That opening line from the song “The Living Years” resonates with anyone who has lost a parent, grandparent, teacher or mentor and comes to appreciate that, “we are all prisoners of what our predecessors held dear”.
One of my prepared talks (post-covid bookings are now being taken!) includes me reading a paragraph from one of the required textbooks of my undergraduate years, Immediate and Replacement Dentures. Chapter two, “The patient as a person”, has a section called “The quiet mind”, this starts with a definition of the normal patient which reads, “The normal patient is one in whom the loss of teeth follows previously satisfactory dental treatment”. When presenting, I pause and read it again emphasising loss of teeth, normal and satisfactory.
The reactions of the audience, if I am fortunate enough to have attracted one, is varied, the baby boomers nod and smile in remembrance, Generation “X" shake their heads in disapproval, Millennial (Generation “Y”) are cross and want me de-platformed, Generation “Z” need to be revived after the trauma and demand post-presentation counselling.
Not only do I believe that subdividing groups of people into “Gens” in order to predict their behaviour is akin to astrology for sociologists but it can also prove confusing and futile. There are rarely true generation gaps in a profession like Dentistry where changes are introduced slowly and incrementally. Teaching of undergraduates reflects the previous doctrines filtered through the published research, the experiences of the, as yet, unpublished opinions and the perhaps more dogmatic, heavy hands of department heads.
All this of course is filtered and influenced by that relatively new group, the educationalists, or specialists in education, whose views on the manner of teaching delivery may have a significant bearing on what, how and why knowledge is delivered by whom, where and when.
I was moved to write this piece for two reasons. The first was another in a long line of consultations from dentists who are deeply unhappy in and with their chosen profession. Almost all of them tell me that they felt they were too young, usually 14 to 16, when they made the decision to study dentistry and that their undergraduate training, whilst fine at the science of dentistry, hadn’t prepared them for the reality of life in (UK) dentistry.
My other stimulus was reading David Epstein’s book, “Range”. In it the author examines the virtue of early specialisation with many hours of deliberate training in one field compared with the value of being a generalist.
I am not sure if I have come to any definite conclusions. What I know is that I never wanted to be anything but a dentist and it took me 25 years to accept that I didn’t enjoy being a “wet-fingered”, micro-managing surgeon. With hindsight I can see that I spent too long climbing up the wrong wall, my ladder looked perfect, others were envious of my achievements and success, but it didn’t make me happy, indeed quite the opposite.
A proportion of dental graduates are not suited to the careers available to them and would walk away if they could. Unfortunately the pressure from parents and peers, not forgetting the financial implications, means that leaving is the social equivalent of not turning up for your own wedding. For many who persist this means that further down the road comes a moment where they wake up, unhappy, wondering, “is that all there is?”
Epstein quotes Winston Churchill whose words are used to encourage unhappy, unsuited people to show “grit”, “Never give in”, he said, “never, never, never, never”. What nobody tells you is that he finished the sentence by saying, “except to convictions of honour and good sense.”
What could be done? Could we go down the American route of an honours “Bachelor of Medical Science” degree followed by a three-year dental programme taking 46 weeks per year of proper work? A 21 year old is in a better position to make a career decision than a 17 year old and other pathways are available to those who are unsuited.
Would a better career path in general Dental Practice work? Perhaps a three-year post-grad programme with spells in different independent and corporate practices, NHS, specialist and private with clear transitions, supervision and significant mentoring. Some years ago there was a brave move to start an independent vocational training scheme, which foundered after the intervention of the NHS who were opposed to anything that they could not fully control.
What we have can be inconsistent and does not help everyone. Dentistry is unsure of itself. Is it still a speciality of medicine? Does it want to truly embrace teamwork, if so exactly what model works best? Or is it straddling the divide with one foot rooted in the disease model and the other trying to run away along the road of cosmetics?
Are we failing the next generation? Will more and more unsuited young people be ground beneath the NHS wheels?
You say you just don't see it, He says it's perfect sense,
You just can't get agreement, In this present tense.