I’m now in
my 5th week of 3rd block. This will just be some random
updates though there so many past events that I haven’t written about.
Just got my 2nd block results last
week, not satisfy with my General Surgery and General Medicine. The MEQ format can
really kill you in the overall marks. By just mistaken Squamous cell carcinoma
of the leg for diabetic foot ulcer, half the marks for that component are gone.
*sad*
On a
brighter side, I did my first extraction on a 1st and 2nd
upper molar 2 weeks back. That happened during the last week of Oral Surgery
posting. The aunty was actually very co-operative. Bhairavi gave the PSA nerve
block; Dr. Venkat supervised me on the extraction part. (Need to thank Bhai for
pulling me over to do it and Sonia for her patient) The first tooth to go was
the 2nd molar, I was excited and nervous at the same time. I first
learnt to elevate the gingiva. Visibility
was a problem for the distal side of the tooth but sir was happy with my job. While
trying to make the buccal bone expansion, I gave some motion to the lingual
side, and caused the mesiobuccal root to fracture. Luckily Dr. Venkat was all
cool about it, he said “don’t worry, I will show you how to take it out after
we remove 16. “ Learning from experience of the previous, all I gave was a
buccal motion and 16 was successfully out of the socket. Still need to be more
confident in the placement of the beak of the forceps.
That very same
day also, before the aunty’s case, I came across my first witness of a paranoid
patient in clinics. (Still remember Dr. Deepti’s class on the 4 types of
patients in clinics) It was a little hilarious but I shall keep it to myself.
My first
nerve block was an inferior alveolar nerve block on Yung Yee’s patient using
close mouth technique. It was a case of impaction of 48. Had no guts to do the
incision on the gums and so Dr. Venkat showed us instead. I assisted in the
suction and was able to appreciate the whole procedure. The patient was also
super co-operative. I later did suturing straight onto the patient. Must really
thank Dr. Venkat for his patience. Was actually fumbling to do the knots. The second tie was better. Still needs more
practice and confidence.
Now I’m in
Oral Medicine posting. All we can do is E&D. I’m not sure about other dental
schools, but we spend at least half an hour on this. This includes taking a
detail case history, general examination, dental examination and planning the
best treatment option for the patient. Due to the time limitation of our
clinics (we are given a slot of 2 and a half hours), it’s very hard to strike a
balance to do what the patient wants and the protocol followed in our school. Some
patient came merely for a scaling but because of many other factors, they end
up with only E&D done, to which the patient feels is simply utter waste of
time. Yes, you may argue that it’s our fault for not explaining the importance
of E&D to the patient and thus making them rant about us but I still feel
that something can be done to make things more efficient. I have been thinking
of ways to speed up, but my minimum time for a thorough E&D is half an
hour. Some patients are co-operative
that they even take time off work or travel all the way from KL, just to come
for subsequent treatment, but many have gave up on us due to this. To be
honest, all patients that come to us are really precious because the patient
pool in our clinic is so limited. Our patient is our best teacher in the world.
We often need to call and persuade the remaining clinic contacts to come for a
check-up. Not to mention the amount of quotas to fulfilled before the end of
the year. It’s also not ethical to keep the patient waiting till you are posted
into a certain speciality clinic to handle the case. So much to think and
handle for clinics. (some more got studies to do along the way)*headache* For
me now, I will think in terms for the benefit of the patients and do what’s
right for them. The quotas, God willing, I will finish them. *sigh*
I think
many of my classmates and I personally have come across the problem of handling
patients with bad breath. This is especially with those patients who smoke.
The
mouth mask is not enough as a barrier; even formalin in dissection hall can
easily penetrate it. I make the patient
to rinse with mouth wash before I examine the mouth. Some are really afraid of
the stingy sensation from the mouth wash and prefer not to rinse with it. (Oh
boy!) I had seen one or two batchmates who took a short stroll away from the patient
to breath in fresh air. Well, the secret to better breath is to scrap away the
plaque off your tongue.
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That’s where the major source where fermented food is
retained in the mouth. For smokers, please stop smoking. Not only your mouth
stinks but your whole body emits the stench of tobacco.
(This how we feel inside the mouth mask)
One thing I
observed during the past few cases of scaling, in Malaysian, there will always
be one or two chili flakes found retained either subgingivally or at the
interdental region. Remember once I was “undermining” through a heavy calculus
and suddenly a chili flake was “discovered” inside. (Sound like some treasure
hunting event going on right?) That’s why you really really really need to
floss yo’!
Hope things
in clinics will improve; I will strive hard to improve! Let’s improve!
(All photos are taken from the Internet via Google Image, Credits belongs to the respective sites)
