Positively addictive… No, I’m not talking about Grand Theft Auto Mark VIII, or the latest series on a satellite channel. I’m actually thinking about a colleague who has gone bankrupt. Bust. Whilst that’s been uncomfortable for him, fortunately he
lives in the US, where bankruptcy, for an entrepreneur at least, is almost a badge of honour. You tried, it didn’t work out. You start over.
Maybe that’s going to change a little since the Lehman Brothers affair in 2008, but I don’t think it will change too much. In the UK, on the other hand, bankruptcy is a badge of failure for most, and especially for entrepreneurial dentists (although I could name at least two striking exceptions).
The trouble is, we’re addicted to the positive. We don’t like to think that things fail. ‘Our’ restorations always last longer than the average, ‘our’ root canal fillings remain stoically inactive for decades, and even ‘our’ dentures... no, let’s not think about the dentures.
Tragically, though, just about everything fails. In industry, 90 per cent of projects, new materials, great marketing sensations, actually die the death within a couple of years. A famous professor (who might be reading this) told me that if he snapped the palatal cusp off an occlusally restored first upper premolar, then given the choice between an adhesive composite build-up (which might need to be replaced every five or so years) and a full crown, he’d go for the build-ups every time. “After 15 years, I’d still have the natural tooth tissue I started out with” - was his comment.
This isn’t meant to be an advert for minimally invasive dentistry, because everything will fail eventually, we just have to hope (dark humour alert) it will be post mortem.
There is, I learn, even a museum of failure. Appropriately, you might say, it’s located in Michigan and people pay to go and visit it, mostly engineers, designers and marketing people. Astonishingly often, they see an exhibit spookily like the one they are just about to launch. Even more astonishingly, it was sometimes produced by the very company they work for.
We should take a leaf (literally) out of Michael Wise’s excellent book Failure in the Restored Dentition. Here is one of the foremost skilled and expert clinicians in the country not just accepting, but even planning for failure. And he is absolutely right. We should all have a plan B and even C, if the treatment proposal is of any magnitude.
Traditionally then, we were taught as undergraduates that failure was to be avoided. Maybe we should change that and learn to embrace failure, because unless we do, we won’t learn from it.
I found a long time ago that if things go well, patients are pleased. If things go wrong and you put them right again, patients are ecstatic. I should add, of course that the process of consent means that a warning of the likelihood of failure in advance is of course essential. What you say before things go wrong is wisdom; what you say afterwards sounds lamely like an excuse...
I wonder what we might choose to put in the dental museum of failure? Some would argue the contract reforms of 1990 and 2006. Others might well differ and say that we have learned a great deal from those events - such as the law of unintended consequences. Still others again might say that the consequences themselves were a greater failure for patients and the profession. Going back to Lehman Brothers for a moment, the failures of banks over the preceding decade have heaped huge ignominy on banking, particularly investment banking, since 2008 when they were, and are, widely perceived to have ‘gamed the system’. It would be greatly to our discredit if we were – as the OFT contended – to be seen to have done the
same.
Don’t get me wrong in all of this. Striving for excellence and longevity is to be applauded and encouraged at every turn. But don’t let the power of positive thinking delude you into the belief that failure doesn’t, or won’t, occur. I find nothing more depressing than to hear the words: “My root fillings/crowns/implants never fail” because either (a) it’s untrue, (b) patients go
somewhere else or (c) you just haven’t been doing them long enough yet.