Understanding the importance of dental referrals

Sometimes the best treatment a dentist can provide is none at all.

This may sound like an unusual thing to suggest.  After all, a dentist’s job is all about treating patients.  However it’s vital that the treatment provided is performed appropriately and in the best interests of the patient.  To ensure this, there will be times where referring a patient to another dentist, rather than providing treatment, will be the most appropriate course of action.

Understanding your scope of practice

All dentists should develop their own personal and unique scope of practice.  This will be based on what they know they’ve been appropriately trained to do and have the necessary experience in.  It also requires them to be honest and open with themselves regarding their knowledge and expertise.

The next step for a dentist once aware of their own personal scope of practice is to recognise when the required treatment is outside that scope of practice and therefore not something they should undertake.  When the treatment is outside a scope of practice, the patient should be referred to another dentist.

Benefits of referring

Whilst it may at times be tempting to not refer a patient to another dentist as that could be seen as losing business, there are a number of benefits to consider.

By referring a patient to a specialist, you’re providing the patient with what you see to be the most appropriate treatment.  Whilst the outcome of treatment can never be guaranteed, the most appropriate treatment is more likely going to provide the patient with the most appropriate outcome.

Guild Insurance regularly sees claims where a patient has experienced a poor outcome following dental treatment and then requires corrective treatment from a specialist.  It can be argued that in some of those cases, the dentist should have considered referring prior to commencing treatment.  If these poor outcomes lead to a complaint or demand for compensation, the dentist’s clinical decision making and treatment planning may be questioned.

These poor outcomes can also have a detrimental impact on the relationship with a patient.  It’s to be expected that a patient will be disappointed if they experience a poor or unexpected outcome following treatment.  However factors other than the outcome can contribute to or exacerbate this disappointment.  When a patient requires corrective treatment from a specialist, they often question why they weren’t referred to a specialist initially.  This can lead to patients developing a sense of not trusting their dentist due to believing the dentist hasn’t acted in their best interests.  Some patients will even question if the reason for not referring was due to financial greed.  And it’s important to keep in mind that patient’s don’t just complain about clinical outcomes, many also question the behaviour and professionalism of the dentist.

It’s not uncommon for health professionals to feel uncomfortable telling a patient that they can’t perform a particular procedure.  However patients quite often appreciate this honesty and don’t expect a health professional to know and do anything and everything.  Patients will most likely appreciate being informed that there is another dentist who may be more skilled in a particular treatment and that it would be beneficial for the patient to be treated by this other dentist.

Refusing to treat

Sometimes not treating a patient is about more than just a referral and becomes a refusal to treat.  Occasionally patients will be referred to another dentist, yet they don’t want to take up that referral and would prefer to be treated by the dentist they know and trust.  However dentists need to remember that if the treatment is outside their personal scope of practice, they shouldn’t provide it.  If there’s a poor outcome following that treatment, claiming that the patient insisted on it being provided is no justification.  Dentists are always responsible for the treatment they provide and they mustn’t let a patient convince them to treat if they know they aren’t appropriately skilled or trained to do so.

In summary…

Before providing treatment, always stop to consider whether you are the most appropriate person to be performing this treatment and whether the treatment you intend to provide will be in the best interests of the patient.  And remember that referrals can contribute to patient satisfaction and lesson the likelihood of complaints.

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