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QUESTION: We have an older RDH who refuses take x-rays, vitals, or other basics because it is "overkill." She does 15- to 20-minute prophys, and then patients want to know why their teeth fall out. She also refuses to be politically correct, demeaning the housekeeping staff with a few choice words. I won't even begin to go into detail about her other ridiculous rants. What boss in his right mind allows this? This RDH is not even a production center because eight patients a day with no frills is her limit. I sense extortion of some sort with the previous owner and now the new one. Does this fall under the description of a toxic team member? It’s certainly not fair that the rest of the team is expected to work and behave properly and not confront her. Is there anything we can do to convince the doctor to get rid of her?
ANSWER FROM JANET HAGERMAN, Janet Hagerman Consulting:
Oh my. Where to start? Your narrative does indeed fall under the description of a toxic team member. Please consider the following.
You say, "She refuses to take x-rays or vitals because it is 'overkill.' She does 15- to 20-minute prophys.” First, the practice should have an office policy manual and job descriptions outlining the specific duties expected of the hygienists and each team member. This should specify things such as radiographic protocol, vitals protocol, and periodontal and prophylaxis protocol. The office manual should also outline acceptable, expected, and professional office behavior. A good resource for this used by many health-care practices is the human resources company Bent Ericksen & Associates.
You say, “I sense extortion.” As to whether or not your sense of extortion is legitimate (a serious charge) or an unfounded suspicion on your part, this would also be a matter for an HR expert.
What boss in his right mind allows this? I would be curious to know what conversations you’ve had with your boss to inquire about the congruency of your practice philosophies. You really need to understand your doctor/owner’s vision for the practice and that's aligned with your own, and that it is something you can support.
She is demeaning to the housekeeping staff and other ridiculous rants. Is this within hearing distance of patients? If not then you may have to simply ignore this. Toxic personalities thrive on drama and attention to their negative behavior. That’s why they do it. Do not give in to this. And by all means, do not stir the pot by gossiping about this with your other team members.
One option is for you to go directly to this person. Ask to speak to her in private, in the office or off the premises. Start by asking for her help (yes, help). Tell her what you like, admire, and respect about her (find something, anything). Then let her know that you'd like to work as a team and ask if you can both agree about certain aspects of patient care. Asking for help doesn't put the other person on the defensive and opens the door to a peaceful resolution. This is basic conflict resolution protocol. If this doesn't work, you can take your concerns to management.
Anything we can do to get rid of her? Since you're not the owner, there is nothing you can do directly. Here's what I suggest. First, speak to the office manager. Schedule a conversation in private and let the OM know how much time you would like. Be prepared with valid and specific concerns, and how these affect your performance, patient care, the team, and the practice. Be professional, not emotional. Suggest thoughtful and positive solutions, such as job descriptions that hold everyone accountable for the same jobs or contacting an HR company for assistance. If you do not get the interest you feel this deserves, then have a private conversation with the doctor, and again, be prepared, respectful, professional, and ready with positive suggestions. Contrary to your “sense,” the boss may be totally unaware of this behavior, although I doubt it. Above all, be a problem-solver with suggestions for resolution, not a complainer.
In a situation like this, it's easy to get caught up in the drama. Don't do that. You must maintain your professional integrity. The best way to do this is to lead by example. Be the most professional, respectful, ethical person that you can be. Be your best and let your best be an example for the rest of the team. You might decide that this is not the team for you. But know that toxic people exist in many places and the sooner you learn to deal with them in a healthy and positive manner, the better for you and all involved.
You may ultimately decide that this is not the practice for you. In the meantime, develop your own team and leadership skills as you grow professionally.
I suggest your team hire a coach who specializes in teamwork, leadership, positive motivation, and overall hygiene performance.
ANSWER FROM AMY SMITH, Amy Smith Consulting, LLC:
From what you describe, this is a very stressful work environment, with a list of potential legal pitfalls facing your doctors. Without knowing more, I urge you to review the following questions to see if the answers lead you in any particular direction to help in solving this problem.
1. Does this RDH have a written job description? 2. Are there other RDHs on staff? If so, what are their feelings about this person? 3. Does she have an employment contract, and is there any documentation of her behavior? 4. Is she avoiding established office protocol? 5. Have you spoken to the doctors yet, either individually or as a team?
Quality of care
1. As an RDH she must take CE to maintain her license. Is she doing this? 2. States have different requirements for RDHs. Do you know what your state requires in terms of quality of care? If so, is she providing this level of care? 3. Is she afraid of new technology, the “old dog, new tricks” problem?
1. Has she been at the office so long that the doctor fears patients would miss her? 2. Is she planning to retire soon and the doctor is simply taking the easy way out and not dealing with her behavior? 3. Is the doctor afraid the RDH can’t get another job or that she needs the money? 4. Do the doctors exhibit similar unacceptable behavior? 5. How old are the doctors? Are they sympathetic because they are of similar age?
1. What happens if, after researching “toxic” behavior, you and your fellow team members decide to leave and sue the practice? 2. What happens if your housekeeping staff overhears her comments and sues for [name the violation]? 3. Is the doctor afraid of being accused of age discrimination if he lets her go? 4. Does the doctor realize he is also responsible for her maintaining her RDH license and acting according to state regulations? 5. Per her rants and raves, are there HIPAA violations being committed? 6. Does the doctor realize her behavior makes her a ticking time bomb for the practice, with potential liability on several fronts?
If you have not spoken to the doctors yet, I encourage you to do so as a team as soon as possible. Keep your comments concise and free of judgement. As always when there is office conflict that is not being addressed by the people in charge, it is ultimately up to you whether you choose to stay with this office. You can stay and accept the status quo, or you can look for employment elsewhere.
I wish you all the best and hope your providers take appropriate action to remedy what seems on the surface to be a volatile and liability-laden situation.
Don't be shy! If YOU have a tough issue in your dental office that you would like addressed, send it to [email protected] for the experts to answer. Remember, you'll be helping others who share the same issue. Responses will come from various dental consultants, as well as other experts in the areas of human resources, coding, front office management, and more. These folks will assist dental professionals with their various issues on DentistryIQ because they're very familiar with the tough challenges day-to-day practice can bring.
Originally posted in 2017 and updated regularly