Hygienists gone wild

[Advance]

Hey all! I haven’t made a post on SDN in a while. I’m just looking for advice or words of wisdom.

I currently work at a corporate office and have been here for about a year and a half. So far we’ve been using temp hygienists 3-4 days a week to keep up with our hygiene schedule.

This week we hired a new full time hygienist. Who is very heavy handed with probing depths and “diagnosing” periodontal disease. Yesterday there was a patient scheduled for a prophy and she changed it to a 4+ 4 quad SRP without letting me know. I was confused because the X-rays didn’t show any radiographic calculus or signs of bone loss. I looked at her probing depths she took and she got 5s and 6s. I went into the room and did some spot probing and I got 2s and 3s without any BoP or CAL. This particular patient didn’t seem to mind paying 650$ for the SRP vs the 50$ prophy that he was initially quoted but I know it’s only a matter of time before a patient takes issue with it. She also tried to plan a 4+ 4 quad on a 19 year old with gingivitis yesterday. So yeah.

I kind of figured this would be a problem with her. During her interview she threw jabs at dentists saying we aren’t trained properly in periodontal diagnosis and Tx planning. She also said she also had issues with dentists in the past that didn’t give her any autonomy and made her check in with them if she wanted to change any tx. Now I understand why. Unfortunately as an associate I don’t have any say in who they hire.

I informed my OM about it and she seemed happy that she was changing all these prophys to SRP. My office is super busy and I don’t always have the time to check her schedule during the day to make sure she’s doing and billing what I treatment planned.

I’m pretty concerned about it, but maybe I’m overreacting? Is this common at other offices?

Any advice, suggestions or anyone have a similar experience?

---

Members don't see this ad.

 

[yappy]

You are not over reacting. It's a really big deal. I have not had this experience at the offices I have worked at. The best office I worked at had a very well defined periodontal program and the hygienists were calibrated by a PT periodontist. I felt comfortable with this because the protocols were backed by perio lit/ AAP recommendations. Now that I think of it, it's surprising that all of dentistry isn't practiced this way. Conversely, there are some dentists that completely ignore periodontal disease and undertreat their patients, allowing the disease to advance unchallenged. It sounds like you have a hygienist who may be overzealous, or worse, unethical.

If I were in your shoes I would look at the most up to date AAP dx and treatment guidelines and abide by those. If you find that she's changing treatment on patients that you're involved with/examining, then I would raise the issue and stop it.

 

[DrJeff]

Maybe 20 years ago there was a bunch of media attention when an article in the old Reader's Digest magazine came out about various treatment plans from various dentists on the same patient ranging from just a few direct restorations all the way up to full mouth reconstruction.

This may be a situation, on the hygiene side, that isn't much different. And as someone who's office isn't too far from a couple of "corporate" chain offices, I can't tell you the number of times where my office gets a new patient in for a 2nd opinion after having gone to one of the corporate offices, after having received a TX plan for 4 quads of S/RP, subgingival antimicrobial treatment, various home iral care devices, etc, even in situations like you referenced where the radiographic and clincal eveidence of perio disease just haven't appeared in my eyes to be there. Granted, there have been some legit perio patients seeking a 2nd opinion where I agreed with an aggressive perio TX plan, however it seems like the standard for most any new patient in many corporate offices seems to be an multiple quads of S/RP, antimicrobial therapy treatments and various home oral healthcare devices that they will sell you in that specific corporate office for every new patient, regardless of their perio status. Be carfeul, and also remember with that new hygienist, in the vast majority of states, hygienists, under the dental practice act, AREN'T technically allowed to diagnose disease, so if she is altering treatment plans without approval of a licensed dentist, then she is practicing outside the scope of care that she is allowed to do so. And that could put the practice, and your owner/boss in a liability sitauation. Might be time for the 3 of you to have a sit down and deliniate who decides upon the treatment plan that is presented to the patient

 

[oralcare123]

Hygienist is not allowed to diagnose, only treat under direct supervision of a dentist - you. Your license is on the line, if patient decides to sue or complain to the board. Be very firm in your explanation to both manager and hygienist.
This situation is very common in DSO's because they are all about production. The owner of one of them plainly told me, that she likes all patients to have SRP's for "their own benefit". Keep in mind, that hygienists get payed production % or bonus when they reach certain numbers in production
I will advise you to email your concerns to hygienist and whatever regional managers to have something in writing in case of a lawsuit. No point talking about ethics, just legal stuff, that you noticed, that hygienist changes diagnosis, which she legally has no right to do
Often it is not possible to just leave crazy workplace, try at least minimize your risk

 

[Hygenie08]

Hey all! I haven’t made a post on SDN in a while. I’m just looking for advice or words of wisdom.

I currently work at a corporate office and have been here for about a year and a half. So far we’ve been using temp hygienists 3-4 days a week to keep up with our hygiene schedule.

This week we hired a new full time hygienist. Who is very heavy handed with probing depths and “diagnosing” periodontal disease. Yesterday there was a patient scheduled for a prophy and she changed it to a 4+ 4 quad SRP without letting me know. I was confused because the X-rays didn’t show any radiographic calculus or signs of bone loss. I looked at her probing depths she took and she got 5s and 6s. I went into the room and did some spot probing and I got 2s and 3s without any BoP or CAL. This particular patient didn’t seem to mind paying 650$ for the SRP vs the 50$ prophy that he was initially quoted but I know it’s only a matter of time before a patient takes issue with it. She also tried to plan a 4+ 4 quad on a 19 year old with gingivitis yesterday. So yeah.

I kind of figured this would be a problem with her. During her interview she threw jabs at dentists saying we aren’t trained properly in periodontal diagnosis and Tx planning. She also said she also had issues with dentists in the past that didn’t give her any autonomy and made her check in with them if she wanted to change any tx. Now I understand why. Unfortunately as an associate I don’t have any say in who they hire.

I informed my OM about it and she seemed happy that she was changing all these prophys to SRP. My office is super busy and I don’t always have the time to check her schedule during the day to make sure she’s doing and billing what I treatment planned.

I’m pretty concerned about it, but maybe I’m overreacting? Is this common at other offices?

Any advice, suggestions or anyone have a similar experience?

As a hygienist I see this a lot too and it is very disheartening. The problem with these corporate offices is that they incentivize these hygienists with "daily bonuses" and quarterly profit sharing bonuses and place high production goals on them which leads to unethical practices and the company and even a lot of the doctor's don't care because they all benefit from it. The sad thing is that it is getting harder to get away from corporate dentistry as these DSO companies are buying up all the privately owned offices. It has me thinking of leaving the field altogether. I definitely think you need to put your foot down. Either with her directly or with the powers that be. SOMEONE needs to advocate for the patient. Good luck.

 

[Molar Whisperer]

I actually received a Board Complaint due to the Hyg probing 2-3 mm deeper on a periodic exam. I used to work for Aspen and the Hyg gets SRP and Arrestin production. The Board Complaint was terrible because at Aspen, all the charting were still loose paper and all the documentation were messy and some were missing. I pre-emptively took numerous risk mgt and charting courses during that time so the Board could just slap me with a letter of concern for submitting poor documentation.