Fraser still flourishing
Thirty years after starting out as a sole practitioner, the popular winner of both the Clinician of the Year and the General Practice of the Year awards continues to put the patients in his community at the centre of everything does
On April 28, 1988 people in Glasgow woke with excitement and anticipation. It was the first day of the Glasgow Garden Festival, an event that would begin to transform perceptions of the city.
The same day was equally memorable for Fraser McDonald. As others readied themselves for a once-in-a-lifetime occasion, he collected the keys for a dental practice in Shawlands that he’d just taken over.
It's vital to be amiable. If you can talk to patients and have them talk you, they're more relaxed and you're able to ease any anxieties or worries they have
More than 30 years later, Glasgow’s miles better and Fraser remains at the same practice. What’s more, he’s just celebrated winning Clinician of the Year and General Practice of the Year at the 2019 Scottish Dental Awards.
It’s quite an achievement for a single-person practice. But it seems it’s no change for a dentist who has been picking up prizes since his school and university days.
There was no sign that Fraser would become a dentist when he was growing up. “My background is pretty normal – my dad worked for the electricity board and my mum was a home-maker. Originally I considered medicine as a career, but realised I wanted to do something using my hands. That’s when dentistry became an option. I turned up at Glasgow Dental School for an interview and got shown round. After seeing everything the job involved I was convinced.”
He might have been sure, but his interviewer, spotting that Fraser had won maths prizes at school, had another suggestion; Fraser should take a maths degree before moving on to dentistry. “Being young, I thought he was crazy – why spend four years doing something else before getting on to do what you really wanted?
“Coincidentally when I was a house officer at Glasgow, the consultant David Stirrups suggested I do an Open University degree in programming. Eventually, when I was in my 50s I followed his advice.”
During his time as a student at Glasgow Fraser met Clare. She changed his outlook. “At school I’d always got through by the skin of my teeth, doing the minimum studying required to get through exams. But Clare liked to study, so I began accompanying her to the library and my marks massively improved. I had really good teachers too and managed to achieve the Dean Webster prize, which is awarded to the most distinguished graduate in dentistry.”
That wasn’t the only accolade he picked up in his graduation year, 1984. He had carried out a research project under the guidance of Martin Ferguson. It earned him the Colgate Hoyt Prize for research.
After qualifying Fraser became a house officer and then senior house officer before general practice called. He gained experience in Dan Cairn’s practice in Motherwell where he says he was taught the importance of a good sense of humour. Then, he learned even more about the job working with Bob Morrison and Jim Law in Coatbridge.
The desire to be his own boss prompted him to take a chance when the Shawlands Cross practice came up for sale. “As a sole practitioner you can be a little more iconoclastic and do what you want. Crucially, it’s allowed me the biggest luxury of my life – a great family life and the opportunity to spend time with our seven children.
“Having my own place has allowed me to buy equipment that’s been good for patients and indulged my interests in dentistry and computing. For example, I bought a Cerec machine for my 40th birthday and was an early adopter of air abrasion units.”
His philosophy is that in dentistry, as in life, you have to keep finding things that interest you. “Every day is different. It never works out the way you imagine. You get to listen to patients’ stories and get to know them – that’s a real buzz.”
Indeed, patients are at the centre of everything Fraser does. To illustrate his approach he cites a phrase adopted from Jim Whitelaw, the former head of the general practice unit at Glasgow Dental School: “There are ‘Three A’s’ of dentistry – affability, availability and ability, and of those three the third is the least important.” Fraser explained: “I don’t know if I completely agree with that – ability is very useful. However, I do think it’s vital to be amiable. If you can talk to patients and have them talk to you, they’re more relaxed and you’re able to ease any anxieties or worries they have.
“I know today’s undergraduate courses include patient and communication skills. Back in my day you had to learn these things for yourself, or if you were lucky enough, they came naturally to you.”
While he has enjoyed making his own decisions and pursuing his interests he fears young dentists may not have the same breadth of choice he did. “When I left dental school I had options; perhaps to pursue an academic career before joining general practice where I would have a choice of different practices. I’m concerned that the variety of practices is reducing for today’s graduates.”
He believes the future survival of small practices could be under threat, unless they find ways to share services. “I’ve seen people face increasing pressures. For one thing, the amount of admin involved in the job has increased immensely over the years. Meanwhile, the HMRC questioning of associates’ self-employed status encourages an environment where direct employment becomes the simplest and most cost-effective option.
“I worry about these trends because there’s the possibility that fewer practices will survive and we’ll have less diversity in the profession; that’s not good for patients, as well as dentists.”
By joining together to share common services it may be that the owners of small practices can increase their financial viability and even improve work/life balance, allowing them more time for themselves. He suggested co-operation can help in other ways. “With regular inspection comes the pressure to produce written protocols. Those sorts of resources could also be shared, which would help spread good ideas, as well as help save time, effort and money.”
On the theme of working together, Fraser said he had observed a shift in the relationship between health boards and dentists. “I have to say, the way we work with dental advisors and inspectors is very positive today. In the past there had perhaps been an ‘us and them’ feel. However, now advisers are seen as people who offer advice and listen to your concerns. And they play an active part in sharing ideas between practices. If they see an effective protocol in one place they are very happy to take it to others. That helps all practices, small and large.”
Notably, Fraser has a long-held belief in the value of communication. He’s been part of groups such as the Scottish Dental Practice Based Research Network, which promotes practice involvement in research projects and working with academics. He added: “I also have a keen interest in dental informatics which helps share knowledge online. And there’s huge potential for more digital exchange between practices and practitioners.”
Information exchange is vital in his part time job as an associate lecturer with the Open University where he teaches programming. “It’s great fun. I’m a huge proponent of distance and lifetime learning. And, with most of my children being female, I’m a big advocate of addressing the gender imbalance learning STEM subjects.”
With much to occupy his time, Fraser is relaxed about the future. “I’m still happy being a solo practitioner. At the age of 57, it might be that I start thinking about different ways of moving forward. I’m quite content to continue as I always have, but if new opportunities came up I’d happily explore them.”
Follow your intuition
Fraser’s passionate interest in computing extends to a love of cyber security games and it’s an area in which he has excelled. “I admit it – I’m a geek. I like maths, programming and tackling cybersecurity challenges, and have been invited to London for face-to-face finals.
Alan Turing was one of my heroes. He was a polymath, but heavily into intuition too. Co-incidentally, I think intuition is great for both maths challenges and for clinicians. There’s often a wee voice at the back of your head giving you a warning about your choice of action or a difficult diagnosis, where there’s more to the story. Is it the best course to take and is it best for the patient? As a clinician, you must learn to listen to that voice.”
Secrets and surprises
The successful nominations for Shawlands Cross Dental Practice at the Scottish Dental Awards were compiled in secret by Fraser’s wife, Clare, who works alongside him. She gathered comments from patients and presented them to him on his birthday in February before submitting the application to the awards’ judging team.
“It was a surprise to be shortlisted, and an even bigger surprise to win, especially when we picked up two awards,” Fraser said. He’s hoping his success encourages other dentists in similar situations to put themselves forward. “If I can win, so can others. There are lots of people out there doing good work for their patients and they deserve recognition.”