Referral letters in oral medicine: an approach for the general dental practitioner

The use of tools to support oral lesion description in oral medicine referrals

“…9 In order to be useful, referral documents must provide organized information, rhetorical relevance, appropriate level of detail, and be concise. 12,14 However, several studies have reported that referral letters often lack important information, 7,8,9,10,12,13,15,16 which can result in problems such as improper scheduling, prioritization errors, 9,11,13 unnecessary repetition of tests 7 and, ultimately, inadequate care and delay in treating the illness. 10 Several studies aimed at defining the necessary information for the referral of patients.…”

“…8,9,10,12,16,17 Depending on the specialty, the clinical description of the lesion is considered essential. 9,12,13,16 Lesion details may include type (primary morphology), 13,16 size, 9,16 location, 12,13,16 color and eventual ulceration, 9,13 shape and consistency, 9 thickness, texture, presence of rolled margin (in the case of oral squamous cell carcinoma), 13 duration, 12,16 symptoms, 12,16 clinical diagnosis, 12,16 suspicion of malignancy, 17 risk factors for disease, and management details, such as use of medications/mouthwash, previous biopsy or denture/tooth adjustment. 13 Specific strategies have been suggested to improve the content of referral documents, such as the use of support tools, 6,10,16 investment in education and training of professionals, 6,10 and the use of electronic referrals.…”

“…8,18,19 Some studies evaluated the quality of the referral documents specifically within the Oral Medicine field. 9,12,13,16 The use of guidelines or forms seems to result in the inclusion of a greater amount of information and detail in the referral documents, resulting in improved quality. 9,10,13,16,20 Some authors, however, found no improvement with the use of these instruments.…”

Does the use of photography help to prioritise patients when referring to the oral medicine department?

“…Recent studies into the quality of oral medicine referrals by Navarro et al, 3,4 which compared the use of standard and non-standard referral letters to oral medicine specialists, found that standard letters were more complete and contained important information commonly absent in non-standard letters. However, the studies also revealed that regardless of the type of referral letter, much of the essential information that one would expect in any referral letter was generally omitted (eg the patient's age and address).…”

“…This may potentially lead to delays in patient diagnosis and treatment. 3,4 In considering how oral medicine referrals could be improved we have encountered the use of telemedicine as a potential solution in helping the referrer improve referral into the specialist arena. Telemedicine is a broad term that encompasses the use of telecommunication in doctor-patient as well as doctor-doctor interaction.…”