Injecting The Wrong Arm
What are the most common dental procedures performed in the HDB heartlands in Singapore? You may have guessed it -extractions, fillings, dentures. All these procedures have been taught in dental school. All dental graduates are familiar with them. What the older dentists who have been practising in the heartlands for years are more familiar with, are difficult extractions, teeth that should be crowned asking to be filled and guaranteed will never fall out and dentures which have fractured a hundred times asking to be repaired and guaranteed won’t fracture again.
I sincerely believe that the kind of training our dentists received in dental school are comparable to some of the best in the world. I believe that the skills that even the youngest and least experienced dental practitioner in Sinagpore posseses are quite adequate for handling the uncomplicated extractions, fillings and denture cases encountered in the average HDB setting.
As a young, inexperienced practitioner just stepping out into private practice almost 20 years ago before Continuing Professional Education was compulsory, I was rather enthusiastic about improving my clinical skills. But as far as common HDB procedures like extractions, fillings and dentures were concerned, I realised that my limited skills and knowledge were more than adequate in dealing with the technical aspects of these procedures. What I had a lot of trouble handling, however, were teeth that should be crowned asking to be filled and guaranteed will never fall out and dentures which have fractured a hundred times asking to be repaired and guaranteed won’t fracture again. I would have paid anyone my annual income to teach me how to convert these patients to more reasonable and understanding ones. There were some courses out there. I remember attending one that taught us how to prevent litigation, but no angry patient in Hougang ever sued me. They just stood outside my clinic and shouted to people passing by how much I just charged them. Some pasted threatening notes on my back door. One even threw used sanitary pads.
We don’t need any surveys to find out how ugly some Singaporeans can be. On top of that ugliness, is a general lack of awareness of dental health issues. We do have a survey conducted by the Health Promotion Board which showed that out of 6,560 respondents, one in four hardly ever visit a dentist. 29% insist that they have no need to see a dentist. 16.7% thought that dental treatment is too expensive and 10.9% have no time.
The folks who argue for compulsory CPE feel that as professionals in a developed country, our dentists should measure up to their peers in the States and in Europe. But take a look at the findings of that HPB survey. Are our patients and potential patients measuring up to their counterparts in the US and Europe?
The Chinese have a saying: 英雄无用武之地. The courses, meetings, symposiums available for the bagging of CPE points are generally held in grand auditoriums and function rooms in 5-star hotels. Most events cost the participating dentists hundreds of dollars. Some courses cost thousands. Topics covered include implant dentistry and other state of the art, cutting edge technology employed in some of the poshest dental spas in the world. When a dentist from the forgotten heartlands (and there huge plots of forgotten places in progressive Singapore) attends these courses, it’s like a kopitiam owner attending a course on how to run a French restaurant. After learning how to pronounce foie gras, he goes back to brew his kopi-O whose cost is going to go up because of the foie gras which is not even on the menu.
What’s more, dentists need 70 CPE points while doctors only need 50 CPE points for the same period. Do the folks in charge want to show that dentists are more serious about their CPE or that we are more stupid and need more hours of CPE to remain competent and relevant? Those of us who need to learn more are already voluntarily attending courses and applying what we have learned in our clinics. We don’t really care about the points. Those who can’t be bothered? Having been there before, I can fully understand why? They have no need to learn how to prepare foie gras when they won’t be serving it. It’s all a matter of going through the motion. The policymakers seem to be doing a great job kicking the butts of lazy dentists who won’t upgrade themselves while the public blame dentists for the increase in fees for procedures which they think shouldn’t cost more than a few plates of char kway teow. Even though I am personally a strong supporter of continuing education (for myself), I would vote against compulsory CPE if I could, all for the sake of my colleagues who are contented practising basic toothache dentistry.
Kicking the butts of dentists who won’t upgrade beyond their needs is not the way to improve the standard of dental health in Singapore. The folks imposing compulsory CPE are giving an injection in the wrong arm. What is sorely lacking and about which very little is done, is patient education. Noting the immense popularity of
dental implants in Korea where GPs do more implants than our oral surgeons, the solution to getting dentists to upgrade themselves is really to create the demand for more sophisticated skills and services. We shouldn’t be afraid that dentists won’t learn the skills if patients want the services.
