How to Present for a “Start”

I started shadowing in my school’s clinic as a D2. One particular day, the D4 I was working with suggested that I present the patient to faculty for a clinical start! I had no clue what this meant, but she walked me through the process. It ended up being a great experience to get my feet wet! As you transition to clinic, I highly recommend asking if you can present a patient for a clinical start to get experience! Here’s how to present a patient for a clinical start…

What is a “start?”

A “start” is permission to begin treatment. To obtain a start, you will provide an overview of the patient case to faculty before beginning treatment. After presenting the case, the attending faculty may want to examine the patient and/or their radiographs. Finally, the faculty will give you the go ahead (hence, “start”) to begin treatment.

How do you request a start?

  1. Bring the patient back to your chair.
  2. Review the chief complaint (why is the patient here today?)
  3. Take the patient’s blood pressure.
  4. Review medical history and medications (any changes?)
  5. Place patient bib and goggles on. You may wish to take a quick peek in the patient’s mouth to re-familiarize yourself if it’s been a while since their last visit.
  6. Jot down the following notes in your clinic notebook (see my post on What’s in My Bag, Clinic Edition):
    • Today’s date
    • Patient Initials & Patient #
    • Medical history
    • Medications
    • CC, Today’s planned treatment
  7. Present these notes to faculty. When done, ask if he/she would like to take a look at the patient and/or their radiographs. Here’s how I typically present a patient:
    • “Hi Dr. Smith, May I present for a start? I have a 30 year-old female patient. Her blood pressure is 120/80. Her medical history includes high blood pressure and acid reflux. The patient takes 40 mg of Losartan for her blood pressure. Her acid reflux is well controlled with diet. She is here today for #3-MO. Would you like to come over and take a look?”
    • If the patient does not have a significant medical history, the fancy way to say this is, “The patient’s medical history is non-contributory.” 
  8. Some faculty may ask you about specific medications. Be familiar with the drug classification, mechanism of action, and any dental-related side effects (especially medications that may cause xerostomia or gingival hyperplasia).

What should you have available after requesting a start?

After presenting, the attending faculty may want to examine the patient and/or their radiographs. Be sure to have the tray and radiographs ready! Your tray should have: mirror, explorer, perio probe, and 2×2 gauze. Some faculty get impatient if these instruments are not on the tray, ready to go. Your patient should have their bib on. Patient goggles should be on, or readily available.

Do you present for a start differently? Any tips for rising D2’s? Comment below!


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