In conversation with Dr Doug Watt.

[(0:00)] Prav Solanki: Doug, welcome to the Dental Leaders Podcast.

[(0:03)] Doug Watt: Thank you.

[(0:04 )] Prav: We just want to capture your story, everything from your digital, your practice journey, growing up. I’ve sort of come to know you over the years. Just at events really, we just crossed paths.

[(0:20)] Doug: Yeah, like ships in the night.

[(0:22)] Prav: Like sheeps in the night.

[(0:23) ] Doug: Ships. It’s not in Wales now.

[(0:24)] Prav: Like ships in the night, and it usually is at night, actually.

[(0:32)] Doug: It’s kind of usually nighttime in a bar.

[(0:36)] Prav: Yes, often. If someone was to ask me, what’s this Doug guy like? My first answer is, he’s tall. I’m very short, so I’m always having to look up.

[(0:53)] Doug: Who wears picnic blankets to formal dinners and things like that?

[(0:57)] Prav: Yeah, but the one thing that often springs to mind. If someone mentions your name to me, you make me laugh. There’s a comedy factor just in your narrative that you always bring humor into the equation whenever we’re chatting. I love that.

[(1:17)] Doug: It’s to hide my deep-seated insecurities and my impostor syndrome. No, yeah, I do like to be of humor.

[(1:27)] Prav: We’re going to take this podcast in different directions. We usually start off with how you grew up and stuff, but let’s touch on the impostor syndrome. I mean, you’re a speaker. You’ve been involved with the BACD at a high level. You’re still involved, and probably a lot of dentists look up to you for advice, education, mentoring, and all that sort of stuff. Just talk to me about the impostor syndrome. Has it ever affected you? Does it still affect you?

[(1:55)] Doug: Yeah, I think so. So, the first time I heard about impostor syndrome. It was from my sister. She was saying that she thought my dad had it years ago. My dad was a very successful consultant anesthetist. He sort of talked online. He was involved in societies for computers in anesthesia in the 1980s and things like that. So he was very sort of forward-thinking in anesthetics. I remember my sister said, “I thought that’s interesting. I wonder if I’ve got that.” And I think, a lot of dentists, if you’re doing dentistry at a high level, you sometimes kind of look and you think, “Actually, I’m not as good as some of these other guys. I don’t think I should be talking about this. I don’t think I should be here.” Someone’s going to find out at some point when’s it all going to come crashing down. I’m going to realize that, actually, I’m a fraud. I don’t have the hand skills to do this. I know I’ve got these cases that look really nice, but what if I fail? Then I’m not the dentist they think. It’s a weird one.

[(3:01)] Prav: I’ve suffered from impostor syndrome for a long time, and I still do from time to time. So, sometimes, I’ll go into a practice, I think, “This practice is smashing it. What am I going to teach him?” Then we find something because not every practice is perfect. There’ll always be something, right? And often the way I’ve dealt with it, with impostor syndrome [myself, is I am the world’s authority on the perspective from Prav. That is how I deal with it in the fact that I may say something or deliver the same news as somebody else who’s got 10 years more experience, but no one else will do it.

[(3:46)] Doug: No one’s got the same experience.

[(3:48)] Prav: Yeah, and no one else would do it like a thick 5’5″ Mancunian who’s got no hair, right? Whatever it is, I am the number one guy at delivering Prav. That’s how I’ve become comfortable with it, but I can’t say I’ve fully recovered yet. If you come to terms with sort of things, how do you deal with them?

[(4:09)] Doug: I think to some extent, you’ve got this sort of fake it till you make it attitude, that means to go in there. Even if you don’t necessarily believe in yourself 100%, you believe in yourself 80%, and you push the last 20%. I mean, even going back to something basic, I remember we did some business consulting, we feel the dentists should go out and get the patients. I was thinking, “Oh, God. I spent years doing that,” and I hate going out into a waiting room and calling someone’s name, especially if their names are hard to pronounce, or there are two people with the same name, or you go out, and everyone just stares at you like dead-eyed. And the person you’re actually calling hasn’t heard you, or they’re not even there.

So that’s a very basic thing to do is walking out compared to what we do in dentistry, walking from my chair to the door, going into the waiting room, “Mrs. Jones, do you want to come to…” That is so basic. But to me, there was something holding me back, thinking, “I don’t want to do it.” Compared to everything else we do in life like now, compared to standing up in front of a roomful of people and starting talking about the dentistry I’ve done and putting myself out there for everyone to criticize my treatment planning, my implant placement, my restorative way. So I’ve gone from not wanting to go out and get the patient from the waiting room to standing in front of a roomful of people and showing my dentistry which is a bit of a bizarre transition. But that was very much a sort of fake it-till-you-make-it thing. I just went sort of I’ve got to do this, get up, go, and call them in.

The other thing, is I remember so many times I’ve spoken to other dentists. The problem is, as you say, I presume to things, I’m probably relatively self-deprecating in that as well because I’d rather make myself the butt of the joke than someone else. So I’m not going to go up to you and say, “Haha, you’re a short 5’5″ Mancunian with no hair,” as you just did. Again, self-deprecating, but I would do the same. I wouldn’t turn around and take the piss out of someone else. However, a lot of dentists, when you start speaking to them, you find that they’re very confident in themselves. They’re very overconfident. I’ve realized over the years, these dentists I’ve seen what they’re doing, they’re giving me advice, they’re telling me how to do stuff– they’re probably giving me advice on digital dentistry as well. And when you actually see what they’re doing, see their actual amount of knowledge and see their work, they’re not at the same level as you are. They’re not even close sometimes, but they’re so confident in what they’re saying that makes you feel down here.

[(6:39)] Prav: The opposite of impostor syndrome, the Dunning-Kruger effect, and unskilled and unaware of it.

[(6:44)] Doug: Sometimes people hang around at the top of that curve, and they never dropped down. Those are the people I think that make the people wallowing in the bottom of the curve feel worse because actually, you’ve got the guys who are up here are fine. If someone is up there, fine, they’re brilliant, they’re great. Guys like Andy Chandler Powell, Guth Bert, all these guys who are amazing dentists, they’re really good. But they are probably somewhere on that impostor syndrome curve on the way up here. But it’s the guys here that are dangerous for the guys who stay there, for the people who are down at the bottom.

[(7:17)] Prav: I think it’s dangerous on many levels, not just for the guys who were suffering from impostor syndrome. It’s the patients– it’s the people who they’re dishing the advice out with that. It’s the old “You don’t know what you don’t know.” And they’re super confident with the fact that actually, I do know what I do know [crosstalk] and going to fish them out.

[(7:39)] Doug: They don’t look beyond that. That sort of specializing is learning more and more about less than less until you know everything about nothing or nothing about everything. It’s just, you know, the more you look at what you’re doing, the more you specialize, and the more you realize you know less.

[(7:58)] Prav: Got a little question about what you said going into the waiting room maybe induced some anxieties back in the day. Can you remember the first time you got up in front of an audience of dentists or dental professionals? Do you remember the day? Do you remember the week leading up to it? Do you remember how that felt?

[(8:16)] Doug: So it was the first IDDA Conference in 2018 in Manchester. I sort of volunteered, and I kind of thought afterwards, “Why the hell did I do that?” I don’t know if I should swear on this. I thought, “Why have I done this?” So I was presenting a digital crown lengthening case of a way of doing the surgery, guided through digital at the first conference the IDDA did. I was the last speaker of the day, so a bit of a graveyard shift. And there being the guys from all over the world before me, Phil Reddington had been speaking and the guy who originally was involved in DSD split talking. They rigged me up, and I had a Britney Spears mic on. So I sat there in the front row next to my mate, Ross. He said, “You’re up because the last lecture finished.” I said, “Oh, shit.” Then, I realized that turn the mic on. “Oh, shit,” was reverberating around the whole room. So then I had to follow on from saying, “Oh, shit” to the whole audience, as the first thing I said– had to get up on stage and present.

But the problem was, right before I went up before the lecture that was prior to mine. I think Adam came up to me, he said, “Oh, we’re running really late. So can you do yours as quickly as possible, get out of the way in 20 minutes or whatever?” I was like, “Oh, great. I’ve been trying to make it last half an hour. Now, I got to do it in 20 minutes.” Then right before I went on, he said I was fine. “We’re back on time now so take your time.” I was all geared up, clicking through my slides. “So teeth did this… thanks, bye.” Runoff. Yeah, I remember leading up to it. There was obviously anxiety.

Interestingly, I recently get far less anxious when I’m speaking. Earlier this week, coming up to this event, I started having some weird anxiety dreams associated with this. So I woke up in the night, and when you’ve had a dream like that, you can actually reset your brain to not keep worrying these things over in the middle of the night unless you get up and go for a walk or whatever. I had this dream that I come here, and I forgot my laptop. So then I have to go back, and bizarrely, I went to my mom’s house. Now, my mom passed away right before lockdown, so it was a bit of a “Why am I going to my mom’s house to get my laptop?” And probably some anxiety leading into that. So then, when I got my laptop, it was 45 minutes to get there. I was on in an hour and a half– 45 minutes to get there. So in my head, I’m working all this out. Then my laptop wouldn’t download the presentation from [crosstalk] my Cloud account.

[(11:05)] Prav: Dropbox or whatever.

[(11:10)] Doug: So, I had this sort of dream on Tuesday night. That’s weird, I don’t usually get this these days or sort of anxiety. So then I obviously turn my laptop on, I made sure that I downloaded both of my presentations, saved them on the hard drive, made sure my computer is working, packed my iPad as well, packed accessories, HDMI cables [crosstalk] because last time I tried to plug it in the [inaudible] conference, it didn’t connect to the projector. I was like getting everything in place, making sure I had no IT issues. Then yesterday, obviously, my computer didn’t turn on when I first started the lecture. I thought it was brilliant. I’m teaching people about digital dentistry and using computers in dentistry, and my bloody laptop won’t turn on. Great.

[(11:54)] Prav: Yeah, so it never fully goes away. I mean, I know I’ve done bits and bobs of speaking here and there. There’ll be times I’ll just turn up and think, “Alright, it is what it is. It’s sort of a day at work.” And there will be times when I get a little bit of anxiety or anxious. I think it’s healthy.

[(12:11)] Doug: Yeah. I mean, with the digital side of things, I’m really comfortable with talking about software and things like that. I’ve got used to using it a lot. The problem, I suppose, is when I come to speak or something like this, you’ve got guys like Fulham[?] in the audience, and he’s going to do far more implants than I do. His knowledge of full arch surgery is way more than I’ll ever have. My interest is in full arch implantology. Although I’m a general dentist, I’m a restorative dentist– I’m not really into full arch stuff. That’s fine. There are plenty of people doing that, so I don’t need to. However, I’m talking to people about this. Then obviously, questions are coming in when yesterday, it was less so about implants. I remember last year people saying, “What’s up with implants? Are you comfortable using it on a molar site?” I’m about to talk about digital, not my personal preferences towards implantology.

But it’s interesting because I went to another course– we actually ran a course up in Edinburgh. And again, it was a full day of digital lectures, hands-on, bits and pieces. At one point, someone pulled out their phone and start showing me pictures of the case and asking how I’d layer the composite on this because the composite case I showed they really liked. Now, we’re into discussing composite dentistry, layering all that kind of stuff, which isn’t something I teach on. It isn’t something I consider myself to be and I close my authority[?] on. I know how to do it, I’ve been on courses. However, I would never stand up and go right and look at my composite layering protocol because it’s not something in my bag. So then I’m sort of going through this case trying to give this woman advice on how to layer a composite. “I use this system. I do it this way up.” But it is what it is.

That’s the problem, I suppose, doing any kind of teaching and lecturing is people are looking at my cases, and obviously, there’s a lot more stuff in there. There’s period surgery, there’s implant work, there are dentures, there’s restorative crown and bridge, veneers, esthetic stuff, all that kind of stuff is in my cases, and I do all of it, but my main focus of most of these things is digital. So when someone asked me a question about something slightly off that on dentistry, it catches me out a little almost. Obviously, I can answer the questions usually because I’ve done the cases and I know what I’m doing but I’m not ever going to profess to be as good as Hartnell Grafi and people like that on crown lengthening [inaudible]. These guys are periodontists– they do this all day. They’re amazing at it. Most of my days are taken up with general dentistry, so it’s quite interesting.

[(15:00)] Prav: When it comes to digital dentistry, I guess there are those who really embrace it and there are those who still haven’t either invested mentally or educationally, or in the actual toys, what would your piece of advice be to a digital dinosaur?

[(15:18)] Doug: I think the first thing is to get a scanner to try out and just see how it works because I think a lot of the problems people have is trust. Dentists, we’re very tactile. We’re used to having something physical, something we can pick up and go, “Yeah, that works or whatever.” So if we get an impression, we can have a look. We get instant feedback on the impression, and we can say, the margins on that are great, or there’s [inaduible], we need to retake it, all that kind of stuff is there for us to see. So the problem with digital is you’re instantly thrown into a situation where you don’t have that. You have data, you have a picture on a screen, fine, you can move that and manipulate that. But if you don’t know how to move and manipulate that, and also you don’t trust that data will give you an accurate situation to fit a crown or do a denture or whatever you’re doing with that data. If you don’t trust that, then you’re never going to jump for it. So the only way people will get to trust it is by trying it themselves and actually physically experiencing the benefits.

So to my mind, if you can get, say, a rep in from your supplier from a company who supplies the scanner, so say, 3Shape or Shine or Align or whoever, whichever system you want to get into, if you can get them to come in and let you test it out on a case, I think they’ll give the opportunity to try it on a live patient because the majority of the time, people will scan this model. It’s like, “Well, the model doesn’t have a tongue, it doesn’t have cheeks, it doesn’t cough for you.” It’s got none of those aspects of a real-life situation. So if you can get someone to bring it into the surgery, try it on an actual case. As I said in my talk yesterday, the first case I did was on my dad, and I always say I got my dad and did a couple of crowns. So he did actually need crowns. It wasn’t just the case. But I think doing something like that, getting a crown, a couple of crowns in, prepping them, scanning it, and just seeing for yourself that it fits and works. Whitening trays, anything like that, just get it in, get the reps in for a morning, and just everything you do, just scan. I think that’s a really good way to work out how it works in real life and get the trust, I suppose.

[(17:30)] Prav: Now the other minefield is which scanner. There are so many out there, so how would a virgin go about choosing the right scanner?

[(17:44)] Doug: I think any virgin, you have to take it for a ride and see what you like. I think if you try a scanner on a patient, that’s the best way to see if it works and get that– it’s not trusting. Look, I think you need to look into all the benefits. There are pros and cons of the scanner. There’s a lot of data online as well. There’s a review from the IDS show in 2019 in Cologne. That goes through what each scanner can do. It makes sense if all you do is Invisalign to get an iTero because it works really well, and it’s designed for that system. If you want to do a lot of other stuff, then I use 3Shape. I find that to be a really good system from the trail scanner all the way through to the lab software that we use. So it very much depends on what people want to do and testing it out and seeing which scanners to go for. I wouldn’t say 100% there’s one scanner for one person, but you might well find that if you tried a scanner on a few patients, and actually you can’t get on with it. But another scanner you do, get on very well and that can make your mind up for you.

[(18:58)] Prav: Okay, and then over to the Neodent system. How long have you been using the Neodent implant system?

[(19:04)] Doug: I think probably four or five years now. So, it was just after the GM helix came out. One of the other partners in the practice looked into it and said it’s a Straumann-owned system. We should have a look at this because, at the time, we’re using Ankylos. So we’d move from Straumann to Ankylos. Then he said he’s got a lot of similarities with Ankylos and got a lot of the benefits of that system. But also, you know, with new updates and digital workflows and things like that, so yeah, we were pretty digital then. So we looked at it and moved over.

[(19:42)] Prav: And just going back to the beginning, so tell us a little bit about your childhood, your upbringing, and where you were brought up.

[(19:51)] Doug: So I grew up in Birmingham. I’m the youngest of three kids. My dad was a consultant anesthetist. My mom was a nurse, but when my brother was born, she didn’t work as a nurse after that. So yeah, I grew up in Birmingham and Edgbaston and went to school in Harbourne. Then my formative years around Birmingham generally, and you can tell by the accent that I’ve avoided that as much as I can. I’ll go fully probably now. We’ll do the rest of the interview Peaky Blinders[?].

[(20:26)] Prav: By order of.

[(20:27)] Doug: Yeah, by order of. So growing up in Birmingham, I went to school and studied for secondary school. So I guess I have a relatively blessed and privileged childhood.

[(20:42)] Prav: Were you the joker of the class, were you the class clown?

[(20:45)] Doug: Sometimes, when I was really young, but when I got a bit old, not a class clown, but I like to like to make jokes. I suppose I try not to put my head above the parapet that much in junior school or secondary school.

[(20:57)] Prav: It had with your [inaudible].

[(20:59)] Doug: I wasn’t there, unluckily. I grew late. It was funny. I remember my friends were all growing at similar rates, and we all got sort of mid-5’7″, 5’10”, and then people started dropping off, and I just carried on going. I think I got to sort of 15-16 and to my mates hit about 6’3″, and then I just kept going and went to 6’5″. I was 14 years old with size 14 feet so I was L-shaped. I was shorter, like a Weibull[?], you can knock me over, but I’ll just pop straight back up.

[(21:38)] Prav: Were you a Swathi? Were you a smart student, a straight-A guy?

[(21:44)] Doug: No. I suppose academically, I probably didn’t really hit my stride until A level going into uni. I think I was born in June, so I’m sort of younger in the school year. So certain subjects as well, I was always good at science. Languages weren’t my thing. I hated history and geography. It was one of those things– it was always a chore just to get through those subjects and get a decent grade on them. So I wasn’t the kind of kid who could turn their head in literally any aspect and just go. I’m probably more like that now than I was then. But at the time, I just had no interest in history and geography, so I passed those. I got Bs or GCSE or whatever in those. I didn’t excel at those subjects, but I was always good with science and art as well as music.

[(22:48)] Prav: You’re a guitar player, right?

[(22:49)] Doug: I am, yeah.

[(22:51)] Prav: Were you self-taught? Did you have lessons?

[(22:54)] Doug: I had lessons. Around 12, I think I went to my parents and said I want to learn guitar. My dad had an old classical guitar, so I played that a bit. I remember my cousin who borrowed it, and someone put their foot through the side of it. So it was super glued back together, and it worked, but it wasn’t the most glamorous intro to guitar playing. But then, I said I wanted to play electric. So, one Christmas, I think Christmas when I was 12, I went to a guitar shop and dad got me a Squier Telecaster and just started collecting guitars after that and go into that.

[(23:34)] Prav: I’ve never played a musical instrument. My kids are playing, so you go through these grades from one to eight, is it? [crosstalk] what did you get in that whole thing?

[(23:49)] Doug: I didn’t bother with grades, honestly. So I had lessons on this guitar school and my teacher kept saying, you should do some grades, and I can’t really go. I did go for one grading, years after I started playing. It should have been a slam dunk, but I had an issue, and it completely threw me. So I turn up to this grading. You got to do some sight reading. It was a Rockschool grading. You got to play a set piece that you’ve learned. You’ve got to do some musical exercises they put in front of you. So I turn up, and I’ve got my Jackson, which is like I said, metal shredding guitars. So I’ve got that with me. I’ve got my longer curtains down to my 1990s– I look like a death cap mushroom. This guitar has what’s called a double-locking tremolo bar. So you’ve got a tremolo bar for doing all your whammy stuff, but it locks at the top, and it’s got Allen key screws that lock the strings in. So when you do that, it doesn’t change the tuning. The problem is you can’t retune it easily, so you need to unlock the screws or your Allen key to retune the guitar.

So I come up to this grading, and they say, “All right, our performance piece, there’s something wrong with the cassette player,” or whatever at the time. So it’s half a tone down, so you got to retune your guitar. I was like, where’s my Allen key? I didn’t have the Allen key. So I couldn’t retune the guitar. So I start playing, and I say, I’ll just play in the other key. It’s like the worst two minutes of my life. I’m there playing discordantly. I can hear its way out trying to play this discord and piece of music to a backing track. Just thought I’m going to fail, and I did because one, I think they wanted me to show that I could retune my guitar, and I didn’t have an Allen key, so I couldn’t. Two, it sounded bloody awful, and I think everyone in the room just sat there for the whole two minutes going, “This is painful.” So yeah, I think I failed by one point. I said, “I’m not doing gradings again.” That week also had, I think, a martial arts grading in, I think, three exams at school. So this was the last thing of multiple things in that week.

[(26:11)] Prav: So with the guitar, did you read music? Are you one of these guys who actually hear something and says, “I can replicate that by selecting the strings,” or whatever it is?

[(26:22)] Doug: Yeah. With guitar, you’ve got tablature, right? So you can do sight reading, I did sight reading when I was younger. I don’t tend to sight-read things. A lot of what I do is either through the tab or listening. So tablature gives you six lines for each of the strings and then a number to press on the fret. Then just the timing of things I just get by listening to the actual music, or a lot of the time, it’s just chords and strumming patterns. So I just pick up the chords and sing along and do that kind of stuff or record them and post on Instagram. I’m just reading the chords as I go along, and the lyrics.

[(26:59)] Prav: Is that one of these things that just sort of comes naturally to you inherently? I look at my daughter now– she’s seven. She reads music and plays the piano. I’m thinking to myself “how can you figure out which keys to press based on those letter Ds and letter Ps that are up and down those lines that go with them”? It baffles me.

[(27:22)] Doug: It’s just a muscle memory connection. If you get into it young enough, you get all that stuff. I mean, for me playing chords on the guitar, it’s fine. If it’s certain chords, it comes easily. If I’ve got a slightly different chord, that throws me off sometimes, I have to take a bit of time getting used to that. But yeah, the majority is just a muscle memory thing. My youngest son’s a drummer, and he picks it up like that. The drum teacher will say, do this. I remember when I was trying to learn, trying to disconnect my feet and legs and arms and everything from each other.

[(27:57)] Prav: Rub your belly and pat your head sort of thing.

[(27:58)] Doug: Yeah, exactly. And doing that kind of stuff on drums, but he just gets it, and he’s really good. He’s got a natural musicality and a really good natural sense of rhythm. He’s brilliant.

[(28:08)] Prav: Then, my oldest son plays the saxophone. What he says is that to him, thats his escape. That’s his happy place where if he is stressed about an exam, there’s something going on– he goes and plays the saxophone, he escapes into a different world, and is in his happy place. Similar to the guitar, does it take you somewhere else?

[(28:33)] Doug: Yeah. I love singing as well. So if I’m in my car, always, especially if I’m on my own, it gets a bit antisocial if we got a load of other people in there and I turn up the volume and start belting stuff out. But yeah, I love to just sing along to songs with a guitar and just strumming and playing, and if I think it’s any good, I’ll record– that just gets me out of there. Something like that is really, really healing in a lot of ways, to be able to just step outside whatever’s going on around you in the world and just do something just completely disconnect and focus on that. I think the drumming as well, I always found that more physical and actually quite good because when you start, if you’re just smashing away on the drum kit and listening, I’ve got one of these electric drum kits, so it doesn’t disturb too many other people. My son’s got an acoustic one. I just think that’s really good– I’m not very good at drums. I can play beats and keep up with stuff, but I’m not a good drummer. It just feels nice, really sort of therapeutic.

[(29:44)] Prav: So when did dentistry factor into your life? Is it the fact that dad, mom, healthcare, and that was almost like the expected?

[(29:57)] Doug: So I think I was always good at science, and it got to the point where I was 17, 18, you cast applications and all that kind of stuff. I was considering veterinary medicine. I think I’d have been a terrible vet because I think I would cry every time I had to put an animal down. I’m too soft for that. I still cry every time, I have a little funeral for teeth and walk down the river on a little. So yeah, I wouldn’t have been able to do it in reality. So then, I got my A-level results, and I had the greater dentistry, and my mom said to me, “Why don’t you just go for dentistry because it’s a good job with reasonable hours?” Because I think one of her focuses was that my dad was working a lot as a doctor. He was either on call, he’d be called out at three in the morning, and the thing for someone in my dad’s position, where he was the sort of high-level consultant anesthetist, he only really got called into the hospital on call when the shit really hit the fan. So he’d be called out at 3 am in the morning when someone’s literally about to die on the operating table.

So I remember, we sort of grew up in a bigger house in Edgbaston. So we’d come around, someone at the phone would go downstairs, pick up the landline, “Is dad in?.” So I think my mom was very focused on a career that would be more family-life-friendly than medicine. So I think my dad kind of tried to talk us out of doing medicine as kids. My sister, of course, did medicine because that’s what you do when your dad tells you not to do something. So my sister’s a medic. She then did a law degree. Now she works as a medical legal adviser. So she sort of got our medicine. I think because of that, my mom saw dentistry seemed to have a nice lifestyle and a relatively reasonable family life. So she said, why don’t you do that? I had the grades, I was good with my hands. I liked science, and it was medical. It was vocational. So it all ticked all the boxes. I didn’t really know what I was getting into. I just applied for the course and went along. I think, like a lot of people, I thought dentistry was just filling teeth and pulling teeth out, that was kind of it. But then, when I realized that actually there was surgery involved and more advanced things. Actually, this has been a bit interesting. So yeah, that’s how I sort of came to the state in Birmingham, moved into student accommodation, but I’m still in Birmingham.

[(32:37)] Prav: So you’re watching[?] over the weekend. What was student life like for you?

[(32:44)] Doug: It was good, yeah. I remember it was good fun. I think it’s a weird one in dentistry because your first year is like everyone else’s year. Your lectures with the medics, you do all of the same sorts of stuff, although you can’t really miss lectures and you’re lectures nine till five. And I remember one of our housemates was doing psychology, and we’d leave him lounging on the sofa when we went out to uni. We’d come back and say, “No lectures today, Ricky?” and he goes, “Oh, there’s one of four, but I decided to suck it off.”

[(33:19)] Prav: I remember those days.

[(33:21)] Doug: You’d think, how can this guy just sit here doing nothing? He was doing psychology. He barely seemed to go to lectures, which seemed crazy to me, because psychology was the most female-populated course in the whole uni, but he never went in. So we did that. It’s the first year, and then when you get to the second year, you get moved out towards the dental school, which at the time was in the city center of Birmingham. Obviously, you then separate it from everything, and you end up with five years of uni, and after three years, most people leave. So you sort of end up with the medics who started with you and those are the only people around after your year three. So I really enjoyed uni, and then it got much more serious in the fourth and fifth years. Student life was good.

[(34:16)] Prav: I’m sure. What happened afterwards? So you qualified?

[(34:24)] Doug: Yeah, 2003, and then got a vocational training job down in Cheltenham. So I moved to Cheltenham for a year there. The chap I did vocational training with had workers associated with practice in Stratford, where one of my friends was doing vocational training. I bumped into the owner of that practice walking around Shelton, and he said, “What are you doing next year?” I said to him, “I’m looking for a job,” and he said, “Okay, I’ll give you a job,” kind of thing. Talk to me. So I went over and sort of [crosstalk].

[(34:54)] Prav: Just randomly bumped into him? [crosstalk]

[(34:55)] Doug: Yeah, just bumped into him. The guy I did vocational training with a guy called Simon Crutchfield, who still works in Cheltenham now. He had worked in Stratford on Avon[?] for a chap called David Lachman because I’ve been for a VT interview with David. Then I bumped into him in this shopping center in Cheltenham. I met Dave, who was working for him at the time. So he offered, he sort of said, “What you’re doing next year, staying on in Cheltenham?” I said, “No, I’m going to move somewhere else.” I was contemplating different places to move to. He said, “Why don’t you have a job for me?” So I went over to do two days a week there– two days or three days a week and ready for another practice with a guy called Dinesh Fakie. He was a lovely guy, and I worked for him.

[(35:45)] Prav: What sort of dentist were you doing with around that time?

[(35:47)] Doug: So very, very generalists love amalgam, a bit of crown and bridge because it was still free Brighton[?]. So we still could do bridgework, it wasn’t a massive loss to the lab fees and things like that. So we could still do a lot of the dentistry, do chrome dentures, all that kind of stuff that people sort of shy away from now because of lab fees. So yeah, I learned quite a lot at that point. Also, David pushed me to do implants. So he sent me on the implant course straight after I started there, so 2004-2005. I did that two-day implant course because he had been doing implants for a few years, and he had done a year course, and he knew of implant dentistry. He mentored me through those implants. So that was a really good way to get into implants quite early in my career because my hand was held through all my early placements.

[(36:41)] Prav: Say that your mentors in either your career or life really do shape the direction in which you go. Who would you say that the key sort of mentors in your dental career?

[(36:55)] Doug: Yes, I think my first few years, obviously, my BT trainer and working in practice with David. Interestingly, in that practice, through the partners I have now with Lemington both work in that practice, so one of them, Paul, left when just before I started. So, again, like a ship in the night. So he went to use the place where I am now right before I started in 2004 with the practice in Stratford. Then Charlie, who was also a couple of years above me, now works at the practice as well. So he came in after I did so, I think for not so much mentorship, but from peer contacts, I think those guys, we chat about dentistry and we sort of learn a lot of each other and pass around ideas and chatter[?] cases. So that’s brilliant.

From an implant perspective, I think, in the last few years, Ashok Sethi has been probably my biggest influence. I did a course with him in 2014 and 15. Then I’m doing the plan with him and Monese. He’s such a humble guy, such a lovely guy, but also such an amazing surgeon. So I think, I’ve learned a hell of a lot from Ashok. I did a lot of courses with Paul Tipton, which I think set me up well for a lot of restorative stuff. From Apereo’s perspective, pantomography has been really helpful, and I learned a lot from him when I did his period-academy course.

Guys like Guth Bert, as I mentioned earlier, he worked with the practicing associate for a bit. So it was nice having someone in another [crosstalk] ship in the night– someone else to chat through cases and bounce ideas off. A good friend of mine who I do a lot of music with is Andy Chandler Powell as well. He was present at the BACD a couple of years ago. Again, it’s not so much mentoring but just peers who you speak. So I think mentor-wise, you’ve got these guys like Ashok who are sort of the OGs of implant dentistry and pull tips and, obviously, who have been running restorative courses for years and train loads of people. But I think there’s a lot to be said in the stage of my career when I’m in my 40s now, of having peers around you who are doing similar stuff in similar situations that you can get ideas off and bounce ideas off. So I think that’s a massive thing for me now, rather than mentoring to some extent.

[(39:36)] Prav: So when did the BACD feature in your career stroke[?] light for you? Did you join straight away as a new sort of graduate, or are you a student member? Then how did you start getting involved, and to what extent have you been involved with BACD?

[(39:51)] Doug: I was quite late to it, really. I suppose it was 2015, I think, I went to my first BACD conference. I suppose I’ve been in practice for a couple of years. I was thinking I started doing more private dentistry. I thought that’s a really great place to learn about more esthetics, cosmetics, and all that kind of stuff. So I just booked the conference for that year and went along. I just thought it was a really good conference, well organized, really good lectures, good social aspect to it as well. So yeah, it was the kind of thing I went to then every year after that. I suppose just through knowing people who went every year, guys like Luke Hutchins and Andy and all that, I got to know a lot of other people: Paul Abrams, Chris McConnell, Simon Chard, all these guys, I got to know through BACD. I got asked to do the regional rep role for Warwickshire pre-COVID, a few years ago. So that was my first introduction to doing anything with the BACD. Then, obviously, COVID hitting it all went a bit [inaudible].

Then last year, I was on a train, I think, up to Edinburgh. It was September, I was going to the ITL conference. It was the most bizarre situation. I got a phone call from Paul Abrams, who was then President saying, “Do you want a position on the committee or board?” We started to chat through that, so I went for the board election that year. But strangely, I hung up the phone. The guy opposite me said, “Sorry, I can’t help but overhear your conversation. Are you in dentistry?” And I said, “Yeah.” He said, “Oh, I’m Nigel Jones.” He is high up in the Practice Plan, and the top guy in the Practice Plan. We’re having this chat. I said, “I did a webinar for dentinal tubules with someone from the Practice Plan earlier in the year” because we’re talking about in-house plans. Then they had a Practice Plan that we were talking about. It turns out it was Nigel who was sitting opposite on the train who would be on the webinar with. We didn’t realize it till later.

So I texted Drew, and I was saying, “Who was on this webinar with?” “Oh, yeah, it was him.” So I texted him and said, “Oh, it was us on the webinar together.” Like the most bizarre meeting ever, sitting on a train, taking a phone call to suggest I go for election onto a BACD board. Then this guy starts talking to me, and it turns out we’ve been on a webinar with each other earlier in the year. So it’s just like, yeah, it’s weird how these interactions, you’d meet a lot of people in dentistry, obviously, as well conferences. Yeah, it’s just bizarre, really odd. Neither of us realized we’d been on the webinar with each other or recognized each other. It would be really embarrassing if it turned out, “We did a webinar together.” Then I was stone-faced. Luckily, neither has realized.

[(43:01)] Prav: You’d have blocked it. So, practice ownership, how did that sort of feature in your careers? You were at practice were somebody who went to Euston’s place. You’ve crossed paths and all the rest, how did the opportunity come about for you to become a practice owner, and is business something that you’d always have your sights set on?

[(43:30)] Doug: Yeah, I think owning a practice had always been something I wanted to do. Partly due to control because I saw the ways people run practices and didn’t necessarily agree with them and thought I could probably do better. I know that’s quite an arrogant thing for a young dentist to think, but whenever you work in practice, you see how things are done. Then it doesn’t necessarily fit with your ethics or the way you want to do things.

[(44:00)] Prav: It’s different, right?

[(44:01)] Doug: It’s different, especially with NHS. I think the issue with NHS dentistry generally is it forces you to do things in a certain way, or people play the game or play the system or whatever. And that didn’t sit right with me, the fact you had to think about how you claimed. I remember during my vocational training, “Oh, you need to claim this, this and this,” because this is the way to maximize that claim and all that kind of stuff. We had that in our vocational training, like group sessions that we did on a Friday where people come in and say the best ways to claim NHS fees. I thought that’s not what my job should be about, surely. My job should be about dentistry, focusing on teeth, not thinking about the best way to claim the most money out of this situation back in the old SDR days. So yeah, that didn’t sit well with me.

So my viewpoint was to go for a private venture. I did ten years in the NHS. I think that’s more than enough for me. I mean, we still have a small NHS contract in practice, but it’s not a significant amount of my work reality. So, practice ownership, I knew one of the guys who owned the practice that I’m at now because his wife was associated at the Wellesbourne practice I worked up. So again, the small world dentistry, everything’s interconnected. I also knew Paul, who worked at that practice and was over there. So I met him because he still came back for the Christmas due in the first year, and I was always there. I won’t tell you what happened, but it was an interesting meeting of minds and alcohol. So that was the first time I met Paul. We got along well.

Then at my wedding in 2007, the guy who owned the practice, a guy called Andy Skilbeck, was at the wedding with his wife. Apparently, he told me since I’ve had a few drinks, and I said to him, “When you retire, I want your job.” He said, “Okay.” A few years later, he phoned me up and said, “I’m retiring. Do you want my job?” He phoned up and said; “I’m looking to sell my share of the practice. Do you want it, basically?” He gave me first a few [inaudible]. So I said, yes.

[(46:25)] Prav: How long did it take you to make that decision?

[(46:27)] Doug: About five seconds. I phoned him back. Well, he phoned me about a year earlier saying, “Look, I’m thinking of doing that– think about when it comes to…” and then I didn’t hear anything. I think the few things that happened, he took a bit longer to come to sell it. And then, yeah, so he phoned me again, and I think I phoned him back and made him an offer, basically, and he accepted.

[(46:55)] Prav: Just out of curiosity, because I’ve never been involved in a situation like that, how do you even go about sticking a value on a share of a practice? I don’t need to know the numbers, but what’s the structure of the ownership in terms of three partners, four partners, and equal splits? How would you go about valuing that?

[(47:17)] Doug: His first sort of thought process was another guy left the practice a couple of years ago. This is what he realized from his sale; I want to find something similar, basically. The interest in the share of the building versus the share of fixtures and fittings versus the goodwill, that was the sort of makeup of it, really. The biggest part was the goodwill.

[(47:45)] Prav: So just to clarify, in this business deal, you’ve got a building, you’ve got some goodwill, and then you got the toys.

[(47:52)] Doug: Yeah. The toys were next to nothing because it was secondhand dental chair. There weren’t a lot of amalgamators and that kind of stuff. The goodwill in the practice is the biggest part. The building is an odd one because, obviously, it’s a quarter share of a building. That’s a commercial property. So it’s actually a quarter share worth nothing. And security from the bank is impossible to get because you don’t have an asset that you can then reclaim to try to get the money back. So it’s a bit of a tricky one, funding and everything else. And that caught a share of the building, obviously, it’s given an arbitrary value. So you sort of get someone to put values down, but there’s a bit of an odd one.

[(48:36)] Prav: But you do– I’m assuming you charge rent back to the business for that building.

[(48:41)] Doug: So we did on certain things. So because we did have part of the building rented out and things before– we sort stuff out. I’m sure it’s all about the board.

[(49:02)] Prav: So we go back to this, you’ve got your three elements of the practice. You’ve got a number. Was there an immense amount of due diligence that took place at this time, or was it that [inaudible] the number seems about right?

[(49:18)] Doug: So the number seemed right, but there was a lot of due diligence that went into it. So my solicitors were constantly in contact with the practice manager. I mean, I’ve still got boxes full of stuff that she sent over to the solicitor, and then we went through it, and it’s one of those things you get to a certain point, like with the house purchase, you get to a certain point and think, is it actually going to stop me buying it now because I’m so far invested if they find that slightly more radon gas in the atmosphere, or whatever it is at this point is going to go. I did all the due diligence as much as I could and tried to understand how the business operated, but it was such a complex business we did. It’s simplified things a lot now, but the way is such complex that you walk in, and you can see what the profitability as you can see what is great about this building. There are always going to be building issues, though. So the problem is if you looked into all of it too much, and you were too risk averse, you’d never buy anything.

[(50:23)] Prav: Sort yourself out of it.

[(50:24)] Doug: Yeah, exactly. So it’s one of those things where I just had to sort of swallow my impostor syndrome and anxiety. Just go fake it till you make it.

[(50:33)] Prav: Since buying the practice, what’s it been like? How many business partners is it?

[(50:39)] Doug: It’s four of us.

[(50:41)] Prav: It’s four of you, and you were equal shareholders?

[(50:42)] Doug: Yes.

[(50:44)] Prav: So how does it work in that situation? Let’s say Doug says, “Look, I want to buy six printers and four scanners because I’m into this sort of stuff.” And the other three guys turn around and say, “Are you having a laugh?” Did you have those sorts of disagreements or situations?

[(51:01)] Doug: Not so much. So we’ve got a situation where we’re buying something for our own surgery, something specifically we pay for it ourselves if we want to buy things in expense. So as a shared thing, then we will have a discussion about. If it’s something that only the three of us will use– so recently, we got a new 3d printer, so we just split that between the three guys and the implant workers. It makes it easy, and we just pay that off implants, surgical kits, all that kind of stuff, a big box of implants we buy. We just split that between the guys doing implants and then associate the charged, the implant value to use those implants. So it works. I think it could very easily be an area of contention, but I think we all get on well, and we’re all reasonable. I think the problem is when people get a bit too picky about small amounts of money, and if you’re arguing when you’ve got a business with a large turnover like that, you’re arguing over a couple of grand [inaudible] there. It’s just pointless. You’re just gonna fall out over something ridiculous, which all of us do find out the practice. We will sort of do okay.

[(52:24)] Prav: Any advice for people who are looking to get into a partnership with other, say, business partners or looking to buy into a practice?

[(52:36)] Doug: I think it’s important to get on with the people you’re going in with. That’s easy to say but difficult to do because people won’t show their true colors at first, or potentially, you don’t know what people are really like. But I mean, if possible, if you can work there as an associate, it will give you a good idea of the practice. So I didn’t get that opportunity. But it worked out for me, and I knew Paul already. The other partner who was still existing, Gaiko Billflora, an absolutely brilliant guy, retired at 73. This guy, he was an oral surgeon, he did everything like he’d go in and say, “Oh, Bill is having trouble with a wisdom tooth,” and you look at what he’s trying to take out and I wouldn’t even look at trying that. He just has absolutely no qualms whatever, just going for a deeply placed horizontally impacted wisdom tooth lying straight across the nerve. He’s just going for it, and you just think fair play. The thing is, this guy was 73 when he retired. A few years, probably 15 years before that, he bought a microscope. So he would have been 60 years old, and he bought a microscope. He started doing all his work through a microscope when he was about 60 years old and then carried on using the microscope for everything he did until he was in his 70s. You just think that’s forward-thinking for a 60-something-year-old dentist. Absolutely amazing guy. He cracks me up. He just has a really good sense of humor.

I think it was a shame that, actually, I didn’t go there for the VT audit[?] because he was a VT trainer as well, and I met him earlier in my career because he was one of those people you meet and you just get on with instantly. You just hit it off with some people. When I met him, I was just like, I liked him straight away. I remember our first meeting, we’re in this hotel when I first definitely buying to the practice, and I hadn’t met Bill or Vinny before. I knew Paul. We go along, and we have a drink before we go out for dinner and chat. He sits there, and he just looks me deadpan in the face. “So, before we start, can you just give us 20 minutes on the new BPE coding?” I can take this two ways. I can either assume he’s joking and go with a sassy answer, or I can look awkward and start talking about BPEs. I said “You know what, I’m going to need at least 40 minutes. Is that okay?” And he just laughed and took off from there. It was just a very sort of deadpan sense of humor. So I’ve gone really well with him.

Then Charlie came into the practice later, and I got on well with Charlie as well. So, that side of things was really good that I got these people, I got on well and then I knew, but I didn’t know that was going to happen until I got in there. And it could have easily gone the other way. I suppose if you work as an associate, you can see one of the ethical values of the people you’re working with, and if they don’t align with your values, it’s never going to work. I hate when dentists are too money focus, who’s all about the cash. I think if you do the right treatment, then the money will come later. You need to build up your skill set to do high-quality treatment and money follows. That’s a very strong belief in that. I’ve never been focused on money.

Obviously, we’ve got to make a living, but I would do molar endo on the NHS on upper sevens and things like that because I saw it as a benefit investing time in it, to learn to do these things. So I had the skill set to later on use in private practice. I’d take an hour on my crown prep because I want to get good at prepping crowns rather than, you know. I remember in VT; they tried to teach us how to do 20-minute crown preps. I was like, that was the ethos is that you need to be able to do a crown prep in 15-20 minutes, and 10 minutes to fit a half an hour for a crown. That’s how you make money on the NHS. That didn’t fit me. So I took more time; I wasn’t a good NHS associate, probably because I wasn’t quick and I wanted to do things well. But it set me up for a better situation later.

[(57:03)] Prav: So, during your career, have you heard of the black box thinking or the concept of it?

[(57:09)] Doug: I’ve heard of it.

[(57:11)] Prav: So just a quick summary, in the airline industry, there’s a black box in every flight, and it records everything, mistakes, the good stuff, the bad stuff, all of that. The concept is that any potential mistakes or small things that happen, or small mistakes are not only shared with that airline but the whole industry. So that the safety of flying is improved as a whole. In healthcare and medicine, there’s this tendency to cover up our mistakes and not talk about them. The book alludes to a lot of mistakes that have been covered in healthcare. So with that in mind, is there anything…

[(57:53)] Doug: Confession time.

[(57:54)] Prav: Confession time. What is your biggest clinical mistake, Doug? You look back, and I’m going to just sort of rephrase this. Have you ever had a no-shit moment where you’re in a patient’s mouth, and you think, “What have I done?” and how have you dealt with it?

[(58:14)] Doug: So I remember– I think the majority of my “oh, shit” moments have come with surgery because you’re sort of trying to take a tooth then something slips or goes about array[?]. Then I remember a patient started bleeding quite heavily. As a younger dentists, you go, “Crap.” I think a couple of things come to mind. So I remember doing an implant mentored, and I raised a flap, and then blood just started spraying down the patient’s drape. Luckily, I was being mentored by Raz Shomer at the time, and he just went, “I’ll deal with that.” He did sutures and I was like, “Oh, that’s easy.”

So that scared me a little bit, but then when I was mentoring another dentist on some implants, exactly the same thing happened. I remember I said to him, “Right, it’s starting to bleed quite a bit on the plate [inaudible] of that, put a bit more local and just build[?] with adrenaline[?] in there and cut that down a bit.” So it took a bit longer than possibly– I would have liked to get the local in there. So I turned away; I think probably were discussing something else. So the nurse just go, “Doug,” and I turned around, coming out of the patient’s mouth, and I was like, “I know how to deal with this. Put pressure on this.” So that kind of thing is always scary when it comes to surgery and the first time you experienced that, but when you’ve done a few of them and you’ve seen that, you know how to cope with it.

I suppose sometimes the other thing is when you’ve done something like an endo, and you’ve overextended it, or you’ve got a load of GPR at the end of it or something like that you haven’t predicted, that’s always a little bit scary. I think the important thing with all of these things is being completely honest with the patient and putting it in the notes because if you messed up, it’s not illegal to make a mistake if you look at all the GDC cases where people gain a lot of trouble for clinical mistakes is because they’ve tried to cover it up, or they haven’t been honest about it a lot of the time. So I think if you make a mistake, the most important thing is to own up to it. I cant think of any [crosstalk].

[(60:32)] Prav: Have you ever pulled the wrong tooth out?

[(60:34)] Doug: No. Who told you that? I remember one woman coming in saying I’ve broken a tooth. She had two unrestorable teeth. And I took out one of the unrestorable teeth and then saw there was another one behind, I was like, “Oh, was it that one?” I never called the wrong tooth out, but it’s just one of those things where you think, “Yeah, if they hadn’t both been knackered, then it could have been an issue.”

One thing that did happen, I remember in vocational training, I was taking out an upper canine, and as I started to move it, again, it was a pretty short teeth terminal dentition kind of situation. But as I started to move the canine, obviously, the bone flexed and the four behind it just popped out of the socket. The hell? I pushed it back in, carried on with the canine, and popped out again. So I called my vocational trainer. He went, “Oh, that’s weird.” And obviously, there wasn’t much holding it in place. It was already shot[?], but he just said to explain it to the patient. Well, you’re coming in for one tooth to be taken out, you’re having two taken out. Two for the price of one, exactly, that kind of thing. When you’re inexperienced and young, you don’t necessarily spot that it’s going to happen and you sort of panic or worry about it. But again, honesty with the patient, telling them what’s going on and what’s happened, is key.

[(62:03)] Prav: Doug, at the end of this podcast, we usually ask perhaps the final question which is, it’s your last day on the planet and you’ve got your loved ones around you; what three pieces of advice would you leave them?

[(62:26)] Doug: You see, my mind straightaway went to the apocalypse and the world’s ending. So there’s no point giving advice because it’s my last day on the planet. No, but now I see what you mean. I think be kind is key, because I think there’s enough nastiness in the world. Do what makes you happy as long as it doesn’t make other people unhappy. Don’t worry too much because we’re all gonna die. So, it’s not as depressing as it sounds. I worry about things like failures of treatment, problems with treatment, and things like that in dentistry.

I had a patient early in the year, and she was a lovely lady. She’d had quite a lot of treatment. She was quite anxious about treatment and quite neurotic about results, had a massive stroke, and died. She spent all that time worrying about her treatment, all that time worrying about minor issues with the teeth and things like that, time in the dental chair that she probably didn’t need to come in and say, “What about this? What about that?” And then, out of nowhere, huge stroke, gone. So, yeah, it’s fine for me to say don’t worry too much, but I worry about literally everything all the time, so I’m a hypocrite on that. [crosstalk] But I think if I could tell my kids that or even tell myself that, I think it’s key.

[(64:07)] Prav: Doug was… what would it say on your– what do they call it?

[(64:17)] Doug: Eulogy?

[(64:18)] Prav: That’s it. What would it say?

[(64:23)] Doug: This is my opportunity for major self-deprecation, isn’t it?

[(64:25)] Prav: You do whatever you want, mate.

[(64:29)] Doug: Doug was awesome.

[(64:32)] Prav: Love it, mate. Love it. Final, final question. Fantasy dinner party, three guests, dead or alive, anyone, who would it be?

[(64:44)] Doug: Jimi Hendrix, Bruce Lee, and Gwen Stefani.

[(64:50)] Prav: It will be a hell of a party. Doug, thank you, buddy.

[(64:53)] Doug: Cheers.

[(64:57)] Prav: That was good, mate. That was good.