Tales from Phoenix #1 – Orthodontics

logo_scuba diver_vert_FINLast week I spent two days in Phoenix Arizona at the excellent ConationNation conference organised by Kolbe Corp. The conference was as inspiring and educational as usual and, as ever with these things, one learns much during the breaks.

One of the great conversations was with someone who works for a brokerage that sells orthodontic practices and therefore finds suitable purchasers for them. The costs involved means that it is rare for anyone to be able to buy a practice upfront and a period of associateship / purchase is involved. (That’s another conversation with relevance to the current UK market). What she didn’t know about the finances of orthodontics wasn’t worth knowing; so that’s treatment patterns, types, costs involved, etc etc. She has 12 years or so experience purely in the orthodontic business (and a background in dental management prior to that) and Initiates in Fact Finder and really knew her stuff.

She has watched the rise of General Practice led orthodontics and the effect that it has had on both specialist and general practices amongst other phenomena. Invisalign has led and promoted, and continues vigorously to promote, the commoditisation of orthodontics – so people are buying a thing first and foremost, not a personalised service. In the USA people are more often buying purely on price – a price that is reducing all the time. The numbers that need to be seen would make the NHS look like a doddle – one orthodontist seeing 120 patients a day – sure they are delegating to assistants but….

We agreed our conclusion by saying the same phrase at the same time, that in view of the widespread availability of treatment, “it’s a race to the bottom”.

OK in the (USA) it’s a more mature market, but there are significant lessons to be learned ahead of the same thing happening on the eastern side of the Atlantic – or is it too late? The only people making real money are the ones who sell the tools, toys and systems or perhaps the ones who put right the treatments that go wrong and there are plenty. And let’s not forget the lawyers who chase them.

White House Report Concludes That Bite-Mark Analysis Is Junk Science

Don’t shoot the messenger..

imagesTHE PRESIDENT’S COUNCIL of Advisors on Science and Technology has concluded that forensic bite-mark evidence is not scientifically valid and is unlikely ever to be validated, according to a draft report obtained by The Intercept. The report, titled “Forensic Science in Criminal Courts: Ensuring Scientific Validity of Feature-Comparison Methods,” is marked as a “predecisional” draft created August 26 that is not to be quoted or distributed, though the title page suggests the report will be made public sometime this month.

Continues here


How to protect yourself from unwanted customer feedback….

There is a PS to this story which I’ll put here. Expedia did make contact with me after my comments and were sympathetic and understanding about the problems that were caused by American Airlines. (Just saying, “I am so sorry to hear what you went through was a great start”). I am now attempting to get American Airlines to listen to my feedback.

I described the problems of my  journey from Phoenix to Dublin with a couple of travelog postings on Facebook. I am fully aware that stuff happens, what makes the difference is how the provider of a service deals with problems. American Airlines were poor, it felt like they didn’t care about their customers. British Airways picked up the discarded baton and it felt like they did care.

Expedia sent me an email yesterday at 00:53 which I received when I was eventually on the ground with another flight to come – this time unplanned.

Here’s the email:






Here’s what happens when you click the red face.




Smart deduction guys…but how do I leave feedback?

The Monday Morning Quote #386

“Humankind seems to teeter between hubris and paranoia: the hubris of our ever-growing power contrasts with the paranoia that we’re permanently and increasingly under threat. At the zenith we realise we have to come down again…we know that we have more than we deserve or can defend, so we become nervous. Somebody, something is going to take it all from us: that is the dread of the wealthy. Paranoia leads to defensiveness, and we all end up in the trenches facing each other a cross the mud.”

Brian Eno (Feb 2016)


If only he had worn a suit and tie….

jackboots-2The CQC Borg will decide….

…..in 2014 when the inspectors last came. He had explained his philosophy and modus operandi, talking of medicine as an art form, “being a human being so patients feel they know well me enough to trust, while maintaining boundaries – compassionate detachment, I call it.”

“On that occasion,” he will recollect later, “they seemed concerned with seeing whether I was running a healthy, happy, well-functioning practice. They looked at feedback forms, talked to patients and made intuitive judgment.” They gave him a glowing report.

This time round…read here.

Michele Golden, head of inspections for London at the Care Quality Commission, says:

“We know, from various inspections, that patients will say how happy they are, and it may be that their doctor is a very nice person, but that doesn’t mean they understand if the system is actually unsafe for them.”

It would seem that Nanny may not always know best…but she holds all the cards.

There has never been a serious complaint against him, and he is exceptional in not having been called for a disciplinary hearing in all his 40 years as a GP.

Although he could continue practising as a doctor, his surgery must close with immediate effect.

The Monday Morning Quote #385

“Overnight success usually takes a decade of uphill work.”

Sam Altman

Source here

The Good Practitioner’s Guide to Periodontology – Launched!

screen-shot-2016-09-13-at-15-56-36Philip Greene changed my life in a hotel room in Leicester.

In Autumn 1987 I was having one of my off periods in my on/off affair with dentistry. I had been working as an associate in a nice new-build practice for a couple of years and was negotiating to buy a share. To my surprise the owner gave me the news that he had sold the practice and the new owners would be taking over “later that week”. The new owners sacked the two hygienists and were were soon encouraging me, “to do at least four crowns on every patient”, as I was, ” a nice guy and wouldn’t have any problem convincing them.”  I found another job, gave three months notice and was subsequently locked out, there had been a (totally false) allegation of my telling patients where I would be working next.

Move on, and I started work in the next practice, it had a new-build branch without an autoclave and a main location with no hot water…

Two courses marked that period firstly was Stockport Dental Seminars’ “Introduction to Occlusion” or the “Battle of Bolton” as it was affectionately known where Roy Higson removed many scales from my eyes. The other was Philip Greene and David Cohen’s evening on perio and endo respectively. The approach to perio was totally different from anything I had been taught as an undergraduate or that practised in any of the practices where I had worked.

I bought 6 CPITN (aka BPE) probes, they were the only ones in the practises where I worked, and set about examing people for signs of periodontal disease. I was a convert, the new zealot took the very first BUOLD course in periodontology with the wonderfully outspoken Marsh Midda and Jerry Rees, joined the BSP and eventually married a hygienist!

I still treasure Jan Lindhe’s textbook and also Colgate’s literature on examining and diagnosing.

So I was delighted to see that the BSP have launched The Good Practitioner’s Guide to Periodontology. It is available as a PDF here and online here. Do take the time to take a look and even consider joining a society that has always been relevant but is most definitely on the up.

Bonded v Vacuum formed retainers? Kevin O’Brien’s blog.

screen-shot-2016-09-12-at-10-06-20It was interesting that there were no differences between the retention regimes.  As a result, I think that our patients should decide on their retainer.  We should  outline the various risks and benefits of wearing and maintaining these two different types of retainer and explain that there is no difference in their effectiveness. Most of our patients should then be able to take an informed decision on their retainer.

Full article here.

The Monday Morning Quote #384

“Sometimes you have to jump off cliffs and grow wings on the way down.”

Ray Bradbury,

Ray Bradbury with his hands out, circa 1980. (Photo by Michael Ochs Archive/Getty Images)

How to make better decisions: consider two options rather than just one.

From John Naughton’s blog.

It’s not rocket science.

Ohio State University professor Paul Nutt spent a career studying strategic decisions in businesses and nonprofits and government organizations. The number of alternatives that leadership teams consider in 70 percent of all important strategic decisions is exactly one. Yet there’s evidence that if you get a second alternative, your decisions improve dramatically.

One study at a medium-size technology firm investigated a group of leaders who had made a set of decisions ten years prior. They were asked to assess how many of those decisions turned out really well, and the percentage of “hits” was six times higher when the team considered two alternatives rather than just one.


That 70 per cent figure is interesting.

Plan A or B Choice Showing Strategy Change Or Dilemas

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