One billion. That is the approximate number of tidbits I gathered during my first semester of clinic. My mind is now cluttered with one billion facts about ferrule and ferric sulfate and free gingival grafts. Dental cements alone have enough detail to fill my whole brain, yet I am asked to shove far more into my mind than that teeny topic. After five months in clinic, I am just now starting to grasp how much I do not yet know.
There are some things I do know, however. I know how to make a patient feel welcome. I know how to be a friend. I know how to ask for help. Spending so much time and money to reach dental school makes it painful to admit that the few things I came in knowing are far more valuable than the one billion facts I’ve been taught here. In fact, my crash course in Clinic Survival came at the ripe old age of five. Everything I know about clinic, I learned back in kindergarten.
Do Your Homework
Preparation is the key to mastering the chaos of clinic, and your research can begin long before a patient arrives in your chair. When you first start clinic, you will inherit many of your patients from previous students. Once you have access to their chart, dive in. Start with the medical history. If your patient takes medications, research their mechanisms of action and adverse reactions. Epocrates is a free, easy-to-navigate app that streamlines pharmacologic research. Hunt down any dental-related sequela related to your patient’s diseases and add them to your list. This investigation requires you to invest time, but the reward is two-fold. Rocking your patient presentation will help you appear competent and confident in front of faculty, and, even more importantly, a thorough understanding of medical history can prevent medical emergencies in your chair.
If you have access to radiographs, determine if you will need to take updated pictures at your appointment. If radiographs are recent, a tooth-by-tooth list is a good organizational tool for collecting information from these x-rays. Once your patient arrives, you can quickly crosscheck this list with your clinical exam. Your list will help you zero in on problem areas that may not be evident to your louped eye.
Finally, review past progress notes. Your new patient will appreciate that you don’t miss a beat in the ongoing conversation between patient and provider.
Keeping notes on your patients will streamline your appointments. Record all your research, including your thorough summary of medications and past progress notes, to ensure that you always have a comprehensive picture of your patient’s care at your fingertips. As always, keep HIPAA-protected information safe.
Even if you are the first student to ever see your patient, you can easily implement these tricks as you progress throughout your appointment! Doing your homework “in class” will save you play time later.
Get to know your patients on a personal level. Does your patient work night shift and need afternoon appointments so she can sleep during the day? Does he have grandchildren he will need to buy Christmas presents for? Does she want all composite fillings so she can sing loud and proud in the church choir on Sundays? The better you understand your patients, the more effectively you can tailor their treatment and motivate them to care for their oral health.
Sign up for a Google Voice number. We work hard to protect patient information in compliance with HIPAA, but this free call forwarding service will protect your privacy when communicating with patients.
Look Forward to Recess
Until you pick up speed in clinic, you are rarely guaranteed lunch. This makes brain breaks even more valuable after a draining day. Schedule time for a hobby that restores you. Eat healthfully. Exercise. Sleep. Pursue relationships outside of school. Life is greater than the sum of your requirements, but often you will need a worship service or phone call to mom to remind you. The better you care for yourself outside of school, the more energy you will have to care for your patients when you return.
Play with PlayDoh
PlayDoh is the single most useful tip I picked up in the lab. From shoring up leaks and creating a “tongue” when boxing impressions to building land area for dentures, my lab life is nothing without PlayDoh. Buy yourself a few tubs and thank me later.
While you’re at it, grab a few lighters, permanent markers, sticky notes, rubber bands, scissors, a hot glue gun, and a shower caddy to carry all your lab junk.
Raise Your Hand
Ask questions. Ask them to as many people as you can, as often as you can. Work with a variety of faculty to expose yourself to new techniques. Dentistry is a beautiful harmony of science and art, and one procedure can have dozens of iterations. Adopt the methods you like, and adjust the ones you don’t.
Spend your downtime assisting older students, and sponge up their shortcuts. Pursue conversations with private practitioners. File away their tips on managing staff or navigating associateships. Practice speaking with sales representatives at sponsored events and vendor fairs. Their wealth of knowledge extends beyond their goods and services. Local sales reps work with practitioners in the area and may have intel on who is hiring in your ideal practice location. Dental school places you at the center of a community of knowledge professionals, and being active and intentional in your conversations will help you get the most out of this unique time in your career.
Wait Your Turn
“Comparison is the thief of joy.” – Theodore Roosevelt
My greatest challenge in clinic thus far has been comparison. For me, requirement anxiety is completely self-inflicted. I attend a school with both high requirements and high patient volume. I am (almost) guaranteed to graduate, and graduate with clinical experience that blows most schools out of the water. Even with this knowledge, comparison is tough. How easy it is to compare myself to classmates who have completed their denture requirements before I’ve even started my first arch. How frustrating it is to assist a friend who can finish her operative in half the time I finish mine. How difficult it is to give up a patient when I want to complete their root canal.
These feelings of greed and jealousy rob me of happiness. Our didactic destiny was linearly correlated to our level of effort. Now, a million variables make our fates seem feeble. We may work in the same clinic at the same time with the same amount of effort, but it often feels that our experiences are in no way similar. We are at the mercy of our personal patient pool, their grab-bag of dental needs, and their uncertain ability to show up to a scheduled appointment. On a daily basis, I wonder how my mess measures up to my rock star classmates.
The most frequent advice I have received from D4 students is to wait. Wait for the no-show appointments and the requirements and the lab work to equalize. Wait for everyone to have a chance at everything. When it seems like your class is racing ahead, know you are not alone in feeling left behind. Everyone will have their turn, and if you patiently wait and help others, you will have yours too.
Draw a Picture
Illustration is one of the most powerful and overlooked tools for communicating with patients. As we transition into a technical vocabulary, our use of layman terms becomes less natural. Describing root canal therapy to an accountant can often require more thought than the procedure itself. We quickly forget that “pulp” and “hatchet” conjure thoughts of orange juice and the heartbreaking novel by Gary Pulsen instead of live tissue and a tool used to create crisp cavosurface margins. A quick picture can help explain procedures and guarantee proper informed consent from your patient.
Brush it Off
Like woodchips glued to your knees after a playground tumble, so many of our clinic fails can stick with us throughout our day. Although throwing a good old-fashioned temper tantrum is tempting, getting up and brushing off our many mishaps will prevent us from developing a fear of failure in the future.
At the end of the (extra-long, super-exhausting, didn’t-go-as-planned clinic) day, we are students. We are not perfect, and we will make mistakes. However, if you are kind to your patients, fellow students, support staff, and faculty, most of your blunders will be met with kindness in return. Pursue excellence for the good of your patient with a sincere heart, and your first semester of clinic will surely be a success.
Although we are only five months into the clinic, it’s comforting to know that we’ve been practicing these skills for a lifetime. Clinic is an incredibly complex exercise in the application of principles engrained in us long ago. When our days are long, our cases are hard, and our patients seem downright impossible to manage, remember that despite twenty years and $200,000 of debt, everything you need to know, you learned in kindergarten.