What Does the Doctor Want?

Dentistry Today


Here you are, in a new position, new office, new surroundings, and a seemingly terrific and supportive boss and staff. So why are you nervous? Sure, you have practiced dental hygiene before, but this is a new office with new expectations of you. Realizing that your expectations and those of your boss may be slightly different, how are you going to find out what the doctor wants you to do? Did you remember to ask all the right questions during your interview, or did you nod your head and take the position because it was close to your home, had better hours, or was paying more than your last job? Don’t get me wrong; all those considerations are valid reasons for a change, but did you remember to get the outline of your job description and other specifics clear at the beginning?

Sometimes, we think we understand what the doctor wants because we have worked in an office before. However, not all offices are alike, and certainly all doctors are not alike. Even if they had all attended the same dental school, there would be a difference in their practices because each practice tends to be a reflection of the doctor. (Some offices are laid-back, some precise, and there is everything in-between.) Just as all hygienists are not alike, each dentist has his or her own style. And when you combine them into a group, it can be a real challenge just to decide who is in charge at any given time!
So, what does the doctor want? I’m going to assume that you are clinically excellent and focused on providing your patients with the best care they have ever received. So we’ll start there. 

Even if no one asks, provide your new employer with a copy of your current license, CPR certification, and latest OSHA training date. All offices need documentation; some forget to ask, and others are embarrassed to ask. Some offices may ask for photo IDs for the file. Always be prepared with your social security number and itemizations for your tax forms. Have a contact name and telephone number available in case of emergency.

Prior to your first day, be sure to ask about the office uniform. Many offices provide scrubs or other uniforms and specify which days of the week they should be worn. Find out if the scrubs are laundered on site, or are they sent out? If you are to launder your own scrubs, do they need to be ironed? Do you wear street clothes to and from the office and change into scrubs there? Do you wear uniform shoes, tennis shoes, or clogs? If you need to provide your own uniform/scrubs, find out where other employees purchase theirs in case you need to update your wardrobe or add specific colors/styles. 

It’s also a good idea to find out what the office policy is regarding in- or out-of-the-office lunchtime. Is there a locker for your personal items and a refrigerator for your lunch?

Once there is clarification on the attire, be sure to ask what time you are expected to be present in the office, and what time patients are scheduled. Many offices schedule a morning huddle after the rooms are set and before seating the first patient. If you need time for chart review, schedule it prior to the meeting, so you can ask questions about patient care, likes, and dislikes. This is an excellent time to focus on your mission for the day, leaving other concerns outside the door. You can always pick up your worries on the way out! 

One of the most important items on the list of doctor wants is for all employees to be familiar with, and agree with, the doctor’s practice philosophy. Has it been articulated in a meaningful way, and do you understand what it means for your patients and the schedule you maintain? Be­fore you are hired, not after, is the time to discover if you and the doctor are on the same page when it comes to patient care.

Some offices tend to be precise about appointment times and are less apt to work a patient into the schedule if they are even just a few minutes late. If your previous office operated on that theme, and this one has a more open and generous policy, you must be ready to buy into it, even if it means you don’t run on schedule or need to be flexible with patient care. If you are an experienced hygienist and are used to patients needing differing amounts of time for their appointments, this may not be an issue for you. Or, if the office has a hygiene assistant who can help with patient flow by taking x-rays, seating the patient, and reviewing the medical history, you may learn to compensate with the ebb and flow of the schedule. However, if you are very precise about timing and need equal time to complete treatment at each patient visit, this philosophy may not meet your needs. You may tire of the constant juggling of the schedule and the stress it produces. 

All schedules produce stress on any given day. One of the challenges in any dental practice is matching the vision of the day (when the schedule is printed up the night before) with the reality after the emergency patients are added, the cancellations are subtracted, and bad weather, traffic, or parking delays make patients late and grumpy. Remember, the only constant in this picture is change, and you need to be able to react in a positive way. Change happens. Be ready for change, adapt to the change, enjoy the change, and be ready to change again.1 A sense of humor while the world expands and contracts around you is the best attitude to have—the one that will win you major points on a really bad day.

Practice philosophy also en­compasses specific approach­es to patient care. Some doctors choose to “watch” areas of concern, while others tend to be more preventive/ag­gressive in their approach. The application of sealants has changed the landscape of treating deciduous and permanent molars, but there are still many doctors who “watch” teeth and are reluctant to restore minor carious areas. Does your doctor want you to discuss sealants with patients and parents and be an advocate for their placement? Can you mirror the philosophy of patient care when it comes to gingivitis and periodontal disease? 

Before you start discussions with patients about their periodontal situation, be sure that you and the doctor agree on treatment needs at early, mid, and late stages of the disease. Charting pocket depths may not occur at each visit, and full-mouth probing may be done on an irregular basis. Some pa­tients may not be familiar with the process at all and may be startled when you insist it be done regularly. Check with the doctor at the huddle to avoid patient care issues later in the day. Be sure that if there is a computer-assisted program used for charting, the procedure is fully explained to you. 

What is the routine protocol for radiographs? Bitewings every 6, 12, 18, or 24 months? Ask what type of full-mouth x-rays are taken, how many and how often, for both adults and children. Is there a pedo full-mouth protocol? Do you take x-rays on very young children? Is there a panorex machine, a ceph? Are digital x-rays in use? If a patient is in pain, do you take the x-ray first? How does the office handle a patient’s right to choose not to have x-rays taken?

When you call the doctor in for the exam, the latest x-rays should be on the viewbox and the chart should be available. If you have spent the appointment educating the patient about caries, periodontal disease, oral health and systemic disease relationships, etc, be sure to brief the doctor before the exam so the dialogue can be focused and supportive for both of you. If there are changes in the medical history, note them and make the history available to the doctor. 

If the patient is stressed, nervous, anxious, or is having a personal crisis, your doctor wants to know. Part of your job is educating, most of it is listening with all your senses tuned to the patient’s individual needs. Most pa­tients will appreciate your coaching and attention, and the doctor will appreciate knowing about potential “land mines” before they go off. 

Have literature available for the patients to take with them and encourage them to call with questions. Many times the patient will ask you things they would not ask the doctor! There are published brochures for disease, nutrition, whitening, orthodontics, cosmetic dentistry, etc, available from outside resources, but you may want to have information that your office has put together on particular treatments and procedures within your practice, listing the length of time required for procedures, fees, and expectations.

These days, patients are more apt to be well-read about dentistry through the use of the Internet and a myriad of websites full of medical information. You may need to answer questions about things that only partially relate to dentistry. Include time for questions while you are waiting for the doctor. Patients who relate to a staff member have a more secure relationship with the practice and are more likely to return. Everyone benefits when that happens.

When you have changes in your schedule and find you have some time, be productive. Help with instruments, assist the assistants, answer the phones and make appointments, confirm the schedule, or pull charts. The rest of the staff will enjoy the help, and you will be more a part of the team.

Begin your day on time with your first patient, and when possible, stay on time with your patient schedule. If you like to chat, make it relevant with one eye on the clock. When you have completed treatment on your last patient, clean and restock your room, write-up your charts, and review your patients and schedule for the next day. Then, if it is time to leave and appropriate to do so, say goodbye. If the staff leaves as a group, be sure to help out until all staff can go at once. I remember one doctor who had a difficult time keeping all staff busy until all were done with their day’s work. People would leave one at a time, and the same staff would stay late to finish up. After much frustration, he started parking his car at the back of the line, so no one left until he did. Is that an answer? I guess so, but there is probably a better and less passive-aggressive one!

One of the greatest compliments a boss can receive is to hear from a colleague or friend that a staff member is a terrific asset to the practice. Remember, you represent the office even when you are not in it.

As a hygienist, you have great responsibilities to educate, nurture, and foster healthy development of another person. You can choose to live for the responsibility and cherish the impact you can have on others. You can do it part-time, full-time, in private practices, group settings, hospitals, universities, and in public service. Be proud of your education, training, and ability to change lives for the better. You already know what your doctor wants—you knew it all along!


  1.  Johnson S. Who Moved My Cheese. New York, NY: Penguin Putnam, Inc; 1998:94.


Ms. Cary is the president of Creative Solutions, a dental consulting company specializing in the growth and development of dental practices and their teams. She lives and works in Atlanta, Ga, coaching, training, and enjoying the uniqueness of consulting as a career with many options. She has worked with many solo-, group-, and hospital-based dental practices and residency programs, helping them reach their potential. Presently her focus is assisting practices in the midst of growth, change, and transition, streamlining systems, and moving staff members through its processes. She can be reached at Jbarcary@aol.com.