Readers' Forum

It is obvious that Dr. Neiburger cares much more about how much money a hygienist can make for him; he certainly doesn't have any regard for quality patient care.

Quality of care is a driving forceDear RDH:Your publication is very thought-provoking and enjoyable professional magazine. I have been an avid reader for several years and not until now have I felt so compelled to respond to a column. I have been practicing hygiene for more than 13 years and feel very strongly that Dianne Glassoce made some good points surrounding what a typical hygiene appointment should entail (July 2001 issue).

In the September issue, Dr. Neiburger opposed Ms. Glasscoe's response to the Speed Demon letter about the hygienist doing prophys in 10 to 15 minutes. He felt that any "well-trained hygienist could easily do a good scale and polish in 10 minutes on most 'normal' patients." This kind of response is exactly what demeans and causes disrespect for the dental hygiene profession — another good argument against preceptorship!

I would like to think that not only is the dental hygiene profession a driving force behind the quality of care and service provided to our patients, but also our patients themselves are becoming more educated and want the best care we can offer. I certainly would not be in practice with, or be a patient in a practice such as Dr. Neiburger's. Fortunately, the dentists that I work with are very competent and compassionate professionals who share my personal philosophy.
Julie M. Neuman, RDH
Lake Oswego, Oregon

Proud to earn his disrespectDear RDH:I've read Dr. E. J. Neiburger's letter (Speed it Up, "Girls") in your September issue several times, hoping to find some redeeming quality or sense to it. I simply cannot find either. While I could write a treatise on how condescending and unprofessional his letter is, I will stick to only a couple of points.

Dr. Neiberger must not adhere to recognized standards of care in his practice since he uses the philosophy that "the public, and indirectly, the dentist, are the ultimate sources of what treatment hygienists should do and the level of service and quality that is needed." How many patients actually understand the true nature of periodontitis, or the need for a sealant or fluoride treatment? Using Dr. Neiberger's standards would likely mean that patients receive very little care, or only palliative procedures.

Does he honestly practice dentistry this way? Does he not replace asymptomatic fractured fillings, or does he treat conditions only when his patients decide that a service is needed? If not — and I suspect, hope, and pray that he doesn't — then he cannot expect an oral health care colleague (dental hygienist) to render care in this manner.

What I find especially repulsive about Dr. Neiburger's letter is how he deems dental hygienists as "girls" who should provide care as quickly as possible in order to "earn more money and get more respect from the dentists and patients." Hey Dr. Neiburger ... did you know that there are male hygienists? Furthermore, we female hygienists are not "girls," but oral health-care professionals.

Such a sexist and derisive attitude does nothing to foster team work. Ultimately, the quality of patient care suffers — it would be impossible for it to flourish in such an environment. If that's what it takes to get respect in his practice, I'd be very proud to earn his disrespect.

Ultimately, providing careful, thoughtful, high quality care is much more difficult than the "fast dental service" recommended in his letter. It's a tough world out there, Dr. Neiberger. Are you up to that challenge?

Jill Rethman, RDH, BA
Kaneohe, Hawaii

Editor's Note: Hopefully, every RDH reader recognizes the name of the letter writer above. If not, Rethman is the editor-in-chief of the excellent journal, Journal of Practical Hygiene.

Patients approve of 'time wasters'Dear RDH:This letter is in response to Dr. Neiburger's comments published in the September issue. The topic was concerning the 10 to 15 minute prophies and the perceived public acceptance.

Dr. Neiburger, did you not learn your lesson a few years ago when you made the same comments in "The Profitable Dentist?" Do you still believe that most patients prefer the Jiffy Lube approach instead of comprehensive care? I will grant you that there are some people out there that base most everything, including dental care, on time and/or financial investment. However, I also believe most patients do approve of the so-called "time wasters," such as blood pressure screeening, periodontal charting, and oral hygiene instructions. In our present day litigious society, how can a health care professional ignore the direct correlation between periodontal health and systemic health?

I realize that many different philosophies can come into play concerning our patients' periodontal or restorative care. I would imagine the quickie cleanings make it difficult to establish rapport with patients, therefore limiting most want-based dentistry.

One last thing, Dr. Neiburger, I am far from being the most politically correct individual, but I think you should be more respectful to our dental comrades, the hygienists, when you say, "Speed it up, girls!" Just my opinion.

Tim Kuiava, DDS
Las Vegas, Nevada

Is this just a dream?Dear RDH:I am a member of the ADHA, take CE courses routinely, and have worked clinically for many years. I am constantly trying to figure out how to find the time within my appointments (the usual 45 minutes) to perform all of the "things" that are expected of me. After all, I am a licensed professional with a legal and moral responsibility to do this, that, and the other — blah, blah, blah.

And then I read a letter like the one from Dr. Neiburger, and I just throw up my hands and scream, "What a hoot — give me a break, will ya!?" Well, people, I need to know ... which is it, huh? The "10 minutes should be plenty of time" speech (do the words supervised neglect ring any bells?), or the "you really need 90 minutes for each patient" speech that was touted during the convention in Nashville this year. Oh, please, let's cut to the chase — a 10-minute slot with the hygienist is hysterical! I can hardly say hello, screen for periodontal disease and check the oral cavity in 10 minutes, let along pick up a scaler.

I recently worked at an office that was pushing for a "kid's day," where I would basically bounce from room to room every 10 minutes. I thought that idea was absurd, and now we're talking about the same thing with adult patients? Hardy har har! Has anyone thought about, oh, maybe fatigue? Has anyone ever seen the Stepford Wives — are we all robots? I don't care how ergonomically correct I am — that is a killer day! What good is any extra money if I end up in the hospital for exhaustion?

I think it boils down to one thing and one thing only — greed. You heard me! Yes, the almighty dollar rears its mighty head. Let me ask a question here, do you still charge the same amount of money for this 10-minute prophy as you would for a 30-minute one (which, in my mind, is still pushing it)? It is much nicer to bring in charges for six appointments rather than for two. We're talking major production figures here. Please don't patronize me any further.

Hey, I have an idea! Let's just hand the patients a brush and shine the light in their mouths. Would that be fast and efficient enough? I do not dare to add the word quality here because it simply does not belong.

Am I on Candid Camera? Is this all just a bad dream? Unfortunately, I know it is reality. And while the terms rip-off, Jiffy Lube, production line, and cleaning mill all popped into my mind while reading Dr. Neiburger's letter, I know those with guilt are trying to justify it. Sorry, the buck stops here. I for one am not buying it. I say three cheers for me because I don't care what his advocates think! I know better. Shame, shame, shame on you!

Joyce Shunk, RDH, BA
Wilmington, Ohio

A ring of malpractice?Dear RDH:I just have to answer Dr. Neiburger's letter in the September issue that was titled, "Speed it up, girls!" Hopefully, this dentist was used as a shill to generate responses. To be equally ludicrous, I am so happy not to be working for someone like Dr. Neiburger that I told my employer that he's paying me way too much.

Please give the general population some credit for discerning between fast food and a good meal, or a Jiffy Lube and a full-service garage. For a licensed doctor of any kind to practice according to his or the patient's likes or dislikes and not according to the treatment needed has a ring of malpractice. To "use" a hygienist as a mere cleaning machine sounds very inhumane and nonpersonable for everyone involved.

Dr. Neiburger, I find your whole attitude most upsetting.

Marcia Brey, RDH
Sturgeon Bay, Wisconsin

Editor's Note: Dr. Neiburger is not a "shill," which would imply an alliance between the magazine and the doctor. We give him credit for at least enough intelligence to look up our mailing address successfully and write down his opinion about RDH editorial — in this case, a column by Dianne Glasscoe.

However, we were not naive enough to think that Dr. Neiburger's letter would not generate a single response from readers. We're glad you did! It's heartening to see visible evidence that hygienists still believe very strongly in comprehensive care.

Up for the challengeDear RDH:While reading Dr. E.J. Neiburger's comments on the "well-trained hygienist doing prophys in 10 minutes," I was aghast and offended by his narrow-mindedness and obviously ill-educated awareness of treatment of a patient. To become aware of the patient's status at that appointment, the "well-trained hygienist" becomes informed of dental concerns, pocket depths, and overall health. In addition, performing a good scaling, especially if there is moderate to heavy calculus, requires time and sensitivity to the patient's feelings while in the chair — it all requires time.

In our very busy office, we schedule our patients hourly. My actual scale and polish time on an average patient is 30 minutes. The actual patient time in the chair is approximately 45 minutes. I have worked in this office for more than 11 years and am seeing the same patients since I began. I am booked 1½ months into the future. Yes, Dr. Neiburger, I am up to the challenge and I will continue to be.

Sheryl Rolnick, RDH
Coral Springs, Florida

An example of what causes burnout?Dear RDH:I would like to respond to the letter from Dr. E.J. Neiburger in your September 2001 issue. His pompous and arrogant attitude toward dental hygienists really angered me. I have been a hygienist for 30 years and if any dentist told me I was expected to do a prophylaxis in 10 minutes, I would immediately head for the door.

It is obvious that Dr. Neiburger cares much more about how much money a hygienist can make for him; he certainly doesn't have any regard for quality patient care.

We often hear of hygienists leaving the profession because of stress and "burnout" and this type of employer is a prime example of the cause of these situations.

Thank you for letting me express my opinion.

Diane Driscoll, RDH
Cranston, Rhode Island

A creative approachDear RDH:You have all heard about how "necessity is the mother of invention." Here is yet another experience to back up that saying.

Many years ago as a new hygienist, I found myself in an office that did not have bwx xcps. Whether I did not ask for what I needed or the "hygiene department" didn't have the budget, I had no help in taking good bite wings ... so I continued to cone cut and dread taking X-rays. Soon enough, I came up with a trick for taking great bite wings without a holder.

Twenty-five years later, after discussing this embarrassing and triumphant part of my hygiene career, my colleague encouraged me to send this tip to your magazine, for she felt it would surely help others in the same predicament.

This technique works on horizontal and vertical bwx. Place the film in the patient's mouth. Have him close. Put your index finger perpendicular to the tab. Align the rim of the X-ray head closest to you to the first knuckle for vertical, and the second knuckle for horizontal. This takes a bit of effort to align and adjust the head to a 10- to 15-degree angle with one hand, but you can do it. Then snap the picture. After a while, you'll be able to eyeball a perfect bwx.

Sara DiCesare, RDH, BS
Alexandria, Virginia

Correction
In the September 2001 issue, an article titled, "A beacon in ultrasonics," addressed the research behind ultrasonic scalers. The article referred to a videotape titled, "Tuneable ultrasonics with modified tips." The article incorrectly referred to Clinical Research Associates as the distributor. Clinical Periodontics Seminars is the correct source, and more information can be obtained at (800) 894-3341.

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