Behind a Smile with Dr. Shauntel Ambrose
I host a podcast that shares the secrets behind some of the most resilient healthcare businesses worldwide, innovative products, savvy strategies and daily inspiration to reach your ultimate in your healthcare career. I interview the movers and shakers of healthcare who courageously push boundaries. Whether you a start-up, or needing a push to keep going or a family business or looking for mentorship without the business know-how. This is an all-inclusive, keeping it real, not for the faint-hearted, haters or the nay-sayers live your best life as a member of a global community in healthcare podcast!
Behind a Smile with Dr. Shauntel Ambrose
Heartfelt Reflections on Compassionate Care and the Impact of Mentorship in Dentistry with Dr. Kavir Rajkumar
As I sit with my heart full of memories, I can't help but remember how my late father's enduring spirit shaped my path in healthcare. Joined by my husband and mentor, Dr. Kavir Rajkumar, this episode of Behind a Smile is a deeply personal exploration of the values that drive us to provide compassionate care and the transformative power of mentorship in the medical field. We delve into the challenges and disparities of public healthcare in South Africa, sharing stories that highlight the urgency of empathy and personal connection in medicine, while considering the systemic improvements that could change lives in our communities.
Technology in healthcare often sparks debate, but Dr. Raj and I stand united in the belief that it should complement, not replace, the warmth of human interactions. This episode examines how innovative tools like the Vula app are reshaping patient care, improving communication, and referrals — a beacon of progress amidst the often-overwhelming demands of the healthcare industry. But amidst the discussion of advancements and efficiency, we don't forget the importance of unwinding; we share the hobbies that keep us grounded and remind us that life is about more than just work.
Loss has touched us all, and in this heartfelt conversation, we acknowledge the delicate balance of carrying personal grief while caring for others. We discuss strategies for healthcare professionals to manage the complexities of career advancement and personal well-being, offering insights on personal branding and job crafting. This episode is an invitation to join a community where your struggles are recognized, your ambitions are supported, and your dedication to healthcare is celebrated.
Hello and welcome to Behind a Smile. I am Dr Chantal Ambrose and I am a dentist. I host a healthcare business podcast where I interview healthcare practitioners around the world, sharing tips on how to improve your healthcare practice, innovate and grow, while living your best life. We share products and information from healthcare partners that can help you in your practice journey, be it a startup, a family-based business or a multidisciplinary healthcare team. Most of the information provided here is based on personal experience and opinions. Of the information provided here is based on personal experience and opinions, so please supplement what you learn here with approved research, studies and professional advice. Thank you to everyone who has subscribed and I invite you to join our community. If you haven't, we would love to hear from you. If you would like to be on the show, drop me a mail at behindasmile2 at gmailcom. Let's make it happen together. So welcome once again. It's Chantal from Behind a Smile.
Speaker 1:I haven't been around for a while. It's been an emotional rollercoaster of having lost my dad. Today's one of those very special tributes. It's something that I wanted to dedicate to his memory and was something that I think that he played a huge part in the way I was able to manifest a business and get step-by-step mentorship and eventually get to the point where I'm at right now. But I've been lucky enough to have more than one mentor in my life along my journey, and today I get on my show yet another one of my mentors that I've been lucky enough to. Somewhere during my really I think we were going through to a teaching meeting and I was lucky enough to meet my husband at one of these meetings and today I have him on our show. So I want to introduce to you Dr Kabir Rajkumar, and I've been lucky enough to work alongside him for a number of years. But I've also been lucky enough to actually learn a lot from him, and the reason we're doing this show today is not due to any nepotism, because you know by now that I actually am one of those super ethicals that if I go wrong I will apologize and I will move on, but I will also put in place a lot of processes and systems so that that mistake doesn't happen again. It's actually so that you can realize that anything is possible if you are able to put your step in the right direction and somewhere along the line you meet the right people, and I've been lucky enough to have met him.
Speaker 1:So just a little bit about his CV. It's quite humbling to read digital dentistry and the application of technology to offer the ease to dentists with speed, reliability, convenience, serving patients in a modern way to solve age-old problems. Now he claims his purpose for a decade is to offer his services to patients suffering from trauma as well as pathology in the maxillofacial and oral region, and he has a number of accolades, and I see that he hasn't really touched base on many of them, on many of his qualifications, which again is part and parcel of the package of Dr Ash Kumar, and I think that a really wonderful part of his written CV here is that he's been given a rare glimpse into the lives of South Africans and how, when the basic humanity and kindness is stitched together with clinical expertise, not only do you get to improve their ailments but add a smile to their scars the way very few practitioners can. And so I'm very humbled to introduce to you Dr Kabir Rajkumar, very well known as Dr Raj, welcome.
Speaker 2:Hi everybody. Hi, chantelle Babes, it's great to finally have earned the right to be on your show. I've been begging you for quite a while to get on and I'm glad I'm finally there. Yeah, it's a bittersweet day. As you know, we've laid your dad to rest today, so I'm really really sorry about that, and he's a man who I've held very close to my heart. What I've learned from him over the years has been massive, and hopefully I can grow our lives and plants the way he's grown his, and that's what I want to try and get done to make him just a little bit proud of my lifetime.
Speaker 1:I appreciate that. I think that it's a hard day for both of us and I think that it's important that we still have something to give to our audience. I always feel like it's a little gift that we give every single time that we record, and it comes from incredible people that we give every single time that we record, and it comes from incredible people that I've had on the show, you being one of them. I think that it's always wonderful to have someone behind you every step of the way. That will give you something positive about what you're going to do, and I think that I'm very grateful to have that from you.
Speaker 1:But I think from all of the time I've met a lot of dentists, from all of the time that I know you, I think the most humbling thing about you is that the way you do community-based health is absolutely epic. I've never met anybody that is so committed to their job but more committed to their patients. They're nearly almost to that point where they could probably drop almost anything to get it right, and it doesn't necessarily mean that you need to be particularly wealthy or you need to be someone to get great treatment. Now, I can't say that is true for everyone, but I do think it's true of you. So can you tell us what has led you to that community-based journey?
Speaker 2:As a practitioner and as someone who's just trying to look out for my patients and their best interests, being able to serve communities. It started for me very, very early on, even in my undergrad actually. In fact, I was on the teleprompter train where we were all the way in Saldana attending to patients there, and it was something which, for me, I had the opportunity to treat patients who I'd never seen before, never experienced before, and learned a lot from them and were able to give them a little bit of relief in their mouth for a bit and I thought that was a reasonable exchange at that point in time. And you know, this stemmed over all the way into community service for me those who know I was in Pofana, which is Moira of a clinic. So you know, apart from seeing a lot of patients every day, from the least I think I'd get to see is about 10. And the most went up to 40 or 50 a day for a single practitioner at that stage was massive. And I was lucky enough to be able to have excellent resources at my lovely clinic with my previous CEO, mrs Lachwayo. It was an absolute treat for anyone leaving university and being thrown into the bushes literally to practice dentistry and to offer expertise and a perspective of your mouth to patients. Amongst my friends, I believe I had the most best kitted out surgery at the time. We had a fully functional chair equipment. We had two autoclaves. I even had a Kodak RVG and an x-ray sensor for me as well and an assistant.
Speaker 2:So I was very spoiled for choice in what I could have done and at that stage I had reached out to one of the guys at head office in Peter Marisburg and I asked them for filling material. I asked him for root canal stuff and off I went, because naturally you just left university knowing crown and bridge and root canals and a whole lot of shallow chamfers and deep chamfers in terms of your preparation for crowns, and now you're just going to do extractions all day long. It's not something I was prepared to do. So I pushed for that and I got it done and you know it was one of the best things. Where at the local supermarket I would go to just get little groceries or whatever. And one of the patients who I did composite veneers for she had fluorosis. So I just did a six to six composite veneers for her and as I'd walk past she'd say Togatela and she'll smile at me and she'll show me her teeth and everybody else would look and think what is going on between these two.
Speaker 2:But you know it's very humbling and very grateful to have been given that as a gratitude and as a thank you rather than just thank you. So that's where there's a bug for reaching out to communities that don't experience dentistry, let alone aesthetic dentistry, at that level where you're able to actually improve somebody's smile. You know the stuff that you'd like to see on Instagram and all of that, and you're able to reach out and improve these patients' lives. And that facility grew so big that we ended up being booked out for a few months. In the two years that I was there in Moira, my ex-assistant Siabonga and we got up to lots of fun, and you know part of reaching the communities. He's taught me Zulu and I've become quite proficient at speaking Zulu. So you know it's being able to reach out, to touch people's lives, and they touch you in return in a way that this bug bites you and you want to do community-based stuff some more After Moirova.
Speaker 2:I've then left and I joined Gray's Hospital in Peter Marisburg, as you know where I'm currently based, and you know I joined a maxillofacial and oral surgery unit and the community service still hasn't stopped. We still see a massive drainage of population from the KZN province. If you just go back and have a look at 20 census, kzn's estimated population is about 12 million and the various districts which we drain are five of them all the way down from Kockstad, all the way up to Newcastle, from Cox's Dad all the way up to Newcastle. So that's a massive drainage of the interior region of KZN known as Area 2, which we drain and see for maxillofacial and oral surgery problems, trauma complications from dentists in the periphery and we're able to assist them and chat to patients and get to meet them and help them out with whatever they may need. Sometimes it includes surgery. That's how I look.
Speaker 1:Okay, so we know that. Now perhaps community is not something that you chose. I think community chose you from the sounds of that story. I think that in private healthcare what happens is we really get to see maybe just a few parts of South African stories. So when we talk and I don't think many of our guests won't understand that sometimes our dinner conversations are often about some graphic trauma cases that you may have done, or some really difficult pediatric cases that I have done, or whatever it could be.
Speaker 1:Sometimes we'll work together, sometimes we work with other teams. So what's really, I think, critical to understand, and something that I've learned from you, is that I've always been in private health care, but I've never truly understood the requisites of public health care in South Africa until you really share a little bit of what that looks like. Now we talk about the health care crisis in South Africa, but I don't think that we truly understand it until you walk that path Right. So can you tell us a little bit about what in the hospitals are you seeing? So what kind of trauma are you seeing in the dental chair? Are your dental chairs working? How long are you waiting for beds and how long are you waiting for theatres? What is the South African perspective in government hospitals? And I'd like to mention that this is a perspective, but I do know that some of our government hospitals are some of. Actually, they may be comparative, if not better than a lot of our private institutions. In fact, we would love to hear.
Speaker 1:What is that when you walk through those doors and you're not going in as a patient, you're going in as a doctor and you're part of the maxillofacial department. What does that look like in government?
Speaker 2:Well, from my experience, you know, fortunately in Grey's Hospital we are tertiary unit, so we've got a lot of facilities that are available to us. Things look nice and pretty, they are kept as best as possible, and this is my experience of it. And you know, we've all heard and seen the horror stories of patients lying in hospitals without cushioning, lying on the floor, sleeping on the floor. These are all true. These are all true as far as I've seen Not as much as perhaps other people have, but I can certainly confirm. I've seen these things with my own eyes and it's unbelievably humbling and you leave being completely grateful that you are a little better off than someone right next to you. But it also leaves you with the understanding that you can offer more to these patients just because of their situation. It doesn't mean that the bare minimum would be adequate, the bare minimum being you'd see the patient in your chair with whatever they've got, check on them, find out how their treatment plan is going, do an x-ray check if everything is in order. Is there anything getting better? Is it getting worse? Do you need to do anything? And thank you, goodbye, here's your next appointment. You can visit the pharmacy on your way out. I think if 90% of South Africans receive that kind of service they'd be all right with it. It won't be the best thing they've ever received, but they wouldn't complain terribly much about it. Then you go a little bit deeper and something in you will ask well, where are you from? And the patient will give you a response and they will tell you well, you know, doc, I've actually traveled two and a half days to get to you. We've slept overnight in the hospital that has referred us and from there we've had to take a taxi or we've had to take public transport or a family member has had to drop them off and they are a certain distance away from that family member or transit point as well. So these patients, they travel unbelievably far distance. They have to travel with their blankets, their pillows, change of clothes, food, and some of these patients that we see are children as well. So it's really unbelievable the amount of distance they will travel to see you.
Speaker 2:And when your service is just adequate, it's just not good enough in my eyes. You need to be able to offer so much more and more than just your service. It's just that human connection, just a basic. How are you doing? How's things going? Hey, I see you've traveled from here. You know I have a friend who's coming from there. You know how far are you from this hospital? This is where they work at Just a little bit of chit-chat, basic raw. But you're still able to relate to that even though this patient is so far removed from where you currently are location-based. But you're still able to develop and establish a connection with it.
Speaker 2:And you know I have this problem of fly fishing and fishing in my life. So a lot of the places I know which are out regions are famed for fly fishing and river destinations. So you know, I chat to the patients about it and a lot of them look at me and, yeah, this guy doesn't understand. Man, there's no rivers near us. That's a good, far long walk away.
Speaker 2:You know it's a lot. It's a lot and state hospitals do have a lot to be desired. But it comes with this burden of health care and oral health problems that we have in South Africa. And I firmly believe, even if you have that volume of patients and that number of morbidity and mortality that state hospitals have to bear, if private hospitals have to bear that same load, I think they won't look far off. It's simple numbers. It's a simple numbers game, I feel. I just feel that there are some which are needing a lot to be desired. And then you get our very own in Durban, in Kosi Albert Lutuli Central Hospital, which has got phenomenal support, beds, status, facilities and doctors. And one must not forget that the very same doctors who are in private hospitals are also those who are sitting in government hospitals on a part-time or a permanent basis.
Speaker 2:So it's not as though the hands that treat are different in the private sector. A lot of the time it is shared and it is the same, and the difference is probably the mindset of the practitioner, or maybe it's the facilities that they have at their disposal. And you know, a lot of the time it's something that is a little bit of ingenuity which needs to happen in the practitioner's head. They're needing to problem solve at a level which you won't find in South African dental journal or somewhere on Google. Very quickly. It's about applying principles which you have to fix your problem. It's not ideal, it may not look pretty, but it will fix the problem at least as best as you possibly can. Yeah, so you know, that's what public health looks like in South Africa at the moment.
Speaker 2:In my eyes and you know I'm not sure if it's always a budget issue that is the problem, but a lot of the time it may be people not placing orders in time to replenish stocks at certain levels it's smaller system errors that I feel could be corrected.
Speaker 2:But perhaps it is budget issues, perhaps it is political pressure from different sides which I'm not all clued up about, and I think these all culminate in sometimes a situation which looks very, very hard, sore when you look at it from the outside, but unfortunately for these patients, they've understood this to be a normality For them. They've grown up. This is how you attend a hospital, this is what it looks like and this is how you need to prepare to go for it, and that, for them, is a normality. And hopefully they find some people along the way who are able to at least make that doctor-patient interaction a little bit pleasurable, even though it shouldn't be because you're coming for an illness or an ailment, of course. But if you can make that just a little bit better and just give more than just oral healthcare advice or more than just your clinical perspective on what's going on, I think that human interaction is very valuable. It is what will make us human after all. But perhaps if we do that more we'll find a little bit more light in the world.
Speaker 1:It's a very special person that gets to be able to still have that empathy by the end of the day, because, you know, if I had to take into perspective what my patient load on a busy day looks like and what your patient load on a busy day looks like, I think that even the strongest practitioner, with the best intention, will have it hard to have not eaten for the day and still have 15 patients waiting in line. And I think that what's also quite incredible is the type of procedures that are being done in the chair, because you know, when you're in private, it's not something where you would be hands-on with fractures in a chair or you're actually doing excisions in a chair. So can you share what kind of procedures?
Speaker 2:Oh, absolutely. You know, this is something that we've started to develop within our unit and I'm very, very lucky and blessed to have been surrounded by a team who have got exceptional clinical skills, great team presence, and they're able to just get it together and just push work out in a orderly manner to the best of their ability, get the job done, get the patients moving and keep them as comfortable as possible. I think when you consider that, with the volumes that we're seeing every day, every week, every month, it's really a mammoth task which my team and I are able to succeed at and that's fantastic. So, as you're aware, you know, unfortunately we only have one theater slate a week for anything maxillofacial and oral surgery. That's not an emergency. So anything elective will be done on one day every week, providing it's not a public holiday, of course, and on that one day you could get a maximum of four to five patients done. Now let's do the maths on that when we see patients over Monday, tuesday, wednesday and Friday for reviews, we are seeing an average of around a week for the past year and a half. So that's a massive number and a lot of those patients simply cannot be done in theatre. It's just that their fractures cannot wait. It will be well.
Speaker 2:Okay, let me say the fractures may wait. You certainly are allowed to put a patient on a waiting list and wait and let this waiting list build up until a few years' time. But there are other options which you have. Wiring under chair under local anesthesia has been done successfully for a long time, and biopsies and excisional biopsies have been done for a long time as well under local anesthesia. However, when you turn into consideration the age of the patients that we're starting to see, with problems with fractures, with tumors, with growth starting to develop, you need to think of a kinder and a simpler and a gentler way to manage this. And we've resorted to sedation, and by using sedation, naturally, one would start with verbal sedation.
Speaker 2:We don't have nitrous oxide at our disposal in the clinic, but we do have some ketamine which we do use, and it just makes light of a very, very difficult scenario. We've been having to do ORF, that is, plates and screws for fractures on the chair, on a regular basis under local, because we just simply can't delay their treatment any further. Your bookings are a few months in advance and these may be acceptable for other types of ailments, but for this kind of fracture it's not advisable. The patient's difficulty to manage basic everyday functions with that fracture will just be too difficult to manage. So we discuss it with the patient and we tell him this is the plan, this is how we're going to move forward, excuse me, we get our consent and we move ahead and we get the treatment done as quick and as pain-free and as efficiently as possible and the patient's on his way. Naturally, ketamine is a drug which can cause respiratory depression, so you need to be very careful who you use it on and you need to use the correct doses with these patients.
Speaker 2:I've been able to do archbioelastics for a three-year-old who's fallen off a jungle gym and fractured their mandible. We've done massive cysts. I mean from 2-4 all the way up to 3-6. So that's almost a complete mandible. This cyst has been enucleated, luckily.
Speaker 2:You're going to go for, or what would be advisable would be a unicystic lesion that you're going to enucleate and you're going to naturally play to the presentation that you have.
Speaker 2:Is this patient someone you can consider this option for and are you going to do any benefit?
Speaker 2:Will you actually will your effort and will the patient's sacrifice?
Speaker 2:I'm going to say what you're going to put them through, will that be worth what you will achieve?
Speaker 2:And these are very, very difficult to predict because they're not only your factors as a practitioner and your skill and your resources and the chair time you're going to use, and you also have to consider will your patient be able to manage this? Are they able, going to be strong enough? Will they just not manage? Will they be too emotional to bear with this? And you've got time ticking away because, as you said, you know there are patients waiting in the queue wanting to know why they aren't seen yet, because you're taking an extended time for a procedure. So you know, naturally you have your monitoring and you wait for your patient to be completely functional before you release them from your care. So all these little factors which are important and which will really help you and your patients, it's a great advanced procedures, not only in the chair but even in the field. You know I had a course where I did advanced wilderness emergency medicine and this is where my introduction with ketamine began.
Speaker 1:Yeah, you know, it's fantastic to be able to have a team where you get advised on these drugs that I think you will need advice on in order to use them, and I think that collaborative care that happens in these hospitals that are able to service patients at the level that some of the procedures you've mentioned would not even be considered as an option to do in a dental chair unless you have general anesthetic, and given the fact that these patients are traveling for days sometimes to reach you, they haven't had a meal and they're often kids sitting and waiting in line and maybe refused to be seen for a number of different other general health issues that take precedence over the dental issues, even though they have either pathology or fracture related or trauma related injuries. So, you know, in all, I think the collaborative care is something that is outstanding. If you had to. I recall a story where you were just saying that a dietician asked you to do a frenal release because there was a baby that just wasn't feeding well, and you know that sounds like such a that sounds like such a collaborative way to be able to solve problems at.
Speaker 1:Maybe this, it's this team at large, it's even when a medical doctor asks you know, do you have a chlorhexidine, at least for the patient, because they're still needing to wait in order to go to theater for weeks. You know, it's almost as though each person learns a little bit more about somebody else's medical care and then offers it to people where they fall within that category, and I think that everyone gets better when everyone collaborates and everyone learns. So I think I recall you saying to me that you were quite involved in getting a paperless system launched in your hospital. Can you tell us a little bit about that?
Speaker 1:Yeah, I know that you're driven by technology, so yes, no, no, no, no.
Speaker 2:This has been a project which I've been involved in for a while now and we're trying to.
Speaker 2:It's kz and health driven, and what is trying to happen is we're trying to create a health system e being electronic health, where the files that go missing and patients who were supposedly booked but are not expected on a specific day, this electronic system, which will be database driven and stored up on a database accessible to South Africa at least KZN for now, but countrywide in future where all of the patient's details their name, date of birth address, what they attended, which hospital did they get blood results, were there any x-rays and all of this available to a practitioner anywhere with access to e-health. So you know it's something that I really really like and you know I've tried to prototype and develop one for our own private practice. The point is is that nothing can really be technology-driven. It's always personally driven, it's person-to-person, but the technology behind it will make that easier and faster and hopefully cheaper as well. This is where technology will come in. Technology will never replace people. Ai is simply a tool for people to use to make things better, easier, cheaper, faster. It will not replace people, at least in the near future. So with that in mind, the technology is simply made to make things quicker and streamlined and it doesn't make people wait out for so long.
Speaker 2:You get the complete patient on a single piece of your laptop or tablet, whatever you have at your disposal at that point in time and that bit of technology will help you see your patient completely. You won't miss out information which would be the patient may have forgotten to disclose to you. Perhaps you're seeing a patient who is unknown at the point in time but based on their blood results, based on other things, you're able to track this quite quickly and get a name for this patient and contact their family members and inform them of their family member being ill or being found at a hospital. So it's a fantastic initiative and I think it's going to go quite far in terms of reducing that gap of lack of or, let me say, suboptimal service delivery. It will really improve that, because all it will do is it will make things much more efficient.
Speaker 2:Everything is timest stamped and practitioner stamped, so if you see a patient on a certain day, it will be. Your name would be written clearly, legibly, and your notes are written in a orderly fashion. It will even guide you through your examination process. It's still in its infancy, but it is progressing and it is coming forward and should be implemented in a few hospitals and rolled out in a few more as we go on. So yeah, I was very privileged to be involved with that and that was exciting. I enjoy technology and enjoy applying that to healthcare systems and problems and that's fun, that's exciting.
Speaker 1:You know, listen, I think that the future is something that may look actually quite promising for our oral healthcare public system, but what's your perspective of that?
Speaker 2:So remember I currently think that that's going to be magnificent. You won't have patients with files missing. As I said earlier, all your x-rays will not be missing. They will be found in one place. There's an app which we're currently using which is called Vula. Now a lot of practitioners across South Africa are using this and it is a referral app.
Speaker 2:So if you're sitting somewhere and you find a patient with a problem, you're not sure what it is, but you can find out what this is. You've got access to a phone and you take pictures of your patient, you take pictures of the file of your blood results and you send this to somebody. Anyway, it doesn't matter and they will be able to give you more information in real time and tell you okay, maybe this isn't me who will be able to attend to your patient's needs, but I know who can, and you involve them in that conversation as well immediately, and this is tracked, so it is stored, it is archived. So two months down the line, if there is a problem, I can go back and refer to this and I say but, doc, you sent me this patient, but you didn't send me what I asked you to send me, and why have you not done that. I've asked it repeatedly and you still haven't provided it.
Speaker 2:And now we have a problem where we're needing to solve this issue. So that ability to go back in time where notes can't be edited and you know, from a medical legal perspective, this gives you a very solid standpoint to defend yourself from, because everything is clear in black and white. The clinical information is there, as well as the communication, and it just makes it more efficient. It makes it also when you get to handover, it's quite clear in your department or between your colleagues that this is what was done, this is what I've asked for, this is what I've received, this is when the patient is coming. This is my plan. We're just waiting for them to arrive to execute the treatment. So it makes it very efficient, that streamline and flow which happens, and it just makes things quicker.
Speaker 1:So your outlook is that the future is good.
Speaker 2:Definitely. I think it can only be good from where we are at, and the only people or the only reason it isn't better is a human reason is people not wanting to adopt technologies, not wanting to use it for the best advantage and also not looking to improvise and take on how do you say calculated risks that are still safe for your patient, but risks that will certainly improve the well-being of your patient, but is not what is normally done in your facility currently and that's going to only improve your patient's well-being. And if we are not advocates for our patients, nobody else will be. There's no one else who will fight for a patient other than their own practitioner, and if that is what we are doing, or if we fail to do that, I think we really need to think about what it is we're actually doing at that point in time, because it must always benefit the patient.
Speaker 1:I wonder if many people know that you are a very involved fly fisherman and you've been featured in a few fly fishing magazines and you have been given some wildlife photography accolades. So tell us a little bit about that.
Speaker 2:Well, I think, thanks, you know, from a very early age you know this. In my career at least, publication was something I enjoyed. I enjoyed documenting something and getting a photo of it and printing it out in media. And Moira started this disease of mine where after work the sun would set at about seven o'clock so you'd get at least a good few hours of fishing before you got back for supper. So you know, that's where this disease of mine started.
Speaker 2:And when you're in such pretty surroundings and you're chasing this fish or you're just chasing this chance to be around water or be around a river, it's just very, very relaxing, soothing and calming and that's fantastic. It's really interesting and it's fun. And it's also a technicality. There is a rhythm, there is a muscle memory which you find in fly fishing and it becomes an art form when you look at it after a while. Then you can take this art form to various lengths and depths according to your ability and will and time. Really, you can tie flies, like I do, or you can drive up to Lesotho whenever you get a chance and do fly fishing in the mountains there. But you know, the funny thing is it also teaches you discipline and patience, and these are things which you can apply to your everyday dental practice too. So there you go you become a better dentist by being a better fly fisherman. Comes from me.
Speaker 1:Well, I quite like that. I like any sort of original spin on how to improve our work and how to make it more fun. So I really enjoy that tip. But you know, coming back down to what your main line of work is, which is with oral surgery, and you have a dip in oral surgery and it's almost your love job that you do- it is I think a lot of people in private move away from surgical extraction simply because they feel ill-equipped to do so, and I'd be interested for hearing from you what advice do you have to those dentists.
Speaker 2:Well, I think, first and foremost, it's quite clear to identify which teeth you would suspect to be high-risk teeth. Naturally those teeth which are root-cannelled. They are more brittle and more prone to fracture and therefore there will be harder extractions. Premolars, we know, are notoriously difficult to extract Impacted wisdom teeth the same. So I think the practitioner needs to guide or at least gauge their ability in an honest fashion, rather than you know what. I can pull a few extra codes if I take out this wisdom tooth here. That would be great for my bottom line for the end of the month, and that's a dangerous trap to fall in. It may work once or twice, but there will come that time where you get caught out and if you don't have the ability or the tools or the know-how to get yourself and your patient out of that situation, it becomes ugly quite quickly. So I think identifying which patients are high risk for being difficult in extractions is a number one, it's foremost, and it begins right there. The rest, what you can avoid, you must avoid the rest. You do the best that you can, while doing as little damage as possible to your patients, and identify when to call it quits and when to explain to your patient. Sorry, forgive me but I'm not able to complete the job which I've started. So this is my plan going forward and I think it's important to do that. And why I say this is over the few years only from state, I need to emphasize some of the practitioners who contacted us were from private as well, where it was an extended duration of an extraction, difficult extraction from the beginning tooth snapped off and multiple times there were teeth fragments breaking off and after an hour and a half, multiple injections, local anesthetic, multiple lengths of chair time, multiple x-rays. Later you got a fractured mandible and that could have been avoided at an early stage. And I think it's important with practitioners from the private settings who may be not doing surgical extractions as frequently, to know when to call it quits and when to refer that off to a colleague maxillofacial and oral surgeon or whoever you're comfortable with sending the patient to assist, to get that patient sorted, rather than continuing and ending up harming the patient in a greater way, even though it was not what your intention was, but that may land you in a bit of trouble with our governing bodies. That be Now.
Speaker 2:But with that being said, we've now removed what we can from the problem scenarios. Now we're going to go to the skill level part and I find a lot of practitioners don't open flaps quite frequently and these are things which we were taught quite frequently in undergrad and I find a lot of private practitioners and even sorry, I'm not going to say private, let me say general practitioners don't open surgical flaps up frequently. One of your principles of surgery is access and vision. You need to be able to see what you're doing and digging with a crier into roots. Vision you need to be able to see what you're doing and digging with a crier into roots, into how do you say cavities within bone that's bleeding makes it very difficult for you to see what's going on. So, yeah, I think improving your vision and being able to get those roots out would help quite a lot.
Speaker 1:What most generalists need to know is that they need to know where their boundaries lie, where their expertise lie, where their experience lies and whether or not they're going to be able to manage that patient and to recognize the danger and then to communicate to the patient with some sort of support.
Speaker 1:Absolutely, so the patient's not left in the lurch to go to whoever it is that's going to now just help.
Speaker 1:Whatever situation it is, whether it's an OAC or whether it's a broken root or whether it's a very humbling premolar which I think every single person I know has been humbled by one premolar in their life, and if they haven't, they still have a number of years to complete in their dental journey. Absolutely so it's just one of those rites of passage and I think that, yeah, that's really great advice for anyone that is in that position where they just feel like they're not going to do any surgical extraction simply because they're just not equipped to, and now they know that they need to have a few people on board to maybe gain some of those skills and if they're not feeling confident, maybe it is the best to just refer on without now leaving the patient in a lurch and maybe still giving them some level of support. So we have run out of time, and my last question is what inspiration do you have that you can leave us with for today?
Speaker 2:Well, I think that inspiration is all around you, it is everywhere. It's just you need to be open to the perception of beauty, and the perception of beauty can be found in simple, everyday things. Or it can be found in the magnificence of a blooming orchid. It can be found in the magnificence of casting a fly out into a river and watching a fish bite your fly, or just taking a photograph of a sunset. You just need to be open to the opportunity of it and receptive to that opportunity, and sometimes the best sunsets are those which are not photographed. Be present in the moment that you're in, put your phone down and just absorb it. Be present in that moment with your loved ones, with your family, and enjoy what you can, because sometimes they're not there anymore. Yeah, I'd like to close with that.
Speaker 1:I'm highly appreciative of you being able to share this really intimate journey with me, for today that's owed to the death of my dad, and it's really sad yet embracing sort of. You know, your moments become heavier and your days become longer, and in that exact single moment I actually really reach out to every single person that has to go into work tomorrow and still have had something that made them really heavy for the day and still need to have to give off themselves personally to their patients, because really that is what we're meant to do here. We have taken that oath for improving somebody else's life and I think in many ways, you do that in every way possible. So we're very grateful to have worked with you, to be with you and to have shared this moment in time. Thank you very much.
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