By Cindy Isaak-Ploegman

Slander is defined as making a statement about another person with the intent to implicate them in a criminal activity, ruin their professional reputation, imply they have a terrible disease, or cast doubt on their chastity (Jerrold, 2001). Slander may cost individuals their client base, employment opportunities, promotion, and a good name.
 
 

In my opinion slander when mixed with power, is one of the most repugnant unprofessional behaviors. Foucault maintained that power is not an entity, but occurs only in relationship and cannot be exercised without the production of truth or knowledge (Foucault, 1980). This is why students are vulnerable to the power exerted by their educators (Nicholas, 1999), and clients are vulnerable to power by those who provide them with dental hygiene care and health education.
 
 

Educators need to be mindful to avoid creating or allowing a culture infused with slander between professionals or between students and instructors. Practitioners need to be careful not to speak disparagingly of those they serve: their clients.
 
 

We seem to be almost gleeful in our quest to know details of other's dirt and are so hooked on casting light on evil doing, but we seldom question the veracity of the information. Freedom of speech does not include a departure from professional conversation or the truth.
 
 

Even the grave offers no insurance from slander (Taff, 1988). When Whitney Houston passed away, we felt we were owed all the gory details not considering the implications to her family and friends of the speculations that were made.
 
 

The legal implications of slander involve a defendant needing to prove that the statements were not meant to be slanderous, but were expressions of fact or merely a difference of opinion, and the plaintiff is not required to prove harm was done (Jerrold, 2001). Even though a slanderer may not be found liable in a court of law, they may be found guilty of professional misconduct by their governing body, so statements of superiority, negativity, and commenting inappropriately about a colleague should always be avoided (Jerrold, 2001). Although escaping paying punitive action in the courts, a governing body still has the power to remove a professional’s license.
 
 

Other implications may include a professional's liability insurance that only covers the professional if the context in which the slander occurred included a professional service, and may not cover a professional choosing to speak disparagingly of a fellow colleague outside the context of client care (O'Hern, 1968).
 
 

The implications for the workplace are obvious, as power exists between those being bullied and those being employed. It has even gone full circle with employers now hesitant to provide an honest assessment of former employees in a reference due to the risk of being accused of slander (McConnell, 2000).
 
 

The antidote to slander is communication between colleagues and between professionals and clients to diminish potential misunderstandings. Clarification goes a long way to explain what we may assume is unethical (Broad, 1982) or suspect behavior or character.
 
 

And finally, what goes around comes around. Our slanderous comments may not definitively land us in a legal battle or cost us our licenses, but we know for sure we do not want to be on the receiving end of slander. If we are honest most of us have participated in slander: its gossip after five minutes. If you have been the victim of slander, you know it only leaves a nasty taste in your mouth. I look forward to hearing of your experiences and views on this topic.
 
 

References
 
 

Broad, W. J. (1982). NIH grapples with misconduct. Science (New York, N.Y.), 217(4556), 227.
 
 

Canadian Dental Hygienists Association. (2002). Code of ethics. Retrieved from http://www.cdha.ca/pdfs/Profession/Resources/CDHA_Code_of_Ethics_public.pdf
 
 

Crow, S. M., Hartman, S. J., Nolan, T. E., & Zembo, M. (2003). A prescription for the rogue doctor: Part I--begin with diagnosis. Clinical Orthopaedics and Related Research, (411)(411), 334-339. doi:10.1097/01.blo.0000068762.86536.c6
 
 

Foucault, M. (1980). Two Lectures. In C. Gordon (Ed.), Power/Knowledge: Selected Interviews and Other Writings 1972-1977 (pp. 78-108). Kate Soper, trans. New York, NY: Pantheon Books.
 
 

Jerrold, L. (2001). Sticks and stones. American Journal of Orthodontics and Dentofacial
Orthopedics, 119, 455-6.
 
 

McConnell, C. R. (2000). Employment references: Walking scared between the minefield of defamation and the specter of negligent hiring. The Health Care Manager, 19(2), 78-90.
 
 

Nicholas, B. (1999). Power and the teaching of medical ethics. Journal of Medical Ethics, 25(6), 507-513.
 
 

O'Hern, V. M. (1968). Liability insurance for slander and libel. JAMA:The Journal of the American Medical Association, 206(13), 2985-2986.
 
 

Taff, M. L. (1988). Libel and slander protection for the dead. another problem for medical examiners. The American Journal of Forensic Medicine and Pathology, 9(1), 1-4.

By Cindy Isaak-Ploegman RDH

Do we own our patients? The issue of patient stealing has become a recent concern due to fiscal restraint in the dental community nationwide. When you combine this with dental hygiene employment opportunities that are at a premium, the issue of patient stealing causes us to take a step back and examine what is unacceptable and what is appropriate in terms of informing patients of our new employment opportunity.

If pleasing a new dentist employer or attempting to be successful in an independent practice means resorting to unethical means to secure a patient base, we need to be careful to not to win the battle, but lose the war. The war, in this case, is our license to practice.

I find I agree with Maihofer (2011) only on one point, that it is unethical to go through a former employer’s charts to gain patient’s personal contact information to lure them to another dental practice. Firstly, it breaches confidentiality to use patient information in a context it was not intended for (Canadian Dental Hygienists Association, 2002) and secondly, securing the information for the primary goal of personal gain is unacceptable (Canadian Dental Hygienists Association, 2002). It is also unprofessional, the insinuation being that the patient will not be treated properly if they remain in the former dental practice. In other words, “Come to see me for the real dental hygiene care.”

We need to bear in mind that no one owns the exclusive right to offer dental health care to a specific person and patients are free to go to another practitioner at any time for any reason (Jerrold, 2002). For example, if an associate dentist left an employer and his/her patients followed, specifically those patients who had contact with the associate prior to the associate working with the employing dentist (relatives and friends), the former associate could not be found to breach the restrictive covenant that normally protects sharing a patient list (Jerrold, 2002). The issue is the permanence of the patient/professional relationship and the patients’ right to autonomy, that is, the right to choose where they receive their dental care.

Even though I may be convinced, I am the most caring dental hygienist in the universe, and I may even have a clientele that reinforces that thinking, I still don’t own my patients. I find the message of promoting me versus promoting care can be separated by a tiny subtle area.

When patients ask about former hygienists, I frame the conversations in an exclusively positive light, but divulge no information on where they currently practice, even if I know. If I shared this information I would be undermining my practice setting. I had one patient who expected me to provide him with my home phone number so I could talk him through his flossing, because the former hygienist did it; I declined.

We need not enable co-dependencies to satisfy our personal insecurities or resort to unethical practice to pay our bills. The primary ends and means of dental hygiene care are to put the patients’ interest first.

If patients perceive they are cared for they will remain in my practice. But some of my biggest fans, for whatever reason, have moved on. It may be due to location (they moved residences or changed jobs), the smell of my new soap, my red color uniform, my conversation, having to pay a delinquent bill, or they are tired of paying for parking. The list goes on.

It is easy to forget sometimes that we offer a fee for service and our relationship with patients is a tricky one. We need each other. But we are both fickle. We are free to change employment settings and patients are free to change their dental hygiene providers.

I would love to hear from you and your comments on this timely topic.

Cindy Isaak-Ploegman

References

Canadian Dental Hygienists Association. (2002). Code of ethics. Retrieved from http://www.cdha.ca/pdfs/Profession/Resources/CDHA_Code_of_Ethics_public.pdf

Jerrold, L. (2002). I knew him when. American Journal of Orthodontics and Dentofacial

Orthopedics, 121, 236-7.

Maihofer, M. (2011). A hygienist is stealing my patients! Journal of The Michigan Dental Association, 93(5), 24-25.

Originally posted September 17, 2010

By Cindy Isaak-Ploegman

Setting boundaries for relationships with patients is dicey when you are young or even when older and think of yourself as “on the market”. What if you are sexually attracted to your patient? Appropriate behavior toward patients is hopefully role modeled by your educators when training to be a dental hygienist, but I found that for the most part I had to find my professional legs on my own.

The issue of territoriality as outlined by Darby and Walsh’s (2005) human needs model, serves to complicate things further. The patient’s (member of the opposite or same sex) face is 12-14 inches away from your face. If you are like me, you find it difficult to stare at them and work at the same time, so you are mostly off the hook. However, you are still  required to guard your verbal communication and not “accidentally” touch an arm or leave instruments on his or her chest.

Some patients find the close face-to-face distance disconcerting and leave their appointment feeling as if something intimate has just taken place. The patient is unaware you are usually only focused on the fact that you are yet again running late, a common misconception.  I have in the past (when I was “hotter”) had this situation followed up by questions about my personal life, that I was not always prepared to answer.

Sleeping with the enemy

And the issue does not go away just because you are married and provide care for your spouse. Aside from the usual jocularity about “doing it” in the dental chair, if you choose  to continue to treat your spouse or someone you are sexually intimate with, you run the risk of being brought up on charges of sexual abuse. This is due to the imbalance of  power on the dental hygienist’s part that inhibits patients/spouses from providing a valid informed consent. One Canadian dental hygienist had her license revoked for five years by the College of Dental Hygienists of Ontario for providing dental hygiene care to her then husband (Lang, 2005).

(for further discussion see also Jerrold, 2001; Lang, 2005; Milestones, 2005; Peraya v. College of Dental Surgeons British Columbia, 1970; Regulated health professions act of Ontario, 1991).

However, the balance of power can be displaced to the patient. Sexual abuse among dental hygienists has not been the topic of a lot of research, but what does exist confirms it is an issue (Chiodo, Tolle, & Labby, 1992). A few years ago, one of my dental hygiene students was upset that an older gentleman patient had accidentally touched her breast. I sat with her throughout the remainder of her appointment with him so she would feel safe and her learning experience would not be hindered.

What if your patient finds you attractive and you don’t reciprocate? I remember working with a junior associate dentist who was young, attractive, and unmarried. He was stalked by one of his middle aged female patients. Eventually, he was so afraid of her that he insisted on the presence of one of the dental assistants during all interactions with her. This patient would follow him to his car, which I think you would agree is crossing the line.

I am interested to hear about your experiences or your comments. Looking forward to hearing from you, Cindy Isaak-Ploegman, friend to canines and canines.

References

Chiodo, G. T., Tolle, S. W., & Labby, D. (1992). Sexual advances by patients in dental practice: Implications for the dental and dental hygiene curricula. Journal of  Dental Education, 56(9), 617-624.

Darby, M. L., & Walsh, M. M. (2000). Application of the human needs conceptual model of dental hygiene practice. Journal of Dental Hygiene, 74(3), 230.

Jerrold, L. (2001). An affair to remember. American Journal of Orthodontics and Dentofacial Orthopedics, 119, 327-9.

Lang, R. (2005). More insanity. Oral Health, September, 3-4.

Peraya v. College of Dental Surgeons British Columbia, 1 C.C.C. 73 (B.C. S.C.)(1970).

Regulated health professions act of Ontario. (1991). Sexual abuse of a patient. Retrieved October 9, 2006 from http://www.e-ws.gov.on.ca/DBLaws/Statutes/English/91r18_e.htm

Revocation of a dental hygienists’s certificate of registration. (2005). Milestones, May, 4-5.

By Cindy Isaak-Ploegman

Have you ever given thought to what your clients are consenting to when they present for treatment? Have you ever had clients attend their regular 4 or 6 month recall appointment and when it was over they had received periodontal maintenance as well as flap surgery to remove the instrument tip that you were unable to fish out on your own? I have. And have you ever stopped to think about the fact that that client hadn’t signed a written consent form for either procedure?

It is interesting that informed consent for periodontal maintenance appointments are rarely explicit and written, but primarily verbal and implied. Patients’ consent is implied through being seated in the dental chair, offering updated information of their health history, or opening up their mouth (Downie, McEwen, & MacInnes, 2004). Consent may be withdrawn throughout the procedure either verbally or through a demonstration of discomfort (Downie, McEwen, & MacInnes, 2004) such as a groan, grimace, or white knuckles.

Continuing or beginning treatment without valid informed consent constitutes battery. For example, halfway through an appointment your client complains about TMJ pain during scaling or root planning. In this case a wise choice is to stop the procedure and offer to provide frequent breaks so they can close their mouth. One hygienist went ahead with debridement in spite of her client’s protests and ended up the object of legal action (Rogers et al. v. Faught, 2002).

The ambiguity on the part of whether informed consent has been provided by the dental patient is the reason communication skills are so crucial for dental health professionals. However, do you notice how little you expect of your clients with respect to proper communication?

For instance, do you ever talk during your treatment and ask your client a question expecting only a grunt in return? If you are like me you usually are so time conscious and concerned that if you remove your hands from their mouths and allow them to chatter, your precious appointment time will run out. This ambiguity of communication is taken for granted on the part of both clients and dental hygienists and has been the brunt of comedians’ jokes.

Aside from denying clients the ability to get a word in edgewise, have you ever noticed how indecisive some of your clients are about consenting to radiographs or fluoride treatments? Do you wait for a definitive “yes” before proceeding to place the film or tray in a client’s mouth? If they oscillate or hesitate, allowing them time to discuss their decision making process is more appropriate than trying to persuade them otherwise. It is ok to provide unsolicited additional information, however, it is a fine line between trying to persuade them to “see the light” and coercing them to go along with your professional recommendation.

What challenges have you faced with respect to gaining informed consent from your clients? Looking forward to your comments, Cindy Isaak-Ploegman

References:

Beauchamp, T. L., & Childress, J. F. (1994). Principles of biomedical ethics. New York: Oxford University Press.

Downie, J., McEwen, K., & MacInnis, W. (2004). Dental law in Canada. Markham, Ont.: LexisNexis.

Rogers et al. v. Faught et al. 212 D.L.R. (4^th) Ontario Court of Appeal 2002

Have you ever thought about the reason why you do what you do? Are you motivated by something other than caring?  I know for the longest time I gave no real consideration as to why I do what I do. This was until I was reminded a year ago by another researcher that I needed to be humble. I noticed that he was different; he was not here for himself but for others. What a refreshing concept! I was then reminded of an evidence based continuing education lecture on “the caring professional”, I was at that was poorly attended. It left me with the impression nobody cared.

But you do care. Does caring for patients need to compete with all the other complex mix of ideals that are not wrong in themselves, but distract you from your role as a caring professional? Does paying for your mortgage, attending to our childrens’ needs, or desire for promotion have to be at the fore when providing daily care for clients?

Isn’t it possible to take a break from yourself for that one hour, and focus on serving your client? When I started to think of serving clients instead of treating them, I realized how my philosophy of care had colored all my interactions with my clients and colleagues. I had been treating clients in a top down “I am the expert and you are the lucky recipient of my brilliance” manner. I even managed to make myself the focus of my conversation throughout the appointment.

Wouldn’t you love to be served rather than treated?

Doesn’t having something done to you almost ring invasive as opposed to having something done for you?  Ozar (1985) differentiates between three models of professionalism: the guild model, the commercial model, and the interactive model of care. In the guild model, the dental hygienist is motivated to keep the profession alive as if it were an entity. The dental hygiene profession is the focus and the dental hygienist makes all the decisions and provides the treatment for clients as he or she sees fit. In the commercial model, the dental hygienist is providing a product (dental hygiene treatment) and competes with other dental hygienists for the consumer or patient’s dollar. Decisions are made on which dental hygienist offers the best deal. The interactive model means exactly that, there is interaction with clients whom are autonomous decision makers that work together with their dental hygienist. The dental hygienist serves by offering their expertise.    

I love being served and when it happens I tell everyone I know what a great experience I had.

I am not suggesting replacing competent clinical care for a spa experience. Advertisements in local dental offices that claim to only have gentle dental hygienists make me wonder about all the undiagnosed 7mm pockets that will be referred to a periodontist five years from now.

What I am suggesting approaching a workday with a mindset of “How can I make everyone else’s life around me better”? This would include drawing 7mm pocket depths to my client’s attention.

If you served your clients you wouldn’t need to worry about them coming back; they would come back on their own. If you served your employers, you wouldn’t have to ask for a raise, they would provide it on their own. If you served your colleagues, you wouldn’t need to solicit their support, they would do it on their own. If you served your employees, you wouldn’t need to ask them to do anything, they would do it on their own. Servants are irreplaceable as they are rare.                                                                   

Cindy Isaak-Ploegman

References:

Greenleaf, R.K. (1998). The power of servant leadership. San Francisco: Berret-Koehler Publishers, Inc.

Ozar, D. (1985). Three models of professionalism and professional obligation in dentistry. The Journal of

the American Dental Association, 110(2), 173-177.

By Cindy Isaak-Ploegman

Have you ever felt like you just needed a hug? Has a situation or someone left you feeling needy and in need of reassurance, preferably of the physical variety? Dr. Jay Baruch (2010) relays his interaction with a lonely homeless heroin addict in a hospital emergency that asked him for a hug. After he granted her request, she caused him to regret behaving unprofessionally when she became clingy and expected him to listen to her problems longer than he was prepared to. His colleagues’ reactions were ones of horror when he relayed the incident to them because she may have contaminated him. Initially, he thought his choice was admirable, but was left thinking he had made an unwise choice, causing him to be concerned with infection control rather than his patient’s emotional needs.

Dental hygienists, similar to emergency room physicians, are not experts at addressing our patients’ emotional needs, but we know that our patients are just like us and in need of physical reassurance. Have you ever had an appointment where a patient poured their problems to you, which left you thinking “I should have reached out more to her, or offered some reassurance of hope”? We know health consists of spiritual and mental health as well as physical health, but dare we cross the line and actually do something to address health needs of this variety? Do we need to be psychiatrists to deliver hugs to our patients? You may consider your psychiatrist unprofessional for hugging you. Healthcare has become so clinical and specialized that sometimes we are unable to see the forest for the trees. Freshly debrided teeth are no replacement for reaching out to someone’s soul.  A patient may never know whether your dental hygiene treatment was well done, but they’ll remember that you cared about the when they really needed it.

We are so guarded about not being convicted of battery that we would never hug spontaneously without first asking, “Can I give you a hug?” Is it only appropriate coming from a female professional than a male professional? Who made that rule?  What about cross gender hugs?

I recently attended a resident Christmas party at a personal care home where my sister resides. My sister, my Mom and myself, sat at a table with two other residents who had no family in attendance. One very sweet lady shared that she is finding her transition to institutional life difficult. She said the food wasn’t as good as her own cooking, but what she missed the most was her family’s hugs. I challenge you as well as myself to give the gift of unprofessionalism this time of year and reach out to our patients’ “other” needs by granting them a hug when it is appropriate and needed. Afterwards, you may even feel better yourself.

Please let me know your experiences and I welcome your comments.

References:

Baruch, J. (2010). Hug or ugh? Hastings Center Report, 40(2), 7-8.