When UK dentistry restarted back on June 8^th after such a long break, I naively thought that it might be a fresh start for the relationship between dental staff and patients. In my mind’s eye, I pictured a beautiful slow-motion reunion between dentist and patient on a beach, against a background of crashing waves, accompanied by a sweeping orchestral soundtrack of music lifted from 1970’s Love Story.

In that vein, I tweeted a few days into the reopening, asking if the DNA rate had gone down, now that dental appointments were so precious. I naturally assumed that patients would covet a dental slot in much the same way that I worship any product that comes out of Apple Park Way, Cupertino.

I was soon apprised of the true nature of the ‘new’ relationship between patients and time-keeping/appointment-attending with tweet replies that varied between hysterical laughter emoji’s to “Yeah. Right!”

What I hadn’t taken into account was the two opposing factors which came into play during the lockdown and closure of general dentistry. Firstly there was the seething resentment of some patients who felt that they had been badly let down by their dental practices. Either they were unhappy at the way they had been ‘fobbed off’ with antibiotics and analgesics to solve their problems, or they felt that it was the dentists themselves who had been placing the restrictions on access. The other sort of patient (which, if I’d ever met any, would have been my kind of people) appreciated that the shutdown and restrictions weren’t down to practitioners themselves and were immensely grateful to be seen by their dentists as soon as the shutters went back up again. I’m assuming these people didn’t rudely batter on the door while waiting to be let in by a sweaty mask-fitted nurse playing musical patients in order to ensure patients never met face-to-face.

I HAVE met patients in the past who try and get ‘revenge’ when things don’t quite go their way. Fortunately it only really extended to time-keeping. Occasionally I’d run late – mainly because I had fitted an emergency in – but patients would sometimes really blow up and deliberately turn up late for the next appointment. One woman actually barged into my surgery half an hour early while I was treating a patient and, furiously pointing at her watch said: “I’m watching.”

I have no concept of what is happening in dental practices post-lockdown at the moment with regard to broken relationships between practitioners and patients or between colleagues themselves. But I think I have a vague idea from talking to people in the biz.

Apparently, some patients are really cheesed of to a score of 10 on the Gorgonzola scale, resenting their NHS treatment being curtailed so abruptly in March, despite the decision taken to shut down being made mainly because there was a reasonably elevated risk of you catching something from the Sun-reading mouth-breather sitting next to you in the waiting room if dentistry HADN’T shut down. There seemed to be no big affectionate reunion between dentist and patient.

 

 

Others are apparently quite cool about the whole thing and are happy to finally be able to access treatment even if they do make the odd remark about the cost of PPE, though they appear to be in the minority.

But do dentists feel ‘valued’ on their return to practice? Quite a few apparently do – at least quite a few reckon that at least their patients are pleased to see them – though I’m not quite sure how the patients can recognise them under the heavy-duty face masks visors and other bondage equipment they are required to wear under stringent SOP’s.

But not everyone returning to practice feels valued, particularly associates.

Over a few days a couple of weeks ago, without solicitation, I received three messages from dental professionals telling me of several NHS associate colleagues who had been dismissed by the same corporate. The feeling was that the company was taking advantage of the fact that practices only currently have to hit 20% of their normal UDA contract target and was offloading ‘expensive’ dentists – targeting those who were on high UDA rates in particular – and pocketing the proceeds in the process. I had no reason to disbelieve the incidents that I was told, but was unable to confirm the veracity of the claims with the ‘victims’ directly.

A couple of friends of mine who both work in the same group mixed practice down south went through a wobbly time recently. Both, primarily working in the NHS but with a couple of private sessions each week, found themselves being lumbered with most of the triaging and picking up of and dealing with, emergencies. Their associate colleagues meanwhile, were apparently cherry-picking patients from the triage list and offering private early appointments, leaving my friends to pick up the stuff their colleagues saw as being way less lucrative. Apparently, both of my mates were told by one of the practice owners that they “Don’t talk to patients in the right way” in order to solicit private work. Dawn said “Yes. That’s because we’re dentists, not used car salesmen.” The episode has left the two feeling undervalued by their practice colleagues, feeling silently chastised because they aren’t dragging private money in. More to the point, they feel that the other associates are taking advantage of their willingness to clear the NHS backlog, allowing them to take on more private work. “Undervalued” and “vultures” were recurring terms during a conversation I had with one of them this week.

I tried to get the point across that the patients surely value their help? “Nobody cares about that. I feel a warm glow, but there’s no respect for doing the right thing,” said Dawn.

I’ve also heard from another friend that in my old practice, there has been resentment from his colleagues who have been carrying out treatments for NHS patients.  They object to seeing locum dentists who appear to have been doing the bare minimum of treatments since the reopening, having realised that the practice as a whole has been hitting it’s 20% NHS target and therefore they don’t have to exert themselves particularly.

On Friday I wrote, half-jokingly, that “Since UK dentistry reopened, every single patient has become excruciatingly appreciative and there are never any FTA’s or patients arriving late for appointments.”

 

 

I was still half-hoping that maybe patient-dentist relationships HAD generally improved since the lockdown. That illusion was soon shattered. Dentist Steve Tittensor replied: “It was like that for about a week. Then the entitled whinging started.”

 

 

Ferret lady (@madferretlady) also replied: “I am finding all the understanding and patience shown during lockdown has long since run out. Replaced by moaning and complaining and lack of compliance. And still complaining about paying 62 quid for molar endo and 5 restorations.”

Dental nurse Rachel (@lovelyhair) echoed those sentiments about patients: “I wish they were like that in community. It’s like they’ve forgotten there’s been a pandemic and it’s business as usual. They’re being super demanding.”

 

 

Resentments have also been expressed online from patients, disgruntled with the perceived ‘over-the-top’ approach UK dental staff have taken in order to safeguard patients from the coronavirus. One lady reckoned precautions British dentists were taking during treatments were completely unnecessary. She apparently worked as a ‘frontline’ NHS hospital worker and she implied she didn’t feel that the PPE dental staff use in surgery was necessary even for hospital ‘frontline’ staff. It transpired that she didn’t actually work with overtly infected patients. She was far from ‘frontline,’ working as a technician in a department not renowned for spraying potentially infected saliva in people’s faces.

Another member of the public proudly showed photographs of post-treatment results after she’d been on a trip abroad to seek dental treatment. She also remarked that her treatment had been carried out safely, yet without the fuss British dentists apparently make, providing a photograph as proof. Maybe a LITTE fuss wouldn’t have been amiss. The photograph showed a dentist in a popular dental tourism destination, without a nurse and in a normal pre-pandemic surgical paper mask, performing (presumably) crown preps with no other PPE and his wristwatch on, while the patient was doing her own aspiration, sans safety glasses. She seemed happy with this arrangement. Presumably, she saw UK PPE as being for wimps. She preferred dentistry with a frisson of danger.

Early in the shutdown I heard of one dentist threatened with legal action by a mother for politely explaining why she couldn’t at that point carry out an elective and non-urgent white filling. Even this week I was told that of the 90 or so calls my old corporate practice receives per day, an estimated two-thirds of them are abusive.

And while we’re talking of not being valued, the profession was kept in the dark for a good portion of the early lockdown with not exactly a torrent of information coming out of the England Chief Dental Officer’s department. Many were turning to the Scots or the Welsh CDO’s for information, and when the opening up of dentistry in England was finally announced, many working in dentistry found out from the telly, rather than being told first officially by the bods that run the NHS. At that time, many expressed their dissatisfaction with the way the profession had been treated. “Cinderella service” was a phrase that frequently cropped up in Twitter posts describing the way dentistry was viewed by the Government.

Being well-clear of the whole debacle nowadays, I have no real concept of how life is in practice at the moment. I can only build a picture in my own head. I strongly suspect I wouldn’t like it – especially dealing with the thorny subject of PPE charges.

I always generally felt appreciated as a GDP and assumed my skills were similarly regarded by my patients. One day I was visited by a new patient, a senior journalist with whom I had worked thirty years or so previously. He came in with toothache in a periodontally involved upper seven. I couldn’t get anywhere near it because of severe retching (his, not mine). After examination, I realised he had severe advanced periodontitis I suggested a course of deep cleaning. He refused. Since he’d apparently had recent treatment (“I’ve had all that stuff with poking around ineffectually by you people. What are you going to do any different?”) I suggested I refer him to the local dental school perio department.

At that he said: “What? Refer me to even more monkeys?” He added, give me some antibiotics. That’s all you dentists are good for. You are ALL monkeys!” I never saw him again. On that day, I really did feel undervalued and underappreciated.

 

 

Over the years, the dental profession has been accused of encouraging the poisoning of the nation’s water supplies by advocating the addition of fluoride at source. We’ve also been accused of poisoning the nation with mercury. Now the profession is being accused of being overly-protective. We can’t win.

They say that the only patients who you remember clearly, are the handful who give you problems. It seems that soon, you’ll only remember the ones who don’t give you a mouthful when they enter the practice.

I think I’ll go and play with my new rubber tyre on a rope.