Know your patient, know yourself

“YOU will never forget your first Le Fort fracture.”

This article, like everything I write, comes from my personal experiences as a clinician, practice owner and coach. I try to share lessons I have learned over the years in the hope that they might bring some help, inspiration and consolation. This particular piece is more personal than most, and the opening line will soon become clear.

One thousand, one hundred and twenty five. 1,125. The number of days that passed between 20 March 2020 and 19 April 2023. The first date was the Friday when the UK government accepted that Covid was a serious threat and announced plans for a nationwide lockdown. I had been at a practice in London that day and took the last flight from Stansted to my home airport of Cork, feeling as if the doors were slamming shut behind me as I went.

The second date was the day I first showed signs and symptoms of having a Covid infection. The day before I had attended a funeral in the West Midlands for my mother’s cousin – a dentist friend and long-time mentor who had died at the age of 83.

Back in 1992 he provided some advice I would not forget. A new NHS contract that year had resulted in fee clawback of 17 per cent. My new, busy, but debt heavy, little practice clearly was going to struggle to survive and I rang him, desperate for advice.

We agreed that I would eventually have to move away from the NHS but I was worried about patients' reactions to any change. He gave me one small piece of advice, which was: “You can only help the patient you are with at the moment, focus on them in that moment. In the same way you cannot be blamed for their disease, you cannot be blamed for the actions of a third party who does not care for your patient, your happiness or the risks to your business.” The wisdom of these words took a while to sink in. I have never forgotten them and our conversation was a catalyst for action.

What has this to do with never forgetting your first Le Fort fracture?

A French surgeon René Le Fort, who examined crush injuries in cadavers, classified fractures of the middle third of the facial skeleton. In my short maxillofacial surgical career, I spent the early part in an inner city teaching hospital where I had seen plenty of zygomatic, nasal and mandibular fractures, usually the result of “alleged assaults”.

I saw very few injuries caused by road traffic accidents until my next post in a rural district hospital and I soon discovered these could be catastrophic. I knew what to look for in a Le Fort fracture, how to examine and what radiographs to order. The words “you’ll never forget your first” lingered until I discovered why. The patient in question was a front seat passenger in a car and they had removed their seat belt. A few minutes later the car collided with a stationary lorry, throwing the passenger into the car’s dashboard.

The “thing” you never forget is the mobility of the middle third of the face, placing a finger behind the front teeth and being able to detect movement of the “floating” maxilla is a sensation that stays in the memory banks forever. But more important is knowing that I’d possibly be the only person who recognised the injuries and the associated risk of airway blockage.

As a senior registrar in my previous post had put it: “It is likely that you’re the only one who understands the risks to their life. At that brief moment you are the most important person to them.” He taught me well. My consultant boss arrived about 40 minutes later by which time I had ensured the patient’s airway was stable, had organised bloods, booked an operating theatre and we started the patient’s very long journey of recovery.

Back to my dentist friend’s funeral. Before I qualified I spent a few days as a “fly on the wall” in his surgery watching him work. His patients knew, liked and trusted him. He liked them, he wanted to serve, care and help them to the best of his ability. They knew it; they felt it. A naturally quiet, even shy, man, his patients liked and respected him in return.

The links between my observing him work, our conversation about my business future and the need for recognising a fracture clinically are clear in my mind. One privilege of dentistry is being able to serve patients by using your unique skills for their benefit.

Know and focus on your patient, know yourself, get the best for both. That way lies success.

Alun K Rees is an experienced dental practice owner who works as a coach, consultant, troubleshooter, analyst, speaker, writer and broadcaster. Find out more at www.dentalbusinesscoach.co.uk