How To Speak To Your Diabetic Patient’s Physician

When I see a patient and I have questions about a medical history, I want information right then at the point of care.  As a dentist with a focus on caring for patients with special needs, the health histories I encounter are usually complex. Having information to read about a disease is important, but sometimes I still need to speak with the patient’s physician.

I admit there have been times when I felt reluctance to call a physician for fear of not knowing what to ask and appearing uninformed. But this reluctance will go away if I can formulate informed questions because the physician will know they are speaking with a competent colleague. If I can think about my questions beforehand, the discussion can quickly focus on safely treating the patient instead of impersonating Bugs Bunny (“Eh, what’s up doc?”).

But making sure I have well informed questions is not always easy.

What exactly do I ask a physician about a patient with poor control of her diabetes? Or in the middle of a bone marrow transplant that needs urgent dental care?  What are the questions about immunocompetence and hemostatic competence that pertain to my care of the patient? Do I remember what the absolute neutrophil count should be or platelet count should be before delivering care?  Or, do I know if an existing mucositis that is affecting the ability to wear a prosthetic should resolve soon?

Helping the clinical staff feel confident when consulting with physicians is a goal of the Dental Symphony Clinical Team. We delved into the questions the dentist may need to ask a patient’s physician that provide guidance in the patient’s tailored point-of-care analysis (see example). A disease summary includes information specifically for this purpose.

Here is an example of the guidance for a patient with diabetes:

diabetes-medical-consult

Let’s think about the phone call from the physician’s point of view.  A physician friend of mine says he will occasionally have a dentist call and ask if he can pull a tooth on a patient and that’s pretty much the only question that the dentist asks.  My friend wants to say “Well how would I know if you can pull the tooth?  Did they teach you how to pull a tooth in dental school?”  The point is that it would be much better if the dentist asked specific pertinent questions.  Here’s an example:

“Mrs. Patient has caries and periodontitis and requires multiple extractions and alveolectomy to prepare her for prosthetic replacement of her teeth. She had a stroke two years ago and tells me that you are managing her anticoagulant regimen and also treating her for type 2 diabetes and congestive heart failure. She doesn’t know her target INR or her latest lab value of it.  Her description of her congestive heart failure leads me to think that it is a mild case and well compensated.  She describes her diabetes as controlled but doesn’t know her last A1C value.  The reason I am calling is to ascertain the severity of her congestive heart failure, learn of her diabetes control and to get your input regarding the advisability of stopping her anticoagulant medications before the surgery.”  

This kind of conversation will quickly get you the information you need to know. It may even help the physician understand better the care you plan to give by explaining that extractions are more invasive than, say, endodontic care. It behooves dentists to communicate skillfully with medical colleagues and provides opportunities to learn and share important information.

 

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