Pulling teeth

The news this morning included a bizarre item that suggested dentists should be our front line of defence against the dangers of cancers caused by excessive drinking.  We are more inclined to go to the dentist for routine check-ups than to a doctor and, therefore, the dentist might pick up signs that would otherwise not surface for some time.  Apparently, as they peer into your mouth, dentists might notice decay caused by stomach acids, ulcers etc.  Presumably, they might also smell your breath!?  But a spokesperson declared that dentists might then be able to offer advice and he even went so far as to say they could offer ‘cognitive behavioural therapy or talking therapies’.  Wow.  I have this weird image of a doctor peering into your mouth and trying to practice as a psychologist at the same time.

I don’t know about you, but I have never associated dentists with empathy and with therapy.  They tend, in my experience, to be highly judgemental about the lifestyles and habits of their patients.  Having only taken my postcode, one dental surgery once asked me whether I was a drug addict!  Such tact.  Such delicacy.  But then, their patients are rarely able to anser back when there are sharp implements stuck in their mouths.


4 Responses to “Pulling teeth”

  1. 1 Jennifer April 18, 2012 at 3:15 pm

    Hmmmmmm. Not too sure about the talking therapy approach but absolutely right that dentists should be talking to people who they believe are at risk of developing mouth cancers.
    data demonstrates that oral cancer are not only mainly preventable but are largely attributable to smoking, alcohol consumption, diet etc. http://info.cancerresearchuk.org/cancerstats/causes/comparing-causes-of-cancer/visualisationoftheresults/
    (if that link works i will be so proud of myself!)

    if dentists are poor at having these conversations then that needs to be addressed but it doesn’t mean that they are not best placed to,.

    Apologies for being so right on. Not my normal style at all! ;o)

  2. 2 mikerowe April 18, 2012 at 4:10 pm

    I can’t argue with the case for identifying cancer etc early. My concern is with the talking therapy idea. My entire experience of dentists suggests this is not simply a matter of needing to be addressed. It is a serious issue – I tend to avoid dentists because they are a judgemental bunch. The whole training programme for dentists would need reviewing and the professional development of current practitioners would be very significant…. But maybe I have a particular bias.

  3. 3 Jennifer April 19, 2012 at 8:45 am

    I think your experience reflects how much the quality and efficacy of healthcare is based on the behaviour of individuals. I am sure there are some dentists across the country who would be brilliant at delivering talking therapies, others would be rubbish. A third group probably fall somewhere in between and could be supported to deliver them through training but their enthusiasm is probably variable.
    The difficulty of trying to reform healthcare strategically is how to incentivise behaviour change to get the best out of the people who do this well by choice and expand this to the ones who are very poor at it.
    In my experience this tends to default to two approaches: either we assume the best of people and ask everyone to deliver a change in practice as a matter of course (i.e. dentists are asked to deliver talking therapies to those who they believe are at engaging in high risk behaviour), which means that the good people do it well and the less good people do it poorly, and results in some patients feeling insulted and patronised.
    OR we assume the worst of people and micro manage implementation (i.e, all dentists are required to deliver talking therapies…. in order to deliver talking therapies you will need to undergo a 2-day ‘talking therapies’ training course.) These are normally linked to performance measures (90% of all dentists are required to complete a mandated training course by 1st april 2013) – by which point any sane person has lost the will to live. The dentists who were naturally good at this resent wasting their time on a training course and those who are poor at it are unlikely to change their behaviour by being hit with a stick. Again resulting in poor patient experience. (it is also costly and time consuming).
    Which is starting to make me think that there has to be a better way of incentivising behaviour change than looking at it through a systems approach. Interesting conversation this week at work about how “kind” the NHS is, or isn’t, to its staff and its patients and whether we really value “kindness” alongside “productivity” and “effectiveness”. Encouraging more constructive engaged behaviour from professional may be due to a values change rather than a system change? To get dentists t engage in cancer prevention is not by demanding they change their practice but by shifting what it is we value from our dentists????
    Anyway, back to work……

    • 4 mikerowe April 19, 2012 at 2:00 pm

      You are, of course, right. We do need to think differently about what we ant and how we incentivise public service professionals (not just dentists). I think we also need to recosider what sort of organisaions we have within and between which those individuals operate. I should stop being too negative and try and pose the issues and dilemmas more positively – mea culpa

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