It's time to come together. With everything we know and are learning about the oral-systemic link, dentistry can no longer be the missing piece of to the health care puzzle, an entity separate from the rest of the health care team. That simply isn't good enough for your patients. You have to become involved in your patients' overall health, and that means building relationships with their medical doctors.
Diabetes. Heart disease. Low birth-weight babies. These are just a few of the systemic conditions associated with periodontal disease, and among the reasons it’s so important for dentists and physicians to communicate, to have a relationship where both sides feel comfortable coming to the other for advice. And sure, as more research comes out about the oral-systemic link and both sides see the need for stronger MD/DDS relationships, the line separating dentistry from the rest of the health care team has gotten thinner. But many professionals on both sides of that line say there’s still a long way to go.
“It’s not about dentistry, and it’s not about medicine. It’s about overall health and well being,” said Dr. Sam Low, President of the American Academy of Periodontology. “Oral health care is part of that process, and that’s the concept that needs to occur.”
It starts in school
Before their careers even begin, dental students and medical students are separated, Dr. Low said. They typically don’t interact much during their schooling, and while dental students learn a lot about medicine and the rest of the body, medical students typically don’t learn much about dentistry and the mouth. So when a physician comes across a problem that a dentist should see, he may not even notice it, or if he does, he might not think to refer or even make a call to a DDS.
Yet patients consider themselves as a whole person, not as a body and a mouth, said Dr. Barbara Gottlieb, an MD who works at Brookside Community Health Center in Massachusetts. Often patients will come to MDs with dental problems, even though physicians aren’t properly trained in this area—making communication between the DDS and the MD vital. Physicians know a lot about the human body and its pathologies, but they simply aren’t taught much about the mouth and its relationship to the systemic conditions they see every day. They’re becoming more and more interested and educated, but they certainly don’t have the knowledge you do.
Luckily for Dr. Gottlieb, she can turn to the dentists who work in the health care center for advice, an advantage most physicians and dentists just don’t have.
“On the occasion where I have to communicate with dentists who are outside of my own system, the communication is a lot more difficult,” Dr. Gottlieb said. “Often the patient is the liaison, which you wouldn’t find with other specialists. You’d have provider-to-provider communication, and you wouldn’t just rely on the patient to say my dentist told me to do this or that. When that happens and I try to connect with the dentist to get more information, sometimes I don’t hear back.”
Taking the first step
Changing medical school curriculum and integrating the two disciplines is one way to solve the separation problem, but that’s not something you can control. There are, however, several things you can do to develop and maintain relationships with the physicians in your area. The easiest? Pick up the phone.
Yes, this can be intimidating. Because you don’t interact with physicians on a regular basis, you may be hesitant to make that call, said Dr. Kelly Blodgett. Maybe you’re worried about not being able to communicate the problem, or maybe you think the physician won’t want to bother with your call. You have to get over that. It’s highly unlikely the physician will call you, and if you want to provide the patient with the best care possible, you have to be the one to get the lines of communication flowing. And talking about something you have in common—a patient—is the best way to do that.
“It’s a health care provider on the other end of the phone, just like you,” Dr. Blodgett said. “Both of you are interested in seeing the patient healthy. Focus on that rather than, ‘they know things I don’t know and I don’t want to sound ignorant.’ It’s not about that. It’s about helping the patient see better health.”
Most physicians are appreciative, even flattered, when you call them about a patient, periodontist Dr. Peter Cabrera said. Whether you’ve noticed a potential problem or have a question for them about medication a patient is taking, they tend to be happy for the contact. And after you call them three or four times and establish yourself as a doctor who knows what you’re talking about, they may even start calling you.
Beyond the phone
It’s also not a bad idea to reach out to physicians you know socially, Dr. Blodgett said. If you know someone at the golf course or local sports club, talk to him or her about the importance of including dentists as part of the health care team. This “grass roots” approach may help get some physicians thinking more about the oral-systemic link and what it means for their patients, and hopefully will help break down some of the barriers that still seem to exist between many GPs and MDs.
You don’t have to limit those in-person conversations just to people you already know. Don’t be afraid to stop in at a local physician’s practice and introduce yourself, even if you don’t necessarily have a patient to talk about, said Bob Spiel, MBA, of Spiel Consulting. Bring some information about the oral-systemic link, and maybe even some type of treat to help staff members remember you. Follow up by inviting the physician to breakfast or out for coffee. Little gestures like that can help remind the physician you’re there and happy to work with him whenever you can.
“It’s the one-on-one relationships that make a difference,” Dr. Low said.” If I were a young dentist starting out in practice I think I would attempt to stop by and see every general physician, OB/GYN and internist in the community.”
