Onkar Mudhar reveals his top tips to help newly-qualified dentists master taking a new patient assessment.
We are often led to believe during our university training, that the intricacies of complex procedures like molar root canal and surgical extractions are what will keep us up at night, dreading arriving to work the following day. This is, in fact, so far from the truth.
Without a shadow of a doubt, the most multifaceted – and one could argue, ‘looked over’ – treatment is the humble new patient assessment. This is something we perform on an everyday basis.
Whether you are taking over the list of a previous dentist, or are an incoming foundation dentist, the principles of the new patient assessment do not change. During your first few weeks as a foundation dentist (or new associate), the shift in pace is evident.
From having two hours for a ‘treatment planning’ session at university, you’ll often find check up’s ranging anywhere from 10-20 minutes. This is often halved for paediatric patients.
Below, you’ll find a summarised list to make your first few new patient assessments (hopefully), a lot more streamlined.
Clinical notes
Ensure you have read (at least the most recent) clinical notes and inspected any radiographs/pictures beforehand. This will enable you to build a clinical picture in your mind’s eye, as well as letting you know if you need to take new radiographs/records or not.
At this point, I will also check if there has been any recent paperwork filed for the patient (eg referral letters/responses etc).
Discuss how you work with the dental nurse
Make sure you have thoroughly discussed how you work with your allocated dental nurse prior to the patient entering the room. This is extremely pertinent during your first few days/weeks as a foundation dentist.
If you have a ‘specific order’ in the way you do things (eg charting from upper left-lower right), make sure this is also discussed as repetition and fumbling over software will cause delays.
Collecting the patient
The new patient assessment begins from the moment you (or the nurse) collects your patient from the waiting room.
Personally, I’ve always preferred collecting my own patient from the waiting room as it allows you to immediately gauge your patient. Are they nervous or relaxed, have they come alone or with someone else? All of these elements should in theory help you build rapport with the patient and make them feel at ease as the appointment proceeds.
Introductions
Bring your patient into the room and allow them to get seated and comfortable. If you haven’t already introduced yourself and the dental nurse, now is the perfect time.
Personally, I prefer a first name basis (eg ‘I’m Onkar, one of the dentists, and this is Juliana, one of the nurses – we will both be taking care of you today). However, again I know this is personal preference
Set the tone
Set the tone and manage expectations from the outset. Ensure the patient knows today is an assessment and make them aware of what that involves.
For example: ‘Today you’ve been booked in for a check-up, I’ll have a quick look outside the mouth, and then we’ll assess all the teeth and gums, if I need to take any X-rays or photographs, I will let you know – would that be okay?’
This is often all that is needed, and you can settle into your usual history taking. Again, make sure this is a two-way conversation between you and the patient.
Structured questions for medical history
Have a structured questioning system for obtaining a history. Avoid repeating yourself and ensure you cover all the relevant points. Obtaining a thorough medical history is key, however do not disregard any relevant dental or social history.
If a patient is attending with a specific dental concern, make sure you obtain a detailed timeline of their presenting complaint.
Clinical work
The clinical part is often the easiest. After five years of university, this should be second nature. I still prefer to talk out loud and inform patients what I’ll be doing (eg ‘I’ll be doing a quick check of your gums now, using this blunt instrument, stop me at any point if it hurts’). This takes any ‘fear of the unknown’ away for the patient, and again, ensures you are sticking to a routine.
Make sure however, you note anything ‘different’ – eg do they have a complex occlusion? Are they are bruxer/clencher? Do they have any soft tissue lesions? All of these will enable the building of a well-rounded picture.
If clinical records (eg photographs or radiographs) are indicated, now is the time to take them. If you are taking digital photographs, ensure you obtain consent (both verbal and written).
Explain – and speak slowly!
This is often where most new graduates struggle. The ‘talking stage’. Putting all the findings together, and explaining it all back to the patient in layman’s terms. One thing I’ve found, is explaining radiographs and BPE scores to patients is an extremely useful educational and motivational tool.
Unfortunately, this can only be achieved with practice. One must remember not to use dental jargon and to speak slowly! Make the patient aware they can stop you at any time if they feel overwhelmed.
Prioritise the patient
Prioritise the treatment needed and construct a plan. One way to do this is in the following categories:
- Acute – is there anything to be done urgently?
- Prevention – (oral hygiene instruction, diet advice, scaling)
- Stabilisation – (fillings, extractions, NSPT) etc.
At this point, you can discuss costs with your patient. This will be a first as treatment in most dental universities is subsidised/free. Be aware of your NHS bands and what they include. Again, ‘confidence’ in regard to talking about numbers will come with time.
Refer to guidelines
Set your recall rate by referring to guidelines such as NICE or FGDP. Make sure the patient is aware of their ‘risk levels’ and what this means.
Conclude examination
Conclude your examination. Personally, this involves recapping what we’ve done in that appointment and making the patient aware of what the next steps are. If there is anything urgent to be done (and I have time), I will try and offer the treatment during that slot. If this isn’t achievable, I will check my diary and try to bring the patient back as soon as possible.
I will then walk my patient back to reception and allow them to book their follow up appointments according to their schedule.
Note taking
Note taking often forms a large part of the day. Make sure your notes are clear, concise and contemporaneous. Don’t rely on templates, instead try and type a few pointers during the consultation which you can then use around your templates.
If there are any other pieces of admin to be done such as hospital referrals, get these done efficiently as to prevent the dreaded scenario of an entire weeks’ worth of referrals piling up, resulting in you having to stay back on Friday until 9pm to get them sent.
As you proceed through your foundation training/first associate job, your routine will slowly fall into place, and you will find your own groove. Make sure you don’t overthink what you’re doing, and try to work well with your dental nurse as teamwork does in fact make the dream work!
Good luck!
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