October 1, 2001
by Peter Birek, DDS, MSc., Dip. Perio
In the February issue of Oral Health, Dr. Janice Goodman aptly outlined how to make a referral to a specialist. Today I will look at this issue again. This time, from the perspective of the specialist, who is on the receiving end of the referral. The two editorials could help the cause of the most important entity in this script, the patient.
I belong to the group of specialists who admits of welcoming referrals, any way they come. A specialist is one that complements the services of a family dentist, albeit at arms length. I view a referral as a vote of confidence in my abilities to address a problem or two while my staff is dealing with the patient in an exemplary way. My goal is to solve the problem(s) and return the patient to the referring dentist who will likely express gratitude for being referred to me. Both dentists involved in this exchange have high stakes in achieving this goal. That simple. Simple as it sounds, as many of my colleagues well know, it takes a lot to achieve this goal, particularly with a high betting average. The modus of referral is a decidedly important first step. Let’s learn from examples.
One of my best referring dentists writes a short note for literally every patient. The note contains maximum two paragraphs. Her letters should be a model for all. The note makes is clear why the patient was referred and what is the main question for me to answer. Somehow, this referring dentist manages to include the pertinent medical and dental histories and the (tentative) dental treatment plan as well. Her hospital-based education clearly is in evidence here. The letter arrives on time via snail-mail or via fax. A copy of the letter often goes to the patient as well, which is also a good idea. In my view this is the best model for referral.
Others use my referring pad that includes a few pertinent check-out radio buttons and a few line worth of free space for notes. This method is also very helpful, and in most cases it is just about enough. Writing legibly on this pad is a key to this kind of referral. In many cases this model fits the bill.
Another of my referring colleagues often writes very detailed letters because of the elaborate restorative plan that he is upon to embark on. The questions I have to answer are clearly stated and, by means of carbon copy to the patient, the information is timely shared with the patient. When he or she shows up in my office I can count on a well-educated person. We can go straight to the point, and address specific questions. Undoubtedly, it is a delight to deal with such situation. Such a comprehensive referral is time consuming though and it is unpractical in most routine cases.
The least desirable referral modus is exclusively by telephone. During a busy day, for both the referring and the recipient, my colleague will quickly summarized very detailed information about patients, including tooth numbers and such. While on the phone we are often interrupted by our staff for solving ongoing issues while our minds are still with the procedure we had to interrupt to take the phone call. In computer lingo this is called “multiplexing” and it is done far better by the silicone beasts than human brains. Both parties being busy we usually talk about several patients in manner of milliseconds. During our discussions I frantically take notes that will become part of the patient’s chart. This takes time and there is a great risk for error on both ends of the phone line. Often the referring dentist does not have the patient’s chart in front and speaks from memory –another failure prone human brain component. This scenario can and will often lead to errors. I don’t diminish the value of discussing cases over the phone or in person. In many instances, this is the best way to solve problems and address questions, particularly the complicated once. Most referral though, are routine and can be handled in a less intrusive way. If for no other obvious reason this mode of referral is bad for your blood pressure.
So in conclusion, here are some suggestions:
Use a written from for referral. Outline the problem and what is it that you wish the specialist to addresses. The more specific you are with your question(s) the more likely that you will get your answer(s).
Send this note in advance of your patient’s presentation at the specialist’s office. Fax is a good way to accomplish this – I can just hear the objection of one of my well respected colleagues’ to the use of the fax, a method that has little regard to patient confidentiality. He is right, of course. Given the fact that the medical profession uses the fax for sending almost all our lab results and communications of any sort, does not make it right either. The reality is though that this is an efficient way to have information reach you in time and without interrupting both parties involved. Securing a dedicated line for the fax is compulsory for this modality of communication.
If you have a special issue to discuss or a warning of some sorts that you do not wish to write down, a phone call is well substantiated. I would argue though that if an issue cannot be disclosed to your patient then you are at risk for other reasons – full disclosure is the norm.
There is one exception though when I suggest a phone call before the referral or writing any notes. This is a case where the specialist is given the chance of declining to see a given case. More often because it falls outside of his/her expertise or seeing the patient could lead to conflict of interest.
Modality in which we handle referrals has a great impact on treatment outcomes and is one of the most professional and least costly ways to promote your practice. You should see the facial expression of the patient presenting to my office when, after introducing myself I say: “I got an excellent letter of referral from your dentists and I know why you are here.” What I said is true, it is right and it is excellent promotion. Mostly, you can say that the referral was done In the Name (and for the benefit) of The Patient.
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