DentistryUnited.com

Foreign Trained Dentist Narratives

doctor — Sat, 19 May 2012 19:11:16 +0000

Chronicle 14 : If you did not write it, you did not say so!

This was the third time I was calling my patient to remind him of his dental appointment. He turned a deaf ear and did not confirm. I was in my weekend mode and did not bother to update the charts on Friday. I was too excited to go home early that day. This patient had been very irregular to get his dental care. He always needed multiple reminders to make to the appointment. He was also a rude one. He always kept using abusive language when he came in for treatment. I am a tolerant person and decided it was very unprofessional to decide not to provide dental care because of abusive language. Also it’s the law not to refuse treatment. This went on for a couple of months and I did not think it was necessary to document any of the abusive language or the missed appointments on his chart. As a matter of fact I forgot about this person for a few weeks! Since he did not call back to get his next appointment, I was even more thrilled! Good riddance I thought.

A few days later my office manager received a mail from the lawyer. The letter stated that the patient that I was treating was suing because of the neglect! My manager thought this would not be a problem case and said, bring me that chart dear. This should be a straight forward one. ‘’You have made your notes right?’’. I said, ‘’Err, well….”. I brought her the chart and showed no entries made! She was furious! We did have to compensate that patient since I had not made entries about any of the missed appointments and rude behavior. The documentation did not hold well with law.

I am glad it happened when I was a student. I learnt a valuable lesson to document. At school, we had sessions exclusively dedicated to documentation. At first I thought it was paranoia! After experiencing this incident, documentation was unavoidable. The professor stressed on having a format for writing the basic notes and adding on to the notes, the details and specific notes. Conversation between doctor and patient was also stressed upon. There is always a change in the story when spoken with a third person about the conversation between the patient and the doctor. So recording that in the notes in a professional language makes the story or verbal communication accountable for. The professor also insisted on making photo evidence available in certain ‘esthetic’ situations and diagnostic model documentation for complicated cases.

Legal implications vary from country to country. In the US, it is stressed upon to have sufficient legal write up to support any statement. I am sure that rule would be useful around the world. A legal document is usually kept on record for until seven years after the last visit of a patient. Being a new practitioner, I do get overwhelmed and feel its unnecessary to spend that extra time working on paper work. But more than making money, I realize, holding on to what you work hard for is also very important. I am not perfect and having that patience everytime to record an elaborate chart is time consuming. But I am hoping it’s all worth it!

Dr Meenakshi Umapathy is a General Dentist who graduated from India. She moved to the USA and completed her DDS from New York University College of Dentistry. She is currently practicing General Dentistry for Kids in Indiana. She shares her stories about dentistry in India and the US through her narratives at the DentistryUnited every Saturday

Disclaimer : The views expressed in this blog are solely the views of the author and need not reflect the views of DentistryUnited.com . For any clarification you can get in touch with the author directly at the address mentioned above.

BeInG stuDENT : Class 2 Dilemma

doctor — Tue, 15 May 2012 18:48:10 +0000

Amalgam restorations were the only restorations that were taught to us in the school. The typhodonts were the best tools to start experimenting them on. So, the classes started, first with a lecture on what is a restoration, then the classification as stated by Sir G.V.Black, followed by a demonstration. Hmm, it seemed pretty easy when she started; but, God! when it was the time for approval it was a BIG headache. Slowly, we got a hold of the class I design. So, the teacher progressed to Class II. We thought Class II was just an extended Class I and chipping of the proximal wall was seeming a very cool thing to ‘hands-on’. The trouble started when our hand-pieces and foot controls started. Ten or fifteen teeth got spoiled, not to account the adjacent teeth; but, my teacher wasn’t satisfied of my Class II design. When somehow I learned and got promoted to patient work, the scene was still dramatic. The patients tongue would always interfere while drilling; I would fix the retainer and call the instructor, but, by the time the instructor is back, the patient has the retainer in his hand or almost on the verge of choking himself. Also, never ever ever have we used a rubber dam, always wondered how to use it?!?

We always saw the designs in the book, they were so clear and precise. Our instructors also showed the pictures to us and asked us to be fair and judge our work. Somehow, with practice some skills improved, and the time we used to take in one restoration got reduced. We were kinda “GETTING IT”. But that was towards the end of school. Restorations were something we were finally confident about.

My dental dream of restoring for one and for all died just the next week after leaving school, the clinic I joined was of a general dentist; but, nobody preferred silver. I tried to explain them the cool advantages of silver, strength and on and on, but, all wanted something that wont show their flaw. All wanted the WHITE FILLING, more conservative designs and more trendy materials. I barely knew how to handle them, and the design was making me crazy, composites also had so many types and kinds,there were also different designs if the tooth was grossly carious, when to use what, was confusing! There were no forms that we crazily learned at school!

I wasn’t able to do the one thing I learned at school because nobody wanted it. Slowly, after careful observation and a lot of reading about the NEW COOL restorations, I started realising that they were still simpler, then the ones we slogged for.

It is essential to learn, the old amalgam restorations obviously as they teach you the basics of any restorations on a larger scale. But, the latest options available must be taught and practised too, as that is what we will definitely need to practice once we step out of our cocoons!

Through the blog I would like to convey that some time should be given for teaching or rather introducing the newer things available to the students so that they are aware about what to do when the patient asks for a WHITE FILLING or for newer advances!

Dentistry has progressed immensely and so should we!!! With DentistryUnited, lets progress for the best!

About The Blogger : Dr. Rukhsar A Vankani is a young and charming dentist passed out of Pad . D Y Patil Dental College , INDIA. She intends to make it big in the world of Dentistry and as such is a good poet and a writer. She will be sharing her views on DentistryUnited every Tuesday. Email-dr.r.a.v@hotmail.com

Editing The Practice – ” Availability At Clinic /Disponibilidad En La Clínica”

doctor — Mon, 14 May 2012 21:14:16 +0000

The entire business revolves against an important factor, if you thought it was money,,,, you are wrong !!!

Its availability…..

availability at clinic /disponibilidad en la clínica

With a huge investment in infrastructure and ever waiting overheads towards the end of every month, it becomes very vital to distinguish between two factors.

Clinic working hours v/s Required hours of working.

Any practice with a gestation period of three years does end up in a good practice even with less range of available services. Many a practices normally “work” in the evening with very few cases turning up in morning. The major reason for such part time practice is the lack of availability of the dentist.

As a new practitioner you should remember that barely investing in infrastructure and design does not give you good returns even if you have good skills as compared to your competitor.

The greatest investment what one can make is by “spending time in the clinic” , even if no patients have appointment ,especially in the first three years. Once the population knows that the dentist is available from 9am to 9pm , you have hit upon the jackpot.

Eventually, as the practice grows , your team grows. And five years down the line you have your junior dentists working in shifts and you handling the cases of your interest and expertise in selected hours of your choice.

And yes, DentistryUnited was created by me in 2004 during those “waiting for patient” days , in the beginning of my practice.& today you see how many dentists are being helped by DentistryUnited.com

“Customer is king” and king can walk-in your practice anytime, just patiently wait.

“Long living” positive results are more important than “short lived” big achievements.

Aim at a practice that runs for 12 hrs a day with uninterrupted inflow of good patients ,where in you are satisfied by the quality standards of treatment delivery and the financial returns at the end of the day.

Dr.Syed Nabeel is the Founder and CEO of DentistryUnited.com, started in 2004. Dental Follicle – The E Journal of Dentistry (ISSN 2230 – 9489 (e) is his brainchild, started in 2006. He is the Managing Director of Smile Maker Clinics Pvt Ltd , which runs a small chain of Dental Clinics, down south India. His practice is confined to Neuromuscular Dentistry, full mouth rehabs and Smile Makeovers. This is one of the few private practices on planet earth who also are keen on publishing with their own in-house research team. He is also a speaker on practice management , a wild life photographer , a traveler , a thinker , a gardener and a man of imagination. He can be reached on nabeel@dentistryunited.com

Dentistry Hope : The Purpose

doctor — Wed, 09 May 2012 19:00:53 +0000

The day’s work was over and I closed down for the day. Stepping just outside the building that houses my clinic I could hear people murmuring something inaudible. The voices got a bit, more audible as I walked towards my new car. Oh, were they gossiping about me? Did they utter my name? They were discussing what a raw deal they had gotten when I appeared out of my clinic And I wasn’t so sure what they were up to. Of course they had a different topic every day for discussion. It was the faint mention of my name that day that alerted me. So was it me or something else that was being gossiped about?

Why were they discussing me? I was sure not up to any mischief. Most of my patients were contented with my treatment. And I asked myself which doctors have kept all patients contented? Not everyone, I answered my own question satisfactorily. Not everyone can be satisfied. But one must try his best. I have always done my best for my patients and been very transparent in my dealings. I also helped in community projects in any which way I could. What more do people expect? Which brought me back to my original troubling thought, why were people gossiping about me behind my back?

It wasn’t easy to fall asleep that night. I woke up early and dressed up for a dental conference. At the conference I interacted nicely with many professionally colleagues. Hi-fives, back slapping and all, yet when I was sitting by myself in a corner one doctor walked up to me and stated a conversation. On the surface it was routine small talk. As the conversation deepened, we got into discussing equipment and techniques and dental materials I use. “But that is not the best material” He said indignantly. And what equipment did I use? “But that is not a safe machine to use”, “And what technique do you use”, “but that is an already an out dated technique, I know something better”. The mental rape continued for some time. Envy I told myself. This guy is suffering from envy. I wasn’t sure, but why does this guy start a conversation with me when I wasn’t interested? And why does he offer advice which I didn’t ask for?” May be he was really sincere. But his barrage of questions seemed to be too aggressive. There could have been many reasons; ENVY could be one of them. Mine is bigger and better than yours!

We are always surrounded by people. We never know what they really have in their mind. Some may be full of praise of our achievements. Some may be indifferent, yet some may be envious of us. Some may even be conniving to get back at you for some reason by doing revengeful acts. We may never know their minds. Yes, the envious kinds are quite successful in creating unfavorable situations for us. At times it makes us hate our work and our lives.

Then what is the single most important deterrent that stops us from going mad? Or for that matter going into chronic depression?

Our Goals, the aims, objectives and ultimate purpose for which we set our foot outside out house to practice our profession.

Our Goals stop us from getting entangled into needless brooding, anxiety, anger or any other self-destructive actions. Our Goals keep the meaning of our lives intact.Reassessing our purpose in life is a sure shot remedy for avoidable headaches. Have you assessed your goals by now?

Dr Sanjay Jamdade is a speaker on dental implants and is a visiting consultant with few prominent dental clinics in and around Mumbai for implants and oral rehabilitation. He is also the CEO of Dr Jamdade’s Dental clinic and Implant center since 23 years which is a practice devoted to aesthetic dentistry, microscope assisted endodontics, implants and oral rehabilitation situated near Tarapur Atomic Power Station at Boisar Tal Palghar Dist Thane near Mumbai, India, email: –sanjayjamdade@gmail.com

BeInG stuDENT :The Job Interview-scared as hell?

doctor — Tue, 08 May 2012 19:22:10 +0000

I am a doctor!! Graduating was something I was so proud as, and so was everybody in my family; even the extended far off people I hardly knew names of! Well the moment of pride was over and the main trouble had to start then: Looking for work!! Not that I was in desperate need of money but experience is what all of us fresh graduates seek. So all of us were some place or the other to start off in the new world!

So what happens in the interview, you are warmly welcomed into somebody’s office and they show you around, ask some questions and happily accept you in! Well that happens in the fairyland where we all had been partying. Ideal situations don’t work that way, most places are not so warm or welcoming.

Some places provide no respect and also the petty amount they pay to hire us. Some make us miserable and depressed and force us into believing that we are incapable of “what it takes to make a doctor, after becoming one!”

We all are helpers to humanity, then why are we always trying to defame and belittle every new person? Students like us demand just a little care to work wonders, words of disgrace and an unwelcoming attitude turns us away from accepting the art, then we just do it for the sake of doing it, which is ultimately not treatment, it’s just rubbish!

Well, this is the situation here, I have no idea of other places, but, if it is not prevalent any other place, kindly don’t allow the same. A positive learning attitude can be instilled by just a warm welcome and a less skeptical approach to all new candidates. Teaching it with the right attitude would bring a lot more change and progress.

“Do not ridicule us, we will not do the same with our work!”

Editing The Practice – ” Accountability / Responsabilidad “

doctor — Mon, 07 May 2012 18:49:43 +0000

Accountability / Responsabilidad

The next important thing is saying “NO” to all the salesmen who are going to sell you “all” that is not a “primary necessity” to run a practice. The cash is usually lost in the conferences when u come across “amazing products” with ” amazing uses” , never seen or heard before this day.

Managing cash flow , what goes out of your drawer is more important than managing the inflow. In simple words, at the end of the day send all the “cash” to the “business bank account” and issues cheque against the bills to “lab and dental material suppliers” at the end of the month by one single cheque.

Having said that, also keep an “eye” on your expenses associated with the office, be it “gas” or “office stationary”.

A separate book with “1 dental material each” mentioned on top of the “every page” and “adding up cases” done by using those particular materials , under each page helps after a year to “look” into the actual pricing of the service and “how your prices can be improved” upon based on the “remuneration”.

Being less dependent on consultants or negotiating a reasonable “price for procedure” by the consultant is damn important. of-course..keeping a monthly cheque to consultants too makes the business profitable. For example, lets assume on a day when all the patients are seen by the consultant, if you generate 50,000 . that 50,000 = consultants see + dental materials price + lab work if any + inventory usage + disposables + your fee.

Assuming that you add “50,000″ to your bank account and issue a cheque to the consultant + lab + Dental materials will give you the exact profit you have earned plus.. it increases the credibility of the business in long run. suppose you move to another city , just your bank account is enough to get you the best price to sell out the “business”!

Common sense plays a major role in “practice management”.

Penny saved is penny earned….many a times , I meet , many a dentists who run a practice under loss. i.e. they pay up all the money in a haphazard and unorganized way…leading to a “practice generating loss after loss”!

Falling in love with the practice management is a primary necessity for the success of the practice in long run… having a substantial growth of 50-60% in profits yearly takes the practice to a state called “successful” practice..

Happy Practicing…

Foreign Trained Dentist Narratives

doctor — Sat, 05 May 2012 18:52:05 +0000

Chronicle 13 : Women Dilemma Part 2

Continued from Part 1

We had a dean for OSHA and related personnel safety at NYU. He toured the school and picked on students who were not upto standards. Many students hated him! We ran and hid in the nooks and crannies if we were not following proper protocol. While it was fun and exciting tricking him then, what he said keeps ringing in my ears all the time. After graduation, I am on my own and I can trick nobody!

Having open hair always is very presentable but not when treating a patient. The patients do not relish the idea of the doctor’s hair falling into their mouths! Many students did make an extra effort to gel their hair and still have them open (less chances of hair mishaps) and others just tied up and saved the trouble. There still were ones who worked with their hair loose and almost caught fire fabricating dentures!

With all these observations, I have decided to opt for either scrubs with sports shoes or full pants with socks and ballerina shoes for work. I always have to wear a fully sleeved coat to protect my hands and tie up my hair most of the times for work. I have had bad hair days and disheveled ones too! It is very challenging for women to strike a balance with being presentable, compete with peer pressure and be professional all at the same time. But women do excel with all these limitations. There is no set rule and there is a very fine line that can be drawn here to enforce safety rules for women. But most of them know and can realize whats best for their safety.

Interestingly, men have a better chance with these injuries. Most of them wear full sleeved shirts for school and they have formal shoes on. So the body is fully clothed and protected. They have short hair and less hair fall chances and fire mishaps. They could get up disheveled and still come to school or work because they can brush their hair in a jiffy! Peer pressure demands some deodorant and that’s workable. No skin showing for men, so life can be less complicated. The patients don’t seem to prejudice the maturity of men based on clothing. I am sure men have their qualms too. If I were to be a man, I would think differently from the other perspective?

BeInG stuDENT : Redefining skills!!

doctor — Wed, 02 May 2012 11:31:14 +0000

Licensing is something so important once you move to a foreign state; but, those exams just have theoretical questions for most of the countries. So does this licensure qualify that you are fit to practice quality dentistry as you know the theory?? What does it signify??

It is just a legal formality to ensure that the candidate is safe to practice according to the standards set by them.

Judging their calibre with a safety theory test sounds a little like “testing half knowledge” and we all know what that means-DANGEROUS! Ensuring quality work via a skills test seems more practical. The standard of practice could be raised a lot higher by this and extra quality care could be provided to all.

Transparent mode of judging and improved standards of practice could be incorporated. A practical way of assessing the skills seems more fair and complete and real, as ultimately one has to perform and not lecture!

Lets demand artistry in dentistry!!

Foreign Trained Dentist Narratives

doctor — Sat, 28 Apr 2012 20:24:00 +0000

Chronicle 13 : Women Dilemma

Part 1

The first time I started dental school, I was happy about the fact that there were many women in the class. I was glad that I was getting into a profession that was more women friendly. I was very thrilled that so many women thought this was a profession where they could make a mark. Interestingly, women whatever profession they are in, have to adapt and change. Women always have to multitask- they need to be doctors but also be pretty ones. They have to appear and talk more mature than their men colleagues. Many mothers who multitask have to rush all the times and still look very presentable.

I saw and imbibed a few changes when I was in dental school in my country and in dental school in this new land. Back home, when I first started, Salwaar kameez was the most commonly worn dress for most occasions. So, it was the dress for school as well. Many women were and are still comfortable wearing this dress for work. This dress, though comfortable, came in various designs. But very few wore them full sleeved. The white coat for dental students were half sleeved and with a short sleeved or sleeveless salwaar kameez, these women were never protected from body fluids and needle pricks when treating a patient. The most complementing shoes with this dress were sandals or open toed shoes. There again, the chances of injury doubled in a new student’s perspective. What if a sharp instrument fell and injured the foot?

Saree day was very common in India. Women wore ethnic traditional wear on certain days to work. I remember that at that age, I was still new to saree and I struggled to even walk with that 7 yard cloth wrapped around me! It was a socially accepted thing that women who wear a saree were more traditional and more mature. They were more respected among the Indian patients. But little did these patients realize that their doctor was thinking more about her dress unwrapping and embarrassing her when walking or her beautiful dress getting ruined by blood stains! I could not find the foot pedal under that drape of clothing and did not realize if I was pressing on the right one most of the time. If I remember correctly, half of my friends did not work on patients on saree days!

In the US, once I started school, I was always wondering if women had a common dress code. The laws were more set in place that the body should be fully protected. Most women just opted for scrubs, the most widely and safest clothing option for men and women. But some including me opted for formal and semiformal clothing. The formal and semi formal clothing had to follow some standards: Cover and protect the body fully. Women found it easy to follow that rule in winter because they had no other option. They were double layered from head to toe! Fully covered shoes, pants or stocking for legs and fully sleeved shirts were very common. Come summer, things changed. Peer pressure demanded some skin being shown! Then came the hidden skirts from closets with ballerina shoes. Stockings were supposed to be worn with the skirts but were missing on many. I always thought it was a hindrance to wear them.

To be continued in Part 2

Dentistry Hope : COMPULSIVE COMPASSION -2

doctor — Thu, 26 Apr 2012 19:19:47 +0000

Continued from Part 1

Tossing and turning in my bed night I spent time going over the evening’s case. For the patient the previous guy was a big hero and a role model. Never mind the rotten dentistry. His lack of dental skills was his ‘compulsion’ `and forced him into ‘pseudo sainthood’! What I call “compulsive compassion”.

So did quality dentistry matter ever? Or was it something meant to be easily forgotten the moment the dental degree was acquired? Well then all that hardwork & honesty in studying and attending lectures, and conferences and everything else was a complete waste. Probably learning to sweet talk your patients was all that was needed.

What is it that happens in the long run to all these below average dentists? Do they end up packing their bags and closing shop in a couple of years?

Well that is an outcome we pray for all the time, after all we believe in justice, that if you do good you get good, if you do bad then you get bad too. That’s what our wise elders have rightly taught us. However it doesn’t happen that way in real life! The below average, the good and the excellent all survive. We see it all around us all of the time.

And why does this always go against the law of nature taught to all of us?

Simply because what the patient thinks is important to him is different from what we think is important for him! The patient’s criteria for evaluating us are very different from what we think! So good and bad all survive.

So the patient that day had put “being a gentleman” as a top requirement of a good doctor. Never mind the quality of dental work. Quality of work was secondary to him. Some want “prompt dentistry”, never mind how you do it. Others seem to search for an “economic” practice and want “affordable dentistry”. And yet others want “quality lasting dentistry”. The list of criteria could be endless.

So it makes perfect sense for the dentist and his patients to mutually assess whether they have common goals of therapy.

In the absence of common meeting points all you have left with you at the end of the day is a severe pounding headache! .