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Sep 18
The Decline of Public Trust

I was discouraged to read that on a list of most respected professionals, dentists are now in tenth place (Image below: Insights West 2017 online survey of a representative national sample.)

I remember that 40 years ago, we used to be in second place.

While there are some bad apples in every profession, the vast majority are unfailing professionals. So why the downward slide in public perception and what can we do about it?

I have been thinking and reading a lot about this. Factors such as dental advertising, easy access to online health information and ratings sites, and media coverage of scandals involving healthcare practitioners may have resulted in more skeptical, less trusting patients.

I believe that better-informed patients can reduce the hierarchy that is evident in any doctor-patient relationship – this is good. But when people consider themselves less as patients and more as consumers, we shouldn't be surprised when they become more cynical and less likely to believe that their dentist is truly working on their behalf. The public hears the market message about dentistry rather than the message of professionalism.

It is easy to blame outside forces. We, as dentists, have contributed to the decline of professionalism, most especially through the volume and content of advertising. If this market message continues to increase, trust will continue to be eroded.

So what can we do about it? We need to talk about ethics deliberately and regularly. If we can strive – through discussion and communication and education – to hold ourselves and our peers accountable for providing ethical and professional care, maybe we can reverse the trend and regain the reputation that we have lost.

I will be exploring this topic further at listening sessions this fall in Vancouver, Kelowna and Prince George. I hope you will join me.

Listening sessions will be held in Vancouver (25 September), Kelowna (19 October), and Prince George (15 November). Registration information is available here.

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Sep 15
Are the College's Bylaws "old school"?

The membership of the College Board has changed significantly: 14 out of 18 board members joined the Board since July 2016. With this in mind the Board has done something incredibly brave. We have hired an independent consultant to set up a board self-evaluation process. This will allow the Board to function at the highest level possible in fulfilling our responsibility, authority and oversight in the College's sole mandate of public protection. We are also developing an evaluation process to assess and develop the skills of the Board's sole employee: the Registrar/CEO.

One major item that the Board will be tackling is a rewrite of the College's Bylaws. We have set up a Bylaws Working Group to recommend revisions to the bylaws that will promote clarity and transparency in our governance and regulatory process. We are also paying close attention to what is happening with other regulatory boards in B.C., across Canada, and around the world.

When we compare ourselves to the best practices among regulators in other jurisdictions, Bylaw Part 2 (College Board) that outlines board composition, size and election process appears "old school." While there is nothing wrong with "old school," it behooves us to look into what changes could make the Board function better.

There are consistent elements that I see in the evolution of board size, composition, elections and succession planning. Boards are getting smaller to be more nimble and efficient. Sizes of 9-12 seem to be the norm. Elections are changing from regional representation to more qualification-based representation that enlist certain skill sets. Succession planning is most often accomplished with the president or chair being voted for by the Board who, in turn, are voted in by the registrants.

My first year as president involved more than 40 hours per week of study to bring myself up to speed. The presidency position was designed to allow a practising dentist to take one day a week out of his or her practice to manage College affairs. This role was not designed to require a dentist to devote five or even six days a week to College activities.

It would not be fair to expect a working dentist to parachute into the presidency without knowledge or history of the College. For this reason, I am a strong advocate of some sort of succession plan. A succession plan could be something as simple as a president-elect as we see with the BCDA or, of the many variations on a theme, it could be election of a president or chair from the Board.

Do you have thoughts about possible changes to Bylaw Part 2 (College Board)? This will be a discussion topic at the fall 2017 listening sessions in Vancouver (25 September), Kelowna (19 October) and Prince George (15 November).

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Mar 31
In memory of Jessica Anderson

I am writing this post with sadness in my heart. My daughter Jessica (38 years old) took her own life in our home on January 28 of this year. Jessica has had a long history of depression. Jessica's first attempt at suicide was at 15 years old. At age 25, she again attempted suicide. Jessica has spent the last five years of her life with Penny and me with daily expressions of love and laughter. We thought that she was in a good place, but alas, that was not so. Her death left us with inconsolable grief for several weeks. This was followed by expressions of guilt. Maybe we could have said something or done something more to change the outcome. This was followed by anger. How could she have been so wrong in her decision to end her life? Since that time on January 28, Penny and I have cycled through these emotions of grief, guilt and anger. With time we cry less and heal more but the devastation in our lives will always be there to some extent as the years pass.

The reason that I am sharing this story is three fold. First, I have been writing on the wellness subject and how the College and the BC Dental Association have embarked on the assisting of members of our profession who suffer from addiction. This is on the same theme of how people deal with depression. Second, I have been touched by how many people have come up to Penny and me to express their condolences at our loss but who have shared the same experience of suicide, be it with a family member or friend. Third, by bringing this topic out in the open, it is my hope that having created an open forum of discussion on this subject of suicide, that the negative stigma might be taken away from this affliction and prevent this action from happening to a child or adult due to a new found understanding of society.

Most of us think suicide is something that happens to strangers – not to people we know. The US Centres for Disease Control says the age-adjusted suicide rate in the US increased 24% from 1999 to 2014. According to Statistics Canada, mental illness is the most important risk factor for suicide; and that more than 90% of people who commit suicide have a mental or addictive disorder. Depression is the most common illness among those who die from suicide, with approximately 60% suffering from this condition.

Under the high stress of dentistry and life, I have struggled with depression several times in my 43-year-career. I have had love and understanding and help to get me through these episodes of depression. In the dental class ahead of me a dentist died by suicide. In the dental class behind me a dentist died by suicide. In my class a classmate died by suicide. The son of a classmate died by suicide at the age of 22. A College staff member shared with me that she had two people in her life who had died by suicide. This story of suicide has been repeated to me countless times by so many individuals as they share their grief and understanding with me following Jessica's death.

What is wrong with everyone? Everyone needs more love. When the pain of living becomes too great, more often than suicide an individual will resort to numbing the pain with drugs or alcohol. Drug addiction may be a symptom of a greater problem. Identifying this issue is the first step.

As I look around our profession there are several of you who are in crisis. There is at least one individual who, under the stress of life, is dealing with the pain of living and is in crisis. Realize that one in four in our profession have feelings of being alone and are in stress.

If you are feeling alone or not feeling awesome, you are not alone, you are not weird, you are not odd, you are not different, you are not broken, and you are not weak. You are with family. We are all one and we are all human and we are all the same.

Whether it is in your church group or the staff room in your office, whether it is in your family or fraternity, whether it is in the team that you manage or in your online community, when you go out and talk about suicide and drug addiction and do not gloss over it and don't flinch, you make people feel better about it. It is my hope that by talking about suicide that we may be able to get those individuals the right kind of help. That is how you can save lives.

The monster is the isolation. Isolation is what kills. We are not wired for isolation, we are wired for love.


"Depression: let's talk" is the theme of the United Nations World Health Day on April 7. The Canadian Mental Health Association – BC Division offers resources for those who need help in emergency and crisis situations, if you need someone to talk to right away, and in your community. CDSBC registrants and their families can access additional assistance and support through several programs, including BCDA's Dental Profession Advisory Program and CDSPI's Member Assistance Program.

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Jan 24
​​"Raising the bottom" for those struggling with addiction

I have been furthering my interest in the topics of wellness and addiction since I last wrote about them in October (see Depression, Addiction and Dentistry). I have found the writings of Terry Gorski and the Love First  book and website from Jeff and Debra Jay to be particularly helpful in furthering my understanding. I'd like to share with you a few of the key things I've learned, and update you on College developments in this area.

One item that really stood out to me from Gorski's writing is the myth of the popular belief that you must wait for an addict to hit rock bottom. Gorski is quick to point out that the bottom, in this context, is often death. So instead of waiting for that outcome, there are ways to 'raise the bottom' – to create urgency and set limits so that the addict is faced with consequences.

This leads into the work of Jeff and Debra Jay which is about planning and preparing for an intervention. They tackle the myth that interventions must be confrontational. Their process tries to make the addicted person feel safe, loved, and supported so that they are less likely to be defensive and more likely to be receptive to what their friends and family are saying. The idea is to stop 'desperate enabling' and instead create 'leverage' — what they describe as loving limit-setting for the addict, and for friends/family, that will motivate the addict to accept treatment.

Another central theme around interventions is the importance of a strong team to influence the addict because, as the authors put it, "one on one, addiction always wins."

Because of these high stakes, it is important to have the best advice and information available if you think you need to proceed with an intervention. I am sharing these resources because they have helped me understand more about the topic. Please contact the supports and make use of the resources listed at the end of this post if you or someone you know are in need of help.

Before closing, I want to draw attention to two important items. First, I hope you will have read in the renewal fee memo that the Board will establish a practitioner wellness fund this year that will provide resources/supports to registrants who may need assistance with medical assessments and with their recovery. We know that assessments can be a barrier to treatment and while we are still in the early stages, I am proud of the College's work to help registrants in this area.

Secondly, I'm happy to say that the College continues to keep this important topic at the fore. At this year's Pacific Dental Conference, we will be presenting the exciting panel presentation From Pain to Wellness – Opioids and Beyond.

The session will have presentations and Q&A with experts in addiction medicine and dental pharmacology, in addition to our own Dr. Cathy McGregor, who heads the College's wellness program. I hope to see you there.

Further reading:

 

Resources:

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Jan 16
Priorities for Sedation

This fall we heard the terrible story of the sedation incident with young Amber Atwal in Edmonton. This child had a general anaesthetic (GA) sedation procedure provided by a dentist, after which she suffered a brain injury. My heart goes out to this family and, as a father myself, I understand why they are demanding answers.

Although this incident took place in another province, the College has fielded multiple requests for information about sedation dentistry. On one hand, I can reassure patients in B.C. that we do not allow a single-operator model for GA. I am very pleased to report that GA standards and guidelines were already at a very high level and were much safer than what was the standard in many other provinces. (You can read our statement here.)

On the other hand, the job of protecting the public is always evolving and, through the Sedation Committee, the Board is making the following changes:

  1. Addition of capnography (end-tidal CO2) monitoring to deep and moderate sedation standards and guidelines. Recent changes to both the ADA and AAPD/AAP documents mandated the use of this monitor. Changes to the B.C. documents now bring us on par with our U.S. counterparts and ahead of almost all provinces (in fact, I think we are the first in Canada to mandate this for dentistry).

  2. The deep sedation/GA standards and guidelines are presently under review. A working group has been formed to take on this task. The working group is comprised of a biomedical engineer, a medical anesthesiologist, a general dentist with advanced training in anesthesia (DA), and two oral surgeons. The sedation committee will be asking users of the present document to give input on what changes they would like to see in the new document.

  3. A second subcommittee has been formed to look into pediatric sedation. As you know, children present the highest risk and lowest error tolerance during sedation procedures. This committee with be considering our present requirements and suggest changes that will make the sedation of children safer in B.C. 

  4. The Board placed a moratorium on new applications to register credentials to provide moderate pediatric sedation for dentists who have learned the modality in a short-course format. The moratorium (PDF) will last for a year, giving the Sedation Committee time to conduct an analysis and make its recommendations on the safety of this modality.

  5. We have re-structured the Sedation Committee based on a recommendation from the Governance Committee and approved by the Board. The Committee is now composed of five oral-maxillofacial surgeons, six general dentists, two pedodontists and a periodontist, in addition to two medical anaesthesiologists and a biomedical engineer.

 

At the same time, the committee will continue its ongoing work of inspecting all moderate, deep and GA facilities to ensure that they are complying with our requirements.

Led by Dr. Toby Bellamy, this committee is incredibly dedicated. I can tell you that I am impressed by both the work ethic and work volume from the committee members. I have a new-found respect for what this committee has accomplished, and for its focus on public protection.

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Comments or questions?

 Email me at danderson@cdsbc.org