By Eileen Morrissey, RDH, MS
At the close of my most recent continuing education seminar, I asked the group if they had questions. One hygienist raised her hand and asked how best to respond to a patient who has not been scaled effectively in the past, and is now questioning current findings. Significant amounts of interproximal calculus were left behind, with corresponding inflammation and a compromised periodontium. Apparently the patient was "treated" regularly by the hygienist in another practice, and when the new hygienist assessed the mouth, there was much "catching up" to do.
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It was not a cleaning that could happen effectively in one visit, and necessitated instead two half-mouth periodontal debridement visits with a formal reevaluation and a more frequent maintenance cycle. Now the patient is asking, "What happened with me previously?"
This scenario must be treated carefully. We may know full well that we are righteous; however, be forewarned. While it may be tempting to speak poorly of those who have gone before us, it is ill advised. There is no gain in bashing a colleague. This is simply not appropriate and may return to haunt us. Read on!
There is a case in Colorado now where four dentists who teach at Colorado University of Dentistry are going to be named in a lawsuit for making disparaging comments about dentistry. The remarks were made by dentist employees at Comfort Dental, a large, national dental franchise.
Apparently some slides of restorative dentistry performed by dentists at Comfort Dental were shown in a class, and comments were made to the dental students. One of the dentists who will be named in the lawsuit allegedly told one of his dental classes that Comfort dentists are not good doctors and deliver patient care worse than private-practice dentists because they are "out for the money."
Another of the four allegedly told a student that it was "typical" of Comfort Dental dentists to provide shoddy work and leave it for other dentists to correct.
My answer to the hygienist was, "I would respond by saying I can only treat you as best I know, right now, based on what I've assessed in your mouth and on your radiographs. I cannot speak to how you were treated previously, as it would be inappropriate for me to do so. I wasn't there."
And then I would stop talking. It is best to let patients form their own conclusions. Who can say why scenarios like this happen? Was the previous hygienist in a work environment that allowed her an inadequate amount of time to treat this patient? Is the patient telling the truth? Are there other factors at play that we are not aware of?
The previous hygienist is not there to defend herself, and it is not our job to get caught up in this type of dialogue. There can be no gain, only pain, and I'm a firm believer in the old adage, what goes around comes around.
Where it gets tricky is when the hygienist who is mistreating the patient is in the same practice and working down the hall! Now what? I know a hygienist who was new to a practice and was faced with this very scenario.
The hygienist in question scaled superficially but was beloved by many patients because she had a wonderful rapport with them. She was part of the practice for 20 years. Dental hygiene visits with her were always comfortable because, while the care was not always thorough, the conversation flowed easily. She knew everyone, and had watched families grow up. She was as much a part of the patients' lives as was the doctor.
The new hygienist went to this doctor and told him what was happening. Apparently he was either oblivious, or was in denial. More likely it was the latter, as he was able to see calculus that remained behind on radiographs. It was very difficult because he feared the ramifications of ending his long-term hygienist's employment and what it might do to his practice.
The dentist made the right choice and confronted her because of a bigger fear that was looming large. This was realizing that failure to diagnose and treat periodontal disease was placing him in a position of extreme liability. The hygienist made the decision to retire rather than change her approach to patient care.
The new hygienist is now allocated more time for assessment and treatment. By some she is considered the bad cop, but she has now been with the practice for three years and has her own following of patients. The transition was imperative.
Being a crusader for truth and justice is never easy. Onward we go; it is in our hearts' core!
EILEEN MORRISSEY, RDH, MS, is a practicing clinician, speaker, and writer. She is an adjunct dental hygiene faculty member at Burlington County College. Eileen offers CE forums to doctors, hygienists, and their teams. Reach her at [email protected] or 609-259-8008. Visit her website at www.eileenmorrissey.com.
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