What I grapple with is a solution. I hate to disappoint my
readers, but I don’t really have a
solution. I had the sense that one
hygienist wanted these behaviors and
expectations and working conditions to
be banished. How? With strong moral statements and condemnations from those more righteous and caring?
The reality is that’s not going to happen. Stuff like this
goes on every day in health care, and everywhere. We’re
aware when it happens in dentistry, but probably not aware
when it happens in a law firm or insurance company or restaurant, for example. So we can’t necessarily control it. “But
what about the patients who trust…” you say. “It’s just not
right!” Yes, I hear you.
The only thing we can control is choosing where to place
ourselves. That’s where the going gets tough in a saturated dental hygiene marketplace, with positions not exactly
growing on trees.
We have to decide what we can live with. In these instances, “the system” is not likely to change. Can we come
to peace with the care that’s being provided? Should we justify that substandard care is better than no care? Recognize
that patients have the right to say no, or to seek second opinions to treatment?
There are no easy answers. I understand that it’s difficult,
and many of us are struggling to earn a living. If you’re walking in these shoes and just can’t take it anymore, a reality is
that another hygienist will gladly jump in to take your place.
Realize also that what bothered you may not be a problem
for the next hygienist in the least.
As an old friend of mine used to say, “That’s why there
is vanilla and strawberry. There is something out there for
everyone, and not everyone cares as much as you do.”
Onward we go; it is in our hearts’ core… RDH
A reader wrote and asked if I would consider writing about
corporations that purchase dental practices, and of the undesirable happenings that occur after the change in ownership. She’s heard numerous stories from RDHs, and since
her own doctor was nearing retirement age, she was worried about what the future might hold. She cited huddles
that took place at the start of the day to discuss the need for
increased production, and the expectation to promote unnecessary dentistry.
Since I don’t know any hygienists who work in this type
of environment, I felt skeptical about how to approach the
topic. I’m forced to rely on the word of RDHs who wrote to
me. As I read some of their letters, however, I felt that they
spoke from the heart about their concerns.
I thought about some of the practices I’ve worked in clinically through the years. In several, consultants were utilized.
We were absolutely encouraged to start the day with a huddle to discuss how we would approach and reach production
goals. Note: This did not involve the promotion of unnecessary dentistry. So, the idea of goal setting for production,
and a discussion of how we might achieve those goals, was
sounding like a perfectly legitimate business practice.
The letters described in detail shortened appointment
times for hygiene visits. In a 30 to 40 minute visit, the RDH
was expected to review the medical history, take radiographs, provide an oral cancer screening, do a complete
exam including periodontal charting, and provide a prophylaxis. It was the responsibility of the RDH to promote
ViziLite exams, and if five of these were sold, the RDH’s
name would be entered in a drawing for an iPod. In other
words, much was expected, and inadequate time was provided in which to do it. Any patient with pocket depths of 4
mm or higher (no mention of bleeding) was to be presented
with periodontal therapy.
After reading a number of these types of letters, I thought
about some offices I had temped in during my clinical lifetime with similar working conditions. These offices had single owners and were not part of big conglomerates. Yet the
doctor-owners, like the conglomerates, were guilty of sacrificing quality for profit. As a temp, I witnessed doctors doing
exams and prescribing treatment that was aggressive, and
in my opinion, not appropriate. Since these were temporary
assignments, I could opt out of returning to these practices.
I guess the point I’m trying to make is that substandard
care, poor working conditions, and unnecessary treatment
being prescribed are not limited to practices that are part of
big, corporate entities.
B Y EILEEN MORRISSEY, RDH, MS
EILEEN MORRISSEY, RDH, MS, is a practicing
clinician, speaker, and writer. She is an adjunct
dental hygiene faculty member at Burlington
County College. Eileen offers CE forums to doctors, hygienists, and their teams. Reach her at
firstname.lastname@example.org or 609-259-8008. Visit
her website at www.eileenmorrissey.com.