To read part 1 click here!
Once we've moved on from that initial discussion, we can then move to your experience of specialists in the modern world, which is often extremely frustrating.
Let's go outside dentistry for a minute, though, and go into the hospital service.
I want to recount to you just some little musings of when my late father-in-law was ill in hospital with what seemed to be multi-system organ failure.
It started with a kidney problem and then progressed to various other parts of his body, but it was literally almost impossible to get an answer from anyone because all everyone wanted to do was pass it to the next expert and the next expert.
I made the mistake of thinking that everybody I saw in the hospital who had a white coat on was a doctor, but it turned out that none of them were doctors; they were all specialists.
Being a specialist like this allows you to abdicate the responsibility for your general knowledge.
One of the best doctors I have ever known is Philip Hollows, my friend who was my registrar in maxillofacial surgery (doubly qualified) and who went on to be an extraordinary head and neck cancer surgeon.
Phil carried a stethoscope in his pocket; he was always able to listen to a patient's chest or prescribe the medicine that was appropriate, but he was not a surgeon. He was a healthcare professional.
And this is where I turn my attention to dentistry. I have had the privilege of running a specialist dental practice for over 17 years. I've worked with many specialists inside and outside of my practice and now in the ITI on a global level.
I am a specialist. I am a specialist in oral surgery, which seems honestly a little bit ridiculous.
I am of the honest opinion that dentistry is a subspecialty of medicine, and therefore, it's not necessary to break dentistry into specialisations such as oral surgery, endodontics, molar endodontics or upper left first molar endodontics, upper left first molar mesiobuccal canal endodontics.
Everybody wants to run into a narrower spectrum, but the patients who sit in front of you are not in that spectrum.
If we carry on in the discussion here about how education has developed around the specialist obsession, everyone wanted a master's in a specialist subject; everyone wanted to do some sort of specialist training; everyone wanted to be an orthodontist because the gravy train of NHS orthodontist looked like the biggest paycheck in the world.
But for the people that I have worked with, and the ones that I work with now in our Clinic, the best guys, the Andy Legg's, the Alex's, they're generalists. They can see a patient, open a root canal, extract a tooth, scale a tooth, crown a tooth, place an implant, place a bone graft, define, decide, and prescribe maintenance aftercare; that's what a good practitioner - start to finish.
No, actually… that's what a great practitioner is.
It's easy to be a specialist (I am a specialist), narrow your field of view, and concentrate on one little area. It's really, really hard to be even an average generalist.
If you are a general dental practitioner in practice, trying to do the right thing, you have to be a jack of all trades and a master of all. It is so hard to do your endodontics appropriately, to do your crown preps as well as you can, to be good at extracting, to understand the options for patients, to understand the materials that you're using, to understand the filling materials, the bonding materials, the crown materials, the suture materials, all of that stuff which makes it so difficult. It's why when someone has mastered this, they're brilliant.
Add the initial patient consultation into all of this.
If you are a specialist, sitting in front of a patient for a consultation whom you have never met before, your vision is narrowed so much that you cannot see the wood for the trees.
The final thing to consider about specialists is that for many of them (and I am speaking from direct experience here), the specialist title seems to come with some sort of ego bubble that they are better than other people, and it's quite astonishing to watch. They seem to think that they are more valuable, by right, more talented, by right, more likely to be able to run a successful business and more likely to be able to lead a team.
That is utter bullsh*t.
All of those other skills are learned outside of the specialist environment.
And so for young dentists now that I'm speaking to regularly, my advice is this: create your own pathway (that would be what AI was for), decide your 5 or 7-year pathway from qualification and learn from the best people you can in all the skills that would make you a successful clinician.
Be the best diagnostician you can be, and understand diagnostics and diagnostic planning as well as you possibly can.
Be a brilliant photographer and a brilliant, even better communicator.
Be as honest as you can and think about the long term for patients, but assume that what you will do will not work for the rest of their lives and understand that the more of their care you can provide them, the better it's likely to be.
Generalists are on the hook for all of it: education is changing, GDPs are changing, and access to information and courses is changing.
The specialist is dead.
Long live the generalist.
Blog Post Number - 4091