Rolling with the punches

by Janet Hagerman

As a consultant for Hygiene Mastery, I am required to remain clinically active. This serves several purposes. It keeps me clinically sharp and current. It gives me the opportunity to "practice what I preach." It provides me with a wealth of information and stories about which to write and speak. And, probably most importantly, it reinforces my credibility to you. Yes, I feel your pain — I'm in the trenches with you.

I do this by substituting as a temporary hygienist. In these different offices, I observe many different ways of practicing dentistry. Some are beautiful examples of what we strive for in providing excellent care. Some are blueprints for disaster — a guarantee for hygiene burnout.

In these last two weeks, I worked nine days of clinical hygiene. During that time, I went through a roller coaster of emotions — from burnout to breakthrough. In the stress and frustration of each day, I was reminded of why I burned out on hygiene years ago, and I asked myself repeatedly — where's the breakthrough in all of this?

Let's roll

The office in which I temped is the largest provider of Medicaid in the state. Patients come from great distances for dental care, and the place stays packed. In the morning huddle, we reviewed a schedule of 82 pediatric patients for the day! (One of the big problems with Medicaid patients is that they don't value their appointments and "no-shows" are rampant. Thus, the heavy scheduling to cover broken appointments.) In addition, we were short-staffed and the doctor would be very busy with his restorative schedule as well, making patient exams a challenge. By the way, about half of the kids and their parents are foreign and do not speak English. He finished by reminding us that we would like to finish on time, so please "Let's get rolling today." I felt like I needed to strap on roller skates! The other hygienist reinforced this by repeating that we needed to just keep rolling with these patients. Don't talk too long to the parents; keep 'em rolling. "Rolling" seemed to be the operative word. This would be a challenge for a gabber like me, committed to patient education.

Before the day was over, we had a personality "conflict," which required the attention of the office manager and two doctors. It was a minor issue of misunderstanding, a molehill made into a mountain, which was handled poorly, in the clinical area, in full patient view.

I mention this because staff conflict resolution is something that can make or break an office experience. It's not a matter of if, but when. In any industry, job, or career, how you handle conflict resolution will determine whether you break down, fail, break through, or blossom.

Don't take things personally

I relied on all my communications training to get a smooth result. I asked myself what else could this mean? A private conversation with the office manager revealed that the other hygienist was going through personal challenges. I told myself not to take it personally.

By the end of the day (we finished on time!) I was exhausted. How long can you remain on this treadmill before getting burned out? Of all the beautiful esthetic practices I write about, speak about, and have had the privilege to observe, what was I doing in this "baby factory?"

The next morning, a new hygienist appeared to work with me. Not surprisingly, turnover is high in this office. Experienced and eager to accommodate, but daunted by the heavy scheduling, she asked me the very question I had been struggling with: How can I keep from getting burned out?

When all else fails, re-commit to service. What, I wondered, can I do today — right now — to increase my level of patient care and reduce my stress? Be creative. Learn some Spanish! I picked up a few words and phrases and ... Wow! ... What a difference! "Abre grande" means "open big." "Mui bien" means "very good." "Cosquilles" means "tickles." Amazing how much more responsive my little patients were when I spoke just a few words of their language. And, it became fun!

When you're at the threshold of frustration, ask yourself:

o What is my outcome?
o What else can this mean?
o What can I do to change my focus?
o What can I try that I haven't tried before?

Be creative! What I love about pediatric dentistry is introducing little kids to dentistry in a way that makes them comfortable and compliant patients, as well as teaching their parents effective preventive oral hygiene. What I hate is seeing babies with bottle-mouth syndrome, kids with two-week-old toothaches, and children that need pulpotomies and stainless steel crowns.

Unfortunately, our society is promoting a culture of government and insurance dependence when it comes to health care. Over and over again, parents told me they suspended their child's dental care for lack of insurance. Many of these mothers were again pregnant. What has happened to personal responsibility for one's own? As a promoter of ideal and esthetic dentistry, I wondered if I wasn't compromising my personal and professional sense of integrity by working in this environment.

That night I shared my frustrations with my husband. He asked, "Well, don't you provide a needed service?" I ventured a conditional answer. "The clinical dentistry is good, but it's such a mill, an assembly line. It just doesn't feel like the patient service I believe in." That's when he told me about our friend David. David is a used car salesman on "that" side of town. His auto financing charges 30 percent interest to cover all the bad debt he has to re-coup. My husband once asked him, "David, how do you sleep at night charging 30 percent interest?" David replied without hesitation, "I sleep just fine because if it wasn't for me, these people couldn't buy a car. Their credit is so bad no one else in town will finance them. I provide a needed service. And for the ones who re-pay their loans and improve their credit, they can go on to apply for lower interest loans."

With that metaphor in mind, I returned to the "baby factory," confident that we were providing a needed service. These patients were getting more than they were paying for, which, in the case of Medicaid, is nothing. I have strong personal feelings about the inequity of the Medicaid system and the lack of personal responsibility. But the children and babies that show up don't know anything about "the system." They only know that they hurt and need our help. So our responsibility as health care providers is to deliver that care to the best of our ability. Our responsibility to ourselves is to do it in a way that provides fulfillment and fun.

I was beginning to see the light of breakthrough at the end of the burnout tunnel. I returned, feeling a renewed sense of purpose, only to discover the office transferred me to the adult clinic. Now we only saw 30 patients a day. There was no morning huddle, no fluoride protocol, no perio charting (unless they were really bad). "Over here, we just keep them rolling." Hmm ... sounds familiar. Better keep those roller skates on.

I valiantly kept optimistic. If I could transform my paradigm, find purpose, and provide service in pedo, I could do it for adults, too. Well, maybe and maybe not. After a day of bloody prophies, periodontal frustrations (how do you scale and root plane with no curettes?), and prophy jet tips that all leaked, I began to question my effectiveness. Is this where I belong? Can I continue with this lack of appropriate patient care for even three more days? I asked myself the same questions I'd asked in the pedo clinic:

o Am I able to serve to the best of my ability?
o Am I making a useful contribution?
o Am I supporting my ethical and professional convictions?

Sometimes, we need to change our environment to remain true to our vision. In order to prevent burnout (if only for a few days), we need to ask: "Can I sleep at night, feeling good about what I did today?" For me the answer suddenly became quite clear. This was not a system where I belonged. Rolling with the punches was one thing, but I couldn't allow myself to roll into a mindset of complacency and neglect. I learned to distinguish between:

• "Ideal dentistry," with all the bells and whistles, modern equipment, great team.
• Less than ideal circumstances that still provide an important service for our communities.
• Situations that are simply not tolerable.

These are important distinctions, because knowing where you are, what you are committed to, and what you are willing to tolerate is what keeps you from burning out. Burnout prevention is not an external thing. It's not about "finding" the perfect job or place. It's about creating your own opportunities wherever you find yourself and making a difference personally.

I'm writing this column in Florida on my mother's patio. I'm visiting her this week to help her recover from hip replacement surgery. At breakfast this morning, she pushed her bowl away, half eaten, declaring, "I'm full." I answered, "When did that ever stop you from cleaning your plate?" A child of the depression, my mother still remembers being hungry. As a result, her compulsion to always clean her plate has resulted in a weight problem that has plagued her for years. "No," she said, "I don't do that anymore." She finally broke through a limiting belief that was hurting her. I am so proud of her. Having never been really hungry in my life, I can only imagine what a huge breakthrough this is for my mother.

Life is a continual journey of busting through limiting beliefs and creating new personal and professional expectations. This is what keeps your career and your life interesting. I feel good about my decisions. Good about leaving the adult clinic. Good about staying with, and contributing to, the "baby factory." I'm continually learning more about the process of evolving out of burnout.

At Hygiene Mastery, we have a belief that on the other side of breakdown is breakthrough. Breakdowns are opportunities for growth disguised as frustrations, challenges, or rolling with the punches.

So, strap on those roller skates and get to the other side!

Follow these guidelines:
• Be pro-active. Take action. Take baby steps, if only a few at a time.
• Don't be so hard on yourself.
• Don't take things personally.
• Take your responsibilities seriously, not yourself.
• Laugh. Have fun.