I practice orthodontics full-time in a hospital setting. My patient population is about as diverse as they come. Kids with chronic disease. Kids post-transplant. Kids with intellectual disabilities. Kids with syndromes. Kids who are termed well-children. There isn’t a day that goes by where I don’t see something so unusual that I might not see it again in my practice lifetime. I am often asked by friends, colleagues, and parents of prospective patients how I am I able to treat such cases. The answer is simple: I treat each patient the best I can in light of their limitations, my limitations, and in some instances, I elect not to treat them at all!
I have no magic wand, no miracle drug, and definitely no special appliance system. It’s remarkable though how many general dentists, pediatric dentists, and orthodontists think that I do. My favorite referral that comes in is usually from an outside orthodontist who has examined a patient, brought them back for records (fee charged), and then dismissed them from the practice on the basis that the patient is too difficult to treat. The last line of the referral letter is usually something like this, “You should consider general anesthesia and/or sedation to treat this patient.” So let me get this straight, I should take the patient to the operating room to place the braces, use some form of conscious sedation for all routine visits, take them back to the operating room if things break, and then take them back to the operating room one last time to take the braces off and take impressions for retainers. Really?
When I examine an extraordinary patient, I remind myself of these things:
- Be honest with yourself and the patient’s parent in that first meeting
- I don’t know everything and I can’t do everything asked of me
- There is nothing wrong with saying that you do not have the skill or experience to treat the patient, as long as that’s how you truly feel
- If in your opinion the patient cannot be treated for a particular reason, tell the parent why and stand by it
- Don’t take records if you know beforehand that you won’t treat the patient
- If you are unsure about anything, let the parent know and offer a second opinion referral if you believe someone else may realistically be able to treat the patient
- Will I do any harm if I try to treat the patient
- Imagine that you are that parent
I think that we all could learn some beautiful life lessons from this type of referral, I sure have. Really!