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:

The Paperwork

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! Or the doctors just use the referral slip as a way to give the patient directions to the office, and there is no clinical information on it.

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.

We recently 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?

Handling emergency patients is something that endodontists deal with every day, both true and supposed dental emergencies. And while most practices leave spots in the schedule for patients in need, assessing what is TRULY an emergency is SO important for a referring dentist. In our office we use a pain scale: P1, P2, P3:

  • P1 is what we label when the patient is in so much pain they can’t think straight.
  • P2 represents that yes, the patient is in pain, but pain meds are working.
  • And P3 represents that the patient needs a root canal, but they really don’t have any pain and they can wait for an appointment.

And sometimes we get referring dentists who are pushing patients with little to no pain (P3s) as emergencies, that we “MUST fit in immediately!”. We want our level of communication with referring dentists to be open and transparent, so we can be on the same page. 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.

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 in. A lot of patients arrive and expect to be brought right back, and the patient may not be able to wait that day. So let your patient know about the schedule, or that there may be a delay, so they can arrive prepared and in the right mindset, since they didn’t have an appointment that day.


Prepping Your Patient

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, so 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 because we really want patients 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.

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 but also 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 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

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, so there can be better communication — THAT in my opinion is the best recipe for success. Your patient will be cared for better and the specialist will understand the patient’s level of pain a bit better.

And don’t underestimate that sometimes the doctor needs to get on the phone and talk to the endodontist because it’s such a special case. I will tell you that I’m leary of the doctor who calls me wanting a same day appointment, but they’ve never referred to me before, 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 “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 may be fully committed to other patients, you have somewhere to go. We’re not happy to say no, but sometimes there’s just no wiggle room in the schedule.


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!  

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