For years I wished there was a way to make the referral process smoother, for myself, my team, my referring doctor, and the patients caught in the middle. After time, I identified these key steps to lessen the frustration for everyone throughout the referral process. (No matter what specialist you’re working with!) So here is how to be a good (and happy) referring dentist:
We often get patients without referral slips, so we ask at the very least, please fill out the form! Put any of your clinical findings on there, and make sure they are accurate. I can’t tell you how many times the wrong tooth number is circled! Some doctors just use the referral slip as a way to give the patient directions to the office. They put no clinical information on it. We could really use a hand here, since you know the patient’s history better than we do.
Make sure the patient brings the referral form to the office, because that’s really the only information or communication between your office and the specialist. You won’t believe how many patients leave the form at home or in their car because they don’t understand how important it is.
I once had a patient who had a huge language barrier, and there was nothing on the referral slip, so I didn’t know what the doctor wanted me to examine.
The patient pointed to everywhere in her mouth and said, “It hurts me here.” The patient was frustrated and we didn’t know where to start. The appointment took double the time. Not a great patient experience, and all of this could have been prevented with a completed slip!
Is It an Emergency?
Endodontists handle emergency patients every day. But not all emergencies are created equal! Some are true dental emergencies where we need to see the patient right away. Others are less urgent, since proper pain management would help them get through a few days. And while most practices leave spots in the schedule for patients in need, it is SO important that you, as a referring dentist, assess what is TRULY a “right-now” emergency.
Consider Using this Pain Scale
In our office we use a pain scale: P1, P2, P3:
- P1 is when the patient is in so much pain they can’t think straight.
- P2 is when the patient is in pain, but pain meds are working.
- P3 is when the patient needs a root canal, but they really don’t have any pain and they can wait for an appointment.
Sometimes I get referring dentists who are pushing patients with little to no pain (P3s) as emergencies, saying that we “MUST fit them in immediately—like TODAY!”
We want our level of communication with referring dentists to be open and transparent. This pain scale is a simple communication tool that can be used by both the GP office and the specialist’s office. And it’s easily understood by the non-clinical team members, too. Consider adopting it in your own practice, and sharing it with your specialists, so you can all be on the same page.
In our office, if we are getting a patient sent over the same day, we like to speak to the patient directly. We want to discuss their insurance and finances, or let them know there may be a wait because we’re working them into the schedule.
A lot of patients arrive and expect to be brought right back, and they may not be able to wait that day. So let your patient know about the schedule, or that there may be a delay. That way, they can arrive prepared and in the right mindset, since they didn’t have a pre-scheduled appointment that day.
Prepping Your Patient as a Referring Dentist
You know my favorite word, right? WHY.
You want to make sure your patient understands WHY they’re being referred.
Let them know the specialist is also going to be doing an evaluation, mainly to confirm your diagnosis, and also to orient the patient with the procedure. Most endodontists see so much referred pain on a daily basis that they need to confirm your findings before they dive in.
In my office, the evaluation is more of an orientation. That way the patient knows what we’re going to do, what to expect, how they’re going to feel, and what the post op recovery is going to be like. We take time with our patients because we really want them to understand what goes into their care.
Perhaps your endodontist works the same way. Sometimes an extra evaluation appointment can be frustrating, for both the patient’s schedule and finances. But in the end, I’ve learned that people really want to learn about their health and understand the process.
It’s Important to Manage Your Patient’s Expectations
Your patient should also know that additional radiographs may be necessary, taken at different angles than the ones that are sent by your office. And maybe additional imaging is needed, like a cone beam, that could help diagnose. Plus it can be used as an education tool to show the patient. For example if there’s a missed canal, a cone beam image can show the patient why re-doing the root canal would be beneficial.
So you should prep your patient by letting them know that there may be an evaluation and additional radiographs first. Most endodontists will triage patients, using proper pain management, and then decide whether within 24-48 hours they can get all the treatment done in one step. Or if the patient’s pain level is through the roof and they can’t make it through the night, that patient should become first priority and treatment is usually started right away. Trust your endodontist to make the right call for your patient.
When you spend just a few more minutes to walk your patient through the process of going from your office to the next office, and then back, they feel good. If your specialist is having the same conversation with the patient that YOU’VE had, that confirmation puts the patient at ease. It decreases their anxiety, they feel better about both parties, and they feel better about the whole process.
Build a Relationship as a Referring Dentist
A level of communication from your front office to the specialist’s front office is imperative.
Take the time to get to know your specialist, and get to know their flow. Meeting the people on the “other end” to make a connection is so important. Get together over coffee, at a lunch and learn, or for dinner to put the face to the voice. THAT, in my opinion, is the best recipe for success and good communication. Your patient will be cared for better, and the specialist will understand the patient’s level of pain a bit better.
And know that you might sometimes need to get on the phone and talk to the specialist because it’s such a special case.
I will tell you who I’m leery of. It’s the doctor who calls me wanting a same-day appointment, but they’ve never referred to me before—and yet they’re expecting emergency treatment!
That’s why having a relationship with your endodontist is key. It’s disheartening when we get the call from a referring office that says, “If you can’t see this patient right away, we’re going to call someone else.” CLICK! We get that a lot, and it’s not a great way to foster a partnership.
You will want to start a relationship with a few different endodontists or specialists. So when you have that patient who can’t stand the pain, and your main specialist is fully committed to other patients, you have somewhere else to send them. We don’t like to say no, but sometimes there’s just no wiggle room in the schedule.
So What’s Next for You?
So, I hope that was a helpful view from the “other side” of the referral slip. Putting these steps in place will make the referral transition much smoother for both you and your specialist. When you become a good referring dentist, your patients’ experiences improve, and so does your practice!
What will your next steps be as a referring dentist? Will you implement the P1, P2, P3 system? Will you invite your specialist to lunch? Let me know in the comments.
Hi, I loved the way you represent the importance of referral slips. I am a dentist and I have seen so many patients refered to endodontics or surgeons for difficult cases with no slip Or no prior treatment information. Also Pain evaluation is commendable at point P1,P2 and p3. But in my opinion, one more thing should be added in it that sometimes one endodontist feels uncomfortable if he or she has to work with another specialist. I have faced this. Understanding the treatment from another’s point of you is also important.
Hi Dr. Janika – I work with other specialists all the time and we definitely work as a team. I have also been put in the uncomfortable situation of working with other endodontists on the same patient. I think as long you approach these moments with an open mind, respect and support, it should have a positive outcome.