Referral relationships, or maybe the lack thereof, are a familiar topic of discussion that appears in journals and magazines, on Spear Talk and other blogs and in our discussions among colleagues. These conversations reveal a wide spectrum of expectations among us, resulting in frustration about referral relationships in dentistry.
What exactly do we want and need in this relationship? Whether we are general dentists or specialists, why are referral relationships lacking our full support as colleagues? Are general dentists too “demanding,” and are specialists too “elite,” making us all just too afraid to communicate?
When we talk about interdisciplinary treatment planning, we can hardly take a single step in that direction without having a relationship with someone beyond the patient.
If we agree that including other perspectives is the very core of interdisciplinary care, what are these roadblocks obstructing our way to such a valuable partnership? Is it because we think we should “know it all” ourselves? Is it the fear of losing a part of what we want to keep in our own practice? Or is it that we will lose control of the case and the treatment outcome?
It can be a combination of all of these concerns, with the most common roadblock I hear being loss of control. Whether you are the general dentist and the last to know when an implant was placed or the surgeon having to place an implant in an inadequate space because the braces have already been removed or the orthodontist trying to recover after the implant was placed in the wrong position. We have all been there, and the result is high frustration that we were not included as part of the treatment planning process from the very beginning.
The following five best practices for referral relationships can provide some ideas that you can put into practice today.
1. Embrace technology in the dental practice
Now that technology has connected us to a level of instant communication, we can easily, at a time that is convenient for each of us, communicate with one colleague or 10 all at the same moment. They, in turn, can review your message at a time that is convenient for them. Your communication can include photography X-rays, scans and even videos. You can add commentary, ask questions and present a wish list. Embracing technology includes making your practice a “photography practice.”
Using words as the only form of communication can limit how effective and efficient we can be. Use photography for sharing your ideas, your concerns, your questions and your plans, as a key to clarity of your vision. A Keynote or Powerpoint presentation is easily accessible for organizing and demonstrating that vision (more on that in point two below) Need more technology? Once you have shared your vision through photography and organized it in a presentation, you can, from the comfort of your own home or office, set up a conference call including video to review and discuss a case without having to drive across town.
2. Expand delegation and resources
If you can practice alone and complete everything by yourself, then I congratulate you; I don’t know how you do it. If you are like me, you need a good team to help you run a successful practice. Right next to you every work day, there is a wealth of support to aid in developing and maintaining your referral relationships. Your team can assist you in so many ways if you will only ask them and train them. Many of your young team members grew up using Powerpoint in school years ago (a long way from my days of poster board, blunt end scissors and Elmer’s glue. Powerpoint for Dummies?That was me!). Several resources exist on Spear Online to learn how to add patient photos and place templates, arrows and lines.
Use the strong memory banks of your team to select among your treated cases to use as examples to clarify your goals. Don’t have the one you need? Use Spear on line as a resource for the specifics you are looking for. Once you have one presentation completed, it now becomes your template for future cases. When you are on your conference call or in your in-person meeting, your referral team will easily understand what you need and can determine their part of supporting you with the case.
3. Ask, don’t tell your referrers
As an orthodontist, I have heard from frustrated restorative doctors asking, why is it that an orthodontic case is not finished according to their expectations? A long list of inadequacies that they believe should be part of a finished orthodontic case are lacking, and now the braces are off. At this point in time. the comment comes out sounding something like this: ”I can’t work with them. I’m never referring to them again.” We could insert any number of specialists into this scenario for a similar story.
At this point, there are few choices that can be made to improve this level of frustration. I do believe that there is a pathway to follow for preventing this breakdown in relationships. With a set of photos to serve as the example, ask the specialist: what is possible for future cases? Ask, is this possible? What is the roadblock for this outcome? What can I do to assist with achieving this result? When you ask, the doors to communication are open and non-judgmental. When you tell, our defenses come up, and we close the door on helpful problem-solving communication.
4. Specialists: accept the quarterback
The restorative dentist is in the best position to be the quarterback of the patient's care. They choose the people that will be on the treatment planning team. As a specialist, I love this. I now have someone to ask, what do you need, where are we going, what do you need to do your best work for this patient? As the specialist, I can be the leader of that component of patient care, and I am no less important to the success of the outcome.
In the interdisciplinary team, it is the restorative dentist who receives the results of the specialist’s care. The restorative dentist is the specialist in the materials, in understanding the ways of conserving tooth structure, and in providing a dental home for this patient. They need to be in control of what will come back to them to finish and live with. The investment of the specialist is transient; the investment of the restorative dentist is lifelong.
5. Expect respect from your referral relationships
This is the core of referral relationships. We all should expect respect. We all have those cases, the ones we either did not yet know what we know now, the ones where patient was not optimal or the time when things just plain did not go the way we expected. When that case shows up in your office, we all deserve and expect respect. There will be good aspects as well as things that need improvement. If the grafting did not give us the ideal, if the second molars are not perfect alignment or the color and hue is not of your choosing, make it your goal to move forward with what is positive and work to improve what is not. The respect you give will be a reflection of your own future work, and you deserve it, too.