Spineless doctor

Jan. 1, 2009
I have been a dental hygienist for 15 years, and I have worked full-time in the same practice for five years.

Dear Dianne,

I have been a dental hygienist for 15 years, and I have worked full-time in the same practice for five years. About three weeks ago, an incident happened in my office that upset me to the point that I am considering giving notice.

The patient was a man whom I had seen one other time. I distinctly remembered him from the previous visit.

When I seated the patient, he said, “I do not want you to touch my front four teeth, because I'm afraid you will pull my fillings out.”

I was taken aback by his request, and I asked him if another hygienist had ever dislodged any of his restorations in the past.

He replied, “No, but I do not want to take that chance.”

This is a patient with poor oral hygiene and generalized gingivitis. He would not even allow me to probe the anterior teeth. So when I saw his name on the schedule again, I asked the doctor if he had any ideas about how to approach this problem. He told me to abide by the patient's wishes.

As I seated the patient, he again warned me not to touch his four front teeth in the upper arch. While doing my tour of the mouth, I could see calculus around the gingival margins. I gave the patient a hand mirror and asked him to look with me.

When I touched Tooth No. 8 with my explorer, the patient became angry and shouted loudly, “Damn it; I told you not to touch that tooth! Are you deaf?”

Everyone in the office heard his angry remark. I was so shocked that I couldn't think of anything to say. I fought back tears.

I completed the rest of the mouth and summoned the doctor. I pointed out to the doctor the gingivitis and calculus at Teeth Nos. 7 through 10, and the patient retorted to the doctor, “I told that bitch not to touch those teeth.”

Guess what the doctor said? Nothing. Absolutely nothing. There was not one word from him in my defense. He finished checking the patient and left the room without a word.

It has been three weeks, and neither of us has broached the subject. Dianne, what, if anything, should I do?

Hurt and angry hygienist

Dear Hurt,

Shame, shame, shame on this doctor for not defending you! At the very least, he should have told the patient, “I will not tolerate your being verbally abusive to my staff member. We're finished here — for good!” Next he should have promptly dismissed this patient from his practice through the appropriate protocol.

First of all, the doctor should have taken the situation by the horns on the patient's previous visit. The patient's admonition not to touch certain teeth was unreasonable and unwarranted.

The doctor should have said, “What you have requested is against the law. It is called ‘supervised neglect.' We can see visible signs of gum disease, which is completely reversible with conservative care. Since you are so afraid of losing a filling, I will replace — at NO charge to you — any filling that comes loose in the process of a hygiene visit on those four teeth. What do you say?”

Hopefully, the patient would submit under those terms. If the patient still refused care, there would be no argument. The patient would be dismissed from the practice.

However, the patient was allowed to return and verbally harass you without a word from the doctor. I only have one word to describe the doctor's behavior — spineless. I suppose the doctor was so intimidated by the patient's rude and brash behavior that he was speechless. Judging from the previous visit, the doctor should have anticipated unpleasantness from this patient. Indeed, you discussed the previous situation with the doctor, but the doctor declined to take positive action should a similar (or worse) situation arise. A defensive strategy should have been discussed at the morning huddle or before the patient's visit.

Every employer has the responsibility to provide a workplace that is free from harassment, discrimination, and harm. By not taking prompt action in this situation, the doctor did not act within the guidelines set forth by the U.S. Equal Employment Opportunity Commission. The EEOC outlines what constitutes harassment:

Harassment becomes unlawful where ¿ enduring the offensive conduct becomes a condition of continued employment, or ¿ the conduct is severe or pervasive enough to create a work environment that a reasonable person would consider intimidating, hostile, or abusive.

The employer will be liable for harassment by nonsupervisory employees or nonemployees over whom it has control (e.g.; independent contractors or customers on the premises), if it knew, or should have known about the harassment and failed to take prompt and appropriate corrective action. (http://eeoc.gov/types/harassment.html)

The guidelines go on to say that “isolated incidents (unless extremely serious) will not rise to the level of illegality.” However, the latest incident was a second exposure to this patient's unreasonable behavior. Again, this patient relationship should have been terminated after the first appointment if the patient continued his unreasonable behavior.

What should you do? First of all, make sure that the whole incident is thoroughly documented in the patient chart. Put the patient's exact words in quotation marks. Stick to the facts. Next, inform the doctor that if he intends to allow this patient to continue receiving care in the practice, you will not be providing care in the future for this man. Let the doctor know how disappointed you are that he did not rise to your defense. Then ask the doctor if there was anything you did or said that did not meet his expectations.

Some people use verbal rudeness as a control mechanism. They have learned over time that many people are caught off guard or so intimidated by some rude comment or outburst that they do not know how to react quickly. We are not in the habit of receiving verbal abuse and, therefore, are unprepared to respond. It is regrettable that your boss did not have the courage to respond appropriately in this unfortunate situation.

Thank goodness, unreasonable patients like the one you described are not common in our practices. I believe most practices have a large majority of people whom we enjoy seeing. We often form connected relationships with our patients and become more than caregivers — we become their friends.

Best wishes,