You graduated from hygiene school with the excitement and expectation that you will soon be making a difference by serving your community. Everything you learned about prioritizing your patient’s oral health needs is about to become your reality.
Then the expected is met by the unexpected when you are asked to make the office production goal your priority. You never even heard of a production goal. You are soon comparing your name on list of who produced more that week. Moral challenges and ethical dilemmas for new hygienists can be very stressful when you’re just starting out in your career. These challenges can even lead you to question your career choice.
Hygiene school: What we learned
The clinical philosophy we learned in school is in order to practice dental hygiene. We should be able to
recognize our role and responsibility in prevention of dental disease,
provide total oral health care and education,
demonstrate ethical and professional practice, and
deliver service based on the patient’s individual oral health and treatment needs.
That is the core of our philosophy as hygienists. For me personally, the biggest takeaway from dental hygiene school was something my instructor reminded me of constantly. That the person in my chair at that moment was the most important person in my life. Whatever care I expected that person to receive, my patient should receive.[Native Advertisement]
And that is what motivated me for entering into this career field—that I was a part of an organization that truly cared for every individual patient. That it didn’t matter what your background is, where you came from, who you are, who you’re not—none of that is of concern—but the main mission is to treat all patients to the best of our abilities. I truly believe no hygienist ever loses sight of that.
Unethical dilemmas: Reality hits
Maybe you’re asked to throw a few fives in a periodontal chart, give local anesthetic when the doctor is out of the office, or sell a toothbrush for a ridiculous markup over drugstore price.
No matter the type of ethical dilemma, all can be stressful and damaging to your image of dental hygiene. These ethical challenges make you realize how important it was not to fall asleep in ethics class. As a new hygienist, you might ask what you have gotten yourself into. After all, you never intended on getting into a career where you felt like you could lose your license at any time if you did not pay close attention. So, what happened? When did all this caring turn into selling?
History of care turned commerce
If you want a great read on America’s silent epidemic of oral disease and a brief history on how and when commercialization of dental practice developed I recommend Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America by Mary Otto.
As preventive therapies such as topical fluorides and sealants were developed, and community water fluoridation programs established, tooth decay started to decrease, which, in turn, decreased traditional dental work, and cosmetic dentistry began to thrive. There are many factors that helped commercialize dental practice—one of them being the 1982 decision of the U.S Supreme Court lifting restrictions on medical advertising. This helped create more competition in the marketplace and a way for providers to sell procedures to the public. (1)
Cosmetic dentistry is now a multibillion-dollar industry. It has helped influence the change in our image of the doctor-patient relationship to a buyer-seller relationship. But this is not business, as some would argue, and our goal should first and foremost be health care.
Understanding the doctor: It might not be the case
Before we start pointing fingers, we should recognize the fact that we do not pay the bills. Our services help provide for the bills, but personally I have no idea what the doctors’ costs are to run the office. I can only assume by seeing the cost of dental supplies that I need for my particular service that the cost is high. Bruce Peltier, a professor at University of the Pacific Arthur A. Dugoni School of Dentistry, explains in his article Commerce and Care, that demographic economics of dental practice have certainly contributed to the evolving ethical problems in the practice settings.(2)
Peltier noted, “In the world of modern American dentistry, the boundaries between caregivers and salespeople, customers and patients have become blurred. The cost and competition that go along with running successful private dental practices have contributed to an irreconcilable tension between selling and caring.” (2)
According to Peltier, overhead rates of 50% to 65% are common and acceptable in mainstream dental practice, but the actual numbers can be alarming. Besides ethical problems, this also creates social problems. For example, student loans contribute to the immediate need for a young dentist to work in a more desirable community where patients have good insurance and are able to pay out of pocket, creating a lack of access to health care in undesirable communities. (2)
There’s a need for dental hygienists to also help keep that practice running. It’s important to discern what an ethical dilemma is and is not because you want to be a part of helping that practice grow.
Facing an ethical challenge
What can you do when faced with an ethical dilemma?
Run as far away as possible. At least that is what our first reaction is. But maybe you could resolve this dilemma. Talking to the doctor may seem exhausting or useless, but it might be the first step you should take.
Come with solutions and not just complaints. Maybe you are unwilling to do certain things that you feel are unethical. But how can you help improve production and maintain your ethics? Find products that you believe in and request the doctor have a sales representative come in and share information on the product before presenting to your patients. Chances are that if you feel that way, there could be someone else in the office who feels the same way. If this is the case, the organization’s purpose should be established.
The doctor can interview the staff and discover the overall patient care standard. Once discovered, he or she can invest more time and resources in classes and training that align with the organization’s purpose. Of course, this is easier said than done, and I am not saying these are cures to the dilemmas you’re in—merely offering advice. Ultimately, it’s your decision, and no job is worth going against who you are and what you value.
Remember why you started
The need for hygienists is rising. The elderly, disabled, young, and poor are waiting for our care. Every hygienist is critical to help end America’s silent epidemic of oral disease. The understanding of the connection between oral health and the overall body along with the evidence is growing. Opportunities are arising for hygienists to work in areas other than traditional practice settings.
The future is bright and dental organizations need even more hygienists that believe in prioritizing people above profit. Your personal values and morals have a huge effect on how you react to ethical dilemmas. If you’re a person of faith like I am, then you know, after all, that it’s people that God calls His treasure. So, in the battle between people and profit, people should win every time.
Author’s note: Do nothing out of selfish ambition or vain conceit. Rather, in humility value others above yourselves, not looking to your own interest but each of you to the interest of the others. Philippians 2:3-4
1. Otto M. Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America. The New Press: New York; 2017.
2. Peltier B, Giusti L. Commerce and Care: The Irreconcilable Tension between Selling and Caring, 39 McGeorge L. Rev. (2016).
Marisa Stoffel, RDH, is a practicing clinician in Porterville, California, with experience in cosmetic and general practices. After serving four years of active duty in the US Army, Marisa went on to attain her degree in dental hygiene from San Joaquin Valley College in Visalia, California, in 2016. She is currently pursuing her bachelor’s degree in interdisciplinary studies at Liberty University.