I am a dental assistant for a larger company that serves the less fortunate. Most patients are on state benefits. Meaning, a large portion of the patients dental care is paid for by the tax payers. Patients come in with many different back grounds. Maintaining oral health is not their first priority. Mental disabilities caused by the type of upbringing the patient has had and following their own life choices such as drugs, alcohol. With that comes disabilities both physically and mentally. In light of this, I occasionally work for a dentist at this same company that does not do well with this setting . She is unable to connect with her patients. She lacks communication skills and compassion. Patients that come in with pain and already agitated feel dismissed. In turn the patients become aggressive sometimes words are exchanged between the patient and dental assistant and doctor. After the dismissal of the patients the dental assistant charts the notes . Then the dentist writes her chart of treatment completed along with Next Visit and discussions with in the chart. When I read my chart notes and my dentist, the event of what happened is no longer an account that is properly documented. She changes what the assistant writes. It's not the assistants English grammar that's changed. The dentist alters the event and charts an entire different account of everything said between patient, dental assistant and herself. The chart is written where the blame is put on the patient or the assistant or front desk. Her charts is written only to protect herself. Chart notes are notes should not favor anyone. What she is doing is wrong. This is not in my best interest to report her. But, it bothers me. All workers and lead dentist is aware as well as the office manager. It feels wrong. Thanks for listening.
Chart notes:
- Thread starter KKWood
- Start date
I just want to say I feel you ! I used to be a microbiologist , I had to pass products base on their contamination . My supervisor was making me pass products that were contaminated with E.coli. I never did cuz I didn’t want to make anyone sick . I quit my job. It hurts !
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I once worked in a state institution. We worked with highly charged people where legal repercussions were a constant threat. We also had management staff that were motivated by political forces. As a result, our charts and records were heavily scrutinized. "Shading" of the records did happen there. Here are some ways we protected ourselves...
1) Keep your own set of records and store them at home. Should an issue come up, you have your protected records.
2) When something funny happens write up an incident report, outside of the standard record system, with multiple copies for multiple people.
3) Keep your head in the fox hole! The jerks usually self-destruct in time. (Don't go down with them!)
4) The phrase, "As Directed By..." is very helpful, in the notes, when the boss is telling you to do something you know is not right. That way every one knows who was behind the errant actions.
------BTW You sound like a caring DA that we would love to have working as part of our team.
1) Keep your own set of records and store them at home. Should an issue come up, you have your protected records.
2) When something funny happens write up an incident report, outside of the standard record system, with multiple copies for multiple people.
3) Keep your head in the fox hole! The jerks usually self-destruct in time. (Don't go down with them!)
4) The phrase, "As Directed By..." is very helpful, in the notes, when the boss is telling you to do something you know is not right. That way every one knows who was behind the errant actions.
------BTW You sound like a caring DA that we would love to have working as part of our team.
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Thank you... I really appreciate that advice. Especially the phrasing. That will go a long ways.
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Usually electronic records keep a record of all changes that have been made.
