Evolving clinical intuition and professionalism: knowing when to swing at the pitch

Knowing where a pitch will ultimately cross the plate remains a critical skill for major league hitters. Variations in pitchers (right- and left-handers), pitching styles, and pitching speed, amid a host of variables — all ultimately challenge hitters. Having an intuitive sense about when to swing at a pitch takes time, practice, and humility. A batter needs experience and patience. A player who can learn from his mistakes will certainly improve. Clinicians are subject to the same phenomena as we also face a host of common, and also anomalous, variables that present themselves every day. How we address these variables will ultimately determine our professional satisfaction and success.

As clinicians, an infinite set of clinical and human variables confront us on a daily basis. For example, from the clinical side, tooth No. 5 can have two canals or three canals, and within those, roots canal system variations are substantial. From the human side, our patients and staff are all unique individuals with conflict and communication difficulties providing inevitable variables, challenges, and opportunities. Even our equipment presents challenges. Radiographic interpretation is highly sensitive to interpretation and, depending on the condition, can present often atypical features. Such variation needs to be expected. No matter how long we practice, we will see new things and expand our clinical viewpoint, deepening our knowledge.

Therapeutic disparity among treatment outcomes remains another variation providing growth. Similar treatment protocols can yield variable responses among our patients. For example, certain patients under almost identical circumstances may benefit from a medication, while others do not. Why the difference? Another common dissimilarity is that some teeth remain tender after treatment, while others treated in the same manner become rapidly asymptomatic.

Treatment plan decisions are best evaluated on the considerable variation we see in radiographic interpretation, osseous integrity, subjective, and objective examination findings. Our professional diagnostic acuity becomes enriched and developed through the process.

Nonclinically, schedule discrepancies are a considerable variation challenging our office systems. We must learn to channel this variation into an appropriate therapeutic response, which may range from immediately seeing a patient with an acute infection, writing a prescription, or giving the situation a tincture of time.

We are asked to make continuous decisions throughout our careers that will affect our patients’ well-being. Aside from clinical practice, these decisions are influenced by variation in dental research, product development, marketing, and material enhancements. We study professional journals, visit conventions, attend study groups, and other forms of continuing education to keep abreast of the variation being driven by progress in materials science and clinical techniques.

Experience is a significant variable in and of itself. Inexperience and its co-partner, enthusiasm, can lead us into consternation early in our careers, as we have not seen enough inconsistency to evaluate complexity when presented. With time though, the cumulative benefits of addressing an almost infinite variation in experience, circumstances, and stimuli certainly will begin to amalgamate, molding our professionalism, if we remain open to change. Professionalism in this sense might be knowing which patients to treat and which to refer. Such wisdom often amounts to having a sixth sense, understanding what clinical pitches to swing at, and when to take a pitch.

Like the baseball batter who embraces the variation and matures from experiences and environment, as clinicians we have a fundamental choice to learn and develop, or conversely stagnate and grow irrelevant. In essence, we must allow variation and its benefits to quietly drive our professional enhancement and wisdom.

Enjoy the journey!

Dr. Jeffrey Krupp

Jeffrey Krupp, DDS, MS, a board-certified Diplomate of the American Board of Endodontics, has been in full-time endodontic practice for more than 35 years in San Jose, California. He earned his dental degree at UCLA dental school and received his postgraduate endodontic certificate and MS at Marquette University. His passionate interest in education and sharing knowledge is the energy behind “Success In Endodontics 2.0” an endodontic interactive self-study CE program created by Dr. Krupp at www.successinendodontics.com

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