Dear Dianne,
The practice I work in is quite large, and the hygiene schedule is packed for months. Patients often wait for several weeks or months to get a hygiene appointment. To address this problem, our doctor hired an additional hygienist. So, what's the problem?
The problem is that this new hygienist does 10-minute "quickie" prophys on everybody! I once observed her doing a child prophy in seven minutes — seating, prophy, fluoride, doctor exam, and dismissal! Recently, I observed her doing two quadrants of scaling and root planing (which should take 1 ½ - 2 hours) in 15 minutes, all without an assistant!
Is it possible that I am just being naïve, and that appropriate care can be given in this amount of time? Am I justified in feeling that patient care is being compromised by her hasty work ethic? Furthermore, what should I do about this problem?
Suspicious in Sarasota
Dear Suspicious,
You have every right to feel that patient care is being compromised. No one wins in situations like this. The patient does not receive good care. The hygienist is depriving herself of the joy of truly helping patients. The doctor is risking a malpractice suit. The dental hygiene profession is demeaned.
In the example you cited about the child, two of the most important aspects of the appointment were probably omitted — building rapport and patient education. It takes me at least seven minutes to disclose and review home care before the prophy is even commenced on a child.
In the two quadrants scaling/root planing example, the first 15 minutes should be spent administering anesthesia if needed and reviewing and reinforcing home care. When necessary, I have spent twice that amount of time helping patients develop the skills to perform the home care that is so vital to treatment success. Fifteen minutes for two quadrants of periodontal therapy is preposterous!
Let's be realistic. For a hygienist to do a 10-minute prophy on an adult patient with a full complement of teeth, little more than a polish is performed. This is probably the least important aspect of the visit. There is no possible way all the tasks that should be done can be accomplished in 10 minutes. Those tasks include:
- Review and update medical history
- Blood pressure screening
- Inquire about dental problems
- Expose any necessary radiographs
- Extraoral/intraoral exam
- Periodontal charting
- Scaling
- Polish
- Floss
- Home care instructions
- Doctor exam
- Dismiss and make the next appointment
- Tear down and set up the operatory
You did not mention where the new hygienist previously worked. However, if she came from a managed care or high-volume practice environment, perhaps she learned to work in an "assembly-line" fashion to stay on schedule. This is not to imply that all practices that participate in managed care work like this. Some do; some do not. However, I believe that most hygienists will do what they have to do to stay on a reasonable schedule. If that means omitting certain steps in the hygiene appointment, that is exactly what they will do. Additionally, I believe that it is difficult for a hygienist to slow down and incorporate those necessary procedures when he/she has become accustomed to working in a rushed manner.
Not all hygienists are created equal. Most hygienists fall into one of four categories with regard to clinical skill and speed:
- Quick and thorough
- Quick and not thorough
- Slow and thorough
- Slow and not thorough
Of course, to be quick and thorough is a desirable combination. But the reality is that excessive speed requires certain steps to be omitted.
Having excellent clinical skills is only 50 percent of what is needed to be a consummate dental hygienist. Possessing warmth, empathy, and impeccable communication skills complete the other half. Rushing through an appointment deprives patients of meaningful discourse about their oral health. It is my guess that the new hygienist is deficient in both clinical and communication skills.
Recently, a friend approached me and said, "I saw a new hygienist last week, but I will never permit her to clean my teeth again!" When I asked why, he continued, "She didn't clean my teeth at all! She was done in 10 minutes with everything! I felt she did a poor job, and my money was wasted!"
Obviously, this patient was comparing his latest dental experience with previous experiences. In the past, he had been used to having more time spent on his care. He was also accustomed to communicating with a friendly hygienist who showed interest and concern for him as a person and a patient. The new hygienist struck out her first time at bat with this patient. My friend also told me he had registered a complaint with the doctor.
You asked what you should do. My advice is to do nothing. Continue to deliver good, thorough care to your patients. Believe me, unless your doctor is blind, he/she is aware of the problem. If the hygienist is omitting steps in the hygiene appointment, it will eventually come back and bite her. Patients are not stupid, and they will complain or refuse to see her. Radiographs or periodontal charting needed for insurance purposes will be missing. The doctor will notice her operatory empty on a regular basis.
The doctor should handle this problem. He/she should take this hygienist aside and spell out exactly what is to be accomplished in the hygiene appointment. The doctor should scrutinize the hygienist's work closely to ascertain if she is scaling thoroughly. If the doctor comes to you and asks your opinion, be completely honest and open. However, I would offer no opinion until such time.
In practices where the doctor is truly attuned to good, thorough patient care, speed is not a virtue. Most speed demons hit the wall eventually. If I were you, I would stay clear of the situation to avoid being hit with flying shrapnel!
Dianne
Dianne Glasscoe, RDH, BS, is an adjunct instructor in clinical hygiene at Guilford Technical Community College. She holds a bachelor's degree in human resource management and is a practice-management consultant, writer, and speaker. She may be contacted by e-mail at [email protected], phone (336) 472-3515, or fax (336) 472-5567. Visit her Web site at http://www.professionalden talmgmt.com
