DentistryUnited.com

BeInG stuDENT :TOO MANY DOCTORS SPOIL THE CASE!

doctor — Tue, 21 Feb 2012 10:42:14 +0000

Inspired from Dr. Meenakshi Bharti’s blog on the same website (http://dentistryunited.com/mb6)about the way she was schooled in the USA, I’ve elaborated my experiences on the same note.

“Jack of all and master of none” is an age old saying, in the current era it goes like this “Jack of none, and master of nothing!”

There have been a lot of times when in school, I wondered that why I wasn’t allowed to complete any of the patients I started with.

I’m posted in oral medicine and radiology department, a patient walks in, I establish the diagnosis, note it down on the chart and tell him what all needs to be done, but, I can’t clearly tell him what he could settle for or what is the best and leave it on him to decide. I’m unanswerable to questions from patients like how much time the treatment would go on, and which one would precede the other as different departments would have a separate consult, a separate plan and a separate appointment schedule. I checked the patient, but I’m not his doctor. He would have many doctors, the first floor lady doctor, and the third floor muscular guy doctor and so on. In all this mess, nobody has the time for the patient or his psychology or his financial issues and other concerns. Even in other departments, I see that the patient requires prophylaxis before I start the endodontic treatment, but, I cannot help him as the appointment with the periodontology department couldn’t be scheduled before mine. This is not the case only with the undergraduates in school; the story remains the same for postgraduate students too. My postgraduate friends start their cases from the second year of their study, and some patients require a long time treatment as for an orthodontic case could go on for a really long time. The doctor completes his program in between the treatment, he walks away to a different life and the patient is again in a mess of the multiple doctors. Some would have a different line of treatment, some would have some other thing to say and the patient was informed about something else by the previous doctor. The patient can never make a responsible decision as nobody responsible ever told them clearly what all was possible, and what was the best and what could be done for him keeping in mind their financial aspect.

In the current setting, the student doesn’t adequately learn and practice all his skills together also they cannot master the skill to completion. The diagnosis to treatment plan journey is in bits and pieces and most of it is almost undiscovered. Most of the patients get so frustrated with the whole scene that they prefer pain to treatment, and I don’t see it as a healthy way of spreading awareness and concern about oral health. I’ve seen the plight of so many of them, that I always wanted a better way to treat them and not just do the procedure and get over with.

There are a lot of us who feel that way, a lot of us also have better ideas, and the only thing that we lack here is stepping forward and demanding the change and start treating patients. Hoping that DentistryUnited helps us get a step closer to 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

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.

Foreign Trained Dentist Narratives

doctor — Sat, 18 Feb 2012 19:54:25 +0000

Chronicle 6 : Go comprehensive?

It was the day we started to shadow the seniors into the clinics at NYU. It was buzzing with students and patients like in a market! That is an odd comparison- but that is how the place buzzed with activity. The professors were all bunched up in one corner. It looked like they had their running shoes on to go from one student to another to help them out. They all had name tags on. They were a mixed group of general dentists, prosthodontist, periodontist, endodontist and orthodontist. They were all in one place I thought! How can that help?, I wondered.

I had very nice person as my mentor. She was confident and full of information. She showed me around the clinic.She had a patient to treat on one of the sessions and I got to watch.Even before the patient came in, she had everything set up all by herself and she had a plan ready for him. This was her patients second visit. She had his diagnostic models, his radiographs (all eighteen and a PAN!) and a treatment plan for him. She also had the payment plans that she could offer him on hand. That was the first time I was watching an actual procedure at school.

She greeted her patient with a good smile. After prophylaxis, she presented the treatment plan to the patient. She had a plan for every single tooth in the mouth that needed work to be done. In this patient she was consulting, she needed to take care on many levels. He needed a comprehensive care. She had consulted with the periodontist, prosthodontist and the endodontist to make sure that he was aware of the risk benefit options. She had plan one that was “ideal” and plan two that was “realistic”. Payment was always on a patients mind. She did offer all the plans that the school had and made the patient comfortable with the financial aspect. Now she could do all the work the patient needed. She was this patients doctor. She could follow the outcome of the treatment she does! All the help from specialist faculty was right there. Now did I realize what the periodontist, prosthodontist and endodontist were doing on the floor. The faculty came to students. The students did not go looking for faculty.

Immediately my mind started racing to compare the two worlds I have been in!

In my senior year in India, I remember being in one department for two months. The entire year I had to rotate between different departments to learn that part of dentistry. For example I had my entire two months in oral surgery for first two months and then two months in oral medicine and radiology. I moved on to restorative for two months and perio,prostho, pedo and ortho for the next couple months. I learnt only about oral surgery for two months and then I had to forget those hand skills for the other departments for the rest of the year! I was thinking there must be a better way for me to do dentistry all year round and still not lose focus on diagnosis. I did not have one patient to call my own. I did not have to follow to see the outcome of what I did. I had go department hopping to learn dentistry. When could I actually put to use my skills? Only after graduation.

The upside to the Indian way of dentistry was that I was a skilled technician. I could restore teeth at ease. I could extract teeth confidently at the end of two months. But sadly that is not the way when I start my own practice. I don’t have different departments to do the planning for the patient. I have to be able to do it. I have put the pieces of the puzzle together after graduation! That can be a daunting task for many. I did not feel complete. Comprehensive dentistry in NYU did complete me. I was sure how to plan ahead. I had answers for ” what happens if I don’t get this done?” and “why this treatment and not that?”.

If given a chance to do BDS again, I would definitely have a good network of friends. I would have some friends in each department and team up with them to follow up on a patient. Try to get the information from visit one and make a plan to channelize the patient to get the necessary work done. At least then I would have had the idea of how successful my treatment planning skills are?

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.

Dentistry Hope : Greed and Profit

doctor — Wed, 15 Feb 2012 20:03:47 +0000

Some guys have all the problems in the world when it comes to maintaining necessary, correct and well functioning equipment in their clinics. There is a reason why that happens. Lack of finances. Why? Due to division of attention and finances over too many things and wanting to be the master of everything! In short greed!
But how did it all start?

You used to be a good student back in dental school and have had a good clinical hand. You have been told that we should be well versed in all the different branches of dentistry because that would make us an “ideal all-rounder dentist”. Right?Well, right to a point.Knowledge is useful and a well informed doctor is appreciated in society.

But taking advanced courses in advanced dentistry comes at a price. Firstly the cost of acquiring that additional knowledge and credentials, secondly the cost of equipment to practice that new specialty. After all if you have invested all your time, energies and finances to take up that course in microscopic endodontics you would need an endodontic operating microscope and micro-endodontic instruments. If you took up Orthodontics you would need a constant supply of Ortho pliers and new sharp cutters. If you took up pedodontics then you would need an assortment of preformed crowns, and other pedodontic stuff etc.So in few years you have spread your time, energy, finances and attention thin over a wide range of dental specialties.

Now you cannot sustain any single specialty completely! You have become “jack of all trades and master of none”! Result – you lag behind in each and every thing you do in dentistry.Solution- “Refer your cases” even though it is unfashionable to do so.

To keep your clinic in the profit, just keep those type of cases you seem to manage well and refer others that are tougher to other dentists who could do justice to the case. For the matter even to an in house dentist who could handle them better. After all we cannot be good at everything and we make a profit only in those cases which we handle well!

You could master everything in dentistry, but can you keep making a handsome profit at the same time?

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 :LET US CUSTOMIZE!

doctor — Mon, 13 Feb 2012 19:58:40 +0000

Choices they say are important to make. But, somehow it never struck me that the choice I would be offered, was only between black or white; and never grey, dark grey or light grey!

Dentistry is the same worldwide, but, its presentation is slightly altered in every geographic zone. Post graduate programs around the globe are highly varied, but, they may not necessarily suffice an individuals interest completely. As for example, my interest is rehabilitation, and the term to me means an amalgamation of endodontics, prosthodontics, oral surgery, implantology and periodontology. Now, if I look up the various programs as an aspirant, it would be very difficult, almost impossible for me to locate a program that would enhance my knowledge in all these zones. There are programs offering only one subject, two subjects, some may also go till three; but, why can’t I get the exact thing I want?!?

Years have passed and our knowledge has expanded in leaps and bounds, we have moved from conventional to contemporary; so why can’t our programs also be contemporary and not conventional?

Universities could offer customized courses as per a persons interest, and intellect. Also, they would be specialists in what they completely admire, so the output is going to be beautiful and commendable. It’s the era of customization;

let’s get it to DentistryUnited!!

Concluding with a couplet composed by me-

“I don’t know why I am in the middle of this or that!

I don’t know why I always have to select this or that!

I don’t see the point of this or that!

I want this also and a little bit of that too!”

Foreign Trained Dentist Narratives

doctor — Sun, 12 Feb 2012 13:36:32 +0000

Chronicle Five – Am I there yet?

Lots of chattering in a big auditorium. I stepped in with an anxious look. The place could easily seat four hundred people. This was supposed to be my class room for the next three years. I was one among the three hundred and fifty students in the class of 2011 DDS program. I could see a lot of people but they all looked same, but different. They were all in the same boat as I was- heading determined towards a DDS degree. But they were all different- from different countries, races and color. Some were older than others- way older!

I had enrolled into the program inspite of the fact that I was a new mom. I missed my son but I had a career to pursue as well. Juggling the program and a baby was extremely challenging. Supportive parents and spouse made my life manageable. While the whole time I was thinking all about myself, I got to meet my new colleagues from different places in the next few days. Each one had a story, an ambition, a journey….

Many of my friends and collegues were new parents just like me and they had travelled hundreds of miles to get into this program. Separated from family and friends, they had to make a new life in a strange land. They had to leave their young children behind with their spouses or parents only to call them once a week or video chat once a week. Each one had to make financial arrangements to reach this far- all for one hope “provide better for their family with better education.” Isn’t that every immigrant’s dream?

While I was getting to know new people around my age, I noticed a few people who looked like professors but were wearing student coats. I spotted one of them and headed to introduce myself. He was a middle-aged Indian dentist with a successful practice in the middle east. He also had a ten year experience after graduating BDS. Right next to him was another older dentist from Nigeria. He also had a successful practice in his home country. Chatting with them was an older woman dentist from India who had taken a break from her career to raise a family. Well, after a decade of practice, work experience and no experience in case of the woman dentist, why would anybody want to do schooling again! Simply perplexed, I asked why they were doing this program at this age. The Indian dentist wanted more education and better living for his family. The Nigerian dentist wanted to get back home with this education to serve his people. The lady wanted to get back to her career that she had long desired. She wanted to spend the next decade for herself as she had spent the last exclusively for her family. Imagine there were three hundred and fifty students in my class and these were just three people that I mentioned.

Listening to their stories and challenges they had faced to come so far, I felt all the differences melt away. We were after all the same. We were all here for a better future. A better us, a better family, a better living. My challenges seemed to look small. Life after BDS may be challenging but there is more to it than just that. The planning of what to do for a future, gathering resources and above all being determined and hopeful have brought many together here. I am sure many of you out there have different stories to share. But for many who are still looking forward to a different life after BDS, remain positive and hopeful. Age is not a factor for success. You can pursue good education and better prospects whenever you are ready. Planning ahead and aiming for the better, leads to a successful career.

BeInG stuDENT :CERTAINLY UNCERTAIN !!!

doctor — Tue, 07 Feb 2012 10:33:28 +0000

We all entered dental graduation program at least with the assurance to be coming out as a dentist within the specified period of time or a little bit here and there. But, after the specified five years of study, some have some interests and others have other choices. So, after passing, are we really certain that we would be doing what we like? Also, not even sure that to do what we like will take how much of money, time, traveling and energy! Moreover, even after all the pain and effort put behind getting what we want, are we really having a bright future??

Each Indian dental school has an annual fee ranging from 1,50,000Rs – 5,00,000Rs for the graduation program, and, the summed amount of money we put in for the entrance exams, the travel fare, the hotel stay, the local transport is almost equivalent to the annual fee of the dental school. Different exams for different schools and that too at selected test centers only, makes it gruesome for people residing in completely different cities. Apart from the uncertain amount and time and money we are putting for these uncertain tests with uncertain results; our futures have no certainty of getting back all that we put. If I get a rank in the top three, then only can the choice be mine and the money I put is of some value! But, if I don’t, I would be forced to take what they give me irrespective of my acumen for something else, and then do what I don’t like and still be thankful. These are not the only two choices, there is also a chance I don’t make through; so after that I would either re-take the entire drama a second time or start working again with another uncertainty.

So amidst this uncertainty, what is our role as a student? Well, the least we could demand is one exam for all colleges and all states in India and demand for a cleaner process of selection, and this can only be possible with unity amongst the profession, the other wonders would definitely follow, the students will achieve their dreams and the profession would also gain its glory and it wouldn’t be an unsorted mess any further.

Foreign Trained Dentist Narratives

doctor — Sun, 05 Feb 2012 19:11:11 +0000

Chronicle 4 - “Practicing to Perfection”

Strange looks we exchanged with each other. I was one among the hundred students in that pre clinical lab for ‘crown preparation’. The manikins were all set up and ready for us on our first class in the DDS program. The typodonts were screwed in with a full complement of teeth and set up in the manikin head. It was nostalgic. I had done this before in India too. It was all happening again. But the only difference was that we never did posterior crown preparation practice in India. We had done tons of class 1 and class 2 amalgam preparations in pre clinical labs back there.

I was in a class that was a mix of regular four year DDS program students and foreign trained dentists. Having done work on a typodont before, I was quite sure I could do better than most in the class. A handpiece was not new to me unlike the regular program student. I had better knowledge and experience than the new batch of students. I was pretty confident that I could get an ‘A’ in that course. Little did I know how determined the others were.

I prepped my first posterior crown prep and was checking the dimensions out. I liked it but thought it could be better. Even before I could head to the instructor, I noticed that a bunch of new bees had already finished and started getting their grades. I was curious and headed to check out a couple. Amazed, I was! A couple of first timers had the best crown preps I had ever seen! Curious, I started a conversation with one of them and heard him say “ I practiced for two days before this class to get it right” I realized at that moment “experience gave me an edge but practice would make me perfect”. I knew what to expect in a clinical scenario but only practice would give me that dexterity to get fine results. From then on, I did not take my previous experience for granted. I used the previous skills that I had and honed my new ones.

There are many dentists out there. But I realized that good work always gets recognized. Dedicating the time to learn the work right and practicing it the right way will always give desired results.

Dentistry Hope : In-credibly simple!

doctor — Wed, 01 Feb 2012 19:10:26 +0000

Why do patients disregard a dentist’s advice? Why do they choose someone else’s services over ours? Especially when they can easily afford our services, are staying pretty close to our practice, they have seen our latest gadgets and gizmos. Shortly put, there is no logical reason for them to avoid our practice. And on the other hand why do they go elsewhere and spend twice of what they would have in our practice? And probably even end up boasting about their new crowns, laminates and new ‘whatever’.

The number of reasons if put together could fill up a book! Yet one reason stands out. Credibility. Yes, credibility! What gives doctors credibility? Look at it the other way around. What gives credibility to the car mechanic in whose hands we trusted our car for the first time that we did so? And how did he gain our confidence? Firstly by being an authorized car care center, not the ‘run of the mill’ type. By telling us beforehand what the car check would cost and then by patiently hearing us out and analyzing the problem carefully, examining our car in great detail and taking notes on the ‘job sheet’ while doing so. Coming up with a provisional explanation as to why that problem occurred, and only then offering a solution that any worldly wise person would easily accept. Finally explaining what all repairs and replacements would be needed in a systematic manner and writing against it the estimated expense for repairs, replacements and the labor charges plus taxes if any. His words then have “credibility’.

We as doctors should hear out our patients completely, do thorough examinations, conduct all needed tests and take radiographs if needed, compare our examination findings and test results, all according to a scientifically current protocol accepted worldwide, involve the patient at every step only then offer a logical diagnosis. Take your time and draw out a treatment plan in parlance with the patient, listing out necessary treatments and their sequence, the costs involved and how the payments are expected to be made. Always have a ‘plan B’ ready, in case your ‘plan A’ doesn’t appeal to the patient. Needless to say, be thoroughly trained for the proposed job and eventually execute the treatment just as you planned and as adroitly as possible. Be consistent in thought, word and deed.

When we convey to the patient that we have really “understood” his problem and drawn up a “road map” to health and written in clear terms how we will go about it and finally how we expect to do be remunerated for our efforts we have created “credibility and trust” for ourselves in the eyes of our patients. And that credibility shall see us through decades of successful clinical practice!

In-credibly simple, isn’t it!

BeInG stuDENT : ASK TO LEARN, AND LEARN TO ASK!!

doctor — Mon, 30 Jan 2012 20:06:36 +0000

Graduates from dental schools often work for dentists or straightaway start their dental practice, but, their first encounter with the clinic is always unsatisfactory. Talking to a lot of freshly graduated colleagues and having some experiences of my own, I am sad to say, but we are not trained the right way. We are doctors, but we are scared when the patient is scared, and that’s not right! In the school, we weren’t taught to face challenges that might just meet us on our way out.

A difficult child, or an adult in pain is what we fear the most, but that is what happens to be the most common scenario in our clinics. We know that the textbook has mentioned such and such a thing on that page in that section. But, on the chair, the hand is shivering, the mind is wobbling and then the inability to perform or even know how to proceed is really shocking after five years of schooling. A little knowledge, they say, is a dangerous thing and for a doctor it is a lot more dangerous!

Say, a patient walks in to your operatory with severe pain in the lower left molar, quite a common thing to face; but since most Indian dental schools do not train graduates in posterior endodontics, all that most of us would do is prescribe more antibiotics and analgesics and tell the patient to stay calm until the next week when he could consult the specialist. The patient is already in so much pain and expecting him to wait for a week to come back to you is foolish. Had we been trained to at least relieve his pain, he would have something to look forward to in the next appointment!

This is the multiplying reality in the current times, and this ought to be stopped at all levels!

Through the blog, I would just want to convey to my colleagues graduating or freshly graduated to not lose hope and strive to learn the right things, it’s never too late: and to those still in school, demand a better teaching; ask to learn and learn to ask!

Foreign Trained Dentist Narratives

doctor — Sat, 28 Jan 2012 18:36:37 +0000

Chronicle Three – Statement of “Purpose”

Number 75- the board flashed. My father and I were in this huge line of dental school applicants for two hours, waiting to be called. All of us had written a common entrance test and each of us had a rank number based on our score. With couple of thousand people waiting in line, each of us had a rank number ranging from “one” to some “thousand” number. I had a nail biting wait with my eyes fixated on the huge electronic board with changing names and numbers on it with each applicant. The applicants ahead of me were choosing the more popular of dental schools. I was hoping to get into the one in my own city. I almost chewed my fingers when my name was called. Looking perplexed at the board, it took me a couple of minutes for me to realize I had some seats left in the school that I wanted! Excited I was!

Well, dental school admissions were a lot different when I stepped into the US. No long lines, no two hour waiting. It was months of planning and days of research to see which school I wanted to get into. This included writing long essays to say ‘why’ I wanted to get into the particular school. It was a kind of exercise that was extremely annoying when I first started. I could not reason out why someone would need to prove that he/she wanted to be a dentist. Even after the excellent NBDE scores and the TOEFL scores, the ‘Statement of Purpose’ clearly determined ‘why’ I wanted to study in that particular school.

After a couple of torn sheets and hours of deep thought, I resigned to the idea that I could not come up with a clear reason for getting into dental school in the US. Then I turned to my trusted resources for help- my husband and the internet. Both seemed to say the same point- “you need a story to tell”. I never really gave a thought of why I wanted to be a dentist in the first place. I knew there was a lot of peer pressure and my interest in the medical field made me choose dentistry. But wasn’t my own dental experience that influenced me deep down? There it was! I had a story to tell.

I had a two page essay after lots of writing, typing and editing. I formatted, read and re-read that paper to make sense a dozen times before printing it out. I followed all that the ‘gurus’ on the internet had posted. My story had a reason of ‘why’ I choose dentistry. It had simple sentences and easy to use words. I put my thesaurus aside when I wrote my essay! I did lots of research about the school I wanted to be in and personalized each school essay. I wrote my real life experiences to show that I was genuinely interested in the program. My good scores, well formatted resume and the SOP all tied up to make a good application packet. I think it did make an impact with the admissions! I had my interview call in two weeks.

Though it’s different in each country, the stories are real and they still impact our lives in many different ways. Many don’t have to say it out loud and some do.