Seating the Patient

     Though seating is merely an extension of greeting the patient it is still important in setting up your performance as their doctor. I don't mean performance negatively as in fake. I mean the manner in which you maintain your happy, confident demeanor throughout the visit. Notice that I am referring to the patient's visit not the patient's procedure. The distinction is important. Most dental students, and I am sure a lot of practicing dentists, focus on the procedure they will provide. However the patient's experience of the procedure begins the moment they walk in the dental school clinic (or dental office) to the moment they leave (or thereafter if they have post-operative pain). Your job, which is equally important as your clinical skills, is to make the entire visit as reasonably pleasant as possible.

     Be gentle when seating the patient and placing the napkin around their neck. You may gently touch them on the wrist or shoulder while making a point in conversation (as cultural prohibitions allow). Patients will experience a gentle touch on the wrist or shoulder as how gentle you will be with them intraorally.

     After the patient is seated give them a moment to take a breath. Don't rush over and say 'open.' Do they look nervous or relaxed? How rapid is their respiration? Are they making eye contact with you? Are they seated half out of the dental chair? Do they have to be somewhere in a half hour?

     I have seen social workers write up fabulous reports about a patient's social history within the context of a medical record. You need to do the same. Perhaps one can actually ask a social worker within a hospital/university setting to give a lecture on the subject. The point is to understand your patient as you understand their teeth.

     Who is the person attached to the teeth seated before you? How well educated are they? What might be their level of comprehension? Should you avoid the use of SAT words or technical dental jargon in conversation? How might their age affect their desire for treatment? Some older patients feel they are too old to invest in dental work for themselves. Why? How might their ethnic, religious, or cultural background affect what dental treatment they seek? How can you inform a patient about an ideal dental treatment if they don't fully comprehend it? Is the patient a busy professional who can give you 4.5 minutes for a procedure or a carpenter who says 'take as long as you need, doc.' Does the patient live on Fifth Avenue or in the South Bronx? What does their clothing, hair, makeup and/or accessories say about them? How intelligibly was their medical history filled out? How significant is their medical history? Did they present for an emergency and exhibit a mouthful of broken teeth or did they present for a cleaning and a check up?

     I am not suggesting stereotyping patients and offering them differing levels of care. To the contrary, I am suggesting understanding the human being who comes to you for dental care so that you will be able to offer them, and have them accept, the most ideal dentistry possible. I personally find it disturbing that many patients of lesser means are offered less ideal treatment options based upon cost without a full disclosure of the benefits of more ideal, more expensive alternatives.

     A dental students perception of a patient's ability to pay for dentistry does not relieve them of the obligation to inform all patients of all treatment alternatives and the benefits and risks associated with each. Only the manner in which this information is presented to the patient may vary based upon the individual's wants, needs and level of understanding.

     Ideal dentistry must be offered to all people. To not do so means the patient was not provided with adequate informed consent which could be argued is malpractice.

     Then why don't dental students offer all patients multiple treatment options from ideal treatment on down? This is because diagnosis, treatment planning and case presentation for multiple treatment options often requires a mastery of dentistry beyond the skills of most students. Yet it is attainable to a significant degree even while in school if the student is willing to make the effort. Thereafter, honing this skill can become a source of pride for the practitioner.

     Diagnosis is the specific description of the presenting dental problem. Treatment planning involves offering multiple treatment options from ideal dentistry on down, usually varying based upon fee and treatment time. Case presentation is the communication of both the diagnosis and treatment plans in a manner a patient can understand so that they are able to personally chose what is best for them.

     I think that the patient is now comfortably seated.