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Upfront, OD President's Page Gerald Smith DDS

Patient + General Practitioner + Specialist
= Happy Ending

As professionals, or more importantly as health-care professionals and doctors, we put the needs of our patients ahead of our own. It could be said we have a fiduciary-like responsibility: a duty of care, an ethical duty and a duty of loyalty to our patients in much the same way directors do to the organizations they represent. We are held accountable. Dentists continue to enjoy self-regulation in the province of Ontario because our Regulatory Body does the same in fulfilling its responsibility and mandate to protect the public – our patients.

Often a general practitioner becomes a "jack of all trades" when it comes to treating patients, but certainly GPs are not the "master of all." This brings me to the point of this President’s Page: the importance of specialist colleagues. Specialists are an integral part of a dental team and a necessary part of the profession who work in conjunction with GPs to provide optimal oral health for patients. Unfortunately, there are instances when GPs feel the need to do everything within the scope of their practice, or worse, feel fully capable of treating all cases in every discipline in dentistry – the perceived "master of all."

There are times when GPs’ clinical experiences or their continuing education (a few sort courses) provide them with a false sense of confidence. Standards of practice exist. We must remember that we are all held to a standard of care that would be equivalent to the treatment results available, or the best outcome that could be expected, relative to our peers, in the geographical area in which we practice. To put it another way, I believe that, if general practitioners are going to provide any treatment, especially for the more challenging and/or risky cases, treatment outcomes should be clinically acceptable and more or less equal to those of a local specialist, if one exists. This standard becomes even more important should something not go as well as planned, or should a complaint arise. One must take into account all of the potential risk factors that may complicate treatment and adversely affect the outcome. If risk factors exist that may compromise the success rate that a GP cannot predictably overcome – refer. It is in the best interest of the patient – and the GP as well. As my friend, Dr. Karam Ashoo, stated in a

CE course he presented, "A good outcome is the holy grail of all dental procedures." Our responsibility as dentists is to do all that we can to ensure a good outcome for our patients, who have entrusted us with caring for their oral health. Patients must leave your office better off than when they arrived.

Specialists are available to support GPs in daily practice; they are not just there to bail out GPs or deal with problem patients. It’s best if GPs know their limitations and identify those cases that are likely beyond their level of expertise and therefore best served by the appropriate specialist. We could all ask ourselves: Who would I want working on me if I had similar treatment requirements? What is in the best interest of my patient? What is the most suitable course of action that will result in a happy ending?

GPs are the primary treatment co-ordinators and hence the "responsible dentists." If you are a GP, assist and guide your patients through the treatment process, from your office, to the specialist’s office and back again, until the treatment is successfully completed. Know the credentials of your specialists and understand their referral process. Clearly convey your general expectations in the relationship and the specific expectations with each case. Good communication and collaboration between GPs and specialists is imperative to maintain continuity and quality of patient care. Communication is a dialogue that goes both ways between the referring GP and specialist, with the patient kept well informed throughout. This will ensure a good outcome for everyone involved: GP, specialist and, above all, patients. OD

Dr. Gerald Smith maintains a general dentistry practice in Thunder Bay, Ont. He may be reached at

Are you a GP looking for specialists in your area?
A great starting place is the ODA Member Directory (a member-only benefit), which lists ODA member specialists according to geographical location. The ODA Member Directory is available on the ODA website, at

12     Ontario Dentist • April 2015

Reproduced from Ontario Dentist, The Journal Of The Ontario Dental Association, President's Page, p.12, April, 2015.