I believe I am the senior Samizdatista, in years if not in eloquence or influence. And one of the privileges of advancing years is the right to inflict upon strangers the details of one’s various medical infirmities and experiences. I can’t, yet, quite manage the truly, Platonically essential, shameless way of doing this, which is: in a very loud voice on the top deck of a double-decker bus. But, a blog is a satisfactory next best, so here goes. Stop whatever else you may be doing or trying to do, stop talking amongst yourselves, and listen to me.
A few months ago, a crown that had been attached to one of my disintegrating British teeth started to loosen, and about one month ago, this crown fell off. My non-British dentist advised that what remained of the real tooth was now useless and that it all should go. This was not a wisdom tooth; those are long gone. It was the next one in, top left. But I wouldn’t miss it, said my dentist. If I did, an “implant” could be contrived.
So, a week ago now, the tooth was duly removed. The NHS had been asked to do something about all this, as soon as the crown had become loose. But not a peep was heard from the NHS in three months (apparently a whole clutch of letters due to go out had been delayed for some obscure reason – waiting lists?), so when the crown finally did fall off, I decided to go private. Had I been content to lie about how much it was hurting (in reality it only started hurting after the tooth had been removed), the emergency bit of the NHS might have obliged. But, forced to choose, I preferred buying to lying, and so, for £150, the date was fixed and the deed was done.
Local anaesthetics do away with almost all pain, but I can’t get used to the notion that all that grinding and sawing is not hurting, and I love it when it ends. But taking out a tooth involves flesh, not just teeth. I had supposed that once the tooth had gone, any discomfort involved would end, but gouging out a tooth does damage. It does less damage if all of the tooth comes out in one go, but mine did not. After most of the tooth had been removed, a long, thin root remained, and further damage was done to my gum while that was dug out. So, not surprisingly when I actually thought about it, it was only when the local anaesthetic started to wear off that the serious discomfort began. The pain has by no means been unbearable, but it started out quite bad, and has still not truly abated. For a couple of days all but the smallest mouthful, the shallowest spoonful, involved a painfully slow wrenching open of the jaw. I am still chewing only with the other side of my mouth, not least because the hole takes time to fill itself in. Further dentistry may be required to this end.
Okay, so much for the shouting on a bus bit. Now it gets a little more officially Samizdata-esque. Just before yanking my tooth out, the specialist tooth yanker who was about to do it handed me a bit of paper, which he asked me to read and then sign. It said that Tooth Yanker:
… has fully explained to me the purpose of the procedure(s) and has also informed me of the expected benefits and complications (from known and unknown causes), attendant discomforts and risks that may arise, as well as possible alternatives to the proposed treatment, including no treatment. The attendant risks of no treatment have also been discussed. I have been given an opportunity to ask questions, and all my questions have been answered fully and satisfactorily. I acknowledge that no guarantees or assurances have been made to me concerning the results intended from the
procedure(s) which the above-named dentist or his/her associates may consider necessary.
I also understand the financial obligation attached to this procedure and
agree to comply as listed below.
Total amount due £……………. (“150″ filled in by hand)
I understand that I am responsible for all fees. I also understand that as treatment progresses the above fees may have to be adjusted, but that I will be informed of these adjustments and how they will affect my payment plan. In the event that my payments are not received by their due date I agree to pay all costs, including, but not limited to, reasonable agency/solicitors
I confirm that I have read and fully understand the above and that all blank spaces have been completed prior to my signing.
I hereby consent to the proposed dental treatment.
All of which was so, and I duly signed.
Underneath, there was a shorter declaration from Tooth Yanker, saying that he had done his bit, in terms of explaining everything and supplying any required answers.
Really just to make conversation, what with Tooth Yanker being young and Irish and the sort who seemed to want to make “relaxing” conversation, I asked him when this form first started happening. Because, I’d never come across this before. When those original crowns were put on the remains of my British teeth, which was much more complicated and surely just as hazardous, I don’t recall signing any consent form. How long have these forms been around?
Tooth Yanker’s answer surprised me. They have, he said, been around for about one week! This was only the second time that he had deployed such a thing.
Some “guidelines” had apparently been issued, and they were the kind of guidelines that, if you are a low-on-the-dental-pecking-order tooth yanker, you are firmly guided by.
It reminded me of a weird conversation I had with an unfamiliar doctor just after my mother died, asking me if I thought there was anything untoward about the care she had been receiving. At first I thought he was accusing us of having murdered our mother. But it turned out that he was just checking to make sure that her regular doctor had not murdered her. Doctor Shipman, you see. More guidelines.
Please do not get me wrong. I am not complaining, just reporting. This form was clearly intended to protect honest dentists against dishonest patients, and honest patients from dishonest or incompetent, or even evil, dentists. I certainly had no problem about signing it.
However, I can’t help feeling that all this tells us something about the way that British dentistry is now heading, and perhaps British life generally.
It is becoming more private sector. This all coincided, remember, with me going private to have my tooth out, the NHS having ignored me. I’m guessing that the NHS is protected by all purpose laws which say that the NHS can do no wrong, not even if it does do wrong, in fact especially if it does do wrong. But the evil private sector? Well, patients must be positively encouraged to sue those evil people, mustn’t they? These guidelines are the latest defence against this new atmosphere. I don’t know, I’m just guessing. But that is my guess.
I connect this form in my mind with the rash of television adverts there have recently been about how, if you have been careless at work and had an accident (like: you slipped on a slippery floor), then instead of just suffering like an old fashioned person of the sort who Won The War, you can instead blame someone else for your foolishness and ruin their life too.
I connect this form with the big signs that you now see, wherever there is a slippery floor.
More generally, I connect this form with the signs that you now see on building sites, like this one, listing all the many foolish things that you ought not to do on a building site.
You miss the point if you think that these signs are merely there to alter your behaviour. They are also, surely, legal documents. I have started particularly photographing such signs (and signs in general), because signs are, I think, and especially now, signs of the times that we live in.
One can perhaps sum all this up by saying that British dentistry, and British life in general, is becoming more Americanised. As in: less socialistic, but much more inclined to litigate and hence frightened of the litiginousness of others. And although I think it rather harsh to blame America for the annoyingness of lawyers everywhere, such an observation does suggest one particular thing that may get seriously underway in Britain. In the short run, changes like those alluded to in this posting probably mean a lot of turmoil, grief and added expense (they certainly meant added expense for me). But, in the longer run, does all this spell the demise of British teeth? Will British teeth in two or three decades time all be immaculate and sparkling? Maybe so.
The NHS traditionally has been rather indifferent to demands for mere beauty. But if customers are going to have to get used to paying, that means that dentists will be spending more time doing what customers actually want. And one of the things that more and more customers want is not just functioning teeth but pretty teeth. All of this will be too late for me, but it is surely one of the ways all this is heading.
About half way through this, I stopped shouting, but then started rambling, which is the other talking privilege of advancing years. I have, in particular, rather muddled together the increased litigation thing with the way that British dentistry is now being denationalised. But actually, I think, the two things do go together. Both are about dental customers moving from a world in which they take what they are given and suffer, should suffering be involved, in silence, to a world in which they demand, sometimes rather nastily and expensively, what they want. In the past, you trusted, and hoped for the best. Now, you distrust, and demand it.
As with so many discussions of clashing interests, not least those of lawyers, form printers and sign makers, this one makes me think yet again of the point made by Leon Louw in this publication (now over two decades old, linking to ancient things being another privilege of advancing years) that the society in which everyone’s rights and interests are taken seriously is the most difficult to legislate and litigate about.