Solving dental office conflict: Does coworker’s unprofessional conduct violate patient confidentiality

Dear Dianne,

I am an RDH in a single-dentist general practice. I have had numerous conversations with our dentist regarding the receptionist coming into the operatories in street clothes to, in her words, “help clean up.” Although she may have very good intentions, this is not proper business attire—but her clothes aren’t the main problem I want to focus on here. There are no documents in our files proving that she has had a hepatitis vaccination, OSHA training, or HIPAA training.

Recently, at an office meeting, when I broached the subject that the receptionist should not be allowed in the clinical area of our office, the doctor merely said that he is not a fan of office conflict. I believe the doctor should be aware of the violations, and I guess he knows I am correct in my objections. But that’s where it ends, and nothing has been done to fix this issue.

Further, the receptionist will walk into the operatories to converse with the doctor and his patients about whatever they are talking about. She will go into operatories with questions about a patient she has on the phone, announcing the patient’s name, discussing the condition in detail, and continuing to talk with the doctor as he works with another patient in the chair.

The doctor’s relationship with the receptionist, whom he calls his contemporary, is completely different than the relationships he has with the rest of the dental team. I am sure that contributes to his reluctance to correct some of these issues we’re having.

I have made it clear that I do not want the receptionist to seat my patients or come in to clean my treatment room. She runs into my room to tell me that my next patient has arrived, even though I still need the doctor to come in to check my current patient. And she always announces the next patient’s name aloud. I believe this is unprofessional conduct, and I am concerned about patient confidentiality.

Our office has many issues that need to be addressed, and they are affecting how our patients are being treated. I would love to read an article covering these matters so I can protect our staff members and patients and make sure we all are using the right communication tools.

Sincerely,

Respecter of HIPAA and OSHA

Dear Respecter,

First of all, I question when and why a business assistant would have time to be running back to the clinical areas. Is the business office so overstaffed that she gets bored sitting at her desk, or does she really desire to be where the action is, which is in the clinical areas? It sounds to me as if this staff member would like to be a dental assistant. So, if she is continually leaving her desk, it seems logical that business desk duties are being neglected.

When I first began my dental career, I was hired to be the “receptionist” in a one-doctor office. I did everything at the business desk single-handedly, and I certainly did not have time to be running to the back. Phones ringing, patients to check in and out, insurance questions, filing, paying bills, dealing with salespeople, working on recall—the duties were never-ending. I was never expected to do anything in the clinical area—ever.

This staff member may be trying to be helpful in cleaning up, but there is a bona fide hazard in having an untrained person handling contaminated instruments. At the very least, she ought to be donning a lab coat when she comes into the clinical area. I don’t know what state you live in, but the rules vary by state regarding what dental assistants are allowed to do legally with and without formal education. OSHA is a federally mandated program that is designed to protect personnel. All dental offices are required to conduct yearly OSHA updates, either through off-site courses or on-site training. Each office is required to keep records of training.1

I practiced for 10 years in a multidoctor office with six hygienists. One of our hygienists was named the OSHA compliance officer. As such, she conducted the annual training meeting, and she did a great job! In fact, we all looked forward to that meeting. She assigned different sections to various staff members, and it was always organized and helpful. She was given paid time to prepare and organize the meeting in order to make it a success.

HIPAA is another federal program designed to protect patient confidential medical information. It is not a HIPAA violation to speak another patient’s name aloud in front of other patients, nor is it a violation to have a printed list of patients that is visible to other patients. It is also not a HIPAA violation to have a sign-in sheet for patients to sign when they arrive. These are known as “incidental” exposures. A violation of patient confidentiality occurs when protected medical information is shared or divulged, such as having someone’s HIV status on the printed schedule.

Even so, it is unprofessional when someone announces the arrival of the next patient in the presence of a patient in the chair, as this sends the message, “We better hurry up; Mrs. Smith is here.” Clinical staff members need to know when their next patients have arrived, but expecting a business assistant to walk to the clinical area to announce arrivals is unrealistic and obtrusive. We have all kinds of communication methods today to alert clinicians as to the arrival of their patients. Announcements should be unobtrusive, and the patient in the chair receiving care should not be aware of them. The business assistant should not distract the doctor from the patient who is receiving care. Discussing patient calls in the presence of another patient constitutes unprofessional conduct. It sounds as if both the doctor and the receptionist in your office need a refresher in professionalism.

Your boss sounds as if he is one of those nonconfrontational types who would rather walk across hot coals barefooted than confront a staff member with an issue in the workplace. It also strikes me that the staff member may be looking for reasons to come into his presence. Does it make her feel more important? Does she have a crush on the boss? Is she merely a social butterfly who hasn’t been taught proper professional communication?

Since the doctor allows this behavior, I wonder about his personal feelings toward her. Is he reluctant to correct her behavior because he is attracted to her? I hope that is not the case. The business owner (doctor) is 100% responsible for the safety of the staff members. To allow a staff member to knowingly breach federally mandated rules puts the doctor in a high-risk category for liability.

Here’s what I would say to the obtrusive staff member: “Melissa, I think you are trying to be helpful, but I want you to know it is highly unprofessional to announce that my next patient has arrived when I still have a patient in my chair. How would it make you feel if you were the patient in the chair? I’m going to ask you as nicely as I can to please stop doing this. Also, I would respectfully ask that you stop coming into my treatment room to clean. I prefer to do this myself.”

Trying to get some doctors to change anything is like trying to kiss someone who is leaning away from you or climb a wall that leans toward you. Both are impossible. You may have to accept that, especially if there is something romantic going on. This might just be one of those situations that you have to learn to let go. The doctor is responsible for seeing that HIPAA and OSHA guidelines are followed. If he is lax in those areas, I doubt anything you say will cause him to tighten up. Just be the best hygienist you can be, and don’t allow coworkers to give you a sour attitude.

All the best,

DIANNE GLASSCOE WATTERSON, RDH, BS, MBA, is an award-winning author, speaker, and consultant. She has published hundreds of articles, numerous textbook chapters, and two books. Dianne’s new DVD on instrument sharpening is now available on her website at wattersonspeaks.com under the “Products” tab. Visit her website for information about upcoming speaking engagements. Dianne may be contacted at (336) 472-3515 or by e-mail at [email protected].

References

1. A guide to compliance with OSHA standards. U.S. Department of Labor. Occupational Safety & Health Administration website. https://www.osha.gov/Publications/OSHA3187/osha3187.html. Published 2003. Accessed September 20, 2017.