How to anticipate the doctor

March 1, 2001
By definition, the word "anticipate" means to expect or foresee, to wait for or predict; which is exactly the skill that every good chairside assistant needs to develop.

by Mary Govoni, CDA, RDA, RDH, BS

By definition, the word "anticipate" means to expect or foresee, to wait for or predict; which is exactly the skill that every good chairside assistant needs to develop. In order for patient treatment to flow smoothly and quickly, the chairside assistant must be able to anticipate (with reasonable accuracy) what the doctor is going to do or to need next, and be prepared to make it happen. How can you always know what the doctor needs? Experience certainly helps, but if you're new to the profession or working with a new doctor, how do you anticipate what comes next without some special psychic powers? The answer is through communication, close observation, preparation, and visibility.

It all starts with excellent communication between the doctor and chairside assistant. Every assistant needs to clarify with the doctor what exactly are his/her expectations. Does the patient's chart or treatment plan clearly indicate what procedures are to be performed at a given appointment? Does the practice have specific guidelines for instrument and materials set-ups for each procedure? Does the doctor expect the assistant to pass instruments, or does the doctor prefer to retrieve his/her own instruments from the tray? (Note: If the doctor is retrieving his/her own instruments, efficiency will be significantly decreased.) Does the doctor follow a specific order or sequence for using instruments and materials? If you are not sure of the answers to any of these questions, you and your doctor need to take some time to discuss them and write down some standard operating procedures to follow. Finally, though it may seem rather trite and simple, if you're not sure what the doctor needs next during a procedure, ask, rather than assume. Keep in mind that if stress levels are high, the doctor's response to an incorrect assumption may be exaggerated and it should not be taken personally. Be proactive by asking questions about what is needed next.

Remember also that a great deal of communication takes place non-verbally. The assistant needs to be observant of the doctor's nonverbal cues as well as verbal communication to fully anticipate his/her needs. The same is true of the patient's needs, which most often will be communicated non-verbally during treatment.

Another key to anticipating the doctor is preparation. Making sure that the instruments and materials are in the treatment room, within easy reach of the work area, should be a routine part of setting up a treatment room. The use of tubs to organize materials by procedure is an excellent way to make sure that all supplies are available when needed. For example, if the patient's treatment plan indicates that an amalgam or composite restoration is to be replaced, but the assistant can see that it is a very large restoration, and might need a core and crown, having a tub ready with core and crown/bridge materials will allow the team to make a quick and smooth transition from one procedure to another. Taking photographs or making checklists of tray set-ups and the armamentarium for each procedure is especially helpful for new employees.

The last key to anticipation is visibility. That is, the assistant needs to see what the doctor is doing at any given time, and to be able to recognize what is needed next. The assistant also should be able to see without straining her/his posture when seated at chairside. If the assistant's visual access is blocked by the doctor's hands or head, she/he cannot effectively anticipate what is needed. Communication is critical again. If the assistant continually has difficulty seeing during a procedure, she/he needs to let the doctor know, so the doctor can adjust his/her position to allow for visual access for both the doctor and assistant.

By remembering the keys - communication, observation, preparation, and visibility - you can become highly skilled at anticipating your doctor and your job satisfaction level will increase greatly.

OSHA update: New standards that affect dentistry

OSHA recently finalized three new standards that dental practices must comply with. Those standards are:

1. Ergonomics Program Standard - Effective Jan. 16, 2001
This standard requires that employers provide training for employees on principles of ergonomics and the possible musculoskeletal disorders (MSD's) that can occur as a result of a work-place injury or risk factor. This training must be completed by Oct. 14, 2001. Additional requirements must be met if an employer receives reports of MSD's in the workplace.

2. Occupational Exposure to Bloodborne Pathogens; Needlesticks, and Other Sharps Injuries - Effective Jan. 18, 2001
This standard requires employers with 11 or more employees to keep a sharps injury log in addition to required reports for other work-related injuries. It also requires that employers must solicit input from nonmanagerial employees who are responsible for direct patient care who are potentially exposed to injuries. Solicitation of this input must be performed and documented by April 18, 2001. At the present time, dental practices are not required to use any particular safety needle or device.

3. Recording Work-Related Injuries and Illnesses - Effective Jan. 18, 2001
These guidelines apply to employers with 11 or more employees and must be utilized when a work-place injury requires medical treatment beyond first aid, restricted work activity, or job transfer, days away from work, or loss of consciousness or death. The old recording forms, 101 and 200, have been replaced by new forks, 300 and 300A, respectively.

For more details about these new standards, visit the OSHA Web site at