Oh, you're not Jessica

April 1, 2003
For the past few years, I have devoted a limited amount of time to clinical hygiene. One of my New Year's resolutions was to find a dental practice that shares my clinical philosophies and also would be flexible with my schedule.

By Kristine A. Hodson

For the past few years, I have devoted a limited amount of time to clinical hygiene. One of my New Year's resolutions was to find a dental practice that shares my clinical philosophies and also would be flexible with my schedule. I soon discovered that fulfilling that resolution would be no small feat.

Anyone who has been through the "job search" — searching the want ads, Web sites, calling offices, scheduling interviews, and faxing resumes — will easily understand the disheartening process. In the past, I have been very lucky with my career. I was, however, extremely nervous to put the final revisions on my resume and fax it to dental offices.

Why was I so apprehensive? I "perceived" expectations of how offices would react. I anticipated whispers, "Oh! Miss Speaker girl wants a job here," or "Why hire her? She probably thinks she knows it all."

My roommate in hygiene school, Doreen, can testify about my newfound nausea when I temped in her office. The plan was for me to fill in for a hygienist who was taking a continuing education program. I was petrified. The saying that "it is just like riding a bike ..." Well, believe me, I still had training wheels on until about 2 p.m. that day. It was a paperless office, and I had an overactive click finger. I think I charged one unsuspecting patient four times for the same procedure.

The office, however, was very gracious about it. Thanks to the ladies in the front office — they caught all of my computer errors and, with good humor, rolled with it all day.

When it comes to explanations about why the "regular hygienist" is "out," I think that it is easy during one- or two-day temping assignments. Most patients understand per diem work and that the regular hygienist is taking a continuing education course, a vacation, or taking care of other obligations.

Anyway, after I got my courage up, I went on a few interviews. I felt a connection with some offices — definitely not with others. One particular interview was scheduled in December. I usually screen my calls on my house phone just in case it is a business call. I was right in the middle of chasing my children and yelling at them — no TV until John's toys are picked up and Catherine's homework is finished, that sort of thing. In a weakened state of maternal exhaustion on the day before Thanksgiving, I picked up the phone — lo and behold — it was the doctor from the next week's interview. He introduced himself and apologized that he would not be in the office when I came in for the interview. (Thinking about it now, I even forgot to send a thank-you note. Make a note to myself — register for Etiquette 101.)

During the interview at the office, I met the manager of the hygiene department. She was in charge of leading, organizing, and developing hygiene departments in the practice's two offices in two separate towns. She had been practicing hygiene in this setting for about 15 years and had the enthusiasm and passion for it that you would find in a new graduate. She sensed my tension and immediately put me at ease. In fact, she divulged that she even felt a little uneasy playing the role of the interviewer because my CV seemed so extensive. I assured her that my accomplishments outside of clinical hygiene paled to my desire to provide quality patient care. I shared with her my fear of taking a full-mouth series, because many years had passed since I had last done one.

In the other office where I worked, I was extremely spoiled. Cathy, one of the best dental assistants who I have ever worked with, usually took all the FMXs. Why? Because she was faster, gagged fewer patients, and was truthfully a master with or without a Rinn kit.

So to speed this story along, I was hired. However, once I survived the interview process, the challenges surfaced. Do not get me wrong; in no way did the office misrepresent itself — the people are wonderful and we do all share the goal of excellent service and care.

The bumps in the road came with the patients.

I heard so many times during a day, "Oh, you are not Jessica. She was soooooo nice. I loved coming to see her. Well, I guess you will do." I still kept a smile on my face. They were not exactly criticizing me, for they did not know me yet. Any RDH reader who has taken over for a beloved hygienist can relate to this battle.

How have I been able to successfully combat these well-meaning patients who are genuinely surprised to see me and not their pedestal-swirling Jessica? The first key is what you choose to focus on. I could focus on Jessica and get myself upset because she was liked so much. But how will that serve my patients or me?

Instead, I focus my energy and attention on gratitude and contributing. I start my day by asking myself who and what am I grateful for? Who do I love and who loves me? How can I contribute today? This helps me get a clear and positive focus before I enter the office. Granted, some days are harder than others to discover answers to these questions, but the answers are there.

Once I am in the office, I try not to generalize my days as, "This was a bad day," or "This patient is xyz." Instead I try to focus on minutes. There are certain minutes within a day that can be more challenging than others. But those minutes are easier to shake off than writing off the entire day. Look for minutes, or even seconds of joy, appreciation, or gratitude with your patients, your team, and your family.

Next, I confront the "want to be with Jessica" patients with open communication and thorough hygiene services. After the initial exchange of pleasantries, updating the medical history, and completing all of the preliminary paperwork — all while explaining that Jessica is retired and enjoying a wonderful life outside of dental hygiene — I say, "Mrs. B., my approach to this session may be a little different than what you are used to. I will begin with an oral cancer screening. No, you can close your mouth. Actually, it will feel a little like a facial massage. I will be checking your neck, cheeks and even around your ears."

Once that's completed and I am lowering the chair, I then continue with the intraoral examination. "Because you often visit your hygienist or dentist more times than your physician, I like to provide this service. You did great. Thank you. You can relax."

Since one American dies every hour from oral cancer, and there are simple tests that improve identification, evaluation, and monitoring of mucosal abnormalities in patients, I truly do not understand offices that are choosing not to implement these exams to every patient. The first is the ViziLite (www.zila.com), a disposable hand-held, light-based oral lesion examination system. Normal epithelium absorbs the device's illumination and appears blue or purple, while abnormal epithelium reflects it and appears bright white. This test uses the same technology that has successfully improved identification of pre-cancerous abnormalities in thousands of exams of squamous epithelium of the cervix. Another complementary test is the OralCDx® (www.oralcdx.com). These tests, once 100% incorporated into hygiene protocols and new patient examinations, provide not only a higher standard of care for your patients, but may also save lives.

When I continue with my intraoral examination involving periodontal health, restorative options, esthetic possibilities —and ultimately scaling and polishing — I explain to the patient, "Mrs. B, when I am evaluating and cleaning your teeth, I look for three basic things: One, anything that I see that can cause you immediate concern; two, anything that I detect that should be placed on your radar screen and you need to be informed about because it may effect your health; and, lastly, with all of the advances in creating healthy and beautiful smiles, any areas that may be refreshed or upgraded. Now, I am sure that Jessica shared a lot with you over the years. But, since this is the first time we are working together, do I have your permission to talk to you about any findings?" To date, I have not heard a "no."

Joining a new practice can seem stressful, especially if the patients have built up a rapport with a previous hygienist.

Another consideration is that, if you are a hygienist who is making a shift to retirement or to another office, it may be nice to leave behind a letter or note. This brief goodbye can be shared with the patients of record so they do not feel abandoned, as well as serving to ease the transition for the new hygienist. If, on the other hand, you find yourself replacing the best-of-the-best and feel a little deflated, remember to continuously provide the high quality services that you know you are capable of providing. Trust yourself, and your patients will soon see your shining talents and skills and become walking ambassadors of your services.

Kristine A. Hodsdon, RDH, BS, is an international speaker, author, and software developer. She is the author of Demystifying Smiles: Strategies for the Dental Team. The book is available online at www.pennwell-store.com. She can be contacted about speaking or coaching at [email protected]. Visit her on the Web at www.hygienemastery.com.