quarterback

My first associateship out of dental school was in an office where almost all of the treatment remained in-house. While it gave me the opportunity to see a lot of dental work I otherwise might not have, it made referring to specialists one of my biggest weaknesses. Once in another practice, I quickly learned how imperative the restorative dentist/specialist relationship was to achieving desired treatment outcomes.

When you refer one of your patients to a specialist for treatment, the specialist’s practice is an extension of your own. Ultimately I want my patients in the office of practitioners who are knowledgeable, skillful and, perhaps most importantly, have excellent communication. My best outcomes in complex cases result from the interdisciplinary team staying on the same page at all times.

There are a few things that are key to maintaining the health and happiness of your patients when they’re receiving treatment outside of your office. Here are some tips I learned through trial and error along the way. If you’ve got any additional tips, I’d love to hear them! Leave them in the comments section below.

​Tip 1: Set the stage

The patient walks into the specialist’s office with the expectations you have set. If you don’t set expectations, the patient thinks the specialist will be just like you. I like to give my patients these expectations:

a .Let the patient know the schedule of the specialist. If their office is harder to get into than yours for a consult, you should tell the patient up front so they book soon and aren’t put off by the wait time. If there are details that can assist your patient in making the appointment, share them! If there are specific things that differ in your specialist’s office compared to your own, inform the patient. One of the periodontists I frequently refer to works in a group practice, whereas my practice is a small, one-practitioner office. I let the patient know this up front so they aren’t overwhelmed by the contrast.

b. Let the patient know what to expect during their consultation. If they are seeing my periodontist, I let them know there may be additional images taken, including a CT scan. If they’re seeing my orthodontist, I tell them about the potential for a ceph. If the goal of the consult is for the specialist to gain information that he or she can then bring to a treatment planning session with me, I let the patient know that it’s an information gathering appointment.

c. I try to keep my patient in the loop for the order of operations. I work on a lot of complex adult cases that involve an orthodontist and a periodontist. I let the patient know that they will see the orthodontist first for a consult, followed by the periodontist for a consult, after which the three of us will sit and discuss the case. The patient leaves my office knowing that the next time he or she will see me will be for a review of findings after I’ve spoken with all of the specialists.

Tip 2: Send the appropriate information

Your specialist should know why your patient is in their chair before ... well, before the patient is sitting in their chair! I send a referral email to a specialist as soon as possible after the referral is made with this information:

a. The patient's name, chief complaint, and goals

b. My assessment from the comprehensive exam, including goals for the overall outcome and possible limitations. I also highlight questions that I have for the specialist – “I’d like to move 2 into the position of 3 but I’m not sure how orthodontically feasible that is.”

c. I let my specialist know what to do with the patient at the end of the appointment. If that’s scheduling a review-of-findings appointment with me one to two weeks after the patient sees the specialist, or if it’s sending the patient from specialist A (i.e. the periodontist) to specialist B (i.e. the orthodontist), that information is clear from the beginning.

d. A set of photographs

photos for specialists

Tip 3: Train your specialist 

The specialist should know exactly what expectations the patient has walking into his or her office, and the specialist should know what you are hoping to gain from their visit together. If you don’t want your specialist giving treatment options until you’ve discussed all of the options together, he or she should know that in advance. If there are things the specialist can do to make your life easier, you should share them. If there are things that the specialist shouldn’t do, share those too! The specialists I routinely work with know these few things:

a. Don’t give the patient a treatment plan

b. Don’t do any definitive treatment on a patient until the plan has been finalized

c. I like to have copies of any additional images taken or data collected

Tip 4: Be willing to be trained by your specialist

Just as there are things your specialist can do to make your life easier, you may be able to provide more or better “things” as well! Open that line of communication and ask what you can do to be the best referrer you can be.

Tip 5: Communication is key!

There’s nothing worse than a patient getting lost in the shuffle. It’s hard to know what the next step is if you aren’t even sure if your patient has been seen by the specialist. There should always be communication between everyone on the team when a patient is seen in an office, whether that’s during the treatment planning stage or when treatment is performed. My best specialists will communicate photos and open a dialogue the same day my patient is seen. If there’s a question while the patient is in the chair, we hop on the phone. One of my favorites is when I get a message from my periodontist with photos of the treatment before, during and after on the day of surgery, sometimes while the patient is still in the chair. Don’t just expect communication from your specialists though – you need to provide it, too!

Tip 6: The round table

This one is imperative, but can be hard to find time for. When you treatment plan interdisciplinary care and involve multiple specialists, everyone needs to sit down together and work through the possibilities and limitations of the case before presenting treatment to the patient. It’s hard with our busy schedules to get three, maybe four dentists together at the same time. I’ve recently found that Facetime, Skype and phone conferences can overcome some of the difficulty. Again, it’s difficult to find time for, but an absolute necessity for success.

talking with a specialist

Tip 7: Give feedback.

Patients will often give you feedback on their experience with the specialist. Passing that feedback along can help to facilitate continued, or improved, experiences for your patients in the future. If your patient loved their experience, share that. If your patient gave you specific things he or she liked, or maybe didn’t like, share those things as well.

Tip 8: Accept feedback

Your patients may or may not give feedback about you to the specialist. If they do, that’s great; you can learn from hearing it. More often though, your specialist might have feedback for you in terms of the information you did or didn’t give to the patient or the specialist. Be accepting when there are things you can improve upon.

Tip 9: Circle back

After the patient has successfully completed their “tour de consults” and returned to you for a review of findings, you’ve likely got a treatment plan to set in motion. Now’s the time to get a very detailed list together of the order of operations. The patient should know the timeline and the steps along the way, and each of the specialists should as well. Now is your time to shine as a quarterback! It’s your Tom Brady moment!

Tip 10: Get your patients to the right specialist

The specialists I refer to most often are not necessarily the ones in my backyard. While proximity isn’t the key factor for me, it often is for the patient. Know which specialists can provide your patients with the best information and skills, and which specialists will support and nurture what you’re trying to accomplish for your patients. Know how to communicate to your patient why you think they should see a particular provider and the benefits associated with seeing that provider. Your patients trust you, and if you have confidence in who they should see and why, convey it with conviction and they will likely go.

It truly is a team effort to get your patients the care they need. Getting your referral team together and working on those relationships can make a world of difference in stress relief and positive outcomes. I’d love to hear your tips on nurturing this group effort. It takes a village!

(Click this link for more dentistry articles by Dr. Courtney Lavigne.)

Courtney Lavigne, D.M.D., Contributing Author - http://www.courtneylavigne.com


Comments

Commenter's Profile Image Bradley W.
August 22nd, 2016
Excellent article! I am a periodontist and will share this with my restorative dentists. With screen sharing on Google hangouts, the virtual meeting can also include reviewing photos together.
Commenter's Profile Image Katie D.
August 25th, 2016
Really great points- I especially like the comments about communication, and being open to feedback. I think that every interdisciplinary case is a fabulous opportunity to be shown different perspectives, to "see" different things, which is how we learn and how we grow! Thanks, Courtney!
Commenter's Profile Image Bridget M.
August 29th, 2016
Great reminder to set the expectations for the patient. Great article--Thanks :)