Most patients have an excellent relationship with their general dentist and as such can be extremely resistant to accepting a referral to a dental specialist. Here are some answers to some frequently asked patient questions along with some of Dr. Maguire’s recommendations.
Why do I have to go to see a specialist why can’t you do it?
If you wish to make the referral at the time of diagnosis….
Doctor – I have performed a thorough radiographic and clinical examination of your tooth. Your tooth has “unusual anatomy” (or has received “previous root canal treatment”). As a general dentist I received training in dental school in order to treat teeth with a more normal anatomy. This tooth is not one of those. In order to maximize the chances for a successful treatment I think it would be best if this tooth was treated by an endodontist.
By way of analogy I tell patients that family physicians are trained to deliver babies but if the physician determines that the delivery will be complicated he will refer the expectant mother to a specialist to maximize the chances of a successful delivery.
If you think you might be able to complete the case but aren’t sure. Schedule half the time you might usually to do the case. If you can get a #10 hand file 1mm past the radiographic apex on ALL of the canals in that time then you know you can complete the case at the second visit. If you cannot get a #10 hand file 1mm past the radiographic apex on all of the canals bill the patient for a PULPECTOMY and refer the patient to an endodontist to have the case completed.
By way of an analogy this is like a family physician delivering a baby if he starts to get in trouble he calls in a specialist (Obstetritian).
I can’t afford to see the specialist, can’t you do the best you can? I promise I won’t sue you if the case doesn’t work out.
This puts a lot of pressure on the general dentist. What the patient is really saying is..
” I want specialist dental care for general dental prices..”
In any relationship there needs to be a “win-win” result for the relationship to be successful over the long term.
If you as the dentist spend an inordinate amount of time on a difficult case, the case works out and you only charge your normal fee the patient “wins” and you “lose.
If it doesn’t work out you get a “lose-lose” result.
In order to get a win-win result in this scenario I recommend the following.
Doctor: This is a very difficult case and I feel quite uncomfortable about attempting it. I am going to document in your chart that you refused referral to an endodontist against my advice but as a favor to you I will attempt it and do the best I can. I want you to understand that there is a significant possibility that my best efforts will not be successful and the tooth may need to be extracted if the treatment is unsuccessful. So that there will not be any misunderstandings I want you to understand I will be charging you my normal fee for this procedure and (this is important) I will not be able to refund to you any fees if the treatment is unsuccessful. Do you still wish me to attempt the case?
If the patient refuses referral to an endodontist and the alternative to attempting the root canal is extraction nothing is really lost by attempting the case and ending up with an unsuccessful case.
Therefore in this scenario I recommend you document the refused referral in the patient’s chart (for an additional layer of medico-legal protection you could get them to sign a waiver) and then schedule the normal amount of time you would normally schedule for an uncomplicated case and charge your normal fee.
If the case works out you get paid and the patient gets a successful case a win-win scenario. If the case doesn’t work out you still get paid your normal fee and the patient realizes you did the best you could in a complicated case i.e. you went above and beyond the call of duty, still a win-win scenario.