by Eileen Morrissey, RDH, MS
One of the challenges in my clinical life occurs when I am temping in different practices. Having practiced clinically for many years, I have developed philosophies and attitudes toward products and services that are a culmination of research, my practical experiences in different environments, and being exposed to the diversity of clinical philosophies of various practitioners I have worked with.
The challenge happens when something I believe in is not in keeping with the philosophy of care in a practice in which I am temping. An example might be using personally — and therefore accustomed to recommending — a certain power toothbrush. In a temp office, I might be faced with having to try to sell a different one to patients because it is a revenue-producer for the practice. How do I handle this, especially when I am not a fan of that particular brush?
More recently, the following scenario came up with regard to whitening. In my permanent office, it is common for me to look at a patient’s teeth and assess as to if they would go up in shade if they were whitened. Additionally, I would determine if there would be any contraindications. In short, see at a glance if this individual’s smile could be enhanced? My approach would be routinely to ask such a person if they have ever given it any thought?
I would tell the client it is my standard operating procedure to ascertain if improvement could happen in their case. I would present the various whitening options available, including how my own daughter has used over-the-counter whitening strips with positive results, as well as my personal experience with fabricated custom trays. I would explain that process, the fees, and how insurance will not cover the procedure.
This system has worked well in my permanent environment. So imagine my surprise in one office hearing, “In our practice, we do not bring up whitening unless the patient specifically asks about it.”
I was stunned. It was foreign for me to comprehend that it would be inappropriate to make any sort of recommendation without the patient first initiating the inquiry. When I tried to explain this to the practice’s hygienist, I was told, “It is your opinion that their smile needs to be enhanced.”
I knew this one was dead in the water. How I felt (but did not elaborate on at the time) was, it seems very appropriate to increase a patient’s awareness to products or services that might benefit them. Otherwise, how would they learn about them? And then, and only then, does it become the patient’s decision whether or not to move forward with the products or services. I believe that my not presenting to them the option is doing them a disservice.
The message of today’s column is twofold. I will leave you to ponder my philosophy on whether or not it is appropriate to bring up whitening (or other cosmetic services) if a patient has not raised the issue first. I understand it’s a sticky wicket. In years past, I worried that by raising such a question, I might offend the patient. I got beyond that because I was thanked so many times by people who appreciated hearing options. Options do not commit an individual; they educate.
How do we handle ourselves as a visiting temp if faced with conflicting views? As a guest in the office, I believe it is appropriate to stay within the recommendations and philosophies of the practice, providing no harm or lack of ethics occurs. It’s not up to me to try to change their world. Were I to become a permanent employee, it might be appropriate to present my beliefs moving forward, and then perhaps decide if, in fact, the practice is the appropriate home for me. Onward we go; it’s in our heart’s core!”
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 protected] or 609-259-8008. Visit her website at www.eileenmorrissey.com.
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