Your new patient is a young executive who started comprehensive orthodontic therapy in a large city 500 miles from your office before being transferred by his firm. Your receptionist tells you that he had contacted 3 other offices in town, but all had refused to accept transfer patients. He located these offices through the Internet and did not have a referral from his previous orthodontist.
Your evaluation reveals a moderately crowded dentition with deep overbite. The only sign of treatment is in the maxillary arch, which is bracketed with ceramic appliances of unknown slot size. You explain your office policy of requesting copies of his original records and an American Association of Orthodontists (AAO) transfer form from his previous orthodontist, and you schedule production of progress records for later that week.
Two weeks pass, and your treatment planning consultation is completed, but no records or transfer form has arrived. A phone call to the previous orthodontist’s office reveals that the patient is current in his payments, and the receptionist advises that “the doctor will send the records and a note when he can.” Three more weeks go by, including more phone calls and a follow-up letter from your office. Finally, the records arrive. They consist of a panoramic film and a poor copy of a lateral cephalogram with insufficient clarity for viewing the incisors. No transfer form or explanatory letter is enclosed to communicate case history, treatment plan, appliance design, and so on. Rather than casting disparaging remarks about the previous orthodontist, you proceed with the patient’s treatment without further discussion.
Unfortunately, this experience is neither unique nor unrealistic. Transfer of orthodontic care is a fact of life. Transferring patients often say that orthodontists in their new town are reluctant to accept them as patients. Whether this decision is motivated by business philosophies, liability concerns, or reluctance to become involved with a previously established treatment plan, we must realize that we are first and foremost doctors with the obligation to help our patients. This obligation includes not only competence, compassion, and empathy, but also acting with a sense of justice.
The ethical concept of justice is focused on “treating people fairly” and “giving people what they deserve.” A patient who initiates orthodontic care does so in a climate of trust, with the confidence that his welfare will be preserved and treatment will proceed to a favorable result. The patient thus deserves continuity of care, despite the necessity of transfer, because he cannot establish such continuity himself. However, in this case, the patient was not treated fairly and did not get what he deserved. To make matters worse, the complications depicted here could have been readily avoided. Not only was there a failure to cooperate with the new orthodontist, but the initial orthodontist failed to responsibly and fully inform the patient of the transfer procedure.
As a start, the departing patient should receive a list of orthodontists in the new area. Once the patient relocates and chooses a new orthodontist, that orthodontist should contact the original orthodontist, who should provide the case history, treatment plan, and copies of the initial records promptly and efficiently. The transfer forms published by the AAO for both active and retention patients are invaluable in communicating these issues clearly and succinctly.
The original provider is obligated to maintain the patient’s trust by providing the services mentioned above. Orthodontists who are asked to accept transfer patients should not universally refuse to provide care but should consider each new patient individually by assessing the patient’s need in relation to the orthodontist’s skill level and treatment acumen. Although we are not required to treat every patient we evaluate, our obligation is to serve patients justly and with skill. Our patients deserve this at the very least. The mismanagement of departing patients by initial orthodontists and the routine rejection of transfer patients is not only negligent, but also unethical.