The Digital Dental Surgeon

Here I am, sitting at Starbucks enjoying my usual Caramel Frappucino while the wifey goes shopping at Isetan. I’m not much of a window shopper, as previous experience with my mom shopping along Jalan Masjid India has shown that I tend to get bored and tire easily at the sight of limitless number of clothing racks.

An Arab family is sitting in front of me, the father has just arrived with a trayful of Starbucks goodies, the son is playing his PSP while the mother, ahem, smokes on a cigarette. It is not uncommon these days to see women smoking, although it seems that the trend is more likely to increase rather than be shunned by the ladies.

My dad smokes. He did try, unsuccessfully, to ditch the habit. Many of my friends smoke as well, including some medical doctors. Perhaps stress is an important factor, as high powered professionals are exposed to high levels of stress at work. Imagine dealing with a hundred sick patients in a day and then end up doing late night rounds during on call. Thank goodness I do not have to do on calls anymore!

I do not smoke. Well, I did try to when I was in high school and the habit just didn’t manage to stick. How could it, when I couldn’t even make the damn cigarette puff on the first try. You could say I gave up on the first (albeit unsuccessful) puff. All the horror depictions of cancerous lungs with tar dripping from it did not scare me really (no wonder the ads do not make a difference), it’s just the inability or perhaps lack of skill and talent to smoke put me off. I’d rather spend my hard earned money on something else, like food for instance. My wife is thankful that I do not smoke, and I’m thankful of her being quite the gastronomic adventurer as I like to have trips to various food joints now and then.

I’m sitting here thinking of the future. Soon we’ll have a baby boy which currently does not have a name yet. We had thought of a name for a baby girl, only to find out on the last visit that it will be a baby boy! Talk about pleasant surprises. I’m happy really, to have the first child a baby boy. I don’t mind having a girl, as either gender is irrelevant. I’m going to be a father!

We didn’t plan for it really, trying not to have a baby until our immediate future is decided. Private practice, continuing as a government specialist or jumping onto the teaching bandwagon, these were the choices. Considering that we’ll be having a baby this November, rationally heading towards private practice is less attractive as it will involve in a lot of hard work on my part plus I could ill afford that much time off from the clinic for the family. The initial plan was to be in the private sector, slog it all out for the three years my wife will be overseas doing her Endodontics specialist training. This plan is put on hold and potentially shelved altogether as the baby’s arrival is imminent.

I’m not confirmed yet in service, although I’ve been working for three years in the service. Why? I chose not to go for the induction course when I was in Johore. Why? I was disillusioned by the whole structure of the service then. Come on, being a dentist means more than pulling people’s teeth out day in day out. The administration at the place I worked did not have the vision to push forward dentistry as a whole. We could do more as dentists, instead we were made to complete daily outpatient numbers, tend to the denture waiting lists and avoid complaints.

Don’t let me start with the dental school services. In essence, it is a very good idea really, to provide service to the school children. But in reality, we do not have the sufficient manpower to provide high standards of oral healthcare to all children. Every year it’s a race for the dental nurses, soon to be relabeled as dental therapists. Try imagining 600 students at a school. Imagine close to fifty high schools. Imagine completing treatment in the school in less than a week.

Lets say in general the dental team would spend between eight in the morning till one. That is five hours per day. Multiply it by five days and you’ve got twenty five hours, just an hour more than a day. So you’ve got a thousand and five hundred minutes to complete the school. That would take, what, two and a half minutes per child? Having the kid to sit on the dental chair (if you could call it a dental chair that is) would take more than a minute not to mention having the decency in communicating and making the child comfy in front of the dental probe and other instruments. The good patient-relations are just thrown out of the door.

The outpatient clinic is the same really. Lets take an average of fifty patients for a dentist during the morning till lunch which is somewhat less than most clinics. You’ve got five hours before you reach lunch at one. That is three hundred minutes for fifty patients, which will net you a cool six minutes per patient. More often than not those measly six minutes will be finished as soon as the dentist has completed his clerking. In six minutes the dentist had to investigate, come up with a diagnosis AND treat the patient. It’s Formula One territory I tell you!

Tell me how long do you have to spend when you’re having a tooth filled. Tell me how long do you have to wait for your turn. Most of the time you would be given an appointment, come again later to have those teeth filled. I personally wouldn’t mind the initial waiting time, if I could get my fillings done on the same day. I’d be quite upset if my wait ends up with another stub telling me to come again another day for the appointment.

But that is, sadly, a fact.

Of course, we do our best to treat patients and give the good oral healthcare. My wife and I are quite the mavericks during outpatient days. Dental Surgery Assistants, or DSAs, would push the dentist to faiti! faiti!, to hasten up, as patients begin to clog up the registration counter. My wife and I would just take out time to talk to the patients, understand their problems and treat them there and then. No point giving them another appointment as they had already endured long waits. Most patients understand during our outpatient days, they did not complain as they were treated professionally and were satisfied with our service.

I believe it is the time the dentists to stop from being factory workers, tending patients like an assembly line. We should view patients as a person, listen and treat them. Not doing the routine jab, wait five minutes and pull the damn tooth out. We are more than just doint dental extractions. We are dental surgeons goddammit! My wife does root canals, even the molars. Not many general dental practitioners in the government service do molars, even if it’s indicated for. Time constraints and lack of instruments and materials are the main reasons I assume. You won’t find rubber dams in most clinics.

Enough ranting. I believe in good professional oral healthcare starts with a boss with the vision to fully utilize the dental surgeons under him/her to provide with quality work instead of quantity (100% coverage is just bullshit with the current number of dental professionals really).

1:8000 dentist-patient ratio? Did you know that this includes administrators that do not do any clinical work as well? In reality it is much much higher.

Time for a change.

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