Doctor/Assistant Relationship

Jan. 1, 2001
There are no two members of the dental team who work more closely together than the doctor and chairside assistant.

There are no two members of the dental team who work more closely together than the doctor and chairside assistant. This relationship also can have a tremendous impact on the success of the practice, since the doctor is the chief producer in the practice. Does it not stand to reason that the doctor's ability to produce is directly associated with his/her relationship with the chairside assistant? Yet, when I ask my seminar audiences and my consulting clients who the other producers are in the practice, hygienists are always mentioned, but rarely are the assistants credited with being producers. Why is that? Histori-cally, dental practice acts did not allow chairside assistants to perform many functions outside of suctioning and retracting tissue for the doctor. Because of the limitations, it was difficult to measure the productivity of assistants in the past, but that has all changed as many states now allow assistants to perform many intraoral functions, such as temporization and sealant placement. But before we look at the productivity issue, we need to better understand what comprises an ideal doctor/assistant relationship.

The dynamics that make a successful doctor/assistant relationship are many. Communication personality styles have the greatest impact on the relationship. The doctor and assistant must have a clear understanding of how gender differences affect communication. For example, men tend to focus their communication more on problem-solving, while women tend to focus their communication more on caring or relationship-building. If one or the other's needs aren't being met, a breakdown in communication occurs. In addition, personality styles will affect the relationship by influencing behavior and both verbal and nonverbal communication. Un-derstanding each other's personality style and motivators goes a long way in improving communication between the doctor and chairside assistant, as well as other members of the dental team.

Personality-assessment tools are readily available through practice-management consultants. Numer-ous books are available on the differences in gender and communication.

It's not all about communication, however, as several other dynamics will affect the success of the doctor/assistant relationship. First is the need for mutual respect between the dentist and the assistant. The assistant must respect the doctor's level of education and clinical expertise, and the doctor, in turn, must respect the level of the assistant's education or on-the-job experience and his/her clinical abilities. If respect is missing in the relationship, it is likely that the next dynamic also is missing - trust. Each must trust that whatever the other is doing is in the best interest of the patient and the practice. This is difficult sometimes when the dentist doesn't feel that the assistant is highly skilled. But the doctor must determine if this situation is a result of his not delegating tasks to the assistant that allow him or her to demonstrate the ability, or if the assistant requires additional training or mentoring.

For the assistant, trust may be difficult if he/she feels inferior to the doctor or doesn't feel any sense of commitment or ownership of the practice. In this case, the assistant must continually strive for personal and professional development by improving his/her knowledge and skills and by making a commitment to live by the mission, vision, and goals of the practice.

Honesty is another critical dynamic in the doctor/assistant relationship. Just as in a marriage, two people who live or work so closely together must communicate honestly with each other, even when that means giving negative feedback. Agreeing with or overlooking behavior that is unacceptable to either party ultimately will lead to resentment and lack of trust. This happens many times, however, because we believe the other person's feelings might be hurt or the person will become angry. Even though hurt feelings or anger may initially result from sharing information, looking for mutually acceptable resolutions or compromises to certain situations eventually will overcome the hurt or anger and make for a better relationship.

For example, if a doctor is unhappy about the manner in which the chairside assistant explains treatment options to a patient, he or she has two options. The first is to tell the assistant that he/she isn't doing it right and to do it him/herself. This approach will likely make the assistant resentful and hurt his/her self-esteem. The second option is to explain privately to the assistant that he/she would prefer to have the information presented in a different manner and why. The doctor then should communicate to the assistant how he/she would like the treatment options presented, ask for the assistant's suggestions about how to best accomplish the task, and give the assistant some key phrases and/or patient-education materials to use. This option lets the assistant know that he/she is not meeting the doctor's expectations, but gives him/her the criteria and tools to do so. The previous option will likely not motivate the assistant to take on new tasks or initiatives.

By the same token, if the assistant does not let the doctor know when certain behaviors make his/her job more difficult, resentment can again result, which leads to job dissatisfaction and de-creased productivity. A common occurrence at chairside is the struggle between the doctor and assistant for both to have visibility in the oral cavity. For example, what if the doctor constantly has his/her head or hand in the way of the assistant, so that the assistant cannot see where to place the suction tip? The assistant needs to let the doctor know about the problem, so that some modifications can be made to allow visibility and access for both doctor and assistant. Simply ignoring the situation and not trying to improve it again creates resentment and disinterest. The doctor and chairside assistant should sit down together frequently to ask each other how things are going, and what could be done to improve their performance.

While there is no "magic wand" that can be waived over the doctor and assistant to make them a happy and productive team, there are some very tangible and practical things that we can work on in our quest for excellence in dentistry.