1.8.10 Issue #409 Forward This Newsletter To A Colleague


Belle DuCharme CDPMA
Instructor/Consultant
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Protocol for Referring Patients to a Specialist

“I actually stopped referring to my local periodontist because they told my patients that they could do a better cleaning in their office and we would not be able to provide the same service! Ironically, all of my hygienists had more years experience than those in the perio office.”  (California dentist)

Because the basic referral process often requires additional appointments, additional diagnostic procedures and administrative tasks for financial arrangements and insurance processing, it is not uncommon for communication to breakdown along the way. For instance, if your patient has unresolved periodontal disease and has not shown significant improvement with scaling and root planing, the use of anti-microbials, and is compliant (or non-compliant) to periodontal maintenance, it is time to consider referring the patient to a periodontist. But before sending the patient to this specialist, it is important that standards of patient care between the general practice and specialist be clearly drawn to prevent the patient from being in the crossfire of miscommunication.

Referring the patient out of the office for care should be treated with sensitivity and should be monitored by your Treatment Coordinator. Tracking patient retention in practices has shown a number of patients do not return to the general practice after being referred to a specialist for a specific condition.  Fear of the unknown or misconceptions about the treatment and the costs often cause patients to postpone going to the periodontist. Some patients go to the consultation appointment but are not sure of what to do, therefore remain in limbo, not seeing the specialist or the general dentist.

It is common for the general practice to assume that the patient is going to go to the specialist and that a report and or a phone call will follow after the treatment. Follow-up as to whether the appointment was kept with the specialist is crucial. When that patient shows up later in recall and questions arise as to the status of treatment, it is difficult at that time to make a positive impression of caring to that patient.

Before referring patients from the general practice to a specialist practice, it is important that the two dentists know each other and have shared philosophies regarding patient care and expected outcome of procedures and prognosis for long-term success.  A discussion as to how the recall appointments are to work between the two practices and agreement as to what dialogue will be used by the team to communicate to the patient is vital to patient acceptance and trust.  If unity is missing between the two practices, the patient feels pressed to choose where they are most comfortable receiving care.

For better communication between the general practice and the perio practice, it is suggested that the following information be communicated to the periodontal practice prior to the arrival of the patient.

  1. Is the patient new to the practice or established? What recall interval has the patient been on in the past?
  2. Has the patient been assessed by the hygienist or dentist for periodontal disease? What were the results?
  3. Has the patient had scaling and root planing in the last two years? List the dates and quads involved.
  4. Has the patient had any type of periodontal surgery in the past? List the dates and procedures.
  5. Does the patient wear removable prosthetics?
  6. Does the patient wear an occlusal guard?
  7. Does the patient use an electric brush or water pik?
  8. What (if any) anti-microbial has been administered to the patient? List type, sites and resolve.
  9. Send a current periodontal charting via email, fax or mail.
  10. Send radiographs taken and identify type and dates. Send via email or mail.
  11. If there is any special information regarding the patient’s insurance or financial situation, have the practice call and speak to the Treatment Coordinator.

If a patient complains of mistreatment at the specialist office, do not discount their concerns or send them to another specialist without looking into the situation. Call the practice in question and report your concerns to the dentist. If it is in the patient’s best interest to see this specialist, it is worth a phone call to settle a miscommunication. If you are a specialist and you notice a sudden drop in referrals from a dentist who has sent you many patients in the past, it is time for a phone call or a lunch date to reestablish your relationship.

Remember that only 4 out of 100 people actually complain of poor customer service.  They usually say nothing and leave you wondering what happened.  To improve treatment acceptance and business protocols, sign up today for one of McKenzie Management’s Advanced Business Training courses and get a head start on a successful New Year.

If you would like more information on McKenzie Management’s Advanced Training Programs  to improve the performance of your team, email training@mckenziemgmt.com

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