This is a challenging scenario, common to many new dental hygienists. Let’s break down each question and address the situation thoroughly.

Scenario Analysis:

1. Ethical Issue or Dilemma?

• Ethical Dilemma: This situation presents an ethical dilemma.
• Conflicting Obligations:
  • Obligation 1: Patient Care: Providing thorough, comprehensive care, which includes full mouth probing, within the standard of care.
  • Obligation 2: Time Management and Professional Boundaries: Maintaining a reasonable schedule, adhering to appointment times, and managing workplace dynamics.
  • The hygienist is being forced to choose between proper patient care, and time management.

2. Type of Law:

• Civil and Administrative:
  • Civil: Patients could potentially file a civil lawsuit for negligence or malpractice if they experience harm due to inadequate care (e.g., missed periodontal disease).
  • Administrative: The state dental board could take administrative action against the hygienist for violating the standard of care or professional conduct guidelines. This could involve disciplinary actions, such as fines, suspension, or license revocation.

3. Right Course of Action and Justification:

• Right Course of Action:
  • Address Time Management Immediately: Communicate with the office manager or dentist about the scheduling issues. Request adjustments to the schedule, such as longer appointment times or fewer patients per day.
  • Confront the Assistant: Have a private, professional conversation with the assistant about her lack of support. Document instances of her negligence. If necessary, involve the office manager or dentist.
  • Proper Patient Care: Under no circumstances should the standard of care be lowered. Full mouth probing is a standard of care. PSR screenings are not a replacement for full mouth probings.
  • Prioritize Patient Needs: If running behind, communicate with patients and explain the delay. Do not sacrifice quality of care.
  • Documentation: Meticulously document all patient interactions, including any deviations from the standard of care and the reasons for those deviations.
• Justification:
  • Standard of Care: Dental hygiene practice is governed by professional standards that require thorough patient assessment and treatment. Full mouth probing is essential for accurate periodontal assessment.
  • Patient Safety: Compromising patient care can lead to misdiagnosis, delayed treatment, and potential harm.
  • Professional Ethics: The ADA and ADHA Codes of Ethics emphasize patient well-being, professional integrity, and adherence to the standard of care.
  • ADA Code of Ethics: The ADA Code of Ethics emphasizes patient autonomy, nonmaleficence, beneficence, justice, and veracity. These principles are being violated when proper care is not given.
  • ADHA Code of Ethics: The ADHA code of ethics stresses the responsibility to provide quality patient care, and to maintain professional work environments.
• References:
  • American Dental Association (ADA) Principles of Ethics and Code of Professional Conduct.
  • American Dental Hygienists’ Association (ADHA) Code of Ethics.
  • State dental practice acts and regulations.
  • Wilkins, E. M. (2017). Clinical practice of the dental hygienist. Lippincott Williams & Wilkins.

4. Missing Information:

• Office Policies: Are there established protocols for scheduling, patient flow, and assistant responsibilities?
• Dentist’s Awareness: Is the dentist aware of the scheduling problems and the assistant’s behavior?
• Patient History: The patient’s full medical and dental history is needed.
• Assistant’s Reasons: Why is the assistant not helping?
• Office Staff Communication: What is the general communication between staff members?
• Previous Patient Complaints: Has this office had similar patient complaints?

5. Possible Consequences:

• Patient:
  • Delayed diagnosis and treatment of periodontal disease.
  • Increased risk of oral health problems.
  • Loss of trust in the healthcare provider.
  • Potential for legal action.
• Healthcare Worker (Hygienist):
  • Disciplinary action from the state dental board.
  • Civil lawsuit for malpractice.
  • Damage to professional reputation.
  • Job loss.
  • Emotional distress and burnout.
• Healthcare worker (Assistant):
  • Job loss.
  • Reprimand from the state dental board, if certified.

6. Other Thoughts and Feelings:

• This situation highlights the challenges faced by new graduates in balancing ideal care with real-world constraints.
• It underscores the importance of effective communication and teamwork in a dental practice.
• It emphasizes the need for dental professionals to advocate for patient safety and ethical practice.
• The office needs to be aware that unhappy patients, will find a new dental office.
• The dentist has the ultimate responsibility for the actions of their staff.