You pays your money and you takes your choice.

Lancaster city centre.



The Monday Morning Quote #373


Go to the end of the path until you get to the gate.
Go through the gate and head straight out towards the horizon.
Keep going towards the horizon.
Sit down and have a rest every now and again,
But keep on going, just keep on with it.
Keep on going as far as you can.
That’s how you get there.

Michael Leunig

I have come across the work of (Michael) Leunig recently, he’s an Austalian cartoonist, writer and thinker.

Here’s a link to his website.

It happened – so here’s an Irish take on “Brexit”.

image-20160619-11135-13fpgkx_2One of the pleasures of living outside the UK and, for the moment anyway, being able to visit freely the country where I pay income tax, is listening to and reading other opinions of the land where I spent my first 60 years. I am no longer a UK citizen, I gave up a dozen years ago as my way of saying to Tony Blair, “not in my name”, when he sent another collection of young men off to die for his vanity.

The phrase “to see ourselves as others see us” was written by a Scot, Robert Burns. These are not my words but I wish they were.

Fintan O’Toole on Brexit: Is England ready for self-government? from the Irish Times via Memex.

Is England ready for self-government? It’s a question that the English used to ask of peoples less obviously made from the right stuff than they are, such as the Indians and the Irish. But it’s time they asked it of themselves.

Brexit is essentially Exit: if the Leave side wins the referendum it will almost certainly be without securing majorities in Scotland or Northern Ireland. For all the talk of reasserting the sovereignty of the United Kingdom, the desire to leave the European Union is driven above all by the rise of English nationalism.

And the chief consequence of Brexit will be the emergence of England as a stand-alone nation. Whatever entity might eventually emerge from a tumultuous breach with the European Union will almost certainly not, in the long term, include Scotland: a second referendum on Scottish independence will be inevitable, and this time Scots would be voting to stay in the EU.

It may or may not include Wales. (A resurgence of Welsh nationalism in reaction to the rise of English nationalism seems possible.)

And its relationship to Northern Ireland will be increasingly tenuous and fraught: if nothing else the Brexit campaign has made it abundantly clear that what happens to the North scarcely merits an English afterthought. The kingdom founded by Boris I will, in time, come to be bounded by the English Channel and the River Tweed.



Michael O’Leary calls it wrong…

But I’m sure he will make the best of things…

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Chris Baker on the Dos and Don’ts of Email Marketing

Postman with envelope and e-mail sign. Isolated

A great article that first appeared in Dentistry.  Written by Chris Baker from Corona Dental Marketing.

As a practice, one of your most valuable resources is your existing patient database. The most cost-effective way to communicate with this base is via email – this is why you need to be doing it. Here are my top 10 tips on using email to the benefit of your practice, and a few things to avoid.

Top 10 email marketing tips

  1. Spend a little time working out what might appeal to your patients and what you would like to promote
  2. We have found that a mix of practice news, treatment education, promotions and dentistry in the news (for example the sugar tax) works best
  3. Don’t just sell, sell, sell. Consider these emails as an informative newsletter and write accordingly
  4. ‘Storyboard’ four to six emails in terms of treatments, practice news, promotions and so on – fail to plan, plan to fail!
  5. Consider your subject lines very carefully. Most campaigns will prosper or fail depending upon the quality of these. What would make you open it?
  6. Export all your data into an Excel spreadsheet, having first removed data on all patients aged under 18
  7. Use third-party email marketing software such as Mailchimp or Dotmailer. These will provide large amounts of useful statistics such as open rates, what was clicked upon and so on
  8. Keep the stories short and sweet. If they are longer, host them on your website and include a link to them in the email
  9. Ensure that you have plenty of clickable content in the emails – this means you can measure what those who opened the email wanted to read
  10. Review your reports regularly so that you can tailor future emails to what your audience has expressed a preference for.

Things to avoid

  • Don’t try and include everything in the first email
  • Don’t send emails on Mondays – most people are busy and open rates are generally lower
  • If you have nothing to say, don’t send it! Hold fire and send out an email next month when you do.

When are notes contemporaneous?

3D clocks

  • Contemporaneous – This is defined as an accurate record, made at the time, or as soon after the event as practicable. It is a record of relevant evidence which is seen, heard or done, by the maker of the note. EVIDENCE ACT 1995 – SECT 72.
  • Contemporaneous – records should be made at, or very close to, the time of the examination, treatment, observation or discussion, and they should be dated and signed legibly. Dental Defence Union

I was a relatively early adopter of computers in practice management, an Amstrad PCW256 in 1988 was followed by something that ran on 4.5″ floppy discs in 1990. Finally a very neat little system called Dental Practice which was put together by a dentist and his brother, a programmer. This was bought out by Denplan, sold on to a supplier subsidiary of Henry Schein, possibly Kent Dental or Rexodent, then left to wither on the vine and finally became part of the SoE empire when the users were told that it wouldn’t be supported any longer so why not move to Exact? A friend of mine explained the means of the growth of computer software, and other, companies this way, “buy up the opposition and close them down”.

The one area that I resisted, through choice not by being a laggard, was the writing of clinical notes.  I was taught both as an undergraduate in Newcastle and especially during my six months in the trenches as one of two resident housemen in Oral Surgery at The London Hospital that my notes were to be coherent, comprehensive and contemporary. It didn’t matter where you were, what the time was or who was waiting for you, write up full notes and sign them. “Be prepared to stand in a courtroom in 10 years” said Brian Littler one of the two Senior Registrars, “and be cross examined, with only your notes to remind you of what went on.” My handwriting isn’t the best, but it is mine. My thoughts in those days were pretty coherent because of the excellent systems that we were taught and the notes reflected that. (I did have to write a report some 10 years later about one incident that lasted fewer than 20 seconds yet had repercussions. My notes, forwarded by the investigators, brought everything sharply into focus.)

“Never ever let anyone else write your notes”, I was told, “certainly don’t delegate them unless you can read everything that has been written and can amend and then countersign it.”

Having worked in (quite) a few practices after selling, and before establishing myself with enough coaching and consultancy work to keep body and soul together, I came across some variations in the way that notes were written. By now probably 60% – 70% of practices were able to write notes using the computer software. My feelings then, and still, are that too often the software is driving the record keeping process rather than the other way round.

  • Nurses writing everything and closing the notes before I could see them.
  • Branded as a troublemaker for insisting on seeing and checking the patients’ medical histories.
  • A nurse criticising me for being picky for writing ridiculously long notes that, “nobody will ever read.”
  • Being told that there was no time to write the (paper) notes and that I would have to do them at the end of the session.
  • Not being happy with the treatment screens meaning that I “only” had to adapt to and make my notes fit the proformas.

So I was concerned to read of a new set up on one of the leading software suppliers’ systems which means that,  “you can now charge whatever you want through but have the rest of the day to alter and finish your notes on that same patient without having the notes locked”.

That doesn’t sound like the notes will be contemporaneous to me, but perhaps people have better memories than I did?


The Monday Morning Quote #372

“You don’t sell anything to anybody unless you think they are going to come back for more.”

Sam Rogers / Kevin Spacey

Margin call

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