Patient Referral in Orofacial Harmonization: Best Practices

Referring a patient is part of the practice of any health professional. In orofacial harmonization it is especially common: the patient arrives with a complaint that calls for an eye assessment, with a psychiatric condition that changes the indication, with a complication that requires hospital facilities, or with a request that simply is not your area. Doing it well protects the patient and protects you.

This page gathers best practices at the review level. It does not replace your professional board's rules, nor legal counsel's opinion on specific situations.

Why referral is part of care

There are two opposite mistakes. The first is referring too late, after insisting on approaches beyond your preparation. The second is referring everything out of insecurity, without facing what is yours to resolve. Good practice lies in the middle: knowing your own scope, having clear criteria, and a network of trusted colleagues.

A well-made referral has four characteristics:

• Timely: it happens before things get worse.
• Clear: the patient understands the reason and the next step.
• Documented: it is recorded in the patient record.
• Followed up: you know what happened afterward.

When to refer

Some of these topics have their own page: chest pain in the office, epilepsy and orofacial harmonization procedures, visual complication after filler, and body dysmorphic disorder in orofacial harmonization.

Emergency or elective?

How to communicate with the patient

How you say it matters as much as the decision. Avoid sounding like you are getting rid of the case, and avoid alarmism.

Some practical points:

1. Explain the reason in simple language.
2. Say what you expect the other professional to do, without promising the outcome.
3. Offer more than one professional option, when possible, respecting the patient's autonomy.
4. Agree on how you will follow up afterward, and do it.
5. Record what was said and how the patient responded.

How to communicate with the colleague

The clinical summary should be objective and useful. Include only what the colleague needs to provide care.

Prefer direct contact when the situation is a relative emergency. A two-minute call avoids misunderstanding and speeds up care.

Ethics, confidentiality, and the LGPD

Referral involves sharing health data, which is sensitive personal data. Share what is necessary, for the purpose of care, and inform the patient. Professional confidentiality remains, and the LGPD guides how to handle and store data. Patient photos call for additional care: see consent and LGPD for photos.

Some ethical points to keep in mind, always in line with your professional board's rules:

• Do not refer with a financial benefit in mind. Commission agreements between professionals are sensitive and may violate rules.
• Do not disparage the previous colleague or the new one. Describe facts, not opinions.
• Respect the patient's choice and the continuity of care.
• If there was an error or suspected error, describe what happened honestly, in the patient record.

Building a referral network

Having names and phone numbers before the need saves time. A minimal network usually includes an ophthalmologist, dermatologist, plastic or head and neck surgeon, oral and maxillofacial surgeon, psychologist or psychiatrist, general practitioner, and a nearby emergency service. Agree with each one on how they prefer to receive the patient.

Recording in the patient record

Record the date and time, the reason, the destination, what was advised, the patient's response, and the contact with the colleague. If the patient refuses the referral, record the refusal, the advice given, and the risk explained. For the structure of the record, see patient records and documentation in orofacial harmonization and recording the complication in the patient record.

Frequent mistakes in referral

Some slips repeat themselves and are worth knowing:

• Referring without telling the patient the reason, which creates anxiety and distrust.
• Sending the patient away without contacting the colleague, in situations that called for a phone call.
• Forgetting to follow the outcome, leaving the patient without backup.
• Sharing more data than necessary, including photos without a clear purpose.
• Blaming the previous colleague in front of the patient, which harms the relationship and ethics.
• Delaying the referral out of pride and making the condition worse.

Reviewing these points periodically, as a team, helps maintain a standard. A well-made referral usually strengthens the relationship with the patient, because they see they were treated seriously.

When the patient refuses the referral

The patient has the right to refuse, and the practitioner has the duty to clearly inform the risk of that refusal. Explain what may happen if nothing is done, offer alternatives, record the conversation and, if possible, ask the patient to sign an acknowledgment of the advice. Keep the door open: many patients change their mind after a while, and they need to know they can come back.

If the refusal involves a serious risk, such as suspected vascular occlusion, do not leave the patient alone, call emergency services and stay until care is provided. A patient's refusal does not end the practitioner's responsibility to advise.

Reverse referral: when the patient comes from another professional

The reverse path also exists: a colleague refers a patient to you. Receive the summary, read it carefully, and confirm what was done and what is expected of you. If you realize the case is outside your scope, send it back honestly. Returning feedback to the colleague, with what was done and what is suggested, closes the loop and strengthens the network.

In summary

Referring well is a clinical skill. Have clear criteria, a trusted network, honest communication with the patient and the colleague, and accurate records. A patient who feels cared for to the end, even when someone else took over the case, tends to come back and to recommend your work for the right reasons.