Mistakes we didn't make, corporate responsibility

​ I worked for two corporates, I had letters from both of their  solicitors  when I highlighted problems I had providing an adequate service. They were concerned of their corporate image, not our duty of care. If you don’t have the correct materials, the equipment is broken, the support staff are changing frequently, it all adds to stress. And stress creates poor performance, which creates problems, complaints, and more stress. As our values were not aligned, and I was over 60, I retired because I could. And I had  developed a hobby that I thought could help support the profession. I'd waited too long for support from any government of the day.


There is a constant legal issue over if there is a complaint, is it the dentists fault? Should it not be the companies?
The conventional blame culture and pathway is as outlined in Don Norman’s book.
As we become more reliant on AI, shouldn’t the equipment, materials, and other external factors be taken into account?


The worst corporate is the NHS. It's not the dentist who is at fault. It’s the system. In any other business, if there is a problem you look at the cause. And in the past for a large corporate the CEO would resign. Our health ministers are not in post long enough to resign any more. Matt Hancock resigned not because he failed to address a long term prevention plan for dentistry, but an inappropriate fumble with his staff.


Are these quotes from Don Norman’s book applicable to dentistry? Is the NHS system, the corporate environment, or the individual at fault,?

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Think of the exponential growth of AI, which carries out 70% of radiographic diagnosis in hospitals now. There are programmes already developed for diagnosing interproximal decay, and periodontal bone loss. So who will be responsible for the diagnosis? The dentist, the programmer, or the software company?

I was in Las Vegas in 2015 Sirona brought out their latest chair unit with the scanner and cone beam unit attached at over $120,000 from behind one of the round screens with dry ice, lasers and pumping music, and 1,000s of American dentists clapping and whooping. It was sold within minutes as with this kit AI could design the template to locate your implants on a 3D printer.

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Which was just as well as the dentist who bought it was aged 82. So if the implant failed, who was responsible, or is there a shared responsibility. Not least with patient who didn’t maintain adequate oral hygiene, and persisted in smoking.

​I did a year long distance learning course for orthodontics around 1990. I learned that the diagnosis was full of difficulties, and ultimately referred everything apart from moving a tooth over the bite. However, now it’s a huge industry, and a great source of income for adults who never had braces in their youth, and those cases who have relapsed. A few on-line course seems to be enough, and leave the diagnosis to the AI. Who is responsible?

Finally, with restorations. These scanners continue to improve exponentially, and the requirement to change parameters is minimal. Just like the patient needing to be in the green before commencing treatment, the computer will give a green or a red depending on your scan and its ability to produce a proposal. If the scan is an amber, and you fit the inlay, only, crown, veneer, laminate, or any new named restoration design. Who is responsible? It was clear back in 2015 that the main cause of  failures of the Volkscrown were due to dentists not following the correct cementation procedures. And that is a learning process, with human error of slips and mistakes. Many years ago I had failures with Dicor crowns. The same material is now used successfully when milled. It was reassuring to know after about 20 years, that the failures were not a human error, but bad design.

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If only lawyers weren’t so lazy and targeted the bigger fish, we could all benefit. If only our defence organisations nudged them to look elsewhere, or as Kevin Lewis advised at the last BDA meeting, that any NHS service had a simple contract . "I will not sue the NHS".