in health care stuff

Doing reps

Let’s say you need a procedure. Perhaps a filling or a crown. You have a choice between two dentists to do the procedure for you. You can choose yourself at this moment or you can choose yourself 10 years ago. Or 5 years ago. Or 20 years ago. The point being you are choosing yourself at a time when you had significantly less experience than you do right this second.

Who would you choose? I’d wager that you would choose yourself at this moment. Why is that? It could be that you’ve started using a new instrument or learned a new technique. It could be because the technology has come a long way since you were the other you. But most likely it’s the reps you’ve put in.

I look back on some of the work that I did 15+ years ago. Some of it I’m kind of proud of, but more often I cringe a little. I see underprepared crowns. I see overprepared direct restorations. Mostly I see things that were done to the very best of my ability at that time. Which is good. But much of it I would do quite differently today.

When I was a newly licensed dentist I planned to take the world by storm. I thought I knew a lot. And let’s face it, I did. I knew how to pass tests. National boards, clinical boards, microbiology exams, operative practicals. I knew how to play within the rules that were set by others that proved I was qualified to be a part of the profession.

What I didn’t know a lot about was how to be a dentist. I had done a bare minimum of clinical work on patients. I sometimes complain about how little clinical training I had, but let’s be honest. How much would have been enough? If I had done 5 more crowns in a setting where I had to check in with an instructor at every step would that have made me “experienced?” Probably not.

I’ve become the clinican that I am through reps. I’ve diagnosed real disease on real patients and then treated them. And make no mistake, I’ve learned how to treat patients by treating patients. It isn’t that I’m asking patients to be guinea pigs. But to some extent I ask them to believe in my abilities and experience up to that day.

Your patients trust your judgement and ability even though they really can’t know much about either. A poorly done restoration can be done painlessly. I’m not trying to make newcomers to the profession feel bad. You can’t get experience without doing the reps. But understand that most of us learn best by doing. I was never any good at reading the directions and then doing exactly as the directions said and having success. Those directions were written by someone with experience but were being read by me: someone with much less or different experience. For me, dentistry is a “learn by doing” profession. The only way I learn is by being open minded enough to see that there are different ways to get the job done and being patient enough to try something new.

The profession continues to evolve and as clinicians we evolve as well. I believe that most of us really do the best that we can at any given moment. But make no mistake, we get better by doing reps. This isn’t an excuse to be cavalier about treatment but a call to humility. Do your best, but be committed to being better next time.

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  1. Whatever Al. I’ve been perfect since day 1. ;)

    But really, you are correct. Some of the stuff from 5 years ago makes me cringe. Interesting to see what the next 5 will bring.

  2. What a beautifully written piece. I couldn’t have said it better myself. I’ve been in practice 27 years and sometimes still feel ashamed when I reflect on how ignorant and cocky I was right out of the chute. The only thing that probably kept us going at that time was not knowing just exactly how much we did not know. The sanitized bubble of dental school only gives us the bare minimum knowledge to obtain state licensure, but in no way fully prepares us for the real world of dental care. As you have pointed out, only time and practice can do this. With the paradigm of dental delivery systems that are emerging today, I’m afraid the lost art of mentoring is all but extinct. And as an important aside, when a fresh graduate is turned lose in a corporate setting requiring quotas that far exceed his or her abilities at that time, horrific mistakes can be made. Just something to think about.

  3. Hi Alan,

    I just wanted to say this was a delight to read. Do you still get nervous when you are operating on your patients? I’d imagine that after all your work, you’d feel confident but are there times in which you still get nervous? Like is there a specific routine or procedure which gives you the shivers to do?

  4. Hi!

    I stumbled upon your blog as I was reading physicians blogs tonight. I wondered “will there be any dentists blogs?” and voilá, I found yours.

    I am a dental resident at a hospital in New Jersey and I find your article very true. I, as a recent dental graduate, feel the need to expand my experience in the safety of a residency. Hopefully, this will give me the confidence I need to tackle the real world when I get into a private practice. Keep blogging, your wisdom is not lost on the vast cyberspace. Dentists are watching!

  5. Experience is so vital in the field of medicine. You’ll get to know what all are needed for a dental procedure. All the small talks i had, during patient visits, with the dentists at Centenary Dental Toronto, Canada, they told me the most important thing that a dentist should have is – the instinct that tells you what to do and what not to do during dental procedure can only come with experience.