Time squeezed

Jan. 1, 2010
I have been a practicing hygienist for 15 years. I've been in my current practice for the past 10 years.

by Dianne Glasscoe Watterson, RDH, BS, MBA
[email protected]

Dear Dianne,
I have been a practicing hygienist for 15 years. I've been in my current practice for the past 10 years. The problem I'm facing is causing me to consider whether I want to stay in dental hygiene for the rest of my career. The problem is that I'm being asked to do more and more with less and less time.

When I first got out of school, I felt good about what I could do to help people. I was anxious to be the best hygienist I could be. I loved my job, my coworkers, and my patients. My schedule allowed adequate time to do what I needed to do. Now, I often don't have sufficient time, but I'm being asked to do more. For example, the doctor recently installed computers in the operatories and wants me to make my patients' future appointments at chairside. He also wants me to use the intraoral camera more and talk to patients about cosmetic dentistry. I feel tremendous stress already without these additional chores!

Many days I go home feeling sad, frustrated, and bone-tired. I'm sad because I feel I'm compromising on the quality of care I deliver in order to stay on time. I'm frustrated because it feels like nobody understands my issues. I'm bone-tired from being over-scheduled.

Is there any hope for me?
Drowning Hygienist

Dear Drowning,

Here's your life preserver — COMMUNICATION! But first, let's dissect and examine the issues.

The first issue I see is the schedule. Business assistants are often not aware of nuances regarding why one patient may need more time than another. So when some patients call to make appointments, the business assistant may give them the “standard” appointment, when in fact they need additional time. Sometimes assistants do not take the time to pull the chart and check. If your practice is completely computerized, the fact that a patient needs extra time may not be readily evident. Accessing your schedule from chairside is actually a good thing, because it gives you more control over your schedule. Think about it. When you schedule your patient's next visit, you can proactively consider what the patient needs on his or her next visit. If you took X-rays and performed a full-mouth periodontal charting today, he or she will not need those services at the next six-month visit. You can control the amount of time you need. Conversely, if your patient needs additional services at the next visit, you can schedule the time appropriately. The average time needed to schedule an appointment is about one minute.

The intraoral camera is one of the best ways to help patients understand the needs in their own mouths. Maybe your resistance to this marvelous tool is that you're uncomfortable with the technology and need practice. It should not take more than one or two minutes for you to snap pictures of any restorative needs you see.

As with many businesses, dental practices are looking for ways to work more efficiently and trim waste. Time is money, and we should all be using our time to its best productive capacity. Are there areas in your routine that could become more efficient with better organization? For example, do you use a stackable tray system and preload all the items you use on patients at the beginning of the day so you can reset your room quickly? Think of how much repetitive motion you exert opening the same drawers over and over during the course of the day. Many years ago I discovered how a multiple tray system helps me save time. Do you waste time in too much chitchat? Do you have to make too many trips to the supply room during the day? Take a critical look at your routine to see if you can improve your efficiency.

Do you wait until you're finished with your patient to summon the doctor? If so, it's likely you'll run behind schedule from waiting on the doctor to check your patient. Unless the doctor has no patient, it is unlikely he or she can leave his or her patient immediately to check your patient. I suggest working out an “interrupted check” system. My advice is to seat your patient, perform all preliminary tasks including radiographs and chartings, and then summon the doctor. (If your patient has excessive soft debris, you may need to polish first to facilitate the doctor's ability to examine the teeth.) By doing this, the doctor will have plenty of time to get to your operatory before the appointment is over. When the doctor appears, stop what you're doing and say to the patient, “I'm going to stop and let the doctor check you. Then we'll finish up.”

Over the years, I learned to adapt to various practice protocols wherever I worked. In one unusual situation, I worked in a practice where I felt I was given too much time with patients. Imagine that! The doctor in that practice did not like to be rushed, and if he kept my patient and me waiting 20 minutes, that was perfectly acceptable to him. As the practice owner, he set the rules, and I did my best to abide by them.

Please understand that I'm sensitive to your time issues. I know the realities of working in a busy practice, running behind schedule, and feeling like I didn't have enough time. I remember being grateful for a cancellation so I could take a much-needed bathroom break. I know the feeling of being bone-tired at the end of the day, only to go home to my second job of being a mom to two rambunctious boys. There was dinner, homework, laundry, baths, dishes, and runny noses demanding my attention.

What is the reason that scheduling has become such a problem? Have you talked with the doctor? You should sit down and write your thoughts on paper. If the scheduling protocol in your practice has become so unreasonable that you're unable to deliver high quality care to your patients, you must speak with the doctor. After all, the patients are the doctor's responsibility. Ask him to consider how he feels when he needs an hour for a procedure but is given only 40 minutes. What would he leave out? If the patient were his family member, what corners would he cut to stay on time? Let the doctor know that it is your desire to treat patients with the most excellent care possible. Be ready to offer solutions. Be a problem-solver, not a problem-maker. If you approach the problem with the right attitude and are willing to critique and improve your own efficiency factor, the chances are good for an equitable solution.

Please don't leave the profession — your patients are lucky to have someone so concerned with high quality care!

Best wishes, Dianne

About the Author

Dianne Glasscoe Watterson, 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-Watterson for speaking or consulting, call (301) 874-5240 or e-mail [email protected]. Visit her Web site at www.professionaldentalmgmt.com.