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Corporate quotas: An ethical dilemma for dental hygienists

Jan. 19, 2017
Your corporate employer asks you to perform an SRP you know isn't needed. How do you respond? This situation is very familiar to dental hygienists.

Corporations, large and small, are abundant in the United States. No matter their size, they all have a couple things in common: production goals, and the desire to make those numbers climb. So what do you do if you are a hygienist and you know that the patient being proposed for scaling and root planning (SRP) is a gingivitis case at best and doesn’t need SRP?

This is where your ethical standards come into play. Should you perform SRP or shouldn’t you? Should you be that whistleblower or should you be the hygiene soldier just carrying out the daunting task of a procedure that you know should not be performed? Here are some things to consider.

Evaluate the situation. If you constantly find yourself in this position, accept that trend for what it is: you are frequently being asked to practice unethically. Will you help the corporation or the patient? Remember that, in the eyes of your employer, you are replaceable. If you will not complete the work, someone else will. It all boils down to ethics and how comfortable you are with the situation.

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Some corporations are legally getting away with this kind of unjustified treatment. As a hygienist who knows better, it is baffling. Patients are in the dark because they just do not understand their treatment fully. They are told by a doctor they trust that they need a certain procedure, or else the worst can happen. They consent and it is completed. Or worse—the doctor dictates the unnecessary treatment plan and you have to explain to the patient. It’s a completely disgusting side of our profession, and it happens every day. Unless you would like to become a whistleblower, the only other option for you is to either stay or go.

If this situation happens only once in a while, you could easily talk to the doctor alone. You need to be united as a team and not go against the doctor’s recommendations in front patients or staff. If you ever go against the recommendation in front of anyone, that will definitely come back to you, and not in a good way. Express your concern that your charting and assessment dictates treating the patient with a debridement or a prophy, not SRP, and see if you can work as a team for the patient. If the doctor is set and will not change, you are trumped. These are the worst parts of being a hygienist: knowing that a procedure is unnecessary, yet not having a clear voice over the dentist, or knowing a procedure is necessary when the dentist fails to recommend it. You are an advocate for the patient, yet you are muted when the doctor makes the treatment plan against your educated evidence.

The bottom line here is that if you leave, will your patients benefit or suffer? Dentistry is really about helping the patients. Will they benefit by you staying? Over time, perhaps you could create change. This is not to say you should stay and commit fraud by going along with a treatment plan that you know is unjustified, but rather than leaving, consider being a voice for your patients. They do not have a voice because they don’t understand.

I must clarify that not all corporations are like this. I have worked for three, and two of the those were performing textbook perio programs and recommending textbook perio treatment plans. They did everything by the book, and are helping, not robbing, patients. Their patients are loyal and their employee turnover rate is very low. They invest in employee CE and offer wonderful benefits.

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It is a lot of work to succeed in these offices, but if you utilize textbook dentistry, it’s not that tough. “Textbook” includes actually charging for a one-to-three tooth SRP, performing oral cancer screenings on every patient, recommending the proper prescription-strength fluoride toothpaste, really listening to your patients and conquering their issues of sensitivity by providing fluoride in-office application four times a year, treating them for bruxism properly through guard therapy—the list goes on and on. The key is that every one of these procedures has an associated cost, and many times private practices complete these at no to little charge to make their patients happy. Your time and your services need to be valued, not given away! Dentistry is a business that helps people. Don’t overcharge them, but realize your time has value.

If you are a corporate hygienist, you know what type of corporation you work for. Your ethics will reign over your decision to stay or go.

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Editor's note: This article originally appeared in RDH eVillage Focus. Our editorial team would be happy to deliver content like this to your inbox twice a month. Just let us know by subscribing here.

Nicole Giesey, RDH, MSPTE, enjoys researching, writing, and educating on topics related to dental hygiene. She is the dental hygiene product specialist for Maxill. She can be contacted at [email protected].