When I posted this on the forums last year I thought people might not be that interested in it. How wrong was I! This sparked such a big response. Easily the biggest of any of my blog posts. In the first 24 hours alone over 500 people liked or commented on it. The debate was long and extensive so to take in all of it I would probably recommend heading over to D4D and requesting to join that forum (there is a link in the useful resources page) and searching for "rambles" which is how I labelled all my blog posts there. There have been quite a few posts recently about people being sued and proper consent for different procedures. I too have been contemplating this topic and decided to try to standardise my consent process by creating some standard dental procedure consent forms. Up till now the only signed consent I have been obtaining has been for photos. And in the last few months I have moved to doing that digitally by getting it signed directly on the iPad and then saving it as a PDF which I do via the adobe fill and sign app (here: https://appsto.re/gb/V_vO4.i). I really like this process because it means no printing, scanning and shredding and I also found that by wording the consent form carefully it actually made it easier to get formal photo consent because everything is laid out in order. So I searched on google for dental consent forms and was surprised to find a pretty poor selection available with most being so text heavy that I just couldn't imagine them being useful. So I widened my search to medical consent forms and found a template style that seemed to make more sense to me. It is pretty much this: 1) Explanation of the procedure and its intended benefits. 2) Expected complications from this procedure that occur almost every time. 3) Common complications/risks. 4) Rare complications/risks. 5) A statement pointing out that this procedure doesn't work every time and therefore what might be needed in the future. 6) Alternative treatment options. 7) Pt to sign confirming they understand this procedure and have had time to ask questions and are happy to proceed. Now I know this type of consent can't stop a pt making a formal complaint against you all the time but it might hopefully have some weight in that scenario. However for me I will be trialling it predominantly as a way to standardise my consent process so that I can ensure important points are not missed. There are some procedures that I have not created forms for yet because I don't do them (eg implants) and I might end up doing things differently for some situations. For example I have heard in the past of people getting pts to sign a "consent to ignore professional advice" form when pts choose to not have a procedure that you strongly advise them to. I will have to think about that. And obviously it is likely that over time my wording my need tweaking if pts routinely don't comprehend certain parts etc. I am very happy to take any comments about any of the wording if you think there are points that need adding or changing especially if you are a specialist in any of the fields. I am very happy for you to use these if you think they will be useful to you. They can be downloaded from my google drive here: https://drive.google.com/open… Since the first time I posted this I have also created "information sheets" corresponding to each consent form which are basically the same form but simplified slightly which some its seem to prefer. They too can be found on my googledrive.
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I have been using an iPad for dentistry for about 2 years now and keep on finding new ways that it can make dentistry better so I thought I would dedicate one blog entry to this and maybe other people might have found uses that I have not as well.
Some of this information has already been put up here in the form of my "apps thread" etc. 1) Photo management. I take photos with an SLR using a flashair SD card which has a corresponding app. I know there are other similar apps available. This means that I can take photos and transfer them directly onto the iPad in a few seconds to show to the pt and edit etc. My photos are stored on the iPad and sorted via google photos. This allows them to be put into pt specific albums which can be shared with technicians etc. Google photos also has basic editing tools for cropping and rotating photos, however I also use adobe photoshop express for flipping shots that were taken with occlusal mirrors. If you want to get more serious with your photography you can also get Lightroom for the iPad. This allows for storage and manipulation of Raw images which can allow for some pretty impressive tools such as the eLabor_aid protocols to help take the uncertainty out of awkward shade choices. If you have seen my clinical cases here you may have noticed that they are watermarked with my logo to ensure that others don't claim it as their own work. This is done directly on the iPad with the iWatermark+ app. There are other ways of getting the same effect but I find this very simple to use. 2) Patient demonstration animations. There are a few different pt demonstration apps available. Some are free, some you have to pay for. I use 3D4M almost every day to help explain dental anatomy, RCT, perio. It has hundreds of other animations that I have not used with quite a lot of implant variations too. I really like using animations to help explain complex procedures as I feel like my pts really understand what is going to be happening. 3) Consent forms. If you are doing written consent forms then the iPad can really help here. Instead of printing out the form, getting the pt to sign it, then asking your nurse to scan that form onto the computer and shred the form you can instead just do it all via an app such as Adobe Fill & Sign. You import your consent form onto the app and can then directly input the pts details and add/take away sections that are not relevant. The pt then signs on the iPad and the form is then saved as a PDF in iBooks. 4) Document management with Google drive or Dropbox etc. On a similar vein you may also want to consider file management apps like google drive or Dropbox to allow you to organise documents and have hem easily to hand. This would potentially be useful for clinicians working in multiple practices etc. I also have a folder on my google drive specifically for files I am happy to share with others such as when teaching first year dentists. 5) CPD. You can get CPD in many ways and the iPad can be a very good way of having lots of sources easily to hand so that if a pt doesn't turn up the time can at least be put to good use. I have a section for journals I often read but you can also do things like the quiz app "Dental Anatomy Master". And when you have done some CPD don't forget to log it via the Dental CPD pro app so that all your CPD records are in one place. 6) Additional monitor for your work computer setup. By using the Duet app it is possible for you to use an iPad as an additional monitor for your computer. I like this particularly for long appts such as RCT when I want to be able to look at the radiographs but also keep an eye on the daylist. 7) Scanning and milling. This is a field I have not got into but for those that have there are a few apps that might be useful such as 3Shape communicate and the e.max shade selector apps. These allow you to monitor the workflow of scanned items and help to work out which e.max block is likely to provide the desired shade. 8) Stock management. Depending on who you do your ordering with you may be able to have an app for that company (I know that dental directory has one) so that you can do ordering directly via the iPad. I have heard of some practices in America where the nurse logs every item used so that it can be centrally monitored and then automatically ordered when stocks hit certain levels. 9) Amazon music. As I have discussed previously I do have wireless headphones I offer to pts and then they can choose some music from my Amazon music database to stream. Some people love this however personally I don't use it very often as I prefer my pts to be able to hear me explaining each stage of the process as I treat them. 10) Clinipad. Again something I have not tried but I know that some practices really like to have all MHs etc filled out on the iPad to make paperwork easier. There are different types of tablets available and they may do many of the same tasks but I have not had a chance to try them out. If you have or if you know of other ways in which tablets have helped your dentistry please add it here or on the apps thread. I thought for this blog I would talk about how I help nervous patients and then hopefully other people can add their thoughts as well.
We don't offer sedation in our practice and if we did I'm sure that some patients would love it, but instead I try to use just a few simple principles to help nervous patients: Firstly I treat everyone as if they might be nervous. New patients may have slight apprehension because they are in an unknown environment not knowing whether they will like their experience today. Patients returning for an exam may have some nerves about whether I will discover a big problem which will take a lot of work to fix or will cost them a lot of money. And patients returning for treatment may be nervous about whether it will hurt, how long it will take etc. So if you treat everyone as if they are nervous about something then the ones who are perfectly relaxed are just a nice bonus. I pride myself in my explanations to patients and I think this really helps to overcome nerves. I always start every appt with the same patter checking complaints and MH etc then explaining what I will be doing at that appt and asking if the pt has any questions before we start. During treatments I explain every step that I am doing. I find this really helps pts to understand what we are doing and why and hopefully highlights my passion for high quality dentistry. I also find that using photos and iPad animations really helps my ability to explain things well to patients when discussing treatment options, and as I have discussed previously I am a big fan of written OHI and personalised complex treatment packs summarising options. Remember that patients forget 50% of what you say to them. So when they return next time they might be nervous about the bits they cant remember. If you can give them written info it will allow them to fill in those blanks after they have got home, I make a point of giving LA really slowly to make it as comfortable as I can. You could invest in an LA wand but I just use a traditional syringe very slowly. This helps amazingly because a lot of people are understandably nervous about LA as most people have had a painful experience in the past. If you can make their first part of the treatment pain free then suddenly they relax a bit more. I have previously discussed offering pts wireless headphones so that they can block out some of the surgery sounds and choose some music to listen to instead. I do use this but not very much. They block out external sounds so well that it means they cant hear me explaining what I am doing so I personally don't really like treating pts who wear them. For extremely nervous ones they can be good and for really long appts like multiple crown preps or endo they can be OK. And the final thing I do is to remember to experience what it is like as a patient every now and then. I have had very minimal work on my teeth up till now. Just a couple of fillings in my teenage years and ortho. It can be very easy for us to forget what pts are going through when they are in the chair. So I make a point of having a S&P now and then to remind myself of that feeling. And when I get a new material try it out on myself. See what your impression materials taste like etc. So nothing revolutionary here but a few principles that I work by to help my nervous pts. What do you do? It's been a little while since my last blog entry because I realised recently that I was feeling massively stressed. My home life got busier because my wife has been unwell and we lost a family pet, work has been full-on with some big cases being undertaken pushing my boundaries and I have had some job interviews/prospects playing on my mind. So I made a conscious decision to put my phone down in the evenings and largely ignore the forums for a while. But now things are better as I have made some changes in my life I thought this might be a good topic to write about.
With so much going on I have had to take stock of my life and work out how I can cope better. While at work I get so focused on the dentistry and the constant turnover from one pt to the next that I often get to the end of the day and feel really dehydrated. My nurses are good at making tea regularly but I have also taken to bringing a sports bottle to remind me to top up with water as well. If you are dehydrated your brain doesn't work well at all. The same thing applies if you are not eating properly either. I am normally good at eating a decent amount for lunch while at work but the big cases have meant that I have been rushing my lunch so that I can go do treatment planning or answer emails etc. Try to make sure you actually do have time for a proper lunch to refuel for the afternoon. I have said previously on these forums that I honestly do feel I am addicted to dentistry. It occupies my mind a lot of the time. Having the passion for high quality dentistry is very important, but you also have to remember to switch off from work. This is something I have not been good at lately. If you don't switch off you may well find yourself burning out leaving you either unable to do good dentistry, losing the passion or causing major home-life problems. Dentistry requires a sharp mind but I think it is often underestimated how physically demanding the job is too. I used to have a bad back all the time. Making the move to high power loupes has really helped my posture so that isn't a issue any more but I find my shoulders can be quite sore from holding my non-working arm in silly positions for extended periods of time. I think this is made worse by the fact I have not done any proper exercise in years. So two changes I have made recently in my spare time is Tai Chi in the mornings to help stretch/relax my muscles and mind and I have started jogging a few days a week. It is surprising how much of a difference these simple changes make to how I feel. So the main message in this blog entry is look after yourself. It will help you to survive the stress of dentistry and modern life in general. The suicide rate among dentists is unfortunately extremely high and I think this is something we don't talk about enough. |
AuthorDr Chris Harper Archives
August 2020
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