22/11/2023
TMD or TMJ disorders, and other types of jaw pain,
especially those presenting with a history of sudden onset, limitation of function and acute pain,
require prompt referral to a qualified specialist Maxillo-Facial Surgeon.
Delaying early referral of acute TMD can result in greater difficulty to treat and cause prolonged functional deficits.
If you are a patient who is not being referred appropriately, you have a right to demand a referral.
Remember, in South Africa, patients still have the legal right to self-refer to a specialist and to choose to see the doctor of their choice. (Medical Funders may limit your choices based on refusal to fund visits to non-network doctors, but this part of the agreed upon contract that you as their client agreed to. You still have the choice to self-fund if you do not wish to see a network provider. )
In the resource strapped, costly world of healthcare, we implore our colleagues to please not waste resources and raise unnecessary expenses for patients by conducting non-contributory tests trying to confirm conditions that simply do not correlate with the clinical presentation.
Unfortunately, we see this all too frequently with oro-facial conditions, where the paucity of subject knowledge in the medical training curriculum, results in millions of rands wasted in unnecessary tests, radiologic investigations, and multiple admissions for misdiagnosed conditions.
All of this has the effect of needlessly prolonging patient suffering.
8 out of 10 TMD patients who finally make their way to seeing us, do so after having been misdirected on a merry-go-round of multiple inappropriate disciplines over many financially and functionally costly months.
Those who finally arrive, often do so by self-referal, after having to resort to "google" to direct them appropriately.
Google doing a better job of referal should be a source of embarrassment to the medical establishment.
It costs the GP or other medical specialist nothing , to contact their Maxillo-Facial colleague and ask for advice or to just refer promptly, except a minor acknowledgement that they may not be an expert in cranio-maxillo-facial pathology. If anything, appropriate referal elevates the status of that doctor as one whom the patient can trust to have a high level of clinical insight and wisdom.
Arrogance and pride should not be the reason patient suffers.
It is important for doctors to remember that failing to appropriately refer a patient can open that clinician up to liability.
When in doubt, the responsible clinician seeks the opinion of an appropriate speciality and refers the patient if necessary - The emphasis being on "appropriate".