Blast from the Past

Do you know how it was like to work at dental practice in the 70’s?

Once upon time there was a young nurse Jane. She was hard working and liked by the dentists. One day Jane moved to another town and applied for two dental nurse’s posts. She was offered a job from both of them but she chose a dental practice of four dentists. She was allocated to work with a 30 year old dentist Anna.
Anna was pleasant in behaviour towards Jane. Using kind words and voice when talking to her. Jane was very happy to have found such a good workplace.

But then – and not very long after Jane had started working there – became a day when everything changed. Jane had done something to upset Anna. It was something that Anna found completely incomprehensible.

“You are not a very good nurse, are you?! Not half as good as your predecessor! She at least cleaned my windows!” Anna said with a raised voice.

Jane wasn’t sure how to react. She was in shock about this sudden change in Anna’s behaviour. What windows did she possibly mean?

“I don’t understand what you mean?” Jane said cautiously.

“You… What… You… Don’t understand?!” Anna gasped.

“MY windows of course. My windows at home!” She added and stormed out of the room.

Jane was standing still for a while holding the instruments she was organising. She didn’t know she was supposed to clean dentist’s private windows as well. And probably on her own time as working hours she spent in the practice. That’s not what she signed for.

From this day onwards Anna treated Jane like garbage. Shouting and swearing at her even in front of the patients. Jane felt humiliated and insecure. Should she leave? She didn’t want to as nurse’s jobs were hard to find. So she stayed and the thing that made it easier to put up with Anna’s bullying was the practice’s other dentists’ support to her. They told Anna off many times but it made no difference whatsoever.

One morning Jane came to work and was walking practice’s long corridor to her surgery. Just when she was reaching to open the door Anna came out. She was sitting on her chair and rolling it forwards with her feet.

“Odd.” thought Jane, “What a peculiar thing to do…”

She watched Anna and her transporter chair rolling to the other end of the corridor where the toilet was. In she went and so did the chair without Anna getting up. Her long white saggy uniform got stuck between the door and it went up and down as Anna tried to pull it in without opening the door. Jane was amused and was wondering if Anna has completely lost it. Probably has.

The bullying – and the chair rolling – carried on for the next 4 months but Jane put up with it and did her job as well as she could. But she did not clean Anna’s windows. Nor her home. That’s where she drew the line. She was a dental nurse, not a servant!

Jane had been working for Anna for almost six months when Anna one day – at the end of the day – said to Jane

“Your employment will be discontinued in a fortnight.”

Jane was caught by surprise and wasn’t able to say anything sensible to Anna. But perhaps the question mark over her head was so obvious that Anna continued with a blunt voice

“I am pregnant and my due date is in a month.”

Now Jane was even more surprised but suddenly it all made sense. The saggy uniform, rolling with the chair, mood swings… It wasn’t because Anna was a loony. She was pregnant which now was obvious!

Jane felt angry and helpless. There was nothing she could do but to find a new job. Should she have known it was a temporary post she would have chosen the other job she was offered.

The working relationship between these two ladies came to an end. Whenever Jane saw Anna in town with her baby and husband she never greeted Jane or made any gesture she knew her.

Today is the day of the retirement for Jane but she remembers Anna and her bullying like it was yesterday. Even 40 years was not enough to forget or forgive and she secretly feels satisfaction over the fact that Anna is in a care home suffering from the Alzheimer’s.

“Karma” She thought when she closed the door of her work place for the last time.

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Part II: Just Another Day at the Office

Dental Revelations Blog-
“The most dangerous irony is, people are angry with others because of their own incomptence” – Jar of Quotes

Goodness gracious me! It has been too long since my last post. Hope you are still there and reading my posts!

It is time for the dentist’s point of view as a team member of dental practice.

At 8.45am

Oh no, not the Ms. Flumsy again” thought the dentist in the morning when she entered her surgery. Apparently her regular nurse was off sick or something as the practice manager (PM) had called in the temp. The one that had visited the surgery before.

The dentist was disappointed at the PM who clearly had not listened to her when she said she would not want to see this temp again.

You see, everything was wrong with this one. She had long and colourful nails. She had heavy makeup and strong perfume. She didn’t have any idea of assisting a dentist. She thought that using the suction was the most important thing as a nurse. And every task she did took ages to do. And she did them in wrong order. And knew nothing about cross infection control. And went for a cigarette when she should have called a new patient in.

Even though the dark cloud hanging above the dentist head was obvious she forced a smile and said with overly sweet voice “Good morning. How are you?”

“I’m good. And you? Okay?” replied the nurse with a wide cockney accent sending shivers down the dentist’s spine.

The dentist took a look at the day’s schedule. She could feel panic increasing the further she read the day’s treatment plans. Check-up, root canal treatment, crown work, extraction of wisdom tooth, check-up… And of course the time-table had been planned so that the dentist would have her regular nurse assisting her. It was a tight schedule but manageable when the nurse knew her business.

Nevertheless the dentist made a decision not to cancel any patients.

At 9.05am

The first patient was sitting in the patient chair with the bib and safety glasses on. She was about to have a check-up done.

“Oh, I didn’ remember yew ‘ave dis computer software! Don’ know ‘ow ter use it” the nurse says suddenly. The dentist sighs and gives a piece of a paper to the nurse to record her findings.

Then she begins her check-up routine and after checking the teeth with a mirror and a probe she reaches for the fiberoptic. Only it’s not there. She turns her gaze at the nurse who is at the front of the computer screen cleaning her fingernails and looking disinterested.

“Could I please have the fiberoptic?” she says with overly calm manner.

The nurse begins to go through the drawers but cannot find the device. The dentist waits. The nurse checks the autoclave.

“Gawdon Bennet! There are instrumun’s ‘ere from yesterday but its not ‘ere, innit.”

The dentist remembers that her colleague sometimes borrows the fiberoptic as the practice has only one of them. She asks the nurse to go and check from there. She examines the patient’s soft tissues meanwhile.

“Here i’ is” the nurse says triumphantly when she returns and waves the fiberoptic in the air and attaches it to the unit. The dentist notes that the nurse did not wipe it with disinfectant but she thinks it’s not that big deal especially now when she’s running 5 minutes behind the schedule.

She completes the check-up and sends the patient to the reception. Then she records her notes to the computer as quickly as she can.

“Exam” she writes. No time for all the gibberish.

Then she updates the chart from the piece of paper and checks the next patient’s records. A root canal treatment. She notices that the nurse has placed only the basic instruments on the tray and disappeared somewhere – probably for a ciggie. The dentist starts to collect instruments she needs and calls the patient in. She feels her blood pressure raising.

I really cannot be doing nurses duty, simply just cannot…” 

She is numbing up the patient when the nurse walks in.

“Oh, yew ‘ave already taken da patien’ in! Wasn’t da appointmen’ at 9.45?” 

The dentist does not reply and carries on with the treatment.

At 10.10am

The dentist is done with the filing of the root canals and is about to rinse the canals with the sodium hypochlorite for the last time. The nurse grabs the suction.

Silence.

The nurse places the suction back to its holder and takes it off again.

Silence. Not a sound.

The dentist realises that something is wrong and it cannot be fixed quickly. She asks the nurse to inform the practice manager about the malfunction.

Meanwhile she tries to figure out how she can finish the treatment without the suction. Luckily she wasn’t born yesterday and she takes a sterile gauze and places it close to the root canal treated tooth before she rinses the canal with the sodium hypochlorite. The gauze absorbs the liquid. She puts the calcium hydroxide to the root canals and seals the canals with temporary filling.

She escorts the patient to the reception in an intention to ask the PM what she has done about the suction but then she sees two practice’s regular nurses entering her surgery. She goes after them to see if they can fix the problem.

The nurses try to figure out why the suction is not working even though all the other suctions in other surgeries are fine.

The dentist checks the time. She’s now over 10 minutes late from the schedule. And the next treatment is crown work and that cannot be done without the suction.

The nurses need to return to assist their dentists and the PM needs to call in repairman. This means the dentist needs to cancel the next patient’s appointment. Zero income for the next two hours or so or until the suction is fixed. She walks to the reception to meet the patient and break the news.

The patient is not happy. He has taken two hours off work to come to the appointment. In a fear of losing the patient to another practice the dentist promises a discount from the treatment.

At 12.30pm

The dentist has tried to make a use of the spare time and goes through laboratory bills in her surgery. The repairman has not been in yet and it is soon lunchtime at the practice. Things are not looking good. She won’t be working until the late afternoon.

The surgery door opens and the hygienist pops her head in.

“Great, you don’t have a patient. Would you mind coming in to my surgery to check something? I have your patient in the chair and I think I found a decay on the lower right 6 and also something on soft tissues…”

The dentist walks in the hygienist’s surgery and greets the patient. She puts the gloves and face mask on.

Dentist: When did I do the last check up?
Hygienist: Err, yesterday…
D: And where was it that you suspect a decay?
H: On lower right 6. On the buccal side just below the gum line. There is another one as well but I think it is still in early stages…
D: Where is this?
H: On upper right 2, mesially. I don’t have a fiber optic so I couldn’t check it properly.
D: There is one in my surgery.
H: I know, but the turbine attachment is not working in my unit.
D: Ok then, let’s have a look…

The dentist takes the probe and checks the lower right 6 first while the hygienist stands on the nurses side and watches.

D: It seems to be ok…
H: It’s more subgingivally. You need to push the gum aside slightly.

The dentist feels this unpleasant feeling in her stomach when the probe sinks inside the tooth on the site hygienist mentioned.

D: Yes… yes, you are quite right. This needs to be repaired. Let’s see what we can do about it as it is quite deep… How about the other one. It was the upper left 2?
H: Upper right 2 mesially.
D: You are right it is decay but hard to say without the fiber optic if it’s advanced. I will check it on the next visit.
H: There is also something on the soft tissues I’d like you to have a look. It’s on the cheeks and under the tongue. Could it be lichen planus?

The dentist takes a look.

D: I can see what you mean. Hard to say for sure without biopsy but it does look like lichen.

Then she goes on informing the patient about lichen and asks the patient to book an appointment to decide what can be done to the lower right 6.

The patient looks shaken. Yesterday she got all clear and today she hears there is something seriously wrong with one of her back tooth plus something – possible cancer – on her soft tissues. She is not convinced when the dentist says there’s nothing to be worried about.

The dentist leaves the surgery and feels like going home. Or to the pub. This day is just one of those days she would like to forget. But she must stay to treat the rest of the patients – providing that the suction is fixed before this.

But it is time for a lunch first and she decides to go out for the full hour.

At 2.30pm

The dentist returns to the practice after the lunch break and chats with the receptionist before going to the surgery. The receptionist tells her that the repairman came in and did his magic in 15 minutes. The suction works again. Whoopty doo!

When the dentist reaches the surgery she can see through a glass tile window that the surgery’s lights are off. She opens the door and sees the unit lifted up to the highest position which the nurses do at the end of the day.

“What the hell?” comes out of the dentist’s mouth.

She walks back to the reception to see the PM.

“Why is my surgery closed?”

“Oh is it?” replies the PM and walks to the surgery.

“Oh lord” she says when she sees the surgery, “the temp must have gone home… I thought she went for a lunch!”

“I cannot believe this… this is unacceptable… did I or did I not tell you that I do not want to have this temp assisting me ever again?”

“I’m sorry but I did not have…”

“I don’t care. Your job is to keep the surgery running and I have seen only two patients today which is outrageous. And those two I have had to treat practically alone as the nurse is useless…”

“I understand. I see what I can do… I will try to reach the temp. Maybe she’s somewhere close by. I don’t understand how she thought she could go home.”

The dentist was fuming. She did not want the temp back but she did not have other options if she wanted to see the rest of the patients. But she soon learned that the temp was nowhere to be reached. The PM offers to come in to assist her.

“Well it’s better than nothing” she replies.

After she had seen the first patient for the check-up she was much calmer. She took in the next patient who had just seen a hygienist for a scale and polish.

When the patient opened the mouth she started to get annoyed again. The hygienist had not rinsed the polishing paste properly. It was in every between the teeth, this gritty blue paste.

“Seriously, who uses this much polishing paste!” she thought whilst her cheeks were getting red from the annoyance. You see, this wasn’t the first time. It happened with every patient who came to see her after the hygienist treatment. Soooo annoying!

At 5.30pm

When the day was over the dentist felt like she was the only one in this practice who knew her business. How was it possible that she was surrounded by so many incompetent people? She thought about changing jobs.

But would the patients follow? Some probably. Would it go from bad to worse? Yes possibly. Should she start her own practice? Definitely not, too much stress. Should she quit dentistry? Yes, it would be the wisest thing to do but she wouldn’t afford it as she’s still paying the student loan.

She went home fearing what the next day would bring. One thing she has learned in these couple of years of practising dentistry was not to check the next day’s patients. It was about minimising the stress. But there were so many other things she had no control over that sometimes just felt too overwhelming. Way too overwhelming.

 

 

Where it all started

Dental Revelations Blog-2382
Do you know your dentist behind the mask?

There was whispering behind the reception desk when I arrived to work.
“Morning!” I said cheerfully and carried on downstairs to get changed to my uniform.

I was a dental student working as a trainee and was very happy that I was earning little extra on top of my student allowance. There wasn’t many dental practices who took in trainees on those days to work as nurses until they graduated.

I put the uniform on and went upstairs to the reception before setting up my surgery. There were two nurses and a receptionist still whispering as the reception was filling up with that morning’s first patients. I was a newbie but understood that something was going on. Something that made the nurses very annoyed. I heard a word Harry.

One word and I knew what was going on. Eventhough I had been working as a trainee only for a month, I knew almost all the secrets the practice had. Harry was a dentist and a partner of the practice which meant he had lots of freedom to decide how things were run. He was the one who paid our wages. Or to be precise, he made the money that paid our wages but it was the other partner of the practice, Sally who run the payroll. She had no dental education and dealt with all the finances of the practice.

Harry and Sally had been lovers on and off many years and had had this dental practice in the heart of the city for a long time. It was a very popular practice amongst celebrities who had extensive cosmetic treatment done by Harry. Veneers, crowns, implants… yes, implants as well eventhough he wasn’t an oral surgeon. He was a regular dentist who never attended any annual dental show case to revise. Worrying combination.

Now back to that one morning when Harry had once again done something to stir up feelings at the practice.

Harry had arrived to work drunk. Wasted. Pissed. Drunk as a skunk. And it wasn’t the first time. One would think that a dentist cannot work when drunk as they use various instruments that can cause serious damage to the patient, nurse and the dentist himself if used incorrectly. The drill for example, that is used for drilling through the enamel of your tooth – the high-pitched one – rotates up to 400 000 rpm. Imagine it in the hands of a drunkard. Scary as hell in my opinion.

Did Sally or Harry’s colleagues stop him from treating patients? No they didn’t. Neither did I but my excuse is that I was a newbie and didn’t have any say on anything really.

On this particular morning Harry was guided by his trusted nurse Tina from downstairs office which he shared with Sally to upstairs where the surgeries were. Half way up the stairs Tina realised that on her own she’s not able to prevent him from falling so she called help and another nurse came to her aid. Together they managed to steer Harry safely upstairs.

“Not that way!” I heard Tina whisper to Harry who was entering a wrong surgery. Tina pushed Harry from his shoulder to the direction of his surgery where the first patient was already in the dental chair with safety classes and a bib on. Tina sat Harry down to his chair and put a face mask on.

This is as much as I could see what was happening. The patient was treated and she left without complaints. So did the next one. No-one ever complained that the dentist was drunk. Didn’t they notice? They must have as the smell was obvious.

Why didn’t Tina say anything? She had worked with Harry for ages and had seen everything that is going on. How did she put up with this kind of behaviour and malpractice? I got an answer to this question couple of years later (already after I had left the practice) when I found out that Tina was Harry’s mistress. Love is blind, it sure is in many ways.

One day Tina was off sick and I was told to replace her as Harry’s nurse. I soon realised that the nurse was expected to do much more than what nurses normally do. And that was probably how Harry could carry on as he did. When Harry wasn’t able to do the treatment, Tina did it. Thankfully Harry realised that I wouldn’t be able to replace Tina fully. I wouldn’t use turbine (the high speed drill). So he was only hungover on the day when I was working with him. Phew!

What I saw that day, I never forget.

Patient one.

A 70 year-old man who had had two implants done to replace lower front teeth. The plan was to have an implant supported bridge done once the implants were fully integrated to the bone. He came in to complain odd feeling and appearance of the area where the implants were done.

The patient had a very low alveolar bone and the mucogingival junction was almost on top of the alveolar bone. The alveolar mucosa had probably pulled the area where the surgery was performed and opened up the incision. As a result the alveolar bone was exposed.

“Should it be like this?” the patient asked.
“Well it shouldn’t!” I thought.
Harry examined the area quickly and slurred something vague. Then he sent the patient home until the next scheduled appointment. My eyes were as wide as saucers but of course Harry didn’t see them as he was out of the surgery already before the patient was.

Patient two.

A 50 something year old lady who had started a restorative treatment for her lower teeth. The plan was to restore the bite by two rather long bridge. The bridges were going to be cemented today.

Harry fitted the bridges. He had difficulties in getting them in place and he had to use a drill to file away some of the metal of the bridge. Eventually the bridges went in and the patient was asked to bite the teeth together only to notice she wasn’t able to. Only the very back teeth were in contact leaving the mouth quite open. Harry took the high speed drill and started to file away the ceramic.

He drilled off a large area of ceramic and part of the metal structure underneath. I wanted to close my eyes as he was destroying the beautifully shaped cusps of the bridge but then the mouth of the patient would have flooded. So I carried on watching this mad man’s way of cutting corners.

Once Harry was done, he cemented the bridges into their places.

“The bite does not feel right…” the patient said.
“It will feel odd at first. It needs some getting used to.” Harry replied and left the surgery.

The patient left the practice with horrid looking bridges and bite that was not anywhere close being balanced.

I was in shock after that day. I knew this wasn’t going to be my future work place. Not a chance. And it wasn’t.

 

If you are interested to read more on the subject in another blog, visit here.

Soap Opera of the Dental Practice

Sandbox-3239
Sometimes colleagues act like kids in a sandbox. On a frosty day.

The next time you lay back on dentist chair to have either check-up or treatment done, instead of concentrating on squeezing the handles in a fear of the pain and unknown, pay a close attention to the chemistry between the dentist and the nurse. If you are lucky, it can be very entertaining to watch and listen, and you forget the whole business of being nervous.

Ideal Dentist-Nurse Relationship

An ideal relationship between a dentist and a nurse is such where mutual respect prevails. They are two human beings, professionals working together for the patient’s health and earning their living. Both of them understand that one could not work without the other (at least without seriously compromising the safety of the patient) and especially that they could not work without the patient. They may be good friends that go beyond the working day.

Dentist-Nurse Relationship from Hell

It can be a sign of a non-working relationship if it is the nurse that calls your name at the waiting room of the dental practice. Not always, but often it is so.

Why? Because normally it is the nurse who has more to do after the previous patient than the dentist. The nurse spends long time wiping surfaces (should do), equipment, patient chair with a disinfectant, sterilizing instruments and preparing the room for the next patient.

Meanwhile the dentist chats with the previous patient, records the visit (takes couple of minutes, sometimes even less if the dentist is not bothered to write anything else than check-up and adding a sign that tells us professionals that nothing special was found) and checks the next patient’s treatment plan, which she should have done already in the morning. All this often takes less than what the nurse needs to do.

A revelation:

Some dentists feel that they are too highly educated to walk the aisle of the surgery to call the patient in. It is the nurse’s duty even if it meant that the dentist has nothing to do while the nurse is finishing with disinfection business (well, she can always have a cuppa while waiting).

Here is an example of this. I have witnessed a very highly educated specialist taking a seat in the front of the computer every time the nurse walks out to call the patient in. And when the nurse returns with the patient, the specialist is looking intensely at the computer screen looking all important and wise for few seconds and then almost like apologetically getting up (for not noticing that the patient arrived) and rushing to shake hands. This happened with e-v-e-r-y patient. Honestly.

But.

There are nurses that prefer to call the patient in from their own will. In this case any of the following won’t happen in the surgery. So keep reading!

Once you have taken a seat in the dental chair, the nurse gives you the safety glasses and a bib to cover you shirt and tilts the seat down. Here comes the next battle of the non-working relationship between the dentist and the nurse.

The ergonomics are very important in dental profession. It means early retirement or occupation change if you work in wrong positions for many years. In a good healthy working environment the dentist and the nurse have tried and tested the positions of the patient chair that is good for both of them (there will be exceptions e.g. when very large patient or heavily pregnant patient comes in).

So the nurse placed the seat down and sits beside you. The dentist washed her hands (hopefully) and puts on the face mask and gloves. She moves her chair beside you and starts adjusting the patient chair’s hight and tilting-angle. If you see the nurse moving hastily further away from you or standing up, you know they do not work well together. The dentist has just adjusted the seat so that the nurse is not able to find an ergonomic position.

If they have worked together like this for years, there is lots of anger and resentment from the nurse’s side. You might be collateral damage in this war, I’m afraid. If you feel like your mouth is filling up with water, you need to swallow it a lot (by the way, you can swallow it, it’s just a tap water, is a lie and I will write about it later on this blog) or it pours out from the side of your mouth on to the dentist’s lap, it might be a silent demonstration against the dentist’s tyranny over the position of the patient chair and the patient’s head.

Twisted, but that’s how it goes.

Other Signs of Non-Working Dentist-Nurse Relationship

  • they don’t chat while treating you
  • they don’t make jokes to try to ease you fear
  • you hear lots of clatter from the instruments (they are thrown in the tray)
  • they reply cynically to one another (normally nurse to the dentist and in non-funny way e.g. as soon as I have time)
  • they argue about treatment, equipment and materials. How they should be used or should they be used at all – the dentist wins these arguments as they are the higher educated ones and cannot be wrong. Especially not in the presence of the patient
  • the nurse sits like a statue after the dentist has requested for an instrument. Just before the dentist is about to renew his request the nurse rolls her eyes and slowly reaches for the instrument

Definite Sign of Non-Working Dentist-Nurse Relationship

The nurse walks out of the surgery.

Conclusion

Just imagine what it is like to work as a pair and the chemistry does not work. It is simply and utterly torture for all including the patient. And it is very common in dentistry.

If you, a dental professional recognised yourself from the above, please start working towards a better relationship. It starts from the respect.