Junior’s failing dentistry

Dec. 1, 2005
Trust me, your senior doctor notices! He’s probably worried sick about this problem that is compounded by the fact that the young doctor is his son.

Trust me, your senior doctor notices! He’s probably worried sick about this problem that is compounded by the fact that the young doctor is his son.

Dear Dianne:

Let me start by saying that even writing this letter makes me anxious, but I feel I have nowhere else to turn.

For the last 2 1/2 years, I have been working in a very beautiful high-tech office with two other full-time hygienists. (This is my first hygiene position.) When I started, there was only one doctor. Several months later, the doctor’s son joined the practice after he graduated from dental school. At first, the new doctor was eager, understandably nervous, and willing to work with the staff. His work was OK for a new graduate. He took his time to do fillings and crowns. The honeymoon quickly wore off, though. The senior doctor’s son has become arrogant, aloof, and difficult.

Junior’s work has gone from OK to downright appalling. I have observed his having to redo resin fillings as many as four times for one tooth in less than a year. (He does not charge for redoing his fillings if the filling was done within the past year.) We have suggested using a rubber dam, but he refuses because he does not think his patients will like it. His crowns are leaking and undercut, and he occasionally drills into the wrong teeth without letting the patient know. He will tell them that he found some stain and removed it for them at no charge.

He also neglects to remove all of the decay or even treatment plan the decay, so some patients have suffered needlessly and have ended up needing a root canal and crown. He rarely takes continuing education courses. I believe he is aware of these mistakes but blames his staff.

My co-workers and I take numerous intraoral camera shots for documentation should the patient ever decide to file a complaint with the dental board about the quality of care. We document verbatim conversations between the doctor and the patient.

Although it has been brought to the senior doctor’s attention that much of his son’s dentistry has to be redone, the senior doctor appears not to notice. At our last staff meeting, the junior doctor stated the material or bonding agent caused the problems and told his assistant that it was her fault for not holding the curing light properly. He has taken no responsibility for his neglect.

He tells new patients at their comprehensive exams that he will be better able to chart their decay after the hygienist cleans their mouth. This is true in some cases, but his examinations are not thorough. He misses too much decay! He leaves this responsibility to the hygiene or assisting staff.

Once, he even prescribed medication for a patient without checking the medical history. The patient had indicated she was allergic to that particular medication. Fortunately, the pharmacist caught the error.

I have consulted with a doctor who is not practicing in my state about my concerns. He stated that I have the responsibility to bring these facts to my state dental board. He said this dentist should not be practicing anymore.

I am reluctant to report this doctor to the dental board since I am afraid I might lose my job. A friend had gone to her state board anonymously years ago about a concern she had with a dentist. She was fired from her position after 13 years of service for some stupid reason with not so much as one flaw in her reviews.

Unfortunately, I live in a state where there is a shortage of dentists. Jobs are very few and far between. I have been looking for months for a new job. I even joined a temporary dental staffing agency with the hope of finding a new position. Nothing new has turned up. I fear I risk the chance of being “blackballed” should I report this injustice and they find out it was me.

I don’t know what to do or even whom to contact. I am physically ill and not sleeping over this situation. The staff is trying in a professional manner to let patients know that having dentistry redone over and over again is not normal. Patients’ mouths are being irreversibly damaged, and their teeth and periodontal status have been affected.

We are tired of covering up for the doctor and hope that patients will start filing complaints. Some have left the practice, and each day we are getting more and more patients who only want to see the senior doctor. What do I do?

Feeling Desperate

Dear Desperate:

When I read your letter, I couldn’t help feeling a little sorry for the young dentist. It brought back memories of a practice where I worked many years ago, and a young dentist fresh out of dental school joined our practice. I recall how his hands trembled those first few weeks. He seemed totally disoriented! Thankfully, his assistant was very seasoned. She was such an asset in helping him find his way in the jungle of “real-world” practice.

Some new doctors need months, even years, to develop and hone their skills. It seems unfair that new doctors are expected to get up to speed fairly quickly after exiting dental school. While Dad has had 25-plus years to develop his skills as a dentist, Junior’s work is compared with Dad’s right out of the chute. When Junior makes a mistake or botches something up, staff members can’t help but notice. Junior starts to get more nervous, more mistakes surface, and staff members come to expect him to screw up.

Still, it appears that there are serious competency problems here. Situations like this make me wonder how this doctor ever successfully completed dental school!

I see two problems here - the young doctor’s competence and ego. When doctors have to redo their dental mistakes, the profit simply evaporates into nothing. Profit is the sustaining force that keeps any business afloat. Without healthy profit, businesses fail. At least in this situation, the senior doctor is a kind of “safety net” and can keep the practice viable. Can you imagine what would happen if this incompetent doctor were on his own?

Further, if his ego were not in the way, he would be asking for his dad’s help (or another clinician) in solving his clinical dilemmas. It’s sad when people get puffed up with pride and think they are above asking for help. Blaming staff members and lying to patients do nothing to help this doctor. He needs a good reality check. He needs to set his pride aside and face the truth that he needs help.

Trust me, your senior doctor notices! He’s probably worried sick about this problem that is compounded by the fact that the young doctor is his son. Were this anyone else, I expect the senior doctor would have wasted no time in dismissing him from the practice. Make no mistake; this problem is both embarrassing and disturbing to the senior doctor.

You stated that you discussed the problems with a doctor who lives in another state, and he advised you to report the young doctor to the state board. It’s easy for him to advise you this way, because he doesn’t have anything to lose in this matter. You do.

There are several reasons I advise against reporting the junior doctor to the state board. First, he is fresh out of school and trying to get accustomed to real-life practice. Second, he is in a position to get help from his dad. Maybe he needs time to “come to himself” and set his own ego aside. Third, board sanctions can have serious and long-lasting consequences, even with just a reprimand.

Finally, you could lose your job and become labeled in your small town as a “trouble-maker” hygienist. Are you prepared for those consequences?

Instead of going to the dental board, I feel it would be more appropriate to go to the senior doctor if you feel you must talk to someone. Request a private meeting after hours. Talk about the problems calmly and unemotionally. Have your facts straight, and wind up the conversation by telling the senior doctor that you are merely trying to ascertain that he is fully informed about the situation at hand, that you have the safety of patients and well-being of the practice at the forefront of your concerns. Then ask him if there is anything you can do personally to help. I strongly urge you not to discuss the junior doctor or any of the problems you outlined with your co-workers or anyone outside the office.

If this doctor keeps going in the wrong direction and doesn’t get some help, my prediction is that some disgruntled patient will file a complaint with the state board. That’s certainly a possibility, but I’d rather see the complaint coming from a patient than you. In my years of clinical practice, I made some mistakes along the way, and I’ll bet you have too. I’m glad no one reported me to the board when I was in error.

The best marketing in any dental practice comes from satisfied patients who go out and tell their friends and family about the exceptional service and treatment they received. Patients are not stupid! When the treatment they receive falls apart in a short time or has to be redone over and over, patients talk about that too. It is negative marketing and can give a practice a bad reputation. In situations like you described, there is a self-limiting aspect. In other words, if his competence doesn’t improve, he won’t have any patients.

I believe in loyalty to the one who signs the paychecks. I can only imagine the angst your senior doctor is experiencing. Try to put yourself in his shoes. After all, this is his son that is screwing up, and he probably spent a large sum of money putting him through dental school. If I were you, I would try to be patient and let the senior doctor call the shots. At the same time, keep your eyes and ears open, as there are sure to be future job openings somewhere in your driving area. Let’s hope it is sooner rather than later!

Best wishes, Dianne

Dianne D. Glasscoe, RDH, BS, is a professional speaker, writer, and consultant to dental practices across the United States. She is CEO of Professional Dental Management, based in Frederick, Md. To contact Glasscoe for speaking or consulting, call (301) 874-5240 or email [email protected]. Visit her Web site at www.pro fessionaldentalmgmt.com.