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By Richard Pilkington FDS RCS
It was Shakespeare who wrote about the seven ages of man in As You Like It. In those days of olde, man progressed through these stages and inevitably ended up ‘sans teeth, sans eyes, sans taste, sans everything.’ Modern man still goes through these seven ages and it is your practitioner who leads you through your journey of life and helps you maintain your health. The general dental practitioner’s role is to educate patients so that they can achieve and maintain their oral health.
Journeyman
This is a term that comes from medieval times from the medieval trade guilds. Derived from French (journee = a day), they were paid on a daily basis and they served their apprenticeship in a trade and worked as a fully qualified employee. One started as the apprentice (dental student/VT/GPT) and progressed to the journeyman (associate) and finally the master (principal).
Life in little Britain
We can look at the seven ages that make up our development. Starting at:
1. Infancy
2. Childhood
3. Teenager
4. Early adulthood
5. Thirties to forties
6. Fifties to retirement
7. 70 plus.
Throughout this time, our patients’ health will change according to their lifestyle habits - a result of personal, financial and social circumstances. A practitioner has to assess these demands and how they will affect the patient. Patients will only offer this information in a trusting dentist/ patient relationship that develops over time.
During this development, the GDP will be screening the patient for various dental and medical problems, such as:
1. Caries ‘at risk’ patient
2. Periodontal disease
3. Orthodontic / orthognathic assessment
4. Oral cancer
5. Personal neglect
6. Medical factors (predisposing to xerostomia/ complicating dental treatment/coping abilities).
The illusion of doing nothing
If you watch a swan swim across a pond, you can only admire how gracefully it moves, almost without any effort. However, if you were to pop your head under the water you’d see two feet paddling like there’s no tomorrow. Why do we as GDPs always have to seen to be performing? We all know dental disease is preventable, and yet NHS dentistry is still driven by a ‘got to be seen to be doing’, fill/drill culture. We can’t appear to our colleagues as the swan moving gracefully, we have to look as though we’re paddling frantically and performing to target.
Landmarks in dental history
If you were to take a trip around the Royal College of Surgeons, you would soon realise that dentists have been pioneers in many fronts. John Hunter started the profession before advancing into general surgery. Anaesthesia was developed by a dentist. We are pioneers of providing expertise, treatment and advice to our patients so that they can have oral health. And yet at this current time of NHS reforms I feel unworthy to be in my profession. All I can say is that people will look back at this moment at the winter of discontent in the dental profession.
Skilled professionals are being reduced to fill/drill providers, with the bigger picture of oral health being excluded.
Where do we go from here?
I’m just a journeyman, trying to take my patients to reach that goal. My masters before me have built up practices to treat and educate their patients. Yet, the goodwill of the practice seems to have disappeared overnight. Practices no longer have patient lists - patients can now see anyone as a misguided attempt to tackle ‘access’.
Autonomy
NHS dentistry is grinding to a halt and GDP’s feel less and less able to fulfil their patients needs. In Shakespeare’s time, it may have been acceptable for man to accept that he was to going to lose everything. But this is the new millennium and patients want their health. As a journeyman, I want to respect my patients’ wishes. However, the new contract completely opposes this.
From what I have seen of the new contract, I feel that as a GDP, I will be unable to securing patients’ oral health and their dental needs.
Patients don’t want compromise and I don’t want to work in a system that is flawed either. Our patients are well informed and if we agree as a profession to accept this new contract, I can see it will only be a matter of time before the lawyers come knocking because we have failed as journeymen. If you’re already agreeing to sign the contract, get ready to start practising ‘Yes, your honour I readily signed the contract knowing to best of my interest that I would be unable to fulfil my professional duties in attempting to secure the oral health of my patients.’
Ignorance is no longer bliss.
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