At our public health clinic we have fresh, young faces. 3/4 of our full time dentists have less than 4 years of experience. A position at my clinic would be a great residency for any dentist who wants to see all of the things that their instructors tell them they will never see unless they visit sub Saharan Africa.  

Our new docs were quickly placed in management positions in an effort to share some of the administrative responsibilities and give them leadership experience. The only potential problem is that this position is their first job, ever in history.  

Even with formal management training the position can be a bit cumbersome because of the patient volume, patient population and number of staff members. We have a patient goal of infinity, but ideally the goal is 3 patients per an hour. Our patient population consists of low income, newly immigrated patients armed with full benefits. Our staff is just as diverse as our patients with mostly young, spicy females fully armed with new degrees and certificates. 

The stress of the high patient volume and the bazillion staff members is only amplified when we have a special patient situation. On this particular day in DC, a bit west of sub Saharan Africa, I was asked to redo a prophy for a patient. A “prophy” is short for prophylaxis and is a preventative dental cleaning. The patient was from East Africa, had absolutely gorgeous almond brown skin and was just under 100 years old. She presented with her daughter/caretaker who insisted that her mother received a less than ideal cleaning on her last visit. She complained that the prophy was only 10 minutes long and was hastily done. Luckily for me, I had an open chair and two church sermons still fresh on my heart. 

 As granny scooted up in the chair I gave her my best Amharic greeting and began her treatment. I noticed she had light staining common with my east African patients but no gross amount of bacteria. I was relieved and put away my elbow grease, preparing for a simple procedure. 
Within 5 minutes my fragile patient could barely hold her mouth open.  

I was bending my back in ways that suggested I had an Olympic gold medal tucked away just to get a glimpse of her teeth. And then it dawned on me… I wonder if the manager asked the hygienist that saw her on the last appointment why her appointment was “cut short”. I wondered if he thought that we would short change this woman of great treatment for any reason other than her inability to withstand it. These are all logical questions that an experienced manager may pose. Logic the cousin of common sense is often thrown out the window without experience. I had to quickly look around and remind myself of my current location and lower my expectations for management. 

 My elderly patient had severe occlusal wear and did have some clicking that I noticed when I did my extraoral and intraoral exam. Perhaps my smooth faced friend can not handle the prophy. Eureka! My 6 plus years of education had once again lead me to properly interpret that I was put into a bad situation. 

After her 18th break from the treatment and her self initiated imaginary spit suction session, I explained to her daughter that her mother can not withstand long procedures.  The daughter agreed and I finished up quickly. 

After sitting up the patient and offering a rinse, a panicked expression flushed her face. She could no longer close her mouth and was terrified. I had to dig way deep into all that is kind and mature in me to hold in my frustration as I asked the dentist who placed her in my chair to come pop her jaw back in place. I felt bad that she was in that position and it was completely preventable with proper clinical notation and questions. Now I hurt an old lady and it was all my fault dot com. 


Again, all thanks are owed to Christmas special baby Jesus for allowing her jaw to slip back in place with the dentist’s help.  
We are all learning if we keep our curiosity peeked, eyes peeled and ears open. I have faith that with these ingredients and proper training anyone can be made into an excellent manager. 

Patient requests should be met with compassion, empathy and a few doses of common sense. In dentistry we often allow them to dictate priorities and treatment. They want whitening with periodontal disease, veneers with malocclusion and long procedures on 100 year old women. 

In most public health offices requests are met with swift education and a firm suggestion of treatment. Our clinic tries to uphold private practice privileges to match the modern appearance of our office. In this particular case of granny and her daughter’s grand request, this was a failure on our part. Bless her mandible and the hygienist that has her recall.