In this patient problem, the patient has a large tongue and continues to complain of biting her tongue. We’ve done everything we can to help the patient.
It is now time to refer. Our obligation is to refer when we can’t handle the problem ourselves. This is in the best interests of the patient and is a step in handling the patient without the potential legal accusation of patient abandonment.
Scene:
1. A separate appointment is made for discussion of the problem. It is desirable to invite the spouse to be in the operatory for the discussion.
2. There should be at least as many professionals and paraprofessionals in the operatory. In a case of patient and spouse, have two or preferably three members of the practice in the operatory as well.
3. Prepare yourself in the following manner:
a. Have an article from the literature printed out. Three copies of the article are good so that you may distribute one to the patient, one to the spouse, and keep one for reference yourself. You can get abstracts and sometimes full text articles from Pubmed.gov. You can get full text articles from the ADA by writing to library@ada.org and sending the reference to the librarian. I would make the request with your ADA membership number in the email. The librarians are great and get the articles to you within 24 hours by email in nearly all cases.
b. Highlight short pertinent sentences from the article in advance.
4. Contact the people that you will refer to by phone in advance so that you have advised them of the problem and can get their agreement to see the patient. That way, you can assure the patient that you’ve talked to the doctor(s) that you’re referring to and be able to briefly answer questions that the patient might ask. However, the most common answer would be, “I think Dr. ____ will be able to address that question better than I.” Find out the cost of the initial visit from each person you will be referring to so that you may answer that question when the patient arrives.
Here is a sample script of the visit:
Your goal is to present the material in a concerned and doctor-like fashion. You’re presenting the material objectively. This should be completed in 5-10 minutes. (Here is what we did with the macroglossia patient:
Hi _____.
“I wanted to meet with you today to discuss the problem that we’re having. The problem is called “macroglossia,” which, in everyday terms, is an enlarged tongue. I’ve gone to the medical literature to find a review article that will better describe the problem. (Hand the patient the paper and briefly review points that you’ve highlighted.) Unfortunately, until that problem is corrected, you will have continuing problems in chewing and inadvertently biting your tongue.’ve checked with two sources of therapists who may be able to help you.
One is a myofunctional therapist, (name of therapist) A myofunctional therapist is a physical therapist fort the tongue. The next person I called is Dr. _____, an oral surgeon (or ear, nose, and throat surgeon) that I work with who treats the problem. They both can provide some potential solutions for you. [Hand the patient business cards or contact information for each.}
“I’ll continue to see you here for regular cleanings which is important to maintain your dental implants. We’ll schedule your cleaning visit in the month of April. Danyel will give you more information on that. .Do you have any questions? (Let the patient ask questions for a limited time. The answer should typically be.,”I think you’ll be able to get an answer about that from Dr. ____________. Danyel will take care of arranging the referral.)Then wish them well and leave the operatory, letting your office manager complete the cycle.
The office manager might ask the patient, “Would you like me to set up the appointments? I’ll be happy to do so. What days and times are best for you?” Or if the patient wants to make the appointments themselves, he/she may do so.
If they ask the question, “Who is paying for that consultation?, the answer is “You would be responsible for the cost of the visit. It is possible that your medical insurance will help. You’ll be able to get more help regarding the cost of treatment and resources available from Dr. ____’s office. The cost of the evaluation visit will be approximately $_________”