A second word on referrals
Deciding to refer a patient to a colleague may come about for a number of reasons. Such reasons may also include concern that you are not getting on with this patient or that a personality clash can be foreseen. We all retain the right to not treat if we so elect, except in true emergency situations. Even then a patient may be referred if a suitable alternative source of treatment would be better and is readily available.
The main issue in all instances calls for an assessment as to whether it will it be in the patient's best interest that we place them in more expert hands.
The methodology is important. Do not say for instance, "I would prefer not to handle this case - I think you should find an endodontist, or other specialist." You wouldn't do this? But it happens!
Nominate the practitioner felt to be most appropriate and write a referral letter detailing the reason for the referral, enclosing a radiograph if possible and any clinical aspect of consequence. Do not leave it solely to the patient to hand over. They might not go, and of course curiosity ensures they will open it to see what you've said to the specialist! Always ensure that a copy of your referral letter is provided directly to the specialist.
Associated with this topic is a matter which concerns the ADAVB CROs at times. A patient is referred to a specialist practitioner for a specific matter within his or her area of expertise. In the conduct of this treatment it is not infrequent that other related treatment requirements may be discovered. Ethics demand that specialists should return the patient to the referring general practitioner who may well wish to conduct these treatments themselves, or on the other hand may refer elsewhere, either on his or her own preference or on advice from that specialist. At times we hear of referrals by a specialist to a specialist colleague without advice to the general practitioner, and even at times without the courtesy of a report.
Never make a telephone call referral to an oral surgeon for a required extraction without a written confirmation. The receptionist may get a tooth identification wrongly interpreted, the surgeon may make a wrong entry at a busy moment - and a major problem eventuates. Theoretical? No - this also happens.
One final tip - always check with the specialist in due course that your patient has followed up the referral. Cases have occurred where, for instance, the patient has not attended nd serious events have developed. Later the eneral practitioner is accused of not earlier dentifying a now extreme problem.
KEY LEARNINGS :
- We all retain the right to not treat if we so elect, except in emergency situations.
- Always ensure that a copy of your referral letter is provided directly to the specialist.
- Never make a telephone call referral to an oral surgeon for a required extraction without a written confirmation.
- As a specialist, if during the conduct of treatment you discover other related treatment requirements, ethics demand that you should return the patient to the referring general practitioner who may well wish to conduct these treatments themselves, or on the other hand may refer elsewhere, either on his or her own preference or on advice from yourself.
Bruce Drysdale
Senior Community Relations Officer and Professional Consultant, Australian Dental Association Victoria Branch
