Atenolol, Prozac, Coumadin, Fosamax, Omeprazole, Lisinopril. We all have a patient with a long list of medications that, at a glance, resemble alphabet soup. Often, these are the same patients who are battling complex medical conditions and are being seen by multiple physicians. Obtaining a comprehensive medical history is crucial. I am always glad when my patient comes prepared with a detailed log of their past surgeries and medical diagnoses. Other patients are less certain about their history. Some patients report they are “taking a bunch of pills that [so and so] organizes for me every week” (obviously an unclear picture of their current medications).
Oral health is a window to overall health. Our patients’ systemic health can play a direct role in their oral health; the converse is also true. As the population becomes more complex, it is necessary to communicate with other health professionals regarding patients’ medical conditions – particularly those that can affect the delivery of surgical dental treatment. The need for efficiency, improved record keeping and confidentiality has shifted communication from phone calls to written medical consultations.
A 2008 article in the Journal of Dental Education found that “medical consultation requests often yield inadequate answers or no information from the physicans.” We may be guilty of sending a medical consult asking for “medical clearance for a particular procedure” or “any contraindications for dental care.” Geist et al. suggests this problem stems from a lack of knowledge on the part of dentists as to what information is relevant. In many instances, this can result in delayed patient care and treatment.
To effectively communicate with physicians, we must become familiar with current guidelines regarding dental management of patients with complex illnesses and extensive medication lists.
Here are some tips for writing an effective medical consult (from peer reviewed literature and my personal experience):
- Medical consults should be concise and should only contain “pertinent and specific questions for the physician to answer.” It is not necessary for the physician to know the patient’s pocket depth on the distal of tooth #30. Give an overview of the treatment plan in terms that can be understood by “non-dental healthcare providers.”
- Follow up with the office after sending the medical consult. Talking to a receptionist or an office manager can ensure that your request is addressed in a timely manner.
- Inform that patient regarding the importance of receiving a medical consult. Patients are often unaware of the dental manifestations/complications of systemic conditions and will greatly appreciate your interest in their overall health.
- Don’t fax a medical consult to a phone number. I have unfortunately done this and it did not turn out well.
- Realize that values such as INR and HbA1c are time specific. It is vital that you obtain INR values as close to the dental appointment as possible to ensure accurate values. Inform your patient that elevated values can delay dental treatment until the values return to normal.
Have you had experiences with medically complex patients? Share your tips below!
~Sarah Khan, Stony Brook ’16, 2014-15 associate, Council on Professional Issues