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The employment of auxiliary personnel
O p inio n o f O ther Journals
The employment of auxiliary personnel m m At the turn o f the century the majority of den tists worked not only single-handed in the usually accepted sense o f the term, they had no surgery staff whatever. A butler, a boy in buttons, or a par lour maid according to the situation o f the prac tice would usher in the patient but would not re main in attendance. M ost practices had a workshop with a suitable staff but seldom were members of this allowed into the surgery. There were some practitioners who did all their own prosthetic work themselves and some still prepared their alloy for amalgam fillings. T he development of dental science and dental equipment through the years has brought about a revolution in the methods o f conducting a dental practice. Very few dentists, if any, would today wish to work without at least one dental surgery assistant and many consider that two are neces sary. In addition, in some practices a secretary/re ceptionist may also be employed, thereby enabling the surgery staff to be entirely free from other duties. Dental hygienists, to whom so much opposition was shown when they were first introduced, are now accepted by the majority o f the profession as being able to m ake a valuable contribution to the maintenance of the dental health o f patients and although they are employed mainly by hospitals, local authorities, and the armed forces, they work in an increasing number o f practices, usually on a sessional basis. A uxiliary workers o f the New Zealand School Dental Service type were introduced under pro test as strong as that which originally greeted den tal hygienists and this opposition has not yet com pletely disappeared. Provided they continue to work under the established safeguards they will undoubtedly become an essential part o f the den tist’s team. The employment o f hygienists and dental nurses o f the New Zealand type in dental practice in the United Kingdom, has come about only since the last war and there are dentists who see in it a threat to their professional interests, but to accept this would be to take a very narrow view o f the devel 242 ■ JADA, Vol. 76, Feb. 1968
opment o f the profession. T he extension o f dental science and the increasing demands by the public for more complicated treatment inevitably re quire that the dental surgeon shall delegate any work he can to someone less highly trained, pro vided that it is without conflict to the interests of the patient. This is in accordance with the evolu tion o f m edical science and medical treatment gen erally and the discussion should not be centered around the desirability o f employing auxiliary workers, but only the extent o f the work they may be allowed to do. Each generation thinks that the full scope of dentistry has been reached because it is not possible to know the developments that will take place in the future, but we may be quite sure that the more the dentist evolves into the wider concept of the stomatologist, the more will it be necessary for him to have auxiliary personnel to relieve him of work that can be done by others who do not need to accept his full responsibility. In the days when the dentist was the head of a small, indifferently trained and lowly paid staff he was, quite rightly, regarded as such. The more he becomes the leader o f a well trained, well paid, and responsible staff, the more will his work be recognised as having the value it really possesses. It is not a matter o f looking forward to the day when the dentist will sit at his desk doing little but controlling the activities o f a large staff o f auxiliary workers. This idea was an Aunt Sally put up at one time by those whose minds were at tuned to the past rather than to the future and it must not be assumed that they were all o f the old er generation: many were recently qualified and there is nothing more conservative than youth when its understanding is circumscribed by lack o f experience. D isease o f the teeth and jaw s, greatly increased by modern civilisation, will increase in incidence until a means is found o f combating the agents that cause it. Fluoridation will doubtless be o f as sistance but, valuable though it is, under presentday conditions its contribution is likely to be that o f lessening the increase o f dental decay rather than eliminating the disease. The United States o f Am erica, which knows more o f the beneficial effects o f fluoridation than any other country in the world and has a better ratio o f dentists to pop ulation than we have in this country, still holds the opinion that the fully qualified dental surgeon needs supplementary help and has a definite poli cy o f encouraging the use o f auxiliary personnel and is at present engaged on an investigation into the extent to which they could advantageously be
employed and the conditions under which they should work. In the U.S.A. the standing o f the dentist social ly and economically is much higher than in many other countries and one reason for this is that the profession has for many years sponsored dental health education and encouraged the use o f auxil iary help. There is probably no country in the world where dental treatment is more freely avail able to all sections of the population than in Great Britain but we are twelfth from the top of the den tist/population table. It is true that the opportuni ties to practise some of the more involved types of reparative treatment both within and outside the National Health Service are not sufficient but serious endeavours to correct this can be made. Among them are education of the public, an in creased number o f postgraduate courses, and pres sure on the M inister to give greater facilities for such work within the N.H.S., but all this must be accompanied by an extension of auxiliary help to the dental surgeon. Therefore, the profession it self, in its own interests as well as those of its pa tients, would do well to examine these matters in an objective and unbiased manner to see what
should be done. There can be no doubt that auxil iary workers will continue to be employed and to an increasing extent; if the profession does not take a hand in the development of their training and employment, this will be done by other au thoritative bodies. A positive approach can do nothing but good to the profession in every way including its standing with the public. We should not wait for the Gov ernment to educate the public to seek the best in dentistry, we should set the example ourselves and as we have around 14,000 public relations offi cers each working as a dentist in his surgery this is quite practical. But concomitant with this we have the duty of encouraging the development of the team behind the dental surgeon. This develop ment for the future is but an extension of what has taken place in the past and those whose powers of perception are not dimmed by a fog of fear will understand that it is inevitable and realise that it will be more advantageous for the profession to guide it than to try to hinder it. Reprinted w ith perm ission from th e October 17, 1967 B ritish Dental Journal.
243
The employment of auxiliary personnel m m At the turn o f the century the majority of den tists worked not only single-handed in the usually accepted sense o f the term, they had no surgery staff whatever. A butler, a boy in buttons, or a par lour maid according to the situation o f the prac tice would usher in the patient but would not re main in attendance. M ost practices had a workshop with a suitable staff but seldom were members of this allowed into the surgery. There were some practitioners who did all their own prosthetic work themselves and some still prepared their alloy for amalgam fillings. T he development of dental science and dental equipment through the years has brought about a revolution in the methods o f conducting a dental practice. Very few dentists, if any, would today wish to work without at least one dental surgery assistant and many consider that two are neces sary. In addition, in some practices a secretary/re ceptionist may also be employed, thereby enabling the surgery staff to be entirely free from other duties. Dental hygienists, to whom so much opposition was shown when they were first introduced, are now accepted by the majority o f the profession as being able to m ake a valuable contribution to the maintenance of the dental health o f patients and although they are employed mainly by hospitals, local authorities, and the armed forces, they work in an increasing number o f practices, usually on a sessional basis. A uxiliary workers o f the New Zealand School Dental Service type were introduced under pro test as strong as that which originally greeted den tal hygienists and this opposition has not yet com pletely disappeared. Provided they continue to work under the established safeguards they will undoubtedly become an essential part o f the den tist’s team. The employment o f hygienists and dental nurses o f the New Zealand type in dental practice in the United Kingdom, has come about only since the last war and there are dentists who see in it a threat to their professional interests, but to accept this would be to take a very narrow view o f the devel 242 ■ JADA, Vol. 76, Feb. 1968
opment o f the profession. T he extension o f dental science and the increasing demands by the public for more complicated treatment inevitably re quire that the dental surgeon shall delegate any work he can to someone less highly trained, pro vided that it is without conflict to the interests of the patient. This is in accordance with the evolu tion o f m edical science and medical treatment gen erally and the discussion should not be centered around the desirability o f employing auxiliary workers, but only the extent o f the work they may be allowed to do. Each generation thinks that the full scope of dentistry has been reached because it is not possible to know the developments that will take place in the future, but we may be quite sure that the more the dentist evolves into the wider concept of the stomatologist, the more will it be necessary for him to have auxiliary personnel to relieve him of work that can be done by others who do not need to accept his full responsibility. In the days when the dentist was the head of a small, indifferently trained and lowly paid staff he was, quite rightly, regarded as such. The more he becomes the leader o f a well trained, well paid, and responsible staff, the more will his work be recognised as having the value it really possesses. It is not a matter o f looking forward to the day when the dentist will sit at his desk doing little but controlling the activities o f a large staff o f auxiliary workers. This idea was an Aunt Sally put up at one time by those whose minds were at tuned to the past rather than to the future and it must not be assumed that they were all o f the old er generation: many were recently qualified and there is nothing more conservative than youth when its understanding is circumscribed by lack o f experience. D isease o f the teeth and jaw s, greatly increased by modern civilisation, will increase in incidence until a means is found o f combating the agents that cause it. Fluoridation will doubtless be o f as sistance but, valuable though it is, under presentday conditions its contribution is likely to be that o f lessening the increase o f dental decay rather than eliminating the disease. The United States o f Am erica, which knows more o f the beneficial effects o f fluoridation than any other country in the world and has a better ratio o f dentists to pop ulation than we have in this country, still holds the opinion that the fully qualified dental surgeon needs supplementary help and has a definite poli cy o f encouraging the use o f auxiliary personnel and is at present engaged on an investigation into the extent to which they could advantageously be
employed and the conditions under which they should work. In the U.S.A. the standing o f the dentist social ly and economically is much higher than in many other countries and one reason for this is that the profession has for many years sponsored dental health education and encouraged the use o f auxil iary help. There is probably no country in the world where dental treatment is more freely avail able to all sections of the population than in Great Britain but we are twelfth from the top of the den tist/population table. It is true that the opportuni ties to practise some of the more involved types of reparative treatment both within and outside the National Health Service are not sufficient but serious endeavours to correct this can be made. Among them are education of the public, an in creased number o f postgraduate courses, and pres sure on the M inister to give greater facilities for such work within the N.H.S., but all this must be accompanied by an extension of auxiliary help to the dental surgeon. Therefore, the profession it self, in its own interests as well as those of its pa tients, would do well to examine these matters in an objective and unbiased manner to see what
should be done. There can be no doubt that auxil iary workers will continue to be employed and to an increasing extent; if the profession does not take a hand in the development of their training and employment, this will be done by other au thoritative bodies. A positive approach can do nothing but good to the profession in every way including its standing with the public. We should not wait for the Gov ernment to educate the public to seek the best in dentistry, we should set the example ourselves and as we have around 14,000 public relations offi cers each working as a dentist in his surgery this is quite practical. But concomitant with this we have the duty of encouraging the development of the team behind the dental surgeon. This develop ment for the future is but an extension of what has taken place in the past and those whose powers of perception are not dimmed by a fog of fear will understand that it is inevitable and realise that it will be more advantageous for the profession to guide it than to try to hinder it. Reprinted w ith perm ission from th e October 17, 1967 B ritish Dental Journal.
243