Changing the routine

Oct. 1, 2009
by Lory Laughter, RDH, BS

by Lory Laughter, RDH, BS
[email protected]

My household adopts pets with quirks. Currently we own two such creatures that keep our lives interesting — a cat named Duh, and a wonderful 95-pound wimp of a dog named Spencer. Amazingly, observing pets can teach you a lot about life — more than “don’t bite the hand that feeds you” and “never wet on the carpet,” although both are excellent rules to follow.

Animals tend to become creatures of habit and they do not easily change their daily routines. At this moment, Duh is yelling at me with a mix of a meow and a whine, telling me she’s ready to sleep. Her routine includes my lying on the bed in such a way that she can lie on my left arm. Never my right arm! I have no idea how she gets any rest when I’m gone, since only my left arm will suffice. My son is not good enough for Duh.

Those of us in clinical practice can develop similar rigid routines in our patient care. Polish first, polish last, begin on the right, begin on the left. Even when patients can ask questions is sometimes set in cement in our minds at work. I’ve seen schedules totally fall apart when patients ask to speak with the dentist before treatment begins. Don’t these people know that the exam and questions come after the cleaning?

Many years ago when I was temping, a patient sat in my chair and immediately pointed out a stain on the mesial of No. 8, then asked if it could be removed. While she was still sitting in an upright position, I took a sickle and gently picked off the offending item. The patient was pleased, and I went back to her health history questions and finished the appointment. The assistant later chided me because stain removal was to be done only by polishing, not by “digging” at the stain with an instrument. She assured me I should have learned this process in college.

Spencer also has certain routines that work for him and he simply cannot vary. It is hot in California in the summer, and Spencer’s metal water bowl bakes in the sun, making the water undrinkable. Yet he will not drink from a plastic bowl. Since he spends part of his day outdoors, I moved his bowl to the garage out of the direct sun.

One evening Spencer went to the back door to be let out, then stood right where his bowl usually sits and stared at me. I walked him into the garage and pointed to his bowl, which he acknowledged with a sniff. He then went back to the bowl’s usual spot and looked at me again. I repeated this process three times, and noticed that the bowl was still completely full. Our dog would not drink from the bowl until I carried it back to its original spot. He seemed to be willing to risk dehydration in favor of his routine.

Children in my treatment room receive oral hygiene instruction before ever lying back for a prophylaxis. Adults, on the other hand, receive instructions after the cleaning is completed.

Why? I have no idea, it’s just my routine. I will point out problem areas as I treat, but most often I save instructions for the end. I know hygienists who will not touch an instrument before removing plaque with a rubber cup. I even know a dentist who will not do an exam before a hygiene appointment is complete, no matter what the patient wants.

Are we hindering care with our rigid routines? Tomorrow I am going to try mixing it up, then I will evaluate the effect it has on providing health care. Routines are great for making sure all steps are covered, but when they get in the way of addressing patient needs or desires, it’s time to try something else. Drink from the plastic bowl!

About the Author

Lory Laughter, RDH, BS, practices clinically in Napa, Calif. She is co-owner of Dental IQ, a partnership responsible for the Annual Napa Dental Experience. Lory combines her love for travel with speaking nationally on a variety of topics. She can be reached at [email protected].