e-mail Print Share

MyView: The most dangerous place on Earth: My dental office

March 21, 2016

By Susan Becker Doroshow, D.D.S.

Dr. Doroshow
With all of the rules and laws impacting it, you'd think that a dental office is the most dangerous place on earth. Our office environments are nothing like manufacturing plants or large hospitals, so how did we become ensnared in the same regulatory dragnet? Some of the mandates are necessary but nettlesome, and a few are critical and potentially lifesaving. But countless regulations intended to "protect" do little more than add to the cost of patient care while providing few tangible benefits.

For instance, a Skokie, Illinois, ordinance requires my office to undergo an annual "fire safety check," performed by a licensed contractor. The technician was literally in and out the door; my fire extinguisher wasn't as much as removed from its mounting.

Front exit light functioning — check.

Back exit light functioning — check.

All done, doctor, give me your check.

On the other hand, I'm thrilled when the Skokie Fire Department comes by unannounced for a random inspection. After several of these visits, the paramedics have become well-acquainted with my office and its layout and now know how to reach a patient as quickly as possible in the event of a medical emergency.  

Another annual chore is the testing of our reduced pressure zone valve. The penalty for noncompliance is steep — $750 per day. I have one device, so although the cost is modest — about $210 — it also requires coming into the office two hours early to avoid losing any patient care time.

The inspection of our dental X-ray unit every few years isn't that big a deal, and it actually has helped us improve our technique, thanks to the technician's valuable feedback on our exposure times and processing routines (yes, I'm still a wet film dentist). The annual registration fee paid to the state, however, is just one more dip into the coffer.

Top-of-mind in the category of critical and potentially lifesaving is basic life support training. At a course I took recently, I actually learned something new and now keep a pocket mask in my clinic coat and insist that staff does, too.

This office rule ensures that we'll be protected wherever rescue assistance is required. Wouldn't compliance be easier, though, if the basic life support renewal schedule matched our dental licensure cycle?

Have you looked at your thick, dusty material safety data sheet binder recently? I was stunned to discover that there's a material safety data sheet for both dental dam and tray adhesive.

Did that mean that twin threats in the business office, rubber bands and rubber cement, each needed a material safety data sheet? Taking no chances, I downloaded both of those five-page documents.

This might be laughable if the mass of information weren't such a dangerous distraction. But in an emergency, could we find the material safety data sheet we need? Could firefighters quickly identify the explosive or respiratory perils? And it defies logic to simply catalog materials without considering their quantity or use. The risks presented by the 6-ounce bottle of Trim II acrylic liquid in my office, used a few drops at a time, are miniscule compared to the danger presented by an industrial drum of that same liquid, just a half mile away at the Bosworth factory.

OSHA, EEOC, FTC, EPA, FDA, DEA, IRS, FRB, IDFPR — the list of agency acronyms is an endless string. Dentists are subjected to statutory regulation at every level of government.

The sheer volume of these regulations leaves all of us vulnerable to violating some of them through oversight or ignorance, exposing us to fines disproportionate to the actual harm done or the size of our practice revenues. And this bureaucratic quagmire is only getting worse.

At one time, I could simply focus on taking great care of my patients. But today, each new law is one more nail in the coffin of solo practice. Unintended consequence, I wonder? Or, with so much danger lurking within my office, was that the goal all along?

Dr. Doroshow is the former president of the Chicago Dental Society. This editorial, reprinted with permission, originally appeared in the September/October 2015 issue of the CDS Review.