Dear Dianne:
I graduated from hygiene school two years ago. I have an acquaintance who has been a hygienist for 20 years. She told me that her employer was going to add a second hygienist in the practice where she worked and asked if I was interested. Of course, I thought it would be great to work with a friend with so much experience. Now I think I made a big mistake.
One thing that really bothers me is how she is always pointing out areas of calculus on my bitewings. She acts as if I left the calculus there from a previous visit, even when this is the first time I have ever seen the patient.
Another thing that bothers me is how she hangs out in my room when she doesn't have a patient in her chair. Sometimes she comes in my room and takes over the conversation with my patient, discusses treatment, then goes to the doctor and tells him what was discussed.
Recently, I had a little girl in my chair that was slightly apprehensive. The child's mother was present, and she was helping to calm the child. The mother's presence did not bother me, because the little girl was allowing me to polish and the appointment was almost finished. However, the other hygienist entered my room and told the mom that she needed to wait in the reception room while I finished. This really steamed me!
It seems this hygienist has an inflated view of what she can do for periodontal patients. She never feels any case is too difficult to refer to the periodontist, and she will tackle 10mm pockets and furcations like it is a piece of cake. This goes against my training, as I feel patients are better served in many situations by being referred. I learned in hygiene school that any periodontal pockets greater than 6mm to 7mm should be referred to the periodontist. She has moved patients off my schedule and onto hers because she feels she can clean these deep-pocketed areas so well.
Additionally, there have been other problems. Recently, a patient came in asking if he could get his teeth cleaned. He had suffered a heart attack two weeks previously. I explained to him that there was a waiting period, usually three months, before he could safely have his teeth cleaned. The other hygienist told him she had never heard of that. She further stated he should call his physician and not listen to me! She also informed me that I was not using my prophy jet enough to polish. When I told her that there were some contraindications for prophy jet use, she said she had not heard of that either!
The final straw came a few weeks ago. I mentioned to her that I was going to ask for a raise. Two days later, she asked for a raise!
Truly, I think people in my office think I am stupid. I am beginning to hate hygiene and am wondering why I even work in the dental field. I have felt the best course of action was to keep my mouth shut and not talk to her. Then she tells everyone I am mad at her.
How do I handle this co-worker? I do not want to leave my job. Please help!
Nearing the End of my Rope
Dear Nearing,
Whew! You have raised enough issues here to fill a book! However, I'll try to address your problems within the confines of this column.
My first impression is that the other hygienist sees you as someone she wants to mentor. She feels her years in the profession have given her expertise that only comes through years of real-life work experience. However, I believe she has crossed the line from mentoring to micromanaging.
You stated that you graduated two years ago, so you are entirely uninitiated. There is no doubt that some things have changed over the years. Some of the protocols you were taught in dental hygiene school may be different from what your co-worker was taught.
The issue of seeing calculus on radiographs is moot. Even the most skilled clinician misses calculus from time to time. Her practice of pointing this out to you is only serving to make you feel inadequate at the expense of inflating her ego. It would be a humbling experience for all of us to take radiographs at the end of the scaling so we can see areas that were initially missed. However, this scenario does not seem practical in most dental offices, especially if the doctor performs the exam before the end of the appointment (which I highly recommend).
You described a situation where the other hygienist stepped in and asked a parent to leave the operatory. This was most inappropriate. She should not have intervened unless asked to do so. Neither should she be loitering in your operatory and discussing treatment options with your patients unless she is asked to do this.
Regarding periodontal patients, many hygienists feel inadequate treating pockets greater than 6mm. Indeed, we know our ability to access deep areas is limited. However, it is also true that many patients respond quite favorably to a nonsurgical approach, even with deep pockets. Many wonderful advances in ultrasonic and piezo technology allow us to access and debride areas that were previously inaccessible. A hygienist's comfort level in treating periodontal disease increases with experience. Therefore, I can understand your reluctance and her eagerness in treating such patients. Most patients would prefer a nonsurgical approach if given the choice. My advice here would be for you to step out in the water a little deeper and increase your own level of knowledge and skill by tackling some challenging cases.
However, do not recommend any type of referral without first consulting the doctor. In addition, I do not feel it is appropriate for the other hygienist to be moving patients off your schedule, unless the patient requests it. In offices where the hygienist is paid on commission, this would cause a full-fledged war! Again, the practice of moving patients is stroking her ego at the expense of preventing you from gaining valuable work experience that only comes through seeing tough cases.
You raised a question of when it is safe to do a prophylaxis on a patient who has had heart surgery. This prompted me to do some research, and here is what I found out. My local cardiologist stated that there should be a minimum wait of two months for any interventional cardiology, such as stent, angioplasty, pacemaker or defib placement, and bypass for heart attack patients.
The only exception is an emergency dental situation and then with premedication. The cardiologist stated that 90 percent of heart patients today get stents inserted to keep arteries open, and that these patients take a potent blood thinner for 30 days following surgery. The blood thinner is active in the patient's system for at least 10 days following cessation of the medication. Another cardiology group I checked with recommended a three-month wait.
Several years ago, I had a patient who had received a new pacemaker one month prior to his appointment with me. I called his cardiologist (just to be sure), and he wanted this patient premedicated for any dental procedures for a period of six months following placement. So you will find differing opinions among doctors. The bottom line is that there indeed should be a delay on dental treatment after cardiology intervention, and your best advice is to check with the patient's physician on length of wait and if premedication is needed.
Air polishing is another issue that sometimes causes controversy. Some hygienists use it almost exclusively, while others rarely use it. I find patients either love it or hate it. I have even had patients say, "You're not going to use that sand blaster on me today, are you?" Other patients will say, "Please don't use that gritty stuff to polish my teeth. I prefer the baking soda." If you have both methods of polishing available, why not just ask the patient which method she or he prefers? You may be surprised at the replies you receive.
Personally, if my patient had no preference, I used polishing paste because it was less messy for both my patient and me. Additionally, you are correct in stating that air polishing is contraindicated for some patients, such as those with respiratory problems, communicable diseases, gaggers, patients on low sodium diets, and certain esthetic restorations.
Don't discuss salaries with co-workers
Now, your last issue causes me much angst, because staff members should never be discussing wage issues among themselves. Some doctors have made co-workers discussing wages with other co-workers an offense punishable by firing. If you decide to ask for a raise, that is your business and your business only. When everyone in the office is privy to everyone else's wage, resentment and jealousy flourishes! Please promise me from now on that you will refrain from discussing wage issues with other staff members.
Shutting down the communication is not the way to handle this problem. Of course, when someone in the office refuses to talk to you, the obvious conclusion is that someone is mad. That makes you look like the bad guy here. I am certain that is not what you want.
What I see here is a clashing of two differing generations of hygienists. The senior hygienist sees you as a threat of sorts, and evidence of her insecurities is surfacing in her efforts to micromanage you as a young hygienist. However, let me also say that I believe your own ego is being bruised a bit and you don't like her suggestions/intrusions onto your turf. I think you are both at fault.
Laying it out on the table
Here is what I recommend. I want you to sit down and write your problems down on paper. List them 1-2-3. You can even use this letter as part of that process. Somehow, putting things on paper helps to clarify the problems. Next, I'd like you to take the other hygienist out to lunch. Buy her lunch. You both need some private time away from other co-workers to talk. Start out with the good news: "I want you to know that I was very excited and glad to get to come to work with you, especially since I've known you a long time. But I'm having some real problems here that I believe you can help me settle. I would like to keep this strictly between us since this does not involve any other staff members or the doctor. Is that OK?" Then in a calm, controlled manner, pull out your sheet if you need to and lay the problems on the table.
Above all, let the hygienist know that you respect her and her desire to help, but you do not like being micromanaged. Let her know how you feel in a kind and gentle way. Do not allow yourself to get heated up or emotional, but keep a steady, mature tone of voice. Understand that her efforts to help you, while not always appreciated or needed, are just that — attempts to help you.
I certainly can tell you this situation will not get better until the communication is opened up between the two of you. You have already built walls of resentment around yourself because of her unwelcome intrusions, and she probably has some walls of feeling unappreciated and insecure herself. You both need to get about the business of tearing those walls down now, and understand that your tension is bad for the office environment and practice morale.
Hygienists need to work together. You can both learn from each other, and your patients are the ones who benefit most from the collective wisdom. Hygienists who have been practicing for a number of years should remember what it was like when they first graduated. New hygienists need to appreciate the knowledge of hygienists who have learned from many years of experience. Helping one another can only help our profession grow in a positive direction.
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 Lexington, N.C. To contact Glasscoe for speaking or consulting, call (336) 472-3515, fax (336) 472-5567, or email [email protected]. Visit her Web site at www.profession aldentalmgmt.com.
