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Unethical PC

Okay RDHs, here’s a sticky situation. Today my DDS asked me about recession changes on a patient I was seeing for my first time today. Since the pt. was due for radiographs today and not PC I compared the two PCs from the last two times they were taken; 2018(RDH-A) and 2019 (RDH-B)- each by a different RDH. My issue is that both charts are IDENTICAL, Probing, recession (Pt. did have a graft and 19B recession went from 5mm to 3mm), BOP, Furca, Mobility. I find that odd since I could do PC on the same patient one year apart and there with always be minor differences in PC, for example what was a 323, is maybe a 324 or 313 to 323, but I feel that is normal to have minor discrepancies, we’re human. I just found it odd that there are no changes, so I looked at a few others RDH-B has done from different months and most are the exact same from prev. year’s PC. I’m also finding RDH-B’s chart notes stating that an updated PC was done but there are no updated PCs saved. So I feel like RDH-B may be just copying down what the prev. PCs are and saving them as an updated PC. Seems really unethical and poor standard of care. I also realize that this is a huge accusation and I’m not taking it lightly and not even sure what to do? Do I ignore it? Do I speak with her, or should I bring it to the attention of the doctor. Also… the office manager is her cousin so there’s obvious bias there which is why I feel so at a loss. I’ve known RDH-B since hygiene school- she graduted the year before me and I’ve always thought she did good care, but this is really concerning to see. Also could this be considered fraud? If not, what would it be called? I so appreciate any thoughts on this matter.



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1 Answer

This is a sticky situation! Just like you, when completing a full periodontal assessment their are generally changes, even if it’s a discrepancy of my probing; they never seem to be exactly, 100% the same. I’ve gotta give you a high-five for your attention to detail!
 
I wouldn’t ignore this, especially when the chart notes state perio charting was completed, but there’s no perio chart to be found. I would speak directly with this hygienist. It is very important not to come off as accusatory, just curious as to why chart notes say a perio chart was completed, but cannot be found. Does this hygienist need help with the computer program and saving them? Be very careful when asking about perio charts being exactly the same. Perhaps ask if this hygienist doesn’t has enough time to complete perio charting and needs help. In other words, offer a solutions, instead of just accusing of taking shortcuts.
 
Depending on how this conversation goes and the outcome, is how you decide if it needs to be brought to the attention of the doctor. Perhaps a team meeting about standard of care, including perio charting, needs to take place. This way the hygienist doesn’t feel singled out.
 
I’m not sure if this would be considered fraud and/or neglect of care. Regardless, if what you think is happening is truly happening, it’s not good! Best of luck with this situation. Your patients should be proud to have you as their hygienist!

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