March 21, 2007
Clinic Experience (or lack there of)
So the beginning of my clinical experiences started off great, but now I feel like I am stuck in the biggest rut of all time. I have the luck of the "patient no show" or cancellation, which happens weekly. It's the most frusterating feeling in the world and I now go into clinic with questions regarding whether the patient will show up today or not. I have no problem scheduling them, I call them and confirm them, but for some reason when its time for the appointment, they just don't show up. It has become quite the stress for me because I have not met most of my requirements for patients and only have completed a couple of patients. Not only is it frusterating because I find myself wandering around looking for things to do and begging dental students, but I really feel as though I am missing out on important clinical practice.
Here's to hoping my patients show up this week... (and they better because one is my brother-in-law!)
Developing a treatment plan for each patient is difficult for me. I get confused when looking at the treatment form if I am supposed to write everything treament the patient will receive for the day, and does that include oral hygiene instruction? I need to compare the new treatment form with the old one, and figure it out. I feel like some of the items have been combined in the new form and maybe thats why I am feeling confused.
On a more positive note, I enjoy getting a patients mouth clean and calculus free. Its stimulating to use my hands to feel for calculus that you may or may not be able to see, and remove it.
March 20, 2007
Lessons Learned - A Clinical Experience
In pondering what my difficult and enjoyable clinical experiences would be for this blog, it turns out they are one in the same. In reviewing a patient's chart prior to her appointment, I realized that on her latest health history she indicated both yes and no to the question regarding heart problems, underlining damaged valves. Upon examining the notes made by the dental student, there was some question 30 years ago as to whether or not this patient had a heart murmur. There was never any "treatment" and the patient's heart was described as "good."
Looking through the chart I found no documentation confirming or refuting any valvular damage or the need for premed even though the patient had been in several times for treatment with her dental student since filling out the new form! I knew that I was going to have to do the research, so I called the patient. On the phone, the patient declared only that her heart was "good... no problems!" There was a bit of a language barrier and I was concerned the patient did not fully understand what information I was trying to get from her. As indicated by the dental student, this was something that was investigated by the patient's doctor 30 years ago in her native European country. She had the murmur investigated again since moving to this country and had an EKG, but it was 10+ years ago and she no longer had the doctor's name, however no murmur was indicated. The patient also told me she was anxious about having to take any antibiotics prior to her appointment and that she never had to in the past.
I followed up by talking to Dr. Brooks who said that the patient would need a med consult due to her complicated history and that I should try calling her current physician. With the patient's permission I called her medical doctor. He was out of town for 2 weeks and his associate could not give me a definitive answer regarding the premed. I tried calling the patient to fill her in, but couldn't get in touch with her before her appointment later that day. Her son brings her to her dental appointments and it is not easy for her to get here, so I was quite anxious about having her come all this way and not being able to treat her. I didn't think she would be willing to premed and if she did, with the med consult, I didn't think I'd be able to finish her prophy in one appointment. And to be honest, I was worried about my schedule and my grade.
At this point I had been worrying about this patient for three days and was quite anxious when her appointment finally arrived. I explained to her the need for concern and the risks associated if we did not determine whether or not she needed the antibiotic. The patient was so appreciative of all the work I did to make sure she was safe at her appointment and that she understood all that was going on. She really appreciated that I went out of my way for her, but I told her that was my job.
The patient was very concerned that I would not be able to treat her and was quite willing to have the med consult and premed if necessary. While we waited the hour for her premed, I did as much for the patient as I could and was ultimately able to complete her prophy that day so her son would not have to bring her back. I ended up learning so much at this appointment, but on top of that I felt truly gratified at how appreciative the patient was. She told me how cared for she felt and hugged me after I walked her out to the front desk. All the grief and all the aggravation I felt about my grade that day went away because really this is what clinic is all about… helping the patient.
1st year clinical
Clinical has been a rewarding and yet challenging experience for me so far this year. Working with patients in the clinic setting has helped me to realize that I do love this field! I really enjoy meeting my patients, getting to know a little about them, understanding their challenges when it comes to caring for their mouths, and being able to help them improve their oral hygiene. It's been so encouraging to have patients who are concerned about their mouths and who want to hear new ideas for self-care.
The difficulty I run into during clinic is time management. Although I feel I am doing my very best to manage my time, the 3 hours still seems to fly by!! I feel like 3 hours should be plenty of time, however if I spend adequate time with my patient... scaling their teeth to remove all the calculus, and with patient education... I often don't know where the time is to do all the paperwork and charting of restorations! There is a lot of pressure in the area of time. I hate to ask a patient to come in for another appointment, especially when they couldn't believe it would take me 3 hours to begin with. I understand it's a learning institution and that they need to be accepting of that, but still I find this a challenge.
Also, nearing the end of the semester there is a lot of stress to fulfill all the requirements. It's difficult to find all the right number of patients who classify 2B or class III, and also those who have restorations on 10 teeth. For those who do have enough restorations, I'm always hoping I'll find the time somewhere to do their chart reading and do an acceptable job of removing all the calculus!!!
My Clinical Experience
All in all, clinic is going alright. The areas that I am having some problems in is scheduling patients and the loads of paperwork. I was struggling in the beginning of the semester to schedule patients (not because I was nervous too, but I just wasn't getting referrals). Now as I'm trying to make up green cards, there are no overrides available, so that just makes it difficult. The paperwork isn't too bad, its just an adjustment that I'll get used to. My favorite thing about clinic is being able to interact with the patient and finding out more about them!
The one challenge that I am having in clinic is with the paperwork. I often forget to have form six completed before the instructor comes for the final check. Other than that everyting is great. I learn something new everyday through trial and error. I look at it as a learning experience. The one thing I love about clinic is patient education. This gives me the opportunity to apply what I've learned in my classes.
March 19, 2007
Clinic is challenging....I take it one day at a time and strive to keep my head above water! A couple things that i have found equally challenging is limiting conversation with patients and paper work. I find myself engaged with conversation and loose track of time. The other is working through all the paper work, (there's soooo much of it), but, I am getting more and more aquinted each week. I look forward to when it will be like riding a bike!!!
March 18, 2007
clinic goods and bads
The most difficult part of clinic is dealing with the stress of fulfilling all the requirements. We have to have so many patients who are certain classifications and have this kind of chart, etc. It is hard enough finding patients, especially in 2blue, let alone finding certain kinds. Of all my patients, only one chart was readable and I made to many mistakes and did not get credit! It is very frustrating knowing that I could be penalized over things I cannot control. Patients cancel or dental students do not need help and to be thrown into clinic and be graded down b/c of all these factors that we cannot control makes it very hard to cope with.
On the positive side, I really enjoy when patients come in and ask me questions then believe me, like I actually know what I am talking about!! But seriously, patients come to me with questions and concerns and I have the ability to help them and make an impact on their health, I really feel good about what I do. Plus, it makes me feel really cool!!
Clinic has been a mix of good and bad for me. In the beginning I couldn't get a patient to save my life, now I have more than I have clinic days for. Just like many of my classmates, I feel the push to attain all of my requirements. I feel bad wishing for complex patients...but they are needed. All of the paperwork bogs me down, but it is getting easier every time I do it. I really enjoy interacting with patients. It is actually a challenge for me to stop conversation and get everything else done. I really enjoy the patient education aspect. It is so rewarding to use all of the knowledge I've gained this year. With each patient, all aspects of clinic get a bit easier.
March 15, 2007
I am enjoying my time in clinic so far this semester but I am worried that I will not be able to fullfill all of the requirements that we need. Another concern of mine is how long it takes me to work on a patient. I feel bad when I have to bring a patient back because I do not work fast enough. Is there anyway that I could speed up my appointment or are there any other suggestions? Something that I really enjoy about clinic is getting to know the patients that I am working on. It is fun to meet them and find out about what they do and where they are from. I just need to make sure that I don't spend too much time focusing on that and actually do some work!
March 12, 2007
My issues... well at least the clinical ones...
Overall, I love clinic. I think its a fun and totally interesting way to get out of the classroom and really apply what we've learned so far. However, the one component that I have found confussing are the green cards/ days without patients. I understand that you are able to have 2 "free" green cards without being deducted points, but what happens if you have more green cards, and do the green cards from the first part of the semester count toward your grade as well. I know we talked about this today in seminar, but after I left, I still am unsure.
Anyway, on to the fun stuff, my favorite part of clinic is a tie between being able to work with different patients and understanding how their lifestyle effects their oral healthcare, and using the ultrasonic to actually see the calculus "blast" off the tooth. Starting with the latter of the two, working with different patients is enjoyable to me because I am actually able to see the difference that I am making in a patients mouth/life. As for the first one, I find it very interesting to know that most people are not as oral hygiene concious as I have been my whole life. With that said, to see that the things that you tell your patient (if they agree their homecare responsibilities) will make their lives and smiles much brighter. :)
March 11, 2007
I found this week to be especially dificult for me. It had been three weeks since I had a patient and both of the patients I was supposed to hve were no shows. I try very hard to stay positive about clinic and tell myself that all of the challenges will only make me stronger, but its so overwhelming at times.
The thing that I really like about clinic is the support of the instructors and upperclassmen. They have all been so helpful and understanding. After I talk to them, I realize that they have all gone through the same things (or even worse). They know its hard but they also know that we can do this.
I find myself struggling most with the paperwork- treatment plans in particular. I feel like we can go over them time and time again but I still con't seem to get it. Each instructor is very helpful with them, but as soon as I think I get it someone else shows me the "right" way to do it. Why has this become so confusing??
My Thoughts About Clinic...
Well, a few of you have taken the words right out of my mouth! It's really comforting to see that a lot of us have the same feelings and are experiencing the same 'stresses' in clinic.
I do enjoy clinic; I feel like each day I am becoming more and more experienced, I am challenging myself and I am trying to do better than the last time. It's such a great feeling for me to be able to sit there and educate my patients, and then also, after the appointment I feel great knowing that I did my job well. I know that I have a really important job, and I feel good about that--not too many people have a change to make a difference like we do :)
I must say that I would feel lost without the help of the upperclassmen and the instructors, most of the time they really make me feel like I am doing alright and everything is going to be okay! I need that in my life right now I think!
One thing about clinic that really stresses me out is finding patients to schedule, and also filling all the requirements for my Class 2b and 3 patients! It just adds SO much pressure on me because I have no control whether my patient is a class 1 or class 3. Also, finding a patient with 10 restorations....I'm really nervous about not having a patient that fits those requirements. I wish there were something we could do to make sure we can fill this requirement so that we don't have to stress out about passing clinic.
Overall, I am so proud of how far I have come. There are days when I lose a bit of my confidence and become upset and stressed and angry at myself, but that is just something that I have to work on--- I'm too tough on myself sometimes! I will say that I actually cried one day in clinic, and it was after that when I sat myself down, spoke with some classmates and thought to myself,'this is truly a learning experience, and this skill is something that will REALLY take us 2 years to master'. It is okay to have these feelings, I know I am moving in the right direction. We should not be afraid of making mistakes-- we learn the best from them! With time and practice, I will get there, we all will :)
Well, I can finally say I like clinic. I use to stress out every night before my clinic day and dread it. A classmate suggested to chill out and relax and that I was fine but my stress level was too high (not in those exact words but you get the picture). I contemplated on that for awhile and decided to relax. Now, after each patient I reflect on each patient and the experience, whether it was good or bad. I realized that I have come so far since last semester and it is a great feeling to me that I have taken the skills and I am applying them. I'm getting closer to becoming a real Dental Hygienist.
The only frustrating thing is the paperwork. I forget little stuff and it is a consent challenge. My thoughts are all over the place. When do I do the charting again? Is xerostomia a risk factor? For what though? Hum.. Am I writing too big? Did I do this right? I'm sure this skill will come with time.
March 10, 2007
I just wanted to say it is the upperclassmen that help me enjoy clinic and have made it a smooth transition for me. Without their help, their confidence in me and their support I would not be doing as well as I am. They tell me stories of how they messed up when they first started clinic and reasure me that everything will be ok when I have a difficult patient and feel lost. It was one of the upperclassmen that had to help me with a difficult situation that I was in during clinic that I will tell you about.
As you all know I had an obese patient who weighed 500 pounds. When I went to go get him he told me I would have to work on him from his wheelchair because he wouldnt be able to fit in the clinic chair. Already I was nervous, because I had no idea how I was going to clean somebody's teeth in a wheelchair when I'm still learning how to clean people's teeth in the clinic chairs! It turned out that I was able to work on him from the chair, but for half the appointment I had to do it standing up because he was uncomfortable and couldn't breath very well laying down.
It was a struggle getting him into the cubicle and it was a struggle to take his blood pressure! I tried the electronic one with the extra large cuff, but it didnt work on his arm! What I had to do was put the large adult cuff on his forearm and place my stethoscope on his wrist.
As soon as he sat in the chair, the first thing he did was lecture me and tell me that he hasn't brushed his teeth because he chose living and saving his life over his dental hygiene. He told me last time he came to the dental school he was treated with disrespect and he doesn't want me to tell him what to do, he knows he needs to take care of his teeth. I told him as a student here, it is my responsibility to educate him about his dental hygiene, but he didn't want to hear it. I did it anyways.
He had supra and sub calc on every tooth and at this point we hadn't learned how to use the ultrasonic yet. I did the best I could with my instruments, but the patient was uncomfortable, he was sweating and kept asking for water. He was in pain and wanted to leave. This is when one of the upperclassmen came in with the ultrasonic and helped me do the rest of the prophy. Even one of my classmates helped me throughout the appointment. Without their help, I would have frusterated myself and my patient.
Even though this patient was difficult, he exposed me to new situations that I had to learn to handle. I had to try new methods of cleaning his teeth, new methods of handling the patient and had to experience an unhappy patient who did not care much about his teeth. I'm only thankful that I had all of the instructors confidence that I would succeed and the help of the upperclassmen, because without them I'm sure I would leave clinic crying.
It is the instructors and the upperclassmen's faith in me that gives me confidence in myself and allows me to handle any situation. That is my favorite part of clinic. Knowing that I tried my best and even if I made mistakes, I have the instructors, the upperclassmen and my classmates guiding me and making sure I get through the appointment and I dont make the same mistakes again.
March 08, 2007
What I like and what I don't!
Clinic overall has been one of the best learning experiences I could have ever asked for! Everyone is so helpful and I love being in 2BLUE clinic. The only problem I am having at this point in time is getting my treatment plans straight. I leave small things out alot and they end up being very important. It's just very difficult because you have so many different types of patients with different things wrong with them that if you miss a beat sometimes it can throw your whole game off. I just need to take a little more time to analyze the whole patient because somethings are not as BOLD and right in front of your face as others. Sometimes you have to dig a little deeper.
One aspect of clinic care that I find enjoyable is the look on patients face when they look in the mirror at the end of the appointment. I had a lady a few weeks ago who was so happy that her stain was gone she kept thanking me and telling me how wonderful I was for doing that for her and it just felt really good. I had always loved my hygienist growing up and now I'm in her shoes and know exactly how it feels to make someones day! :)
The one component that I find most confusing/difficult would have to be charting restoration etc. The reason I am having trouble I believe is because I have not had that much experience in a dental office. I hope with seeing more patients I will feel more comfortable and just be able to look in a patient mouth and be able to ramble restorations off without second guessing myself! Practice makes perfect and I can't give up. :)
The aspect of clinical care that I most enjoy would have to be the feeling of performing a job that is so beneficial to an individual. Not everybody in the world has a job like dental hygiene and a patient can't just go anywhere. We provide a service that in a few ways can change a person life, make them feel good and boost there self confidence.
So far, clinic has been going pretty well, for me. I am lucky to be on 3 green because they have given us a list of patients, so I don't have to depend on referrals. I love having Friday clinic, even though its in the afternoon. I don't like Tuesday clinic because I am rushing all day and that is our longest day, it does go by pretty fast though. When I am in clinic, I always get nervous especially in the beginning when I have to go and get the patient, they look at me and treat me like a professional and in my head, I am like "Gosh, I hope I don't hurt you, or mess up" but then I remind myself that, I am going to mess up and that's why I am here to learn and become a better hygienist, I just get nervous because I want the patient to understand that I am a student and everything is going to take time. When they ask me if we are almost done, I start rushing and I HATE RUSHING! The other day I had a Down's Syndrome patient, and I was very nervous, not because he had Down's Syndrome but because I did not want him to get frustated at me and get upset, if I didn't understand what he was saying. My uncle has Down's Syndrome and it is very hard to understand the way some people with Down's Syndrome communicate and whenever he talks sometimes I don't understand what he is saying. They are so wise, and they know when someone is listening, and when someone is ignoring them. So I made sure that when I met my Down's Syndrome patient, that I gave him ALOT of ATTENTION, and I did, I took my time and figured out everything he was saying to me, because if not then he may have gotten very upset with me, and I did not want that.The appointment went by very well, and I was very proud of him, because he had GREAT oral care. To me, I think clinic is going to be an experiene we learn from every minute we are up there, and when we graduate we are going to know how to work with all kinds of people, which is awesome!
Trouble in clinic
I have had a rather smooth time in clinic except for a few things. First of all, I have had some trouble with patients canceling their appts. I find this frustrating considering that our grade depends on them showing up. Second of all, I think that it is upsetting that I have not had a readable patient for charting and our grade depends upon that as well. I understand that we need criteria for grading but how can it count against us if we simply don't get the patients. On a lighter note, I enjoy clinic when I do have a patient. I have learned how to manage time very well. I chart my patient when I am waiting for checks and enjoy talking with the patient about their life and oral care. My favorite part of clinic is that we are never alone, we have each other to ask questions, and we have peer teacher and teachers to help us when we are not sure what to do next. I am enjoying clinic and hope that it only gets better!