The Referral Letter
This is not meant to be a condescending section. Referral letters vary from the very helpful to the valueless.
All too often referral letters are received that say in their entirety: ‘This patient has a TMD; please see and treat.’ Sometimes even the patient’s contact details are missing. This is of no value to either the patient or the treating clinician.
This is a template for the details that an ideal referral letter should contain. Some of the details will not always be relevant but the referral letter should not be regarded as ‘refer and forget’. You are asking a specialist to help you in your patient’s management. This might be a brief interlude in your patient’s history, but from your point of view you may be entering long-term supervision of a chronic problem that might need to be revisited at intervals, so you need to understand the specialist’s philosophy and match it to your patient’s needs.
Obvious details to include are the patient’s personal and contact details. Full name, address, date of birth, day time, evening and, if acceptable to the patient, mobile telephone numbers.
A brief history of the patient’s complaints is invaluable. Remember that some signs and symptoms come and go in patients with a TMD but it is useful to have a chronological order of what the patient has been experiencing. For instance:
- Did pain precede a click or did a click precede pain?
- Has the patient ever had locking?
- Is the range of movement restricted?
- Are symptoms overall worsening or improving?
- Are symptoms worse at any particular time of day?
- What is the precise location of the pain?