2.7.14 Issue #622 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Carol Tekavec, RDH
Hygiene Consultant
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Serious Conflicts
By Carol Tekavec RDH

Most dentists keep their patient’s well-being foremost in their minds. In my experience, they are some of the most competent, compassionate and caring individuals in the health care field. Dentists who work with McKenzie Management are focused on high quality care in a happy, productive atmosphere. They number in the thousands.

We know, however, that every workplace provides opportunities for success and failure. We create some of these opportunities by the way we approach the work that we do. Office circumstances can also dictate how many successes or failures come our way. As hygienists, we work in an environment where we function somewhere in the middle of an office hierarchy. We work primarily alone, but many times we rely on others in the practice for our daily schedule of patients. We provide treatment and screening, but we rely on the dentist for the “last word” on patient recommendations. We have control over how we approach our patients and the amount of time we devote to each segment of their appointments, but we lack the ability to stay on time if the dentist is busy and exams are delayed. We watch the clock constantly, but are keenly aware that each patient deserves our full attention and care.

The good news is that most of the time we are able to juggle all of these factors successfully. We work in offices where others on the dental team are working with us to make the practice run smoothly. We respect our dentists and co-workers and value everything they do to take care of patients and make sure they get the treatment they need and deserve. We also try to do our share in being “part of the solution and not part of the problem.” We accept that some conflicts may arise, but understand that many of these conflicts are within the realm of being handled with good faith adjustments and a focus on providing proper patient treatment.

The bad news is that in some offices, serious conflicts can make providing proper dental care extremely difficult. An experienced dental hygienist contacted me recently with a story of such conflicts. She was wondering what, if anything, she could do about her situation or if she should simply leave the practice. 

Conflict #1: Pre-Medication
All of us know that antibiotics have been overused in the past, and are not being recommended in the same way they were previously. Guidelines for pre-medication have also changed dramatically. Be that as it may, some patients still require pre-medication, and can suffer serious problems if this is ignored. The hygienist who contacted me told of a patient with a recent joint replacement. His physician recommended that he be pre-medicated with a certain antibiotic prior to dental treatment. He had not taken this antibiotic prior to his appointment with her today. Her dentist did not believe in keeping antibiotics in the office to cover patients who appeared without taking a pre-med. The rationale was that patients should know if they needed a pre-med and contact the office in advance to receive a prescription. “Why should the office pay for the antibiotics? It is the patient’s responsibility.” 

The hygienist talked with the dentist and told him about this patient. She wanted to reschedule him. The dentist told her to treat him today. Because she felt she could not do this in good conscience, she left the office, went across the street to another dentist’s practice, and “borrowed” the proper pre-medication to give to the patient. She then had the patient wait in the reception room for an hour, and completed his appointment during her lunch break. The dentist was very upset that she had ignored his direction and an unpleasant argument ensued. She felt that since she knew from her training that a prophy might cause a bacterial shower that could affect the patient’s joint replacement, and also that the patient’s physician had recommended pre-medication, she had to either reschedule or arrange for a pre-med today. She also knew that she had overstepped the bounds of her legal duties by providing an antibiotic without the dentist knowing.

Conflict #2: Full Mouth Probing
A new patient presented with serious periodontal disease and bleeding tissues. His mouth was extremely sore and the slightest contact with the periodontal probe caused him pain. A preliminary “screening” revealed 5 and 6 millimeter pockets around all molars. The normal routine for a new patient visit was a full mouth periodontal probing and recording. Investigation of this patient’s situation revealed that he did not have dental insurance. However, he readily accepted this hygienist’s recommendation of full mouth scaling and root planing with a subsequent evaluation to see if referral to a periodontist was appropriate. The hygienist decided that she could record all probing depths on one half of the mouth after the patient received local anesthetic at his first SRP appointment, and the other half of the mouth at his second SRP. Since dental insurance approval necessitating full mouth depths prior to treatment was not a consideration, she felt that this would be the best way to approach his care. When the dentist came to perform his exam he was upset that probing depths had not been recorded. He berated the hygienist in front of the patient and insisted that she complete the probings now. The hygienist did as instructed but was very upset, as was the patient.

Luckily, serious conflicts such as the ones described are not common. This dentist is an outlier. The hygienist risked her license by providing an antibiotic and should not be placed in this position again. Being berated for showing concern for patient comfort is also wrong. My advice to her was to begin looking for new employment right away. When conflicts arise that go against a person’s knowledge of proper dental practice or concerned dental care, it means a change in employment should be considered.

Carol Tekavec RDH is the Director of Hygiene for McKenzie Management. Carol can improve your hygiene department in just one day of training “in your office.” Interested in knowing more about how to improve your hygiene department? Email hygiene@mckenziemgmt.com.

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