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Technology challenges

June 1, 2020
This dental hygienist realizes there is no law that mandates computer charting, but she believes not diagnosing periodontitis is a serious concern. She asks Dianne Watterson, MBA, RDH, for advice.

Dear Dianne,

I graduated from hygiene school one year ago. I accepted a position with a doctor who is hoping to retire in the next five years. There are a number of systems in the office that are not up to par with what I was taught in school. For example, they used instrument cassettes but did not wrap the cassettes so that they would stay sterile until opened. When I brought up that this was a breach of infection control, it caused a huge issue in the office. Thankfully, this is now fixed. 

Another problem is my boss’s reluctance to use technology. What I’m finding is that many patients do not have a periodontal chart at all, yet it seems like the doctor does not want me to periodontally chart. Some of the existing paper charts are illegible and incorrect. Many of our patients have never had existing restorations charted. So, when I started computer charting, the doctor made a scene in front of a patient and yelled about how he doesn’t want anything on the computer except radiographs. He doesn’t want chart notes, existing restorations, or periodontal charting on the computer. He angrily said, “This isn’t hygiene school, and what they teach you is nonsense and not necessary.” Needless to say, I was embarrassed and humiliated. 

The office has a great computer software program, so I am completely clueless as to why the doctor does not want me to use it. I was taught computer charting and feel it is so much better than paper charting. I was also taught that it is part of the standard of care to do periodontal chartings. I’m seriously thinking about leaving this practice, but my coworkers are begging me to stay. I know there is no law that mandates computer charting, but not diagnosing periodontitis is a serious concern. What are your thoughts?

Midwestern RDH

Dear Midwestern,

What we have here is a gigantic failure to communicate. We have two generations of dental professionals that are light years apart in technology and protocol. This senior doctor is feeling intimidated by you, the young whippersnapper hygienist. He is like so many senior dentists who are both change-averse and intimidated by technology. 

Several years ago, the Obama administration mandated electronic health records for the medical field. It states in part, “As a part of the American Recovery and Reinvestment Act, all public and private health-care providers and other eligible professionals (EP) were required to adopt and demonstrate ‘meaningful use’ of electronic medical records (EMR) by January 1, 2014, in order to maintain their existing Medicaid and Medicare reimbursement levels. Since that date, the use of electronic medical and health records has spread worldwide and shown its many benefits to health organizations everywhere.”1

Dental practices have not been mandated to transition to EHRs. However, in 2016, dentists who accept Medicaid became subject to payment reductions up to 5% if they had not successfully switched to EHRs. According to an article on DentistryIQ, the greatest adoption of EHRs is among large dental practices. Most dental practices are still solo practices.2

No doubt electronic records are here to stay. However, for some clinicians the transition from paper charts is very difficult. I remember a former client telling me that he would quit dentistry before he would give up his paper charts. 

My opinion is that this doctor showed you considerable disrespect by raising his voice, especially in front of a patient. Maybe he felt the freedom to act this way because of the age difference between the two of you, or maybe his technology frustration boiled over. Maybe he doesn’t want to exert the time and energy to come into the 21st century. Why would someone purchase terrific technology and not learn how to use it? It’s like owning a fine car with lots of modern features, yet the owner knows only how to crank it and put it in gear. Whatever the case, the doctor owes you an apology. 

My suggestion is to approach the doctor at the end of the day and ask for a few moments of his time. Here’s a sample script of what you can say. “I’ve had some time to think about our unpleasant exchange recently, and I feel a need to clear the air. First of all, please don’t remind me that I’m not in hygiene school anymore, and do not disparage my education. From now on, if my job performance is not to your standards, please do not embarrass me in front of a patient. You humiliated me like no one ever has before. I respect you as my employer, and I expect you to respect me as a fellow dental professional.” 

Then, you need to address the lack of periodontal charting. “Dr. X, I feel a great responsibility to you and your patients to be diligent about finding and identifying perio problems. I believe it is part of my job to bring problems to your attention so that you can decide the best course of action. Do you agree? If you choose not to use the technology in your practice, that is your decision. But why would you deny me the opportunity to use the technology that you purchased?” The two of you need to have a frank discussion about technology implementation. If he chooses not to use it, then as the owner he has the last word and you must follow the way he wishes. 

A word of advice is that you need to respect this doctor throughout the discussion and present your side calmly, thoughtfully, and with almost no emotion. Write down your thoughts ahead of time. 

The bottom line is this: the practice belongs to the doctor, so if you want to stay with the practice you need to acquiesce to his wishes by not using computer charting. You also need to come to a meeting of the minds with the doctor, especially with regard to periodontal charting. 

I find it ridiculous that you have to have this discussion, but the reality is that the doctor doesn’t feel competent to use the technology in his own office. Your problem is not unique. I’ve seen multiple examples of doctors who are very tech savvy but have staff members who are resistant and reluctant to learn new things. People tend to become set in their ways over time.

Employers who do not respect their employees will often display their disrespect with inappropriate behavior, including sharp words and loud voices. This is never OK. Unfortunately for this doctor, I can guarantee that the patient who was in the chair will think much less of the doctor and will feel sympathy for you. 

People treat us the way we allow them to treat us. If we allow them to treat us badly and we don’t have the courage to defend ourselves, then we shouldn’t be surprised when it happens again. If this doctor continues to disrespect you, you should find another job. I hope it works out where you are now, but it might not. 

All the best,



1. Federal mandates for healthcare: Digital recordkeeping requirements for public and private healthcare providers. USF health online. Accessed March 25, 2020. https://www.usfhealthonline.com/resources/healthcare/electronic-medical-records-mandate/ 

2. Foisey CQ. Still don’t have electronic health records (EHRs) for your dental practice? DentistryIQ. April 4, 2016. Accessed March 25, 2020. https://www.dentistryiq.com/practice-management/practice-management-tips/article/16352869/still-dont-have-electronic-health-records-ehrs-for-your-dental-practice

DIANNE GLASSCOE WATTERSON, MBA, RDH, is a consultant, speaker, and author. She helps good practices become better through practical analysis and teleconsulting. Visit her website at wattersonspeaks.com. For consulting or speaking inquiries, contact Watterson at [email protected] or call (336) 472-3515.