What Dentistry Taught Me About People

It was 1973. I was a trainee reporter.

I can’t remember what season it was, just that it was a bit cold. But there again, it was always a little bit cold in this particular magistrate’s court.

I was sitting in the press box, right next to the box where the defendent sat – literally sectioned off from the accused by a very low, albeit sturdy bit of oak panelling. I often thought a two year-old could clamber over the partition without much effort. The reason the layout of this court bothered me slightly was that I was always quite accessible. I was once covering  another court in a bigger town nearby, one Monday morning, after a group of Birmingham City supporters had kicked off at an FA Cup match at the weekend. They were being dealt with in number 2 court – not the best place for reporters. We were just sat in chairs right by where the prisoners were brought in from the police holding cells. As the first thug was brought into the room, he looked at me and the reporter from the Birmingham Evening Mail and shouted “Oooh. There’s a f*****g party!” and he proceeded to kick us both, really hard, before being subdued by two officers after they deftly brought him to the ground. In those days, you just sucked that sort of thing up. There were never any thoughts about suing or prosecuting. Reporters and photographers occasionally got battered with half a tennis racket (another thing that happened to me). Fact of life.

On this particular morning, a local man was appearing in court charged with assault and causing grievous bodily harm. The defendant was a slim, tallish chap, in his late twenties, with long, lank hair and he sat in the middle of the bench in his box, looking intently at the proceedings. For reasons that will become apparent, I will leave out his name.

The circumstances of his appearance were briefly this: He had entered a pub with an unnamed accomplice, dragged out a man from the bar and kicked seven sorts out of him, in revenge for a private car deal that had gone awry. I have forgotten the exact details of the ‘deal.’

When the victim came into the court to deliver his testimony, there was an audible gasp, even from the magistrates. The chap was in his fifties and was still purple and blue, from head to toe, a month or so on from the assault. He shuffled in on sticks and with one leg in a brace and his head and shoulders were similarly in a brace with a surgical head frame to keep his skull together.

The tragedy of this tale is that the victim wasn’t even the ‘right’ target. He was just an innocent regular drinker at the pub and had nothing to do with cars or deals. The defendant in the case and his unnamed accomplice were merely carrying out the instructions of another unknown man who had just given them a physical description of the man he wanted duffed up.

The defendant was identified by pub regulars and the case seemed pretty clear cut. The magistrates went out to consider their verdict. While they were out, the policeman who had been with the defendant went to have a chat to another officer in the court, and the accused, unattended, slid towards me and leaned on the partition. He asked me if I thought he’d “Go down.” I would have put a month’s wages on it, but instead I said something like “I don’t know. You never can tell.”

He said “Fair enough” and then we had a pretty normal, yet surreal conversation about the the poor heating in the court and current affairs. By the time the magistrates came back, I was sort of hoping that the magistrates wouldn’t go too hard on him. He seemed a reasonable bloke who had just gotten a bit lost and had fallen in with the wrong crowd. Despite the mincemeat he’d made out of his victim, I found it difficult to see any malice in this man, although our ten minutes of conversation was admittedly, not very deep.

The magistrates came back and announced that they couldn’t give him a big enough sentence with their restricted sentencing powers and I’m pretty sure they had to refer the guilty man to the Crown Court for sentencing. “Shame,” I thought.

Six or so years later and the same man turned up in the headlines again, after being alleged to be part of a gang which had been accused of carrying out a murder which caused national outrage. The gang were gaoled and served 18 years before being released in 1989 after the Court of Appeal ruled that the trial had been unfair, due to certain areas of evidence being fabricated by police in order to persuade one of the gang (who at the time of the appeal, was deceased) to make a confession. One of the gang admitted to being present at the site when the murder occurred, and the Appeal Judges noted that in the light of the confession by one of the gang to being present at the time the victim was shot dead, they said “We consider that there remains evidence on which a reasonable jury properly directed could convict." It’s worth pointing out that ‘my’ defendant was in court not too many years ago, on a charge of dealing in Class A drugs.

And the moral of that tale? I was at that time obviously no competent judge of character. But after having over a decade of mixing with the great and the good and the frankly dubious as both a reporter and press photographer, I thought by the time I entered dental school at nearly 30 years of age, I DID know everything about people and that dentistry could teach me nothing in that regard. After all my wide experiences dealing with the public as a journalist – I’d once been described by a local city councillor as a “Lackey from the local gutter-press” and had even been arrested and put in the back of a police van – surely I knew all there was to know about people?

I couldn’t have been more wrong.

Lesson 1 – A Lot Of People Are Horrible.
A Few Are Princes or Princesses

After all my varied encounters in newspapers, which you would have thought would have primed me for anything, I wasn’t quite prepared for the hostility, bullying, sexism and racism in dental school. My dental school was just like a never-ending gladiatorial fight to the death except the students weren’t armed and any hint of a likely protest would be given a swift thumbs-down from the ‘Emperor’ as the heads of department used to like to be known.

I once struggled with a very large amalgam restoration. The crown of the tooth had only about a quarter of the walls standing. It was really a tooth that needed crowning (and I desperately needed it crowned for my quotas), but a lecturer who clearly had me on the bottom of his Christmas card list, had perversely treatment planned it for a pinned amalgam. Anyway, I had placed pins and then struggled for ten minutes or so to get a matrix band around the tooth, but it kept falling off, no matter what I did. Eventually I steeled myself to go and approach two of the lecturers on duty that afternoon, who clearly resented the fact I was disrupting their chat. If George W Bush had been around in those days, I’d have called those particular lecturers the ‘Axis of Evil.’ Reluctantly, the part-time lecturer (a GDP who came in to the school twice a week) came over to the patient and sat down. He didn’t even try to place the band and show me what to do. Instead, he picked up the Siqveland matrix band and almost pushed it in my face. He then started to tighten it up, theatrically, saying loudly in front of the patient “This is how you put a matrix band on. I’ve never met anybody as stupid as you in the whole of my life.” That was it. No help or instruction.

After he left my unit, my patient said “If I’d been you, I’d have hit him quite frankly.”

I waited a couple of minutes and then that rare creature, the decent human being on the restorative department payroll, walked on to clinic and I grabbed him. He sat down and said “I’m not surprised you couldn’t get that on. It’s impossible. I’m writing this up for a crown.” He then showed me how to use wedges effectively so I could sort-of keep the band on and fashion some sort of pinned core. He was a rare prince.

Lesson 2 – People Can Be Two-Faced (And horrible)

At my dental school, I encountered so many vile lecturers, I’m spoiled for choice for examples to illustrate my point. One lecturer I had a particularly bruising relationship with was a prosthetics ‘specialist’ who was on my case for the whole time I was on clinics. She was a short Aberdonian with sharp features that must have consumed the power generated by a thousand suns in order for her muscles to produce a smile. This is incredibly un-PC, but the late, great Terry Wogan had a phrase he used in those days to describe a character on Dallas – ‘The Poison Dwarf.’ That was my secret name for her. It gave me some solace. And yet, she apparently had a massive following from the other lecturers and with them she was all, admittedly strained, smiles.

When I first went on the prosthetics clinic, she was a supervisor and we were taking primary edentulous impressions. I showed her my alginates and one of them had an air-blow in it so small that you would have needed a precision micrometer to measure it accurately. She told me to take it again, which I thought would put the patient, an elderly gagger, through an unnecessary procedure. I did tell the lecturer that my impression was “More than adequate” for construction of a special tray and blocks. Well she shook with rage and at one point I really felt that she was about to give me a ‘Glasgow Kiss’ on my knee (remember, very short). She spluttered “You should take more pride in your work.” I called for a sick bowl and took it again. The second impression wasn’t as good but she passed it since we were getting close to her lunch hour.

From that point on, my card was marked as far as she was concerned and there was nothing I could do right and most stages of denture construction I had to repeat because she picked fault in absolutely everything I ever did. When the joint heads of department were on supervising duty, I had no such problems. All her venomous tellings-off were spat out in a Caledonian hiss that were only audible to me and her, but in a split second she’d turn the strained smile on to speak to either another student or member of staff. She presented a picture to many that she was a sweet individual, in whom, butter wouldn’t melt, whereas a few other victims as well as me, knew better. I was surprised she managed to keep up the pretence for so long and keep her job, so I was delighted to hear from an ex-student who also suffered at her hands that she eventually left the dental school after many years, relatively recently, having failed to ever pass FDS. Don’t begrudge me having a little smirk at that news after three years of hell.

Lesson 3 – More People Than You Think, Are Crooked/Unethical

I think I met more crooks in dentistry (and yes, I’m talking specifically about dentists), than I ever did as a court reporter. Not only that, they were also morally bankrupt.

The top unethical individuals on my list are the husband and wife practice owners who disposed of sharps for many years, at the local tip, till some blabbermouth (yes, me) discovered what they were doing and told them to put a stop to it immediately. Naturally, one of them was on the local LDC. They are also the pair that withheld a nurse’s wages out of spite one week, after she put her notice in. They also withheld my pay after I backed up the nurses. When I’d finally decided I’d had enough of them and I handed my notice in, my pay was withheld again, until (and I’m not proud of this) I had to ambush the husband on the stairs as he was sneaking out the practice again to avoid me. I politely, but firmly suggested he bring me a cheque by the end of the day, but I think my face probably threatened to spread the odious little git all over the practice. I got my pay at the end of his lunch hour.

At another practice I discovered that, under the instruction of the practice owner, the practice manager was secretly opening my child GA referral letters and on the days I wasn’t in the practice, the boss was doing GA’s in the chair, without an anaesthetist or suitably trained assistant, with PURE nitrous oxide. He was effectively using suffocation to induce unconsciousness. I resigned from that one immediately and again had to threaten to report him if he didn’t give up GA’s, tout suite. I shouldn’t have been doing that. I’d been out of dental school only a few months and he had 30 years of experience.

Another crook I worked for temporarily – again, an ‘upstanding’ LDC member – ran a small corporate in the North. ‘Corporate’ was maybe a bit grand. It was really a big practice with smaller outlying branch practices. Although the head office surgery was lovely, the branch practices were shoddy (this was in the days pre-CQC). I was doing just a few Saturday mornings to help out while one of the practices was trying to hit targets before March 31^st. Literally nothing worked in the practice, even the ultrasonic scaler, and I found my requests for stuff to be fixed, fell on deaf ears. I worked for about two months and the week before my stint was due to finish, the owner of the empire had forced the resignation of a dentist who had been in that practice for many years before his corporate took it over. The associate had protested when he didn’t receive any money for two months, because the corporate owner (a practising dentist himself) had decided to impose clawback on all associates in the group, even if they had individually hit their targets. The week before my contract was due to finish, I looked at the book and there were only two patients booked in for the following Saturday. As I left, receptionist told me to expect a call during the week, cancelling my next session. After having just heard about my colleague’s sacking and realising I couldn’t face working in the place again with such inadequate equipment, I decided that I would hand my notice in. After all, it was only one morning session I would be missing.

The response to my resignation was an email from the owner saying that he witnessed the hygienist using the scaler and blamed the resignation of the associate on ‘mental health issues.’ Naturally, I didn’t get paid for the work I did a (I did some crown and denture work) and in any case, the company had a bizarre method of working out associate pay which I hadn’t ever encountered before or since. Vague, was an understatement. The next contact was a phone call from the owner, saying that I wasn’t going to be paid because “You’ve dropped us in it” (by resigning a week early from the end of an agreed period) and not only that, if I pursued the matter, he’d report me to the General Dental Council. Lovely bloke.

I’ve probably done to death the tale of the crook who bought my practice and put me through hell by encouraging people to take me to the GDC in order to ‘prove’ to county court that he had to do fictitious replacements of restorations. I ended up reporting that dentist to the NHS fraud office after the practitioner committed irrefutable fraud, among other things claiming and charging a patient for a Band 3 (inlay) despite breaking it during the fit and merely putting a composite in, instead. The practitioner was also morally bankrupt, implying to NHS patients that they could only have one crown per course of treatment, had dubious cross-infection control and was sacked from a previous practice for cross-infection guideline breaches and bullying staff. The dentist also stole about £700 from that practice, pocketing payments made by emergency patients over a weekend on call.

The incident that really upset me though was when a dental therapist who I got on well with (I thought) and whose work was exceptionally good, stole £1,600 in cash from the practice and wrote cheques stolen from the practice manager’s drawer, out to herself to the value of £500. She didn’t initially admit the crime and everyone (including me) were under suspicion and we were all fingerprinted by the police. She was later charged and appeared in magistrates court. She was ordered to pay the money back, but the payments stopped and I hadn’t got the will to chase it. My only problem was that I had recommended her to a colleague. I rang him up in haste. He told me not to worry. He’d sacked her when she was found to have stolen a nursing colleague’s wages from the changing rooms a couple of weeks previously.

Lesson 4 – People Can Be Kind

Dental colleagues were exceptionally kind and understanding when my wife became terminally ill in 1994-95 and the help I received in running was overwhelming. Colleagues at the practice down the road volunteered to look after emergencies when I was away with my wife at chemotherapy and surgical appointments, and one former colleague who I rarely saw, turned up on my doorstep during the summer of ’95 with big bottles of water he’d queued up for, when emergency tanks were brought into the city during the water shortage. I was so preoccupied, I had completely overlooked the fact my kids were slowly wrinkling from dehydration. At my wife’s funeral, I was again overwhelmed with support from former colleagues and friends I had trained with, who travelled from afar to pay their respects

Similarly, when my son was critically ill in 2013, it was my dental colleagues and corporate practice managers who rallied around and helped sort out work commitments as well as giving much needed emotional support.

Lesson 5 – Receptionists Are Fierce

I once threw a corporate colleague’s lunch away in error, thinking it was mine that I hadn’t eaten the day previously. I was lucky not to have been turned to a pillar of salt. I am glad she was on my side against the odd patient that ‘turned.’

Lesson 6 – People Can ‘Turn’

I’m thinking here, patients who SEEM nice, but turn nasty when things don’t go exactly according to plan. Towards the end of my dental working life I ASSUMED that people were going to eventually go a bit ‘Norman Bates’ unless they proved themselves over time to be Mary Poppins.

Lesson 7 – People Don’t Listen

You treat patients every day. You don’t need me to tell you that.

Lesson 8 – Nurses Diet

Yes.  Nurses are always on on/off diets.  Nurses also like cake. Especially the ones on diets.

Now the above is not an exhaustive list, I’ve learned a lot about human nature as a dentist, particularly related to anxiety – my own mainly. But my main point is that in dentistry, all human life is visible and you don’t need a microscope to see it. 

Just take a few moments to take a look, if your safety glasses aren’t steamed up.