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D
on’t let anyone other than you have the final say in
what treatment you perform or whom you recom-
mend and refer your patient to. Being a patient’s
dentist is a big role and one that is an honor to fulfill. I
could quote the whole “with great power comes great
responsibility” thing but I’ll spare you the cliché (oops too
late). Seriously though, when you are the one responsible for
someone’s oral health it means a lot more than simply doing
dental work. You have to identify problems, recommend
treatment and solutions, and most importantly, be confi-
dent in your decisions. This all encompasses the “practice of
dentistry.” And remember, it is your license that you’re prac-
ticing under. And whatever the practice/clinic environment
you work in, this prin-
cipal needs to resonate
clearly on a day-to-day
basis. You’re the dentist,
and when it comes to
deciding what treatment is
needed the dentist makes
the final recommenda-
tion. The same is true if
you are referring a patient
to a specialist for recom-
mended treatment. The
dentist should have the final recommendation of who the
patient should see and why. (Of course, the patient has the
ultimate final say in what treatment they accept and who
they accept it from.)
Many of you are probably saying, “I know that, nobody is
telling me how to treat my patients.” Maybe that’s true, but
maybe you’d be surprised. If anywhere in your employment
contract there are clauses about where you are required to
refer specialty work or send lab work to, then you may be
wrong. Now most of the time, if this is the case in your
contract, this isn’t much of an issue as long as the lab sends
back acceptable work and the specialist performs clinical
competence with acceptable outcomes. But what if they
don’t, and you are required to continue to sacrifice your
patient’s oral health and care due to something that is out
of your control? When you get a crown back from the lab
with a 1 mm open margin do you cement it in or have it
remade and apologize to the patient. If you have to do that
time after time should you really keep using that lab. After
all, it is you’re license so it will ultimately reflect on you. If
your endodontist has 3mm short apical fills and significantly
higher failure and retreat rates compared to the norm,
do you keep referring to him/her? If your oral surgeon’s
implants have poor restorability due to placement or fail
frequently, do you keep referring? Or what if your specialist
does great work, but every time you refer for one thing they
blatantly over diagnose and your patient comes back with
a $10,000 treatment plan. The patient might be frustrated
with the specialist for the large potential and unexpected
bill, or they might be mad at you for not finding these other
“problems.” What if the specialist has substance abuse prob-
lems, either documented or discretely, and is still practicing?
Would you feel comfortable sending your patients to him/
her under those circumstances? Wouldn’t you at least want
the option to help make the appropriate choice for your
patient? Now some of these examples may be a stretch and
don’t happen all the time. By far the vast majority of special-
ists around that I know of provide great care for patients
and work well with referring general dentists. My point is
that each of these examples can easily happen from time
to time and can be a thing that you may have to deal with
as a referring GP. That is part of having a professional rela-
tionship with your specialists. But part of that relationship
should also allow you to find someone else if these problems
become too frequent and less of the exception.
There have been some of the aforementioned circumstances
occur here in New Mexico where the dentist contractually
had to still refer to the same specialist. The NMDA and
ADA have taken steps to try to protect the dentist in this
situation. But first and foremost understand your employ-
ment agreement contracts before you sign them. Or if that
point is passed, at least get them out and read them again so
you know what you may or may not be obliged to do. After
all, you are the dentist. Now I’m sure there’s plenty of you
type A’s out there that have had your boss pants on well
before dental school and calling the shots is second nature
to you. Maybe you’re a new dentist and being the boss or
having the final say is a little new to you. Get used to it. If
you are being forced to practice dentistry in any way that is
“against your will” so to speak, then bring those issues to
the NMDA. The ADA also offers a great service in contract
reviews where they will look at your contract and break it
down for you so that you can better understand if you are
getting into something that maybe you shouldn’t.
By Joe Gherardi, DDS—Albuquerque, NM
If you are being forced
to practice dentistry in
any way that is “against
your will” so to speak
then bring those issues
to the NMDA.
Committee on New Dentists —
You’re the Dentist, You Call the Shots