When is a Doctor-patient relationship established?

When we are evaluating a patient’s health history, there are many factors that we are assessing. But it is imperative to understand one thing: we must be certain we are willing to establish a relationship with each and every patient before we begin treatment. Once we have performed dental services, there is a Doctor-patient relationship. Inevitably, the relationship exists when the patient believes it does. If, after your initial patient consolation, you feel that you will not be able to either meet this particular patient’s expectations or adequately manage their particular health care needs, then have that conversation with them….at the time of the initial exam! I know this sounds simple: even archaic. It is imperative to trust that still, small voice inside you that whispers, sometimes hollers at you…”you should refer this patient to a specialist!”, “this patient does not own responsibility for their health: this is a patient I do not want to treat”. At the very moment you hear the voice, make the decision and don’t waiver.  Your explanations should be succinct, yet explanatory. A specialty referral should include the exact reason for referral (curved canals, possible fourth canal, challenging extraction, crown lengthening) or a referral due to a medically unstable patient should have very clear verbage. An example such as: “I am quite concerned as it appears that your (blood pressure, diabetes) is not regulated by the use of your current medications. At this time, I will not be providing your dental care.”You should take the opportunity to explain to them the effects of an unregulated chronic illness and it’s effects on the success (or failure) of your dental treatment.  It is not necessary for you to provide a referral to another dentist. You can suggest the patient seek care from a specialist in the primary area of their need (endo, oral surgery etc). But it is important for you to realize that you are not responsible for providing emergency care for this patient for thirty days until they find another dentist. It would be in the patient’s best interest for you to suggest they return to their physician for a complete physical to evaluate the issue that is of concern to you. If you follow these guidelines, you will feel a greater sense of confidence and authority in your practice. Your staff depends on your decision making. Remember ,“we treat our patients with their permission, use this gift wisely” (Catharine Goodson)

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