Top tips to avoid feeling overwhelmed when going into secondary care

on 28th January 2019

Simran Bains lists some of her top tips to consider if you’re looking to go into tertiary care.

The transition from practice to secondary or tertiary care may seem like a daunting venture. However, it is full of exciting opportunities, various experiences and numerous challenges.

If you’re unsure about a career pathway, a year in hospital will offer you a great insight into the different specialties within dentistry. The maxillofacial team is made up of a range of clinicians from a variety of specialties. Talking to an array of people can prove to be quite inspirational and help clarify your future.

Currently there are less dental core training (DCT) posts than dental foundation one (DF1) posts, making the process very competitive. It is important to thoroughly research each hospital senior house officer (SHO) post prior to ranking them as they all differ in their own way.

There are two types of hospital – a teaching hospital and a district general hospital. Some hospitals are more trauma based, whilst others are more head and neck cancer based. Certain hospitals have overnight on call, whereas others have varying shift on call patterns.

Managing referrals from medical practitioners

When you commence your dental core training it is very easy to accept all referrals from senior colleagues, purely because you don’t want to say no. However, not all referrals may be appropriate, so it is imperative you gain as much information from the referrer before accepting the referral. Below are a few questions to aid you in gaining a detailed history:

  • Name, age, patient number
  • Full medical history
  • Can the patient breathe and swallow comfortably?
  • Are there any swellings? Size of swelling? Is this compromising their breathing?
  • Is the patient pyrexic?
  • Is the floor of the mouth firm or raised?
  • Does the patient have reduced mouth opening?
  • Laceration: When? Where? Other injuries?
  • Is the patient clear from a head injury point of view?
  • What is the referrer’s differential diagnosis?

If you are unsure if a referral is appropriate run it by your registrar first.

Prioritising patients

When you are on call, as well as having a busy ward to manage; you may also accumulate a number of patients in A&E, in addition to providing advice to dentists and doctors in the area about how to manage their patient. It is important to be organised and prioritise these tasks in order of urgency using the ABCDE framework. For example, if a patient has a rapidly increasing swelling thus compromising their airway they should be attended to before a patient with a laceration of the lip.

It can be helpful and time efficient to ask the nurse in A&E to get a set of observations, bloods and any special investigations you may need for the patient. This allows you to have all the results of the investigations when you assess the patient so you can make an informed decision when reaching a diagnosis. Have a note pad to hand and if you’re in the middle of dealing with something else take a number to call back.

Recognising abnormalities

Secondary and tertiary care exposes you to a variety of diseases, conditions and postoperative complications. Whether this is observed in clinics or in theatre sessions, this will be invaluable in creating a foundation of knowledge.

Being on the receiving end of referrals from primary care, helps to clarify the features of diseases accepted in hospitals and which can be managed in general dental practice. Throughout the year your management of patients will greatly improve.

Knowing your limitations

You can’t be brilliant at everything and knowing your limitations is critical. Maxillofacial surgery has both a dental and medical aspect and you are not expected to know everything medical, but you are expected to be a good dentist. It is not just about knowing how you do something, it’s knowing why something is done to gauge a deeper understanding when treating the patient holistically.

Secondary and tertiary care is an extremely supportive environment; if you find yourself stuck don’t be afraid to ask your registrar or colleague for advice.

Getting involved

Practise makes perfect, so practise cannulation and taking bloods on the ward and on A&E, this will help you become more confident in your own abilities. Find out if there are any audit projects or research projects you can contribute to.

At the start of the year make a personal development plan and find out if there are any CPD events that you would like to go to. Use your time wisely to learn as much as you can.

Eat healthily and drink plenty of water

It’s very tempting to fall down the slippery slope of junk food and chocolate. Plan ahead and meal prep for the week. Have some healthy snacks to hand for those on call shifts and drink plenty of water throughout the day. Don’t forget to have a big breakfast before going into theatre.

I hope that this has helped you understand what a DCT post involves and learnt some tips to avoid feeling overwhelmed. Even if you decide at the end of the year that you are more suited to practice, a lot of the skills you have learnt throughout the year are transferrable. Suturing and cannulation are useful in oral surgery and IV sedation and you’ll feel much more confident in managing a medical emergency.

You cannot underestimate what you do not know. So embrace it, be open-minded and be enthusiastic to learn.

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