Chapter 3   Acquisitions & Assignment of Patients

3-1. Acquisition of Patients.

A.      Registration and Dental Screening Examination:  The patient population for the dental students of the Medical College of Georgia is acquired by means of a dental screening examination program.  Prospective patients contact the School to plan an appointment for registration and a screening examination.  At the present time, patients are screened weekly.  The purpose of the examination is to record certain demographic information and to record the oral health needs of the patient.  The clinical examination consists of an oral examination, appropriate radiographs, and a fee of $25.00.  Individuals are selected to become dental patients on the basis of their suitability for teaching purposes.  Prospective patients view an informational video which describes the dental treatment program at MCG School of Dentistry, the School's objectives and the patient's obligations. The patients receive a Patient   Information brochure and a Patient Relationship information sheet to keep for future reference.

B.      Patient Assignable File:  After the examination, the patient information obtained at screening is computerized and the patient is placed on an assignable list.  From this information, patients are selected for assignment to students.  We do not guarantee assignment.

C.      Screening for the Southern Regional Testing Agency (SRTA) examination.  The following categories of patients for the SRTA examination and their management are identified.  Students are reminded that no fee is required for treatment provided during the SRTA examination.

1.      Category I:  Assigned patient for whom examination and treatment plan have been approved.  No special arrangement required.

2.      Category II:  Patient assigned to Screening, not assigned to a student.

All diagnostic activity must be performed only during the designated clinic hours under faculty supervision.  Any deviation places graduation in jeopardy.

a.      The Work up and Treatment plan must be approved and a student fee ticket issued for each procedure.

b.      Regular clinic fees must be collected.

3.       Category III:  Students may recruit unscreened patients for the SRTA examination.

a.      Patient will sign a statement that no other treatment or obligation is assumed by the School.

b.      Bitewing radiographs, if not available, may be made to confirm lesions suspected from panoral radiograph.  No fee for bitewing radiographs, but a written order signed by a faculty member is necessary for any radiographs.

c.      Any patient showing an interest should be encouraged to apply for treatment in the normal teaching program.

D.      Southern Regional Testing Agency Exam.  During the exam, NO ONE WILL BE ALLOWED TO ENTER THE 3rd floor clinic or lab areas from 5:00 PM on Thursday through 5:00 PM on Sunday.  Please remember to remove all articles you might need since you will be unable to get them during this three day period.

Policies and requirements of the examination are available through the SRTA.  Dr. Kevin Frazier serves as liaison faculty to arrange resources for the examiners. 

 3-2. Assignment of Patients.

A.      Special Screening

Students are encouraged to obtain suitable clinic patients from among their contacts.  Relatives, friends and patients asking to be assigned to a particular student will be accommodated whenever it is compatible with the student's experience and current patient load.  (Check with the appropriate Coordinator if there is a question.) Screening appointments should be arranged with the Admissions staff 721-2371.  Please ask the students to inform our staff that the Special Screen and assignment is for you.  

B.      Other Dental School Patients 

When a student recognizes the need to add a patient to his/her patient population, the request for patient assignment is posted in writing on the Patient Request Form in the Dental Records Area on the first floor.  This request should include the date the request is made and the type of dental treatment needed by the patient (e.g. restorative dentistry, endodontic therapy, etc.).  Efforts will be made to fulfill these requests as soon as possible.   

When requesting new patients, students should anticipate their clinical requirements and make requests well before departmental deadlines for completion of those requirements. 

C.      Contacting the Patient:  

After receiving the Patient Registration Form, the student will contact the patient and arrange an initial appointment.  This should be done within two weeks of assignment date.  At this time the patient should be told how to contact the student should an appointment change be necessary. 

D.      Patient Reassignment:  

Some patients who have not had treatment completed by the time the assigned student graduates will be reassigned.  The student's Coordinator will make an entry in the Progress Notes giving directions concerning the procedures which are required for the reassignment examination.  A Recall/Reassignment (Figure 3-2b) form will be completed and the examination findings confirmed at a Diagnostic Review appointment by an Oral Diagnosis faculty member.  After approval, the Reassignment form will be inserted in the Patient Record.

E.      Duty Not to Abandon Assigned Patients:

Once the student has begun care for his patient, he is obliged to continue with that care for as long as the patient needs his dental treatment and complies with the school policies.  Moreover, the student must be available to his patient at any time the patient may reasonably require assistance.  To do otherwise is to be guilty of patient desertion or abandonment.  Should a student be guilty of patient abandonment, he will be subject to disciplinary action up to and including immediate dismissal from school.  Patient abandonment is one of the most serious ethical and legal violations. In practice, the dentist guilty of abandonment may be sued for breach of contract (malpractice).

Document carefully, patients who are not being treated regularly.  Periodic review of patient records will help avoid potential problems of abandonment.

Approval in writing must be obtained from a Patient Care Coordinator, if for any reason it is necessary for the student to terminate his relationship with the patient before treatment is completed.  The reasons should be clearly documented in the progress notes of the patient record before the request is presented.  The patient will then be informed of the discharge by letter.

3-3. Reassignment of Patients (STEP TRANSFER OR CASE TRANSFER)

Patients are reassigned from one student to another at graduation or in special circumstances.  These reassignments must be approved by a class coordinator before treatment begins.  It is imperative that the new dental student have a thorough knowledge and understanding of the patient's health history, of the patient's desires, what has been treatment planned, the treatment that has been performed and to verify that there is not new pathology or circumstances which might alter the treatment plan. 

The newly assigned student should carefully study the patient's dental record and determine what type of dental examination would be appropriate.

3-4. Transfer Patients to/from Residency Programs (Figure 3-4a) 

When it is in their interest, patients are offered the option of referral to one of the residency programs for completion of complex procedures.  When this occurs the student should inform the patient, obtain permission for treatment, and inform the patient of the difference in fees.  The actual fee will be set at the time of consultation by the resident.  The patient records are available upon request from the records center.  The resident should appoint the patient, provide the treatment, enter the treatment information in the record, return the chart to the record center, and provide a written report to the referring student.  The residents must follow the same guidelines for requesting charts in advance and returning them immediately after each encounter. (See Section 6-10). 

Occasionally the residency programs request care for their patients in the predoctoral program.  These patients must be registered patients.  The requests are sent to and evaluated by Dr. Bouffard.  If appropriate, the case will be assigned to a dental student.  The dental student will be required to follow the reassignment protocol as previously outlined.  If the patient has not received a comprehensive oral examination by the resident, the student will be required to do it.  If the patient has paid for a COE in the residency program, the fee will be waived. 

3-5. Recall

Patients should be recalled at regular intervals to evaluate their oral health status.  The recall procedure (00120) is for all patients for whom the treatment plan steps have been completed. Students are responsible for recalling all patients for whom they have completed care.

3-6. Patient Care Partners: 

The Patient Care Partners Program has been developed to improve our patient care program.  To achieve this and the goals stated below, students from the first and third year classes and pairs from the second and fourth year classes have been matched.  The goals of the patient care partners will be to:  

1.      Provide continuous care for patients after student graduation; 

2.      Identify a primary referral person for complex procedures assigned to beginning students and for simple procedures in the advanced students' portfolios; 

3.      Improve the method of orienting students in the clinical programs and introducing students to patients.

To reach these goals, students will be asked to work in pairs to resolve patients' needs as well as their student requirements.  We will continue to emphasize comprehensive care and quality treatment.  However, we believe that students can work as partners to improve the quality of care while achieving their own personal goals.  Below are listed some guidelines for students in each class. 

SENIORS: 

1.       Assume a leadership role with your sophomore partner.  All of your patients, for whom previous arrangements have not been made, will be assigned to the sophomore when you graduate.  Introduce the patients, assign step referrals, transfer study casts, review the cases with the student, offer advice on practice management, or assist in any way to make the sophomore's career more successful. 

2.       Arrange meetings with your sophomore partner for review of your patients' needs. Keep the sophomore informed of your patient schedule so that he/she may meet your patients during breaks or at the end of the clinical session. 

3.       Refer steps for simple or isolated restorative procedures.  Consider step referrals for maintenance recalls or other examination procedures.

4.       Serve as mentors during sophomore block rotations.  Sophomores will assist while seniors provide operative treatment during the first sophomore rotations.

 JUNIORS: 

1.       Arrange an introduction with your freshman partner.  Drop by the preclinical lab or schedule a brief meeting. 

2.       Encourage the freshman to meet with you to observe or assist while you are treating patients. 

3.       Develop opportunities for your partner to meet your patients before you graduate. 

4.       Identify patients who have treatment needs that will be appropriate for the freshman restorative or periodontics courses. 

5.       Plan procedures that can be referred to your freshman partner during the fifth quarter and subsequent quarters.

SOPHOMORES: 

1.       Use unscheduled times and broken appointments to meet with your senior partner.  By assisting or observing you will have an opportunity to develop a rapport with the patient and learn from the senior. 

2.       Over the next six months, familiarize yourself with the treatment needs of each patient assigned to the senior.  In June, most of these patients will be reassigned to you. 

3.       Help your senior partner find patients who would be suitable for the mock board or the state board examination.

FRESHMEN: 

1.       Meet with your junior partner for advice and review of step referral opportunities. 

2.       Consider assisting or observing during unscheduled time.  This will give you an opportunity to learn some of the subtleties of the patient care system as well as a chance to meet patients who will be reassigned to you when your partner graduates.

3.       These goals and guidelines are intended to improve patient care and simplify the transition from preclinical to clinical dentistry.

The Medical College of Georgia
is an Equal Opportunity Educational Institution.