Can I as a hyginest refuse to take a patient's x-ray

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skrrrrrr in Victoria, British Columbia

91 months ago

30 year vet in Edmonton, Alberta said: No...you do NOT take xrays of a pregnant patient.

This is outdated knowledge based on unsound science. Disregard Edmonton Vet until she can show us a regulation or peer reviewed science to back up her claim. There is no law or regulation against xraying pregnant women.

If there is a pressing health concern that the doctor wants to investigate with an xray, you MUST take an xray. I might fire you if you refused in this situation, and the hygiene college would be right to reprimand you. If she is simply due for annual bitewings, it is OK to pospone xrays based on your office policy, but unwise for you to refuse to take the xrays if the doc and patient agree. Most times we do postpone xrays on a pregnant patient due to their own fears - there have been only a handful of times when xrays were needed immediately in my short career. I think the trend is towards scrapping the whole xray-postponement during pregnancy as science and technology march onward. The outdated regulations requiring lead aprons are slowly being rescinded also - esp in Europe.

Besides, we are hygienists. We can neither prescribe xrays, nor forbid them. Defer to the person with the authority and who is within their right to do so - the dentist!

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Suzanne in Terre Haute, Indiana

91 months ago

skrrrrrr in Victoria, British Columbia said: haha, Touché Suzanne ;) But then how is what you do different than Dental Assisting with the scaling module?

Assistants in IN cannot use hand scalers or an ultrasonic scaler. Just last June (08) they became eligibe to do coronal polishing and administer fl2 tx. I have heard there is legislation underway for them to be regulated to remove both hard and soft deposits above the gumline but I don't know how far along in the process it is. Hygienists are licensed to scale supra and subgingival calculus, root planing and curretage with or without anesthetic. I got on several websites for DA schools today out of curiosity and none of the curriculum had a scaling module. I wonder if they do allow it in the future how much theory they will have to learn and if they will have to be licensed as we are or if they will take a weekend course and get a certificate? Should be interesting.

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smile in Calgary, Alberta

91 months ago

30 year vet in Edmonton, Alberta said: No...you do NOT take xrays of a pregnant patient.

YES you do if required. Bacteria from infections enter the bloodstream, get in between the wall of the uterous & placenta & dislodge the placenta. The amount of radiation is insignificant to this senerio. informed consent is required though. If the patient is in for an emergency exam or is PAIN....the key word, you do what is required. LA is a different story, as there is no scientific proof that it crosses the placenta but there is know proof that it doesn't.

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skrrrrrr in Victoria, British Columbia

91 months ago

Suzanne in Terre Haute, Indiana said: Assistants in IN cannot use hand scalers or an ultrasonic scaler. Just last June (08) they became eligibe to do coronal polishing and administer fl2 tx. I have heard there is legislation underway for them to be regulated to remove both hard and soft deposits above the gumline but I don't know how far along in the process it is. Hygienists are licensed to scale supra and subgingival calculus, root planing and curretage with or without anesthetic. I got on several websites for DA schools today out of curiosity and none of the curriculum had a scaling module. I wonder if they do allow it in the future how much theory they will have to learn and if they will have to be licensed as we are or if they will take a weekend course and get a certificate? Should be interesting.

I was being tongue in cheek, of course. The scaling module is usually a CE course, but so far is only used in a couple states and provinces. Of course it doesn't cover the plethora of knowledge and advanced perio techniques that us RDHs get.

I am a bit unsure what you mean by 'diagnosing.' Do you mean you do not attempt to chart existing restorations, missing teeth, visible lesions on teeth (other than decay)? This is clearly within our scope in my province, and we had to do it on all patients in DH school (the school with 2 CDHA presidents as instructors, and some who sit on the board of examiners and board of eductors for all of Canada).

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hyg sucks in Richmond, Virginia

91 months ago

Diagnosing is telling the pt tooth #3 has a DO. You can chart it but you can't say the pt has it till the DDS said it first. I think dismissing the pt because of refusal of xrays is so OM. Some people have a fear of radiation, amalgam, and fluoride. The proper way to handle it is to tell the pt the benefits of x-rays and why we need them, have the pt sign an xray refusal letter, and document it in the chart. You should still ask at every appt. Most pt's will if they end up with problem. I had pt's bring their own water because of their phobia of water in the dental office. 20/20 had something on there about the water in the dental offices. Are you suppose dismiss those pt's too? Or what about those pt's who take x-rays but refuse to do tx because of cost. I guess they get dismissed too.

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hyg sucks in Richmond, Virginia

91 months ago

skrrrr aren't you suppose to be working? Prime example of OM on the computer instead of working. I guess being married to the boss has it's perks!!!!!!!!!!!!!!!!!!!1

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skrrrrrr in Victoria, British Columbia

91 months ago

hyg sucks in Richmond, Virginia said: skrrrr aren't you suppose to be working? Prime example of OM on the computer instead of working. I guess being married to the boss has it's perks!!!!!!!!!!!!!!!!!!!1

Today is the day of Remembrance for our fallen soldiers, so most Canadians are off of work. The difference is I don't get paid today, but all our staff does get paid full wages for this day off, which is a great perk for them.

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skrrrrrr in Victoria, British Columbia

91 months ago

hyg sucks in Richmond, Virginia said: Diagnosing is telling the pt tooth #3 has a DO. You can chart it but you can't say the pt has it till the DDS said it first. I think dismissing the pt because of refusal of xrays is so OM. Some people have a fear of radiation, amalgam, and fluoride. The proper way to handle it is to tell the pt the benefits of x-rays and why we need them, have the pt sign an xray refusal letter, and document it in the chart. You should still ask at every appt. Most pt's will if they end up with problem. I had pt's bring their own water because of their phobia of water in the dental office. 20/20 had something on there about the water in the dental offices. Are you suppose dismiss those pt's too? Or what about those pt's who take x-rays but refuse to do tx because of cost. I guess they get dismissed too.

There is significant discussion about this among dentists. It may be considered malpractice, and a letter of consent to decline xrays may not be enough to protect the doctor from a malpractice suit or discipline from the regulatory board. A doctor must dismiss a worker who refuses to maintain standard of care.

No Hyg should be diagnosing decayed surfaces and Rx Tx, I wanted to just see what Suzanne is talking about - sounded like recording existing fillings is off-limits in her view?

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exp in Massachusetts

91 months ago

skrrrrrr in Victoria, British Columbia said: This is outdated knowledge based on unsound science. Disregard Edmonton Vet until she can show us a regulation or peer reviewed science to back up her claim. There is no law or regulation against xraying pregnant women.

If there is a pressing health concern that the doctor wants to investigate with an xray, you MUST take an xray. I might fire you if you refused in this situation, and the hygiene college would be right to reprimand you. If she is simply due for annual bitewings, it is OK to pospone xrays based on your office policy, but unwise for you to refuse to take the xrays if the doc and patient agree. Most times we do postpone xrays on a pregnant patient due to their own fears - there have been only a handful of times when xrays were needed immediately in my short career. I think the trend is towards scrapping the whole xray-postponement during pregnancy as science and technology march onward. The outdated regulations requiring lead aprons are slowly being rescinded also - esp in Europe.

Besides, we are hygienists. We can neither prescribe xrays, nor forbid them. Defer to the person with the authority and who is within their right to do so - the dentist!

If your R.D.H. is a good employee, and refuses to do this, you would fire her? Why not make the Dr. and the Pt. happy and you two take this responsibility and have the Dr. take the x-ray....then if their is a problem with the PG pt. it is the Dr.'s shoulders of litigation....as the R.D.H. would write in her notes:" Dr.....took and X-ray of tooth....". This would help all three: Dr., pt. and R.D.H. With the way things are going in the Hygiene field, and many more pt's "willing to sue a practice" , this I feel is the best scenario....R.D.H.'s have enough to worry about just finding employment.....

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skrrrrrr in Victoria, British Columbia

91 months ago

exp in Massachusetts said: If your R.D.H. is a good employee, and refuses to do this, you would fire her? Why not make the Dr. and the Pt. happy and you two take this responsibility and have the Dr. take the x-ray....then if their is a problem with the PG pt. it is the Dr.'s shoulders of litigation....as the R.D.H. would write in her notes:" Dr.....took and X-ray of tooth....". This would help all three: Dr., pt. and R.D.H. With the way things are going in the Hygiene field, and many more pt's "willing to sue a practice" , this I feel is the best scenario....R.D.H.'s have enough to worry about just finding employment.....

Do Docs know how to take a good xray? I have never seen a doc take an xray to date. I would not want the docs I know taking an xray on me because the DAs and HYG are more skilled at this and far less likely to make errors/do retakes.

I think in the OP's case, it is time that the doc sat down with the RDH and show the scientific evidence and the regulations, and give her a 2nd chance. There needs to be a discussion about it, and to listen to what the RDH has to say about the situation. If she ignores this and continues to refuse to do her job duties, then what kind of employer would I be if I didn't fire her? If she was refusing to probe patients at every recall visit, she would get fired. If she was leaving subG calc and refused to change, she would be fired. In the xray situation it is worse than just refusing to do her job, though - it is misleading to the patient by implying it is unsafe to take xrays on a pregnant woman, which undermines the patient's confidence in the practice and understanding of the safety of xrays.

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exp in Massachusetts

91 months ago

skrrrrrr in Victoria, British Columbia said: Do Docs know how to take a good xray? I have never seen a doc take an xray to date. I would not want the docs I know taking an xray on me because the DAs and HYG are more skilled at this and far less likely to make errors/do retakes.

I think in the OP's case, it is time that the doc sat down with the RDH and show the scientific evidence and the regulations, and give her a 2nd chance. There needs to be a discussion about it, and to listen to what the RDH has to say about the situation. If she ignores this and continues to refuse to do her job duties, then what kind of employer would I be if I didn't fire her? If she was refusing to probe patients at every recall visit, she would get fired. If she was leaving subG calc and refused to change, she would be fired. In the xray situation it is worse than just refusing to do her job, though - it is misleading to the patient by implying it is unsafe to take xrays on a pregnant woman, which undermines the patient's confidence in the practice and understanding of the safety of xrays.

Skrrr, Many Dr.'s "do know how to take a good x-ray", they had to learn in school and many here in the states take there own if needed. What would your wife do if the R.D.H. and the D.A. were out sick....would you be taking the x-ray for her? Many, PG pt's and R.D.H.'s , I think , still feel that x-rays can wait til the baby is born....and I feel that if the Dr. insists on the film, he/she should take it if it is absolutely necessary to THEM. If you were a woman and PG you might think differently, but you are a man so....

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skrrrrrr in Victoria, British Columbia

91 months ago

.. so you're more likely to believe in make-believe, not science?

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exp in Massachusetts

91 months ago

skrrrrrr in Victoria, British Columbia said: .. so you're more likely to believe in make-believe, not science?

Dr.'s in BC ....you don't trust them to take x-rays? Does your wife know how to take them....I'm sure she does and well , I'm sure....so you didn't answer the question: if by chance the D.A. and R.D.H. were out sick and the Dr. was the only one to take the x-ray...then what happens? Do you take them? (Do you still have your license....)? Again, I reitterate, you are not a woman and so if it were you....wouldn't you rather wait if it could til after you had your baby?

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skrrrrrr in Victoria, British Columbia

91 months ago

My wife would be PO'd if a staffer decided to stand there and refuse to do a necessary xray. I'm not so sure she could get a good Post PA on her own, esp with our digital xrays. I don't think she's taken more than a handful since dental school 9 yrs ago - and in school they were usually taken by DAs.

I take dozens of xrays every week, being careful to keep the head aimed away from my gonads, and following the regs and CDA advisories. I also make sure the staff don't take more than 4000 xrays on my own teeth in one year, because that is the max allowable yearly limit ;) I would imagine taking only 1000 or so would be more than safe for a pregnant woman, even my wife, though so many xrays would never actually be done.

It is still up to the patient to consent, of course.

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skrrrrrr in Victoria, British Columbia

91 months ago

if the DA and all the RDHs are away from work, the office is effectively closed. If there is an emerg patient on closed days, I take the xray, or we bring in a DA. Doc can choose to do whatever she wants - she doesn't pull teeth nor place implants either (We have associate doc for that).

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skrrrrrr in Victoria, British Columbia

91 months ago

I'll just add that my wife and I think very highly of hygeinists. Never run into difficulty with them, and she has given them plenty of lattitude to practice as they wish. Generally, there has been nothing but amicable relations between the doc and the RDHs in her 9 years.

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30 year vet in Edmonton, Alberta

91 months ago

skrrrrrr in Victoria, British Columbia said: This is outdated knowledge based on unsound science. Disregard Edmonton Vet until she can show us a regulation or peer reviewed science to back up her claim. There is no law or regulation against xraying pregnant women.

If there is a pressing health concern that the doctor wants to investigate with an xray, you MUST take an xray. I might fire you if you refused in this situation, and the hygiene college would be right to reprimand you. If she is simply due for annual bitewings, it is OK to pospone xrays based on your office policy, but unwise for you to refuse to take the xrays if the doc and patient agree. Most times we do postpone xrays on a pregnant patient due to their own fears - there have been only a handful of times when xrays were needed immediately in my short career. I think the trend is towards scrapping the whole xray-postponement during pregnancy as science and technology march onward. The outdated regulations requiring lead aprons are slowly being rescinded also - esp in Europe.

Besides, we are hygienists. We can neither prescribe xrays, nor forbid them. Defer to the person with the authority and who is within their right to do so - the dentist!

Skkrrrr....I realize you post VERY frequently on all of these threads........

We do not take xrays--BWS routinely on our pregnant patients. Obviously, if there is an EMERGENCY or AN INFECTION and absolutely NECESSARY DENTISTRY HAS TO BE DONE FOR THE PATIENT in an acute situation, we will take a PA, but ROUTINELY, we DO NOT take xrays on our pregnant patients and if you were to ask all the dentists who work in our office the question, they would all say NO, we don't take routine xrays on pregnant patients. Regular cleanings during pregnancy is our routine in our office and IF any acute situation presented itself, we would advise the DDS and possibly do a PA if necessary.

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exp in Massachusetts

91 months ago

Skrrr, Your wife should take a course or you, can show her how to get the best angle for "all PA/bw's". Many Dr.'s take there own films/digital x-rays....what else does she feel that she can't do, and NEEDS an R.D.H. or D.A. for? It may be the case someday, so what will she do? Again, you are not a female...if you were a woman, I feel you would feel different about having an x-ray taken while PG. (The comment on your privates.....not necessary)...

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Suzanne in Terre Haute, Indiana

91 months ago

skrrrrrr in Victoria, British Columbia said: There is significant discussion about this among dentists. It may be considered malpractice, and a letter of consent to decline xrays may not be enough to protect the doctor from a malpractice suit or discipline from the regulatory board. A doctor must dismiss a worker who refuses to maintain standard of care.

No Hyg should be diagnosing decayed surfaces and Rx Tx, I wanted to just see what Suzanne is talking about - sounded like recording existing fillings is off-limits in her view?

I do chart existing restorations on new patients, along with missing teeth. I may even tell the pt dr will probably rec a bridge or a partial, or maybe a crown. But I'm leaving the diagnosis to him/her. That's as far as I'll go. Then afterward, I'm happy to explain the procedure or why it's rec.

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Michael H in Mercer Island, Washington

10 months ago

DAWEST in Boston, Massachusetts said: Thank you. The patient agreed to the x-ray and the doctor told me to take it but I refused as I thought the patient should not be exposed to x-ray.

If you are not allowed to diagnose, why are you refused to take xray on a patient when the doctor ultimately responsible? I hope you still have a job with the office, just saying.

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