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Ethical dilemma: Dental hygienists who work while sick

April 17, 2017
Dental hygienists often feel ethics are compromised when they treat patients while ill, or are forced to treat sick patients.

By Nicole Giesey, RDH, MSPTE

In the height of the flu season, hygienists are right in the thick of the action. We all know how the flu, strep throat, colds, and even hand, foot, and mouth disease are spread. Many people are so pressed to go to work and not miss any time that they are not resting and getting better. More importantly, they are spreading their illness to others.

I will never forget the day that I had a 1 p.m. opening, and it was filled by a 10 year-old who should have been in school. I was light-hearted and, just to make conversation, I asked how did the patient get so lucky to miss school that day. The mother said that he stayed home and just went to the doctor’s “this morning because he has strep throat, but don’t worry he took his antibiotic right before he came.” She said she could not take time off to come to the dentist, so she thought she would try to fit everything in one day.

I then had this dilemma. I know the route of transmission, and I smiled and excused myself to talk to the doctor. He came in and said, “I heard this little guy has strep throat. Let me see.” The doctor examined the patient’s throat and told me, “Just wear a mask. You will be fine.” These are the trials of a dental hygienist. We can probably collectively write volumes of novels on this subject.

There is a flip side to this as well. What are we to do when we are sick and contagious, and yet expected to perform at a top-notch level or else. So many dental hygienists are out of a job and would love to temp for a day, and they are really good, productive hygienists. Some offices just cancel their day’s production because they refuse to get a temp and then lay a world of guilt on the sick hygienist. This is just unprofessional and unethical. The dental hygienist then feels like she can never call in sick because the office’s downfall of production is their fault. It’s definitely a fine line. The hygienist is putting not only their patients at risk but also themselves.

OSHA and the CDC recommend that if a worker is sick with a fever and respiratory symptoms to stay home 24 hours after the fever of 100 degrees of higher is gone without the help of a fever-reducing medication. Their website shines with recommendations on how to avoid the flu and other illnesses this season. Here is the link if you would like to check it out and maybe email it to your boss.

Here are a couple ways you could avoid bringing in the illness through your patients who feel like they are magically better even though they thought they were dying the night before. Upon check in, have the receptionist hand them a five-question survey about their current health status. One question would be: Within the last two weeks, have you had a fever in the range of xyz? General questions that easy to complete will give you a narrative if the patient should be seen or not.

Also, your receptionist should be educated in verbiage when confirming the patient to eliminate the patient’s reaction if they are turned down in the office. From the example above, had the receptionist asked these questions, the strep patient would not have even been put into the schedule in the first place.

A third method (if your doctor does not like the previous two) is to put signs in the waiting room. Many offices are doing this as a minimal way to make the patient aware if they have signs or symptoms of illness that they will not be penalized or charged for rescheduling. Some signs are very straightforward, and some signs are funny or sarcastic about it.

The major downfall of the signs is that you are leaving it in the hands of the patient that felt like they were fine enough to come in, and the chances of them saying something is pretty slim. It is a fine balance of the office not wanting to lose production, not wanting to upset the patients, and from our point of view wanting to eliminate or reduce transmission levels.

No matter what method of screening you are using, nothing is better than ensuring the patient that it is to their benefit to not be seen when they are ill. It is not to the benefit of your boss that when staff members come to work sick. When you are forced to work by your boss and then they get sick, they may blame it on you as if you had a choice about it.

This is a very rampant ethical dilemma that is unfortunately a problem in our profession. The bottom line is that we are, after all, human, and we get sick. Everyone needs and deserves the best care and rest while they are sick.

Use the resources that are available out there to cover production during an illness.

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].

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