The request for consultation carries different connotations among health professionals. To some, the consult: ant is only expected to tender an opinion and’ not to begin implementing any advice until given permission
by the patient’s admtting physician or, in the case of the emergency room, <bythe patient’s designated emergency department physician. However, many physicians allowconsultants to perform any test or procedure necessary to act on their opinion. Therefore the dental consultant must clarify witH the requesting doctor whether only an ,.opinion is being sought or if the dentist can proceed to order tests and render treatment before seeing the patient. In some cases, the consultation request form provides
a section in which the .requesting doctor can indicate the type of onsultation desired. Emergency roo”, consultations. Emergency room
consultations are usually requested verbally because of the urgency of the situation. The dentist should make useof any history and physical examination, lab oratory, and radiographic results already available, to avoid excessive duplication. However, thedentist still needs to do a careful,
comprehensive history and physical examination of the oral and maxillofacial region and order special radiographs as necessary to allow a complete, well-organized assessment of the patient’s dentofacial problems. All of his information is recorded in the medical record on a
consultation form, in the progress notes, or in the emergency
room record. A recommendation should be offered that considers other medical problems, acute or longstanding, and the urgency of the treatment. Guidelines for answering consultations are shown in Box 31-1, and a
sample of a written emergency suite dental consultation is shown in Fig. 31-2. The way emergency suites are equipped for dental therapy varies. If the dentist cannot offer high-quality care in the emergency setting, the problem should be emporized and an appointment made for definitive care –
in the dental office, Dentists who are frequently called to hospital emergency rooms sometimes find it useful to carry in their car a set of instruments and supplies neces-: sary for initially handling common oral emergencies, If more than one dentist serves as a dental consultant to
an emergency room, a call schedule is usuallv established to designate, on a daily, weekly, or monthly basis, which dentist is expected to be available in case o an emergency, When on call, the dentist should keep the hospital aware of how the dentist can be quickly contacted. lnnatieut ronvult ation«. Dental consultatic ..•l for a hospitalized patient is similar to consultations for emergency patients: the dentist is expected to evaluate the oral
and maxillofacial region, offer an assessment, and Iorrnulate a dental treatment plan that considers the overall clinical vituation. Dental consultation requests should be written on standard hospital consultation forms on which the requesting physician states the question or questions to be answered by the dental .consultant. Therequesting doctor should also provide a brief statement of other active problems the patient may have. It a dentist receives an unwritten Or unclearly written consultation
request” the dentist should make an effort to clarify what is desired. The dentist should make every attempt to answer all consultation requests within 12 to 2-1 hours. written consultations should be sufficiently complete to document all significant findings (both positive and
problem list, and the treatment plan should be clearly written, with an indication of the priority and ljrgency of any necessary care. The terms used should be those physicians and nurses can understand, rather than technicaldell tal terms. Excessive verbiage should be avoided. If the dentist finds it impossible to finish the evaluation without additional tests, arrangements should be made toobtain necessary tests in the near future, and a preliminary consultation note should be made to inform the
requesting physician of the findings and preliminary recommendations.
After seeing the patient, it is good practice to call the physicia ‘ who requested the consultation to ‘inform the patient of findings and recommendations. However, it is still necessary to record a formal answer
directly on the consultation form or on a progress note, with an indication on the consultation form of where the . answer has been written. In addition, if the consultation request asks for care to be provided, the dentist should carefully document that care. In addition, as in any care provided in the hospital setting, the dentist should collect enough data about the patients to allow the office staff to properly bill for services rendered. Codes for such care and consultations are available in standard medical coding manuals. An example of a dental consultation form is presented in Fig. 31-3.
Requesting a consultation. When a patient has a problem. the dentist does not feel qualified to evaluate or manage’ alone, a formal consultation request can be made: When requesting a medicalconsultation. the dentist
should indicate whether the consultant is free to rder necessary tests and to proceed with any necessarytreatment. Preferably the requesting dentist should personally call to as]; the consultant for an opinion. Alterna-
• tively, an order can be written directing a hospital clerk to
call the consultant’s office. A consultant’s recommendations should be viewed as an (‘(!ucall’d opinion. A dentist is under no obligation to follow
:1 consultant s advice in its enurcry or at all. The patient’s attending docor must. make the final decision of which 110stictests to perform and what care the patient win iccclvc, including when ihc attending doctor is a dentist.