Posted on 16th March 2021
When we think of dental education, we think of universities, lecturers, tutors, and clinical practise. Or we might think of postgraduate courses, seminars, and study groups. But, as we all know, the best form of clinical education is clinical experience. And (possibly) the best teacher is the experience of making a mistake. It all depends on what we do after we have made the mistake. For more than forty years, members of the Western Australian Branch of the ADA have had the benefit of a calm, level-headed educator who was there for us when we were in trouble. I refer to “The Legend”: Dr Ronald McPhail Townsend.
Ron acquired the nickname, “The Legend,” following a career-long commitment to ADAWA. His was a consistent voice, not only in providing guidance to members of our profession, but also to continually argue for the highest standards from our profession. In 1994, in recognition of his contributions to ADAWA, and to ethical practice, Ron was granted Honorary Life Membership.
This article begins near the end of Ron’s career. My approach-in-reverse is inspired by Ron’s assertion that his later professional years amounted to “the best time of his life”. Specifically, his “best time” encompasses two time periods: the first includes the years, 1995 to 2003, when he was a Consultant for the ADA’s Dental Cases Committee (DCC); and the second period began when Ron accepted an invitation to help the WA Dental Board manage a back-log of unresolved dento-legal complaints. This second period ended when AHPRA took over State-based regulatory bodies in 2010, when Ron was 84 years old.
Ron describes himself as a “committee man” and, over the years his organisational and speaking skills made him a valuable member of various committees associated with ADAWA. In particular, he spent many years serving on the Counselling Peer Review Committee and the Practice Management and Ethics Committee. These committees met in the evening after a day of work. Among those who worked with Ron, were Drs Ray Owen and Gary Davis.
The Counselling Peer Review Committee was the earlier forum from which the ADAWA developed and honed its ways of managing an ever-increasing requirement to resolve grievances. The principles developed in the 1980s and 1990s have provided a sound foundation for addressing the more complex dento-legal situations that are faced today. Dr David Hallett, the present CEO, tells me that—of all the ways in which ADAWA represents its members—the most highly valued is the provision of indemnity insurance and professional support.
As Ron will explain, however, representation by the ADAWA is not to be understood as “blind support.” As a profession, we wish to see our patients receiving appropriate treatment. Further, we want to ensure that our profession’s standing in the community is protected. Repeated acts of criminality or negligence are not defended, while members who have been falsely accused or have made a well-intentioned error of judgment are offered an array of support measures.
Ron Townsend was a forerunner in ways of mentoring dentists who were found to have failed to provide satisfactory treatment. He, along with other counsellors, steered away from the judgemental and disciplinary attitudes of the past; seeking, instead, to work through a contentious case, grasping the complexities, offering ideas, and proposing solutions. Calm, respectful communication with the upset patient was also integral to management of the case, and the outcomes were frequently excellent. As Ray Owen explained, the Counselling Peer Review Committee saw its role as presenting a fair-minded dental opinion to all parties.
Ron Townsend’s philosophy concerning counselling of colleagues is described in an address given on behalf of the DCC, to the ADAWA in July 1989:
May I stress—very EMPATHETICALLY—that the Peer Review Committee is precisely what the name infers. It is a committee of your peers or colleagues. Its members, both past and present, are everyday practising dentists who have been asked by your Association to examine the details of complaints made by some patients, and to attempt to offer some sort of resolution in the interests of BOTH parties.
Your current problem with a particular patient is being looked at by a group of fellow practitioners who, themselves, experience the same problems that you do, who understand the terminology, who understand the variations of treatment, who understand the difficulties of diagnosis and prognosis and whose main concern is to help, advise, assist and, hopefully, resolve.
The address was filled with suggestions detailing ways in which dentists might avoid confrontation or resolve confrontation when it arises. Ron’s founding principle was: “Communication, communication, communication.”
The principle of informed consent has not always been the norm. Historically, it was understood that dentists (and all health professionals) knew more than the patient, and the patient was expected to submit to treatment “for their own good.” With improved public education, this notion of “superiority” was challenged, but attitudes changed slowly. Many patient complaints were the outcome of “blurry borders”—where old assumptions clashed with new. It is fair to say that Ron was among the vanguard of Western Australian dentists who swept away the blurriness—no longer was full treatment disclosure a choice: it was now a requisite.
The 1990s saw an era of rapid growth in the population of Western Australia. The ADAWA’s membership grew proportionately—no longer did the Association represent a small band of sociable colleagues. At the same time, a more demanding public increasingly sought legal process to resolve problems. Due to the time taken to achieve their unshakeable goals of mediation, mitigation, and resolution, the number of patient complaint cases piled ever higher on the desks of the voluntary committee.
This mounting pressure motivated ADAWA, headed by President Stuart Gairns, to “re-invent” the Counselling Peer Review Committee. The result was the Dental Cases Committee (DCC), formed in April 1993.
The Counselling Peer Review Committee was not abandoned at this time but integrated into the larger DCC structure. Members of the DCC included the President of the Branch, the Immediate Past President, and the Chairman of the Counselling Peer Review Committee. Also planned for inclusion was a Liaison Officer who was to represent the Dental Protection Limited (DPL).
Dental Protection Limited (DPL) is a member of the Medical Protection Society Limited (MPS). DPL is an international company, based in London, but with branches worldwide. It is not an insurance company; rather, it is a mutual organisation (not-for-profit) that uses its huge membership as bargaining power to access superior indemnity protection. But facilitating payouts to injured parties is not the organisation’s core function—its greater goal is to protect its members’ professional reputation, livelihood, and integrity. To this end, DPL emphasises education programmes featuring risk management.
The ADAWA Council Minutes dated 14th March 1994, indicate that Sir Paul Bramley and Dr David Phillips of the DPL proposed to appoint Dr Ray Owen as the DPL Liaison Officer. Ray was tasked to “negotiate between patients and the dentist, to prevent cases reaching a conflict stage.” Ray had a busy dental practice and was only able to commit one morning per week to the job. As always, he put in tremendous effort, and worked as a conduit between the DPL and ADAWA members for almost a year.
Dr Ron Townsend was the DCC’s second DPL Liaison Officer. Ron had retired from private practice in 1992 and, given his gift with language and his considerable experience in problem resolution, the ADAWA knew that they were appointing an outstanding individual. Ron had the time to address the challenges that faced him. For instance, he was able to clarify the vagaries of the job description: “negotiate between patients and the dentist, to prevent cases reaching a conflict stage.”
It is one thing to espouse fine ideals concerning conflict resolution, but another to affect them. Ron saw his role as the Liaison Officer as one that involved active instruction in risk management; in other words, he addressed dental complaints pro-actively—before they happened. If a complaint did arise, Ron attempted to negotiate a mutually acceptable solution at the local level. Ron’s “legend” status comes from the fact that he straddled the differing requirements of the ADAWA Members and the DPL. Often, he faced irate patients, outraged dentists, and aggrieved dental personnel and, quietly, he calmed (most) of them down. He says, “As they got louder; I got quieter.”
Ron’s achievements draw from his integrity and obvious flat-line common-sense. He has always been serious-minded, analytic, direct, intelligent, ethical, and determined. In his capacity as DCC Consultant, Ron won intra- and interprofessional respect, and, in so doing, he reflected a light on our profession—that dentistry is a profession to be admired.
It is apparent that DPL admired Ron’s moral compass, for the company accepted as written all recommendations made by ADAWA’s Dental Complaints Committee. For example, if a grievance could not be resolved by local mediation, Ron would write a report and refer the case to the DPL head office. Ron’s analyses were never questioned. And, many of Ron’s “Ethics & Practice Management” lectures were dissected and re-worked into DPL Risk Management brochures.
Illness forced Ron to retire from the DCC in 2003. The Dental Director of DPL, Dr Kevin Lewis, flew from London to attend Ron’s retirement party. Dr Lewis wrote the following in the Editorial of the DPL journal, Riskwise:
Ron’s superb case handling skills and massive experience made him a highly respected member of this small group of specialists in the dento-legal field internationally. Ron has been up there amongst the very best of them, and his skill and experience is not easy to replace.
In the October 2003 issue of the Australian Dental Association (WA Branch) Newsletter, Dr Peter McKerracher, ADAWA Executive Director at the time, made this powerful commendation:
Members can be assured that the dispute resolution processes of the ADA (WA Branch) are held in very high regard right across the country and have been quoted by the Director of the [Western Australian] Office of Health Review as a model of professional dispute resolution that should be a benchmark of all professional associations.
Members of the Branch should be particularly proud that the Association has this reputation, and it is through our Dental Cases Committee and [Ron Townsend] its Consultant that such a high accolade has been awarded.
Ron did not stay out of the “cut and thrust” of dental conflict management for long. In 2008, at the invitation the WA Dental Board, he accepted the task of assisting Board Members with the rapidly accumulating files of unresolved cases. It was not until 2010 that Ron and Freda, his wife, really retired to their beautiful rural property in Brigadoon.
It is reasonable to argue that the two World Wars were responsible for giving shape to the man Ron Townsend became. Ron’s father, Frank, had been injured in World War I, and, increasingly, became unable to work. For various reasons, Frank was ineligible for social support, and, as his disabilities became more severe, his family sunk into real poverty. For much of his childhood, Ron lived in South Perth, in a small house on the tramline.
Frank died in 1941, and Ron, aged 14, was forced to leave school immediately. He did not complete his Junior Certificate of Education, but obtained work, which helped his family circumstances. Like so many intelligent, but underprivileged youngsters of the time, Ron attended night-school. There, he passed the “Junior,” and then continued studying at night to gain a qualification in Accountancy.
World War II gave Ron the chance to strive for high goals; something that had been denied his father. Ron joined the Royal Australian Airforce the moment he turned 18 years of age and began training to become a pilot. Although he did not complete his pilot training, when discharged from the RAAF in 1945, he was given the opportunity to undertake any course of study that he wished. He chose dentistry.
Ron’s time as an ex-serviceman, mature-age dental student was marked by constant financial struggle, which at times became embarrassing and wretched. But Ron passed, and with it, he developed an intense pride not only in what he had managed to achieve, but also in the noble profession he had chosen. He holds the profession gloriously high, but being realistic, he knows that, if elevated ideals and scrupulous integrity are to be maintained, supervision is required.
For the same reasons, Ron was also deeply involved in the debates of the 1970s concerning the training and deployment of dental therapists and, later in the 1980s, concerning dental prosthetists. As always, he was passionate about maintaining the highest standards within the profession.
A pragmatist, a dreamer and ethical to a fault, Dr Ron Townsend will always fight for what he believes is fair and right. At 94-years of age, he still says:
“I worked so damned hard to get to being a dentist, I won’t let it be messed up!”