Yours Toothfully by Dr Chan Joon Yee

Yes, it should be “how would I know?” in English, but a direct translation from proper Chinese 我怎么知道?, Singaporean Hokkien: “wa mana ei zai?” or Thai : “ja roo dai yung ngai” would be “how I know?”.

Like “how would I know?”, all the remarks above are often made in indignance or denial of responsibility. Sometimes, such denial is fair. For instance:

“How would I know you would come visit me if you didn’t call beforehand?”

“How would I know there is an appointment if you didn’t tell me?”

“How would I know you were standing behind the curtain?”

“How would I know you were sleeping under the car?”

When you do things or make plans that others cannot reasonably expect to do or plan, “how would I know?” is a reasonable response from them when something undesirable or disastrous happens.

But there are also instances where “how would I know?” is unreasonable. There are too many of such examples in my daily activities and encounters. Indeed “wa mana ei zai” is not a good excuse when such things are common knowledge. Of course, we can’t know everything; not even if it’s common knowledge. When these gaps are identified, the best thing we can do is to acknowledge our lack of knowledge, learn it, remember it and move on.

Of course, issues concerning “face” and “ego” affect everyone. We all feel good when our egos are stroked. We all feel unpleasant when we are embarrassed. Such feelings are universal. Not so universal, however, is the typical response from people whose egos are bruised. In some societies, including certain levels of our own society, shocking violence may greet a person who has not show respect for someone’s “face” or “ego”. Identifying and bringing someone’s mistake or shortcoming to light is sometimes viewed as an unforgivable sin. Simply criticising someone or forcing him to admit a mistake can result in extreme violence.

When dealing with these individuals, it would be wise to just walk away when they say “how I know?” when their mistake has been pointed out. Pursuing further for an apology may result in the scene above.

On a milder yet no less extreme and unreasonable note, there are cases where the ignorant control freak decides and dictates what everyone can do or can’t do and then turns around to shirk all responsibility when it turns out that their decisions have not been that good.

“This is your plan. Your idea. Look what’s happened.”

“How I know?”

“You insisted on this and that, threatening when it’s not done according to your wishes. Look what has happened?”

“How I know?”

Huh? Shouldn’t you be listening to others and not throw tantrums at people who may know better because they have been in the business for decades?

“How I know?”

Push it at your own risk.

It’s a worrying trend. Almost every week, there would be a case of a doctor/doctors being censured. It’s usually due to the over-prescription of addictive drugs. Sometimes, it gets more “exotic” like passing off as a plastic surgeon when you’re are really a GP. It’s just the beginning of 2010 and the axes are already grinding. Bring in the lawyers and we’ll all smell blood. And the public will love it at first.

Then, they’re going to find their doctors becoming less “flexible” with prescriptions and MCs. Charges are likely to go up if the risks of getting sued or suspended see a upward trend and professional indemnity costs more.

Cost more? No way. There is only one thing that can cost more in Singapore. And if the Ministry Of Good Ideas rakes me in with a salary of $1M a year, I would gladly sabo my medical colleagues with some bright ideas and brilliant policies which will keep the public very happy.

Like I said, there is only one thing that can cost more in Singapore. It’s better to have a lion lead a herd of sheep than to have a sheep lead a pride of lions. Of course! Who is going to lead if the lions eat up their sheepish leader? If citizens are not like sheep, how are the lions ever going to grow fat? Oops! I digress. My job in the Ministry of Good Ideas is to make sure that only one thing goes up and everything else must be better and cost less. So how do we rein in the poor and desperate doctors? How do we satisfy a public that keeps thinking that the doctors earn too much? I have an idea. Let’s go to Haiti.

In the aftermath of the devastating 7.0 earthquake, there are bound to be starving survivors dying to leave this sea of decomposing dead bodies in search of a more pleasant environment. How about Singapore? To date, we have not sent anybody down there to distribute aid and supplies. Why not do something better? Why not absorb Haitian doctors and make them citizens? After that 7.0 shock, I’m sure they wouldn’t mind working from 5am to 10pm for a loaf of bread and a couple of bananas. Yes! That’s the kind of citizens we need. Hardworking and hungry. Our local doctors had better stand on their toes and put some spurs on their behinds.

Oh! And make sure the psychiatrists don’t have any weapons within easy reach.

I survived 2 days of lectures at a dental symposium held over the weekend at a hotel in Orchard. Usually, the best parts of such seminars are the food, the comfortable chairs and the chance to catch up with members of the fraternity.

Of course, I have already attended many seminars, conferences, meetings, symposiums or whatever the organisers call them. To be fair, this is not the worst and most time-wasting. Why am I talking about it in my blog? Because this particular symposium brought out a big irony of “updating” ourselves at compulsory continuing education seminars.

The whole rationale of making continuing education compulsory is to ensure that dentists don’t become dinosaurs. We need to be updated on the latest technology. Very few members of the public would argue against that. We are bombarded by new technology every day. Almost without thinking, we accept that the latest #$%&* Plus as superior to #$%&*.

Many people wonder what dentists use to “glue” their crowns on prepared teeth. The material you see above is one such cement. When I was a student, I cemented all my gold inlays with this cement. However, many young dentists would not have seen this cement, let alone use it. Of course, I don’t expect them to be very familiar with gold inlays either. Of course this cement can be used to cement other types of crowns. It’s just that newer, sexier, hi-tech and much more expensive materials came into the market and everybody forgot about zinc phosphate. In some developed countries, you shouldn’t even tell people you have used zinc phosphate cement if you don’t want them to know how old and oudated you are.

In the first lecture of the symposium, the elderly speaker spoke on the development of dental cements over the decades. It was an enlightening history lesson. Some cements worked well. Some didn’t work so well, but dentists later found out why and managed to solve the problems. Some gave disastrous results. Dentists also found out why, but the they didn’t manage to solve the problems. Some of these disastrous innovations, strongly touted by some of the biggest and most reputable dental material manufacturers as the best cements during their time, quickly got pulled off the shelves when crowns broke and teeth fractured.

Dentists have been conned. Patients suffered and sued. I can’t say that I find the speaker very objective, but he does share some of my thoughts. If something has been working well for years, why change to something new and untested? Frankly, I have not even heard of some of the cements the speaker mentioned. And it’s certainly a case of ignorance is bliss. My patients ought to feel so fortunate that continuing education wasn’t compulsory back then. I would have attended one of those seminars, got conned into using those new products and done my patients a great disservice.

The big irony here, is that the “update” we’re getting here is telling us that all the cement “updates” we have been receiving all these years are not really “upgrades”. We wouldn’t have lost much if we had ignored them all and stuck with good old zinc phosphate.

The conclusion? Our speaker strongly advocates gold restorations and zinc phosphate cement. Some of these combinations have lasted 40 years in the speaker’s patients’ mouths. As a practitioner of cosmetic dentistry, I wouldn’t want to have any gold inside my patients’ mouths and I’m sure they won’t get mad at me if their crowns don’t last 40 years. But this speaker made a very valid point which the organisers and administrators of continuing dental education should take note of.

Not all “updates” are “upgrades”. Many, or should I say too many new dental products simply don’t work as well as their ancestors. Such guided evolution panders to the public’s insatiable appetite for new technology. As discerning professionals, we shouldn’t be so obsessed with the latest tabloid news. We can already see a confusing explosion of information and misinformation on the internet. How much of what is released is worth listening to? With a rigid 70 point criteria to be fulfilled in a 2-year period before your dentist can renew his practising certificate, are you not worried that he pays his way to be fed with misinformation which will cost you in more ways than one?

One of Confucius’ students was arguing with a stranger.

“There are 4 seasons in a year.” said Confucius’ student.

“No, there are 3 seasons in a year.” the stranger argued.

“I’m very sure you are wrong.” said Confucius’ student proudly.

“I’m sure you’re wrong too.” insisted the stranger with equal pride. “Why not ask your teacher to decide who is right?”

“Great.” said the student confidently. “Whoever is wrong must kowtow to the winner.”

The stranger agreed. Just then, Confucius appeared. The student eagerly went up and asked his master to tell the stranger how many seasons there are in a year.

“3 seasons.” said Confucius.

The student was shocked. The stranger laughed as the student kowtowed to him.

After the stranger left, the bewildered student pressed his teacher for an explanation.

“Do you realise that you were arguing with a grasshopper?” asked Confucius. Grasshoppers don’t live past autumn. It would be impossible for us to convince them that there are 4 seasons in a year. Why waste your energy arguing with such people?”

The world is full of grasshoppers. Every day, salespeople smile and declare that there are 3 seasons in a year in order to close deals with grasshoppers. Those working under grasshoppers not only have to say there are 3 seasons in a year, they may even have to hop around and wear green. Not being able to do that, I not only went into private practice, I wasted no time in starting my own practice. This is the courage that people who call others grasshoppers should have. If you think your boss is a grasshopper who is not treating you fairly, go ahead, set up your own business. I believe many people have done that, only to to find out that the grasshopper is the one in the mirror.

How do I explain to the de facto grasshopper CFO that I need to install fibre optic handpieces to do my molar endodontics properly? How do I explain that I need an OPG xray machine to do my implants properly and to impress patients enough to let me do their implants? How do I explain that sitting $60,000 in an outmoded practice is myopic?

Grasshoppers can also appear in the form of kids (real kids or kids in adult bodies), spouses or even parents. This is where it gets tricky. Unlike customers and superiors whom you only deal with only once or just once in a while, the grasshoppers that you live with are not so easy to deal with. Agreeing with their 3-season theory can be tiring and nerve-wrecking.

Imagine you’re flying a plane and someone who hasn’t had her hands on her controls before throwing tantrums when you don’t swing the controls her way. How does one handle such grasshoppers? No use turning to Confucius. The great sage has warned against such difficulties more than 2,000 years ago.