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Referral etiquette: Please don’t be that dentist

April 16, 2023
Dr. Stacey Gividen spoke to one of the endodontists she refers patients to and learned what referring doctors can do to steer clear of clinical issues and make their cases go more smoothly.

Do you drive your referring endodontist (or any referral doc) crazy? I confess, there have been times when the specialists I’ve sent my patients to would look at the referral slip, scratch their heads, roll their eyes, and say, “Come on, Stacey ... really?!” Yup. Guilty.

So now you’re thinking, “How in the heck can you screw up a referral slip?” Well, if you dissect it out, it’s not so much that I was screwing it up; it’s that I wasn’t being as comprehensive as I could have been when passing the baton. But as with all things, I like to do and be better, so I went straight to one of my referral sources to get a taste of the situation from their perspective.

I asked my good friend who is an endodontist what, specifically, he likes and what drives him crazy from the docs he gets referrals from. Here’s what he said.

You might also be interested in: How referring patients to a specialist can be mutually beneficial

What referring dentists do that make things easier and more efficient

  • They send diagnostic images (sometimes root ends are missing which can make it harder). Sometimes all I get are bitewings, which can be helpful, but we usually need a periapical x-ray.
  • They provide messages about what to do with the restoration. For example, do you want me to place the buildup or send the patient back temporized? Sometimes there is no information about the final restoration, so I do what I feel is best at that time.
  • If the dentist is planning on placing a post and lets me know that in advance, I can prepare a space in the best canal.
  • Having advance warning regarding behaviors, significant medical histories, or patients who are talkers helps us plan accordingly.

What referring dentists do that make things harder

  • Sometimes I get referrals and the patient says, “I have no idea why I am here.” In these cases, it usually takes more time to find out what’s going on, which can be frustrating for patient and provider alike.
  • Building patients’ expectations unrealistically. What I mean by this is that some patients think they will have root canal treatment or surgery based on a conversation they had with their referring dentist. While this may be the case, it is possible that a scan could be needed or pretreatment indicated over surgery. This can create an awkward situation when patients present with preconceptions about what’s going to happen.
  • No information is given on the future restorations.
  • Sometimes referring dentists will inform patients that their treatment can be completed in a certain time frame, for example. This can make it hard for us because some teeth can be done in a single visit while others may require more time. 
  • The patient has not been informed of complications (separated files, perforations, etc.) that initiated the referral. Also, problems can arise if the patient was aware of the complication but was made to believe that removal of a file, for instance, is an “easy” thing to do. The referring dentist should never assume the ease or difficulty of procedures in the specialist's practice, giving patients false hope.

Potential gray areas

  • In some cases, there will be an obvious carious exposure but questionable restorability. Please indicate what you would like me to do on the referral slip. Otherwise I won’t know if (1) you want me to make that call, or (2) you feel the tooth is restorable and you plan restore it when my work is completed. At times, due to concern, I have sent patients back to their general dentist to assess for restorability before I even get started on the case. If we are all on the same page from the outset, it makes things easier. 

While this perspective is from an endodontist, the take-home point for all areas of dentistry is the same—the more info you give your referral docs, the more efficiently and thoroughly your patients will be cared for.

Editor's note: Originally posted in 2020 and updated regularly