Keeping Your Focus on What’s Important

Dentistry Today


With any endeavor, routine actions have a tendency to interfere with your purpose. The career of dental hygiene is no different. The goals you set for yourself when graduating with your dental hygiene degree may get lost in the clutter of everyday responsibilities, and they may seem unattainable when you realize just how much has to be accomplished during an actual patient visit. There are times when you may find it impossible to remember what excited you about the career when you first embarked on it. Wherever you are in your career at the present time—a new graduate, a seasoned professional, or somewhere in between—hygiene is an interesting career choice and can work to (1) enhance other aspects of your life, (2) connect you to people you might not relate to under other circumstances, and (3) force you to think “outside of the box” more than once a day.

Remember working on your first “real” patient in hygiene school? Were you terrified that you would forget some of your training and blow it with all your instructors in the room? I was, and it didn’t help that my first patient was a “regular” who was wearing a full upper denture with a clear palate. I was stumped for several minutes about who to tell and what to do! It was the twinkle in the patient’s eye that helped me through. I have never forgotten that lady and my first day in the clinic.
At some point, you will realize that the didactic and clinical courses presented as a part of the dental hygiene curriculum tend to prepare you for only 60% of what actually is expected from you while treating patients. There are times when you must remember anatomy, physiology, pharmacology, microbiology, dental anatomy, sociology, philosophy, and current events to help you to gain a perspective on the health, wellness, and medical/dental needs of your patients. As you continue to work in your career and encounter an ever-growing and diverse population of children, adults, special needs patients, and those with specific medical issues, you may find that patients will begin to consider you a reference source on some level. The significance of this is huge. This signals that you have transformed yourself from a healthcare provider to their healthcare provider. In many cases, your care is the only routine healthcare some patients receive. Your responsibilities to them increase exponentially along with your ability to nurture, understand, and respond to their needs. 
For example, it is not unusual today for patients to be taking several medications simultaneously and for many patients to have more than one physician. They may also be receiving information and care from alternative sources such as herbalists, chiropractors, and the Internet. You may be the one person who discovers, through the mechanism of your routine medical history review, that some of the medications are at worst contraindicated or at best synergistic. In addition, patients’ visits with you may be the only time they are screened for high blood pressure and the results recorded on a regular basis. You may be the only person who asks for a complete list of medications that are seemingly unconnected to the dental visit. 
Many patients do not understand the interaction of prescribed medications on their oral and general health, and as a result they may be surprised that drug ingestion can affect the mouth as well as the body. There is enormous effort underway to educate both physicians and patients that a healthy body is one where infection is not present—not in the mouth, not anywhere. As a consequence, there are physicians who are beginning to recognize occasions where patients will need “clearance” from their dentist before cardiac and other major surgeries are performed. Patients who will be immunosuppressed for various medical and surgical reasons will need all infections eliminated before they can proceed with medical treatment. 
Similarly, and just as importantly, you may be the person who discovers an ulceration within the oral cavity, and through use of a noninvasive biopsy procedure, identifies and interrupts oral cancer in its earliest stage. Your ability to recognize disease, inflammation, infection, bruxism, and other destructive habits is enhanced because of your background and training in all those science courses taken while working to receive your degree. When you are in the training process, it may be hard to look forward and see what information you may need, but I would be hard pressed to deny in retrospect that didactic and clinical training has been crucial to your continued advancement as a patient care provider. What it may have done, however, is to keep you at a distance from, and unconnected to, the patient. 
For many years in hospitals, patients were referred to as “the gall bladder in room 202” or “the hysterectomy in 412.” More recently, staff members have tried to remember the name of the patient, not just the disease and room number. There is a message here; you are working on a patient, not a set of teeth. If you don’t stay connected to the patient, who will?

What then do you say to yourself as you leave work for the day? Have the 8 hours spent in clinical patient care been an interruption in your day? Are you exhausted and stressed from (1) dealing with difficult team members, (2) a doctor who is never pleased with your performance, or (3) patients who do not tell you when leaving your treatment area that “this was the best cleaning I’ve ever had”? Are you wondering about your career choice and how you can possibly continue more of the same for the rest of your life?

As your mother might say, “Take a deep breath and stop for a moment.” If you have to, close your eyes and think back to what process you followed to make your career choice. Who or what was the motivator for this particular career? Are you following a role model and/or an inner feeling of service to others? Do you truly love meeting people and experiencing an aspect of life through others that is missing from yours? Do you like following rules and staying on a schedule, starting and completing something several times a day? (If you think managing might be a better way to go, any manager will tell you that one of the hardest parts of supervising others and running an office is the feeling that nothing is ever done. Your desk is never clean!)

Okay, come out of your head for a moment and think back to one of your best days. Think about what made it so good and how you felt as you zipped through the hours of patient care. A major hurdle for most clinicians is to keep the focus continually on the patient and not on all the extraneous peripheral clutter that is necessary but intrusive. In an average patient care appointment of 45 to 60 minutes, you must find a way to complete the following:

(1) start a dialogue.
(2) review the medical history.
(3) take and interpret blood pressure.
(4) have the patient read and sign the notification of privacy for HIPAA.
(5) expose, develop, and mount radiographs.
(6) complete or update a periochart.
(7) scale, polish, rinse, and floss.
(8) provide home care and nutritional instruction.
(9) check for suspicious hard- and soft-tissue areas.
(10) wait for the doctor’s exam.
(11) write clinical findings in the chart.
(12) schedule the next appointment.
(13) release and escort the patient to the front desk.
(14) clean and disinfect your treatment area and set up for the next patient.

Your biggest responsibility has been left off the list, and that is connecting with the patient. With OSHA regulations, personal protective devices, and the impact of the HIPAA on privacy, some would consider connecting with the patient to be impossible and simply give it up. There are hygienists who work quietly and quickly with attention given to the patient only as an adjunct to the work performed. At some point and for some reason, they have become disconnected to the body in the chair and see only the teeth and the need to clean them. They are not watchful for signs of patient tension in the clenching of the hands, the beads of sweat forming on the upper lip, or any other external signs and symptoms that make that person real. If there is conversation at all, it is incidental and perfunctory and not a personal connection that starts to form bonds of a relationship. And while their clinical skills may be terrific, patients find them anonymous and have difficulty remembering them from visit to visit. As far as the patients are concerned, it doesn’t matter who sees them at each recare appointment because there is no relationship keeping them connected to the practice. They come because the office is convenient, because it accepts their insurance, or because they have a connection to the dentist who sees them for their exam and treatment care needs.

Cancellation rates and broken appointments abound when there is no relationship. Patients may feel reluctant to tell the doctor why they are ambivalent about keeping appointments, and in fact, may not know why themselves. The doctor appreciates that the clinical treatment rendered by the hygienist is excellent because at each patient exam the results speak for themselves. The results are measurable, and performance evaluations can have standards of excellence. 
It is much more difficult to evaluate the ability of the hygienist to forge a relationship with the patient. Good clinical skills are important, but of equal importance is the ability of a clinically excellent hygienist to bond with the patient and remain aware of subtle changes in the patient’s health from visit to visit. I don’t know about you, but since the whole experience of a dental visit can be anxiety-producing for most of the population, I want to believe that there are ways to make the visit easier and more pleasant for each of my patients. Sure, some of them can be demanding, but winning them over is truly an experience that rates right up there with having a grandchild call you on the phone, tell you they made the honor roll, and “pay up for each A.” 
Graduating from a dental hygiene program over 30 years ago has given me a perspective on this career and my participation within it that only comes from looking back. I can remember patients who have shared incredible secrets with me, have been terrified of the dentist (and thus, of me), and have grown from small children to full adults with children of their own and continue to be “recalled.” I also remember patients who have helped me through some rough times of my own with their own concern, empathy, and friendship granted 2 hours each year. 
This career has allowed me to expand my horizons beyond my wildest dreams, which, when you are in a 7- x 10-foot room for 8 hours a day, can be a mind-numbing process. When you are truly ready to experience more, more will become available. Teaching, research, writing, consulting, traveling to poverty-stricken countries, working with children in school programs, advocating better nutrition in school lunches, assisting with the elderly in nursing homes, providing van-based dental care, and providing dental care for our military forces are just some of the ways to go beyond your basic career choice. The clinical practice of dental hygiene requires physical stamina, the ability to read and interpret clinical and physical data, cultural awareness, a dedication to excellence, adherence to an ethical standard, and ongoing education.
Your background and training will have prepared you for many different ways to practice your career. Your professional and personal growth will help you decide how and when to practice. At the end of the day, however, it will be the patients who bring you back and help you to focus on what’s important. The ability to work 1-on-1 in a therapeutic environment, enhancing the well-being of another person, may keep you grounded; your ability to relate to another adult or child will keep you “flying high.”
Indulge yourself, your career choice is worth it!

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, 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