis, the majority. So uh, um, [00:11:35] however if I had to take out full four premolars. I probably am more comfortable [00:11:40] committing to fixed appliances than aligners. That said, I’ve got a couple of cases on the go, but of course I’ve got the [00:11:45] skill set to be able to switch between the systems if that turns out to be necessary. But [00:11:50] I can think of one. I can think of one adult and one child that I’ve started with [00:11:55] aligners that I’m clearly going to switch to fixed appliances for the adult already the child to come one. [00:12:00] Yeah. And it’s compliance. You know, they’re just not wearing their aligners. So it’s [00:12:05] not it’s not it’s not because the aligners themselves have failed. It’s patient compliance.
Payman Langroudi: And on your [00:12:10] NHS side I guess there’s no aligners available.
Claire Nightingale: Is that right. There aren’t. No. That’s right. Um, [00:12:15] however, I mean, my one of my bugbears is that we are still training [00:12:20] young orthodontists in the way I was trained 35 years ago, and I think this is a [00:12:25] big issue, you know, because of course, in my NHS post, we’re still taking alginate impressions and [00:12:30] we’re using fixed metal braces and that’s about it. And I feel that [00:12:35] given the the complexity of well, not even is it complexity. But given [00:12:40] how I’ve been able to embrace digital technology in private practice, I feel increasingly [00:12:45] the gulf between what we’re delivering on the NHS, but what the rest of the world is doing. [00:12:50] And I and as a people involved with training, we’re we’re not doing [00:12:55] the best by our trainees if we can’t introduce them to all this technology. So what I’ve [00:13:00] done, I mean getting it. Trying to get it through the NHS, particularly in District General Hospital, [00:13:05] is nigh on impossible. It’s impossible. It’s such a battle. So what I’ve done [00:13:10] is I have reached out to align technology and they have something called the Arc programme, [00:13:15] which is acts of random kindness. And, and, and basically each [00:13:20] doctor, you know, dentist has the opportunity to do two cases a year pro bono [00:13:25] on the lab bill. Yeah. For, for cases with a particular need. So for [00:13:30] and so what I’ve done is I’ve managed to get my registrar in my NHS post. I managed to get [00:13:35] her doing two Invisalign cases under my supervision, which I’ve put through the private practice. One of which [00:13:40] has come from this Arc programme and it was a child with such severe hypoplasia [00:13:45] of his enamel, it was unlikely we were going to treat him out with fixed braces because of breakages. [00:13:50] So I reached out to a line and they gave him a free, free, a [00:13:55] free treatment, which of course we are doing for him in the NHS.
Payman Langroudi: Where are we in orthodontics [00:14:00] compared to world leaders? I mean, is the NHS holding us back? It must [00:14:05] be right if our orthodontics are being retained.
Claire Nightingale: I’m sure it is. I’m sure it is because, [00:14:10] you know, you know, of course we should be using scanning technology, you know, not because [00:14:15] it’s just a simple way of generating a study model or sending lab work, but because when [00:14:20] you can look at the screen and you can draw up the occlusal features, you learn so much about the [00:14:25] case, you know, you know, the diagnostic value of and [00:14:30] record keeping as well Of digital technology is phenomenal. But how do we quantify that in a business [00:14:35] case? When an NHS trust that is bankrupt is only looking at cost savings, [00:14:40] you know, and you say, look, we can get a scanner for 20 grand, but alginate is pennies, [00:14:45] you know that. That’s the. That’s the challenge.
Payman Langroudi: I don’t know young orthodontic trainees. [00:14:50] Now, they know that once they get out, they’ve got a whole lot of other education that they need to [00:14:55] to do to get anywhere near, you know, what’s what’s the sort of standard [00:15:00] of of care.
Claire Nightingale: Well, they’ll come out as good orthodontists, [00:15:05] you know. And let’s not forget, what underpins good orthodontic treatment is going to be good [00:15:10] knowledge of tooth movement growth, sensible treatment planning. So [00:15:15] the skills that are required to treat people well with aligners are going to be absolutely transferrable [00:15:20] skills, aren’t they. They’re going to come out of that training programme and diagnosis and treatment planning, as [00:15:25] we were talking about briefly, is going to be essential for that. I mean, it’s not difficult to [00:15:30] learn how to scan. You know, it’s not difficult to learn how to plan with aligners [00:15:35] particularly. But I mean, what’s so interesting, of course, is that people who are leading the way [00:15:40] with training and aligners are. What do you think of that? So let’s be pragmatic about [00:15:45] that. And remember that GP’s have always carried the lion’s share of [00:15:50] orthodontic provision in the UK, you know, either fixed braces or more latterly [00:15:55] aligners. So GDP also is nothing new. Um, and [00:16:00] with the size of the population that we have in the UK, the relatively small number of specialists [00:16:05] we have, which I believe are less than 1500, although you’d have to fact check, [00:16:10] you know, we couldn’t possibly cater for the demand. So GDP although is a good thing. [00:16:15] You know, when I was listening to Marina talking about elective devitalisation of teeth [00:16:20] to provide veneers, that persuaded me even more that GDP ortho is a good thing because at [00:16:25] least that kind of work isn’t being done being done anymore. I would hope, but [00:16:30] I think that. What? And of course, when I went into orthodontics, the only way [00:16:35] you could get any education at all was to enrol on a formal master’s programme, of which there was very little opportunity [00:16:40] and hotly competed for.
Claire Nightingale: Now, with the advent of the internet, there’s [00:16:45] so much, so many different ways that people can access education and and be trained. [00:16:50] And I’ve been very impressed by listening to some of the GP’s who are doing clear aligner therapy [00:16:55] as to the level of their orthodontic knowledge. Um, where I think [00:17:00] the problem lies is that I think specialist orthodontists are probably [00:17:05] on their way out as a speciality. Now I might well be regarded [00:17:10] as a doomsayer a doom monger, if that’s the right phrase and [00:17:15] I. But I don’t think I’m alone in thinking like this, [00:17:20] which is that what is going to be attractive for young [00:17:25] people to want to go through competitive entry with national recruitment, [00:17:30] to do a three year year master’s program, or maybe not a master’s degree, because that [00:17:35] the the project element has been is no longer compulsory to [00:17:40] be trained currently in doing orthodontics in exactly the same way that I was trained 30 years ago, [00:17:45] which is fixed metal braces or functional appliances with no real access to technology. [00:17:50] And then they come out of it. And then what are their choices? To go and work in specialist orthodontic [00:17:55] practice, where the fees are about £1,500. Now, remember when I qualified as a specialist, they were probably [00:18:00] about £1,200. And that’s like about almost 30 years ago. So the fees [00:18:05] have really dropped in real terms. You know they get a small percentage of that [00:18:10] while their mates who’ve come out of BDA, you know, BDS have gone on a few aligner courses [00:18:15] and are doing a line bleach and bond and charging 3000 a case or whatever, you know, so I [00:18:20] struggle to see how Orthodontics as a speciality [00:18:25] is going to continue to attract the type of calibre people that we would like to attract [00:18:30] for the long term.
Claire Nightingale: When that’s the reality of what they are facing [00:18:35] when they come out. So if I ruled the world, you know what [00:18:40] I you know, there are various changes that I think I would make. And, you know, within training [00:18:45] I would like to introduce more technology. So, you know, I think, you know, scanners, possibly [00:18:50] dental monitoring, although I’ve not had any experience of it in high volume NHS settings. [00:18:55] Um, we need to try and train people in clear aligner therapy [00:19:00] using clear aligners as a way of delivering great care. But [00:19:05] I also think that we have to make sure that what people are coming out for is attractive, and [00:19:10] that means either vastly increasing the NHS fees. No, because I think [00:19:15] to expect people to treat palatal canines, that is a treatment that might take three years, [00:19:20] you know, for £1,500. Gross. I think that’s an absolute disgrace. And [00:19:25] I think that I can’t see why people are going to want to do that. And I understand that a lot [00:19:30] of young orthodontists, their ambition is to go into speciality, into go into private practice. But, [00:19:35] you know, I don’t think it’s an attractive week to work in 5 or 6 different places, [00:19:40] you know, pick up a day as an in house.
Payman Langroudi: Some people like it.
Claire Nightingale: But I mean, my head spins [00:19:45] if I work in two places predictably every week. Rigid routine. [00:19:50] But if I step out of my routine, I just fall over, you know? I can’t remember where I’m meant to be. [00:19:55] And how can you be confident that you’ve got the right brackets or the lab work being delivered? So actually, [00:20:00] if I ran the world, I would now be looking at restricted practice. You know, I’d be looking at [00:20:05] and what I mean, I don’t mean that restricting GP’s from doing orthodontics, [00:20:10] but I might restrict the complexity of cases that it is reasonable for a GDP [00:20:15] to treat. But I think I would be looking at saying that orthodontics as a As a specialist [00:20:20] should. Care should be delivered within a specialist practice setting so [00:20:25] that rather than. And I think that would be better for patients and it would be [00:20:30] better for clinicians all round if orthodontics was you know, so for example, you would have a hub and spoke arrangement, [00:20:35] you know. So when I joined dentists, I said my ambition, what I would love would [00:20:40] be if Queensgate Orthodontics became the orthodontic hub for the dentists practices [00:20:45] around it.
Claire Nightingale: And so rather than have in-house specialists where patients were able to go [00:20:50] one morning a week or a day a month, five days a week, six days, seven days a week, [00:20:55] they could come and access care at Queensgate Orthodontics. There would be a team of people there. The [00:21:00] emergencies would be covered. We’d have the bespoke software, we’d have all the scanners. We’d be able to do [00:21:05] audit, you know, peer review, turn to each other for specialist second opinions, you know, that [00:21:10] sort of thing. And unfortunately, that won’t ever happen because [00:21:15] one thing that corporates are very hot on is not restricting clinical freedom. [00:21:20] So they’re very strong on clinical freedom. And that is on the whole led by HMRC [00:21:25] and not wanting to run the risk of an associate being seen as an employed person. [00:21:30] Okay. So it’s not going to be led within the corporates to have a specialist [00:21:35] hub. Um, but I do believe that that’s the best place for patients to be [00:21:40] cared for properly. Let’s go back.
Payman Langroudi: What made you become a dentist?
Claire Nightingale: Right. So [00:21:45] how old were you? Go back a long, long time. So I was [00:21:50] about seven years old, growing up in Durham. And one day I noticed that I [00:21:55] had what I called a gumboil. So we go off to the dentist, and the dentist says, oh, she needs some teeth out. [00:22:00] And in those days, there were two things common running through the 1970s dentistry. [00:22:05] Serial extractions and gaps in the dental chair. Yeah. So? [00:22:10] So my mother was instructed to bring me back to the dental practice. Starved. And she was to bring a scarf. [00:22:15] Those were the were the instructions. So we get there and I ended up having gas [00:22:20] in the dental chair. A number of deciduous teeth removed. To this day, I remember the dream [00:22:25] I had, and I woke up crying and I was still in the dental surgery. [00:22:30] They slapped a bit of gauze in front of my mouth, tied it around my head with a scarf, and off I [00:22:35] went with my mom on the bus back home anyway. Amazingly, a year later she got me back to go through [00:22:40] the whole experience again. So it’s been deeply traumatic. But somehow I went back and did it all again anyway. A [00:22:45] couple of years later we moved down to London and the first family we met. The mother was a dental [00:22:50] nurse and she said, you must come and register with my dentist. Mr. Wilson. And Mr. Wilson looked in my mouth and [00:22:55] said, you need to see a specialist orthodontist.
Claire Nightingale: So I was about 12, probably by this [00:23:00] stage, and I thought that was really exciting. I felt special that I had to go and see a specialist. [00:23:05] So we go off to Watford and see this chap called Mr. Marks who said, yep, four [00:23:10] fours. So I’d obviously just had cereal extractions, four sees, four DS, four for fours. But [00:23:15] Mr. Wilson used local anaesthetic, and it was revelatory because I had such [00:23:20] a positive experience, you know, and I thought, and I must have thought at 12, this is [00:23:25] what dentistry is like, you know. I mean, these men became heroes to me, really, you know, to my [00:23:30] childish, in my childish world. So and the other factor was, I think there were two other [00:23:35] things. So I became aware of going to the dentist early. I became aware of how differently [00:23:40] dental treatment could be delivered. I was always very creative. I was always [00:23:45] modelling and making clothes for my Barbie dolls and making furniture out of Kellogg’s boxes, [00:23:50] this sort of thing. And I come from a very caring family. So my father is a priest, [00:23:55] an Anglican priest, and my mother was a social worker. So human care, looking [00:24:00] after people was very much a theme that ran in family life. So you put all those factors together. [00:24:05] And also I was interested in science and good at biology, and I just thought, you know what? Dentistry [00:24:10] looks like a good career option. So I made.
Payman Langroudi: A good student at school as well.
Claire Nightingale: Come [00:24:15] on, head girl.
Payman Langroudi: Where are you? Of course.
Claire Nightingale: What do you think? So. Yeah. [00:24:20] So, you know, so the advantage of saying at the age of 12, I am going to be a dentist. [00:24:25] It’s just brilliant. Because then you know what I mean? In my day, O-levels, A-levels, [00:24:30] what you had to do a bit of work experience. Et cetera. Et cetera. You know, and and so I [00:24:35] did wobble between dentistry and medicine when I was, you know, particularly during my A-levels. [00:24:40] My grandfather was very ill and subsequently died of cancer. So I kind of had that. Oh, should have been [00:24:45] a doctor. But I really don’t regret sticking with plan A, you know, [00:24:50] so that so basically that was why. And I think what’s interesting about this story is [00:24:55] that I say, you know, you know, when I reflect on, you know, the learning of this story [00:25:00] because it’s very weird for a child of seven not to be deeply traumatised by the experience [00:25:05] I had. And you question, you know, what was it in my either my own personality [00:25:10] or my my my mother’s parenting skills and also the attitude of. In the 1970s, [00:25:15] you know, we took the doctor’s advice, didn’t we? You know, we we went with professional [00:25:20] advice. We didn’t question professional advice. And now when I say to families, oh, your child needs a [00:25:25] baby tooth out, you know, they look at me, I couldn’t possibly put my child through that trauma. I think, well, it [00:25:30] changed the course of my life. What are you talking about? Get yourself down there. Um, so.
Payman Langroudi: You’ve got that responsibility [00:25:35] with my daughter now because she went in to, uh, your treatment [00:25:40] with you saying, I know I don’t want to be a dentist, so it’s up to you. [00:25:45] Well, it’s up to you to change that.
Claire Nightingale: Well, I think I think, I mean, she has. [00:25:50] She’s out perfection. Me, as I think you might know and you know. And now she draws micro [00:25:55] imperfections to my attention. And I’ve told Carla quite clearly, I’m only taking on patients [00:26:00] for treatment who are long sighted from now on. I’ve had enough of this close examination, [00:26:05] but, you know, but when I come back to my own childhood, I think what I learned as a child, clearly I [00:26:10] was resilient, you know. So resilience has carried me through life. You know, I also [00:26:15] made a positive from a negative, which is the best way to look at negative experiences [00:26:20] for sure, you know. So so those two lessons from that story are very, very important. [00:26:25] So that’s how I became a dentist. And when all along.
Payman Langroudi: You knew you wanted to be an orthodontist.
Claire Nightingale: So [00:26:30] did I know throughout uni. Well, I guess yes, because, I mean, I made that decision when I met [00:26:35] Mr. Marks in Watford when I was like 12 years old. Really? It wasn’t even just that I wanted to be a dentist. It was I’m [00:26:40] going to be an orthodontist. But of course, um, you know, we were hardly exposed [00:26:45] to orthodontics as undergraduates. And I do think I mean, I have had I’m [00:26:50] now we have this wonderful WhatsApp group of my year group, and in many ways, we’re closer [00:26:55] 40 years from because I started dental school 40 years ago, which is unbelievable. [00:27:00] And we’re closer now as a group of people than we were as dental students. [00:27:05] And we were recently reflecting on our time and I said, I thought we were all bullied. [00:27:10] We, you know, we were equally bullied irrespective of gender, you know, and we were there was a there was what we [00:27:15] would now call it bullying for sure. And particularly amongst the restorative, the staff and, [00:27:20] and of course, it’s terribly undermining of your confidence. And I never [00:27:25] thought I was any good as a dental student.
Claire Nightingale: I knew I was good academically because, you know, every [00:27:30] exam, you know, we were examined so frequently and I was always getting great marks, but I didn’t know how [00:27:35] good I was as a pair of hands because nobody ever told me. And I didn’t know until the fourth year out of [00:27:40] five that we were being graded on our on our clinical performance. And you had to go down to [00:27:45] the dean’s office and ask the secretary to see your personal file. And then I got my file and discovered [00:27:50] I had like A’s and B’s. And of course, the students were underperforming, were being hauled up in [00:27:55] front of the dean and told to go off and read textbooks. Not also very helpful, but but of course, no one ever [00:28:00] said I’ve been to the Dean’s today to be told I’m rubbish, you know? So, you know, I just had no idea [00:28:05] what I was like as a clinician. And, you know, I think when you’re undermined and bullied and not [00:28:10] told that you’ve done well.
Payman Langroudi: The curriculum was to bully the students. Right.
Claire Nightingale: But then it’s hardly very [00:28:15] nurturing to then decide that you’re going to become a restorative dentist. Yeah.
Payman Langroudi: But I think [00:28:20] I spoke to once I became a dentist, I finally spoke to one of the cons guys as [00:28:25] it was, and he was saying, yeah, you know, dentistry is a pressure job. So we put pressure on [00:28:30] the students to see how well they’ll take it. And it’s a very unhealthy dynamic. Yes. [00:28:35]
Claire Nightingale: Well that’s true, that’s true. Um, and it is a high stress. It is a highly [00:28:40] stressful job, of course. And I you know, it’s taken me almost my entire career to realise how different [00:28:45] it is from other, other jobs and how we are. I always say that every day [00:28:50] is a triumph in the face of adversity. Yeah, there is never a day when you [00:28:55] have every member of staff are there, you don’t have equipment. You know, every day there’s people off [00:29:00] equipment failure, it failure, all.
Payman Langroudi: Of that having left it. Yeah, yeah. I mean, [00:29:05] number one leaving you really crystallise what you loved about it and [00:29:10] what you didn’t love about it. Yeah. So that’s one point. But the question of is [00:29:15] it a simple job or easy job or not? It clearly isn’t an easy job. It’s a difficult job. But [00:29:20] I would say it’s easy money. Being a dentist. Now, why do I say that? You [00:29:25] can get an average person, not an extraordinary person like you or someone else. [00:29:30] An average person who doesn’t push the boundaries, doesn’t do anything out of the ordinary. [00:29:35] And he could make, I don’t know, let’s just throw a number out £250,000 a year. Owning his own [00:29:40] general practice. Yeah. In any other field, that average [00:29:45] person would not be doing that would not be doing that. It would be an extraordinary. People [00:29:50] in other fields make good money, you know. But let’s say that same [00:29:55] character said, oh, I’m interested in marketing. Yes. You’d have to be. You’d have to be head of marketing [00:30:00] for marketing for some major conglomerate to make £250,000. And so it’s not an easy job [00:30:05] at all. It’s a difficult job. It’s a backbreaking job. It’s a stressful job. You’ve got the legal side. You’ve [00:30:10] got the patience. You’re on the stage all the time. All of those things are true.
Claire Nightingale: Yes, but.
Payman Langroudi: It pays. [00:30:15]
Claire Nightingale: Well. And I mean, I think that that’s the point which [00:30:20] we can extrapolate from that is about the selection criteria for Dental students. [00:30:25] Perhaps, you know, because when I went to dental school, the the offer was a B and [00:30:30] two C’s. Yeah. Me too. And the, the academic staff said that dental students, since [00:30:35] they, since they’d raised the entry requirements from like two E’s. Dental [00:30:40] students were not so much fun anymore. You know, they’d had a lot more laughs with the rugby playing [00:30:45] men who got who got in on two E’s. And now, of course, it’s extraordinary, [00:30:50] you know? And the problem is, is that I believe that actually what you need to be to be a [00:30:55] good dentist is you need to have emotional intelligence and a good pair of hands [00:31:00] and be resilient. And you don’t have to remember the Krebs cycle. You know, and so I [00:31:05] do think we are we’ve set the bar way too high to get [00:31:10] the right people in for dentistry. And and I do [00:31:15] also, again, you know, one of my worries is about the geographic variation, because I understand that now [00:31:20] 50% of undergraduates for dentistry and medicine come from London, you know, and apparently [00:31:25] so.
Claire Nightingale: And of course, London has great schools, you know, nationally, you know, [00:31:30] outperforms in academic performance compared to the rest of the country. But as people gravitate back to where they [00:31:35] grew up and where their families are, how how are the mining communities of the North East going to [00:31:40] be served? You know, where this is the problem. And I think that, you know, if I [00:31:45] could rule the world, then I would be selecting people on the basis of emotional [00:31:50] intelligence, empathy, being, wanting to care for people [00:31:55] and geographically appropriate as well. You know, because when I was at dental school, we had at least three [00:32:00] young lads who were from mining communities who had come and done really well and got their B [00:32:05] in two CS and then went back and served their mining communities. And that’s what we [00:32:10] need. We need people like them to be good dentists. So you’re right, you know, you’re right in [00:32:15] this in the sense that we don’t need academic geniuses to be dentists, but we do need some really solid, [00:32:20] grounded people who have got big hearts.
Payman Langroudi: I think the emotional intelligence [00:32:25] piece is super important. And you’re involved in training orthodontists. There isn’t [00:32:30] any training in it. Or is it something that can’t be trained?
Claire Nightingale: Oh, that’s [00:32:35] a big question.
Payman Langroudi: It’s so important. I mean, the way you handle your patients [00:32:40] and staff and call it suppliers or your stakeholders emotionally, [00:32:45] really, I think is the key difference between successful or maybe a great dentist and a [00:32:50] good dentist. You know, it’s that extra piece. Yeah. And there wasn’t a wasn’t a mention of [00:32:55] it in dental school.
Claire Nightingale: No no, no. I’m not the right person to answer [00:33:00] the question about whether you can train people to be empathetic and have emotional intelligence. Clearly people [00:33:05] in training. But I need to need to know that. But it’s certainly an essential. I mean, you know, [00:33:10] I certainly don’t get it right all the time. And sometimes I just don’t have the stamina to get it right all the [00:33:15] time. But fundamentally, it’s one of the core skills for, for for life [00:33:20] for life in general, isn’t it? Dealing with people, you know. Full stop.
Payman Langroudi: Yeah, yeah. [00:33:25] Let’s talk about private practice. So when you decided to make the leap, and that was [00:33:30] kind of a little later on for you, right? In your 40s.
Claire Nightingale: You mean in terms of ownership? [00:33:35] Yeah. Oh, really? Late in life.
Payman Langroudi: Why did you leave it so long?
Claire Nightingale: Oh, because the right [00:33:40] deal didn’t come across my timeline. So, you know, did you have.
Payman Langroudi: A very clear understanding [00:33:45] of what the right deal was?
Claire Nightingale: Well, I quickly learned what the wrong deal was.
Payman Langroudi: Tell [00:33:50] the story. Tell the.
Claire Nightingale: Stories. Okay, so I mean, I think [00:33:55] that there’s so much that’s interesting about practice, ownership and ambition. [00:34:00] Actually, you know, so if we go back 40 years ago and what was the Dental landscape? Well, [00:34:05] dentists tended to be single handed individuals working from the front room of their own home. [00:34:10] You know, we weren’t allowed to advertise. Um, you know, [00:34:15] I know there were those sorts of restrictions anyway. And, of course, anybody [00:34:20] could. Anybody could set up a practice anywhere under the NHS. Right. [00:34:25] So people were used to working by themselves. They just worked out of residential properties [00:34:30] that we didn’t have high street dentists. And remember that NHS that goodwill [00:34:35] sold for a pound. So you know so I have been chuckling to myself at [00:34:40] remembering my two closest friends from dental school when they bought their first practice. Well, their [00:34:45] only practice, actually. They bought a practice in a fabulous location in Jesmond in Newcastle. [00:34:50] They bought it bought it for a pound and the building cost like, say 60,000. Right. [00:34:55] And and of course, they lived above the shop for a while and they, they made, made they converted [00:35:00] it into a beautiful private practice in the end. But when they took me round to view it, it was an old standard NHS [00:35:05] practice. And the waiting area was the corridor by the staircase. A few old [00:35:10] dining chairs shoved in a row, and the only thing that was on the wall to [00:35:15] welcome the patients was a skull with a fag hanging out of its mouth. That said, smoking kills, [00:35:20] you know. And I can contrast that now to, you [00:35:25] know, I was the judge at the private dentistry awards where the the winning, the winning practice. [00:35:30] His mission was to make it look like a high quality hotel from Dubai.
Payman Langroudi: The [00:35:35] Black Swan.
Claire Nightingale: Yes, I think I think that would be it, you know, up in Glasgow.
Payman Langroudi: Or Glasgow.
Claire Nightingale: Or [00:35:40] Scotland, certainly. Anyway, unfortunately, I can’t remember the name. That’s embarrassing. But, you know, I [00:35:45] do remember being hugely impressed. But when you look where dentistry has gone. It’s phenomenal. [00:35:50] And so at the point I’m and you know, no one until 2006, Corporatisation didn’t [00:35:55] really exist. You know, the changes in the regulations. And now, of course, you know, we [00:36:00] all expected to make money from treating patients, didn’t we? So, you know, it was high volume churn [00:36:05] or low volume churn and high prices. Yeah. That’s how we made our money as dentists. Nobody [00:36:10] expected when they came out of dental school in the 80s, that you’d make money from the value [00:36:15] of your business, you know, you know, and now, you know, the thought of buying and selling practices to make a [00:36:20] margin. I mean, you know, that is just alien to my way of thinking, because I came out [00:36:25] of a generation that expected dentists to be single handed operators working out [00:36:30] of a front room of a house. So why I’m telling you, all this is talking about my ambition, [00:36:35] I suppose, because of course, I never had the [00:36:40] imagination that people would own more than one practice, or that you would build up a chain of [00:36:45] practices.
Claire Nightingale: It was Unimaginable to me. And so when I qualified, you know, [00:36:50] what my landscape looked like was a hospital career or going into [00:36:55] private, going into practice and being. I am ambitious, and [00:37:00] I wanted a foot in both camps, you know, and, and, and and of course, quite a lot of people [00:37:05] now have a foot in both camps, but at the time people tend to be full time either way. Yeah. So [00:37:10] I always and so if we come back to Mr. Wilson, my very first dentist, he, he owned his own [00:37:15] practice. So yes, I always saw practice ownership as something that I wanted to do. Um, but of course, [00:37:20] when you do a long period of extended training, as I did, I didn’t come out as a specialist [00:37:25] orthodontist until over the age of 30, you know, and I did my senior registrar training, which [00:37:30] was four years after that. So I managed to time my first child with the [00:37:35] good fortune of being about 6 or 7 months pregnant as I as I.
Payman Langroudi: Set my.
Claire Nightingale: Time. [00:37:40] No, no, I met my future husband in Bristol, and then we moved back to London because we [00:37:45] felt he’s not a dentist. He’s a surveyor. Okay. But we felt that London was the best place that [00:37:50] we could have an equal shot at a career. So we gravitated back to the South East, and it was difficult. It was difficult [00:37:55] for me to get a job, actually, because I wasn’t a London girl. I wasn’t a London undergraduate, I wasn’t a London postgraduate. [00:38:00] And that’s where national recruitment really comes into its own, eliminating those prejudices. [00:38:05] Anyway, on my third attempt, I got a senior registrar post, so I had [00:38:10] to wait a couple of years to get that. So by the time I had my first child, it was a [00:38:15] week before my 35th birthday, you know? And in fact, I’m going to jump [00:38:20] ahead because, you know, at the end of this you’ll ask me about advice. But, you know, one of my pieces [00:38:25] of advice as a woman is to and not so different for [00:38:30] men. Men have obviously a bit more time on their side, but I would say time your family on the [00:38:35] age you want to be when you have your last child, not your first. I mean, your first is important, but we you know, if you leave the first [00:38:40] too late, you may not get the second, you know, and I was very lucky that I managed [00:38:45] to have three children. So what it means, what I’m trying to say by all of this is that, you know, as a professional [00:38:50] woman, if you are, you know, you’ve got an extended period of training, then you want, [00:38:55] you know, you’re competitive and you want a foot in two camps, you know, and then you want a family and you want more than one [00:39:00] child.
Claire Nightingale: You know, all of a sudden you’re in your 40s before [00:39:05] you are and not having a Dental spouse as well. So I didn’t have a [00:39:10] partner that was securing a practice on my behalf, so I had to do it by myself, you [00:39:15] know. So yes. And then my ambition, you see, because I’d met John [00:39:20] Bennett, the B and m t at Bristol. My ambition he had said to me that with my [00:39:25] he said, you’ve got a great pair of hands. And by the way, you speak with patients and their parents, you’d do really [00:39:30] well in private practice. So, so the bar got raised again because I would have come out thinking [00:39:35] NHS practice was fine, but all of a sudden I had this West End practitioner suggesting to me that [00:39:40] I would be good in the in the West End. So I kind of thought, oh, well, Harley Street, you know, sounds all right. So [00:39:45] I had an ambition to follow John and um, and then, of course, you know, you [00:39:50] look at partnerships and anyway, it’s very difficult. So what I’m saying [00:39:55] is, is that I had eggs in a lot of baskets, and I was waiting to see which one came up [00:40:00] first. And ironically, the first opportunity that came my way, [00:40:05] um, I was working in an NHS practice in North London, and it was just as the contracts [00:40:10] were about to change. We were told in 2003 that the contracts were changing in 2006. [00:40:15] So I thought, oh, right, I need to get my own practice really quickly because I could see that the valuations would [00:40:20] rocket.
Payman Langroudi: Why? Why were you so sure? Because of the change in my business [00:40:25] instinct.
Claire Nightingale: So yeah.
Payman Langroudi: Of course.
Claire Nightingale: Okay. So you know, prior, [00:40:30] remember that prior to 2006, NHS dentistry was an absolute [00:40:35] gold mine. You know, you could and particularly orthodontics and you know, there’s a there’s a whole host of young men [00:40:40] that built up fabulous, you know, large grossing practices very quickly [00:40:45] after coming out of specialist training. Yeah. So anyone under the NHS under the [00:40:50] age of 18 could have treatment for free. You know, there was no limit to how much you could gross. [00:40:55] Um, and you could work 6 or 7 days a week, you know, and [00:41:00] of course. So of course. And it was the explosion in the NHS orthodontic spend that [00:41:05] brought this to the attention of the government. And I thought they’ve got a cash limit this we’ve got, we’ve got to limit our liability. So [00:41:10] that’s when they introduced there were so many changes, you know they introduced ITN, [00:41:15] they introduced contracts and contracts then had to be competitive. You had to bid for them, you know, and they [00:41:20] also changed the ownership of practices and said anybody could own a practice. You didn’t have to be a dentist. So there [00:41:25] were massive changes happened that then changed the landscape of dentistry [00:41:30] to what it is now. Now, you know. So there I was thinking, right, [00:41:35] okay, so it’s 2003.
Payman Langroudi: Get on with.
Claire Nightingale: It. Yeah, I’ve got three years before I. [00:41:40] The opportunity is lost. And then, of course, when you’ve got more demand than supply, [00:41:45] you know, so more purchases for less for the same number of practices. Of course the valuation is going [00:41:50] to go up and then you can’t just go off and set up a squat under the NHS, you know. [00:41:55] So, you know, it was a no brainer to see that we, you know, that if you didn’t have a practice, you were [00:42:00] going to be potentially really screwed over, you know, so so I said [00:42:05] to the principal of the practice I was in that I would like to buy, buy his practice. And also [00:42:10] he was at this point all of 50. And as far as I was concerned, he was over the hill. You know, he [00:42:15] must be looking to retire. You know, that’s what I thought happened at 50. Anyway. [00:42:20] I said, look, I’d really like to buy your practice. And at the time I was pregnant with child number two. [00:42:25] And he said, okay, well, when you come back from your maternity leave, we’ll set it to a timetable. [00:42:30] And a week later, he was killed in a motorcycle accident. So it was a terrible, [00:42:35] terrible experience for me. Awful. You can imagine [00:42:40] a heavily pregnant woman with a toddler trying to negotiate with a grieving widow. Neither [00:42:45] of us have had any experience of buying or selling practices before. Ended in complete disaster. [00:42:50] Terrible. I had to walk away massively distressed. Really [00:42:55] ill. I mean, you know, which again, all of these things feed into the life’s learning. Um, [00:43:00] but in the end, it was one of the best things that happened to me, [00:43:05] bizarrely, because had I bought that practice, um, I would have been in a [00:43:10] part of an area of London I didn’t particularly want to be anyway, you know, as you as, you know, I mean, anyway, that was my first [00:43:15] attempt at buying a practice. And then after that, you know, I realised I looked at [00:43:20] partnerships, you know, really, really difficult to go into partnerships with people. The valuations of practices [00:43:25] were rocketing and on the partnership point.
Payman Langroudi: Yeah. Is it that you’re a lone wolf? Is that what you mean? [00:43:30] Or is it that you didn’t find someone that you would want to partner with or.
Claire Nightingale: No, I just, I just, you know, are [00:43:35] you a lone wolf.
Payman Langroudi: Very scared to go into a business without a partner?
Claire Nightingale: Oh, [00:43:40] that’s an interesting. Yeah. Well, I mean, I have rarely observed a [00:43:45] really happy partnership in dentistry. Um, no, I explored two [00:43:50] partnerships out of circumstance. Um, neither of them turned out to be [00:43:55] right. Are you a lone wolf?
Payman Langroudi: Am I a lone person who wants to make an immediate decision? And it happens. [00:44:00] And you don’t want to run it by someone else? Is that all you’ve ever known or. Oh, well, I.
Claire Nightingale: Mean, I’m [00:44:05] certainly a decision maker. I’m definitely not a procrastinator. And the moment I’ve made a decision, [00:44:10] I want it just enacted there and then.
Payman Langroudi: Claire, what are you bad at?
Claire Nightingale: So that’s [00:44:15] an interesting question. Payman. Because I will tell you off the, you know, off the cuff that I’m bad [00:44:20] at clay pigeon shooting and handwriting, but I suspect that the gist of your question is [00:44:25] either what are my weaknesses? Or why did I never have a business partner? And [00:44:30] where would my business deficiencies be? Is that really what you.
Payman Langroudi: Want to.
Claire Nightingale: Drill down to? So [00:44:35] I’ll say to you, I mean, you know, the standard way of responding to what are your weaknesses? We’ve always been trained to portray [00:44:40] them as as a hidden strength. So I would say to you that my weaknesses [00:44:45] are that I am impatient and I have a low boredom threshold, both of which are very true, [00:44:50] but it drives me to do multiple things and be an effective [00:44:55] completer of tasks. So, you know, I’m always looking for the next project. I’m never happy unless I have [00:45:00] a project to work on. Um, but you don’t you don’t.
Payman Langroudi: You don’t strike me as the kind of person [00:45:05] who I’m like, I love a new idea, but the follow through [00:45:10] of it, I don’t enjoy it at all. So it’s like, well.
Claire Nightingale: We need to.
Payman Langroudi: We need to do a.
Claire Nightingale: Test [00:45:15] on you, Payman, and see what where you are. Where you.
Payman Langroudi: Are. When you say when you say boredom, [00:45:20] boredom. So you get bored quickly. Does that does that affect you negatively [00:45:25] as well as positively?
Claire Nightingale: Negatively? I mean, it’s a funny thing to say, isn’t it? As an orthodontist whose treatment plans [00:45:30] take forever to say you’ve got a low boredom threshold. No, it just means that, [00:45:35] you know, that’s why I will go off and do the comedy or do my expert witness course or, you [00:45:40] know, start preparing the next conference for the Women’s Dentist network. Think of the next idea.
Payman Langroudi: What [00:45:45] about you? Don’t live in the moment enough.
Claire Nightingale: Yeah, yeah. I think that is very [00:45:50] I think that that is planning.
Payman Langroudi: Ahead a lot.
Claire Nightingale: I think you have got a very good point, actually, and [00:45:55] I think certainly in my early 20s, I was very guilty of [00:46:00] living too much in the future. You know, it was all about, you know, doing the primary [00:46:05] and the secondary PhDs. And then which job did I have to do to get on an ortho course? All of that. You’re absolutely right. [00:46:10] And actually, very, very recently, I have summed up, I [00:46:15] do make a conscious effort to live in the moment. I do, despite the fact that I’ve got all these projects. [00:46:20] And I would say that my philosophy now is, you know, look to the future, [00:46:25] learn from the past, but live in the live in the moment. Yeah, I think that’s a good encapsulation [00:46:30] of what’s a muscle.
Payman Langroudi: In a way. You have to train that muscle. Yeah, you have to you have [00:46:35] to actually think. Yeah.
Claire Nightingale: And I tell.
Payman Langroudi: You what, on the seat almost, you know, what is the.
Claire Nightingale: Biggest prompt? [00:46:40] It is the death of a friend, isn’t it? Or, you know, a terrible diagnosis as [00:46:45] unfortunately, I’m at that stage of life, you know, of our of friends. So there is nothing like a bit of bad [00:46:50] news to really make you live in the moment. Yeah. Um, but, you know, if we come back [00:46:55] to business, you know. And why at Queensgate Orthodontics did I never have a business [00:47:00] partner, which is what we’ve touched upon. And the answer would be that a mono [00:47:05] speciality private referral practice is like living in a leaking [00:47:10] bucket. You know, whenever you’ve got a new referrer appearing at the top or a new source [00:47:15] of patients at the top, another one drops out at the bottom and that bucket is constantly [00:47:20] leaking. And therefore I just say it’s very simple. You know, the practice never had has never had [00:47:25] enough churn to really support 2 to 2 people, you know. [00:47:30] And of course, you could argue that if I had and then, of course, I’d had two [00:47:35] attempts at partnership before, which had failed and had been a bit scarring. Um, [00:47:40] but and of course I wouldn’t. I’m pretty representative of people of my age [00:47:45] group who have continued to run single handed practices, you know, like Moira Wong, Asif Chattoo [00:47:50] and, you know, we’ve all been running single handed practices for four [00:47:55] years. Um, and you could say that where I have been time [00:48:00] poor has been focusing on marketing. You know, marketing is an alien concept [00:48:05] to me. And also on the finances, you know, things like fee setting, [00:48:10] um, realistic fee setting. I think my fees are realistic, but I kind of do them [00:48:15] on the back of an envelope, and I’m sure someone with an accountancy background would do something [00:48:20] a little bit more scientific. Um, and if I had brought [00:48:25] in another partner who had those skill sets, they might have been able to drive their books sufficiently [00:48:30] to serve two people within the practice. You know, but what. [00:48:35]
Payman Langroudi: I said about partners. Yeah, the thing that would bother me the most about not having a [00:48:40] partner is almost the loneliness of when there are moments in any, even [00:48:45] in the happiest business, there are moments where I wouldn’t say the team turn [00:48:50] on you, but there’s there are moments where it’s an us and them yes moment. Yes. And [00:48:55] in those moments, I find having partners be the most important.
Claire Nightingale: And that’s.
Payman Langroudi: Why you [00:49:00] found yourself lonely in.
Claire Nightingale: Those moments? Yeah, absolutely. I think I’ve referred to the fact that [00:49:05] it’s lonely at the top of the pyramid, irrespective of how small or high that pyramid is. So you [00:49:10] build your net. If you’re a single handed person, you build your network outside of the business. [00:49:15] So even though I was single handed as the practice owner, you know, I had [00:49:20] my school mum friend who was a top notch corporate lawyer. You know, I bought [00:49:25] in external practice management services. I had someone else who I employed for HR [00:49:30] advice, that sort of thing, you know. And I had various shoulders to cry on, you know. [00:49:35] So, um, so you could say. You could say that I was I wasn’t a single, [00:49:40] you know, in effect, I put it like this. I didn’t have a paid partner that had an ownership [00:49:45] of the business, but I had plenty of people around me supporting me every [00:49:50] step of the way. Because you can’t survive unless you’ve got your safety blanket.
Payman Langroudi: Coach and all that, right? [00:49:55]
Claire Nightingale: Well, I never had proper coaching, actually. No, I mean, I’ve mentioned before my fondness for Chris [00:50:00] Barrow. Um, and I would always listen to [00:50:05] him when he was talking at any kind of business meeting. Um, and I did join his [00:50:10] coaching program in Covid. He had that wonderful, uh, you know, virtual [00:50:15] program. But when I had a 1 to 1 with him, he actually said I didn’t need him because he said [00:50:20] I, I he, I asked him what was the difference, why would I not [00:50:25] need him? And he said, because you. He said his coaching was a lot about people who just simply didn’t know where to start. [00:50:30] And I always have a very clear idea of where I’m starting and where I’m going and what I’m [00:50:35] doing.
Payman Langroudi: We were discussing before. Yeah. Can a great clinician be a great business person as [00:50:40] well? And and there are skills that both need, you know, and you seem to [00:50:45] have access to those skills.
Claire Nightingale: Well, I think I do, but I’ve only done it on a small scale. Yeah, yeah. [00:50:50] And I mean, you know, to scale up, I would have to stop being a clinician, you know.
Payman Langroudi: Yeah. [00:50:55] But, you know, I had I had the CEO of Bupa. Yeah. Sitting where you’re sitting. Yeah. And he [00:51:00] said when he said 8000 employees. And I can’t even fathom what that [00:51:05] means. But then when we drill down, there’s really there’s 30, 40 [00:51:10] people he’s in touch with. Yes. You know, so yeah. Even in an 8000 person [00:51:15] business, it’s not an 8000 relationship. Because you’ve got a small business, [00:51:20] you feel like it would be just that scaled. But it’s not necessarily, [00:51:25] you know, a Payman.
Claire Nightingale: I’m going to suggest to you that actually, business principles are pretty simple, and I’m [00:51:30] going to see if you would agree with me. And I think, I mean, essentially, I think it’s kind of like for, [00:51:35] for things, you know, it’s money in, money out. You’ve got to make sure that more money comes in than goes [00:51:40] out. You’ve got to pay really careful pay, great care for your customers, stroke [00:51:45] patients and paying attention to detail. I think that’s it. Yeah. [00:51:50]
Payman Langroudi: It’s tough.
Claire Nightingale: In managing staff is difficult, which is I.
Payman Langroudi: Always think of it as keep your [00:51:55] three three constituents happy, which is your your customers, your staff and your suppliers. [00:52:00] Yes.
Claire Nightingale: And I and.
Payman Langroudi: I in my world, suppliers make a big difference, you know, because there’s a lot [00:52:05] of trust in it. Um, there’s IP involved in it. You know, [00:52:10] I’m getting my particular desensitising gel from a particular factory where we’re [00:52:15] signing off to say, you know, you’re not going to sell that somewhere else. Things like that. Yes. Um, [00:52:20] but those three things. You’re right. It’s not people. People make it more complex than than it has [00:52:25] to be.
Claire Nightingale: And I say to my staff that it’s a triad, you know, it’s the patients, [00:52:30] it’s the business and it’s the team. And we have to pay attention to all of those to stop [00:52:35] the pyramid, the triad falling over. But we don’t have to pay attention in the same amount. [00:52:40] And also at the same time. But we can’t neglect one because the whole thing comes down. [00:52:45] And, you know, and I still can’t read a PNL. She actually, you know, [00:52:50] and actually, I don’t care because it’s still money in, money out. It doesn’t matter quite how an accountant dresses [00:52:55] it up. It’s just no more difficult than your domestic finances.
Payman Langroudi: If I could be bored of [00:53:00] YouTube videos.
Claire Nightingale: If you chose to, if my low boredom threshold allowed me to [00:53:05] try and remember what a bracket meant. And what variance [00:53:10] from the budget did it matter? You know, cash flow. Cash flow. That’s the [00:53:15] other critical thing I would say that I’ve always enjoyed taking listening to people. And [00:53:20] you learn one thing from most people you listen to. So, for example, a chap who was a management [00:53:25] consultant in the NHS trust I was working in who became a personal friend for a while. [00:53:30] He said to me when I was looking at going into partnership and into practice, that wasn’t [00:53:35] very profitable. He said the thing that brings successful businesses down is not lack [00:53:40] of profit, but lack of cash flow. And so when I did run Queensgate Orthodontics, [00:53:45] I always kept a very substantial sum of money in the bank because all of my loads [00:53:50] of my patients paid in advance. And, you know, and I thought, well, I actually don’t really know what’s due to me. And if [00:53:55] they ask for their money back, like northern Rock, you know, I could have had a run on Clare Nightingale [00:54:00] Limited and gone under. So, you know, why did it take me so long to buy a practice? Because I looked at five [00:54:05] before I found the right deal, and I walked away from five opportunities that [00:54:10] were Go through.
Payman Langroudi: Some of the issues with those five deals. So, you know, there’s people who’ve never, ever [00:54:15] bought a practice and now are about to embark on that. What kinds of things did you come across that [00:54:20] put you off those other five?
Claire Nightingale: Um, well, okay. So I mean, ultimately the first [00:54:25] one that I had to walk away from in grief, ultimately, the [00:54:30] opportunity was offered to me as a partnership by the person that did buy, but [00:54:35] she, her husband wanted to be was going to be the practice manager. And I realised I’d be in a husband [00:54:40] and wife partnership and then I wouldn’t have a voice. Good decision. So I [00:54:45] walked. Okay. So that so that was one. So you could say incompatibility in partnership. You know, [00:54:50] not sharing, not having the same shared values um, and aspirations and modus [00:54:55] operandi. You know, as I said, I just like to make decisions and implement them quickly, uh, [00:55:00] because on the whole, most decisions you can retake, you know, um, not [00:55:05] every decision has to be right, but you do have to make one do it.
Payman Langroudi: No, you’re absolutely right. A quick [00:55:10] decision is much better than the right decision. I completely agree with that.
Claire Nightingale: Um. Next one [00:55:15] practice massively overvalued. You know, and back up against the wall in a bad [00:55:20] partnership. You know, being told one thing and then the reality in writing was another. [00:55:25] This sort of thing, you know. Um, next practice I looked at was a [00:55:30] sublet on, on a in a health centre, and the head lease was coming up [00:55:35] for renewal in 18 months after the purchase, and also because the contracting [00:55:40] changed that the vendor was not actually working on the premises. And when I asked the woman [00:55:45] in public mental health, who to whom is this contract? Who will own this contract? [00:55:50] She said it’s going to be owned by the associate, not the principal, because the principal didn’t work there. So? [00:55:55] So I realised that I could end up buying a practice, but within 18 [00:56:00] months, the associate could walk off with the contract value and the head lease could expire and I could be kicked out. [00:56:05]
Payman Langroudi: Did you get into the sort of the weeds of that? Or did you have a lawyer or something?
Claire Nightingale: I [00:56:10] believe you, me? I’ve haemorrhaged cash to Russell. My lovely friend, Russell Abrahams. In [00:56:15] fact, I go out to eat with him so often, I kind of think I’m just eating my way back [00:56:20] through my credit. Anyway, I mean, you know, I mean, out of the silver lining, I [00:56:25] mean, you know, I, you know, again, you know, be resilient. You know, I was on I was floored [00:56:30] by my first experience. I mean, it was terrible. And in fact, you know, I know I’m jumping ahead to deathbed [00:56:35] advice, but I genuinely got deathbed advice from my grandmother at the time, who died within 12 months [00:56:40] of that also. And she looked at me and she said, Claire, is it really worth making yourself [00:56:45] ill over? And I was profoundly ill. I just I had developed Graves disease, [00:56:50] but I didn’t become clinically identifiable as having graves disease [00:56:55] for another ten years. Was I a hypothyroidism? High hypothyroidism. But [00:57:00] my weight dropped to seven stone. Five. Wow. Yeah. And I. That was after two So. [00:57:05] Yeah. So so actually I listened to my grandmother. It was my grandmother saying, is [00:57:10] it worth getting ill over? And I just realised that I was listening to wise Words. So [00:57:15] I walked. So. Yes. So where are we at? What were the what was the next one? Okay. [00:57:20] Next one. Okay. So the next one, I mean basically overvalued [00:57:25] goodwill, you know, because as I said, I’d missed the boat, although I had had an ambition to buy [00:57:30] a practice by 2006, I’d missed the boat.
Claire Nightingale: And indeed, I was absolutely [00:57:35] right. Valuations rocketed, you know. So one practice I was offered, the [00:57:40] NHS goodwill was, let’s call it a I think it was £1 million. And I thought, [00:57:45] you know, if I invest £1 million in goodwill, bearing in mind [00:57:50] that 15 years earlier practices were selling for a quid, you know, [00:57:55] you know, you think, yeah. Well so I spent £1 million on NHS goodwill. I can’t [00:58:00] live in it. I can’t eat it. And when I come to retire, is the Is the NHS going to exist? [00:58:05] Can I? It’s going to be an awful lot of earning back to earn £1 million. [00:58:10] Be down £1 million. Yeah. Right. So I walked away from I walked away from that [00:58:15] one. Another one I was offered was, um, you know, again, a [00:58:20] tragedy. You know, somebody was dying and they wanted and he had a share in three [00:58:25] orthodontic practices. And would I come into a partnership and take on his share [00:58:30] of three practices? And again, I thought, well, you know, it’s expensive. I, [00:58:35] you know, the chap who I would have been in partnership with is a delightful man. We didn’t explore [00:58:40] whether or not our values and aspirations were going to be the same, but on the surface of [00:58:45] it, I was going to spend almost £1 million, and then I was going to run ragged between three different settings. [00:58:50] So I thought, you know, unfortunately that’s not for me either. You know, I tried to figure out a way the.
Payman Langroudi: Fact that [00:58:55] it was three, that was the.
Claire Nightingale: Issue. Well, the value, the valuation. Well, valuation, it was going [00:59:00] to be the I mean, I had three small children, you know. Could I run around between three practices [00:59:05] and service a £700,000 debt? I tried to. I did propose a way [00:59:10] where they amalgamate. I bought one of the practices and they kept two, but it wasn’t palatable [00:59:15] to the vendors, so that didn’t float. So I had got to the point. So [00:59:20] basically I felt like I the analogy was that I was a refusing horse. You know, I had [00:59:25] this ambition, really burning ambition to have my own practice, [00:59:30] you know, have it all. I, you know, I had the three children, I had the part time consultant post, I wanted [00:59:35] the business, but I’d looked at 5 or 6 different businesses and explored [00:59:40] them and spent money on legal fees, getting down to the nitty gritty and then walked [00:59:45] away over a long period of time. And I got really, really despondent. And I really thought [00:59:50] that it was never going to happen for me and I.
Payman Langroudi: Questioning yourself.
Claire Nightingale: Of course, you [00:59:55] say, what’s the common denominator here? Hello, it’s Clare Nightingale. It’s [01:00:00] my problem, you know. But actually and I did say to I had this really lovely [01:00:05] Irish nurse and I said to her, oh, I know I wouldn’t recognise the right opportunity [01:00:10] if it hit me in the face. And she said he will, Clare. You will. And then one day, when I was [01:00:15] absolutely miserable because of my dream, had imploded in the West End, you know, his partnership [01:00:20] hadn’t worked out and I’d been kicked out. Actually, that was another story. Um, [01:00:25] and and I was and I was working as an in-house specialist in a practice in [01:00:30] Harley Street. And I had my consultant job. So in many ways that should have been enough. But [01:00:35] I wasn’t an owner, you see. And and after three months of feeling utterly [01:00:40] miserable and despondent, all of a sudden it was like for no reason whatsoever, a [01:00:45] cloud had suddenly been lifted from my shoulders and I just thought, I’m content. And it was [01:00:50] the first time in about a decade that I hadn’t been pursuing [01:00:55] a dream or an opportunity. And and I still had that dream, [01:01:00] but I wasn’t chasing something for the first time forever. And I just thought, [01:01:05] oh, actually, I’m content. And then this period of content, of just thinking, [01:01:10] not trying to manipulate the future, not trying to create an opportunity, just live in the moment [01:01:15] for a brief time, which maybe that’s what I’m bad at, is living in the moment.
Claire Nightingale: Um, [01:01:20] and I recognised I could articulate, you know, someone said to me, how’s it going? [01:01:25] And I said, I am content. And then a few months later, out of the blue, [01:01:30] I suddenly got this text. And it was from this wonderful chap called Rod Edwards, who had [01:01:35] a practice called Queensgate Orthodontics, and he was looking to retire. And I just got this text. And [01:01:40] the connection again, it comes back to John Bennett. So the connection was that John had [01:01:45] looked out for me, but he also had looked out for rod. So we were all about 15 [01:01:50] years apart in age 10 to 15 years apart. And rod was looking for a safe pair of hands that he could hand his [01:01:55] business over to. Too. So he just texted. Would you like to come and meet me? Come to the practice. [01:02:00] So off I went. And I arrived at Queen’s Gate, and he opened [01:02:05] the door of this basement flat with a big smile on his face. And I stepped across the threshold and I [01:02:10] was like, this is the one. This is the one that I’ve been waiting for. This. It hit me. [01:02:15] And, you know, straight away I recognised it. It didn’t have to hit me in the face, and I just. Rod gave me this [01:02:20] big smile and I walked, stepped across the threshold, and I thought, this is the. This is the one.
Claire Nightingale: And what [01:02:25] made it so different was that, um, it was purely a [01:02:30] private practice so I could thrive or fail on my own merits. You know, [01:02:35] I wasn’t going there wasn’t an NHS contract that was going to be removed from [01:02:40] me. Okay. So it was really up to me to sink or swim. [01:02:45] The second thing was that it was the share of a freehold of a building. So I wasn’t going to be locked [01:02:50] into an upward only rent, you know, full rent, you know. Full rent, you [01:02:55] know, upward. Only rent review and full repairing and insuring lease. It was share of three freehold. [01:03:00] Okay, so it was bricks. I was investing in bricks and mortar that I could [01:03:05] live in. And rod didn’t want a huge amount of money for it. He wanted a reasonable sum for it. [01:03:10] And I think that given that he would have ultimately taken out quite a lot of work in progress, and I had [01:03:15] to completely ultimately over the next four years, I completely refurbished and brought it into the modern [01:03:20] age. I think the price I paid for it was appropriate. I don’t think it was inflated. [01:03:25] So those so it was like, right, this is it. And although it was the most expensive [01:03:30] opportunity, um, it was so obviously the right opportunity and with [01:03:35] least risk actually, because although I borrowed an enormous sum of money, it was largely [01:03:40] tied up in bricks and mortar.
Payman Langroudi: So when you’re when you’re buying that sort [01:03:45] of business, a lot of times you’re kind of reliant on referrals. [01:03:50]
Claire Nightingale: Yes.
Payman Langroudi: And the question of will you continue to get the referrals that he was? [01:03:55] Yeah. How do you deal with that? Was there a was there a period where he was sort of handing over and introducing [01:04:00] you to his referrals?
Claire Nightingale: Yes, he did that very nicely. Yeah. Yeah, I went I mean, the whole [01:04:05] I mean, as a specialist author, you know, as a particularly a mono [01:04:10] speciality private practitioner, you, you never stop worrying about [01:04:15] will.
Payman Langroudi: It dry up.
Claire Nightingale: And it always does, you know. I mean, you know, it’s just it’s a very it’s a difficult [01:04:20] game to play. And particularly in London. So yes. So for that first [01:04:25] year I mean basically what happened was I, we completed on the 31st [01:04:30] of August 2012 and rod was out the door by the 14th of December 2012. [01:04:35] You know, we had you know, and what he did was he took me out for dinner with his core referrers. [01:04:40] He really charged me up to all the patients, told them they were so lucky that finally a decent [01:04:45] orthodontist was going to be taking care of them. And that wasn’t him, you know. And [01:04:50] I went through that first year. I mean, again, very interesting learning. You know, I didn’t [01:04:55] lose a single patient or a single referral. Excellent. You know, so there we go. Emotional [01:05:00] intelligence, you know, not sweating the small stuff. So, you know, treating I did treat. [01:05:05] And I remember I took on I had to change the treatment plan for one patient. And I [01:05:10] ended up treating her out in lingual braces. And I carried all the costs of that. But that was part [01:05:15] of the purchase cost. You know, just keep everybody on side, you know, don’t worry about the small beer, [01:05:20] you know. But I did have challenges with staff who who were used to a very [01:05:25] different way of working.
Payman Langroudi: And just sorry to interrupt, but, you [01:05:30] know, the way he handed it to you and and it was a different time. [01:05:35] Yeah. But and and everyone hands their business over hoping that the [01:05:40] person who takes over is going to look after the staff and the patients and all that. But, you [01:05:45] know, in a way, it sounds like he handed it to you in a very personal all sense. And [01:05:50] then you sold to a corporate? Yes. And it’s changing times. [01:05:55] It’s changing times in a corporate may be the right, the right entity to look after your patients. [01:06:00] But do you reflect on that? Did you not did you not want to sort of pay it forward the [01:06:05] same way as he did?
Claire Nightingale: Absolutely I did. So so so so let’s look at how [01:06:10] the landscape changed over the nine years. Because I only owned a practice. It was only nine [01:06:15] years. Yeah I know. Which which in some ways is a source of disappointment [01:06:20] in some ways disappoint.
Payman Langroudi: Well, just because you didn’t.
Claire Nightingale: I kind of [01:06:25] think I was a bit of a lightweight. You know, I’ve only run a business for nine years.
Payman Langroudi: Resilient, [01:06:30] bones.
Claire Nightingale: You know, should have flogged myself for longer. No, I mean, obviously, because [01:06:35] I came to ownership a little bit late. Later than average. Um, I didn’t run it for very [01:06:40] long. But on the other hand, you know, the other way of looking at it is what a what a wonderful [01:06:45] thing to have bought a business and then sold it on again within nine years, you know. [01:06:50] I mean, you know, so it feels.
Payman Langroudi: Like I lost money for the first nine years, I didn’t. [01:06:55] Well, definitely the first five years. I mean, yeah, you have to the fact that you managed to do that is an [01:07:00] accomplishment in itself.
Claire Nightingale: But but the landscape, you know, one of the many reasons why [01:07:05] I brought it to market when I did was because of the changing landscape in the referral base. [01:07:10] So, yes. So I sustained those referral relationships for, let’s say, two years. [01:07:15] And then what happened was my two principal referrals. Got an in-house orthodontist. Yep. [01:07:20] So I lost those. You know, what.
Payman Langroudi: Do you mean by a principal referral. How many patients does someone have to [01:07:25] refer to you to feel like? Well, they were.
Claire Nightingale: Probably sending 20 to 30 patients a year, most of [01:07:30] whom would convert to treatment, you know, so, I mean, you know.
Payman Langroudi: Can, can, can that sort of 60, [01:07:35] 70, 90 patients referred a year to an orthodontist, can that sustain an orthodontist? [01:07:40]
Claire Nightingale: Yeah, I think that you can. I think I think you need about 80 [01:07:45] active patients to keep you going for a couple of days a week. Oh, really? Yeah, I think [01:07:50] I mean, my caseload, I haven’t it probably runs around about 190 active patients, [01:07:55] which is quite.
Payman Langroudi: Small. It’s not many humans to keep to keep a business going.
Claire Nightingale: It feels [01:08:00] like a it feels like thousands Payman thousands. No, you’re right, because [01:08:05] I’m a high, you know, I’m a high end practitioner, you know, that charges significant sums [01:08:10] of money. I’m not a high, you know, pile of high selling cheap operator.
Payman Langroudi: And then sorry, word of mouth [01:08:15] from existing patients must be a big factor. Yes it.
Claire Nightingale: Does. And yes, [01:08:20] of course. I mean, the landscape has changed, without a doubt. So you know what [01:08:25] happens when you’re a specialist in my specialist journey? Of course. Rod retired [01:08:30] slightly earlier than his peers who supported me. But then they retired, you know, and, you know, [01:08:35] people get ill, people have crises. You know, when you’re a referral practice, [01:08:40] your your fortune rises and falls with [01:08:45] the good fortune of your referrers as well, you know. And, um. [01:08:50] And of course, I mean, uh, GDP, Invisalign. You know, we know [01:08:55] that the majority of Invisalign is provided by GDP. And of [01:09:00] course, the volume of work that’s being done in tooth straightening is, is, is is enormous, you know, and of course, lots [01:09:05] of those adults would never have had treatment full stop anyway. So it’s not that I’m missing the business but [01:09:10] but people but but but yeah of course you know dental referrals have [01:09:15] dropped off a lot anyway. So I would say so. The reasons [01:09:20] why I sold my practice were I felt, well, there were all sorts of reasons. You [01:09:25] know, we’ll start with the fact that I felt as an individual, I had achieved everything [01:09:30] with it in those nine years that I really wanted to, you know, and I would say that, you know, those achievements [01:09:35] were I’d taken a business from a very old fashioned business, that the computer was only [01:09:40] used for word processing, and it was otherwise a pen and paper outfit, and the Dental chairs [01:09:45] didn’t go up and down and back.
Claire Nightingale: You know, I just I take it I’ve taken it. Yeah, [01:09:50] but I did it in a very sensible way. I did it out of cash flow. I didn’t want to increase my debt. [01:09:55] And I did it in, in bits. I didn’t, I mean, you know, turn the clock back. I would have had the [01:10:00] confidence to gut it and make something lovely and put in a really decent computer network [01:10:05] from the beginning. But we did it in dribs and drabs. And my husband and I, we used to drop the kids off at Stagecoach, [01:10:10] and that would give us three hours of a Saturday afternoon, where we’d whizz into the practice to put together a [01:10:15] computer network or assemble a cupboard. You know, that’s the sort of stuff you do when you’re [01:10:20] on a shoestring, when you’re on a shoot, when you’re not thinking big. Actually, you know, when you’re doing something for the first time on [01:10:25] a shoestring. But but I’d transformed it from what I’d bought with one best [01:10:30] practice in the UK in the dentistry wards in 2020, I doubled the turnover and my little boy had [01:10:35] done the practice website video that I had written, and we’d done it as a little family project, [01:10:40] and it’s still up there, and I’m still proud of it.
Claire Nightingale: And I still laugh every time I watch it. And I thought, [01:10:45] okay, so I’ve done everything that I really want to do. I’d [01:10:50] learned from this experience remember my very first attempt at buying a practice. The owner had been killed [01:10:55] a week after he had effectively agreed that I would buy it from him at some point. [01:11:00] So I was very much aware that as a single handed operator and having a non [01:11:05] Dental spouse, that if something happened to me, it would be an absolute [01:11:10] disaster for my family. I had had it valued three times in four years and the valuation [01:11:15] was on such a steep trajectory, I didn’t think it was possible that it could get any more valuable [01:11:20] than it was at that moment in time. And a very good friend of [01:11:25] mine had sold his practice to dentists 18 months before, and [01:11:30] and had was happy. It was very happy, and also had told me he was [01:11:35] in a five year earnout, you see. So. Yes. So I was thinking projected forward. Yeah, exactly. [01:11:40] I was thinking, okay, so I’ve done everything I want. I’m [01:11:45] vulnerable because I’m single handed. And when you hit your 50s, [01:11:50] your peers start getting sick.
Claire Nightingale: Yeah. Yeah, yeah. And, um, so [01:11:55] without wanting to sound doom and gloom, you know, you need part of the entrepreneurial [01:12:00] cycle is cashing in your asset. And I think it’s a big mistake to [01:12:05] think of cashing in an asset as a stage of life thing as opposed to a valuation [01:12:10] thing. Yeah. So, you know, I think, you know, and I do and so [01:12:15] I just so I thought well okay so I’ve got an I’ve got, I’ve got a really valuable asset. [01:12:20] But the value is all about personal to me. It’s all about me. So if anything happens [01:12:25] to me, my husband has to pick up the pieces in a terrible situation and the family lose [01:12:30] all this value too. So cash it in. And of course, I was thinking, would I like [01:12:35] to give? I did offer it to an individual orthodontist first, actually, but she couldn’t raise the [01:12:40] funds and, you know, so. And the second thing is I was worried, I, [01:12:45] I was worried that whoever came and took it on after me would be in this very, very difficult marketplace of [01:12:50] having to maintain referrals and all the rest of it. I don’t think, actually that private [01:12:55] or small private orthodontic practices have legs for the long term. And I, [01:13:00] rod and I are still in touch, you know, sporadically and [01:13:05] rod and I and and I just thought I would worry for that person.
Claire Nightingale: You know, I know you [01:13:10] could say caveat emptor, but I would worry if someone bought it from me for a large [01:13:15] sum of money and then went bankrupt or were unable to make it work. So [01:13:20] on balance, I thought it was better to bring it into the umbrella of a bigger organisation [01:13:25] where I thought that we would all be more protected. Really. Um, [01:13:30] so. And I was just, I was very fortunate that I fortunate that I’d managed to hit the right threshold of turnover [01:13:35] for a corporate to be interested. And of course, the other thing about selling to a corporate is that there’s no [01:13:40] messing about. You know, once you’ve signed heads of terms, you go forwards, you know, there’s they’re [01:13:45] not going to mess you about, you know, the the vendor might mess about. Whereas an individual, you [01:13:50] know, it’s like buying a house. You’ll get lots of people who will pull out. And I just thought and [01:13:55] I just would as I said, you know, I don’t procrastinate and I like decisions I make to be effected [01:14:00] quickly. So actually doing doing what rod had done, which was to [01:14:05] sell it on relatively cheaply for someone to be nurtured, I just thought it I was [01:14:10] perhaps setting someone up for failure if I did that.
Payman Langroudi: And then they’ve known for [01:14:15] was it dentex? Dentex dentex are known for leaving you alone afterwards? [01:14:20] Yes. It’s terrible. It’s a real problem for us suppliers because you said, [01:14:25] you know, you do a deal with dentex. You’re like, hey, put it through your 70 practices or whatever it is, [01:14:30] and now it’s Portland. Yes. And they’re like, oh, we’re not allowed to say anything to our practices. [01:14:35]
Claire Nightingale: Oh yes. That’s right.
Payman Langroudi: From outside.
Claire Nightingale: You mean in terms of political freedom? Yeah.
Payman Langroudi: And [01:14:40] well, was that part of it? I mean, did you did you look at other corporates? Well, I had.
Claire Nightingale: I had, I had [01:14:45] offers from Dental and Portman.
Payman Langroudi: Before they. Yeah.
Claire Nightingale: Before they merged. Yes. And the [01:14:50] deal from dentex was better. And, and also my friends were very extraordinarily [01:14:55] happy with dentex. So yeah we had you know we had 18 months of working [01:15:00] with dentex. And now we’re part of the Portman Dentex group.
Payman Langroudi: I’m quite interested in the question of, you know, [01:15:05] why is it someone who’s, you know, known as a brilliant clinician can’t be known [01:15:10] as a brilliant business person? I mean, I know you can, but we kind [01:15:15] of feel like those two things are in tension. And when I listen to the way you talk, it’s [01:15:20] like you almost put the same outlook on the way you look [01:15:25] at a case as you do looking at a at a business?
Claire Nightingale: Yes. [01:15:30] Is that right? Yes, I think I think you’ve hit the nail on the head. And, you know, [01:15:35] it’s about I mean, I you know, I actually really love data. I love looking at spreadsheets. [01:15:40] You know, when I sold my practice, the bit I really enjoyed was looking at spreadsheets. The bit that I found really [01:15:45] tedious was reading legal agreements. You know. So. So I love looking at KPIs. [01:15:50] I love looking at trends. I find it fascinating. But I think and [01:15:55] I have done business courses, you know, I mean, not not [01:16:00] in any enormously extensive fashion, but I went to a day on setting up [01:16:05] in practice that was probably run by the BDA years ago and listened. I you [01:16:10] know, you always learn something, don’t you, boss? Yeah. Or, you know, one young man [01:16:15] said he’d set up a practice almost on leaving dental school so very young and he disregarded [01:16:20] everybody’s undermining him about his age, saying, oh, you’re way too young to do practice. You know, he went off and did it anyway, [01:16:25] you know, so feel the fear and do it do it anyway. And he said something like, [01:16:30] look, go and set up where they’re setting up a Waitrose, not a Lidl, you know, that sort of thing. You [01:16:35] know, there was a tip, you know, someone else said when something you know, when you’re an associate [01:16:40] and something breaks in the practice, go and watch what the principal does to mend [01:16:45] it, you know.
Claire Nightingale: So I am the only one, really, who gets on my hands and knees to try and identify where [01:16:50] the leak is coming from, you know, or opens the door and fiddles around with [01:16:55] the float, the float of the spittoon, or notices that a light bulb is out, or notices [01:17:00] that the steps need to be swept of leaves, because otherwise the patients are going to slip and everyone’s oblivious [01:17:05] to that. Okay, so that’s the difference between being an associate and a principal. And you’ve got to start looking [01:17:10] through the eyes of the principal. Um, so another course I did was run by Fiona [01:17:15] Stewart-wilson, who I think is fabulous, and it was a practice managers course, basically. And interestingly, [01:17:20] she said when she goes into a practice, the first thing that she asks of the owner is what’s your [01:17:25] What’s your exit strategy? Yeah. So coming back to when my friend said he was in a five year earnout, I [01:17:30] thought, okay, so what does my life look like in five years time? In five years time. My youngest child would be at [01:17:35] university. My parents will be in their mid 80s.
Claire Nightingale: They might need me to take them off to hospital appointments, [01:17:40] you know. Um, and I thought, so if that’s my obligation is going to be different. [01:17:45] So I need to be freed up of obligation in order to then [01:17:50] take, you know, to serve that need if it’s there, you know, and of course, I’ll be 61 [01:17:55] as well. Amazingly. I can’t believe that. So so that’s what I did. So I looked [01:18:00] ahead and I. So those were the multiple reasons why the timing of that sale, the [01:18:05] decision I made. And it turned out to be perfect. It was I nailed [01:18:10] it. It was perfect timing. So I’m so happy for that. Um, [01:18:15] but so so I’ve done two of Fiona’s courses. And then, of course, I adore Chris Barrow, and I love listening to, [01:18:20] you know, the things that he says. Um, but I think. But why? But but [01:18:25] perhaps being a good clinician has held me back from being a good business person, because I’ve ended up doing [01:18:30] it on a very small scale. And had I not been [01:18:35] so committed to clinical care, and had I [01:18:40] been had I gone to dental school 20 years later, when the dental landscape is as it [01:18:45] is now, maybe I’d have been a micro corporate owner.
Payman Langroudi: You could you could have pulled that off.
Claire Nightingale: No, probably. [01:18:50] Probably probably. But but I am, I am I have been held, [01:18:55] I have been in I have not done that because a I didn’t have the vision. And secondly, [01:19:00] I came to it too old, you know, and I’m too entrenched in clinical care. [01:19:05] Anyway, I did what I did and I achieved my goals.
Payman Langroudi: I’m interested in in your [01:19:10] day to day, insomuch as in the hospital job, you must come [01:19:15] across very complex orthognathic type cases. Yes. Different socioeconomic [01:19:20] Economic groups. Yes to you. No to Queen’s gate. No. Queen’s gate. Right. That’s where. [01:19:25] That’s where my kids go to school and all that. Yeah. And, you know, I’m sure you know, you’re saying my daughter’s [01:19:30] one of them, but that you must get these exacting parents. Yes. You know, over [01:19:35] over a millimetre or something. Discrepancy. Well, how does that play out? [01:19:40] How does it play out? Is it is it a healthy thing? Is it a nice thing to have both?
Claire Nightingale: It’s very nice to have both. It’s [01:19:45] very nice to have both. It’s. I couldn’t cope with having more than two places of [01:19:50] work in a week. Um, but, um, so having [01:19:55] having two working places is good. One definitely complements the other. I mean, from a clinical [01:20:00] perspective, actually, I get very challenging cases at Queensgate because I have quite a large private [01:20:05] orthognathic practice there. Yeah. Um, the clinical work as a consultant [01:20:10] has become less interesting over 20 years because I think the specialists are doing [01:20:15] more complex cases because of the changes in iotn Yen. And mostly [01:20:20] what I do is impacted teeth actually, which is a bit dullsville really. Um, in [01:20:25] terms of the demands of the families I look after, actually, it’s not so much [01:20:30] the clinical demands, it’s the social demands. So, you know, I might have a child who lives [01:20:35] in Scotland and is at boarding school in London and then goes abroad every holiday, that kind of [01:20:40] thing. And dancing around somebody’s social needs, you know, I have on a few occasions, [01:20:45] you know, had to do an adjustment whilst a taxi is waiting outside [01:20:50] to take the kid off to Heathrow Airport, that sort of thing. Or, you know, occasionally you’ve.
Payman Langroudi: Private jet order.
Claire Nightingale: You [01:20:55] know. I mean, look, I think you’re kind of I think I suspect you, you lay out your [01:21:00] stall as a clinician without quite realising it, and then you attract people that are [01:21:05] like you. So actually, I don’t look after well, to my knowledge, [01:21:10] I don’t look after enormously mega rich people or celebrities. I’m [01:21:15] just looking after affluent middle class families on the whole, which is a good thing because I can [01:21:20] relate to them and they can relate to me.
Payman Langroudi: Well, I asked my wife this morning. I said, why do you refer [01:21:25] to Claire? Why? And she said, the main thing is that several times [01:21:30] you’ve said, no, this person doesn’t need treatment or yes, this person can wait another two [01:21:35] years. And yes, you know, you’re not led by the finances.
Claire Nightingale: Yeah, that’s true.
Payman Langroudi: And it’s [01:21:40] a nice thing because it’s easy to be led by.
Claire Nightingale: Yeah, I am the master [01:21:45] of the undersell. Patients have to get on their hands and knees and beg for treatment. [01:21:50]
Payman Langroudi: So, Claire, tell me about life after selling your practice.
Claire Nightingale: Well, it’s been an interesting [01:21:55] experience. I think the most important thing to remember is that when you sell, you sell. [01:22:00] And then you have to accept that changes will happen, that will be beyond your control, and you really can’t [01:22:05] have your cake and eat it, you know? So I am eternally grateful every day that somebody [01:22:10] was interested in acquiring my practice and the money’s in the bank and my exit strategy [01:22:15] is secured and everything beyond that is a win, you know? So if I’d sold to an individual, [01:22:20] I’m sure they would have had me out of the practice pretty quickly because they would have needed to earn the money. But [01:22:25] selling to a corporate has meant that I continue, really to run the practice many ways, and [01:22:30] the style it always was. But of course there are external factors that my practice managers [01:22:35] have to get used to that makes his life more difficult. But in the big picture, I think the only way [01:22:40] to embrace the change is to do it positively and accept that you’re just not the owner anymore. You’re [01:22:45] back to being an associate.
Payman Langroudi: So does it grate with you that you have to ask for permission [01:22:50] when you want to change something?
Claire Nightingale: Well, I mean, as you’ll appreciate, I initially sold to dentex [01:22:55] and then of course dentex partnered or were acquired by Portmann. And so there have been constant changes [01:23:00] over the three years since I sold it. They’ve [01:23:05] both both corporates are really like the people that I’ve come into contact with. And a whole new world of opportunity [01:23:10] has opened up to me as a consequence of becoming part of a of a bigger organisation. Well, for example, [01:23:15] I met me, so I became part of a big WhatsApp group of the partners that had sold [01:23:20] and I and do you know, Mitesh. So Mitesh runs [01:23:25] a fantastic charity called Smile Star, and he does multiple visits [01:23:30] to African countries doing extractions for poor people in peculiar places. [01:23:35] And he posted on the group a question about feeding a neonatal [01:23:40] cleft baby that had just walked into his clinic in Sierra Leone. And I responded [01:23:45] with some completely useless information dredged up from my time as a senior registrar. But as a consequence [01:23:50] of him asking the question, me replying, we struck up a text conversation that [01:23:55] culminated in my saying, oh well, one day maybe I’ll come with you. And then finding myself [01:24:00] in Jamaica last Christmas, together with three of my family members taking teeth [01:24:05] out, which I haven’t, which I haven’t done for 30 years. Yeah, yeah. You know, so, I mean, I got a bit hoist by my [01:24:10] own petard Because I think I was a bit insincere when I first said, yeah, [01:24:15] I’d love to do that, you know? And then I found myself in this WhatsApp group and before I could say, [01:24:20] actually, I’m a complete fraud and I never intended to really commit to coming along. [01:24:25]
Claire Nightingale: Um, the first person who confirmed that she was going was a woman who I knew was in marketing. [01:24:30] And I thought, frankly, if a marketeer thinks she can be useful, then so [01:24:35] can a rusty DS. And then when. And then it was two weeks over Christmas. I didn’t [01:24:40] want to leave my husband for that long, so he came along as a dental nurse. And [01:24:45] then when our daughter heard the words of all inclusive three star hotel in Jamaica, she [01:24:50] invited herself. And then we told the youngest he was coming, too. So we had a great trip. We were away [01:24:55] for 14 days, seven days. We did clinics seven days. We were off having fun. [01:25:00] There were 22 of us. We were dubbed the Honorary Gujarat. Um, and of [01:25:05] course, because it was over the Christmas period, you know, I introduced Secret Santa and we And we celebrated the [01:25:10] new year together. But but I mean, most importantly for me, I got back on that horse, you [01:25:15] know, and my hand was shaking like a leaf when I gave my first buccal infiltration. Yeah. [01:25:20] And I was only given the periodontally involved teeth to take out to begin with. But after [01:25:25] seven days, I put in a block, elevated nine roots from the lower left quadrant and stuck in four sutures. [01:25:30] So you know it came back.
Payman Langroudi: What did it do for you? Did it feed you somehow? Well, [01:25:35] I expect I expect that my daughter’s one of your patients, right? Yes. I’m we’re talking about the [01:25:40] kind of people my daughter and her friends might be. Or parents might be very exacting [01:25:45] on the odd millimetre rotation or whatever it is, and balancing that [01:25:50] off with someone who’s just in pain and wants their tooth taken out. Does it keep it real? Did it [01:25:55] keep it real for you?
Claire Nightingale: You know, I really loved getting back to, I mean, going to make a terrible [01:26:00] pun, aren’t I? Inadvertently. But getting back to my roots. You know, I loved oral surgery. In fact, [01:26:05] you know, there was a moment when I considered doing all going off and doing medicine and becoming a career [01:26:10] surgeon. But of course, I’m perfectly happy with the choice that I made to stick with ortho. But [01:26:15] but I would embrace the opportunity to get back to doing some general dentistry. It’s [01:26:20] just that I’m unlikely to ever do it in the UK, you know, because I’m way too out of touch and out of practice. But [01:26:25] I mean, certainly I didn’t mess up, you know, these people benefited from my care. [01:26:30] And in fact, I’m off again in the beginning of February. I’m going to Mozambique, this time.
Payman Langroudi: Effective [01:26:35] altruism.
Claire Nightingale: No, I haven’t tell me what’s that?
Payman Langroudi: So the question is, it’s [01:26:40] a bit of a contrarian way of looking at it. Yeah. But it’s it says if your interest [01:26:45] is to alleviate pain, stay in South Canton, [01:26:50] charge people top dollar, make that money and send it over and pay [01:26:55] locally for local dentists. Yes. You know what I mean? Yeah. As the first question [01:27:00] I asked was does it feed you. Yes. Okay. So it does feed you obviously to to go and help people. Yeah. [01:27:05] Yeah. But that question of do we do charity for ourselves to some extent?
Claire Nightingale: Yeah. No, that’s a [01:27:10] very good question. And the answer is I do both. Payman.
Payman Langroudi: Yeah.
Claire Nightingale: You know, so, um, and [01:27:15] in fact, I. So another consequence of selling my practice, I mean, there’s all sorts of consequences [01:27:20] that were unexpected. So Barry Lanzmann was the chief executive of dentex when [01:27:25] I was acquired. And he introduced me to his partner Nicola, firstly as a patient. And then she and I have become [01:27:30] great friends. And when she knew that as a family, we liked scuba diving, [01:27:35] she suggested to us that we should go to Mozambique, to a place called Vilanculos, [01:27:40] which the scuba diving is awesome. I mean, it’s comparable to the Red sea and and basically [01:27:45] you go kite surfing when the wind is up and scuba diving when it’s calm. And, [01:27:50] you know, I tried flying a kite. It’s really hard. And I found it incredibly painful because I spend my [01:27:55] day looking down. I don’t spend my day looking up, you know? So the muscles on the back of my neck were [01:28:00] screaming out in excruciating pain within five minutes. So I never got on to [01:28:05] the water, but I gave it a go. You know, we all gave it a go. Um, but more importantly, [01:28:10] the kite. So the place that Nicola and Barry. Well, Nicola recommended us to stay in Vilanculos [01:28:15] and use a kite surfing outfit which is a non for profit, [01:28:20] not for profit.
Claire Nightingale: And this incredibly generous Swiss couple have set up a kite surf [01:28:25] school with accommodation and they apply. They plough all the profits back into the local community [01:28:30] and they support schools and an old people’s home and water, which is much more effective than [01:28:35] me dipping my hand in my pocket from South Kensington or going and taking a few teeth out. But [01:28:40] but the laugh was that this young man, who’s the kite surf instructor, naturally [01:28:45] assumed that I was a relative of Nicola and Barry Landsman, and [01:28:50] it was way too complicated to explain. So I sold my practice and she was a patient, and then she [01:28:55] said, come on holiday, you know. So I just said, yes, she’s my cousin, you know. So he, in the way that they [01:29:00] had embraced the local community nurses took me out to meet all the kids that he’s caring [01:29:05] for, because a lot of these kids have been abandoned by their parents. And this young man, Nursia, who’s one of the few with [01:29:10] a regular income as a kite surf instructor, is looking after now no fewer than 17 [01:29:15] children. Wow. Yeah. So I found myself putting my hand in my pocket when I was out there as well. [01:29:20] And he needed to build a house for a fisherman, a disabled fisherman who had lost it [01:29:25] in a cyclone.
Claire Nightingale: You know, so on my last day of holiday, I went off with him to buy [01:29:30] some cement, and we bought roofing materials for a house that he was building. Anyway, I’m digressing, [01:29:35] but the point is, as a consequence of selling my practice, I ended up going to Mozambique. [01:29:40] I ended up becoming part of this community with this kitesurfing instructor. [01:29:45] And now I find myself in a WhatsApp group with Barry Landsman, Nicola Nursia and some [01:29:50] of the kids trying to support them in learning English. So when I go out to Mozambique. So I [01:29:55] went out to Mozambique, also on the request of Barry, and he’s going out for a for a second trip. [01:30:00] This time I’m going along, and not only will I go out and be taking teeth out in incredibly [01:30:05] remote places, that will involve us taking a boat to go to remote islands to provide care. [01:30:10] But I’ll also be hanging out with the kids and going shopping to buy them school materials and all this sort [01:30:15] of stuff. It’s fine. But of course, you know, if you go on a if you if you’re open [01:30:20] to opportunity, life has some incredible journeys. Right. Yeah.
Payman Langroudi: Of course. So surely [01:30:25] you’ve been in the clinic now that there’s the corporate overlord? Yes. [01:30:30] I should call them. You’re saving time.
Claire Nightingale: Oh, I wish that [01:30:35] were true. I’m not. Actually, there must be.
Payman Langroudi: Stuff that you used to have to do. Payroll that [01:30:40] you don’t have to do.
Claire Nightingale: I don’t have to do payroll. I don’t have to manage annual leave. I don’t have to pay the bills. [01:30:45] Yeah. So. So what was going on?
Payman Langroudi: Have you found yourself now broadening [01:30:50] in other ways because you’re not spending the time worrying about running the practice itself? Running the [01:30:55] practice?
Claire Nightingale: Uh, well, I’m not palpably noticing that [01:31:00] my day is much different, to be honest. Yeah, I mean, in many ways, you know, give a busy person if [01:31:05] you want something done, give it to a busy person. So in some ways, I’m a bit frustrated about the [01:31:10] time it takes to achieve things. You know, so I’ll give you an example. Refurbishment. You know, [01:31:15] I would habitually refurbish the practice when it was necessary over the two week period of time that [01:31:20] were closed over Christmas, you know, and I would quickly, you know, commit to a builder, sort [01:31:25] out the flooring, bang. It would all be done. You know, now we have to go through multiple tiers of sign [01:31:30] off, multiple quotes. Et cetera, et cetera. And because I’m not driving that, it just drags. So those are [01:31:35] the sorts of frustrations that come up. But I seem but I seem to be [01:31:40] busy clinically. Um, I don’t think that I’m finding the time professionally [01:31:45] to to do anything that’s obvious in that time that I’m not [01:31:50] paying the bills. I was just obviously quite efficient.
Payman Langroudi: Dental network? Yes. Has that not come about [01:31:55] because you’ve had sort of some bandwidth to think about.
Claire Nightingale: Um, possibly. So, I mean, [01:32:00] I was involved with it to an extent before. So, yeah. So let’s talk about the women’s Dentist network. So [01:32:05] the Women’s Dentist Network is a group of, of of female [01:32:10] dentists. Clearly. Although I must emphasise at this time that men are very welcome to join us as friends [01:32:15] and people in the Allied dental professionals are welcome to join us as friends. It’s effectively the same benefit. [01:32:20] It’s just we don’t pop them in the main WhatsApp group, that’s all. And it was set [01:32:25] up as a consequence of, you know, the beloved Uchenna having a conversation with Linda [01:32:30] Greenwald before the pandemic, actually probably 2018, 2019, saying, come on, Linda, [01:32:35] it’s time to do something again, because Linda, of course, together with Jennifer Pinder and a few others, [01:32:40] had been instrumental in setting up women in dentistry 40 years ago, 40 years ago. So [01:32:45] it started off a few of us just meeting for afternoon tea in a hotel in [01:32:50] Soho, and we would just sort of just discuss what our purpose might be. And [01:32:55] it’s kind of evolved now into something a bit more formal. So our purpose is to showcase women [01:33:00] as speakers and to be supportive as a group of women dentists [01:33:05] and offer mentoring and tips and advice, and generally just be nice to [01:33:10] one another. You know, it’s a network because so often women are overlooked as speakers at [01:33:15] events, and that’s either because they don’t get asked, or it’s because they feel that they’re not worthy [01:33:20] of the in the invitation and they refuse, you know, which we call imposter syndrome. [01:33:25] So the way.
Payman Langroudi: That they don’t put themselves up.
Claire Nightingale: Or. Yes, I think that’s very, very true. No, [01:33:30] you’re absolutely right. Because we do wait to be asked as, as as a gender. We, [01:33:35] you know, we are not active in putting. In fact, I have to say, I didn’t even know that that was a thing. I [01:33:40] didn’t know that people put themselves forwards. I’ve always waited to be asked. It was only Linda who said, oh, well, actually, [01:33:45] the men just asked to speak. Oh, that was news to me. Um, so we are now [01:33:50] a group of over 100 people. It’s only £100 a year to to join. [01:33:55] And for that we host three virtual conferences on a Sunday [01:34:00] morning. So three hours of CPD. So we’ve covered business. We’ve [01:34:05] covered various clinical matters. We have done menopause because of course that’s our age, some of our [01:34:10] age group. But actually we’re doing one in on January the 19th on fertility. And we have our [01:34:15] second in-person conference at the Belfry Golf and Spa Hotel on Saturday, the [01:34:20] 22nd of March. And I’ve got a fantastic programme lined up, lots [01:34:25] of volunteers from within the group speaking, and hopefully one keynote speaker will be joining [01:34:30] us all to be confirmed, but we’ll be posting information on our various social media [01:34:35] channels about that. And if anybody wants to join us, please, you’re very welcome. Just go to Women [01:34:40] Dentist Network.com and join us through a link on our website.
Payman Langroudi: So you said, [01:34:45] look, the goal is to get more women speaking. Yes, which I understand. That. [01:34:50] Um, I’ve got a question. Have you found something out unexpectedly [01:34:55] by being part of this group that you didn’t know before?
Claire Nightingale: Well, [01:35:00] I’m really impressed by the talent that, you know, that that that shouldn’t be a surprise. But, [01:35:05] you know, we so often go to conferences and we hear the same people talking time after time. And, [01:35:10] and it tends to be academics that tend to get asked. But actually the talent within the group [01:35:15] is phenomenal. And the enthusiasm to be kind to one another is just [01:35:20] wonderful. Also. And you know, when I ask for volunteers to do things [01:35:25] or to speak, actually quite quickly, people come back. So at the conference we have an imposter [01:35:30] slot. We have a deliberate half hour where we invite people to do a ten minute presentation [01:35:35] who have never presented before within a friendly audience, you know, knowing that [01:35:40] they would be well supported and applauded for their efforts.
Payman Langroudi: So is [01:35:45] there an experience that women dentists have been through That’s more common [01:35:50] than you thought. I don’t know. Sexual harassment. Not getting a job. A [01:35:55] patient thinking they’re not up to taking a tooth out. Was there anything that any [01:36:00] insight that you gained from talking to? Lots of talking to lots of people.
Claire Nightingale: I [01:36:05] think those sorts of conversations come out more 1 to 1 in small groups. So, for example, [01:36:10] there was quite a lot of sharing that I won’t talk about, but [01:36:15] at the Women’s Dentist Network, you know, because at the meeting at The Belfry. So the reason we [01:36:20] go to the belfry is that they offer a fantastic package. You know, they offer an incredible day rate for [01:36:25] dinner, bed and breakfast and use of the facilities. So but the but the weekend expanded. [01:36:30] So what what happened was those who committed, someone said, oh, if we go on secret escapes, we can [01:36:35] get the Friday night really cheap, you know? So a number of us then committed to the Friday and then somebody else said, and if [01:36:40] we go on this website, we can get a cheap deal on the spa. So a number of us went to the spa on the Friday [01:36:45] afternoon that gave us Friday dinner to chat. And then on the Sunday morning, I organised [01:36:50] a golf lesson. You know, for some of the women staying over. So within those small groups, confidences [01:36:55] were shared. And I think it is quite interesting to discover what [01:37:00] has gone on in people’s lives, both professionally and personally. That was [01:37:05] surprising, actually, and I’m sure more of that sharing will happen when we get together again.
Payman Langroudi: But [01:37:10] I’m interested in one aspect that I don’t know has been talked about enough or not, [01:37:15] but many women dentists are the primary earners. [01:37:20]
Claire Nightingale: In their.
Payman Langroudi: Relationship. In their relationship. Yeah. And that [01:37:25] puts an extra responsibility that many women don’t have [01:37:30] onto them. And an extra stress, I say, on the relationship, because [01:37:35] my advice to any woman who earns more than her man [01:37:40] is not to bring that up. Yes. Yeah. Yeah, it’s really important [01:37:45] for for a man to hear that. It’s very emasculating. Um, [01:37:50] and at the same time, it’s a fact, right? So why shouldn’t you bring it up? Yeah. [01:37:55] Um, but but not to bring it up as a power play. Yeah. And I think [01:38:00] in my, in my own friend circle, there’s, there’s, there’s examples of, of [01:38:05] it where it’s worked really well, but often it hasn’t worked very well. And I think many [01:38:10] hygienists are primary earners as well. Interesting. And I’d be interested to know [01:38:15] I’d be interested to hear stories of, you know, has it been an issue?
Claire Nightingale: Well, I mean, it’s [01:38:20] interesting. Um, nobody shared at that level. I mean, you know, people have talked [01:38:25] about supporting their husbands doing higher education, you know, so I know a number of women [01:38:30] whose husbands have gone off and done medicine, and the wife who has carried on being the breadwinner [01:38:35] during that period, or somebody has gone off to do an MBA and the wife has carried on. [01:38:40] And but you kind of expect that ultimately there’s going to be a rebalance in the [01:38:45] earning potential of that partner later on.
Payman Langroudi: But recently, there was a post, I don’t know if you saw it, and she said, [01:38:50] I’m an associate earning 17,000 a month, and my partner is [01:38:55] a man earning £1,000 a month. Yeah. And it’s all good. [01:39:00] And I was aware of it, but he doesn’t seem interested in increasing that. [01:39:05] And that lack of ambition was something around that. Yes. Okay.
Claire Nightingale: Well I that [01:39:10] sounds to me like the woman has an issue, not the man, if you see what I mean. You know, it’s for her to reconcile it. Really? [01:39:15] I mean.
Payman Langroudi: The other interesting question I’m interested in is women in dentistry get [01:39:20] a bad deal, but for me, not necessarily the dentist. [01:39:25]
Claire Nightingale: In what regard do you mean? And in [01:39:30] what way do you think the deal is bad?
Payman Langroudi: If you if you read, if you go on their on their on their [01:39:35] groups, sometimes they get some really awful treatment by their bosses. [01:39:40]
Claire Nightingale: Okay.
Payman Langroudi: The career prospects are limited in terms of progression [01:39:45] and that cohort, you know it. And you said, you know, [01:39:50] DBS are welcomed as friends or whatever it was. And you’re right. Look, [01:39:55] the women putting themselves up as speakers is an absolute issue that needs addressing. But I think this issue [01:40:00] also needs addressing. If only some of the hygienist stories I’ve heard, some of the nurse stories, I’ve heard terrible [01:40:05] stories.
Claire Nightingale: Okay, well, I’m sorry to hear that, obviously, but I think there are a few points [01:40:10] that I would make in response. I mean, I think that throughout dentistry, throughout the history of dentistry, [01:40:15] men have been treated badly as associates in circumstances. I have been treated [01:40:20] badly as an associate. You know, bad behaviour is rife, [01:40:25] if you like, throughout the profession and always has been in certain circumstances. [01:40:30]
Payman Langroudi: Overwhelmingly female if.
Claire Nightingale: You count.
Payman Langroudi: Everyone.
Claire Nightingale: Right. It is. And well, I think the other two things I’d say [01:40:35] is that if we go back, you know, DC are now paid considerably [01:40:40] more than they were paid 30 years ago. You know, before regulation, before, [01:40:45] you know, dentists, dental nurses had to be regulated, you know, and registered. I [01:40:50] mean, registrants, of course, is what I’m trying to say. You know, like, you know, 40 years ago, [01:40:55] it was very common that a woman would start working in dental practice, having had her kids, [01:41:00] you know, and it was an easy way to get back into work. And they were unbelievably valuable contributor [01:41:05] to the workforce. I mean, the days where a woman could come back, learn how to mix some [01:41:10] cement and hold an aspirator and cover reception and take a telephone message as well, meant [01:41:15] that the workforce was phenomenally versatile. And I miss those days, to be frank. [01:41:20] You know, the registration has really limited flexibility within the workforce, [01:41:25] but they also used to get paid a pittance, you know, and there were no pensions, you [01:41:30] know, so clearly there have been some massively important changes. But we now know that dental nurses [01:41:35] are extremely valuable, you know, and can command really quite a high hourly rate. [01:41:40] And if you look how much an orthodontic therapist is paid. So I don’t I don’t agree that [01:41:45] women are being underpaid in dentistry. And I would also [01:41:50] say that there is and I see this in the various WhatsApp groups that I belong to, that there is a tendency [01:41:55] for those who feel most hard done by to be the ones that are speaking out. You know, nobody, [01:42:00] you know, rare. Well, I mean, those who are in a good place don’t tend to shout about [01:42:05] it. True. And might be boasting if they are, you know. So so I think we just have to keep [01:42:10] take a, you know, look at it with a sense of perspective.
Payman Langroudi: Let’s get to the darker part. [01:42:15] Yeah. We like to talk about errors.
Claire Nightingale: Clinical errors. Yeah. Okay.
Payman Langroudi: So that we can learn from each [01:42:20] other’s clinical errors comes to mind.
Claire Nightingale: Well, the worst [01:42:25] thing I have done as an orthodontist is failed to. Okay. [01:42:30] So an impacted canine. Okay. And in a In a young person, [01:42:35] young man who was crowding crowded. He had a two for contact. [01:42:40] So in one quadrant, upper left quadrant he had a two and an upper lateral was and an [01:42:45] upper first premolar were in contact. And he had a difficult canine and he was crowded [01:42:50] everywhere else. So the treatment plan was take out three premolars in and [01:42:55] align the impacted tooth, but leave the premolar in situ [01:43:00] until I was confident that the canine was shifting. Okay, so you’d think that was all totally sensible. [01:43:05] Anyway, so I made I observed how his treatment was progressing by how quickly [01:43:10] the gold chain was lengthening. I was counting the links of gold chain as they came out from the mucosa. [01:43:15] I hope I took a check X-ray, but I can’t be 100% [01:43:20] certain from memory that I did. Anyway, I got to the point where I was confident to prescribe the [01:43:25] loss of the first premolar. So off he went and had the tooth extracted. And [01:43:30] then we discovered a few months down the line that the canine was enclosed. And [01:43:35] so why was the change? Well, this is the retrospect, you know, with [01:43:40] hindsight. So I went back and looked at the radiographs. And what I saw was that when the surgeon [01:43:45] had done the exposure, she hadn’t pulled the gold chain out under tension. [01:43:50] And what what had happened was that the gold chain was actually coiled up underneath the flap, and I [01:43:55] was just pulling out the gold chain, and I wasn’t putting any tension on the tooth at all. And that [01:44:00] was a bad, a bad, bad call on my behalf, you know, because, um, [01:44:05] he ended up with an implant, you know, so that’s how that one played out.
Payman Langroudi: We’re [01:44:10] lucky to be small. The most difficult sort of patient parent nightmare. There [01:44:15] must have been.
Claire Nightingale: One of those. Yeah. Okay, so I think the best thing I can do is share a few stories. [01:44:20] Okay. So, uh, recently I had a child [01:44:25] who was who had come in from to have Invisalign fitted. So child at boarding [01:44:30] school. Very difficult, you know, to find the time in the diary to come. Came in to have her Invisalign [01:44:35] fitted. And when we opened the box, the Invisalign had been manufactured to completely the wrong scan. [01:44:40] It wasn’t her. It wasn’t her aligners. Right? So we said, oh, look, really terribly sorry. [01:44:45] You know, manufacturing issue. Clearly not your aligners. You know, mum’s put out. I [01:44:50] said, look, if you like, I can quickly put fixed braces on. No, that wasn’t the plan. We weren’t like, okay, terribly [01:44:55] sorry. You know, sent off a fresh, raised it as an error with Invisalign, set them to [01:45:00] come back for a second time. They come back second time. Guess what? We open the box. Same bloody thing. Same thing. [01:45:05]
Payman Langroudi: How often does that happen?
Claire Nightingale: Never. Oh, well. One. Only one. Only, you know and you know. [01:45:10] And so of course, what you know. And I was absolutely mortified, you know, what can you say? A complete [01:45:15] mess up in every regard on their, you know, on Aline’s behalf, on our [01:45:20] behalf.
Payman Langroudi: It falls on you, doesn’t it? Well, you know.
Claire Nightingale: You know, so what happens? You know, you get a delivery [01:45:25] and the staff tick, you know, so and so’s aligners have arrived, but nobody opens the box [01:45:30] to check that the aligners matched the scan. Because you know what? It never happens. It’s a never event. [01:45:35] Apart from it did happen. Okay, it happened twice to this to [01:45:40] to a boarding school family. And I just looked at the mum and I said, look, I don’t know [01:45:45] what to say. I am so sorry. You know, this shouldn’t have happened. [01:45:50] I should take taken personal responsibility myself to check the aligners, you know. [01:45:55] So how did I manage it? You know, you fess up, you know, my, you know, our [01:46:00] error. You know how. I’m very sorry. You know, let me reduce your [01:46:05] fee, you know, not 10% off the overall cost of treatment as a gesture of apology. [01:46:10] How are we going to make sure it’s better next time? Well, I will take personal responsibility to [01:46:15] check that when that lab work comes back, it’s the appropriate one for your daughter. Okay, so what happens [01:46:20] next? She recommends us to her whole family, you know, so.
Payman Langroudi: The way wrong, [01:46:25] then did it. I mean, I’m talking about something that something that went wrong. Well, I.
Claire Nightingale: Mean, all I’m saying is I’m talking about how do you manage adverse situations, [01:46:30] and it has nothing.
Payman Langroudi: To do with your relationship with the patient was excellent there. It [01:46:35] wasn’t.
Claire Nightingale: On the second time they came and they said.
Payman Langroudi: Well, maybe, maybe if that person said, no, [01:46:40] I don’t want to go ahead and left, that would be a good story.
Claire Nightingale: Yes.
Payman Langroudi: Okay.
Claire Nightingale: All right. Okay. [01:46:45] So I’ll tell you another story. So this one will float your boat. Uh, so I [01:46:50] had a kid who was a transfer case from America, and they [01:46:55] had a palatal expander. Right. And I said, oh, well, you know, it looks like it’s done [01:47:00] the job. I mean, I’ll show you another story. Well, anyway, it looks like it’s done the job, so I’ll [01:47:05] tell you what. Why don’t I take it off for you and you can be really comfortable, so. Yeah. Yeah, yeah. So [01:47:10] kid does that. Now, the slight twist to this story is my own daughter was on work experience [01:47:15] at the time, and she was sitting on the reception desk with my receptionist, and all I could hear [01:47:20] was gales of laughter coming from reception. Right. All seemed all very [01:47:25] everything at that moment in time was very jolly and happy. Anyway, I put some band removing pliers [01:47:30] onto this TPA, not realising that unlike in the UK, everything [01:47:35] is soldered, you see. So you know, you pop off one side, it remains intact, you pop off the other, [01:47:40] out it comes. On this occasion, the orthodontist had used palatal sheaths and [01:47:45] the the expander was inserted into a sheath. So when I took off the band, it wasn’t attached [01:47:50] to the expander and the patient promptly swallowed it. Oh, yeah. So there [01:47:55] I am, sort of thinking, oh, God, you know, let’s hope it’s I mean, it wouldn’t be inhaled, but how [01:48:00] do how am I going to tell the mum that her child has just swallowed half of his orthodontic appliance? [01:48:05] I’m sort of like in the meantime, hearing my daughter regaling the practice [01:48:10] manager with this completely inappropriate stories about toilet malfunction on a coach [01:48:15] in New York on her scout trip.
Claire Nightingale: And I’m thinking, I need some help here. Please stop all this hilarity. [01:48:20] Anyway, so of course, I have to say to the to the mum, look, you know, I think I’ve just dropped half [01:48:25] of the appliance down your child’s throat and I’m now going to have to write a referral letter to [01:48:30] A&E at Chelsea and Westminster, and you’re going to have to go off and be x rayed. You know, so off they [01:48:35] go. Um, yes. And I phoned them up the following day to find out how it had went. And mum says, [01:48:40] oh, it was quite funny actually. And I thought phew, I’ve turned this one around. [01:48:45] And what she was referring to was that her humour at seeing her child’s orthodontic appliance in her child’s [01:48:50] stomach on the x ray. Wow. So, you know, so you know, they didn’t I mean, [01:48:55] they’ve been lost to follow up. So they haven’t come back. But you know, is that the kind of, you know, is that a disaster? [01:49:00] It you know, it’s it’s one.
Payman Langroudi: You’re still looking.
Claire Nightingale: For, right? Payman. Let [01:49:05] me think of another one.
Payman Langroudi: That’s just, you know, I dropped something. I, you know, there’s plenty of those [01:49:10] I’m talking about where the confidence of the patient or the or the parent. And the reason why I’m asking is [01:49:15] because there’s a parent patient, you know, that that sort of triangle situation. There [01:49:20] must have been a worse situation than those two.
Claire Nightingale: Well, I’ll just keep talking and then I’ll share. I’ll [01:49:25] share. Let me tell you the other things. So, um. Okay, another, uh, [01:49:30] I mean, you know, I had, um, another difficult moment, [01:49:35] a young man who had been in braces for a long time and, um, uh, [01:49:40] decided not to complete his treatment. I took him out of my orthodontic therapist, was actually de-bonding [01:49:45] him again. We had a young work experience student watching in the surgery. Anyway, I get [01:49:50] the call to go in because this young man had dislocated his mandible while she was [01:49:55] taking off his brace. Now, I’ve never had I’ve never seen a dislocated mandible. Right. So [01:50:00] I walk into this room, and the patient himself had actually apparently had a history of [01:50:05] dislocating his mandible. So I wasn’t particularly alarmed because this had happened before, and, [01:50:10] um, but couldn’t talk to me. I didn’t know, you know, you can’t talk, you know? [01:50:15] So I’ve got this orthodontic therapist in a bit of a flap. I’ve got a young work experience [01:50:20] student, a dog and a man and a patient whose mouth is propped open. And [01:50:25] and it was probably a Friday. You know, it was probably a Friday afternoon. And it’s my peak [01:50:30] time.
Payman Langroudi: Did you have a go at repositioning? Well, I.
Claire Nightingale: Went and phoned a friend. Right. So fortunately my [01:50:35] surgeon picked up the phone and I was like, what do I do? And he said, right, [01:50:40] what you do, you know, put your thumbs on the external oblique ridge, get the patient to cough. And when he coughs, you [01:50:45] push down and back. Okay. So I go back do that. Coughs down and back. And there [01:50:50] was this gratifying pop and the condyles re-seated in the appropriate place and the pay [01:50:55] and we all high fived. You know, this is great, you know. Anyway, a week later, this young man came back [01:51:00] a complete wreck and clearly hadn’t slept because I said, right, we won’t take off your [01:51:05] top brace. You know you’ll do that next week. Came back, was in great distress, [01:51:10] clearly hadn’t slept and had developed extreme pain. Oh, I tell you before he’d left, what [01:51:15] I’d said was I’ll just put on a little bit of bit of power chain. You’ve got like a millimetre of space. So I’ll [01:51:20] just close down this little bit of space. Come back next week, we’ll take your top brace off. Anyway. Came back, wouldn’t let me touch [01:51:25] him. Um, the relationship had completely flipped. Um, and [01:51:30] he left. And then a few weeks later, I got the solicitor’s letter. [01:51:35] Right. This is a meaty story for your pain. This is what you want to hear, isn’t it? Right. Okay. Right. [01:51:40] So I got this solicitor’s letter saying that I had caused this man acute [01:51:45] pain, and he was now taking legal action, so I kind of was slightly puzzled. [01:51:50] Um, and, um, anyway, and this, this went on [01:51:55] for years, actually, you know, because it all goes quiet and I was and I didn’t actually know [01:52:00] what I was potentially being sued for, you see.
Claire Nightingale: And after three [01:52:05] years, I get the letter from my solicitor saying that they had been unable [01:52:10] to find any clinical expert witness to support their case. [01:52:15] So would I be inclined to give them another six months to go hunting? So naturally, [01:52:20] because apparently that’s what you can do. You know, you’ve got three years to bring a case, and then you can ask for an extension [01:52:25] of six months if the person you’re suing, if the person you’re suing is an agreement. So [01:52:30] like, well, that was the quickest decision I’ve ever made, I can tell you. Let me really think [01:52:35] about that one. Long and hard. No, but this was the only point [01:52:40] that I was told what I was actually being sued for. And amazingly, I was being sued [01:52:45] for the careless application of power chain. Okay, now this absolutely [01:52:50] made me laugh out loud for the simple reason that I did my whole thesis on the application of power [01:52:55] chain and the forced decay of power chain. So I replied to my solicitor. I said, oh, [01:53:00] interesting that I’m being sued on the application of power chain, because can I refer you to the five [01:53:05] publications I have on the four stroke of power chain? You know, do you think [01:53:10] it was malicious intent? No. I mean, there were deeper things going on with that [01:53:15] case, which I won’t go into. So it wasn’t malicious. It was, you know, it was just [01:53:20] one of those.
Payman Langroudi: And what can we learn from.
Claire Nightingale: Patient [01:53:25] selection. I’ll use an analogy which, um, [01:53:30] so my my oldest son, his first love when [01:53:35] he was 17, and his, his and the girlfriend’s mother never [01:53:40] allowed her daughter to be unchaperoned. Right. And never wanted my son to [01:53:45] be there in their house with her, without the mom being around anyway. My son was naughty. They were naughty. They. [01:53:50] They hung out together one morning and stupidly posted a photograph [01:53:55] on social media. And there was some phenomenon called maintaining your streaks. Do you know what that means? I don’t [01:54:00] know, I think it was about posting every.
Payman Langroudi: Day or every day having to. Yeah.
Claire Nightingale: Yeah, yeah. So? So [01:54:05] the girl was found out because her mum looked at her phone and found the photo and, you know, [01:54:10] and all hell kicked off and and I was walking to school with my youngest [01:54:15] son, who at the time must have been about ten years old, and I was sharing [01:54:20] this story with him, you know, and my message was really about respect. You know, I wanted my young [01:54:25] son to recognise that people have you have to respect people’s rules and, [01:54:30] you know, and you pay respect to people and observe their requests. So I said to [01:54:35] Harvey, so what do you think the learning outcome of this story is, Harvey? Meaning [01:54:40] I’ll respect the rules, ma’am. And he said, don’t date a girl with a psycho mom.
Payman Langroudi: So [01:54:45] true.
Claire Nightingale: So we come back to case selection by [01:54:50] that analogy.
Payman Langroudi: Tell me about comedy.
Claire Nightingale: Yes. Okay. So this kind of [01:54:55] moves on to the next stage. Looking ahead, you know, what am I doing? So, you [01:55:00] know, I’m three years into my earnout. So I’ve got two years before I am freed of obligation. That [01:55:05] doesn’t mean I’m going to stop working, of course, but I would like to do less clinical work, So I [01:55:10] got to the start of this academic term, September time. And I thought, well, what am I going to do? [01:55:15] So I did two courses. So the first I did a course, the Bond Solon course in expert witness [01:55:20] work so I can start to build a Dental legal career. And the second was stand up comedy. [01:55:25] And did that come from where did it come from? Well, I am someone that’s always enjoyed performance. [01:55:30] You know, I’ve always it’s been difficult in the sense that I’ve worked [01:55:35] so hard professionally that I haven’t committed to any form of amateur operatics or anything like [01:55:40] that for decades. But when I was at university, I was very involved with the Gilbert and Sullivan Society, [01:55:45] and I used to play in various swing bands, that sort of thing. And I went to a stand [01:55:50] up gig at the Museum of Comedy, and I happened to notice a sign on the wall that said Comedy [01:55:55] Course This Way, and I clocked it for future use. And and in [01:56:00] the summer I signed up to do the course. So it was so much fun. So between September and [01:56:05] November, I did a ten week course three hours a night on a Monday at the Museum of Comedy, [01:56:10] run by a stand up comic called Logan Murray.
Claire Nightingale: And there were about 15 of us that started on the course, [01:56:15] 12 completed. And the first five weeks we just did improvisation games, [01:56:20] which was great fun. So I would be asked, I’d be given a microphone [01:56:25] and told to stand up in front of the group and discuss whether doors or windows were better, you know? [01:56:30] And the obvious answer is, well, it depends whether you’re a cat or a burglar, you know? So we larked about [01:56:35] for five weeks, and then we started doing five minute sets. And [01:56:40] I decided I would just try a different set every week and see where the laughs landed. [01:56:45] And after about three weeks, we were told we had our homework was to go and start gigging. Wow. [01:56:50] So there’s a pub up in Highgate called The Boogaloo. So a number of us started [01:56:55] a few sets up there of a Thursday night. So again, you know, the laugh was [01:57:00] so and in order to do a set at this particular venue requires you to [01:57:05] you to bring a paying guest. Right. So you can’t stand up and perform if you don’t have a [01:57:10] guest in the audience. So bless him. My oldest son agreed. My husband was [01:57:15] busy, so my oldest son agreed to come along. But so funnily did Nicola and Barry. [01:57:20] So there’s another twist in the tale of my practice that my. At my first ever stand up gig, [01:57:25] there was Barry supporting me in the audience, and he did laugh and say, Clare, please remember [01:57:30] that the sale agreement only required me to come once anyway. So [01:57:35] yes, so I did like.
Payman Langroudi: Is it very scary?
Claire Nightingale: Um, well, I suppose because I am clearly a bit [01:57:40] of a show off, and I am so used to lecturing and [01:57:45] performing that it was an extension of that. Anyway, you know, and my comedy [01:57:50] is talking about my life. I’m just looking at the humour in my life [01:57:55] and exaggerating it. You know, it’s.
Payman Langroudi: Not Invisalign humour like.
Claire Nightingale: Invisalign, [01:58:00] Invisalign humour, what would be? So tell me a knock knock joke about a clear aligner. Yeah, [01:58:05] no, I have a anyway, so. And of course, when you start off doing something for the first time, you [01:58:10] start to understand the ropes. So just to enlighten you, enlighten. Um, [01:58:15] the industry standard is five minutes. So when you’re starting out in comedy, you do a five minute [01:58:20] set and no more, you know, and that’s really difficult to time it because [01:58:25] when you’re listening, five minutes is an eternity. But when you’re performing, five minutes goes by in a flash. [01:58:30] So I now have and so I mean, so I did my first [01:58:35] comedy set, um, at the Boogaloo. And then a week later I went back and did [01:58:40] a second set. And what was interesting for me is that the audience demographic was totally [01:58:45] different between the first two occasions. So the first occasion it was me, my comedy [01:58:50] group, who were, you know, largely late 40s 50s, um, [01:58:55] and the second week it was all young people in their 20s. And of course, my life experience, [01:59:00] I’m talking from being a being a middle class, middle aged white woman about my life experiences. So [01:59:05] my sets are about childbirth, they’re about dentistry. They’re about going on Mark Warner [01:59:10] Holidays and I opened the set saying, well, not opened it. But at one point [01:59:15] I said, I’ve just come back from a mark Warner holiday. And everybody looked totally blank. I didn’t know what it was. And I [01:59:20] and I sort of managed to sort of carry it through. But I realised that if you if you’re [01:59:25] wanting to be successful in comedy, you’ve got to be really fleet of foot. And you look at your audience and you think, well, [01:59:30] if I’ve got a choice of six sets to pull out of the bag, which one is going to suit [01:59:35] this 20 year old demographic and which is going to suit this 70 year old demographic, depending [01:59:40] on where you’re at?
Payman Langroudi: I mean, you say it’s similar to lecturing, but, you know, you don’t bomb [01:59:45] in the same way when you’re lecturing, even if people don’t like your lecture.
Claire Nightingale: Well, [01:59:50] I mean, you know.
Payman Langroudi: People sort of sort of sit on their hands, but if people aren’t laughing. Yeah. [01:59:55] I mean, how does that feel when you tell a joke and people don’t laugh?
Claire Nightingale: I’m yet to bomb. But, you know, [02:00:00] I’m sounding like I’m an expert. Can I just put it into the context? I’ve done three gigs, you [02:00:05] know, I’ve done two at the Boogaloo and the end of term. End, of course show. [02:00:10] Now, fortunately, in the in the boogaloo, everybody, the. [02:00:15]
Payman Langroudi: Friendly audience, it’s.
Claire Nightingale: A friendly audience. You know, everybody was either a gigging themselves or they were [02:00:20] a bring e there to support. So it was two friendly audiences at the the end of [02:00:25] course show, we performed on the stage at the Museum of Comedy, which is a crypt in a church [02:00:30] off the Tottenham Court Road. And of course, the whole audience were family and friends. So [02:00:35] I’ve yet to have that utterly humiliating.
Payman Langroudi: In an audience where the guy was bombing. [02:00:40] Yeah, it was awful just being in the audience, let alone being on stage [02:00:45] being bombed.
Claire Nightingale: I mean.
Payman Langroudi: Who’s your favourite comedian, by the way?
Claire Nightingale: Oh, well, it has to be Michael McIntyre, doesn’t it? [02:00:50] You know. Well, I mean, you know, I don’t watch a huge amount of comedy in truth, because I’m just very busy in the way I don’t [02:00:55] really read social media posts either. I’m just busy doing my own thing. But I love the Michael [02:01:00] McIntyre sketch about having his failed extraction on the Finchley Road. He must be [02:01:05] familiar with that one. It’s it’s a joy. Um, so, you know, so the question is, [02:01:10] you know, is the you know, I’ve done this to enhance my life when I have more time. And [02:01:15] the thing that’s holding me back at the moment is I have no time. You know, I’m still running at top pace [02:01:20] professionally. Um, but today, in fact, just before I came here, I have booked the [02:01:25] Fiddler’s Elbow for the 9th of March. Uh, no. 12th of March for us to redo [02:01:30] our end of term end of course gig, because we forgot to get it professionally. Professionally [02:01:35] videoed. You know, there we were. We were all doing the culmination of a ten week course, and we forgot [02:01:40] to capture our finest moment. So tell us a joke. I can’t tell you a joke for the simple reason. [02:01:45] If I start doing comedy, you’ve got to warm up. You’ve got to be the compere. You’ve got to warm [02:01:50] up the listeners. And then I’ll tell you my the best ever joke. But it is very dark [02:01:55] and not appropriate for a Dental Leaders podcast.
Payman Langroudi: Definitely this podcast does get dark. [02:02:00]
Claire Nightingale: Yeah, yeah, you probably don’t want to hear about paedophile English tutors. Okay, [02:02:05] but there is comedy even there.
Payman Langroudi: Yeah, it’s been a massive, massive pleasure talking [02:02:10] to you. Let’s get to the final question. Fantasy dinner party.
Claire Nightingale: Okay.
Payman Langroudi: Fantasy [02:02:15] dinner party.
Claire Nightingale: Now, interestingly, I was discussing this with my daughter on Saturday as I was driving a [02:02:20] picking up from university, and we both chose the same first guest, Ella Fitzgerald. Oh, [02:02:25] lovely. Yeah. And not only would I eat with her, but I’d ask if I could sing with [02:02:30] her too.
Payman Langroudi: Are you a singer?
Claire Nightingale: That’s something I’m bad at. Yeah, [02:02:35] I’d like to be. Yeah. Okay, so, Ella Fitzgerald, inevitably, I have to go for Mrs. Pankhurst. [02:02:40] Oh, lovely. And then the third interesting story. Somebody [02:02:45] called James Miranda. Barry. Yeah. Now, James. Miranda. Barry. I [02:02:50] discovered this person when I was looking at. I was in the old operating theatre, which is near Guy’s Hospital. [02:02:55] Really interesting place to visit. And I just stumbled across a photograph on a wall and then read about [02:03:00] this person. So James Miranda Barry was a military surgeon, so born [02:03:05] in 1795, died in 1865. And she he [02:03:10] performed the first recorded caesarean section in which both the mother and the child survived. [02:03:15] Okay. It went off to medical school at 14 up in Edinburgh, learnt [02:03:20] in Latin, had a stand up row with Florence Nightingale during the Crimean War. [02:03:25] Very very interesting person. Lived a very interesting life. But when the body was laid [02:03:30] out for burial turned out to be a woman.
Payman Langroudi: Whoa!
Claire Nightingale: Yeah. Lived a life as a man to [02:03:35] fulfil professional objectives. Wow. Yeah. So [02:03:40] fascinating. Fascinating story. That one. Next question.
Payman Langroudi: Yeah. Good choices. Good [02:03:45] choices. Our final question. It’s a deathbed. Yes. We’ve kind [02:03:50] of alluded to some of them, but let’s see what you got. Deathbed. Deathbed. Pieces of advice [02:03:55] for your friends and family? Loved ones. Right? For the world.
Claire Nightingale: Okay, so I’m not obviously [02:04:00] waiting till my deathbed to give the advice, right? So, um, you know, based [02:04:05] on. So based on my personal experience. So stress is pathological. [02:04:10] So get out of stressful situations early. So one thing I’ve been bad [02:04:15] at is not cutting loose. You know, just recognising [02:04:20] that I was going down a dead.
Payman Langroudi: End with your other thing about resilience, though, you know, it’s problematic because, [02:04:25] you know, on one side, you want to be resilient. Yeah. So that takes a little bit of stress.
Claire Nightingale: So [02:04:30] resilience led me to grave’s disease. What a fabulous reward. Yeah. So cut your losses [02:04:35] early. You know, if it’s quite obviously things are not going to work out. Just get out of the situation [02:04:40] and respect your health. You know, respect that your mental wellbeing, your physical wellbeing [02:04:45] trumps everything else. You know, get out of it. There’s always going to be another alternative. But I mean another [02:04:50] opportunity. But you can’t often see the wood for the trees, can you? So that would be one thing. Um, [02:04:55] I have talked about, um, planning your family around [02:05:00] the age you want to be when you have your last child? Yeah. Hugely important, actually. And the other [02:05:05] one, I would say speak up. Speak up. You know, I have spent my life speaking up. [02:05:10] Um, and I would like to tell you a story, and it comes. So, I [02:05:15] mean, when I was at orthodontic, um, on my orthodontic course, Jonathan Sandy, who was our course [02:05:20] leader, dubbed me the Jemmy Knapp of the orthodontic course because Jemmy Knapp at the time [02:05:25] was quite an aggressive trade union leader, you know, in the 1990s. So that’s what he called [02:05:30] me. Um, but recently I spoke up at [02:05:35] the Invisalign Summit in 2023. And the reason why there [02:05:40] were two, there was the reason why I was a bit, um, enraged was because about two weeks [02:05:45] before Invisalign had invited me to a women’s and dentist networking [02:05:50] event where we’re all women around the table, and they were talking.
Claire Nightingale: It was led by a woman, and the idea was, how can [02:05:55] they support and nurture and mentor women, blah, blah, blah. And we all had this lovely touchy feely evening. [02:06:00] And then two weeks later, I went to the Invisalign summit [02:06:05] to discover that of 12 speakers, ten of them were men. And the two women that were [02:06:10] speaking were dental nurses talking about being treatment coordinators. Right. So, [02:06:15] you know, I thought, how does this marry up? You’ve just hosted this occasion of 15 [02:06:20] female dentists and not a single. Anyway, so I thought, right. And [02:06:25] the laugh was, is that at this meeting we’d been talking about how do we get more women speaking at [02:06:30] events? And I said, well, we have to call it out. You know, whenever there is an event where [02:06:35] less than a third of the speakers are women, we have to call it out little, [02:06:40] knowing that the first event I was going to call it out at was their own. Right. So [02:06:45] you called it out?
Payman Langroudi: Yeah.
Claire Nightingale: So what happened? Yeah, I did. So I was in a room. Let’s [02:06:50] say there were 400 people there, and I thought, okay, so I’ve said, I’m going to call it out. I’ve told them that [02:06:55] I’m going to do it, but when am I going to do it? Because I thought, I don’t want to do it at the beginning of the day, because I [02:07:00] don’t want to take the dampen the mood of the day. But if I leave it too late, everybody [02:07:05] was going out to get their hair done for the party, you see. So anyway, I was gifted this wonderful [02:07:10] moment where they were wrapping up with a panel discussion. So picture ten [02:07:15] men on stage and one man leading the discussion, and he turned [02:07:20] to the panel and said, where would you like a line technology to go in the next 12 months? So [02:07:25] I thought, this is the moment. So I leapt to my feet because I’m so short I [02:07:30] had to stand up and be visible. Pardon? I was a participant. You were a participant, a participant. [02:07:35] So I was their worst nightmare. So yeah, I leapt to my feet, sort of shouting David! David! [02:07:40] Because it was the wonderful David Rajkovic was the chair. Yeah, I know where I would [02:07:45] like a line technology to go in the next 12 months. So at that moment, a micra, a young woman came up to me and thrust [02:07:50] a microphone into my hand. So I said, right, I would like first of all, I would like you to reduce your packaging [02:07:55] because we can’t and also talk about recycling.
Claire Nightingale: I want you to become more environmentally sustainable [02:08:00] because we can’t talk about the best care of teenagers and at the same time simultaneously trash [02:08:05] their world. Right. So there’s a round of applause. Okay. And then I said, and then [02:08:10] secondly, you know, whilst I don’t want to discredit [02:08:15] the gentleman who’ve been speaking, many of whom have been speaking their second language, and it’s been hugely impressive. [02:08:20] Nevertheless, I sincerely hope that this is the last event, Invisalign summit [02:08:25] I ever come to, where there isn’t a single female orthodontist or a single female executive from a line. Technology [02:08:30] speaking. And at this point, the room erupted into cheers, you see. So there were whoops and cheers [02:08:35] and it had a big impact. Anyway, you know, after the adrenaline had settled, I was kind [02:08:40] of waiting for, you know, in a line to reach out to me. And nothing happened for six months. [02:08:45] And then I bumped into Evren Köksal at the Portman Dentex conference last December, [02:08:50] and he came up to me and said, oh, thank you very much for that feedback. You’ll be really delighted, because this [02:08:55] year I’ve made sure that we have 50 over 50 male and female speakers. [02:09:00] I said, that’s brilliant, Evren, because I was really worried, of course, that you would feel [02:09:05] negatively about me. No, no, no, we’re really welcomed. It really glad you spoke up. Next [02:09:10] thing that happens in the in February this year, I get an invitation from Align Technology [02:09:15] to become their UK specialist on their Emir advisory panel.
Claire Nightingale: So I’ve now been to [02:09:20] two meetings with them, one in Poland and one in Madrid. And at the Madrid meeting [02:09:25] they had all of the senior executive team there, so they had Joe Hagan, Simon [02:09:30] Beard, they had their chief financial person and we had been primed. So I’m now part [02:09:35] of this committee of international orthodontists that meet twice a twice a year, [02:09:40] and they run ideas past us and get feedback. And we’d all been [02:09:45] asked to bring a question, you know, what would we like to ask executive team? And I was told afterwards that the one question [02:09:50] they were certain would come up was sustainability. That was the one they had prepared for. But [02:09:55] actually since then they have reduced their packaging. So I can’t tell you that it’s [02:10:00] cause and effect. But I but I’m delighted, of course, that they’ve now got more discreet [02:10:05] packaging. It’s smaller in volume. It’s made out of recyclable materials. Um, but they’ve [02:10:10] asked me to do something for them, and I didn’t like aspects of the contract, so I flagged [02:10:15] it up to Joe Hagan and said, um, you know, I’m not a lawyer, [02:10:20] but these clauses don’t look very favourable to me. And they’ve sent [02:10:25] me a rewrite of the contract. And I think that all of that is incredible [02:10:30] that I, as a single voice, was [02:10:35] willing to stand up and speak out. And they, a big American [02:10:40] corporate, have been big enough to welcome the feedback, to make some changes and [02:10:45] and welcome me in.
Payman Langroudi: Do you think women don’t speak up? Do you think [02:10:50] it’s a woman thing?
Claire Nightingale: I think it’s a I do think it’s a woman thing, [02:10:55] and I think it’s a shy man thing as well. But people should speak up because [02:11:00] you need to be heard, and you can do so in a way that is positive. You [02:11:05] know, I speak up a lot, but, you know, but when I do, it comes from a place [02:11:10] of wanting to make things better. I’m not trying to be complaining or critical or aggressive. [02:11:15] My stance is, can we do this differently? Can we [02:11:20] make it better? And you know, in my own professional life, negative feedback is [02:11:25] painful, but actually it’s more beneficial if you want to move forwards and make [02:11:30] things better than being told you’re doing great, you know? But of course, um, a [02:11:35] negative feedback delivered in an aggressive way is just a terrible experience. [02:11:40]
Payman Langroudi: Claire Nightingale. It’s been a massive, massive pleasure. Thank you so [02:11:45] much for coming all the way here.
Claire Nightingale: It’s been my pleasure to Payman. Thank you for inviting [02:11:50] me.
[VOICE]: This is Dental Leaders, the [02:11:55] podcast where you get to go one on one with emerging leaders in dentistry. [02:12:00] Your hosts Payman Langroudi [02:12:05] and Prav Solanki.
Prav Solanki: Thanks for listening, guys. If you got [02:12:10] this far, you must have listened to the whole thing. And just a huge thank you both from me and pay [02:12:15] for actually sticking through and listening to what we had to say and what our guests has had to say, because [02:12:20] I’m assuming you got some value out of it.
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