To ensure optimal patient care, coordinating treatment with the patient's physician may be necessary, particularly for patients who have chronic conditions such as diabetes and heart disease or are currently undergoing chemotherapy or anticoagulant therapy. Traditionally, dentists have utilized a "medical clearance" form to inform the patient's physician of upcoming dental treatment and to verify patient allergies, medications and other health conditions that may be factors in proceeding with the proposed treatment plan.
Requesting a medical "clearance" is troublesome for both the dentist and the physician. To the physician, "clearance" implies providing permission or authorization to the dentist to proceed with dental treatment. This is concerning to the physician due to the potential liability situation that may be created. For the dentist, requesting medical "clearance" indicates relinquishing some of his/her professional autonomy to the physician in making the decision to treat the patient.
Obtaining medical "clearance" is also misleading because it implies that the patient is "cleared" for treatment. No patient is free of risk when undergoing any medical or dental procedure. The decision to proceed with treatment or surgery belongs with the dentist and the patient. Requesting a medical "clearance" does not shift any liability from the dentist to the physician, as dentists are ultimately responsible for the decisions and treatment they provide their patients.
The changing landscape of dentistry and oral health care requires significant changes in the way dentists practice to improve outcomes for their patients. Aligning with physicians and other health professionals to concentrate on optimal patient care leads to appropriate and coordinated treatment planning. It is vital that dentists and physicians collaborate, coordinate and consult with one another to address any potential concerns about their patient's medical condition prior to treatment. This may also assist with mitigating possible liability issues for the dentist.
CDA offers the following suggestions to assist dentists' collaboration with their patients' physicians to achieve an ideal patient outcome:
First, dentists are encouraged to work on developing open lines of communication with physicians in their community. Build a stronger knowledge base of other health professionals and foster professional relationships to increase opportunities for consultation and patient care coordination.
Second, utilize the proper instrument for obtaining the information or facilitating a collaborative discussion or record sharing by ensuring that the proper documentation has been completed and submitted prior to requesting a medical consultation for the patient. CDA advises dentists contact their liability carrier for a standardized form.
- Under state and federal privacy laws, and with certain limitations, the use or disclosure of patient health information may be disclosed to other health care providers for the treatment of the patient without authorization of the patient.
- Consult the linked resources below to ensure HIPAA compliance for the electronic and facsimile transmission of personal health information.
Third, reach out to the physician and propose a peer-to-peer discussion about the proposed treatment and any concerns regarding the patient's health condition(s). If this consultation occurs in-person or via telephone, document the discussion and include it in the patient's record.
There may be instances when reaching the patient's physician may be more challenging, e.g. the physician participates in a closed network. Large provider groups have varying policies in place outlining their protocol for responding to a request for patient information or a physician consultation.
- If the physician (or medical group) is failing to respond to the request for consultation or records, engaging the patient is necessary. As the common denominator between the dentist and the physician, the patient may need to reach out to the physician (or the medical group) to facilitate the release of information to the dentist.
- If the physician (or medical group) fails to comply with the requests for consultation or patient health information, the patient may file a complaint against the physician with their medical group and/or the California Medical Board.
- Dentists may also file complaints with the patient's medical group and/or the California Medical Board in the event that the physician fails to respond to requests for information or consultation.
Dentists may bill their patient or the patient's dental benefit plan (as applicable) for a medical consultation. The American Dental Association® added a professional services code for consultation with a medical health care professional in the 2021 CDT manual©, D93 l l.
Finally, dentists have received the necessary skills and training to evaluate patients and the appropriateness of the dental treatment proposed. Collaboration, cooperation and coordination with other health professionals is necessary for meeting the shared goal of improving the patient's health.
Additional resources regarding medical consultation are listed below (ADA or CDA log-in required):
Medical clearance: an issue of professional autonomy, not a crutch
HIPAA Safeguards