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
fees.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.
I don’t mind paying for dentistry. Nothing is free in this life.
I do object paying the state to provide me with NHS dentistry and then not providing any NHS dentists in my area.
There is still a large contingent of NHS office staff administering NHS dentistry in my area. They work in a huge NHS office block which I travel past every day. They were the people who were supposed to arrange for me to get another NHS dentist when my last one went private. They said they’d ring me back. They didn’t. My emails went unanswered.
Fortunately the Primary Care Trust’s business plan for 2009 includes a desire to ‘Facilitate the progression of the PCT towards excellence in its delivery of stakeholder engagement.’ So I expect I’ll be getting a new NHS dentist, and an excellent one at that, quite soon.
The only stakeholder we nee is Van Helsing.
Similar situation Brian. Dentist in Belfast wanted to pull a back molar. I waited and spent a bloody fortune (well, on my income it was) while on the trail here in the US. They did not pull the tooth, they did a double crown. Much better for the jaw in the long run. Also will make it easier if they are going to implant some day because you get shrinkage after the pull and they’d need to do some bone grafting as well. Which they do here as well. An elderly relative had all her teeth re done at one point, at great expense and has better teeth in her 80’s than I do.
The UK likes to pull teeth. The US likes to save them or replace them.
Now imagine if the government had forbidden you by law to go the private route, because that would lead to “two-tier health care” and thus would spell the end of civilization.
Can you tell I’m Canadian?
Thanks for sharing the pain Brian. Before your post I was feeling fine, but now I’ve definately got toothache.
Either that or it is mouth cancer.
Damn this hypochondria. I knew it was terminal when the doctor said I had it…
Seriously though – sympathies.
“This form was clearly intended to protect honest dentists against dishonest patients, and honest patients from dishonest or incompetent, or even evil, dentists.”
The problem with these forms is, that at least in the USA, the form does no such thing. A good lawyer can twist this form to mean whatever he wants it to mean, Wonderland-like. In fact, a sufficiently clever lawyer can convince a judge and jury that the mere existence of the form constitutes an admission of negligence!
So all the form does is generate more work for lawyers. And then someone else invents a form that you have to sign stating that you have read and understood the first form. But that form can be twisted too, ad nauseum. Because American courts have bought into the Marxist nonsense about how words have no fixed meanings. And also because, when you get right down to it, the lawyers and judges are all members of a tribe, and most of them stand by their tribe first.
As I was reading that release form I kept thinking that it sounds very American, so when you reached that conclusion it certainly was no surprise. I was unaware that British society was becoming as litigious as is American society, and I think that’s unfortunate (for you) as unbridled litigation is one of the primary drivers of the high cost of our health care. Sounds like you’re going to have the worst of all worlds. Of course, we’re moving there, too, if from the opposite direction.
But your comment on “pretty” teeth is interesting. Where I live the concept of “cosmetic dentistry” is very much mainstream; local dentists advertise it aggressively (and, almost as an afterthought, mention that they can also perform routine cleaning, cavity filling, etc.). And of course “tooth whitening strips” and other whitening compounds are big business here, being sold by the toothpaste manufacturers. That’s coming your way, too. So perhaps you’re right: in another 10 years Craig Ferguson will have to stop making jokes about British teeth.
I had a tooth extraction (back left molar, badly split tooth; a root canal op was not successful) about two months ago. I am having an implant done in late summer, once my jaw has fully adjusted. The process has gone fine so far. The whole cost of the implant process, including the new tooth, is about £2,000.
I went private, using these guys. I have saved up money for this as I knew that it would be expensive to have an implant. The actual op to extract the tooth was quite long, and painful, but the guy did a great job.
One of the main reasons why I had the op was because the jaw under the affected tooth got infected; I have read stories about how infections in the jaw can seriously erode your health and general sense of wellbeing. It can seriously reduce life expectancy, apparently.
Like Laird, I think the arrival of litigious culture here is not a good idea, but as Brian says, the “take what you are given” approach of the NHS is clearly not good enough. And it is changing.
BTW, I get the impression that dentistry in places such as Germany is pretty good. Not sure about some of the southern European nations such as Spain (their teeth don’t look good).
Sorry, here (Link)is the link to the dentists I used.
I mostly agree with what you are saying Brian – but I suspect that the American view that British teeth are bad has less to do with the NHS and more to do with the simple fact of Britain being relatively poorer than America. As we’ve got richer over the last few decades (as we have, whatever they say) desirable luxuries like cosmetic dentistry have become more commonplace. It has also become much more nearly socially obligatory for parents to pay quite a lot of money for braces for their children, for tooth alignment problems would not have been corrected at all a few years back.
Americans express shock at how bad British teeth are. They are certainly worse than American teeth but I don’t believe that they are worse than, say, Chilean teeth or Bulgarian teeth. The thing that really shocks Americans is that people who talk the same language as them have teeth like poor people. It’s tempting for free-market types to blame everything on the NHS but I think it’s mostly money. Americans wouldn’t dream of even noticing that the Mexican woman selling them souvenirs had poor teeth.
I do like these sociology-of-ordinary life pieces, BTW. Sorry you had to undergo some pain to produce this one!
150 pounds to have a tooth removed? Even with air-fare costs, it would be far cheaper for me to travel to the U.K. to have my tooth “done” privately.
Nothing to do with dentistry, but much to do with liability. Our town has a substantial bit of forest, which is regularly logged. The township handles the cleanup of leftover branches and such. Recently, we did just this: piling branches into huge bonfires.
It had rained recently, so there was no danger of the fires spreading, so when we were done, we left them burning and went home. My son went by the site the next day, and said that the fires had reduced down to huge beds of coals, which would probably be glowing happily for another day or so.
The site was in the forest, but not all that far from a nearby road. I rather hoped that some children might happen on the fires. A lovely chance to roast sausages and have a pleasant evening around a bonfire.
At the same time, I couldn’t help but think what would happen in the USA or the UK. Parents might never have taught their children that fire is hot, or perhaps had never learned this minor fact for themselves. We should be required to put up a fence, or leave a 24 hour guard, lest someone somehow a meters high fire and accidentally stumble into it.
It’s my experience that the British teeth stereotype is largely a myth. These days at least. Possibly something has persisted from American contact with the British during the war and partially fed by a lack of British worry over having unnaturally perfectly straight teeth. Certainly, most, if not all, of my (English) schoolmates had perfectly acceptable teeth (Though several members of previous generations in my family had false teeth).
At least here in Tennessee, teeth are somewhat on par with England though the bell curve is a little wider due to the competing forces of dental obsession on the one hand and the redneck lifestyle, chewing tobacco and crystal meth on the other.
You fill in forms just like that with the NHS. I filled one out about 2 years ago when undergoing a minor (albeit undignified) procedure at my local hospital. Can’t speak for my non-NHS dentist, because I haven’t had any work done in several years other than the 6 month checks
I agree with Richard Thomas about British teeth. By and large most people under 60 seem to have reasonable teeth.
Completely OT, but my (American) dentist has in his waiting room a book called “Dentistry Through the Ages”. It contains the gruesome details, fully illustrated, of dentistry in the past. I often wonder why he put it there. It is either due to his total disconnect from the realities of what his patients go through, or else comes under the title “you think you’ve got it bad, but look at these poor buggers.”
Nonetheless, he does an awesome, pain free job.
It reminds me of my answer to people who lament the loss of the good old days. My answer is two words: “dental anesthetic”.
Most enjoyable post, interesting and informative. My family used to use an excellent NHS dental practice run by two very nice female dentists. When one went private and the other went off to be a mummy, we spent quite a while being batted from pillar to post by the NHS before finally deciding to go private. The service that we get from our dentist is superb and is definately worth paying for, but as an earlier poster said, I am paying the state to provide a service that they are not providing. Any private company that took people’s money and then failed to deliver the goods would be dealt with by the law of the land, we hope.
The tail end of the post made me think of the song by Wierd Al Yancovich, I think it’s called I’ll sue yer.
I’m thinking that the end of ‘British Teeth’ is an outcome much to be desired, but could someone redo Kenneth Clarke’s ‘Civilisation’? I couldn’t get past episode 2 as I couldn’t get my eyes off the train wreck he was speaking with.
That would be this one, Stonyground. Spot on.
Yes, sounds very American. Except you sign the financial part when you first come in as a patient. It’s at the end of the form where you list your home details plus employer, work address, work phone, and Social Security Number so they can hunt you down if your check/cheque is bad.
(In between, on pages 2 and 3, the form asks about your medical history, allergies, and whatnot.)
Also, every receptionist has a sign saying, “Payment is expected at the time of treatment.”
The informed-consent statement is standard with surgeries and hospital admissions. Something almost identical shows up on a form they shove at you when you refuse the treatment they want to do.
I’ve only seen this once, when I told an emergency-room doctor and the cosmetic surgeon he claimed was a hand surgeon that I didn’t need to be admitted to the hospital for a skin infection in the hand … whereas I did need to be at home as the sole caretaker of my dogs.
When the prospect of possible death wasn’t persuasive, I got the Against Medical Advice form. They completely ignored the requirement to list possible negative outcomes of admission while reminding me – twice – that I could die if I ignored their advice. Or, at the very least, my hand could fall off.
In the end they decided they could do what I’d had done before, which was to come in every day for a week for a dose of Vancomycin (Vancocin).
If I died, I’m not aware of it yet.
When was the last time you counted your hands though?:-)
“It’s my experience that the British teeth stereotype is largely a myth.”
Yes, but it’s a gold-mine of humor. Did you ever see the Simpson’s episode where Lisa walks into a dentist’s office and finds “The Big Book Of British Smiles”? On each page there is a horrifying cartoon of a smiling Brit, until the last page has Prince Charles.
And here it is! But it’s not Lisa, it’s Ralphie.
http://www.hulu.com/watch/26212/the-simpsons-british-smiles
Isn’t the Lisa one where they show a computer simulation of what would happen if a slight misalignment were not corrected? The outcome including a fang exiting the upper part of her face.
Jonathan Pearce: “BTW, I get the impression that dentistry in places such as Germany is pretty good.”
Yes, but is it safe?
Why do people bad-mouthe dentists? Well, they started it!
LOL!
“One can perhaps sum all this up by saying that British dentistry, and British life in general, is becoming more Americanised.”
What a load of tosh.
I’ve been going to the same dentist in the US for 26 years. He has never asked me to sign anything like this.
By-the-by, it took him 10 years to fix the legacy of British dentistry and unflouridated water that I brought with me. And he’s never pulled a single tooth apart from an impacted wisdom tooth. I don’t give a whit for appearance, and he knows it, it’s just that pulling teeth – the preferred UK solution to any dental problem it seems – is just-about always the worst solution.
On a wider point – what has happened to NHS dentistry? I remember it as being widely and immediately available, albeit brutal. Now, as I understand it, you can whistle for an NHS dentist. How has this been allowed to happen? Can the NHS simply stop providing some services with no recourse and no accountability?
On a darker point – bad as it was, NHS dentristry at least did some good. I shudder to think that the teeth of the average Briton will be like now that there apparently are few if any NHS dentists.
llater,
llamas
Llamas, NHS dentistry has really become the frontline example of the unsustainable lie that socialized medicine is. Funds were squeezed so much that fees became so low that (slavery still not yet legal) many, if not most, dentists simply stopped accepting new NHS patients. Because lack of dentistry is rarely life threatening, it didn’t cause too much of a stir. As usual, Labor was all up in arms about it before they got to power then failed to fix things when they got there.
A pitfall of using LOL was recently discussed on TV. A vet heard about the death of a dog, and sent LOL as his message of consolation to the owner. He only later found out that it DIDN’T mean ‘Lots Of Love’, as he’d assumed… You lose more customers that way.
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