Zen and the art of clinical judgment.

A student once told me that he preferred to work with another instructor because I took too long to make clinical decisions. When 1 asked him why, he gave me several examples of situations in which I had deliberated upon too long for his liking. None of these was simple in my opinion, nor did I agree with the other instructor's solutions. My dismay and introspection about this student's revelation ended when I observed the other instructor in action. An older dentist, he would be described by some as "from the old school," and it became clear that his advantage over me was not his knowledge, but his far more simplistic view of the practice of clinical dentistry. Long cloistered in the same dental school, he had avoided evolving dental science, consumerism, and other changes in clinical practice that I, as a young instructor, had tried to incorporate into my clinical teaching. This other-preferred-instructor provided the student what he needed to finish his education , while I delved into strange and irrelevant issues that could be left for now to the outside world. Few would disagree that the practice of dentistry is growing more and more complex with advances in science, changing social values, and more regulation. Some of these complexities force their way into our clinical world, while others, like changing science, wait for us to seize and use them wisely, compassionately and profitably. The issue of incorporating new science into clinical practice is one which, fortunately, puts the locus of control into the hands, literally, of the practicing dentist. We have the ability to use or abuse changes in dental science at our glovetips. Pediatric dentistry has seen its share of changing science. Posterior composites, exotic pulpotomy dress-ings, early management of occlusion, and pulse oximetry are just a few selections from an almost endless list. How do clinicians decide what's best for their patients? How do they assess the claims of the scientific literature , the circuit-speaker, or the advertisement? The answer to these questions isn't simple. It would be nice if it were. Our imperfect world will never provide all the clinical trials needed to document totally the safety and efficacy of a product or technique, and the clinician's best tools are a knowledge of how to assess the literature and good old common sense. A dangerous and disconcerting trend quite apparent today is dentistry's willingness to …