Strengthening Dentist-Physician Communication
Making a connection with physicians can benefit patients and boost your practice
Instead of acting like oral physicians, too many dentists function more like molar mechanics. If there's a hole in a tooth, they fill it. If a tooth is missing, they replace it. If teeth are crooked, they straighten them. Performing these tasks are all necessary parts of being a dentist, but there is so much more with which dentists must be concerned when providing patients the best possible care.
About Building Relationships
Besides the obvious doctor-patient relationship, it is essential for dentists to forge a strong relationship with their patients' physicians, especially for those patients with complex medical conditions. Even taking a comprehensive medical history may not be enough, as your patients may not have a complete understanding of their own health issues. Contacting physicians prior to any invasive dental procedure should be part of an established protocol for patient care. Many physicians are now realizing that there is a strong connection between oral health and systemic health and are eager to become co-therapists.
Many patients do not take ownership of their own medical conditions, or they don't think their medical history is even relevant to their dental care. Some complain about needing to fill out the annual medical history update. On the other end of the spectrum, others arrive at their appointments with a long list of medications and diseases. Because it may not be clear exactly what each medication treats and their possible side effects, it is important to communicate with their physician for clarification.
Creating a form that can be emailed securely to the physician's office is an ideal and recommended way to provide a record of written communication that can be used for documentation. The form should have the patient's name and the name and contact information of the dental practice as well as a place for the physician's signature with date. This should specify the clinician's diagnosis and proposed treatment plan, including the anesthetic and materials to be used. It should also include a request for a list of the patient's medications to confirm that the patient's information is accurate, descriptions of side effects of those medications, and information about any allergies that they may have. Finally, the forms should ask whether there are contraindications to the proposed treatment. This form will not only provide the needed information, but it also serves as a legal record of the physician's response.
Because it can be expected that the form will be filled out by a physician's assistant, medical assistant, or nurse for the physician's signature, it may be necessary to speak directly to the physician for clarification. When a patient is on a blood thinner or requires antibiotic premedication for a joint replacement, stents, or prosthetic heart valve replacements, be sure to request the physician's protocol, which may not conform to the recommendations of the American Heart Association or the American Academy of Orthopedic Surgeons. If this is the case, the author recommends following the physician's regimen after documenting the conversation.
An Opportunity to Educate
When speaking to the physician, the dentist should not only discuss the health conditions and medications of the patient, but also seize the opportunity to let the physician know about the connection between periodontal disease and systemic health, the side effects of different medications and their impact on the oral cavity, and the necessity of administering the new human papillomavirus (HPV) vaccine to both boys and girls to not only protect from viral infection but also to prevent the future possibility of cancer caused by HPV.
This is also an opportunity for clinicians to make physicians aware of their services, since many physicians may not know about the new services and technologies dentists have to offer. If applicable, a dentist might want to consider letting the physician know, for example, that oral cancer examinations are performed routinely in the dental office (especially if you use an adjunctive device) and that your practice does laser biopsies. If the physician is an oncologist, the conversation should include the pre-surgical and pre-radiation protocols necessary to maintain dental health. At this time, dentists can also encourage referrals for the physician's other patients, especially if there is a suspicious lesion in the oral cavity. The physician should understand that a visual inspection of the oral cavity is not enough, so it is important to emphasize that the dentist's use of an adjunctive device (eg, Velscope®, LED Dental, www.velscope.com; Identafi®, DentalEZ, www.identafi.net; Vizilite®, DenMat, www.denmat.com) can aid in the detection of premalignant and malignant tissues up to a year earlier than an exam without the device.
Additionally, they should know that the majority of prescription medications can cause dry mouth, which in turn can cause an increase in caries. Suggesting that physicians refer their patients on medications that cause dry mouth for fluoride treatments is a simple yet necessary part of the overall care of their patients. Bear in mind that in this era of the Affordable Care Act, a physician's time is very limited, so comments should be brief, and accompanied by an offer to send literature. This is also a good time to ask for referrals.
It goes without saying that the primary concern of clinicians is to provide the best possible care for our patients. Taking the time to converse with physicians will not only benefit the specific patient concerned, but also the new information provided might greatly benefit physicians' other patients as well. Taking the time to consult with physicians–even offering to continue the discussion over lunch or coffee–will change their perception of the dental profession, and this could lead to new, mutually beneficial relationships. Clinicians should make the effort to give patients what they deserve so that they receive the very best care.
Click here for a sample medical form that you can adapt for your practice. To personalize the form, save to a computer with Adobe Acrobat.
About the Author
James A. Pasternak, DDS, has been practicing for more than 40 years in Chatsworth, California. He is a member of the American Dental Association, the San Fernando Valley Dental Society, the American College of Forensic Examiners, and is a fellow of the Academy of General Dentistry. He is a voracious student, attending over 200 hours of continuing education courses per year. This commitment to education and patient care distinguishes his practice and makes him a leader in oral health care.