Audio

Intro Voice: This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.

Payman: What do dentists have to make sure they get clear before they go in and what would you do in your case in the first few weeks and months?

Christopher Orr: I think it’s probably fair to say that my overall feeling on the PPE situation is that we don’t have enough information. Unfortunately, we do have to, many times, make decisions on the basis of incomplete information. And you couple that with our national mentality of being very cautious and it’s understandable why dentists in the UK are tying themselves up in knots because many people seem to want this nirvana of 100% safety no matter what they do. And we see it at the moment with some of the teaching unions who are saying unless you can guarantee it’s 100% completely safe we’re not going back to the classroom.

Christopher Orr: And that is perhaps an unrealistic expectation. There’s always been an element of risk in dentistry that existed long before COVID came along, and the question really is what do we do to really try and mitigate that risk? First group of people we have to make feel safe is our staff. And I’m aware that in terms of what we do, and again particularly around the issue of protective equipment, we have this basically, probably three ways you can look at PPE. There’s what’s proven to be effective, there is what is recommended by guidelines, and there is what’s available. And frequently we’ve seen that what the guidance is fitted to what’s available, and that’s about as good as we can do at the minute because there’s an absence of absolutely concrete proof [inaudible] on what personal protective equipment is necessary.

Christopher Orr: The FFP2 versus FFP3 thing. The consensus opinion seems to be that FFP3 is not necessary in the dental practise unless you’re treating somebody who actually is suffering from a COVID infection at that moment. And we look around the world, most jurisdictions seem to have settled on an FFP2 mask and a gown for doing an aerosol generating procedure. That’s the basis on which the French dentists went back to work, I think it was at the start of this week, on Monday. In Germany they’ve paid long attention to transmission data coming from Wuhan province in China, which seems to indict that the dental surgery is a much lower risk in terms of transmission of the virus. So the German dentists, they have not closed. Met a man in Berlin, has been seeing patients throughout the entire lockdown period. He’s been doing that at about 60% of the normal speed. They’ve been wearing visors and some masks and that seems to be about it.

Christopher Orr: And I think we’re probably overthinking things. There are a few confounding variables that have come out from the conversations over the last couple of weeks. Some people have been suggest that FFP2 masks need to be fit tested and FFP2 masks, probably the majority would fail fit testing, if you look around the opinions of people who know what they’re talking about. the FFP2, it offers additional protection for you, but whether the additional protection of the FFP3 is necessary, that seems to be fairly negligible for dentists. That was Mark post on dental health.

Christopher Orr: So we will have to settle on something. My hope is two things, one, that whatever it is is commence work with being able to do some dentistry. Even though you can put yourself in all sorts of protective gear, but if it actually gets in the way of doing your job then what’s the point? And the second thing, which I think was either quite correctly said yesterday on webcast, was that these things, when we have these kind of standards we never seem to come back from them. Jason gave the good example of single-use endo files. We’ve not yet got to the point where we can say it’s actually we know it’s okay to re-use these things if we sterilise them. The second thing that I would hope for is something that actually, it’s a temporary situation. And whatever is in the legislation has an expiration date, a sunset clause, whatever you like on it, that can be reviewed and renewed, but otherwise, it falls away when the situation that we’re in hopefully has past. Because if it’s a permanent change to all the personal protective equipment, I think it’s a very seismic change in dentistry, which I think would grossly affect the nature of what we do.

Christopher Orr: So in terms of getting back to work, I think the staff, most important, staff being reassured that the work environment is safe. Is safe for them. And most of the PPE stuff that has been recommended, a lot of it is coming from the point of view of protecting the healthcare worker. To a lesser degree, we’re protecting the patients from us because if you look at all those filtration things, they filter the air on the way in, but not on the way out. Particularly the valued ones. So therefore, there’s not a lot for the patient to stop them getting stuff from you but you’re not getting things from the patient.

Christopher Orr: So in terms of return to work, whatever date you pick, we’re going to have our staff in for probably two or three days before we start seeing any patients. Those couple of days would be used to, number one, reacquaint them with the practise, which they probably haven’t been in for a couple of months. Number two, update them on the new procedures to how we’re going to be doing things. Make sure they can put their PPE on, make sure that they’re able to do that correctly.

Payman: You envisage writing down all of these policies as in risk assessments and so forth. Would you say every practise now has to do a big-

Christopher Orr: Yes, absolutely. There’s a number of reasons for that. I know there’s been some discussion about whether the CDO has any authority over private practises. And the answer, it’s a Vicky Pollard answer. It’s yeah, but no, but yeah, but no, but kind of. In terms of statutory authority, no. In terms of indirect authority, yes. And many of the other organisations we know and like, like the CQC, like your indemnifiers, they will be looking to what the CDO is saying to give them an indication as to how things ought to be going.

Christopher Orr: So whilst there are some people who are saying if you wish to run a private, urgent dental care centre you should crack on, and you can take a view on that, my advice would be that you need to be very, very clear with your indemnifier as to whether they’re going to cover you for that, and have that response from them in writing before you start cracking on and throwing the doors open.

Payman: But what would you say… Chris, when you say that are you saying that the GDC rules are you need indemnity so that’s that, or are you actually thinking of a worst case scenario where, I don’t know, a member of the public or your team goes down with COVID-19 and blames you, the practise owner?

Christopher Orr: In theory, yes, that is the risk. Proving that the dental practise was the play, the onus of proof is on the accuser. But in theory, and of course in Britain, we like to tie ourselves up in knots on theoretical risks of this and this and this. And what you don’t want to have is being sued by somebody and your indemnity provider say, well, actually, we’re not going to cover you. And exactly what is acceptable to the different indemnifiers or insurance providers, it will vary from person to person. My advice for your listeners is they need to have that conversation.

Payman: But they might say that… Let’s say we get a disruptive indemnifier who really wants to make their name now and says, as long as you’ve got CQC and PPE and all this in place, we’re backing you. So then let’s say we start practise and your hygienist catches Coronavirus in McDonald’s and then sues you and says that there was nothing written for whatever it was, procedures. At that point, your indemnifier may not pay anyway. It’s not that you’re going to be left… It’s a discretionary thing. It depends on… For me, is it a GDC thing or is it we’re really going to have these problems? I’m not so convinced one way or the other.

Christopher Orr: We can argue this all day long. The GDC, I don’t believe it is their statutory function to determine when practises should be open and for what. Their job is to protect the public, protect patients by controlling who is allowed to do the dentistry. When those people are allowed to do the dentistry, I believe, falls outside their remit. And I know they’ve taken a bit of flack for sitting on the fence or pointing people towards the CDO, but at the end of the day, that, I believe, is the mechanism.

Christopher Orr: Now, this whole crisis in dentistry has highlighted one of the problems that we do have, that we have numerous different competent authorities who don’t seem to communicate terribly well with one another. It seems they communicate by telegram almost. This minimum amount of information goes from one to the other. They don’t seem to coordinate. Now, of course, in this country, the way we have things set up, in other jurisdictions, the dental society, the equivalent of the BDA, acts as licencing body, trade union, and in some cases offers indemnity as well, depending on how things are set up. In the UK we don’t have that. At least not for dentistry. Some other professions perhaps. And the reason, of course, things were set or split up was that at some point, somebody in the past has argued that the profession should not be allowed to regulate itself unless you’re a lawyer, because the law society do get to do that. But if you’re not a lawyer then you’re not allowed to regulate yourself because there might be a conflict of interests. Therefore, we better get some lawyers to run the GDC and regulate the dentists because they’re not capable of doing it.

Payman: So if you were the king of the world, Chris, what would you-

Christopher Orr: Unlikely, but yeah.

Payman: … would you stick the BDA and the GDC into one organisation? I think it would make sense because it would make the GDC more of a wet-fingered organisation.

Christopher Orr: You could do. And it’s difficult where you’ve got government stuff, private stuff all in the same pot, but it could be quite interesting to look at if you merge those bodies. But at the end of the day, again, that’s a conversation we can have over a number of glasses of wine later. I haven’t really answered the question about going back to work, which is probably what the listeners are interested in right now rather than navel gazing about whether we can merge the organisations.

Christopher Orr: So in terms of back to work, staff safety, staff training, number one. Things do have to be written down. When you are returning to work things are clearly going to be different. The CQC are probably going to want to be reassured that things are safe because that’s obviously their job to make sure that everybody’s safe, brackets apart from care homes, but that’s not our problem at the minute. So everything needs to be written down, staff need to be trained, and then within some limitations we can probably start seeing some patients again.

Christopher Orr: Prior to the lockdown, and I think there was probably a period of about two weeks where we could all see it coming if you were watching the news in any capacity, during that time, what we did at our practise was we went through all the patients who were under treatment, about to start treatment, or were due to come in for consultations. And we broke them down basically into three different groups: people to be worse off, people who will be okay if we wait, and people who we better not start things on. And the reason that was relevant at the moment is when we open up again, there are going to be that same stratification of patients. The ones who need urgent care. So the ones who have something that is broken or come off, or have a toothache they’ve been managing with AAA protocol. Those people need to be gotten in quickly. Patients who you needed to do something on and you couldn’t get them in before lockdown, again, those sort of people. So things like orthodontic adjustments, people with active caries, people who can be moved onto the next thing. So those are the people you probably need to see first.

Christopher Orr: Second group of people who will not be any worse off if there’s a delay in treatment, those are, maybe, I don’t want to say priority, but they are less urgent to get in. And people in the third group, the ones who you need to be sure you can complete the treatment on, that’s a group of patients in some practises which the dentist I think need to give a little bit of thought to. So for example, if you’re doing implants and you have a patient on whom you’re planning to do some autogenous bone grafting, you do the autogenous bone graft, there’s a clock ticking. And unless you get the implant in pretty quickly, the bone’s going to go away again. So the problem, I don’t why I’m perhaps smiling, the problem potentially is if we have a second outbreak and a second lockdown those people are not going to be able to complete treatment and you end up actually with them no better off or even worse off when they started. So a little bit of caution rather than throwing open the doors to everybody.

Christopher Orr: And again, please don’t ask me question about bone grafting. This purely comes from a conversation with George our oral surgeon. And we were having this conversation yesterday and he was saying the patients who need that type of bone grafting I’d rather not start until we’re sure that we can remain open for long enough. If we’re doing particularly the bone grafting in a patient, that is much more stable and therefore, if that was the procedure that’s planned then we can get on with doing that one. Because if we have another lockdown for several weeks the window of opportunity, if you like, is longer. So I think a little bit of caution who you get in and how. And that needs to be done on a patient by patient basis.

Payman: Prav, you were saying your practise, you’ve got loads of patients who’ve paid for their treatment already. And-

Prav: Yeah. Go on, sorry, Payman. Carry on.

Payman: Patients who’ve paid for their treatment already and are desperate to get going and desperate to finish off.

Prav: I think, pretty much we’ve certainly not been as analytical as Chris on this, but in terms of categorising I think it’s an incredibly sensible thing to have done. But I think this really hit us all pretty hard pretty quickly and so a lot of our thinking came into place on lockdown. So one of the things we realised is there were a lot of patients… So we looked at the business from several aspects, and one of them obviously, was the needs of our patients, and then the other one was from the financial aspects of the business for it to be able to survive, and how we could meet those demands. And obviously from those patients who were mid treatment, so to speak, they just needed some reassurance really. There wasn’t much we could do at this point in terms of treating them. So what we ended up doing is launching the video communication really, really early and inviting those patients to have rather than a telephone conversation, see the whites of the eyes of their practising dentist, their clinician, and just have a conversation with them. Saying, listen, we’ve put lots of things into place. We’re going nowhere. Everything’s safe but we’ve had to put a pause on your treatment.

Prav: If they were an orthodontic treatment, let’s say some kind of aligners, just keep wearing your last aligner. If that patient was due a set of aligners, let’s say that week, then what happened was almost like a doorstep appointment where they came and picked it up from outside the practise. But other than that, it was more, to be honest, these patients, they just want some reassurance that you’re still going to be there, you’re going to finish off the treatment. By the way, you’re holding onto my money there, is everything going to be okay?

Prav: Then we had those group of patients who hadn’t even started any treatment and they’d handed over a substantial sum of money, especially patients who were talking about implant dentistry. We do a lot of immediate load stuff. Same day teeth treatments in our practises and they put down some hefty deposits for that and booked surgery days and clinicians. Sometimes we have clinicians travelling in to do that sort of treatment. And so there was that side of things, and we had quite a few patients getting to us asking for refunds. And what do we do to manage that process whilst we’re trying to keep the business afloat as well and you’ve got two conflicts. So the first thing we said to those patients is 100% absolutely you can have that money back, it’s yours. And no problem at all. However, on a couple of them we had offered them a heavily discounted rate at that time, so we wouldn’t be able to honour that in the future. And then the second thing was with those patients was actually their place in the diary. Now, we’re going back to dentistry on the first of June, and that’s the date we’ve set. May not be the date we go back, but that’s what’s mentally in everyone’s minds and all the patient’s minds. So we’re booking those patients in from there onwards.

Prav: And what happens as we get closer to that date, we’re having conversations with those patients. That’s happened a couple of times now. It’s incredibly time consuming but what it does is it allows us to keep in touch them along. And so those patients who’ve paid upfront, who had surgery dates booked in and whatnot, they’re going to be seen earlier. And so we have had to make some substantial refunds, understandably. Whereas some patients have said look, hold onto my money. They just wanted that reassurance that we’re still here, we’re not going to go pop. And they’re still in need of that treatment. They still want that treatment and they want us to do that treatment. It’s just they wanted that reassurance. So I think opening up that communication has been fundamental to just giving those patients peace.

Prav: Your practise, have you had any team members who have been anxious about the thought of coming back to practise or just said to you, I feel anxious, is it going to be safe, those sort of things? Because there’s so much in the press at the moment and we’ve heard quite a bit of negative press about dentistry we’ve had some of our team members express some concerns about that. Have you had anything similar at all in your practise?

Christopher Orr: Couple of things there. You were talking about patients and things. I have to be honest and say 99.9% of our patients have been extremely reasonable and understanding and I think they realise that we are all in the same boat together. So the issue with pre-payment and discount and things, that’s not how we operate, but had we been in that situation we probably would have approached it in a similar way. Staff members, I’ve not had any of our staff come to us and say we don’t feel safe. During the time when a lot of our staff have been furloughed, we’ve had small meetings, basically over a cup of tea in the mid morning with everybody just over Zoom, just talking to them and saying how are you? What have you been doing? This is where we’re at. And we’ve not had any of them coming to us saying we don’t feel safe coming back to work. But I think what comes out of what you’ve just said, and I guess the answer to both those questions, it is all about communication.

Christopher Orr: And one of the cliches that’s come out on the internet a lot in the last month or so is there’s a lack of leadership in dentistry. Higher up, certainly there’s a lack of leadership. But every person, every dentist is leading a clinical team. That is from the practise principal leading the whole practise through the associates who are leading a very small clinical team in their surgery. I think it has to come from the, not just what is in place, that will come from the practise principal, but the implementation of that. Everybody has their role to play to make sure that all of our team feel completely safe and confident that they can get back to work.

Payman: Chris, have you been in touch with your patients as well?

Christopher Orr: We’ve sent a couple of newsletter and things out. We put the video consultation thing into place very quickly. I should give credit to who’s one of my associates. just came up with that completely by himself and said, is it okay if we do this? And that’s been working extremely well. We’ve had, honestly, relatively few patients calling us. People have contacted. We have been able to give them advice and things over the phone. For the most part, they’re generally well-cared for patients, they generally look after themselves, and there have been, I think if anything, we’ve had probably fewer people ringing up with emergencies than we would have in a typical four weeks, eight week period if we were open.

Payman: So Chris, it seems like in private practise, which both of you guys seem to be talking about, there doesn’t need to be massive changes. An element of triage, risk assessment, PPE. But the timings will suit it. What’s your feeling, if you had to guess, for an NHS practise? They’ve been doing quite well right up to now being paid for sitting on the phone, but going forward, what do you think’s going to happen and what should happen?

Christopher Orr: I think a lot of that is going to depend very heavily on PPE. Availability of PPE, what standard of PPE is required or said to be required by Public Health England.

Payman: Let’s imagine there was PPE available.

Christopher Orr: Now, the next question is how much is that PPE costing the practise? Because if you can imagine, you’re going to do a band one NHS treatment, which may include some scaling. So an aerosol generating procedure. And at the current price levels, that represents, depending on who you buy it from, 25, 35 pounds worth of PPE per band one treatment. So that therefore means that it may be financially inviable for the practise to actually do that unless the NHS assort so much PPE that they’re able to supply it to NHS dentists in high volume, which I think is unlikely given that I read on the news earlier this morning that some doctors are expressing concerns that they are being told not to speak in public about PPE shortages in hospitals.

Christopher Orr: So the PPE’s going to be a problem, and I think it may… In terms of an NHS practise, there’s one of two possibilities. It either makes it completely inviable or the government is going to apply a very big dollop off financial fudge to funding for NHS practises for probably the next 12 months. They will pay them their money, UDAs may get recorded, but whether the service levels for it are enforced, I think, is highly doubtful. And that did come across quite a bit in the CDO’s webinars. I didn’t understand a lot of what the NHS payment people were talking about, but it did seem that that might be what they’re… They’re going to be just get your money as normal. You see as many people as you can. They will keep tabs on that in some way. Because otherwise it’s not going to be feasible to open your doors because it was just about feasible to open your doors doing NHS stuff before that.

Payman: And what about for your courses, Chris? How do you see your courses being affected by all of this?

Christopher Orr: Well, a few different answers to that. If we look at the last big crisis, financial crisis that hit the world, in the time after 2008, we actually saw more patients wanting elective treatment than before. So I think the demand for treatment will be good, and therefore the demand to scale up will be good. The time after 2008 was actually one of the years where we ran more sessions rather than less. And the mindset of the dentist, we think, was that they realised there was going to be a bit of downtime and it might not be a bad time to skill up. So we would be running our programmes. and I were speaking to the people who do our website this morning, working out exactly the date we open bookings. We are planning to run the programme as normal and we will see what unfolds. Quite how you do that, it depends on how social distancing and how much social distancing is coming. But by that stage, I would imagine that restaurants would be open as normal, bars and other places would be open as normal so it should be, I hope okay, for all of us.

Payman: I think the evidence-

Payman: … I think the evidence from abroad is that the patients are prioritising healthcare. Have we lost Chris? Patients are prioritising healthcare in the return. I don’t know if you guys yourselves have thought about this, but you think about when we go back, it’s realigned your priorities and what’s important and what’s not. And healthcare seems to be, it’s in my mind as hey, look after yourself a bit more. So I think we’re good in the medium term as far as that goes. Chris, we were talking on the phone and I was saying to you it’s a funny situation because if we were a dentist a 100 years ago in the last pandemic you could have more influence, sort out more problems than as a dentist now. And I looked it up. Two AM last night, I looked it up.

Payman: In 1921 there were 5,000 registered dentists and right now we’ve got how many UDC? They claim 400 UDCs doing the same treatment really. It seems to be extraction treatment. Hopefully we’ve got better PPE now. But how do we next time, I don’t want to go finger point this time, next time there’s a crisis, and there will be one, whether it’s a financial crisis or something like that, how do we next time not end up in the mess that we’re in this time as a profession? Because you can see other countries reacting much better much quicker, and much, much more scientific way. And we’ve got to rely on one dentist sitting in Leeds who’s doing a lot of reading to come and tell the government what the latest science is, while the government’s telling the whole nation that they’re letting the science decide what they’re doing.

Christopher Orr: Well, it’s interesting actually. This is a point that I’ve heard Dominic O’Hooley raise a couple of times. That there is not a huge amount of transparency in where the information the CDO was basing their decisions on. I think at the end of the day, there’s a universal problem that politicians are reelected every roughly five years and they tend to want to have things that they can show to the electorate within that time period. So they can say hey, look what we’ve done for you, let’s get reelected. The difficulty we have here is that by many accounts, the government will present with a lot of information on how they shouldn’t prepare for this and they didn’t really pay attention to it. So they were a bit hamstrung and they missed the boat on a couple of occasions. So I think in terms of preparedness, there’s an awful lot that we will learn from this pandemic. If there is another one in our lifetime then hopefully we will be in a better place to respond quickly, and that probably means having stocks of PPE and things ready so that there isn’t this sudden shortage of it.

Christopher Orr: The other thing that I think is quite interesting if you look around the rest of the world, again, one of the issues in, or the lack of issues in Germany, stems from the fact that they make, in Germany, the vast majority of their hospital equipment, whereas we outsource it all. And in Germany they had a period of time where for a couple of weeks supply levels were low and they did not like that. It was unacceptable that there wasn’t enough stuff. But things got back to normal quite quickly, whereas here we were ordering stuff from China. A lot of the places in the early days of the Chinese lockdown, the regions where the factories were were all locked down as well and the supply chain, it’s still not back to normal. There’s lots of stuff that you can order on Amazon, for example, where if I order it today I’m going to get it in July. So I think better prepared, and it’s better management of stocks and trying to order things in advance so that we have them, knowing that some stuff might not necessarily get used. And again, there’s a balance that we have to accept there where if you plan for overcapacity there is going to be some wastage there.

Christopher Orr: And I think really I was very disappointed couple of weeks ago. I can’t remember which government minister it was. The talk about the Nightingale hospital in London had only seen handful of patients and [inaudible 00:32:46]. And yes, of course it was [inaudible] you don’t want to have bodies piling up in the streets and in A and E. So the fact that the government spent that money, there is going to be some spare capacity, which unfortunately is lacking in the NHS because everything is pared back to the bone. So better budget for the NHS. And sorry to say it, that actually might mean higher taxes for us to pay so that we have that in the system when we need it.

Payman: Do you not think it’s more of a systemic issue though? There are dentists now who have PPE who can’t work. PPE isn’t what’s stopping them. For me, it seems to be the speed of decision making in our profession is slow. And in the end, we’re looking to one human. All right, she’s got an office, but again, she’s the head of the NHS. So shouldn’t the profession now set itself up in a way that there’s a scientific community, a scientific board that can look into things if there’s a scientific issue quickly? Because look, that’s all I see. I see the politicians saying it’s the scientists. And then we look where we know what’s going on in our area and there’s no science. We’re relying on one Dominic O’Hooley to teach us to read the work. What have you thought, Chris, when you’ve read all of this work from the different SOPs you’ve seen? Do you feel like that’s what’s happened? Is that there’s such a vacuum of information from the top that the grassroots is pushing information up? That’s my sense of it.

Christopher Orr: Yes and no. People are responding because they feel they need to try and make sense of the world around them. That’s a normal human response. I do not envy anybody in the Department of Health, their job, just at the moment. The problem that you’ve got is that if you issue advice it needs to be well-written and fairly robust so that the number of exceptions and queries on the advice is absolutely minimum. I can imagine there is somebody in the CDO’s office right now, a team of people, probably rewriting standard operational procedures for when NHS practises are going to reopen. And when they’ve finished that task it needs to be checked, et cetera so that it’s valid, and then it can be passed down. So people who like firing stuff off without any kind of validation, I think it’s counterproductive because, again, that national mindset of caution. People like to be told very clearly in black and white this is what you do, and then you go on and do it.

Christopher Orr: So could we respond better for that, possibly. A committee of dentists who make recommendations. And again, the question is who do you put on to such a committee, and how do you actually feed them into the whole process? How do you get everybody to say yes, we agree with that, because we have a large number of clinical standards and standard setting organisations. So the FGDP and NICE and many other organisations, and there are so many guidelines that come out that it’s almost impossible for anybody to keep track of what you’re supposed to do under normal circumstances, never mind right now. So yeah, less bureaucracy and speedy decision making, I’d love to see that. How you would actually go about achieving it, I really don’t know. Head scratcher.

Payman: Prav, going forward, your [inaudible] your marketing now. Are you thinking you’re going to be coming out of this in a better way somehow? Do you think there’s an opportunity in it? I do. I think there’s a land grab. If we’re talking in those terms, I think that the practises who focus on [inaudible] people working from home is what I was going to say. People working from home who are relatively getting richer right now.

Prav: And do you know what, even if I’m looking at my team, and I’m talking about the team in my digital agency rather than my practise, speaking to them, they’re getting richer because they’re being paid, they’re spending less money, they’re not going out. But do I see it as an opportunity? Well, I think initially we’re going to go back phased approach, less volume. So what you’ve really got to think about is how you’re going to phase that comeback. And if you go out and launch some marketing campaigns and get a truckload of leads coming in, and then start processing them and having conversations with patients, where are you going to fit them in? And so from our perspective, what we’re doing, initially, for at least a short to medium term, we’re extending our hours.

Prav: So we’re going to do six days [as standard 00:38:13]. We’re going to do more evenings. And [inaudible] patients [ought] to take care and look after our existing patients who’ve been waiting patiently for so long. So to get that out of the way, so to speak. Are we running marketing campaigns now, yes, absolutely. And we’re having video consultations with patients and they’re all subject to an in-person clinical checkup. So we have a conversation, we build some rapport with those patients. We talk to them about the way we do dentistry. We give them some approximate price guides, saying it’s from this to this. But for you to get a treatment plan, you need to come in and have a comprehensive assessment and this is what the investment in that assessment is, and we’d be looking at getting you in around this period of time.

Payman: Prav, as a marketing guy, are you saying that you’re going to be marketing safety as well? I think it’s an error, personally, but have you bought fogging machines and air purifiers and all of that?

Prav: So what we’ve done is we have bought PPE. The various masks, visors and gowns. We haven’t bought air purifiers, and that may change. And the reason being… Actually, do you know what, if I segment my two groups of practises. In one we have, in one we haven’t. And in actually the one we haven’t, we’ve bought three that go into rooms that have no windows. So that’s the three [inaudible] that we’ve bought. But to be honest, a big part of the purification [line 00:39:56], it’s not my area to go [inaudible] the patients, and we’ve had certain team members who’ve expressed some concerns. But we haven’t gone all out and bought 11 purifiers for 11 rooms, for example. And so from a marketing perspective, back to your question, are we going to be marketing safety? Yes, but not as a USP. I think more in terms of reassurance. That saying, as dental professionals, it’s always been an incredibly safe environment to come into.

Prav: We’ve put some additional protocols in place to step up that level of safety, which will include a oral mouth rinse, less people in the waiting room. No escorts allowed into the practise anymore, et cetera, et cetera. It’s according to the SOPs. Am I going to be using that? If a patient is choosing their dentist over an SOP, over an air purifier, we’ve got something seriously wrong.

Payman: I think it’s a mistake.

Christopher Orr: No, I agree. The issue of air purifiers, there is no proof at all that they reduce the risk of transmission. And such evidence is unlikely to be forthcoming. So from my point of view, the air purifiers are there if you wish to make your team feel you’re doing everything possible. Fantastic. But the 2,000 pound a surgery ones, absolutely not. Again, I agree completely with you, these are not devices that we should use to market our services and try to claim that we’re better than some other practise, because in the absence of proof that they actually do what we’re implying they are with such marketing, we’re misleading patients. So yes, perhaps to make your team feel better. Perhaps if it makes you feel that you can turn around rooms more quickly, particularly those without windows, fantastic. But otherwise, no, it’s not a marketing ploy.

Payman: What I would think about air purifiers is they’re a good idea in general pre COVID. So if you’re that cat, if you’re the person who wants this thing that cleans your air in general, fine, absolutely fine. But I’ve been thinking about this a lot and what we’ve done with our team is we’ve focused our team on finding mom influences around each of our regional centres. And mom influencers have much more engagement than pretty girl influencers with their audience. And so in each town there’s two or three moms who’ve got massive Instagram presences and we’re going to be reaching out to them and saying come and have a free teeth whitening, as soon as that’s an appropriate thing to say. Because let’s say in a town like Leicester perhaps, where you’ve got those two practises, or you’ve partnered in those two practises, there’s literally three or four of these types who set the agenda for the moms. And the reason I’m pointing out moms is because mom is the safety representative in the house. So what I’m saying is marketing safety comes in many ways, many forms. We mustn’t just think I look like a spaceman, here’s my fogging machine. That might make us feel safer but I don’t think patients want to see that in marketing.

Christopher Orr: It implies there was a problem that we weren’t dealing with before. At the end of the day, we’ve had aerosol and the knowledge of aerosol for a long time. We had it when HIV came along, and we have not had anybody catch HIV through aerosol transmission in the dental surgery in how many years of being aware of it.

Prav: I do feel if, and to be honest, I’ve actually seen some campaigns already go out, with people who’ve made videos about their whole protocol. And it’s almost sending a message out to those patients along the lines of this is a very dangerous place to come to, guys. But because we’ve got all this stuff on, you’re going to be safe.

Payman: It’s just very one-dimensional thinking, isn’t it?

Prav: Yeah. And I think the other thing is that everyone’s pushing this message out as though every person walking through your practise is COVID positive. And they’re not even taking into account that hold on, we’re doing these pre-screens. There’s a level of risk mitigation that’s going on prior to a patient even being allowed to step through your door. But the measures that some people are taking, it’s almost as though you’re having to treat these people in a space because you’re assuming every single person [has got it 00:44:46].

Payman: But then [crosstalk] a thing that I accept that. It’s the marketing of it that I find strange. There are smarter ways to market safety than saying I’m wearing a spacesuit. Chris, going forward, what’s your message to principals and associates? [Because we’re going 00:45:06] to have to work together now.

Christopher Orr: I think there’s a lot of stuff that we’ve already talked about. It’s really number one, make your team feel safe. Number two, make sure that everybody is trained and comfortable before you start seeing patients. A phased approach, you’re not going to go back to a full book of patients. You need to think about who needs care the most. And I would encourage all dentists to go through their patient books, the patients whose appointments were cancelled or deferred before the lockdown, those people need to be the priority. We mentioned also, and Prav, you talked a lot about patients who’d prepaid for treatment, there are the patients who are on maintenance plans. So the Denplan, Privilege Plan, those sorts of things. Those people, again, the ones who did not cancel [inaudible 00:45:54], their loyalty to the practise needs to be recognised. So in terms of getting people in at the appropriate moment, those people need to be prioritised. Because again, that’s where the business aspect of things comes in. You need to thank customers for their loyalty. So principals point of view-

Payman: If one of your delegates said, listen, I’m going to open, I’m going for it, would you advise them to go for it?

Christopher Orr: … I would advise them that they have got indemnity cover in place and that has to be in writing from their indemnifier. They need to have carried out their risk assessments and probably have some up to date standard operating procedures. It’s interesting to see that a lot of the new dental societies and associations and groups are staying away from writing standard operating procedures. That they seem to be waiting for the CDO to come out with some things. But I think the major thing, really, is making sure that everybody’s safe and making sure that you are indemnified. And like I said early with your indemnifier, you need to be crystal clear with the indemnifier about exactly what services that you’re planning to offer.

Payman: Let’s say you have. Let’s say you’ve got all of that down and some new indemnifier, TVS, one of those PDI whatever, says you’re covered. Can they go?

Christopher Orr: Yeah.

Payman: Advise them to [inaudible 00:47:23]?

Christopher Orr: Go for it. As long as everybody’s happy, everybody’s safe and you’re indemnified, I don’t see why not.

Payman: I’d agree with that. I’d agree with that. Especially as we’ve seen it. We’ve got the advantage of being three weeks behind so many other virus regions and we can see what’s happened over there. Prav, you going to open up soon?

Prav: Like I said, we’ve set a provisional date and I think I am not the person to make that decision. I’m just the guy that brings the patients in and helps with the patient journey and the communication sides of the practise. So for me being a non-clinical member of the team, I’m certainly not the right person to be making those decisions.

Payman: What’s your date? 15th of June?

Prav: No, first of June we had provisionally, but we’re moving patients along 15 days at a time. So I’m definitely not that person to make that decision. Having heard everything that I’ve heard, and listened to the science from Dominic, I’d open tomorrow if I could. 100%. And I don’t think with the way dentists and how our practises have been operating pre COVID, I just think we just need to respect a little bit more distancing, a little bit more space. And I think a lot of these are SOPs that have probably taken things to a level slightly above to be additionally cautious, so to speak. And Chris, as you said earlier, going over the top with these masks and some of them the inspire there is protected but the expire there isn’t, and stuff like that. So there may be an argument for sticking a normal mask on on top of that.

Christopher Orr: I’ve heard that said. To be perfectly honest, the whole thing with the masks, I think we are overthinking it. Very, very classic dentist way of looking at things. We try to over-engineer and we get to a point where you actually can’t do anything because you can’t make a decision. So from that perspective, it’s really just about recognising that we can’t do everything to be 100%, but 95% may be the level that we have to accept.

Payman: Well, thanks a lot, Chris. And hopefully we’ll get back to some form of normality. Thanks for injecting some common sense into it.

Christopher Orr: Thank you.

Payman: There’s information overload.

Christopher Orr: I think it’s been information overload for the last about three months. And that’s the problem. That this continual need to make decisions and change things as we’re going along and evolving situations. It’s very stressful. Very stressful indeed.

Payman: All right, Chris.

Christopher Orr: But hopefully back to normal soon. [crosstalk 00:50:18].

Prav: Have you got an opening date, Chris?

Christopher Orr: Beg your pardon?

Prav: Have you got an opening date?

Christopher Orr: I am going to have the staff coming back, I’m thinking either first of June or eighth of June. And we start booking patients in towards the end of that week and gradually ramping it up over the next couple of weeks. So early to mid June. Exact date to be determined.

Payman: We’re waiting for the chief dental officer now, with the legal situations kind of clarified yesterday as well. I guess we’re just waiting for that. Brilliant. Thank you, Chris.

Prav: Thank you. Thank you so much.

Christopher Orr: Thank you very much, both of you. Thank you. Take care. Bye-bye.

Payman: Bye.

Outro Voice: This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts Payman Langroudi and Prav Solanki.

Prav: Hey guys, and welcome to the Dental Leaders podcast. Thanks for tuning in and today’s interview was with Mark Topley, the CSR Coach. Before I met, this guy didn’t have a clue what CSR was, and how you go about implementing it in a business and he educated us a lot. His journey about the charities, the struggles, the fraud, and the challenges that he faced really, really interesting conversations, and a really nice guy as well. Pay.

Payman: I love that, but I knew the stuff he was up to. I knew that CSR stands for corporate social responsibility.

Prav: Meant nothing to me.

Payman: But what I didn’t know was that sort of combining charity with business kind of idea. You always think with charity, sort of just people who want to do good and somehow there’s a there’s a demarcation between the charity sector and the business sector. It’s very interesting how you combine those two together and if you want your business to be more accountable to your team, accountable to the society around it, then he’s your guy. He’s the guy you go to and I love that. I love that he’s made that connection between those two worlds which I wouldn’t normally connect.

Prav: And super niche, right? He’s really niched down on what he does and who he serves.

Payman: And great guy, great guy. Lived abroad and done a bunch of work and there’s lots of dentists have done their bit through Mark and his organisations. Excellent. I think you’re going to enjoy it.

Prav: Enjoy.

Payman: When you were living there, what did you miss most about the UK, outside the family and friends?

Mark: Real ale.

Payman: Was there no ale? No, I guess not.

Mark: Fizzy lager. Fizzy lager.

Payman: Was there not an Irish Pub somewhere?

Mark: No, there was. So in Dar es Salaam, where Prav’s dad comes from, there is an Irish Pub.

Payman: There’s an Irish Pub in every city in-.

Mark: There’s an Irish Pub in every country in the world.

Intro Voice: This is Dental Leaders. The podcast where you get to go one on one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.

Prav: Today, we’ve got the pleasure of having MarkTopley here, who is the CSR Coach and has got a long standing history with lots of dental charities, which a lot of you will know about. I think would just like to kick off by saying, thank you very much for making the trip to come and see us today and share your story with us. I just like you to give the audience a bit of a background of your backstory, how you grew up, and then your first career and how you ended up finding yourself here working with dentists.

Mark: Of course, yeah. Well, thanks for having me. It’s a pleasure to come in. So where do you start? I’m a boy was born on the south coast and lived in a place called Bognor Regis right down the south coast, which some people would have been on holiday to. A lovely little town. I did a bit of time there. I grew up in sort of West Sussex, and then when I was about 10, 11 years old, my folks decided that they were going to up sticks and move to South Africa for a couple of years, which we did. We did a couple of years overseas.

Mark: My dad at the time, had been working in a variety of jobs and had an opportunity to learn dairy farming. So from that age on, I was a farming boy. We did a couple of years in South Africa, had a great time, came back, lived in the New Forest for a while, continued with school, and then went off to college and did a teaching degree in Southampton, which was a lot of fun and still live near Southampton nowadays.

Mark: After college went off to Havant and taught in a place called Leigh Park, which is just up the road from there. Did four very happy years as a primary school teacher and from then on a whole variety of things. I think I got itchy feet when I was a teacher, I really enjoyed education but wanted to travel, wanted to do stuff. So got into community projects, then ended up in the music industry, working as a tour manager, as a drum tech, did some production management.

Payman: What’s that like?

Mark: What’s it like? I wouldn’t want to do it now as a married guy with three kids but as a guy with who was newly married, it was a lot of fun because it was a lot of time away travelling, blocks of time away. Yeah, a lot of fun. A lot of fun. You got to see the inside of a lot of venues and not a lot else because you get on the bus at the end of the day and then off you go.

Prav: What’s the craziest story you’ve got from back in those days?

Mark: See, the guys I work with a fairly tame when it came to the whole sort of alcohol thing. I guess the most challenging thing was working with people that were teenagers in bands because they just haven’t got an organisational bone in their body. So trying to get teenagers through airports was an absolute nightmare and I guess the closest, I never ever missed a plane. I did miss a ferry once, driving into Dublin and getting completely lost on the way to Dún Laoghaire, which meant we did actually miss the gig the next night in Liverpool.

Mark: One day I decided to give one of the guys who was working with us the responsibility of planning the trip to the airport. So we turned up at the time that we were supposed to and got in the bus and off we went, and then somebody forgot something which they always did and then we ended up, anyway, on the way to the airport, we realised that he hadn’t planned to be there when checking opened. He’d plan to arrive when checking closed, which meant that we were now going to be half an hour after check in had actually closed.

Mark: So we made a mad dash got to Heathrow, threw the stuff on the floor, ran through the terminal, ran onto the plane and sat just as they closed the doors, and he never was given the responsibility of planning that again.

Payman: Well, you’re not telling me that’s the craziest road story. We’re thinking more of sex, drugs, rock and roll.

Mark: Do you know what, those guys weren’t really into that-

Prav: Was it the same band all the time?

Mark: No, no, I worked with a variety of different people and it was mostly stuff where you’re working hard. Although, I think at certain levels of the music industry, they get above a certain level where you’ve got enough money to be able to kick back and do those sorts of things. A lot of people who work in music just working really, really hard. They’re working jobs as well. So we had fun, but was somewhere next to get to the next day, and something else to do and then you have other commitments you got to do, recording and those sorts of things. Yeah, not much in the locker, I’m afraid.

Prav: Thinking about growing up as a kid, we’ve interviewed lots of people on this podcast who are dentists and we ask them what did you want to be when you grow up, and a lot of say a dentist. So I guess your first stage in your career ladder was a schoolteacher? Is that what you always wanted to be? When you were growing up as a kid, did you think I want to be a schoolteacher or were there other ambition?

Mark: Do you know, I had no clue about what to do. I kind of found my way into teaching because it seemed like a good thing to do, and one of my best friend at school, his mum was a lecturer at a teacher training college and I found out there was a ratio of nine girls to everyone, bloke, and I thought, well, that sounds like a good course to go on, but I kind of happened into it and I was okay at it.

Prav: What sort of teacher were you?

Mark: I was the hard taskmaster who had a lot of fun. So we laid the law down, and we could be serious when we needed to be, but we had a lot of fun as well. We had a lot of laughs and I’m still in touch with a couple of people that when I started teaching they were working and then they’re head teachers and it’s great because their schools are exactly that sort of thing. High standards, but they have a lot of fun as well.

Prav: Did your pupils get good results?

Mark: I don’t know. I was a primary school teacher. This is pre SATs era. So before any of that nonsense came in, and people started measuring whether people could pass tests or not.

Payman: I know you spend a lot of time in Africa, though and do you see the difference between the status of teacher over there compared to over here, because certainly, my experience with other third world countries, teachers actually, massive job in those countries, well respected and well paid. Whereas here, you’re almost relying on the sort of vocational sort of aspirations of the teacher and the goodwill of the teacher to give a job to someone who’s a quality person. Someone who really wants to do something right, but is happy not to have a career that pays the mortgage. Do you know what I mean?

Mark: Yeah, certainly for Tanzania as an example, teachers were undervalued, underpaid, demoralised.

Payman: Really?

Mark: Yeah. I’ve seen it. I have seen it people held in higher esteem elsewhere. I think it’s one of those professions where, unfortunately, it’s always going to be undervalued, unless people really need to have a teacher or work closely with a teacher and then you see the value of people. In some ways, those sorts of professions, you don’t really want people going into them that are in it for the money. You want them going into it because they care about the kids and that doesn’t mean that you should then pay them less because they’ll put up with more, but inevitably, you’re going to end up with the people that want to do it for the right kind of reasons.

Payman: I’m thinking of a friend of mine, who was very talented. Went to Oxford, wanted to be a teacher but he could earn 10 times as much doing computer science somewhere, like being a computer guy for a bank. In the end, ended up doing that.

Mark: Yeah, and that’s always going to be the case because you can’t compete with the salaries that the commercial sector can offer but it certainly should be better than what it is, and conditions could be better as well. Unfortunately, education like health care is a political football and whatever government in power we’ll use it for their ends, largely.

Prav: So just fast forward in from teaching if you just summarise your career and how you ended up landing in the world of dentistry.

Mark: So while I was working as a teacher, I was doing a lot of travelling, I did community projects overseas, worked in Ethiopia for a bit, bit of teacher training in a slum school. That’s an interesting thing as a 24 year old and while I was doing that, I realised that I needed to make a change because I was running out of holidays. Hard to believe, but I was running out of holidays to travel.

Mark: So I ended up starting doing some communities projects, play schemes, that sort of thing for a church that we were part of down the south coast, they then brought me on staff for a couple of years. While I was doing that, I did some charity startup works, because all sorts of little projects offer that kind of organisation. Then from that I had mates that were in bands and needed somebody to carry the gear on a weekend and then they got more and more successful.

Mark: So we started not shoving at the weekends, but touring in blocks of time and then from that, people pick you up and use you for other things, which is when I then started ushering teenagers through airports. Then from that, what basically happened was that I was about to take on a major national musical in terms of production management. So left my job, got ready to go and then the contract was cancelled.

Mark: So I took a month off and learned to play golf, which I still play very badly, so it wasn’t a really month well spent, but it was a beautiful month, and gave me a bit of time and space and that’s when somebody phoned up and said, look, can you do some work for us, and it was in Wilson from Bridge2Aid who just started. They needed somebody to help him with their systems and stuff like that.

Prav: How did you know Ian?

Mark: So him and his wife Andy he had moved down to the same city that we lived in, in Chester and we found ourselves in the same church at the same time. They were one of the unusual couples that we didn’t have kids at the time, they did. They were one of the only couples we could find to have a drink with on a Monday night, because everybody else was like, oh no, you’ve got to put the kids to bed and that sort of thing.

Mark: So we would hang out with them and just chat and have fun together and then we waved them on their merry way when they moved out to Tanzania in 2002, moved into their house, rented it from them. Then that’s really when things started to kick off in the whole oral health world because we started to get involved with Bridge2Aid.

Payman: Is your charity work informed by your religious beliefs or not?

Mark: The charity itself was started off the back of a couple of people who had spent time overseas doing things from a church context and wanting to start something from that sort of motivation. For us it was, that’s where our friendship originated, that’s what tied us into to them. I think, we hang a faith tag on what we do, and the drive behind it, other people do it for other reasons. With Bridge2Aid, we wanted to make it a charity, where people were clear about the fact that we were believers, we were Christians, but actually anybody could come and do their bit without any sense of judgement or whatever.

Mark: We had a number of people who came to work with us who have been to other organisations and not had the same response and that was something that we were determined to not have happen. Certainly nowadays, it’s a charity which retains those kind of values at the core in terms of relationships, people, caring for the poor, justice but it’s not an overtly religious organisation in that sense.

Payman: The world of charities, do you think of competitors in the way we do in the commercial sector?

Mark: Yeah, absolutely. I think it’s a difficult one because people are working towards similar aims. People are working for the common good but the reality is, is that for every one pound there is out there, there are seven charities chasing it and it makes it very competitive. I think what you’ve got to do, and I think there’s a lesson for this, and I think you probably guys would be on the same line anyways is that you don’t seek to compete, you just seek to stand out and be very, very clear about what it is you’re trying to achieve, why you’re trying to do it and how what you’re doing is a good way and is achieving results, because people will find whatever cause they want to support and the thing that when I was chief executive at Bridge2Aid, I would say be very clear with people.

Mark: I don’t expect everybody to support this charity. In fact, that’s not going to happen. But what we do want, you should find what you’re passionate about and then go for that 100%. If that’s Bridge2Aid, then great, but whatever it is that you do, make sure you’re doing something that that you feel you can make a contribution to.

Payman: Is there a marketing department and an operations department? For the record, I think Bridge2Aid’s marketing is excellent. If you said to me name, six dental charities I couldn’t. Bridge2Aid is the one I could think of. Is that you? Was that you or how does that work?

Mark: To start with, we did everything in the beginning. When things started, it was just Ian, Andy and then it was myself and my wife, Joe, together with them and a couple of Tanzanians and we did everything to start with, and it’s not to the point of a marketing department. Now there are people who have some responsibility for marketing, but we were very fortunate in that we managed to establish relationships with people in the industry who had skills that we could draw upon. To this day, Bridge2Aid has a creative group of different people from across the industry, in the sort of marketing and sales arenas that meet once a year and say, right, let’s throw some ideas around and then that means we can go in and implement them.

Prav: As somebody who has got a choice of six to seven charities to donate their pound to or whatever it is, there’s always that question on someone’s mind is, where’s my money going and how much of my pound goes to that end cause of either treating patients, educating people, whatever that end goal is. What was the case with Bridge2Aid? So would you be able to tell me for every pound that went into the business, what ended up and how you actually went around measuring that and being transparent about it?

Mark: I’m glad you asked this question because it’s one that comes up a lot and it’s one I feel really strongly on. I think that the difference between the commercial world and the charitable world is that the commercial world expects charities to do things that they would never sign up for. So, if I said to you tomorrow that you got turn off your sales and marketing budget, but you’ve got to sell more, then you’d be like, aye, what you’re talking about?

Mark: So there is this whole thing that a charity is going to make an investment in its marketing, and in its fundraising, what it does with that is it leverages the money that I give you. So for me, it’s not a case of, well so much a case of how much is going to the cause. Because that’s a little bit like asking my car, how much of my car is the parts and how much is the R&D and everything that went into it? It’s a similar sort of thing.

Mark: I can tell you how much the materials cost and how much it costs to run the car and all those sorts of things, but there’s a whole load of other things that are kind of involved. So I think question I would always ask is, if I’m giving you a pound and you choose to use that for fundraising, How much you’re going to turn it into? Because if you just turn it into another pound, then that’s rubbish.

Mark: You should be turning that into at least three or four pounds for every one that I give you, and if you decide, okay, I’m going to spend 20p of every pound on fundraising, but I’m going to turn that 20p into a pound or into two pounds, I’d be like, crack on, and that’s the creativity that I think charities have to be able to use, but that requires trust from their donors to say, do you know what, you know how to run a charity, I don’t, and I’m not going to use a simplistic a metric is how much do you spend on admin, whatever admin is. Is that paperclips or is it people who work in the office?

Prav: So I guess the way you’re, and I haven’t thought about it like that is that, if you’re using part of that budget, or that budget for fundraising, is actually the donation creates cash flow for you to multiply that cash flow to then…

Mark: You have to. If you didn’t use it for fundraising, if you said 100% goes to the cause, unless you’ve got a sugar daddy, who’s paying all your fundraising costs, or unless you’ve got a couple of hundred million quid stacked away that’s paying your operational costs, then that’s just not happening. I would question anybody that says that not over 90% of their money goes to the cause, because they’re doing something to dress up the figures. Ours is about 83, 84p in the pound, but that made things really, really tight. If a charity didn’t invest any of the money that it got in fundraising, it would die in about six months, because the cash would all dry up.

Prav: When you say like 83, 84p in the pound goes to the cause, are you talking maybe 50p of that goes towards fundraising, which generates more that allows you to make that 83, 84 overall figure?

Mark: No. 83, 84 would be going to the cause and then the other 16, 17p will be split about 8 or 9p to fundraising and the rest between the other things that we have to pay for.

Payman: Explain to us with the Bridge2Aid model, what was the way that it worked with regards to, we always hear about dentists going and firstly fundraising, climbing a mountain or rock bike rider and then secondly actually giving their own time. Talk us through what happens when they go and visit, for instance, a country like Tanzania.

Mark: Sure. So one of the things that Ian was very passionate about at the beginning was mobilising volunteers in a way that would make a long term difference. I think he’d spent a lot of time in the 90s when he was a young man, he turned grey a long time ago, but he spent a lot of his time travelling around doing short term dental visits, which were great for the time that he was there, but actually left very little behind, and would in some cases, demoralise the local workforce because you’ve got people that are, you’re going in and doing something but then you’re walking away and leaving a complete vacuum.

Mark: So one of the things that he was very passionate about Andy, his wife was very committed to as well was this whole thing of sustainability. So when we started the training programme, it actually morphed from, okay, let’s get some volunteers out to a conversation with the government to say, what can we do that will make the biggest difference to the healthcare system?

Mark: They were very clear that they had this cadre of workers, clinical officers, three years diploma training in medicine, that were based in the rural areas that had no dental training and yet, the majority of people that would come into a health centre were in dental pain of some kind of varying degrees. So they had a defunct training programme, which had been very successful. They couldn’t fund it, they couldn’t resource it.

Mark: So we put that together with all the volunteers that wanted to come and work with Bridge2Aid and said, well, what can we create from this? So with Ian’s dental expertise, my wife Joe’s expertise in training, she’s got a background as a nurse and my logistical kind of expertise, you put those three things together, what you ended up with was a two week intensive training programme in emergency dentistry for these rural medical workers where they would work one to one with a qualified dentist over a seven to nine day period.

Mark: On day one, the dentist was doing all their extractions because that’s all we were covering was just simple extractions. Then on day nine, the clinical officer was doing the extractions and the dentist was just supervising and watching. What that meant was that every dentists that came to work with us and every nurse that ever came to work with us, they might have seen four to 500 patients in the two weeks that they were with us, but the legacy of every trip was five or six people, each responsible for another ten thousand’s care, that are for the rest of their careers are able now to practise an emergency dental skill.

Mark: That’s a huge leverage of investment from the dentist and the nurses and from the organisation. Because I walked away from Bridge2Aid two years ago now, and in the time that I was there, we trained about 450 people, that’s access to emergency dentistry for about four and a half million people. Had I walked away from that at that point and just run short term training programmes, all that work would be done now, but those people that we trained when I was there and still treating and they’re still treating, they’re still treating, that’s what it’s about.

Mark: For me charity, in a development sense, it’s about outside of the world of emergency aid, it went in disasters, that’s a different shebang. We’ve got to be looking at how we can build the healthcare system, how we can build capacity into it, how we can serve the governments of countries overseas and help them to do things for their own people.

Payman: It’s interesting what you’re saying. I have a couple of questions really on that. Firstly, how easy is it to get access to the government of Tanzania? Are they all up for it straight away or is that not a easy thing?

Mark: It was in the early days, Ian did a lot of the groundwork and Ian, if you ever meet him is a very gregarious, charismatic kind of guy. He can kind of talk his way into anything, and thankfully out of most things as well as I’ve found, but yeah, he did a lot of the legwork and I think the big difference with Ian is different if you’re the UN or you’re a big international organisation, you’re walking into some of these government departments to get an audience but he was a nobody.

Mark: He wouldn’t mind me saying that. In the early days Bridge2Aid was a nothing but he went in with humility and a genuine desire to serve and said, what can we do? Got to know people. The Tanzanian culture is very much a relational culture. There is a hierarchy but it’s not transactional. You’ve got to be very, very relational in order to win people over and win people’s trust. It’s a form of socialist government.

Mark: So in some areas, there’s a natural distrust of foreigners that are coming in to save the world before next Tuesday. So he worked very hard on the relationships, built the trust and then we were able to then build on that over the next 10, 12 years. As the organisation grew, and we followed through on what we said we were going to do, then it became easier and now, we’ve got a couple of our patients, former health ministers, the current High Commissioner in London is one of the patrons. So we’ve got some fairly influential Tanzanians on the organisation now.

Payman: Did you ever think that it might make more sense to have people full time over there training these medical offices rather than getting dentists to come up all the way through or is it that dentists want to give their time and so that’s part of the whole business model?

Mark: Yeah. It was an interesting one we had to balance. In the early days there wasn’t a question of having people on the ground full time because we were still building the evidence base for it. During my time, couple years before I left, there came a point where in a strategic discussion with the government, we change to a two pronged approach, where we’ve been laying the foundations for what we call phase two, which is where rather than training dentists to clinical officer, we would train dentists to regional dental officer or district dental offices.

Mark: So you’re training qualified dentists to be trainers. It’s a train the trainer’s programme, which builds capacity for the long term, but the size of the country and the amount of resource that was available, we weren’t going to cover the whole country by doing train the trainer’s quickly enough without the other thing. The other thing we had to balance was the fact that and this comes down to funding, is that a lot of that funding came from dentists.

Mark: So we had to balance that need to keep people engaged with our commitment to sustainability, and that’s a difficult one to navigate but I think I was happy with the way that we navigated while I was there.

Prav: Was it quite easy to recruit volunteers, dentist because I can imagine certainly for a lot of clinicians, you’re giving up a sizable amount of revenue. I think probably the biggest cost to them is their time out of the clinic, and giving up that time is a big ask. I’m sure obviously there are lots of people out there who are willing to give back to the community. Did you have a recruitment process for that or were volunteers just knocking your door down, saying look, I just want to give back and how do I get involved?

Mark: Yeah, we had both of those things. We had people knocking on the door, but we had a very strict and stringent recruitment process. So everybody was interviewed. Everybody was properly prepared, vetted references, those sorts of things. Because as well as being qualified, academically and clinically to do it, we wanted people that we’re going to play nice with the other kids. So we had a fair amount of that.

Mark: You can imagine putting a team together that then goes to a developing country and has to land on the ground and has all of their buttons pushed. You need people that are fairly resilient or weren’t going to sort of cave under pressure.

Payman: So did you end up rejecting many people?

Mark: Not many, but we did do, ad there was a few, to my knowledge, there was a couple we didn’t ask back. We were pleased when they didn’t ask to come back, but the overwhelming majority were fantastic people and repeat offenders, as it were.

Prav: How do you test whether a candidate is good for coming out and delivering aid work? You say, obviously, you’d filter some people out and they need to be resilient because you’re going to push the buttons while they’re out there. Would you try and push the buttons over here?

Mark: No, it was a little bit more relaxed than that. So, the process now is different to when I was in, well, it was a long time since I’ve done any interviews. We interviewed people face to face and you’d get a sense for people. I think a lot of it was more what to look out for, or who to pair them with rather than this person can’t come. The ones that we did reject, it was very clear from the interview that this wasn’t going to work because they had a different agenda. I think that’s really the only thing where it was a big issue.

Prav: What are the agendas that people might go out there for?

Mark: A bit too, I’m going to do it my way. I do it like this in my clinic and that’s the way it’s going to be. We would gently push back and say, well, actually, there’s a protocol here, you’ll be expected to follow the protocol because you’re not just training one person, you’re training six people, and they’re going to go around each of the trainers over the time. If you’re telling them one thing, and you’re in and they’re being told something else by somebody else, that’s going to screw up the whole process. So if they’re not prepared to adhere to a protocol, then we would weed that out.

Prav: Playing devil’s advocate here. Do you think there are any people who want to go out there not to do good, but to look good?

Mark: Yes. I mean, the short answer the question is, yeah, but I think my hope would be that even If they came for those reasons, they’d go home very different anyway. I can only think of one or two people who came thinking this is the latest thing on my CV and went back and carried on being exactly the same out five, 600 volunteers probably that they’ve had now.

Mark: So, my hope would be that even if people did arrive a little bit full of themselves that you don’t have to do anything, because the experience will sort people out because everybody will reach their low point and everybody will reach their high point. We worked very closely with them in terms of the leadership teams and how we looked after people in the whole process to make sure that was all out worked and processed properly.

Prav: I guess you’re changing a high volume of number of lives, the easiest way for me to explain it, in comparison to what they’re doing back home, either in private or NHS practise, right?

Payman: How many teeth would they take out in a day?

Mark: Oh, not as many as you think because they were training. You’d be looking at Probably 20 to 30 patients a day. Again, sometimes as low as sort of 10, 12 because the priority is training. We might take 20, 30 minutes over one patient. What we would do in cases where I mean, one day, I think the record for the time that I was there was 400 people who turned up looking for treatment on one day, and in those situations, we would protect the training, but then the people that were supernumerary in terms of our clinical oversight, and the local government oversight would then set up a chair and we’d have extra equipment, where we could just bash through people and get them out of pain as quickly as possible.

Prav: How many dentists on a typical trip?

Mark: They might shoot me down. I think it was seven. So six training and one supervisor, site clinical lead, and four nurses. It’s been a while, I might get the numbers wrong. I’m sure I’ll get a phone call.

Prav: There or there about.

Mark: There or there about. Small teams. 11, 12 people, enough to fit in two Land Cruisers because you’re working in some pretty remote areas,

Prav: You’re looking at between that team, about 140 teeth a day?

Mark: Yeah.

Prav: Still quite a lot, isn’t it?

Payman: Working in the third world, there’s always going to be issues. Tell me about the worst clinical issue that came up. Anything. You’d imagine something’s going to happen, go wrong.

Mark: Yeah, we had instances where post extraction complications and nothing that wasn’t then dealt with that was pretty traumatic, and for the patient.

Payman: Bleeding.

Mark: Bleeding and then having to travel to access care. Thankfully, very, very, very rare. A number of cases where we’d get so far and then had to stop and then refer them so that patients then got a couple of days before they’re able to then get to a full blown clinic and have a surgical extraction. We were very, very careful to make sure that in the training, we taught limitations as well as skills. So to my knowledge, thankfully, nobody during the training has ever run into such a problem that we had a real big medical emergency.

Mark: We had a few medical emergencies, fainting often because people hadn’t eaten for a long time and then they’d get an anaesthetic and faint, but we carried crates of soda for that sort of thing and people usually tend to perk up. Because we’re not doing sort of general surgery, thankfully, we were able to control the environment as much as possible.

Payman: Then from the admin side, you had a couple of well publicised issues. Run us through those. Run us through your lowest moments. Perhaps this is the favourite, perhaps favourite part of the podcast.

Prav: [inaudible] get you to cry, buddy.

Mark: Never a dull moment. Never a dull moment. I think all sorts of things. I talk about the financial issue but we had people involved in car crashes on the way back from the airport and all sorts of stuff, planes not arriving, people getting sick sometimes because of poor choices they’d made. Other times just because they got sick, but we had a good infrastructure set up. The hardest one I think was the financial issue in 2013 into 2014, where we had a big grant cut, and at the same time, we had a fraud perpetrated on us in the bank.

Mark: The two of those added up to a shortfall of about $200,000 that we were looking for in our budget, having just ramped up for a big expansion in programmes. So we had to launch an urgent appeal to do that, which was start at 2014 for 50,000 pounds just to get us back on an even footing. We’d made cuts, we’d save money wherever we could, and I think that the challenge at a time was, can you talk about fraud because if you talk about fraud and charity in the same sentence, then people will get very, very scared.

Mark: There was a huge reputational risk with going public with that, but we all felt as a senior management team, it was really important to be completely honest with people. So we did, we wrote about both circumstances and the fraud was probably 10% of the deficit and the grant was 80% of it, but we felt it was important to do that and thankfully it paid off although there was a few nervous moments and sleepless nights over Christmas in 2013, I can tell you. It was-

Payman: Tell us about the first time you found out there was a shortfall in the bank account. I mean, exactly how did you find out and how did you feel?

Mark: Do , I would felt sick to my stomach because I knew that if it had happened, that was going two major consequences. One would be the actual loss of money, and the second one was going to be dealing with the whole process, because Tanzania’s set up from a legal standpoint and a policing standpoint is very different to the UK. In the UK if that happened, you could feel confident going into police interviews, and you could feel confident that the police were going to handle it.

Mark: We probably had less confidence given the circumstances and the amount of money that was involved. So that was the initial reaction. The only reason we found out was because the first fraud happened two days before we found out about the next one, they made another attempt and it was on the second attempt that it was uncovered. So there was a whole mix of, money’s gone missing, police are involved, all that sort of thing. It’s all that kind of crisis.

Prav: Were you more concerned over there than here because of corruption?

Mark: I think my major concern was, we’ve got to manage the process with the bank and we’ve got to manage the financial thing. The financial thing can wait a little while, although we’re going to have to deal with it quite quickly because it would leave a big hole in the cash flow, but it was more navigating the complexities and the subtleties. I think one of the things that I found when I used to come back from Tanzania to the UK was, there was a level of stress that you live under, when you’re an expat in a different culture that you don’t live under here and it’s almost like it lifts off.

Mark: It’s subconscious in many ways, but there’s a lot more going on behind your back than you realise and even what’s going on in front of your face you don’t truly understand. So, I think my friends that are fluent in the language, although we’ve got a reasonable grasp of Swahili, but my friends who are fluent in the language are much better.

Payman: Do you speak Swahili?

Prav: No. Just about say, hello mate. Jambo, habari gani?

Payman: Was there any idea that the bank would pay you? I mean, if it happened here, you’d imagine the bank would find the money for you somehow. Their error. Were you thinking that?

Mark: That was our argument. That was our argument. I can’t go into too much detail about it because we made agreements in closing the whole thing off, but from our point of view, it was a breach in protocol. From their point of view, there were things that shouldn’t have happened that did happen, which we disputed.

Payman: Did you change banks?

Mark: Yeah. Very quickly, very quickly and it worked out. The great thing was picking up the phones to friends in the UK after it happened, the people that have done work overseas were like, you can have all the due diligence and all the protocols in the world, and people will find a way through and they did. Then they close that loophole, and they’ll find another one.

Payman: I remember that time very well. I think it was interesting what you said. Bridge2Aid was doing really well. So you’d scaled up, but the nice thing is that Bridge2Aid was doing really well, so people really wanted to help at the time. It seemed personally, not for a minute that I think, look at this fraud or that’s something they’ve taken. I thought this is just, but then coming from a third world country, you can understand the way these things work, but people did then come up with money from the appeal which is lovely.

Mark: Yeah, it was great. It was one of those really bad things that turns into something really great and you move forward with a whole load more confidence. Although we still had a tough, tough period to navigate.

Payman: What’s it like living in?, you just alluded to it living in Tanzania. You’ve adopted three children you were telling us before. Do they go to regular school or do they go to English school and then what’s it like bringing them here after living there all that time?

Mark: So we were fortunate in that the city that we lived in, in Tanzania is the second city. So there’s an international school teaches British international curriculum. So they went to that school amongst probably a smattering of white kids and a bunch of Asian kids and a load of Tanzania kids. Then they came back to the UK and it’s the complete opposite, because obviously, there are very few ethnic minorities where we live.

Payman: How old were they when you adopted them? Were they babies?

Mark: Yeah, our youngest was six months when she came to us and the boys were both 18 months. So relatively young. We’ve got a friend, Amy who’s now based up in Bolton who started the home that they lived at while they were overseas and they all came from the same place. Fantastic woman, got her MBA now, started an orphanage, it is a baby home because it’s an interim care home for kids. Kids that are abandoned or lose parents in childbirth. One of the big problems in Tanzania is that because formula is so expensive, fathers can’t afford to raise kids if the mothers died in childbirth.

Mark: So they will take, Forever Angels is the name of the baby home, make a donation. It’s fantastic charity. They will take the baby in for two years, feed them look after them. Take regular visits from the family. They’ll do vocational training for families to help them to get jobs and get skills, and then at the end of that period, they’ll go back into the family and then they’ll carry on with their lives. For kids like ours who didn’t have anything To go back to, they will find them homes to go to, or push them up into the next sort of level. So they all came from there.

Prav: So what were the specific stories of your children? Had they mothers passed away in childbirth or different circumstances?

Mark: Yeah, different circumstances and hard to know, because there’s not very much information about it. In Tanzania when you adopt, you cannot adopt any child that has any living relatives, and so it has to be proven first that there’s no living relatives. So [inaudible] been through that process, which is why they could be adopted, but that’s the daily reality and as I say, Amy, who still runs the baby home, but she lives in the UK, would be fighting for and receiving kids on a daily basis. That’s the reality of life for most of the world, unfortunately.

Payman: When you were living there, what did you miss most about the UK outside the family and friends?

Mark: Paper.

Payman: The newspaper?

Mark: A newspaper, yeah. Real ale.

Prav: Was there no ale?

Payman: No, I guess not.

Mark: Fizzy lager. Fizzy lager.

Payman: Was there not an Irish Pub somewhere?

Mark: There was. So in Dar es Salaam, where Prav’s dad comes from, there is an Irish Pub.

Payman: There’s an Irish pub in every city in-

Mark: There’s an Irish Pub in every country in the world. So it was those sorts of things.

Payman: A paper and a beer. How about what’d you miss most about there now that you’re back?

Mark: Now that we’re back, there’s not an awful lot that I miss. I think I was ready to come back. 10 years living in country, another two sort of travelling backwards and forwards I was ready to move on. I think it’s different for my wife. I was face to face with the bureaucracy and the challenges of doing business every day and so I was ready to step away. The main thing I miss is people, friends that we made out there some of whom now I live in the UK, some live in different parts of the world, some still live there.

Payman: And the tomatoes. Do you know what I mean?

Mark: I tell you what, fresh fruit, fresh fruit. My kids, that’s the thing that they miss is the fresh fruit. So we would have mangoes and watermelon and pineapple all chopped up in the fridge the whole time. So miss those sorts of things. Yeah, for sure.

Prav: So the next step, there must have been some point when you decided to step away from Bridge2Aid. What was the factor that made you make that leap?

Mark: It’s interesting. I was listening, just after I made the decision to leave, I was listening to a podcast that Deborah Meaden did with a bunch of entrepreneurs and they were all saying that 10 to 12 years was the maximum, the top end in anything that they would do before they’d move on. Because at that point, you’ve kind of given everything you’ve got to give to it and I’d been in Bridge2Aid 10 years, seven years as CEO. So it was that point in time combined with, I worked myself almost to death in 2016.

Mark: We set up Bridge2Aid in Australia. So I was there and back two or three times for four or five days stints, at the same time flying backwards and forwards to Tanzania to look after the team. I got to the point where, it’s that perfect storm of you’re exhausted. You’ve reached the end of your tenure, somebody is trying to tell you something.

Prav: Did you think to yourself at this point, do you know what, I want to do my own thing now. It’s time for me to start my own business, be that entrepreneur and do your own thing basically. As a lot of us who own businesses, we have that turning point in our life and say, you know what, I want to be in control of my own destiny. Was there an element of that?

Mark: A little bit, and it’s interesting because the person that joined Bridge2Aid is very different the guy that left Bridge2Aid, like hugely different. The way that I developed as a leader, working alongside people like Ian, other mentors like Chris Barrow and other mates that have sort of shaped me, and I guess, given me the confidence to lead and I think that’s the key thing for everybody to understand is that, you don’t wait for people to give you permission to be a leader, you just find out who you are and what you care about, and let that be the driver for it rather than waiting for a door to open.

Mark: So I came out a very different sort of person and I’ve been in an organisation for 10 years. The responsibility of leading a large team, of having to raise 50, 60k a month, just to keep the doors open, I think you reach the point to say, okay, we’re going to cut it right back. What do I want to do? So the decision to leave was the first one. I didn’t know what I wanted to do when I left, but started looking for jobs and thought, no, I want to find something I want to do.

Prav: So you didn’t have a master plan in place?

Mark: No.

Prav: You didn’t think to yourself, okay, 12 months before I leave my job, this is what I want to do and start making a plan, set up my own coaching company, rock and roll.

Mark: Not at all. I never had a master plan.

Prav: So was the CSR Coach an accident? Did you happen to fall into it because of a few experiences and then thought, actually, do you know what, I’m pretty good at this.

Mark: Yeah, I think it was a combination thing. I think once you create the vacuum, once you create the space, things start to happen but a lot of people wait until, they want to wait until they’ve got the right idea before they step out. So I think, it was a happy set of circumstances that brought me to that point and thought, well, crap, I stepped out. What am I going to do now? I got three kids and a mortgage to pay, and we’ve always worked for charities. So we got no money, what are we going to do?

Mark: So then you start thinking about, is what I’m passionate about something that people will buy, and that takes a while because what you’re passionate about, you think people will buy, but they don’t but then you find one or two friends who are prepared to give you a go, like Colin Campbell and Joe [Bat] and other people like that, who say, yeah, come on, let’s do this. Then you shape it up and I think over the last, what is it, nearly 20 months, I guess since I left and started things up, there’s been a daily process of thinking how we’re going to make it work, but it’s very exciting at the same time, because I’m in my sweet spot and doing what I love to do.

Prav: I think one thing that you’ve just touched on that really resonates with me is that you’ve got to create the space to make it happen. So it’s a bit like, I’m part of a mastermind and a coaching group and one of the topics of discussion that I’ve had is, you want to work with a certain type of client, but say 30% of your client base is not a client base that you want to work with. How do you make that point, that switch when you say, I’m going to let go of the 30% so I can do that? If you never make that space, you can never make it happen and I guess, for you in your career, making that space, making that jump allows you that freedom to be able to drop into what you did.

Mark: Yeah, absolutely. Getting into Bridge2Aid was because something else got cancelled and getting into this was because, I feel like I need to make the change. No idea but, I’ll bet myself to find something to do that will be good.

Prav: Did you ever have any doubts about the CSR Coach? Did you ever think that, oh, crap, do you know what-

Payman: Every day, right?

Mark: I was going to say, tell me an entrepreneur that doesn’t go, blimey, I really hope this works.

Payman: Mark, the thing you should bear in mind, I don’t need to tell you, but three years, any endeavour, three years, who’s your ideal client? Are we looking at Henry Schein dental directory or are we looking at dentists down the road or both?

Mark: It’s a bit of both. The stuff that I do works for all businesses. If you’ve got a team, and you’ve got customers, then it works. It even works for, so my biggest client is a multi academy trust in London. So, they’re a charitable trust, but they’ve got to attract staff and they also have a strong set of values around who they want to be as an organisation, and they know that as a corporate entity, that has to be fleshed out somehow. So going back to the dental side of things, I work with dental manufacturers, and I also work with practises.

Mark: I guess, the ideal client isn’t a certain size, it’s more of an attitude and an aptitude for, the best people to work with other ones that go, do you know what, this is the right thing to do, but I know it’d be good for business as well. So I say to people, don’t do this, just because it’s the right thing because although it is, but actually, this is something you can really use as a tool to grow your business.

Mark: The caveat to that is if you’ve got a real dysfunctional team issues, then you need to deal with that, but this will really help with it. If you are struggling to stand out because you’re rubbish at what you do or your website’s rubbish or that your branding is not good, then this can’t turn that around, but in a world where everybody looks competent, otherwise they wouldn’t be in business, and where everybody’s got a good team package, what’s the secret sauce, what’s the differentiator both from a customer point of view and a team point of view, that helps you to bring the right people in and provides the energy in the business.

Mark: Oh, and it’s a great thing to do as well because you’ll go ahead and put your head on the pillow and think, yeah we did the right thing today. We’re doing it intentionally on a regular basis rather than every now and then.

Prav: So before we move on in this conversation, just as I did before I met you about an hour ago, what on earth is CSR? What does it stand for and because you described it quite clearly to me earlier, actually, what it means in real term words and before that it was just a three letter acronym that I didn’t really understand how it sort of expresses itself in your business, so to speak, and what it means. Would you mind just telling the audience what it is?

Mark: Yeah, sure. So when you asked me that question earlier, I said, well, you said, who would know what CSR means in the street? I said, well, probably pretty much nobody. A few people would know that it stands for corporate social responsibility, but if you said to them, you know how people now expect businesses to do good, how they want them to treat staff right and to have a team that’s motivated not just by money, but because they care about doing the right thing, and about how the business needs to care for the environment and not be just chucking loads of waste out and using up loads of electric needlessly, or driving really big thirsty cars the whole time, and how you want them to be a positive contribute to the local community.

Mark: When you put those three things together, and that’s corporate social responsibility. So as a business, as an organisation, we choose to make a commitment because of our values and those are unique to every business. Every business makes, because of their values, they make a commitment to doing the right thing for their people, to doing the right thing for the environment and to doing the right thing and being an active and positive contribute to their local community. All I do is take people’s aspirations and put them into a simple structured plan, train somebody how to run it, so that it adds value to the business year round and they can use that as a differentiator to help them to stand out and show that they’re one of the good guys, which everybody is pretty much.

Prav: Cool. So you provide the structure to help businesses be essentially good guys in terms of socially, environmentally, and I guess in terms of leadership as well, right?

Mark: Yeah. Because I think, two problems people face, they either don’t know what to do. So they’ve got this idea that we want to do the right thing. We’re not quite sure what that looks like or they’ve got a very clear idea of what it should be, but they struggle with structure and putting it into a plan and making it consistent. So they don’t have a staff meeting in six months and think, well, that thing we did for charity a few months ago, brilliant, why don’t we do more of that? Then it gets forgotten about for another six months. So it’s going to be part of the business plan, part of the management system. That’s from my experience, that’s what I bring in and help it to work in that way.

Payman: Well, it seems to me that when times are good, companies are up for this sort of thing, but when it’s recession, then they’re not particularly Looking at this sort of thing. Is that right? Does CSR suffer with that a lot?

Mark: I would say no, and the reason for that is that, at the front end, a lot of the stuff that I do with clients is cost neutral. So any client that I work with, I can guarantee that at the end of the process, 80 to 90% of what they’ll be doing, they’ll be doing the same things, but they’ll be doing in a very different way. So they’ll be leading differently, or they’ll be communicating differently, or they’ll have tweaked a few things, but at the outside, that is all based and founded on a purpose that they started in terms of going back to their values and what their commitments are.

Mark: There will be some small things on the edge, which will be around giving some money back because it’s important that businesses have skin in the game because it shows to the staff, we’re not just asking you to do a bake sale or to raise money, whatever and we’re not doing anything about it, but we are actually putting something into the process. I would say that that investment more than pays off, and some of the stats around engagement of teams that work in socially responsible businesses.

Mark: The stats from Gallup are that staff in socially responsible businesses are 67% more engaged than staff in non socially responsible businesses. So that means they’re much more switched on. Now, every engaged employee that you’ve got will generate 120% ROI on salary. If you’ve got somebody who’s disengaged or actively disengaged, they’re costing you money because they’re generating 60 to 80%.

Mark: So you take an average salary, a lower end salary is 20 grand a year. If that person’s disengaged, they’re generating 16k. If you can flip them to engaged, they’re generating 24k in the first year, multiplied by the number of staff that you’ve got and you can see that putting a few grand into a CSR programme and making it happen actually is going to pay off in the long run in all sorts of ways.

Payman: So whenever we’ve done any charity, call it charity work, apart from the good that the work itself has done, from a selfish perspective, definitely for me the effect it has on the team is the biggest issue. Not necessarily the “marketing message,” that did that but I don’t know. I’ve never really tried to measure that, but the effect it has on the team and what you said before about it can actually solve friction within the team. Because there’s something about management and workers that people think, they don’t care and somehow glues the team together.

Payman: Certainly what I’ve noticed a couple of times that we’ve done anything CSR related, and I never really thought of it that way. I never thought that that would happen. It’s an interesting point, isn’t it? It’s for the good of doing what you’re doing. There is, I’m sure some marketing in it, but this one, definitely I thought the most worthwhile thing from the company perspective was how the team come together for something like this.

Mark: What’s the sort of age range of your team?

Payman: 25 to 35, most of them.

Mark: So they’re in the sweet spot. Anybody under 35, the millennial generation, three quarters of them are looking for socially responsible employees to work for and if they’re employed by those people, there’ll be more engaged, they’ll give more to it, they’ll advocate for the business, they’ll produce more. So times have changed. It’s not the carrot and stick anymore, if you do well and you’ll get a reward. It’s like what are we all trying to achieve here, and people want to come to work in a place where they feel they’ve got a sense of purpose.

Mark: Although there’s a commercial purpose and that’s around excellence and doing the right thing for the customer and personal growth, you add a CSR element on the charitable side and it’s actually, as a business by doing business, we’re doing good because we are either generating funds that’s going into things or as a team, we did something nuts or we do something nuts on a regular basis. We have a lot of fun together, it builds collaboration and the whole team gets a buzz from that.

Payman: I know it’s different for every practise and depends on what they come to you with in the first instance, but run us through Dr. Prav and his team want to do something CSR related. They’re not sure, they want to kind of help the community, would be nice to help someone abroad as well. What’s the process? They get you in? Have a conversation?

Mark: Yeah, so we always start with values. So I’ll always talk to an owner or a senior management team and say, what is it you’re trying to achieve? What are your particular issues that you’ve got? What stage is your team at, what stage is the business at, what are you doing already?

Prav: I guess to a lot of people who are not well versed in business language or talk and you talk values, core values, what are your aims? What’s your vision-

Payman: Go on. Go on Dr. Prav, go on. What are you sort of do the thing, pretend to be that dentist?

Prav: So actually, you know what my values are is, I want to treat my patients in the best possible way. I want to deliver great dentistry and I want to make more money, do more high end dentistry and I want my team to be happy. In terms of vision and values this, that neither, I’m actually not sure what you’re talking about.

Mark: So in terms of vision, I’d probably ask you why you bought the practise in the first place. What was it that got you into dentistry? What was important about that? If we were to fast forward 10 years time apart from sitting on a beach, what does it look like? What does the practise look like in 10 years time?

Prav: So the reason I got into dentistry was it seemed like the right thing to do as an Asian. I was too clever to be an accountant and run a corner shop or drive a taxi. So I became a dentist and I finished my anatomy classes at the neck. So I decided dentistry and not medicine.

Prav: So about the practise to basically move on from being an associate and be the, I guess the controller of my own destiny but I ended up working a lot more hours probably earning less money and I’m at a space at the moment now where I just want to reduce my hours, spend more time with my family, but I want the business to run on its own two feet is my ideal and if I could wave that magic wand [inaudible] I would say and pluck up my dream scenario in 10 years time, I’d be working two days a week in the practise, working a day a week on the business and enjoying the rest of my time with my loved ones.

Mark: So it sounds like family and balance and work that’s fun, work that’s rewarding is really important to you. So we then look at okay, tell me about it when the business is running really, really well in terms of the team, in terms of how patients are being treated, what does it look like?

Prav: I’ll tell you what it looks like, everyone’s really happy. There’s no argument. There’s no bitching. There’s no he said that she said that. Everyone’s given that little bit more discretionary effort, going above the hundred percent and I don’t know quite what it is about that, but there’s times where that business is just ticking away and firing on all cylinders and there’s times, almost like the total opposite where things hit rock bottom, shit hits the fan and it’s just like, I don’t know why. So if I could have my business firing on all cylinders like a well oiled machine, and everyone was super happy all the time, I think I’d get to that position a lot quicker. Can you help me get there?

Mark: Well, I’ll tell you what, what you’re talking about is a cultural thing around expectation of performance but also tolerance of types of behaviour. So what we can certainly do when we look at the people aspect of CSI is look at how you’re leading, what expectation you’re setting for the team, how you’re rewarding people that behave in the way that you expect them to behave in, how you’re recognising those sorts of things. Sounds like there’s a lot around communication in there as well about do we know where we’re going, what we’re trying to achieve.

Mark: So in terms of that vision piece, the vision thing is no grander thing to say, well, how do people know what you want them to do unless you tell them what you’re trying to get to? So if you can tell them why you’re trying to get to, then people will engage and get behind it in their own way. There’s a whole piece around culture, there’s a whole piece around expected behaviour. We can shake that up with the community and charity side of things in terms of getting people involved in stuff and if you’ve got people that are aspiring leaders or could do better, we can give them some responsibility in that area before we test them on live stuff like running the finances.

Mark: So there’s all sorts of things we can do around that as well, and in terms of getting more high end patients in now you need to talk to somebody a specialist in dental marketing about that. What I can tell you is that consumers will come to you if they can see that you’re a good person to do business with and you’re a trustworthy person to do business with. They don’t just see that from your website and your testimonials.

Mark: That’s a big part of it but if you can show them that actually you’re rounded out as a person and as a business, then that will help to build trust and to help and to feel that they can to you for their dentistry.

Prav: Cool. I’m just going to step straight out of role play now and ask you a question that’s actually really current with me right now, and it’s a recruitment question. So I really love the fact that pretty much every one of my team members gives me what I consider to be discretionary effort and as a boss, and I’m being very sort of blunt here, I can expect 100% from my team. So I pay the money, I expect 100% and I can’t dictate or expect 110% for example. I get that every time though.

Prav: I get the 110%, I get my team members stay in after hours, never dictate it to them. I get my team members texting me, messaging me, emailing me at midnight, 11 o’clock caring about the business the way I do, sometimes more. How do you recruit for that?

Mark: One of the things that I’ve found is that you can train skills, but you can’t recruit values. So if you’re going to recruit people that are going to do that sort of thing, you have to be able to identify what those values are and get those people in, and even if that means somebody less qualified than somebody else that’s a high flyer but won’t fit in the business and you’re very lucky, if that’s what you’ve got, then you’ve done a great job in building that.

Prav: I have and I feel very fortunate, but I would say you can’t teach the art of give a shit. You can teach everything else, right? What would you do to screen that in an interview?

Payman: Difficult one, isn’t it?

Prav: It’s one I struggle with all the, I am recruiting-

Payman: I think Prav, there’s a big part of your thing. You’re very happy to fire people too.

Prav: I wouldn’t say I’m happy to do it.

Payman: Not happy but-

Mark: You need to.

Prav: You fire fast, right? Definitely. Definitely, but never happy to.

Payman: I didn’t say, yeah. I did say but I didn’t mean that. I didn’t mean that.

Mark: If you’re a human being, then firing should always be hard because it has a consequence to that person, but we’ve all had to do it, and sometimes very early on, and it’s painful from all sorts of perspectives.

Prav: Taking food off someone’s table, and whatever all those other consequences are is really, really hard but then, as you said earlier, you’ve got that vision. You’ve got the rest of your team who are pushing in the same direction. It’s a responsibility to them.

Mark: Yeah, absolutely. Going back to your question, I’d probably tell me a story about, tell me about a time when that happened, get them to tell you about stuff that they’ve done. If they can’t think of anything, then that’s probably a good indicator.

Payman: Mark, do you think your time in the charity sector has prepared you well for what you’re doing now? So it’s clear that you’re obviously a leader, you’re obviously the kind of person you’ve managed big budgets, you’ve managed lots of people, you’ve talked to government, or do you think nothing prepares you for entrepreneurship?

Mark: Well, it’s interesting because I think, a few things happen. When I was with Bridge2Aid , it’s like you’re always reading in podcasts and blogs and those sorts of things. I seem to find myself on a lot of entrepreneurial type blogs because they tend to have the best tips. Very often I think you very much are an entrepreneur in the sort of charity that we were doing. It was a startup charity. It started with two people 15, 16 years ago. So you have to be able to think on your feet.

Mark: Cash flow is king. You can’t go to a bank and ask for another injection of funding, you’ve got to think on your feet in that way. So I think the charity was very helpful in that. I also think a lot of people that I met, a lot of people that I’ve worked with, during that time shaped my thinking, and got me ready. I think being prepared to grow as a person, had I not been prepared to grow during the time that I was chief exec, then no, I wouldn’t have been ready, but that’s not to say that I was ready when I started, but you’ve got all the tools in the box to use to build what it is that you need to build.

Mark: So I certainly feel like all the experiences I’ve had to date have got me into a position where I’m ready to take this challenge on. That’s not to say that it’s an easy one, but at least I know how I’m going to approach it and what I’m going to do, and it’s a lot of fun.

Payman: We’d like to wrap this conversation up with perhaps a favourite question.

Prav: Just before that. I just want to, there’s people out there, I am sure, like burning question on their mind. If I want to hire this guy, where do I find out about him, how much does it cost?

Mark: Okay. So to work with me, costs two and a half grand to get me in to do a two month intensive with you. That’s a couple of meetings. So I’m meeting with you as the principal with your senior management team. I’ll go away and put a plan together and then I’ll come back and I’ll meet with your team and get them overexcited about what it is you’re going to do together. Then once that’s done, I’ll then handhold whoever it is that you appoint to look after your charity work, your environmental work and your people stuff through the first month.

Mark: We then hand it on and then if you want to keep me on, which 90% of people do it, there’s something called the CSR Club, which is anything from 175 a month, starts at 79 a month for 10 months following that. So you’re looking at about 4k to get me in, all bells and whistles.

Prav: That’s for the year?

Mark: For the year.

Prav: And the club, is that a community of CSR devotees or whatever you want to call it?

Mark: Yeah, they’re busy people, so they don’t tend to hang out much but what I do is I check in them on a regular basis. So with my level one clients, I’m Zooming with them or calling them once a month and it’s not just a friendly chitchat. There’s a set of objectives that they’re supposed to have delivered. So what it means is that the principal can hand it on and sign up for the club and know that their CSR is going to get taken care of because I’m going to be watching and making sure that it’s all happening and supporting them. So that’s the way it works, and if you want to find out more than my website is marktopleyco.uk

Prav: Wicked. Thank you for that, and just onto my final question, Mark. So imagine it’s your last day on the planet, and your three children are all grown up, in their own lives, and they’re stood at the side of your bed. You can give them three bits of advice, life advice that they can take away from dad, what are they?

Mark: Three? Gosh. First one, I think would be, don’t let fear stop you doing anything, and never make a decision that’s based on fear. Always make a decision that’s based on hope. The second one would be, don’t worry. If it happens, it happens. You’ll deal with it. The third one would probably be, it’d be something about giving, that life’s not about taking. It’s about you get more out of life, through what you give to others, and that’s everything from me what you choose to do with your whole life to what you choose to do on the way back to the tube station, and that’s where the sweet spot of life really is about giving back to others.

Prav: Lovely, and just while we’re on that subject, I know that was my final question, but what do your kids want to do when they grow up? Any ideas?

Mark: Oh, who knows? My youngest wants to be a radio presenter. So one of my best mates is a presenter on local radio, BBC local radio down in the south. So we went in to see him over the Easter holidays, which saved my bacon because it was like what am I going to do these kids throughout the day. So we went in and they were on air and all that sort of thing, which is a lot of fun. So now he wants to be, his radio name is Bobby Strong on BBC Radio silent instead of Radio Solent.

Mark: So that’s what he’ll be doing. So he’ll do that. My oldest is a strong woman. She’s going to be awesome. She already is awesome. She’ll either be a chef or a lawyer and I don’t know which one I want more and I think my middle boy, Jack, I think he’s going to do something in sport. He’s only 11 but he’s already built like a [inaudible] and he’s great footballer. I think he’ll end up either playing football or he’ll end up on the sports science side of things as a physio. He’ll be keeping people healthy and keeping himself active.

Prav: Amazing. Mark, thank you so much for your time today-

Payman: Thank you so much Mark-

Mark: Yeah, it’s been great to be here.

Prav: It’s been absolutely really brilliant.

Payman: It really has. I think for me, not a dentist but definitely a dental leader. Definitely a dental leader.

Mark: Thank you very much.

Payman: Thank you so much.

Mark: Cheers guys.

Speaker 4: This is Dental Leaders. The podcast where you get to go one on one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.

Prav: Thanks for listening guys. If you got this far, you must have listened to the whole thing and just a huge thank you both from me and Pay for actually sticking through and listening to what our guest has had to say because I’m assuming you got some value out of it.

Payman: If you did get some value out of it, think about subscribing, and if you would share this with a friend who you think might get some value out of it, too. Thank you so, so, so much for listening. Thanks.

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

Payman: When will we not, when should we do?

Bertie: June, definitely, that’s me, yeah.

Jason Smithson: It’s because the cogs are very big and turn very slowly. That’s the problem.

Bertie: Yeah.

Prav: Are you saying 1st of June as well, Jason?

Jason Smithson: Is 1st of June a Monday? If it were a Sunday, I would say no, I haven’t got a calendar at hand.

Intro Voice: This is Dental Leaders. The podcast where you get to go one-on-one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.

Payman: As we enter week seven of the lockdown, many of us are looking at the virus, and we passed the peak in, at least, in metropolitan areas. I know there’s other parts of the country where they’re just going into that. But at the same time, we’re looking at the unlock. There’s patients with untold misery out there and there’s practises who are sitting on their hands. We’ve got dental professionals who can’t treat those patients while they clog up the one-on-one system and A&E. And so, we thought it would make sense to try and unlock this, and we’ve got three guests from the British Association of Private Dentistry which has recently been formed. So let’s welcome the guests. We’ve got Dominic O’hooley on the scientific community who’s done outstanding work looking at all the latest research.

Payman: And guys, before I go any further, I just want to thank the three of you and I know there’s a bigger team behind you guys for all the work you’re doing for the profession. Someone needs to stand up, step up, while we’ve got such a vacuum of advice coming from the top. We’ve got Jason Smithson who kind of started the BAPD with a few others with Zacky and with Neil and the others and has done stunning work on the political side and I think you guys are coming out with a bunch of recommendations for back to practise guidelines. And we’ve got Bertie Napier, who’s on the comm side and on the bunch of other sides of the BAPD, former president of the BACD as well. Lovely to have you all. So let’s start with Dom. Dom, where are we as far as you can see, we’ve got this aerosol issue which you put out your document on. Do you want to summarise what that document said and your thoughts going forward on what dentists should be doing next?

Dominic O’Hoole…: Happy to do that. Really just a little disclaimer to begin with, I’m just a dentist. Because I’m just a dentist, I’m able to look at all the research very carefully and one of my little things is that I am quite geeky with regards to that. So I have spent a lot of time collating and curating that research data together. And it’s provided me with the opportunity to formulate an opinion on this. And it’s not 100% clear, but we’re getting clearer that the two primary methods of transmission of the SARS-COV-2 virus are via droplet spread and something called ballistic droplet events. And the second one is by a surface spread through things called fomites.

Dominic O’Hoole…: And the issue with what we call dental aerosol generating procedures is a bit of a misnomer. And what we seem to be seeing with the literature now is that there is a consensus developing, the aerosol spread of SARS-COV-2 is not regarded as the primary vector of infection. And so, therefore we have to be very careful if we’re looking at a science based approach to going back to practise, that we don’t run down roads that are not going to lead us to a very effective way back. And we end up perhaps purchasing very expensive pieces of kit, that actually don’t provide us with any risk mitigation for our patients whatsoever and don’t provide our staff with any safety benefits either. So that’s really where I am at the moment with that.

Payman: Okay. Jason, you want to jump in?

Jason Smithson: And well I can just really only agree with Dominic and I think our main concern as a profession, certainly one of mine, is if we’re going to go back to restricted procedures, so we’re going to go back to aerosol producing or non-aerosol producing procedures without really any science base. And we have the other concern, if we go back to only completing non-aerosol producing procedures, what happens, as we discussed yesterday, what happens if the patient coughs? Which is as Dominic will probably confirm is a ballistic droplet event that non-aerosol producing procedures suddenly becomes potentially quite dangerous. Yeah, so that’s where we are.

Payman: Okay. So what I’m hearing you say is you don’t see a good margin of difference between a non-aerosol producing procedure and an aerosol producing procedure?

Jason Smithson: I don’t see any difference at all, but I think the first… I should really preface that by saying I think we should go back safely. So I think there are certain things we should be looking at and we’re currently, in the British Association of Private Dentistry, working on some forms of guidelines for that literally right now. But one of the things I strongly believe is that there doesn’t really seem to be much difference in risk between aerosol producing and non-aerosol producing, even though we’re going down that route quite seriously. So, that’s where we are with that. Dom, do you want to chip in on that? Because I think that will be valuable.

Dominic O’Hoole…: I’m just going to briefly chip in to just say that every time we… As I said in my paper, every time we breathe, we create a respiratory secretion aerosol. And so, there’s a bit of a false differential between aerosol generating procedures in dentistry and just being alive. And so, we’ve got to be very careful that we’re aware of the fact that when we use our humpies or our cavitron or the pieces of equipment in the dental surgery, they create clean wall on aerosols and these things are usually, it’s either clean sterilised water, or it’s an antimicrobial that’s used in those. And it’s only when it actually impacts into the oral commissure that you actually get what we call a mixed aerosol.

Dominic O’Hoole…: And there is real positive studies with regard to mixed dental aerosols. But what I would say is, I think Jason’s very correct in saying that I think it’s very wrong of us to have a red flag for dental aerosol generating procedures on one side and non-aerosol generating procedures on the other. I think what we’ve got to do is we’ve got to look at a risk mitigation approach to get back into practise with safety for our patients and staff at the heart of that. But at the same time keeping our eyes on the evidence all the time and not going down an emotive route. So anyway, that’s my kind of point where regards to that.

Jason Smithson: I would kind of add to that in a practical terms, what is the real difference in doing, for example, an extraction on a perhaps an older person with chest issues who may be coughing throughout the procedure in comparison, which is considered a non-aerosol generating procedure, in comparison to putting a rubber dam on and doing a small cavity or perhaps even a root canal access on a fit, healthy patient who is not coughing. And that would be considered to be an aerosol generating procedure. In my opinion as a dentist, I think my risk would be higher in the first approach rather than the second. And yet the guidelines are for us to do non-aerosol generating procedures.

Bertie: I think I’d like to support what Jason and what Dom are saying. And I think the first thing that resonated with me immediately with some of Dom’s work was, there’s a difference between an aerosol generating procedure or aerosol and droplets spread. These are two completely different things. And I think what’s tending to happen is this has all been lumped into one thing. And this is where the confusion is coming in for so many people. And we’ve also got to look at the history of dentistry as well. We’ve been faced with other epidemics in the past. We’ve had the SARS thing, I think it was 2003, we’ve had MERS previously and none of these things have we ever had where dental practise or the practise of dentistry has resulted in a massive or what we call a Super-spreader event.

Bertie: If we’ve read Dominic’s document, it’s got a very clear explanation of a Super-spreader event. And dentistry has never been that. So for people to come out and say that these aerosol generating procedures are, so, I think I’m going to use the words that have been used, dangerous without having any scientific backing to make that statement is a bit questionable.

Prav: I’ve got a question for you guys. Well, how do you think all of this media attention is going to impact the public perception of the safety of dentistry or how safe it is to walk into the practise? And I’ll just add to that, that I’ve seen and I think to share the video with you guys this morning, people have started to advertise their practises as the safest place to come in: “Look at the precautions we’re taking. Look at this air purification. Look at this space suit that I’m wearing.” And to me, that feels like you’re saying to the patient, “The dentist is an unsafe place to go, unless we’re kitted up like this.” My fear is that is we’re putting the news out there in the public that it’s an unsafe place to go.

Bertie: Which is a big problem. That is a big problem. I was on the phone with my son just a few minutes ago and these are his words exactly, “Come on dad, when you walk into a dental surgery, you probably know that it’s the cleanest place you’ve been in that day. If you’ve been in the supermarket, the tube, the train, on a bus, in a taxi, when you walk into the dentist surgery, that is probably the cleanest place you’ve been in that day.” And that says it.

Jason Smithson: I actually went on Friday evening out to get fish and chips for my kids, because they going crazy, they wanted take away food. And obviously, fish and chip shops have a health and safety regulations and actually CQC as well, which is one of our regulators, and standing outside the fish and chip shop at a two metre distance from all the other clients, I didn’t notice any masks on the people serving the fish and chips, I didn’t notice any gloves, I didn’t notice any significant wipe down of surfaces between people even though they are handing over money and putting their hands on the counter. And the fish and chip shop is open, providing a nice service and great but a non-essential service. Meanwhile we have, in my area people with fat faces, people with tooth ache, people with broken teeth and we have a very strong longterm record, I think since HIV, I think it’s fair to say, we’ve had a very good, strong longterm record for cleanliness and sterility in our surgeries and yet we are closed and patients are walking around in agony. Now, is that correct?

Dominic O’Hoole…: Can I just jump in that Prav, just to go back to your point, I think there’s two issues. I think Jason has very neatly summarised that, and I think so as Bertie. But what I’d say is I think that we had a little bit of a vacuum of leadership at the beginning of this. So unlike Wales and Scotland for example, we didn’t get really leadership from the top. This kind of vacuum created a situation where there was a real hunger for information happening and it wasn’t coming through. And I think the public were aware of that. And I think the second thing that happened is that when the urgent dental care centres opened, I think there was a second level of misspeaking information coming from the top with regards to the number of these urgent dental care centres and how many of them were actually ready to see patients.

Dominic O’Hoole…: And I think this fed into the general media worry regarding PPE. And it didn’t do the dental profession any favours at that time. Because I think that it tied in quite closely with the very many media reports we were seeing of patients who were having to do their own treatments, take their own teeth out and things like that. So from a dental profession point of view, I think that there was an issue with regard to how our leadership showed leadership with regards to this pandemic. Now I think going to your second point, I think if you look at what you were mentioning about potentially practises or corporates using a safety differential to kind of give themselves a commercial advantage over the other corporates or perhaps or the dental practises, well for me, I’m going to be quite open about this, I think that’s an example of naked profiteering.

Dominic O’Hoole…: And if it’s not science-based, I’m concerned about it very much. What I would say is that it’s perfectly reasonable for people to perhaps purchase things such as air purifiers, if they feel that that’s going to give the right message to their staff and it’s going to say to the staff, “Look, we’re willing to spend and invest in this kit. We know it hasn’t got a lot of evidence behind it. We’re going to invest it because we want you to feel safe to come back to work.” And I think that’s an entirely honourable way to go forward. But I think where it’s very different is if they start using these potential own evidence-based, pieces of kit to create this kind of safety focus that is not really true. And I think that’s not really what we should be doing as a profession. I think if patients go to a specific practise because they’ve got an app purifier, then I think we failed as a profession being true and honest to our patients.

Payman: Look, certainly I don’t think from a marketing perspective it makes much sense anyway. I think it makes you feel unsafe when you talk about this. But Dom, from your experience, from your research that you’ve done, what would you say is safe as far as equipment, air purification, high-volume suction, masks, what would you say, if you ruled the world, what would you say is the standard that we should be following?

Dominic O’Hoole…: I think if I ruled the world, we’d be in even worse situation than we are now. Well to be serious, I think if we got back to the premise that dentists, as Jason, and Bertie as well is, dentists have got a long history of being the experts of universal precautions. We’re absolutely au fait doing cross infection control extremely well. And we’re taught about at undergraduate level, and is then instilled in us as dental professionals going forward. So from my point of view, we are in a great position to be able to provide a safe environment for our patients. And that to me provides me with this troubling thought that we’ve been closed down. And yet as Jason said, so many others seem to be open where there is not the same level of regulatory control and we’ve got patients walking around with severe tooth ache and potentially very serious morbidity happening.

Dominic O’Hoole…: So go into your specific points. I think that if we look at what we always did first, so I think that the use of surgical masks which prevents a lot of wearer associated infection to patients because it’s a preventative measure in that way. The full face shield which prevents what we’ve talked about, the droplet ballistic events contacting the moist areas of the face, so your eyes, your nose and your mouth. The use of very careful and meticulous clean down between patients that we’re well aware and we use regularly already. These are the sort of areas where I think that we’ve already got an existing safety function for our practises. We use antimicrobials in many cases within our dental waterlines. Originally this was to reduce or remove biofilm within the waterlines. However, it seems logical to me for those antimicrobials to be used for a secondary function, which is to potentially reduce the viral load within patient’s mouth as well.

Dominic O’Hoole…: I think it’s interesting to look for us, and we are looking at this at the moment, to be looking at preoperative mouth rinses, to think about another way of reducing that viral load within the mouth. And it’s a simple, safe and effective way to make a material difference to the risk to our patients in our practises. And I think that when you start looking at really, really less evidence-based things such as floor standing air purification systems, wall mounted ones, or the ceiling mounted ones, I think the real issue there is twofold.

Dominic O’Hoole…: I think one issue is that they are not evidence-based and they’re absolutely very, very poor and limited amount of evidence that’s available doesn’t support the use. And then secondly, that they’ve become an extremely commercially sensitive product that appears to be pushed to people who are in a position where they feel they want to get back to work. So there’s an almost a mass hysteria going on. “We’ve got to go back to work. We need to do this. We need to do that. We need to buy this.” And the problem with doing that is, that if it isn’t evidence-based, we’re actually spending money on things that are not going to make a material difference whatsoever to our patients.

Jason Smithson: Yeah. The other thing Dom is perhaps the rubber dam, which is the other big aspect. The use of rubber dam reduces obviously ballistic droplets if the patient were to cough whilst you’re working. So all of those things really, I think that Dom’s mentioned, barring the pretreatment mouth rinse, we’ve pretty much been doing anyway, we all been wearing a mask, most of us wear a visor, we all cleaned down between our patients and ideally, you should be using rubber dam. So it’s not like you’re going to have to rip your surgery apart and put big glass shields at the reception and put huge air purifiers everywhere, and this and the other. The fact is we’ve already been working to a very, very high standard as dentists anyway. And that’s actually interesting enough, that’s actually been reflected in the research shows that the transmission rates to dentists over the last two to three months have been very, very low. In fact, no difference from the general population.

Payman: Globally as well, that’s what-

Jason Smithson: Globally. Yeah.

Payman: What would you suggest regarding virus in the air, how long does it stay there? How much of it gets there? and high volume suction is used, what percentage of it is taken out?

Dominic O’Hoole…: This is very interesting. I think without going into too much detail, if we look at actually the virus measure in aerosol first. So if we’re looking at trying to measure SARS-COV-2, in aerosol, there is a recent study that came from two hospitals in Wuhan, which looked to collecting a proxy measure of the virus within, it ended up being two specific areas of the hospital. One was patient toilets, and the second area was areas where soiled PPA was removed or doffed. And what they did there, is they actually were able to measure viral RNA and they admitted in the paper there’s an issue with that.

Dominic O’Hoole…: The issue is that viral RNA doesn’t tell you if it’s effective virus or not. It just tells you that it’s either dead, demoted or potentially live virus there at some point. So the second issue that was there is that, one of the most heavily measured areas was the patient’s toilets, and it seems that something called faecal airialization which is where your toilet flush. I know this is a bit disgusting, but this is another way that we can actually obscure SARS-COV-2 enter aerosol is through toilet flushing.

Dominic O’Hoole…: So there’s a lot of problems with that paper and I don’t think that it provides really anything like weighty evidence to suggest a change in the consensus that we’re looking at primarily droplet and surface primary spread. So thinking about your point there Payman, regarding aspirators. I think what’s interesting there is that it’s very clear that high volume aspiration, just from a visual point of view, takes away the vast majority of the aerosol that’s generate as you do in your procedures.

Dominic O’Hoole…: If you tie that in with what Jason mentioned, that using rubber dam where possible, obviously you can’t do that if you’re doing-

Jason Smithson: Scaling.

Dominic O’Hoole…: … scaling and things like that. In a way you can use it. But at the same time if you use a really efficient, high volume aspiration and if you’re making ensure that your nurse is trained in forehand dentistry so that she can provide you with optimum aspiration, then it’s a very effective method of reducing the aerosol generated by your dental procedure. And you can see that on your face mask. Just a simple measure look at your face mask if it’s been done properly and it remains very clean. So with regard to formalise measuring of that, I don’t think there’s been any studies that have shown a percentage of their aerosol is taken away by high volume aspiration. But it seems to be a large, large majority of it.

Payman: Well I think that then works into the N95, the FFP2, FFP3 story. Once you layer the reduction that you get from rubber dam and high volume aspiration, layer on to that the small percentage difference between these masks, the differences we’re talking about between surgical masks and the top mask might be a 1% difference at the most. And you were making-

Jason Smithson: I can tell you exactly what it is in a moment.

Payman: Oh go ahead.

Jason Smithson: Give me a moment,

Payman: But Dom made a very excellent point when I spoke to him, that the FFP3 mask is an uncomfortable thing. We’ve been advised to wear it all day. And inevitably as dentists, we know inevitably you’re going to touch that thing, particularly when it’s uncomfortable. And so any marginal gain you would have got from that mask is immediately lost because you touch it so much. So the idea that keeping a mask on between two patients just seems ridiculous anyway to us because we’re so used to changing things. But what it says to me is possibly a surgical mask is safer than FFP3 mask because of these nuances.

Jason Smithson: The differences 0.4% before we go forward.

Dominic O’Hoole…: I think one of the issues is that when FFP3 masks were used in COVID wards with patients who’ve all got COVID-19, there was a recommendation made for various reasons that they shouldn’t be changing those FFP3 masks all the time, they should be wearing them. And part of that, possibly was due to a lack of PPE. But there was a very good reason for it as well insofar as you can’t really infect people who were already infected. But when you come to dentistry, the vast majority of our patients are actually noninfected. There will be a subset of patients who’ve got subclinical or asymptomatic infection, but most of them won’t. And that suggests that after every single patient we need to change the FFP3 mask. And that gives you an issue with regards to the actual practicality of that measure in the longer term.

Dominic O’Hoole…: The other thing with FFP3 masks particularly, is that the tight fitting nature of the mask means that… Studies have shown you actually tend to adjust the mask more often and bring… You actually put your hands onto the mask a lot and they’ve noticed areas of former generation around the handle of the mandible with these masks. And the other thing they’ve noticed for certain people, is that they actually end up with a form of bad sores on the face from wearing these masks. They get surgical sores around where the mask fits. So for various reasons, I think that if you can actually avoid moving down this route towards this really, really uncomfortable type of mask, then we should do so if all possible.

Prav: Just a question that’s not COVID related but related to dentists working in close proximity of the mouth, precovid, influenza, is there any evidence to suggest that the infection rate to dentists without wearing a shield and cracking on is normal and the rate of infection with influenza is actually higher amongst dentists because you’re in and out of people’s mouth all day, every day, some of them are probably coughing, You’ve got these ballistic events, you do an AGP all day long, surely the infection rate amongst dentists with influenza, you’d expect it to be a lot higher, right?

Jason Smithson: Well Andre Haigh actually did the research on COVID with the same model so it’s probably more useful. I think Dom can probably fill you in on that because he has a co-author.

Dominic O’Hoole…: Well I can. With regards to COVID, it’s clear there isn’t an increased infection rate if you use the proxy outcome of a self-diagnosed infection because what we weren’t able to do, was actually use formalised testing. But if we go back to your point Prav, with regard to influenza, there are no studies that suggest an increased infection rate in dentists worldwide for influenza and that can be for many reasons. I think one of them is that our existing crossing function control measures are adequate. For a well recognised respiratory pathogen, they work well. I think the second reason is that there is some argument that we are quite a essentially healthy population base and that we may due to micro exposures to all these different pathogens every hour of our working lives.

Dominic O’Hoole…: We might have actually primed our innate immunity in some way to be actually almost like we’ve got super human… not super human immunity, but we’ve got really well functioning immunity. That in another way, what we do for a living is actually possibly protected us slightly. When you look at studies of dentists, they seem to be healthy individuals who unfortunately we find that they’ve got a lot of orthopaedic problems from being bent over patients looking like prawns. I think there’s something about slight increase in kidney disorders. And there’s also unfortunately very, very sadly, there’s a high rate of suicide in dentist, but there’s absolutely no evidence whatsoever of an increased risk of infective disease, of any type in dentists.

Payman: What do you attribute the fact that… I’m not sure you know better than me, but the fact that ENT surgeons do seem to catch coronavirus now?

Dominic O’Hoole…: I think that’s very interesting and it’s a really important point. I think the first thing to say is that these were very early in the coronavirus pandemic, that there were reports of excess infectivity among ENT surgeons and ophthalmologists as well actually, and these were what we’d call anecdotal reports at that time. So there was no very, very detailed specific study that was double blind and randomised that showed that there was an actually increased risk in those surgical subgroups. Because people have tended to adopt different precautions since that, we don’t really have any further evidence since those early reports. I think the second thing to be aware of, and this is, again, entirely anecdotal, is that we’ve got to ask ourselves, are they always using there PPEs effectively as dentists are? And were they doing that before this crisis? And I wouldn’t like to allude negatively in any way, but I would say that there are some anecdotal reports that they use of masks and eye protection among those groups for routine procedures, where as not as widespread as it is in dentistry.

Payman: I think you’re right. I mean after I spoke to you on this subject, I spoke to an ophthalmologist about it and he said, “Look, we only have two states, totally a septic or dirty and there isn’t a one in between.” And what he said to me was in the consultations and he said it for EMT as well, outside of operations, they never wear a mask. So they’re doing a consult, they’re right close up. He mentioned something about tidal breathing. You were saying as well that the volume you speak at all of these stuff actually affects the amount of virus coming out of you. But it’s a very interesting point because, yeah, we seem to, Because of our history, we have a mask on at all times and in hospitals, Dominic O’Hooley was making a point. If you visit the hospital, you can see this cross infection breaches happening just at every point. It’s very interesting. So now going forward, with all of this evidence you guys are producing this document what else would the document comprise of? Are you looking at other countries? Are you looking at other professions?

Jason Smithson: We’ve looked at other countries fairly comprehensively, but we’ve written a report, which, well, we’re just editing it right now, aren’t we Bertie?

Bertie: Yes.

Jason Smithson: it’s very close actually. Should I say it will be out tomorrow? Is that too much? Maybe Thursday.

Bertie: Thursday for sure.

Jason Smithson: Yeah, we’ll see. But it compares and contrasts what’s going on in other countries with what’s going on in the UK. I’ve just read it this morning for the third time. And what strikes me is the countries that have done well and are currently getting back to work. A good example would be Australia. You would see a very, very coordinated approach and a very organised approach to managing the disease. For example, in Australia the government was advised very strongly by the ADA, the Australian Dental Association, and all of the correct evidence and the pathways back to work, the various levels of getting back to work were all displayed on the ADA website. So that means that the dentists in Australia had the ability to get the correct information from one site rather than running around like headless chickens looking at things on Facebook, which is perhaps not the best way to do things.

Jason Smithson: And that’s very similar in New Zealand. Canada is slightly different, they went state by state, but they also had very coordinated ability through their state websites or through their province websites. And I think I’m correct in saying Denmark was pretty much the same. Is that right Bertie?

Bertie: Yup.

Jason Smithson: Yeah. So yeah, the paper will be out quite soon but it’s quite interesting.

Prav: Just in terms of going back to dentistry based on what you guys have said today, we should be going back when we go back I’ll be able to do AGP from day one. Am I hearing that correctly with the right precautions?

Dominic O’Hoole…: You are from my point of view.

Jason Smithson: Yeah. There are some small differences we’ll have to make, but I’m not seeing a vast difference in dental practise. Maybe for some people, but not a vast difference in past good practise. Let’s say that.

Dominic O’Hoole…: The other thing to say there I think is really important is that the absolute key to this is very effective patient pre-screening. And I think that’s going to tie in with an enhanced and improved testing policy UK-wide. I think understanding the parameters of what level of asymptomatic people we’ve got in the population and what level of people have the infection and what their immunity is. And whether we go forward with formalised immunity, passports and that kind of thing. I think it’s dependent on further scientific knowledge on the levels and the efficacy of immunity anyway. And also there’s some other aspects with regard to personal freedoms and things like that. But for me, I think patient pre-screening is an absolute key. And then looking at patient throughput into and out of the practise.

Dominic O’Hoole…: And I think we can make subtle modifications to that to avoid our waiting rooms being full of patients sitting two foot away from each other, chatting into each other’s faces and potentially things such as perhaps putting screens, partial screens between reception and other areas, and looking at trying to avoid contact transactions. So therefore, using money free and contactless payments as much as possible to try and limit the amount of surface contact that we’re having with things such as cash machines and card readers, and pens and things like that. So there’s a lot of things we can do to adopt that best practise. Well, the bottom line from my point of view, and this is my opinion, is that there is nothing where we can not think about, as a profession, that should stop us going back to a full range of dental procedures when we go back.

Prav: Who decides how we go back in what capacity when we can and can’t do AGP? Is that down to the CDO? Is that down to dentists and individual practitioners discretion? Have you guys got the answers to that or do we just simply don’t know?

Jason Smithson: I think Bertie can answer that, I think.

Bertie: Look, we’ve been told by the CDO that she doesn’t speak for private dentistry. The reality is that whatever she says, we are expected to comply with because if you listen to our defence organisations, they’ve made it pretty clear that if we don’t follow CDO guidelines, we need to have a very good reason as to why we haven’t done that. And I think the danger is, this is the only danger, and it’s not to do with dentistry being dangerous, the danger is that if somebody contracts COVID-19 somewhere else, and they’ve been to the dentist, this is what the defence organisations are pointing at and saying, “Oh, it’ll be difficult to defend or it’s going to create a case that wasn’t even there.” Yeah. We know the cases, the cases are not good, but just going back to who’s making the decisions in the end.

Bertie: What this whole thing has highlighted for us is there’s a massive void in representation of all of dentistry at the highest level. So we’ve got a big representation for NHS dentistry which is the CDO. We’ve got the BDA doing its best to represent dentists, but when it comes to the whole profession being represented, especially a strong voice for private dentistry, which has got a massive contribution to primary dental care, we simply don’t have a voice. So the decision is going to be made by others on our behalf, but we are doing our level best to change that. And that’s part of what the BAPD is about. Is to make sure that that change actually happens.

Bertie: I don’t believe that we would be in the situation we’re in now if there was a stronger representation for private dentistry in the first instance. I do think things have gone wrong. It’s not about pointing fingers, but we cannot let this carry on. So we are doing our best to try and have input at the highest levels possible. I think you’ve heard from Dom’s contribution to this conversation today, that there are people out there who are doing well, who are wet finger dentists who are really, really good at looking at the research and applying these things. Yeah. The decision. Yup. Somebody else is probably going to make the decision, but we’re doing our best to influence that decision now.

Payman: It’s high time, we had a BAPD even without coronavirus. But it’s accelerated it now. And that’s a good thing in a way for private dentistry. But how did you guys achieve so quickly? With regards to parliament, all those MPS signing the letters? What did you do differently?

Jason Smithson: I think it was way to numbers. I think everybody in the group, and by the group, I don’t mean the committee, I mean the whole group, the whole 8,000 members, PUT their shoulder to the wheel, they signed all the petitions. We released, I don’t know how many petitions, perhaps six. They all signed those. They, hopefully all wrote to their MPS. I can’t remember how many DMs I used to get up to in the morning saying, often a hundred, “I’ve written to my MP.” And all that pressure.

Jason Smithson: It was not us as a committee that did this, it was us as a committee that facilitated it, yes. But it was pure way of numbers of members. And I don’t think that’s been done before. Not only was it members who were dentists, it was members who were dental technicians, dental hygienists, therapists, nurses, practise managers, and even patients. That’s what made the difference, I think.

Dominic O’Hoole…: And just to say if we… The fact that it happened so quickly, the fact that within a couple of weeks of starting with over 6,000 members and it just showed you that that massive appetite was there among this big population of private dental professionals that they wanted this voice, they wanted this conduit to be able to speak to people who actually make the decisions. And just briefly going back to that, if we talk about the CDO in England for example, we’ve got to remember, she’s actually been seconded as a deputy commander for PPE procurement. So she’s actually been taken almost out of her role in some ways. There’s a lot of the day-to-day running is done by her deputy. And then we’re starting to hear now that despite initial perceptions, that it wasn’t input from SAGE, which is the government committee that was shrouded in secrecy for a while.

Dominic O’Hoole…: It’s now clear that they do actually facilitate dental specific guidance through the department of health, through NHS in England, to the office of the CDO. And one of my specific concerns here is that there appears to be no dental specific representation on SAGE or its subcommittees whatsoever. Now I can’t be 100% clear about that because despite them yesterday releasing all the member lists, there were certain members decided to remain anonymous. So we haven’t got all the members and then there’s a potential, some theoretical chance that the ones who remained anonymous were dentists or dental professors, or the rest of it. But it seems unlikely to me, and I think that that’s at the heart of this whole thing is that we need somebody, we need people who know about the day-to-day running of dentistry to be providing the centralised advice that we can then get and input into to allow us to go back to doing what we do best. It’s as simple as that.

Payman: Yeah. In some countries, dentists are considered key workers. Over here we… if you look at the Irish exit plan, it looks like… To me it would look like, with the current situation here, we would be coming out at the same time as hairdressers and phase four or phase five tattoo artists. How do we change the agenda over here to make them just like key workers? Why would you… Jason, you travel the world, as far as the respect for dentistry, do you see us as the poor cousin in that sense?

Jason Smithson: To be honest, I don’t have an answer for that. The reality is, in many countries dentistry is seen as a branch of medicine, which is an in a sense essential service. It was not so many years ago in Italy you had to train for medicine and then did dentistry as a sub specialty. And certainly in the UK, Royal College level, for example, dentistry’s still part of the Royal College of Surgeons, et cetera, et cetera. So I really, really can’t give you an answer as to why we are considered separately, and no detriment to hairdressers or anything like that. But we are a subspecialty of medicine and we should be considered so. As to why we’re not, I don’t know,

Payman: But what do we do from the sort of agenda perspective to try and put us up in this… I think in these sort of times, it’s actually a good opportunity to affect that. So is there something we can do now?

Jason Smithson: As a group or our association?

Payman: Well, as a profession. My inkling of it is it’ll take a problem like someone has to die of tooth ache… Something-

Jason Smithson: Well, somebody nearly did, didn’t they? In Exeter quite early on. Somebody was in intensive care in Exter after a dental infection so somebody nearly did. I honestly can’t answer that question. Bertie, do you have any thoughts?

Bertie: I’ll be very honest. For me, that was one of the most shocking things when I came over. Because I graduated in South Africa and worked there for a while, and the level at which dentists are treated as part of the healthcare team was a bit of a shock. Because we were almost at the same level as the milkman, the dentist man, the whatever. It was just so… I sort of looked at it and I thought, “Well, if you treat people at that level and then you hold them to such high standards such as the GDC holds us to, there’s a massive disparity in what’s going on here.” I don’t know how we’re going to solve this. You hear the CDO saying things like, “We’re putting dentistry back in the mother.” I think she meant the mouth back in the body. Yeah. How do we go about it? I actually don’t have an answer. It’s a bit of a situation we’re in actually.

Payman: Sometimes you see journalists hassling politicians during that afternoon briefing thing. One side of you says, “Yeah, you should hold them to account.” Because there’s been a lot of lack of transparency, some incompetence of course. It’s a new situation, it’s a difficult situation. And so should we just be leaving people to it or should we be holding their feet to the fire? And my feeling on it is just like, coronavirus was a great time to accelerate the BAPD, coronavirus is a great time to examine the GDC’s role, examine this problem that we’re talking about right now. And it shouldn’t even be a question of elevating or reducing. But my feeling on it is dentists should be allowed to go back to work. Those who don’t want to don’t have to.

Jason Smithson: I think we’re picking up traction in the media as well certainly Yu Chana gave a very good interview on Sky News this morning. Some of you may have seen that. And the message was very, very different. And I thought it was a very respectful interview and very constructive.

Bertie: Yeah. She’s very good actually. Yeah. And the interview was very good as well.

Dominic O’Hoole…: I think it is a golden opportunity in this awful crisis. It’s a golden opportunity for dentists to come together like never before. I think that many of us share the perception that we have a very heavy touch regulator. And I think that we want to reconfigure regulation so that it’s got the right touch. And I think that happens as part of this overall process of rebirth of dentistry in the UK. And I think that the regulators should be thinking, “We are being looked at now.” That’s a perfectly reasonable thing for us to do because I think that the first contacts we had from the GDC after this COVID crisis started, was a little missive telling us that they were… Just not to worry about them because they were all working from home.

Dominic O’Hoole…: And from my point of view, partially set the precedent that, “I’m sorry, you’re not really speaking for the profession.” And that could very well say, “Well yes, but why the regulators and why not really.” You know but, no, it doesn’t work like that. I think one of the things I’ll be looking for is a GDC that’s by dentists for dentists. So that wet finger dentists are integral and central to the regulatory process for dentists in the U.K. And I’ll leave it at that.

Jason Smithson: I think I would add to that for the dental profession, not just for dentists but everybody within the dental profession, because I think everybody’s in the same boat. There are enough or more dental nurses with issues. Were you? I didn’t notice

Bertie: I’m proud of your Dom, I like the way you put that.

Dominic O’Hoole…: Thank you.

Bertie: Especially that… And I agree with you about the first missive we received from the GDC, it was all about them. It had nothing to do with the profession, with protecting patients, with looking after the people that regulate it was, “We’re working safely from home.” It may not have been what they intended, but that’s certainly what came across to us.

Dominic O’Hoole…: Absolutely.

Prav: Just going back to the media. And stuff that’s been out to the media the various dentists have been interviewed. Some have said things that are so negative about the profession and alluded to the fact that it’s a little bit dangerous to step into a dental practise. Now they are going to be dentists who are probably watching this who may get invited to speak to the media and I’ve never sat up in front of the media, had a camera in my face and all the pressure of that and within 30 seconds had to say anything you can slip up. Now I guess what I’m asking you guys is if somebody does get invited to speak to the press about COVID and dentistry, what sort of message should they be putting out there? And what tone of voice should they be speaking? And if you were to advise them or brief them five minutes before they goon in front of the camera.

Jason Smithson: My first message would be if you’re not confident to speak in front of the media and give the message that you’ve clearly thought out in your own head some hours before or even some days before and prepared carefully because this is an important issue, then perhaps you shouldn’t be speaking to the media and perhaps you should contact somebody who is confident to speak to the media. That will be my first message because it can be very alarming for dentists and patients. Bertie.

Bertie: Yeah, I agree. I think you’ve got to be prepared and Prav you’re right, the pressure is probably… It’s unbelievable. Again, you might prepare in your mind exactly what you want to say, and even they might even give you the questions ahead of time, but sometimes they’ll phrase something slightly differently which can throw you. But Jason is right, you need to prepare yourself. You need to be really well prepared. And don’t wait until you maybe get a call to do something or say something. Prepare yourself well ahead of time as to what you would say. You’re watching other people saying things and you may be thinking, “Oh shouldn’t have said that.” How would you have responded in that situation? So take great, great care and sometimes as much as we all would like our little 15 seconds of fame, if the right thing to do, might be to pass it onto someone who’s going to do a really good job with it.

Prav: I think that’s probably the best advice, because I think especially a lot of dentists feel a little bit… Get this celebrity type persona on them and think, “Wow, I’ve been invited by the press, this is my 15 seconds of fame” or whatever it is. Get a bit star struck and whatnot. And I think that’s right, Is that if you’re not confident at doing it, especially during these times, probably the best advice is don’t do it, pass it on.

Jason Smithson: It could. It could even be something as basic as a patient calling you for some advice. It doesn’t even have to be the media, but you have to give the correct evidence-base message and not spread alarm. That’s the important thing.

Payman: One thing I would say guys is that a week ago, the evidence-based… Now Dominic has found, wasn’t there and

Dominic O’Hoole…: I just like to say that I think that… Just alluding to what both Bertie and Jason said, I think that it’s very easy to go rogue when you’re in front of the camera. Very easy for the rabbits in the headlights. You’re brain disconnects from your mouth and you basically say somethings that you’d never possibly say if you’d actually had the opportunity to reflect beforehand, and you say things that are inappropriate. And I feel great empathy with individuals where that has happened, I really do. What I would say though is that I think sometimes it’s important, with hindsight, that you’re then able to put your hand up and apologise in a very, very non-ambiguous way. When you see that you have actually created a damaging perception within the profession and within patients. And I think that that’s something that I would have liked to have seen in certain cases that I’m thinking about at the moment.

Payman: Going forward guys, what are the silver linings of the situation? We were discussing more use of rubber dam for instance.

Bertie: I think it’s brilliant. I think we where patients that had a resistance to rubber dam in the past. It’s always easier when you say, “Well, the guidelines say that this is what we should be doing.” And I think it takes away the excuse from a lot of dentists as well that the patients don’t like that kind of thing. So we know that that’s one of the things we’ve recommended. I think our defence organisations would love it if we used rubber dam on most of our procedures where we are actually doing treatment. And this is an opportunity for us to introduce this into our practises and just start using it as a normal part of what we do.

Payman: Jason, do you agree?

Dominic O’Hoole…: I would agree with that.

Jason Smithson: I’d agree entirely with that, Dom.

Dominic O’Hoole…: I was just going to say that the innovation that we’re seeing as well. So for example, something as simple as being able to innovate and get a really effective facial that works well with prismatic loops, how fantastic is that? We went from a situation where people were trying to lodge the old face shield in front of the loops with it sticking out of four or five degree angle and providing no benefit for anybody. So a situation now where you can get certain brands of face shield, I mean Oregon’s a good example where it’s incredibly comfortable to wear and yet you can weigh your 4.5 mark loops and forget that you’ve got the face shield on, how fantastic is that?

Dominic O’Hoole…: This crisis has brought the best of British engineer and excellence into play. And as a profession we’re really designing things that are fantastic. We can see that with 3D printing as well. The 3D printing technology that’s allowed wider bar aspirators attachments that can go on our existing aspirate attempts thing that just people think laterally and we come together and we do something that works super well. And it’s this rapid prototyping thing. We’ve got a crisis so we’re not going to mess about, let’s get it done.

Jason Smithson: It’s very British.

Bertie: I think if we look at it… I’m part of a group called the IDDA International Digital Dental Association or Academy rather. And when you look at the reaction that these guys have had on an international cooperation that’s actually gone on between dentists to try to find solutions, innovative solutions to a number of things. And you think, “Wow, if we were this quick with so many other things, how much more can we actually achieve?” And I think it has been really great in pulling people together. So that’s another silver lining on what’s happened with this.

Payman: Prav, what do you say?

Prav: For me, I think it’s been the digital communication between dentists and patients and we’ve broken down lots of barriers. So I’ve noticed now in my practise as we started doing live video triaged consultations and then we’re having conversations with our teams where we say, “Hold on a minute we’d usually get this patient here to have a chat about their treatment plan, we could just do it over a video at their convenience in an evening or whatever.” So I think the thing about doing this sort of stuff, a lot of people find talking to a camera uncomfortable. But I think Zoom and stuff like that has just broken those barriers down with the kids doing fitness classes over Zoom, talking to their families, communicating with their grandparents. So now suggesting to a patient, “Well, let’s do a video consultation or a video call and save an appointment,” I think those barriers have been broken down and I think that’s a big silver lining that’s come out with this.

Payman: I think Jason, you’ve had some successful webinars going on. Do we perceive now that the dental population is going to come in more educated than before?

Jason Smithson: Well, it’s encouraging to see that people have spent their spare time, firstly doing dental education, which is great and, but also maybe connecting with their families, doing a bit more exercise and maybe sitting back and, myself included in this, and looking at actually what you were doing with your life precovid. Perhaps it wasn’t quite the right direction, certainly for me it wasn’t. And there is-

Payman: Finding a more balanced perspective

Jason Smithson: Absolutely. I was looking at, I’ve spent so much more time with my… I’ve spent all my time with my family, which has been amazing. And how we can work forward in the future to maybe do that. Obviously I won’t be able to spend 24/7 with my family, but more time with my family. How I could take more exercise. And I’m sure everybody else is in much the same boat, not only dental education, but all facets of your life really.

Prav: Jason do you think online education is here to stay? Would that be part of your ongoing curriculum considering]-

Jason Smithson: It certainly is for us. Yeah. I think the convenience for dentists of… Well let’s say this, the normal format for most whatever educational programming in whatever sphere is, you sit and listen to a lecture and then sometimes you do a bit of hands on. I think I would hate to see conferences go, to be honest, because I think that has a huge social aspect. It’s not only the conference and the learning, it’s the lunch and it’s the party afterwards. And even if there’s not a party, there’s going for a beer or whatever with the people afterwards, and it’s social interaction. I’d hate to think we were all sat in our little boxes looking at our screens. That would just be weird.

Jason Smithson: But I think you can certainly dynamize your education business by perhaps doing quite a bit of it online and then either the hands on courses are shorter which impacts overheads and makes it cheaper for people or you do more hands on in the same amount of time rather than doing the education, so I think there’s quite a lot to be said for that. So yeah, that’s kind of where we are. But yeah, I’d still like to see a big congresses going. I think it’s very social.

Payman: I’m going to ask the three guests, what’s your estimate of when are you going to get back into your surgery date? When are you going-

Jason Smithson: 9:00 AM at…

Payman: When’s going to do hands on course and when’s the next time we’re going to be able to hug each other again?

Jason Smithson: Oh, I’m not sure I want to hug you at all, Payman.

Payman: Dom, go ahead. What do you think?

Dominic O’Hoole…: Well I think that I’d like to think that by June we’ll have a phaser turn into general practise.

Payman: 1st of June?

Bertie: I agree with them. I think I’d really like to see us by beginning of June that we are… Actually, I’m of the opinion that by the middle of next week we should be able to start seeing emergency patients-

Payman: When will we is the question.

Bertie: Pardon?

Payman: When will we not, when should we?

Bertie: June. Definitely. That’s me. Yeah.

Jason Smithson: Because the cogs are very big and turn very slowly. That’s the problem.

Payman: Are you saying 1st of June as well, Jason?

Jason Smithson: Is 1st of June a Monday? If it were a Sunday, I would say no. I haven’t got a calendar at hand. So I would say early June. I would hope

Payman: How long before we can do hands on courses?

Jason Smithson: Well I have a council call scheduled for mid June and I have up to now no intention of cancelling it because my feeling is if the government stance is if hotels are opening and the course is being run in a hotel, why would you not do a hands on if somebody is sitting in a restaurant, why would you not do hands on it with correct social distancing?

Bertie: And with people who know what to do.

Jason Smithson: Yeah, exactly.

Payman: Providing PPE masks at the hands on.

Jason Smithson: No. But we will be providing rubber dam.

Payman: So do we have to wait for a vaccine before we can hug again?

Dominic O’Hoole…: No, I don’t think so. I think that that’s a false premise. I think that it depends a little bit on the testing with regards to the massive subset of the population who may have had asymptomatic infection. So studies are very variable on this at the moment. Anything from between 15% and 80% of the study cohort had had an asymptomatic infection. So I wouldn’t like to predict what the actual answer to that is, but there seems to be a consensus developing that it can be an excessive 50% so you can tap find that you’ve got many, many factors of times higher number of people in the population that had this infection than the ones that are reported. I think that creates a background kind of hard immunity situation. I think the second thing is, we have to be a little bit more logical and a little bit more calm about what kind of immunity we’re going to get.

Dominic O’Hoole…: Even if we find that the immunity does weigh in after a year or so, that doesn’t mean that we’re going to get a second COVID-19 infection with the same level of morbidity that we got the first time. A lot of scientific evidence suggests now that even if we did have that situation, that the second time we get the infection it’d be very, very different, sub-clinical almost. And so, I think we’ve got to inject a little bit of optimism into the situation at the moment. I’m very optimistic about it. I think as a civilization, as the human race, we are incredibly resilient people and I think that we will, we will achieve an outcome. There is some of the darkest moments we’ve seen in recent weeks we could never have imagined. But I’m very optimistic.

Payman: I think after the 1914 to ’18 war, then the pandemic in ’18 to ’20 was it, and then the roaring 20s after that. So back then without any of the stuff that we’ve got and then the great depression after that. So yeah, I think there is cause for optimism. Hopefully our businesses can survive this. I want to thank you guys. I think on Friday we’re having a panel of one dentist from each country to see what each of the other countries are like and what those dentists are going to actually say in practise about what their life is like, what the government’s doing, and bearing in mind the different positions of the virus and there’s different times. But I really want to publicly thank you guys for giving so much to the profession.

Prav: Thank you guys, so much.

Payman: All right guys. Thank you so, so much.

Prav: Thank you guys. Thanks a lot.

Outro Voice: This is Dental Leaders, the podcast where you get to go one-on-one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.

Prav: Are we all done?

Jason Smithson: It seems so. That went quite well actually. Are you’re happy?

Dominic O’Hoole…: Bloody hell

Jason Smithson: Go on, Dom. Go on.

Bertie: You know you want to.

Jason Smithson: Not one bleep, amazing.

Dominic O’Hoole…: The bloody fagots were chewing me balls all the way

Payman: I’ll stick that in the outtakes, Dom. We’re still recording mate.

Dominic O’Hoole…: Don’t mind I’ve got no shame.

Prav: So Pay, tell me how has lockdown been for you, Enlighten at home, things like that? Well, obviously we went through the mass panic, the hysteria, not knowing what to do and how things would settle down. Just talk me through the stages that you’ve been up to now, and obviously we’re going to be moving on to the interview where hopefully we’re going to get some of the answers of maybe what we should be doing and what the new normal will be in dentistry, buddy.

Payman: So look, for me, the first couple of weeks were kind of rabbit in headlights is the way I would describe it. So I didn’t know what to do and think. And at the same time I quite enjoyed being at home with the family. I’m enjoying being home with family right now, to tell you the truth. I think my life and your life are a bit different to most dentists lives. They have to be there at 9:00 AM. I know you get up at 4:00 AM anyway, but I was feeling guilty, Prav. I was feeling guilty that I didn’t have solutions to the problems that we were having. And it started off with the team at Enlighten. We met together and said, “Look, sales are going to go to zero.” I think we kind of anticipated that a week or 10 days before the actual lockdown was actually put in place and the team were already working from home before lockdown started, but how are we going to fund it all? The furlough scheme came in place, helped us a little bit.

Payman: Currently we’ve got four people not furloughed, four people sort of running the life support of the business, and we’re considering how to unfurlough people a week at a time going forward. But what’s made me feel a lot better now is I’m kind of being kinder to myself and not feeling guilty on this subject. And as soon as I started feeling that way, I started to find some solutions. And I think for us, as a company where all of our customers are dentists, of course a lot of our customers are patients as well, but actually it’s a B2B2C business, it’s become clear that the health of the dental practise as a business is number one, and only when the dental practise is a viable business will they even consider cosmetic treatments.

Payman: And so we’re planning now how do we help our users, our regional centres get out of lockdown in a sort of obviously safe way, and that’s something we’re going to be discussing later, but in a way that the business is viable. And after that I think we’re going to see another month lag between practises actually opening and practises actually thinking about looking at our products. Although I think, lucky for us, bleaching is non-AGP, and my thesis on it in the end is that non-AGP treatments like bleaching, aligners, facial aesthetics are actually going to be the things that save practises from a financial standpoint. What about you, bud? You’ve partnered in what, six dental practises?

Prav: Yeah. But before we talk about the practises, bud, what you just said there, I remember speaking to you when you’d just come out of … and you had the conversation with your team, and you’d said to them, “Look, this is what’s going to happen.” And they all turned around to you and said, “Thank you,” right. And it was pre-furlough. You said to me you were going to reduce their wages, right?

Payman: Yeah.

Prav: And a lot of their friends and colleagues had been fired, laid off, whatever, right. And I remember you building up to that conversation. You were saying it’s such an emotional time. And for me, mate, it was the day that Boris Johnson made that statement, okay. I remember Bob, my copywriter, senior copywriter, knocks on my door and he goes, “Prav, there’s just been a statement. They recommend we work from home.” So I called everyone over and I said, “Listen guys, this is what we are going to do. Pack your computers up. Today’s our last day here. And we may not come back for three months, four months, six months, whatever it is, but I guarantee you, whatever happens from this point onwards, you will not need to worry about your salaries.” And for them, it was huge, right. For them, it was enormous. And for me, okay, it’s remortgage my house, take some cash out of the business, and they’re the team who got us where we were today, and they’re the team that’s going to help us grow in the future, right. So I felt I owed it to them.

Prav: In a similar way, Enlighten is a family. Every time I visit your office, it’s a family. It’s not a corporate business. You know what I mean? It’s a fun place to be and everyone feels like they’re at home. And so that’s what happened in the agency. And then look, moving forward to the practise, a week or two later, we’re having these conversations and then doing cashflow forecasts. Who do we furlough? Who do we keep on for normal tasks? And then having that conversation. I was trying to get through my head that people who have been furloughed, sit at home, do nothing, get paid 80%. People who are not being furloughed, getting paid 100% but working their socks off, yeah. I had to get my head around that. [crosstalk 00:05:44]. It’s hard to compete with that, right. But at the same time you’ve got to be grateful and thankful that we have government support. Yeah. I mean we can all sit here and pick holes in it.

Prav: So there was all the shock, the rabbit in the headlights, the massive loss of income, yeah. And then everything settles, three or four days pass, and I say to myself, “This is actually pretty good.” Falling in love with my family again, spending times with my girls. My youngest has a nap at one o’clock. I’ll go to her bedroom at two o’clock and she’s drenched in sweat, yeah. She’s been sleeping. And she wraps her arms around me and falls asleep again on my shoulder. Never experienced that before, ever. And if it wasn’t for COVID, I wouldn’t have done. So there’s so many little micro moments like that that I am grateful for and thankful for. And for me, got myself into a routine. I don’t wake up at 4:00 anymore. Wake up at 6:00. It’s a respectable time, yeah. Get in the gym. I’ve got dedicated time with my family. I’m in the office. We’re busier than ever, and the team are collaborating together.

Prav: At the same time, on the practise side of the business, there’s lots of battles and things that we’re struggling with, and some of them is when we go back, how we will go back, in what capacity we will go back. What about all those patients who’ve paid for half of their treatments and need finishing off with AGP? Yeah. And we’re booking patients in now for say mid May, and now ringing them up and moving them on until June, and we may need to move them on until July. And there’s that whole admin process, and those systems, and process, and protocols, and at the same time we’re still carrying on with marketing, so we’re putting content out there. It’s more education. It’s less offer based. It’s more about connecting video consultations, and just making sure that people out there who want our services tomorrow, I want to develop rapport with them today. I want to make a connection with them today, yeah. I don’t want to sell to them.

Payman: Yeah. In marketing speak it would be work on brand now. It’d be marketing rather than sales now.

Prav: And it’s not a traditional advert. It’s not, “Roll up. Roll up. Get your £1,000 off this in free whitening, this, that, and the other.” The message is more along the lines of, “Hey guys, as dental professionals, we’re locked in our homes. Unfortunately we’re not in a position to see you face to face. And you’re spending more time at home as well. Let’s connect. Have a video call. We think it’s a good idea. Why don’t we just … Why don’t we just allow you to learn about how we work, what we do and how we can help? And then in the future you might want to come in for a full mouth checkup.” The message is that simple, okay. And what’s really surprising is that there are lots of patients who are unaware that dental practises are closed. They’re definitely not scared of walking into a dental practise, and they want to rock and roll with treatment straight away. Even though we know we can’t fulfil that.

Payman: The thing is, dude, your practises are so content heavy that if I am a member of the public doing some research into implants, aligners, whitening, whatever it is, your practises seem to come up. And of course that’s because of all the marketing bits you’ve put in place before. So what I think is your practises are funnelling in the demand for that, and that’s why they’re such successful practises. But going forward, as doors open, as the unlock happens, will lots of patients, the majority of patients feel comfortable coming in? And the conversations I’m having with non-dentists is, “How do you feel about going to the dentist?” And without fail, most of them say they’d be nervous about going to the dentist. When I ask them why they don’t mention AGP. It’s not on their radar.

Prav: They don’t know what it is.

Payman: Yeah. Although, a couple of TV appearances later, they might be, but what they’re saying is just close proximity to another human. Because with social distancing, we’re getting used to just crossing the road when someone’s walking this way and so on.

Prav: Do you know where the first time social distancing impacted me?

Payman: No.

Prav: Very first time it hit home for me what it was. I walked into your office.

Payman: Oh, that time.

Prav: Held my arms out, yeah. Because you’re a hugger, right. Okay. We normally give each other a big hug, yeah. And I held out, and you looked at me like, “No.” I was like, “For real?” And you were like, “Prav, I don’t think you realise how serious is this, buddy.”

Payman: I had relations come in from Iran, and obviously Iran was ahead of the curve because of the disease, and over there they were doing the elbow and the foot things. So that’s why. I’d seen them.

Prav: So that happened. The morning after I went to have coffee with my buddy Danny Watson, yeah. And so we had coffee in Starbucks the morning after, in Manchester. And I looked at him, he looked at me and goes, “Are we going to hug or what?” He said, “Yeah, fuck it,” yeah. And we gave a hug, right. And that was it. And at that time, I don’t think it had sunk in how serious everything was in the whole social distancing thing, right. But very rapidly it did scale up. So with patients now, with what’s in the press, with the governmental recommendations, I think you’re probably right, the general public confidence of stepping in anywhere where it’s not a utter necessity, for example a supermarket or something like that, is going to be-

Payman: Yeah, I think that’s one of the main challenges for the profession as a whole, because I was on a BDIA call and they were saying in Holland dental practises are now seen as vectors of disease. People feel like you go to dentists if you have to, but actually you wouldn’t go at all because that’s where you catch COVID. And we’ve got to avoid that scenario in the UK, otherwise we’ll get put back another few months. But the problem we’ve got is there seems to be a vacuum of advice, a vacuum of regulations. We don’t even know where to look. I mean, is it The Chief Dental Officer? Is it the GDC?

Prav: Definitely not Facebook, mate.

Payman: Exactly. Is it CQC? Is it looking at other countries? We’ve spoken, both of us, to colleagues in Germany and Sweden, where Germany is doing so well on the Coronavirus and the dentists never closed. And in fact in some of these countries they don’t even see the electric handpiece, electric motor handpiece as a aerosol generating procedure. And so I think we thought the best thing to do was to get some experts on, and see from their position where we are, and try and unpack. Okay, it’s a new virus. It’s a new situation. It’s a once in a hundred year situation. So we’re not expecting all the answers right now. But when the answers come, where are they going to come from? Will it be CDO, GDC, or CQC? And what will they rely on? Will they rely on evidence? Will they rely on scare mongering? What will they rely on? Will they look at the far East where they’ve had SARS and MERS before? And that’s really the question for me. Who are we waiting for? Is it regulatory or is it advisory?

Prav: And speaking to a lot of dentists now, and key concerns in my own practises as well is it all revolves around this huge amount of uncertainty. A lot of scaremongering, a lot of, I feel personally, unnecessary panic buying, right. Masks in volumes, yeah. Air filtration technology. Fogging machines. Extra oral suction machines, yeah.

Payman: I think they’re a good idea, but, but keep going.

Prav: But whether it’s a good idea or not, we’ve got no guidance at the moment, right. So average practise goes out, blows 10 grand on all this stuff. Guidance comes out and goes, “Listen, just stick a visor on, make sure you follow these cleaning protocols, and you’re good to go.” So then what happens? Does that end up becoming a USP in a private practise? “Hey, I’ve got an air filtration system.”

Payman: I think that would be a shame if that happens, in my opinion. I saw a webinar with Miguel Stanley, and he said patients are going to seek out safe dentists, but I think it would be a shame if the communications message was, “Look at our practise, we’re safe,” because I don’t think overall that’ll work. That itself will go in the heads of the patient as practises are unsafe.

Prav: Unsafe. You’re not going to win that war, right.

Payman: Yeah. For me. I think that’s the case. I can’t be sure exactly how it will pan out, but the best thing for me would be if there was some basic guidelines that everyone had to stick to that work-

Prav: They’re discretionary extras.

Payman: Exactly. Nice to haves. But then I don’t think it’s wise to market my practise is safer than the practise down the road because I think that makes you look unsafe by itself. [crosstalk] were Dominic’s, I thought. Dominic’s piece that he wrote about aerosol, Dominic O’Hooley, and Tony Kilcoyne wrote a lovely piece 10 years ago. I don’t know if you read that. Did you read that?

Prav: I haven’t read that.

Payman: 10 years ago he wrote a piece about, “Look, why do we only clean the surgery? Why don’t we clean the waiting room? Why don’t we clean doorhandles? Why are there toys everywhere with cross infection on those?” Some simple basics.

Prav: Yeah. I read Dominic’s, and it really sort of got me thinking.

Payman: He does. Brilliant writer.

Prav: Because do you know what? When you consider all the hysteria on Facebook, the panic buying, the what ifs, the buts, the SOPs, all this, right. And then you look at the science, and I’m a scientist at heart. So you look at the science, you look at the evidence, and I reached out to Dominic and actually said thank you because I think he’s done something really good for the community in spending the time. He’s definitely got something up here, and the energy to be able to dig into this research and then put it down in a way that’s very easy for all of us to digest, right.

Payman: Well, one word of caution, Prav, though. It’s been banded about quite a lot, there is no evidence to suggest, yeah. Under normal circumstances that would mean something, but in this situation, I think we do need to be aware that it’s so new that there isn’t much research, and just because there is no evidence doesn’t necessarily mean it’s not true yet.

Prav: I get that. And no evidence doesn’t mean that hey, we’re totally safe, right. But if I’m looking at things from a very, very simplistic perspective, right, and scientific, but not super scientific, right. And say right, okay. There’s some water firing down these lines and it’s got hypochlorous in it. And it hits the mouth, and then some of it bounces back out, and 99% of it goes down a massive vacuum cleaner, and 1% of it comes out as an aerosol. And it’s incredibly dilute, yeah. I think everything that we do involves taking a risk, mate. Walking out your front door, getting on a bike, jumping in your car. And I think we need some guidance on what that risk versus benefit things should be, okay. Because there becomes a point where you’ve got diminishing returns, yeah.

Prav: You can add on layers and layers and layers and layers of protection, and then the decontam room, the fogging, the this, the that, 20 minutes between, 30 minutes I’ve heard, between patients. What’s the implications on patients actually getting healthy mouths again? What’s the financial impact on the businesses? Let’s not skirt around the financial issues, right. We can always say, “Oh yeah, dentists agreed,” and all the rest of it, but we’ve got businesses to run, okay.

Payman: Yeah, I mean it sounds like 30% are in trouble.

Prav: We’ve got jobs to maintain, okay. And people’s livelihoods, and putting food on the table for our team members, yeah. And so we do have to look at the commercial side of things. All this extra PPE, laser protection, I think it adds time, it adds expense. Who’s going to pay for this? Is it going to be the government? Are we going to do it? Are the associates going to pay for it? Are the principals going to pay for it? This has got to come from somewhere, right. I really, really hope that the three guys who we’ve got on today have the answers to the key questions, which are who’s going to make that decision for us? What does comeback mean? Yeah. In what capacity? And when will it all end? Are we going to be in a position where this is the new normal, or is it a new temporary normal and then we go back to normal?

Payman: Yeah. I think [inaudible] the latter, I think the latter. We won’t know for sure. It’s going to be phased. The guys we’ve got on, they’ve got years of experience, both in the research side and what I would term as the corridors of power. Maybe they’ll shed light on it. We’ve got to be aware though, dude, it’s once every hundred years. So no-one’s been in this particular situation before. We did have SARS, we did have MERS, we did have HIV. So I’m looking forward to it.

Prav: Absolutely. Let me ask you one final question, mate. Obviously your wife’s a dentist. How does she feel about going back to work?

Payman: My wife’s a at risk dentist, so it’s a layered thing, but she’s quite relaxed about it, strangely enough. Quite relaxed about it. I think she’s thinking … She works at Bupa. I think she’s thinking that Bupa will take care of it. But-

Payman: … but we’ll take care of it, but it’s one of those things. Your brother’s a dentist.

Prav: Yeah.

Payman: Your brother’s a dentist. So, this affects everyone. The thing about it is even if you are not a dentist, even if you’re not in contact with people, you’ve got a grandparent and on the global perspective, if any good comes out of this, there might be some feeling of whatever’s happening in a rich country, we’ve got to look up for the poor countries too because infected people will be infected people. For me, if we’re really zooming out, it’s a disgrace that there’s bio weapons labs, what’s that about? Is it ever going to make sense to attack another country with a germ warfare? If it does make sense that’s not a future I want to be part of that would be great. Just like some of the other silver linings, that the environment is cleaning up.

Prav: Amazing, yeah. Yeah.

Payman: I think tele dentistry, virtual …

Prav: Consultations.

Payman: Virtual consultations should be something that continued forever because why not? Why shouldn’t someone triage that patient before they come in and you book them a 40 minute appointment, really it should have been 10 minutes or whatever it is. For me, and I want to put this to the guests as well, the NHS, the way it was, 40 patients a day, is it possible to clean up between 40 patients a day properly? And then is it possible to treat those patients with work that’s going to last and isn’t going to come back and haunt the NHS again? For me it would be nice if, if that volume dentistry again, Miguel talks about slow dentistry, but we’ve all known about it. If anyone’s ever been exposed to NHS dentistry, they know about it. It would be good if after this there’d be some sort of impetus to improve the NHS, put more money in, or call it a core service and people save up for their teeth. Yeah, that’s the one thing I’m going to ask them.

Prav: Cool. Let’s get the boys on.

Payman: Let’s get it on.

Intro Voice: This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.

Payman: Welcome guys to the first of the Dental Leader’s Bulletin. This little meeting that we’ve organised today is to look at the situation that we’re in right now and to try and put some light on, some of the unknowns that the profession is going through right now. I mean obviously with the new virus, it’s difficult to get the full story, but we’ve got a panel of experts with us. We’ll start with Professor Nairn Wilson, who’s served as the Dean of both Manchester and the Kings Dental Schools. He served as the president of the GDC, the BDA, developed visible light curing. We could keep going, but right now prof, you’re actually founding the College of General Dentistry soon to be hopefully the Royal College of General Dentistry.

Nairn Wilson: Absolutely right, and I’m here today as capacity as chair of the college, thank you.

Payman: Perfect. We’ve got Tony Kilcoyne who has served in many roles. He’s served on the GDC twice. He served at the BDA. He’s currently serving at the BDA. He’s been trainer of the FD, he’s the director of training of FDs for over 30 years now and has been an examiner at the Royal College of Surgeons. Although Tony’s speaking independently today as one of us, one of the front line. Nice to have you, Tony.

Anthony Kilcoyn…: Thank you.

Payman: And we’ve got professor Mike Lewis who’s professor of oral medicine at Cardiff, past Dean of Cardiff and has served as the president of the British Society of Oral medicine, president of the British Society of Oral and Dental Research, currently on at Cardiff Dental School. Is that right, Mike?

Mike Lewis: Yeah, yeah. I’m sorry, you broke up a little bit there, but yeah, Cardiff Dental School, professor of oral medicine.

Payman: So I think we want to unpack the situation a little bit and I think the first thing we want to start with is we know that the exit out of lockdown is going to be phased. That’s one thing we know. What should those phases look like and who makes the decisions. Let’s start with what those phases should look like. Should we start with Nairn, Professor Wilson?

Nairn Wilson: Well I think as you’ve indicated, I think it’s got to be phased, I think has got to carry the confidence of the public, the patients we treat. They don’t want a run of … As hospitals and GPS are saying, people frightened to go and speak to them. We’ve got to bring them back and gain their confidence, in the different levels of phase that we move in, we’ve got to be a safe environment for all the members of the dental team within the practises. They’ve got to feel safe coming to work, et cetera. But of course we’ve got to be safe, our colleagues who are in practise have got to be safe for the sake of themselves and their own families and so on. So I think safety, trust and an evidence-based approach to getting back to it, I think is what we’ve got to do.

Nairn Wilson: I think it will be step by step. Clearly we’ll have priorities of extending emergency dental care services so people don’t have to travel big distances to dental care centres, et cetera. Then rolling that out as a system of priorities, maybe kids, elderly people, et cetera, et cetera. That sort of approach very much I think is the sort of thing that we’re going to hear of how the country’s going to get out of lockdown. I think it will mirror that a little bit, but it will be prioritised in my view in moving forward. I don’t know what the other folks think.

Payman: Tony, what do you think?

Anthony Kilcoyn…: It’s interesting isn’t it? Because I think there is two aspects to this. There’s very much the psychological aspect. You want the confidence of the public. Even our teams going back are going to be a little bit unsure and of course then on a individual patient dentist relationship, coupled with we have a mountain of pent up dental need. Bear in mind now, we’re entering the second month of basically loads of people having dental problems not being attended to. The three As approach. I mean come on, it’s a bit desperate isn’t it, really? Because dentistry nine times out of 10 or more, needs an actual direct intervention to improve matters. That is the nature of our job. It’s very hands-on. So we’ve been putting things off with painkillers, advice, antibiotics, but those problems haven’t gone away. There’ll be very few things that will have been fixed by any of that. So there’s actually a tsunami of need.

Anthony Kilcoyn…: So the idea of a phase back fits in nicely with the psychology of it. Let’s dip our toes in the water. Oh great. We didn’t all fall off our perches straight away. Let’s do a bit more expansive scope. Oh great, we all survive that. Then psychologically we can get back to almost normal operative dentistry because let’s face it, without high speeds and ultrasonics and all the rest, we’re not actually doing more than 50% of the routine dentistry and the substitutes for it aren’t that great. It’s a bit like the triple A approach is not a great substitute for dentistry generally. So I think the phases are more psychological than what the science would say because if you put certain risk reduction approaches in place, and I think the history has shown that dentistry is actually a relatively low risk environment.

Anthony Kilcoyn…: If you put certain risk reduction processes in place, I personally don’t see why and the evidence base is just generally weak is our problem, but I personally don’t see why we can’t make those phases go a little bit more rapidly than some of the reports I’ve been hearing generally of, we won’t be back to normal dentistry by the end of the year. I’m sat here thinking, well why not? What’s the evidence for not doing that? But I think there are some psychological barriers to overcome first. We will have to look at how we do risk assessments and how we chase some approaches. Not because dentistry is dangerous, but because psychologically the general population, we’re in unprecedented times. We’ve had a lockdown in society. I don’t remember that happening in my working lifetime of over 35 years.

Anthony Kilcoyn…: So this is being taken seriously. We have to be seen to be taking it seriously. So I think the phase in is more psychological steps than it actually is, well the evidence says that’s all it’s safe to do because I don’t think the evidence says much at all.

Payman: Do you think it’s going to be emergencies only or none GP only?

Anthony Kilcoyn…: People are going to argue about where are the lines drawn. I would argue that you have to look at the risk assessment and probably look at it from three points of view. Your staff, first of all, I mean some of those might already be suffering or having infections, who’s able to work who isn’t, who’s recovered and already relatively immune to the disease. That could change the way we approach how we treat patients. So we have to actually assess, literally risk assess, what are staff are like, what’s our environment like, and what’s the patient attitude like?

Anthony Kilcoyn…: I know some areas you could say, “Yeah we’re doing everything,” and there’d be a queue out the door. You could just say, “We’re seeing emergencies.” There’s still going to be a queue out the door because we have this pent up need that’s there. So I think almost just logistically as well, you’re going to have to look at how about pent up need can best be managed because it will have to be managed, where … It’s a bit like the R number in reverse. We need to get through more than one patient to fix them before another patient gets worse. We need to get two in before one gets worse so that gradually, we start reducing this mountain of built-up dental need. Because for a while we’ve been saying dental disease affects your general health too and if people are walking around with more infections and all those toxins going into their own systems and so on, that’s not good for their general health either. So for society, we’ve had to make this work.

Prav: One of the questions on my mind that I, being a practise owner as well as speaking to a lot of practise owners and the uncertainty about not only when do we go back but Payman, you mentioned this phased approach and let’s just stick to say phase one. What does that look like? Because some practises are putting together SOPs that involve fogging the surgery, cleaning it down, 20 minutes decontamination, patient waiting in the car park, et cetera, et cetera, and there’s a complete lack of guidance or certainty in terms of what’s the right thing to do, a lot of confusion people putting together these SOPs and as a practise owner, part of me’s thinking, how are you going to get through the NHS waiting list if you’re mopping down for 20 minutes in between patients? Who’s going to be the person who actually decides this is the protocol? Or is that going to be at our discretion as practise owners or is there going to be a minimum guideline set? What is that? Who will decide? Will it be different for NHS or private?

Prav: Quite a few questions there that have stemmed off phase one but I think when I’m speaking to practise owners and my principles, it’s this uncertainty of phase one, what is it? Prof Lewis, you mentioned that … the air filtration systems, for example. Will that be mandatory in practise or will it be a nice to have, for example?

Mike Lewis: Right. Yeah, and I think you know, I agree with Tony and what Tony was saying. I mean, I think underlying this we have to get dentistry back on the road. I think we are all striving to get that. It’s frustrating me with my patients here that these clinics are all closed. But to do it in a way that we’re comfortable, we feel safe, our staff feel safe and the patients feel safe, again as Tony said, I think you have to accept that dentistry really is got the rough end of the stick here because of the aerosol generation and the fact that COVID is in saliva. If you generate a saliva, there is no doubt we haven’t measured loads yet, but it has been shown that it’s in saliva. So for non-aerosol generating procedures, that’s what I’m doing here at the moment.

Mike Lewis: I spent a day yesterday, I saw about 20 patients yesterday with toothaches that needed … perhaps they needed some extractions. I saw an urgent suspected cancer that needed a biopsy done. I did that biopsy with just routine mask, visor without, FFP3 regulations and I had no problem with that. We’re washing down the units in the same way as we would as every day, pre-COVID. So I think for certainly for the non …. Phase one would certainly be let’s get back, non-aerosol generating procedures. Let’s get the patients back in. If we do say that … I think the air clean systems aren’t going to be the way forward. I remember and Nairn will certainly remember, we used to clean our instruments between patients in a hot water bath at the end of the comms clinic in dental school and then we got these things called autoclaves and then we actually started wearing gloves.

Mike Lewis: I mean that was a miraculous … I remember all the things. It’s all about, “We’ve got to wear gloves and do we wear the same gloves all the time?” And then of course, prions popped along a now we’ve got to have washer/disinfectors. I mean this is just the next stage, that the issue of viruses in saliva, it’s not been before. Herpes simplex has been documented at spreading from saliva into nurse’s eyes and hepatitis B can be spread from saliva into the eye as well. So the aerosol issue has to be addressed and I think we can reassure ourselves and address it with high volume aspiration. The video clips that were shown on the television didn’t really quite explain what happened but there were two there and one of them was with the use of high-speed volume aspiration dramatically reduces the aerosol, it’s taking it down 99%. then if you had an air clean system in the surgery as well, that will take the rest out. These air clean systems are very effective.

Mike Lewis: Whilst we did the research 10 years ago, we were looking at bacterial spread, the filters that can be put in these air clean systems, will take COVID out and all sorts of other things that we may be worried about, particles in the environment. Because the latest research from two weeks ago where they were looking aerosol generation, the virus will float around in the room for about three hours. But if you’ve got an air cleaning system, it’ll take that right down.

Mike Lewis: So we, I think as dentists, would be more confident where we’ve got this environment. The support staff would be more confident and then hopefully the patients will be more confident. That is the realistic way of getting dentistry back on the road because we’ve got to do it. I’m frustrated here. We have a dental school sat empty and I feel for … The final year students fortunately have done most of their practical work, but the ones that are coming in for fourth year into final year, we’ve got postgraduate students paying large sums to be learning dentistry, hands-on techniques. They’ve paid us money, we’re not delivering it. It’s an awful situation but I think with common sense and us all working together, then we’ll beat this.

Nairn Wilson: One of the things, I know I’m not personally involved, but standing back and looking at it. I think one of the great sadnesses to me is that the current system has not taken opportunity of all that dentistry could offer. For example, why aren’t dentist practises being used for virus testing centres? 20 odd thousand around the country, good access and local communities. Get dentists, well-trained health care professionals who know about infection control. Give something dentists to do, give them some money coming into the practises and if then, through using those practises as testing centres, A, the dental team are tested maybe once a week. I know it’s not every day, but at least once a week and the patients who come for testing, you know that if they’ve got a problem that they need to be [inaudible 00:18:05]. You’re saying, “Well, you’ve got a negative test, we could see you, we can do something. I’m negative, you’re negative. We could start.”

Nairn Wilson: To me, a way of kick-starting dentistry back in would be let’s use dentistry. People have heard me lecture in the past, heard me say, why aren’t dentists use for things like winter flu vaccination and so on. We are properly trained healthcare professionals better us than the army doing this testing. These poor guys in the army that are recruited into this, they don’t know one end of a swab from another, sort of thing. We [inaudible] and our healthcare professionals taking these samples at back of a throat, I think we might be quite good at that. That might’ve been a way in.

Mike Lewis: Can I just come and say Nairn, I think that is absolutely fantastic because I don’t know if you saw on the news last night they were talking about the self home kits and they show the person where they’re supposed to stick the swab. We know where to stick our swabs. There is no doubt about that and I think this suggestion is fantastic.

Nairn Wilson: It’s going back to what Tony was saying, what I was saying about building that, getting that relationship back with the patients, trust. “I came to you, you’re the guy, or person, lady who tested me, kindly just down the street. You reassured me I don’t have the disease, et cetera.” That’s breaking that psychological link again and getting them back in a practise and building that trust and giving everybody trust. We’re only treating people who have tested negative in the last three, four or five days or whatever and we’re all tested negative and wouldn’t that be good that if we’re helping to pick up people who are carriers who’ve got the disease and of course in the process, as Tony was saying, our link with general health and so on, we’re going to say, “How are you?”

Nairn Wilson: These people aren’t going to their doctors about heart attacks, strokes, cancers, lumps and bumps. A good dentist with good communication. “How are you doing Mrs. Smith?” Or, “Well I’ve been a bit anxious the last week or two. I’m breathless, I’ve had chest pain.” We could pick that up and get these people back to hospitals and so on. We’re good at it and we’re not being used and I think it’s a great shame that dentists and the facilities and the potential is there. It’s just not in the minds of the folks that are firefighting this terrible situation the country finds herself in. I wish somebody would wake up and say, “Here’s a wonderful resource. Let’s use it.”

Payman: Nairn, you’ve been in the corridors of power. Who makes these decisions?

Nairn Wilson: Well, as you see, it’s the advisors to the government to et cetera, but with no disrespect, they’re all medics and so on. We’re probably just not in their thinking. We’re not on their radars.

Nairn Wilson: And we’re probably just not in their thinking. We’re not on their radar screen. They don’t appreciate… And even, again with no disrespect to them, some very senior people in medicine, who think that dentists are just filling and taking teeth out, don’t really appreciate that the extent of our training and appreciation of human disease and looking at people holistically.

Nairn Wilson: And it is sad in this day and age that there is this lack of appreciation of what we can contribute, as Tony was saying, to general health and wellbeing. And this, to me, is an example that we could do this and we could make a huge contribution. They’re very much in the thinking of the College of General Dentistry of getting this brick in this dome. We are part of healthcare system in the UK. We are important.

Nairn Wilson: And other issues are missing at the minute. I know it’s the immediate topic today, but why aren’t people being encouraged to brush their teeth and use mouthwash before they go out in the street? Possibly more important than some face covering, or equally because there’s not much evidence, we keep getting told that it’s not much a benefit. Maybe brushing your teeth and using a mouthwash before you go to the supermarket, or whatever.

Mike Lewis: If I can come in there, the ITV have just asked me to put out a press release following on from what I was saying on the TV early in the week. There is no doubt I have a mantra. Wash your hands, clean your teeth. And the basis behind that is that there is no doubt that from the work that we did here and published in Critical Care about four years ago, we were looking at oral hygiene in relation to ventilator patients.

Mike Lewis: And we demonstrated without any doubt that if you go into… Say you’re COVID, you go in and you have to have a ventilator, your chances of coming out of there alive will be related to your oral hygiene. Now that’s on the basis of going in and of course maintaining oral hygiene when you’re ventilated is difficult. And we did studies using brushes and swabs, and everything.

Mike Lewis: I don’t want to complicate it too much about that, but there’s the benefits of good oral hygiene at this stage. If you were unfortunate enough to get COVID-19 and then be unfortunate enough to require ventilation, the better that your oral hygiene when you go into there, the greater the likelihood of coming out and there is no doubt about that. We publish these papers three or four years ago on a molecular basis.

Mike Lewis: What I do agree with you right now is that if it’s a great opportunity to get people brushing their mouth. And I said the four… You’re all in lockdown. The four most important minutes of your day today are two minutes brushing your teeth this morning and two minutes brushing your teeth this evening. And when I said that on the TV, the newsreader actually laughed a little bit, because it’s true.

Mike Lewis: That should be the message out there. The foremost important, because not only is that going to be good at hopefully preventing if you are unfortunate to become COVID-19 positive, but it’s going to get people brushing their teeth anyway. And for the benefits of the dental need out there, that we’ve been trying to get them to brush their teeth for two minutes twice a day for, I don’t know, as long as all of us have been in the profession and it doesn’t work.

Mike Lewis: This message out there is brush your teeth. We are now in a fantastic opportunity. Now there’s a little bit of evidence that Martin Addy I understand published in the BDJ, had a letter in the BDJ two issues ago. And I think the press have picked up on that and they’re going to interview him this weekend about some of the active ingredients in toothpastes, because some of the components of toothpastes actually have… They’re the same as they are in hand sanitizers.

Mike Lewis: Now if you teach it… And the way I teach virology is you imagine it as a little scotch egg and the scotch egg is… The COVID-19 is the egg inside. It’s an RNA virus. The crumbling coating on the outside will determine which cells that virus gets in. Now in COVID-19 it’s cells in your lungs. So, it allows it to get into the lung. If you disrupt that coating, it can’t get into the lung. It cannot get in.

Mike Lewis: So, anything within… If there’s saliva in the mouth or the throat, brushing is good, but also using a toothbrush, or some of them. The Listerine mouthwashes, the essential oil mouthwashes, povidone-iodine. Chlorhexadine not so much, because it only has an anti-adherence effect, but I have to pick up on what you said there and the ITV are coming back to me. They’re doing some national meeting at the moment. They’re going to ring me back later today, but I’m hoping that the dental profession out there is… And I’ve altered my email signature. Wash your hands, brush your teeth.

Nairn Wilson: Sorry, very quickly. I’ll come and… We haven’t heard from Tony. He’s being uncharacteristically quiet there. But a little bit of dental history, they say it’s nothing new and our medical colleagues… Again, notice, right? The same problem there. In the first world war where they had to operate on people with ether and its inhalation. If, as was very common, they had trench mouth, i.e. acute ulcerative gingivitis, or whatever its new term these days. I do get confused.

Nairn Wilson: The perio people keep changing the terminology, but it was well known then that given your mouth’s such a bad condition, if we give you an anaesthetic, it’ll probably kill you. So, maybe we’ll operate without the anaesthetic and you might survive. Now that was in the first world war. Same message, yeah? And our medical colleagues who given a hundred years that this sort of stuff has been appreciated, it hasn’t twigged on them. And when they’re giving all… Mike is saying they’re showing all these pictures of people coughing and sneezing and so on. Where’s it coming from? At least half of it’s coming out at the mouth, yeah?

Narin Wilson: Tony, what’s your experience? Okay, we’re saying central government medics don’t appreciate where we’re at, but once it filters down to dentistry, is it the chief dental office, is it the GDC, is it CQC? Who’s going to regulate, or is it down to the professionalism of the dentists themselves going forward?

Anthony Kilcoyn…: I think my other two colleagues on this forum today have made an excellent point that generally dentistry is being undervalued and it’s probably due to a lack of wider knowledge. Even in our medical colleagues, but also regulators, politicians, the people with power. They really can only relate to their own personal experience of dentistry. When I speak to them, lobby them, as do many of my other colleagues, they’ll often quickly refer to their personal experience with their dentist.

Anthony Kilcoyn…: So, that’s very important. Don’t get me wrong. That is very important, but their relative breadth and depth of knowledge of dentistry is not good, and that’s being subtle. Unless it becomes a news story, or a disaster, or a problem, and then they look at it and it becomes an irritation and an annoyance. And for so long I feel like we’ve been the Cinderella of all the health care sector. I think the only other healthcare sector that’s probably treated even worse than us is mental health. Well, after that it’s us. It’s dentistry.

Anthony Kilcoyn…: We’re highly skilled, we’re highly trained, we do five years at university, and all the other additional skills. Narin said the point of we have a bigger role to play in society as diagnosticians and interpreting the results and doing it well. We’ve got a big role in improving oral health to improve general health, and we can monitor and interpret that.

Anthony Kilcoyn…: We do medical histories on everyone all the time. Our quality of PPE and routinely changing things between patients. I don’t know about you guys, but I laugh sometimes when the show a TV clip of the medics struggling and they almost need that second person to remind them what to do in more order, because they’re doing something out of the ordinary. We’re looking and thinking, “Well, it’s obvious how to put a mask on and take it off, and not touch the front and not contaminate it.”

Anthony Kilcoyn…: We do this between every single patient. That’s our normal. We are very good at this and that’s I think is actually what has protected us for so long. But the appreciation of what we can do and what we do for society is very poor in many levels of politics, regulation and even in all these advisory bodies at the moment. Going into SAGE, how many dentally qualified people are on SAGE? NERVTAG, who then feed into that, and then when they do all that evidence about PPE and saying, “Oh, you can wear the mask for a full session.”

Anthony Kilcoyn…: We’re all scratching our heads thinking, “Well, hang on a minute. That’s even worse than what we were doing before. We were changing everything between patients.” And I drill down all their evidences and papers, and there’s about 19 papers. They’ve lumped us in with all the medics again, but there’s only two specific papers there that are dentally related.

Anthony Kilcoyn…: And one’s from 2011 and one’s from 2006, and you sat there thinking, “Oh, my God, they’re talking about this wonderful NERVTAG panel they’re feeding into SAGE, they’re feeding into COBRA, they’re feeding into the politicians.” And you sat there thinking, “Basically they’re using two out of date references that sort of semi-related to dentistry and they have no idea what’s happening on the front lines.”

Anthony Kilcoyn…: You ask the CQC who is the best healthcare performer of all the healthcare sectors that they regulate, who’s the best? Number one by a mile: dentistry. In fact, they were surprised that why is dentistry been added to our list to inspect? When they went around the practises and saw what happened, and saw how intrinsically patient centred we are, they were scratching their heads thinking, “Why have we got dentistry?”

Anthony Kilcoyn…: We’re in the top 90 odd percent performers. We’re so good. They’re actually saying on average we only need to visit you once every 10 years. Everywhere else, the hospitals, or the medical clinics, they’re in the 80%. They’re struggling. The poor care homes at the moment, they’re far higher risk and don’t have the same cross infection control and what I would call a closed circuit environment that we control so well, and have been patient focused for decades.

Anthony Kilcoyn…: This is not new to us. This is our bread and butter. And we are very, very not just unappreciated, but nobody realises actually just what high standards we have routinely. So, this is when people talk about after lockdown and going back, and so on. I don’t think we’re a million miles away at all. I think medicine might be. I think the way we visit people in hospitals and wards, and the free flow of vectors with different patients and hospital acquired infections.

Anthony Kilcoyn…: Somewhere between 4000 and 8000 people die a year from a hospital acquired infection. They went in with something and ended up catching something else and it killed them. So, we just don’t have that in dentistry, because we’re so well controlled. It’s our closed environment. Okay, patients are there for a relatively short time and they’re not residential overnight, but we’re already in tight control of that. So, when Mike says stuff about the aerosols and so on and reducing it, we’ve been using high volume suction for a long time.

Anthony Kilcoyn…: In fact, as I go around and inspect practises, we’re all supposed to have extractor fans in the room. Now it goes through different phases of how important that is, but even health and safety executive will tell you that there’s a minimum of air change that has to happen every hour. But if you look at the latest guidance coming out about these high filtration units now, they’re talking about if you have six room changes of air in an hour, then you need to leave an hour between patients to be a hundred percent sure there’s no aerosol there.

Anthony Kilcoyn…: But if you have 12 changes in hour, you can leave 30 minutes. And, of course, everyone’s going, “Well, I don’t know what my fan does.” So, I had to go back and look at mine. Mine does 15 an hour, but that’s the 12 inch Xpelair super duper one, because I remember putting it in and thinking, “Well, if you’re cutting up through all through my glass, we might as well pay another 50 quid and have the better fan on, because I’m doing it once kind of thing.”

Anthony Kilcoyn…: So, who knows? So, of course, we need some at near the mouth and so on, but what I’m saying is we already have a lot of these risk reduction ideas in place. We might have to enhance in some way. We certainly are going to have to screen the patients better. We can’t have 40 people a day just coming and filling up the waiting rooms and being too close to each other at this time. So, we are going to have to streamline that, but I think with a few sensible risk reduction approaches and the phased approach, not because we’re high risk but because psychologically we just need to reassure patients first, nobody dies. Right, we can step up a gear and so on.

Mike Lewis: Right, can I just come in on that just to support Tony completely on that. Firstly with regard to washing your hands, PPE, et cetera. When we did infection control audits across this site, that’s not just the dental hospitals, but it’s the University Hospital of Wales, the biggest hospital in Wales. Dentistry always came out on top. Our house was in order. We were always up there in the high 90% for adherence to the hand washing and an appropriate PPE. So, tick that.

Mike Lewis: I can give you examples of that in a large hospital setting. Also with the air clean systems, I was actually… I unfortunately couldn’t go and look up the value, because I had to go and see a patient, but I’m glad you reminded me it’s six air changes per hour. But in fact some of the ones I was looking at earlier today will do 20 air changes per hour, which is even better than your 15. And I think with that type of volume air clean, that’s the what we can say to people, “Look, we’re doing this. It’s safe to come into this environment.” I can’t agree with you more.

Nairn Wilson: How do we get out of this? Become part of the agenda and to get our message across. And disappointing if our CDOs are not part of the core team, or they’re saying these things and they’re not being listened to. I’m sure people have said these things to our chief dental officers and so on. And I feel sorry for them if they’re not being listened to, or I feel…

Nairn Wilson: Goodness what goes on? You have a chief dental officer, you ought to listen to them, yeah? If they’re not being listened to, that’s a real problem. I think one of the things that has to come out of this at the end of the day, other than getting dentistry up and running, and go back and say, “I think a great way to get it will be to be testing centres and get recognised through that.”

Nairn Wilson: We must address this once and for all, and be part of the healthcare agenda in this country and indeed internationally. As and when the next crisis, whatever it is and what shape it takes, whether it’s AIDS, respiratory, something else, we’re not the forgotten tribe of well-trained healthcare professionals who comply, who are good at this stuff, and can really make a difference and make a major contribution.

Nairn Wilson: We’re currently just forgotten, or we’re not on somebody’s radar screen. And that’s really, really sad. And one of the things I would like to do again with my new college is that very much a part of the agenda. Dentistry has never had its own independent college, let alone our own college. Maybe we’re not being heard because maybe the secretary of state says, “Get all the presidents of all colleges in here.”

Nairn Wilson: We’re not there, because we don’t have a college, let alone our own college. So, we’ve got to take all action we can to be at the right place and be at these high level meetings. So, the voice can say, “Hey, dentistry could really help here. We can do something.” And you could keep these dentists and their dental teams employed in the process, not run the risk of them all disappearing and going bust. And no dental service as and when we do get back to business. It’s sounds a no brainer to me.

Mike Lewis: That very point. When I was Dean of the Dental Faculty at the Royal College of Physicians and Surgeons in Glasgow, when I was chair of joint faculty meetings, I tried to get representation for dentistry from one of us from the four colleges onto the academy and medical and they said no. And what happened was one of the medical presidents or surgical presidents represented us, but I thought dentistry should have… And I fought and I did the battle for a year and I gave up.

Anthony Kilcoyn…: I think both guys have made great points. We need to raise dentistry’s profile. I suppose if there is a silver lining to this cloud, what I have noticed is a quite positive side effect is that it’s unified dentists and dentistry with a common sense of purpose. We’re all struggling in different ways. We’re all quite keen to get back to help patients.

Anthony Kilcoyn…: We’re all thinking in the same direction and we’re all feeling a little bit under utilised and unappreciated at the moment. There’s examples of colleagues now setting up urgent dental care centres. They’re buying their own PPE, they’re bringing in all these extra risk reduction things. There’s almost zero support coming in from the system and they’re the only ones who are trying to look after this tsunami of acute need patients at the moment. And it’s just totally inadequate.

Anthony Kilcoyn…: So, in a way by allowing a phase one in a bit perhaps earlier than they might have been thinking about, it would actually be a dual benefit. It would take some pressure out of the central system. Let’s be honest, by the time they get around to planning something that actually works, most practises could be looking after at least that level of acute care themselves, be doing it safely and well, following certain protocols, and doing risk reduction assessments.

Anthony Kilcoyn…: And, yeah, we can’t see 40 patients a day like that. We’re going to have to slow it down and have no more than one person in the waiting room and family members can sit in the car, or however we manage that. There’ll be ways of doing it. They’re going to be some people we’re still going to have to do an AGP on now. Now it might be we’re allowed to do one of those a day and they’re the last patient of the day. Whatever. There are ways to risk reduce, to risk mitigate, and to do it effectively and safely.

Anthony Kilcoyn…: And there’s certainly a big desire now in our profession to just… We’re doers, aren’t we? We want to crack on and get this solved. We don’t want bureaucratic barriers stopping us from providing the care we know we can do safely.

Prav: Tony, you mentioned about cracking on and doing and all the rest of it, and funnily enough I got off the phone with a colleague of mine who’s a dentist in Sweden this morning. And he’s a personal friend as well and I just said, “Listen, mate, what’s going on out there? How has dentistry changed?” And he said, “We’re operating at approximately 30% to 40% of our previous rate.”

Anthony Kilcoyn…: Yeah.

Prav: “We’re being sensible. We’re wearing visors. We didn’t wear visors before. There’s gaps between patients. We’re doing AGP and I am looking after my existing patients. I’m not taking on new business. I’m not advertising. I’m not doing any of that, but we are just being sensible about it.” Same story in Germany, same story in Finland I hear.

Prav: Do you think we should have taken that approach, or do you think the approach of completely closing down in line with letting the peak come and go and isolate was the right thing to do, or should have we been following our colleagues in Europe?

Anthony Kilcoyn…: Sure. I would just say one word of caution.

Prav: Yeah.

Anthony Kilcoyn…: If I look at it, I’m sure like my fellow two colleagues, we have lots of friends and connections.

Prav: Yeah.

Anthony Kilcoyn…: And academic…

Anthony Kilcoyn…: We have lots of friends and connections, academic as well as frontline level dentistry, and in the medical and especially virology, immunological… So it’s really interesting, isn’t it, just to compare-

Prav: Of course it is.

Anthony Kilcoyn…: … what a country’s done, different systems, how they’ve approached it. Do you know what? They’ve nearly all done it differently. They’ve been at different phases, with different problems at different times. We can pluck out the dental bits but we do have to be careful to see how has Sweden done that in the context of how they manage the general population, and that’s why it is a bit different.

Anthony Kilcoyn…: So I’ll give you one example of mine: Thailand. So I was there in January, speaking at a massive dental conference. It was like a joint conference between Thailand and Germany. It was just packed. Thousands of people, over a week. Of course, I’m arriving at the airport thinking, “Oh, why are they doing the thermal checks on the temperature as people arrive?” It is that part of the world where about 20% of the people walk around wearing masks anyway.

Anthony Kilcoyn…: It’s really interesting how they behave and interact. Very polite, lovely people. They always find it a bit strange when I put my hand out to handshake because it’s a nice, respectful bow, at a respectable distance. So they kind of respect personal space. There’s none of this hugging or French kissing on both cheeks, or whatever. Suddenly, as a lookback exercise now, I’m thinking, “Wow. They were already intrinsically safe in many ways that they behaved.”

Anthony Kilcoyn…: They’re not more high tech than us, although it has advanced a lot as a country, but I would say, probably because they’ve had experience of bird flus and swine flus and they’re in that Asian region where there’ve been many epidemics and pandemics before, they were far more prepared. They’re a far more compliant general population. Again, like us, they adhere to cross-infection control as dentists very well. But the first thing they did was, they had the sterilisation arches. So whenever you went to a shopping mall or anything like that, you had to walk through an arch and it would just spray a mist on you, which was antiviral or whatever. But everyone just cooperated with that. They’ve had a lockdown of sorts but it’s been a mild one, but what they haven’t done is the widespread testing in the population and so on. I think probably just because of costs and so on. But they took early preventive measures.

Anthony Kilcoyn…: Now, their dentists, they’ve stopped for a while and they’re starting again. They stopped for a while and they’re starting again. But do you know what the total number of deaths was? And I’m about a week and a half out. The total number of deaths from coronavirus in Thailand: 41.

Prav: Wow.

Anthony Kilcoyn…: We were getting more an hour last week, of deaths.

Mike Lewis: Also, in South Korea, I was in South Korea a couple of years ago, and South Korea, I think their death toll is less than 40.

Anthony Kilcoyn…: Yeah. It’s incredible, isn’t it?

Mike Lewis: It’s similar behaviour.

Anthony Kilcoyn…: So the bigger picture is important. We pluck out the dental picture, which is actually very encouraging because, as you know, there’s been studies in Wuhan. They’ve even looked at the dentists who worked all the way through there and whilst there’s some casualties, it’s no worse than the general population. So it’s more likely that it happened out of dentistry than within.

Anthony Kilcoyn…: So there’s some hope that what we do is intrinsically protective but, again, I think we have these physiological barriers to overcome here, both for our own worry and our team’s concern, as well as the public. So I think it will be a turn the taps on, dip your toe in the waters, get a little confidence with that and you move forward from there.

Narin Wilson: Yeah. Our position in the U.K. is that we’re not integrated into general healthcare. Part of the issues in Thailand and Germany and Sweden, all these countries that we’ve mentioned, and many other countries around the world, dentistry is much greatly… much more value put on it and it is seen as an integral part of the healthcare system, and these people are very much part of it, not as an add-on as we often feel in this country.

Narin Wilson: One of the things I felt I failed to do in my career is to do this, to achieve it, and there’s all sorts of examples, issues about general anaesthesia and this and other, and various things. You go to government briefings and stuff and they produce stuff and you had to stand up and say, “When you talk about medicine, do you include dentistry or not?” Isn’t that sad, that we had to ask, “Does this apply to dentistry too?” Of course it ought to be because we’re meaning it to involve nurses, pharmacists, this, that and the other, but we weren’t sure whether it meant dentistry as well.

Narin Wilson: I think one of the things we must learn from this and take forward is we’ve got to address this, and we’ve got to put that one to bed and catch up with the rest of the world, that do value good oral healthcare and dentistry and appreciate it more than it has done so in this country.

Narin Wilson: But coming back, I very much hope that a way can be found to get us moving again. I totally agree with Tony. It’s a bit like the tsunami that cancer care and hip surgeons are going to have once they get started again. We’ve got the same problem. I agree entirely with it, and the sooner we get started and we can find a way to get in and use our expertise and our resources. It’s a wonderful geographic distribution of well-trained healthcare professionals, and here we are sitting frustrated.

Payman: What about going forward, the psychological part of it that we’re talking about? Firstly, for dentists and teams, will they feel confident going back, as far as safety? And then, secondly, patients. Even when, let’s say, the regulators or whatever decide that we can open, what can we do to encourage patients to come in? To the approach of, in the media, is it right to talk about aerosols in the media or isn’t it? This influence that you’re talking about, Prof. Wilson, do we get influence by politics or do we get that influence by media, or is it a combination? What are your thoughts on the psychological side?

Narin Wilson: I think you’ve got to fire on all fronts: media, politicians, et cetera, and do it in a meaningful way, not get angry and aggressive because that never helps. Gently reminding people, “Hey, we’re here. We can really help. We can do things,” et cetera. It won’t be the regulator. It’s impressing departments of health, Public Health England, NHS England, the Chief Medical Officer and the Chief Dental Officer to think afresh and to stand back and say we must embrace this, all aspects of dentistry. Not just the NHS, the whole of dentistry, including private dentists as well. If you said to a private dentist, “Will you help? You can make a difference,”… of course a bit of funding to cover costs, et cetera… I bet you they’d all say, “Of course I’ll do it.”

Payman: Yeah, of course they will.

Narin Wilson: We’re a very professional group of people. As Tony said, just give us a chance. If we’re given the chance, I think we’ll get the route in to getting back, and getting back and established. I think a lot of the psychology, if we embraced by the system and they talked to us in the way that they talk about nursing and pharmacy and so on, then I think that would have a great transformation in the public perception of dentists as well. If we were seen to be part of the family, I think that would make our lives a lot easier. I think part of it is that we’ve, historically, not been included. I think getting around that psychological stuff, if we were integrated and we were talked about as if we were part of the healthcare family, I think a lot of these issues would disappear or be a hell of a lot easier to deal with than they are as at present.

Prav: I know we’re running short on time and something that’s very high on the agenda that I mentioned earlier on is what is this new SOPO protocol going to look like when we come back to dentistry. Let’s say when we come back to AGP dentistry, for example. I think if anyone can answer this question you guys can, having the research background that you have.

Prav: The key things that have been brought up in conversation after conversation is PPE and the level of it. Obviously, high volume aspiration. Fogging. Hyperchlorus in the lines. Clean air technology. And then another hood of suction that sits above the patient that sucks some air out. So it’s almost like some practises are going like absolutely ninja on this, right? I’m looking at this and thinking, “How is this sustainable?” And if

Anthony Kilcoyn…: It sounds like we’re going on stage of Britain’s Got Talent and the fog clears and the dentist appears in full PPE from head to toe with the patient in the chair!

Prav: Absolutely. And gives

Anthony Kilcoyn…: Look. I’m on many forums and still Zoom, and meet with many dentists up and down the country. Because there isn’t this guidance that’s clear for all of us, we’re all making up our own and chucking it into the pot, and it’s just chaos, and that’s worrying.

Anthony Kilcoyn…: Cut a long story short because I realise we’re running out of time. The best one I’ve seen so far, and I hope Mike Lewis agrees with me, is the Welsh SOP. They released it only just a week ago, so it’s one of the most modern ones as well. I would still pick faults at it and adjust things in it but if you’re going to score something nine out of 10, it would be that. So I think that’s a good basis for the other CDOs to look at that and adapt it, and then just modernise it again in another week or so because it will be two weeks out of date by then.

Anthony Kilcoyn…: We’ve got through April. We’ve got through the peak risk to the general NHS system. I’m kind of half pleased we’re not hearing much about Nightingale and the ExCel Centre because it’s not getting used. Apparently the Birmingham one’s totally unused. So we’ve now got excess capacity with the ventilators and the ICUs and so on.

Anthony Kilcoyn…: So the general burden on the NHS, yeah, it’s still big, we still need to applaud them every Thursday night at eight o’clock, but it’s not what it was and now, this is 1st of May, I think we can start looking forward instead of backwards and start planning it. But you’re right, we need something to say, “Look, this is the start. Use this as an example.” But it’s a continual process. We’ll all have to adapt it in risk assessing our own environments.

Prav: Tony, are you a practise owner?

Anthony Kilcoyn…: Yes.

Prav: So what would your SOP be going back, and obviously I don’t

Anthony Kilcoyn…: Well, I can tell you mine.

Anthony Kilcoyn…: We’ll be here all day. So I’ve already been

Payman: I’m sure you wrote an article 10 years ago about this.

Anthony Kilcoyn…: Yeah, I did. I wrote an article 10 years ago almost predicting this, I would be wiping door handles down and so on. So those are our protocols. I’m hardly going to have to do… I will have to do some things but I’m not going to have to change much. I think there’ll be a lot more prescreening before people come down, and so on. Mine is a private practise. So I have more time per patient and I don’t have 10, 15 people sat in the waiting room all the time. So actually it lends itself to this.

Anthony Kilcoyn…: So I think NHS systems are going to have to change and start looking at units of dental time and making it practical and work, and that’s a subject for a whole other seminar I’m afraid. The private practise will have to adapt but it isn’t going to have to adapt that much. It isn’t going to have to adapt that much because it’s already kind of units of dental time focused. Dentistry is very good at finding solutions to problems. That’s what we do, that’s our day job. So someone needs to just bring this together and give us the starting point. Let us go, and we’ll evolve quite quickly.

Prav: Am I right in assuming that NHS and private dentistry will be measured by the same yardstick, so the same standards will apply? Because, from my understanding, I might be incorrect here, the CDO is the voice for NHS dentistry. It that right?

Narin Wilson: No.

Prav: Oh, is that not right?

Narin Wilson: The role of the all the CDOs is very careful, it’s overall responsibility for the oral healthcare of the nation. They have a focus on NHS understandably, because that’s the government funded side of it, but the role is to advise ministers and so on on the oral healthcare of the nation. Yeah?

Prav: Yeah.

Narin Wilson: We, as a profession, should work… and I keep thinking it’s so unfortunate that we have this division because most practises are mixed economy anyway, and that’s another thing I would like to see getting rid of. This is the nature of the beast. Very few people can survive on NHS only. Hardly the entity of an NHS practise because most practise has got an element of private, they’re all mixed economy, and there’s relatively few absolutely purely private that don’t do anything in the NHS. So we should, again, try and get away from this. We’re dentistry and we’re dental practises, and of course we’re there to serve patients first and foremost. We do it in subtly different ways.

Narin Wilson: If I come back on the guidance, it will never be specific for everybody because all the practise and configurations and the nature of them, the age of the building, quality of the ventilation, all the rest of it, as with anything, the guidance will be a bit generic and it requires our professionalism again to apply the rules and make them work in all of these different environments, that you feel safe, your staff and your dental team feel safe, and your patients are going to feel safe about coming into it.

Payman: When we talk about going back to normal, one thing I wouldn’t want to go back to normal is the volumes of patients the NHS dentists are seeing because if you look at… they’re seeing 30 to 40 patients a day. If you look at a five minute clean up in between those, it’s impossible to see 30 or 40 patients a day. So the clean up must be one minute, and one minute’s not enough to clean the surgery pre-COVID.

Payman: So if something can come out of all of this, perhaps it’s that the NHS has to change, and maybe that means people have to start saving for their dentistry, which hasn’t been in the culture here as it has been in lots of other countries. But we do need to pull out some silver linings from this cloud, and I think that will be one of them, that the NHS finally changes and either becomes a core service or more money goes into it, God forbid! But somehow I don’t think that’s going to happen. But who’s going to pay for it?

Anthony Kilcoyn…: I would just say, that’s been an ongoing issue since UDAs came in in 2006. Target-based healthcare-

Narin Wilson: Even before then though.

Anthony Kilcoyn…: … has been recognised as not good anyway. So maybe this will be the catalyst that finally drives some change. Instead of having pilot after pilot after pilot and kicking the can down the road, maybe finally someone will go, “You know what? Let’s grasp this nettle. Let’s make something fit for purpose.”

Narin Wilson: I couldn’t agree more, Tony. No disrespect, something like the Jimmy Steele report, lots of great stuff in it, still relevant, but that’s now… how old is that? 12, 13, 14 years, and the world has changed in that time, let alone through this episode, and we can’t be building a system on a report that’s that old, and through this.

Narin Wilson: I couldn’t agree more that, again, a fresh approach, a fresh look at this, the feasibility of quick turnaround, high volume patients, et cetera, it’s not going to work. In a new world and the new norm, there is a need, and a realisation that… and your pragmatism about what money can be afforded for oral healthcare and how do we spend that best. If, in the grand scale of things, as is common in most countries, total spend on health, that you can afford 2%, 3%, or something, of the total spend relative to cancer and all the other things you do, and that’s about what the level is, what can we do with that money and use it to best possible advantage to achieve something that we can all be proud about, and we can all sign up to and move on.

Narin Wilson: Yes, I think if there’s a silver lining, it should precipitate a fresh look and a fresh consideration of we need oral healthcare, it’s important to general health, let’s do it in a way that can be a good use of money and can be most effective, and we can all feel very proud about it and get on with it.

Mike Lewis: Just have to say I absolutely, totally agree. Gentleman, I am going to have to go in five minutes because I’ve got a patient to see in the emergency clinic. I’ve found this last hour fantastic. It’s a great opportunity to have discussed this problem from the various angles that we’re coming from. I thoroughly enjoyed it, and I hope that anyone that watches this comes out with… gets the impression that we are all trying to work to the common good to get our profession back on the road and in the best possible shape.

Anthony Kilcoyn…: I agree.

Prav: Thank you so much.

Mike Lewis: Thank you.

Payman: Thank you. Maybe we’ll reconvene in a month and see where we are.

Mike Lewis: Indeed, indeed. On PPE.

Payman: Thanks a lot, guys. Thank you so much for taking the time. I know you’re all busy.

Anthony Kilcoyn…: Thank you.

Mike Lewis: Thank you very much. See you, guys.

Mike Lewis: Bye, everybody.

Anthony Kilcoyn…: Cheers.

Outro Voice: This is Dental Leaders, the podcast where you get to go one-on-one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.

Payman: Hi guys. We’ll come to the dental leaders podcast. Today’s guest is Neil Jay’s, well, one of the most high profile dentists out there. Not only because of his love of cars and what kind of guy, he’s a connector, knows everyone in dentistry. The way I see it lately. He’s also started a new defence organisation. So I thought it was super nice talking to him finally, you know, in public like bears to get his sort of state of the union on generally on where things are and especially [00:00:30] at this time perhaps with the GDC issues and the defence issues to have the balls to say I’m going to have a defence organisation. It’s just lovely to see that

Prav: it’s cool and just his, you know, what it took away from that was his approach to providing cover based on measuring risk accurately rather than just taking a blanket approach to defence. And then his love of cars. I was never aware that you could own half a car. [00:01:00] Phil Neil told us about, about the concept. So really interesting conversation. Really nice guy. It just great chatting and um, apparently we have the same body posture. So he told me anyway, enjoy guys. It’s going to be fun.

Neel: It’s really nice. Now where was, I was like gumball on Regent street and I was queuing up to watching the cars go past and there was three guys next to me and Oh, let’s take a picture for turbine and I go, that’s me. That’s me. So [00:01:30] the artist,

Intro Voice: this is dental leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts Payman Langroudi and Prav Solanki.

Payman: Lovely to have you.

Neel: Thanks for having me.

Payman: Thanks a lot for coming down. I’ve known you for a long [00:02:00] time because your dad is friends with Sanchez. That right? My partners Dad?

Neel: So I grew up in a little Northeast town called Cleethorpes, which is near Grimsby. So it’s in the Northeast coast. It’s funny, people think I’m a southerner, I was born in London, but no, grew up in Grimsby and quite proud of it. And actually San Jews, one of the enlightened directors, obviously a dentist as well. We knew his whole family, a very early age, pre 1977 or something.

Payman: Your Dad’s a doctor?

Neel: My dad’s a doctor. His dad was obviously [00:02:30] a doctor as well. So I’ve got fond memories of, you know, an Earl and Sanje and going to Cleethorpes beach and eating ice cream and riding donkeys.

Payman: Did you have in Cleethorpes until you went to university?

Payman: No Cleethorpes and Grimsby, which has sort of neighbours and then Sanjay moved to Birmingham, but we stayed in touch. And then just by chance we were both dentists. And actually when I came to uni in 91 I don’t think I had accommodation for a little while. So I stayed with the parents and you know, stayed in the house for a [00:03:00] few months.

Payman: So you studied in birmingham?

Neel: Yeah. So I studied in Birmingham and obviously Sandra’s in Cardiff and yes, I’ve known him a long time and it’s, you know, I’m really proud to see such a nice guy as you know, a very humble guy. And just to see his development and I’ll CC you guys how well you’ve done with enlighten, with all the struggles he had. People don’t see the struggle. I saw you guys struggling and it’s so pleasing to see what you’ve become.

Neel: So no. Yeah, I’ve known him a long time probably, you know, 40 odd years.

Payman: So what kind of, what kind of a kid were you? Were you academically good [00:03:30] to you? What kind of kid were you?

Neel: I think generally I’m quite bright and I’m quite sensitive, which is a kind of way I’m now, I’m a relatively intelligent, relatively sensitive to communication and people. But I have to say I was probably, I struggled a little bit in childhood with confidence and with being the only Indian person in the school. So I think in junior school isn’t the, you know, one in a couple of hundred when you went to secondary school? I was one in 1200 I think I always gravitated towards girls. I’ve always [00:04:00] liked girls, you know, and their company, lots of female friends. And I think that’s just comes from a young age where, you know, they’re more comforting, the more nurturing, the more social, whereas boys just want to hit each other or.

Payman: Do you have a sister?

Neel: Now just me and a younger brother who is a solicitor. So I kinda think I developed into a sort of a softer person and maybe not so confident. And then as I got a bit older through uni and not through uni, through secondary school, I think by the second year people sort of see you as an individual [00:04:30] rather than as a, you know, you still get it here and there. I mean it was a tough area. Grimsby, you know, is not the most salubrious of places. So that was a little bit tough. But I remember one incident if then, if he is a bit of a boring one, but I remember we used to play football. I used to love football, used to play a lot of it. So you know, every lunchtime, every dinner it goes to the yard and you’d, you’d have massive football games.

Neel: And I think I was probably a first year and some of the second or third years were trying to steal the ball off me. It was my ball. I remember holding onto it really tight and all these kids trying [00:05:00] to grab it and push me around and stuff and I didn’t let go. And I think after that it wasn’t me standing up for myself. It was just, it’s my ball and I think a little thing like that and it just changed the balance and they left me alone. Bizarre, stupid little thing.

Prav: You mentioned you were the only Indian brown guy in school. Me and my brother were the same. Right. And.

Neel: Where did you grow up, sorry,

Prav: Manchester.

Neel: Okay.

Prav: And we went through a pretty rough time, especially a primary school. Can you, did you have a similar experience or,

Neel: I think not in primary [00:05:30] school. I think they were just quite nice. Primary school kids and middle-class parents. And initially I went to sort of a quite a nice primary and a posh school – a junior school. And then my dad took me out of that as, it must’ve been finances, I think, and went into a Catholic school. So I actually probably did six till 11 in a Catholic school. So I’m quite good at ASCE and uh, you know, and I’m Catholic school. Yes. Yeah. So we all can sing to hym.

Neel: [00:06:00] Right. I mean it was quite interesting and that, and that’s where I’m kind of, if you want to go into religion, I had quite a Hindi background, but I also had that kind of Christian background. And then as I’ve grown up having Jewish friends and Muslim friends from Birmingham, you kind of see all the similarities between all the cultures and religions. And it’s a shame that we’re all divisive. We’re actually, you know,

Payman: Do you believe in God?

Neel: I don’t think I’m clever enough to sort of, I mean, a belief is a belief. So, you know, who knows. I would say obviously this higher [00:06:30] power, there’s a spiritual nature in us all. We naturally want to do good things, you know, and help each other. That’s the natural human state. So yes, I believe in God and I kinda think God’s come to us all in different ways.

Neel: I don’t think he is just for one type of nation or one type of person. And I kind think I, you know, the Abrahamic religions, whether it’s two days in Christianity, Islam, they’re all, to me it’s like, you know, star Wars, return of the Jedi is all a continuation. Really just different stories which get adjusted for the times, you know, weather, [00:07:00] things like not to eat pork, you know what I mean? I wouldn’t have very safe thing to do. So it’s interesting that, you know, Christianity and Judaism have that. Islam has that as well. So no, I definitely believe in it. I hope. I don’t believe in karma, but I think if you do the right things and do good things and help others, I think it’s practical. Yeah, it’s practically, it makes, it makes it, you know, it’s altruistic. You want to do things that you enjoy.

Neel: And one of the things is helping people.

Payman: Do you remember when you decided to look at dentistry as a career?

Neel: Didn’t want to do dentistry?

Payman: What did you want to [00:07:30] do?

Neel: I think I want to draw cars draw fast. That’s all I ever did when an aeronautical engineering [cross talk]. Oh well I liked art, I liked books. I read voraciously as a child, you know, book a day and you know, under the covers with a torch and mom telling me off at three in the morning when you know, Lord of the rings at nine 10 you know, difficult books. Shakespeare, I used to really enjoy reading so I was probably a reading creative type person, but obviously with Indian parents. So you know, when it came [00:08:00] to picking my O levels, which is, you know, GCSE for younger guys it was ‘right, you’re doing, chemistry, physics, maths, biology, and going to be a doctor.’ And I’d sort of done English, French, you know, art history.

Neel: So yeah, I didn’t really want to do dentistry and didn’t do very well in my O levels at the time. You know, as I said, it was a big comprehensive school. The average grade was probably D’s and E’s. I think I got C’s and D’s if I did better than most. But it really was a long way short. And [00:08:30] at that time dentistry and medicine were A’s and B’s, you know, it’s not like now where it has to be a triple star or whatever it is. So I was fortunate enough, and again, you know, people look at other people and think, Oh their parents have helped him out and this and that’s why successful. And you know, we all have those privileges. We all get help from a family and we would do that to our own family. But you have to kind of do it yourself as well.

Neel: You know, you can easily squander those opportunities. So I was lucky enough when I was 17-18 to relocate, although it was difficult,from Cleethorpes to Cambridge. So I re-sat my a levels in the six months [00:09:00] in a year. And I think it went from CD to AAB. So it just shows you maybe being away from home a little bit. That helps. But actually.

Payman: did get to of those tutorial.

Neel: to a place called st Andrew’s, which was one of the best times of my life and really, really just started to open. I was, yeah, I was a small boy from Cleethorpes and I ended up, everyone was wearing blazers. This was sort of 1988 now, you know, and there was people with helicopters from Nigeria, from Brazil, from [00:09:30] Boston, you know, all the global, kind of one of the like a Benetton advert, you know, really.

Payman: And it just changed me. And the way I, even the way I spoke, cause no one could understand that.

Payman: you have a Northern accent.

Neel: I didn’t know the accent, which basically involves swearing every other word and people really couldn’t understand me. And so you had to speak slower because there were foreign nationalities and they also, a lot of them were public school educated. So you just kind of, [crosstalk]. I can do it. Imagine you [00:10:00] with it. Not that I can do it just involves swearing. I don’t want to swear. I don’t encourage swearing. I’ll do it to later.

Prav: What about under the influence of like drink or something like that?

Neel: It’s so far removed. I mean it’s, you know, half it’s a half a lifetime away. I can do. It’s a parody. It’s probably not a real accident. I can kind of, I’m just caricature.

Payman: Caricaturing yeah. So then you decided to apply for dentistry?

Neel: No.

Payman: Oh, you didn’t even then?

Neel: No. Medicine. Dad was a GP, you know you’re going to be a doctor. And I knew I [00:10:30] didn’t want to be a GP because when we were younger we lived above the surgery and I just saw the amount of stress my dad was living above a surgery is not a good idea. And the kind of person he is, he was always on call. He would always help somebody. He would always…So all I saw with lots of ill people coughing in the waiting room and just these long hours. And it wasn’t like now when you were doing on call, you were on call and you were working the next day. And again having to put up with racism and things. I remember there’s all sorts of things written on our Gates and window smashed and car scratched.

Neel: But I mean [00:11:00] it’s always a minority and you know, most of the patients absolutely adored him. And that’s where I got my kind of caring side from. I think he was just genuinely, he put, and he’s one of the Indian dads, he put his heart into work and the family was left with mum and the kids to sort out. So he was very much there for his patients. And I do that a little bit as well. Now I’m there for my patients and when I’m off work I kind of really shut down a little bit and I’m a more closed person. So you know, you do develop into your dad to some degree.

Payman: Sorry to interrupt, but do you two feel racism now?

Prav: Certainly not [00:11:30] me. Not anymore. But growing up,

Payman: Does it ever crop up?

Neel: No. I mean I live in Wellington, which is a very white area again.

Neel: And I was at the pub quiz and I noticed – hang on – I’m the only Brown person here, so it didn’t, that wasn’t racism.

Payman: When you’re the only Brown person. I don’t think there is racism because you’re a curiosity more than anything else.

Neel: I don’t think they even notice. I really don’t think they notice.

Payman: You think as a country, Britain’s over that.

Neel: I think there’s a bit of a, well,

Payman: There’s a bit of a revival.

Neel: I know [00:12:00] in London, which is what I love about London. It’s a global city. And I consider myself a global person. So you know, we met Laura, the Lara, the other just now is Spanish and you guys and everyone’s from everywhere. And I think that’s the home counties is a reflection of London because London’s expanded. So I think where we are, it’s quite normal. I think if you do go to some isolated places, I don’t know.

Neel: I haven’t been there for a while, but when I did my VT in Norfolk, you’d get phone calls from patients saying to these speak English, you know, things like that. So that was 20 odd years ago [00:12:30] whenever it was. Yeah, I’m sure it’s better now, but it’s all about, um, the mix of people that are in place. And obviously I think also when communities isolate themselves, they sometimes don’t do themselves any favour. They become scapegoats, you know, rightly or wrongly.

Payman: So come on with the story. You, you didn’t get intimate.

Neel: I think my two A’s and a B weren’t enough. It would’ve been all right first time. It wasn’t enough as a re-sit. And then I think I probably took a year out trying to get through – I don’t even can’t remember – clearing and things like that, whatever it was at the time. And I worked a little bit at an accountant’s [00:13:00] in London, so I lived in Queens park, which was a really dodgy area at that time.

Neel: Did some travelling, went all around Europe. So that’s where my love of travelling sort of started. I mean my parents had taken me to India every two years, so we’d go to London two or three times a week and in Cleethorpes, if you’d gone to London, it was a big thing, let alone going abroad, you know it’s pre eighties /seventies when it just started, you know, the charter flight actually to go to London was a huge thing and go abroad. So I had already done that. And then I think it’s probably in that [00:13:30] year off, let’s call it , I Euro-Starred around Europe, you know this is pre-phones pre-internet pre-wifi? Sent a postcard here and there and I also got an amazing deal from – and i can’t quite remember it – but it was six weeks worth of airline travel in the States.

Payman: Yeah, we did that.

Neel: For like 600 bucks.

Payman: Something like that on any Delta plane that is there is a seat on, yeah, nothing. We used to, we used to run out of money in Miami and say well we can’t afford a hotel. [00:14:00] This is get on an overnight flight to San Francisco, get a meal, get some sleep.

Neel: Was it six weeks?

Payman: It was a monthly thing.

Neel: A month or something.

Payman: If it was the same thing as I’m talking about, it’s called Delta.

Neel: I’m sure that’s it. I’m glad you remembered cause.

Payman: We had it on our elective.

Neel: How old were you then?

Payman: Elective, so 21-22, that sort of thing.

Neel: He must’ve been around that time because I went to everywhere I went to Minneapolis.

Neel: Um, I went to Minneapolis. I’m a big Prince fan.

Payman: Yeah, me too.

Neel: And in terms of, you know, when [00:14:30] you’re growing up, you’re talking about that earlier, you sort of, you want an identity and obviously you know, so I sort of took on Prince’s persona a little bit. Not with the falsetto but just kind of a little,

Payman: Did you get to Paisley park studios.

Neel: I didn’t get to Paisley. I did get to Minneapolis and stood outside first Avenue. I couldn’t actually get in. I was too young. But it’s interesting, you know it was just for me, ‘oh, Neel’s a Prince fan’ and it just gave you an identity and obviously you grow out of that. But I think teenagers do need to sort of figure out who they are or even adopt a persona. [00:15:00] And I do, I mean having the younger patients now I really feel for them because they can’t hide or they can’t reinvent themselves.

Neel: And you know, there’s all the Facebook and Instagram and you see that some of the bullying and the way society’s changed. So I think we were, we were more sheltered, but we also were allowed to develop yourself in a different way without, you know, the whole exposure of what happens now.

Payman: So then what happened?

Neel: Er, didn’t get into medicine. Got into dentistry. Though this is going to be easy.

Payman: Were you disappointed in yourself? What was – I mean – how did you feel? You feel [00:15:30] like a failure?

Neel: I think when I got my level results, I was really happy. You know, getting two A’s and a B in six months or nine months, you kind of think, Oh, this is good. I remember the joy of that. But I suppose as a teenager, introverted, you don’t, you know, you’re not a grown man, only about 35 years. So when you’re an 18 year old, 19 year old, you don’t know what you’re doing.

Neel: You don’t know the how it’s going to affect your life. So I just think I just got tottered along in my sort of belligerent, Kevin and Perry way.

Prav: Were your parents happy with dentistry?

Neel: Uh, [00:16:00] no. I think they thought it was a failure really. I think there was a thing that dentists were, you know, medics didn’t make it, and actually I wasn’t sure about dentistry. I did think was going to be easier if it wasn’t going to be medicine. So I did cruise a bit, but I remember sort of my first – I had two positive experiences of dentistry when I was younger, which kind of made me think this might be okay. One was I had a horrible dentist who I hated when I had a little filling occlusal amalgam, which I’ve still got up and then didn’t go back to him for years.

Neel: So managed, luckily got away with it but I was used to these [00:16:30] old school dentists who weren’t very nice. I went to see probably when I was 15-16, Peter – I can’t remember his surname – is still practising in Cleethorpes, and I thought, Oh, he’s got a nice car, and his hygienist is nice. And he showed me the x-ray and they did a scale and polish. I thought that felt better. So actually a saw even then, you know, which was 20-30 years ago, a different side of dentistry. And the other person was Neil Sikka. I’m sure you guys know Neil Sikka So he’s from Grimsby as well as all the good people from Grimsby and he had a Saab 900 convertible and he [00:17:00] seemed to be doing really well. And I thought this dentistry actually might not be just a secondary job. It actually has its own merits. So I think I had that and it, it did take me till I kind of finish university and beyond really to find the dentistry that I enjoyed doing.

Prav: So from that age it seems you had a passion for cars.

Neel: I think. Yeah. I don’t know where it came from really. But it’s again, probably from childhood dad taking you to motor shows, you know, that was such a big thing at that time. You know, you’d go to the London [00:17:30] motor show and you get these to get loads of freebies, you know, all the little bags full of stuff, which is like the dental showcases used to be, you know, when you’re a student. So I think that, and I remember also my dad first having a mini, you know, small little mini, which was our family car, you know, I don’t know how we all got in there. And then I think he went from that to afford Granada, which I used to say Ford Banana because I couldn’t say Granada at that time.

Neel: And then he went to a Mercedes. Now this was probably 1978 and if you’re an Indian person with a Mercedes, you kind of made it, [00:18:00] you know, it was a orange one or a and then a cream worn. And I actually thought the joy of him having that car and seeing actually all the, the abuse and the effort and the hard work. So to me it was kind of the reward for him. And I think probably that sort of stuck with me a little bit in terms of that. And then so I’ve always liked cars and then I’ve enjoyed driving cars as you’ve got a bit older.

Payman: So we’ll fast forward quickly then to Turbine the Facebook group . You started [00:18:30] that when like two, three years ago, longer,?

Neel: You know, time is really weird.

Payman: Can’t remember?

Neel: I don’t know what I had for dinner yesterday. And the thing with phones nowadays I found it takes a bit of your memory away because you rely on it for phone numbers, addresses so, you know, it’s like it should be connected and wired into us.

Neel: Yeah. So I actually don’t know what day time, year or what I’ve done. It’s because you’ve just automatically in your brain switched it off. So that’s a dangerous thing. So I don’t know how long it’s been going to answer your question. Probably three or four years.

Prav: How many members?

Neel: I think it’s pretty good. 1500 1600 [00:19:00] and I was just saying to Sanjay earlier, they actually, the active membership is, cause there’s loads of crews for thousands of members and nobody posts anything. It’s really pleasing to see. We’ve got 800 900 active members, people looking at it and stuff. Really good ratio, you know, so it’s a, it’s a powerful group and obviously it was a reflection of me a little bit in terms of, I don’t mind sort of negative stuff and you know, and that kind of thing.

Payman: But I think you organise sort of drives and track days and all [00:19:30] of that sort of stuff.

Neel: Yeah. I think just basically Facebook when it was sort of at that time there was just lots of arguments going on and lots of hatred and lots of egos. And I think, you know, when you, when I talk to you guys, I’m talking to Prav, we’re just going to be obviously very civil to each other. And if we have a disagreement about something we can, I can see his micro expressions and we can walk away. Facebook is, you know, [crosstalk] difficult. Well it’s a bit like two people driving a car. You don’t see the person’s face, you just get the road rage. And I just thought this is really unhealthy. And there’s [00:20:00] stuff going on with the, you know, the GDC and indemnity and CQC and all those other factors. And I just thought we just need to bring dentists together. So it wasn’t really just let’s look at who’s got a nice car. It really was a means of we’ve got a shared passion, let’s bring dentists together.

Payman: You don’t worry that some Daily Mail will get their hands on it or something?

Neel: Well, there’s a, there’s lots of, um, recent newspaper articles of dentists with wealthy cars and wealthy houses and all that stuff. So they can always find stuff if they want [00:20:30] to find stuff. Of course. And again, it’s approach mentality of is success a bad thing? It’s okay if you’re on made in Essex and you’ve got, you know, million dollar watches, but if you’re a dentist and you work hard, you’re actually a bit of an evil person.

Payman: so you don’t worry about it.

Neel: No, never have. I really, I think, and also if you look at turbine, we might up pictures of Ferrari’s and stuff, but we’d also put up little pictures of cars.

Payman: Yeah, you’re right. It’s a car enthusiast group.

Neel: Love and we all appreciate 40 year old classics and we all appreciate a LaFerrari, [00:21:00] which we know we may never see or hear, but you know, it’s just gonna…

Payman: It’s definitely raised your profile in the whole dental world a bit, hasn’t it? Yeah?

Neel: Which is really nice. I mean I think people knew me a little bit before from sort of the spear stuff maybe from tubials from other stuff as well. You know, and I’ve tried to help a lot of people and engage a lot of people, but generally I think it’s really nice now where was, I was like gumball on Regent street and I was queuing up, watching the cars go past and there was three guys [00:21:30] next to me and say, Oh well let’s take a picture for turbine. And I go, that’s me. That’s me. So it’s really nice that, you know to…

Neel: Yeah. People do say, Oh you like the cars and they do think sometimes I own all the cars I post, but that’s not the case.

Payman: But what cars do you own?

Neel: At the moment? I’ve got a little BMW I3 which I actually love, absolutely love. And I am pro electric cars, which sort of divides the group. We might have to change turbine to, you know, battery [00:22:00] might have to change the name of it. But now I love the I three and his work superbly in town and I’ve got half an Aston Martin GTA,

Prav: which half?

Neel: hopefully the engine.

Neel: But what I learned early on is actually, um, a lot of these nice cars they have, you don’t really drive them that much. You know, they’re special occasions, nice weekend cars. And the fixed costs are still the same.

Payman: GTA’s the one with the big wing, the big racing car.

Neel: Yeah, it’s got the big front splitter and I mean it’s one of the fastest car by any means. But [00:22:30] you know, to me it’s not about speed, it’s about emotion.

Payman: It’s hot.

Neel: And when you see in it, when it rumbles, the exhaust titanium exhaust, it’s just really, really emotive car. And if my brother was into cars, I’d have bought half with him. You know, and if you’ve got a family and a few of you together, you know, why not get a nice car together and share it. So in a way, what I’ve developed a little brotherhood of my own.

Payman: So what’s the arrangement.

Neel: Well I think we do about a thousand miles a year. So we get about 500 each and [00:23:00] then anything we do together, if you want to take it somewhere, I want to take on the track. You know, I’m quite amenable and easy to get on with. And you know, usually I find if one person’s amenable they can work.

Prav: with a close friend or.

Neel: a friend and a peer. So again, the opportunities that brings, because suddenly I’ve got someone in my life who I can talk to and who’s more learned than I am and more experienced than I am. So actually it’s a connection that helps me in other ways as well. And then you have another goal. I had a Ferrari four 88 spider for three months, [00:23:30] which is quite hilarious. But again, another friend of mine who’s a vet and he loves his cars as well. So we kind of figured out we could just about have the Ferrari, move it on, do 2000 miles an hour and not lose too much.

Neel: Which is lucky what happened, but it’s honestly a bit stupid and a bit of a risk. But it’s one of the best experiences of my life. Having that car and you know, tick box, you know, done and dusted and considering that costs like five grand to hire a day, I think it costs us five grand for the three months we had. It [00:24:00] is not a bad idea and it was a beautiful, beautiful thing. So I like Ferrari’s obviously a very nice, I do like Aston’s as well and they have a nicer image.

Payman: Looking at it from the outside, you seem to have a relationship with some of the garages and all of that. Is that something you actively go out to get? Do you talk about turbine and one and a half thousand vendors or what?

Neel: Well initially one of the things I hated, and it’s whether it’s in dental practises, in hotels, restaurants is service.

Neel: I really like good service and I think it’s not difficult to be nice to somebody and you know, appreciate them [00:24:30] and thank you for their business. And you go into most car dealerships and they’re absolutely awful. They really are awful and I mean, I’m spending a lot of money. I don’t want to be treated like rubbish. I just want a thank you or an acknowledgement even. So I think from there I just started to, and I realise you know, it’s all about buying people. You know, when I buy Enlighten I buy you, you know, or if I do, the websites aren’t by you as a person. So the company and what you do is one thing. But actually we all like to deal with people that we get on with, we like, we trust, we want to support. Yeah. So [00:25:00] within the industry of, I found a few people that I just thought these are decent guys.

Neel: They do what they say and they’ll try and help you. And just by my own links, whether it’s Ferrari or Aston or whoever, or BMW or Audi, Porsche, I’ve tried to make links. And within the group we always try and recommend people because I always think it’s like when I see some great work, I mean most of my new patients come in and they’re not in a good a good way. Unfortunately British dentistry is in a difficult state, but when sometimes you see some beautiful work, you know, really nice occlusion and I will ring the dentist up and just say, Oh you saew this patient 10 years ago and he’s [00:25:30] actually looking really nice, just we don’t see a lot of good work. I just want to say, you know, give you some feedback. So I think it’s always nice to have that. So with these guys as well, you know, if we want to support them because we want the good guys to win.

Neel: So we have a list turbine recommended dealers and people and stuff and that changes. But also it’s accountability cause they kind of know if they annoy one of us, they annoy a thousand of us.

Prav: Is there like a minimum standard or whatever? Is there some unwritten rules they abide by? So they [00:26:00] must offer great service and.

Neel: Well there’s nothing written. So I do, I mean obviously we’ve got deals with us not deals with car dealers, but we try and support them and hopefully they look after us. Porsche don’t really help us very much because they can sell cars hand over fist. But you know like you know,

Payman: and also recently missed that Lamborghini day of yours.

Neel: The other day. Yeah.

Payman: And it was because I had to pick up my daughter because we brought my dad, he just left. But my daughter apologised to me.

Payman: [00:26:30] She could tell what I was,

Neel: You’re raising her well then.

Payman: Eight-year-olds. Apologise.

Neel: It was such, it was such a nice, such a nice car. Surprise. Yeah. Because I don’t like SUVs because when I’ve been in Megannes and stuff I just feel they wallow, like your sitting on the back of an elephant. And that’s what I was expecting because some of the Alpine pass corners are quite tight. I forgot I was in an SUV. I don’t know what they’ve done, but it’s really, really, it’s a sports car and I think I did 160 on [00:27:00] the straight, 140 on the uh, the bank track and it was really stable, I don’t know if I’d get one.

Payman: What’s it like inside?

Neel: There’s a sport version, which is nicer. It feels like very Lamborghini and all the buttons, everything. And there’s a comfort one, which was a bit ordinary for me. I’d rather have the sports version, but I think the problem of SUV is if you’re going to get one, we’re now looking into electrics and hybrid technology. I think getting a Petrol SUV is not a longterm good option.

Payman: Really?

New Speaker: Yeah.

Prav: You a good driver?

Neel: On the whole, [00:27:30] no, I’m a three out of 10 and I know my three out of 10 because I passed the high performance drivers club so I wanted to go and I want to, I’ve taken lessons, I do track lessons, I do road lessons. I’m a safe driver. I’m not naturally talented and I don’t have enough. I need to drive more to, you know, you got to practise about really pleased to get into the high performance drivers club, which is a two day test. And to get in is a little bit tricky and I was pleased to get in but they marked me at three so it means I’m good.

Neel: But he shows you there’s [00:28:00] guys who are eight or nine.

Prav: and when we’re talking about driving, they were talking about a truck. Are we talking about on the road?

Neel: Both the different, very different. The apex is a different, how you drive is different. I think on the road, firstly I don’t think half was a safe. I think most driving is, it’s appalling. You know? And I think there should be a test every five to 10 years that you have to pass again. And I think there needs to be a test. If you get a car that’s over 300 brake or over 500 brake, cause you’ve got too many people are very, you don’t have to drive with very expensive fast cars and you can see them on YouTube getting into trouble. [00:28:30] And it’s an easy one for the government. It’s an easy taxable thing, you know, make you retake it, retake your test.

Neel: So I’m pretty safe on the road and I’m always careful of speed limits, especially through villages and schools. You know, you’d have to be, we don’t like people being idiots because we do these drives as Payman was alluding to. We do lots of different things. You know, we’ve gone to Geneva, we’ve done Lamborghini days, we did Aston days, we’ve done, we do drive out, we’re getting to the Isle of Man, we’ve been to Wales few times, but anyone who doesn’t drive, um, you know, in a polite manner we don’t ask them [00:29:00] them to come back Really. Track again is a whole different ball game, you know, as much higher speeds, much different awareness. And whenever I’d be in, I always get instructor because you, you know, you’re twice as fast with an instructor and you learn more. And I’ve got a few instructor friends now as well, so that’s quite interesting.

Prav: I went on a track for the first time this year, right. And I drove, I think I was going around a corner at 50 miles an hour and I felt like I was going a lot faster than that.

Payman: Scared you?

Prav: Yeah, absolutely. Can you remember [00:29:30] your first track day?

Neel: Yeah, I think it was Silverstone and I really didn’t enjoy it. There was too many cars on the track. I didn’t really know the route very well. You know, it wasn’t familiar and yeah cause getting past you a huge speed so, so that’s why second time and third time with an instructor much safer, much more fun and you can get him to, you know, what do you want out of the day. The other thing I did the week before is watch the lap on YouTube every night. So I knew every corner [00:30:00] cause that’s half the thing – where the road going.

Neel: So I think, you know, learning the track before you go. And I know my friend Shiraz was doing that as well with Silverstone. You know just learning it and learning and learning it. And I think if you have these, I don’t play video games but you know these PlayStation games or the tracks and stuff, they don’t give you the elevation. But you know, I’m sure a lot of these kids know exactly what’s going to come next and what bend.

Payman: I’ve, I’ve, I’ve, I’ve understood, I understand actually you can do much better drag times. If you played those games,

Neel: That’s probably that’s probably why I’m not very quick.

Payman: What’s [00:30:30] your dream car dream half of your dream?

Neel: I think it would have to be a dream garage, really. You know, I know people who’ve got 10 cars, 20, 30, 100, 200 300 cars and you know, obviously it was, why do you need 200 cars or 20 cars?

Neel: And it’s a bit like, you know, I didn’t need 20 shoes. You know, it’s just if you can and you enjoy it. And actually look at some of the dentists with a huge car collections, what a, you know, investment they’ve been. So I would, I’d have to, I could probably narrow it down to 10 or 20 as a collection.

Payman: What’s [00:31:00] your favourite car? Come on. What’s your favourite car?

Neel: Past, present, future, anything. All time. I think if you could have a DB five Aston or Ferrari 250 you know, a classic, it says class all over it. It’s a beautiful thing. May not be the best thing to drive, but when you arrive in a car, it makes you feel special. Even if no one’s looking. If you’re in a car that’s got a heritage, provenance, quality, you know, interesting stories behind it.

Neel: It’s a bit like [00:31:30] a Patek Phillipe, you know, you never just buy one.

Payman: I was just about to bring that up. I was just about to bring that up because I, I don’t get watches at all. I get it, I get it then you’d be wrong. I get it. But I’m not interested at all in watches when someone’s not interested in cars, do you get it?

Neel: Yeah, absolutely. You know? Yeah. We all have our passions and actually all people say as well, and you need to go A to B and actually you live in London and what, what’s the point of having a nice car? You just need an autonomous and sit in the back. So if it’s not your passion and if you.

Payman: On [00:32:00] the flip side, is there a deficit that you’re filling with the car? You know, like that?

Neel: Well, I think a bigger picture thing, this is getting existential.

Neel: Women make babies, they have a connection with human beings that no man can ever have. You know, no matter how good a father you are, I’m sure the connection with in uterine is surpassed and they’ve created something. We don’t create a lot really apart from mess. So actually we probably look for mechanical [00:32:30] things to nurture. So whether that’s a pet or a car or aeroplane, we want to have something, we want to have a with it, want to have experiences with it. I mean I put my car, in its pyjamas at night, you know, it’s almost like a child, you know the car cover goes.

Prav: oh really.

Neel: And I know people who kiss their cars good nigh and.

Payman: Are you nifty at fixing cars.

Neel: No, I’m terrible. I like engineering and obviously, having placed a few implants and stuff you understand the sort of that side of it and [00:33:00] I time watch YouTube things, but in there there’s lots of people who are much better at it than I am and understand it more. Luckily electric cars are quite easy to understand without an internal combustion engine. But no I’m not tinkerer.

Payman: changing gears. I remember.

Neel: no fun intended.

Payman: First time I met you I think was at Perry’s practise I think in uh,

Neel: in Wellwyn Garden City. Yes. He’s just bought a new car, which I helped him with 911 GTS. I’m sure he won’t mind me saying so. And he’s really worked [00:33:30] hard for that lovely car.

Payman: What I remember – yeah nice guy – what I remember about you back then was, and I see it, it’s common practise now, but back then you had you, you would talk to your patient and your nurse would be typing, typing away. And I remember even back then thinking, this guy’s going to be really good as a boss. He’s going to be able to inspire his people because she was so into what she was doing. Remember that? Are you a good boss?

Neel: Am I a good boss? I think the boss [00:34:00] being a leader has so many facets to it.

Neel: Yeah. And that’s what we’re looking at nowadays. And then, you know, it took me through quite a lot about leadership skills. And you know, we helped grow the study clubs from one to 50 and we created leaders within those groups. Leadership, I mean, you must do it with Enlighten. It’s about passion. Actually. If you got passion, you’re halfway there. If you believe in what you do, if you’ve got – I hate to say it – a mission statement or something in your mind that you want to do, which is, you know, we want to really help people. We want, I want the best practise in England. We want to do things really well. I want my team to, people are rewarded [00:34:30] and my everyone to be happy. You know, it’s a basic kind of premise of what we’re about.

Payman: People can get behind that.

Neel: Yeah. Who doesn’t want to be happy?

Neel: You know, I’d love to, you know, double my nurses wages and give them a great life and be a successful practitioner and, and change lives and smiles, you know? But then, you know, we’re all human beings and we all falter. So sometimes we better than others. And I noticed the really successful dentists, they’re so disciplined. I wish I was a bit more disciplined, but people like Mark Hughes and Ravel and Joe bough, you see these guys [00:35:00] I know you had earlier on. They get up in the morning, they do their work, they’re machines. And I’m probably having not been married and no kids. I’m still probably an overgrown teenager a little bit and you know, and haven’t had that drive. I think once you have children, the drive to kind of do something better for them comes in. So I think I’m a reasonably good leader, but I could be better.

Payman: You practise in Wellwyn village, this is not,

Payman: it’s Old Wellwyn sort of a, it’s a Roman [00:35:30] little village,

New Speaker: different than Wellwyn Garden City.

Neel: Yeah. Wellwyn Garden sort of came up out from that. A new town, but Old Wellwyn’s really charming and full of history.

Payman: So I remember when you opened that, and I remember the early days you were very worried and quite rightly so. But anyway, don’t get me wrong. How far in was it when you thought, right, I don’t need to worry anymore.

Neel: Three years.

Payman: Three years.

Neel: Yeah. I think the – you know, again, you know, we’re dentists, we’re not really business people unless you’ve got that kind of family background, which I haven’t had so you naively [00:36:00] go into it thinking I’ve just got to make a nice practise and be nice to people. I know how much it’s going to cost to build. I know how much I need to earn to live, which was not a lot for me because I was on my own.

Neel: And I thought, all right, this is gonna work and it did work. But what I didn’t realise was actually there’s overheads and if you talk to associates now and you show them the overheads, which I like to do because it’s good that they know about these things, but they’re shocking. Our overheads are shocking in dentistry and whether that’s VAT, whether it’s exchange rate, whether it’s staff [00:36:30] costs, whatever, you know, pensions. So it really had to borrow my way out quite a few times in the first two years just to keep going. And I was fortunate again, whether it’s friends, family, banks, whatever, to have the opportunity to do so. But if they hadn’t supported me, the business would have gone.

Payman: You didn’t go in with a giant building and you know, in a small place,

Neel: Two surgeries, modern place. Bought the freehold. Wasn’t expensive.

Payman: where you can, you can see where, you know, some people over stretch on size and on.

Neel: [00:37:00] I think we should, we have our dreams of what we want. But actually sometimes you have to break down the dream into little pieces sometimes. Right. And there are huge risks in running a private practise. There really are. You haven’t got that squat from school as well.

Payman: And what would you say, what would you say is your top tips? Like if someone was going to do that, what sort of thinking about doing that right now, what are your top tips?

Neel: I think one is have a, a good surplus of money and more than you think. Probably double more than you think. I think look after your health because [00:37:30] when everything goes to pot and being men and we just throw ourselves into it. So you know the weight goes on eating badly, don’t exercise because you feel a bit of a martyr to it. And especially when you owe people money, you think I can’t, I shouldn’t be happy because I’m not in the place where I should be.

Neel: So you sort of demonise yourself. For two years I was just my worst enemy and didn’t look after myself and still has effects. Now I’m not super healthy yet. And I remember going to spear and that sort of nicking the bread [00:38:00] from lunchtime to have it dinner, you know, and getting buses in the pay for school. Yeah, I think, I don’t know how in the overdraft,

Prav: I have to steal bread.

Neel: but it was priorities and spear changed my life and without spear that practise wouldn’t have succeeded. So it was a sacrifice at the time.

Payman: So if that advice you’re giving to the advice I’m giving one who is going to open a squat? Good spear.

Neel: I think I like the American school of holistic thought of big treatment planning, looking after people comprehensively. [00:38:30] It’s a Pankey philosophy. You know, know yourself, know your patient, know your community.

Neel: So I really liked the Pankey philosophy gets a bit lost in translation. It can be a bit sort of people think it’s about happy clappy but actually it’s a really good philosophy and spirit [inaudible] endorsed the neural panky link to some degree. So I think we’ve never even as undergraduates, in fact most people haven’t even came to come across that kind of thinking. And when you look at people like crystal or and stuff, they’ve been to Spiro Chen has been to spear. So many of our leaders [00:39:00] in the field at the moment have got that from lots of other things and lots of hard work. But they’ve seen a different way of doing things.

Payman: And how much have you done the whole thing?

Neel: It would spear, there is no continuum like Coys cause there’s obviously 2030 things you can do. So you can dip in and out.

Neel: But I’ve probably been 10 12 times. I think climbing is an expensive business. But it does you good. It changes your life. And also they’re so nice to dentists out there and it’s such a nice place, you know, it’s sunny, the hotels could people call it, you know the nurses are nice to you and they call your doctor and when you’re an American hysteria dentist, dentist,

Payman: what [00:39:30] does it really every time.

New Speaker: if you do the seminars, I think it’s about $1100 plus getting over there plus accommodation at hands on workshops, which I think are two days or three, I can’t remember about five grand.

Prav: So each time you go, what do you spend in flies, accommodation, the course fees.

Neel: if you do on a budget, which I was doing pretty much six grand, seven grand, 11 times 11 I didn’t do workshops every time. And that was a faculty club member for a while and there was conferences and there was nice stuff, but it was a great community.

Neel: [00:40:00] So I would definitely say look at Pankey, coy spear, look at the American wave and just dip your toe in just to get the vibe. I almost feel like I want to go back just to get the reading reinvigorate. You guys get to Chicago, Chicago, don’t you? Do you feel that difference? Do you feel that kind of energy?

Payman: Yeah, I hear you. Yeah. Okay, so more advice there. I mean, look after yourself, have some money,

Neel: look after yourself, get some education, know your craft and know your community. Be in the community. That’s what really helped me,

Payman: that I was talking, we were talking about this before, after I came [00:40:30] to your place. Then we went to the pub. You knew everyone. It’s a small place, but you’re, you’re that cat. Right?

Neel: I think, you know, initially it was like going to every business, giving them toothpaste and saying, yeah, you know, I mean, we didn’t spend any money on marketing.

Neel: I know Chris said to us, I don’t know how you did it without 50 grands worth of marketing, but I think we spent 500 quid in the first year, but it was, you know, going to each business is saying, hello eating in the pub, going to the pub quiz. Yeah. Yes. Networking is just being part of the community and when people [00:41:00] feel that means they want you already. I was living there, which is one of the reasons why I started there because I knew the area. So it’s being part of the community and even like think in the third year, I don’t think I got my first Aston, which was kind of an a knackered old seven, eight year old car and it was a stretch to get to it. But even then that paid for itself because suddenly I was in the mastermind owner’s club and I think 15 of the members became practises patients.

Neel: So it’s all just getting yourself into opportunities and extending yourself and one thing [00:41:30] leads to another. But it was just about being nice, being helpful, all that kind of local stuff. Location, location, location. It’s a nice spot right on the [inaudible] feel. So you know these guys starting up in central London where you can’t have any billboards, no one knows where you are, so you have to spend a hundred grand on Google. Whereas we’re on the corner, we’ve got good signage. So look, if we had, if location was anywhere different, we wouldn’t have succeeded.

Prav: I’ve made a tonne of mistakes in business, you know, just starting out and they will look back at the stupid mistakes that [00:42:00] I made back in the day and a lie. Why did I do that? But obviously experienced teachers and you learn from failure. What’s the biggest business mistake you’ve made now? Or some of them?

Neel: Some of the business mistakes I think I don’t lose touch with them being any huge ones. And I think as you said, you do make little mistakes and you keep changing and you keep changing the course.

Payman: What would you have done differently.

Neel: What would I have done differently.

Payman: knowing what you know now?

Neel: Well, we’ve definitely outgrown the business. So yeah, I mean it was the right premises to get because [00:42:30] there’s so it’s next to the doctors, it’s opposite a car parked on the corner and probably we’d reached its capacity probably a year four. So we’re at year seven now, I think. So it needed a second site or to relocate. But when you relocate, you lose the premises. Whether that be, you know, there’s some probably some rationale three years ago to have it as people come in and then they go to somewhere else if you really want us to grow so we don’t have a staff room, we don’t have an office and we struggle to plan a little bit [00:43:00] and not having that space to plan into.

Neel: So yeah, I think the biggest thing is just not having space and we still trying to find contingency plans and we haven’t come across it yet.

Payman: But I mean it seems like because you said you had these cash crises and if you’d go, if you just started with a bigger place that could have been, again,

Neel: I think it was the right thing to do and the right location. It was just probably a year four. We probably needed to say year three was pretty good year for the year five you pay off, your dad’s good. Most of them are five-year things. Then [00:43:30] he said, Oh, this is a good year. And then what happens in this year, seven is everything goes wrong and you have to buy new equipment or technology catches up with you. So I think there probably the time to sell, it’s probably about a year five year six if we have to reinvest.

Payman: Are you looking for new premises.

Neel: Now we were doing and we’d had something in mind, which was just across the road, but a little bit small. But I’m cutting back a little bit. I’ve got so many plates spinning that I want to just concentrate on two things, which is basically the practises that is, and I think it could be the best practise in England. I was doing some judging for private dentistry awards and lots [00:44:00] of lovely practises, but I said, I don’t think we’re too far off. It just needs a little bit more. And going from a seven to a nine or an eight to a nine is very tough. Going to afford to an eight is quite easy. So it’s a, it’s gonna be a challenge, but honestly think we could be the best practise in England or one of the best. I know it’s arbitrary and it’s only an award, but the ideology of actually this should really be a flagship practise on how to do things for patient care.

Payman: Well man or do other things well, but actually it’s a really good model of looking after patients holistically. That.

Prav: sounds egotistical. [00:44:30] Differentiates you Neil. So you know Joe blogs off the street and you talk about customer service, the experience being different. I talked to a lot of my clients about how they can create almost like a shock in our customer service experience. Just talk me through like if I was a patient at your practise, well what would I expect differently from job logs down the road?

Neel: Well, I mean we have new patients every day locally, which is really nice and it’s my favourite bit because it’s a chance that they’ve actually, I [00:45:00] mean some of them integrate practises and you know, you’re not going to get the wow of shock and awe. Nor is he do because thankfully there are other, the good practises aren’t there, which is brilliant.

Neel: But if they’d been to an average practise and they come to us and it starts off with actually the reception is we’ve made it very non dental and it doesn’t smell like, and actually the lady this morning, I can say she was an aromatherapist there’s quite interestingly she felt, he said a, normally I’m anxious in the waiting room because of the smells and the sounds and the feel. So she was really relaxed straight away. So I like that. It feels like [00:45:30] home to me a little bit, you know? And I’m quite comfy there. It’s not like a workplace. I think if you’re going to, cause I was living at work really, you know, for the first few years he might as well make it nice. Yeah. So the ambience in the field. And then the other thing is we’re talking about leadership earlier and being a boss.

Neel: If all the staff are happy and smiley and Elsa, you’ve employed those people or you’ve attracted those people. We always have nurses laughing and smiling and that’s such a positive thing. You know, if you’ve got one miserable person in the room, patients feel it, you know, they’ll come and they’ll tell me about [00:46:00] it if they know. So creating that positive environment is an intangible, you know, it’s a bit like, um, yeah. And you can say, Oh, you need a Sarah machine or we need this or need that. Actually, you just need nice people being nice to people in a nice place. And that really comes from the top as well. You know, if you’re gonna kill people, the reflection as to your customers and for sure. And then really it’s simple things. It’s rapport building, you know, and um, I sit them down next to me by the computer and I try and gain rapport as quickly [00:46:30] as I possibly can and not in any kind of, I want to influence some way, but if they like me and unlike them, we can have a better conversation and understand their needs.

Neel: So I’ll sit down with them and figure out where they are, what they’ve had done, what their issues are, and we will plan a phased approach. But it will be, you know, the launch of my practise is with so many great dentists. You’ll see me. Then you’ll see Mel Preble who’s our brilliant therapist hygienist. Then you might see Addie is a fantastic endodontist to get that redone. Then you might [00:47:00] see Rachel as specialist orthodontist and remove these teeth in a better place than you might see David bloom. Who’s going to make these teeth look great. So it’s a journey and no one’s ever really talked to them about, I want to use you, get the rest of your life for the rest of your teeth. So I’m thinking, especially with our cohort of patients who are generally older or they start thinking about their lives as well and what they want out of it.

Neel: You know, when you’re younger you kind of just think, let me fix this problem and go away and back to work.

Prav: So a lot, a lot of dentists that I speak to struggle with this rapport building. So you [00:47:30] know though, getting in those seats, Oh God, I’ve got to follow this system, this process. I’m going to ask the patient how they got here today. How was the journey, et cetera, et cetera. And it seems like, you know, that’s probably one of the most important things in your consultation is building that rapport. Yeah. What advice would you give someone who’s new at this game?

Neel: So I think it’s a key. I mean, I just went to Barry’s course, Barry Alton’s course as a refresher. And again, that’s a great course to do. By the way. First of all, you’ve got to like people, if you don’t like people, you’re not going to artificially [00:48:00] gain rapport with them.

Neel: And there’s a story and everyone, every patient that comes in that you always find something interesting about them or a human, you have to find the human in them. So I think people think, Oh, I’m going to ask these questions. They’re going to watch where their eyes go and I’m going to try and emulate them to mirror them. Actually just find out who that person is, where they like you guys are doing today rather than tactics, actual interest, being interested in people and they forget. I mean, they’re so busy doing the tactics and the checklist and have eyes, you know, Oh, he’s crossed his arms like that. Cross my arms. Just actually think that’s a human being [00:48:30] is a new friend. You want to kind of know a little bit about him. It’s not speed dating, but you know, where did you grew up? Where, who the last dentist?

Neel: How’s your experience has been? What do you want from your teeth? How can I help? You know, I’m going to try and find solutions to help you. We’re going to work this together. It’s just being nice looking in the eye. Don’t talk to him in the dental chair because you know, you, if a friend came round, you will put him in dental chair and start quizzing him. You know, you’d get him a glass of water and you would sit like this and we’d have a chat. And I think communication is for kids, for teenagers, for work, for relationships, [00:49:00] for relations with your family and friends. If you haven’t got communication, you’re going to struggle in life and you can get away with a lot of lack of skill. If you’ve got great communication and you can get other people to help you, the little things, but it comes from communication and you’re looking at practise.

Neel: Melanie Preble, a brilliant communicator. David bloom, brilliant communicator. [inaudible] brilliant communicator. So you surround them and then the nurses pick up on that and they know how to talk and what to say. And you kind of create this thing.

Payman: What’s your, what’s your pet peeve regarding associates, dentists who work [00:49:30] for you?

Neel: I think engagement. I think if you’ve got a really good team,

Payman: how’d you know though? Whether they’re engaging with their patient is that we mean engaging with their patient.

Neel: engagement in the practise.

Payman: Oh, I see.

Neel: So there are associates who are mercenaries. They will come in for themselves. Yeah. You know, do something that is not black and white, but they’ll come in there, everything’s ready for them. They’ll see a few patients, they’ll treat them as a job or a project or you know, like a car coming into service, do this, whatever needs doing and then [00:50:00] go say thanks to the nurses.

Neel: Brilliant. Which is okay. Back in the day, you know, that used to work. But at times the tough, now, you know, competition is hard, overheads are hard. We all need new patients, you know, whether it’s through SEO, marketing, whatever we need, we’re all looking for new patients because the overheads are much different to what they were 20 years ago. And the profitability has gone from like 50 60% to 15% if you’re IDH, I think it’s five 7%. So the biggest earners for us are those new patients who are willing to, with their oral health. So I think [00:50:30] if they realise what’s good for the practise, it’s good for the associate, then come to meetings, engage positively, you know, be nice to your nurses. Don’t be there on time, respect their time, respect the patient time. So just if you can make the practise as good as it can be, you’ll have a better environment for yourself.

Neel: So I think it’s really just, I think if you’re an associate, engage with the practise and even if you’re gonna leave in a year or two, you’ll gain so much from that knowledge and the experience of engaging. You’ll know what to do next time.

Payman: Yeah. I think that’s for me [00:51:00] a key key point that you can learn on someone else’s dollar or whatever. They’d like someone else’s risk. As an associate, you can really get yourself involved.

Neel: and free mentoring.

Payman: Of course.

Neel: You know, nobody gets anywhere without mentoring. I was just reading the book from, what’s it called, different dental masters, but it was a, the collection of stories has just been released. Mel was in it. She let me the book, so I read it all in about an hour, just kind of get through it and thought it was between patients and the stories were very similar.

Neel: They struggle a little bit through uni or through school. Then [00:51:30] they, um, at the right time got the right job with the right mentor. A lot of them went abroad for their studies, bought a practise and it was one woman in their life where they found the right person, whether it was a great dentist or someone who’s really good at PR or someone who’s connected or someone who knows all the other, you know, it was a person. And you can use these mentors to guide your life and you don’t have to reinvent it. The steps have already been done. Just find someone that you like trust and whether it’s exercise [00:52:00] or dentistry o.

Payman: who your key mentors. Frank Speer?

Neel: Yeah, I mean I’m in relationship with Frank, obviously his ethos in terms of the way they do dentistry, which has that sort of Pankey philosophy I would suppose.

Neel: But it’s, it’s, I try and surround myself with people who are nice because I think if you hang around nice people you’ll be nice as well. And also, I know lots and lots of dentists and I like dentistry, but also I really find it interesting if I meet someone who’s into our history or who’s into engineering [00:52:30] and have a broader outlook on people. But I have to say, you know, people like yourselves and unreal and Mark and re-haul and um, the guys in my study club and drew, just everyone I hang around with, there’s something to be learned from everyone.

Payman: Drew’s a real enigma, isn’t he, Drew.

Neel: He talking about passion drive at the expense of everything else, whether it’s as health and time, you know, he’s obviously a superhuman person and really it’s finding the right mentors [00:53:00] and they’re always around you. And I remember Raj, Arla Wally was one of my early mentors.

Neel: He said, they’re always there. It’s just you weren’t ready for them. You didn’t see them. So they are around you. You just got to figure out a lot of people phone me and just say, Oh Neil, should I do this course? I should have that course. Cause they tend to follow herds. They see who’s popular on Facebook and thinking, I’ll do that or I’ll do an implant course or I’ll do this. And I usually say, actually, where do you want to be in 10 years? Which throws them, where do you want to live? What do you see yourself doing? Do you want to practise? Do you want to just to endo and then just work backwards and find people to help you on that journey. Too many people [00:53:30] don’t know where they’re going, so they’re not going to get there. So I think a 10 year plan, which, you know, when you’re young, you can’t think 10 years ahead, but when you’re a bit older you start sort of thinking, you know, where am I wanting to be?

Neel: And whether it’s in relationships or in business or in financially, you know, have a goal and then that’s makes that sets all the decisions up.

Prav: So where do you want to be in 10 years?

Neel: Now I would like to be financially secure. I think I’d like to look after my family, make [00:54:00] sure they have a nice life. I’m not thinking it has to be spoiled and wealthy, but just, you know, have, I think money buys your health care and it buys you education. So if I can educate them and give them health care and a nice place to live and a safe place to live. So I’d like to do that. So that’s a personal goal, is to have a strong family and look after them. And I think partly one of the goals is financial is to try and get there. And I think also, um, changing and we’re talking to Sandra Lee about this as well.

Neel: [00:54:30] I still want to keep my hand in dentistry and I wanna understand how dentists have feelings cause I need to represent them, but it’s the indemnity business now. So with dentistry I can help maybe a thousand people a year maybe. You know, I think with indemnity I can help 20,000 people a year because if you help a hundred dentists, you’re going through litigation indemnities, not just them who were affected, it’s their wives and practises.

Payman: When was it that you have the idea for PD?

Neel: PDI? So professional dental [00:55:00] indemnity, just to give it a plug. So I was helping drew, I was doing study clubs, I was running the British Academy of Microsoft dentistry and I thought, and it is, education is the way out, you know, for all these young dentists who are struggling in whatever way and they want to be more, it’s, you know, we have to educate them.

Neel: And I was doing my best to mentor and help people and get phone calls and the phone calls I was getting from younger dentists where I’ve had a complaint about this or I can’t do that. Or you know, they want to leave the profession because they left an apex in [00:55:30] and they’ve had a complaint. So I kind of had it in my mind that wanting to teach someone is not a safe environment to be learning. We learned on the NHS, I made thousands of mistakes and you learn from them and get better. Now if you make a mistake you are really, it could be the end of your career. And it’s happened to some young dentists, you know, not to name any. So had that in the back of my mind. And then I had a complaint from an anaesthetist who was a casual patient, not the kind of patient like we’d like to see you and we want to see people and grow with them and develop them.

Neel: [00:56:00] And he just basically used it as an emergency service and ring me six in the morning. And because he was a colleague or a peer, I tried to accommodate him, but he got to the point where it was saying, actually I don’t think this is the type of practise for you. Can I help you find another dentist? And um, maybe I should have worded it better. And we’re talking about communication. And this was after about a year of patching things up in glissando, which is not what we do at all. And he was just that professional courtesy. So he wrote a seven page letter to the GDC and probably for three months I was, again, [00:56:30] we talked about self-flagellation. When you’re starting a business, you just think you’re an awful dentist. You hate your patients, you think of them all is out to get you and you lose.

Neel: I honestly am a very caring person. I want to help my patients. I have no, I never think financially, I never think like that. I just want to do the best for them. And that’s my capacity. So when someone, what you feel stabbed in the bag, you lose all your heart and it affects your staff and the friends around you and the people around you. And I thought this isn’t even a big complaint and it could have gone to the GDC because who knows what they’re going to do. [00:57:00] But it would, I would have left the career over one complaint because the human nature is we get 99 thank you is we get one complaint, we feel like we’re the world’s worst dentists. And then I talked to people I already share and they told me about their TDC experience and nurse. I talked about other people and it seems like everyone’s got a GDC issue now.

Neel: 20 years gave him in the GDC, you’d done something and there is a need of the GDC. We all know that, you know, we have to go in and be, we have to be policed, but the current GDC is just, I don’t know what’s happening and it’s just overreaching. Their powers charging us a huge amount. [00:57:30] Doesn’t think to be fair. And I’ve had friends who are on the GDC panels and stuff and they’ve walked out because, and I’d like to know what that lady, when she left, while the gagging order was what she was thinking. So it was kind of in my mind. And then through turbine through cars, I met a chap called Gary Monaghan, is my, who turned out to be my business partner. So he’d run an indemnity company, insurance company where you can reverse the terms for plastic surgeons in. They pay about 50 60,000 pounds a year.

Neel: And when they paint that much, they start looking around and [00:58:00] they weren’t getting the service as well. And that’s what I found actually with my insurer when I actually rang them for advice. They were so poor and I said, was I used to ring you guys 20 years ago and you were brilliant. What’s happening? And you know, actually want to complain. I don’t think it’s very good. And they said, Oh, well there’s an already a complaint system. Just talk to your advisor. I’m sure you’ll be all right. And I just thought I, from having a huge confidence and trust in this entity to having, actually maybe it’s the emperor’s new clothes, it’s not as what it seems. So Gary was running a indemnity company for plastic [00:58:30] surgeons with a partner at I think two partners. And it became hugely successful, is still going. And I was talking to my niece to this friend and he’s actually a member, so he created something amazing.

Neel: And then he left the company and he basically had an exclusion to say and I think for a year. And he likes cars and he knows lots of plastic surgeons. So he was doing CPD for plastic surgeons in Switzerland, you know, they drive car around and you know, enjoy some nice food and wine and so from turbine. So you know, one thing leads to another. So you can say actually his cars are a waste of time. But actually his opportunities and meeting people, [00:59:00] we just started talking and I said, this is what’s happening in, you know, you’re talking about indemnity, this is what’s happening and this is how we feel. And from there we basically, he already knew fantastic underwriter Sharon. And you met her colleague job and you met Cheryl. Oh yeah. So she’s phenomenal and she’s a fighter and she doesn’t like rolling over and paying in and you know she’s worked hard, really hard in a man’s world to get where she is.

Neel: Very clever, astute lady. And we have a good relationship. Again, it’s about rapport building and [00:59:30] having good relationship with people. You buy people. So I basically bought her, I think she’s brilliant and she’s got so much dental knowledge. She’s been in the industry. Yeah. And you know caring as well. But she’d come on, it’s a tough cookie but she actually cares what she does and she’s proud of what she does. She’s had the best policies and she knows she has the best policy and when she looks at other underwriters and they just copy her or they don’t know anything about dentistry. So it’s quite good actually. I really feel we have the best policies, the best product and the best underwriter. And then from there we have brokers who are intermediaries. [01:00:00] And then Gary and I’s job really is to market this vehicle, talk about car analogy and also liaise with Sharon and make sure we have got the best product and that we know our customers are happy and dentists are being looked after because actually the way it’s going, everything is going to be insurance-based.

Neel: And if we don’t have a say in it, it’s going to be like car insurance where you ring up, they can do what they want and they’re separate entities. So actually this is the chance where actually a dentist can have his say and we can say to [01:00:30] Sharon, actually, Oh brilliant Weldon, can we have this? Can we have that? What can we do? Or actually we’re not happy. We’re going to move the whole lot over to another underwriter.

Payman: Unpack this sort of discretionary situation. So what would the traditional indemnity alumni’s, they don’t have to support. Well what that means.

Neel: in a way. So when the indemnifies started, which are all the big guys, they had really strong principles, let’s get dentists together. Let’s look after each other. We’ll all put some money in, we’ll invest it. And [01:01:00] this was a time when we didn’t get sued a lot and there wasn’t this no win, no fee and all these different scenarios at different time.

Neel: And those guys had brilliant education, really supported you had the top people on board and looked after you, put her arm around you and you felt supported. I think times have changed. The financial things have gone silly in terms of how much the pay outs are. And I don’t think the model works anymore. And what they say is you give us some money every year and we will look after you. That’s all you have. And they’ve been doing that for years. But then now cracks and chinks [01:01:30] are appearing where they’re, the good of the members may be outweigh your good. So if they feel that they want to settle, they have the choice. If they feel they want to drop you and don’t want to represent you any more because you’re a risk, they dropped me overnight. If there’s a condition that you get. So I don’t know.

Neel: To me having not been in a little while. And I’ve seen lots of, you know, you get to hear all the stories and you get to see things that are unfair. And it’s a shame because I think they have been brilliant, but I don’t think it works in the current model. [01:02:00] So when you, when I was with whoever we’re going to say every year you just pay renewals, you didn’t have any kind of contract and you’re just relying on Goodwill within insurance products. It’d be like buying car insurance. Now there’s cheap car insurance and there’s expensive car insurance and there’s something which she feels appropriate for you. And I always buy decent car insurance cause I’ve got a nice car. It’s very important for me that this car gets looked after, whether it’s, my analogy being my career is very important to me. So I want to know, I’ve got great lawyers, great understanding, and a really comprehensive contract.

Neel: [01:02:30] So that’s what we’ve done with PDI. We’ve created a really comprehensive contract. We’ve got a really big legal team. Wait men’s, I think they got 50 men, male lawyers, and you’ll speak to the senior partner and they’ll ask who’s wife’s a dentist as well. So if I’m going to be a member of it and my and my friends are, the responsibility for me is to make sure we have the best product and we honestly have the best product. May not be the cheapest product but with the best product and when you’re the GDC or when you have a car crash, you don’t get a nice courtesy car. You’ll wish you had.

Payman: But it’s cheaper [01:03:00] than the traditional.

Neel: it is. Yeah, it is cheaper and it’s also fairer. So at the moment you get lumped in with everybody else and as their risk goes up overall, your, your premium will go up.

Neel: And if they’re paying for doctors as well and add that in, especially the GPS are now going to change to crown indemnity. We send you, I think it’s a five to eight page letter and we ask, you know, who are your mentors? If you had a trouble, who would you ask? What courses have you been done on? And you know, and the underwriters will go to clinics and they will [01:03:30] go and see ortho places and they’ll come and see you guys and get an understanding of what you do. So they know actually actually these guys, he’s got mentors, he’s in a great practise. He hasn’t had a claim. He’s been on the right course because we know who these courses are. We know they run well.

Payman: They can assess the risk more accurately.

Neel: It’s a person, it’s not an algorithm. The other one is you, you know, one year, two year qualified, are you doing implants?

Payman: Not, and that’s your band.

Payman: Is it scalable in that sense?

Neel: It’s scalable in what way?

Payman: Or you know it seems like it’s not, it’s not an algorithm.

Neel: It’s labour intensive. So we can [01:04:00] take two days to do it. We can take two weeks to do it. And if you’ve got a lot of claims and a lot of history, we can take three months to do it. But Sharon keeps a very clean book. She is very key. We reject, which is unfortunate for us, about 30% of people applying because what Sharon says, these guys are risky, rightly or wrongly because you know, we don’t know the circumstances. And if I had to put everyone’s premiums that next year because I’ve miscalculated it, you won’t be happy. So we have very clean good dentists who care about what they do, [01:04:30] who look after the patients and you know, improve that.

Neel: Educate themselves. And why wouldn’t you want that? Isn’t that kind of dentists want other support?

Payman: I think dentists are, it depends on the risk profile of the, of the insurer. I mean there might be another insurer wants massive because it’ll come with the high risk.

Neel: Well they might sell their book in three years, build them up quickly, get them in cheap. And then actually we’ve made our money out of this and now it’s looking risky. He wants to buy it now.

Payman: But what the question’s gonna ask you is a lot of patients, a lot of dentists, [01:05:00] they worry that the insurance company is going to settle when, when they did nothing wrong. And either they’re not going to defend.

Neel: It’s a huge thing, isn’t it? Like dentists generally feel like they’re caring people, they’ve done the right thing and it’s, you know, it’s wrong that we should settle and you know, we want to defend ourselves.

Neel: And in those cases where the dentist wants to defend themselves and can be prepared for whether this takes three months or two years, if they’re willing to do that, if their notes are good [01:05:30] and they’re in the right, then we will always fight and we’ll encourage you to fight because why should we just settle on? Because it’s not good for anybody, but the factors are, if your notes aren’t good, we might have to say, look, actually, if any written XLA upper left seven, there’s not a lot we can do with this. Or actually, you know, I’ve got a family, I’ve got a kid. It’s a big stress on me. I actually don’t want to, you know, and you don’t need, and I can understand that you may not want to. So it’s a dialogue and it’s a conversation. They’re not [01:06:00] going to say you must settle.

Neel: They will have a conversation. When you said that these are the plus points, these are the minus points, this is what we feel you should do. What do you feel? And there’s a number and there’s an insurance ombudsman as well and they’re very regulated, extremely regulated. They have to be seen to be doing the right thing for you. They can’t let you down, they can’t misrepresent you. So you have a lot of rights. But unfortunately there’s a lot of good dentists out there who don’t want to go to the fight, which I understand. And there are some Eagle tickles, egotistical dentists. He might think, actually [01:06:30] I’m mr God Ashley, even a million pounds worth of claims, maybe you need to look at what you’re doing and do it slightly differently. And people are people. So it’s interesting what we see on paper, but you can kind of quite easily know.

Neel: Actually I get to talk to quite a lot of them and I kind of know within five minutes who’s a decent dentist. So he’s not a who cares about his patients and their education and then the way that they look, you know, you get a sense of someone, you do it all the time with your clients, you do it all the time, you know who’s a good guide only.

Prav: of course you do. And you mentioned that you look at what courses [01:07:00] they’ve taken and stuff like that. Does that impact the premium?

Neel: Yeah, I think if you’ve done a weekend course and you’re placing 300 implants a year, it might not work in the longterm. If you’ve done a really approved course and you’ve had mentoring, I think doing a course is one thing. Actually. I think mentoring is more important. You know, you can know everything you want, but you know, I think my first 20 or 30 implants I placed, I had someone next to me and it’s invaluable.

Neel: And having a principal next to you maybe has placed a thousand implants next to you. You know, I met a girl yesterday whose dad [01:07:30] does loads of implants and she’s doing a lot already at 26 and you think that’s a risk? But actually a dance next door mentoring her and he’s a an expert. So they will look at you in terms of what you’ve done, what support you have and it isn’t just the courses and that’s one thing. It’s what support you have. And the question is, you know, if you weren’t sure about something, who would you ask? What resources do you have? I’ve never had any insurance company asked them.

Payman: the question.

Neel: going back to being what we’re talking about earlier, mentoring, coaching. No they did. I know which [01:08:00] is even better.

Prav: We had, we had Mahmud Maldjian earlier today and he is really inspirational. Good story behind it. And he talks about life being full of ups and downs. You ever had like a really low point in your life that you’ve had to bounce out of? You could share with us.

Neel: I’m probably have quite a load and, but you know, just one thing that comes to mind, which is probably not quite the question you’re asking, but you know when the first thing you think in your head, and that’s the answer, isn’t it? So the arms to me, I was, [01:08:30] I was working in Australia for about two years and when I say working, it wasn’t really working, but it was in between travelling. I was doing some dentistry flying doctor stuff and some stuff in prisons. It was really interesting. I was there for the Sydney Olympics and I think I was in Queensland and I’m near Darwin crocodile Dundee territory. And I got bitten by a spider and I’m in the middle of nowhere and my eyes started swelling up.

Neel: And so I have to get off this bus and check into, I don’t know which hospital it was. And there was a doctor from Malaysia [01:09:00] and his English wasn’t great talking about rapport and communication and he basically drew me a diagram of my face. Then we are going to put some local anaesthetic, we’re going to cut this out and you’re gonna have a big defect in your face and being on the other side of the world, on your own. Uh, you know, I was 23, 27, 28, so I’m still a kid.

Prav: Terrified,

Neel: terrified. And, um, I was with dentist job search and they were really nice to me. They were nice people and I rang her. I didn’t wanna ring my mom and dad up. Oh, they’re not listening because I thought what they’re going to do, how can they help me? They’re just [01:09:30] going to be worried.

Neel: So I ranked into job search up and talk through it through them. And luckily having some dental knowledge and some medical knowledge, I basically got a tax discharge myself. Got a taxi, which was $400, which is quite a lot of money for me. And went to Darwin, wait in a three in the morning, put myself into a private clinic, you know,

Payman: was it getting worse at this point?

Neel: I couldn’t see you and I was feeling sick and you know, I mean I wasn’t well on your own, on my own and got into it, you know, talking about environment [01:10:00] and how an environment is field. Nice hospital, knife pay, you know, nice doctors, nice nurses look after you feel a bit better. And they said no, you wouldn’t want a local anaesthetic in there. You’ll just spread the infection. We’ll have a short GA and I never had a GA before and we’ll incise it and drain it and petrified.

Neel: You know what, if you don’t wake up and this silly silly things and talking about, you know, how you make a patient feel. The most important thing I remember from there is when I was on the trolley going in, I know it’s not easy to bite, but actually one of the nurses [01:10:30] did that to me, which I’m just holding payment’s hand, which he’s very comfortable with and that hand touched to resonates with me and the human contact, that reassurance. So I know we’re not allowed to touch our patients, but I will tell them on the shoulder or on the hand and just say, you’re doing really well, are you okay? And I know our nurses will do that to our patients. And it’s just something that comes back to me from when you’re distressed or a bib said, you know, a cup of tea and a hug or something like that is what you need.

Neel: And I think the scar I’ve got left, you probably just can’t even see it. [01:11:00] It’s a little red line. But you know. Yeah. And I think, you know what? I was 27. I was good looking in vain to say to ruin my face. I’d be then.

Payman: what about a professional low point.

Neel: professional list? I think it’s just whenever I’ve got a complaint letter, which is probably in you know, 20 years.

Payman: break, you can’t like break your comp.

Neel: Let me think. Two or three times. One probably in 2004. This is an Easter sky. [01:11:30] Um, one on Tuesday. Actually I had one last week. Um, I fitted a gold crown two years ago and a lady who had existing bruxism, TMJ and she said I made a bruxism worst cause I’ve pushed this crown in so hard and uh, you know, it’s chronic situation and nothing. Why would she come back two years later?

Neel: I’m sure she’s got some financial difficulties, but again, just upsetting, you know, so that’s a low point is when you don’t feel it’s right, you’ve done your best for the patient, you’ve cared for them. I really, this is a friend of a friend, so you go the extra mile and [01:12:00] now that I go the extra mile anyway, really cared for her. She’s very nervous patient and they’ve actually just thought of you as a greedy dentist and not actually appreciated how much care and time you gave someone. So they’re the low points radius when people don’t feel appreciated.

Payman: And what’s the best decision you made.

Neel: going to spear.

Payman: Do you really think.

Neel: that changed my life.

Payman: Really?

Neel: You know you were saying people know me through turbine, but there were knowing me before that because I jumped a level from, no not very good associate. It didn’t really understand dentistry, didn’t understand comprehensive [01:12:30] care, haven’t got great hand skills from just doing that course to actually really understanding dentistry, reengaging my passion in it and jumping up, you know, you’re suddenly in the big boy league, you know, so the people you’re hanging around with.

Neel: And so just by doing that, although I was broke when I did it, it got me around know Raj and Mark and hap Gill and all these people. So I was in a different, you know, fish tank, I was swimming with different guys and then our learning off them. So it wasn’t just the five grand and do a course. It was the mentoring, [01:13:00] the companionship that way. It made me feel and it set my practise over my practise. The way we do things is not just a single dentist and refers when he needs to. It’s a team effort of getting a patient from a to B, you know, which I don’t think happens very often and I think we’re doing patients to disservice.

Payman: How many days do you work load yourself?

Neel: I do about two and a half days a week of dentistry and it is, I’d say it’s new patients and recalls.

Neel: My shoulder’s not great. I’ve actually sort of given up a little bit of some of the, you know, difficult dentistry [01:13:30] and as PDI takes off, I need to give it more time really. And I’m in that kind of phase where the practise needs me and PDI needs me and I’ve kind of kind of make a jump. But otherwise both. They’re going to go down a little bit as I’m trying to manage my time, but it is be like you guys when you were practising and with enlighten, there’s a time when you actually need to step and be brave and it’s easier when you’re younger and younger commitments,

Payman: but it’s actually Prav who helped me do that. Really it was, I was doing one day a week, I had a bad day and then I talked to you and he’s, [01:14:00] he’s given up medicine one six months into being a doctor and he said to me, why?

Payman: Why are you doing this one day? And I was like, it’s a shame. I want to keep my and acres. Just get out of it. You know? You’d said those need permission.

Payman: Yeah. You’re where you need to, someone to reflect for you as well. By the way, I’m not sure that’s the right move for, you know, I’m known a practise, practise, different situation. Now, what I’d like to do is it’s going to be able to run without you, I guess because the, yeah, the PDI thing, [01:14:30] you know that that’s a business, a business needs.

Neel: and again, mothering, you know, I think it’s really, it’s a pivotal point. It’s a turning point. We, everyone’s talking about it. Everyone wants to move, they’re all a bit scared.

Payman: It’s a great sign for that.

Neel: Say they want to move and unless we have a big enough model that can take one thousand two thousand five hundred and ten thousand dentists, you know, is talking about scalable.

Neel: It is scalable because the lawyer is massive. The underwriter’s massive big global company. But if we as dentists don’t have a say in it and there’s probably five or six other products coming into the [01:15:00] market as we speak an.

Payman: it’s just an insurance basically a either a CEO to run PDI or a CEO to run, you’ll tend to see at the moment I’m kind of CEO both fully.

Neel: I think with the practise, if I can get a dentist and I’m looking at a few who can fume plan and has the approach and the patient care philosophy, then I’m happy to pass that on now and just keep an eye, keep leadership and overview it. And I think the [01:15:30] more I put into PDI, the bigger it grows. So I just need to kind of figure out the next three months really and how I transition.

Neel: But it is spinning plates the now I’ve got a lot of plates spinning your guy, you guys all have losses and I’ve let a few go that the microscope grew, grow a little bit. I’ve let you build, grow a little bit. So I want to concentrate on PDI and the practise and relationships and my health. So talking about my health, he is, my blood pressure was crazy in the beginning of the year. I think one 80 over one 20 you know, not good. And it’s just that years [01:16:00] it’d be like other people do. They throw themselves into the work that comes first. They neglect themselves. We’re all alpha males, teenagers thinking we can wear immortal. So actually having to take some medicines now, which I really don’t like. Um, I think actually now I need a bit of time if I’m, I’ve gotta be around for the next 30 40 years.

Neel: I need to just actually have some time for myself. So getting back to what advice, you know, don’t look back and think actually I’m really unwell and I’m making the people around me suffer because I’m unwell, you [01:16:30] know, look after yourself.

Prav: So what are you doing to your health now?

Neel: Interestingly, a friend of mine, his neighbour, Graham Phillips, he’s a really senior pharmacist and we’ve been talking a lot about the effect that gut has on inflammation on insulin. So giving insulin to a diabetic is the wrong thing to do because it just really makes them more polarised. So if you can stop your blood glucose spikes, you’ve stopped your insulin, insulin spiking, you don’t put on weight. So he had a blood glucose monitor, which sort of sticks in the back of your arm and you can zap it with your phone and get readings. [01:17:00] So I did it for three weeks and I lost eight pounds.

Neel: And it was just having the angel on your shoulder all the time. So it worked well. Then life got in the way and I’ve stopped using it.

Payman: It was a blood glucose monitor.

Neel: Yeah. It just tapes on your own sort of peers is even not that you’d notice or really doesn’t even mention it and you get your iPhone and you click it on some diabetics. Javier, I don’t think it’s on the NHS but children have it if there is severe. Yeah. And so when you can see actually a porridge was making me spike to 14 you know, whatever millimoles of glucose [01:17:30] and bread was and this was whereas other things were keeping and you just want to kind of stay in the zone and you’re not hungry, be just choosing more sensibly. And my willpower isn’t good enough to do it without it. So I bought a few more and Graham’s actually going to be speaking to our study club next year as well.

Neel: Because again, part of that thing about being comprehensive care where I want to offer our diabetic and a cardiac patients, a way of helping the general health cause they amounts aren’t going to get better if they’re not healthy.

Payman: What would you like to be known for? Like [01:18:00] I will legacy,

Neel: I think a nice guy who tried to help people. You know, I don’t really want more than that. I think if I’ve left the place and enriched some lives in whatever way that’s more than any bank balance or anything, you know, it’s really about him. Not influences is the wrong thing, but actually helping, you know, I think in the more people you can help and in a way you might say bill Gates helps lots of people or you know the Apple guy because they’ve created a product that brings so many people together. So for [01:18:30] me it was that the dentists, I can only help certain amount of people with insurance company.

Neel: Maybe I can help ten thousand twenty thousand people. I’d love to help 105 hundred but that’s being an industrialist really. So I think the more you, I mean each person valuable if you change one person’s opinion or duration. And I, and I think I’ve done that quite a lot and it’s really rewarding. But when I said, you know, these are the low points in your life and it is those complaint letters and let alone if you have to go to the GDC and the effect. And I know so many good dentists who’ve left the profession wrongly. So if I can save [01:19:00] through the insurance company and that grief, that hurt that I’m going to give up on the 15 years education and the time I put into it because of one thing.

Payman: What’s cool and what’s your advice? If someone gets a letter from the GDC tomorrow and their world’s falling apart because it does, right? It does worse than the letter from patient as they, cause.

Neel: I think don’t be ashamed because like I said, 10 years ago you got letter, you’d done something wrong. Chances are you might have done something a little bit, but you’re being overly punished for it. So I think you’ll be [01:19:30] surprised. Talk to your friends, they’ve all been through it and you know, just get someone to buy your beer and actually talk your way through it because they’re, you know, problem shares from the half. So you know, it’s a cliche, but get your support group around. You get your nurses and your team around you say this is what happened. You know, I think, and there is amazing, like this complaint letter I had on Tuesday, all my nurse and team are gay are all behind me. They’re all like, I can’t believe this. You know, and they’re not looking at me like I’m a worst dentist cause they know who I am.

Neel: They’re actually thinking this is a story state to be in. So [01:20:00] I feel better that people around me are supporting me if I don’t feel vilified unless they have a right to be. And really comes down to talking about drew and two bills and some of the education stuff we’ve could Scott to have fantastic notes. You know, record keeping, get in trouble. Camera picture says a thousand words. I was talking to a VJ from Evo, you know we on Saturday they videotaped the whole conversations and the little harddrive so it’s a bit American is a bit far, but actually yeah they [01:20:30] can send it and they’ve got an amazing consent process. They know they do all these Tara gourds and they’re doing one thing really well. So they’ve got it down and they said, you know, if you send a lawyer 16 hours of video tape, they’re going to think twice because they want to watch it cause it’s time is money for them.

Neel: So actually you’re defending themselves because it’s all there. Now some people might say, well what if I miss something? You won’t miss anything because you’ll have your checklist, you’ll be on video. And a picture is brilliant because you know a picture of a cracked tooth or this is what I did all this is what tooth I worked on. I think it’s a shame but I think we’re going to have to start videoing things. [01:21:00] So record keeping note taking in whatever form is paramount. Second thing is work on your whole team. If a complaint happens because you’ve rescheduled the patient twice cause the lab hasn’t returned it stuff. The receptionist hasn’t smiled at the patient. The lose dirty, they’ve come in, they’ve seen some dust and all, something’s scruffy. Then you give them an injection. So now they’re on their fifth negative thing and you think if their first negative thing.

Neel: So bring the team together, create excellence, create care, create an [01:21:30] environment of care. Because if they like you and they’re like, you know, multiple like points, they like their hygiene. If they like the nurse and the reception, they’re more willing to work with you cause you know we do make mistakes and things do go wrong. Something go.

Payman: Yeah. Speaking to your Android Jew, she said to me was that you guys get more complaints from NHS patients than private ones. Now is that because there are more,

Neel: I have a lot of statistics.

Payman: She said she had an easy thing. It was more, it was actually something to do with the [01:22:00] [inaudible], the volume she was, she was saying that they feel entitled to a free GP and I don’t like paying for dentistry. In fact they’re paying, albeit NHS fees makes them much more consumerist and there’s complaints happy. Which kind of surprised because I thought, I thought it was more a private dentist problem.

Neel: I think, well, most dentists in England and the NHS say proportionally, if you’re going to see more full-stop now, what are the advantages you’d like to have with your patient? You’d like [01:22:30] to have time, you know, and you don’t even need a lot of time for a poor. You need to just have the will to build rapport and your focus has to be on patient care, not UDS. So if you’re going to practise thinking, I really going to care if this patient spend the time they need. And do a great job. Then you’re probably halfway there. If you’re thinking, I’ve got 30 patients today, my, you know, I need to get my UDS, are we going to get clawed back and penalise your mind? Some might be slight different.

Neel: I know with best intention they all want everyone to help people but if it’s not your primary goal objective, [01:23:00] patients might pick up on that. And I think it is very difficult. You know the NHS colleagues are trying so hard in a very difficult situation, a very, you know, time and resource, limited opportunity and I think they aren’t going to get into trouble. I’m worried about root canal. Three treatments, you know are root canal treatments or practise had done superbly well and they can be done very well on the NHS. But if you’re not, I’m wondering five years if you haven’t got me, cause I know I’m dental upon ship, I’ve got a CT scanner in the office apparently. So if you’re not getting media buckled three and you’ve been paid [01:23:30] 40 quid or whatever it is to do an endo, which we charge a thousand pounds for, it’s not the same but it’s just going to, I think it’s gonna be another revenue three from them and they’re trying to increase their business by 20% next year.

Neel: Some people said, Oh and vicarious is the other one. Vicarious liability. The going for the principals, not the associates now because the associates, you could argue some of them are actually employees. They’re there five days a week. They have a contract and they have a certain amount to do. And the PA, the patient came to your practise with your name on it with your materials and your staffing. [01:24:00] So, and it’s an easier, it’s easier to go after them. And if the associate’s gone back somewhere or changed or retired, there had been vicarious cases, so unfortunately there’s going to be another bill our door for we need a vicarious liability.

Prav: What about people who teach other dentists so you know they, they teach and train and mentor. Do they need protection against various liability?

Neel: Depends on which way. I know like we’ve, we’ve talked with some of the, I don’t [01:24:30] know if I can mention them, but you know some like IAS or whoever.

Neel: Yeah, of course they are giving advice and there’s mentoring, which is the right thing to do. You know, you don’t want to just go on a course and they leave you. So I think those courses which are very good, have a high standard. There’s an element of mentoring. Send your case along, we’ll discuss it. You need an element of vicarious, it’s not going to be a huge risk, but they will need something if you’re doing a three day course and that’s the end of the course at the end of the time, I don’t think there’s any risk then. Okay.

Payman: What are you, where are you seeing? Are you seeing the stats or where [01:25:00] the claims are coming in from? What kind of treatments is also growing?

Neel: I think basically the basic things, what we do is crown bridge perio. It still is, I think I can’t, I haven’t got the facts, but I think it’s still 80% or whatever.

Neel: That’s my feeling too. You know, hard to do crowns well are two. You know, if someone’s been at practise for 10 years, you know, and I was saying to patients say is it’s not that the dentist generally does something wrong, but when you move into a new house, I see everything wrong. So when I see a new patient, I see 50 I think this lady, I can see 15 [01:25:30] things wrong with you, but in three or four years we’ll build a rapport. I’ll get, we’ll get comfortable with each other. It’s like living in a house and I’ll let those things go a little bit. And I think over time it’s human nature. You don’t want to give people bad news, you don’t want them spending their money. They know their grandkids have got that. So I think just as human beings, we tend to let things go a little bit and it’s probably a nice thing. And in our practise we do is every couple of years have a recall with somebody else. Just get some fresh eyes on it. Yeah, that’s interesting. I think it’s useful because you know, I always say there are 10 [01:26:00] different ways of doing this and they’ll get 10 different opinions. What we want is a consensus that works for you.

Prav: I’ve got one last question from me, which is looking back in time, having a conversation with 20 year old now,

Neel: Oh God,

Prav: why advice would you give him.

Neel: stop looking in mirrors.

Neel: Nothing seriously. It’s have a 10 year plan. You know, I couldn’t think more than a month a week. But if you’re going to achieve something, whatever age [01:26:30] it’s, have a plan, figure out what you want in life. You may not know, but you can have an idea. Sure. And get the right people around him.

Prav: Mentors and.

Neel: mentors, friends, uncles, whoever they are. You know, I remember when I went, you know when I did that state thing where I stayed and uncle the always find you find family everywhere when you’re travelling on it. Yeah. And he used to get up every morning at 5:00 AM and do an hour’s yoga. And you know, my 18 year old me thinking what a waste of time. But actually that same up for the whole day. So yeah, look after your health, have the right people around you, do the right thing, [01:27:00] support each other.

Payman: Very nice.

Neel: Thank you for having me. Thank you. For me, it’s very enjoyable.

Payman: Really lovely conversation.

Neel: in what we’ve talked about is he’s a little rubbish, but you find something interesting in there.

Payman: Thanks for coming.

Neel: Thank you. Thanks Prav.

Prav: Thanks for your time.

Outro Voice: This is dental leaders, the podcast where you get to go one on one with emerging leaders in dentistry, your hosts, Payman Langroudi and Prav Solanki.

Prav: [01:27:30] Thanks for listening guys. If you got this far, you must’ve listened to the whole thing and just a huge thank you both from me and pay for actually sticking through and listening to what we had to say and what our guests has had to say because I’m assuming you got some value out of it.

Payman: Get some value out of it. Think about subscribing and if you would share this with a friend who’s using might get some value out of it too. Thank you so, so, so much for listening. Thanks.

Prav: and don’t forget our six star rating.

Jennifer Pinder: There’s nothing that annoys me more than coming to meetings-

Prav Solanki: Unprepared.

Jennifer Pinder: … and somebody hasn’t read the papers.

Payman Langroud…: Yeah, that’s me.

Speaker 3: This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.

Prav Solanki: Hello, and welcome to the Dental Leaders podcast. Today, we have the pleasure of interviewing Jenny Pinder, who I’ve known for probably about eight or nine years now.

Jennifer Pinder: Yes, yes.

Prav Solanki: Nearly a decade. Just chatting now before this interview, we learned so much about the different things that you’ve achieved in dentistry and the different things you’ve represented in terms of the women’s groups and being on the GDC and the FGDP, which we’ll expand on and learn a lot more about. But Jenny, I just want to start off by asking about your upbringing, where you grew up and what your childhood was like.

Jennifer Pinder: I grew up in Doncaster in South Yorkshire. My father was a dentist and had a… Well, for those days he had a very beautiful practise. The town is a mining town, or was. But my father was a dentist. My mother was a dentist. Both my grandparents were dentists, and they were dentists under the old 1921 Act where they hadn’t got any… Because the other people call them proper qualifications. And then I’ve got two uncles, two cousins, and two of my brothers are dentist technicians, and still to this day.

Payman Langroud…: My goodness, wow. So your mother must’ve been a real pioneer, one of the very, very early lady dentists.

Jennifer Pinder: Yes, she was. And it’s only fairly recently I found out that she got a Carnegie scholarship. Her parents weren’t very well off. If you were a dentist pre-1948, it was a bit of sometimes could be scratching a living really. So without that scholarship she wouldn’t have been able to go to Glasgow University. And yes, there were only two women dental students at the time. But ultimately, the war came along and she was called up. And my father was also called up. And they met during their service in the RAF, and the rest is history from that point of view. My mother didn’t work again as a dentist after she was married, partly because there was no retraining schemes. The tax system was such that if she worked my father would be in the upper tax bracket and so she really wouldn’t earn anything. And he, also, I don’t think was very keen on her to do it. So her career went into a bait and switch it, which is a pity, but that’s how it was.

Payman Langroud…: Your childhood, what are your memories of being the kid of two dentists?

Jennifer Pinder: We were in a town where a lot of the dentists and doctors had a fairly closed social group. A lot of them had come out of the forces after the war. And then the NHS began in 1948, and that was really when my father’s practise took off in a big way, in particular making dentures. And they had a lab on the premises for three technicians. And every Friday was denture day. And I remember going up to the lab. They had a measuring thing on the wall to be measured as we grew in height.

Payman Langroud…: I studied in Cardiff. It was a common thing, my patients used to tell me, for their wedding present their parents used to give them a full set of dentures so the pictures would be nice.

Prav Solanki: Serious?

Payman Langroud…: Yeah.

Jennifer Pinder: I think that’s a bit of a myth rather like-

Payman Langroud…: I heard it from the horse’s mouth. Yeah, really. All these different patients would tell me this.

Prav Solanki: Wales might be different.

Jennifer Pinder: Well, I think Scotland was different as well, wasn’t it really?

Payman Langroud…: Yeah, sure.

Jennifer Pinder: It’s a bit like the myth of, “Oh, the dentist put his knee on my chest when he was talking my tooth out.” That goes round and round and round.

Prav Solanki: It’s normally the foot, isn’t it?

Jennifer Pinder: The foot. [inaudible 00:04:31].

Payman Langroud…: So when did you decide to be a dentist? Were you always going to be a dentist or was there a moment when you realised…

Jennifer Pinder: Well, I always wanted to be a doctor actually, all those years ago. I went to boarding school for seven years, from when I was 10. And the teaching on physics was absolutely terrible. We were girls and it wasn’t really that… Somebody came to the local grammar schools. So I failed A-level physics the first time. And in fact the second time I only scraped through with an E when I went to the local tech to retake my A levels. So I didn’t get in to do medicine. There were quotas then. They only took 15% of women, at the maximum 25%. There were just as many women wanted to get in. Anyway, so ultimately going to Sheffield University to do physiology, I was bored stiff with it. So I asked if I could change to dentistry. And my dad agreed to fund it, and so that’s what happened.

Prav Solanki: And was changing over at that time, was it quite simple and straightforward to do, going from physiology to dentistry?

Jennifer Pinder: Yes, it was actually. The course was long. Well, the course in dentistry then was only four years.

Prav Solanki: Oh, okay.

Jennifer Pinder: So yes, it was easy. It just meant an extra year at university that my father had to fund. Because we only got the minimum grant really.

Prav Solanki: Why were there quotas back in the day? I mean you referred back to your boarding school and it wasn’t predominantly female, say, or mixed 50-50, was it?

Jennifer Pinder: It was all female.

Prav Solanki: Oh, so it was an all-female school.

Jennifer Pinder: Yes, it was an all-female school.

Payman Langroud…: They probably didn’t mix boarding schools back then.

Jennifer Pinder: Oh no.

Payman Langroud…: [crosstalk 00:06:16].

Jennifer Pinder: Oh no. I mean we had, just up the road past the crossroads where we used to go for walks, there was an Army apprentice school.

Prav Solanki: Right.

Jennifer Pinder: And we were not allowed to go. We could either go left or right at the crossroads but not-

Prav Solanki: Not across.

Jennifer Pinder: Not across, no.

Prav Solanki: Oh dear.

Jennifer Pinder: Oh dear.

Payman Langroud…: How many women were there on your course, your dental course?

Jennifer Pinder: Four out of 40.

Payman Langroud…: So I bet you were popular then?

Jennifer Pinder: Well, it has its advantages sometimes. It had its advantages when I couldn’t bend… We had to make our own Adams cribs and things in those days. And I was utterly hopeless at bending wires. It seemed to me that the men were better at that. So somebody always used to step in and help.

Prav Solanki: Happy days.

Jennifer Pinder: Oh, happy days, yes.

Prav Solanki: So going back to applying for medicine, which is what you wanted to do. I guess rebel against the dentists in your family. The reason that you didn’t get in is probably because they had quotas back in the day. Is that the first time you kind of felt like you were discriminated against as a woman?

Jennifer Pinder: Yes, I think it was. They had quotas because they could. It was not until the 1975 Sex Discrimination Act was passed that it all changed. Of course now, we’ve swung over probably to be slightly more women applicants for either medicine or dentistry as well. Then again, the second thing I found I was being discriminated against was when I went to work, I applied for permanent health insurance to cover me if I was off sick. And I did it through Dentists’ Provident. And I discovered that to take on an extra thing was through Friends Provident Life. And for that, I had to pay a premium of 75% more than men for being female.

Prav Solanki: And was that standard practise back then that women would pay more?

Jennifer Pinder: Yes.

Prav Solanki: What was the reason for that?

Jennifer Pinder: They said women were sicker more often. It didn’t cover pregnancy, didn’t cover anything like that. And I thought, “Well, this isn’t right.” And for me, if I think something is not right, I will stick at it and pursue it. So ultimately, I went to the Equal Opportunities Commission, as it was then, and said, “What about this?” So they agreed to fund the case. So we took the case to court and actually we lost. We lost then but a little bit later on things did change.

Prav Solanki: I mean I’m sure there were many women in your position who probably thought, “Oh, okay. It’s a higher premium. It is what it is.” And there you come along and say, “I’m taking this to court, sunshine.” What is it about you that made you just think that actually, “I’m going to make a difference and I’m going to stand up for women.”?

Jennifer Pinder: Well, there’s something within me that stands up for anybody or anything that I think isn’t just…

Payman Langroud…: Where do you think that comes from, Jenny?

Jennifer Pinder: My grandma.

Payman Langroud…: Really?

Jennifer Pinder: My grandma who had 11 children of whom of the six brothers she was determined that my grandfather was going to get on and she was determined. Her father was an iron ore miner from Cambria. And she was determined her sons were going to be something. And I think there is an element of-

Payman Langroud…: Were you very close to her?

Jennifer Pinder: No.

Payman Langroud…: All right.

Jennifer Pinder: Not at all.

Payman Langroud…: To the stories.

Jennifer Pinder: But yes.

Payman Langroud…: How interesting.

Jennifer Pinder: One of the things I’ve done since I retired, and I was training for it in the last years of retirement, was I’ve become a professional family history researcher. So I’ve gone into quite a lot of depth of my own family. It puts your life in perspective when you do that.

Payman Langroud…: Yeah, I bet it does. I bet it does.

Jennifer Pinder: You understand why people have done what they did really. So that was that. Yeah, so I got the sex discrimination case. There was a lot of publicity. Before that, a lady called Fiona Simpson, who was also on the general dental council with me and who I got to know. No, actually before that, I was chairman of the GDPA when it existed. You may not remember that. It was-

Payman Langroud…: Like the BDA but different.

Jennifer Pinder: Yeah.

Payman Langroud…: Something higher level, was that what it was?

Jennifer Pinder: Lower level I think.

Payman Langroud…: Lower level.

Jennifer Pinder: It was lower level. I think it was looked down on.

Payman Langroud…: Oh really?

Jennifer Pinder: And I became the chairman of that. Anyway, I met Fiona Simpson and she found out I was doing this case because there was some publicity. It took about four years to come to court. And she put a petition in the Belfast Dental School where she was working, which she sent to me with all the signatures in support. And so with her, and because of the publicity, we started Women in Dentistry.

Payman Langroud…: Which year was that?

Jennifer Pinder: 1985.

Payman Langroud…: And we were discussing before, I was saying there seems to be a lot of new women in dentistry. We had [inaudible] on, who has a group-

Jennifer Pinder: Linda Greenwall.

Payman Langroud…: Linda does something. And we were asking all of them, is it harder to be a woman in life than to be a man? Forget dentistry for a moment.

Jennifer Pinder: No, it’s different.

Payman Langroud…: Yeah, I’d agree with that.

Jennifer Pinder: It’s different.

Payman Langroud…: I was talking to my team about it last week, right? And there are obvious physical situations where… My marketing manager Laura was saying often she’s walking down the street and having to worry whether someone’s going to jump on her. And she was saying that’s not something that a man has to worry about. And I get it. I do get that sort of thing.

Jennifer Pinder: Yes, yes.

Payman Langroud…: But outside of those obvious physical strength situations, is it harder to be a woman in life or not? You’re saying no.

Prav Solanki: Different.

Jennifer Pinder: It’s different. And I think it’s different at different times of life. I think there is certainly harder things in careers when it comes to the years when having children becomes important.

Payman Langroud…: Although dentistry is one of the careers where you’re sort of least affected by that in my view. Because a lot of careers, if you take five years out and come back, you’re no where near where you would’ve been. Whereas with dentistry, the primary relationships are one with the patient. And if you’ve got a good patient relationship, you can come back and hit the ground running. So what about obviously back then you saw this situation where men and women weren’t getting the same treatment as far as insurance. But with job prospects, with the way patients talk to you, the way bosses talk to you, I mean you’re someone who’s gotten on in politics and teaching and so forth, would you say it was harder as a dentist to be a woman back then and now? What would you say about that?

Jennifer Pinder: No, I don’t think it was hardest actually to be a dentist as such. Back in those days what came out of Women in Dentistry was there was no maternity scheme for women dentists in the NHS, which was a big-

Prav Solanki: It’s huge, yeah.

Jennifer Pinder: It was a huge gap. And actually we found that really the BDA were not interested. And the BDA, at that time, overwhelmingly male and none of them were interested in this except one person called Diana [Scaret] who took it and ran with it. And ultimately, there is a maternity scheme, which we were directly responsible for getting. So if there are things that need addressing, the BDA weren’t interested because it wasn’t of any interest to men in general. They’ve got other things to be more interested in politics. So if you haven’t got any women around there to be interested in it, it doesn’t get done. So that’s where we were able to fulfil a need really to do that.

Prav Solanki: When you were working on the GDC, you mentioned that you’d sat on various panels and hearings and things like that. And prior to that, you were talking about how you’ll stand up for anything if it’s unjust. Did you ever find yourself in a situation where you thought, “Do you know what? This just is not fair.”? A dentist was up and perhaps it wasn’t his or her fault or whatever.

Payman Langroud…: To be fair, it was less common back in the day. Nowadays, I think it’s every case [inaudible 00:15:14]. But go ahead.

Jennifer Pinder: It maybe isn’t less common but it was dealt with in a different way. They had a preliminary proceedings committee, which of course there were I think 14 elected dentists. There were heads of dental schools. And although that it was criticised of them and us, there was a lot of very sound, sensible, capable people there. And you felt that it was a privilege to be there because you’d been elected by your peers. Was there ever an unjust one? Yes. And one sticks out in my mind. And it may seem like I’m… We had a preliminary proceedings committee, which were mostly dentists with one lay person. There was just a few people. We used to have a huge bundle of papers to look through, most of which came to nothing. There was serious professional misconduct and it really I think was the serious ones that got through, that went through. It has its faults.

Jennifer Pinder: But this particular case was a youngish chap from Brighton had a practise. And he used to do sedation. So this lady had come in and she had a sedation. And she then turned around and accused him of stealing some money from her handbag. Well, it turned out actually that if he’d stolen the money he would have to give her change for the amount of money that was in her… Which was completely impossible. And the poor chap had had to cancel his holiday that he’d planned for his wife and three small children. It was awful. So it got thrown out. I mean there were enough of us…

Jennifer Pinder: The other case I do remember was a very serious one actually because it was in a practise where they did sedation. And their anaesthetist, his idea was that when people had had their sedation finished that he would give them a suppository of pain killer. So not to go into too much detail, one of the patients went home and thought she’d been assaulted. Then another young patient came up. And what we believed was that the anaesthetist was getting some gratification out of that. Anyway, when the barristers were questioning people… And again, I actually said to the dentist there, I said, “Would you let that happen to your wife?” Because it’s not normal for people to be given that in a dental practise. Their defence was, “Well, in the hospitals, that’s what they give.” But it’s by a nurse. Anyway, I think there were two of us… And in the end, he got a homily. They used to get what’s called a homily in those days.

Prav Solanki: Which is what?

Jennifer Pinder: A little telling off.

Prav Solanki: A slap on the wrist.

Jennifer Pinder: A slap on the wrist. Yeah, so he got a slap on the wrist. But if we hadn’t stuck up and said so, I don’t think he’d have got anything.

Payman Langroud…: Wow.

Jennifer Pinder: But all different then. All difficult.

Payman Langroud…: What other I mean juicy ones? I don’t mean like that. What was something that was clearly the dentist was doing something wrong and it was the right thing to do to stop him from practising ?

Jennifer Pinder: Okay.

Payman Langroud…: So was it about skill level? I’m sure you had all of these, right? Stealing money from the system, NHS or whatever?

Jennifer Pinder: I think the one that, again, sticks out a bit was there was a man, he practised in North London. And I think in those days, and this must’ve in the late ’80s… He was grossing £300,000 a year on the NHS. And what it turned out was we saw a patient who came as a witness that he’d done root fillings on every tooth, every posterior tooth.

Prav Solanki: Oh god.

Jennifer Pinder: And he said that he could do… His notes said that he’d done two quadrants of these in an hour. So I remember saying, “Mr. [Daugherty 00:19:17], you were”… Oh, I shouldn’t say his name I suppose. But it was public.

Prav Solanki: [inaudible 00:19:22].

Jennifer Pinder: “You were able to work very fast.” And he just said, “Well, I’m very efficient.” And I laughed. Not laughed but I thought, “Okay.” Well, he was a menace.

Prav Solanki: Right.

Jennifer Pinder: He was damaging patients. The patient was happy. He said, “I’ve got no pain.” And I think he was using something called SPAD. You might remember SPAD.

Payman Langroud…: Yeah, yeah, yeah.

Jennifer Pinder: Which was not the greatest of materials, was it?

Payman Langroud…: When was the first time you’re a practising dentist and you thought, “I’m going to go for GDC election.”?

Jennifer Pinder: It was when I was chairman of the GDPA. And I just thought it was something I would like to do. And I worked hard at it. At the time, there was only one woman on the GDC, elected member. That was Margaret Seward.

Prav Solanki: Oh.

Jennifer Pinder: And there was a lay lady as well. So I thought, “Okay, well I’ll have a go.” So one of the things I did was I got the register and I sent out envelops canvasing to every woman on the register and every couple, so that I might get two votes. And also through the GDPA, through their magazine. So I got elected quite easily.

Payman Langroud…: What about the GDP. Prav and I both want to get stuff done in our businesses, let’s say. But personally, I don’t like meetings and panels and all of that. So I’ve never put myself forward for anything like that. But clearly you must be quite good at that to become the chairman of the GDPA and then to go for the GDC and so on. Are you one of those get stuff done in meetings type of people?

Jennifer Pinder: There’s a lot of stuff you can get done-

Payman Langroud…: Sure.

Jennifer Pinder: … not in meetings.

Payman Langroud…: Oh, okay.

Jennifer Pinder: Behind the scenes, or if you know people. I read very easily. I speed read books.

Payman Langroud…: Oh really?

Jennifer Pinder: I can read two books a week. And I’ve always been careful that when I did meetings that I knew my brief, that I’d read my papers. There’s nothing that annoys me more than coming to meetings-

Prav Solanki: Unprepared.

Jennifer Pinder: … and somebody hasn’t read the papers.

Payman Langroud…: Yeah, that’s me.

Jennifer Pinder: Oh dear. Oh dear. Well also because, if somebody hasn’t read the papers, you have to go through the whole thing all over again. So that’s that. No, I don’t like meetings particularly but there have to be in some respects.

Payman Langroud…: Of course.

Jennifer Pinder: And I think the other pivotal thing was when I met my husband, he was a journalist with The Toronto Globe and Mail. And he was then called back to Canada, and I agreed to go with him. At the time, he wasn’t divorced and I couldn’t practise as a dentist at that time. So as patients, I had the head of The Salvation Army worldwide who was Canadian. And they got me a job in The Salvation Army hostel so that I could get landed immigrant status-

Payman Langroud…: In Toronto?

Jennifer Pinder: In Toronto, on the basis of that.

Payman Langroud…: Which years were you there or which year were you there?

Jennifer Pinder: 1975 to ’77.

Prav Solanki: How different was dentistry there compared to here?

Jennifer Pinder: Oh, it was like a different world.

Prav Solanki: Higher level?

Jennifer Pinder: Much higher level. Much higher level. And in fact, during it, it made me realise how low our standards were. And the Canadians really, really look down on British dentists. Funny enough, the only dental school that they felt was any good was Newcastle. Newcastle graduates used to pass their terrible… The exam that had a 10% pass rate because they didn’t want foreign dentists. So I went through all that and I worked in a hospital for a year. They taught me how to make dentures properly and a lot of other things. So when I came back, I was determined. And I failed that exam the first time so I was determined not to be seen as a failure. So I was one of the first people that took the MGDS. Which, because of my time in Canada, I passed.

Payman Langroud…: Right.

Jennifer Pinder: And there was not a very high pass rate at that stage.

Payman Langroud…: That was a tough exam too.

Jennifer Pinder: [inaudible] exam.

Prav Solanki: That short time in Canada, do you think that accelerated your growth as a dentist in terms of skillsets, knowledge?

Payman Langroud…: Sounds like it.

Jennifer Pinder: Absolutely.

Prav Solanki: Yeah.

Jennifer Pinder: Career defining really.

Payman Langroud…: Jenny, what would you put the level… Sorry, the quality of the dentistry in the UK being lower, what would you put that down to? I mean we’ve got some of the best schools. Would you say the NHS is the thing?

Jennifer Pinder: Yes.

Payman Langroud…: And with your experience of the dental world from when you started and your parents, how would you summarise NHS dentistry. Would you say overall it’s a good thing, a bad thing? Where are we now? Was it good before and it’s no longer? Because from when I qualified, I did VT. And I said to everyone I knew, “I’m not going to do anything in dentistry anyway.” After VT, I went and applied for a job in private… And back then you couldn’t go from VT to private.

Jennifer Pinder: No.

Payman Langroud…: And I said to the guy, “Look, I’ll take 40%.” And he suddenly changed his…

Jennifer Pinder: Right, yes.

Payman Langroud…: Because back then it was 50% split.

Jennifer Pinder: Yes.

Payman Langroud…: And I said, “I’ll take 40%.” I did not want to work in that system. And we’re talking about this summer of 1997.

Jennifer Pinder: Yes.

Payman Langroud…: Yeah. And today it’s worse for dentists and for patients.

Jennifer Pinder: How can’t it be? I think it is one of the tragedies of my career that… When I came back, I was on a mission to say, “Look, there’s a better way. This is not right. We worked far too fast.” And it was item of service then.

Payman Langroud…: Yeah, yeah.

Jennifer Pinder: So the faster you worked, the more you got. And that’s okay, some people could work very fast. And in fact, I was always quite a fast worker. I was quite fast.

Prav Solanki: Efficient.

Jennifer Pinder: Quite efficient. That’s a better word.

Payman Langroud…: What was the guys name at the GDC?

Jennifer Pinder: And then over the years of course we got to 1988 and they changed the contract to the capitation element. And I just started my practise. Yeah, I’d just started my brand new practise, which was from scratch, just north of the Barbican. And they reduced the fees by 10%. I had massive loans because this was 1988. At the time, interest rates were 10%.

Payman Langroud…: Yeah.

Jennifer Pinder: And in fact, I remember Black Wednesday, or whatever it was called-

Payman Langroud…: I remember that too.

Jennifer Pinder: When they went up to 15% overnight. I remember sitting on the sofa at home and say, “I’m finished.”

Payman Langroud…: Yeah, I remember that day. Like Nigel Lawson, isn’t it?

Jennifer Pinder: Yeah. I thought, “I’m finished. There’s just no way I can pay back these huge loans.” So I was disadvantaged. And I was disadvantaged and I wanted to do a good service, et cetera. And then, ultimately, I realised I couldn’t. I was giving private dentistry basically to NHS patients. So it wasn’t going to work financially.

Prav Solanki: Just going back then, how hard or how easy was it to get your hands on money compared to… Now, it’s really hard. If you apply for a bank loan or that sort of stuff. Even going back to 2005, if you were setting up your own dental practise or a new business, you’re a dentist, they’ll give you 110% loan.

Jennifer Pinder: Yes.

Prav Solanki: No PGs. What was it like back then?

Jennifer Pinder: It was generally easy, except for women.

Payman Langroud…: Oh, really?

Jennifer Pinder: Women used find they had to have a guarantor.

Payman Langroud…: How crazy is that?

Jennifer Pinder: Well, it’s crazy but actually, ultimately, I was on the Women Dentistry Stand in Glasgow, [inaudible] conference. And the NatWest I was at had a new woman bank manager. Her name was Rita Hanratty. And she spoke to me and she looked at my things and she said, “I’ll fund you.” So that’s how it came about. She was marvellous actually. But I remember once having something and I wanted a bit of an overdraft extension or something and I said, “Oh, this has happened, that has happened.” She said to me, “There’ll always be something, whatever it is.” And that sticks in my head because it’s true, isn’t it?

Prav Solanki: So true.

Jennifer Pinder: Something happens and you get right, and something else happens that you haven’t expected and you have to be able to deal with the unexpected and uncertainty really.

Prav Solanki: Yeah. If it’s not finance, it’s team members or illness or health or whatever, right? Something’s going to get in the way.

Jennifer Pinder: Or something happens in politics and they take the funding away. You’ve seen all the changes in life and the changes that have happened in dentistry. But to me, the saddest and the worst thing is that they got something called the UDA system.

Prav Solanki: UDA, yeah. Madness.

Jennifer Pinder: When they were discussing it, I thought, “That can’t be because it’s ludicrous. It’s completely ludicrous. The rest of the world doesn’t have this nonsense.” And it’s been there for so long.

Payman Langroud…: But Jenny, you worked in the corridors of power, let’s say. How do these things happen? I mean most dentists are out there pulling teeth, and then the system changes. Surely there’s a dental representative doing that deal with the government.

Jennifer Pinder: Yes. I think the den-

Payman Langroud…: How does it work?

Jennifer Pinder: Well, I just think they’ve let us down completely.

Prav Solanki: Our leaders?

Jennifer Pinder: Yes. Completely. The BDA does do good things. And I was a member for a long, long time. I was president of the metropolitan branch. The social aspect was great. I actually enjoyed the politics, et cetera, et cetera. But when you look at NHS dentistry, which is actually for many, many dentists still their bread and butter, what’s happened since I qualified in 1971 to today when we’ve got this dreadful system? It’s evolved from something.

Payman Langroud…: And not to mention you said the NHS started and that made your dad’s practise.

Jennifer Pinder: Yes.

Payman Langroud…: Take it back a bit further and it was a wonderful thing, wasn’t it? It was a beautiful thing.

Jennifer Pinder: What, the NHS?

Payman Langroud…: Yeah.

Jennifer Pinder: It was. It was a good thing because most of the people had no access to dentistry at all. Anyway, that’s where we’re at today. Of course my other interest is in, because I got a psychology degree from Birkbeck, another life changer, and that was in 1986. But I knew I was good with anxious patients and I thought, “I’d like to teach.” There was no VT or VT had just come in, I can’t remember which, and I thought, “Well great, I’d like to teach.” But I thought, “I can’t just go and say I’m good at this because that’s nothing.” So at the time, there were no health psychology degrees so I went and did this degree at Birkbeck instead.

Payman Langroud…: Evening classes or something?

Jennifer Pinder: Evening classes.

Prav Solanki: Really?

Jennifer Pinder: I don’t know how I did it actually.

Prav Solanki: So you came from Canada.

Jennifer Pinder: Yes.

Prav Solanki: Back to the UK, wanting to practise private dentistry on NHS patients.

Jennifer Pinder: Yes.

Prav Solanki: Do you psychology degree.

Jennifer Pinder: Yes.

Prav Solanki: And then what comes from all of this is that actually what you want to do is provide a higher level of care for those patients who are absolutely terrified or walking in the door.

Jennifer Pinder: Yes.

Prav Solanki: And that’s how we met.

Jennifer Pinder: Yes, it is.

Prav Solanki: Many years ago. I remember I’d set up a website focusing on dental phobia. And then I did a lot of research and your name kept popping up. Dentist for phobics, Jenny Pinder.

Jennifer Pinder: Yes. That’s right, yes.

Prav Solanki: And you had lots of advice on not just for the general public but I think dentists got a lot from your advice that you’d published online just about how to do the basics like talk to patients, assess their anxiety levels and their scores and things like that. And there was nobody else. And this only going back eight to 10 years ago. There was nobody else doing what you did. There were people trying it. There was that group from abroad that we spoke about, the guy who would take them off, anaesthetise them.

Jennifer Pinder: Oh yes, yes.

Prav Solanki: Do you remember?

Jennifer Pinder: Yes.

Prav Solanki: And we spoke about that. And how did that whole thing evolve? Did you develop your own system, your own process? Or did you just find that you were naturally good at helping patients by giving them more time? What were your little tricks and hacks in terms of being able to successfully treat nervous patients to the point where they were travelling miles and miles and miles just to be having basic treatment with you?

Jennifer Pinder: One of the things, interesting, when I was a kid I used to hate having dental treatment. And my dad used to say I was terrified of it.

Prav Solanki: Your dad was your dentist, I assume.

Jennifer Pinder: Yes. Well, he tried. Poor man. [inaudible] lunch on Sunday. Dad would say, “Well, we’re going to the practise this afternoon.” “No, we’re not.” “Yes, we are.” “No, we’re not.” And he would take me in and I would only agree to have anything done if I could mix the amalgam in the mortar. It’s not very safe. But I really hated it. And it was not till I was 17 when I allowed him to give me an injection that I would actually be more comfortable with dentists. To this day, I don’t like it.

Prav Solanki: What did you hate back then? What instilled the fear or the dislike back then? Was it the smell, the noise, something?

Payman Langroud…: I mean the needles, right?

Prav Solanki: No, no, no. But you talk about-

Jennifer Pinder: But in those days, I think they thought that kids’ teeth didn’t hurt.

Payman Langroud…: Yeah, yeah, yeah.

Jennifer Pinder: So you drilled them without any local. And of course it does hurt. And that sets up the problem really. How did it evolve? So yes, so then I began giving some lectures to… My very first lecture was to community VTs on their first day on the training. And I was given the opportunity by Stanley Gelbier, who actually was a sort of mentor for me. And I remember that first day. I was very, very nervous. It was the time after lunch and in those days they had a huge lunch on the first day with some wine. And I remember somebody giving a feedback which said, “Went to sleep.” And that was all I could focus on, this went to sleep. So that’s how it started. And then when I was working as an associate, I knew I was good and I wanted to promote that when I moved into my own practise.

Prav Solanki: So your lecture, that first lecture that you gave, was it on the topic of treating nervous patients?

Jennifer Pinder: Yes, it was.

Prav Solanki: What did you map out? Did you map out a patient journey, a conversation structure? What were the key elements to treating nervous patients back then? Today, a lot of people focus on, say, sedation or giving patients more time or adapt to the environment so you’re using these things like the wand or putting on music or TV, distraction techniques. What was it back in the day in that lecture that was key? And this probably holds true today as the key elements to treating a nervous patient.

Jennifer Pinder: I think the key elements I used to think were taking enough time and doing a proper assessment. In the end, mine evolved in almost like a therapeutic interview where you would actually get people who come in crying. And by the time you’d talk things through, they were smiling. Because a lot of people have never been able to talk to anybody about this before. Being non-judgemental is very, very important. A lot of dentists think that people don’t go to the dentist don’t care, but actually that’s not true for a great many people. And people feel that. Once they see you as a person who’s empathetic and actually is prepared to understand them, that’s a real key element.

Prav Solanki: Do you think your psychology degree had a lot to do with just understanding people and their emotions and how to deal with them?

Jennifer Pinder: Yeah. I think it did. But also, studying in a different way. Dentistry’s very hands-on or you learn about pathology or bacteriology or whatever it is in undergraduate. But a psychology degree, you’ve got to think. It’s a whole different way of thinking, which is quite a lot to get your around really.

Payman Langroud…: Sorry, sorry. I don’t think enough dentists realise, from the marketing perspective, what a massive thing it is to be a gentle dentist. I think it’s much more out there these days. But my wife’s very gentle. That’s probably the biggest thing that people think about her as a dentist. She doesn’t Invisalign. Clinically, she’s a regular dentist. But people travel far and wide to see her. And I only realised it myself when she gave me an ID block about three years ago. And I didn’t feel it go in and I suddenly realised all those ID blocks where I’d pushed that plunger in and how much, outside of the amount of pain I’d caused by doing that, but how much loss of business I’d caused by doing that.

Jennifer Pinder: Yes.

Payman Langroud…: And that connection’s not often made. I mean we talk about anxious patients all the time but we don’t teach dentists that actually it’s very good for business to be gentle.

Prav Solanki: I think what a lot of dentists look at is time and product. I know it’s probably not right. So if we look at a nervous patient consultation with Jenny and a standard consultation with another dentist-

Payman Langroud…: How long does it take, Jenny?

Prav Solanki: How much time would you give a patient?

Jennifer Pinder: My consultations used to be 45 minutes. One of the things I used, and it was interestingly on one of the forums, somebody was slagging off doing questionnaires beforehand. But actually there’s two of them, one of which you’ll find out the level of somebody’s anxiety. And it may be nothing at all. But the other thing, it might be way up. And then there’s a questionnaire that actually focuses down on what they’re anxious about. You say to a patient, “What are you anxious about?” “Oh, everything.” Well, I’ve never come across anybody who’s anxious about everything, so you pin down. It’s either fear of needles, fear of gagging, whatever. And they’ve got that information before they come in. And the other way I used to find out a lot of information was I used to do a lot of email chatting before a patient came in.

Prav Solanki: Would you email the patient directly?

Jennifer Pinder: Usually they emailed me.

Prav Solanki: Yeah, yeah. But I mean you would correspond with the… Today, it’s rare, apart from we talk about Instagram and Facebook, DMing patients.

Payman Langroud…: Do you mean before their first visit?

Prav Solanki: Yeah.

Jennifer Pinder: Yes.

Payman Langroud…: Because that’s massive.

Prav Solanki: No, it’s huge.

Payman Langroud…: Remember we were talking about that oral surgeon from the [inaudible] example. But you were doing that back then.

Jennifer Pinder: Years ago.

Prav Solanki: Yeah.

Payman Langroud…: That’s huge. It’s huge.

Jennifer Pinder: It’s huge because instead of a dialogue the patient knows a bit about you. You know a bit about them. And people will open up on an email in a way that they might not talk to you as well.

Prav Solanki: You build that confidence, and even just educating them and providing information that maybe they didn’t know can be part and parcel of their therapy. What’s the longest furthest distance a patient has travelled to have care with you?

Jennifer Pinder: Well, I had a few regular patients that used to travel from abroad but the one that sticks, the one that-

Prav Solanki: You say that as though it’s no big deal. Well, I had a few that came from abroad.

Jennifer Pinder: Well, don’t forget, I practised in the city of London so it was…

Prav Solanki: Yeah.

Jennifer Pinder: I think the one that sticks out for travelling was a guy contacted me, again through email. He hadn’t been to the dentist for 50 years.

Prav Solanki: Wow.

Payman Langroud…: Wow.

Jennifer Pinder: And he was in an awful state. It was to do with something which happened when he was child of five, or whatever it is. Anyway, we had to chit chat, chit chat, chit chat. And so I said, “Well, if you want me to treat you, you’re going to have to come and see me.” I said, “And maybe you could go to the dental hospital or whatever, or find a community dentist. No, he didn’t want to do that. He wanted to come see me. So he came to see me from Leicester. This man was severely needle-phobic, among other things. He’d been diagnosed as diabetic and he wouldn’t have any-

Prav Solanki: Insulin.

Jennifer Pinder: He wouldn’t have any blood taken to check his blood. So it had to be done all with urine tests. So his teeth were… I mean you’ve never seen anything like it. He looked awful. He said he was losing work because he looked so awful. And what I used to do as well was, we were fortunate, we had digital X-rays and so I could do a digital… I think everybody who came, if they needed it, had a digital OPG, which was brilliant because you could then have it back on the screen and they could look from a distance and you could show them what was going on. This chap needed full clearance.

Prav Solanki: Right.

Jennifer Pinder: Well, sedation was going to be the only way. And we got him finally, after a lot of whatever, to agree that he would have the injection in the arm. We had a one very experienced anaesthetist from a firm called Andre Du Plessis. He was terrific with nervous patients. I mean they were safely sedated but they were well sedated. So he obviously had to bring somebody with him all the way from Leicester, and obviously had to go back again. I tried to get him in to one of the hospitals in Leicester. Nobody was interested. Couldn’t find anywhere to take him. So we were left with that. And under sedation, he agreed to have a finger blood tip for his diabetes.

Prav Solanki: Diabetes, wow.

Jennifer Pinder: Even under sedation, he was what I call a chase me around the chair patient. Even under sedation, he was throwing himself backwards and forwards, et cetera. Because we had to get lots of injections in. Because in reality he would’ve been better off with a GA. But as there was no other way for this poor man, we did it. So we did take all his teeth out. And I went to talk to his wife and she burst into tears. She said, “You cannot know how many holidays have been ruined by trying to find antibiotics and constantly on antibiotics,” et cetera. I then recommended he went to a clinical dental technician.

Payman Langroud…: For dentures.

Jennifer Pinder: For dentures. Whether he did it, I don’t know. But he was probably one of the worst cases.

Prav Solanki: Did you work alongside many clinical dental technicians during your career?

Jennifer Pinder: I chaired the Dental Auxiliaries Review Group.

Payman Langroud…: Of course you did.

Jennifer Pinder: And one of the-

Payman Langroud…: You like to chair stuff, right?

Jennifer Pinder: I like to chair stuff. I like to be in charge.

Prav Solanki: Just saying.

Jennifer Pinder: So one of the groups I had to deal with was the dental technicians about getting them registered and also registering clinical dental technicians so they could legally-

Payman Langroud…: See patients.

Jennifer Pinder: … do dentures to the public. Well, dealing with the technicians was actually, in a way it was wonderful. I think because of my background, that my grandparents had been what were dental mechanics or whatever then, and my dad having a lab and my brothers are technicians, that I had some credibility to talk to them. Because it was like dealing with the trade unions. But I did it. And I got them on board. And so that it is where it is today. I’m sure there’s some illegal denture making.

Prav Solanki: Oh, there’s tonnes of it.

Jennifer Pinder: I’m sure there is.

Prav Solanki: Tonnes of it. So you were pivotal in getting clinical dental technicians authorised to practise dentistry direct to public.

Jennifer Pinder: Yes.

Prav Solanki: Wow.

Jennifer Pinder: And dental nurses registered.

Prav Solanki: Wow.

Payman Langroud…: Were you not going to mention that in our little chat outside?

Jennifer Pinder: No. Well, I seem to have done quite a lot.

Payman Langroud…: You’ve done a lot. You’ve done a lot.

Jennifer Pinder: I’ve done quite a lot.

Prav Solanki: Yeah. Well, my business partner, Marc Northover, is a clinical dental technician [crosstalk 00:44:37].

Jennifer Pinder: Oh, right.

Prav Solanki: I would say that his patient manner is phenomenal. And the way he utilises the relationship between a dentist and a CDT to give a patient a complete treatment plan where they talk them through the steps of how they make the dentures, get them involved in the choosing of the teeth. The whole process, I think it’s an incredibly unique relationship and a really special one if you can get a dentist and a CDT to work together in the interest of the best patient. I’m sure Marc’s got a lot of things to thank you about, being able to practise [crosstalk 00:45:13].

Jennifer Pinder: I was the person on the GD… Funny enough, Margaret Seward was the president at the time. And she was a mentor for me. So she gave me things to do.

Payman Langroud…: Nice.

Jennifer Pinder: Which was good. And they were really, really interesting. It was terrific, that feeling. The other thing I did when I was on the GDC, I chaired the Behaviour Sciences in Dentistry group which I set up. And we got behaviour sciences into the undergraduate curriculum.

Prav Solanki: Oh, wow.

Jennifer Pinder: Yeah.

Prav Solanki: Amazing.

Jennifer Pinder: I mean it seems to me that although we’ve got behavioural sciences into the curriculum, has it changed much in terms of communication skills?

Payman Langroud…: Well, I think they’re pretty good at communicating. What people worry about, the new, young graduates, is they’re not that great at drilling anymore because they’re doing less of that, for sure.

Jennifer Pinder: Yes. Yes, I think that’s probably true.

Payman Langroud…: What do you think about the fact that back when I qualified the grades you needed to become a dentist were kind of average and now you need to be a top student-

Jennifer Pinder: [crosstalk]

Payman Langroud…: … to get into dentistry, academic to get into… Do you think that makes for a different type of dentist?

Jennifer Pinder: Well, it could do. I think it’s a shame because sometimes with lesser degrees… It depends what they’re looking for. Is it because there’s more competition to get in-

Payman Langroud…: [crosstalk]

Jennifer Pinder: … and thus they have to set the bar higher? But then that has a knock-on effect on having people who are more academic or less… I don’t know how they test their clinical skills, whether they’re any good with their hands or whatever.

Prav Solanki: What makes a better dentist, I guess, is… I don’t know how well you did academically, but it’s very clear from the reports we’ve seen on our website, of patients you’ve treated and interacted with and the life change and impact you’ve had, is the majority of your skillset, other than the drilling, comes from making patients feel comfortable, spending that time with them, assessing them, liaising over email. You can’t assess that in the A level.

Jennifer Pinder: No. Nor can you assess it in a 15-minute-

Prav Solanki: Interview.

Jennifer Pinder: … NHS new patient interview, can you really?

Prav Solanki: No, no.

Jennifer Pinder: I think that’s too bad. What I always say when I’m lecturing on nervous patients is because people might say, “Well, this job isn’t as good because the patient was nervous.” Well, actually I’m not quite sure how you can do that today, whether that would go down as an excuse or whatever. Because you’ve actually got to somehow be able to do a clinically competent job. It’s very nice. But the skill is getting the patient to have the clinically competent job in the first place rather than have this first thing and then go away and never have any treatment done. So you’ve got these stages. You’ve got to get the patient to get in in the first place. You’ve got to get the patient sorted so that you give them the treatment plan and they accept whatever part of it they want. Then you’ve got to get them to the treatment. And then you’ve got to treat them in a way that’s pain-free, without using the wand. Doing all your skills so it’s pain-free so that their experience is good so they’ll go onto other things.

Jennifer Pinder: When you talk about it from the business point of view, I’ve had patients who have been absolutely petrified. And of course they’ve got to get the basics. Because some of them come in and say, “I’d like whitening, please.” And you think, “No, not yet.” So they’ve got to go through certain stages. They go through certain stages. Some of them then go on to having Invisalign, to go on to have ortho. They go on to have cosmetic dentistry, and then they can have tooth whitening. And one of the patients I used to treat at my old practise is a young woman who’s got lots of problems, but she always used to cry every time she got over the… She would say she could smell the dental practise in the street. And then when she got to the door, she burst in tears. And she was so sweet. She works for a hedge fund company. She’s got a bit of a gagging problem and she wanted to have whitening. And it was never okay. I headhunted somebody to take over my patients, who is good with nervous patients. And so-

Prav Solanki: When you were retiring?

Jennifer Pinder: When I was retiring.

Payman Langroud…: What was that like?

Jennifer Pinder: What, retiring?

Prav Solanki: Having to.

Payman Langroud…: Well, first of all finding this guy, finding this guy who’s good with nervous patients.

Jennifer Pinder: It’s a girl.

Payman Langroud…: This girl.

Jennifer Pinder: It’s a girl. Actually, she’s not that young actually either. It’s a female. Anyway…

Payman Langroud…: Where did you find her?

Jennifer Pinder: Also now, Victoria, this patient is going to have her bleaching done because they’ve done the impressions with a scanner.

Prav Solanki: Of course.

Jennifer Pinder: They’ve got a scanner in the practise.

Prav Solanki: How many years later is that?

Jennifer Pinder: What, from…

Prav Solanki: From the initial conversation with yourself.

Jennifer Pinder: About 10 years.

Prav Solanki: Wow.

Jennifer Pinder: About 10 years. But isn’t great that she’s going to have it now because of innovative technology.

Prav Solanki: Yeah.

Payman Langroud…: Yes. So tell us about retiring. How was that? How did it feel? When did you realise that the time’s come to stop?

Jennifer Pinder: I decided I-

Payman Langroud…: Had you planned it ahead?

Jennifer Pinder: Yes. I retired when I was 70. And by then, I knew that physically it was becoming more difficult.

Payman Langroud…: It’s physically a hard job, dentistry.

Jennifer Pinder: It’s physically a hard job. I mean I have got back trouble now. And I had one case where I was trying… I won’t go into the long story but I had an upper six to take out, which had been like it had a golf ball of calculus around it. Young woman as well.

Prav Solanki: Really?

Jennifer Pinder: And when we took the calculus off, this tooth was there but it was hollow. So when I put the forceps on it went-

Prav Solanki: Crush.

Jennifer Pinder: It crumbled. It was obviously fused to the… I could not get it out. However, battled on and on. The patient had had 10 milligrammes of Valium. She was actually very valiant considering where she’d come from. And I had to get somebody else in to do it for me. And then I thought, “Hmm.”

Payman Langroud…: Had enough.

Jennifer Pinder: This is-

Payman Langroud…: I had a moment like that.

Prav Solanki: It’s a sign.

Jennifer Pinder: Did you?

Payman Langroud…: But I was 32 at the time.

Jennifer Pinder: Okay. Oh well. I went on a bit longer than you then. But I knew I was right. My last three months was amazing. All the patients who hadn’t been in for a bit, all wanted to be seen now before I left, just one more time. And every day I used to go out with laden down with bags of goodies I’d been given. And yeah, it was very emotional.

Prav Solanki: Yeah, I bet.

Jennifer Pinder: Very, very emotional. Patients who’ve been seeing you for 40 years and cry.

Payman Langroud…: Wow.

Jennifer Pinder: And you don’t know what to say to them because you… But things move on.

Payman Langroud…: Sure.

Jennifer Pinder: Your doctors change. You have to do that.

Prav Solanki: Sure. You go home the day after you’ve done your last day, what’s that like? I mean I always say to myself I’ll never retire, because I wouldn’t know what to do with myself.

Payman Langroud…: [inaudible] retired already [inaudible 00:52:38]?

Prav Solanki: No.

Payman Langroud…: Carry on.

Prav Solanki: I think I’d be lost. Just talk me through just from your perspective.

Jennifer Pinder: I think you have to prepare not to be lost.

Prav Solanki: Okay.

Jennifer Pinder: The first week, I used to feel really odd on Sunday night at not going to work the following day. I’ve never not had anything to do. The last few years, I studied to get an advanced diploma in genealogy and I’ve set up a little family history business. So I have that.

Prav Solanki: Tell me about that.

Jennifer Pinder: Tell me about that.

Prav Solanki: So a client comes to you and what’s a typical scenario? What information do they want and what do you provide as a service?

Jennifer Pinder: I have a contract with Forces War Records, which is a database. And I do research on people’s World War I ancestors as part of it, which is fascinating and sad as well often, but great when you find out for people what their background is. Other ones you get, I can do research back into the 18th century because of the training I’ve had done. I’ve got one at the moment who wants to find her father’s illegitimate… He was illegitimate and his mother was illegitimate. And he wants to find out who his grandfather’s father, something things-

Payman Langroud…: What’s the process, Jenny? How do you go about that?

Jennifer Pinder: Well, there’s an awful lot online now. But it’s not all online. And sometimes you have to go and visit the National Archives or visit, in London, the London Metropolitan Archives. And you have to order stuff. And then you can look at the original documents.

Payman Langroud…: Literally pay books, papers like that?

Jennifer Pinder: Yes. Books.

Payman Langroud…: What was that thing microfiche or something?

Jennifer Pinder: Microfiche.

Payman Langroud…: What was that? Do you remember that? No, it’s before your time, Prav.

Prav Solanki: I’ve heard of it.

Jennifer Pinder: Oh, they’re a pain in the [inaudible 00:54:41], aren’t they?

Payman Langroud…: In libraries, people used to have to those things.

Prav Solanki: Yeah, yeah, yeah, on the screen.

Payman Langroud…: Yeah.

Jennifer Pinder: Or they have things that they roll around and you look at that. Well, it’s not so much like that now. But you can look at original documents. And some of them are really very, very-

Payman Langroud…: It must be fascinating.

Jennifer Pinder: It’s fascinating. I knew nothing about history. I like the social aspect of it, finding out people’s background.

Prav Solanki: Was that in preparation for retirement?

Jennifer Pinder: Yes, it was.

Prav Solanki: That you thought, “This is what I want to do,” my new trade so to speak?

Jennifer Pinder: Yes, yes. Yeah, I was afraid of having vast areas of time and nothing to fill it.

Prav Solanki: So you planned that out.

Payman Langroud…: You’re also doing this Confidental thing.

Jennifer Pinder: Yes.

Payman Langroud…: Which did it come from the Mental Dental group from Facebook?

Jennifer Pinder: It did. I have to say-

Payman Langroud…: Tell us about that.

Jennifer Pinder: Yes, there’s Mental Dental. And Lauren, who set that up, is now the admin. It was an amazing thing. Because suddenly all these things came up.

Payman Langroud…: So much of it.

Jennifer Pinder: People opened up in a way that they’d never opened up before.

Prav Solanki: Before.

Jennifer Pinder: And you saw the level of such a problem and that actually had been buried. So it was Jeremy Cooper’s, partly his idea first. He got people together. And so there was Lauren from Mental Dental and Keith Hayes who runs RightPath4, who actually has provided the seed funding for it. And I really, really want him to get the credit for that. And he does a lot of the administration. He’s a very kind man. And so, anyway, eventually it ended up as just four of us. Because I approached Jeremy and said, “I’d like to be involved with this.” Because many years ago, I had a bit of a meltdown. And I had support. I knew where to go. But there was a couple of times where something had happened or I’d got a letter from something or something. And if I’d had somebody to ring up and talk to at 10:00 at night when I was in a state, it would have been wonderful. So that’s why I thought Confidental-

Prav Solanki: Confidental.

Jennifer Pinder: … was something which was going to be a service that was needed.

Payman Langroud…: So is it 24 hour?

Jennifer Pinder: Yes.

Payman Langroud…: And there’s someone on the line you can call?

Jennifer Pinder: Yes.

Payman Langroud…: Wow.

Jennifer Pinder: Although, we’re finding that there’s certain times of day. Lunchtime, people can stop practising or maybe they’ve got the letter or one of the letters from the dreaded-

Payman Langroud…: Is that a very common call then? “I’ve just had a letter from the GDC.”?

Jennifer Pinder: Yes. Or, “A patient sued me,” or, “I’ve done something on a patient [crosstalk 00:57:28].”

Payman Langroud…: And what’s your general advice if someone makes that call? What’s the first thing you say?

Jennifer Pinder: We’re not there to give advice. We’re there to listen, let them get off their chest. There was a call the other night where it was obvious the person was depressed or whatever. She didn’t know about the Dental Health Support Trust. And she didn’t know about the Practitioner Health Programme. The caller was able to signpost, give her that information. Obviously what they do with it is up to them. But it’s-

Prav Solanki: But you could point them in the right direction, couldn’t you?

Jennifer Pinder: Point them in the right direction.

Prav Solanki: And I guess there’s some organisation set up. If you’re not a member or you’re not paying your subscriptions and things like that, you don’t even get that, right?

Jennifer Pinder: Yeah, because the BDA has obviously just got this new scheme for its members. But not everybody’s a BDA member, so they haven’t got anywhere to go.

Prav Solanki: How many calls are you getting? Do you know, roughly, a week or a month?

Jennifer Pinder: We started about last May. And I think we’ve had about 120 calls. But it seems to be taking off now because it’s becoming more widely known. So we’ve got some lovely volunteers, very, very, very good.

Payman Langroud…: And training them and all that?

Jennifer Pinder: Yes, they’re trained. Well, they have a two-day course.

Payman Langroud…: Are they dentists?

Jennifer Pinder: They’re all dentists. All retired dentists or some of them have been trained in psychotherapists as well, some sort of counselling or mentoring background.

Payman Langroud…: The calls that you get, if you had to break them down, you’ve got the, “I’ve had the letter.”

Prav Solanki: I get that call all the time.

Payman Langroud…: From your clients?

Prav Solanki: Yeah.

Payman Langroud…: Really?

Jennifer Pinder: Do you? Yes.

Prav Solanki: A lot. And you’re right, they want advice of reason. Their career isn’t over at that moment in time even though they start planning for it to be over or, “What if this, and my house and my mortgage and my this and my that and my kids and my private school education?” Everything comes out in that conversation. And it’s just a letter saying we’re looking into this. Obviously I’m not qualified to give them advice, but you’re there to listen and just give them a little bit of advice of reason. But it’s amazing how that one letter can just set off a whole trajectory of sleepless nights, depression. And also, the time between when that letter comes and anything actually happens-

Payman Langroud…: It’s interesting.

Prav Solanki: It’s like cortisol levels must go through the roof.

Payman Langroud…: It’s interesting that they call their marketing guy. You’re more than that, aren’t you?

Prav Solanki: I’m more than that.

Payman Langroud…: You’re closer to the clients than that?

Prav Solanki: Yeah, yeah, yeah.

Payman Langroud…: What other types of calls do you get? Is it the whole gamut, everything?

Jennifer Pinder: It’s a whole gamut. Usually if it’s not the GDC, it’s, “Oh, I’ve done something with a patient,” or whatever. Or disputes between-

Payman Langroud…: Principals and associates.

Jennifer Pinder: And associates. More often than not it’s associates. We’re getting quite a lot of muddle about maternity pay. We had somebody who was employed by a therapist and was owed multi-thousand pounds and there was disputes here [inaudible 01:00:43]. And then this person was threatening to take the person they owed all the money to to the GDC. So people can hold referring people to the GDC over people’s heads to get them to go away in disputes as well.

Payman Langroud…: I’m sure that’s very common actually.

Jennifer Pinder: And women going away on maternity leave or they’re on maternity leave and they’ve been off for three months, and they’re terrified of going back. And now there isn’t anywhere for retraining. There’s nothing to support them going back to work.

Payman Langroud…: It’s interesting that the women’s issues still exist around maternity.

Jennifer Pinder: Yes. Yeah, why? I mean I don’t really know.

Payman Langroud…: Jenny, we were asking everyone, you can answer it whichever way you like. But from the notion of black box thinking is the idea of what’s the biggest clinical mistake you’ve ever made? It could help others. In medicine dentistry, we don’t tend to talk about this. But if you’re happy to talk about that.

Jennifer Pinder: Well, the biggest clinical mistake I think I ever made, and it was a very long time ago, was a women, she’d had an accident. She had a blow to a tooth. Anyway, it was root filled. It was an upper lateral. Because I can see it today.

Payman Langroud…: That’s the nature of it.

Jennifer Pinder: You do, isn’t it? And anyway, so we were going to make a post crown for this because it was discoloured. And that’s what you did in those days. You chopped the top off and put a post up and did this, that and the other. So it came to the stage where we were going to take the temporary off and put the post in. So I took the temporary off and didn’t give her a local or anything. And she went, “Ooh.” So I’d taken the tooth out as well as the temporary crown.

Payman Langroud…: Had you grabbed it with forceps?

Jennifer Pinder: No. I think it must’ve been-

Payman Langroud…: A loose tooth, right?

Jennifer Pinder: But I hadn’t taken a X-ray. And if I’d taken-

Payman Langroud…: That sinking feeling as soon as you make a mistake.

Jennifer Pinder: It was that sinking feeling. So I didn’t say anything.

Payman Langroud…: Didn’t you?

Jennifer Pinder: At the time. I just went off to the telephone and rang Dental Protection or whatever [inaudible 01:03:02].

Prav Solanki: Straight away.

Jennifer Pinder: Straight away. I felt sick. I did not know what to do. And in the end, we had to be honest.

Payman Langroud…: Of course.

Prav Solanki: Yeah.

Jennifer Pinder: And in those days, we sort of said, “Oh, that would probably have happened anyway. It would’ve failed at some stage.”

Payman Langroud…: In those days, you could say what you like and patients would-

Jennifer Pinder: Well, yes. I said, “Well, maybe that’s for the best it’s happened now.”

Payman Langroud…: Yeah.

Prav Solanki: Yeah.

Jennifer Pinder: Not thinking that at all. And so I think we got her a temporary denture made overnight more or less.

Payman Langroud…: We’ve got to be kinder to ourselves. I mean because you’ve got a 50-year career, right? You’re going to make several mistakes in that 50-year career.

Jennifer Pinder: Yes, yes.

Payman Langroud…: And it’s important to talk about them, because I bet you never did that again, but to learn from each other, to learn from each other.

Jennifer Pinder: I think the other learning thing, when you’ve been in a career for a long time or you’ve had patients with you for a long time, you can see your good work and you can see work that you think, “Oh, did I do that? Ooh. It must’ve been a bad day.” And you have to not flannel but it happens. And again, it depends on the patient and then circumstances.

Payman Langroud…: Yeah. We’ve had Tif Qureshi and he says being in the same practise for long time is way better education than doing any course you want to do or any sets of courses you want to do, because you can see what’s happened to the work.

Jennifer Pinder: And you can see if you got a crown that’s failed within one year or something like that, why did it fail?

Prav Solanki: Right.

Jennifer Pinder: What could you have done differently? And so you don’t do it again because you want your work to last. And of course, people are more litigious.

Prav Solanki: For sure.

Jennifer Pinder: In this day and age. What happened, then, I’m sure something else would’ve happened probably.

Prav Solanki: We’re in the Instagram age now. Do you have an Instagram account?

Jennifer Pinder: Yes.

Prav Solanki: You’ve been on the dental Instagram, sort of Instadentist.

Jennifer Pinder: Not really.

Prav Solanki: There’s a lot of it about. There’s a lot of before and afters. And interestingly now, TikTok’s come along. It’s even more ridiculous. It’s like singing along to the-

Jennifer Pinder: Isn’t TikTok the Chinese one?

Prav Solanki: Yeah, yeah. Some dentists have got accounts on there. My question to you, you’ve seen it from Doncaster to the Instagram age, what would be your advice overall to dentists? Leave a bit of advice for a young dentist, a dentist in the middle of their career, whatever, whatever you like. What’s your key advice?

Jennifer Pinder: People get stuck in jobs that they’re not happy about. They use the word can’t, “I can’t do this. I can’t do that.” But actually, you can. Sometimes making changes, when you look at them in retrospect, is the best thing that could ever happen. You see a lot of people stuck in jobs that they’re not happy about, and they just stay stuck. And improve yourself. Go on courses. Stay connected with other dentists, whether it be… Now it’s more on social media, but to do that so that you engage with dentistry, keep up with things. When you talk about Instagram, women dentists that were sort of a little London group, we had Manrina Rhode came and gave us a great talk on how to do your Instagram accounts. And then next day, all of these, it included some students, there was all their Instagram accounts being updated. So I’ve got one but I don’t [inaudible 01:06:36]. I do like Facebook.

Prav Solanki: Talking about change and don’t get stuck in the job that you’re not happy with or doing anything you’re not happy with, if you could do it all over again, what would you do different?

Jennifer Pinder: I might’ve gone into doing a specialty in special needs I think, if I was going back into that way. Because actually that’s really what I became a sort of subset of really.

Prav Solanki: Would you have chaired all the things you chaired?

Jennifer Pinder: Oh yes. Oh yes, I would.

Prav Solanki: And some more?

Jennifer Pinder: Oh no. No.

Prav Solanki: I don’t think it’s possible to chair anything more.

Jennifer Pinder: I became vice dean of the faculty.

Prav Solanki: Here we go.

Jennifer Pinder: So I had a lot to do with that. No, I had my time. And there comes a time to move on. And I think people who stick on the same committees for years and years and years is a bad thing. There should be some movement in people. I mean I would like to see the BDA PEC committee, or whatever it was, have more women on it. But the way the things are stuck at the moment, it’s not going to happen. But for me, no, I think would I change anything? Yeah, as a said, the only thing I would change, I’d probably go into special needs on a higher level. When I say on a higher level, I’m the one who can treat people in general practise and can pretty much treat anybody.

Prav Solanki: So true. And I think Tif talks about GDP as being, and I’m not quoting his words here because he might pull me up on it, the best specialists. Because as a GDP, first of all you see the patient right from the beginning to the end multiple times. You see the impact on their health, their confidence, their life, obviously their oral health and their teeth. Whereas as specialists, sometimes you just go in and do your one hit, your bit of perio, your bit of implant, your ortho, and then send them back to their general dentist. So maybe not, hey?

Jennifer Pinder: [inaudible 01:08:52].

Prav Solanki: What would you like your legacy to be? What would you like people to remember you as?

Jennifer Pinder: This is going to sound funny. A benevolent battle-axe.

Payman Langroud…: I like that.

Jennifer Pinder: Do you like that?

Prav Solanki: I like that.

Payman Langroud…: Love it. Love it. I do like that.

Prav Solanki: Yeah.

Payman Langroud…: It’s been a lovely conversation. Thank you so much.

Prav Solanki: It’s been great.

Payman Langroud…: Thank you, Jenny.

Prav Solanki: Thank you so much. Thank you.

Speaker 3: This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.

Prav Solanki: Hey guys, and thank you for listening to today’s episode of the Dental Leaders podcast, a vision that myself and Payman had over two years ago now. And if you have got some value out of today, just hit the subscribe button in iTunes or Google Play or whatever you’re listening to. Let us know in your comments what you actually got out of the episode. Because we love sitting back and reading those reviews. It really does make our day.

Payman Langroud…: It’s a real pleasure to do this. it’s fun to do but I’m really humbled that you’re actually listening all the way thorough to the end. And join us again. If you got some value of it, please share it. Thanks a lot.

Payman Langroud…: Did you learn any Japanese?

Vicky Wilson: [foreign language 00:00:02].

Payman Langroud…: Apart from that?

Speaker 3: This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.

Payman Langroud…: So Vicky, lovely to have you in the studio. Unfortunately, today, Prav’s not with us. So you’re not going to get the Prav questions, but I’m going to do my best to be him and myself.

Vicky Wilson: I can’t wait. Thanks so much for inviting me.

Payman Langroud…: My pleasure. My pleasure. So tell us a bit about yourself to start with. Where were you born? What kind of childhood did you have?

Vicky Wilson: I was born in Sidcup, just outside London. I’m an only child. We lived in Chislehurst for about four years, then we moved to Tunbridge Wells, and my dad got a job in Japan.

Payman Langroud…: Oh, what did he do?

Vicky Wilson: He was a money broker.

Payman Langroud…: Okay.

Vicky Wilson: And we moved to Tokyo, when I was four.

Payman Langroud…: Oh, really?

Vicky Wilson: Yeah.

Payman Langroud…: For how many years?

Vicky Wilson: A year.

Payman Langroud…: Do you remember?

Vicky Wilson: I do, it’s really bizarre. I think because it was so-

Payman Langroud…: Such a big change?

Vicky Wilson: … such a culture shock. It was so different. I remember things so clearly, from the steps walking down from where we lived, to the shops that I used to go to on my own. There was Muji. I remember Muji.

Payman Langroud…: Really?

Vicky Wilson: It was so safe there, mom used to let me, she could see from the window, walk down to the shop when I was five. It was so-

Payman Langroud…: The good old days.

Vicky Wilson: Yeah, it was so… The good old days. It so safe. Culturally, it was so different. Visually, it’s so different. And there weren’t that many expatriates there at the time.

Payman Langroud…: Something I’ve noticed, when I go to the Far East, is you suddenly understand why those Japanese tourists are taking pictures of banal stuff in London. Because you catch yourself taking pictures of post boxes and things, in Bangkok, or whatever, India. It’s such a different aesthetic, isn’t it?

Vicky Wilson: Yeah. And talking about pictures, one thing that stays with me more than anything, I couldn’t walk down the street without pictures, pictures, they-

Payman Langroud…: Because you were a foreigner?

Vicky Wilson: Or the Japanese would come up and say, “Can we take a picture?”

Payman Langroud…: Funny. Did you learn any Japanese?

Vicky Wilson: [foreign language 00:02:33]

Payman Langroud…: Apart from that? Because, I take that as a no.

Vicky Wilson: Limited. Very limited. It’s a regret, I have to say. Mom and dad, because it was such a culture shock and there was obviously no internet back then. For me, I really missed my grandparents, because I was very close to my grandparents at the time. And phone, speaking to them, it didn’t happen that often. So mom and dad sent me to Sacred Heart there, which was an international school. And that’s one thing, I wish I had a bit more of a voice then, say, “Send me to Japanese school,” because I would have picked it up. I understand where they were coming from at that point, it felt, “Can we send our daughter to…”

Payman Langroud…: I mean, it’s a big step.

Vicky Wilson: Big step.

Payman Langroud…: So then, where did you go after Japan?

Vicky Wilson: Came back to the UK.

Payman Langroud…: Okay.

Vicky Wilson: Just turned around.

Payman Langroud…: Do you remember the first time that you realised you were going to work in dentistry? How did it happen? What did you do? Because now, you’re a famous hygiene therapy.

Vicky Wilson: [inaudible 00:03:33].

Payman Langroud…: Key opinion leader, trainer.

Vicky Wilson: Maybe.

Payman Langroud…: But what was your first exposure? Did you get a job as a kid? What happened?

Vicky Wilson: Well, I was actually writing an article, last week, about my first exposure to dentistry when I had a fascination for dentistry. I remember going to the dentist with my mom, I must have been maybe eight, around that age, tickling her feet.

Payman Langroud…: While she was in the chair?

Vicky Wilson: While she was in the chair. I was fascinated. I remember this really clearly about what the dentist was doing. Moving forward, it came to work experience time.

Payman Langroud…: 16?

Vicky Wilson: Yeah. I remember going to Mark lane dental clinic in the city, my dad’s dentist, Sean. I used to go there for work experience. I went I think two years in a row. Then, I really decided… I tried physio. I knew I wanted to work in health care, I wanted to be practical, looking after people. I couldn’t envision myself sitting at a desk. It’s very creative. That’s another side of what I wanted to explore, but I really wanted to work and treat patients.

Payman Langroud…: So did you go train as a hygienist soon?

Vicky Wilson: I decided I wanted to go into dentistry, didn’t get the [inaudible 00:04:58].

Payman Langroud…: Yeah, me either. I begged Cardiff who finally let me in.

Vicky Wilson: This is common. Maybe I could have gone for dentistry, but now look at me.

Payman Langroud…: Should have looked at Cardiff.

Vicky Wilson: I wish I would have known.

Payman Langroud…: Cardiff needed people.

Vicky Wilson: So then I thought, “What can I do?” Hygiene was something I was interested in, but when I found that I could do therapy, that was it. I’ve never looked back. I’ve never really felt I want to continue to further my training to be a dentist. I love-

Payman Langroud…: Other than the work experience peace, you didn’t really work in the practise. You weren’t a dental nurse for any period of time, because that’s the usual sort of pathway, isn’t it?

Vicky Wilson: It is. When I was still at school, I was at Mayfield in a village close to where we lived. It was time for UCAS and I remember them frowning at me. What do you mean you’re not going to do UCAS? What do you mean you want to be a dental hygienist, dental therapist, what’s this? So they didn’t really help me. So I remember working on this with in… The work experience really helped me, because I had started the work experience at a young age and I was still at school. I went to the Eastman for an interview. That was the only one I went for.

Payman Langroud…: And you got it?

Vicky Wilson: They said, “Based on your A level results, yeah.”

Payman Langroud…: It’s a tough course, isn’t it?

Vicky Wilson: Really tough.

Payman Langroud…: I remember in dental school, I remember the hygienists were having a harder time of it than we were from the homework perspective, like the amount of work they had to do. It’s a very intense coarse. Hygiene is two years and then therapy is, what, three years? How does it work?

Vicky Wilson: it was I think 27 months.

Payman Langroud…: Was hygiene one year and therapies two years?

Vicky Wilson: It was less at the time when I did it. So I qualified in 2003. The hygiene is finished I think in September. Or no, July and we finished in the December, so it was a bit longer. But yeah, it was really tough.

Payman Langroud…: Do you remember the first time you drilled someone’s teeth?

Vicky Wilson: Phantom head?

Payman Langroud…: I remember that.

Vicky Wilson: You remember that? [crosstalk]

Payman Langroud…: Do you remember the first time you gave an injection?

Vicky Wilson: For me, that really-

Payman Langroud…: Was a big deal.

Vicky Wilson: That was a big deal. It was scary, but yeah, the Eastman was tough. But saying that, I did do, in that year out between, because I got the place deferred so it was a year, I did go and do some dental nursing. First day, I passed out on the floor.

Payman Langroud…: Why?

Vicky Wilson: This guy came in fallen off his bike, and it was too much blood, I was like, “I can’t. Oh my god, the poor guy.”

Payman Langroud…: You qualified. You went and worked in a few practises?

Vicky Wilson: I did a bit of low coming. I did some therapy work in an NHS practise.

Payman Langroud…: Which year was this?

Vicky Wilson: 2003. Then, I found the kind of practises that I wanted to work in. Then, I worked in Tunbridge Wells for a short amount of time. Then, I worked with James Gollnick in Berlin.

Payman Langroud…: That must’ve been a big change from wherever you’d come.

Vicky Wilson: It was brilliant.

Payman Langroud…: Yeah, brilliant practise, right?

Vicky Wilson: Amazing. James is just incredible to work for.

Payman Langroud…: He just wants to do things differently, doesn’t he? He wants do things better all the time. That’s the feeling I get from him. When we had him in here for the podcast, I felt like he just… Did you listen?

Vicky Wilson: He’s brilliant.

Payman Langroud…: He wants challenges, doesn’t he?

Vicky Wilson: He really does. I feel so fortunate to have had the opportunity to work with James. [crosstalk] so early in my career because it set a standard and I kind of… It built something in me that I really… You’ve got to work hard. I never ever minded doing anything extra, working hard, appreciating your team. We always felt so appreciated. He’d take us to Champneys as a tanks. I don’t know who else was getting that at the time. He was so inspirational. We had team meetings, no one else was doing that. Morning huddles at the beginning of the day. I would go through the whole list and that was brilliant.

Payman Langroud…: In the morning huddle, you’d say, “Mrs. so and so is coming in today.” Would it be about… When I was a dentist, the practises I worked in didn’t use to do morning huddles, so I’m not 100% clear on what happens. Is it, “Can we go that extra mile for her somehow?” It was that the idea?

Vicky Wilson: Well, yes. Everyone knows, exactly. You just pull out what are the highlights of the day, what patients are coming in, maybe what highlights there are specifically about specific patients so that everybody is in tune with it. Everyone knows, maybe we need to look about this… Everyone’s brought together. Although maybe we’re not in that surgery, we know what’s going on elsewhere. We know that maybe we want to say hi to them, follow up with them, maybe pop in if we can. It just brings everyone together. That, for me, is teamwork.

Payman Langroud…: Especially from the hygiene perspective. A hygienist can sometimes feel like an add on to a practise because of the number of days that hygienists are in sometimes. You were telling me the hygienist always gets the worst room.

Vicky Wilson: It’s maybe something that is frequently-

Payman Langroud…: If there’s a nurse missing, the hygienist is the one who loses the nurse and all of that sort of thing, if she’s lucky enough to have a nurse in the first place, right?

Vicky Wilson: Absolutely.

Payman Langroud…: Where I’m going with it is if you were involved in a morning huddle, then you do feel like part of that team.

Vicky Wilson: Absolutely.

Payman Langroud…: Whereas I can think of in practises in I was working at, the hygienist, even though they were a very capable hygienist, they just used to be up there in their room and not the part of the team because they were just there one day or two days a week, not exactly the same.

Vicky Wilson: But to be getting the most out of your team to be working in such an optimal way, that’s what you need as a hygienist or a therapists, always to feel part of the team. Sadly, a morning huddle is the way forward.

Payman Langroud…: We were talking about this before, I was asking you… I’ve been listening to your brilliant podcast, by the way, which we should talk about in a moment.

Vicky Wilson: Thank you.

Payman Langroud…: The podcast is called?

Vicky Wilson: Smile Revolution.

Payman Langroud…: Smile Revolution. Yeah, I’ve been listening to that. The funny thing about it is, I was saying to you that listening to the hygiene, there’s a thread that runs through them, that they’re not being used to the maximum of their education. They’re not being appreciated as much as they should be. I know I’ve certainly come across hygienists that have been in that situation, I’ve read some terrible things on that dentine hygiene group on Facebook about the way some people get treated, which is a scandal, but I didn’t realise even these high level hygienists, famous ones, key opinion leaders, American ones even, some of the ones you’ve been interviewing, have this thread going through them that they don’t feel 100% appreciated. Why’s that?

Vicky Wilson: I feel where we can in the future move forward is I think it comes down to our education. Frequently, dentists are trained separately to hygienists and therapists. We’re a team and frequently, I know some of the courses are changing now. The therapists start with some dentists in some of the training. This, I feel, is the way forward. Because we’re not trained together and there’s not-

Payman Langroud…: There’s a separation from the beginning.

Vicky Wilson: There’s a separation. If we’re training together, we’re understanding each other’s skill set, skill mix, and how to optimise on our skill set and amalgamating that together to work in the best way we can’t serve the patients. Utilising each one of our skill set is really key. That understanding and that open communication is fundamental. I think as education starts changing, this will eventually change. We’re really always constantly now working on open communication, some practises doing it through morning huddles. But the more we are attending conferences together, being invited to panel discussions together, round tables together-

Payman Langroud…: Okay, so this is the solution you’re saying, but am I right?

Vicky Wilson: You are right. 100%, Pay.

Payman Langroud…: That’s really sad, isn’t it?

Vicky Wilson: It is sad.

Payman Langroud…: I really didn’t realise it was such a common thing. I understood there is such a thing that the hygienist isn’t appreciated. But I didn’t realise how common that was. I mean, the solutions you’ve suggested are certainly one aspect, but the business solution, surely the answer comes in by a hygienists worth to the business being proven. So when you’re talking to a hygienist, is that aspect discussed in the teaching?

Vicky Wilson: Not at all.

Payman Langroud…: Not at all?

Vicky Wilson: We’re not trained in business.

Payman Langroud…: Well, neither are we.

Vicky Wilson: But the business side of things, sorry, was that what you were meaning?

Payman Langroud…: Yeah.

Vicky Wilson: So listening to James Gollnicks podcast, he highlighted something beautiful that he does. He’s such a great leader. He talks to his team and finds out if there’s something maybe that’s bothering them or-

Payman Langroud…: Yeah, he was saying anonymously-

Vicky Wilson: Absolutely. Now, this is a great thing for dentists I feel, to ask all team members is there something, specifically hygienists, therapists, since we’re talking about this, “Is there something that we can work on together to optimise on what you’re doing to best serve the patients better? How can we work together?” So facilitating that open conversation question time to get into understand a bit more about maybe the hygienist obstacles, how can they work better? I think that’s a great start for the listeners, some of them to start talking to hygienists to make sure they’re getting the most out of them, because-

Payman Langroud…: Or dentists, yeah.

Vicky Wilson: Yeah.

Payman Langroud…: Yeah. Well, I’m saying to you 25 years experience and I wasn’t aware.

Vicky Wilson: Exactly. Frequently, I talk to dentists. They’re so pro therapist, they work with therapists, they absolutely love their therapist. Then, we speak about do you really get all the roles or duties that a therapist can carry out? And they say, “Actually, if I’m really honest, maybe not.”

Payman Langroud…: Go on, list them. What are the ones that get missed?

Vicky Wilson: Now you’re testing me. It varies, obviously, from one dentist-

Payman Langroud…: They do fillings.

Vicky Wilson: Yeah, we do fillings.

Payman Langroud…: Perio.

Vicky Wilson: Perio, extractions.

Payman Langroud…: Extractions?

Vicky Wilson: Of primary teeth. [inaudible]

Payman Langroud…: Oh, really?

Vicky Wilson: Yeah, of primary teeth.

Payman Langroud…: I didn’t know that. I didn’t know that.

Vicky Wilson: Instal crowns, restorative.

Payman Langroud…: Whitening?

Vicky Wilson: whitening.

Payman Langroud…: Let’s not forget.

Vicky Wilson: I think maybe sometimes the grey area is in how far can we go without restorative?

Payman Langroud…: Yeah. Up to the pulp, right?

Vicky Wilson: Absolutely, impermanent teeth.

Payman Langroud…: Interestingly, [inaudible 00:16:11], we’re getting a lot more therapists on the concept course. I’m not sure, is it because it’s a self selecting thing? Is it that if you’re a therapist and you’re coming up with 1,000 pounds to go on a composite course, does that mean you’re a super ambitious, super on it therapists? But the results we’re getting are better from the therapists than from the dentist. We say it to them every time at the course. We start the course by saying, “Who are you? What do you do?” We say to them, “You’ve got a lot of pressure on you because we’re getting better results from therapists.” Now, is it because they are better? I’m not sure. I think the kind of therapist who chooses to come on such a course is a better therapist, maybe. But there’s several practises I know where the therapists are doing the cosmetic work really successfully.

Vicky Wilson: We don’t have such a-

Payman Langroud…: Therapists weren’t invented for this, were they? Let’s face that.

Vicky Wilson: No, therapists used to only work in community. It wasn’t until I was studying did it change that we could start to work in private practise. But I guess what we can do is more limited than a dentist. So our focus is specifically on let’s say restorative. If this is our interest, that’s what we focus on. It allows us to concentrate more on that skill set to enhance that, if that’s our interest.

Payman Langroud…: Do you know of examples where the business case has meant that the therapist model is the one that is the best business case? I mean, I know a good friend of mine who’s just bought a practise up north. He’s down south, he’s bought a practise up north. He’s got family member managing the practise and he’s going to have it therapists lead, whatever that means. Do you know lots of therapists where the business is reliant on them? At the PAD team, you must meat people like that, right?

Vicky Wilson: Well, yeah, it’s it’s happening more and more. More hygienists are opening their own practises now.

Payman Langroud…: Oh, yeah? Are success stories there for direct access?

Vicky Wilson: Absolutely. I don’t think I’ve spoken to one hygienists that would say they regret it for a second. They’re so happy they’ve done it. They are so happy.

Payman Langroud…: Are the banks lending and all that?

Vicky Wilson: Yeah, I believe. Also they make their finance plans in place from various different companies to support that. So it’s possible, it’s viable.

Payman Langroud…: But it’s not very common, is it?

Vicky Wilson: It’s not that common, but it’s becoming more common.

Payman Langroud…: Really.?

Vicky Wilson: Yeah, because I think the common thread through the hygienists that have done this say, “I get to what I want to do in my timeframe without any limitations.” They’re their own boss. It’s also more affordable to set up a hygiene clinic rather than a dental.

Payman Langroud…: As far as equipment?

Vicky Wilson: Yeah. You don’t need to set up every dental clinic.

Payman Langroud…: Do you know of a situation where the hygienist employs dentists as well? There must be some.

Vicky Wilson: Yes, there are some, because we need a dentist-

Payman Langroud…: To prescribe the therapy and the whitening.

Vicky Wilson: … to prescribe certain… Yeah, of course. But not all clinics have a dentist there all the time, but of course, they need a dentist for various different treatments.

Payman Langroud…: Can the therapist or a hygienist decide to give LA off their own back or does that have to be prescribed?

Vicky Wilson: They still need a prescription.

Payman Langroud…: Both?

Vicky Wilson: Yeah.

Payman Langroud…: Even for a LA [inaudible 00:19:59]?

Vicky Wilson: Yeah because [crosstalk]

Payman Langroud…: Really. You can’t decide to do that yourself?

Vicky Wilson: I don’t know if you’ve heard through BSDHT, the BADT, they are working on the prescribing rights.

Payman Langroud…: Are they working on the whitening as well or not?

Vicky Wilson: Well, it would be great, but that’s under the EU.

Payman Langroud…: Not anymore.

Vicky Wilson: Well, yeah. Watch this space, who knows? Times are changing. I think it’s such an exciting time to be in dentistry.

Payman Langroud…: Are you involved in these political movements?

Vicky Wilson: No, I’m not directly involved.

Payman Langroud…: You know the people?

Vicky Wilson: Yeah, I stay informed as much as I can.

Payman Langroud…: You do get involved with key opinion leader work. You did some work for us at Enlightened. You also did some work with Philips and all that. Some other companies too, right?

Vicky Wilson: Yeah.

Payman Langroud…: I noticed your podcast.

Vicky Wilson: They’re the main sponsor of my podcast, yeah.

Payman Langroud…: So tell me this. Tell me what is it about you that you’ve got you told me 6,000 hygienists in the country heads down doing their period treatment. How come you’re not head down, doing your period treatment? How come you’re doing a podcast and you’ve got this KOL thing going on and all that? What is it about you that’s different?

Vicky Wilson: I love treating patients. I wouldn’t say I wouldn’t go back to surgery. I’d love to see patients again, but at this moment in time, recently in the last couple of years, I’ve had children. A bit of a dream I’ve always thought about. How can we think of something new? How can we advance what we’re doing?

Payman Langroud…: Like James?

Vicky Wilson: Well, maybe he embedded it in me when I worked there.

Payman Langroud…: I’m sure it wasn’t you though.

Vicky Wilson: Yeah, I liked it. I have to be driven by my passion. Dentistry has always been since I started it, something that’s a passion has been driven to me. It’s a drive. You see your patients and you’re constantly thinking about what else can we do? That’s, I think going back to your question, why maybe I started Smile Revolution, is through the years of practising , my mind as I’m sure with many clinicians is constantly ticking over why you’re treating the patient. What’s this obstacle here? How can I deliver that better? How can we overcome this to reach this information before they came to us? What more can we as a profession offer to them? How can we fill in the gaps? Because there are obstacles. At the end of the day, dental disease is the most prevalent preventable disease globally.

Vicky Wilson: What can we do more? There are so many outstanding physicians in surgery, in clinics, treating patients doing a fabulous job. But there are some people like yourself and myself that stepped away from it into something else to still serve the public’s oral health, but in a different way. This is where Smile Revolution came about. I love communication. I think that’s probably my biggest interest and has been throughout my work. How can we communicate better? How can we resonate in the minds of the patients more? How can we change patients perceptions, thoughts on oral health? What can we do differently? Another side of who I am is I love film, and television, and taking people on a journey through-

Payman Langroud…: Media.

Vicky Wilson: … the arts, media, yeah, creative. That emotional journey is something that’s fascinating for me. Communication for me was really a real interest. There are so many fabulous clinicians, as I’ve said, out there treating patients that have got so much to share. So going back to your question and how the Smile Revolution evolved, maybe why I’m working with different brands is I went to them and I presented my idea to create something to advance what we’re doing. I created a pilot, for instance, for the podcast. Dentsply Sirona are all about empowering the profession, especially hygienists and therapists. They thought, “Yeah, we want to be part of this. We want to come on board to support the advancement of the profession, empower the hygienist dental therapists.” I realised it’s not just the hygienist-

Payman Langroud…: What do you mean by empower? I notice you ask all your guests that question. What do you mean by that? Are you an empowered hygienist?

Vicky Wilson: Are you fulfilled? Are you driven by what you do? Are you happy in what you do? Because on the forum, as you read, not everybody is.

Payman Langroud…: No, there’s some terrible stories.

Vicky Wilson: How can we support each other? I think the profession is amazing. Hygienists and therapists, we always meet at conferences. Everyone is so nice. We all get on, we really all get on, we have a great time. We don’t have conferences obviously enough, but sharing that through a podcast, sharing what individual people are doing as we’re doing now, we wouldn’t necessarily have time to have this one on one conversation any other time apart from maybe a podcast recording to share amongst the listeners, for others to gain an insight.

Payman Langroud…: Yeah, yeah, I get all that, but what is it about you?

Vicky Wilson: I don’t know. I create different things maybe. I don’t know. We all see things differently, but I’ve looked at what interests me. I really go with what I’m passionate about.

Payman Langroud…: I feel like you’re less interested in money, more interested in impact.

Vicky Wilson: I am very interested in impact.

Payman Langroud…: I thought you were going to say, “I am interested in money.” I’m sure you are, but you know what I mean? I mean, you could be working five days a week.

Vicky Wilson: Oh yeah.

Payman Langroud…: Doing loads of whitening and stuff.

Vicky Wilson: I could, sure.

Payman Langroud…: You’ve done the composite course. You could be that critical cat. But the way that you’ve structured it, you’re looking beyond that. It’s almost like a helicopter above, looking down. Did you have mentors though that way? I mean, did you see someone else do something like that, that inspired you? Made you think… The first time we ever met, you said to me, “I want to demystify dentistry for the public.” Rhona Eskander is really into this idea too. Was it that eight year old kid dentist experience that made you want to be the demystifyer of things?

Vicky Wilson: I don’t know.

Payman Langroud…: What is it about you?

Vicky Wilson: I think, Pay, a large part of maybe how the Smile Revolution evolved and other things I’m working on is from my dream of being involved in the arts, creating.

Payman Langroud…: Yeah, I noticed that on your Instagram. There’s beautiful images and videos and things like that. Were you good at drawing?

Vicky Wilson: No, I’m terrible. I’m terrible at drawing.

Payman Langroud…: Just like buying art.

Vicky Wilson: Just buying. I love ceramics. I love pottering. I love making jewellery, I love embellishing things. When I was young, when I was-

Payman Langroud…: Still young, still young.

Vicky Wilson: Mom sent me to performing art school because I was so shy. I used to do other festivals and do loads of plays. The reason I went to dental school because I wanted to be able to have something that I loved, a job that I could go in and out of, because my dream was to go to Rhada.

Payman Langroud…: Oh really?

Vicky Wilson: I’ve always liked writing, I like writing scripts.

Payman Langroud…: Do you still secretly want to be an actress?

Vicky Wilson: I’ve done a bit of that.

Payman Langroud…: I do. Is that where this is all going?

Vicky Wilson: You’re tapping into how is Smile Revolution…

Payman Langroud…: I get it, I get it.

Vicky Wilson: I like to create, I like to push boundaries. I have to live by my passion. That is what I’m very true to. I wouldn’t say that I’ve ever lived a day going to work and not loved every minute of it. Now with the children, I want to be with them. But I want to love still my career and I want to make it work. So I’m very focused on I guess building a life and a balance and an overall kind of well being that I feel balance within living my dream in all areas.

Payman Langroud…: How do you feel about balancing this obvious ambition that you’ve got with kids?

Vicky Wilson: It’s a juggling act.

Payman Langroud…: It is, isn’t it?

Vicky Wilson: Yeah, it’s really-

Payman Langroud…: You’re super organised.

Vicky Wilson: Yeah, but when you’re fathoming out a business model, it’s not easy. I definitely got a bit sick last year because I was working so late, until one, two in the morning. I’ve always been somebody that can work late at night. Yet, I found that I got sick and I didn’t get better for six months. It was a chesty cough the whole time. So now, I respect my body. I go to bed when I need to as much as I can. I feel a bit more aligned. I know exactly what I’m doing when I’m doing it more so now, but things are evolving.

Vicky Wilson: It’s not just the podcast I’m working on. So it’s a juggling act. But I was just saying outside to Laura, “You have to be good as a mother, you have to be healthy, you have to be well, in a great mindset to be great for the children and to be great for your business.” So it’s constantly realigning. I’m trying to always be true to myself as I feel the success of anything is really being true to yourself and being driven by what you really believe. Specifically, at this moment in time, I don’t feel like I’m being clinic, looking after or treating patients, caring for patients, and not being there for the children.

Payman Langroud…: That’s cool.

Vicky Wilson: So this is right for me now. So I’m trying to create my optimal dream.

Payman Langroud…: In my experience, you’ll look back on this time and you’ll only realise how significant the things you were doing are later. Once you’ve been around a little while, you suddenly realised that that point, you’re doing something now, it’s kind of uncharted territory. You’re going to look back on this time in six, seven years time and think, “Thank goodness I did that then.” In retrospect, it all ends up being a lot more significant. When you’re doing is, there’s so many unknowns that you sometimes feel like you’re not doing the right thing. Women particularly I’ve noticed are really hard on themselves in this respect. Want to be perfect, want to be too perfect. The perfect mom, the perfect this, the perfect that. We’re not perfect.

Vicky Wilson: You know what I’ve learned recently? You’ve got to give yourself a break. Be kind to yourself.

Payman Langroud…: Yeah, all of that stuff. All of that self care stuff. Super important, super important. Tell me about Dubai, because you were living and working out there for a while. How did that come about?

Vicky Wilson: 10 years I was there.

Payman Langroud…: 10 years?

Vicky Wilson: Yeah.

Payman Langroud…: Bloody hell.

Vicky Wilson: That was a real journey. It was hard because… I have to say, when I started working with James in Berlin, I would never have left that clinic ever. But this opportunity came up. I moved to Dubai, I got a job out there. It was with an English guy. He opened up a practise and he actually knew somebody that my mom used to work with that was a Maxfax at Queen Vic. So yeah, it was a similar world. I was working there for a while, not that much. Then, I had a few gaps in work. Then, I did find an excellent practise eventually to work in.

Payman Langroud…: The one with…

Vicky Wilson: Doctors and Associates.

Payman Langroud…: Yeah, very media orientated. So it suited you?

Vicky Wilson: Yeah, I really enjoyed it. He gave me the free run to create oral health promotional projects. I started working… This is where my work really began working with industry. I worked with Philips, I created this programme for schools with an animal therapist from an autism conference I went to. Is was really different. It really went down a treat in the schools, the children love the little show we put on to support oral health there. David Rhodes was very supportive of everything that I did. I started some seminars within the clinic. I ran those over an evening. Then, I started being invited to lecture.

Payman Langroud…: So it all kicked off in Dubai really, all of this stuff?

Vicky Wilson: Well yeah, I mean, I was how many years into my career before leaving the UK. Maybe three years into my career. So I was young still. Then, I built that in Dubai. In this time, there was no one… Nobody recognised dental hygienists. So we weren’t allowed to have really group organisation meetings there. There was no… We used to like have little meetups, but there was a bit of… I guess they frowned upon… It was limiting to create an organisation. But until I went to the government or the Emirates Medical Association or something like that, under the government, we said to them, “Look, we need to set something up for hygienists.” So then it was a process. It honestly took me nearly 10 years, working with colleagues there to get papers to convince people.

Payman Langroud…: Red tapes a nightmare there.

Vicky Wilson: There’s so much red tape. Speaking to officials there and getting to speak to these officials is so challenging.

Payman Langroud…: If they turn up. I’ve had a few meetings like that in Dubai. The guy didn’t turn up. But what about living and working in Dubai as a general? I mean, would you say… It’s nice to go for a holiday right?

Vicky Wilson: Yeah.

Payman Langroud…: What’s it like living there?

Vicky Wilson: I mean, I had a great time.

Payman Langroud…: Did you stay there during August and all that? The killer hot months?

Vicky Wilson: I used to travel back to the UK a lot pretty much because I was working six days a week and then I would have nearly two weeks off. That’s how I worked my time. I was in and out.

Payman Langroud…: Were you in the UK every six weeks?

Vicky Wilson: Not the UK, but I’d come back somewhere or go somewhere. It was great. I mean, I wasn’t married there, we didn’t have children, and it was different. I had a great time.

Payman Langroud…: Bet you did.

Vicky Wilson: Really had a great time.

Payman Langroud…: Half way to Vietnam and Thailand and all that as well, right?

Vicky Wilson: Yes, I used to go all over. I really had a great time. I met some great people there, had a great life.

Payman Langroud…: Were your patients mainly expats?

Vicky Wilson: A lot of expats, but a lot of locals as well.

Payman Langroud…: Expats from all over the world?

Vicky Wilson: All over the world. I think this what really started my interest in… Not started. This is I guess what allowed my interest in communication to really grow because I realised that what I was saying to me being the English wasn’t working when I was speaking to the French. That’s beautiful and that really pushes you as a clinician to enhance what you’re saying, to really understand and work on understanding people.

Payman Langroud…: Very true.

Vicky Wilson: It was brilliant.

Payman Langroud…: Give me some nuggets of having treated so many different populations. What are French patients like compared to English patients? Because I’ve got my view on this. Go on.

Vicky Wilson: Well, in France-

Payman Langroud…: Or German patients.

Vicky Wilson: Yeah, in France, they don’t have hygienists.

Payman Langroud…: Is that right?

Vicky Wilson: Yeah. I worked for David Rhodes, his friend. That was amazing because I had to introduce-

Payman Langroud…: Explain it.

Vicky Wilson: Well, he’d worked with hygienists elsewhere, but integrating that within the team was… There were some other fabulous hygienists there, but integrating that within the team was a challenge and working with so many different dentists from all over the world and working with them as best we can. But it was a challenge. So yeah, I guess you learn different words obviously from different languages to make sure that you try and build a rapport. Going back to James’ podcast, it’s all about the relationship with the patient. What resonates with one culture doesn’t resonate with another culture. So you adapt.

Vicky Wilson: I think one of the biggest nuggets for any physician leaving maybe the UK, if they’re working in the UK, and working abroad, wherever you go, one thing I let… You can’t take your model of how it is here and how optimal maybe it is here and copy and paste that somewhere else. You have to adapt. You have to be open to adapting. That’s I guess one of the greatest things really I learned there and became I guess able to do, and happy, and comfortable to adapt, which has been a skill set that’s really helped me I feel. I’m not scared of change, I embrace change. For instance, I was giving a lecture for Health Education England last week. 20 minutes before, me and my colleague, we received our presentation had been totally changed.

Payman Langroud…: What do you mean?

Vicky Wilson: They transformed the whole presentation.

Payman Langroud…: Why?

Vicky Wilson: Because some other people have looked at it and they decided that we needed to tweak it. So going for a presentation, you kind of know what you’re saying, you know what slide’s coming next.

Payman Langroud…: Without consulting you?

Vicky Wilson: No. We were warned that it may happen. That’s quite nerve wracking going in, but you know where you’re going. You know your hooks, you know what slide’s coming next. My eyesight is not great at the best of times. I’m looking down at a laptop, not knowing what slide’s coming next. A background chat around this slide. But I guess one of the skills that I learned living in Dubai, being okay with change is okay. We managed to pull it off as scary as it was at the time. But being able to adapt-

Payman Langroud…: What’s the best thing about living and working in Dubai?

Vicky Wilson: Life experience. Being okay with not being set in a way. Changing, adapting, being open to listen.

Payman Langroud…: What’s the worst thing?

Vicky Wilson: Things really took time. It tested your patience, but that’s a good thing. Really tested your patience. You don’t get an answer. You never get an answer on something and you have to find out.

Payman Langroud…: It feels like they’re figuring it out as they go, aren’t they?

Vicky Wilson: Yeah.

Payman Langroud…: I mean, you’re saying when you got there, there were hardly any hygienist, and then 10 years later, by the time you left, you were trying to make a hygienist association.

Vicky Wilson: Well, we did.

Payman Langroud…: But that’s how long it takes, right?

Vicky Wilson: Yeah.

Payman Langroud…: And in that 10 years, they created a whole new part of Dubai, aren’t they?

Vicky Wilson: Yeah, it’s unrecognisable. I’m sure if I go back now, I wouldn’t recognise it.

Payman Langroud…: Yeah, it’s a funny town. They’re just making it up as they’re going along, aren’t they? And in a way, who knows man, like 1,000 years ago, when London was built, probably this was the way things happened, right? And a lot of people say a lot of things about Dubai, but it’s impressive, what they’re doing.

Vicky Wilson: It’s impressive.

Payman Langroud…: You can’t get away from how impressive that achievement is.

Vicky Wilson: The one thing is, one, great, they’re open. They’re open to support what you’re doing. They’re open to change. I think it happens a lot… Obviously, it happens a lot quicker there.

Payman Langroud…: Yeah, yeah.

Vicky Wilson: It may have taken a long time to establish the hygiene organisation-

Payman Langroud…: But you did it, in the end?

Vicky Wilson: … but it happened. Did it. And it’s still running now.

Payman Langroud…: Is it? Is it? That must feel good?

Vicky Wilson: Yeah, they’ve got so many members now.

Payman Langroud…: And I noticed, when I was looking at David’s website, there was a lot of Filipino stuff as well? A lot of the NHS now, is being nursed by Filipinos. The cosmopolitan nature of that town is just crazy, isn’t it?

Vicky Wilson: It’s enriching.

Payman Langroud…: So then coming back, when you came back here, which was not long ago. How long ago, about three, four years?

Vicky Wilson: Three years ago.

Payman Langroud…: How did that feel? Going from the sunshine and all that, and the-

Vicky Wilson: Cold.

Payman Langroud…: … land of possibilities? Yeah.

Vicky Wilson: Cold. Do you know that I missed the weather-

Payman Langroud…: I bet.

Vicky Wilson: From the UK.

Payman Langroud…: Oh, oh, when you were there, you missed it?

Vicky Wilson: Because you don’t have the seasons.

Payman Langroud…: Yeah, yeah, yeah.

Vicky Wilson: So really embraced coming home. It was time for me to come home. I missed my family.

Payman Langroud…: That is a long time.

Vicky Wilson: Yeah, my mom wasn’t very well. So, that was really good. It was a good time to come home. I couldn’t have chosen to come home… We couldn’t have chosen to come home at a better time. Because we were thinking about going back after we had our first daughter.

Payman Langroud…: Oh, were you?

Vicky Wilson: But then, it just felt right to come home. Family support is so important when you’ve got children.

Payman Langroud…: Sure.

Vicky Wilson: And I’m fortunate enough to still have my mom and dad around to help me.

Payman Langroud…: So it’s kind of gone full circle. You’re back in Tunbridge Wells.

Vicky Wilson: Yeah. I have to say I never envisaged myself back Tunbridge Wells. Now, I’m there.

Payman Langroud…: A bit different, isn’t it? Compared to the German banker you were treating in Dubai, compared to the gentle ladies of Tonbridge Wells that you must have been treating after that. What about kids? Tell me about kids. I mean, your particular way of bringing up kids. What would you say? And juggle, expand on it for me.

Vicky Wilson: My way of bringing… I just want them to have a fun life, and to be exposed to us as much, and give them as many opportunities as they can. And for me, it’s really important that I’m around as much as I can, because my husband’s not always around. And I’m there for them as much as I can be.

Payman Langroud…: He’s on projects, away.

Vicky Wilson: Yeah, frequently. And it’s interesting. So, one part of the Smile Revolution is something called Baby Smile Revolution.

Payman Langroud…: Oh, yeah.

Vicky Wilson: Which is softly launched. But anyway, it’s a series of children’s books on oral health. I get the girls to be involved in that. So we’ve got audio books, and Sophia and Alice sing in the book while Sophia does in the first book. Now, Sophia and Alice are recording a podcast with me.

Payman Langroud…: What the hell?

Vicky Wilson: So I’m getting them involved in everything I’m doing?

Payman Langroud…: I like that.

Vicky Wilson: From the age of two and three.

Payman Langroud…: Amazing.

Vicky Wilson: I worked when I was younger. I was only 15, or something. And exposing them to what I’m doing, I think it’s a good thing.

Payman Langroud…: Sure. Sure.

Vicky Wilson: It’s fun. I’m very passionate about what I do and I think it does rub off on them.

Payman Langroud…: Of course, it does. Of course, it does. I mean, my kids know this office very well.

Vicky Wilson: Exactly.

Payman Langroud…: You’ve seen those stickers on the ping pong table here.

Vicky Wilson: Yeah.

Payman Langroud…: Every time my kids come to the office, they add one sticker to the thing. If you ruled the world, what would you change regarding the whole dentist/hygienist relationship? You said you would have them train together.

Vicky Wilson: I would say I’d like everybody to feel the team to feel as inclusive as it possibly could be, to be working as optimally together as possible, that everybody feels fully fulfilled in what they’re doing, mixing the skillset as best we can.

Payman Langroud…: When I was a dentist, I used to want the hygienist to back up what I was selling. Yeah? I still want to give a treatment plan to the patient. I would want my hygienist, while she was doing her bit, to figure out where the patient was with that plan. Is the patient going to go ahead or not? And give more information regarding that and come back to me and tell me, yes or no, or how it’s going, or whatever. Is that wrong? Is that sacrilege? What is that? I mean, we’re talking selling dentistry, right? Can the hygienist get involved in that?

Vicky Wilson: Ethically, of course.

Payman Langroud…: Yeah. But do they? It’s rare. I remember talking to my hygienist about this, sometimes back then, this was a while ago, and some of them were annoyed with me for even suggesting it. It’s interesting, because as soon as you say the word selling, people get worries with ethics. But leaving those two things aside we can use, we can use euphemisms if you like, educating the patient or whatever you want. But I think, if you want this utopia of the hygienist being respected and given the opportunity, that the business case is huge, right? The hygienist can add hugely to the business-

Vicky Wilson: They can.

Payman Langroud…: If, one, they become busy, right? That’s important for any practise. And the hygienist has a big influence on that. Is that right? Yeah.

Vicky Wilson: Huge.

Payman Langroud…: Yeah. Because some hygienists will just do what they’re going to do, but others will find the three month recall type patients, whatever it is, the root planing side of it. The whitening, it really annoys me so much on the whitening.

Vicky Wilson: Well, what you touched on, you said was I right in doing that? I mean that comes down to the communication of you as a dentist with your team. Absolutely, it’s treatment recommended for the patients oral health. That’s not… Sales is ethical, but you’re on the same page. That comes down to the team huddle. If you’re going to go with that philosophy in the morning. If you know someone’s coming in and this is on their treatment plan, prepping them, ensuring that their prevention is in place. That their oral hygiene is as optimal as it potentially can be and needs to be.

Payman Langroud…: Yeah, but I want the hygienist to go beyond oral hygiene.

Vicky Wilson: Absolutely, of course they can.

Payman Langroud…: To talk about the massive plan I was putting together.

Vicky Wilson: Yeah, but of course. This is the key and this is-

Payman Langroud…: In the best practises that you’ve been at, is that the way it’s looked at?

Vicky Wilson: Absolutely.

Payman Langroud…: Really?

Vicky Wilson: We have something coming soon.

Payman Langroud…: Oh, do we?

Vicky Wilson: We do, to support exactly what you’re saying.

Payman Langroud…: Really?

Vicky Wilson: Yeah.

Payman Langroud…: Because that’s so important. Once the hygienist starts doing things like that, then they’re essential to the team. Once they’re essential… We had a lady working in Enlightened who was a hygienist in Canada. She was saying in her particular state, in Alberta, the hygienists used to make more money for the practise than the dentist because they were doing fluoride treatments day in, day out. Whitening treatments day in, day out. She was super respected because the business case was there.

Vicky Wilson: Absolutely.

Payman Langroud…: I feel like rather than focusing on respect me more, you’ve got to prove it to a practise by-

Vicky Wilson: 100%.

Payman Langroud…: … being that important to the practise.

Vicky Wilson: But it’s transitioning. I don’t know if you’ve listened to, for instance, Melonie Prebble’s podcast.

Payman Langroud…: I did, I did.

Vicky Wilson: It’s about understanding as well, and Claire Barry, the business behind dentistry and your value and actually what money you’re bringing to this. To buy your own equipment. All these additional things, but understanding your value. What it is, what it essentially goes back to. Being able to communicate-

Payman Langroud…: Adding value, adding value.

Vicky Wilson: Exactly, adding value but by understanding fundamentally your value, to be able to communicate that to the team. Essentially going back, what we have to come is the Profitable Hygienist, which is to be launched in the next couple of months, which is an online platform of modules that focuses for dentist and the dental team on excellence. Optimal excellence of care, delivering the most excellent care in the most profitable setting for every hygiene department.

Payman Langroud…: What is it? Online education?

Vicky Wilson: Online modules.

Payman Langroud…: Nice.

Vicky Wilson: To support the dentist and the team in getting to that.

Payman Langroud…: Nice.

Vicky Wilson: With Melonie Prebble and Flo Cooper.

Payman Langroud…: I don’t know Flo. Who is she?

Vicky Wilson: She’s a wonderful hygienist. She’s based in Scotland.

Payman Langroud…: Excellent.

Vicky Wilson: She’s got a lot of experience in business in dentistry from the US from training there similar to Mao.

Payman Langroud…: What would be the model? Is it a SaaS model? Would you sell these courses?

Vicky Wilson: Yeah, it’d be-

Payman Langroud…: Would it be a monthly subscription?

Vicky Wilson: … subscription. This is exactly what we’re working on. Whatever we’re working-

Payman Langroud…: When do I envision this will launch?

Vicky Wilson: It’s the beginning of this year. So we actually have a course coming up that you’re part of at the end of February. So soon after that, it’s going to be available to support empowering the hygienists and dental therapists, supporting the dentist to communicate, to ensure that every team member is getting the most out of what they can to be delivering the best care to the patient and being as profitable as possible for the clinics.

Payman Langroud…: Ideally, those two should go hand in hand.

Vicky Wilson: Exactly.

Payman Langroud…: That’s the way it should be. We were talking about when behaviour change, which is a massive part of the hygienist role, education and changing behaviour. One thing that… I talk to dentists about this. Whenever the patient’s brushing their teeth, most of the time, they’re trying to make their teeth whiter or keep them white. We’re focused on the gums, but patients really aren’t. Now obviously, our role is to focus them on the gums, of course. But I was saying to you, and it came out in that podcast, what I was saying to you was we should use the fact that patients are brushing their teeth or would like to brush their teeth to make their teeth whiter to change behaviour and give the health benefit. Interestingly, it came up with Claire. She said something lovely. It was like bring them in on what they want and then tell them what they need. It should be part of the training. Do they train you in hygiene school on behaviour change? They must do.

Vicky Wilson: There’s a small section on behavioural change and I think for the dentist too. But it’s not-

Payman Langroud…: I don’t think we had it. It was years ago. They said, “Brush your teeth like this with the brush at that angle.” They didn’t say how do you get someone to change what they’re doing. The psychological side of it. Although, I’m sure these days, it’s much more in the curriculum.

Vicky Wilson: Well interestingly, I don’t believe… It’s more than when I studied, but I don’t believe it’s still a strong or a heavy module. I’m currently involved in the module for behavioural change in the masters at the Eastman, that module. It’s all quite new to all the students doing the masters. They certainly aren’t aware of many aspects of behavioural change, which we cover within the module.

Payman Langroud…: So you’re deep in this right now?

Vicky Wilson: I love it. I love this topic. When I was in Dubai, I wanted to do another degree or something. When I first studied and left dental school, it wasn’t as available as it is now for hygienists and therapists to do masters and other degrees. But I did find an online course and I did a BSC in oral health promotion, which is what I did my thesis on communication and behavioural change.

Payman Langroud…: So behavioural change is kind of your bag.

Vicky Wilson: It’s my bag. I love it. That’s I guess the basis of the Smile Revelation. It’s all about behaviour change to a point. That’s the long term focus.

Payman Langroud…: Well, if you think of the famous Prav questions that he always likes to ask, I feel like I need to ask his questions because he’s not here.

Vicky Wilson: Go for it.

Payman Langroud…: It’s your funeral. It’s his favourite question.

Vicky Wilson: I’ve heard, yeah, I have to say.

Payman Langroud…: On that legacy fund, how would you like to be remembered, A, by the profession and by your peers and so forth, and B, by your kids? You don’t have to die. Let’s just say what would you like your legacy to be?

Vicky Wilson: I guess, by the profession, somebody that’s there, working with everyone to support the profession, working together with everyone to promote oral health and supporting them in that and bringing the profession together.

Payman Langroud…: Do hygienists argue with each other the way that dentistry does?

Vicky Wilson: I don’t think-

Payman Langroud…: I can’t imagine it.

Vicky Wilson: I don’t know, I’ve never been exposed to anything that happens.

Payman Langroud…: Dentists argue on Facebook and all that. It’s almost under the guise of I’m doing this for the patient. One guy will say, “Invisalign.” and then the other guy will say, “Invisalign is rubbish.” The third guy… Get three dentists together and get four different opinions.

Vicky Wilson: I’d like to say my exposure to the profession, and I said earlier, I feel so fortunate to be a therapist and be surrounded by incredible colleagues. Everybody, I’m honestly exposed to, is lovely. That’s what makes me so happy to do the Smile Revolution podcast, because I get to interview all these wonderful people. It’s not just hygienists and therapists, I interview lots of dentists as well. I think we’re so lucky. I don’t like to ever be exposed to negativity, though, I have to say. If I feel it coming my way, maybe I’ll take a diversion, because it doesn’t feed me Why bring yourself down by something. Let’s look at the positive here. Even if you have a challenge to face, let’s look at how we can overcome it and grow from it together.

Payman Langroud…: And what about advice for your kids? If you had to give your kids, two or three, all our children, a couple of pieces of advice, what are your top tips?

Vicky Wilson: Have fun in everything you do. My husband’s always-

Payman Langroud…: That’s a goody.

Vicky Wilson: … always, always saying that, “Whatever you do have fun in it,” and be driven by your passion. Make sure you enjoy life. If you’re driven by your passion, you can’t go wrong, because you’re being true to yourself.

Payman Langroud…: Are you saying I should go for that international DJ job?

Vicky Wilson: Yes, definitely.

Payman Langroud…: All right.

Vicky Wilson: Turning it back.

Payman Langroud…: I’m out of it. That’s it, I’ve had enough. I’m doing the tour, Sanj.

Vicky Wilson: Sorry, Sanj.

Payman Langroud…: Sorry, Sanj. It’s been fun, but I’ve got to go on a DJ tour.

Vicky Wilson: It’s a bit scary going in the unknown sometimes, but that’s the greatest thing, because you discover and you really learn. The hardest things you throw yourself into, the greatest things you learn. I think that.

Payman Langroud…: That’s true. It’s true. It’s that being comfortable with the uncomfortable, isn’t it?

Vicky Wilson: Well, that’s what I was going to say. I feel very good. I’m fortunate to have such an incredible mom and dad family have always been there for me. And-

Payman Langroud…: I hear that and it’s lovely thing to say, but you’re the only child, so you haven’t got this context that I’m going to do validate. My parents, and my brother’s parents are exactly the same parents, but my brother and I are very different people, like very different.

Vicky Wilson: Yeah, yeah.

Payman Langroud…: I take more risks than he does.

Vicky Wilson: Yeah, yeah.

Payman Langroud…: He’s very, super conservative. You’re saying thanks, of course, say thanks to your parents, because they’re great. I get it, yeah?

Vicky Wilson: Yeah. Yeah. Yeah.

Payman Langroud…: But it’s so nuanced, you know? Your two kids are so close to each other in age, but you must already see they’re totally different.

Vicky Wilson: Very true. Very true. I remember reading, so if you’ve got a really safe background, you take more risks-

Payman Langroud…: Sometimes, yeah.

Vicky Wilson: Because you can. Maybe that’s what I feel in a way, but I’m mostly that risk taker. I thrive on the adrenaline of taking the biggest risks, I feel.

Payman Langroud…: Really?

Vicky Wilson: I do. I like-

Payman Langroud…: I like that.

Vicky Wilson: I like it.

Payman Langroud…: I like that too.

Vicky Wilson: I like it, because you don’t know what’s going to come and it pushes you to really work to get-

Payman Langroud…: Yeah, but look, for some people, that sounds like a total nightmare.

Vicky Wilson: Oh, absolutely. I know.

Payman Langroud…: I think about my wife, yeah? In a room full of strangers, she’s amazing. Like she handles the room, she talks to the right people. If someone’s not involved, she gets them involved or whatever. Me, I’m a bit sort of uncomfortable in my own skin, a bit shy in a room full of strangers, but I can stand on stage and talk. For her, that’s like the biggest nightmare ever, isn’t it? It’s so interesting that you know that different people that thrive on different-

Vicky Wilson: It’s so true.

Payman Langroud…: … situations.

Vicky Wilson: That’s the beauty, isn’t it? Everyone’s different.

Payman Langroud…: It’s been lovely having you.

Vicky Wilson: Thank you for having me.

Payman Langroud…: And I don’t know should we put this out as a simulcast? No. For now, you’re a dental leader. Nice to have the first representative from dental hygiene therapy. Well, thanks a lot for doing it. I’m sorry, Prav wasn’t here to enjoy it.

Vicky Wilson: I’m sorry, Prav. Yeah, thanks for having me.

Payman Langroud…: Thanks a lot, Vicky. Cheers.

Speaker 3: This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.

Speaker 4: Thank you for tuning in guys to the Dental Leaders podcast. I’ve just got a little request to make. If you’ve got a suggestion of somebody else who we should be interviewing or somebody who’s got a really strong story, powerful story to share with us, please send us a message and help us connect with that individual so we can bring their stories to the surface.

Payman Langroud…: Thank you so much for taking the time, guys. If you got some value out of it, think about sharing it with your friends and subscribing to the channel. Thank you guys.

Speaker 4: Don’t forget that six star review.

Transcript

Rahul: Well when we met, she was into a different type of music than I was. Her outgoing was different to mine. So yeah, we were very much different people, but the value is actually is what connected us.

Payman: Or was she into gangster rap?

Rahul: She was actually.

Intro Voice: This is Dental Leaders, the podcast where you get to go one-on-one with emerging leaders in dentistry. Your hosts Payman Langroudi and Prav Solanki.

Prav: Today we’ve got the pleasure of interviewing Rahul Doshi on the Dental leaders Podcast. Rahul, for me, I think my journey with you or knowing about you began over a decade ago.

Rahul: Probably, yes.

Prav: I got into the dental industry, started working in the dental industry where my brother had just qualified back in about 2005, 2006 and you owned the most famous dental practise in the UK.

Rahul: I wouldn’t quite say that.

Prav: In my eyes, and I think in many people’s eyes you were leading the field in patient experience in what you were doing, in the way you communicated yourself in the media. And I think you started off a trend or a generation of practises that are today built on the model that you started off. And then that’s how I saw the Perfect Smile Studios, very, very aspirational clinic from the photographs of the waiting room and then once entering your waiting room right through to the experience you deliver to your patients and-

Rahul: Did you go to it back then?

Prav: Yeah, yeah. I visited it then, and first saw the photographs and I thought, “Wow, this is a dental practise.” And then went and sat down, and I even remember sitting down on the cushions and it just being super cosy, comfortable and being offered a drink. And I thought, “Wow, this is different.” Now every practise does that. But you were a decade ahead of everyone else I think. And I think there’s lots we want to talk about, you, your life, how you became to be that.

Rahul: Get to that point.

Prav: Yeah, but if we just focus on that for a second, what was your inspiration behind creating such an amazing practise and the whole experience?

Rahul: Okay, so let’s go back. I think you have to have a vision and we created a vision and the tagline for the practise is changing lives, exceeding expectations, but that was in all areas, whether it’s clinical and nonclinical. So we want to exceed patients’ experience in every single way once they came to the practise. So we wanted to deliver the best clinical care, but also the best care in the journey while they are there and making that unique. As we all know that when you want to differentiate yourself, you’ve got to something which is totally different to what’s being done as a norm.

Rahul: And we spent a lot of time really sort of understanding what other areas in other businesses do to create an exceptional journey and just bringing it in to the practise.

Prav: Take me back to that moment where you were planning that journey. So you were sat down and you maybe you were drawing flow chats together or mapping out that journey from the moment let’s say somebody first makes contact or steps foot in your practise, and you talked about inspiration from other businesses. Did you visit hotels or what? How did you put that process together because you weren’t just copying someone else. You weren’t just saying, “Let me do this, but a little bit better.” You were creating something new.

Rahul: I think we had to break it down into the steps that a patient takes in the journey. And then we looked at every single step and say, “Right, where can I learn about this aspect from?”

Rahul: So for example, in a patient journey starts with the phone as we know, and then comes into when they visit the practise, then into the treatment room and then the case presentation. And then you’re looking at what can I learn from which industry for every single aspect, whether it’s a hotel, whether it’s other dental practises outside the UK, I’m now talking about US because I used to visit the US a lot. Their patient journey there was at a different level at that time as well. Though the practises were orientated to be something different to what we wanted. We wanted to create a unique culture that the patients felt really relaxed. And as you mentioned, the soft cushion at home and we wanted to make the patients feel at home.

Prav: And I think that’s something that I definitely got when I visited that I actually felt like I was a guest. I felt like I was at home.

Rahul: And the key thing to remember is most patients are nervous, especially the type of dentistry I was doing at that time was a lot of full mouth rehab, smile makeovers. So, that involved a lot of dental treatment. And if patients are nervous, you want to try and really make them feel as happy, comfortable, relaxed, as much as possible in all senses, whether it’s what they listen to, what they smell, what they see. And you had to excite every single sense. So it’s trying to do that in a predictable way, but also create a systematic way for that as well for the patient journey.

Payman: I think what was really special about that practise, like I came quite early on, I think maybe two, three years after you’d started, what was really special was the staff the way they were welcomed, the way people took care of you. I remember at the time I think Laura was working there.

Rahul: Correct.

Payman: I remember at the time thinking, “Yeah, it was pretty decor.” Yeah. But I’d seen pretty deco before in practise. But the welcome, just the way they handled you and I was a supplier, not even a patient. I was there to sell something to them. But expecting you when you walked in, knowing who you were before you even walked in-

Rahul: Just the experience.

Payman: Many practises today don’t do that, nice cup of coffee, engaging with you, engaging with you as a supplier. I remember thinking this is super special, but I think we should go back, go back and try and figure out how you got to that point.

Rahul: So actually though, now I think of it, there is a book that I read called Raving Fans.

Prav: Who by?

Payman: Blanchard.

Rahul: I think it’s Ken Blanchard. And it’s always about trying to do something on a consistent basis. We’ve all been to restaurants, hotels, which look amazing and we may have had exceptional food at. But then when you repeat that experience with another person, it may not be consistent, and then you don’t go back again. So achieving the consistency was actually the kep step. And achieving consistency, you need to create a system. So you’re actually systemizing the patient journey of what needs to happen at every single step, when they arrive, meet and greet, create eye contact, the warm handshake, look them in the eyes, try and predict who they are in the name, all that sort of stuff.

Rahul: And then adding plus one. In Raving Fans, plus one means do something extra every single time they come. So what plus one can you think of when you see the patient again or a supplier like you again?

Payman: Yeah, it was special.

Prav: So where were you born? Where did you grow up? When did you decide to be a dentist? Give us the quickie on that.

Rahul: I was born in Mombasa, in Kenya, and I moved over here in 1975 when I was about seven, eight years old. Schooled here. And why did I go into dentistry? Not because I probably wanted to become a dentist because I wanted to join the medical science field. I don’t think I wanted to become a pharmacist, an optician. So it was almost like taking away what I didn’t want to become leaving really dentistry to me as the option that I thought would suit me, my personality in looking after people. I think Asians were always drawn to some sort of medical sort of arena.

Payman: Were your family already in medicine?

Rahul: No, no they weren’t. My family were in their own pharmacies. So they’re in the pharmaceutical industry. So I think I didn’t want to go in that direction. So it’s a question, choosing another direction in the medical arena.

Prav: And was that in sort of in some part fulfilling your parents’ dreams and ambitions? And certainly I know that for me, I didn’t necessarily want to go into medicine from the outset, and I wouldn’t say I was forced into it, but certainly I was fulfilling their dreams. I was academically good and it seemed like the right career choice, my son is a doctor. And so that became part of the process. And then later on I realise that actually this was what I wanted to do and then later on realised it wasn’t.

Rahul: It wasn’t.

Prav: But was that part of your influence?

Rahul: I think for that sort of generation like mine, I think that you’re always trying to fulfil your parents’ aspirations in some way or what they think are the careers that you should probably be in. And I think there must be some subliminal message that must’ve been handed down to me thinking that I need to go in that arena as opposed to arenas that at that time my parents were not considered to be the arenas that you should go into whether it be art or whatever it may be.

Payman: How’s that advice changed with your kids? What have you said to them?

Rahul: Oh-

Payman: To follow their passion? And big achievers, both of your kids, right?

Rahul: Yeah, my kids, I just told them, “You need to do what you’re really passionate about, what you enjoy and what you think you’re good at. Because once you are good at something, you enjoy doing it, you will actually become excellent and then you will grow in yourself. You’ll enjoy life. And that’s what really life is about.”

Payman: Was dentistry something that you want either of your kids to do or they didn’t want to do it?

Rahul: I don’t think, well neither of my kids have gone into the industry. One of them has gone straight into finance. That’s what he’s always enjoyed that since he was a kid. So he’s followed his passion. My other son, he’s really into philosophy and politics, so that’s the sort of field he plans to go into.

Payman: So what an opportunity it would have been for one of them to go into dentistry. Did it even come up or-

Rahul: I don’t think either of them even considered it, to be honest with you.

Rahul: I had a practise that I think they could have easily followed my footsteps. And actually when you actually follow your father’s footsteps, then you’ve got the foundations laid in some way because you try and reduce the errors that you would make because you’re told not don’t do X, Y, Z, and it fast tracks things, but that’s not the career that they wanted for themselves.

Prav: Okay. So then where did you study?

Rahul: So I went to Guys Hospital for dentistry and that was my undergraduate qualification.

Prav: Anyone who we know in dentistry now who studied with you in your year?

Rahul: So in my year.

Payman: Was Ash in your year?

Rahul: Ash Palmer was the year below me.

Payman: Oh really?

Rahul: Paul Abrahams was a year above me. So a lot of people a year above me, year below me. I’m trying to think of people like-

Prav: Which year did you qualify?

Rahul: In ’91.

Payman: And what kind of a dental student were you? Were you swatty?

Rahul: Actually I think people would say I was swatty on most occasions on most occasions and chilled out on others. So I don’t think I was the biggest swat, but I don’t think I was laid back either.

Prav: Were you gifted? Were you just naturally talented, did things come too easily, memory recall, stuff you know in med school and dental school? You’re doing all this processing, were you say were naturally at that sort of stuff, or you had to work hard?

Rahul: I think memorising things became pretty straightforward to me. I didn’t realise this, but I think I loved art. I only realised that I really loved art when I actually became a cosmetic dentist as such. I didn’t realise it when I was in dental school, but I was very particular in the way I did my drilling, filling, my preparations, and how smooth they were. I was very detail orientated. I think it was all about the details at that time.

Payman: I think it’s a bit of that back in our day. I mean we’re in about the same generation.

Rahul: Yeah.

Payman: Back in our day, art was such a dirty word for someone who was trying to go into medicine that we completely shunned. Even like I remember with me and my friends in school, it was math, physics, chemistry, the odd guy did biology. Anyone who was doing something outside of that was-

Prav: Mickey Mouse degree.

Payman: Yeah. Mickey Mouse, wasn’t considered one of us.

Prav: Absolutely.

Rahul: Yeah.

Payman: And yet personally looking at it now I feel like I’m much more art orientated than science orientated, but it was so drilled into us even by ourselves. I don’t know. We were very proud of being science.

Prav: I think part of it is, and I always go back to this is this parental influence and because certainly for my parents back then it was a survival game, right?

Prav: Driving taxes, running corner shops. It was about giving you a career that there was some stability in and a vocation.

Rahul: Correct. It was all about the stability and that vocation, the thinking that people will always need a doctor, people will always need a dentist and I think for the Asian community also the respect that the families got for their children going down certain pathways was an important aspect for them as well.

Prav: And then the advice you’ve said to your kids is, “Look, just follow your dreams, airy fairy or not, just go and live your dream and just be excellent at what you’re doing.” And I’m giving the same advice to my kids at the moment. My daughter is big into art and if I look at how I would have thought about that 10, 15 years ago, I’d have said, “Airy-fairy Mickey Mouse degree.”

Prav: Honestly, that’s what I would’ve said. But now it’s more about actually follow your passion and all we really want our children to do is be happy, right?

Rahul: I think that’s also from my personal experience. So when I first qualified, and you mentioned that did you rightly do the right degree or not? Well, when I first qualified I was doing general dentistry and I don’t think I was as fulfilled in doing general dentistry as I am when I’d started doing cosmetic dentistry. The more cosmetic denture I started doing, the more I thought to really enjoy what I was doing. It was the art side of me that came out, the creativity, the detail, the detail was there. But I think the passion came in doing the cosmetic dentistry and that took my career to another level, but also my enjoyment more importantly.

Rahul: And so reflecting on that enjoyment and the passion is what has led me to tell Mike, as you said, “You’ve got to follow your passion.”

Prav: Who had the biggest influence on your dental career, mentor or otherwise, that sort of set you off on that trajectory that you ended up embarking on in creating this amazing practise and doing the type of dentistry that you did?”

Rahul: I’ve got to say there was so many mentors that I’ve had the fortune to come across and it’s taking ideas from different people that have allowed me to be who I am. So in terms of cosmetic dentistry, to be honest with you, it’s Larry Rosenthal, the idea that you could change a person’s life, smile by doing what he did. Okay. The style of dentistry has changed immensely since he introduced that. But the concept of cosmetic dentistry came from him and to a lot of people in the UK.

Rahul: So I’ve got to give some attribution to him, but also people who taught how to create good foundational dentistry in occlusion. So people like Frank Spears was very influential to me. I went onto the Hornbrook course where I learned a lot about occlusion as well. So occlusion and foundational dentistry was really instrumental in what I did. But then also things in communication, communicating to a patient, looking after patients. Patient care became a big part of that as well. So my mentors at that time were people like Bill Blatchford who was a coach from the US, so Peter Blatchford Solutions.

Prav: Correct. Yes.

Payman: So then, okay, you qualified. Who was your first boss?

Rahul: My first boss was a practise near Harrow on Rayners Lane. His name is Stuart Hutchinson. So it was a predominantly national health practise.

Payman: Did you get there and think, “God, I hate this,”?

Rahul: Actually, I worked very close to home, literally five minute drive as to go home for lunch as an associate. I mean I just can’t believe I used to go home for lunch and spend an hour at home and come back.

Payman: Home, parents’ home?

Rahul: As in like, yeah, parents home. So literally go home, eat, come back, do my work. So it just was a routine for a few years until I started thinking that I want to expand what I was doing. I had a need to improve what I was doing. So I enjoyed it for that time. It gave me a lot of rudimentary foundational skills in dentistry because you qualify and you need to get exposure to just doing stuff. And that’s what he gave me.

Payman: So then you decided to set up your ow?

Rahul: Yeah, so I think the plan was to always set up my own practise and I worked in active couple of practises at the same time.

Rahul: So, my week was split up into working with three different practises. And the key reason for that was to learn from each practise what to do and what not to do. And actually I found you learn what not to do more than you learn what to do and that gives you a perception of how you want to run your own practise.

Payman: So these three practises was one of them more private orientated or how was it?

Rahul: One of them, so my first one was predominantly national health, but I started doing more and more private while I was there. Another one was private and that was near Hemel Hempstead. And then a third one was in Wilson, which was national health.

Prav: Take me back to that era. What was the work ethic like back then? What sort of hours were you putting in? How much time are you putting in into dentistry? And so I speak to a lot of dentists from back in the day and they do the kind of hours and the things that probably younger dentists wouldn’t today.

Rahul: Yeah. I think if I look back now, so my first associate job I was doing about 40 hours, 44 hours, Monday to Friday.

Prav: Feeble rights of the NHS, right?

Rahul: Feeble rights of the National Health. Half day Saturday. But then I think things became tricky when I bought my first practise because I used to… When was that? That was in ’94 so I used to travel from Harrow to Hornchurch, which was an hour’s journey. I use to start work at eight in the morning, finish work at seven, get back home by eight in the evening. So, I used to do that four or five days a week, work as an associate in my practise that I first worked in just to get continuity of income walls. The practise was taking off.

Payman: Was it a squat?

Rahul: It wasn’t a squat, but I think in the first six months, by the time you actually established yourself, you actually get… there was some nationality, you got fee per item coming in, capital coming in. You knew that cashflow coming in and I wanted to make sure there was enough cashflow, so I had to work as an associate and run the practise and do the dentistry in that practise, too.

Payman: Must have been hard times. Did you have any difficulties? Going from associate to principal’s a big deal right?

Rahul: I remember actually first walking into the practise thinking, “I now own this practise. What now? What do I do?” I had no plan. I knew what I wanted to do in terms of developing it in the decor, the cosmetics, how I wanted to run it, but then actually becoming a leader and actually guiding team members.

Rahul: … a leader and actually guiding team members who’d really you’d not really known and may have met for a few minutes previous to that, and guiding them what to do, it was something that was new and you had to learn a lot on how to become a boss and a leader.

Prav: Doing all those jobs at that time, multiple jobs, multiple associate jobs, and buying your own business, which I’m assuming was quite risky, did you ever experience overwhelm at that time? What were your lowest moments, and did you ever think of just saying, “Do you know what, I give up.”

Rahul: I think whenever you buy any practise or any business, the first year is taken up and consumed by the passion to do well. So, once you’ve got through that one year, that energy and that momentum takes you through that. And once you actually achieve some level of satisfaction or success in that first year, then you can sort of slow down and start seeing where you’ve achieved. It’s when it takes longer, that’s when those low moments can come. I mean, luckily, I didn’t get many of those at that time, so I didn’t see that or face that, because I think we tried to work hard to actually achieve as much as we could in that first year and make sure that the foundations were laid for us to succeed. So, at that moment in time, no, I didn’t get any low moments.

Prav: And just painting a picture of what your life was like back then, were you with Bhavna then, or were you living at home, parents? What was the sort of personal situation?

Rahul: So, I was living with parents. I had just met Bhavna a month before we bought the practise.

Prav: How did you meet?

Rahul: So, I crushed a VT ball. She was qualifying. I turned up and I met her and I then turned up at her hall, because I knew where she was staying. I figured out which floor she was staying on.

Prav: Love at first sight?

Rahul: Yes, it was. So, I knocked on her door-

Payman: … but, you were you a fully fledged dentist at this way?

Rahul: I was a fully fledged dentist. So this is three, four years qualified. And then as you did, you crash the ball. And then that’s where I met Bhavna.

Prav: And the rest is history, as they say.

Rahul: And the rest is history. Yeah.

Prav: So when did you propose?

Rahul: So actually, for both of us, we knew we were right for each other and I proposed literally a few months after that, six months after that. And I think it’s all good to do with whether it’s business or home values and the vibe you get. So when you actually have the … when you have values that match, you know that somebody is right for you. We had the right values, or not the right values. There is no such thing. But, the values that I had were similar to her values and that’s when we knew we were right for each other.

Prav: And the family values, right?

Rahul: Yeah.

Prav: Certainly, for me the values that I’ve got from my wife and she gets from me is our upbringing.

Rahul: Absolutely.

Prav: And just meeting the parents and the family seems like quite a traditional way of doing things. But, I think it’s a recipe for a [crosstalk 00:22:59].

Rahul: Values is one of those words, because for instance, if you look at me and my wife, very different people, very different, but our values are aligned. And it’s an interesting point because if you’ve met us for five minutes and didn’t know who we were-

Prav: … totally different. Totally different.

Rahul: But, we do agree on the basics. Actually, so if you look at Bhavna and me, if you spend time with us individually, you’ll see that I’m actually pretty much a shy person, quiet. She’s pretty much outgoing, won’t stop talking.

Prav: Opposites attract, that’s the thing.

Rahul: We’re total opposites. Yet, our values are similar. Well, when we met, she was into a different type of music than I was. Her outgoing was different to mine. So yeah, we were very much different people. But the value is actually is what connected us.

Prav: Was she into gangster rap?

Rahul: She was, actually. That was a joke, and the answer is, she was.

Prav: You’re kidding.

Rahul: Which was totally foreign to me.

Prav: Amazing. She’s got good taste.

Payman: Yeah, he’s a gangster rap guy.

Prav: So, you work at that first practise, was Bhavna also working there?

Rahul: No, she wasn’t actually. So she had just qualified, so she had to go through a VT. So she was doing her VT while I was at the practise.

Prav: And then? How long did that go on for?

Rahul: So that went on until ’96 when we actually got a second practise. And that’s when Bhavna started working with me.

Prav: Did you sell the first one to get-

Rahul: … no. We kept it. And I needed the help. I needed the manpower. So then we started working together. So the challenges were that I don’t think Bhavna ever wanted to work together because we wanted to keep our life separate, not sort of a mix, shall I say, work and home life. But, necessity meant that needed somebody from the inside, shall I say, working with me. And that was important.

Payman: You were taking care of one, she was taking care of the other?

Rahul: Yeah.

Prav: What was the transition like going from one to two? I got a lot of dentists asking me for this advice, and I don’t think there’s a right way to advise this, but I’m interested on your take, is that someone will have practise number one, it will be at 60-70% capacity. Business is good, life is good, right? And they say, “I need to get my second practise.” My advice is always get practise number one to where it needs to be because there’s room to grow here, less overheads, less stress and then go for practise number two. But, there’s other theories that you could scale up multiple practises, do well, and sell or whatever. And what was your transition like?

Prav: Because a lot of people think you go from practise one to two, and you just double everything, right? Income doubles, everything doubles. What was your perception back then and what was the reality?

Rahul: So the perception is that you get a second practise and everything doubles. But, actually the truth is that if you’ve actually done well in your first and you’ve got the systems right and you can make the systems and carry them over to the second practise, that’s what the second practise is all about is actually taking away what you’ve done in your first practise and actually introducing all those elements into the second practise. If you haven’t done that and you’ve just got away by having a practise and these things just run, then the second practise would be really challenging. The second practise had its own challenges. It wasn’t massively challenging, but everything has its own ups and downs, which, and I can’t remember what they are right now, but because we had the same systems that we had in the first practise that we could just transplant into the second practise, it was pretty smooth going.

Rahul: The only things that double are the stresses of team, dealing with the two teams as opposed to one. So, that was something which I started to sort of really sort of learning about, reading about, is actually people management, psychology management, learning how to develop teams. And again, that journey of becoming a better leader too.

Payman: It sounds like you’re very much into reading around the subject of dentistry, right? Self Improvement.

Rahul: Well, yes, reading around, actually many aspects of non dentistry, shall I say, so leadership, team building, communication.

Payman: You’re fascinated by that?

Rahul: Yeah, absolutely.

Payman: Yeah.

Rahul: I really enjoy that.

Prav: When did business partners come into the mix?

Rahul: So what do you mean by business partners?

Prav: You were partners with Ash at one point.

Rahul: Correct. Yes.

Prav: So how did that come about? How did the conversation get ignited? How did you say, “Well, let’s do this together.” At what point in this journey did that happen?

Rahul: So actually, the first practise, [inaudible 00:07:36], I did that with Ash.

Prav: Okay.

Rahul: And that came about because we, again, were similar minded. We were similarly driven. Again, we had similar values as well. And those values is what kept us going until 2010, so we were together in partnership for a good 16 years, which is a good period of time.

Prav: And the second one was with Ash too?

Rahul: And the second one was with Ash as well. Yeah.

Prav: And then it was Perfect Smile after that?

Rahul: Perfect Smile after that. Yeah.

Prav: Okay.

Rahul: So it’s that, I think you have to have the same values with your partners for things to … the same risk profile, I find important.

Prav: Yeah, absolutely.

Rahul: Because Sanj and I, again, my partner, we’re very different. Again, he’s great with systems, he’s great with computers. I’m more a people person. Again, very different. But, our risk profile is similar.

Prav: Are you sure?

Rahul: It needs to be. Yeah, yeah. It needs to be.

Prav: I’ve seen the bar tab when you run your events, mate.

Rahul: You should see the bill for computers. But, also I think the same drive because if one person wants to have … really wants to grow and the other person doesn’t, then you could have an issue.

Prav: What were you bringing to the team and what was Ash bringing to the team? What kind of people? I’m saying, Sanj was very systems and computers and so on, and he really is brilliant in those ways.

Rahul: Actually, Ash was very good, very much a people’s person. So when he met suppliers, when he met the initial teams, he got along with them. He would spend time with them. He was very likeable as a person. He is likeable as a person. I brought in probably strategy, vision, focus-

Prav: … systems.

Rahul: Drive. Yeah, all that to the practise. So not quite systems. I think Ash was more making systems as well. But, I think I was more direction and vision and marketing, et cetera. That came from me.

Prav: I’m involved in multiple partnerships with multiple different businesses and one of the things I know is all the challenges I have is sometimes I want to go in one direction, they want to go in another, or maybe we’re not 100% aligned and you have different conversations. Maybe your lives are going in different directions and stuff like that. What were the biggest challenges during that 15 years in that partnership, would you say?

Rahul: I think it probably is when there may be, as you mentioned, disagreements in the direction or the main direction. Sometimes the small directions can cause issues, but they can be overcome once you have logic and reason. It’s when there is a big differential in the growth or the direction that you want to go into. I mean, we were both reasonable people so we could both iron out issues. So, that would be fine. Sometimes, being truthful, it may be you’d have team looking at one sort of partner as opposed to the other to influence. And one person wouldn’t be able to be influenced in any way.

Rahul: And I think that was me. The team would never be able to influence me. So they’d go through Ash and then Ash would have to come back to me.

Payman: That happens with us too. I’m kind of the soft touch and Sanj is the guy … because it works too, right?

Payman: Absolutely. You have to sort of good cop, bad cop. It does work. And it works well.

Payman: But, we don’t do it on purpose.

Prav: It’s just the way you are, right?

Payman: Yeah. I’m completely stuck on having the happiest workplace in the world. Sanj isn’t. That’s not his number one priority. And you need both.

Rahul: A motivated team is the key.

Prav: So when did Laura Horton come into the mix in your practise? And sort of do you remember your interviewing her for the first time? And I think you saw something in her.

Rahul: She came as a nurse and she came as a nurse before the Hornsea practise. And she started off as a nurse, became a manager at the Hornsea practise, I believe. And we then sold the Hornsea practise and she came with us to the Hertford practise. So that was the evolution. I think, sorry, between the actual becoming a manager and a nurse, she became the treatment coordinator. So she was a nurse, treatment coordinator, then manager. So, that was her journey.

Rahul: One of the most, I think about work, one of the most beautiful things about it is developing people, isn’t it?

Prav: Yeah.

Rahul: It really is. I mean, you’ve got all the downsides, right? You’ve got all the risk, you’ve got the day-to-day, the discipline issues. But, seeing people blossom. And then on the other side of it, sometimes seeing people not blossom. Where you give an opportunity to someone and they don’t take it.

Prav: I don’t know who said this quote, but something along the lines of, and don’t quote me on these words, is that try and build your team up so they can leave. But, treat them well enough so they don’t. [crosstalk 00:12:51].

Rahul: And whenever I hired team members, the one thing you always think of is what potential do they have and how much do they want to grow? And what can I do to help them grow? So it’s about actually being a servant to their growth. And if you can achieve that, then that business will start flourishing.

Prav: Because, you must see it now, we’ll get onto Dentex now. But, you must see in dentistry, it’s quite hard, isn’t it? The path where you’re saying nurse, treatment coordinator, manager. She went from the very bottom to the very top. But in dentistry, a lot of times we don’t want people to move. We want that person just to stay doing what they’re doing. And that’s a problem, isn’t it? Because if you can’t see a future for yourself career wise.

Rahul: So that’s when people leave and move. If you want to grow your practise, you want some stability. But you want a team that’s motivated. And to get a motivated team, you want the team member to feel that they’re actually contributing much more than the simplicity in the work that they bring to just nursing. So, one of the key things I’ve always believed in is actually creating-

Payman: … photography was a big thing in your practise.

Rahul: Yeah. Well, every team member that comes into a practise is able to take photographs. That’s the first thing we teach them, but they need to create a role which makes them unique and that they are in charge of totally. That means they have a real important role to play within the practise. And without them fulfilling that role, the practise will be under pressure and that they won’t get anywhere else. There’s also freedom to work in the way they choose to.

Rahul: So, there is that autonomy. So the three things I always think of is autonomy. And so they don’t have to report to do certain things to people above. They need to be masterful. They are good. And they need to have mastery in what they do, so they feel confident. And that brings passion. And there needs to be a purpose. So they come to work with a purpose rather than feeling that they’re doing just a simplistic role.

Prav: As I speak to a lot of associates or new practise owners. And there’s one skill that you’ve clearly developed over time and got is this leadership that you’ve just clearly illustrated here. What tips would you give to somebody who wants to develop that skill and develop their leadership skills when they’ve got no experience of actually what is leadership?

Rahul: [crosstalk 00:15:13]. That’s a big question.

Prav: Yeah, it is a big question. But, what sort of nuggets of advice would you give to them? Someone who’s new, they’ve just bought a practise, because they want to be an entrepreneur or whatever. And you must’ve seen loads of practises now with your involvement with the Dentex.

Rahul: Sure. So I think to be a great leader, you need to motivate your team. That’s the first thing. If you can motivate your team, the team will follow you. That’s the number one of leadership. And you’re not there as their boss, but somebody to actually inspire them. The second is to make sure that they are fully trained so that they feel totally comfortable and confident with what they do.

Rahul: The third thing too actually is find out and get them to be passionate about what they want to do as well. So you actually grow them in areas that they’re passionate about.

Prav: How do you find that out? Is it one-to-one conversations with them?

Rahul: It’s regular one-to-one. And actually, once you’ve been with them for a couple of months, you get an idea of what they are really strong at, what they love enjoying, and you see that glint in their eye if they’re doing certain things. And that’s what you’re trying to coax them to do. So you coax them to having roles that they feel happy about when they’re doing it, and they feel most fulfilled. And that’s a simplistic way of actually growing any business. It’s just motivating and inspiring your team.

Prav: Have you had to fire many people? Or was that Ash’s job?

Rahul: No, no, that was more me than Ash, actually. I was the bad cop, shall I say.

Prav: Never easy, right?

Rahul: Never easy. Actually, it’s the most challenging thing to do is to actually take somebody away from their job and tell them that the business has different plans for them.

Prav: Do you get butterflies?

Rahul: Absolutely.

Prav: Talk me through that.

Rahul: So, actually if I had to fire somebody, I don’t think I’d be sleeping the night before or as soon as I realised that that person had to go, until that moment that I told them that they weren’t part of the business plan, I would not be sleeping. I’d be having butterflies until I met them.

Prav: Do you have the conversation in your head?

Rahul: Plenty of times. You repeat that. And it never goes as planned. Because as soon as you utter the first few words, your mouth starts drying off and you may say something totally different to what you planned. They may interpret what you’re going to say. And then the whole thing skewers anyway.

Payman: It’s so hard. Prav has a very interesting story.

Prav: No, I’m not going to tell you that. My one and only aggressive ejection from the practise.

Payman: That wasn’t the one I was thinking of.

Prav: Which one?

Payman: I was thinking about the box of chocolates.

Prav: Oh, geez. Oh, yeah.

Payman: Tell him. Tell him. It’s beautiful.

Prav: He’s probably not going to be listening. But I hired a copywriter and I think copywriting is probably one of the most valuable skills in marketing. If you can write to get the right message across for the right person, you’ve won the game. The design, the creative, all that can come later. So I spent a long time trying to recruit an amazing copywriter. And one of my key things was that this person must be able to write much, much better than me.

Prav: And I’m not saying I’m an amazing writer, but I’m okay. Anyway, I found this guy and we took him through some tests. So we wrote some tests and stuff and in the tests he passed, he wrote better than I thought I could. He got into the job and he just wasn’t cutting the mustard. And there was something, and a couple of weeks passed and I thought, look, he needs training. And there became a point where I realised that this guy is beyond training. So there was some behavioural things that I wasn’t quite comfortable with and blah, blah, blah. Anyway, I said to myself, psyched myself up in the morning, went to the gym, full of aggression, going to fire him today. I’m going to fire him today. Aggressively. And I felt to myself, having the conversation, and I’m not going to say his name because he might be listening, just out of respect. But I was having this conversation, right, okay.

Prav: And I’m going to have to let you go. And these are the reasons why. I’m going to pay you for the next whatever, so that you can spend some time finding your next job and all the rest of it. He walks in that morning with a huge box of chocolates and says, “Guys, I just want to say thank you for welcoming me to the team. I feel so welcome and such a part of the team.” And I was like, so I went through with what I was supposed to do. But, I felt like an absolute a-hole.

Payman: I don’t think I would have done it.

Prav: But, I had already convinced myself that was what I was going to do. And if it wasn’t that box of chocolates that have cost us another week or two or whatever, right? And so I had to let him go. And then as he was leaving, he said, “Enjoy the chocolates, guys.” And I felt terrible. I still made the right decision, 100%. But afterwards, my team carried on saying, “Do you know what? He’s left us these chocolates. Prav, why couldn’t you wait a little bit longer? Give him more of a chance.” But, they also agreed with me that I’d made the right decision.

Prav: They’re given more of a chance, but they also agreed with me that I’d made the right decision, but that was probably my toughest firing. It’s always tough. And you always remember when you’ve had to let go of people, but you’ve got to care for the business, because the business actually cares for so many other people who work for you.

Payman: Yeah.

Rahul: And if that’s effecting the business, then they’re affected, too.

Payman: Even the fired person themselves, they’re not exactly thriving, are they?

Rahul: Correct.

Payman: They know who they… That’s one of those things where feelings take over from logic. So then, okay, the first two practises where regular practises?

Rahul: Yep.

Payman: The third one was a spaceship, compared to those.

Rahul: Yep.

Payman: So that was the influence of, let’s say with Larry, and you’ve been on these courses and all that, but what was it about… Did you and Ash get together and say, “Let’s do this completely different now.” And what would be the equivalent today? It would be some sort of, like something… Robbie’s done something in Liverpool, where from the outside it looks like an IKEA, from the inside it looks like a hotel, it’s was like something completely new that I’d never seen before, when I went to see it. But so, did you feel like you were doing something risky? Wanted to spend money?

Rahul: Well we wanted to create something special, so that’s the key thing, that was the drive. And I think we ran to visit quite a few practises in the US, and see how they functioned, and what created the best, should I say, efficient work patterns for the team. So you don’t want the team members running from one place to the other, going through different rooms, but you want to create a work pattern, which would actually make the patient journey from the front to be seamless, but behind the scenes there’d be stuff happening that the patients would not see.

Payman: And it was a squat, right?

Rahul: And it was a squat. And because we knew the systems that we wanted to bring in, what rehearsed plan from the other two practises, we knew exactly what to do for this practise. And we know what had worked elsewhere in the US, so we just copied that.

Payman: What about patients? So day one, no patients, what did you do?

Rahul: So this was actually [Bavnar 00:42:04]. And the reason why we bought this practise, and this is all about work-life balance, was because we lived near Hartford, we did not want, well Bavnar did not want to go to Hornchurch, or Varnett, because we had young kids, so I needed to develop a practise, so that the school that the kids went to was just literally a few miles away. So we could do a school run, go to work, and then pick the kids up, and go back home. So this was driven towards a work-life balance.

Rahul: And we picked the location because, I don’t know if you remember, when you’ve been to Hartford, the practise, it’s on a road, which is next to a traffic light, so when you actually come into Hartford, the only way to exit the actual town is through that traffic light. And that traffic light’s always red. So most people had to stop outside the practise, see what the practise was, and that’s how we actually got all the patients. So at that time, there was very little, there was no online marketing, we didn’t do any sort of PR stuff then.

Payman: So leaflet, or something?

Rahul: I don’t think we even did that. I think it’s literally the location, which created the influx of patients, the word of mouth, and also the uniqueness of what we delivered. So the name Perfect Smiles. So I remember, there were no practises just focusing on one type of dentistry, it was very risky to actually alienate, and say, “We only do cosmetic dentistry.”

Payman: Yeah. Your main thing, right? How long did it take before it was turning profit?

Rahul: We had the first treatment room made, and that was chock-a-block in the first six months, so six months later, we created the second treatment room, a year and a half later, the third and fourth treatment room came up.

Payman: Oh, so not much pain?

Rahul: So not much pain.

Payman: Very nice.

Rahul: I’m sure we did a lot of networking. I’m sure we did a lot of leaflets, but I think location help, and word of mouth helped. And delivering a service, which at that time, seemed so different and unique.

Payman: Were you active in the community somehow?

Rahul: I was too lazy for that. So to be honest with you, a lot of people go onto the networking rotary clubs in the morning, and-

Payman: Because it doesn’t suit a shy person either.

Rahul: … No it doesn’t, no. And also, is it the right target market? Am I getting the right people in the morning? So yeah, I did that a couple of times, and I thought, “This is not for me.”

Payman: How much of your business, in those early days, say the first 18 months, was word of mouth? Because that type of dentistry wasn’t mainstream as it is today, right? So did it have more of an impact? People were like, “Oh, where did you… I didn’t know that was possible,” it was almost like they didn’t know? It was only accessible to celebs and that sort of stuff? Or did word of mouth have less of an impact?

Rahul: I think word of mouth was quite important, especially it’s like the saying, “Birds of feather flock together,” so it’s actually targeting things like gyms, health clubs, beauty places, and actually networking with them.

Payman: I was doing veneers at that time, too, as a dentist. And to answer your question, the way I felt about it, no one had offered patients cosmetic improvements. And so if you had a 50 year old lady, who must’ve had a nice face 30, 20 years ago, and you could offer them improvement…

Prav: Was that like a sin, or a swear word, or a…

Payman: No, no, no, no. What I’m saying, no one had even offered it to them. So when you say, “Oh, I can make things look nicer,” a lot of people were saying, “Yes,” because no one had ever said it before.

Prav: Yeah. And that’s what I was saying, is that word of mouth, things like that, “Is this possible? I didn’t even know.” It was more positive, than negative, in my experience.

Rahul: So you’re right. So when you actually offered solutions, patients would be dismayed that there was even a possibility, that a cosmetic enhancement could be delivered and made for them.

Payman: There was no botox, there was no aligners, there was nothing.

Payman: Okay. So then, when did the course start? How many years after that did you guys decide, “Well, wait a minute, maybe we can teach this.”

Rahul: Well that started in 2005, so literally a couple of years later, after opening Hartford. So we’d been doing cosmetic dentistry between the three practises for a good five years. So we had a lot of experience, should I say, in doing it, and that’s all we did. And we grew a lot of knowledge in that field, and understood what to do, and what not to do, as well. And I think the teaching really helps the dentistry, because when you teach something, you have to learn it so well that you start delivering even better quality of care, because you’ve learned the intricate details. And the actual dentistry helps the teaching, because if you’re teaching, you want to take exceptional photographs. To take exceptional photographs, you’ve got to do exceptional work, so it pushes your dentistry to another level, so it actually helped each other.

Prav: Yeah. And then the courses themselves, was there a demand? Did you have people say, “Hey, let me come and shadow you for a day?” And then you thought, “Hold on a minute, there’s something here,” or did you think, “Well, Larry’s doing this in America, and no one’s doing this in the UK.”? So what was the thought process around getting the teaching going?

Rahul: So actually that was the thought process, that, “Larry’s doing it in the US, we can do it here. We can actually do it a little bit different, than what Larry’s doing.” I can’t say better, because he so much years experience to us, but what we had done was, Larry was very good in inspiring people, motivating people, but we created systems of what he was doing, so methodology. He would do it with experience, and show how to do it with experience. We were saying, “You actually have to hold a bird. This angle, you’ve got to do it this way. This is the methodology to do every single step,” so we were creating detail and steps in that, and that’s how we were different.

Prav: And I guess, for the UK market, as well, it’s like nuances, or differences, or what was it all [crosstalk 00:48:09]?

Rahul: So this was the key, I think the key thing was to create methodology and steps, because we needed that when we learned. When we learned, we weren’t actually given the steps exactly, we had to figure the steps out. So in figuring the steps out, we created a methodology, and that’s what we were teaching. The European, the UK aspect, of making more natural smiles, probably came a few years later, because initially you’re still in this era of whiter, more American looking smiles, than anything else. And then the market, and the patient’s drive, they want as well. And to create more natural, more bespoke, more personal smiles, was where we started really focusing on.

Payman: Well, and I think a lot of times, you learn from the difficulties in your life. Take us through some of the dark times. I mean, what were some dark highlights, lowlights, if that’s the right word, within this whole process? What were the difficulties?

Rahul: Okay. So when you’ve started doing cosmetic, you’re doing a lot more extensive dentistry, than you are probably used to at that time. So the first thing was that you start seeing patients with wear, and you start saying, “I can solve this,” but then the occlusion learning might not be there, and that’s where we really became really hot on learning, and understanding occlusion. Because without occlusion, things would fail, and we had a few failures, where veneers fail, and they are fractured, and the reasoning was occlusion.

Payman: Before you had the knowledge?

Rahul: Before you had the knowledge, yeah. So the key to any dentistry is actually occlusion, because that is what is going to keep it there. So aesthetics will drive the case, but actually it’s the occlusion which will create a longterm successful outcome for any scenario.

Prav: Have you ever had a nightmare situation, where you came to a point, and a realisation, that’s, “This is a disaster. What have I done?” but now my knowledge is at a level I would never do that, and what did you do about that situation, if it did happen?

Rahul: Yeah. So I think, very earlier on, there was a situation where we had a patient with an anterior open bite. And when you have an anterior open bite, and you think you can actually modify the occlusion, and level it, it’s actually the wrong thing to do. You actually need to keep the anterior open bite somewhat as it is. Otherwise, it’s just like creating all sorts of interferences that patient has never been used to, especially in their guidance forward, and laterally. So you don’t want to create more interferences, that was a big learning curve for me, when trying to help people with anterior open bites. Or even class 3… And so the class 3 anterior open bites, rare cases, were the biggest learning curves for me personally.

Payman: What about in your partnership, did you have moments where you diverged, you didn’t agree, you argued, anything like that?

Rahul: I think, it would probably, sometimes in the methodology, perhaps, I’m now trying to think of the details, but it’s so far away, it doesn’t come to my mind, so I’m just being very open. I can’t remember any specific examples.

Payman: So you ended up buying Ash out?

Rahul: I did.

Payman: And how many years after that did you sell the practise?

Rahul: I bought Ash out in 2010. And then my practise joined Dentex in 2017.

Payman: How did it feel… I mean, we’ll talk about Ash later, but how did if feel selling the place? Did you feel that sense of loss that people talk about? I know Dentex’s model is that you’re still kind of involved.

Rahul: So actually, the only reason why I joined Dentex was not to sell, so that’s an important thing. I did not join to sell, or to leave dentistry. I wasn’t thinking of exit, Dentex were offering me to actually grow the number of practises I had. So they were offering me a way of growing, of not just having one practise, but actually having multiple practises, which they have. And my role, I joined Dentex as what was called a regional partner.

Payman: You’re one of the earlier?

Rahul: I’m one of the earlier people, so I was working with 10 practises within Dentex, I think 9, or 10, practises, I can’t ever remember the number.

Payman: So you transitioned from what you had, to working with 10 practises? What period of time?

Rahul: Within a year. Within a year, or two.

Payman: Geez. And were you just honing on with your experience of what you’d done in your practises, and distributing that? Or did you come across new challenges that you hadn’t come across before?

Rahul: So the reason why I joined Dentex was to grow. And at that time, to still carry on with my clinical dentistry, and I want to be totally left alone in the way I did my dentistry. If I worked for any other practise, I’d be unemployable, because the way I practised was so unique to me, with the team that I practised, and the way I worked in my environment, I did not want anybody to tell me what me to do, and Dentex allowed me to do that.

Rahul: So when it then came to growing 10 practises, opposed to a single practise, because I’d been doing a fair bit of coaching with Bavnar, my wife, in growing other practises, I had that experience with her, so we joined, as a team, to Dentex. And we then were able to grow many practises with her, only because of the experience we had, had in growing other practises previously. And every practise is different, every practise that we’d grown previously had its own challenges. So we were literally just using that same knowledge that we’d gained, and putting into Dentex.

Payman: So just like muscle memory, really?

Prav: Correct.

Payman: You’ve experience the challenges, and you say, “Well, we’ve come across this problem before, and that’s how we’ll fix it.”?

Rahul: Absolutely. And so-

Payman: And it went so well, then they put you in charge of 80 something practises?

Rahul: … Well, so Dentex now has 71 practises. And yeah, so I’m the clinical director, so my title is clinical development strategies director, so my growth of these 71 practises, clinically and in other ways, as well.

Payman: What does that mean, your day-to-day? Day in the life of typical what you’re doing now, compared to what you were doing back then? How different is it? Could you map out a week, very quickly, in terms of what type of conversations you’d be having with whom? Would you be visiting the practise? Would you be overseeing the dentist? Are you doing anything clinic, at the moment?

Rahul: First of all, I don’t do any clinical dentistry now. So one, it’s actually working with dentists, and seeing how I can develop them. So the quickest way to grow any practise is to develop the team. That’s the dental team, and the non-dental team. So I would influence the dentists, by creating a strategy, or a development plan, specific for them, with all the knowledge that I have, and experience I have, on how they could grow individually. How I would help guiding the business managers of Dentex on perhaps what strategies may be needed in the group of practises. I’d be looking at developmental courses, introducing different types of dentistry, to different practises. So it’s so varied, and it’s very much strategy level, a strategic level, and work really with the senior team members, as opposed to going into working with your team members, which is a totally different way of working.

Payman: What are all the… I’ve been to your office, and there’s loads of young people, usually, there working.

Rahul: Yeah.

Payman: What are they all doing? How is it all broken down? Acquisition’s a giant part of it, right?

Rahul: Yeah. So Dentex actually prides itself, in a sense that it really wants to have a support centre for these practises. So we look at the practises that join, as being like the actual customer, that we want to make sure that they’re so happy. And Dentex provides support to them in all various fields, whether it’s HR, marketing, the clinical development that I do, in compliance, which is amazing, the business support, and the business development that they’ll need from the business development managers, financial support of helping them with all their finances, the payroll. So all the people that you saw, were all these different departments supporting these practises. That being, that these practises actually started growing, because all the stuff that they didn’t want to do is outsourced now, to Dentex, and they just focus on their clinical dentistry.

Payman: I was going to say, talking to the practises, or the principles that have been acquired, for now, it seems like it’s working, that they’re happy. And it’s rare. A lot of times when a corporate takes over your practise, people end up being unhappy.

Prav: Yeah, so true.

Payman: I think the challenge is, can Dentex keep that going with the growth? Because I speak to quite a lot of corporates, who have wonderful ideas, but as the thing grows, those ideas get diluted. And it’s great that they’ve done it so far, with these 70 whatever it is, that they’ve got. But it’s nice to see a happy corporate stories. That’s the thing, because of all those sad corporate stories out there. Can you just briefly summarise what the Dentex acquisition model is, and their values? Because I think, it’ll be good for us to all understand that, and to get an insight as to why these practises are so happy.

Rahul: So I think it all boils down that before, even when the first, or second, practise was acquired, minus probably the first few, it was about creating the right values, and the right culture. And the values were all about igniting passion, integrity, self improvement, creating positivity within the practise, creating ethical quality dentistry, and collaborating with the practises. It’s all about collaboration. So Dentex never actually wanted to inform the practises what to do, but actually collaborate-

Payman: To impose? They don’t impose?

Rahul: … Correct.

Payman: That’s one they say, they say, “They leave us alone.”

Rahul: That is the DNA. So an example, not of Dentex, but of Perfect Smile, where I rarely visit now, so I developed the Perfect Smile studios, the team, the way it works, and I go there once every week, once every two weeks, for half an hour, and it still runs exactly the way I left it. Why? Because the DNA, or the values of the culture, have been ingrained into the team. In the same way, Dentex has ingrained its values of collaborating with the actual incoming practises, and the culture, so much, that everything is built around that, and nothing should actually come in the way of the values and culture. And that was important part of Dentex’s growth, and is.

Payman: How’s the acquisition deal structured? So I own my own practise, I come to Dentex and say, “Hey, I’ve heard good things about you. I’m ready to cash in my chips,” how’s the deal typically… I know every deal’s probably different, right?

Rahul: Right.

Payman: But how’s the deal typically structured? You buy 70%, I retain 30%, and then this whole partnership model just happens? How’s that all…

Rahul: Okay, so what happens is that we buy out the practise, but you get 20% is retained as shares, as Dentex shares. Now, so you get 80% up front. The 20% are given on you achieving the same targets that you were doing last year.

Payman: So not unrealistic goals.

Rahul: Exactly the same goals, no different. And it’s just turnover based, often. And you get back the value of the shares, what they will be worth, in five years time. Now, if the Dentex shares, which they will, grow significantly, you’ve got a second upside…

Rahul: Grow significantly. You’ve got a second upside, so you’d not just getting the 20% back in five years, you’re getting the upside back. So you could be getting back a significant amount, as almost like a second exit, in five years or so.

Prav: So it’s like I’d buy in at 20% today’s value and cash in at tomorrow’s value?

Rahul: Correct. Now that’s the biggest advantage in the way the acquisition process works [crosstalk 01:00:27].

Payman: Assuming tomorrow’s value is more than today’s value [crosstalk 01:00:29].

Rahul: And the values increase, the more practises you have. And actually how successfully Dentex maintains the profitability of the practises, which it’s doing exceedingly well in right now.

Payman: So there’s a Canadian corporate that this was all based on, right, that did extremely well?

Rahul: So there’s a Canadian corporate called dentalcorp, which has a lot of influence on some of the ideas, but also our CEO, Barry Lanesman, he’s extremely talented, extremely knowledge in how to build businesses working with partnerships. So he’s almost repeating his knowledge.

Payman: I’d like to say that an idea is nothing. Execution is far more important than the idea.

Rahul: So there’s a lot of experience that’s come in in developing Dentex from his side as well.

Payman: So who is he? Is he a money guy? Who is he?

Rahul: So Barry is a dentist-

Payman: Oh, he’s a dentist?

Rahul: …who studied dentistry. He went into doing an MBA, realised that actually doing dentistry was not his forte, but actually developing other businesses were. He went to helping out financing businesses in Australia. He developed [inaudible] , which he then sold out and came back and-

Payman: A dental company?

Rahul: It is financing dental practises. Yeah.

Prav: Okay. Let’s go back to Rahul, the family man. Tell me about when your kids were born, when they came into this. This whole story you’ve told us at what point they came into the mix and how life changed for you. Because I certainly know it’s… I always refer to it as different levels, different devils, and it’s just different challenges when either new businesses come on board or family dynamics shift. So just talk to me about that and how things changed.

Rahul: Yeah, so I think I always knew when my kids were born that I had almost like a limited shelf life on time with them until they were going to be teenagers where they would want my time and I would want their time. And then as soon as they became teenagers, they would want less of my time. So I wanted to be able to deliver as much time to them when they were young. So yep, we worked hard, but I wanted to ensure we had plenty of time allowed for holidays. I took Fridays off almost to try and do a lot of admin, so I could evolve and give my weekend to them.

Rahul: So it’s one of the reasons why I never sort of took up hobbies, such as golf, because I didn’t want to take up my time away from family time to be spending several hours on the golf course. And literally it was just doing as many things as possible with them whilst they were young. And as they grew up, found that we start developing more time than we’ve ever had.

Payman: And one’s going to Oxford?

Rahul: Correct. One’s almost completing Oxford. He’s in his final year.

Payman: The other’s going to Cambridge?

Rahul: The other one… Well, not quite yet. His in a gap year, so he got his interviews now, and he’s going to China to do teaching for several months.

Payman: You must be very proud of them.

Prav: Tell us about the BACD role. When did you start getting involved with that?

Rahul: So you know what? I was there the first meeting for the BACD. So I’ve always been a BACD member right from inception as I was… well, with my kids, developing the other practises, and the courses, I never had time to get involved as a committee member or a BACD board member until later on in my life. So I actually didn’t want to take up any sort of responsibilities with the BACD until then. So I started working, I joined the board I think in 2011 and I’ve been a board member since then. As you know, was the president last year. So now the immediate past president. And it’s been great working with the BACD because promoting, the word is ethical cosmetic dentistry, is at the forefront of what the BACD does, and getting the message out there to do things correctly, to look after the patient in the best way, to diagnose properly, to evaluate properly, to consent properly, to give all the sort of pros and cons of what you’re doing, is what BACD is all about. And giving that knowledge in the minutia to achieve that.

Payman: But the process of starting, what were you? The education secretary or whatever, and then going up that organisation to become the president. How much of your time is given to that? I mean how much-

Rahul: So the amount of time each board member gives to the BACD is absolutely amazing. As you know, it’s unpaid time. So there are at least seven, eight days of meetings that you just have to evolve. That does include endless emails and conversations that take place in the middle of the week. Then there are committee meetings that take place on a monthly or every few months. So it’s an immense amount of time that you’ve got to give part of the BACD board. But it’s also gratifying because you’re giving back to your profession with knowledge and experience and that’s pretty satisfying.

Payman: But would you say… What are the upsides then? I guess getting access to world famous speakers that you wouldn’t have otherwise had if you were just a member of the BACD or…?

Rahul: So joining the board actually is more about service than actually trying to get any benefits from it.

Payman: But what are the benefits? That’s what I want to know. I get the service level.

Rahul: So as a board member, benefits would be… You may get some access, but that’s not the… you don’t get that much access really. So if a speaker came to the BACD conference, you may speak to them for 10 minutes more than you would otherwise.

Rahul: It’s literally service focused. There is no-

Payman: Setting the agenda, I mean, does the dossiers, did it go in… For instance, when [TIFF] was president, the thing went very much down the [inaudible] route for instance. What would you say your influence on the BACD has been compared to someone else’s influence?

Rahul: Okay. So I think one of the things that we created for the BACD last year was actually create what’s called the values for the BACD, what the BACD stands for. So going back to the values of me in Dentex and in Perfect Smile, it’s important at the BACD because it’s all about the culture, making sure it’s the right cultural fit for our member wherever you are. Whether you’re at a practise level, corporate level, or at an academy level as well.

Rahul: We’ve changed the website. So that’s evolved massively. Education’s been a big forefront of trying to make sure that we are financially stable now. So the reason for the financial stability is that you can only get great speakers if you can afford to pay for them. And that means financial stability. So I think that’s been really good over the last few years because I was part of the financial director and then joining the executive committee. Our role was to make sure that we were really financially sound to drive the actual education, which is what really the academy is for.

Payman: So in your different hats that you’ve got, you’ve got this, this hat, the BACD kind of hat, you’ve got the Dentex hat, you’ve got the cooperative dentist actually with patients, you’ve got the running a business from scratch to sale, you’ve got the teaching element. Which of these is your favourite?

Rahul: The truth is when you’re actually doing… Each of those, I enjoy immensely. Otherwise, I won’t be doing it. So when I’m teaching and I’m actually influencing people, I love it and I know that people are taking things in and you are making a difference in their life. Same with the academy where I’m making a difference to the actual academy. When I’m with patients, knowing that I’m making an influence in their own life because of the way they feel about themselves in the way they look.

Payman: But do you miss clinical dentistry?

Rahul: Yeah. So I think if you’ve been doing for such a long time, you have such immense knowledge in that field, you’d always miss something about it.

Payman: The thing you miss the most, though?

Rahul: So I do miss actually-

Payman: The reveal.

Rahul: … I miss the reveal. I miss showing them what I could do, working as an artist, actually doing the actual dentistry itself. I miss that immensely. I don’t do much clinical teaching, so I do miss that as well. Whether the knowledge of-

Payman: I miss people in dentistry. You meet a lot of people.

Rahul: You do.

Payman: And do you get that now? I guess you’re meeting quite a lot of people with [crosstalk 00:09:12]?

Rahul: So I’m still meeting people. I’m meeting loads of people all around the country. So I don’t think that that’s changed too much. I just meet different people now as opposed to patients. I meet more dentists and team members and in the business world as well.

Payman: Are you on the road? Are you literally off away every week?

Rahul: So I will visit practises. I’ll visit practises that need my help and guidance and that’s really useful. So it keeps me that coaching mode and also educational mode. And ultimately when you go to visit a practise, it’s quite nice because you’re going back to your roots, in a way, of where you came from.

Payman: And with associates, what would you say is your bugbear? What are the things that if someone wants to be your associate, whether we’re talking practise or now Dentex, you’ve got this situation. What would you say is good advice for an associate if they want to excel, they want to do well?

Rahul: I think it’s all about trying to give, being committed, and always on this journey of self improvement and learning. Because, and whether you’re an associate or whether you’re a team member, if you can actually get people or people who want to do that, they will grow and they’ll be more fulfilled in what they’re doing and you’ll enjoy working with them. So I would definitely recommend that people who have that passion, the word passion again, for what they do. And also I tell associates, don’t try and diversify in so many areas of dentistry because you won’t become a master of any.

Rahul: Trying to figure out what you really enjoy, become passionate about that, learn more about that, get experience in that. And then you’ll actually start enjoying dentistry even more than you do. I’m not saying that they don’t, but they’ll start taking the enjoyment to another level.

Payman: Rahul, if you were to do this all over again, what would you tell your 21-year old self?

Rahul: You know that there are always things that you learn about what you should do and what you shouldn’t have done. Always in your life. But I think the way I think about life really is… and I tell this to my kids… I love playing cards. I love card games, and I love also winning my card games as well.

Payman: What’s your favourite card game?

Rahul: Actually, it’s an Indian game. So [inaudible] but the interpretation might not even come out, but it’s like Trumps. So whenever you had… You get a set of cards and you do the best with those cards that you’re given. So with life there will be things that I could have learned and done things different but these were the cards that I had, and that’s how I played them. So I wouldn’t want to take or change any of them because that’s led me to where I am right now.

Prav: Really nice way of putting it. Actually a lot of people go back and say, “I wouldn’t have made this decision, I wouldn’t have hired that person, wouldn’t have done that or taken this direction.” But it’s a really, really nice way of looking at it because you are the person you are today because of your cards.

Rahul: These are the cards that I was handed, I played them. And you played them to the best of your ability rather than being demotivated about, “I could’ve done X, I could’ve done Y.” You got to say, “Right, how do I play these cards now and do well with them?”

Prav: So apart from playing card games, what does Rahul do for fun?

Rahul: I love running, I like going to the gym, like football-

Prav: Time with the kids.

Rahul: Time with the kids, absolutely.

Payman: So you were close with Anoop?

Rahul: Yeah, absolutely.

Payman: And still are, I’m sure. How did it affect you looking at your own life? I mean okay, we all went through something depending on how close you were to Anoop. How did it affect you, thinking about your own life, what happened with Anoop?

Rahul: You know what? It was quite a difficult time when I found out about Anoop. And you always self-reflect about yourself, as you mentioned. He was a family man who enjoyed time with his family and it just reminded me of how important that was and is, and making sure I develop that.

Rahul: The second thing is, I think, a health scare to every one of us. Thinking you’re at this age and if something that can happen unexpected to Anoop, somebody you know, who is fit and healthy, who used to go to the gym and watch his diets. I’d known him for many years and he was trying to do the same thing I am as well, and he used to go to [inaudible] and try and keep healthy in as best way as possible. But also stress levels in terms of trying to make sure you regulate your stress and don’t overburden yourself with things that you have to do.

Payman: What about you, Prav?

Prav: For me it was really tough because he messaged me before he passed. And it was going through elements of disbelief, utter shock [crosstalk 01:14:06]-

Rahul: I was… Actually, the disbelief and the utter shock was something… First of all, you couldn’t fathom it and it would take a while and, sorry to interrupt, even right now we had the BACD conference, and this was the first conference that I had been to where I did not see Anoop. So BADC conference would be the time that I spent a lot of my time with Anoop, and he wasn’t there.

Prav: And he mentioned you a lot, Rahul, as being somebody who is very authentic, someone who is very genuine, and he thought incredibly highly of you. In my personal conversations, he always used to talk about you as being one of the guys who you get what you see, and is a genuine down to earth, honest guy. And he always used to say that about you.

Prav: For me, the shock, the disbelief. I even had conversations with him in my dreams because I thought he was still here. And today he still haunts me regularly by either popping up in my inbox when I do a search for something else or on a timeline and things like that. And the only thing he brings back is a huge smile to my face because every interaction with him was positive. It was funny, he made you laugh, you remembered how kind he was. And I think he’s definitely left us with a legacy of somebody who influenced far and wide, but also everyone just had positive things to say about him. I actually didn’t know how “famous” he was, because for me, he was very one-to-one advisory and he’d tell you straight.

Rahul: Absolutely. You know what? I’ve shared so many… We’ve been away a lot. We’ve been on sort of trips together and-

Payman: Brazil you went to together.

Rahul: We went to Brazil together, I shared a room with him, and you have these memories in your mind of having fun. And you’re right, he just brought a smile to your face. And to be honest with you, it was because of him I actually went and joined the board of the BACD. It was his persuasion, or consistent persuasion, for me to join, that I joined the BACD board. So I was a basic member, but I had no intention of joining the board if it wasn’t for Anoop.

Payman: So for me, two things. One, the family thing that you said because he really was so into his family and it made me think, you know, my family.

Payman: But the second thing that a number of people this guy touched, the people that came out saying, “Oh, he helped me with that. Oh, he helped me with that. Oh, he helped me with that.” And we talk about legacy-

Prav: True measure of a man.

Payman: Legacy isn’t only the institutions you leave behind or… Legacy is the memories you leave. Individual memories with all these people. And yeah, the people you touch and the positive effect you’ve had on them. And he was so positive.

Prav: He touched so many people, but if he could hear me saying this now, he’d make a perverted joke about it. Because that’s just the way he was and yeah, such a special guy. Really, really special guy.

Rahul: Absolutely miss him today, I really do.

Prav: Likewise.

Rahul: I really miss him so many times, so.

Payman: What would you, Rahul, think would be what you want your legacy to be?

Rahul: Actually, I’ve always thought of this, that… not thought of this, but I’ve always want to be thought to be authentic. Almost what Anoop said. I don’t want anybody to have a perception of me being anything different. And that’s all it is. So it’s being who I am and what I do. I’m not there to leave a massive fan club behind or trying to leave a legacy or anything like that. I just want to be the most authentic person I could probably be.

Prav: What three messages, let’s say it’s your last day on the planet. What three messages do you want to leave for your children?

Rahul: Enjoy life. It’s so precious and can be taken away. So for that reason, be healthy. So do everything to maintain your health, and grow in your mind and in every way you can. So yeah, those would be the three messages that I’d give.

Prav: Lovely, lovely. Rahul, thank you so much for your time today.

Payman: Thank you.

Rahul: My pleasure. It’s been great. Thank you so much.

Outro Voice: This is Dental Leaders. The podcast where you get to go one on one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.

Prav: Thanks for listening guys. If you got this far, you must have listened to the whole thing, and just a huge thank you, both from me and Pay, for actually sticking through and listening to what we had to say and what our guest has had to say. Because I’m assuming you got some value out of it.

Payman: If you did get some value out of it, think about subscribing and if you would share this with a friend who you think might get some value out of it too. Thank you so, so, so much for listening. Thanks.

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

Transcript

Linda Greenwal: So we have our plans and our things to do to, to work on that.

Prav Solanki: Unbelievable.

Linda Greenwal: You have to pay-

Payman L: By the way, we haven’t even scratched the surface of all the things you can accept. Honestly, we haven’t.

Linda Greenwal: We have to also talk about how do you chill? Do you know what I mean?

Payman L: How do you chill?

Linda Greenwal: So how do you-

Payman L: Do you chill?

Intro Voice: This is dental leaders, the podcast where you get to go one-on-one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.

Payman L: It’s a real pleasure to have you Linda on the show. We go back a long, long way, particularly with everything that’s happened in bleaching over the years. I guess for me when I think about you, you’re the person who does the most that I know in the world. Every time I come and visit you, I go back home and start complaining to my wife, “We were not doing enough.” And you come from a long line of dentists. Tell us a little bit about that. Tell us a little bit about the history.

Linda Greenwal: Okay. So, I’ll tell you a bit about the family history. So my grandfather’s brother in 1918 decided dentistry was for him. So he came to Guy’s hospital, and he trained at the London hospital. So, there were no dental schools in South Africa, so he had to train in London. He was a keen rugby player. So, soon became very popular, was in the rugby team. His name was Joe Greenwell. And then his brother, four years later came from South Africa and trained at Guy’s.

Payman L: Your grandfather?

Linda Greenwal: My grandfather, yes. And then they went back and the two brothers didn’t have a practise together. One had a city centre practise and one opened a practise in the suburbs. And my grandfather was very dedicated. He did all his own gold work. He had a technician. And then 40 years later my father came along and they worked together in their practise. And then I joined them in 1984 when I qualified.

Payman L: Oh well the three of you practised at the same time.

Linda Greenwal: Yes, my grandfather was just retiring, but he used to come and have coffee at the practise. My grandmother would kick him off, out the house, he’d catch the train and go and sit and have coffee with his patients. Cause they’re all long-term patients, and he would just enjoy being in the surgery environment.

Payman L: And what do you think it was about you that made you want to be a dentist as opposed to you and your brother, wait did you have a close relationship with your grandfather or something like that?

Linda Greenwal: I personally like to work with my hands, and I like art and the creative process. So originally I was looking at physio and OT, the creative and helping and working with your hands. And then when I was 16 I asked my dad, “Are women are allowed to be dentists?” I didn’t know any and I thought maybe they’re not allowed to. And he said, “No, of course you could, women are allowed to do dentistry, but you have to realise it’s a really hard job. Maybe you want to be a hygienist.” So I thought, well let me try dentistry and if I fail first year, then maybe I’ll do speech therapy or something else.

Payman L: Were you an achiever in school?

Linda Greenwal: I coasted along until I found a subject that I was really interested in. I went to an all girls school and they had certain guidelines of how ladies should behave and all that and how women were in the sixties and seventies. And when I realised I was looking at a medical career, I needed to change schools because they didn’t have that kind of facility to study sciences, changed schools, did my graduation and then went on to dental school.

Prav Solanki: Where did you go to dental school?

Linda Greenwal: Oh, I went in Johannesburg. At a university called Wits Dental School.

Prav Solanki: Uh-huh.

Linda Greenwal: That was the only one that was in English. And there are five dental schools that were English speaking.

Payman L: Okay. Its got a very good name, isn’t it Wits?

Linda Greenwal: Yeah, it’s a very good school.

Payman L: A lot of the top guys have been to Wits.

Linda Greenwal: Yes.

Prav Solanki: And you mentioned that you sought permission or you asked, are women allowed to do dentistry? Just why was that a thing back then and also how many women were on your course?

Linda Greenwal: I didn’t know. I had never met a woman dentist, so I didn’t know that women did this kind of thing. I knew about women doing medicine. So, on my particular course there were six out of 60 and we had quite a tough time shall I say, with the people in our class. And we soon realised there is a difference between men and women and we all had to learn how to get along because there were a lot of joking and side remarks and comments, and we realised there’s a name for this kind of stuff that used to go on. It’s now called sexual harassment and hashtag me too and all those things. But in those days we didn’t have that.

Prav Solanki: So, we have interviewed another guest Mahrukh who has set up a group of dentists who focus on empowering women in dentistry. And I know you do the same Linda, and I just want to get an insight into a bit more detail into what that was like being a trainee dentist as a female back then?

Payman L: By the way do you feel it’s harder being a woman dentist than a man dentist today in Britain?

Linda Greenwal: Today not, but I think that there still many issues that need to be dealt with. So, when I qualified as a dentist and I went to work straight for my father, I did a research study and I looked at stress patterns of women dentists. So I did a survey of all the dentists in South Africa, which is not really a lot, and I looked at the responses. And I looked at what stresses a male dentist versus what stresses a female dentist.

Linda Greenwal: What stresses a female dentist is, her child is ill, she’s been up the whole night and she hasn’t had much sleep and she still has to go to work. What stress is a male dentist is the suction and the compressor’s broken down and he can’t work. And that’s a terrible thing. And I looked at ways that they dealt with stress because I wanted to know, I wanted role models, I wanted advice, I wanted to know how to do that. And as I was doing my research, this is in 1984, I started reading about this lady called Jennifer, who’s just retired now, although Jenny, she’s one of my role models, amazing woman.

Payman L: Lovely lady yeah.

Linda Greenwal: And I read that she was taking Canada life to court because of the issues with medical sickness insurance and the unfair changes. And I read about her and I started reading about a few other dentists, female dentist who were doing things. So when I came to the UK we met up and in 1985, we set up the Women in Dentistry. And that was a very big help for me and the excellent society to help all these issues that women had. And we dealt with lots of issues.

Linda Greenwal: We were able to change pension legislation, we were able to change all the maternity issues. We’re able to get women dentists, maternity rights. And I was one of the first to benefit in 1991. And that was very helpful. And so through that organisation we did assertiveness training and training for building your practise and building your teams and met people. And that was really excellent. And it went on for 30 years and we retired a little bit.

Linda Greenwal: But now we’ve realised there’s still more issues that need to be dealt with. And very well known dentist came to see me. They said, “Linda, seriously, you need to do this again.” I was like, “Really?” So, we started again and we’ve set up, it’s called WDN, the Women Dentists Network. There’s a Facebook site and we having a conference next year in June to deal with a lot of the issues and they’re plenty of issues.

Payman L: So what are the issues now?

Linda Greenwal: So another interesting thing that we’re looking at, and I’ve written editorials about this is the pay gap… The gender pay gap.

Payman L: How does that work? Even in hospitals?

Linda Greenwal: No.

Payman L: I mean in private practise from a pat-

Linda Greenwal: And everywhere.

Payman L: From the patient perspective.

Linda Greenwal: Not from the patient-

Linda Greenwal: wow.

Payman L: Whether it’s a man or a woman.

Linda Greenwal: Why do women, dentists, women lawyers, women physicians, why do they earn less? Why? If they self employed or if they’re government employed, why are they earning less? Why? So I’ve started to look at these issues and the whole gender pay gap, you know the gender pay gap has started the whole discussion about it at the BBC, and nothing newsreaders get from their interviewers and their shows.

Linda Greenwal: And then it brought this whole thing to Line. And The Royal College of Surgeons did a whole thing on the gender pay gap in medicine. And-

Payman L: I get it in a hospital situation for the same job being paid less. But if we’re talking private practise, then the market is deciding what anyone gets paid and-

Linda Greenwal: Wow, it may be the market, but then there’s two people who’ve done PhDs in the subject and they looked at does it work against or does it work about hours? The hours worked, the number of children and all those things, and it doesn’t relate to, we thought that maybe if women have a lot of children they don’t earn so much because they have to be at home, but there’s many issues, which are not resolved, which need to be looked at. And the issues that women don’t ask for pay rises.

Payman L: That’s true.

Linda Greenwal: And even some of the corporates have now had… they do have those studies and there’s ongoing research.

Payman L: Do you not think the biggest exploitation of women in dentistry is with the nurses and hygienists rather than with dentists? I mean, I definitely think there’s lots of exploitation of women, but it’s formed the-

Linda Greenwal: And how do you think hygienists are exploited?

Payman L: Well if you look at the hygiene group, if you read their posts, some terrible stories of the way hygienists are treated by their bosses and we’ve all seen nurses being treated badly by people in practise. I certainly think that’s an issue that needs talking about for sure.

Linda Greenwal: So there’s the bullying aspect, which is another bullying aspect of associates and bullying aspect of all staff of course. And that’s another issue. And Jenny, that’s one of the issues she wants to tackle, the bullying of associates in corporates or in positions like that. So, thats another issue.

Linda Greenwal: We also looking about the working patterns of women’s lives, how they balance having family and working and those issues, but also finance issues and pension issues. And we had a really interesting meeting discussing, ensuring women’s futures and what happens, what provisions do they make for themselves. They go, Oh, they get married and their husband gets, “Don’t worry, I’ll do all that.” So the woman just leaves it to the husband. Suddenly they’ll end up divorced, discovered that they’ve got no pension provision, they’ve got no this, they’ve got no this, and they financially better off. What they didn’t take, they left it to their husband.

Linda Greenwal: So those kinds of issues. So there’s a social issue. There’s the social aspect, there’s the woman’s life aspect, there’s the career profession aspect. There is not enough women leadership in terms of many of the organisations. Where are the women’s speakers? I know I speak a lot, but-

Payman L: That’s true.

Prav Solanki: Very true.

Linda Greenwal: Where are the women speakers? Because sometimes this is controversial so I’m just going to say it, when they decide a conference for example, when is it decided? It’s decided at two o’clock around the bar in the evening where everybody’s had the one composite plan in the next hundred. The women dentists are actually nicely tucked up in their bed because they’re absolutely exhausted. They’ve checked in with their kids and they’re sleeping and they are not considered when it happens with a conference and that has to change.

Payman L: Having set up a conference recently myself, we were talking to Bertie Napier on this subject.

Linda Greenwal: Yes, yes.

Payman L: Yeah, he was saying that there should be a rule, they should be a minimum number of women.

Linda Greenwal: I actually think they should be because many women don’t put this themselves forward and not, and at this moment, probably for the next five to 10 years, it needs to be considered. Later on when there are known and they’re more women speakers, then absolutely it’s a natural. But what people have said to me, and I’ve just spoken in class for the whole day on Sunday. They said, “It’s actually a pleasure to hear a woman’s point of view from the clinical side of things. It’s actually really interesting.

Payman L: Definitely.

Linda Greenwal: And so that is often the comment that-

Payman L: But the notion that there needs to be a minimum number. So, we set up this conference and there was nine speakers, and it was difficult actually thinking of women-

Linda Greenwal: That’s what I mean.

Payman L: To put on because for me, the top nine speakers on the subject were men. I mean it would have been you Linda, but I took that bleaching, I did the bleaching myself.

Linda Greenwal: Took it away from me yeah.

Payman L: But I just felt the top and in the end, well we did have one speaker, we had Slaney who was a woman, but-

Prav Solanki: Still is.

Linda Greenwal: She is still a woman as of, yeah.

Payman L: The idea that along with all the hassles that you have when you’re putting on an event to have, to have that minimum number of women in as well as the fact that you want people to get it for their own, for real rather than because there’s a quota. What do you feel about that? Do you feel like it devalues-

Linda Greenwal: Okay, so the thing is-

Payman L: The information to speak?

Linda Greenwal: Not really. I think let’s look at who the audience are now and what’s the age group of the audience and what’s happening because of the big swing away from just the known quotas. But there are a lot of women dentists qualifying now. It’s up to 60%. And because at the moment still they are the ones having babies, the mark could change. But that kind of career balancing, those kinds of gender stereotypes-

Payman L: Let’s go there because you’re the ultimate career balancer of four kids.

Linda Greenwal: Four kids Yeah.

Payman L: How did you balance four kids, a practise, the teaching, this womens thing and all the other things. The charity work you do, the changing the law several times.

Linda Greenwal: We’ve got more work to do on that.

Payman L: I know. How do you balance? And I’ve got a small insight into it. Trying to arrange this appointment with your PA, and your minute by minute scheduled. I did get this well. But what do you do? What’s a hack for other women?

Linda Greenwal: Is it like? What is it like?

Payman L: A hack, it’s a-

Prav Solanki: Shortcut .

Payman L: Or cheat something other women-

Linda Greenwal: How do you do it?

Payman L: Yeah. How do you do it? What’s your secret?

Linda Greenwal: No secrets. The secret is no secrets.

Payman L: Do you wake up at 5:00 AM and go to bed at 2:00 AM?

Linda Greenwal: No I do sleep. I know you have to sleep and you have to have a lot of rest. You seriously do. When I was deciding about having kids, I was married four years I was at 29. And I was thinking about studying for my masters and I was thinking about what do you do? How’d you do this? Should you do the master’s first? Should you have a baby first? What happens? Then I thought about what happened if had this fabulous, brilliant career and it said 45 I decided, okay, now I’m ready for kids. And then they don’t arrive.

Payman L: Yeah.

Linda Greenwal: It’s not so easy. So I thought, well, what is more important to me in my life and it’s more important to have a family. So I thought, why actually let me see if I can start a family side. Started with trying for a baby and I registered for a master’s at the same time. So, my life when I finished the master’s was like this and my specialty, I did Monday, I finished my specialty exams and my MRD exam. So I did a masters and I finished my MRD, it was Monday, Tuesday, I opened my dental practise, and Sunday I had baby number two.

Payman L: Wow.

Linda Greenwal: And that was the one week, and that was a little bit crazy. And while I was kind of having maternity leave, I didn’t really have a maternity leave that time. While I was there my mom said, “Just come sit in the practise and you’ll see what happens and somebody will walk in and you know, you’ll start your practise like that.”

Linda Greenwal: So I did that. So eight days later I took the baby in a basket and brought him there. I was just about walking by at that stage, and started the practise and people curious, walked by trade started and about four months later a journalist came to interview me from the local newspaper Ham & High. And the next morning we had 500 new patients call the practise and at last-

Payman L: It kick started.

Linda Greenwal: Yeah, kick started. So I did all my clinical stuff and then I realised, “Wait a minute Linda seriously like how do you run a practise?” So I did five degrees in dentistry and diplomas, et cetera. When the specialty or prosper and restorative, I actually had no idea about how to run a practise. I had my vision of how I would like it to be, but I had no idea. So during that time I read this book called Great Communication Equals Great Production by Cathy Jameson. So, I read the book and I thought, actually this is really fascinating.

Linda Greenwal: I loved her approach and what she was saying about communication. So I wrote to her and she said, “Linda, do you want me to come and train me?” She’s lives in Oklahoma, I’m in London. And she came and trained me for the year, once a month and we continue to train for 25 years and we still train.

Payman L: Wow.

Prav Solanki: Wow.

Linda Greenwal: And she taught me a lot of strategies. She taught me protocols, strategies, systems in the practise. She’s taught me about delegating. The dentist does only what the dentist is allowed to do and everything should be trained by staff, by the team, the hygienist should be used to do, not to be used, but should be an integral part of the team that they do the best that they can be. They be the best hygienist they can be with full clinical skills using all those clinical skills.

Prav Solanki: Just taking a couple of steps back. You had a baby, you opened a practise and you just passed your exams.

Linda Greenwal: Yes.

Prav Solanki: Now I know, from having four kids myself, that bringing a child up is a full time… It’s more than a… I’ve got a full time job. I’ve got several full time jobs, my wife has got it lot, lot harder than me. Okay.

Linda Greenwal: Yes.

Prav Solanki: I go to work and she is at work every minute of every day. How did you do that? I mean just the routine, the baby cries, you doing dentistry, you’re running a business, you’re hiring people, you’re firing people, you’re marketing, all these cashflow, all these different things to think about whilst bringing up a newborn child. I’m assuming you must’ve instantly fell in love with it right?

Linda Greenwal: Of course.

Payman L: Would you recommend it to others or not?

Linda Greenwal: What falling in love with your babies?

Payman L: No.

Prav Solanki: No, no, no.

Linda Greenwal: I think the issues these days in the world is everybody wants to have a perfect life and a perfect life and all that. So we’re very much into box ticking these days. Everyone thinks that when they choose their partner, they has to tick every single box and be 95% compatible before they’ll even consider a date with that person. And I think that we sometimes have to let go a little bit, so that we don’t micromanage to go, “What if you can’t live in constant anxiety about what if? And what if I do this? You have to go with the flow and trust your instinct sometimes. But coming back to the baby, the baby number one, his name is Andrew and Payman knows him.

Payman L: Yeah.

Linda Greenwal: He did a Master’s in Finance Works, in the bank for property. But I took him to back to work. I was working with my husband at the time, and our receptionist looked after him and that’s how I managed, and I’d go and see him at lunchtime in the practise and that’s how we did it. And then when baby number two came along and I went back to work that same week. I realised that, wait a minute this is pretty hard going. So, I actually asked my mother-in-law from South Africa to help me to send one of the ladies who works with her and she’d already been working 30 years with her family, and she was running the photo shop, the one art developing shop. So, she came to London and she started helping me look after the baby and she stayed with us 20 years.

Payman L: Did she pass away recently?

Linda Greenwal: Pardon? Yes, she’s the one who had passed away.

Payman L: I met her at your house.

Linda Greenwal: You saw her on Facebook, Susie, she has an amazing, amazing, amazing woman and she had a wonderful temperament and she was like sending a grandmother, sending my mother-in-law there, he was just wonderful with the kids and the kids really, really helped her.

Linda Greenwal: But when I had baby number four I was like, “Okay, how are we going to do this?” So at baby number four, it turned out that my receptionist was also having a baby, within two weeks of each other, we hadn’t planned that together. And so I thought what do we need to do now is we need a practise nanny. So we had a practise nanny.

Prav Solanki: Wow.

Linda Greenwal: And so what happened? The practise nanny arrives for the first day in the job with thigh high boots and a micro mini on. And both of us are standing with our babies who are about six weeks old thinking, “Again how’s this gonna work?” And that was kind of her standard uniform so I said to her, “Actually I’m going to give you a track suit cause I mean you need to be on the floor, change the baby, it will be more comfortable for you to wear the track suit.”

Linda Greenwal: And we had these two babies in the practise for two years, and that worked really well. But in order to get that baby ready to come to the practise, he’s now 16 years old, just on GCSEs. In order, that meant I had to get up at five o’clock in the morning and feed the baby and then express milk and pack the baby ready to come plus, all the food and whatever was needed, then drive to work at seven 30 in the morning to be at work by eight o’clock, but get the baby settled, the nanny would start at eight o’clock in the morning. Nanny desperately needed to go out for lunch to smoke. And so she wouldn’t let the babies crawl around the passage way, the hygienists would get angry and we were left at lunchtime holding our babies, answering the phone and feeding and everything else.

Payman L: Wow.

Linda Greenwal: But it was a really wonderful time.

Payman L: Which baby was it that became a dentist in the end?

Linda Greenwal: Joseph, number two.

Payman L: Number two?

Linda Greenwal: Yes, yes.

Payman L: Was someone going to have to become a dentist out of those 4?

Linda Greenwal: Absolutely not. There’s no pressure there.

Payman L: Really?

Prav Solanki: It was obviously the baby who was born the week the practise was up, right?

Linda Greenwal: There’s no pressure, but he chose, he wanted to, he came to me at 16 and said, I think I’d like to do this. There was no like, Don’t you think there was none of that .

Prav Solanki: And he just got a place in Harvard I saw?

Linda Greenwal: Yes, his a

Payman L: Excellent.

Linda Greenwal: Yeah.

Prav Solanki: Wow.

Linda Greenwal: Yeah. So yeah, so we just went along with the flow. But I think you have to be flexible. I think you can’t take yourself too seriously. You can’t live in the “What if?” you have to live in the now. And that’s one of my really key philosophies is to appreciate now, live in the now, what’s gone is gone.

Linda Greenwal: Can’t change the past. You can live in the present, the present is the present and don’t think what if? About the future. Cause you can’t do that much about that now, you can make plans, but you’ve got to be in the now and you’ve got to be present now and enjoy the now and be 100%.

Payman L: Linda where does the can do? Where does the arrogance, if you like, come from? Okay, mother of four a specialist practise. Most people would carry on with that and that would be that. But then write a book, teach all over the world. This was the can do. What’s the process? Well, I’ve, I’ve thought some times I’ll do X, Y or Z, and just haven’t done it. What is it about you? Do you just take action straight away? What do you do? What are your-

Linda Greenwal: I think that I looked at this, why kind of, why me story in terms of what is it? And then I looked at the patterns of my life. Even at dental school, I was the social secretary. I had to run all the student balls, all the cocktail parties. I was even arranging dates for the dentist who didn’t have them so they could get to the ball so we could have enough people at the ball and the food and all that stuff. And my professors got really angry with me. Again, “you’re going to fail.” And in actual fact, because of that, I actually had to get firsts to get the prizes to do that because of the balance. But I’ve always been somebody who’s been involved and engaged with people with change making. If there are injustices then there should be changes. So I have a strong self, a sense of-

Payman L: Right and wrong.

Linda Greenwal: Right and wrong. But also not the complaining aspect, not the, “Oh, isn’t that so terrible?” But, “Okay, this is the situation. What can be, how can we rectify it?” Don’t dwell in the negative.

Payman L: Practicality.

Linda Greenwal: The practical, what can I personally do about this? What small changes can I make personally? So when I had a significant birthday, somebody sent me a video and they said, “Watch this video.” When you’re about to reach a major age change. Watch this video and the video said, how you should contemplate your life and consider your life before and consider your birthday and be grateful and look at the gratitude and then look at, if there’s anything that you really want to do that you always say, “Oh, I’d love to do this.” On your birthday you have special blessing because that’s the day you were created. It’s very philosophical, but it’s the day you were created.

Linda Greenwal: And they actually say that on that day. And this is very spiritual. Your stars were aligned to be created. So, actually you’ve got power in terms of doing good in the world. So if you want to harness that to do good, that is the day. So you build up to that day to think about changes, over as you change from one age to the next. I always spend time on that day, and like a week before starting to contemplate my life so far, what needs to be done? What needs to be changed? What good can I bring to this world? And I’m very serious about that because there’s so many issues that need to be done.

Prav Solanki: And you do that on every birthday or has it been specific-

Linda Greenwal: I’ve been doing it for the last eight, nine years. After I watched this video, I was like, “Okay, seriously, we need to do that.” And that’s when I decided that I wanted to start the charity. And I’d been thinking about the charity for quite a few years and thinking about giving back and looking at ways that I could do that. And I thought, well, I do know a little bit about dentistry and maybe this would be, we can do something with dentistry.

Linda Greenwal: And I’m astounded at how we’ve been able to grow and there’s more growth that needs to be done. There’s global issues with dental, there’s oral health inequality, there’s so much. But again, going back to the basics, there’s a lot of work to be done.

Prav Solanki: So what are the top three things you want to achieve in your next sort of set of goals or your next vision that you’ve got planned?

Payman L: Thought there’s nothing left is there?

Linda Greenwal: No, no there is. So I think again, first of all, on the humanity point of view, I think we always have to consider our role as humans. But the humanity side, and the kindness and the caring and creating a better world because there’s, I mean, a lot of healing that needs to be done all over the world. And so that’s one of the key things. That’s one.

Prav Solanki: What do you mean by healing specifically?

Linda Greenwal: Look at the issues. You pick up the newspaper and see what’s going on.

Prav Solanki: Of course.

Linda Greenwal: And then you see how healing can take place and how it can be done.

Prav Solanki: Is there anything-

Linda Greenwal: And look at the tolerance issues, the issues with all the kinds of things in the world that we live in. And somebody said to me recently, “Linda, what are you personally doing about this situation?” And I thought, “Actually that’s not on my agenda. I’m not looking at that.” And I go, “Well you should.” And I went back. I thought, actually wait a minute. As a human in humanity, if the situation’s wrong, then what are we going to do about it? You can shout and scream, you can march in the streets or you can do something practical and so that is how I looked at that. So the woman dentist issue is an issue that needs to be up there.

Payman L: So to your point, when you were, especially when you were younger, the apartheid regime in South Africa, did you see it for what it was or did you accept that, that’s the way life is because you grew up that system?

Linda Greenwal: No.

Payman L: Or what was it? What sort of things went-

Linda Greenwal: Not really. Growing up in the 60s in the apartheid story, there were already many inequalities that as a little child we noticed and our parents explained those things coming back to humanity, the injustices in the world. And again, there was, we got to dental school for example, and they go, “Now listen here dentists, you are here to do dentistry. You’re not here to do politics. So no marching in the street. And none this.”

Linda Greenwal: In those days there was a secret police. And I think a few years before that, a medical doctor had died in torture, Steve Biko. And there were many issues and Wits University is an anti-apartheid university and a very liberal university. And that’s the opposite way around because of other issues is that went on over there. But because of that, the tolerance and the importance of being, because remember we talking about dentistry, we are carers. We in the caring profession, we care for our patients. So we bring that with us when we come to the patient to treat them. And it’s about when you treat the patient, knowing what’s behind the patient.

Linda Greenwal: Understand their family life and their issues, their concerns specifically about dentistry. But you keep, retreating your human say you need to look at what’s behind the human and if the thinking, maybe the patient’s aggressive and rude to you, maybe it’s because it’s not to do with the dentistry. It’s not to do with any of those things. They’re nervous or anxious or stressed because they’ve had a major life event just yesterday, which has happened. So those are the kinds of things.

Linda Greenwal: And as we lived through the system in 1976 where the riots, so I was in high school and they had the anti-apartheid riots where all the schools were closed because the black students didn’t want to study Afrikaans. And the slogan was we don’t need no education. And we had to be at home because of the dangers, because of the rioting, et cetera, et cetera.

Linda Greenwal: And 10 years ago I went with rotary into the townships to see how we could help, eight years ago, to see how good help with a charity. I’d actually never been into the townships in South Africa because you are not allowed to. I would be arrested. And I looked at what I saw and I wrote to the mayor of Cape Town I said, “Seriously, what are you doing about the oral health of these children? What are you doing?” And they go, “Would you like to open a clinic here? We haven’t opened a clinic, but it’s our intention to open a clinic. We need more money. We need lots of help.” But at the same time, so we looked at that and we looked at how we could, what positive can we do now? What can we do now? And that’s when we started with a research study doing the toothbrushing.

Linda Greenwal: So we started doing the toothbrushing and very quickly we grew to look after 10,000 children a day in Cape Town, in the townships. And what happened was this woman who was one of the teachers who was involved in our programme, she came to see me. She said, “You know Linda, this is an amazing programme you’re doing in the schools, I think you should do it at night. And I’d like to do it in my home with a hundred children.” Her name is Mavis. I said, “Mavis, how are you going to do this?” She said, “Come and see.” So I went to her house at six o’clock she wasn’t even there, because she was only clocking of work at five 30 she’d got eight year olds and 10 year olds to set up the toothbrushes to get them all ready to pet it, place the toothpaste on the brushes to take a roll call to go and fetch the local children in the community to come to do the brushing programme.

Linda Greenwal: So she had one group at five o’clock one at five 30 and one at six o’clock by the time she came home, that’s a hundred kids.

Prav Solanki: Wow.

Linda Greenwal: And then she spoke to other mamas in the townships and told them about it. And very quickly we grew that to what it is now. And toothbrush mama Mavis, that’s what she’s called a toothbrush mama. We’ve just recorded an album where they’re singing and they teach. It’s part of the African culture to teach through stories and drama and singing and dancing.

Payman L: Mm-hmm

Linda Greenwal: So, they created a whole series of oral health songs. You can download it on SoundCloud. We took them to the recording studio to do that. And I have learned you go to set up a charity, but actually what you get back is so much more than you’re ever expecting. It puts a completely different perspective on life, on the way you look at things.

Linda Greenwal: Not only to be humble and grateful, but you see the joy that you can bring in a simple way. And that’s been totally outstanding. So then we started here in London, in Luton and Luton, for example, 16,000 children out of 18,000 live in poverty in Luton. Did you know that? It’s very high, very high. It’s half a knot from here. And so we looked at what we could do and could we implement the same programmes. And one of our trustees, his name is Dr. [Saul 00:32:49], spoke at the poverty conference in Luton. And the schools approached him to say, please could you run some toothbrushing programmes in the schools? And we went to see one of the poverty charities, it’s called level of trust. So we went to see the uniform exchange where they give free uniforms to kids in Luton. And it puts a lot of things into perspective.

Linda Greenwal: We live in different worlds in our life. We live in so many different worlds. We live in our dental world where every 0.3 of a micro millimetre is 100% important when we are assessing a bite and we live in the world where our patients are such a perfectionist, they bring selfie photos of every angle of themselves to have a tiny micron removed from the central incisor, which is not perfect.

Linda Greenwal: So we live in such diverse worlds and so the giving back puts things into perspective. The other issues, which we have a lot, is the burnout of dentists, their stress levels and the intensities. And my one cousin also became a dentist, but he found it extremely stressful working on the NHS. And he, he did a countdown in his kitchen of the months when he could actually give up because he was so stressed working full time on the NHS.

Payman L: Do you do expert witness work as well?

Linda Greenwal: Absolutely. I do. Yes.

Payman L: You must see some stories.

Linda Greenwal: Yeah, and it’s very sad. I think it’s terribly sad when we see this expert witness the stories or meet the people who are making a complaint or to understand the story. How did it get to this level that there is a major lawsuit? How did it get to this level? And what could have been avoided? Because we always want to learn from this, from the experiences, what could I have done differently that wouldn’t have led to this problem and how and who’s making the complaint and why, et cetera. And I think it’s terribly sad because I think it shouldn’t get to that level. I think as soon as problems arise, I think it’s also expectations of patients, expectations of dentists or expectations of dentists themselves to try and be perfect and do the perfect outcome when it’s not always possible.

Payman L: I think there’s been noted where can, even people don’t sue people they like.

Linda Greenwal: Yes.

Payman L: Things like that. So the communication side of it is big.

Linda Greenwal: Yes. So the communication is really, really important. And that comes back to the same discussion with Cathy Jameson. So, when I started the practise, the most important thing was to have a room to sit down and communicate and actually talk it out. Talk first, talk first, talk to the patient. What are your hopes and aspirations? What would you like from me, what would be your expectations of me and ask and wait and, and build a different rapport with the patients so you can totally understand what it is they want from you and what they’re expecting. If they want to be on love Island tomorrow with the whitest teeth, that is a different story.

Linda Greenwal: And recently I was teaching in Derby and the dentist told me, they said, “My biggest problem is everybody wants Jack’s teeth because Jack won last year, because his teeth was super white and they were so white, he went off to Turkey to have a new shade called toilet bowl white.

Linda Greenwal: And so those are her problems, which was really interested. So we looked at ways to strategize and to talk to patients about those kinds of patients who want that look or those expectations, particularly with what whitening can do and what not to do. But what does that look mean for the future to have 20 veneers, what does it mean? Some of them are going to break, some of them are going to need root canals. Some of them the gums are going to recede, they’ll need more dentistry every 10 years and those kinds of things.

Payman L: Tell me about when you got into whitening, because young dentists now take whitening completely for granted, but when I got into, it was around 2000 and I think you’re already an expert at that point. You’d already written your first book. How did you get into whitening? How did you get in touch with the Van Hayward and all that? How did it all come about?

Linda Greenwal: So I was doing my masters at Guy’s 1990 I started and my first research study was then on amalgam toxicity because that was a huge controversy. Everybody was complaining that they fillings are toxic and they are having behavioural changes and memory loss and all those things to do with it. It was a huge controversy in school the toxic tooth syndrome and dentists were changing their practises to have a mercury free practise. This was in 1980, in the 80s, and I wanted to know as a scientist, what is the reason? Are they really toxic? And what are the issues with it? So as an inquiring mind that’s when we started to end the controversy. I like to know about these contemporary issues like the charcoal toothpaste. Which is published on net.

Payman L: Mm-hmm. Yeah.

Linda Greenwal: But coming back to that. So I was doing this research study and I spent six months researching the toxicity of amalgam to understand who gets mercury toxicity? Who loses their mind? Who loses in their memory? Is it genuine? Is it valid? Where’s the clinical evidence? Because as a scientist, that’s our first training and we discovered that actually people who complain of their mercury fillings do not have a job, are unemployed, have major life issues and they used different things, but the mercury was the issue because we looked at those people who had mercury fillings. Did they die sooner than those who didn’t? And a big study was done in Sweden. The only clinical fact was that, if there’s a mercury filling like a buccal amalgam next to the gingiva and there’s lichen planus there, then that’s a reason to take it out. There was scientific evidence of that, which I’ve used to base on that.

Linda Greenwal: So then I had to start the research study, the clinical research study and the professor goes, “No Linda, I know what you’re going to find. So find something else to research.” And I was like, “What I’ve spend six months doing this research? How could that be possible?” So I had to go back into the library and I was recently looking at some of the journals and I saw the Quintessence cover. The Quintessence covered Van Hayward’s article 1989, which is now 30 years ago, had a picture of the upper teeth white and the low teeth are yellow. And I’m kind of a visual person. So I looked at it and said, “How can that be? What is this? What’s going on?” So I read the article about the whitening and I went to my professor and I said, maybe I should research this. I’d like to look at this.

Linda Greenwal: He looked at it, he glanced at, he says, “Okay, you go girl, you go do it.” So off I went to start on the research study and then there was very little evidence about whitening. So the first thing we wanted to know is does it actually work? Is it valid? Is it genuine? Does it work? Is it safe? Those were the key things.

Linda Greenwal: So we took blood and we spun it into wisdom teeth. We sectioned them and we tested eight different techniques. So coming back to the story, it was 1990 it was a year, 1991 it was my first mother’s day and I was in the lab on a Sunday making saliva, fake saliva to test on the whitening, I was like, “Seriously, are you really doing this, it’s your first time you’ve been a mother and now it’s mother’s day and here you are.” And so we looked at that and then we looked at all the studies.

Linda Greenwal: So this was 1991 and 1992 all the studies, all the research, all the evidence about whitening, and it’s a fascinating subject because it was basically brand new. It had been done for 200 years. It was super popular in 1860’s to have power whitening. But there had been no updates about it. And so I looked at everything, every single journal as abstract, every single thing that came out. But in those years, which wasn’t a lot, now there’s thousands and thousands of articles per month. And we still track and look at the research, but we wanted to understand the mechanisms. And then we discovered there were some basic ways that it works. So of course I contacted Van Hayward and I believe that again, coming back to the communication, we should meet these people. You should meet, who is the best in this? Who do we need to speak to?

Linda Greenwal: Have the chutzpah – it’s called chutzpah – to call him up. Call him up, go meet him. Go see him. Go learn from him, learn from the best, and continue your quest for knowledge. That’s the genuine knowledge. Now there’s all this fake news and so you have to be very distinguished as in terms of as a scientist, what’s valid? What’s right? For example, when you go to a lecture, you want to get the facts. You don’t want the nonsense. You don’t want the, I’m so awesome. You want actually the real stuff. Why have I taken off the day today to come to a lecture and somebody is giving me a whole spiel, but I want to know what’s the truth? What’s the evidence? So I started going to these bleaching lectures and I would hear the whole story about the power whitening and all that stuff. And I was genuinely, genuinely interested because when I started it, I couldn’t see much difference.

Linda Greenwal: This is now 1993 I’m in my practise, I’m doing power whitening. I’ve spent five grand on the light and I was like, I’m not really sure, but I think it’s me, but I don’t see anything happening. So I’d go to these bleaching lectures from lecture to lecture and I’d ask the lecturer and find time afterwards or during or when there was a break and say, “Seriously, what really happens? Because, I’m not seeing much happen.” And then quietly they would tell me the honest truth where they also don’t see much happening. But in the lecture they will give me a whole story. And so I was trying to like, well whose right? And what is the story? Which continued the quest and then we discovered the whole legal aspect.

Payman L: Yeah.

Linda Greenwal: And then we discovered all that stuff. And I’d been talking about this a long time. And then, so Paul Beresford, he heard me one day speaking at the Queen Elizabeth Hall and he goes, “Linda, not many people understand your South African humour, but don’t worry cause I’m from New Zealand, I get it, I get it. But he says that I really want to help you. We need to make some changes.” And so we set up in 2008, the British Dental Bleaching Society to lobby for change and to make dentistry the tooth whitening within mainstream dentistry, but specifically to get dentist to be able to practise legally, safely, and to have the patient’s best interest at heart. And so-

Payman L: And you got it done in 4 years, was that 2012 when it really happened.

Linda Greenwal: But Now there’s still more issues-

Payman L: Of course.

Linda Greenwal: And now there’s the issues of the under eighteens.

Payman L: I think the first time we met Linda, we were taking the peroxide out of the gel. We were selling carrier gel without peroxide to the dentist. And then we were saying to the dentist, get your peroxide from wherever you want, but this is where you should get your peroxide. And then the dentist was mixing the two at the chairside at the time the dentists could buy peroxide then use it for internal. We could sell the carrier gel to the dentist without peroxide.

Prav Solanki: Wow.

Payman L: But these were the hoops we were having to jump through and people don’t realise that we were in from 2001 to 2012 selling illegal products and you were teaching on it. Martin said he’d go to jail for it if-

Linda Greenwal: 6 months in Jail.

Payman L: it was an interesting time.

Linda Greenwal: For supply of gel. And then the link with Europe and what happened with Europe and the European legislation and still, what’s happening? And the Brexit issues and all that because so it took a long time. And people like Stewart Johnson, who in the BDA made changes and represented Britain on the scientific committee in Europe. And we have the, there was a tooth whitening committee where we would go and Britain was leading the way in this.

Linda Greenwal: I’m not shy to say that because we had taken whitening onboard, tried to be legal, but the uptake and the education, and it comes back to educating dentists about that. We are quite advanced in our education process with whitening and aesthetic treatments, et cetera. But the current issue is not really an issue, of the under eighteens whitening, It’s not really an issue. It’s only a classification thing. It just at the time when they made the change in the law, they didn’t think they could change two laws. So they kept it simple. But there’s no reason for it not to be. It’s perfectly safe. That’s why-

Payman L: Clinically, yeah.

Linda Greenwal: Clinically it’s perfectly safe for kids under 18 to have it. And that’s why we having the conference on the 15th of November. We are going to lobby and change it and we’ve got an action plan ready to go.

Payman L: So today, well, where we at today in July of 2019, if a dentist has a child who has got a non vital teeth.

Linda Greenwal: Child patient.

Payman L: Child patient, yeah. Or if a dentist has a child patient who has particularly dark teeth that they’re being bullied, should they or shouldn’t they bleach their teeth today?

Linda Greenwal: So, very clearly it comes back to the ruling or the guidelines of the General Dental Council. The General Dental Council said, “If a whitening is for treatment of disease, then it can be undertaken.” So in our recent paper, which we published last July 2018, we looked at the 10 categories when it’s appropriate to undertake tooth whitening for children. I wrote an index of treatment need, which I’ve published for children having whitening and when it’s totally appropriate to whiten.

Linda Greenwal: The main thing is the impact on the child. If it’s impacting the child and it’s in the child’s best interest and they’re being bullied at school, then absolutely it’s the right thing to do. Not just a random thing cause a child wants the same teeth as on Love Island. It’s actually a genuine thing. Now, the problem that we have is that there’s a lot of new diseases in the last 20 years.

Linda Greenwal: There is new diseases and the environment that we live in causing toxicity on the kids’ teeth, the toxicity and the environment, which reflects as white spots on these kids’ teeth. So there’s a global increase in disease of 14% with white spots on their teeth, but there’s a 25 to 40% increase of children’s teeth that are erupting with white spots on their teeth.

Linda Greenwal: That means all of us have to deal with this in our practise. And a lot of these children who had the white spots actually have MIH, which is a disease and that causes a lot of sensitivity, extreme sensitivity. So, all of us have to treat these kids. It’s not a matter of, Oh, I’m not sure I’ll send it to the dental hospital because the paediatric dentist will do it. Many of the dental schools don’t even have whitening gel in the paediatric department because they’re too scared of not following the law.

Linda Greenwal: So it needs to be in the patient’s best interest and absolutely it’s the right thing to do. Specifically when a child at this time of the year, the children have finished school, primary school, about to go to private secondary school and that is when they want to change their appearance and want to. So at the moment we are treating a lot of those children who have severe discoloration, brown, orange, yellow, orange marks, white discoloration at this time so that when they go into high school in September, this is not going to be an issue for them.

Linda Greenwal: And the thing with whitening and the thing with these minimal invasive treatments, it’s so simple to treat.

Payman L: Mm-hmm.

Linda Greenwal: The remaining aspect is the mental health issue, which is a much more difficult. We are not allowed to, we don’t treat that, but we can treat from in terms of the view of the minimal invasive aesthetics for these children who makes a huge difference in their lives.

Payman L: What’d you say to dentists who say, “Whitening isn’t rocket science and it’s not a subject that anyone should choose to focus on because it’s not real dentistry.”? I mean I know what my response is to this is, what’s yours?

Linda Greenwal: So, the first thing that, the biggest issue I have when I teach dentists is they’ve never bothered to learn about the science of whitening, the evidence of research or whatever. They do not know whitening. They make it up as they go along, they make random facts, a new associate will join the practise. The principal hasn’t learned whitening. They give them fake news. They say, well this is what’s done and nobody is the wiser and there whitening programmes are not successful because they just making it up with random nonsense. But there is a lot of, as we know there’s scientific evidence and this certain protocols that need to be followed.

Linda Greenwal: So if the dentists take the time to learn it properly themselves, they can be better teachers for the associates and the hygienists and everything else. And the biggest problem is they’re just making it up as they go along.

Prav Solanki: So it’s more than just taking an impression and whacking some gel in there and telling the patient to go home. Because, I speak to a lot of dentists about different whitening products just mainly from a marketing perspective, right? And it’s the same attitude that Paymans just said there, is that they don’t differentiate between products apart from price and they say, “Oh well this does the same as that does the same as that.” All you’re doing is sticking bleach in there, sending them home and it’ll do the job and their results tend to be variable. So they get some cases that were really, well, some cases in my personal experience from whitening using Payman’s stuff.

Linda Greenwal: It’s very good.

Payman L: It’s free.

Prav Solanki: Because it’s free. Yeah, there is that, but I only need to wear my tray for a couple of nights and they glow. Yeah. And that’s as far as I need to go even though the instructions say 14 nights or whatever.

Payman L: The funny thing in our industry, the weird thing about it is everything’s named by percentage.

Linda Greenwal: Yes.

Payman L: And a lot of people like to think they know what’s going on. And so they think, well 16 centimetres like Nurofen 200 milligrammes is the same as Ibuprofen 200 milligrammes

Prav Solanki: Mm-hmm.

Payman L: But you know, the, the whitening situation is so flexible because you’ve got a physical situation with a tray. And then you’ve got a chemical situation with a chemical.

Linda Greenwal: And you got a patient with anatomy.

Payman L: And you got a patient with anatomy.

Linda Greenwal: Anatomy of teeth or trauma-

Payman L: And bruxism and the difference in the physical things that can happen there and the volatile liquid, the whole point about it is it breaks down and so it’s very, very different to you. Even, though the composite restoration is much more understandable than whitening. But for me when someone says it’s not rocket science and all of that stuff, generally that guy doesn’t know what he’s talking about.

Linda Greenwal: Exactly.

Payman L: But secondly, we know humans know, not just us. The humans know the colour of teeth is the number one concern of our patients.

Linda Greenwal: Absolutely.

Payman L: By far it’s way bigger than orthodontics, caries. That’s what they care about the most.

Linda Greenwal: Absolutely.

Payman L: And often you see these full examinations that the practises sell and market, Oh our examinations, an hour and a half, two pages on the internet about what’s covered. Or we look at the TMJ, we look at the lymph nodes or manifestation, all of this is good stuff. And yet shade’s not mentioned-

Linda Greenwal: Yes.

Payman L: In any of that.

Linda Greenwal: So-

Payman L: Is it a primary concern of our patients? Isn’t culturally in our examination and it needs to be.

Linda Greenwal: Absolutely.

Payman L: And so whitening is to be talked about more or less. Obviously I haven’t got a horse in the game, right? I’m biassed. But this idea that it’s not real dentistry. Well, you’re not treating real patients though if you don’t think its real dentistry.

Linda Greenwal: It’s good to listen to all the objectors and the objections because from a hearing, all that stuff, you can have a strategy to change, to move forward. So here’s the thing, we say number one, take a shade on every single patient. It’s a science actually. And that’s part of your exam. That’s the first thing. Why do you do that? And we teach the dentist to just start with basic shade, which is called A3 just have loads and loads of A3 shades and measure every single patient. The patient wants to know, “Oh, is that a good thing or a bad thing?” So it starts the opening discussion. Some dentist say, “Oh, I’m not really, I’m not good at selling, so I can’t sell whitening.” This is not a sales thing. This is a scientific measure.

Payman L: It’s a service thing.

Linda Greenwal: It’s a service thing, it’s a scientific measure, measure the A3 are they lighter or darker than the A3 you recorded? The patient goes, “Can I see the shade guide? What’s lighter than A3? So my teeth are A3,” and the dentist goes, “Well 90% of patients may have that shade.” And they go, “What’s lighter?” And they go, “A1 well that’s quite a nice shade. Can I have that? Would that be appropriate for me?” And I teach the dentists to do an audit. Everybody hates doing radiology audits, which is fine, they can do that. But do an A3 audit say, in the next hundred patients had come in and we’re going to measure the shade with see who uptakes on whitening.

Linda Greenwal: For it’s a basic thing, six months later the patient comes back, they go, “Could you just check my shade because I think my teeth might’ve got darker. I’m interested now in doing whitening.” So it opens the discussion. It’s a scientific measure. There’s a really nice device now called the VITA Easyshade, I don’t know if you’ve seen it, really excellent. And I think actually many dentists should have that in their practise because it’s a scientific measure. It’s got Bluetooth, it’s got an app and you can measure their bleaching percentage and all those things. As dentists love technology and they love all their stuff. So this is quite a nice handy piece of kit. But every patient should have their shade measured and that should know what’s your shade? It’s not a personal, it’s not an invasive question. So not an invasive question.It’s a scientific measure.

Linda Greenwal: So you start from that. When they say it’s not rocket science, there is tonnes of science behind it. But you start with a basic in terms of, again, coming back to communication, what it is that you want? Did you ever consider, if you’re about to start restorative dentistry, about to do a crown, go to the patient. Mrs Jones, “In the next five years, were you ever going to consider whitening your teeth because we were about to do a crown on your front tooth and we need to keep it at the same shade as your teeth are now. But if you were considering whitening, would you? Now is the time to rather do whitening first before so we can choose a lighter shade of your grant.” So there’s some basic questions that we need to talk about to patients. It’s not a sales technique.

Linda Greenwal: And then the story about the 16%. For some reason, I don’t know why Payman, that they think 16% is the only one and there must have 16% and that’s it. So if you do a survey of an audience, just as I’m about to speak to dentists, they all go they only think that you’d start with 16%. They don’t know when they say, “I only use 16%,” then I know they haven’t had any training on whitening at all. So I know where we starting, which is fine, but we want to educate dentists to able to learn the science to be able to provide the service on top of which the whitening oral health benefits is major, so-

Payman L: Root caries and all of that.

Linda Greenwal: The root caries, but also the gingiva swelling and improvement in oral health. So you turn it all the way around on an elderly patient.

Payman L: Do you tell your patients whitening is good for them?

Linda Greenwal: Yeah. I don’t say it’s good for them, I say it has oral health benefits I say improves the gums, it reduces the swelling, it makes the mouth feel cleaner, the plaque doesn’t stick as much to the teeth. So we talk about those benefits. So we also talk about sometimes we need to integrate it into the whole process of dentistry where we will do cleaning, we’ll start the whitening review and constantly improve their oral health first and then we continue with whatever’s needed.

Payman L: Then the reason you were in the birthday honours with the Queen, was that what it was?

Linda Greenwal: Yes.

Payman L: How did that feel being honoured?

Linda Greenwal: It was a very interesting process. It was, actually last year I went to Buckingham Palace to the Queen’s garden party. That was awesome. But the medal ceremony was in November before that. So November. It started in June 2017, where I was listed in the Queen’s birthday honours and I was very humbled to be recognised for the service to dentistry.

Payman L: Is there a process if Prav wanted to become Lord Solanki of… Is there a process?

Linda Greenwal: I think there is a process and the department of health put out the process to dentists at the time they were looking for a regular people working on the health service and they do, they do want to support people working on the NHS and providing service for care. So the day that I was there at Buckingham palace, we met a lot of the police. We met a lot of people working in the health service, people working in the services. A lot of people give off their time unconditionally, begin to create a better world to do good. And what happened with the seminar, it was announced in June and then I went to the ceremony my mum was invited. She was too delighted and my husband and one child was allowed.

Linda Greenwal: And when it was held at the Tower of London and the Queens Emissary, which is the Lord Lieutenant of London, gives out the medals. And he started by saying that at the event, he said, “This morning I was reading the paper and having my coffee while you’re all driving here or getting here and reading the news is very depressing.” He said, “But today you’re going to hear very inspirational stories of people that have really made London a better place.” And so what happens with the medal ceremony as you go up onto the stage and they read ati citation citation about you and about what you’ve done in your life. And for about 10 minutes and then you receive your medal and have a nice photo. But the stories of the other recipients was very inspirational and it’s a regular person who has done good and taken it upon themselves to do good. And I am interested in that kind of story.

Payman L: Mm-hmm.

Linda Greenwal: I’m interested in somebody who wants to make their life better. They come from nothing with no graduation, no nothing, but they have a determination to want to do good. Like we watched Goodwill Hunting this movie. It’s one of the greatest movies. To see that process of a person. You start, create something out of nothing to do good for society. I think that’s really a key thing.

Payman L: Talking movies, have you seen that Sugar Man movie?

Linda Greenwal: Yes, I did. So when we grew up,

Payman L: Did you know that music?

Linda Greenwal: Yeah, absolutely. It was banned

Payman L: Yeah, really.

Linda Greenwal: and so-

Payman L: Because it was kind of anti-apartheid.

Linda Greenwal: Yes. And all kinds of things anti… And when I went to summer camp we would all, I used to play the guitar,

Payman L: Oh really?

Linda Greenwal: And I used to play all that music with all my friends and yeah, it was quite, quite a big thing.

Payman L: Going forward Linda, I’m sure you’ve got things that you want to achieve like Prav was saying, but do you think that looking back on your life, there were the things that maybe your family missed out on because of your achievements, your ambition? Did Dr. Cohen take care of dinner? Did Henry do bits that you should have been doing? Or you’d, no regrets and you feel like you did everything right? What would you do differently?

Linda Greenwal: And there’s a lot of questions in that one question.

Payman L: Yeah, sorry I was trying to obtain a thought.

Linda Greenwal: So basically, first of all, I think that the one shouldn’t have regrets. I think that every opportunity is an opportunity for the positive as well as the negative. And you’re always seek the joy, you have to learn to seek the joy and seek the positivity. So if a situation arises, which could be construed as a negative situation, the experience that you’ve going through, how can you to turn it into a positive? So what have we learned here? What do we do differently? How did this happen? Now that we’ve learned this in terms of, now the buzzword is reflection, on reflection I would have done this, this, and this differently. So we now know the challenges that arise are there to make you grow as a person.

Payman L: So what would you have done differently on reflection?

Linda Greenwal: Of course, we had lots of stress in lots of things like coming here from South Africa and working as a new graduate and working for a boss who was extremely tough on me and men I was thinking about, for example I felt, I’m sure it’s not legal to sign a form when you haven’t done the filling, but the boss says, just sign the form anyway.

Linda Greenwal: So then I started looking and taking advice, isn’t right you have to sign these forms and it says you’ve done 10 fillings but you didn’t do any. And so those kind of things and realise, you have to stand up for injustice. If in your heart of hearts you know it’s wrong, it’s wrong. And so speaking up, that’s when you asked me about what is left to be done? And what did you learn? I’ve learned as you get older anyway, you speak up more. When you’re in your 20s you always want to do the right thing, “What would this one say about me? And what this one say about me?” In your 20s. When you get to my age now, you can actually, it’s very liberating because you have to speak up, you have to speak up so-

Payman L: I think one of your biggest strengths is you don’t really care what people think about you.

Linda Greenwal: Now, but I’ve learned that you have to speak up you have to say when you’re bringing up four boys, who are rowdy and difficult and the neighbours car window has been broken five times in one week. Then you have to speak up and talk to the boys and say, “Maybe we shouldn’t be playing football or cricket next to the neighbour’s window again.” And so you have to speak up and you have to speak up a lot. And you have to say what you have to say. And bring up boys, you can’t skirt around the issue. You have to deal with it head on and it is what it is.

Linda Greenwal: But the speaking up and the not tolerating the bullying and not tolerating whatever is happening. This is not right. What needs to be rectified rather than get stuck in the misery of the wrong decision and you have spiral negatively downwards.

Linda Greenwal: You think, what can I do to rectify to get out of this situation? In terms of a patient, if something has happened and it happens, stuff happens all the time, immediately apologise. I really, I really strongly believe, high hold up your hands and say, “I’m so sorry this has happened. I didn’t expect it to happen. We weren’t expecting this. This has happened. I’m terribly sorry. I want to rectify this situation or whatever it is.” Appease with the patient if it needs to give them money back, there and then for the simplest thing now rather don’t let it fester and fester till it’s a major volcano. Just sort it out as quick as possible now. When you leave it to fester, it’s very stressful for your own personal circumstance, but it’s stressful for the patient. It’s stressful for the entire practise. If these things are going on and the complaints going on.

Linda Greenwal: So I think that speaking up quickly, rectifying as soon as you can, as quick as possible and move on, learn from it, don’t dwell on it, learn from it. This is what I learned. But move on, move forward, proceed forwards without dwelling on the negative. If you spend too much time thinking about the negative, it holds you back and you spiral. So rather think about, I learned from this, this happened, stuff happened. I’m so sorry. Move forward. How can we rectify.

Prav Solanki: Linda, talking about mistakes? What would you say the biggest clinical mistake that you’ve ever made?

Linda Greenwal: That is a very deep question and it’s been like a long time since I’ve practised. I think some of the biggest clinical mistakes for me personally were, working on the NHS when we were limited to time and so we couldn’t do the best that we could do because you were time restricted and funds restricted and admin restricted.

Linda Greenwal: So you compromise a lot and you have to think about is this the best that I can do for this patient? This is what I can do now under these circumstances. And I worked on the NHS for 10 years looking at these situations. And one day we had to do a, in those days a private white filling probation, and I think the fee was 20 pounds and the patient’s sitting with her Prada handbag 1400 pounds and she said, “20 pounds for the filling. Oh my gosh, what a rip off.” And I thought, “Really?” Let’s put this into perspective here.

Linda Greenwal: And so again, sometimes you work in a situation where you know that it could be different, but you compromised because of decisions and because of these situations. So you always doing the best that you can. And so stuff happens because it compromises this, this, this and this. You can do X, but really a that, that holds you back. But the thing is with dentistry is we have a lot of choices. We make decisions all the time. We even have a lot of freedom to make decisions and as to how we practise as well.

Prav Solanki: Sure.

Linda Greenwal: We’re decision making on a daily basis. Sometimes we may make the wrong decision at that time and you can’t rectify it, but we have choices. And so for me that was very hard working in a system like that. When maybe you couldn’t wait for the gums to heal to take the crown because you were only getting a small amount for the crown fee, so you had to just fit the crown and the gums were swollen or whatever. You do the best that you can.

Payman L: Do you remember were you planning from the beginning to go out of the NHS? Would do you remember the time when you realised, I’ve had enough of that and I remember you were with Mike Wise group for a longtime.

Linda Greenwal: Yes. I trained with Mike Wise for 30 years and that was really an awesome guy. I think that also for us, we always, all dentists need mentors. They need mentors, they need advice. They need people to genuinely help and guide you as you go along. We need good teachers. It’s hard to find a good teacher and it’s hard to find somebody that you can relate to and can follow advice. That’s why we need a deeper kind of philosophical things as well, because our lives need to be in balance. But Mike taught me a lot about clinical excellence, about not compromising, about constant reading, the evidence and the research and the journals. What does the research say about this? Which is the best way to make a post? Should be this post should be that post. What does the research say? And going back to the literature and the signs. And he was a very inspirational guide with that.

Payman L: He’s in touch?

Linda Greenwal: He’s just retired. So we are still in touch. I do see him and we do communicate yeah. But then I also had many other teachers and the study groups and learning from certain people. Not all dentists share knowledge,

Payman L: That’s true.

Prav Solanki: Mm-hmm.

Linda Greenwal: They don’t want to, they keep, they’re worried that we’ll know more than them. And so they hold their cards close to their chest and that is a pity. And I think another issue Payman, is professional jealousy.

Payman L: Yeah.

Prav Solanki: Yeah.

Linda Greenwal: This is a really big issue and I’m astounded at what I see on Facebook on the chat lines, on the chat groups because somebody is genuinely asking a genuine, sincere question. And many people often respond in a flippant way, “Have another whiskey or whatever,” when the person has actually asked a genuine question and then it turns into a personal discussion, a personal aberration of something.

Linda Greenwal: And it goes completely off the tangent, when actually what we should do be doing is respond kindly and actually genuinely wanting to help our fellow colleagues. But that doesn’t happen. But the other issue is we work all day really hard and what do we do? We go and relax and switch on Facebook and see intolerance by other dentists just being mean to each other. I mean it may be entertaining for some, but we actually need to switch off. We need to balance with exercise and with all the other things.

Payman L: What’s your view on the Instagram dentistry?

Linda Greenwal: So-

Payman L: I see your posting a lot more.

Linda Greenwal: I’m working on, greenwalldental is my Instagram, and just today I reached 4,000 which I was super excited about it. It’s actually quite crazy, what we see on Instagram dentistry. The way people learn these days is Instagram University, Facebook University and all those other sites. But there’s a lot of genuine dentists and dental students who actually are really learning stuff.

Payman L: Yeah, yeah.

Prav Solanki: Yeah.

Linda Greenwal: And what I’m concerned about is certain dentists with a following, where they do work out and they show their naked chests on their work out session on the Instagram and then the next case is a 20 veneer case and then you’re watching him work out and all that stuff. But when we see things like, patient was too sensitive, we didn’t do whitening, we just did 2 rejuveneers. We think, wait a minute, let’s start with treating the sensitivity. We haven’t got time to treat the sensitivity. We’re going to just do 20 veneers. And those kind of remarks were, in the end of the day, our philosophy should be minimal invasion.

Prav Solanki: Mm-hmm.

Linda Greenwal: The best dentistry is no dentistry. Actually, no cutting. So how can we improve the patient’s oral health first? Of course there’s the beauty aspect and all that or what you see on Instagram is also not real life.

Linda Greenwal: So maybe that dentist has a beautiful photo of the before and after because he did one patient the whole morning and he took all the photos and he made a movie out of it. But that’s a one patient and that’s not real life. And may look gorgeous then, how will it look next year? And in 10 years? And what will be the stability of that? So, I have concerns so, some of it is very interesting, I see so much unnecessary cutting I’m really shocked at how-

Payman L: Because we are exposed to the whole world-

Linda Greenwal: We’re exposed to the world.

Payman L: And the whole world’s as minimally invasive as we’ve become.

Linda Greenwal: That’s right, as the philosophy.

Payman L: But it’s lovely. And you’ve been really at the tip of the spear of that minimally invasive. Maybe you, Tiff, Jason maybe now Tipesh is doing his best. It’s lovely to see the UK excelling at that because with that NHS sort of baggage that’s been holding us back, let’s face it dentally not medically, but dentally. We never really excelled like the Italians or the Brazilians. But now we really are. And in the area of minimally invasive, we really right up there.

Linda Greenwal: We really are.

Payman L: And its nice to see.

Linda Greenwal: Its fabulous to see and there are really some excellent dentist. So often if I’m lecturing in the US for example, the US have a big thing about British dentistry and English teeth. There seriously obsessed they, from the Simpsons TV show where Lisa opens the big book of British smiles and everyone’s got yellow ugly teeth. That is the stereotype of UK dentistry.

Linda Greenwal: So, whenever I give a lecture in the US I have to start with that because, they all giggle away and they’re like, “Seriously you’re a British dentist, what are we going to learn from you?” And then I say to them that, “Actually, I’m going to show you some minimal invasive treatments, some beautiful dentistry where we’ve created a beautiful smile in a minimal invasive way.”

Linda Greenwal: I recently taught at Tampa University and I gave my presentation with minimal invasion, the three step technique for treating tooth wear by building up the bite with composite restorations and palatal veneers, et cetera, and micro abrasion and whitening and all those things. And at the end of the lecture there was a five minute silence because the Dean goes, “Wow, you did all that and you didn’t pick up a handpiece.” I said, “Yes, so I need to just smoothen on overhang or whatever.”

Linda Greenwal: And that is how dentistry should be going. That is a major paradigm shift. So, to get your head into gear with this noninvasive approach to being able to do this, takes a major rethink in after loss fees. And some dentists, as you know, hate change. They know what they like, amalgam works beautifully in my hands. I’m going to do it for the next 40 years. And then there forced to change, they don’t like to be out of their comfort zone.

Linda Greenwal: So when you have to make these changes, who’re really essential, to be ready to be out of your comfort zone to go, “Okay, this is a new technique. What are I need to know? Who’s going to teach me? Who’s the best in this field? And what I need to learn from them. And how am I going to go from this level to that level and what I need to get there. Which is why I wrote the textbook with Cathy Jameson.

Linda Greenwal: I wrote a book called, Success Strategies in Aesthetic Practise. Because I want to know those secrets of those successful dentists. How do they do it? What does it take to do it? And how do I get there? And how do I maintain? And can I learn from their wisdom? That’s what I want to know. So my current training that I’m doing and learning and I’m undertaking is training with Francesca Villete.

Payman L: Oh really?

Linda Greenwal: Three step technique.

Payman L: Amazing.

Linda Greenwal: And I’ve done eight trainings with her.

Payman L: Have you?

Linda Greenwal: Absolutely.

Payman L: Amazing.

Linda Greenwal: Yeah, and I’ve been to Geneva and Barcelona and wherever she is, I train with her because it’s such an ama-

Payman L: People forget you’re a restorative specialist as well.

Linda Greenwal: They just think just “just whitening”. At the end of the day. We’ve got to go back to the basics and first of all it starts with, if you’re going to do whitening, you need to exclude pathology. That’s the secret word, excluding pathology. What does that mean? Means you’ve got to assist the patient thoroughly and properly. Do when if you need to take a radiograph of a discoloured tooth, you need to do that. But in that assessment, that I need to do, it’s a full restorative assessment because you’ve got to look at all these things, not just whitening the teeth. There’s other issues, which need to be taking place and that’s what Mike Wise taught me about the comprehensiveness of doing a comprehensive treatment plan.

Linda Greenwal: How do you do a comprehensive treatment plan? You sit away from the patient in your specifically dedicated time minus Thursdays between 12 and one and goes through 12 to two and just look at photos and have quiet time where nobody is disturbing you that you can actually think out and plan out carefully the treatment plan. You can’t do this, you make it up on the spot. When you’re seeing the patient for three minutes, you need that planning time.

Linda Greenwal: And so coming back to, that when Mike Wise introduced me to Francesca Villete, and many of the BACD people had told us about Francesca’s techniques, I was like, okay, I need to learn this. What I need to learn, How do I need to do this? How can I do a hands on? How can I do training?

Payman L: And there’s going to be more and more of that kind of disease.

Linda Greenwal: There’ll be more and more because now with digital dentistry, so I’ve just invested in my digital, my scanner,

Payman L: Which one did you get?

Linda Greenwal: The Sirona, the-

Prav Solanki: Primescan?

Linda Greenwal: Primescan yeah.

Linda Greenwal: Primescan and the milling machine. This is the beginning of the journey because with the minimal invasive, with what she teaches, instead of doing direct composites, you will be able to mill that hole out, and stick it in and save a lot of time and open the bite two millimetres and do the whole thing in one hour.

Payman L: Yeah.

Prav Solanki: Mm-hmm.

Linda Greenwal: And that’s kind of my thinking where it’s going and because tooth way is such a major issue now that more patients keep their teeth. Everybody has some type of tooth wear and in general, 70% have severe tooth wear of our patient group. We just go, “Okay I’ll just watch and monitor and just check again.” But actually what Francesca says is that, “Don’t wait. Don’t leave it till it’s so difficult to repair. Get started, be proactive and keep the health minimal.” And with the new techniques there’s no prep, no prep. You open up the bite and no prep, etch, bond and put on the on lay or you do the composite.

Linda Greenwal: That’s again a huge paradigm shift. When the age is, I said, “one millimetre here, 1.5 millimetre you had a formula you had to create.” You don’t have to do that anymore. So that takes the thinking away because you’ve got to go new directions and you’ve got to be ready for it.

Linda Greenwal: But what worries me about the new dentists, they’d go on Instagram, they got Instagram dentistry, they check it out. Okay, I’m going to do 10 but actually they haven’t learned. So you have to learn it face to face. There’s many ways of learning.

Payman L: I mean you’re clearly very passionate about all of this and whether you like it or not, you’re, “the influencer,” key opinion leader. So, does that weigh on you? The fact that what you say moves lots of people. And so, I mean it would weigh on me, in many ways in bleaching your the sort of the final tertiary referral, that you know the final person’s going to get the final answer on all of them.

Linda Greenwal: Yeah.

Payman L: On any particular issue.

Linda Greenwal: Yeah.

Payman L: Does it weigh on you?

Linda Greenwal: It weighs on me. But in that, there is so much more knowledge and stuff that we need to learn. And when I find out new stuff for example, cause I have-

Payman L: The charcoal thing.

Linda Greenwal: Why is that a thing? Why are they 3000 posts on Instagram? It must be good. And then we go, “But is it whitening? Is it this? Is it this?” That’s like, why is no one talking about it from a scientific point of view. So there’s more work to be done and we need to look at it. We need to research and we need to do it. If there’s a genuine thing that it does make a difference and it’s scientific evidence, then we all need to participate in that genuine thing and give a better aspect for our patients.

Payman L: What did you find going to tell us quickly, if-

Linda Greenwal: So, what did we find out about Charcoal toothpaste?

Payman L: Yeah, if a patient asks a dentist, charcoal toothpaste? What’s the answer?

Linda Greenwal: The answer is that we also need to look at their dentition and see if they’ve got any tooth away. But also charcoal toothpaste don’t whiten. They say they whiten because it gives the appearance that the teeth are cleaner, therefore whiter cause the yellow plaque is removed but they don’t actually whiten teeth. Some of them are very abrasive. Some of them have got carcinogenic ingredients in, some of them have no fluoride and there’s no legislation as to where does the charcoal come from? Is it burnt leaves? Is it random stuff? There’s no guidelines. And there’s no, and so everyone’s jumping on the bandwagon.

Payman L: Even Colgate brought one out recently.

Linda Greenwal: Yes.

Payman L: But when you look at the numbers, its gone berserk that, that is selling like hot cakes. The strange thing is why.

Linda Greenwal: It’s strange and so we need to, as scientists and as dentists and as professionals, we need to look, is this good for our patients? If it’s good for our patients then we can recommend it. So, once again when I come back to talking to dentists, “Hey guys, do you realise that this causes damage or this is a problem?” Or, “Hey guys, do you realise this is actually a genuine thing?” And then more people should know about it?

Prav Solanki: Just going back to your Instagram dentistry. So what’s wrong with taking selfies with your chest out and working out and then-

Linda Greenwal: Do you do that? Am sorry if you do that.

Prav Solanki: I don’t, I don’t, no, no, no, no, no. I’m not one of those guys. But I just want-

Linda Greenwal: I think there needs to be a level of professionalism at all times. If Instagram’s going to build me a huge polling, because I’ve got a hot bod in my bikini on my yacht. That is one aspect. But I think that, again dentists need to come back to professionalism. Never compromise your professionalism.

Payman L: Professionalism, I mean if you do something wrong, you should put your hands up and act professional.

Linda Greenwal: Yes, yes. But now we haven’t, I think we should-

Payman L: But are you saying a dentist has to hold themselves in a particular way in the society.

Linda Greenwal: They do yes, unfortunately they do because of the General Dental Council and patient’s expectations of what a dentist, of what a professional should be and should be like.

Payman L: Is that not changing then?

Linda Greenwal: It is changing, it is changing a little bit, but there’s a certain line, there’s a certain line that you shouldn’t cross. For example, some of the medical legal work that I do when I see something’s going wrong, it’s because often the dentist compromise their professionalism where they felt in the heart of hearts it was really wrong. Don’t compromise your professionalism. There’s a code of conduct. There’s a behaviour that is expected of us, of course we need to behave and that is why it’s very, very strict. The behaviour of, the way we do things. So there needs to be a behavioural expectation as well as being a professional person. And that needs to be, that needs to be redefined.

Linda Greenwal: But there are lots of interesting things about it, about the Instagram, and we can all learn a lot and we see some beautiful dentistry in many different countries. But I think that, what your patients see or what the general public sees, I think there’s certain things that don’t, people overshare, they overshare stuff.

Linda Greenwal: And I don’t have a lot of time to go through Instagram. I look at a few things. Not everybody’s got their time. You want to get to the point to say what needs to be done. You know, our lives are too overexposed to too much social media and unfortunately you still got to have a real life. You’ve become so obsessed, they make us be obsessed with our phones. We need digital detox, We need time to be away from it and actually communicate with our loved ones and, no phones, no this, no TV. Let’s just talk it out. Let’s start, “So how are you today?” Rather than everyone being distracted and you take a family meal. Everyone’s on their phone the whole way through the meal who said hello? Who will pass me this? Pass me this? And at the end of the meal, everyone goes back on their phones. You didn’t engage with those people.

Prav Solanki: So true.

Linda Greenwal: That you really need to.

Prav Solanki: So true. Linda, I’ve been sat here for the last hour, absolutely gobsmacked with what you’ve achieved. I didn’t even know half of it and I say if anything, can I work bloody hard and I don’t think I’ve even started to scratch the surface of what you’ve done. I just want to get an idea of how you fit all that in. Because obviously when you do that, you’re surrounded by a team and you’re surrounded by people that give you that freedom to go and realise your vision. What is it about your leadership that makes people want to do things for you? The way you… That allows you to live your dreams in your vision.

Prav Solanki: Because not everyone will be able to, we’ve all got dreams and visions, right? But sometimes, you know, we are our own biggest victim because we have these ideas, but as Payman says, we don’t always execute them. You’re executing, and despite having been in it for 40 years?

Linda Greenwal: I started, my first year in dental school was 1979, yeah.

Prav Solanki: Your passion hasn’t declined whatsoever, That’s so clear. So what, what is your secret to successful leadership?

Linda Greenwal: The first thing is, as a leader, that’s a responsibility and you need to know that, am I doing the right thing in this situation? I think engaging the team is really important. You can’t lead without a team, but your team needs to be fully engaged with you. And there’s the discussion that, are you on the bus? Are you off the bus? Are you in the right seat on the bus? And there’s new bus discussions about the bus. And when you come back to decision making, is this person in the right seat on the bus? If not, and I consult with the teams. And my team is very, very important to me. My key lady has been with me 25 years, my hygienist 20 years because-

Payman L: Whose your key lady?

Linda Greenwal: Nicola Bannerman.

Prav Solanki: Shout out.

Linda Greenwal: She’s been, she’s awesome, she’s absolutely awesome. And she’s been with me right from the beginning of the journey and we had our babies with the nannies together and she’s been absolutely amazing and she will quickly come to me and say, “Linda, this is wrong. This is wrong. What can we do to rectify it?” I like to problem solve and brainstorm all the time along the way.

Linda Greenwal: So in terms of leadership, your team need a clear vision. Where are you going? Where have you come from? Where are you going? Or what is your… Where are you heading? That’s the first thing. And all teams need to know your vision and empower it for their vision and listen to the team, engage with them. And there are so many good things that teams have to share that you can take on board, let them run with it and delegate what they want to do. It’s a very creative process. So this morning we had a team meeting and we brainstormed a lot of what needs to be done? Where are we? What’s happening? What’s our schedule? What’s the plan? Every morning we meet every single morning we really.

Payman L: When you have take us through your day to day? Like what time did you wake up?

Linda Greenwal: So, I try to wake up at seven but most of the time it’s six 30, I wake up at seven have breakfast. You’re going to be really amazed at this, but actually my husband wakes up early and he brings the breakfast and we have tea in the morning together

Prav Solanki: Wow.

Linda Greenwal: And just kind of chat in the morning. Then I will start at about 10 past seven on my phone. Not always a good thing, but actually I have to be out of the house at seven 25 to catch the school bus for my son and we cannot be late. We don’t want to chase the school bus, which we have done. So seven 25 out of the house, take the son to the bus stop and then ten to eight to be at the practise. Eight o’clock start up team meeting, it’s supposed to be from eight to a quarter past eight. First patient at eight 30 going through till one o’clock lunch between one and two and finish at six.

Payman L: Yeah though but today you came here-

Linda Greenwal: So, today-

Payman L: Are you going back to the practise.

Linda Greenwal: Of course.

Payman L: Are you?

Linda Greenwal: Of course, I’m going back to the practise. At our team meeting this morning, we allocated which roles, what do we need to do now? For example, at this time of the summertime when it might be slightly quiet and other people are on holiday, we review the year. We say, how many new patients did we have? Where is the dentistry? What follow ups do we need to do? What is next? Who has dentistry that’s been diagnosed without having treatment?

Linda Greenwal: And we look at all those things. We look at the hygiene retention. For example, what is our hygiene retention rates? It should be at 80 to 90%. Where are we this month? Where were we last month? Where were we? Where are we going? How can we do this better? Who needs to come in? Who’s going to phone that person who needs to come in? How are we going to schedule them? So this morning we allocated, each team member had a role and is going to be working on that like while am away. Besides, receptionist clocking in the patients, et cetera. So we have our plans and our things to do to work on that.

Linda Greenwal: You have to pay and you have to-

Payman L: Pardon, we haven’t even scratched the surface in all of the things.

Payman L: Honestly, we haven’t.

Linda Greenwal: We have to also talk about how do you chill?

Payman L: How do you chill?

Linda Greenwal: So, how do you-

Payman L: Do you chill? Not how do you chill?

Linda Greenwal: So my children-

Payman L: Actually you go away a lot, do you? I do see you travelling.

Linda Greenwal: It’s mostly for teaching.

Payman L: Is it?

Linda Greenwal: Okay, the chill thing is number one, Saturdays are to family time

Prav Solanki: Uh-huh.

Linda Greenwal: And we really digital detox and day of rest and I read a book and check in with those children and just do nothing and eat and rest and go for walks, et cetera. So that’s one thing, joy in… How’d you get the joy? You always have to seek the joy. And for dentists because it’s such a high stress level, you have to have some aspect that brings you joy besides your work, which should bring you joy. So in your work thing, you work out very early in your career, what brings you joy in dentistry to do more of that and do less of what doesn’t bring you joy.

Linda Greenwal: And we do have this choice, but coming back to the joy, what are your joy things that bring you that little extra. Because, of when you are in your joy litter. I like to do my dancing. I do nia, zumba and yoga and walking, but when you your mind is at rest. That is when your biggest insight comes.

Payman L: Yeah.

Prav Solanki: Absolutely agree.

Linda Greenwal: And so you need that rest time. Most people have the Eureka moment in the shower.

Payman L: There is a reason for that, yeah.

Linda Greenwal: Because their mind is actually, there’s- Actually your vision is like, you just chilling and you’re just that, and your mind is clear. We don’t want to bombard ourselves on the phone with all the stuff. So when your mind is clear, you’ve gained clarity and insight. And that kind of, it comes to you because you’re not thinking, thinking and overthinking you actually just resting. That gives you your great- the clarity, helps you to plan your week and to run with the good thoughts, not the bad thoughts to keep with that and so, that’s what I try and do on the weekend.

Payman L: So Linda, we’re definitely getting you back for part two and maybe three and four. Imagine it’s your last day on the planet and your kids are around you and you are going to give them three pieces of advice. You’re going to leave your children in the world with three and only three pieces of wisdom what would they be?

Linda Greenwal: The first thing, if it’s your last day, is you have to share with your children how much you love them. And children have to know that they are loved unconditionally. And that’s really key. If it’s the very last day, that’s making me cry now, It’s very, very important because, children are worried that the parent doesn’t love them or whatever.

Linda Greenwal: So the first basic thing, and we try and tell our children that every day how much we do love them and we accept them unconditionally. And we want to know from our child that, their best person that they can be. If their name is Johnny, that they did, they were the best Johnny that they could be because they were self-actualized and those talents that Johnny was given by God has been able to achieve and accept those talents because, that God gives them that.

Linda Greenwal: So that’s the one thing, is loving unconditionally, be true to yourself and be human. Be kind and caring and make the world a better place.

Prav Solanki: As your children have got older, do you still tell them that you love them, even though they’re young adults?

Linda Greenwal: Even more so actually, actually, actually even more so.

Prav Solanki: Even more so, right?

Linda Greenwal: Even more so because as they become young adults, they’ve got even more decisions to make-

Prav Solanki: Yeah.

Linda Greenwal: About their futures and about their direction and all that, and they need to know that you, as long as they not doing dangerous and all those going off the wrong path, keep them on the path that you love them unconditionally. Because children have challenges as a teenager, they have all these issues that are all very exciting things as a parent, you have to go through.

Linda Greenwal: I’ll tell you about that on another issue, another time. But they have to know that they loved unconditionally.

Prav Solanki: So I tell my kids I love them too many times a day I’m told. Okay. And I cherish those moments where my little girl drags me around the house holding onto my hand thinking one day she won’t want to, okay. Because, they’ll be too cool. It’s not cool to hold daddy’s hand anymore. And then I think that comes around full circle when they get older, right? Did you experience any of that in terms of, there was a little bit of a gap at some point where it was too, “Hey love you mom, love you dad,” all that sort of thing. And then it, and then it’s come back full circle again. Have you experienced any of that?

Linda Greenwal: I think that, so I’ve always tried to be a cool mom in terms of I love to have my kids, I like to keep an open home. So, I want my children to bring their friends over, I want to see who there friendly with, who they mixing with and see what’s going down? What’s the thinking on those children? And to understand that.

Linda Greenwal: So, because again, it comes to communication. To find out and if they say, “Look mom, don’t be embarrassing, whatever.” Of course, I’ll retract back. But if one of their friends is coming to the house, the food comes out the, what would you like to drink? That’s not alcohol, that’s not going to cause an issue at that age, whatever. But welcome to our home, we’re here for you. How can we help? And recognising, to be kind to guests.

Linda Greenwal: And then those kind of values are really key that children grew up with the values. Because you think, what lessons did I give my children? At the end of the day, you’ve given them the family values that you are true to you, that you live your life, but also where you come from. You bring everything where you come from and it’s always important. It’s called one of the sayings that we use is called ethics of the fathers. Always know where you come in order to know where you’re going.

Prav Solanki: Beautiful, beautiful.

Payman L: And a great note to end on. Thank you so much.

Prav Solanki: Thank you, Linda.

Outro Voice: This is dental leaders, the podcast where you get to go one-on-one with emerging leaders in dentistry. Your hosts Payman Langroudi and Prav Solanki.

Prav Solanki: Thanks for listening guys. Hope you enjoyed today’s episode. Make sure you tune in for future episodes. Hit subscribe in iTunes or Google play or whatever platform it is. And we’d really, really appreciate it, If you would-

Payman L: Give us a six star rating.

Prav Solanki: Six star rating. That’s what I always leave my Uber driver.

Payman L: Thanks a lot guys.

Prav Solanki: Bye.

Transcript

Druh Shah: As soon as you can eat on your plate, carry on. You know, like my friend Miguel Stanley says, and a lot of people say, “Don’t build a higher wall, build a bigger table for the bigger-ment of humanity because together we all succeed.” I think that was a philosophy ingrained in me from a very, very young age.

Intro Voice: This is Dental Leaders. The podcast where you get to go one-on-one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.

Payman L: So today on the podcast we’ve got the phenomenon that is Druh Shah, an educator, periodontist, sometimes people forget he’s available for, well, perio- referrals. Druh, thank you so much for coming in. I know you’re busy this-

Druh Shah: No, thank you for inviting me. I’m glad we managed to get a date in place.

Payman L: Yeah, no, I’ve realised how busy you are.

Prav Solanki: Tough man to pin down but-

Payman L: Definitely.

Prav Solanki: I’m sure this interview will be well worth it.

Payman L: Druh is, “You know, I’ve got half an hour between…” “I’ve got half an hour in October.” Druh, tell us a little bit about your early life. Where were you born? How did you grow up? What was your childhood like?

Druh Shah: I was born in Kenya, in Africa. My childhood, I tell you, was very nostalgic. My childhood was one of fun and serious African life childhood and maybe I shouldn’t disclose a lot of it, but I’ll tell you one thing. I think I spent less time in school and more time doing all sorts of silly things. But you grew up in a real community. You grew up with people knowing each other. Even though I grew up in Nairobi, it was people, small community, people knew each other, so I’ve always had a community feel. I grew up in a place which was not far from this untouched forest, at that point. Monkeys, baboons used to be in my backyard all the time. We even had a leopard walk into our backyard when I was a kid. So, I have this love of wildlife I grew up in. I just grew up in watching dichotomy of extremely rich people and extremely poor people, people who were barely surviving the day and you learn to appreciate life and more importantly, you realise actually it was the happier people were the ones who didn’t have things.

Druh Shah: I grew up in this environment of pure collaboration and giving. I think love did nothing, my dad, in that way, was a huge influence with everything. I grew up in the tourist industry. That was my dad’s approach. So I, from a very young age, he put, I think I was about seven or eight, and we had a shop we used to sell tourist goods and tourist curios. He put me in there and said, “Son, sell some stuff for me.” So perhaps I learned how to convince people that these were good products they should buy, but in a nice way did that. I did that. It’s kind of a really vast growing up of different experiences, multicultural, multi types of people. It was brilliant in all aspects overall. I think one thing I learned growing up was my, that society was still very close-minded. Coming to the UK, I’ve realised it’s different, it’s bigger, it’s open-minded.

Payman L: How old were you when you came?

Druh Shah: I was 18. I came here to study dentistry. I did my O-levels and A-levels in Kenya. My biggest passion has always been two big things. They’ve always been music and wildlife so I was a semi-pro wildlife photographer for many years before I started dealing with the microbes of perio. Music-wise, I always played recorder and did theory and all the other stuff that the geeks did. But I play the keyboard. So I did all that growing up there. A part of me has always been exploring beyond just what I do. It’s brilliant and it works from there. Invariably, I had a big, big influence with my sister who passed away five years ago. Massive rock in my life. She grew up in muscular dystrophy and she didn’t have working arms or working legs. A big thing I learned because she was discriminated against massively in Kenya. In that way, the society, the country, the community weren’t thinking. But her example showed me you can break barriers. She was the first person in her primary school to have a special aid unit built for her. Now the 100 people or something in that unit.

Druh Shah: She kind of set hell trailblazing and she was a rock in the life. Many times-

Payman L: Was she older than you?

Druh Shah: She was five years younger than me.

Payman L: Oh, she was younger than you, sorry.

Druh Shah: Yeah. But you see, you find times because everyone else was always very nice to her, very supportive in the family. But I was like the hard-knock brother. She would come home. There was a point she wanted to enter a school. She went there and they literally ignored her so she came back saying, “Just because I am disabled, does that mean that I should be ignored?” I went, “Listen, nobody gives a shit if you’re disabled or not, get on with it. Prove yourself, there’s no time for this.” Invariably, what that ended up doing was I became the person who motivated, inspired her. Because I didn’t take any sadness, just get on with it. When she passed away, she’d become a psychologist, a lawyer, a motivational speaker.

Prav Solanki: Oh my god.

Druh Shah: And she was writing a book. Without two hands or two legs. She was doing this and I felt like, “We’ve got fully functioning body and I’m just a dentist.” As a result, I’ve had to always push my barriers because the more I did, the more she did. The more she did, the more she believed in herself. The more she believed in herself, more I believed in myself. I pushed the barriers more and we kept egging each other on.

Payman L: A massive influence, inspiration to you.

Druh Shah: Yeah. Huge, huge. Five years ago when she went, it’s still a big hole. Massive. I think it’s hard, it was really hard. I’ve never mourned about it. I mean, she passed away on 10th of May, 2014. Eleventh of May we were down there, few days later we had a funeral. Sixteenth of May I was back at work and 17th of May I moved house and I never stopped. I’ve never had a chance to reflect, think, or mourn about it. I’ve just said, “I’ll carry on her spirit.” One day, I’ll break down about it but until then, what she believed in, what she did, is what I try and do to others. This is the kind of background I grew up in.

Druh Shah: I grew up in the… going and doing the wildlife photography in Africa, grew up in seeing the poor kids who barely could afford, forget school fees, they couldn’t afford 50 p for the daily lunch bread. We eat the big Nando’s here, piri-piri chickens or whatever, but they did not afford simple, simple stuff. It has a huge impact on you that you see people who have full potential in life, and they can’t achieve this, and you’ve got to, got to, got to give them a way. Ultimately, that became part of my purpose. Two big things became part of my purpose. Helping people achieve their potential and inspiring people to know that they can achieve their potential.

Payman L: In the third world, it’s easy to put that pain and suffering into the background radiation to stop feeling it because it’s everywhere.

Druh Shah: Yeah.

Payman L: Do you think it’s because of your sister, or is there something else about you that made you actually think about that?

Druh Shah: I think it’s more than just my sister, more than the society I grew up in. Those two are big factors. I think it’s my parents, as well. That they were giving type. My dad was an entrepreneur, as well. I don’t know how many businesses he’s done, had good luck, and bad luck through it all. But he never stopped giving. He never stopped giving. I think there was that strong influence that, listen, as soon as you can eat on your plate, carry on. Like my friend Miguel Stanley says, and a lot of people say, “Don’t build a higher wall, build a bigger table for the bigger-ment of humanity because together we all succeed.” I think that was a philosophy ingrained in me from a very, very young age.

Druh Shah: The sister’s influence, seeing this all the time as an influence, having parents with that, I think it was far too much subconsciously probably putting it in my system.

Payman L: How did it feel arriving in the UK from that life with the colours, the weather, the food, and then arriving in the UK. Had you been to the UK several times before that or what was your story?

Druh Shah: I came to the UK maybe when I was about six years old and never been before. I mean, after that.

Payman L: After that.

Druh Shah: I came here for about five days for my interviews and that’s it. Never really experienced the city. I tell you what, it was a culture shock. I moved to Sheffield where I knew no one and didn’t realise, bloody hell, it gets dark by three o’clock here. You talk about the weather and it gets cold.

Payman L: No leopards in the

Druh Shah: All this is different animals in the pubs and the bars. You kind of see a whole different society, different culture, which was a big challenge. Now, one of the biggest things I found was in university. I think a lot of the people who came to university, there was a culture of, “Let’s go out, let’s go drinking, let’s go do this.” Now, I’ve done that since I was 13, in school, being the rebel. It wasn’t exciting for me. When I got into university, something like Freshers’ week, where everyone’s downing the shots and I kind of sat there and thought, “What next?”

Payman L: Plus you’re paying foreign fees and you’ve got the struggle to get here in the first place, so you’re going to make the most of the education, right?

Druh Shah: I think that was part of it, part of it. But also I think by this time I was probably two steps ahead

Payman L: You’d lived out that-

Druh Shah: Lived that out and also two steps ahead in the fact of this life experience I might have had. But what really shocked me into system was the third year, because the fees I was paying was about 20 grand a year, and then, your living expenses. But in my third year, my dad sent me a text message and said, “Druh, everything we’ve had has been wiped out. You’ve got to quit and come back.”

Prav Solanki: Jeez.

Druh Shah: “There is no way I can pay your fees anymore.”

Payman L: Business failed?

Druh Shah: Well, business failed, it was Africa. A few banks collapsed and all of our savings went down the, well, wherever they went. It was very surreal as a moment because if this is a movie, beep beep, someone picks a text up and there’s a frozen moment. It wasn’t. A text came, money’s gone. You go, “Okay, I’ve got to move on. I’ve got to think of solutions.”

Druh Shah: Next thing, I had 100 CVs and I was out there in Meadow Hall giving them out and going out to the shops and going, “Right, who’s giving me a job here?” Because I said to my dad, “I’m not coming back.” Let’s face it, when I first came and with the crap weather and new people, I was going to quit then. My dad said, “Fine, if you want to quit, come back.” I said, “Thanks, Dad. Now you told me, I’m going to behave the other way around and I’m going to be a rebel.”

Druh Shah: Come the third year, I said the same. “I’m going to survive.” Nine-to-five you do university, 5:00 you get on to the train to Meadow Hall. Six to 11:00 you’re on your feet, selling shoes at Revel. I’ve worked in burger bars, I’ve worked in shoe shops, I’ve worked in chocolate shops. I can tell you every chocolate at that point in time.

Payman L: You earned the money to pay your fees?

Druh Shah: I earned the money, I got a small scholarship at home, I borrowed money, I did anything and everything. I don’t know where, when, how, but we managed it through. I graduated-

Payman L: For that year? Or for

Druh Shah: The next three years.

Payman L: You’re kidding me.

Druh Shah: For three years. My debt was 84,000 when I graduated. But beyond me, there was a purpose. Ultimately, the purpose was that, and I couldn’t quit because it was me and my sister and my family. Everyone had their hopes on me, I couldn’t let anyone down. But more importantly, it was for my own self. It was a challenge and it was almost life saying, “Bring it on.” I mean, “What can you throw at me?”

Prav Solanki: Everyone knows you’re a workaholic, right?

Druh Shah: Yeah.

Prav Solanki: Everyone knows you do these crazy hours. Up early, bed late, and you don’t stop and you don’t switch off. Did that start when you were doing Uni at day, work at night?

Druh Shah: Possibly. I mean, I think it started before that, before I came here for Uni. The problems, the troubles had begun. I mean, I was always a learning geek so at home I was doing four A-levels. I was doing my music grade A at that time, I was still doing my wildlife photography. I’ve always been in and around, I’m a geek.

Payman L: IT geek, as well.

Druh Shah: IT geek, as well, probably. My dad says I’m misplaced in dentistry. My family say, “You should have gone into IT.” Mark Zuckerberg wouldn’t exist. No. That’s what they say. But I think everything has a purpose and reason. But the university definitely intensified that, that you come home at midnight, you don’t eat. I’ve gone through days without food. I’ve gone through days living off Maryland double chocolate chip cookies.

Prav Solanki: They’re damn good, though.

Druh Shah: They’re super and I’m addicted to biscuits now but there’s a guy near our house who sold me four massive packs. Not the normal size, the large size, packs for a pound. Four packs, you have to see it in my bag, and I’d have a little bit at breakfast, a little bit at lunch, and a little bit at 4:00.

Prav Solanki: Jeez.

Druh Shah: I’d finish until midnight, living off biscuits. Sometimes, if I got into Sheffield City Centre in good time, there was a chippy there and you knew this guy will turn up. He’d keep some chips and two samosas for me, 50 p, every time, with mint sauce. I remember eating these on my way home. I’d get home for midnight to half twelve, and I’d work until 2:00-3:00. We lived in a massive house and by 5:00-6:00 you’re awake and-

Prav Solanki: Work til 2:00-3:00?

Druh Shah: Studying. Studying until 2:00-3:00.

Prav Solanki: So your typical day, just map this out for me. You wake up at what time? Just give me a day in the life of university, as Druh.

Druh Shah: University, wake up at, look, we were in a house of five people with one shower. If you didn’t get up in time, you were late. So up at 5:00, 5:30 I’d be in the shower. I’d come back to the room, I’d do some reading, I’d do my, whether I’d do my self-awareness, my meditation bits, I’d do whatever needs doing, get that

Prav Solanki: You’re meditating and self-aware at that time in university, were you?

Druh Shah: Yeah. I’ve always been-

Prav Solanki: Way before this became a fashionable thing to do, right?

Druh Shah: That’s right.

Prav Solanki: Was it guided meditation? Were you reading books? Was

Druh Shah: It was none of that. It was… meditation’s being with yourself.

Prav Solanki: Of course.

Druh Shah: Sit down, just chill, breathe and chill.

Prav Solanki: Okay.

Druh Shah: It’s before it became fashionable. Yoga’s had influence when I was a kid and it is just sit and think. That’s what I did for a bit. I used to work, I used to read other books, I did a lot of stuff then. Then, 7:00, breakfast, half-seven we’d walk down to university. You’d have uni from your 9:00-5:00. Five o’clock I’d walk to the tram, it takes about 45 minutes to get to Meadow Hall where I worked. So 6:00 you get there, and you’re straight on the shop floor, 6:00-10:00. Christmas time, 6:00-11:00 you’d be pretty much-

Prav Solanki: Five days a week or?

Druh Shah: Legally, I was only allowed to work 20 hours a week at the maximum, so that’s what we did. Other days I was, in the evenings, working at home. I then would come back home about 11:00 or 12:00, time to do the assignments, my revision. I’m not the guy who does last minute exam revision. So, I always stayed up and then 2:00-3:00, I’d go to bed, having done that. Part of me always wanted a website so I built a mega portfolio of Kenya. Every single lodge, every single phone part. I used to do that as a side project at that point.

Druh Shah: I had a tutor who was doing the diploma, at least, very clever guy but he said, “I don’t know how to use Microsoft Word.” So he’d give me his write-up and I’d type up his assignment. Not the work, but just type it up and then email him and say, “There.” That was my revision. Various things I used to do. There’s not enough hours in the day, ever.

Prav Solanki: No socials, no parties, no-

Druh Shah: I used to, every now and then, but not as heavy as most people. Going out and doing that, now and then I’d get drunk, but not as much. There was a focus and a drive and I had to do this because I… survival. That was my gig at that point. And it’s a philosophy I carry on. Socials and parties somehow, I struggle with them. Maybe I’m an anti-socialite, I don’t know. But it’s part of the game that I think that what I did was-

Prav Solanki: Bigger cause. Yeah.

Druh Shah: The thing is, I graduated with this big debt and there was a rule at that time, in the UK, foreign national, you can’t work in the country. Off you go, back home. So I kind of sat there and thought, “I’ve got an 84,000 pound debt and I’ve got to now go back home. No way.” At that point, you can see on television there was these long queues of patients outside dentists in the sort of outreach areas of the country. Big issues in Wales and someone alerted it to me and so we went to speak to a Dean.

Druh Shah: I said, “Dean, listen. You’ve got a problem. I’ve got a problem. You’ve got a problem, no dentists. I’ve got problem, no job. Sort this out.” We were the first group with a Welsh parliament who got the approval to do VT in Wales. The conditions were: one, you must go to the complete nether region; two, you must stay there for at least two years; and three, may you must show evidence of post-graduate education. I said, “That’s all fine. Your guys will pay for my education.” Which they did. But, ultimately, it put it to me that if you fight hard, you can build your opportunities.

Druh Shah: Part of my vision became nobody should go through what I did. Education through the world was my first vision. Help people, give them the access, break down the barrier. Enough. All these years, division’s slowly unravelling itself. But that really drove things forward. Over the years, I’ve thought outside the box. I’ve always found ways to make things happen and I think if any of these young dentists come going, “Dentistry’s hard. We’re going to get sued. This is…” No, it’s not. It’s… find your opportunities. Get out of your comfort zone. Find your ways and niche and you will seriously go. You know, mid-Wales, I was only Indian dentist in town. Even then, we used to do stuff and there was no referrals. There was no one else so we had to do all the treatments.

Prav Solanki: Druh, it’s easy for you. I don’t mean… I mean it with the greatest respect. It’s easy for you to sit there and say it’s not difficult but you are a character and a half, okay? I think about sometimes people talk about these problems or when you face a problem, if you think hard enough and try hard enough, the solution will come, right?

Druh Shah: Yeah.

Prav Solanki: There’s the old, I don’t know where this story comes from, but the truck that got caught under the bridge. The further the truck went, the more damaged it got, and then he tried to back out and it was stuck. Then, some little kid in the background said, “Why don’t you let the tyres down?” The truck went through. That’s what I think when I think of you. Because when you face this adversity, you find a solution. You work your Meadow Hall job or you go to Wales or whatever. Nothing’s too difficult you say. What do you think it is about you, as an individual, your make-up that makes you who you are? There are not many people like you that have got that drive, that ambition, and that pig-headed discipline, I’d call it. Just the, “You know what? Throw whatever you want at me. Come and get it.”

Druh Shah: Yeah.

Prav Solanki: “I’m going to prove you all wrong.”

Druh Shah: Look, it’s actually, everyone’s like me. It’s the potential’s there. It’s how you tap into it.

Prav Solanki: Okay.

Druh Shah: It’s only recently I’ve started discovering this and knowing this, which is where we are going now for the next 10 years with Tubules. But on your left, where we set now, you’ll see a book. It’s called Passionate Work. It’s understanding passion and grit. Those are my two books I’m reading at present in the [inaudible 00:20:37]. Ultimately, it is becoming that. Adversity creates a person. Unbelievably, adversity creates a person. Part of me, all this adversities created me. But we’re all faced with adversity every day. It’s how you handle that adversity and how you build that mindset. Tony Robbins has made billions teaching people this. But more importantly, he’s taught people this mindset creation. The fact is, mindset creation is created through education, through surrounding yourself with the right people. It’s extremely, extremely powerfully important to surround yourself with the right community of people. I’m going to say this in a twisted way, but you go on Facebook and you find a mix of it.

Druh Shah: Some things on Facebook are helpful. Some things on Facebook are absolutely powerfully negative and you may just scroll past these things, but they’ve entered your subliminal subconscious. Now, if you keep scrolling past six things saying, “Dentistry’s shit, dentistry’s this,” guess what? It’s going to enter your brain. Stop it. Find the community that’s positive and working for you. That takes that one step of thinking away for you to say, “Is this a positive or negative post? Should I take it in?” Find that. You then start building the mindset that takes you into the passion pathway. The truth is, the more I’ve studied this, the more I’ve realised, I had to do it out of pure situational circumstantial stuff. But I learned things that help you develop this. If you start pressing those buttons, my God, the potential for every single one of us is absolute powerful.

Druh Shah: I worked out this philosophy over the last couple of months that is called motivate, grow, thrive. That’s what I think we do at Tubules. We motivate you first. Then, you help you grow into what you want to be because that’s when you thrive. You probably have been through 20 years, but that’s what, hopefully that answers what you’re saying. It’s doable. Anyone can do it.

Prav Solanki: Just that you’ve unlocked it, right?

Druh Shah: Sorry?

Prav Solanki: You’ve unlocked it.

Druh Shah: I guess I’m unlocking it.

Prav Solanki: You’re unlocking it.

Druh Shah: Don’t know if I’ve unlocked it but I’m unlocking it. I had the natural instinct to unlock it like any pioneer I had to dig the grass out, but there’s a pathway I can now see and people can walk through that pathway.

Prav Solanki: Your visions are Tubules. That obviously started in its grass roots when you were struggling and you wanted to make… if I’m understood you right, education accessible to all. Is that right?

Druh Shah: Part of it. But there’s a backstory again that carries on from here because I graduated. I went through this difficulty, so my first value became that nobody should go through this. I must help them for education to the world. But then I went to do my perio specialties training and within the first year I was going to quit because although I had the world’s best intellectual people, God’s sake they could not inspire me. Because I’m a nutter and an out-of-box thinker. I started Tubules then. But it was that connection of people that Tubules brought me with that brought back my inspiration.

Druh Shah: My big sort of things I want to give people now for Tubules is not just education. Beyond education, what do we want to do? From our end, our values become we want to help people. We want to then inspire them, build that fire in their belly, not under their bum, and connect these inspired people around. You connect these inspired people together and God’s sake you can see the energy that builds up there. The way you do that is you motivate people, you grow them, and you thrive them. That’s what we give every Tubulite the ability to motivate themself and to grow to a level where they thrive.

Prav Solanki: Community, one of the things I see, whether it’s on Facebook, wherever. Even if it’s just a conversation with someone, I mean these people have names. The Tubulites. Okay, yeah. Your followers.

Payman L: Yeah. Followers.

Prav Solanki: But it is and the one thing that keeps coming back to me is the beginning of this interview, that you were brought up in a community and community was strength and everything and you witnessed that, everyone coming together, working together as a team. Is that where the Tubules’ foundation was grown, do you think, in terms of… the first thing that came to my mind was connecting that with Tubules. Does that relate?

Druh Shah: Totally. Totally. As part of my discovery, I’ve realised I’m just reliving my inside on the outside with Tubules. I think it is, it has come from that. The communities, the collaboration, the people. The biggest power in this world is people and resource. Look at China, one billion people. That’s why it’s thriving. But the biggest, it’s power is people. If you can bring people of the same values together, that’s what creates that momentum. That’s what it is. If you can do that, it works really well. Passionate people, when they’re really passionate, it’s not just an intense love for what they do. Passionate dentists or people, it’s not intensely just loving what they do. It’s actually not just investing the time for what they do, but they develop an identity.

Druh Shah: You start building these behaviours and actions that fit what you do and that’s what Tubulites call themselves proudly because that’s their identity. We’re Tubulites because our behaviour is about working together with others, to help and inspire others while we grow ourself. We’re motivating and growing and thriving, but we’re doing that to others. That community, that identity, comes to place. I’ve always seen that. Community together helps people build identities together. If you can do that, everything else just kind of works. Seth Godin talks about tribes. It’s part of that picture.

Druh Shah: If you think about it, yes, my whole backstory of my community, I grew up in my backstory about the bigger world, the environment, doing good for the world. My backstory about motivating my sister, all of these things seem to be feeding the Tubules, motivating people, building community, building it together. But here’s a powerful thing. Let’s go back to dentistry. Let’s go back to talking about BDA, who are meant to represent dentists. These people who sit and say, “Actually, we’ve asked the government and they’re not listening.” Listen, government’s never going to listen because it’s an extrinsic problem.

Druh Shah: We, as dentists, have super values within us. We want to deliver top quality care for our patients. We want to look after people, ultimately. That’s why you went into dentistry, and the money comes as a side effect of that because you do this. You’re building trust with another human being, all these things. I want to build a community of the right values’ people. People who want to help out each other because you know what? That community of dentists in the future is going to go out to the public and engage with the public to change the face of dentistry as a profession. To say, we are not the money grubbers and fast car driving people. We’re interested in you. There’s a whole… we’re building this pathway. If we can engage the public, guess what’s going to happen? A real momentum boost for the profession. But you need a really powerful community.

Druh Shah: Beyond education and motivating people, it’s a bigger picture thinking

Payman L: Why do you think dentistry suffers with the disunity we sometimes see?

Druh Shah: It suffers from the dis unity that we see now and then is because we’ve never touched down to the values. If you think about dentists, dentists were taught to deal with the tooth, the whole tooth, and nothing but the tooth. Ultimately, they think like that. They think small, they think detailed, they think that bigger picture thinking is missing. True leadership in dentistry’s thinking leadership is, “Here’s a vision. Here’s a vision, let’s go towards it.” What’s his name, “I have a dream.” Who kind of said there-

Prav Solanki: Luther King.

Druh Shah: Luther King. There were thousands of people there. Do you think those thousands of people were there because they saw Martin Luther King’s dream? No. They were there because they had the same dream as him. Their values aligned and he said, “You’ve got that dream I have here, so a vision. This is where we will go.” Dentistry needs that. Dentistry is disunited because all these people with different values are not being brought together under one vision, under one mission. That vision is very clear. It’s we’re looking after patients.

Druh Shah: How we look after them is different and what people end up doing because of the details, they start looking at how you do something and what you do and how you do something and what you do. Our hows may be different, our whats may be different, or whys the same. There is nobody who has worked hard enough to bring that why together.

Payman L: I think one side of it is because we’re interested in patient care and we seem to be interested in patient care that sometimes gives you the licence to be rude to each other because we’re so worried about the patient.

Druh Shah: Yeah.

Payman L: You know what I mean?

Druh Shah: Yeah. That’s the how. Again, I’m rude to you because you’ve done patient care the way I wouldn’t do patient care.

Payman L: Yeah.

Druh Shah: Then, I think, “You didn’t skin the cat the way I skin the cat.” If I sit there and say, “Listen, help, inspire, connect, our three powers are. I’m going to help that patient, I’m going to inspire them, and motivate them to look after their health. I’m going to connect them with other patients who are like that.” Blimey hell. Now we’re singing from the same hymn sheet. If we sing from the same hymn sheet, we’re going to say, “It’s fine. You skin that cat a different way.” But you know what, brilliant. Obviously, I think UK society doesn’t celebrate success as much as, I don’t know, American or Indian or other societies, if you’re doing well.

Druh Shah: UK society likes to almost bring people down who are rising up. I’ve seen this, definitely. Do we celebrate success better? Do we celebrate that someone’s done something well for patients? Is this an initiative we should take? In fact, I’ll put it out to you. Your products enlighten the composite you use with their enamel. They’re going after changing patients’ lives, aren’t they? All day long. Can we use this as an initiative to say, “How will dentists change a patient’s life?” I don’t know. But we think there’s some power amidst all this.

Payman L: I think certainly with Tubules, that purpose-driven endeavour, people can see when something’s purpose-driven. People can feel it. We could sit down with my marketing team and we could say, “Listen, we’re putting all this amazing whitening stuff out and people can see that purpose makes something happen. So let’s put out a purpose-driven thing.” People would see straight through that. But with Tubules, because of you, really, it’s different. It’s different from the beginning and it’s been difficult to even give you sponsorship. I mean, I know we had the discussion about, you came over, you said, “Hey, I’m doing this thing.” I said, “Well, do we need another GDPUK?” We’re talking 10 years ago. That was 10 years

Druh Shah: Yeah.

Payman L: I said, “Do we need another forum? Is the internet even going to work?” I didn’t have any money and then you never followed up and your purpose wasn’t profit.

Druh Shah: It never is.

Payman L: It never is. People can feel that and interestingly, when the purpose isn’t profit, people get behind it in a nice way sometimes. Not always.

Druh Shah: Not always. Look, everyone’s got different values.

Payman L: With this leadership that you’ve got going on, I mean, were you always naturally the leader of the gang when you were skipping off school?

Druh Shah: No, I was

Payman L: Grown into this?

Druh Shah: I wasn’t. I was a rebel without a cause. I was not a leader of a gang because I couldn’t go in with a gang because they all had the same approach. I had

Payman L: Outside?

Druh Shah: I was this outsider, who watched things, and quietly made, and quietly did something differently and then managed to piss people off. Now, I jokingly say, “I’ve got two hashtags I love living by. One is hashtag rebel without a cause. And now it seems like there is. The second one is hashtag piss them off.” Because if you piss them off you disrupt things and think differently. Yeah, that’s what

Payman L: I can imagine you sitting around the board table with… going through that must kill you. That must kill you, having to go through the process of a board meeting. You have to stand up and be the inspirational guy in the-

Druh Shah: Sitting around a board and discussing-

Prav Solanki: Minutiae.

Druh Shah: Having a meeting about a meeting doesn’t excite me. No purpose, get the result. What’s the outcome? Ultimately, we need to do that anyway. But yeah, that’s me. We’re going to get there. How are we going to get there? That’s ultimately what it is. For me, yeah, profit is someone’s changing life. I’ll tell you a story of a guy who was within that NHS treadmill, struggling day in, day out. His family life was suffering. He had a five-year-old kid at that point and he was with his wife, and strain and tension in their relationship, and all this happening. Someone picked him out and said, “Become a study director.” He got Tubulized, ultimately, he got Tubulized. Or he got the disease.

Prav Solanki: Tubulite gets tubulized.

Druh Shah: This disease called Tubulitis, which is the energy, the inspiration. But he then, he got so passionate about industry, he changed cities. He now travels a bit. But I’ll tell you what happened. His life changed. His quality of life changed. He got more time with his wife and more time with his kid. Now, I was sitting in a lecture and out of the blue, this WhatsApp message came. My phone goes, “Ping ping ping” all the time and you have the… but I just, this message caught my eye. “Thank you for introducing us to a world we never even thought existed in UK dentistry. Our lives are better for it.”

Druh Shah: Not our education, not our knowledge. But our lives. That’s not their lives, it’s that 80-year-old’s life, with two happy parents. That’s going to make that kid grow up into a super future. You think 10 steps beyond just getting this guy to run a study club and deliver some education. That’s what it does. Tubulitis is all about that. Changing lives like this, that’s the profit that delivers for me. If I can do that day now, and dentistry’s in a place right now where there’s so many people disillusioned. Which is why I always say, “We want to motivate, grow, and thrive them.” We’ve got to do it.

Prav Solanki: So, Druh, you’ve just touched upon a point about this guy, whoever it was, that his work-life balance or family life was suffering. Just talk to me a little bit about what your life is like outside of dentistry, if it does exist. Who is involved in that, and do you actually have a work-life balance?

Druh Shah: I don’t. Because I think for passionate people, like me, work-life balance is a misnomer.

Prav Solanki: Okay.

Druh Shah: It’s almost saying, you’re asking me to think that what I do is work. It’s not. My life is my work, if you will, my work is my life. But I love it. But here’s my important part for me, which I’ve learned. I was obsessively passionate enough to do this all the time. It can happen that other parts suffer. More than work-life balance, it was self-awareness to realise when I need to stop. It’s almost like running a marathon. You run a marathon, if you’re running every day you’re going finish your muscles. Recovery is needed for those muscles to grow even stronger. Then, you run the marathon stronger. Now when you’re resting, it doesn’t mean you’re not working. You’re still subconsciously processing things.

Druh Shah: Twenty-four hours a day, technically, at some level or another, my brain is working. I’m working. But I’m probably not actively and constantly engaged with work. That’s the work-life balance. Outside of my work, life is family, at level. My wife, who thinks that I should be spending more time with her often enough, and I have an 18 month old toddler.

Prav Solanki: Wow.

Druh Shah: Probably, for the first time my life, I put my phone and gadgets away and spend dedicated time with him, doing stuff and realising this. At this point, I guess, that it’s very an important thing that I say and Anoop, who we lost last week and that a real, tragic shocking thing. Now, in April, I did a talk on fear of failure and how Tubules nearly failed and it’s a talk worth watching for a lot of people scared of failure. A lot of people say it was one of the most powerful talks and it got their nerve, got their hearts, got their soul. But Anoop said something very important, “Through his Tubulite we’ll find another tubules, but your son won’t find another father.” I tell you what, the man gave me, it was like an elder brother. But I sit there with him, and every time I spend time with my boy, I remember Anoop. Part of my life is him. Because part of my responsibilities to motivate this kid so he grows and thrives into a positive life.

Druh Shah: Other part of my work-life is this Tubules foundation charity that we’ve built with a vision to build 10 schools around the world. These 10 schools are going to have children there who don’t need a teacher because we’ll use the technology to change their life. They will teach each other. I invest time in that to doing stuff along there. Obviously, I need to spend time with my own fitness and my own personal health, but I still engage as much as I can. What I enjoy, my photography, or my time with nature, or my music. I do all that and that’s why I can’t sleep much, because-

Prav Solanki: How much do you sleep?

Druh Shah: I get two to three hours on a good night.

Payman L: Jesus.

Payman L: Wow. Jeez.

Druh Shah: That’s what I survive on. Don’t quote me that book that says sleeps help your brain develop ultimately-

Prav Solanki: You read the book?

Druh Shah: No, I don’t think I’ve read

Payman L: He doesn’t want to read it.

Druh Shah: I don’t want to read it.

Payman L: Before you came, you were saying you go to bed when I go to bed. But then you wake up when Prav wakes up.

Prav Solanki: Yeah, it’s a perfect combination. This morning I was up at 4:15 but I was tucked up by 9:15, 10:00. Pay goes to bed at 3:00 and wakes up much later and you’re a combo of Pay and Prav.

Payman L: Jeez. That can’t be healthy though, Bud, can it?

Druh Shah: I don’t know. Maybe not but I’d rather, listen, my philosophy is I’d rather live a short, impactful life than a long one where the government’s messed my pensions up. But it’s that, I think there’s just, even if I try to sleep, I can’t.

Payman L: Yeah.

Druh Shah: There’s drive, there’s passion, there’s this energy within me that gets me up at 5:00 going, “Oh, good, an idea. This light bulb that doesn’t let you sleep.” Now, I’ve got a toddler who’s like that.

Prav Solanki: Do you feel whacked? I mean, do you feel, do you ever walk around feeling like a zombie or? Sometimes, if I can’t sleep at night for whatever, my brain’s firing away and then-

Payman L: But the thing is, you get used to-

Prav Solanki: No, no, no I get that. Because people ask me, “Why do I wake up early?” But do you walk around feeling completely whacked? Or have you completely normalised-

Druh Shah: It depends who I’m walking with. If I’m on my own, I’m fine. If I’m with energetic people, I’m on the move, that sort of thing.

Payman L: For all we know, that lack of sleep that he’s got cuts out the bullshit. For all we know. That’s the cat he is. If he slept, there’d be loads of crap, cobwebs in his head. You know what I mean? For all we know, that could be it. He’s definitely thriving, isn’t he?

Prav Solanki: No, without question. Just to give you an insight into that book, the guy talks about the sum total of people who are better off when you take an average with less than seven or eight hours sleep or whatever. It rounds up to zero, okay. However, he’s talking about an average and the sum total, so maybe you’re that tiny, tiny outlier. Outlier, yeah?

Payman L: He’s definitely an outlier.

Druh Shah: Every now and then I’ll get moments when I’ll just knock out for hours on end. That’s my recharge. Tesla. That sort of thing really. I’ll do that every few months.

Payman L: That happens to me, too. That happens to me, too. Maybe once a month. Once a month I end up-

Prav Solanki: Have a good night’s sleep? Or a good day’s sleep?

Druh Shah: Or something.

Prav Solanki: Yeah.

Druh Shah: It does that but I guess it’s the way it worked. But that’s what enables me to achieve things I do and keep that work-life balance and watch things, do things, engage with people, all this. More importantly, I think the lesson learned is focus and you can easily, if you don’t know your values, your priorities, which I probably was still finding, you can easily get sidetracked, which wastes time and focus becomes very important. Michael Hyatt’s book is worth reading on that. But once you know your focus, the hardest thing-

Prav Solanki: What’s it called?

Druh Shah: Michael Hyatt, something on focus. It is focus is the main word on it.

Payman L: Hyatt?

Druh Shah: I’ll tell you that focus It’s a very good book. The hardest thing to do is say, “No.” I’ve learned to do that more and more now. Say, “No.” It’s brilliant. It’s not just brilliant for me, because I say, “No,” and I suddenly realise I’m glad I said, “No,” because ultimately this was not going to contribute to where this road is leading, the path, the vision, But it’s so funny because people want to join Tubules and we’ve realised, it’s a misconception out there at CPD website and the people are going, “Well, why are you seven times more expensive than others?” But we’re using CPD to motivate people. It’s not there. These people, I’ve said, “Look, we’re not seven times more expensive than others. Actually, this is not for you, because you’re looking for something else.”

Prav Solanki: Yeah.

Druh Shah: That ability to say, “No,” to them has turned things around for people to say, “Wait, wait, wait. What do you mean, ‘Not for me?'” It starts and they come in. From a business, I hate calling it business, I call it project point of view, 12 months, our revenues have gone up 136% on the ability to say, “No.” Focus and no have become one of the biggest things for me, interestingly.

Payman L: Druh, what’s a typical day for you? I know you’ve got perio days, you said, two days a week, is that?

Druh Shah: Yeah.

Prav Solanki: Short days from, what was it, 9:00 to 7:00?

Druh Shah: Nine to seven is my day in clinic.

Payman L: Maybe we’ll get to perio, but on a Tubules day-

Druh Shah: It’s variable.

Payman L: What time you waking up?

Druh Shah: I’m normally up between 4:30 and 5:00, something like that. And it’s normally either I wake up, or my toddler wakes me up, one of the two. What I now do is I spend that first half an hour, whatever it is, an hour, whatever time I’ve got available, doing nothing. Coffee, reflecting, it’s as if I’m meditating.

Prav Solanki: Don’t pick your phone up?

Druh Shah: No. I used to, I don’t know. I love a quick glimpse but that’s it. I don’t do more than replying to things or anything like that. Just if anything urgent sitting down. But you learn to do that. That’s typically about 6:00, 6:30 he’s up and you get him ready and drop him to school and normally by 7:30, 8:00 I’m back into the start of the day. That day may be that we’re filming, in which case I’ll be on my way to the studio.

Payman L: Is there an office?

Druh Shah: No, we have a mobile studio. Filming could be done at a conference, filming could be done in a hotel room, wherever. That day could be meetings. I will not schedule meetings early in the day for that reason, simply because I use the first few hours, if I’m not driving, really focusing on the jobs because that’s when my peak performance hours are. Nighttime, between 12:00-3:00, and morning between 7:00-10:00. I’ll do all the tasks I need, at that energy and attachment and drive. Then, 10:00 I might have meetings. I might have things going on. It may be we’re filming. While we’re doing all this, the phone calls, the WhatsApps, the Facebooks, all these messages carry on, so between that you’re always answering

Payman L: Are there employees?

Druh Shah: There are six people in the team, doing the job of 38 people. Better than it was three yeas ago when I was one person doing the job of 38 people while doing dentistry full-time and operating Tubules. I built it with no sleep, all the money, all the time. Everything I had went into it. I was a

Payman L: How much cash do you think you’ve put into it?

Druh Shah: I’ll be honest with you, probably in excess of 120 grand of my cash has gone into the business. If you invest the time and everything else you’d be silly, but there’s at least 120 grand and there was an amount that was paid back, which I’m not even including in that.

Payman L: Told you were hitting a cash crisis and you had to just fund it?

Druh Shah: I had to find investors. More than cash crisis, I was eating a five point of personal person crisis. I could only work until 38 people. I couldn’t replicate myself to work into 39 or 40 people. It was a point, not only that, but Tubules was growing. Tubules was becoming much, more more, more users. Invariably, my duties to serve and support them. So, individually, I couldn’t do so much so I had to bring a team on board. That’s when we went to our first round of funding, three years ago.

Prav Solanki: How’d you go about finding another Druh Shah who’s going to take that load as an individual, and he’s going to do the work of six, seven, eight people?

Druh Shah: You can’t. You can’t. Our next round of funding’s to bring more people. I’ve now got to build a team and that’s part of my growth process. From being an individual, I’ve got to become a leader. What powers a team to become leaders and deliver the vision?

Prav Solanki: But those six people are still doing the job of more than one individual, right?

Druh Shah: Yes.

Prav Solanki: There must be something special about them-

Payman L: Or you.

Prav Solanki: Or you. Are they staying after 5:30 a lot?

Druh Shah: Listen, here’s a story I’ll tell you. One day at, Ifti’s our content manager, and the guy who does the online support with me. Ifti’s a PhD guy, he’s done PhD in a medical, microbiology. He’s an academic. You go to his house, massive library, very cool guy, very intelligent guy, he’s like me, an insomniac. One, two o’clock at night we will have on our WhatsApp group, this next-level intellectual conversation about psychology or behavioural science or adult learning. But here’s the story I’ll tell you to answer your question.

Druh Shah: One day, at 2:30 at night, we were having this conversation. I asked a question, “By the way, randomly, what happened to that event or something that had happened?” David, our CFO stepped in and said, “Yeah, I’m dealing with it.” Kallah, who’s our operations, at 3:00 at night went in and said, “Druh, by the way, I spoke to this guy, as well.” Jemeesh, who you know, does our media, went, “Yeah, just I’ve got the filming date, my diary.” I went, “Guys, it’s 3:00 AM. What the hell are you guys doing?” The response was, “We’ve got Tubulitis, as well, Druh.” This is the team.

Prav Solanki: Unbelievable.

Druh Shah: I don’t tell them when to work, how they work. They work when they want, how. It’s what I’ve instilled in them, is this is our vision, let’s make a change. You decide how, when, what you want to do, as long as we achieve these steps in the way. That’s how I like doing things. I think that’s what the team is about. It’s that energy, that drive, that passion.

Druh Shah: Our first conference, in 2017, Ifti was with us until midnight. He then took everything to the editor and went home to bed. At 4:00, he was back at the editor’s picking things up, so he was operating on my sleep routine. He then said to me, “Druh,” or he didn’t say to me, he said somebody else, “If this was any other corporate, bloody hell I’d be pissed off, asking for more pay, and going home. But Druh, I just love, I’m having fun doing this.” That’s the bit. I think we hit something there, where he loved what he was doing.

Payman L: Yeah, it’s quite interesting, isn’t it? The fun element.

Druh Shah: Yeah.

Payman L: Yeah? Do you actively enjoy-

Druh Shah: Yeah.

Payman L: I know you do. But do you make it fun for everyone else?

Druh Shah: Absolutely.

Payman L: Go on.

Druh Shah: We always make it fun and energetic for people. We make it fun and energetic from a viewpoint of first, “Do you all align to the vision?” Every person we’ve hired said, “There’s no pay for six months, will you come and work for us?” It’s a joke. But it’s to understand they’re aligned to the vision, the values, and what we stand for. That, in itself, is fun. They’re intrinsically-driven. It’s autonomous. As soon as you intrinsically drive them, it’s fun. The second thing we tell them is, “Do what you want, how you want it. I don’t want to know about whether you report at 9:00, 10:00, 12:00, or 4:00. If you intrinsically drive there, you’ll know when to report and what jobs to do, when.” It’s autonomous. They love it.

Druh Shah: I never criticise mistakes. I love to positively tell people, “You’re doing good job. Where can I help you to get better?” That makes it fun. Because they’re becoming competent. They feel that they’re building their confidence. Then, we have fun days out. These are not just fun days out, strategy meetings I call them. The other day we were all had a flight in the 1934 Tiger Moth aeroplane. That was our fun day. But it’s these jokes, these ability to do things, we’d like to do more, I’m not going to deny that. We’re just not there yet. But these are the elements that start bringing in the fun bits. Obviously, we all have a laugh with each other. You can take the piss out of them and I say, “They call me an Ewok, from Star Wars.” And I say, “Fine.” But we have a laugh. Ultimately, if you can’t laugh at yourself, you can’t laugh at anyone else.

Payman L: Take us back to, you told us about that dark day when your dad sent that text about the finance running dry when you were a student. But, and it’s easy to look at Tubules now and think everything’s beautiful. But take us back to your darkest day in Tubules land.

Druh Shah: It’s a whole talk I did last year, the Director’s Day. The darkest day. There’s loads of dark days. Listen, you just find the torch. But last year, in August, Tubules was five days from shutting down. Five days. My wife and kid were back in Kenya when this was happening. I was flying home to pick them up and I was at Dubai airport. If you know Dubai airport, it’s big. I had an eight hour stopover. I paced that airport, cold sweat, because I put my identity, myself on the line for this. I was Tubules. Without it, who was I?

Druh Shah: It was the fact that I’d lost sleep, I’d done everything. “What the hell do I do?” Probably was the worst, darkest day, for various reasons that had happened. But he was almost saying, “Right, it’s going to go.” You’d go home and you fly home and your family and your kid sees you after a few months. Beyond your smile, lies this absolute danger like, “What the hell? We’re gone.” But you know what worried me more, wasn’t me. What worried me most was the fact that if that goes, our team, who rely on me, who believe in me and my vision, are going to go. Tubulites, who use this to inspire themselves, to grow themselves, is going to go. It’s about others.

Druh Shah: That day was very dark. It was, I had no answers. I didn’t know what to do. I think I’ll face that again and again, possibly. But now I know how to deal with it. I was in Salvo, where the foundation school is being built on the edge of a national park. I got to the national park, and you go to this waterfall, and it’s tremendous waters. Absolutely choppy waters, but around it is just peace. There’s no mobile reception, either. I sat there and I had no answers and I just sat there on this rocks and there’s a picture of me, my brother was taken. I just sat there with this water flowing. The one thing I realised, these rocks, they were on messy, choppy waters, but the water was finding its way. I thought, “It’s choppy waters, we’ll find a way.” Flew back home, and I was set one evening and I was just drinking coffee at home, 11:00 at night when I have my coffee.

Druh Shah: I set there and thinking, “Do you know what? I accept that it’s gone.” I literally said, “It’s gone.” I thought, “It doesn’t matter if it’s gone, because the Tubules might have gone, but my values, what I stand for, what I do, hasn’t gone. My purpose isn’t gone.” Tubules hasn’t gone, it’s just a physical representation of it that’s gone. I looked around, I said, “You know what, whether I pass or fail, I’ve fought a valiant battle with true honesty.” Because I did that, I can say I fought the battle. So if it’s gone, I didn’t do it, I was proud of myself. Because of that, my family would think I’m a superhero, and they’d still love me.

Druh Shah: The important things in my life, and I was grateful. I remembered everything I was grateful for. On that darkest day, I remembered whether I pass or fail doesn’t matter because my values, my purpose, my honesty, and my family, the important things remain around me. That was will never go. Those are dark days when they go. The funny thing is, I felt a peace inside me like this burden was lifted off me. Because I suddenly realised, “Those things will always be there.” Suddenly I realised, “Bloody hell, I’ve surpassed a barrier now.” I’ve never lost Tubules. I’ll never lose it. Because it’s in me. I’ll only lose it when I go away, in a coffin some point.

Druh Shah: That gave me the confidence to do things, which I never thought I could do. The company just started rising and rising. I wrote a book amidst all this on the intelligent PDP, which went on Amazon. I wrote that book in three weeks, while I went through this crap. That book.

Payman L: What’s a PDP?

Druh Shah: The Personal Development Plans that we need for the new GDC regulations and all.

Payman L: All those videos you did, they’re so super useful, Man.

Payman L: Someone had to stand up and do that. You just did it.

Druh Shah: I did it. That all came on the back of that book because I had all the knowledge and I put it out. Someone said, “Druh, you should charge for these videos.” I said, “Here you go, Guys. Have it for free.” There were people, we fired it for free.

Payman L: He did something on the, what was it, not CQ, the data?

Druh Shah: GDPR.

Payman L: He did something on the GDPR. Someone needed to stand up and just say, and you did it.

Druh Shah: Yeah.

Payman L: But what you did for the personal development plan, definitely.

Druh Shah: Well, hopefully it helped. Well, people are still using it today, 12-18 months along. That’s how dark days come to light.

Prav Solanki: How did you come out of that hole? You had five days?

Druh Shah: Well, physically-

Prav Solanki: Well, what happened?

Druh Shah: We called suppliers. I mean, I was on the phone to everyone, “Help me out, I’m sweating.” Called suppliers, said, “Look, give us some time. Give us some time. It’ll happen.” I spoke to Tubulites and said, “Listen, Guys, I need your support.” Some of them came out there. Ultimately, then I started to develop. I said, “Listen, PDP, get this shoot-ed message out. If you go on WhatsApp groups in late August last year, I was shooting messages at 6:00 in the morning. “This is how you do PDP. Guys, Tubule’s answers, Tubules does it.” I put it out on Facebook groups, “Listen, this is your answer.” I was intense.

Druh Shah: I was on the phone with people saying, “Get on Tubules.” People were going, “Why?” “Because I need your help. But more importantly, you need me because of this PDP stuff.”

Druh Shah: The membership went up, people realised the value going up, suppliers gave us some breathing space, we just went went went went went. Ultimately, I just connected, oh my God, it was brilliant because ultimately you were doing it as a family, but it was brilliant because I was talking to people at every level, going, “Help me out here. Let’s do this here. Let’s do that.” I was probably on my knees there. But to knock me out would’ve taken a fiver. Suddenly, came the conference and the conference delivered a last pow to people, because they realised it’s not Druh pissing about, he’s serious.

Druh Shah: In October and November, people just went, “Whoa.” Somehow, that message going out all the time, vision, values, all that information, was getting people to believe in us. Like you say, somebody had to. Nobody else was doing it. I did that. I went around the whole country, well over 5000 miles, talking to people about this new CPD and how Tubules helps them. Went to practises, talking to practises, telling practise owners, “Introduce us to some more practise owners.” We started building that network, doing everything we could do. Yeah, lifeline.

Payman L: Druh, I mean, of all the projects in dentistry, yours probably is the most successful for the listeners, everyone’s a listener, I’m sort of holding out air quote. The amount of goodwill for your project, is probably the highest of any project that’s going. Does that not translate to giant sponsorship deals and-

Druh Shah: It could translate to anything. It could translate to someone buying me out. All these things.

Payman L: These struggles, I mean, there’s no point looking at me and Prav. But if I was Dental Direct to your Henry Schein, why wouldn’t I want that halo around? Have you gone to them and said, “Hey?”

Druh Shah: Ultimately, every single person will come to you when they see value in it for them. I could have the biggest community of millions and millions of users in the world, but if you don’t see value, you wouldn’t come there. For us, it was all about working out where our value lies and what it is. While sponsorship deals would come in, the second part was working out well, sponsors will come and say, “We have big checks for you.” big deals. But ultimately, it wasn’t just that, it was, “Can I deliver the value to the other person?” I believe in that straight away.

Druh Shah: We’ve had sponsors who’ve pretty much told us, “We’ll write a big check, but these are the videos and products we want.” I said, “Look, that does conflict with our values and what we stand for. I’m sorry. I’m not going to compromise on my principles at a level because it’s built on that principle.” That’s how we’ve built the user base. Now, I think there’s a very powerful recognition that the user base we’ve got, it isn’t just the quantity of numbers, it’s the quality.

Druh Shah: People don’t come to Tubules to do CPD, they come to Tubules because there’s a powerful learning resource there that’s going to inspire them to grow into better clinicians. Ultimately, that’s what the companies, that’s what people want. Because when you’re there, in a growth phase, now, just the way, after 10 years, you knocked on my door. I can tell you that door’s been knocking. It’s about how we work together with the right people. I’ve always said that. I don’t work with every sponsor. I don’t work with every company. I work with the right people to deliver the right value for them.

Druh Shah: My energy and focus, to a few people, is much more powerful than having my energy and focus to lots and lots of people. I go to these big shows that have 300 stands out there. It’s just an entity, a number. To me, that number has to be value, not an entity or number.

Prav Solanki: Druh, you said some interesting there, that you sort of pricked my ears up. That somebody may buy you out. In my mind, I don’t think you’d ever be for sale.

Druh Shah: Why not, why not?

Prav Solanki: Just let me just take this, qualify what I’m saying here. Is that, I don’t think Druh would ever sell his values.

Payman L: Doesn’t have to sell his values.

Prav Solanki: No, no, no, no, no. Let me just

Payman L: Sorry.

Prav Solanki: So somebody could come along and say, “I’ll give you an obscene amount of money. Just give me Tubules.” You wouldn’t do that, right? Without caveats, clauses, or would you? Is there a magic number where you’d say, “You know what? I’m going to let this go now, and I’m going to do what I want to do.” But what is that what you want to do?

Druh Shah: What I’m doing now.

Prav Solanki: Exactly.

Druh Shah: So David asked me this last year in this middle of this crisis. He said, “Druh, if somebody wrote down a check of 2.5 million, would you?” And that was the value of the company at that point. It’s probably more now. But he said, “Would you go?” I looked at him, I thought hard. I said, “No, my heart wouldn’t let me.”

Prav Solanki: No.

Druh Shah: I think there’s a bigger mission to achieve beyond this. Payman asked me this in Scotland some years ago. He said, “If you won the lottery, would you do what you’re doing now?” Actually, I would do what I’m doing now. I’m actually living the dream. By selling my dream, what am I going to live the nightmare? I don’t know. Ultimately, that’s what it is.

Payman L: Yeah, but this can translate to another scenario. I mean, you can do the foundation could take over, the wildlife photography bit could take over. I mean, you could-

Druh Shah: Ultimately, look, I’ve got to make dentinal Tubules, or the Tubules sort of approach into this big company that changes lives in the world. That’s the vision.

Payman L: That’s the vision.

Druh Shah: But I’ve got to make leaders within the companies. Like any company growing, you know, it’s finance hungry. It’s a monster. You have to release shareholdings. It’s a business level. This project is bigger than me. This project is bigger as a vision.

Payman L: I mean, you’re right. You might be forced to sell.

Druh Shah: If more than forced to sell, it might be I have to bring in more leaders in place, who take the vision. Bill Gates steps back. What’s his name, Satya Nadella, is he Google? Or Microsoft taking over. But you create leaders. Ultimately, I will then be stepping onto the role of then being crucial in the foundation. That’s my journey in life. We all have a journey. I don’t think I’d sell it. I’d think I’d still create leaders who would deliver that vision. There will be that element that goes on and on. Ultimately, that’s how I look at it.

Prav Solanki: Let’s say you were to leave this planet tomorrow for whatever circumstances. Would Tubules survive without you today? Or would it crash and burn?

Druh Shah: It would survive.

Prav Solanki: It would survive.

Druh Shah: It would survive.

Prav Solanki: You’re 100% confident that somebody or someone would take this cause over, drive it, and grow it the way you’d envisioned it?

Druh Shah: I think that they will take it over, they will drive it. They may drive it slightly differently because their vision may be slightly different to mine. That is fine. As long as they continue to help inspire and connect people-

Prav Solanki: Three core values.

Druh Shah: By giving them the motivation, the growth, and the thrive. Those three things, I think it’ll be okay. But that’s not for me to say. While I’m here, I do what my vision delivers. While I’m here, I convey the values. When people walk in, they say, “Those were values we loved.” I will step in. As long as we have people who understand the processes, and the vision, and people who can then say, “That vision was because of these processes,” things will carry on.

Druh Shah: In April this year, I started writing the Tubules manifesto, which is a write-down of every single detail of the company from the vision to each process to each job role and who does what for preparation, for the fact, that I could be hit by a bus anytime. That manifesto sits there to tell people, “Here’s your answers.”

Prav Solanki: If you were hit by a bus tomorrow, how would you want people to remember you?

Druh Shah: As a 5’4″ human being who did what he could. That’s it. I’m a normal person.

Prav Solanki: Your 18 month old, what would you like, “My dad was-”

Druh Shah: Hero to me, made me strong, taught me how to fight battles in life, find my way, and achieve my dreams.

Prav Solanki: Beautiful, beautiful.

Druh Shah: That’s it. Ultimately, we’re all 5’4″ human beings. Well, no, some of us taller. Relatively, all humans doing our job every day. None of us are special. We’ve just got to make it special for all of us, together. That’s it.

Payman L: I think we should leave it right there. We should leave it right there. Thank you so much.

Prav Solanki: Thank you, Druh.

Druh Shah: Awesome, thank you so much.

Payman L: Thank you.

Outro Voice: This is Dental Leaders, the podcast where you get to go one-on-one with emerging leaders in dentistry. Your hosts Payman Langroudi and Prav Solanki.

Prav Solanki: Thanks for listening, Guys. If you got this far, you must have listened to the whole thing. Just a huge thank you, both from me and Pay, for actually sticking through and listening to what we’ve had to say and what our guest has had to say because I’m assuming you got some value out of it.

Payman L: If you did get some value out of it, think about subscribing and if you would share this with a friend who you think might get some value out of it, too. Thank you so, so, so much for listening. Thanks.

Prav Solanki: Don’t forget our six-star rating.