Why good assistants are important

[DrJeff]

Okay, let me preface the following with the fact that my office has 3 geat CDA's who are worth every penny that they get paid. Now, because we like to help dentistry as a whole in my office, and give back to the profession as much as possible, my office is a clinical rotation site for the dental assitant training program offered by my local technical college. On average we'll get 2 to 3 students who rotate through the office in 4 week sessions throughout the year(the training program runs from October to May).

Now, we've had this assisting student in the office for 3 and a half weeks now, and she's been doing chairside assisting with me an my partner for the last 2 and a half weeks. This person just doesn't get it Today for example. I had 5 patients in my morning that I was doing composite restorations on (8 restorations total). All along we've been coaching the student on ways to do her job better, and the main thing that my partner and I stress is that a huge part of her job is to anticipate the next step, and have that material/instrument ready BEFORE we ask for it. So ths morning, I'm on my 8th composite(probably the 30th overall that I've done with her assisting), and she stills doesn't get it I mean I'm basically a creature of habit on my composites, Anesthetize,Prep, matrix(if needed), etch, rinse/dry, bonding agent, cure, flowable + composite, cure, add more composite if needed, cure, polish/finish/ check occlusion (if appropriate). Time and time again, thats what I do.

Here's how all 8 went this AM:

Find the anesthesia(wait a minute while she does this), anesthetize, come back in 5 minutes to prep the tooth (wait while she sets up the hand piece/finds the burs, pick up the handpiece, wait while she goes and gets a suction tip, prep (stopping every 30 seconds or so to reposition the suction for her so so my patient doesn't drown ) watch her put the suction tip back where she had it, not where it should be , ask for the matrix and have her go searching for it(wait another minute while she sets it up(often the wrong way if its on a tofflemayer retainer ), ask for the etch(wait 30 seconds while she gets it out), rinse, wait again since she hasn't got the bonding agent out , ask for the curing light(wait for her to turn it on at the power switch), ask for the composite(2 or 3 times I'll need to mention the shade), tell her to put the curing light down since I need a composite placement instrument before we cure the restoration, ask for her to get the curing light(wait, wait, wait). Arghhhhhhh!!! My blood pressure is up 30 points just remember this. My regular assistant who was watching/help supervise this debacle actually timed the "wasted time" dueing the last restoration and it amounted to 9 minutes 34 seconds, and this patient had only been scheduled for a 30 minute visit Needless to say I ended up a bit behind on the schedule today

Moral. when your in practice and you find a good assitant whom you work well with, pay them well!! When you and your assitant are workig together well, the only thing you'll be talking about 95% of the time is anything but the procedure you're doing (unless its something really funky) since your assistant will know your every move and instrument/material needs!

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[drPheta]

Holy crap, 9 mins??? Dude, I'm only a first year, and when we do composites (no etching steps yet), I have all my junk laid out in chronologic order. If I had to fumble around a look for stuff, I'd go crazy...having to deal with another person doing that? I don't know what would happen.

Props to DrJeff for offering a rotation site. I just hope this person gets it before they get licensed...if they get licensed.


9 Mins...wow. I poop faster than that. TWICE!

 

[DrJeff]

The real challenge is how do you offer "constructive criticism" to the student infront of the patient while your fuming inside

I actually had one situation today where I had a crown prep going on a patient in 1 room and an emergency patient who lost a DO amalgam on a tooth in my other room. I prepped the crown and then told my regular assistant to make the temporary and KEEP the student with her while I worked solo on the emergency in the other room(at that point I was running about 30 minutes late on the schedule since I'd already done 3 or 4 composites with the student and lunchtime was nearing). I figured me working solo on a nervous 7 year old was going to be way faster than the assistaing student, plus after I was done, I could have her clean that room(a 15-20 minute ordeal for her) while my regular assistant and I put it into high gear for a patient or 2 and tried to make up time.

The really sad thing is that at lunch today, my partner and I sounded like 3 year olds, "I don't want to work with her, YOU work with her!" "No, You work with her!".... My partner pulled out the old trump card though on me when he said, "your buy in still isn't complete so technically I"M THE SENIOR PARTNER!" I had to take one for the proverbial team this afternoon, and I'm actually stresing about going into work the next 2 days(this nevers happens to me) since I get the pleasure of working with her during her last 2 days

 

[DcS]

My rant is that I had to do an MOD on 14 yesterday, she had a DO already there that I removed, but had to do the whole prep w/out an assistant. I tried having the patient hold the suction in place...didn't happen, kept getting in the way of my bur. I then tried to wedge the slow speed suction under the frame of the rubber dam...didn't happen. So basically I held my mirror and suction in my left hand and handpiece in my right. Needless to say I ended up using a lot of direct vision and ended the day with a nice tight back. Especially since the D went sub-g. Then when I finish and I'm pissed off I had no assistant, one comes over and asks if I need help

 

[Frank Cavitation]

DrJeff,

Just wondering what the patient gets out of this exercise. If I was paying for a filling I'd like it to be the best possible. With the extra time and hassle, not to mention possibly increased moisture contamination, if I were a patient I want a discount!!

Are there any tips in looking for an assistant, and deciding whether it's worth the trouble to train them or get another one?

 

[UBTom]

Say DcS,

You got me thinking. I wonder if there is such a thing as a rubber dam frame out there with built-in suction attachments (like a svedopter).

Sure would make my life easier... Wonder if such a thing exists..

 

[DcS]

Hey Tom, sounds like a patent, I'll split the revenue with ya


You know how it works. Slap the name "Dental" on any normal product and you can sell it for 300% more!!

 

[preludexl]

Out of curiosity, do the assistants have to be certified? Is that a state requirement or just a little guarantee that these people have been pre-trained and you don't have to train them? I know most medical techs can be taught even if they didnt pay no technical "college" to train them how to do simple repetitive procedures.

 

[3rdMolarRoller]

Did any of you have Dental assistants during your schooling?

 

[Midoc]

We have assistants in the Pedo clinic but no where else.

 

[aphistis]

Originally posted by Brocnizer2007
Did any of you have Dental assistants during your schooling?

We have them in all the comp. care clinics.

 

[Supernumerary]

Originally posted by UBTom
Say DcS,

You got me thinking. I wonder if there is such a thing as a rubber dam frame out there with built-in suction attachments (like a svedopter).

Sure would make my life easier... Wonder if such a thing exists..

Doh, just a few years too late. It's called an isolite - isolation, suction, light all in one.

 

[UBTom]

Hey James,

That's a cool piece of kit! A fiber-optic-lit bite block with suction.

I'm thinking more along the lines of a rubber dam though because the rubber dam does act as a protective ligature for the interdental papillae and probably does somewhat of a better job at keeping sulcular fluid out of the operating field..

Isolite isn't really what I'm looking for, but I'll definitely keep it in mind-- I'll check it out and try it in private practice, hopefully just two months from now.

 

[groundhog]

Some folks just seem to be very challanged when it comes to being able to catch on to handling rapidly changing numereous procedures even when those procedures are repetitive over time. We get them on occassion in our electrical utiltiy apprenticeships. There have also been a few top draft quaterbacks who could not transition from college to the NFL for the same reason. There seems to be no good way to screen for such a flaw which only manifests itself under real life conditions.

 

[Doggie]

I feel ya Dr. J.

Just the other day in the clinic, I had to do a DO prep on a #29. I seated the pt down and explained the entire procedure. Then I proceeded to perform a IAN block. After I had placed the rubber dam onto the teeth, I realized that water was not coming through the high-speed....(@!#!$#) Since all the other chairs in the operatory were taken up, there was nothing else for me to do.......I guess I could send the patient home......but oh wells.

Basically throughout the entire procedure, I had to hold the air/water spray with my left and drilling with my right hand and at the same time, make sure the suction tip stayed lodged between the rubber dam and the frame.

Too bad we dont have any dental assistant programs here at school........

 

[DrJeff]

Originally posted by Frank Cavitation
DrJeff,

Just wondering what the patient gets out of this exercise. If I was paying for a filling I'd like it to be the best possible. With the extra time and hassle, not to mention possibly increased moisture contamination, if I were a patient I want a discount!!

Are there any tips in looking for an assistant, and deciding whether it's worth the trouble to train them or get another one?

The procedure price is still the same, since its the same set of hands holding the drill, and when it comes down to it, that's what really matters

As for finding a good DA, some people like to take someone with an interest and no formal training, and teach them from scratch, finding them a radiology certificate along the way. Others will look for a trained DA from a local community college and/or tech school(hence why my office is a rotation site). Then its the entire "can I work with this person on a daily basis, and will they fit in with every other employee" question that you have to ask.

Of my 3 DA's, 2 we hired after they rotated through the office while they were in the assisting program at the local technical school, and the third was recomended to us by our Sullivan- Schein rep. I can say that even if my office did need another DA right now(and we don't at this moment) the xtudent that's here now wouldn't be offered a job!

 

[succedaneous32]

I do not know if this will help any of you but I have been a Dental assistant for almost 14 years and I have been teaching dental assisting for 2 years, but here it goes anyway:

At our Tech college basically any breathing specimen can take our course. Unfortunately they somehow get through the program and fail miserably on their externship. Now there are a few great dental assistants that come through. The best way to pick them out is attitude. You can train anyone that has a great attitude and a patient dentist to work with that is mutually respectful.

I will have to say that a great dental assistant(s) makes a great practice. I have had to be the right hand for a few dentists (sometimes both hands! )

My advice is not to try and train someone fresh of the streets. That hurts patients in the long run and usually ends up in a dental assistant doing illegal functions. Most states do not require DA's to be certified but it depends state to state.

As far as the bad student, I say let the senior DA's talk to her about her performance. Then again she may never really get it! Good luck and remain calm!! Don't cause a scene in front of a patient. That is embarassing and makes the patients doubt the dentist and his staff.