How To Win The Rugby World Cup.

RUGBY WORLD CUP & BALLWorth re-visiting Graham Henry’s article from The Guardian on how to change from losers to winners. Lessons here for anybody involved in selecting, guiding and leading teams. It’s all about the preparation.

“Graham Henry looks down at the grass of Eden Park. So many matches, so many memories. One wells up above the others. 23 October, 2011, the World Cup final, New Zealand 8, France 7. The culmination of a 37-year career that started when Henry took charge of Auckland Grammar’s under-15 team. “When I was coaching the All Blacks I was probably the most experienced coach in the world,” Henry says. “That’s not an arrogant statement, it’s a fact.”

Henry moved from school coach to province coach to Super Rugby coach. Then there was Wales. They lost in the World Cup quarter-finals in 1999. That was followed by a poor tour with the British & Irish Lions in 2001 that ended in a 2-1 defeat by Australia. Another spell with Auckland, in rugby rehab. Then, at last, the top job. Head coach of the All Blacks. In 2007, came the hardest defeat of all, another quarter-final defeat, by France in Cardiff. For Henry, it was a long road to the 2011 final. These are the pick of the many lessons he learned along the way.

Culture comes first
Henry took on the All Blacks job in December 2003, but he did not really take charge for another 12 months. After New Zealand’s defeat by South Africa at Ellis Park in August 2004, the team held a mock court session. Two senior players, Justin Marshall and Carlos Spencer, passed down the punishments. Mostly they involved downing alcohol. Almost everyone ended up blind drunk. Henry realised then the squad had become dysfunctional. Back in New Zealand, Henry and his assistants, Steve Hansen and Wayne Smith, met two senior players. It was the most important meeting Henry had in his eight years in charge. “We agreed we had to move away from that macho culture.”

The next paragraphs are headed:

  • Check your ego
  • Empower your players
  • Be smart, be secretive
  • Confront your weaknesses
  • Expect the unexpected

Continues here

The Weekend Read – No Place to Hide by Glenn Greenwald

UnknownThis is not a book about dentistry, business, rugby or rock music. Nor is it a work of fiction although some of the press and a great number of politicians would you have you believe that it is.  It’s an unusual one for me to mention here but why not share what could prove to be revelations that have profound implications for the way that we live our lives, the way our governments behave and how we look upon the use of the day to day information we take for granted?

The story of Edward Snowden, the NSA and the US surveillance state has been told and re-told in public, yet I feel its full ramifications are not understood. The fact that the US government records all telephone conversations, emails, Skype conversations and internet activity not only of its own citizens but also of anyone whose email traffic passes through the USA (ie the rest of us) would be far fetched if it were not true.

My brother introduced this to me and I watched Laura Poitras’ Oscar winning film CitizenFour with him. As he said at the time, “it’s bloody terrifying”. He’s right.

What staggers me is not the high handed way the NSA act – we should be used to the repeated paranoia of the US from J. Edgar Hoover, Richard Nixon and George W Bush but the fact that the UK government condones, encourages and joins in through the “Doughnut in Benhall” or GCHQ as those outside Cheltenham know it. I always presumed that my patients who worked at GCHQ were secretive because they knew things about the Russians or the Chinese but now I wonder if it’s because they had information about me.

The courage shown by Snowden, author Greenwald, Guardian journalist Ewan MacAskill and film maker Poitras is inspiring. I would like to think that I might be a tenth as brave.

The tale unfolds like a good thriller starting with a meeting with a mystery man in Hong Kong, then there is subterfuge, tension about publication and a race against time to get the scoop. The only thing to remember is that it’s true.

“it’s bloody terrifying”. Quite.

You can buy it through Amazon, or the Book Depository – just remember “they” will know that you have read it.


The art of dying well – Margaret McCartney

Quantity or Quality?

An excellent article in the Spectator by Glasgow GP Margaret McCartney where she asks the question, “Do we want to live as long as modern medicine allows us, or only so long as life is sweet?”

Death is our only shared destiny, but we are in a new era; it’s not unusual to have 70-year-olds looking after a 90-year-old parent. A few years ago we had to reorganise the shelving in the general practice where I work in order to accommodate the notes of our octogenarians and nonagenarians. In 1917, King George V sent out 24 messages to people having a 100th birthday. In 2011, the Queen sent 9,736.

This is worth celebrating. Just before Christmas, I was languishing in a long queue at the Post Office where a 93- and a 94-year-old were holding court, debating the standards of humour in the greetings cards display to such uproar that the postmistress had to pause to wipe tears of laughter away. Age does not mean a loss of fun, vivacity, or pleasure in living.

But age is still the most potent risk factor for death, and many older people at the end of life have its quality impaired by loneliness and, frankly, too much medicine. If we want good living right up until we die, we should be examining what makes it good — and what stops it being so.


PS For the past 45 years I have churned out a few lines of Roger McGough’s poem “let me die a young man’s death” when death and dying comes up in conversation, I find he has re-written it as, “not for me a young man’s death”….

The Monday Morning Quote #341 – Thomas Leonard October #4

“Tolerate Nothing”

“When you put up with something, it costs you.

Costs are expensive and unattractive.”

Thomas Leonard from ‘The 28 Principles of Attraction.’

Dental Showcase Day 3

Some of the feedback I heard was that the show was quiet and that numbers were disappointing. That said I also heard that on Thursday people came to buy and a lot of sales were made. No doubt the BDIA wil analyse the figures and come to their own conclusions. One suggestion I heard was that Showcase should be reduced to 2 days, Friday and Saturday. Of course The Dentistry Show which also provides loads of free CPD provides a great attraction for dental dealers although the feeling there this year was that there weren’t many people there either who wanted to buy.

  • As usual on Saturday there were families, I watched one harassed mother feeding her fractious infant sweets in an attempt to keep him quiet. Sometimes you despair.
  • As usual on Saturday there were some hangovers on display, it’s a social event too .
  • As usual on Saturday there were a lot of very tired legs and feet by 3.30pm – it’s a test of stamina.

Over the years I have watched trends come and go. Computer systems, membership schemes, tooth whitening methods, loupes, have all settled down with the survivors still doing good business.

  • We’re still seeing lots of “STO” systems but there weren’t any new kids on the block this year.
  • The locum agencies are doing good business reflecting the highly mobile nature of today’s marketplace which sometimes is like a game of musical chairs with unhappy associates and hygienists constantly searching for the greener grass.
  • Finally the sales of practices continues unabated – as the baby boomers try to *cash in / *reap the rewards of their years of hard work. (*Opinion varies with age, of course. I have seen several mature dentists revise their opinions of corporates when the cheque book appears).

 The big firms put on a good show:

  • Henry Schein were taking things very seriously with their stand on 2 levels.
  • Dental Directory occupied what looked like a very large corner of the arena. At one point I counted 40 pink shirted sales people. So many that there seemed little room for visitors – nice to see that they have maintained their cafe.
  • The “Big 2” computer companies SoE and Exact each had a significant presence.
  • I was taken with the elegance of the Kavo stand and noticed that Dentsply and Schottlander were both very busy.

For every large firm there are always several smaller businesses manufacturing, selling or servicing materials, equipment and services. It’s them who are the life blood of the BDIA, every Henry Schein and Wright Cottrell starts with one person with a vision and a desire to make something happen and it is this diversity and choice that makes the dental industry fascinating.

Next year Showcase will be at Excel in East London on October 6th – 8th and I’m looking forward to it already – long may it prosper and thank you BDIA for everything you do for Dentistry – Dentists and their teams couldn’t do it without you.


Dental Showcase Day 2

IMG_0742The photograph above is of the entrance tunnel to the exhibition hall, I heard it called disturbing, weird, uncomfortable and off putting. It reminded me of an 80s pop music video with something of David Bowie’s Stage about it.

On my second day I enjoyed several successful meetings and had some time to catch up with friends and colleagues. Amongst the conversations were a few of the “what the hell did they think they were doing?” and “how can they get away with that?” with Jonathan Jacobs. Stories of broken partnerships and misunderstandings that could and should have been avoided by conversations at the start of a relationship whether business or clinical.

Thirty odd years ago I was “turned on” to perio by the late Marsh Midda, John Zamet and Bernie Keiser, I was considered odd by some of my turbine toting contemporaries. I presumed that by now, with caries under control, all hygienists would be fully booked and at the heart of every practice. According to the BSP it seems that a large number of dentists still don’t do the BPE as a matter of routine and screen for periodontal disease with their eyes only. Two concerns, firstly there is the obvious clinical one of under-diagnosis and second why let work, cash and profit walk out of the doors?

At the far end of the hall were the booths where societies including ADAM, the BSP, BSDHT, BADN and Dental Fusion had representatives. These volunteers do great work on behalf of their members and are well worth taking the time to visit.

I dropped in for a catch up with Ian Pinner of Ceramic Systems, CADCAM and Cerec is alive, well and flourishing I’m pleased to say. Yet again I am forced to eat my words of two decades ago when my uncle described CADCAM and its use in engineering to me. “That would work well in dentistry” he said, “I very much doubt it” was my reply. Wrong for not the first, nor the last, time.

After my comments yesterday about the BDA, I spent some time having BDA Expert demonstrated to me, it’s impressive and all the better for being easily accessible on-line. I still think they (I know that should be “we” as I’m a Branch President) could and should do more to try to attract new members.

Once again towards the end of the day neatly branded FMC Bar was welcoming, there is a great sense of professionalism in everything that FMC does.IMG_0739

I spent the evening at the Bridge2Aid Bash. At the supporters’ reception before the “Bash”, Mark Topley gave an excellent summary of the charity’s work and future plans. His passion for the “project” is clearly undiminished.IMG_0743

At the end of the night I was fortunate enough to be able to cadge a lift back to my hotel in downtown Birmingham – thanks to Richard from taxis4coaches.

Dental Showcase Day 1

logoA few thoughts after what seemed to be a very quiet day at BDIA Dental Showcase at the NEC.

It seems that Day 1 is “buyers’ day”, several people told me that they had met with customers who had come prepared with a shopping list and placed big orders.

Day 2 is “Team Day” when Dentists cloes their practices and give their staff a treat by taking them to the NEC.

Day 3 was described to me as “Buggy Day” featuring the sight of dental parents and their offspring blocking the aisles, loading the carrier bags onto the handles of the baby buggies. The result is they can’t let go of the buggy handles as the thing will tip backwards.

What did I see? A few picks. SFD – Systems For Dentists – continues to impress me, since I first played with their product half a dozen years ago they have continued to make steady progress. They are a firm that talks your language, doesn’t try to impress with jargon or clever but pointless features. The software does what it is supposed to do without fuss and is very reasonably priced.

A new treatment for clenching, grinding and associated problems was being launched by Renew Health Ltd, it’s called Cerezan and works by using a small, custom made insert in each ear. Take a look here.

I picked up an excellent little text book, Getting What You Want From Orthodontics, from the Wired Orthodontics stand. Wired, The Artisans of Orthodontics, is run by Specialist Orthodontist Ian Hutchinson and Laboratory owner Sue Bessant. In a world that is full of systems making all sorts of claims – especially get rich quick – the teaching, training and support provided by Wired is good to see. I am fortunate to work with two of their “graduates” and know how much they appreciate their time spent.

The two big Dental Charities continue to do their great work with both Bridge2Aid and Dentaid having stands.

The BDA seemed to be busy pushing a “system” rather than attracting new members and listening to their current ones, but there was a welcome.

I dropped in at the GDPUK “seating area” and took advantage of the chance to rest my legs for 10 minutes. Presumably the members were all busy in their virtual world as nobody joined me – I’ll try again today.

Practice Plan’s Business of Dentistry theatre seemed to be busy all day and as ever their people were welcoming.

Had a few interesting conversations with solicitors agents and accountants who are in a position to see changes happening through the sales of Dental Businesses.

Towards the end of the day and people were starting to unwind – helped by some fizz from DPAS and a glass of beer at the FMC “pub”.

One notable absentee this year is GSK. The company behind Sensodyne, Corsodyl and Aquafresh doesn’t have a presence, shame.

More tomorrow – enjoy your day.

Narcissistic leaders – who do you know who fits the bill?

From “The” piece, “The appeal of narcissistic leaders is also their downfall“.

It left me thinking about those I have trusted, why I have trusted them, which have disappointed me and how quickly. (why is that Tony Blair is the first person to come to mind I wonder?).

“From the sports field to the battlefield, from business to politics, ineffective leaders often shoulder the blame when things go wrong. Perhaps we should be more careful about who we put in charge. Our research has found that your personality – and how narcissistic you are – is linked to how effective you are as a leader. We found that narcissists may appear to be good leaders early on, but they soon fall out of favour.

U.S. Republican presidential candidate Donald Trump takes a selfie with a supporter as he prepares to leave a campaign event in Anderson, South Carolina October 19, 2015. REUTERS/Chris Keane TPX IMAGES OF THE DAY - RTS5663

Republican presidential hopeful Donald Trump has been called a ‘textbook narcissist’.

As we choose the leaders around us, we often think we are making informed choices about who is most effective. But our research suggests that this is not always the case. In fact, we are more likely to select as leaders those people who display narcissistic traits.

Those who score highly in narcissism tests believe they are special people who are superior. They also report high levels of confidence, are focused on themselves at the expense of others, and are vain. These overly positive views of themselves help narcissists to perform very well in situations that offer them an opportunity for personal glory, such as performing under pressure, performing tasks that are difficult, and doing things in the presence of others.

But when they perceive that there is no such opportunity, narcissists withdraw their effort and perform poorly. Because narcissists are so focused on personal glory they can be difficult team members; yet they might make good leaders. Positions of leadership provide an opportunity to gain glory from others and so are likely to be attractive to the narcissist.

The leader ship is sinking

Others have researched and written about the idea of narcissists as leaders, but until now there has been no evidence of whether or not narcissists actually do make effective leaders in the long term.

In two studies, we assessed people’s narcissism using the Narcissistic Personality Inventory – a standard narcissism questionnaire used in psychology research. Example items include: “If I ruled the world it would be a much better place” and “I am an extraordinary person”. People were asked to score themselves against these items on a scale of 0 to 40, with higher scores indicating higher levels of narcissism. Our mean scores were just under 14 for both the studies which is consistent with most research using similar participants.

We then asked people to work in small groups, completing weekly tasks for 12 weeks. Examples of tasks included naming all the Team GB medallists at the 2012 London Olympics and identifying the states of the USA on a blank map. In the first study (using 112 first-year students, 71 men and 41 women, working in 24 groups in their first semester at university) we deliberately allocated people to groups so that they would be unlikely to know each other. In the second study, we used individuals who knew each other reasonably well (152 final year students, 96 men and 56 women, working as part of 29 groups) and let them choose their own groups.

Both during and at the end of the 12 weeks, the participants rated each other on their leadership effectiveness. The results were striking. Initially, the people who had scored highest on the narcissism test were rated as highly effective, but as time went on these positive perceptions waned until eventually narcissists were seen as very ineffective leaders. Although we expected narcissists not to last long as leaders, we were amazed by how rapidly they lost favour with their group, and how negatively they were viewed by the end. Over time, the narcissistic leaders’ ships sank.

Are narcissistic leaders doomed to fail?

Our results showed that the group was initially attracted to the narcissist’s charisma and vision, which allowed the narcissists to rise as the “natural” leaders. But over a very short time, narcissistic leaders failed to provide their followers with appropriate levels of challenge or support. This ultimately led to their downfall.

Although our data painted a rather negative picture for narcissists in the long run, it is not all doom and gloom for the narcissistic leader. The challenge for them is to be able to harness their charisma and combine it with other factors such as humility or empathy, which should enable them to be seen as effective leaders over time. An extreme narcissist may not care what others think of them and may be doomed to fail in leadership roles. But there are other narcissism traits that may be more effective and even necessary, in some forms of diplomacy for example – such as narcissistic charm.

Being able to choose between leaders who we “like” in the short term and those who we believe will get the job done and be effective over time is not necessarily an easy task. Dealing with this paradox is vital to be able to ensure effective leadership in the long term.

Dentistry, Dermatology, what’s next?

I was the first born and studied Dentistry, my brother born 4 years later became a Dermatologist. I have wondered if there had been any more children they would have had to take up Endocrinology and ENT to keep the alphabetical order.

So I have had more than a passing interest in “Skins” and have listened to Jon’s stories of the attacks on this vital but overlooked area of medicine with disbelief. In this piece in Monday’s Guardian, “It took my patient six years to see me – a dermatologist”, the state of this particular piece of the NHS is spelled out. There is also a link to a “day-in-the-life” companion piece.

I am no great campaigner for the NHS, I think in many areas it is a spent, inappropriate, force. I feel that the repeated lies told over the past 36 years since Margaret Thatcher first coined the phrase “The NHS is safe in our hands” have only misled the population who would understandably prefer not to consider the alternative to the English religion.

Here’s the article:

It took my patient six years to see me – a dermatologist

Dermatology is a microcosm of the challenges facing the health service. It has reached crisis point

Why am I writing about dermatology? Surely the well-publicised crises in emergency medicine and general practice deserve these column inches. Dermatology is a small specialty where a slightly strange group of doctors choose to dedicate their careers to the treatment of rashes. Yet, dermatology is a microcosm of the challenges facing the NHS; like mental health and sexual health it is a specialty that has suffered progressively through NHS reforms and has now reached crisis point.

Imagine you have a rash or a growth on your skin and your GP does not know what it is or how to treat it. It may be scary – is it a skin cancer? It may be itchy, sore, bleeding, painful or looks awful. You are not alone, you are one of the 13 million people who consulted their GP last year about a skin problem and now you are one of the 750,000 referred on to see a dermatologist. These are big numbers, skin disease is common and the impact of skin disease is similar to epilepsy and chronic kidney disease.

It is clear that you need to see a consultant dermatologist, the one specialist who has the experience and expertise to help you. One quick trip to your local hospital and you will be sorted, or so the government would like you to think. In reality this is the start of battle. Firstly your referral will be triaged, another GP or nurse will read your referral and decide if you really need that appointment, many referrals are simply rejected at this point. If you pass through this then you are likely to be redirected to a privately run community dermatology service. These services, run by international healthcare corporations, employ nurse specialists and GPs with an “interest” in dermatology to see you for the cheapest possible price. In some cases they do little more than take a photograph and send this to a specialist for an opinion. It is only once you have gone through this process that you can, if you are lucky, join the waiting list to see a consultant dermatologist. In England you will wait four or five months, in Wales waits of two years are not uncommon.

A few weeks ago I saw a lady whose life had been ruined by constant episodes of swelling of her face leaving her looking like a victim of a serious assault. Her GP had correctly diagnosed angioedema but did not know the cause or how to treat it. It took her six years to navigate through triage centres and community clinics before seeing me. I quickly identified that her blood pressure medicines was causing the problem and by stopping this tablet her symptoms resolved overnight. She was extremely grateful, yet could not believe the journey she had suffered through to see me.

Government reforms have decimated dermatology leaving only 650 consultants covering the whole of the UK. Skin cancer is the commonest cancer in humans and the rates of skin cancer are increasing at a staggering 8% year on year. Dermatologists simply cannot cope with the volume of work and many smaller departments have closed, recently even the large university hospital department in Nottingham has all but shut its doors.

Across the country there are examples of departments restricting referrals or even closing to new referrals. The government promises choice, yet if you choose to see one of the nationally renowned skin cancer dermatologists at University hospitals Birmingham you better hope that you have a south Birmingham postcode as if you don’t then they will not see you. A pattern of referral restrictions being repeated across the country.

There is now a growing acceptance that in many parts of the UK it is all but impossible to see a consultant dermatologist in the NHS. With a government limiting NHS investment to headline grabbing acute specialities, how long before the rest of the NHS follows in dermatology’s footprints?

and also worth a read: The dermatologist: shipping us out of hospitals would be a grave mistake

The Monday Morning Quote #340 – Thomas Leonard October #3

“Focusing on the problem reinforces it.

Focus on the results; problems will take care of themselves.”

 Thomas Leonard


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