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Periodontist Referral Dilemma

I had a patient I have been seeing for years that suddenly had 2-3 mm increases in pocket depths on her lower right with bleeding. I wanted to do scaling and root planing, but I also wanted to have a periodontist take a look due to the sudden nature of the changes (see if surgery was required, etc). We have a periodontist that we regularly refer patients to, however she is a little far from our office. This patient wanted someone closer by, so we decided to try a new periodontist who just bought a practice from a retiring periodontist in town. Long story short, scaling and root planing was recommended, no surgery or anything. The patient decided that if we could do the scaling in our office, she would rather do that because she is comfortable here and didn’t get a really good “vibe” from their office. Both our office and the patient tried to contact the periodontist several times for a report of their findings, and got nowhere (very unusual with specialists in our area). Finally, after several weeks, the office manager at the periodontist’s office and the Doctor herself called the patient via speakerphone and gave her a very hard time about not doing the scaling there. They told her that once she was referred to them, “the money should stay” in their office, and that it was like consulting with an interior decorator and then just stealing her ideas. They told her that we shouldn’t need any feedback from their office at all, and that if we needed a report from them, we had no idea what we were doing and shouldn’t clean her teeth anyways. Obviously, this is all second hand, so I have tried to call their office to clear things up and get sent to their voicemail, no returned calls. This is odd, right? The periodontist we regularly work with has told our long time patients that they are more than welcome to do their scaling and root planing at our office if they are more comfortable. Are we in the wrong for telling the patient in this case that would be okay?

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1 Answer

This does seem odd in my opinion! I have not had a periodontist unwilling to share records and/or information regarding a patient. If you don’t have open communication, how can you treat a patient comprehensively?! I find it unprofessional for the perio office to guilt the patient as well, not to mention not to return any phone calls (to you or the patient). Personally, I don’t think you are wrong for telling the patient it is okay for you to do SRPs, especially if the patient is most comfortable with you. Now, if the patient’s tissue is unresponsive, then it may be time to refer to a (different) periodontist. I also have to mention, based on the patient’s and your experience, I wouldn’t be referring to that particular periodontist any more!

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