BrettsNotes1

Observations

Patient One

For the first patient of the day I observed Dentist B. One of the first things that I wanted to do was get a sense of the physical space that the students were working in. I spent most of the first hour sketching the layout of the workspace and the instruments that were arranged on the various benches. My sketches are shown below.

A top-down view of the workspace.

www.itee.uq.edu.au/~pig/dentist/1.JPG

A closer view of the end of the bench nearest the window. Particular attention was paid to the equipment present on the bench. I’ve labelled some of the items that were on the bench that I recognised. Items that I didn’t have a name for just have a description of their appearance, for example: green mini egg cup holder.

www.itee.uq.edu.au/~pig/dentist/2.JPG

Some more instruments which looked like they were part of a set were placed on the bench. My next sketch focused more closely on their different markings ( coloured bands ). Each instrument had 2 coloured bands on it. Dentist B mentioned at a later point that the coloured bands didn’t represent anything in particular, they were just used to tell the instruments apart.


www.itee.uq.edu.au/~pig/dentist/3.JPG

Next I looked at the 2 walls of the workspace. The first contained a paper towel rack, an x-ray light, and a small panel containing power points and a number of small lights and buttons. The second wall had 2 a4 sheets of paper in protective sheets stuck to it side by side. I think that these have now been replaced with a number of coloured sheets of paper ( noticed during field study 3 ). There was also a box of gloves mounted on the wall.

www.itee.uq.edu.au/~pig/dentist/4.JPG

The next sketch is of the end of the bench on the other side of the workspace. This is shared by the 2 workspaces which are side by side. A patient record is open on the bench facing the dental chair. At this stage I’m not really sure about what is stored in the containers on the bench.

www.itee.uq.edu.au/~pig/dentist/5.JPG

The last sketch is looking at the dental chair and surrounding workspace from the dental student’s perspective as they sit behind the patient. In the sketch I was mainly focusing on what was on the movable bench ( on the dentist’s right hand side ), and the instruments that they had access to on their left hand side ( on the fixed bench ). On the moveable bench a red container of instruments was being used.
Red = restoration
Blue = exam
Green = scaling

www.itee.uq.edu.au/~pig/dentist/6.JPG

Patient Two

Dentist B grabs a couple of items in preparation for the second patient:
- some green plastic
- a brownish plastic mouth piece.
I think that these help to isolate the area in the patient’s mouth that they are working on.
Some equipment was also removed from a sterilised bag.

To begin with the dentist sits on the chair backwards beside the patient, who is reclined in the dental chair. The dentist looks through the patient record and asks questions. A casualty patient. He enquires about the patient’s medical record, blood pressure etc. It sounded like the patient was describing some pain on the left side of their mouth.

The dentist then moves over to the bench and puts up some x-rays. Small x-rays are just stuck at the bottom of the display. They seem to just wedge in. The x-rays are generally kept in a small pouch at the back of the patient record. After this he went back and put a bib on the patient and pulled the moveable bench back around to its original position ( it had been pushed out of the way so that he could sit beside the patient while asking questions ). He then went over to the sink to clean his hands and put on gloves.

To flick through the patient record a yellow banded tool was used from a glass jar on the bench.
At one point the dentist uses 3 tools at once. 2 are from the red container ( 1 of these is the mirror ). Once they have been used they’re placed on the moveable bench.

At one point the cold air blower ( ? ) wasn’t working properly and the dentist had to signal for assistance from one of the lab assistants. As he was waiting, and testing the blower, the patient remarked “what, do you need a mechanic?” The dentist agreed.

Once this is resolved the procedure continues. The demonstrator comes over to check the patient. She washes her hands and then uses the dentist’s chair to inspect the patient.

The tips of dirty instruments are wiped on the cover of the moveable bench.

The dentist records x-ray and patient information onto the white card. The patient has been referred to a graduate dentist. Dentist A leaves a red A4 x-ray card behind ( in the sink ) when he takes the patient down for an x-ray so that the dental assistants know not to clear his workspace.

In the middle of the clinic on the ceiling there is a board with numbers on it corresponding to each of the workspaces in the clinic. By pressing a button on their moveable bench, the dentist can turn these lights on and off to call for assistance. A white light means that assistance is required, a red light means …?

At each end of the clinic there is another board of numbers, again corresponding to each workspace. When a number lights up on this board it means that the next patient is ready and waiting out in the reception for the dentist.
All instruments that rest in the moveable bench and fixed bench on the right and left of the dental chair turn on automatically when they are picked up.

When cleaning up the workspace after the patient has left, the assistant puts gladwrap on a number of objects, such as the top of the moveable bench ( where the buttons and display is ). The act of unrolling the glad wrap, positioning it, and wrapping it round the edges of the table occurs as a very fluid motion. Like executing a rehearsed sequence.

Patient Three

Dentist B puts a bib on the patient and then gives them a pair of glasses from the right hand bench. The dentist puts on a mask, consults the patient record, and then washes his hands.

The dentist needs to swap some of the heads on the instruments at the front of the moveable bench. He grabs a new head for one from a draw. Next he turns one end of the red instrument container around, and then moves the foot pedal out with his foot. These are good examples of customisation and personalisation ( a theme that came out of our Video Card Game activity ). This is interesting because it demonstrates that customisation is something that we can use our whole body to achieve, it’s not just about what can be picked up and rearranged.

The patient holds the suction instrument while the dentist polishes his teeth. The dentist has the mirror in his left hand.

The dentist fits a sharp from the right hand bench to the drilling instrument. Next he turns the light on and waits for assistance.

The dentist gets some anaesthetic from another bench. Uses a blue egg cup. Applies it with a small, thin stick.

A lot of non-verbal communication is used, most noticeably between the dentist and the assistants/demonstrator. Signally for assistance is good example. Often the dentist will be working on the patient and will place an instrument back on the moveable bench, and almost in the same motion will press the button for assistance ( without really having to focus on it ). This is a very smooth sequence of movements. The dentist generally doesn’t look up after pressing the button ( to see if the light comes on ). As a consequence it often appears that the button press is linked to the use of the instrument or else that it triggers something of more local importance ( like turning on a drill ) but this is not the case.

The numbered boards on the ceiling are constantly used as a medium for communication between the reception-dentist and dentist-demonstrator/assistant.

Patient Four

The last appointment that I observed today was the final patient for Dentist A.
He has to fill out a blue sheet which is a payment slip for patients that don’t have a health care card.
A blue sticker is on the front of the patient record if they don’t have a health care card. If they do have a card then there is a red sticker on the front.
There is also a medical history sticker which is placed on the front if there is something in particular that the dentist needs to be aware of.

The procedure starts with a needle and then inspection with yellow banded instruments. There is no coloured instrument kit out yet. The dentist goes and grabs a red one. He takes out the instruments that he needs and places them on the moveable bench.

The sharps cover doubles as a stand. The dentist uses a button to turn on his light rather than the foot pedal.

At one point, separate from the procedure the demonstrator refers to instruments in a sterile bag as “hatchets and chisels”.

I’m not sure about ...

Most of the instruments used are sterilised and then organised into their respective kits ( red, blue, green ). Some are kept in the sterilised bag. What role to these instruments potentially play in a procedure?
What is a “casualty” patient?
Why do instruments have different coloured bands? Couldn’t they be identified just by the ends/tips alone?

Interesting points ...

I thought that the patient’s comment about the mechanic was particularly interesting. Despite the precise, and delicate appearance of the instruments, some of them, at a basic level are mechanical objects. When something goes wrong, the underlying mechanical nature becomes very apparent.

“Hatchets and Chisels” was surprising terminology used to describe the instruments. It doesn’t reflect the delicate and precise appearance of the instruments. How did this name come about?

Implications for design ...