Factoring ego-economics into the referral process

Referring a patient to a specialist can be a rewarding experience for the general practitioner, the specialist, and the patient. By just observing some simple guidelines in the referral process, the general practitioner will have a happy patient, eager to return to the practice for continuing care. At the same time, the GP will develop a rewarding professional relationship with the specialist that will continue to serve them both well in the future.

David L. Hoexter, DMD, FACD, FICD

Referring a patient to a specialist can be a rewarding experience for the general practitioner, the specialist, and the patient. By just observing some simple guidelines in the referral process, the general practitioner will have a happy patient, eager to return to the practice for continuing care. At the same time, the GP will develop a rewarding professional relationship with the specialist that will continue to serve them both well in the future.

The general dentist also can take great personal satisfaction in making a correct assessment and ensuring that the patient receives the best treatment. This will create a positive impression on the patient, who likely will tell his/her friends, family and colleagues that "my dentist wants me to have the very best in dental treatment!"

Realistically, today`s economic influences play a certain role in referrals. Specialists frequently hear general practitioners lament: "We are losing income by not performing the treatment in my office. If we refer patients, we are afraid we will never see them again."

Patients also have their own concerns about being referred. They come to you for guidance. If they are not happy with the referral, they may complain: "I`m going to lose all my teeth! Why didn`t my dentist tell me that?"

If patients feel that they should have been referred to a specialist sooner, they may be upset and threaten to sue. Some also try to pressure the dentist into performing specialty treatment because "a specialist charges too much and you can take care of it just as well."

Given the fragile egos involved in the patient-referral process, when should a general practitioner refer to a specialist? What is the best way to handle these referrals? The guidelines for positive patient referrals to a specialist are simple. As in every other aspect of life, communication is key.

1) The general dentist must gain the respect and trust of the patient.

The patient must feel that you are doing the right thing by referring him or her to a specialist, and that you have the self-confidence, knowledge, and assurance to make a correct assessment about the need for a referral. The general practitioner and the specialist should work together to gain the patient`s trust and confidence.

2) The general practitioner must know when treatment needs to be referred to a specialist.

The GP`s diagnosis and early detection of problems can help prevent the advancement of periodontal disease. The referring dentist should understand the purpose of a periodontal specialist. The periodontist is trying to achieve predetermined goals - whether by nonsurgical or surgical techniques, with implants, regenerative techniques, or by esthestic enhancement - to maintain optimum oral health. If you have confidence and trust in your specialist and promptly refer patients for treatment, your patients will appreciate it and thank you for doing what is in their best interest.

3) The general practitioner must know the personality style and quality of work of the specialist.

The specialist must be trustworthy and keep the referring dentist informed of treatment. The generalist and the specialist must be able to establish a good rapport and develop a good working relationship together. There must be a "symbiosis of care," so that the transition process is seamless from the patient`s perspective.

4) The general practitioner should clearly communicate the desired terms of treatment to the specialist, as well as plans for the patient at the conclusion of treatment.

Make it clear that you wish to perform treatment maintenance or alternative treatment, and voice any concerns that you may have regarding the patient`s treatment. The patient can be alternated between doctors for maintenance appointments, since periodontal patients usually need at least four maintenance visits per year. In our office, we frequently do two of the maintenance treatments, while the general practitioner does the other two. With some patients, we do three and the generalist does one. Other factors also can impact the maintenance schedule. A patient may not want to go back to the specialist for economic reasons (i.e., the cost may be prohibitive). Patients are a part of the team and have choices in the decision-making process. That is why it is so important to communicate clearly with each other in these "ego-economic" sore moments.

5) Concentrate on the overall picture to achieve what`s best for the patient.

The treatment plan must be in writing, and channels of communication must be kept open. Feedback is essential. By presenting an overall treatment plan, patients understand their responsibility and become part of the team. Patients always will appreciate, be impressed with, and respect quality care performed by a "team." Don`t ever underestimate the patient. Most have an intuitive understanding of quality care and appreciate your dedication to ensuring that they receive what they need through the referral process.

In our office, when we receive a referral, we view treatment as a team effort. We communicate with both the general practitioner and the patient. Depending on the patient`s needs, we present the following:

* An overall treatment plan;

* An overall time sequence for treatment;

* A check-off list of treatment as it is accomplished;

* Agreed-upon dates to complete the treatment.

Throughout treatment, we provide continuous feedback to the patient and the referring doctor. By doing this, the patient is not frightened away by the overall treatment plan. The utmost consideration in the referral process should be to save the oral health and teeth of the patients. Our patients frequently tell us: "Economics is a consideration, but losing my teeth would cost me more."

We are the doctors, and with that title comes a privilege and a responsibility. Responsible referral of patients to improve their oral health is a part of our duty to do what is in the best interests of our patients.

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