Frustrated Woman

Thursday Troubleshooter: How should team handle beloved dentist who has terrible skills?

June 19, 2014
This sweet dentist does not realize she's forcing patients to leave the practice due to her poor skills

QUESTION: I am a part-time hygienist in a solo practice that has been treating patients with high-quality dentistry. The dentist recently sold the practice and the new dentist is very kind and gentle, just like the previous dentist. The employees all like her very much, as do the patients. However, her dentistry is terrible. Several patients have returned because the fillings were not done right. The assistant has made some suggestions, but the dentist really needs to improve her skills.

We are all afraid that this wonderful practice will deteriorate due to her poor dentistry. What, if anything, can we do to encourage her to improve her skills?

ANSWER FROM ANDY CODDING, AndyRDHNetwork: This is a tough question to answer because I don't know how long the dentist has been practicing or how the restorations are failing. Are they not bonding? Bad margins? I can think of a few options. I would suggest attending some type of clinical advancement course for the dentist. There are several available, such as Las Vegas Institute for Advanced DentalStudies. It would be a great way to bond with her employees, receive CE credit, and improve her skills. Another option would be to call the sales representative for the bonding and/or restoration material you use. It's possible this dentist previously used different material, and all products are not created equal. Perhaps a visit from the sales rep for a lunch and learn would be a tactful way to approach it. Another alternative would be to just approach the dentist individually and ask, "It's almost time to order new bonding material. I've noticed that we've had some issues with restorations not bonding properly. Do you think we should try something different?" This subtle message is an indirect way to point out some issues without being confrontational or insulting to her clinical skills. Good luck!

ANSWER FROM ALANNA IVY, RDH, BS, Lead Hygiene Productivity Coaches with Inspired Hygiene, Inc., [email protected]
My first question is, how did she receive the suggestions made by assistant? If she took them openly, she may heed them and make changes. This mature response may indicate she is actively working to improve her skills and is well on her way to success. If she took them with resistance, then the problem is not only her skills, but also her lack of leadership and willingness to be on the path to success, which requires constant learning, growing, and changing.

Second question – Does she have a mentor? I think that often we "hear" things more clearly when they come from the "top," or from a source we hold with high regard. Sometimes the mere chain of command or boss/employee relationship blocks effective communication. If she has a mentor, then you could encourage her to discuss any challenges she’s having with that person and hope she brings up the skill piece on her own.

Last question ­– Why is her dentistry "terrible"? How can the team help? Does she have key components such as a schedule with enough time, adequate equipment/instruments, assistants who take quality impressions, radiographs, etc? And, can she see? I know that sounds silly, but my dentist had a decline in his quality of work at one time, and come to find out, he needed a new prescription and adjustment to his loupes. Good luck!

This situation is a delicate one. First, if the new dentist is indeed a “new” dentist, just out of school for a few years or so, then the difference may be in lack of experience and she will get better as she takes CE for advanced learning and gains more experience. In that case it is not a philosophical excellence issue. The team members can “catch her doing something well, almost well, or not entirely wrong” and give her positive feedback — they should compliment the work. What gets acknowledged gets repeated. Even if it is a philosophical excellence issue, this same technique by the team will still be good.

ANSWER FROM JAMIE MARBOE, RDH, BS, Lead Hygiene Productivity Coaches with Inspired Hygiene, Inc., [email protected]
We had this same scenario when Dr. X, who I worked with for 24 years, had his fresh-out-of-dental-school son join our practice. We however, were lucky enough to have his father able to talk to him. The son ended up shadowing his dad every chance he had. But if there is no other dentist in the office, I would say approach it the same way that we approach hygienists who aren't providing good hygiene care. Restorative is easier on some levels to address because a filling that has fallen out, or an open margin on a crown, is easy to see. However, with that being said, it is also sensitive due because she is being called on it and she is signing the paychecks!

Maybe someone on the team whom she feels safe with could approach her. This person could say, "Why do you think that we have had so many fillings fall out lately? Should we etch longer, or is there a different material that our dental rep can recommend?" or "Doctor, I was wondering if it would be a good idea to start taking a pre-seat BWX before we cement the crown, just to make sure that it fits perfect and can still be adjusted?" This would at least get the doctor’s wheels moving in the right direction. Otherwise, honesty with a huge amount of “gingerness” coming from the right person might work. I guarantee she is thinking about it every time she’s having to replace at no cost any of her work. This is a tough one all the way around. Good luck!

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