THE EDITOR'S CORNER
On transfer cases, it is assumed that there is an obligation on the part of the original orthodontist to make a referral. It is open to question how deep this obligation should go, when you examine the basis on which a referral can be made.
Proximity to the patient's new home is one of the first considerations in a transfer referral. Yet, frequently, neither the patient nor the referring orthodontist is well enough acquainted with the geography of the new area to be able to make the most convenient referral. Since convenience is a big factor to the patient, often enough we find that the patient transfers to someone other than the orthodontist selected for him.
Great stress is placed upon transferring the patient to an orthodontist who uses the same appliances and who will presumably be able to carry on the treatment with a minimum of inconvenience to the patient and expense to his parents. Yet, one could not know from notations in a directory or from what an orthodontist says, more than an inference of what appliance and what technique was being used. The Begg man might be using Begg brackets or combination brackets; the edgewise man might be using .018 slots or .022 slots. The Begg man might be using only .016 round arches; the edgewise man might be using only round wire. Still, if you ask, they may all describe themselves generically as Begg or edgewise.
One thing that many of us look for is to find an orthodontist acquaintance in the area to which the patient is moving. Yet, unless you have spent some time in an orthodontist's office, you really don't know much about his appliance, technique or ability. Additional considerations that we all make to a greater or lesser extent are school, date of training, ABO.
I think we are often over-reaching a bit in trying to make a specific referral, because there are so many unknowns in the equation.
The approach on transfer should really be to make the parents acquainted with the problems they are facing in transfer. They ought to know, for example, that not all orthodontists are accepting new cases, not all orthodontists are accepting transfer cases, and not all orthodontists are accepting transfer cases with appliances other than those they use. That does not mean that you have an obligation to find all this out in their new area.
They also ought to know that transfer may cause them an additional expense because appliance changes may be required, because fees and approaches to treatment may vary. You do not have an obligation to make sure that there is no additional expense.
When a parent informs you that they are going to move, it is a good idea to arrange a transfer conference with both parents present. One of the sources of misunderstanding and unhappiness in transfer is inadequate communication. With regard to treatment, the treatment plan should be reviewed and a frank evaluation given of the progress to this point. The parents should be made aware how much treatment remains to be done and of the fact that the new orthodontist may have a different approach to treatment, a different goal, a different way of getting there, a different appliance, a different treatment time. He may also have a different fee. This combination of differences may well result in additional expense but, if so, this may be one of the inevitable expenses of moving.
With regard to finances, the patient's account should be reviewed and an accounting given of what the fee was, how much of it was charged for treatment to date, how much was paid, and what the difference is. If some fee is still owed, the parents should be informed that the records will be sent after the account is paid.
With regard to referral, it is proper to ask if the parents wish you to try to make a referral. You may know a suitable orthodontist in their new area; you may consult the directory and find a suitable one. If you cannot decide on a single referral, you could give the parents a list based on credentials and let them make a selection based on the recommendation of a new dentist or a new neighbor.
You should tell the parents that they have no obligation to transfer to the orthodontist of your recommendation; that, however, they should make that decision soon after they arrive at their destination; and, after having made the appointment with the new orthodontist, request that his office communicate with yours to arrange for transfer of the patient's records. When the request for records does arrive, it is a courtesy to transfer the records speedily so that the new orthodontist will have them prior to his appointment with the patient.
To conclude the relationship with the patient and his family, a suitable letter should be sent. An example of such a letter appears on page 719 of this issue.
