Disparaging remarks

July 1, 2006
Dear Dianne, Recently, I had a patient in my chair who is alternating every three months between our office and the periodontal office.

Dear Dianne,

Recently, I had a patient in my chair who is alternating every three months between our office and the periodontal office. The patient stated that her appointments in the periodontal office are quite painful, but when she sees me, she is comfortable throughout the visit. The patient mentioned this to the hygienist in the periodontal office. Her reply was, “Well, I scale your teeth,” which insinuated that I did not scale her teeth. This really ticks me off!

First of all, I am very meticulous with my work. I resent that another hygienist would suggest that I do less than what is needed. Second, this patient has severe recession and lots of exposed root surfaces. I do whatever instrumentation is needed, but I do not engage in overinstrumentation. In fact, I give the patient a fluoride varnish treatment each visit to help strengthen her root surfaces. The patient said the other hygienist told her that does not really help!

Additionally, the patient said that when I use the Cavitron, it does not hurt at all, but when the other hygienist uses it, it is extremely painful. I use my Cavitron on low power with a steady, warm water drip which cuts down on sensitivity. I suspect the other hygienist is using high power and cold water.

Finally, this patient has mostly PFMs, so I only polish her with mild toothpaste to keep from damaging the gloss and/or porcelain on her expensive crowns. She has asked the other hygienist why she doesn’t do that, and she just waved her hand and said that I was being neurotic, that it didn’t make a difference.

Whenever a patient makes a negative remark about another hygienist to me, I always defend the hygienist because I don’t know the whole situation. My question is, should I do anything about this? I have considered calling the periodontist and complaining to him.
Angry in Arizona

Dear Angry,

Obviously, you have good reason to be upset over the remarks made by the other hygienist. There are several issues here that I will address separately.

The first issue is pain. I have said it hundreds of times in my seminars - people do not want to be hurt in the dental chair! There are literally thousands of people who avoid dental care because of some previous painful dental experience, so keeping our patients comfortable should be central to any treatment we provide. The patient in question noticed a difference in pain levels between visits to two different hygienists and justifiably questioned the reason. The hygienist in the periodontal practice tried to justify her infliction of pain as being necessary to provide thorough treatment. It seems to me the other hygienist is confusing heavy-handedness and possibly improper technique with being “thorough.” It is possible to be thorough without inflicting pain through the use of anesthetics, either local or topical.

In my first job as a hygienist, several patients made this statement: “You didn’t hurt me like that last hygienist ...” I never met the former hygienist, but I was hired to take her place when she relocated to another city. One patient went so far as to call her the “ol’ blood and guts” hygienist who “ripped my gums to shreds.” Because of her roughness, this patient decided to go to another dental practice. Imagine his horror when the very hygienist he was trying to avoid summoned him to the treatment area at the new practice. He had no way of knowing that she worked two days in one practice and two days in the new practice he had chosen!

I agree with your treatment protocol with this periodontal maintenance patient; i.e., lots of power debridement on low power and warm water, hand scaling as needed, polishing with something nonabrasive, and fluoride varnish for exposed root surfaces. Your protocol is right in line with current standards. It is possible that the other hygienist is one of those hand-scaling purists who subscribes to the old mantra that hand scaling is always superior to power scaling. The evidence suggests otherwise. The fact is, we need excellent technique with both modalities. Far too many periodontal maintenance patients have to live with those hour-glass-shaped roots that became that way from overinstrumentation with hand instruments. Further, maintenance patients need a light touch, low power, and warm fluid lavage with whatever type of power scaler that is used.

To my knowledge, all hygienists (with the exception of Alabama preceptors) get a similar clinical education through either a two- or four-year program. However, some hygienists develop feelings of superiority associated with a particular office where they work. While I will not argue the fact that some offices allow the hygienist opportunities to learn that may not be afforded in other practice settings, we all pull our pants

on one leg at a time. We all jumped through the same hoops to get a dental hygiene license. There should be no “big I, little u” among members of the same profession.

Further, sometimes patients who need to see a periodontist refuse to go. We can’t force them to go, so we bear with them and do the best we can within the boundaries they have set. We are careful at each successive appointment to keep the patient informed of his/her disease progression and document any refusals for more definitive treatment. Finally, the patient agrees to the periodontal referral. When the patient presents at the periodontal office with advanced periodontal disease, how is the periodontist or hygienist there to know that you tried time and time again to persuade this patient to seek specialized care, unless you tell them? That’s why I feel it is important that the specialty office be informed through a letter that outlines the monitoring of disease and the patient’s refusal to accept a referral.

The most important part of this discussion is the patient’s professional care. The treatment protocol you are using is right on target with current standards for a periodontal maintenance patient. For that, I congratulate you on keeping up-to-date. You could have taken the low road and thrown a few disparaging remarks about the other hygienist’s treatment protocol. But what would that accomplish, except to confuse the patient further?

What should you do about this? That’s up to you, but here’s what I would do in the same situation. I’d place a telephone call to the other hygienist and say:

“I’m calling about a mutual patient (insert name). Let me get right to the point. I saw this patient on (date) and she related some remarks that were made when she saw you last time. (Be very specific here.) Specifically, did you infer that the quality of care she gets from me is inferior because I don’t hurt her? (Wait for answer.) Did you say I was being neurotic about not using abrasive polishes on her porcelain restorations?” (Let her answer.)

THEN say, “I want you to understand something. This has been bothering me ever since I saw this patient, and I believe it is important that you understand that I do not appreciate your inferences about the quality of care she receives from me. Remarks like this would make us not refer to your office in the future, and I’m considering going to your doctor/employer about this. If this ever happens again, that is exactly what I’m going to do. It is highly unethical to disparage another health-care provider to a patient, especially a mutual patient. In the future, if there’s ever a problem with a mutual patient, please bring it directly to me, and I’ll do the same for you.“

Then you might enlighten her on the use of fluoride varnishes. I’ll bet that a call like this will dilute any future desire to disparage you or any other health-care professional.

Like the commercial says, “Do it. You’ll feel a whole lot better about things ...”
Best wishes, Dianne