Are we too frightened to do treatment? Michael Sultan

In this age of litigation, everyone it seems is worried about being sued and losing their livelihood. For dental professionals in particular, this fear is increasingly pronounced. After all, it only takes one small complaint from a patient and whether you’re innocent or guilty, chances are you will come out the other end questioning your whole career.

All of this means that newly qualified GDPs are now terrified of doing many procedures, having gained little in the way of practical experience while at dental school. While they will certainly know about communication skills, vicarious liability and compliance, some may have only completed a single bridge or root canal treatment before qualifying.

And what are they to do now? Gone are the gung-ho days where dentists could try everything in the first few weeks of practice; the potential repercussions if something doesn’t go according to plan are just too great. It would seem then, that the old adage of ‘See one, Do one, Teach one’ – where students learn by actually practising – has gone forever.

Changing attitudes

So what happened? What has brought about this sea change in the way we approach dentistry? Well for one thing, our society is certainly more litigious than ever before. Compensation or ‘claim culture’ has been with us for many years now, and there will always be someone out there keen to make a fast buck. Not only that but many people these days are very quick to place blame, even when there may be no blame to be found. Often the question of right or wrong doesn’t come into it – if people feel wronged then they believe it is their right to complain, even if it means reporting a complaint directly to the GDC.

But the problems don’t just stop there. In the past treatment options were far more limited than they are today. Our job as dentists was primarily focussed on caries control and treating patients for pain. There were also far fewer specialists back then, so there was much more emphasis on the general dentist, and the skills that each dentist had to offer.

These days however, there is a completely different picture. For a start, the treatments that we can provide are far different to those we were able to offer in the past. Many of these new treatments are focussed on beauty over health. While there is of course nothing wrong with providing patients with brilliant, beautiful smiles, we need to recognise that this has fundamentally changed the relationship we have with patients. This has gone hand-in-hand with a changed role for the NHS that again marks a shift away from the way we did dentistry in the past.

Increasing demands

There can be no doubting the fact that new technologies and treatments have been a fantastic boon for the dental profession. Whether it be fantastic ceramics, microscopes or the latest 3D CBCT scanners, very few would argue that these advances haven’t benefited patients and the profession in one way shape or form. With the latest tools, technology and techniques we can see more, and so we can treat more than ever before. All of these advances have meant that the private sector has grown significantly in recent years, as patients spend more on treatments that make them look and feel better about themselves.

However there is one major pitfall here and it is to be found in the form of patient expectations. Because patients are spending more, they are also expecting more as a result. Costs have gone up and patients expect a perfect cosmetic result every time. They don’t always fully appreciate that there are some factors that are just beyond our control – and many dental treatments just aren’t designed to last for life.

Interesting times

Robert F. Kennedy once said, ‘We live in interesting times’. I really don’t think there is a more appropriate quote to describe the dental profession today. On the one hand, we live in an age of opportunity – we have access to better tools and technologies than ever before that allow us to provide an outstanding level of care. Yet on the other hand, there is a darker side to dentistry, one that challenges us on a daily basis, and threatens to undermine the work that we all so love.

With the ever-increasing burden of compliance, assessments and the threat of litigation, in many ways we live in an unpleasant time to practise dentistry. Colleagues are becoming disillusioned with a system whereby admin work and needless regulations trump good common sense and giving patients the time they deserve.

It would seem that fear today, is one of the biggest threats to our profession. Many colleagues now are too afraid to step outside their ‘comfort zones’ for fear of failure or the repercussions litigation might bring. And yet one can only wonder what the future of dentistry in the UK might be. Currently, if a dentist is tried for negligence, he or she is judged by what one’s peers would do. In the States however, such cases are judged by specialist standards. If these same rules were to come to the UK would GDPs want to perform anything but triage unless they had further postgraduate training? The thought just doesn’t bear thinking about, and would certainly herald the death of the generalist GDP!

For further information please call EndoCare on 020 7224 0999

Or visit www.endocare.co.uk

Dr Michael Sultan BDS MSc DFO FICD is a Specialist in Endodontics and the Clinical Director of EndoCare. Michael qualified at Bristol University in 1986. He worked as a general dental practitioner for 5 years before commencing specialist studies at Guy’s hospital, London. He completed his MSc in Endodontics in 1993 and worked as an in-house Endodontist in various practices before setting up in Harley St, London in 2000. He was admitted onto the specialist register in Endodontics in 1999 and has lectured extensively to postgraduate dental groups as well as lecturing on Endodontic courses at Eastman CPD, University of London. He has been involved with numerous dental groups and has been chairman of the Alpha Omega dental fraternity. In 2008 he became clinical director of EndoCare, a group of specialist practices.