The start of my third year of dental school also marked the start of our transition into clinic. My first rotation was in Emergency Care and despite the fact that I had no previous experience seeing patients up until that point, I felt confident. Assisting and observing my classmates in preparation for my rotation only confirmed this self-assurance. All I had to do was take the patient’s medical history and perhaps arrange for an oral surgery consult. It all seemed simple enough.
Seeing your first patient ever, especially as an emergency case, is an exciting milestone that can quickly turn into an emotional and stressful experience. When we are presented with a patient in acute discomfort, our first instinct may be to avoid inflicting more pain in our attempt to relieve it. However, part of being an effective health care provider means being able to exercise appropriate clinical judgment with the objective information you have in front of you. After all, if you’re second-guessing your own abilities, then the patient will too. Here are a few important lessons I learned from my very first patient interaction that I hope will guide you as you start your patient-care experiences.
Keep it objective.
As I took her medical history, my patient noted that her wisdom tooth was causing her severe pain. I grabbed an air-water syringe to blow air onto the tooth in an attempt to better visualize it, but the patient immediately jerked back and cried out in pain from the unexpected stimulation. Her reaction took me by surprise and in my flustered state, I resolved to be very gentle in my percussion tests to avoid inflicting further pain.
My intention was to provide a comfortable experience for my patient, but in the end, this emotionally-driven choice had two important consequences. The lack of force I used in my percussion tests produced inaccurate results, which my faculty instructor quickly caught when he performed the tests himself. Furthermore, the patient became aware that I was not as thorough as I should have been. A 2000 study published in Social Science and Medicine found that the perceived competence of a physician is central to the development of patient-provider trust. Properly diagnosing your patients may require some short-term discomfort, but remember that it is necessary for the ultimate goal of achieving long-term oral health. Focusing on upholding this standard of care can not only serve to hone your diagnostic skills, but also help you build a stronger relationship with your patient.
Manage your patient’s expectations.
The oral surgery team informed us that their schedule was pretty open, so I preemptively promised my patient at the start of the appointment that we could take care of her oral surgery consult that same day. However, her case was deemed too complex and the sole resident in the clinic that day was fully booked. I quickly reassured her that she could probably be seen by them the next day, only to find out later that she had to wait a week for the next available opening. As expected, my patient was not happy with this turn of events and her mood quickly soured.
Patients who come in for emergency care often have higher anxiety and stress levels than usual due to the acute nature of their problems, so managing their expectations is especially challenging. According to a 2011 study in the Journal of Emergencies, Trauma, and Shock, a large part of being able to manage patient expectations is establishing what can be reasonably accomplished and what cannot. Here, I impulsively made big promises that I couldn’t keep in an attempt to assuage her worries. I may have had good intentions, but my inability to deliver on those promises ultimately lost me her trust and respect. In a situation like this, I would recommend reinforcing early on that you have your patient’s best interests in mind and to remind him or her that you are giving your best effort to achieve an optimal outcome but without making any solid guarantees. Remember to leave room for flexibility for both you and your patient because things don’t always go as planned.
Know your limits and reflect often.
I left this appointment feeling embarrassed by what happened, but upon reflection, I quickly realized that it was an incredibly valuable learning experience. We are all human, and it’s normal to have both good and bad days in clinic. What matters the most is how we choose to respond to these experiences. Both positive and negative patient experiences can help us to better understand how we can improve our interpersonal skills as health care professionals while we are still students. Show confidence in your abilities, but understand that you will not know everything and that it’s okay to ask for help.
~ Sabrina Wadood, Detroit Mercy ’18