At the end of this summer, I started my Senior House Officer (SHO)
job in the South West at a district general hospital. I'm one of three SHOs
working in an Oral and Maxillofacial unit. I've already made the mistake of
calling it Oral Surgery which was a major faux pas apparently! However as with
all things dental, it's usually shortened to OMFS or Max Fax.
SHOs are supposed to be the link between the outpatients department,
the consultants, the ward and the theatres, so be prepared to split yourself
into 4! Ward rounds start at 0800h in most units and last for varying amounts
of time dependent on the consultant and the number of patients. 
We have three consultants, a specialist registrar (SpR), a whole
fleet of nurses and an orthodontic team. The SpR is our immediate senior and
will usually help with any queries or questions. Word of warning: most registrars will answer a question with a
question!
The positives
Okay, if you're feeling a little bit daunted by the thought of doing
an SHO job, let me tell you about the positives (there are some I promise!).
Well, it's a real team effort, everyone will try to answer your questions and
help you in any way they can (for the first few months). Being on-call is not
as bad as you imagine! You'll be amazed about how many wisdom teeth problems,
TMJ disorders, dry sockets come to A+E and can all be treated as though in
practice or dental school. There is some trauma, but it's pretty damn
interesting, in the last few days I've had:
1.
44 year-old male with a lip
laceration caused by his girlfriend biting his lip.
2.
51 year old male with a
fractured mandible caused by a collision with a horse and a polo mallet.
3. 
21 month old boy with a lip
laceration caused by a collision with a coffee table.
You are not on your own
Of course, you're not expected to treat all this on your own, SHOs
are meant to start the ball rolling with a history, examination, IV access and
investigations such as radiographs. The registrar will usually arrive at this
point and the patient can undergo an operation or other treatment.
In between being on call and ward rounds, there are new patient
clinics which is exactly what it sounds like, and follow up clinics where
patients are seen after they have had treatment carried out e.g. apicectomy or
biopsy. There are also minor outpatient procedure clinics such as extraction of
wisdom teeth, biopsies of soft tissues, usually buccal mucosa or tongue and
surgical removal of other teeth. Some units also have "see and treat" clinics
where you will work with a consultant and carry out immediate treatment on new
patients. Another important part of being an SHO is pre-clerking patients for
theatre, e.g. patients who are scheduled for osteotomies or rhinoplasties.
Pre-clerking or pre-admitting is about making sure patients are fit to undergo
the surgery and general anaesthetic. Unfortunately, it involves a lot of
paperwork.
Hopefully, I've given you a little bit of insight into the role of
an SHO, it's a steep learning curve but an enjoyable one. SHO jobs are the
first rung on any career ladder and the skills learnt as an SHO will come in
useful whatever career pathway you follow, whether that's OMFS, post graduate
endodontics or general practice!
Difficult
patient or difficult dentist...?
It's a Sunday night;
it is dark outside and rather chilly for mid October. I am currently sitting on my bed listening
to Mumford & Sons, I should really be reading journals about crowns and
bridges for my tutorial tomorrow afternoon (first of all if my trainer's read
this article I promise that I will do work after I finish this commentary and
second of all for all the student's reading this, I'm afraid you still have
homework in VT!) Instead I am pondering
about difficult patients.
What defines a difficult patient?
This is a term that
has been reiterated numerous times since I have started my vocational training. However, what defines a difficult
patient. As I reassess the past 266
weeks of my dental life I'm beginning to realise that every patient that I have
come into contact with, has to some degree been a difficult patient. I've met the angry patient who can't sleep
due to pulpitis, I have encountered the nervous child and anxious adult that won't
even sit in the dental chair let alone allow an examination. I've treated the patient whose first words to
me were "I really hate the dentist" and I have experienced the patient who just
isn't interested in my treatment plan.
If I honestly re-evaluate
my dental experience so far, I have to ask myself, are these patient's truly
being difficult or am I actually being a difficult dentist by failing to
understand their problems and typecasting them.
If we spend time listening and communicating with our patients we will soon
realise that most have an underlying cause, be it phobia or irritable due to
pain.
Communication
I'm sure many of you
have already experienced the one dentist whom all patients love, who can turn
any patient into a number 1 dental fan! How do these dentists manage it? The answer is communication.
Communication takes
many forms of which the two most important aspects are verbal and non-verbal
communication. I would highly recommend
asking your deanery or university to organise a communication workshop as the
topic is extremely detailed, however here are some tips that I have picked
up/been taught.
1)
Realise
your patient is not just a set of teeth.
Their dental experience starts from the moment they enter the building.
2)
Smile at
your patients and make eye contact.
3)
Be
empathetic and understanding not dismissive.
4)
Go the
extra mile e.g. if your patient had a difficult extraction phone them to check
that they are ok.
5)
Ensure
that your patients have confidence in you and your skills. Try and make the LA as painless as possible, provide
topical, warm up the cartridge and give as slow an injection as possible.
University and VT is
the time to experiment with different communication techniques, to listen and
understand your patients and to change from being a difficult dentist to a
caring dentist because in our UCAS forms and interviews a caring dentist is
what we quoted we wanted to be!