December 1, 2003
by Rich Mounce, DDS
Excellent communication is the hallmark of a productive relationship between specialist and general practitioner (GP). As an endodontist since 1991, I have experienced both successes and failures in my relationships with my referring colleagues and I would like to share what strategies and concepts have worked well (and give light to events which perhaps haven’t worked well) to enhance this communication. My purpose is hopefully to stimulate the reader to enrich their professional relationships in both directions (specialist to GP and vice versa) for the benefit of all involved, most importantly, our mutual patients.
Aside from a friendly and efficient staff, excellent written treatment summaries and top quality clinical care, the following specific talking points are offered for consideration. While the examples given illustrate endodontist-GP relations, they can be easily extrapolated to all other specialties.
It is vital for the two parties to know each other. Misunderstandings can easily occur because the endodontist and GP are, for all practical purposes, strangers. For example, if a general practitioner referring for the first time expects the new endodontist to provide a particular service (a build up for example) without asking, disappointment can result. At a minimum, one of the two parties calling the other in advance of sending a patient can pay major dividends in terms of creating efficiencies amongst other significant obvious benefits. Having the endodontist do the build up after completion of the root canal, if so asked, for example, can save everyone time, allow the patient to potentially have fewer injections and put the patient less at risk for a subsequent perforation, etc.
In addition, relationship is everything. Being available the same day to take phone calls, a willingness to meet for meals to share information, do informal “drop in” consultations in person, etc., all build rapport allowing for more effective communication when a challenging situation arises. Knowing the other doctor’s treatment philosophy can of course enhance excellent patient communication and allow both parties to know if working together is a “good fit.”
Tell the other party if there is an iatrogenic issue with the tooth, a difficult patient or a clinical challenge, which may not be immediately apparent. Sending tooth with a separated file or perforation, etc. without telling either the specialist or patient is not conducive to good communication, patient care, or the best clinical result. Trust is vital in professional relations. Simply telling the endodontist what has gone wrong (and vice versa) when it happens creates a bedrock of mutual respect which can only deepen and ultimately provides a clinical learning experience. Oftentimes the person creating the misadventure can learn how not to repeat the event and also learn from its management.
Take nothing for granted, make no assumptions. One GP may desire the endodontist to treat every tooth deemed to need root canal therapy without wishing to be called. In other words, this referring doctor may turn over a complete set of x-rays, teeth numbers of which the doctor is suspicious endodontics may be needed and simply ask the endodontist to treat the patient as indicated (assuming needed communication about restorability, etc. is exchanged). Other GPs only want treatment on the specific tooth referred, by prescription, without exception. With this second referring doctor, if the endodontist discovers that the offender is a different tooth from the one referred (or that there are two teeth involved) it is expected that the endodontist will refer the patient back with a written report first (even if the patient is in pain) and delay treatment, until the endodontist’s findings can be examined and a second referral made. In other words, expectations about how the specialist-GP relationship is to be conducted can vary considerably. On both sides of the relationship, especially at the start, it is of paramount importance for each party to voice any treatment philosophies that might differ from that commonly practiced.
Show your appreciation for the other party. My impression is that many referring doctors ultimately change specialists, when they do, because they don’t feel appreciated. We all seek to be recognized for all the good things we do and be appreciated for the care, concern and competence that we demonstrate. Calling a referring doctor to thank them for their kind referrals and acknowledging excellence when it’s observed goes a long way to giving the doctor on the receiving end positive kudos that they would most likely otherwise not receive. In return, just saying thank you for the good work a specialist does, especially in a challenging situation, means just as much.
Ultimately, we, specialist and GP alike, are all on the same team. Our team is devoted to helping people improve the quality of their oral health. The long-term success of our profession is not a zero sum economic game where one group wins and others lose. In fact, the more skilled and compassionate we all are creates greater demand for dental services across the board. A rising tide lifts all the boats. Professional exchange of information and ideas about new technologies and materials between specialists and general dentists brought about by excellent communication and cooperation helps create a productive win-win, most vitally for the patient.
Dr. Mounce is in private endodontic practice in Portland, OR. He has been published extensively and lectures worldwide.