By Eileen Morrissey, RDH, MS
What would you do if this happened to you? Nine months ago, my first patient of the day had arrived and was sitting in my chair. We went through the preliminaries, and I asked her if she was having any problems. She told me that before I begin, she needed to warn me to be very careful when I worked with her today. Why? The last time her teeth were cleaned, her gum tissue had “dropped down significantly” on the lower right immediately after the cleaning. She had made telephone contact with the office after, and with the careful use of a fluoride rinse, was able to “bring the gum level back up” to where it normally should be! Inside, I was yelling, “WHAT?”
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I looked in Ms. Misery’s patient record and noted the documentation of the telephone call. I told her that I always try to be as careful as possible when scaling. I did not get into a discussion with her about gingival recession and how fluoride rinses are not known for any ability to raise the gingival margin back to a normal position. (Sometimes it is best to say nothing, particularly to patients who have a predisposed, omniscient attitude about everything.)
While I have treated this patient a few times over the past five years, I have not been her only hygienist. I know her to be a difficult patient to please, as my office would consider her. I looked in her mouth to confirm what I’d learned on her patient record; specifically, that she is an overzealous brusher with numerous areas of recession and abrasion documented. It was recommended quite some time ago that she use an automatic toothbrush and simply ease up!
Trying not to be defensive was a challenge. (Breathe.) I looked at the aforementioned lower right and, yes, saw clear evidence of recession there, as well as throughout her entire mouth! I raised Ms. Misery in the chair and picked up an old fashioned hand mirror. (The intraoral camera was not available.) I explained that I wanted to show her some of her recession prior to any scaling. My goal was to get her to realize that this is an ongoing challenge for her, and not a consequence of her cleaning appointment. I pointed out numerous areas and tried again to educate her about the potential damage she was doing. I explained that my dentist was watching some of those areas most severely abraded, and that he might decide anytime that bonded protective restorations could be indicated.
Ms. Misery seemed to accept my learning lesson, and I proceeded to clean her teeth. Before her exam, I spent a few minutes with my doctor to bring him up to speed on all that had transpired. He came in to do the exam and made a plan to treat her with several protective Class V restorations. He reiterated some of the points I had made, but did not touch on the topic of her original warning to me.
She seemed to leave in normal spirits. I, on the other hand, was still blowing off fumes. I went back in to see my doctor and we had a little “talk.” The gist of it was this:
Him: Eileen, why do you let patients like these get to you?
Me: I can’t help it.
Him: You can help it, and you need to knock it off! You know that I know what Ms. Misery is all about. That’s why we call her Ms. Misery. With her, there will always be something. If you don’t realize by now that I have complete faith in you, I have to wonder why we are working together.
Me: Thanks. I appreciate that, and I hear what you’re saying. But after listening to her rant about the gums “dropping down after scaling” and her “bringing them back up” with fluoride… Did you see what she did to her mouth? And she tries to blame it on a hygienist! I virtually tiptoe around her mouth because she has no calculus to scale!
Him: Why do you think I didn’t even mention this to you after her phone call to the office? I knew it would have this effect on you. Stop!
Me: I know.
Him: Patients say things like this to me too, complaining about my procedures. There was a time when I let it bother me more. And then I had that medical event two years ago and I knew I had to change if I wanted to stay alive. I now let them say what they want to, and I kill them with kindness. I hear them out, I acknowledge, and tell them no problem. I tell them “Everything is fine. Sorry you were worried. Goodbye!” and let them walk out the door, not giving any of it a second thought because none of this is worth putting lines on one’s face or getting a heart attack over.
Me: I’ll keep that in my head.
Of course he is right. What a wise man this dentist is, and what an idiot I am, your columnist. Still, I pound my head when I reflect on that day and ponder why I let a patient impact me like this. I thought back to one of my most precious mentors, Wayne Dyer, whose books and tapes have shaped my life’s philosophy through the past 20 years.
One of the most memorable things I ever heard Wayne say was “It’s not about being right. It’s about being effective.” I’m not sure if it’s my second child syndrome or what, but I definitely grew up with a little chip on my shoulder about feeling the need to let others know I was right in whatever situation. As I have evolved on my journey, I like to think it is something I have conquered. And then Ms. Misery sits in my chair and I realize I have yet to reach enlightenment.
But most days I think effectively, and when I don’t, how lucky I am to have an employer who points out life’s little realities. Life is too short and precious for this, is it not? Onward we go; it is in our hearts’ cores! RDH
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 email@example.com or 609-259-8008. Visit her website at www.eileenmorrissey. com.
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