Lemon juice (original) (raw)

McArthur Wheeler was not a good bank robber. On 19 April 1995, he raided two Pittsburgh banks, one after another, in broad daylight and without any disguise. The local police distributed security camera images and arrested McArthur in the early hours of the morning. 'But I wore the juice,' an incredulous Wheeler exclaimed when apprehended. He explained that knowing it worked as invisible ink, he had covered his face with lemon juice to make it invisible to the cameras.

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McArthur's story came to the attention of David Dunning and Justin Kruger, who embarked on a seminal piece of research into human psychology, the results of which led to the discovery of the cognitive bias which bears their names.1

At its most basic, the Dunning-Kruger effect describes how those with a low level of competence in an area generally overestimate their competence in that same area. This metacognitive dissonance makes the assessor too incompetent to recognise their incompetence. The effect is often incorrectly summarised as people being 'too stupid to realise they're stupid'. However, Dunning-Kruger relates explicitly to tasks and applies to all of us. It's there in the bravado we gain after passing our driving test. We see it in those who 'do their research' into their dental problems. And we see it when we complete our undergraduate training or learn to place our first implant. It's worth mentioning that the effect also exists at the other end of the scale, with high performers often underestimating their skills - a form of imposter syndrome.

Overconfidence due to the Dunning-Kruger effect has the distinct possibility of leading to patient harm. Moreover, it's possible that the practitioner involved wouldn't recognise the damage being caused. Without intervention, this could lead to a nightmare scenario of a well-intentioned professional wreaking havoc through their patient base without realising it. Leaving the patient safety issues to one side, this is the route many cases take to the GDC.

Fortunately, there's a straightforward strategy to combat this problem. And that is one of education, teamwork and collaboration. By learning the difference between a good and a bad performance, we discover what we should be doing and, equally importantly, what we should avoid. And dentists who know their abilities and limitations can better refer on when needed, improving patient safety.

When caught early on, we can turn poor performance around. The benefits for patients and the profession are clear. But our current situation, with no clearly defined GDP career pathway, continuing development varying wildly in quality, and no way to accurately assess our skills, will land many dentists at the regulator's door. And when they're there, the sanctions laid on them can seriously affect careers that, with earlier intervention, either from a structured pathway or less formal mentorship, could be long and fruitful. If the GDC were to handle clinical-based fitness to practise investigations emphasising early intervention and rehabilitation rather than punitive measures, outcomes for patients and dentists would improve. And dentists might look at the regulator more favourably.

References

  1. Kruger J, Dunning D. Unskilled and unaware of it: How difficulties in recognising one's own incompetence lead to inflated self-assessments. J Pers Soc Psychol 1999; 77: 1121-1134.

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  1. Bury St. Edmunds, Suffolk, United Kingdom
    Shaun Sellars

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Correspondence toShaun Sellars.

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Sellars, S. Lemon juice.Br Dent J 234, 559 (2023). https://doi.org/10.1038/s41415-023-5795-8

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