Message from the Editor Dr. Richard F. Roadcap
L
eft homeless by a July 29 fire, the VDA staff found refuge in the nearby offices of the Medical Society of Virginia. New quarters were occupied several weeks later, but they were grateful for the temporary housing. “Super hospitable” and “made to feel very welcome” were some of the comments regarding MSV’s reception of the sojourners. Executive Director Dr. Terry Dickinson said this interlude could open new lines of communication between the professions. Regarding the health of our patients, how well do dentists and physicians communicate with each other? Recent literature suggests there’s much room for improvement. A 2008 study reported that French physicians considered their relationship with dentists “nonexistent”.1 Rapport on this side of the Atlantic may not be much better. Our patient base is getting older, sicker, and more medicated with each year that passes – and the need for dentist-physician collaboration has never been greater. We may see our patients more often than MDs: 74% of Americans who visit the dentist are seen two or more times a year.2 As such, dentists may be more likely to encounter changes in medical history, allergic reactions, new symptoms, and medication side effects than our colleagues in medicine. It’s commonplace to register new patients who need pages added to their health histories just to list prescription medications. When do dentists need to consult MDs prior to beginning treatment? There’s no good answer: much depends on the doctor’s level of training, comfort level, and knowledge of the patient’s medical history. Patients with complex medical histories present a challenge to even the most knowledgeable practitioner. The nature of the treatment rendered plays a role, depending on whether the procedures are inconsequential, benign, or invasive. One dental school, The University of Detroit Mercy, concluded that eliminating unnecessary medical consultation requests (CRs) improved physicians’ responses.3 An example of a needless physician consult would be asking if SBE prophylaxis is required for a patient with coronary artery stents but no history of valve replacement; the guidelines in this circumstance are clear and irrevocable. Alas, Detroit Mercy found even after in-service training faculty and students soon lapsed back into old habits and resumed sending gratuitous CRs.
dentists (with the exception of my colleagues in Oral and Maxillofacial Surgery) haven’t attended medical school. MDs may not understand the intricacies of our treatment, and can’t distinguish the gravity of different procedures. It’s incumbent upon us to lift the veil on our proposals for the benefit of our patients. Communication can take many forms: USPS, fax transmissions, e-mail (be certain to have signed Privacy Act disclosures on file), or phone. Each of us has a preferred medium, that with which we are most comfortable. A few suggestions for getting prompt and accurate replies from our colleagues in medicine: • Be specific – indicate the medical concern, treatment proposed, and any postoperative considerations.4 Ask for information, not carte blanche. • Be persistent – if a reply is not forthcoming in a reasonable amount of time, follow-up. How often have we failed to return a phone call or reply to a letter? Understand that your communiqué may pass through many hands before it reaches the MD. • Be fair – state your planned treatment in layman’s terms, if needed. Don’t expect physicians to research their answer prior to a reply. • Be kind – engage the physician’s staff in the same manner you would like your staff to be treated. Address them by name. A brief thank-you note will make the inevitable future contacts more cordial. Good communication requires effort from both parties. Focusing on the health of our patients will improve relationships with physicians, and other health care providers. Increasingly complex health histories will demand that dentists, as healthcare professionals, adopt a more disciplined approach to achieve a better working relationship with medical providers.
One entry that seems to improve all forms of professional correspondence: specifics. In addition to requesting specific medical information, scripted questions for different disease entities improve physician responses.4 Most physicians haven’t been trained in dentistry and most 1 Tennebaum, A., et. al. Improving the physician-dental surgeon relationship to improve patient care. Presse Med 2008; 37 (4 Pt 1): 564-70 2 Jeffcoat, M. A matter of life and death. JADA 2002; 133(2): 142-3 3 Geist, S.R., and J. R. Geist. Improvement in medical consultation responses with a structured request form. J Dent Educ 2008; 72(5): 553-61 4 Brown, R., A. A. Farquharson, and T.M. Pallasch. Medical consultations for medically complex patients. J Calif Dent Assoc 2007; 35 (5): 343-49 Volume 87, Number 4 • October, November & December 2010
3