• N: Nonjudgment. I can struggle and fall
apart without being judged by you. Conversely, you can struggle and fall apart, and
I will not judge you.
• G: Generosity. Our relationship is only a
trusting one if you can assume the most
generous things about my words, intentions, and behaviors, and then check in
with me if I screw up. You trust that I
would want to know if I said something,
forgot something, or did something
that was not in keeping with our trust.
By mutually listening and sharing, our
trust grows stronger.
TRUST IS A TALL ORDER
Trust is the foundation of any relationship,
whether personal or organizational. Within
teams, members will have higher self-esteem
and be more productive if there is trust. They
will also be happier. Building trust is a process
of showing up every day holding yourself to
the higher standard of BRAVING. Breaking
trust down enables us to talk about it and
also to hold a mirror up to ourselves, 1 to look
back with fearless introspection to see if we
are meeting the criteria for trust.
Trust cannot be mandated, and it cannot
be forced. It can be hard to build and easy to
break. Like fine bone china, once shattered,
it is difficult, if not impossible, to put back
together. Trust must be handled with care. It
needs to be guarded and built in the small
things, so that each team member realizes
that when the big need arises, trust is there.
Leading teams as a creative change facilitator, my role is to inspire others to want to
change and grow. It is not easy to change, and
unless we see the benefits that change brings
to us personally, we will resist change. I need
to help the leadership team that I am working
with understand both the personal and professional benefits of becoming a cohesive
team. And the benefits are both professional
and personal! When we grow in one aspect
of our character, we grow in others. If we
become more creative, empathetic, focused,
and better communicators in our professional
lives, we cannot help but be more effective in
our private lives. We cannot separate the skill
from the person.
Time will reveal if this leadership team will
become cohesive, but I feel confident success
will be achieved. Every team member’s heart
charting. (The standard is that every adult
patient should have a periodontal evaluation
once per year.) The patient has an 8 mm
pocket at the distal of No. 29, but nobody has
detected it. Allowing this disease process to
continue without informing the patient is
supervised neglect. Nobody has detected
what should be glaringly evident because a
key component of care has been neglected,
i.e., periodontal charting.
In the past I’ve witnessed most, if not all,
of what you’ve described in your question in
one office or another. I was hired to do a job,
just like my coworkers, and I was responsible
for my job. So, if my coworkers were breaking
rules, I had two choices—call it to their attention, or mind my own business. I never
wanted to occupy the role of office police, so
most of the time I just tried to do my job to
the best of my ability, including keeping OSHA
rules and adhering to ethical treatment planning for my patients.
It can be overwhelming and frustrating to
work in an office with multiple problems.
Everyone wants to work in an atmosphere
where the correct protocol is followed, and
where you don’t have to stress about things
such as fraud and lack of proper standards.
However, just in case you didn’t know,
there are no perfect offices out there. Most of
us try to do the best we can, but even the best
of efforts can fall short sometimes. When we
see wrong being committed by others, we
usually have to make a choice about whether
we will become involved or whether we will
let the chips fall where they may. I really believe we all reap what we sow sooner or later.
You and I cannot make others do what is
right, but we can, and should, make sure that
we follow correct standards. If you can offer
suggestions about how some processes can
be improved, your suggestions are more likely
to be well-received as opposed to if you just
All the best,
continued from pg. 42
a place of integrity and encourage me to
do the same.
that’s being part of the assessment process.
Hygienists are certainly capable of identifying
carious lesions and periodontal problems,
and I believe most doctors appreciate their
hygienists’ skills in those areas. When it
comes to oral pathology, you’re taught to
point out any areas of abnormality you may
find, but you are not tasked with definitive
identification of lesions or conditions. Make
sure you are not confusing definitive diagnosing with assessment.
We learn ideal treatment and ideal infection control in school, but many offices are
far from ideal. That reality does not excuse
sloppy infection control. If your office is
breaching OSHA rules, just make sure you
are adhering to correct OSHA protocol yourself. I suggest that you take notes where you
observe infection control being breached so
that you have some written documentation.
You might also mention to your doctor that
OSHA has a training manual for dental offices
that can be found at oshamanual.com/Den-tal/Manual. You could think about volunteering to be the OSHA liaison for your office.
As for insurance fraud, well, fraud is fraud.
I really can’t help you there except to advise
you to code correctly for what you do. You
are not responsible for the acts of others in
Periodontal charting and recording is a
necessary part of high-quality care. When
you know your patient will need periodontal
charting on his or her next visit, allow yourself an extra 10 minutes for that task. If you
schedule your patient’s next visit from the
chair, you can allow for that. Be sure to mention to the patient that you will be performing a periodontal evaluation on his or her
next visit. Also, any time you perform a
charting, be sure to show it to the doctor
when he or she comes in to do the exam.
Point out any areas of concern.
You mentioned supervised neglect. According to Mosby’s Dental Dictionary, super-vised neglect occurs when a patient is not
informed of the presence or progress of a
disease, although the patient is regularly examined and shows signs of a disease (Mosby’s
Dental Dictionary: Edition 2, 2007). Either the
disease is not being detected or the doctor
chooses not to tell the patient. For example,
say the patient comes in for regular preventive
care, but no one is performing periodontal