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Dental common sense
8th Jun 2006
I don’t know what you do when you’re travelling, I read copies of New Scientist - a habit acquired in the sixties and still a constant thought-provoker. A couple of weeks ago, I came across an article on teaching computers ‘common sense’. This was defined by Einstein as ‘a collection of all the prejudices we acquire up to age 18’. A group of Artificial Intelligence scientists in the US has programmed a computer with some 300,000 concepts, like ‘snow’ and ‘cold’ and taught it the logical links between them. What interested me was that, compared to the average human three year-old, this computer had just 2% of the information already acquired by a toddler, the information that we somehow put together, process and use to make sense of the world around us. In the first week of May, the Department of Health published the first instalment of the Clinical Pathways Programme, intended to underpin the new dental contract, the Oral Health Assessment. Strangely, it made me think of the New Scientist article. When I first qualified, Yorkshire miners awaiting extraction (or decoronation) would say, ‘So, how long did tha’ take to become a dentist, then?’ On being told four and a half years, they’d add, ‘Whoar, one day to learn to pull a tooth, what did tha’ do with the rest o’thi time?’ I would (patiently) say that I learned to diagnose a patient, but isn’t that how we acquired our dental ‘common sense?’ We were lucky, we saw lots of patients. They needed lots of restorative, surgery, endo, perio, ortho and all that information kind of lodged in a matrix and was all processed each time a new patient walked in. That wouldn’t do nowadays. There has to be a linear pathway. This particular one, Oral Health Assessment, needs 68 pages of explanation. And it’s jolly thorough, with 16 printed pages of clinical notes, nicely designed and supporting all the protocols and processes endorsed by all professional bodies. However three things bothered me. The first thing was that the ‘average’ dental team took 32 minutes to carry it out (plus 14 minutes for the ‘average’ patient to go through the medical history sheets). This seems a bit unrealistic for one UDA, although this was just a pilot. No doubt it will be quicker on the whizzy new touch-screen IT program we’ll all get (in time). Whatever, I suspect it will soon become a contractual requirement of the NHS. The second thing was that as clinicians we don’t really process information this way. A simple framework (like Denplan’s Oral Health Score) is a good basis, but we form our diagnosis in lots of different, parallel inputs, don’t we? And with patient input along the way too. The final thing? Oh yes, the report is dated September 2005. Now why, I wonder, has it taken the Health Department eight months to release it? Perhaps I should use my common sense.
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