Recently, I gave a talk to the Adelaide Dental students. As always, I was impressed by their general level of enthusiasm and desire to do great dentistry.
Dental Students will graduate into a world with more opportunities than I can even imagine.
They will also launch out into a profession that has never been more snarky about each other and with a regulator who, with the best of intentions, has implemented KGB-like "mandatory reporting".
Remember when children reporting their parent's "treason" was rewarded as being a "hero of the state"? Now you can be a hero of the health-Stasi by reporting your mates for the smallest infractions. No judgement required. If in doubt, dob them out.
I'm sure this will be as successful in developing a dysfunctional profession as it was in developing a dysfunctional and damaged society in any country that tried it. The total suppression of honest discourse.
What concerns me in particular is the way some leaders of the profession are treating these new grads who are the future.
We see cases posted that are very complex with a lot to go wrong. The advice is "refer". You touch it, you own it, is the veiled threat.
Firstly, why is it that a very experienced clinician often knows that that something is very high risk? It is often because they or their mentor have done it before, and it has failed. So now they don't want to do it again. And they don't want you to either. So far, so good.
If you want to stop someone from making the same mistake, explain cases that YOU have done that have failed with that approach. And how YOU didn't realise how difficult it was when you first did such a thing. And here are the photos of when YOU tried that and here is the sad outcome.
Such a post will have weight. Just saying "refer" without a good reason why, does not.
Now of course, posting poor outcome cases is sometimes hard on our ego, and I've heard that it can affect referral practices, but remember, it's about best intentions for patients and the profession, not protecting your financial turf. You said so yourself.
And why do some of the leaders of our profession get up in lectures and speak for hours, while sponsored by a company, without once showing the things that can and have gone disastrously wrong for them? Maybe if the audience saw all your complications, they would be much more cautious?
But I do show failed cases, you claim. I show ones done by others that failed, and because of my massive talent and rare IQ, I was able to fix. This dangerously implies that none of your own cases go wrong.
Yet every study shows failures. I was talking to Basil Mizrahi recently, surely one of the finest prosthodontists in the world. He gets complications, he said. He offered to do a whole lecture on it. Frank Spear had whole lectures on complications. But you don't get any?
Why didn't you refer, you cry?
Yet an inexperienced dentists doesn't even recognise the difficulty of the case. They don't see the curved roots of the molar with canal obliteration.
They don't see the thick buccal bone around the distal impaction. They don't see brachy-facial with severe horizontal parafunction that will cause you a world of pain if you try All on Four.
They don't see the temporomandibular joint dysfunction.
They don't see it because if they did see it, they would be experienced. They are at the left side of Dunning Kruger curve. Unable to see what they don't know. You are on the right side. You've forgotten how hard it really is.
They don't see it because you are "too busy" to show a case on the platform that reaches more young dentists than any other.
But you can't teach online you say, as you do a new procedure that you learnt about in a journal article or at a world congress, with no hands on training. You can't teach online you say, as Universities hurriedly build online training revenue streams. You can't teach online you say, as dentists build pay per view websites.
You can't teach online you say, as you post an occasional amazing case. Never showing a failure. Wondering why people are overconfident.
Dentistry doesn't need to be some adolescent fraternity club where each new generation is subject to some abusive initiation rite because "that's how it was for me in my day" or because "our mentors were really harsh in our Post Grad".
We can support dental students, new grads and younger members.
We can remember our own failures, and perhaps try see if there is any way we can build someone up and correct them before we report them to the health Stasi. We can try to think back to the days when our hand moved the wrong way when we used a mirror. And our endo's were short. And we placed implants into too little bone.
Think about the other dentist currently convincing the patient not to sue you for the central incisor going non-vital during ortho or rampant peri-bracket caries, before you throw them under a bus for their ortho not quite finishing in the statistically unusual class one position.
- The molar endo's quietly getting extracted elsewhere, without you knowing about it.
- The composite rehab you did proudly, that has fractured and the next dentist is too afraid to tell you.
Be chivalrous. Show your failures so that others don't make the same mistake. Confront your fear of showing things online despite not growing up with this online world. Your fear of being seen to be showing off. Your fear of tall poppy syndrome. Explain what happened to you when you treated that difficult case, and the reason why redoing it took the profitability out of the next five cases.
Be true leaders. Chivalrous. Generously sharing why you are so cautious at the peak of your career. Why you take so long. Why you would rather not do it, than try to do it cheaply.
And for those that already do this, we are deeply grateful. It is you that are worthy of the referrals that we make when we finally recognise that we are out of our depth.
