The Monday Morning Quote #580

“It is a good thing to follow the First Law of Holes:

if you are in one, stop digging.”

Denis Healey

 

Thought of the day 191114 – “Out of time”

From reestheskin’s blog, under the categories “Bullshit, NHS” Link HERE

At one time the words ‘manager’, ‘management’, or worst of all, ‘line-manager’ were alien to much of medicine or academia. Things still got done, in many ways more efficiently than now. It is just that our theories of action and praxis have been ransacked by Excel spreadsheet models of human motivation and culture.

It is the final line from the quote that those controllers of ‘managers’ should be scared of:

“The next recession will retard this trend but it is unlikely to kill it.”

Oh the places I will go – Part 3 – Bounceback

Part 1 – The World at my feet

Part 2 – The World at my feet – in pieces

18th March 1993

My 40th birthday and a very significant date in the life of my practice. In the wake of the 1990 NHS contract and subsequent clawback of fees a group of dentists in Gloucestershire “held hands and jumped” to remove our dependence on the NHS. Several of us had things in common, we were of similar age, had big loans and couldn’t see how we could square the circle of carrying on providing our best for patients and continue to make a living.

With the assistance of the fledgling group, Gloucestershire Independent Dentists (GID) and supported by each other, in the words of Judith Cameron, we leapt and the net appeared. Some practices changed overnight, I was more cautious and transitioned over a 12 month period, giving all my adult, non-exempt, patients one last NHS course of treatment. This enabled me to have a conversation about the why, how, when and who of the changes. In those days Denplan was just about the only game in town and Gloucestershire became “Denplan county”.

I dreaded making the change, I anticipated wholesale rejection, arguments, insults and my hard work unravelling in minutes. I couldn’t have been more wrong. Because I changed gradually, and every patient received a letter ahead of their next visit plus good PR from GID, the word had got round. I allowed time to talk to explain my motives and to offer alternatives. The overwhelming feeling was one of acceptance, some begrudging, some cancelled their appointments “on principle”, some disappeared and then reappeared. More patients that I expected just said, “I’m surprised it has taken you this long, you have been giving private service since you opened.”

Instead of it being a catastrophe it was a tiny bump in the road. At the same time I started studying with the Open University on their MBA course which was really useful but due to circumstances beyond my control I was never able to complete. I also enrolled with Dr Mike Wise’s year long restorative course which also made me raise my game.

So I found myself with a largely private practice. There was still a significant NHS commitment because of the number of children we had attracted, which took a lot of management but worked extremely well and became a model for others to follow.

Things were looking up, I had managed to get a mortgage after a couple of years of banks not wanting to touch me with a bargepole, had remarried and our son was born in early April.

Life was good and the challenges were under control. The work was no less hard but the road was looking smoother.

The Monday Morning Quote #579

“Listen up – there’s no war that will end all wars.”

Haruki Murakami

Kafka on the Shore

Mouth Cancer Action Month

The report can be accessed here

Oh the places I will go – Part 2 – The world at my feet – in pieces.

1st January 1991.

The world at my feet – in bits. 

A lot can happen in 28 months. After the rapid success of the first practice. Hubris set in and in October 1989, flush with arrogance, I opened on a second site. This time I spent (borrowed) big time. Growth was slower, I was spread thinner and interest rates went through the roof. 

My first wife had fled and started divorce proceedings. What property we owned was in negative equity. The bank, for some reason of their own which I have never understood, forced me to close the first (profitable) practice, leaving me with a long lease to maintain. I spent two consecutive Christmas and New Year holidays and every weekend doing on call sessions to generate income of any sort. Plus there was a new NHS contract to grapple with.

I couldn’t understand how I was working so hard yet seemingly getting nowhere. Dentists were successful weren’t they? I was certainly making money but not keeping any. It all seemed to disappear before I could get it. The bank were constantly snapping at my heels telling me what I already knew – that I was in debt. Bank managers came and went, each one less approachable and sympathetic than the last. 

A recession was apparent and interest rates had recently come DOWN to 14% after 12 months at 15%. With no money, no house and a huge pile of debt I had no choice but to succeed. 

My pride dented, but determined to succeed, I set about taking my business as seriously as I took my clinical practice.

 

Oh the places I will go Part 1 – The world at my feet

8th September 1988.

Oh the places I will go!

This was it. My first patient in my own practice. An adult, a female, she arrived with her mother. Neither of them could remember her date of birth. She insisted that no dentist had ever taken a medical history before or taken X-rays or looked at her gums or done an extra-oral examination.

That first patient felt like hard work. I had no idea how hard it was going to be. My little “cold squat” with the great big sign, in a converted shop on the A38, 2 miles south of Gloucester City. An £8000 loan from my father, a load of second hand equipment and a sofa bed in the backroom where my wife and I slept.

There was no shortage of ambition, excitement and fear. 

The weekly schedule began on Monday morning as an Oral Surgery Clinical Assistant, Pilgrim Hospital, Boston Lincs,. Monday afternoon, all day Tuesday and Wednesday associate in Peterborough. Wednesday evening the 130 mile drive to Gloucester. Thursday, Friday and Saturday morning in my own place. Then back home in Stamford to do the washing and sleep before starting the game over again.

It had taken so long to come to fruition that I had been unable to plan very much, as deadline after deadline slipped by my resolve wobbled but never disappeared. By the time it started it was almost an anti-climax. The second week in one of my two turbines died, a Kavo, almost new or so I had been told. I ordered an NSK, the cheapest one I could find. £80. It ran and ran and ran for nearly two decades, easy to repair, a wonderful workhorse it paid for itself probably a thousand times over.

After 5 weeks I went down to 2 days as an associate, by Christmas I had a close to full-time practice. It looked as if 1989 was going to be a great year, the prospects were good, the future looked bright.

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