One foot in the grave

I thought that the days of me being rendered speechless by anything were well behind me. But, whatever you say about the GDC, they never lose the capacity to amaze, while adeptly shooting themselves in both feet. The latest fiasco in the closing days of February brought the Council to the burning issue of the day. I refer, of course, to the question of whether dentists in the UK should be permitted to use the courtesy title ‘doctor’.

The GDC’s Standards Committee’s recommendation to Council was to take a decision in principle that only dentists who were medically qualified and registered (medical) doctors, or who had a bona-fide Doctorate (PhD), would be entitled to use the title ‘Doctor’ after a future (unspecified) moment in time.

As I have explained previously, I have no massive personal view on this issue and, throughout all my years in general practice, was perfectly content to be a ‘Mr’ and never aspired to be a ‘Dr’. But I was always equally happy for others to make up their own mind and that remains my view – providing of course that those using the title ‘Dr’ are not abusing the courtesy.

In these evidence-based days, it is difficult to describe where, in the Cochrane hierarchy of evidence, one would place the robustness of the evidence upon which the GDC – or more precisely, its Standards Committee – relied when recommending to Council that dentists should no longer be able to use the title ‘Doctor’. To say it is in the vicinity of the well-recognised ‘I met this guy down the pub the other day’ level of evidence would be an overstatement – it’s not that good, to be honest. But it is definitely up there with the rest of the compelling ‘I know someone who met this guy down the pub the other day’ evidence. Has the GDC been overwhelmed with patients who, without prompting, have complained specifically that they had been misled into receiving – well – dental treatment, by someone calling him/herself Doctor?

Apparently not, although when this blindingly obvious question was asked in the public session, it was clear nobody knew the answer. So, without looking for evidence under its own nose, and in the absence of any other evidence to suggest this was a problem, the GDC commissioned its own ‘research’ in the hope of finding some people that could be misled into believing that they had either been misled already, or might be willing to be misled in the future.

Push polling
One of the questions they were asked in the surveys and focus groups was drafted like this: ‘The use of the title doctor is in fact a courtesy title and they (i.e. dentists) are not necessarily qualified medical doctors. Do you think it is OK for them to use the title doctor?’

I had never properly understood what ‘push polling’ was until now. If dentists obtained consent from patients on the same basis, the GDC would cut them off at the knees. But, even when led shamelessly towards the desired answer in the above way, 28% of respondents still answered they were not concerned, as long as the dentist is competent.  This was surely the smart answer

I thought – pity these people are not employed by the GDC. We are asked to believe, according to the papers placed before Council, that members of the public and patients (two separate groups, please note) are likely to be misled by a dentist’s use of the prefix ‘Dr’ even when qualified by the suffix ‘Dental Surgeon’ or ‘Dentist’.

If so, they must be very easily misled. What was not made clear in the Council papers was the fact the original complaint to the Advertising Standards Authority (ASA) – the one which led to the ASA ruling that dentists should not be allowed to use the title ‘Doctor’ in any advertising, and which a previous GDC had the good sense to note, but not to follow (in the sense of imposing a specific preclusion to this effect) – was made by a medical practitioner who was unhappy a local dental practitioner was using the title ‘Dr’ in an advert, even though the rest of the advert made it crystal clear he was a dentist. 

Interested parties

Out of the many, many thousands of complaints I have read over the years in my ‘day job’ at Dental Protection, I can recall four complaints about the alleged potential for members of the public to be misled by dentists calling themselves ‘Dr’.

Two of them were from medical practitioners (one of which was brought in the name of the wife of the medical practitioner concerned), and one was in the name of a ‘dental patient’ who forgot to mention that he was in fact a medical practitioner who had chosen not to use his own courtesy title ‘Dr’ for as long as it took him to write the letter of complaint.

And the fourth complaint was initiated by a dental technician who had himself been hauled over the coals for the illegal practise of dentistry and who suspected (with some justification, it later transpired) that a local dentist had blown the whistle. And his complaint about the dentist’s adoption of the title ‘Dr’ was made, as I am sure you will readily understand, not for any personal reasons or malice, but simply because of his concern that other members of the public might be misled.

Against this background, it was probably not ideal in the interests of transparency, external perception and the confidence that dentists might have in the decision, that of the four members of Standards Committee that had a vote, only one was a dentist.

Of the others, one was a lay person, one was a former medical practitioner and one was a dental technician. But they accepted the research at face value and made the recommendation on a majority vote. Fortunately, it was for the full Council to take the final decision in open session, and having teetered briefly on the edge of taking a spectacularly embarrassing decision and an early grave for a Council barely a year into its five-year term, sanity prevailed and the decision was deferred so that a full impact assessment could be carried out.

And yes, one asks why this had not been done already, before bringing the matter to Council for a final decision based on a firm recommendation from (effectively) three people. It is at moments like this that one realises the price that we are all paying for having a fully nominated (rather than elected) Council, and one which is the least experienced in living memory, in terms of its understanding of the profession.

There are still some sane people on the GDC, including some who can remember the ‘call me Doctor’ debacle last time around – so we shouldn’t tar them all with the same brush. But their voice is being drowned out by others who are perhaps intoxicated by regulation itself, and the result is an alarming disconnect.

We do not yet know whose brainchild it was to unearth the ‘Call me Doctor’ debate, and whether it was driven forwards by a lay Council member or parties within the GDC staff, perhaps – but this will come out in time. What matters much more is that the same factors, if left in place, might yet wreak more havoc on this or other (more important) issues.

One can only hope that the impact assessment will highlight the potential for months or years of entirely avoidable, unnecessary and costly Investigating Committee and Fitness to Practise hearings – perhaps many thousands of them –and quite probably, legal challenges in Europe and elsewhere that will comfortably take the GDC into the middle of this decade.

Don’t even think about what this will mean for your Annual Retention Fee. Dentists are not allowed to behave in a way that undermines public confidence in the profession, but the GDC seems hell bent on doing precisely this at every opportunity.  What we are currently witnessing is regulation not in the interests of the public, as it purports to be, but regulation for its own sake. Regulation that takes, as its starting point, the premise that nobody in and around dentistry knows anything worth knowing, and anyone whose experience comes from outside dentistry will always know better.

Regulation that has lost its sense of priorities and is completely out of control. And we should all be very sad about that, not just angry.

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