Painting by numbers

At the end of a recent seminar about the proposed changes to NHS dentistry, one of the delegates noted on the feedback form that the new dental contract would “take the fun out of dentistry” because it would be all about “painting by numbers”. It was an interesting remark clearly referring to the part of the presentation that focused on the impact of clinical pathways and guidelines.

The smiley face emoticon at the end of the sentence was a little playful, mischievous even. Was the delegate suggesting that that ‘fun’ in healthcare can only be found in an abstract form and that any attempt to standardise clinical practice can only detract from the experience of being a primary care dentist? This view is not an uncommon impression though it is often expressed differently, sometimes as “loss of clinical freedom”. Couched in this way, it somehow lends more validity to the opinion perhaps even taking it to the borders of ‘fact’. To understand the clinical rationale of a pathway-led approach, we must first understand what we mean by guidelines and protocols.