The Ethics of Referrals: Building Relationships to Build Your Practice
No man is an island, John Donne, Meditation XVII, 1624.
When asked what the secret to his highly successful golf career was, Jack Nicholas said, “I always play within my own game.” Jack Nicholas thus won more than 118 tournaments and was named Sports Illustrated “Greatest Athlete of the Year.” Jack Nicholas knew his strengths and weaknesses and always researched each golf course; he played and knew which shot he could complete and which shots he should avoid.
Understanding that we all have limitations in our clinical skill set is essential to practicing dentistry within the ethical boundaries that our profession requires. We tend to recognize our strengths, yet we need to understand the boundaries of our skill sets. Patients entrust their care and oral health to us and we in turn must treat our patients to the best of our abilities. Often our best is to refer our patients for another opinion and/or for treatment by a specialist. Failure to recognize your limitations and refer patients can be actionable against your license. Patients may encourage you to perform the suggested procedure rather than refer them to another clinician. Perhaps your patient may feel confident in your abilities or the patient may want to avoid seeing another practitioner. In any case, it is your duty to know your limitations and refer patients to an appropriate colleague.
Sometimes patients or even your staff suggests that you start a procedure and “see how it goes.” This is not ethically correct for you, your patient, or the dentist to whom you are making the referral. The best referrals are based on a collegial relationship that you have with that referral. You should advise your patent to see a colleague in whom you have confidence, someone that you know as a professional as well as a person. Someone who shares in your concept of the ethical treatment of your patient, for you are entrusting your patients’ care to this specialist, who is assisting you in the overall care of a person’s oral condition.
As the relationship you have with your patient is based on trust and clinical ability, the referral to another office must be made by you personally. In a busy office, this responsibility may be delegated to staff; however, the actual referral should be made by you the clinician