Pearls of Wisdom I:

Feb. 1, 2000
The question can be asked in many ways, but the author has 12 ways to keep a smile on your face no matter the context of the query.

You`ve Been Doing This How Long?

The question can be asked in many ways, but the author has 12 ways to keep a smile on your face no matter the context of the query.

Candace L. Beecher, RDHEF

Patients always ask me, "How long have you been doing this?" My answer varies depending upon how the question is asked. For example, "How long have you been doing this?" indicates that the patient has a pretty good idea, but can`t believe it. When someone asks "How long have you been doing this?" it gives the impression of another non-verbalized question: "Isn`t it time you quit?" Finally there`s the question, "How long have you been doing this?" which hints "How could anyone possibly consider such a gross and disgusting profession?" This is followed by the "ugh!" expression on the patient`s face, which is similar to the look on a person`s face when he or she just ate a bug that was in his or her potato salad.

After I tell the questioning patient that I have been practicing dental hygiene for more than 28 years, I qualify my statement by explaining:

1. I started when I was a child. Yes, I was a prodigy.

2. I am older than you think. This I can say due to a fortuitous gene pool.

3. Yes, I am a bit crazy. I wonder about it myself.

4. Yes, it is a dirty job but someone has to do it! This way I can look like the self-sacrificing hero.

So what is the answer? How can a rational, sane person stay in dental hygiene for so long? My 28-plus years did start when I was quite young, cramming 2 1/2 years into a two-year program, graduating, continuing in night school while working, then obtaining my expanded functions at a local dental hygiene school.

Having read time and again in professional publications that the average working life span of a dental hygienist is 10 years, I have wondered myself how more than 28 years can go by and I`m still at it. I have looked at the reasons that hygienists give for leaving. Among the top reasons are a lack of appreciation and respect from their employer, mental and physical fatigue, and dental hygiene being a "dead-end" profession. After reading those reasons, I began to think of what specific tricks can be utilized to increase staying power in a profession where little exists. I came up with a list of rules for hygienists that I have heeded over the years. I call it "A Dozen Ways to Not Leave the Profession You Thought You Would Love."

Rule 1: Never work full-time.

This is the most important rule of all. Working full-time as a hygienist can completely exhaust you, physically and mentally. When you first begin to work as a new graduate, plan a lifestyle for yourself that will enable you to work part-time. I realize that, after being a starving student, there is a desire to work, but you can lock yourself into a financial lifestyle that will be hard to escape. I personally feel that even four days a week is too much. Try to stick to no more than three days a week if possible. Much more than this and you`ll rapidly feel the effects, then wonder why you ever thought dental hygiene was an attractive profession. If you have a family, cut back as much as possible. If your exhaustion level increases, your family will get the "raw end of the deal." Don`t try to be a super-woman or you`ll end up as a super-pooped woman.

Rule 2: Work for someone you can respect.

It`s a difficult situation, professionally and morally, to work for someone who is unethical or immoral, or whose work is sub-standard. It`s depressing and stressful when you can`t be proud of the work and character of your employer. Perhaps you find yourself making excuses or covering up for the doctor.

You must be able to have pride in your office and look yourself in the mirror every day, knowing that you have done the right thing for your patients and yourself. Ask yourself if you would send your mother, father, spouse, or children to this office. If not, leave.

Rule 3: Remember that you will never please everyone. It`s impossible.

Listen to Abraham Lincoln`s saying about all of the people all of the time, some of the people some of the time, but not all of the people all of the time. Sometimes a conflict can result from a personality clash. Remember that patients are basically there because of a recommendation for the doctor, not the hygienist. Once in a while a patient will come into the office as a referral to the hygienist - which is a nice boost for the ego - but it isn`t common. It`s always nice to have another hygienist in the office to refer a patient to when he or she isn`t your "cup of tea." Just think of this as sharing.

As a new graduate, it`s very easy to have your feelings hurt when there is a complaint, but try to honestly hear out the criticism and determine if it is justified or not. If it is, then improve. Ask yourself if you did everything you could. If so, don`t dwell on the complaint or lose sleep over it. I had a very hard time with this as a new hygienist because I wanted everyone to like me, but that isn`t going to happen. Just do your very best.

Rule 4: Take pride in what you do and do it well.

Dental hygiene may seem like a dead-end job at times, but remember it is a profession. It`s a profession in which attitude can make your day at work a chore or give your day purpose and instill respect from your patients and co-workers. When a patient feels you are giving your best, that patient will usually try to give you his or her best. When you care, they care.

At times, patients actually thank you for changing their dental lifestyle around or for just being there for them. Make sure you tell them in response how much you appreciate their consideration. It will make both of you feel good.

Rule 5: Don`t take yourself too seriously.

After Rule 4, this may seem like a contradiction, but it can considerably ease a day`s stress. When you are feeling as if you`ve failed to get a patient to respond favorably, remember the old saying "You can lead a horse to water, but you can`t make him drink." Not all patients will listen. If you have done your best to make them understand their personal responsibility to their own oral health and they choose not to cooperate, let it go.

This is not a personal reflection on you. I have seen many hygienists become angry and personally offended when a patient chooses to ignore good advice. Remember that people have a choice, and the results of that choice are of their own doing, not yours.

I have found that a very slow, subtle approach on these kind of stubborn patients works far better than the let`s-fix-it-all-now approach. The hammer-over-the-head approach works well with some patients, and the back-door approach works well with others. This is where a hygienist needs to be a bit of a psychologist. Sometimes it takes several visits before coming up with the best approach for that patient.

Rule 6: Make patients laugh at themselves and allow patients to laugh at you.

The best way to ease tension in a stressful situation - as in a dental office - is to laugh. Almost all patients appreciate some levity and lightheartedness. There are patients you can tease a bit and who enjoy teasing back. I have found this especially helpful with my "grumpy old men" patients.

Make notes on your patients. We have a separate card in our office charts just for hygiene information. Not only can you note all pertinent oral conditions and what education you have given, you also can jot down little bits of personal information about the patient to help you in your conversation with him or her during the next visit. You will be pleased at the pleasant responses you get from your patients when asked about their personal interests and activities that you scribbled during their previous visit.

Also, remember that if you are having a bad day - illness, exhaustion, burnout, etc. - give yourself a break. Do your prophy, etc., but realize you don`t have to give the patient the full routine of education, lectures, etc. Unless there is an immediate problem, save it for next time. The patient will often be pleasantly relieved.

Rule 7: Never argue with a patient.

Many times patients are so off-base with their knowledge that you want to set them straight immediately. Resist this urge. Think and listen first. Is the patient belligerent or simply confused and/or frustrated? Does the patient have a valid point, or just thinks he or she knows it all? Perhaps the patient is just nervous and comes across as obnoxious. Ask questions and listen thoroughly before you give an answer. Try to get to the true problem. Sometimes patients simply want to vent, and all it takes is listening and assuring. Other times the patient may have a completely valid problem, but just doesn`t know how to communicate it.

I had a patient who said that she could completely pass floss under the abutment of her fixed bridge. I referred to the bitewings I had just taken and could see absolutely no signs of any openings. I kept insisting to her that the tooth was a real tooth with an intact root and what she was describing just could not be true. We "discussed" this until I finally went into her mouth with floss and threader - which I should have done in the first place - and, sure enough, just as the patient described, the floss went all the way under the tooth! What had occurred was decay under her crowned abutment that was completely undetectable on the X-ray. I apologized and, since then, I always look first and ask plenty of questions. Never assume and always listen.

Rule 8: Stay on top of new products and trends.

Don`t be afraid to try new things. It`s no secret that dental hygiene can get tedious. To counteract this, do your best to stay on top of the most recent developments in dental hygiene and dentistry. Look in the new products sections of journals and read the ads to see what is being introduced. Two of the best items I have found in the new product sections of journals are Glide floss and Cetacaine topical liquid for long-term anesthesia of soft tissue. Both of these items have made my job and the patient`s dental life easier.

Patients ask questions about information they see on television, magazines, and newspapers. You should be able to answer their questions with some degree of knowledge. If you find information that is useful for answering patient questions or little tidbits of knowledge you do not wish to forget, copy it and put it into an indexed binder for reference. I have a binder with different sections on implants, AIDS, cancer, mouthwash, toothpaste, geriatrics, bleaching agents, etc.

Do your best to stay on top of new dental procedures that the doctor in your office may be using, such as air abrasion, so that you can explain these procedures to your patients. Patients often will feel more comfortable asking you about procedures and costs rather than the doctor. Do your best to be prepared.

Rule 9: Treat the staff with respect.

Don`t be a snob. Dental hygienists have a reputation for being the office prima dona. Dispel that reputation by being agreeable and helpful. I think it is wise to be friendly with staff, but not "buddy-buddy." If you are a personal friend of a staff member, save the bulk of your personal conversations for outside the office.

Friendship between two members of the staff can lead to feelings of jealousy or preference in other staff members. Try very hard to not show preferences. Don`t gossip about a staff member, in or out of the office. Be professional, but not so stuffy that you can`t enjoy a good laugh to brighten the day.

Rule 10: Have at least one completely diverse interest or hobby.

Besides physically getting away from the office, get away mentally. Use the other side of your brain. I am a fairly avid gardener. When I work in the garden, I am still using with my hands, but it is dirty, fun, and visually rewarding. I don`t have to please anyone but myself.

I am also a constant redecorator, to the point that it`s a family joke. My husband never takes a second look if furniture is moved or replaced, or walls are newly papered or painted. Playing the piano is a pasttime that takes my mind away from dental thoughts and relieves tightness and pain in my hands and fingers. Whatever your interests, make time for them.

Rule 11: Exercise.

I know, I know. You`ve heard this before, but I can`t stress it enough. At least three times each week, include a program of aerobics, weight resistance, and stretching into your routine. I personally enjoy the Jazzercise program and have been doing it for almost 17 years. It`s well-rounded and offered worldwide.

Choose the exercise regimen that fits your lifestyle and personality. Some people like to exercise with a group, and some like to work out alone. Either way, exercise is a great mental and physical tension-reliever.

It`s no secret that dental hygiene is tough on the neck, shoulders, back, wrists, and hands. It is imperative that time be spent strengthening those areas, as well as keeping them stretched and supple. Yoga is an excellent choice for this. Many good Yoga books are in the bookstores, and it can be easily learned at home.

Exercising for only a few minutes each day can make a world of difference. Typing and playing the piano is great for keeping the wrists and hands free from pain. Amazingly, I have not dealt with carpal tunnel syndrome after all these years.

Rule 12: Make a financial plan for your future early on in your career.

This would include such things as life insurance, private disability insurance, and retirement. There are many options in all three areas, and many good financial planners to help you choose the best options for you. A good financial planner is invaluable and virtually cost-free. I only pay a small annual fee on my retirement funds.

Together with your planner, you can set up all your needs according to your own goals for the future. Again I emphasize the earlier, the better. Planning early allows you to get on with the business of life and not worry about your future as the years very quickly go by. As life changes, it will then be fairly easy to make adjustments to your financial needs with the assistance of your planner.

I hope these ideas will work for you, all or in part. I know they do for me or I would not still be working after 28 years - and maybe 10 more! I think I`ll make it!

Candace L. Beecher, RDHEF, is a graduate of the University of Hawaii and obtained her designation in expanded functions from Loma Linda University. She lives in Upland, Calif., and works part-time for her brother, Dr. Danny Poore, in Rancho Cucamonga, Calif. She recently developed the Crystalmark-Poore A and Crystalmark-Poore S dental instruments that are sold by Hartzell and Son.