Guilty or innocent? As a jury of my peers, how would you judge me? I am a dental hygienist with 13-plus years of full-time experience. I, like many others, consider myself to be a caring, knowledgeable, and thorough hygienist. Above all, I have always considered myself to be professional. I consider professionalism to be the icing on the cake, yet a very necessary attribute. I recently found myself in a position to which I responded in a very questionable manner. I have tossed and turned the issue over in my mind. I cannot condemn or condone my behavior. With such a lack of resolution, I decided to bare my soul to my peers and request a verdict from you.
Here’s my story: After leaving the office where I had worked more than four years, I was in search of a dental hygiene position at a new practice. I found a position where I was immediately hired. Though the office was almost a two-hour commute, the income through profit sharing and incentive programs was too good to refuse. The staff was abundant, the office was visually appealing, and it claimed and appeared to be upscale, which is what I desired. With great excitement, I started on a Monday morning.
I arrived a few minutes early to get situated. I was shown the operatory where I was to practice that day, and was introduced to a hygienist I could seek out for help. I began to search the doors and drawers for the supplies I would need for the day. I found several instruments rolling around in a dust-filled bottom drawer - three mirrors, three bent and broken explorers, one probe, and several extremely blunt and misshapen scalers. I sought out the other hygienist and asked her where the instruments were. She brought me to this sad drawer, then to another room where she presented me with additional instruments of similar poor quality.
I decided that these instruments must have been discontinued and the hygienist(s) at this practice must solely use ultrasonic scalers. There was a unit in my room; however, the hygienist informed me she didn’t know where any tips for it could be found. I was left with the blunt scalers. I attempted my first prophy and found that I could not even scale effectively. I merely broke off some pieces of calculus to the best of my ability. I had only one probe, which I decided to save for just the right patient. I was running late with the 40-minute schedule and was frustrated by the lack of care I could provide.
The disarray of the patient charts, which were folder style and contained all pertinent information, also upset me. I reached inside to pull out the medical history and case notes, but instead was attacked by various papers falling out. There were large papers and small papers and unattached papers ... lots of papers. Finding the appropriate ones was a chore.
I did a full medical review verbally with each patient. When I found the case notes, I attempted to determine what procedures were due for each patient with the help of the patient’s memory. One chart stated that exams were done on a three-month recall patient consecutively during the last nine months. I confidently explained to this patient that he did not require an examination with the dentist unless he desired one, since he had three recently. He explained that he had not seen a dentist since his former dentist retired over a year ago. I was baffled.
One patient still lingers in my mind. He was a lovely elderly man of 86 years. He had a full mandibular denture and a maxillary partial. He had eight remaining maxillary teeth in poor restorative condition. His periodontal condition was not ideal, but fair enough that the teeth in need of treatment should be addressed. Of the eight teeth he possessed, four were in visually obvious need of treatment. In one tooth there was an alloy with 2 mm of space between it and the enamel. I assumed that this man would want to extract when treatment was suggested and then add the particular tooth to his partial. Many elders feel this way. I spoke with him to clarify my assumption. Surprisingly, he felt strongly to the contrary. He wanted to save his teeth if at all possible. He dreaded having a full maxillary denture. I warned him the cost could be high and that touching any tooth with such large restorative needs might lead to a poor prognosis and possible extraction. He was willing to take the chance and hoped to save what teeth he could.
Here is where the judgment of my peers comes into play. By the lunch hour I was extremely disappointed with what I had seen and hesitant to proceed in such a manner. I sat in my car and whimpered to my boyfriend. “Just leave,” he said, which is all the encouragement I needed. I put the car in drive and left as fast as I could. I picked up my cell phone and called the office to give a brief explanation of how I felt I was performing a disservice to their patients and inform them I would not return. “What? Not coming back? At all? Hold on, I’ll let you speak with ...” I hung up and drove even faster.
I was upset, torn, and disappointed with myself. I was disappointed with what I thought was unprofessional behavior. You don’t just walk out of a job, right? But I was angry - angry that I had to sign my name to what I felt to be such poor treatment. I felt misled by the manager who hired me. (In his defense, maybe he didn’t know about the clinical side of the practice.)
I did not respond to two calls from that office. I did not write to apologize. I just put them out of my mind. Somewhat. Am I wrong for abruptly abandoning an office from which I had just accepted a permanent position? Or, am I right for refusing to participate in what I consider to be inadequate treatment of patients? I have not condemned myself, yet. Would you find me guilty or innocent?
Kerri O’Connell, RDH, has 13 years’ experience in dental hygiene, and resides in Massachusetts. She is completing a degree in psychology with a minor in writing this year. She can be contacted at [email protected].