Explaining the 'job'
While mentoring a future student, author reflects on the rewards of developing trusting relationships with patients
by Loretta Sue Humphrey, RDH, MA
Recently, I had the opportunity to reflect on the practice of dental hygiene, specifically, what the job entails. One of our long-time patients, a woman now in her early 20s, applied to hygiene school. As a prerequisite for acceptance, applicants must complete 14 hours of observation in a dental office. Being a firm believer in the importance of education and the fortunate recipient of mentoring and help from my educators, I was more than happy to give back and have the aspiring hygiene student observe me.
With the prospect of having my actions watched, I began to think about what I do and why I do it. My thoughts turned to my own experiences in hygiene school, and what we were taught and how well we were prepared for the "real world" of dentistry. What pearls of wisdom could I impart to Kelly (not her real name), and what do I wish someone had told me at the beginning of my hygiene career?
Since Kelly has not started the hygiene program, there was no point in getting into clinical details. Generalities, yes – the stages of periodontal disease, why we probe, what we look for, treatments, and outcomes – but nothing too involved. I tried to impress upon her there is more to hygiene than the clinical aspect. Ethical, legal, and business considerations must be addressed. Patients must be fully informed of their dental health, treatment options, and outcomes. Entries on charts must be comprehensive and complete. Unfilled appointments mean no money coming in to pay salaries.
I explained the importance of updating medical histories at every appointment, and the mouth-body relationship as it relates to disease and medications. I told Kelly that a good hygienist must observe a patient and become proficient in reading body language, listening to verbal exchanges, and figuring out a patient's concerns and motivations. One must respect a patient's body, fears, attitudes, and humanness.
I then came to another facet of hygiene – that of being a counselor, confidante, and friend. In most practices, the hygienist is the person a patient sees most frequently and spends the most time with. Patients come to know and trust their hygienist. Many will leave a practice if they do not like the hygienist. Having the good fortune to have worked in the same practice for 21 years, I have gotten to know patients well and have shared many happy moments with them. I've seen children grow up, go to college, get married, and bring their own children into our office.
Patients have shared their happiness at weddings, births, retirements, job promotions, trips, family reunions, and graduations. But along with the good comes the bad, and I have shared in patients' sorrow and disappointments in the form of deaths, divorces, job losses, children in trouble, declining health of parents and spouses, financial troubles, and marital problems. Patients will share these details of their lives with a hygienist they trust, which has led me to conclude that the most important service you can give a patient is not always clean teeth.
Recently a woman with a debilitating back problem related her frustration with not only her back problem, but also the medical community, friends, and family who told her to "think positive." She needed someone to acknowledge her frustration. The last thing she needed from me was advice to "keep a stiff upper lip." Another woman asked me if I thought she should tell her college-aged son about a chronic health problem she had kept from him all his life. One awkward situation is when divorcing spouses each relate their side of the story to you. Out of the blue a man, who along with his wife is facing infertility problems, told me he did not know how to deal with his wife crying every month when she did not become pregnant.
Then there is the question of how much to reveal of yourself. I have been through some of the same experiences my patients tell me about. Being a private person and mindful of keeping a professional persona, I err on the side of being quiet, but on occasion I relate a personal experience if it will help a patient know they aren't alone in their struggle. But on the whole, patients just want to be heard and have their feelings acknowledged. They also expect confidentiality, so I told our aspiring hygienist that I treat my room like Vegas – what happens there stays there.
So when I related to Kelly the "job" of a hygienist, I realized that while the clinical aspect is stressed in school, it is probably the easiest, least stressful, and most mundane aspect in everyday practice. More salient are the legal, ethical, and business concerns of practicing hygiene. Speaking for me, the most rewarding aspect of hygiene has been the relationships formed, the friendships forged, and the trust built between the patients and me. Clean teeth are not always the most valuable service I provide.
Loretta Sue Humphrey, RDH, MA, graduated from Palm Beach Junior College in 1976 and has been in clinical practice ever since. Sue lives and works in St. Petersburg, Fla., and divides her time between working in a private practice, writing, and involvement in animal welfare causes. The author can be reached at firstname.lastname@example.org.
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