THE EDITOR'S CORNER
There is a theory in dentistry which insists that the general dentist is in charge of the patient's oral health. He orchestrates the patient's treatment and he decides when specialty work is required; he makes the necessary referral, he confers with the specialist concerning the treatment. The picture is one of a lifetime patient-general dentist relationship, a transient patient-specialist relationship, and a conductor-player relationship between the general dentist and the specialist.
The theory is that a layman is unable to know if he requires the services of a specialist, when he requires the services of a specialist, or even what specialty service he may require. On this basis, many local dental societies will refuse to make a direct referral to a specialist, even though they may maintain a file of qualified specialists in their membership. A person may call such a dental society and say, "Will you please give me the name of a qualified orthodontist in my area?" The secretary of the dental society will reply, "It is not our policy to make such a referral. You must ask your own family dentist". Now the caller may say, "I am new in the community and I do not have a family dentist". Or the caller may reply, "I have. asked my family dentist and he will not make a referral". Or even, "My child is in the middle of orthodontic treatment. We are new to this community. Our former orthodontist could not make a referral". In each case, the dental society is adamant, except that in the event that the caller is new to the community or their family dentist will not make a referral, the secretary may offer to name two or three general dentists in the patient's area to whom they can go to obtain a referral. If this is the procedure followed in your dental society, steps should be undertaken to change it.
The concept of a dental team effort among general dentists and dental specialists with the general dentist seeing his patients at regular intervals, staying on top of their dental problems, routinely referring specialty problems to qualified specialists when they arise is a good idea. At its best, the system should work to the patient's benefit. However, anything less than the best results in some disservice to the patient. At its worst, the general dentist may overlook a problem, may not make a referral, may make a late referral, may attempt to treat a problem for which he may not be qualified by training and experience.
On the other hand, what is the penalty of a direct referral to an orthodontist? At its worst, the orthodontist will decide that the problem does not require orthodontic treatment. The patient has misspent a consultation fee. Even at that, he has had the satisfaction of determining that orthodontic treatment was not required. Furthermore, funneling everyone through the general dentist assumes that the general dentist is better able to make a referral to a dental specialist than the dental specialist is able to make a referral to a general dentist. Actually, most orthodontists I know invariably refer the patient to the general dentist and routinely send six-month reminder notices for dental checkups.
In my experience, of the people who have come for orthodontic consultation, as many were self diagnosed as were diagnosed by their general dentist; as many self-diagnosed arrived early for consultation or on time as were referred on time by their general dentist; as many came without a referral by their dentist as came with one. This is in addition to the people who never did arrive because they were unaware of the problem and no dentist referral was made. So, to me, it is a fallacy that the general dentist is the source of specialty referrals. He is a source. If general dentists were making proper referrals of orthodontic problems to qualified specialists, there would be four to five million orthodontic patients under treatment in this country instead of possibly one to two million.
It is incorrect to conjure up a picture of a lifetime relationship between general dentist and patient in which the family dentist guides and guards the patents dental health, in which he has been solicited for that responsibility by the patient and some kind of an ongoing pact has been made between them. The general dentist doesn't own the patient. The patient has some rights of his own. Among them should be the right to make the mistake of going to the wrong specialist if he chooses. To continue the present policy suggests to me that the patient is the pawn of dental politicians bent on preserving the principle that the general dentist can perform specialty work, especially with the growth of third party programs.
There is a gap between the theory and practice of interdental relations that would make it more of a service for the local dental society to accommodate the public by maintaining a referral service of qualified dental specialists. Find out what your local dental society policy on specialty referral is and work, if necessary, to establish a policy of direct specialty referral available to the public.
